Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

open7PURPOSE: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. SETTING: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). METHOD: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. RESULTS: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. CONCLUSION: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.Purpose: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. Setting: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). Method: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. Results: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. Conclusion: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.openBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, VincenzoBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, Vincenz

A multi-analytical approach for the identification of technological processes in ancient jewellery

The compositional and structural characterization of the constituent alloys of precious metal artefacts is the basis for understanding the technological processes used in the art of the ancient goldsmiths. This research presents a multi-analytical approach to the study of the technologies of ancient jewellery manufacturing through the use of non-traditional methods. The development of original methods, such as the application of hardware devices and software programs, allows us to overcome the application limits of traditional analysis, as in the study of Castellani’s earrings, where statistical analyses were carried out using Pearson’s Coefficient Correlation and Cluster Analysis to identify the correlation of elements in the soldering areas. For the Tarquinia fibula, a methodology based on Imaging Analysis has been used to measure the geometrical parameters involved in the construction of the jewel. For another study, a new experimental apparatus was set up in order to identify markers on the micro/nano scale. It consists of a scanning electron microscope (SEM-EDS) integrated with XRF, an equipment developed in order to obtain a greater depth of analysis and a better integration of the compositional data. The aim of the work has been to integrate data from different analytical methodologies in order to identify technology transfer and/or production features, as well as the circulation of the goldsmith’s artefacts.La caractérisation de la composition et de la structure des alliages en métal précieux est fondamentale pour la compréhension des procédés technologiques liés à l’orfèvrerie antique. Ce travail décrit un nouveau protocole d’analyse dédié à l’étude des technologies de fabrication de bijoux anciens, grâce à l’utilisation de méthodes non traditionnelles. Le développement de méthodes originales, utilisant entre autres des dispositifs expérimentaux et des logiciels, permet de dépasser les limites d’application de l’analyse traditionnelle. Par exemple, dans l’étude de boucles d’oreilles de la collection Castellani, l’analyse statistique réalisée au moyen du Coefficient de corrélation de Pearson et de l’analyse par nuage de points ont permis d’identifier la corrélation entre les éléments entrant dans la composition de la soudure. Dans le cas de la fibule de Tarquinia, une méthodologie basée sur l’analyse d’images a été utilisée pour mesurer les paramètres géométriques associés à la construction du bijou. Simultanément, un nouvel équipement a été créé pour individualiser des marqueurs à l’échelle micro/nanométrique. Il s’agit du couplage d’un microscope électronique à balayage équipé d’un système de dispersion en énergie X (MEB-EDS) avec la fluorescence à rayons X (FX) pour obtenir une profondeur d’analyse plus grande et une meilleure intégration et reproductibilité des données concernant la composition élémentaire. Le but de ce travail a été d’intégrer les données de différentes méthodes d’analyse afin d’identifier le transfert de technologie et/ou de travail lié à la production et circulation d’objets d’orfèvrerie

Capital humano, relacional e estrutural em organizações hospitalares: evidências empíricas / Human, relational and structural capital in hospital organizations: empirical evidence

O capital intelectual tornou-se o principal ativo das organizações por ser um ativo intangível com elevada capacidade de gerar benefícios para as entidades que controlam sua aplicação. Portanto, este estudo tem o objetivo de identificar a presença e as correlações entre os elementos do capital intelectual, agrupando-os em capital humano, relacional e estrutural, de uma organização hospitalar. Esta investigação é de caráter quantitativo, onde foi aplicado um questionário cujas questões foram testadas pelo Little MCAR. Para cada item foi calculada a média, a mediana, o desvio-padrão e o coeficiente de correlação. A organização estudada mostrou alto nível de presença de capital humano; fraco para o elemento capital relacional e moderado para o elemento capital estrutural. A relação entre os elementos do capital humano e do estrutural foi negativa e significativa; entre os elementos do capital humano e do relacional mostrou-se positiva e significativa; a relação entre os elementos do capital estrutural e o do relacional apresentou-se positiva e significativa. Os resultados do estudo permitem recomendar que toda organização deve avaliar a importância relativa de cada um dos elementos formadores do capital intelectual, pois seu desempenho depende da interdependência entre eles

Despite lost contractility, a sub-population of rat muscle fibers maintains an assessable excitation-contraction coupling mechanism after long-standing denervation

