Application of the Italian version of the Intensive Care Unit Memory tool in the clinical setting

INTRODUCTION: The aims of the present study were to assess patients' memories of their stay in the intensive care unit (ICU) over time, using the Italian version of the ICU Memory (ICUM) tool, and to examine the relationship between memory and duration of ICU stay and infection. PATIENTS AND METHOD: Adult patients consecutively admitted to a four-bed ICU of a university hospital, whose stay in the ICU was at least 3 days, were prospectively studied. The ICUM tool was administered twice: face to face 1 week after ICU discharge to 93 patients (successfully in 87); and by phone after 3 months to 67 patients. Stability of memories over time was analyzed using Kappa statistics. RESULTS: Delusional memories appeared to be the most persistent recollections over time (minimum κ value = 0.68), followed by feelings (κ value > 0.7 in three out of six memories) and factual memories (κ value > 0.7 in three out of 11 memories). The patients without a clear memory of their stay in the ICU reported a greater number of delusional memories than did those with a clear memory. Of patients without infection 35% had one or two delusional memories, and 60% of patients with infection had one to four delusional memories (P = 0.029). CONCLUSION: The ICUM tool is of value in a setting and language different from those in which it was created and used. Delusional memories are the most stable recollections, and are frequently associated both with lack of clear memory of ICU experience and with presence of infection during ICU stay

Family-Centered Care to Improve Family Consent for Organ Donation

The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. Organ donation refusal from relatives of potential donors with brain death significantly reduces organ availability. We report a brief analysis about family conflicts in decision-making and causes for refusing donation; moreover, we describe new family-centered strategies in the intensive care unit (ICU) and our systematic communication approach between medical staff and patients’ relatives. In 2016 we conducted a single-center, non-randomized, controlled and before and after study in our ICU, an 18-bed intensive care unit (ICU) of a university hospital. We compared the rate of consent for organ donation before and after the introduction of the new communication approach. The application of a new communication approach between medical staff and relatives of brain-dead patients was associated with a significant increase in the rate of consent to donation. The positive results of the 3-year period 2013–2015 have been confirmed in the 2-year period 2016–2017. Our results highlight the importance of empathy and counselor support of relatives in the ICU

Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury.

BACKGROUND: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. METHODS: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. RESULTS: The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). CONCLUSIONS: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future

MP-shield: A framework for phishing detection in mobile devices

Today, there is an exponential growth of e-services requiring the exchange of personal and sensible data over the Internet. Phishing techniques are emerging as the easiest solution to break the weakest link of the security chain: the end user. Social engineering attacks are deployed by financial/cyber criminals at a very low cost to induce naïve Internet users to reveal user credentials such as bank account and credit card numbers. This problem needs to be addressed in the mobile field as well, due to the large diffusion of mobile devices such as smartphones, tablet, etc. In this paper we propose a novel framework for phishing detection in Android mobile devices which, on the one hand exploits well-known techniques already implemented by popular web browsers plug-in, such as public blacklist search, and, on the other hand, implements a machine learning detection engine which ensure zero-hour protection from new phishing campaigns

Management of acute adverse reactions by contrast medium

The use of contrast medium (CM) in diagnostic imaging is mandatory for diagnosis, characterization, staging, control during and after therapies and in the follow-up of patients affected by various diseases. Contrast agents are atypical drugs, with no therapeutic effects, used for diagnosis, administered in large doses, often at high speed in the bloodstream. Like all drugs, there are also rarely serious adverse reactions due to contrast medium. The Radiologist has the responsibility of choosing the contrast medium that best suits the specific clinical needs, and how administrate it. Radiologist must insert in the report what he did and the description of adverse event due to CM. The Italian Society of Medical and Interventional Radiology (SIRM), through its study section on contrast agents, has realized a consensus document together with the Italian Society of Anesthesia, Analgesia Resuscitation and Intensive Care (SIAARTI) on the management of acute adverse reactions due to contrast agents. The document deals of the various aspects related to the patient’s risk conditions, the type of adverse reactions and how to treat them. Moreover, the document indicates the medical instruments, drugs and the operating procedures necessary to guarantee the safety of the patient and of the health personnel. The methods of training health personnel involved in the management of emergencies due to administration of the contrast agent are also illustrated. The aim of this work is to spread the knowledge of the document SIRM-SIAARTI for the management of emergencies from contrast medium, illustrating the main topics

Gestione del trauma grave

Descrizione del libro Il titolo del libro \u201cLinee Guida\u2026\u201d \ue8 certamente fuori luogo. Le Linee Guida odierne sono il risultato di processi sistematici di analisi della letteratura e del grado di evidenza di ogni dato. Noi partiamo dal lavoro svolto da altri, gli esperti dei diversi settori, ma siamo alla terza edizione e per almeno due di noi sar\ue0, sicuramente, l\u2019ultima, per cui non ce la siamo sentita di cambiare il titolo in \u201cConsigli e Suggerimenti\u201d come sarebbe stato, forse, pi\uf9 opportuno

Zonas de la mediatización : propuestas para el estudio de plataformas, redes e interfaces

Este libro reúne trabajos que fueron originalmente presentados en el Coloquio del CIM “Zonas de la mediatización: plataformas, redes e interfaces”, realizado en agosto de 2019 en el Instituto de Investigaciones de la Facultad de Ciencia Política y RR.II. (UNR) de la ciudad de Rosario.Fil: Busso, Mariana Patricia. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina