Il rapporto tra ospedale e territorio nell’attuazione della continuità assistenziale. Il caso del fine vita

La continuità assistenziale è un principio fondamentale nelle cure primarie. Essa risponde all’obiettivo di creare una integrazione e una collaborazione tra le varie strutture e servizi di assistenza sanitaria. A livello organizzativo rappresenta l’erogazione di servizi inseriti all’interno di un piano gestionale condiviso che dovrebbe sostanziarsi nella capacità di avviare e mantenere attivo un modello di lavoro in rete. Implementare un lavoro di rete tra ospedale e territorio implica un cambiamento culturale radicale che sembra essere perseguito con molta difficoltà nella realtà italiana. La difficoltà di questa sfida è più evidente nella gestione del fine vita, specialmente per il personale medico. A questo proposito il nostro studio si pone le seguenti domande di ricerca: Come i medici si rappresentano la continuità tra ospedale e strutture del territorio deputate alla gestione di pazienti terminali? quali sono le connotazioni culturali prevalenti della struttura ospedaliera e dell’hospice? Come viene trattata la questione del fine vita? L’obiettivo principale della ricerca è stato quello di esplorare i modelli culturali che organizzano le rappresentazioni che i medici hanno della continuità della cura nel fine vita. A questo proposito sono stati intervistati, attraverso un’intervista semi-strutturata, 10 medici (4 appartenenti all’UOC di Oncologia medica dell’ospedale, 4 appartenenti all’UOC di Medicina d’urgenza dell’ospedale e 2 appartenenti all’hospice), operanti nel territorio di un capoluogo di provincia umbro. I testi delle interviste sono stati interamente trascritti e analizzati attraverso l'Analisi Fenomenologica Interpretativa (IPA). Complessivamente i dati emersi evidenziano una offerta dei servizi al paziente terminale non inserita in una rete condivisa, una cultura della continuità assistenziale ancora debole ma fortemente differente nei due contesti di riferimento. Il processo di handover appare una pratica sostanzialmente formale e adempitiva, non basata su una comunicazione efficace e costruita sulle esigenze di paziente e familiare, quanto piuttosto agita in tempi strettissimi e quando il fine vita è imminente. Viene, infine, discussa la funzione della professione di psicologo, evidenziando la necessità di una sua collocazione all'interno del team di assistenza, non solo con compiti di assistenza agli utenti, ma anche di facilitazione dei processi di lavoro e di costruzione dell’handoverContinuity of care is a fundamental principle in primary care. It responds to the integration and collaboration principle between different health-care services. At the organizational level, continuity of care is the provision of services included in a management plan that uses a shared model of network work. Implementing the network between hospital and territory implies a radical cultural change, which shows many difficulties to be achieved in Italian reality. The complexity of this challenge is most evident in the management of end of life, especially for physicians. In this regard, in our study we posed the following research questions: As physicians represent the continuity between hospital and territory in the management of terminal patients? What are the cultural characteristics of the Hospital and Hospice? How it is treated the issue of the end of life? So, main objective of the research was to investigate the cultural models that organize the representations of physicians regarding continuity of care in the end of life. Through semi-structured interview, were interviewed 10 physicians (4 UOC of Medical Oncology Hospital, 4 of the 'Division of Emergency Medicine Hospital and 2 of hospice), operating in Umbria territory. The texts of the interviews were fully transcribed and analyzed through the Interpretative Phenomenological Analysis (IPA). Overall, the findings highlight a offer of services to the terminal patient not included in a shared network and a culture of continuity of care still weak but strongly different in the two contexts. The handover process appears to be a formal practice, not built on the patient and family’s needs, and acted when the end of life is imminent. The function of the psychological profession is discussed, highlighting the need for its placement within the care team, not only with tasks of assistance to users but even on the facilitation of the working group processes and handover construction

Methylated HBHA produced in <i>M. smegmatis</i> discriminates between active and non-active tuberculosis disease among RD1-responders