J Neuropathol Exp Neurol. 2009 Dec;68(12):1256-68. A subpopulation of rat muscle fibers maintains an assessable excitation-contraction coupling mechanism after long-standing denervation despite lost contractility. Squecco R, Carraro U, Kern H, Pond A, Adami N, Biral D, Vindigni V, Boncompagni S, Pietrangelo T, Bosco G, Fanò G, Marini M, Abruzzo PM, Germinario E, Danieli-Betto D, Protasi F, Francini F, Zampieri S. Source Interuniversitary Institute of Myology, Chieti, Italy. Abstract To define the time course and potential effects of electrical stimulation on permanently denervated muscle, we evaluated excitation-contraction coupling (ECC) of rat leg muscles during progression to long-term denervation by ultrastructural analysis, specific binding to dihydropyridine receptors, ryanodine receptor 1 (RYR-1), Ca channels and extrusion Ca pumps, gene transcription and translation of Ca-handling proteins, and in vitro mechanical properties and electrophysiological analyses of sarcolemmal passive properties and L-type Ca current (ICa) parameters. We found that in response to long-term denervation: 1) isolated muscle that is unable to twitch in vitro by electrical stimulation has very small myofibers but may show a slow caffeine contracture; 2) only roughly half of the muscle fibers with "voltage-dependent Ca channel activity" are able to contract; 3) the ECC mechanisms are still present and, in part, functional; 4)ECC-related gene expression is upregulated; and 5) at any time point, there are muscle fibers that are more resistant than others to denervation atrophy and disorganization of the ECC apparatus. These results support the hypothesis that prolonged "resting" [Ca] may drive progression of muscle atrophy to degeneration and that electrical stimulation-induced [Ca] modulation may mimic the lost nerve influence, playing a key role in modifying the gene expression of denervated muscle. Hence, these data provide a potential molecular explanation for the muscle recovery that occurs in response to rehabilitation strategies developed based on empirical clinical observations. PMID: 19915489 [PubMed - indexed for MEDLINE

Enseñanza de Soporte Básico de Vida para escolares: estudio casi experimental

Objetivo: evaluar el conocimiento de estudiantes de la enseñanza básica antes y después de la intervención educativa sobre Soporte Básico de Vida, en situación de paro cardíaco en adultos. Método: estudio casi experimental realizado en 335 estudiantes de tres escuelas de enseñanza básica. Los datos fueron recogidos por un instrumento que captaba datos sociodemográficos y conocimientos sobre Soporte Básico de Vida; posteriormente, estos fueron analizados con la estadística descriptiva y analítica. Resultados: el conocimiento de los estudiantes en el postest (p < 0,05) fue significativamente mayor que en el pretest. La media de las notas en el pretest fue 4,12 ± 1,7 y en el postest fue 6,53 ± 1,9 (p = 0,00) Conclusión: los resultados demostraron efectividad de la intervención con la ampliación del conocimiento sobre Soporte Básico de Vida en paro cardíaco y refuerzan la importancia de la Enfermería en las acciones de educación en salud en las escuelas de enseñanza básica.Objective: to evaluate the knowledge of basic education students before and after educational intervention on Basic Life Support in a situation of adult cardiorespiratory arrest. Method: quasi-experimental study conducted with 335 students from three elementary schools. Data was collected using an instrument that captured sociodemographic data and knowledge about Basic Life Support. Subsequently, they were analyzed by descriptive and analytical statistics. Results: students’ knowledge in the post-test (p <0.05) was significantly higher than in the pre-test. The average of the pre-test scores was 4.12 ± 1.7 and, in the post-test it was 6.53 ± 1.9 (p = 0.00). Conclusion: the results demonstrated effectiveness of the intervention with the expansion of knowledge about Basic Life Support in cardiorespiratory arrest. The results reinforce the importance of Nursing in health education actions in elementary schools.Objetivo: avaliar o conhecimento de estudantes do ensino básico antes e após intervenção educativa sobre Suporte Básico de Vida em situação de parada cardiorrespiratória em adultos. Método: estudo quase-experimental realizado com 335 estudantes de três escolas do ensino básico. Os dados foram coletados por instrumento que captava dados sociodemográficos e conhecimentos sobre Suporte Básico de Vida. Posteriormente, foram analisados por estatística descritiva e analítica. Resultados: o conhecimento dos estudantes no pós-teste (p < 0,05) foi significativamente maior que no pré-teste. A média das notas no pré-teste foi 4,12 ± 1,7 e, no pós-teste foi 6,53 ± 1,9 (p = 0,00). Conclusão: os resultados demonstraram a efetividade da intervenção com a ampliação do conhecimento sobre Suporte Básico de Vida em parada cardiorrespiratória e reforçam a importância da Enfermagem nas ações de educação em saúde nas escolas de ensino básico

Universidade engajada: Resgatando PMES na crise da Covid-19

Efeitos econômicos das políticas de isolamento da pandemia da Covid-19 levaram pequenas e médias empresas (PMEs) a buscar alternativas para sobreviver. Em cenários de crise, uma universidade engajada tem um papel importante ao abordar não apenas questões de saúde, mas também problemas sociais e econômicos em contextos regionais. Neste artigo, um projeto de universidade-comunidade é analisado com o intuito de apontar os elementos necessários para promover uma universidade regional engajada: a Rede de Assessoria SOS-PME, originalmente projetada para apoiar PMEs durante a crise. Uma universidade engajada entrega conhecimento para a sociedade, além de educação e pesquisa. Como resultado, identificam-se elementos para promover a terceira missão da universidade engajada – engajamento social: equipe engajada, multidisciplinaridade, gerenciamento de projetos, agilidade, alianças, estratégia de comunicação, e suporte e reputação da instituição