Precision medicine and precision nursing. The era of biomarkers and precision health

Precision health, by means of the support of precision medicine and precision nursing, is able to support clinical decision making in order to tailor optimal health-care decisions, around the individual characteristics of patients. The operational arm of precision health is represented by the use of biomarkers that can give useful information about disease susceptibility, exposure, evolution and response to treatment. Omics, imaging and clinical biomarkers are actually studied for their ability to positively impact health-care management. In this article, we try to address the role of biomarkers in the context of modern medicine and nursing with the view of improving patients care

Biomarkers for precision medicine in phlebology and wound care: A systematic review

INTRODUCTION: Precision medicine (PM) represents a tailored management based on specific patient biological and medical characteristics, at a highly detailed level, including disease screening, monitoring relapse and/or recurrence, selection and/or prediction of effective drug and/or surgical treatment. PM may be applied to Phlebology and Wound Care area and the aim of this review is to analyze the most updated information on this topic. EVIDENCE ACQUISITION: The following key words were used to search the literature: "precision medicine and phlebology/venous disease," "precision medicine and wound care," "biomarkers and phlebology/venous disease," "biomarkers and wound care." All of those studies which did not fit the query or which reported insufficient data were excluded. EVIDENCE SYNTHESIS: Of the 6845 records yielded by the search, after duplicate removing and after excluded records in title and abstract, 250 articles were left, which matched fulfilled the inclusion criteria. After reading the articles in full text, 203 were excluded because: 1) not responding properly to our research questions; 2) insufficient data; thefinal set included 47 articles. CONCLUSIONS: In the context of phlebology and wound care, PM, through the use of measurable biomarkers coming from omics analysis, may be used in selecting the appropriate treatment, in evaluating response to treatment, and in monitoring recurrences. Thus, a tailored medical approach to patients with vein and chronic wound disease may be useful in order lower the high incidence of important clinical conditions that have great socio-economic impact on the general population

Absorbable suture material in carotid surgery

Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of pediatric surgery or in case of infections. Aim: Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 M [58,53%], 467 F [41.47%], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomized into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.48% and 2.03% for group A, respectively, and 11.79% and 12.92% for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials

Carotid Body Paragangliomas and Matrix Metalloproteinases

Paragangliomas (PGLs) are slow-growing, typically, benign tumors that arise from the extra-adrenal paraganglion of the autonomic nervous system. PGLs arising from the carotid body are relatively rare tumors but constitute the majority of head and neck PGLs (60e70%).1 Carotid body tumors (CBTs) belong to the classification of PGLs, because they originate from paraganglia in chromaffin-negative glomus cells derived from the embryonic neural crest, functioning as part of the sympathetic nervous system. These cells normally act as special chemoreceptors located along blood vessels, particularly in the carotid bodies (at bifurcation of the common carotid artery in the neck).2 CBTs are usually classified using the criteria described by Shamblin et al.3 Matrix metalloproteinases (MMPs), enzymes that regulate cell matrix composition, play a role in several clinical conditions,4,5 including embryogenesis, wound healing,6,7 inflammation, arthritis, cardiovascular diseases,8 pulmonary diseases, and cancer.9 Several studies10e15 have shown that specific MMPs are involved in cancer processes that promote metastasis.The aim of this study is to examine the levels of MMPs in patients with benign and malignant neoplastic CBTs

ADVERSE COMPLICATIONS OF VENIPUNCTURE: A SYSTEMATIC REVIEW

venipuncture is the most routinely invasive procedure performed in clinical settings as it is an important tool mainly for diagnosis, monitoring, drug administration an blood donation. This review discusses the complications that can occur during this procedure. we planned to include all the studies dealing with "venipuncture and complications" and venipuncture and verse events: "we excluded all the studies, whit did not properly fit our research question, and with insufficient data. Of the 2345 records found after removing duplicates, and after records excluded in title and abstract, 173 matched our inclusion criteria. After reading the full-text article. we decided to exclude 144 articles because non responding properly to our research questions or due to insufficient data. The final set included 29 articles.There are several complications resulting from VP such as pained fear, hematoma, thrombosis, infection, nerve damage. arterial puncture, vasovagal reactions, and also rare events. Improving quality in venipuncture site and vein section, also in venipuncture thecnique may help in lowering complications

Insomnia Prevalence among Italian Night-Shift Nurses

Background. Insomnia is one of the major health problems related with a decrease in quality of life (QOL) and also in poor functioning in night-shift nurses, that also may negatively affect patients’ care. The aim of this study is to evaluate the prevalence of insomnia in night shift nurses. This observational online web-based survey using Google®® modules specifically aimed to investigate the prevalence and risk factors for insomnia among Italian nurses. Methods. Data collection for this study lasted one month, with the questionnaire available from 1 March 2021 to 1 April 2021. Continuous variables were considered as either mean ± standard deviation (SD) or median and interquartile range (IQR) based on their distribution. Comparison among insomnia categories was assessed by one-way ANOVA or Kruskal–Wallis test according to variable distribution. Categorical variables were analyzed using chi-square test. Results. A total of 2355 responses were included in the final analysis, with 917 from the Northern zone, 815 from the Western zone, and 623 from the Southern zone of Italy. The prevalence of insomnia in the overall population was 65.4% (1524 out 2355 nurses suffered from insomnia). Conclusions. Nursing is a high-pressure profession, with heavy duties and high professional risks. We found an important prevalence of insomnia in night shift nurses, and we hope it may help to solicit further studies aimed to identify the risk factors for this working disorder among nurses

Upper extremity vein thrombosis: An alert symptom of breast cancer in elderly patients. Experience on personal casuistry and review of the literature

Background: Breast Cancer in elderly patients is a significant health problem representing an important source of morbidity and mortality. Although the most common presentation is the presence of a palpable lump there may be, especially in the elderly population, rare clinical manifestations such as thromboembolic events that often involve the upper limbs. Methods. We retrospectively reviewed a ten year clinical casuistry of patients with Breast Cancer who presented for an initial diagnosis of upper extremity vein thrombosis. Results: 13 patients with initial diagnosis of upper limbs vein thrombosis (1M-12 F; age range 48-76; median age 70 years) resulted affected from Breast Cancer. The diagnosis of vein thrombosis represented the first clinical manifestation related to thier malingancy. All patients of our casuistry had positive ER/PR receptor status. Conclusions: A case of upper vein extrmity thrombosis in an elderly patient should prompt a high index of suspicion for breast malignancy in order to avoid diagnostic delay that may retard appropriate treatment. © 2013 Serra et al.; licensee BioMed Central Ltd