Background. A challenge in tuberculosis (TB) research is to develop a new immunological test that can help distinguish, among subjects responsive to QuantiFERON TB Gold In tube (QFT-IT), those who are able to control Mtb replication (remote LTBI, recent infection and past TB) from those who cannot (active TB disease). IFN-γ; response to the Heparin-binding-hemagglutinin (HBHA) of Mtb has been associated with LTBI, but the cumbersome procedures of purifying the methylated and immunological active form of the protein from Mtb or M. bovis Bacillus Calmette et Guerin (BCG) have prevented its implementation in a diagnostic test. Therefore, the aim of the present study was to evaluate the IFN-γ response to methylated HBHA of Mtb produced in M. smegmatis (rHBHAms) in individuals at different stages of TB who scored positive to QFT-IT. Methodology/Principal Findings. 87 individuals at different stages of TB who scored positive to QFT-IT were selected. IFN-γ response to in vitro whole blood stimulation with rHBHAms was evaluated by short-term and long-term tests and detected by ELISA or flow cytometry. We demonstrated that the IFN-γ response to rHBHAms is mediated by CD4+ T-cells with an effector-memory phenotype. This response, evaluated by short-term-tests, is significantly lower in active TB than in remote LTBI (p = 0.0010) and past TB (p = 0.0152). These results were confirmed by long-term tests. The qualitative data confirmed that IFN-γ responses higher than the cut-off point identified by ROC analysis are associated with the status of non-active disease. Conclusions. In this study we show that the T-cell response to a recombinant and methylated HBHA of Mtb produced in M. smegmatis is useful to discriminate between active and non-active TB disease among those responsive to QFT-IT in a whole blood system. Further studies are needed to improve the accuracy of the assay

Methylated HBHA Produced in M. smegmatis Discriminates between Active and Non-Active Tuberculosis Disease among RD1-Responders

A challenge in tuberculosis (TB) research is to develop a new immunological test that can help distinguish, among subjects responsive to QuantiFERON TB Gold In tube (QFT-IT), those who are able to control Mtb replication (remote LTBI, recent infection and past TB) from those who cannot (active TB disease). IFN-\u3b3 response to the Heparin-binding-hemagglutinin (HBHA) of Mtb has been associated with LTBI, but the cumbersome procedures of purifying the methylated and immunological active form of the protein from Mtb or M. bovis Bacillus Calmette et Guerin (BCG) have prevented its implementation in a diagnostic test. Therefore, the aim of the present study was to evaluate the IFN-\u3b3 response to methylated HBHA of Mtb produced in M. smegmatis (rHBHAms) in individuals at different stages of TB who scored positive to QFT-IT

Epigenome Microarray Platform for Proteome-Wide Dissection of Chromatin-Signaling Networks

Knowledge of protein domains that function as the biological effectors for diverse post-translational modifications of histones is critical for understanding how nuclear and epigenetic programs are established. Indeed, mutations of chromatin effector domains found within several proteins are associated with multiple human pathologies, including cancer and immunodeficiency syndromes. To date, relatively few effector domains have been identified in comparison to the number of modifications present on histone and non-histone proteins. Here we describe the generation and application of human modified peptide microarrays as a platform for high-throughput discovery of chromatin effectors and for epitope-specificity analysis of antibodies commonly utilized in chromatin research. Screening with a library containing a majority of the Royal Family domains present in the human proteome led to the discovery of TDRD7, JMJ2C, and MPP8 as three new modified histone-binding proteins. Thus, we propose that peptide microarray methodologies are a powerful new tool for elucidating molecular interactions at chromatin

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

PROMUOVERE IL BENESSERE DELLE FAMIGLIE DI BAMBINI E RAGAZZI DIVERSAMENTE ABILI: PROGETTO “INSIEME AI GENITORI” DELL’AIPD – SEZIONE DI ROMA

Introduzione La contestualizzazione dei bisogni del bambino diversamente abile all’interno dell’ambiente familiare e la focalizzazione dell’attenzione ai bisogni della famiglia sono aspetti fondamentali del processo di presa in carico globale. A questo scopo l’Associazione Italiana Persone Down offre un percorso di sostegno alla genitorialità. Il progetto offre ai genitori di bambini/ragazzi con Sindrome di Down la possibilità di partecipare a un gruppo di auto-mutuo aiuto, volta a farli sentire accolti e sostenuti, attraverso la condivisione delle proprie esperienze con l’obiettivo di attivare le risorse personali. Lo scopo della presente ricerca è di studiare il rapporto tra il livello di partecipazione al gruppo di sostegno alla genitorialità e l’esperienza vissuta dai partecipanti. Metodi Tre gruppi di genitori (n=35), al termine del percorso hanno risposto a un questionario individuale, volto a misurare i fattori di efficacia nei gruppi di auto-aiuto, e a un’intervista semi-strutturata, volta a esplorare l’esperienza di gruppo. Le interviste sono state sottoposte ad analisi multivariata per individuare le rappresentazioni (cluster) e le dimensioni latenti (fattori) dell’esperienza dei partecipanti e la loro relazione con il livello di partecipazione (χ2, p&lt;0,05). Risultati I risultati evidenziano il bisogno delle famiglie di ampliare la rete formale e informale. Si rileva una distinzione in due gruppi probabilmente connessa all’età dei figli. Esse sono relative al sostegno affettivo dato e ricevuto tra i membri quando i figli sono piccoli e all’aver contribuito al funzionamento del gruppo quando sono più grandi. Conclusioni I gruppi, attraverso lo scambio reciproco e la condivisione delle esperienze vissute, possono rappresentare da questo punto di vista una forza attivante delle risorse personali, contribuendo a migliorare la qualità delle relazioni, nonché il benessere percepito dalle famiglie

