Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC).

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC). MATERIAL AND METHODS: A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession. RESULTS: Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors. CONCLUSIONS: This small-scale study of staff's attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

Surveillance Seasonal Program. Antibiotic Resistance of Pathogenic Agents Isolated From Children With Acute Gastroenteritis, in a Region of North-East Romania.

The acute gastroenteritis is a population health problem, frequently met everywhere in the world. In Romania, for certain etiologies the reporting is compulsory. Also, these infections are reported in the TESSy system, too (The European Surveillance System). In this context, antibiotics therapy and antibiotics resistance have a particular importance. The study aim was to assess the prevalence of bacterial pathogens involved in the etiology of acute gastroenteritis (AGE) on the Iasi County, Romania and the surrounding areas and the determination of the profile of resistance to the antibiotics for the identified agents. Material and methods: 72 strains of isolated and identified bacterial agents involved in the acute gastroenteritis (AGE) in the case of children (0-14 years), with the exception of the Campylobacter spp., in the municipality of Iasi and its surrounding areas were studied in 2012, during the surveillance period of AGE (May to October). Results: The most frequent has been the Salmonella spp. (63.9%) from which the S. enterica Thyphimurium in 21 cases (29.2%) and S. enteritidis in 7 cases (9.7%), followed by E. coli (20.8%) from which E. coli O:127 in 3 cases (4.2%), Shigella sonnei S (13.9%) and Yersinia enterocolitica (1.4%). In the case of the children from the group of 0-1 year, the Salmonella enterica Thyphimurium has been the pathogenic agent most frequently encountered (6 cases ­ 29.2%), followed by Salmonella Colindale, S. enteritidis, Shigella sonnei S, E. coli O:127 registered with a frequency of 5.6%. The antibiotic resistance rates are high in the case of ampicillin (43.1%), tetracycline (31.9%), amoxicillin ­ clavulanic acid (26.4%), trimethoprim/ sulfametoxazole (22.2%), sulfonamides (11.1%). Conclusions: The antibiotic resistance rates are high in the case of ampicillin, tetracycline, amoxicillin ­ clavulanic acid, trimethoprim/ sulfametoxazole, sulfonamides.

Epidemiological assessments on incidence of acute gastroenteritis in 0-14 aged children, in the Iasi County, Romania, between 2009-2012.

UNLABELLED: The study aim was to assess the epidemiological potential of acute gastroenteritis (AGE) in children between 2009 and 2012. MATERIAL AND METHODS: We studied two groups; first, a lot of 7237 cases (group A) recorded in the Iasi County through passive surveillance system, reported monthly by the network of primary health care, the assisted outpatients, respectively, those reported by hospitals. The second group (group B) was composed of 4191 hospitalized cases reported also in the passive surveillance system m by telephone, weekly, during only June/end of May to October/beginning of November. Structural peculiarities of the two groups are due to different reporting methodology, so that they were analyzed separately. RESULTS: AGE cases come from urban or rural areas in relatively stable proportions and slightly increased in rural areas compared to urban. The distribution by sex of cases from the group B is maintained at the same shape from one year to another, with a slight predominance in males. The best represented age group in every studied was 0-3 (54.3% of all cases), followed by children between 5 and 10 years with 17.5%). Laboratory investigations have enabled the etiologic diagnosis for hospitalized cases, which ranged from 15.3 to 17.5%, with the exception of 2009 when the diagnosis was noted for almost half of the discharged patients (47.5%). CONCLUSIONS: AGE remains a public health problem in the Iasi County and Romania also, by affecting all age groups, but especially children under 3, an insufficient knowledge of the etiology, and economic losses insufficiently evaluated.

Descriptive study on acute gastroenteritis in 3,883 patients admitted in "sf. Maria" children hospital from Iasi, Romania, between 2008 and 2013.

UNLABELLED: The aim of study was to assess some population characteristics in children of acute gastroenteritis (AGE) admitted in a regional pediatric hospital. MATERIAL AND METHODS: For the present transversal descriptive study we considered a group of subjects hospitalized for AGE in 2008-2013 (2013--only 6 months) in "Sf. Maria" Emergency Hospital for Children Iasi, Romania. Consultations in the Emergency Unit of this hospital did not take into consideration. RESULTS: Number of AGE cases admitted to "St. Maria" Emergency Hospital for Children Iasi between 2008 and 2013 has seen a steady decline. Male subjects are better represented (54.1%); largest age group 1-4 years, with 1,827 cases, immediately followed by group 0-1 year (1789 cases); together, the two-age groups account for 93.1% of admissions for AGE. Distribution of cases by seasons showed balanced values, with higher percentages in summer (29.7%) and spring (25.5%). The number of cases is relatively constant and lower in winter, affecting predominantly younger groups (0-5 years) compared to the summer when cases aged 5 to 14 years were admitted more frequent. Most cases presented at admission vomiting (41.2%) and fever (40.7%); the presence of bacterial flora was identified in 82.2% of stool specimens, and blood in 13.4% of cases. CONCLUSIONS: A higher number of education measures should be implemented in urban and rural areas in order todecrease the contamination with pathogenic agents involved in infectious acute gas- troenteritis in children.

