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An explorative study of antecedents of organizational mindfulness in emergency room

Emergency Room (ER) can be considered as a High Reliability Organization expected to guarantee reliability despite facing hectic and unpredictable events. To achieve this status, ER should invest on the management style of Organizational Mindfulness, focused on anticipation and containment of errors. The aim of this exploratory research was to investigate how Organizational Mindfulness occurs in Italian ERs and what is the role of Safety Culture and Work Engagement in predicting Organizational Mindfulness measured with an ad hoc questionnaire. Results show how the communal sphere of Safety Culture seems a better predictor of Organizational Mindfulness than the individual sphere of Work Engagement

Critical issues of Emergency Medicine organization in Italy

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Relationship in a Medium-risk Population

By means of an accurate immunoenzymatic assay, the prevalence was studied of antibodies to hepatitis C virus (HCV) in three different populations: 74 patients affected with hepatocellular carcinoma (HCC) on preexisting cirrhosis, 82 patients with liver cirrhosis but with no apparent neoplasm, and 70 control subjects, hospitalized for various conditions, of internal medicine or geriatric interest. 70.2% of HCC patients exhibited anti-HBC antibodies, versus 47.5% of cirrhotic subjects with no tumor and 7.1% of controls. Such results suggest the possible role of HCV in the etiopathogenesis of HCC, and its possible synergy with other agents-e.g., hepatitis B virus, alcohol--in causing chronically injured hepatocytes to become neoplastic

Emergency Contraception: a survey of Hospital Emergency Departments Staffs

The World Health Organization defines emergency contraception (EC) as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians' opinion the vast majority of requests came from Italian nationals (97%) ranging in age from 18 to 30 years (76%), single and not cohabiting with a partner (60%), and nulliparous (64.0%). Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52%) stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills

The McKittrick-Wheelock syndrome: A rare case with a complex acid-base disorder

McKittrick-Wheelock syndrome is a rare condition characterized by secretory diarrhea due to villous adenoma of the colon, acute renal failure, dehydration, electrolyte and acid-base disorders. Diagnosis requires high suspicion especially when the presentation is unusual. Although potentially fatal for its complications, if promptly diagnosed and treated it is completely reversible. We present a case of a 67-year-old man who presented with syncope and diarrhea. On admission arterial blood gas test showed a complex acid-base disorder that led clinicians to further investigations and to point out a correct diagnosis

Artificial Neural Networks and risk stratification in Emergency department

WP 12/14; The primary goal of the Emergency Department physician is to discriminate individuals at low risk, who can be safely discharged, from patients at high risk, who deserve prompt hospitalization for monitoring and/or appropriate treatment. Obviously, the problem of a correct classification of patients, and the successive hospital admission, is not only a clinical issue but also a management one since ameliorating the rate of admission of patients in the emergency departments could dramatically reduce costs and create a better health resource use. Considering patients at the emergency departments after an event of syncope, this work propose a comparative analysis between multivariate logistic regression model and Artificial Neural Networks (ANNs), highlighting the difference in correct classification of severe outcome at 10 days and 1 year. According to results, ANNs can be very effective in classifying the risk of severe outcomes and it might be adopted to support the physician decision making process reducing, at least theoretically, the inappropriate admission of patients after syncope even

Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department.

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained

Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department.

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained