The bare minimum of information at discharge after acute coronary syndrome. Part 2: the quality improvement project

An Acute Coronary Syndrome is a fine example of the communicative difficulties that precede and characterize hospital discharge. In recent years, due to the rapid changes in therapeutic approaches, hospitalizations have become extremely brief. This entails the risk of inadequate information at discharge, significantly affecting the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. There are a series of issues that the health practitioner should cover at discharge with the patient and family members: history of disease and prognosis, risk factors and strategies for their control, aims of treatment, instructions on drugs, diet and physical activity, need for medical check-up; and, last but not least, to verify that the information has been understood. Information on drug treatment is all too often left to patient's interpretation of hearsay or of the discharge letter, the new drug regime can easily be misunderstood or arbitrarily integrated into pre-existing drug regimes. Health practitioners must discuss issues, regardless of whether they are asked direct questions; and they should verify what imparted information has been correctly understood and assimilated. A rapid turn-over is crucial to the organization of acute units, therefore we need to identify a solution that ticks all the boxes of a good discharge in a reasonably brief time. Imparting information should be an integral component of care delivery, and the responsible practitioners (doctors and/or nurses) should be identified. We propose a standardized discharge form, containing the essential information, as a point of reference to be applied in different clinical settings

Therapeutic Adherence: between saying and doing

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[The bare minimum of information at discharge after acute coronary syndrome. Part 1: Factors that affect communication].

Hospital discharge after an Acute Coronary Syndrome represents a potential pitfall for patients. Strict adherence to discharge instructions is sometimes essential for recovery and prevention of complications and patients' knowledge of diagnosis and treatment plan is an integral component of patient education. Discharge communication is an integral part of high-quality, patient-centered care but patients leaving hospital often fail to understand important elements of their discharge and home care plan. This paper describes the existing literature on patient understanding and implementation of discharge instructions, discusses previous interventions aimed at improving the discharge process, and recommends best practices

Cardiac rehabilitation activities during the COVID-19 pandemic in Italy. Position Paper of the AICPR (Italian Association of Clinical Cardiology, Prevention and Rehabilitation)

The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units. The present document aims at defining the state of the art of CR during COVID-19 pandemic, through the description of the clinical and management scenarios frequently observed during this period and the exploration of the future frontiers in the management of cardiac rehabilitation programs after the COVID-19 outbreak

Impact of NOx and NH3 Emission Reduction on Particulate Matter across Po Valley: A LIFE-IP-PREPAIR Study

Air quality in Europe continues to remain poor in many areas, with regulation limits often exceeded by many countries. The EU Life-IP PREPAIR Project, involving administrations and environmental protection agencies of eight regions and three municipalities in Northern Italy and Slovenia, was designed to support the implementation of the regional air quality plans in the Po Valley, one of the most critical areas in Europe in terms of pollution levels. In this study, four air quality modelling systems, based on three chemical transport models (CHIMERE, FARM and CAMx) were applied over the Po Valley to assess the sensitivity of PM2.5 concentrations to NOx and NH3 emission reductions. These two precursors were reduced (individually and simultaneously) from 25% up to 75% for a total of 10 scenarios, aimed at identifying the most efficient emission reduction strategies and to assess the non-linear response of PM2.5 concentrations to precursor changes. The multi-model analysis shows that reductions across multiple emission sectors are necessary to achieve optimal results. In addition, the analysis of non-linearities revealed that during the cold season, the efficiency of PM2.5 abatement tends to increase by increasing the emission reductions, while during summertime, the same efficiency remains almost constant, or slightly decreases towards higher reduction strengths. Since the concentrations of PM2.5 are greater in winter than in summer, it is reasonable to infer that significant emission reductions should be planned to maximise reduction effectiveness

Assessing the impacts and feasibility of emissions reduction scenarios in the Po Valley

This study is focused on a pivotal objective: enhancing air quality and attaining pollutant concentrations in accordance with WHO guidelines. The study extensively evaluates the feasibility of reducing emissions, specifically targeting an 80% decrease in SOX, NOX, PM, NH3, and NMVOC emissions within a limited timeframe. Despite notable emission curtailments of 50% and 80%, the research reveals that recommended pollutant levels are unlikely to be met across most areas of the Po Valley region. Even when implementing the finest available technologies across various sectors, particularly within the Lombardia region, this goal remains unattainable without simultaneous reductions in activity levels. This involves diminishing factors like vehicle miles traveled, energy consumption for heating, and industrial, agricultural, and livestock production. Overall, achieving improved conforming to the new AQG limits is a multifaceted endeavor involving numerous stakeholders and diverse strategies. Successful adherence to Air Quality limits mandates the implementation of Source-Specific emissions standards at the EU level, alignment of the National Emission Reduction Directive with limits specified in the Air Quality Directive, and the formulation of comprehensive Air Quality Plans at national, regional, and local tiers

Cardiac Prevention and Rehabilitation “3.0”: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR)

Cardiac rehabilitation (CR) is the subspecialty of clinical cardiology dedicated to the treatment of cardiac patients, early and in the long term after an acute event. The aim of CR is to improve both quality of life and prognosis through prognostic stratification, clinical stabilization and optimization of therapy (pharmacological and non), management of comorbidities, treatment of disability, as well as through the provision and reinforcement of secondary prevention interventions and maintenaince of adherence to treatment. The mission of CR has changed over time. Once centered on the acute phase, aimed primarily at short-term survival, the healthcare of cardiac patients now increasingly involves the chronic phase where the challenge is to guarantee continuity and quality of care in the medium and long-term. The aim of the present position paper is to provide the state-of-the-art of CR in Italy, discussing its trengths and weaknesses as well as future perspectives

Ozone risk assessment and mapping in the Alps based on data from passive samplers

Passive samplers (diffusion tubes with organic reagent, produced by Passam of Switzerland) were used in a sampling campaign for the detection of weekly mean ozone concentrations in 15 sites over a domain of 80 x 40 km on the southern side of the European Alps from May to August 1998. The area is characterized by vast natural terrain of complex topography, with conifer and broadleaf forests. It is difficult to access and monitor air quality there with continuous analysers. By applying geostatistical techniques (ordinary kriging), and correcting the interpolated ozone concentrations according to the altitude of each single grid cell (2 x 2 km), maps of weekly ozone concentrations were produced. The weekly ozone data were used to assess daily and hourly data by means of an iterative procedure based on a functional dependence of ozone concentrations both on altitude and on the time of day. This allowed the estimation of values with an exposure index such as AOT40 (accumulated exposure over the threshold of 40 ppb) in all 800 cells of the domain. This also allowed the mapping of risk assessment related to the effects of ozone on the regional forest vegetation. Results obtained show values that exceed the exposure standards adopted in the Kuopio protocol (1996). Excess exposure values also match values calculated over a wider territorial domain by using hourly data on ozone concentration derived from continuous automatic analysers