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P Di Pietro

Publications and source records attributed to P Di Pietro.

At least 19 recordsLinked to original sources
PubMed2006

[Neurological disorders in a pediatric emergency room: Epidemiology and clinical aspects].

AIM: The aim of this study was to demonstrate how important neurological disorders are in the organization of services and education of staff in a pediatric emergency room. The first objective was to collect and review data in pediatric emergency care; based on an analysis of these data, the second objective was to design an organizational plan for emergency services to be developed in this setting. METHODS: We used the ICD IX system to search our computerized database created in 2000 and to select diagnoses from the medical records of patients who came to our emergency room with neurological symptoms. Because the system is not yet comprehensive and because this was a retrospective study, we had to select the bulk of the diagnoses following the formulation each of us had given at patient discharge. While this raised the risk of data spread, it still permitted us to identify certain characteristics of the disorders that were particularly useful for classifying their etiopathogenesis. RESULTS: Selected were 2.630 neurological patients that had been discharged or admitted to our unit (2.7% of all admissions). The patients were stratified by disorder and admission code number. Specific disorders of major impact, the clinical approach to their treatment and etiology were reviewed in detail. CONCLUSIONS: The results provide evidence that acute neurological disorders command the immediate attention of the emergency room physician and require prompt diagnosis.

Adolescent↗
PubMed2005

Risk management: medical malpractice and Emergency Department.

Because of the limited number of comprehensive paediatric centres, providing the entire continuum of paediatric care, including subspecialty care, and generally serving as regional referral centres for tertiary paediatrics, paediatric emergency care in Italy is often provided in adult facilities within primarily adult hospital institutions. Consequently, most paediatricians working in hospitals with a separate paediatric ward or department provide Emergency Department (ED) on-call coverage with serious liability concerns: such concerns are due to the fact that successful care of infants and children in an emergency situation requires appropriately sized equipment, well trained staff, appropriate and specialised triage and destination guidelines but, unfortunately, not all Italian facilities fulfil all these criteria. Risk management training of the entire ED staff may reduce the institution's involvement in malpractice litigation. Another useful tool within a paediatric ED is an Observation Unit (OU) for well-defined illnesses (such as asthma, croup, bronchiolitis, gastroenteritis, abdominal pain, mild dehydration, overdoses or poisoning, seizures), which can assure better patient's care, a decrease in missed diagnosis and acuity and decreased lenght of stay, and, consequently, a better risk management, decreased malpractice liability and cost effectiveness. Furthermore, in our paper we aimed to highlight the importance of aspects with a potential risk exposure in our profession, such as informed consent, exculpatory release forms, incident reports and complete ED record documentation of paediatric patients. In addition to that, the quality of care provided at ED in Italy has been assessed by analysing ED-related paediatric malpractice claims in the last 10 years. Finally, the importance of a joint commission within the Italian Paediatrics Society is underlined in order to discuss practice guidelines for paediatricians involved in emergency care.

Documentation↗
PubMed2004

Solution-phase microwave-assisted synthesis of unsubstituted and modified alpha-quinque- and sexithiophenes.

The facile synthesis of poorly soluble unsubstituted and modified alpha-quinque- and sexithiophenes under microwave irradiation in the liquid phase is described. The use of microwave irradiation allowed these compounds to be prepared in a few minutes and at high yields by means of the Suzuki cross-coupling reaction. Unsubstituted sexithiophene was obtained in 10 min via the one-pot borylation/Suzuki reaction, purified according to a very simple procedure, and isolated in 84% yield. The efficient synthesis of two new methylated quinque- and sexithiophenes displaying liquid crystalline properties is reported. A new microwave-assisted methodology for the conversion of aldehyde-terminated quinque- and sexithiophenes into the corresponding cyano derivatives is also described. The use of microwaves was extended to the Sonogashira coupling reaction and found to be very effective in the preparation of a quinquethiophene containing acetylenic spacers. The electronic and optical characterization of this compound is reported and discussed in relation to that of unsubstituted quinquethiophene.

