Ambulatorio a gestione infermieristica per la rimozione del tappo di cerume

Il progetto per l'apertura di un ambulatorio infermieristico per la rimozione del tappo di cerume nell'Azienda USL di Rimini nasce nel 2007 e si è implementato nel tempo dando la possibilití  a infermieri esperti di agire le conoscenze acquisite. Obiettivo: dimostrare, tramite i dati di attivití , che l'ambulatorio a gestione infermieristica è in grado di dare una risposta tempestiva e appropriata all'utenza. Materiali e metodi: i dati di attivití  sono stati analizzati con statistiche descrittive e raccolti attraverso un' analisi retrospettiva. Risultati: l'implementazione dell'ambulatorio infermieristico ha portato nel 2010 ad un incremento delle prestazioni rispetto al 2009 che risultano pari a 682 ; i dati di attivití  del 2011 e 2012 mostrano un andamento più costante e un consolidamento di giornate di apertura e del numero di prestazioni svolte per seduta; tutte le problematiche di pertinenza specialistica sono state correttamente riconosciute dall'infermiere. Conclusioni: la gratificazione professionale dimostrata degli operatori, il buon funzionamento del servizio, il mantenimento degli standard qualitativi e la richiesta minima di risorse economiche per la realizzazione del progetto indicano che, l'ambulatorio a gestione infermieristica per la rimozione del tappo di cerume, potrebbe essere replicato anche in altre realtí  sanitarie. L'ipotesi di lavoro futura è rivolta alla realizzazione di un opuscolo informativo/formativo per gli utenti che soffrono di questo disturbo, un analisi del grado di soddisfazione dell'utenza e una nuova modalití  di refertazione infermieristica.Parole Chiave: tappo di cerume, competenze cliniche, ruolo infermieristicoWalk-in nursing clinic for earwax removalIn the USL Rimini was set up in 2007 a nursing service for the cerumen removal and it was implemented during time.To demonstrate through recorded activities data that this service managed by nurses is able to provide a timely and appropriate response to the users.  Activities data were analyzed using descriptive statistics.The implementation of the nursing service in 2010 led to an increase (= 682) in performance compared to 2009, activities data of 2011 and 2012 show a more consistent pattern and consolidation of open days and in the number of services performed per session, all issues reported by users have been properly recognized by specialist nurse. All positive insights in terms of improved job satisfaction, high quality standards, minimum requirement of financial resources indicate that this service, may be replicated in other health care facilities. Future developments of the service should be aimed at the development of  an informative brochure for users, an evaluation of users' satisfaction and an improvement of nursing notes

Structural characterization and K–Ar illite dating of reactivated, complex and heterogeneous fault zones: lessons from the Zuccale Fault, Northern Apennines

We studied the Zuccale Fault (ZF) on Elba, part of the Northern Apennines, to unravel the complex deformation history that is responsible for the remarkable architectural complexity of the fault. The ZF is characterized by a patchwork of at least six distinct, now tightly juxtaposed brittle structural facies (BSF), i.e. volumes of deformed rock characterized by a given fault rock type, texture, colour, composition, and age of formation. ZF fault rocks vary from massive cataclasite to foliated ultracataclasite, from clay-rich gouge to highly sheared talc phyllonite. Understanding the current spatial juxtaposition of these BSFs requires tight constraints on their age of formation during the ZF lifespan to integrate current fault geometries and characteristics over the time dimension of faulting. We present new K–Ar gouge dates obtained from three samples from two different BSFs. Two top-to-the-east foliated gouge and talc phyllonite samples document faulting in the Aquitanian (ca. 22 Ma), constraining east-vergent shearing along the ZF already in the earliest Miocene. A third sample constrains later faulting along the exclusively brittle, flat-lying principal slip surface t

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Biogeochemistry, grain size and mineralogy of the Central and Southern Adriatic Sea sediments: a review.

Volume 26 Supplement 1, January 2010