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  1. Article: Editorial: Insights in general pediatrics and pediatric emergency care: 2022.

    Kossowsky, Joe / Bressan, Silvia / Cohen, Jérémie F

    Frontiers in pediatrics

    2023  Volume 11, Page(s) 1181390

    Language English
    Publishing date 2023-04-11
    Publishing country Switzerland
    Document type Editorial
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2023.1181390
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  2. Article ; Online: "Procedural sedation and analgesia in Italian pediatric emergency departments: a subgroup analysis in italian hospitals".

    Bevacqua, Martina / Sforzi, Idanna / Bressan, Silvia / Barbi, Egidio / Sahyoun, Cyril

    Italian journal of pediatrics

    2023  Volume 49, Issue 1, Page(s) 23

    Abstract: To date, pain and anxiety are the most common symptoms reported by children who refer to pediatric emergency department. Despite it is well known that the undertreatment of this condition has some negative consequences in a short term and long term of ... ...

    Abstract To date, pain and anxiety are the most common symptoms reported by children who refer to pediatric emergency department. Despite it is well known that the undertreatment of this condition has some negative consequences in a short term and long term of time, gaps in the management of pain in this setting still persist. This subgroup analysis aims to describe the current state of art of pediatric sedation and analgesia in Italian emergency departments and to identify existing gaps to solve. This is a subgroup analysis of a cross-sectional European survey of pediatric emergency departments sedation and analgesia practice undertaken between November 2019 and March 2020. The survey proposed a case vignette and questions addressing several domains, like the management of pain, availability of medications, protocols and safety aspects, staff training and availability of human resources around procedural sedation and analgesia. Italian sites responding to the survey were identified and their data were isolated and checked for completeness. Eighteen Italian sites participated to the study, the 66% of which was represented University Hospitals and/or Tertiary Care Centers. The most concerning results were an inadequate sedation to 27% of patients, lack of availability of certain medications like nitrous oxide, the lack of use of intranasal fentanyl and topical anesthetics at the triage, the rare use of safety protocols and preprocedural checklists, lack of staff training and lack of space. Furthermore, the unavailability of Child Life Specialists and hypnosis emerged. Despite procedural sedation and analgesia in Italian pediatric emergency departments is progressively more used than previously, several aspects still require an implementation. Our subgroup analysis could be a starter point for further studies and to improve and make the current Italian recommendations more homogeneous.
    MeSH term(s) Child ; Humans ; Cross-Sectional Studies ; Analgesia/methods ; Pain ; Tertiary Care Centers ; Emergency Service, Hospital
    Language English
    Publishing date 2023-02-15
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2088556-8
    ISSN 1824-7288 ; 1720-8424
    ISSN (online) 1824-7288
    ISSN 1720-8424
    DOI 10.1186/s13052-023-01426-7
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  3. Article ; Online: Isolated Altered Mental Status in Children With Minor Blunt Head Trauma.

    Bressan, Silvia / Heidt, Rachel / Wang, Caroline / Tancredi, Daniel / Kuppermann, Nathan

    Pediatrics

    2022  Volume 150, Issue 4

    MeSH term(s) Child ; Head Injuries, Closed/complications ; Humans ; Wounds, Nonpenetrating/complications
    Language English
    Publishing date 2022-09-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2022-057138
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  4. Article: The interplay between dividends and leverage inside commercial banks

    Bressan, Silvia

    International journal of financial research Vol. 8, No. 2 , p. 7-39

    2017  Volume 8, Issue 2, Page(s) 7–39

    Author's details Silvia Bressan
    Keywords banks ; dividends ; leverage
    Language English
    Publisher Sciedu Press
    Publishing place Toronto
    Document type Article
    ZDB-ID 2611282-6 ; 2611285-1
    ISSN 1923-4031 ; 1923-4023
    ISSN (online) 1923-4031
    ISSN 1923-4023
    Database ECONomics Information System

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  5. Article: A SuperLearner-enforced approach for the estimation of treatment effect in pediatric trials.

    Azzolina, Danila / Comoretto, Rosanna / Da Dalt, Liviana / Bressan, Silvia / Gregori, Dario

    Digital health

    2023  Volume 9, Page(s) 20552076231191967

    Abstract: Background: Randomized Clinical Trials (RCT) represent the gold standard among scientific evidence. RCTs are tailored to control selection bias and the confounding effect of baseline characteristics on the effect of treatment. However, trial conduction ... ...

