5,050 research outputs found

    Editorial – Musculoskeletal pain: Which role for tapentadol?

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    Chronic pain is defined as pain persisting after healing of an underlying pathology or as persisting pain in the absence of tissue damage. In the last decade, the understanding of mechanisms involved in chronic pain led to an improved approach to patient management, with the aim to reduce discomfort, improve quality of life (QoL) and enhance functional recovery. Chronic musculoskeletal pain, which is frequently encountered in clinical practice, can affect patients of all ages and is particularly common in older patients. Indeed, low back pain is the most frequent chronic pain condition worldwide, with a lifetime prevalence of >70% in western countries1,2. Neck pain is also a common disabling disease, with a prevalence of 23%, and is associated with high costs for medical visits and physiotherapy. Both low back pain and neck pain involve nociceptive and neuropathic pain mechanism

    Dealing With COVID-19 Patients: A Moderated Mediation Model of Exposure to Patients' Death and Mental Health of Italian Health Care Workers

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    Introduction: The COVID-19 pandemic is asking health care workers (HCWs) to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements (ERs) arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms. Purpose: The aim of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19. Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs (physicians and nurses) participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model. Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant. Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher

    Characterisation of flow dynamics within and around an isolated forest, through measurements and numerical simulations

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    The case study of 'Bosco Fontana', a densely-vegetated forest located in the north of Italy, is analysed both experimentally and numerically to characterise the internal ventilation of a finite forest with a vertically non-homogeneous canopy. Measurements allow for the evaluation of the turbulent exchange across the forest canopy. The case study is then reproduced numerically via a two-dimensional RANS simulation, successfully validated against experimental data. The analysis of the internal ventilation leads to the identification of seven regions of motion along the predominate-wind direction, for whose definition a new in-canopy stability parameter was introduced. In the vertical direction, the non-homogeneity of the canopy leads to the separation of the canopy layer into an upper foliage layer and a lower bush layer, characterised respectively by an increasing streamwise velocity and turbulence intensity, and a weak backflow. The conclusions report an improved description of the dynamic layer and regions of motion presented in the literature

    Characterisation of flow dynamics within and around an isolated forest, through measurements and numerical simulations

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    The case study of ‘Bosco Fontana’, a densely-vegetated forest located in the north of Italy, is analysed both experimentally and numerically to characterise the internal ventilation of a finite forest with a vertically non-homogeneous canopy. Measurements allow for the evaluation of the turbulent exchange across the forest canopy. The case study is then reproduced numerically via a two-dimensional RANS simulation, successfully validated against experimental data. The analysis of the internal ventilation leads to the identification of seven regions of motion along the predominate-wind direction, for whose definition a new in-canopy stability parameter was introduced. In the vertical direction, the non-homogeneity of the canopy leads to the separation of the canopy layer into an upper foliage layer and a lower bush layer, characterised respectively by an increasing streamwise velocity and turbulence intensity, and a weak backflow. The conclusions report an improved description of the dynamic layer and regions of motion presented in the literature

    Equianalgesia, opioid switch and opioid association in different clinical settings: a narrative review

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    Emergency or postoperative pain often represents an authentic challenge in patients who were already on opioid treatment for chronic pain. Thus. their management requires not only the physician's ability to treat acute pain. but also competence in switching the opioid that lost efficacy. Different aspects should be considered, such as opioids titration, switching, association and equianalgesia.The objective of this paper is to provide a narrative review. which has been elaborated and discussed among clinicians through an iterative process involving development and review of the draft during two web-based meetings and via email. This expert opinion aims to facilitate the correct opioid use through appropriate practices with a focus on pain treatment in emergency and postoperative pain.Equianalgesia tables were reviewed and integrated by clinicians and researchers with expertise in anesthesia, postoperative medicine, intensive care, emergency medicine pharmacology and addiction medicine. Special populations (liver/kidney failure. elder, pediatric, pregnancy/lactation) are discussed in detail along with other critical scenarios, such as: (i) rapid pain worsening in chronic pain (aggravating pain due to disease progression or tolerance development to analgesic therapy): (ii) acute pain on maintenance treatment: and (iii) pain management of complicated patients in emergency care.Extended and updated equianalgesia tables and conversion rates for 17 different opioid formulations (of 9 different molecules) are presented as follows.Opioids remain the class that best suits clinical needs of emergency and post-operative medicine. However, it should be stressed that equianalgesia can be affected by drug-to-drug interactions and pharmacological imprecision. in a complex field where clinical experience may be the main guiding principle

