Identità in transizione. Il senso di sé personale e professionale in rapporto al cambiamento organizzativo

Il presente lavoro indaga come il cambiamento organizzativo produce delle conseguenze sul piano dell’identità professionale e personale dei lavoratori, oltre che sulla qualità della loro identificazione con l’organizzazione. Nello specifico, a 12 dipendenti di un piccolo presidio ospedaliero, colpito da un processo di ridimensionamento a causa di una rimodulazione del personale e dei posti letto, è stata somministrata un’intervista narrativa finalizzata a indagare l’impatto del cambiamento organizzativo in corso sulle identità personali e professionali. Le interviste, esplorate tramite procedure di analisi statistica del contenuto, hanno fatto emergere come i lavoratori che tendono a identificarsi maggiormente con il proprio ruolo professionale, patiscono ripercussioni negative sulla rappresentazione di sé, venendo meno l’identificazione con l’azienda, percepita come instabile e non in grado di offrire sicurezze. La precarietà percepita in questa fase di transizione mette in crisi l’identità professionale e i processi di metabolizzazione del cambiamento, condizionando le scelte personali e la vita quotidiana dei soggetti coinvolti

Association of Circulating Heme Oxygenase-1, Lipid Profile and Coronary Disease Phenotype in Patients with Chronic Coronary Syndrome

Background. The NF-E2-related factor 2 (Nrf2)/Heme Oxygenase-1 (HO-1) pathway has an emerging role in atherosclerosis. Activated by oxidative stress, it is deemed to exert athero-protective effects. We aimed at evaluating the relationships between plasma HO-1, clinical/molecular profiles and coronary disease patterns in patients with chronic coronary syndromes (CCS). Methods. HO-1 was measured in 526 patients (60 +/- 9 years, 318 males) with CCS. Coronary computed tomography angiography (CTA) and stress imaging were used to assess the disease phenotype (coronary atherosclerosis and myocardial ischemia) in a subgroup of 347 patients. Results. In the overall population, HO-1 median value (25-75 percentile) was 5.195 (1.75-8.25) ng/mL. Patients with higher HO-1 were more frequently male, had a higher BMI and lower LVEF%, but otherwise similar risk factors than the other patients. Their bio-humoral profile was characterized by higher markers of endothelial/myocardial dysfunction, but lower levels of cholesterol lipoproteins. Coronary artery disease was characterized by more diffuse atherosclerosis, with mainly non-obstructive and calcified plaques, and a higher prevalence of functional ischemia. Conclusion: In patients with CCS, higher plasma HO-1 levels are associated with lower cholesterol and a more diffuse but mainly non-obstructive coronary atherosclerosis, confirming a potential role for the Nrf2/HO-1 pathway as a protective feedback

Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population

AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR 640.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The Evolving Role of Multimodality Imaging in Heart Failure

In patients with LV dysfunction, multimodality imaging offers the opportunity to obtain continued information on regional and global cardiac function, myocardial viability, coronary anatomy and regional relative or absolute myocardial perfusion. The different modalities may be performed separately and integrated/fused afterwards (i.e. through hybrid imaging) or may be used in a single step approach to define HF etiology, the extent and severity of myocardial damage/ischemia, indicate and predict the response to targeted treatments (i.e. CRT, coronary revascularization) as well as to perform pre-interventional assessment (i.e. to program trans-catheter ablation of arrhythmias or valvular interventions

Approaches to minimize patient dose in nuclear cardiology

Despite the undeniable patient benefits from medical imaging, there has been growing public concern about radiation exposure from medical imaging and its potential associated health risks. The latest report from the National Council on Radiation Protection and Measurements estimated that nuclear cardiology studies account for around 9% of the entire radiation burden from medical imaging to the U.S. population in 2016. The International Atomic Energy Agency (IAEA) has identified “8 best practices” that would help reduce the global radiation burden from cardiac radionuclide imaging. Likewise, the American Society of Nuclear Cardiology (ASNC) has set the goal of limiting the total radiation effective–dose of patients referred for single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial perfusion imaging (MPI) to less than or equal to 9 mSv. Nevertheless, recent studies have reported that most of the dosereduction approaches and best practices, especially adequate radiopharmaceutical and protocol selection, are still underutilized in clinical practice with most SPECT MPI studies still exceeding the 9 mSv benchmark. This chapter will review new technology and strategies that are available to reduce radiation exposure to patients without affecting image quality or diagnostic information from nuclear cardiology studies

Cardiac Imaging on COVID-19 Pandemic Era: the Stand, The Lost, and Found

Purpose of Review The present review will outline the main effects of COVID-19 pandemic on cardiovascular pathologies, focusing on the role of modern non-invasive cardiac imaging techniques in this setting. Recent Findings Multimodality cardiac imaging seems particularly suited for the in-depth characterization of patients with COVID-19, allowing the assessment of the variegated impact of the disease on the different aspects of myocardial perfusion, structure, and function. The infection of SARS-CoV-2, leading to the coronavirus disease-19 (COVID-19), has represented a consistent challenge for the organization of the healthcare systems, associating to a significant increase of the fatality rate of different acute and chronic disease. Moreover, the reallocation of healthcare providers led to a significant reduction of the availability of tests and therapies, with the deferral of non-urgent tests and non-lifesaving procedures