Journal Article↗
PubMed2004

[Triage and white codes].

AIM: In this paper, the authors analyse the type of accesses to the Emergency Department of the DEA of the G. Gaslini Institute defined by the triage as White Code, monitoring the outcome of said access. METHODS: This investigation was of retrospective type and lasted 6 months. It employed the fast track triage nursing system for the selection of patients. Independently of their age and sex and presenting pathology, the selected patients, at the moment of nursing triage, received the white code on the basis of EPM (emergency paediatric medicine) paediatric triage guidelines. A specially designed grid containing motivations was applied to those admitted to hospital on the basis of the Emergency Department judgement. The prospective investigation was facilitated by the computerised emergency department patient management system that has been operative in our department since June 2000. RESULTS: A total of 22400 white code accesses were recruited into the study; the admission percentage was 3.7% (89 patients). The most frequent reason for hospitalisation was the need to clinically classify a pathology that persisted without a complete response. CONCLUSION: This preliminary investigation will be pursued in the future with a collection of data for organisation type purposes and in order to contribute to greater hospital-local district integration.

Child↗
PubMed2003

[Guidelines: state of the art and peculiar aspects in pediatric emergency].

In recent years pediatric guidelines have increasingly become part of clinical practice, in Italy too. Aim of the present work is, on the basis of a review of national and international literature, to focus on the Italian situation about the use of guidelines in pediatric emergency, with particular respect to methodology, correct use, and related risks and benefits. The developing of efficient guidelines is achieved in different steps: 1) identifying and refining the topic for guidelines, in order to obtain an improvement of healthcare; 2) correct developing strategies, based on scientific evidence, leading to production of recommendations validated by external review; 3) adequate implementation and diffusion in local settings; 4) application with sensible and appropriate clinical discretion. Benefits obtained with the correct use of efficient pediatric guidelines, can be identified at different levels: patients' care (outcome improvement, increased patients' consciousness, influence on public healthcare policy); healthcare professionals (improving quality of clinical decisions, agreement on clinical and therapeutic strategies; medicolegal protection, representing a reference for prospective and retrospective audits); healthcare systems (standardising care, improving efficacy of care; optimising costs). Personal experience in systematic development of emergency pediatric guidelines, applied in a second level Emergency Department is also presented.

Child↗
PubMed2002

[Respiratory emergencies in adolescents].

BACKGROUND: The aim of this paper was to examine the present situation of adolescents admission for respiratory emergency, management of these patients, identify strategies for the best therapeutic options and better collaboration. METHODS: We have gathered data of adolescent patients who were referred to the Emergency Unit of "G. Gaslini" Children's Hospital, and "San Martino" Hospital in Genoa and to the Intensive Care Unit of both Hospitals and to the Emergency Service 118 in Liguria district. Respiratory emergency in adolescence is a rare condition and it is usually due to a poor control of respiratory chronic diseases, i.e. respiratory distress in patients with asthma. RESULTS: We found that there is an increased number of respiratory emergencies because of psychological problems, drugs addiction, multiple trauma; in other words, we had an increased number of admissions due to behavioural problems. Temporary in-patients care has been showed to be the best therapeutic option after the admission in the Emergency Unit. CONCLUSIONS: In conclusion, adolescent patients need to be hospitalized, but appropriate spaces and structures need to be found either in pediatric or adult Hospitals and qualified personnel must be trained.

Adolescent↗
PubMed2001

Two new point mutations at A2062 associated with resistance to 16-membered macrolide antibiotics in mutant strains of Mycoplasma hominis.

We describe two mutants of Mycoplasma hominis PG-21 which show resistance to 16-membered macrolides but susceptibility to lincosamides, obtained by in vitro exposure to increasing doses of josamycin. The 23S rRNA gene showed that each had a mutation (A2062G and A2062T) corresponding to nucleotide 2062 in Escherichia coli, which was associated with the acquired phenotype.