    Abstract Background: Randomized Clinical Trials (RCT) represent the gold standard among scientific evidence. RCTs are tailored to control selection bias and the confounding effect of baseline characteristics on the effect of treatment. However, trial conduction and enrolment procedures could be challenging, especially for rare diseases and paediatric research. In these research frameworks, the treatment effect estimation could be compromised. A potential countermeasure is to develop predictive models on the probability of the baseline disease based on previously collected observational data. Machine learning (ML) algorithms have recently become attractive in clinical research because of their flexibility and improved performance compared to standard statistical methods in developing predictive models.
    Objective: This manuscript proposes an ML-enforced treatment effect estimation procedure based on an ensemble SuperLearner (SL) approach, trained on historical observational data, to control the confounding effect.
    Methods: The REnal SCarring Urinary infEction trial served as a motivating example. Historical observational study data have been simulated through 10,000 Monte Carlo (MC) runs. Hypothetical RCTs have been also simulated, for each MC run, assuming different treatment effects of antibiotics combined with steroids. For each MC simulation, the SL tool has been applied to the simulated observational data. Furthermore, the average treatment effect (ATE), has been estimated on the trial data and adjusted for the SL predicted probability of renal scar.
    Results: The simulation results revealed an increased power in ATE estimation for the SL-enforced estimation compared to the unadjusted estimates for all the algorithms composing the ensemble SL.
    Language English
    Publishing date 2023-08-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2819396-9
    ISSN 2055-2076
    ISSN 2055-2076
    DOI 10.1177/20552076231191967
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  6. Article ; Online: Nurturing the next generation of pediatric physician scientists: the Padova Physician Scientist Research Training for pediatric residents.

    Galderisi, Alfonso / Bressan, Silvia / Da Dalt, Liviana / Perilongo, Giorgio / Baraldi, Eugenio

    European journal of pediatrics

    2023  Volume 183, Issue 4, Page(s) 1567–1570

    Abstract: Less than 2% of physicians complete a research training (PhD) after the residency with a declining trend in those pursuing a clinical scientist pathway in pediatrics. The exposure to research methodology during the clinical training may play a role in ... ...

    Abstract Less than 2% of physicians complete a research training (PhD) after the residency with a declining trend in those pursuing a clinical scientist pathway in pediatrics. The exposure to research methodology during the clinical training may play a role in engaging the next generations of pediatric physician scientist. Herein, we describe the experience of the Padova Physician Scientist Research Training (PPSRT) of the pediatric residency program at the University of Padova. The PPSRT was addressed to residents attending PGY2 to PGY4 of the pediatric program and consisted of two cores: a general one including in person or virtual lectures about research methodology in pediatrics including design of a clinical trial, writing of a scientific paper and statistical methods, and a subspecialties core for the discussion of research challenges in each area and the scientific writing activities. The perceived barriers to a research training and an evaluation of the program were assessed by an anonymized questionnaire. Sixty-four out 150 residents registered for the research training with 62/64 completing the two cores. The major perceived barrier to research during clinical training was the absence of protected time (89%) followed by the lack of specific funds (37%). The group activities lead to the publication of 24 papers.    Conclusion: This is the first experience in the Italian pediatric training of a dedicated research program within the frame of postgraduate medical education. Our report highlights the need for protected time to promote research interest and nurture a new generation of physician scientists. What is Known: • Training to medical research is not part of residency program. • The declining trend of physician scientists might be reverted by early exposure to research methodology and challenges during residency. What is New: • An early exposure to research training during pediatric residency increases the research engagement of pediatric residents. • The lack of protected time for research is perceived as the major barrier to research training during residency.
    MeSH term(s) Humans ; Child ; Physicians ; Internship and Residency ; Education, Medical ; Surveys and Questionnaires ; Biomedical Research
    Language English
    Publishing date 2023-10-18
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 194196-3
    ISSN 1432-1076 ; 0340-6199 ; 0943-9676
    ISSN (online) 1432-1076
    ISSN 0340-6199 ; 0943-9676
    DOI 10.1007/s00431-023-05258-9
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  7. Article ; Online: SIMPEDVR: using VR in teaching pediatric emergencies to undergraduate students-a pilot study.

    Savino, Sandro / Mormando, Giulia / Saia, Giorgia / Da Dalt, Liviana / Chang, Todd P / Bressan, Silvia

    European journal of pediatrics

    2023  Volume 183, Issue 1, Page(s) 499–502

    Abstract: The objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, ... ...

    Abstract The objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, each student managed two pediatric emergency virtual scenarios. At the end of the sessions, students completed a Technology Assessment Questionnaire to evaluate the perceived usefulness and perceived ease-of-use of their VR training experience and rated their perceived level of competence in managing the two clinical scenarios. The median perceived usefulness was 91.7/100 (interquartile range (IQR) 80.6-100), while the median perceived ease-of-use was 77.8/100 (IQR 63.9-88.9). The perceived level of competence increased from 2 (IQR 1-3) to 4 (IQR 3-4) on a 5-point Likert scale, for both scenarios (p < 0.001, Wilcoxon test for paired samples).       Conclusions: The staged VR sessions had a good perceived usefulness and resulted in an increase in the perceived level of competence. The results on the ease-of-use, however, show that an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made; further work is required to ease the integration of VR into curricula. What is Known: • Virtual reality (VR) is a rising simulation training methodology in Pediatric Emergency Medicine (PEM), however little experience is reported about its use for undergraduate students What is New: • VR PEM trainiing was found useful by undergraduate students and its use increased their perceived level of competence, although ease-of-use received lower ratings. • Despite the young age, an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made.
    MeSH term(s) Humans ; Child ; Pilot Projects ; Emergencies ; Students ; Simulation Training/methods ; Virtual Reality
    Language English
    Publishing date 2023-10-16
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 194196-3
    ISSN 1432-1076 ; 0340-6199 ; 0943-9676
    ISSN (online) 1432-1076
    ISSN 0340-6199 ; 0943-9676
    DOI 10.1007/s00431-023-05254-z
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  8. Article ; Online: A SuperLearner-enforced approach for the estimation of treatment effect in pediatric trials