Phages specific for mycobacterial lipoarabinomannan help serodiagnosis of tuberculosis

This study evaluated the possibility to use six phages specific to the Mycobacterium tuberculosis lipoarabinomannan (LAM) as tools for tubercular serodiagnosis. We analysed sera samples from 30 subjects with active tuberculosis (TB+), 30 with latent tubercular infection (LTBI) and 60 healthy subjects as controls (K). Our data indicated a good antibody response of the TB+ and LTBI patients against the phage Ri(7)17; the optical density (OD) values obtained from sera patients was statistically significant when compared to the control samples. Our results confirm that phage display technology might be useful to develop new tools for diagnosis of tuberculosis

Chemical characterization of a variety of cold-pressed gourmet oils available on the Brazilian market

macadamia and Brazil nut) and seeds (grapeseed and canola), and retailed in the Brazilian region of Minas Gerais, were chemically characterized. Specifically, for each type of oil, the fatty acid composition was elucidated by GC-FID, the contents of selected polyphenols and squalene were determined respectively by UHPLC-MS and UHPLC-PDA, whereas minerals were explored by means of ICP-MS. Olive oil was confirmed to have the highest MUFA content due to a valuable level of oleic acid, while oils from grapeseed, Brazil nut and canola were marked by nutritionally important PUFA levels. The highest SFA content found in coconut oil was mainly due to the high levels of lauric acid, known for its advantageous HDL-raising effects. As for polyphenols, gourmet oils from palm, coconut and canola showed higher levels of phenolic acids (e.g. p-hydroxybenzoic, ferulic, syringic, acids) than olive oil, which was though characterized by peculiar antioxidants, such as tyrosol and hydroxytyrosol. Also, olive oil had the highest amount of squalene, followed by the oil from Brazil nut. Finally, all the investigated oils had very low levels (order of μg/kg) of pro-oxidant elements, such as Cu, Fe and Mn. Overall, these findings may fill the gaps still present in literature on certain compositional aspects of commercially available gourmet oils

Chemical characterization of a variety of cold-pressed gourmet oils available on the brazilian market

Different specialty extra virgin oils, produced by cold-pressing fruits/nuts (olive, pequi, palm, avocado, coconut, macadamia and Brazil nut) and seeds (grapeseed and canola), and retailed in the Brazilian region of Minas Gerais, were chemically characterized. Specifically, for each type of oil, the fatty acid composition was elucidated by GC-FID, the contents of selected polyphenols and squalene were determined respectively by UHPLC-MS and UHPLC-PDA, whereas minerals were explored by means of ICP-MS. Olive oil was confirmed to have the highest MUFA content due to a valuable level of oleic acid, while oils from grapeseed, Brazil nut and canola were marked by nutritionally important PUFA levels. The highest SFA content found in coconut oil was mainly due to the high levels of lauric acid, known for its advantageous HDL-raising effects. As for polyphenols, gourmet oils from palm, coconut and canola showed higher levels of phenolic acids (e.g. p-hydroxybenzoic, ferulic, syringic, acids) than olive oil, which was though characterized by peculiar antioxidants, such as tyrosol and hydroxytyrosol. Also, olive oil had the highest amount of squalene, followed by the oil from Brazil nut. Finally, all the investigated oils had very low levels (order of μg/kg) of pro-oxidant elements, such as Cu, Fe and Mn. Overall, these findings may fill the gaps still present in literature on certain compositional aspects of commercially available gourmet oils