Anti-Bacterial Agents↗
PubMed2001

[A case of acute lymphoblastic leukemia with an unusual presentation and slow development].

The authors describe the case of a 3-year-old girl with acute lymphoblastic leukemia which was diagnosed several months after the appearance of the first symptoms. The delay can be attributed to the vague symptoms at onset in the form of a single laterocervical adenopathy which responded to antibiotic and antiphlogistic therapy, the total absence of any indicative hematological symptoms and the patient s persistent excellent general conditions. In the light of this unusual case, the authors stress the need to carry out invasive diagnostic tests on lymph node lesions that are often defined as aspecific given that they may occasionally disguise more severe lymphoproliferative diseases.

Age Factors↗
PubMed1999

A surveillance-oriented medical record as a source of data for both drug and quality of care surveillance.

The medical record for hospitalized patients has been modified in order to orient it towards two types of surveillance: adverse drug reactions (ADRs) and the quality of medical care. The modification consists of an adaptation of the progress notes; the transfer of the information to a special database is facilitated by the use of a simple system of codes that identify and correlate the items necessary for surveillance purposes. During the 6 months of observation of the 1103 pediatric patients included in the study, 35 clinically important suspected ADRs were noted by physicians. For the quality of medical care surveillance, all drug prescriptions were evaluated and areas in which to intervene in order to improve the appropriateness of prescriptions were identified. Quality surveillance was also extended to the monitoring of 'unexplained' adverse events for which no particular cause was attributable. We consider it advantageous to carry out these two types of surveillance simultaneously because they require many common items of information. The use of an oriented medical record as a source of data makes it possible to integrate surveillance with everyday ward activities.

Journal Article↗
PubMed1995

Severity grading of childhood poisoning: the Multicentre Study of Poisoning in Children (MSPC) score.

Scores for severity grading of childhood poisoning may be useful in comparing different causes of poisoning, in order to identify the main risks and their changes over time. The Multicentre Study of Poisoning in Children score is based on four levels of severity (1-mild, 2-moderate, 3-severe, 4-very severe) involving nine target groups: seven relating to organ systems (gastrointestinal, nervous, respiratory, circulatory, renal, hepatic, skin), one to metabolic abnormalities and one to injuries from corrosive substances. Each patient is classified by the highest level attributed to any one of the nine groups. The score has been prospectively tested in 644 symptomatic children, aged 0-13 years, admitted to six pediatric hospitals of Northern Italy from January 1, 1991 to December 31, 1993. Poisoning was categorized as mild (1) in 357 children (53.8%), moderate (2) in 285 (42.9%), severe (3) in 18 (2.7%) and very severe (4) in 4 (0.6%). No deaths occurred. Severity grading according to The Multicentre Study of Poisoning in Children score confirms the prevalence of mild and moderate poisonings in children; the score seems to be an objective method suitable for epidemiological studies in different countries. Its clinical usefulness deserves more investigation.

Adolescent↗
PubMed1993

[Child abuse by intoxication].

Child abuse by toxic substances is not easy to identify due to both the lack of signs of physical violence and the high incidence of accidental poisonings. Twelve cases of documented abuse, out of 6175 poisonings in children aged 0-13 years, were registered during 1975-1990 at Genova, Torino and Trieste Children Hospitals. In other 139 children the suspicion of abuse couldn't be confirmed. An early suspicion of abuse, is needed to prevent abuse and help the child and his family.

Adolescent↗
PubMed1992

[The Gaslini Medical-Surgical Emergency Service. Organizational and functional aspects].

The Authors take into account the organization of the medical emergency service at Gaslini children's hospital. Emergency medicine has been developing as a pediatric subspecialty, involving medical surgical and intensive care units to meet the peculiar needs of the acutely ill child. Moreover epidemiological data regarding all kinds of activity have been collected; they show a decrease in admitted patients and an increase in outpatients. These data undertime how effectively the service can act as a filter as well.

Age Factors↗