[Clinical epidemiological study of acute gastro-enteritis outbreak recorded in a children community, in Iasi, May, 2009]. / Studiu clinico-epidemiologic asupra unui focar de gastroenterita acuta înregistrat într-o gradinita cu program prelungit, din municipiul Iasi, în luna mai 2009.

UNLABELLED: Acute diarrheal disease affect all demographic structures and it is considered a major cause of morbidity and mortality for young age groups; underreporting is due to clinical and epidemiological diversity, everywhere, including the developed countries. MATERIAL AND METHODS: The authors present an epidemic outbreak of acute gastroenteritis by rotavirus in a community of 240 children. Processing and interpretation of collected data was done by statistical, mathematical and computerized methods. RESULTS: A number of 17 cases of acute gastroenteritis caused by rotaviruses were detected and confirmed, mostly in children older than 5 years (92%), with a tendency to focus on large group "A", 40%. All cases showed mild forms evolving medium. CONCLUSIONS: The 17 cases of infection with rotaviruses were the second episode of acute gastroenteritis with the same etiology, reported over two months. Extensivity of the epidemic outbreak was moderate, with the predominant age group affected over six years (58%). Developing and implementing preventive measures included daily cleaning and decontamination standards.

[The etiological aspects of acute abdominal pain in children]. / Aspecte etiologice ale durerii abdominale acute la copil.

AIM: The study of the etiological aspects of acute abdominal pain in children, in order to perceive the clinical-etiological correlations and the disorders distribution related to age, gender and the origin of the patients. MATERIAL AND METHODS: The criteria for including patients were age (between 0 and 18 years) and the presence of acute abdominal pain before or during the consultation with the physician. The research on acute abdominal pain in children was performed on the level of the Surgery and Pediatrics II clinical departments of the "Sf. Ioan" Children's Emergency Clinical Hospital in Galati, between 01.01.2009 - 01.01.2011. The clinical study performed on the patients registered in the studied groups focused on the identification, the evaluation of the symptoms of acute abdominal pain in children, diagnosing and treating it. The criteria for excluding patients were an age older than 18 years or the absence of acute abdominal pain as a symptom before or during the examination. The statistical analysis used the descriptive and analytical methods. The data was centralized and statistically processed in M.S.EXCEL and S.P.S.S. databases. RESULTS: The patients with acute abdominal pain represent a percentage of 92.9% (2358 cases) of the total number of patients who suffer from abdominal pain (N=2537). The highest frequency of cases is represented by acute appendicitis (1056 cases - 44.8%). In the 5-18 years age group, acute appendicitis, mesenteric lymphadenitis, ovarian follicular cysts, acute pyelenophritis and salpingitis are predominant. In the 0-4 years age group gastroenteritis, acute pharyngitis, reactive hepatitis and lower digestive bleeding are predominant. CONCLUSIONS: In females, acute appendicitis, gastroenteritis, gastroduodenitis and cystitis are predominant, whereas in males, peritonitis, sepsis through E. coli, the contusion of the abdominal wall and acute pharyngitis are predominant.

[Nutritional management of cystic fibrosis in children]. / Managementul nutritional în fibroza chistica de pancreas la copil.

Children with cystic fibrosis (CF) are at risk for poor growth. A major goal in the management of CF patients is to maintain a good nutritional status as it improves long-term survival. A balanced diet, which includes adequate calories and the right vitamin and mineral supplements, is key to good nutrition and health. The authors present the improvements in management of nutrition that have occurred, particularly over the past 20 years. They also present the dietetic reccomandations for each group of age.

[Evidence of intraepithelial lymphocytes through immunocytochemistry stains in children with celiac disease]. / Evidentierea limfocitelor intraepiteliale prin coloratii imunohistochimice la copiii cu boala celiaca.

UNLABELLED: The purpose of of this study is to identify IELs through immunocytochemistry stains for counting infiltration duodenal mucosa with T lymphocytes in children with celiac disease. MATERIAL AND METHOD: It was selected up simptomatology (abdominal pain, anorexia, failure thrive, chronic diarheea), features immunology(positifs tissue transglutaminase antibodies) and considering the histopathologic results (IELs > 30/100 enterocytes, crypt hyperplasia and villous atrophy) we made two groups: first group (13 children with celiac disease of 53 children with celiac disease) and second group (13 children with chronic duodenitis nonspecific). For evidence of intraepithelial lymphocytes T using immunocytochemistry tehnicque (immunohistochemical staining) Envision with antibody anti CD 3 from Dako firme. Corresponding Marsh clasification considering patological IELs > 30/100 enterocytes. Statitics method was used The Student' t test. RESULTS: Analyse IELs in two groups our show difference statistics to demonstrate with the Student' t test (t = -12.237; p = 0.003). CONCLUSION: An increase IELs is helpful in recognising early and bordeline, but the finding is not specific. The histopathologic exam remains the gold standard for celiac disease.