    Spectral Analysis of a Two Body Problem with Zero Range Perturbation

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    We consider a class of singular, zero-range perturbations of the Hamiltonian of a quantum system composed by a test particle and a harmonic oscillators in dimension one, two and three and we study its spectrum. In facts we give a detailed characterization of point spectrum and its asymptotic behavior with respect to the parameters entering the Hamiltonian. We also partially describe the positive spectrum and scattering properties of the Hamiltonian.Comment: Version submitted for publication, AMStex, 22 page

    Concerns, Perceived Impact, Preparedness in Coronavirus Disease (COVID-19) Pandemic and Health Outcomes among Italian Physicians: A Cross-Sectional Study

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    Background: Health care workers (HCWs) are among the professionals at serious risk for the impact of the COVID-19 pandemic on their mental health. In this sense, the next public health challenge globally will be to preserving healthy HCWs during this pandemic. Aim: The present study has the aim of investigating the relationship among concerns, perceived impact, preparedness for the COVID-19 pandemic and the mental health of Italian physicians. Methods: From March 29th to April 15th 2020, we conducted an online survey using snowball sampling techniques through Limesurvey platform. Data were analyzed using descriptive statistics and multiple binary logistic regressions. Results: Multivariate analysis showed that the risk factors for perceived job stress were concerns about catching COVID-19 (OR = 3.18 [95% CI = 2.00-5.05] P <.001), perceived impact on job demands (OR = 1.63 [95% CI = 1.05-2.52] P <.05), perceived impact on job role (OR = 2.50 [95% CI = 1.60-3.90] P <.001), and non-working concerns (OR = 1.86 [95% CI = 1.15-3.03] P <.05). With respect to the risk factors for rumination about the pandemic emerged concerns about catching COVID-19 (OR 1.74, [95% CI = 1.12-2.71] P <.05), perceived impact on job role (OR = 1.68 [95% CI = 1.12-2.52] P <.05), and impact on personal life (OR = 2.04 [95% CI = 1.08-3.86] P <.05). Finally, the risk factors for crying at work were perceived impact on job role (OR = 2.47, [95% CI = 1.20-5.09] P <.05), rumination about the pandemic (OR = 3.027 [95% CI = 1.27-7.19] P <.01), watching colleagues crying at work (OR = 3.82 [95% CI = 1.88-7.77] P <.01), and perceived job stress (OR = 3.53 [95% CI = 1.24-10.07] P <.05). Conclusion: In general, our results highlighted that being concerned about being infected/infecting other people, carrying out new and unusual tasks, and witnessing colleagues crying at work were important risk factors for physicians’ well-being. Additional data are necessary to advance understanding of these risk factors in a long-term perspective

    The Effect of Statins on Mortality in Septic Patients: a Meta-Analysis of Randomized Controlled Trials

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    OBJECTIVE: Statins are among the most prescribed drugs worldwide and their recently discovered anti-inflammatory effect seems to have an important role in inhibiting proinflammatory cytokine production, chemokines expression and counteracting the harmful effects of sepsis on the coagulation system. We decided to perform a meta-analysis of all randomized controlled trials ever published on statin therapy in septic patients to evaluate their effect on survival and length of hospital stay. DATA SOURCES AND STUDY SELECTION: Articles were assessed by four trained investigators, with divergences resolved by consensus. BioMedCentral, PubMed, Embase and the Cochrane Central Register of clinical trials were searched for pertinent studies. Inclusion criteria were random allocation to treatment and comparison of statins versus any comparator in septic patients. DATA EXTRACTION AND SYNTHESIS: Data from 650 patients in 5 randomized controlled studies were analyzed. No difference in mortality between patients receiving statins versus control (44/322 [14%] in the statins group vs 50/328 [15%] in the control arm, RR = 0.90 [95% CI 0.65 to 1.26], p = 0.6) was observed. No differences in hospital stay (p = 0.7) were found. CONCLUSIONS: Published data show that statin therapy has no effect on mortality in the overall population of adult septic patients. Scientific evidence on statins role in septic patients is still limited and larger randomized trials should be performed on this topic

    On the Asymptotic Dynamics of a Quantum System Composed by Heavy and Light Particles

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    We consider a non relativistic quantum system consisting of KK heavy and NN light particles in dimension three, where each heavy particle interacts with the light ones via a two-body potential αV\alpha V. No interaction is assumed among particles of the same kind. Choosing an initial state in a product form and assuming α\alpha sufficiently small we characterize the asymptotic dynamics of the system in the limit of small mass ratio, with an explicit control of the error. In the case K=1 the result is extended to arbitrary α\alpha. The proof relies on a perturbative analysis and exploits a generalized version of the standard dispersive estimates for the Schr\"{o}dinger group. Exploiting the asymptotic formula, it is also outlined an application to the problem of the decoherence effect produced on a heavy particle by the interaction with the light ones.Comment: 38 page
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