    Danila Azzolina / Rosanna Comoretto / Liviana Da Dalt / Silvia Bressan / Dario Gregori

    Digital Health, Vol

    2023  Volume 9

    Abstract: Background Randomized Clinical Trials (RCT) represent the gold standard among scientific evidence. RCTs are tailored to control selection bias and the confounding effect of baseline characteristics on the effect of treatment. However, trial conduction ... ...

    Abstract Background Randomized Clinical Trials (RCT) represent the gold standard among scientific evidence. RCTs are tailored to control selection bias and the confounding effect of baseline characteristics on the effect of treatment. However, trial conduction and enrolment procedures could be challenging, especially for rare diseases and paediatric research. In these research frameworks, the treatment effect estimation could be compromised. A potential countermeasure is to develop predictive models on the probability of the baseline disease based on previously collected observational data. Machine learning (ML) algorithms have recently become attractive in clinical research because of their flexibility and improved performance compared to standard statistical methods in developing predictive models. Objective This manuscript proposes an ML-enforced treatment effect estimation procedure based on an ensemble SuperLearner (SL) approach, trained on historical observational data, to control the confounding effect. Methods The REnal SCarring Urinary infEction trial served as a motivating example. Historical observational study data have been simulated through 10,000 Monte Carlo (MC) runs. Hypothetical RCTs have been also simulated, for each MC run, assuming different treatment effects of antibiotics combined with steroids. For each MC simulation, the SL tool has been applied to the simulated observational data. Furthermore, the average treatment effect (ATE), has been estimated on the trial data and adjusted for the SL predicted probability of renal scar. Results The simulation results revealed an increased power in ATE estimation for the SL-enforced estimation compared to the unadjusted estimates for all the algorithms composing the ensemble SL.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 310
    Language English
    Publishing date 2023-08-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: A Bayesian Sample Size Estimation Procedure Based on a B-Splines Semiparametric Elicitation Method.

    Azzolina, Danila / Berchialla, Paola / Bressan, Silvia / Da Dalt, Liviana / Gregori, Dario / Baldi, Ileana

    International journal of environmental research and public health

    2022  Volume 19, Issue 21

    Abstract: Sample size estimation is a fundamental element of a clinical trial, and a binomial experiment is the most common situation faced in clinical trial design. A Bayesian method to determine sample size is an alternative solution to a frequentist design, ... ...

    Abstract Sample size estimation is a fundamental element of a clinical trial, and a binomial experiment is the most common situation faced in clinical trial design. A Bayesian method to determine sample size is an alternative solution to a frequentist design, especially for studies conducted on small sample sizes. The Bayesian approach uses the available knowledge, which is translated into a prior distribution, instead of a point estimate, to perform the final inference. This procedure takes the uncertainty in data prediction entirely into account. When objective data, historical information, and literature data are not available, it may be indispensable to use expert opinion to derive the prior distribution by performing an elicitation process. Expert elicitation is the process of translating expert opinion into a prior probability distribution. We investigated the estimation of a binomial sample size providing a generalized version of the average length, coverage criteria, and worst outcome criterion. The original method was proposed by Joseph and is defined in a parametric framework based on a Beta-Binomial model. We propose a more flexible approach for binary data sample size estimation in this theoretical setting by considering parametric approaches (Beta priors) and semiparametric priors based on B-splines.
    MeSH term(s) Sample Size ; Bayes Theorem ; Research Design ; Models, Statistical ; Probability
    Language English
    Publishing date 2022-10-31
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph192114245
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  10. Article ; Online: Correction to: Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice.

    Sahyoun, Cyril / Cantais, Aymeric / Gervaix, Alain / Bressan, Silvia / Löllgen, Ruth / Krauss, Baruch

    European journal of pediatrics

    2021  Volume 180, Issue 6, Page(s) 1815–1816

    Language English
    Publishing date 2021-02-11
    Publishing country Germany
    Document type Published Erratum
    ZDB-ID 194196-3
    ISSN 1432-1076 ; 0340-6199 ; 0943-9676
    ISSN (online) 1432-1076
    ISSN 0340-6199 ; 0943-9676
    DOI 10.1007/s00431-021-03980-w
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