[Hepato-pulmonary syndrome]. / Sindromul hepato-pulmonar (shp).

The hepato-pulmonary syndrome (HPS) is a rare complication of liver cirrhosis, with poor outcome; the term includes liver disease, increased alveolo-arterial gradient and intrapulmonary vascular dilations, described by Fluckiger, Kennedy and Knudson. HPS impairs survival in cirrhotic patients and the posttransplant outcome is altered in correlation with severity of HPS. Combined determination of SaO2 in clino- and orthostatic position by a pulsoximeter is a simple test for HPS identification in patients with chronic liver disease or non-cirrhotic portal hypertension.

[Helicobacter pylori infection in children with celiac disease]. / Infectia cu Helicobacter pylori la copiii cu boala celiaca.

UNLABELLED: The purpose of this study is to evaluate symptomatology, endoscopic and histopathologic changes of Helicobacter pylori infection and gastritis lesions without Helicobacter pylori infection on children diagnosed with celiac disease. MATERIAL AND METHOD: 15 children under gluten-free diet were selected and, because of the recurrence of the dyspeptic syndrome, an upper digestive endoscopy associated with histopathologic exam was performed. Considering the histopathologic result we made two groups: first group (8 children with celiac disease and Helicobacter pylori infection) and second group (7 children with celiac disease without Helicobacter pylori infection, but associated with gastritis lesions). RESULTS: The main symptom was diffuse abdominal pain in both groups. The endoscopic antrum aspects were congestive with striped aspect (first group--12.5%, second group--42.9%) and congestive with nodulation (first group--25%, second group--14.3%). The histopathologic diagnosis were: moderate active chronic pangastritis (first group--25%, second group--14.3%) moderate active chronic gastritis (first group--25%,second group--14.3%), lymphocytic gastritis (first group--12.5%, second group--14.3%). CONCLUSION: The histopathologic exam remains the gold standard for celiac disease, gastritis lesions and Helicobacter pylori infection.

[The global survival rate calculated by Kaplan-Meier method in children with malignant lymphomas]. / Supravietuirea globala în limfoame maligne la copil apreciata prin metoda Kaplan-Meier.

The Kaplan Meier method is being used in oncology in order to calculate the survival rate during/at the end of the study. The purpose of this study is the assessment of the survival period referred to the clinical and histopathological state, laboratory findings, the diagnostic and treatment time. The material of the study is a LIMCO group (n=308 cases) hospitalized in the Oncology Department of the Children's Clinical and Emergency Hospital "Sf. Maria", Iasi between 1980-1995. The LIMCO group was divided in 2 smaller groups: LMH group (110 cases) and a LMNH group (198 cases). The results statistical analysis was made by chi2, Long-Rank and Breslow test. The results established a series of favorable LIMCO prognostic factors referred to the clinical state I-II, the histopathological type, normal or pathological laboratory findings at the first admission and the quality of the remission after the multimodal treatment.

[Obesity in children: new controversies and present prevention measures]. / Obezitatea copilului--noi paradigme si masuri preventive actuale.

The authors realise a synthesis on classical data and recent pathogenic explanations in childhood obesity. The obesity is a nutritional disorder of great interest nowadays and surpasses the incidence of the major problem of pediatrics until now--the malnutrition. There is documented data concerning the global incidence of obesity which is continuously growing when it comes to children. That is why the prophylaxis must become a priority by using measures in the first period of life (natural feeding, the need of late diversification, the avoidance of hyperproteic diets). The recent pathogenic data and the long term populational studies change the old conceptions regarding the risk of some categories of children. Thus mother's malnutrition, the low birth weight, children that followed hyperproteic diets paradoxically represent categories of risk for obesity. A recent recorded phenomenon, which amplifies the risk for obesity is the early adiposity rebound which is recorded nowadays even for ages lower than five years. There are described the hormonal mechanisms involved in appetite and satiety up to the receptor level: leptin, ghrelin, adiponectin, endocannabinoid receptors. There are pointed out all the long term risk elements (high birth weight, low birth weight, the pregnant woman's nutrition) and the modern medical treatments for obesity.

[Malnutrition and complex nutritional therapy in cystic fibrosis]. / Malnutritia si terapia complexa nutritionala în fibroza chistica de pancreas.

