People-related TQM practices: the role of metaperceptions

Purpose– The authors investigate the role of people-related Total Quality Management (TQM) practices, specifically metaperceptions, in hearing care students’ vocational decision-making. In Italy, audiologists are health professionals and must hold a degree in hearing care. They operate according to clinical principles but must also develop marketing and commercial skills. While employers take these aspects for granted, the expectations of hearing care students often differ from reality. Thus, the authors aim to investigate the vocational expectations of hearing care students. Design/methodology/approach– A survey was distributed to 600 hearing care students. Multiple regression analysis with bootstrapped confidence intervals was employed to test the hypotheses. Findings–Studentswhoperceivedaudiologyastheircallingweremoreinterestedintheclinicalaspectsthan the marketing and commercial aspects of audiology. Moreover, those desiring a meaningful career path in audiology were more interested in becoming a store owner or franchisee. Social implications– Universities and recruiters should consider the influence of relevant others’ metaperceptions on students’ self-perceptions of their aptitudes for different careers. Universities should assist studentstoidentifyaptitudesthatare relevanttocareer-related decision-making.Inthis context,people-related TQMcanhelp students avoid incorrect aspirations and expectations. Originality/value– This study is the first to investigate the role of metaperceptions from a people-related TQMperspective. Metaperceptions play a crucial role in determining the correct course of study as well as job satisfaction and expectations

Accuracy of a CGM Sensor in Pediatric Subjects With Type 1 Diabetes. Comparison of Three Insertion Sites: Arm, Abdomen, and Gluteus

Patients with diabetes, especially pediatric ones, sometimes use continuous glucose monitoring (CGM) sensor in different positions from the approved ones. Here we compare the accuracy of Dexcom\uae G5 CGM sensor in three different sites: abdomen, gluteus (both approved) and arm (off-label)

Long-term continuous monitoring of the preterm brain with diffuse optical tomography and electroencephalography: A technical note on cap manufacturing

open12noDiffuse optical tomography (DOT) has recently proved useful for detecting whole-brain oxygenation changes in preterm and term newborns' brains. The data recording phase in prior explorations was limited up to a maximum of a couple of hours, a time dictated by the need to minimize skin damage caused by the protracted contact with optode holders and interference with concomitant clinical/nursing procedures. In an attempt to extend the data recording phase, we developed a new custom-made cap for multimodal DOT and electroencephalography acquisitions for the neonatal population. The cap was tested on a preterm neonate (28 weeks gestation) for a 7-day continuous monitoring period. The cap was well tolerated by the neonate, who did not suffer any evident discomfort and/or skin damage. Montage and data acquisition using our cap was operated by an attending nurse with no difficulty. DOT data quality was remarkable, with an average of 92% of reliable channels, characterized by the clear presence of the heartbeat in most of them.openopenAlfonso Galderisi; Sabrina Brigadoi; Simone Cutini; Sara Basso Moro; Elisabetta Lolli; Federica Meconi; Silvia Benavides-Varela; Eugenio Baraldi; Piero Amodio; Claudio Cobelli; Daniele Trevisanuto; Roberto Dell'AcquaGalderisi, Alfonso; Brigadoi, Sabrina; Cutini, Simone; BASSO MORO, Sara; Lolli, Elisabetta; Meconi, Federica; Silvia, Benavides-Varela; Baraldi, Eugenio; Amodio, Piero; Cobelli, Claudio; Trevisanuto, Daniele; Dell'Acqua, Robert

Metabolic frailty in malnourished heart failure patients

Muscular wasting (MW) and cardiac cachexia (CC) are often present in patients with chronic heart failure (HF). Aim: To identify whether MW and CC are due to malnutrition or impairment of protein metabolism in HF patients. Material and Method: In 78 clinically stable HF patients (NYHA class II-III), aged from 32 to 89 years, we measured anthropometrical parameters and nutritional habits. In the identified 35 malnourished patients, we also measured: insulin resistance, gluconeogenetic amino acids blood concentration and nitrogen balance. Results: Seventy-five patients had eating-related symptoms. However we found significant nutritional impairment in 35 patients only. In addition, these 35 patients had: 1) significant increase of blood Alanine independently from both presence of insulin resistance or food intake reduction and 2) positive nitrogen balance. Conclusion: Food intake is not impaired in CHF patients. In spite of normal food intake, 35 of 78 patients had nutritional impairment with reduced anthropometric parameters and increased blood Alanine. These findings show alteration of proteins metabolism with proteolysis. We believe that specific physical training with nutritional supplement can be an additional therapy able to prevent protein disarrangement in CHF patients

