From COVID-19 Pandemic to Patient Safety: A New "Spring" for Telemedicine or a Boomerang Effect?

During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine

From syndemic lesson after COVID-19 pandemic to a “systemic clinical risk management” proposal in the perspective of the ethics of job well done

The syndemic framework proposed by the 2021–2030 World Health Organization (WHO) action plan for patient safety and the introduction of enabling technologies in health services involve a more effective interpretation of the data to understand causation. Based on the Systemic Theory, this communication proposes the “Systemic Clinical Risk Management” (SCRM) to improve the Quality of Care and Patient Safety. This is a new Clinical Risk Management model capable of developing the ability to observe and synthesize different elements in ways that lead to in-depth interventions to achieve solutions aligned with the sustainable development of health services. In order to avoid uncontrolled decision-making related to the use of enabling technologies, we devised an internal Learning Algorithm Risk Management (LARM) level based on a Bayesian approach. Moreover, according to the ethics of Job Well Done, the SCRM, instead of giving an opinion on events that have already occurred, proposes a bioethical co-working because it suggests the best way to act from a scientific point of view

Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic

Introduction The present pandemic has exposed us to unprecedented challenges that need to be addressed not just for the current state, but also for possible future similar occurrences. It is worth pointing out that discussions on the allocation of medical resources may not necessarily refer to an exception, but, unfortunately, to a regular condition for a large part of humanity (1). The criteria for admission to an Intensive Care Unit (ICU) setting generally take into account multiple factors. There must be a diagnostic and prognostic basis for the decisions made, considering both biological factors and patient values and wishes. Furthermore, the decision-making process should, whenever possible, respect the patient's advance directives as well as the relationship with the patient's family or attorney. Therapeutic neglect should be avoided. Having applied standard clinical evaluation criteria for the appropriate treatment of patients with COVID-19, including consideration of prognosis, if a hospital then finds itself unable to provide optimal treatment (e.g., due to a disproportion between the number of patients and the availability of beds, healthcare providers, ventilators, and drugs in the ICU), it becomes necessary to evaluate, case by case, how to achieve justice and the best possible good for the greatest number of patients. It is therefore mandatory to explore alternative solutions; these include increasing available beds and healthcare providers, implementing alternative, though suboptimal, approaches (where appropriate), transferring patients to other clinical units, etc. Making these decisions properly also involves the recovery of the political role of medicine and science (2). If the imbalance between needs and resources reaches a critical level, an emergency triage protocol, following the operational and ethical indications of “disaster medicine,” should be activated. These have been deployed in major and serious natural (earthquakes or tsunamis for example) and technological (factory explosions, public transport accidents for example) disasters, as well as following terrorist attacks (3, 4). The question of the feasibility of developing a clinical evaluation algorithm to support the decision-making of the triage team remains open, though many such protocols have been written. According to the above, we propose the following five ethical criteria for the triage of patients in conditions of limited resources, such as the COVID pandemic. They are the result of an interdisciplinary and intercultural dialogue between specialists from different disciplines. Several of the authors are working in the main epicenters of the crisis and currently are playing a central role in the bioethical, clinical, social and legal aspects of the management of the COVID-19 pandemic

Educazione e simulazione nelle Facoltà universitarie. Una review

La pedagogia medica è stata oggetto di studio sempre più crescente soprattutto dagli anni ’90. Il numero di pubblicazioni è passato da una media di 255 annue (tra il 1943-1962) ad una media di più di 6.110 pubblicazioni (2010-2017). Abbiamo focalizzato l’attenzione sul tema della formazione tramite la simulazione, abbiamo svolto un breve excursus storico e abbiamo condotto una ricerca sul tasso di sviluppo della pedagogia medica tramite l’analisi delle pubblicazioni censite dal sito più importante al mondo per i medici e i docenti universitari sanitari (PubMed). Dalla ricerca sulle 6 parole chiave individuate (Medical education; Patient simulation; Standardized patient; Medical simulation; Virtual reality simulation; Healthcare simulation) è emerso che la letteratura dedicata alla pedagogia medica (in particolare la simulazione) negli ultimi 27 anni, 1990-2017, è aumentata del 193% per gli articoli relativi alle Medical Education e di più del 1.146% per quel che riguarda il “Patient simulation”. Un grande incremento di pubblicazioni su riviste con Impact Factor che ci dimostra quanto la medicina stia puntando intensamente all’innovazione anche nel campo della didattica.Medical education has been the subject of increasingly growing study especially since the 90s. The number of scientific publications related to Medical Education has increased from an average of 255 publications per year (1943-1962) to an average of more than 6,110 publications (2010-2017). In this contribution we focused on medical and health professions education through simulation. We made a brief historical overview on the simulation and we did a research on the rate of development of medical pedagogy through the analysis of the publications recorded by the world’s most important website for physicians and Faculty teachers (PubMed). The data obtained from our research on the 6 key words we have identified (Medical education; Patient simulation; Standardized patient; Medical simulation; Virtual reality simulation; Healthcare simulation) showed us that the literature dedicated to Medical education, in the last 27 years, 1990-2017, it is increased by 193% for the articles related to Medical Education and by more than 1,146% for the “Patient simulation”. A great publications increase in scientific journal with Impact Factor that show us how much medicine is focusing intensely on innovation in the field of teaching

Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones

Objective: To examine the mechanisms of action of ursodeoxycholic acid ( UDCA) on gallbladder ( GB) muscle cells in patients with symptomatic cholesterol gallstones (GSs) as it reduces the incidence of acute cholecystitis. Design and patients: A double-blind study was performed on 15 patients, 7 randomised to UDCA and 8 to placebo, treated for 4 weeks before cholecystectomy. Muscle contraction induced by cholecystokinin (CCK)8, acetylcholine (ACh) and potassium chloride (KCl) was determined in enzymatically isolated GB muscle cells, and cholesterol levels were determined in plasma membranes. H2O2, lipid peroxidation, platelet-activating factor (PAF)-like lipids, prostaglandin E-2 (PGE(2)) and catalase activity were determined as biochemical markers of oxidative stress and inflammation in muscle cells. Results: UDCA significantly increased GB muscle cell contraction induced by all concentrations of CCK-8, ACh and KCl, and reduced the plasma membrane cholesterol (mean (SD) 0.32 (0.16) vs 0.72 (0.5) mmol/mg of protein) compared with placebo. In GB muscle cells, UDCA treatment significantly decreased the levels of H2O2 (4.4 (1.9) vs 13.7 (5.3) mmol/mg of protein), lipid peroxidation (malondialdehyde levels 1.3 (0.4) vs 2.52 (0.7) nmol/100 mg of protein), PAF-like lipids (8.9 (4.9) vs 29.6 (7.1) pg/mg of protein) as well as the production of PGE(2) (142 (47) vs 365 (125) pg/mg of protein) and catalase activity (14.5 (9.4) vs 35.8 (12.7) units/mg of protein) when compared with placebo. Conclusion: These studies suggest that UDCA treatment improves GB muscle contractility by decreasing the cholesterol content in the plasma membrane of muscle cells, and the biochemical parameters of oxidative stress, thus explaining its possible therapeutic mechanisms in patients with symptoms of cholesterol GSs

Continuing Education through the Campus Game: A Sustainable Gamification Project to Improve Doctors’ and Nurses’ Knowledge of Quality and Clinical Risk Management

The COVID-19 disease has dramatically changed lives worldwide, including education. This is a challenge for traditional learning. In fact, the European Higher Education Area poses the challenge of boosting the quality of teaching through active methodologies supported by digital pedagogy. Gamification is one of these tools and it has considerable attention in the healthcare literature. We aimed to create a game in the Campus Bio-Medico University Hospital Foundation in order to offer continuing education on Quality and Clinical Risk procedures to our staff. The 2021 “Campus Game” (178 players) introduced the “Badge Challenge” (Team Building, Procedures, and Security) and 73 questions. The leaderboard of every single match was posted in some of the hospital’s strategic areas and also published online on the company intranet to ensure engagement and competitiveness. Gamification has spontaneously promoted teamworking and a virtuous process of multiprofessional education. We found that, during the Campus Game, there was a 4.9% increase in access to the intranet page containing information on Quality and Patient Safety and an 8% increase in access to the Hospital Policies and Procedures. In the near future, we wish to expand this game, involving hospitals with similar types of activity and levels of attention to quality and safety issues, and also to enhance the network of partners and the principles of Q&S management itself

Vaccines Administration in the Perspective of Patient Safety and Quality of Healthcare: Lesson from the Experience of an Italian Teaching Hospital for Pandemic Preparedness

The development and administration of vaccines against COVID-19 was a key element in the fight against the pandemic, as it protected health systems and helped restore global economies. National implementation plans and vaccination strategies for COVID-19 vaccines ensured the immunization of large segments of the population in the shortest time. However, even before the start of the vaccination campaign, it was clear to decision-makers that the usual methods of vaccination were not suitable. The aim of this report is to share the experience of an Italian teaching hospital in the organisation of spaces and activities of healthcare workers to realise a safe vaccination campaign. An in-depth analysis of how the vaccination campaign was organised could be useful to understand strengths and weaknesses learnt from this experience and plan an effective, efficient, and resilient response to future pandemics right away. The adoption of a systemic clinical risk management (SCRM) could guarantee healthcare organizations a more adequate and resilient response in an ethics of a job well done perspective, allowing them to maintain high patient safety standards regardless of the contingent situation for which safety first should be the motto of a disaster response plan

Effect of acute mucosal exposure to Lactobacillus rhamnosus GG on human colonic smooth muscle cells

Aim: To define whether human colonic mucosa exposure to Lactobacillus rhamnosus GG (LGG), American Type Culture Collection (ATCC) 53103, may influence intestinal muscle cell contractility. Methods: Human colon specimens were obtained from disease-free margins of resected segments for cancer. The mucosa and submucosa, after dissection, were scaled between 2 chambers, with the luminal side of the mucosa facing upward and covered with 5 mL of Krebs solution and the submucosal side facing downward into 20 mL of Krebs solution. LGG or normal undernatant (N-undernatant) were added to the luminal side of the mucosa for 30 minutes. Smooth muscle cells (SMCs), isolated from the circular muscle layer, were exposed to undernatant for 30 minutes from the submucosal chamber of mucosa that was either preexposed to N-undernatant or to LGG (36 x 10(-9) colony forming units/mL) (LGG-undernatant). Acetylcholine (Ach) dose-response was obtained for SMCs. Results: SMCs exposed to N-undernatant presented a dose-response to Ach (maximal contraction: 32% +/- 5% with 1-mu M Ach) that is similar to unstimulated SMCs. Exposure to LGG-undernatant resulted both in an 18% +/- 3% cell shortening and a 78% +/- 7% inhibition of maximal Ach-induced contraction. When SMCs were directly exposed to LGG, a significant impairment of contraction (70% +/- 5%, compared with control cells) and a dose-dependent and time-dependent shortening were observed. Conclusions: After acute exposure of colonic mucosa to LGG, a significant shortening of SMCs is observed that possibly contributes to the reduced contractile response to Ach. Further studies are needed to establish the mechanisms of this effect that could account for the clinical efficacy of probiotics in intestinal disorders