Good nutrition is essential for normal growth and development. Cystic fibrosis (CF) is commonly associated with energy deficiency in children. Malnutrition is a very frequent complication and contributes significantly toward morbidity in CF. Although malnutrition due to pancreatic enzyme insufficiency is correctable, the majority of CF patients are underweight and have short stature. During the last few decades, improved treatment measures and nutritional support in CF have increased survival and quality of life in these patients. Patients with CF must receive a hypercaloric and hyper-proteic diet, with a high fat content, a normal quantity of carbohydrates and with pancreatic and liposoluble vitamin supplements in case of pancreatic insufficiency.

[The implications of nutrition in the obesity of children and adolescents]. / Implicatiile alimentatiei în obezitatea copilului si adolescentului.

Obesity is currently the most prevalent nutritional disease of children and adolescents and a common health problem. Besides the bio-ecologic and socio-economic factors (genetical, professional, cultural, educational), the exogenous factors (nutritional) have a pro-obesity action by increasing the caloric intake determining energy imbalance. The authors present the role of nutrition in the occurrence of obesity in children and adolescents and its role in the treatment of the disease.

[Global survival rate calculated by Kaplan-Mayer method in children with malignant lymphomas]. / Supravietuirea globala în limfoame maligne la copil apreciata prin metoda Kaplan Maier.

The Kaplan Maier method is being used in oncology in order to calculate the survival rate during/at the end of the study. The purpose of this study is the assessment of the survival period referred to the clinical and histopathological state, laboratory findings, the diagnostic and treatment time. The material of the study is a LIMCO group (n = 308 cases) hospitalized in the Oncology Department of the Children's Clinical and Emergency Hospital "Sf. Maria", Iasi between 1980-1995. The LIMCO group was divided in 2 smaller groups: LMH group (110 cases) and a LMNH group (198 cases). The results statistical analysis was made by chi 2, Long-Rank and Breslow test. The results established a series of favorable LIMCO prognostic factors referred to the clinical state I-II, the histopathological type, normal or pathological laboratory findings at the first admission and the quality of the remission after the multimodal treatment.

[Celiac disease associated with Helicobacter pylori infection]. / Boala celiaca asociata cu infectia cu Helicobacter pylori.

Celiac disease, also known as gluten-sensitive enteropathy, is an autoimmune enteropathy caused by the ingestion of gluten-containing grains in susceptible subjects. The authors present a 3 years and 5 months old girl diagnosed with celiac disease at 1 year and 5 months old. Initially, the evolution after gluten-free diet was favorable. After 2 years the child presented abdominal pain and anorexia. The IgA antigliadin antibodies had normal values. The gastric biopsy found Helicobacter pylori gastritis. After treatment for Helicobacter pylori eradication the symptoms disappeared.

[Lamotrigine in the treatment of pharmaco-resistant epilepsy in children]. / Lamotrigina în tratamentul epilepsiilor farmacorezistente la copil.

Lamotrigine (LTG) is an antiepileptic drug whose therapeutic effect may be due to inhibition of the excitatory transmitter glutamate release. The aim of this study is to evaluate LTG efficacity and tolerability in the therapy of drug-resistant epilepsy in children. LTG is tested in 27 patients with different forms of epilepsy. Results show a satisfactory response and the low adverse effects of LTG in agreement with literature data. The therapy also improve cognitive function and relationship.

[Arterial hypertension in children. II. The pathogenetic mechanisms involved in arterial hypertension and the therapeutic correlates]. / Hipertensiunea arteriala la copil. II. Mecanisme patogenice implicate în hipertensiunea arteriala si corelatii terapeutice.

The author discussed the principal pathological mechanisms of the essential hypertension, i.e the importance of sodium and natriuretic factor, the importance of the sympathetic nervous system in the adjustment of the blood pressure, the importance of the renin-angiotensin-aldosterone system, as well as the implication of the kidney by its pressor and depressor mechanisms. The authors emphasized the interrelation of the pressor mechanisms in the essential hypertension. He concluded that the essential hypertension is a "disease of a complex adjustment" with a clinical, biological, haemodynamic and therapeutic heterogeneity, that the genetic factor is well accepted, thus the identification of other genetic markers would have a great importance. There are also presented the principal groups of drugs used in the essential hypertension, in correlation with the pathological mechanisms.

[Arterial hypertension in children. I. The epidemiological and etiological aspects]. / Hipertensiunea arteriala la copil. I. Aspecte epidemiologice si etiologice.

The authors present the etiology and the epidemiology of the hypertension in children. It is emphasized how important is to know the hypertension in children, which would allow to adopt measures in order to overt the hypertension's disasters in adults. It is defined the hypertension in children and there is presented the normal range od the arterial blood pressure as well as the methodology of measuring blood pressure in the arteries. There are presented the aspects concerning the incidence and the prevalence rates of hypertension in children, the factors that influence blood pressure and especially the risk markers. There are also brief presented the essential-hypertension and the etiology of the secondary hypertension.