Adherence to Guidelines among Italian Urologists on Imaging Preoperative Staging of Low-Risk Prostate Cancer: Results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study

Objective. A number of evidence-based guidelines for diagnosis and management of prostate cancer have been published. The aim of this study is to evaluate the adherence of Italian urologists to the guidelines concerning the preoperative imaging staging of prostate cancer. Methods. In October 2007 a multicentric observational perspective study called Multicentric Italian Report on Radical prostatectomy Outcome and Research (MIRROR) was started in 135 Italian urology centers. Recruitment was closed in December 2008 and 2,408 cases were collected. In this paper we have taken into consideration all examinations carried out for preoperative imaging staging, evaluating compliance with the recommendations in the American Urological Association (AUA) and European Association of Urology (EAU) guidelines. Results. Five hundred sixty-seven (53.34%) patients were not managed according to the EAU guidelines concerning T-staging, 545 (51.27%) concerning N-staging and 757 (71.21%) concerning M-staging. According to AUA guidelines, we also analyzed patients with a Gleason grade of biopsy specimens of 7: 238 (57.35%) of these patients had undergone testing for T staging, 244 (57.35%) for N-staging and 322 (77.60%) for M-staging. Conclusions. The compliance of Italian urologists with the guidelines is low, leading to an inappropriate increase in cost of care and unnecessary anxiety for the patients

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients’ ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients' ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs

Requirements elicitation for robotic and computer-assisted minimally invasive surgery

The robotic surgical systems and computer-assisted technologies market has seen impressive growth over the last decades, but uptake by end-users is still scarce. The purpose of this article is to provide a comprehensive and informed list of the end-user requirements for the development of new generation robot- and computer-assisted surgical systems and the methodology for eliciting them. The requirements were elicited, in the frame of the EU project SMARTsurg, by conducting interviews on use cases of chosen urology, cardiovascular and orthopaedics procedures, tailored to provide clinical foundations for scientific and technical developments. The structured interviews resulted in detailed requirement specifications which are ranked according to their priorities. Paradigmatic surgical scenarios support the use cases

Low serum total testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for active surveillance

Active surveillance (AS) is currently a widely accepted treatment option for men with clinically localized prostate cancer (PCa). Several reports have highlighted the association of low serum testosterone levels with high-grade, high-stage PCa. However, the impact of serum testosterone as a predictor of progression in men with low-risk PCa has been little assessed.In this study, we evaluated the association of circulating testosterone concentrations with a staging/grading reclassification in a cohort of low-risk PCa patients meeting the inclusion criteria for the AS protocol but opting for radical prostatectomy.Radical prostatectomy (RP) was performed in 338 patients, eligible for AS according to the following criteria: clinical stage T2a or less, PSApT2) and upgrading (GS≥7; primary Gleason pattern 4) disease. Unfavorable disease was defined as the occurrence of pathological stage>pT2 and predominant Gleason score 4. Total testosterone was measured before surgery.Low serum testosterone levels (<300 ng/dL) were significantly associated with upgrading, upstaging, unfavorable disease and positive surgical margins. The addition of testosterone to a base model, including age, PSA, PSA density, clinical stage and positive cancer involvement in cores, showed a significant independent influence of this variable on upstaging, upgrading and unfavorable disease.In conclusion, our results support the idea that total testosterone should be a selection criterion for inclusion of low-risk PCa patients in AS programs and suggest that testosterone level less than 300 ng/dL should be considered a discouraging factor when a close AS program is considered as treatment option