"Modelli organizzativi di assistenza infermieristica in carenza di organico: le sinergie tra didattica, assistenza e volontariato"

Il volontariato in Italia e nel mondo è ritenuto una risorsa, in moltissime occasioni, insostituibile nel supplire le carenze di una Stato che non riesce più ad erogare , in numerosi settori, un'assistenza adeguata ai fabbisogni della popolazione. In Italia da diversi anni alcune organizzazioni affiancano le competenze del servizio sanitario nazionale, supplendo e sostenendo aree fragili e servizi carenti. In questo elaborato ho descritto la complessa interazione tra stato sociale e SSN in particolare nella nostra Regione e nella nostra Azienda Ospedaliera. La seconda parte del lavoro mi sono concentrata sull'importanza del reclutamento, della formazione e della validazione del volontario che aspira a prestare la sua opera in ambito ospedaliero e nel far questo mi sono avvalsa dell'esperienza accumulata e dei mezzi fornitimi dai corsi di laurea. Inoltre, il processo di valutazione non è stato mai distaccato dalla esplorazione delle motivazioni del volontario. Si è poi analizzata la carenza assistenziale nei reparti della AOU Federico II e confrontandola con la disponibilità dei volontari, si è organizzato un servizio suppletivo. Ho evidenziato i limiti di questo approccio che possono riassumersi fondamentalmente nella indisponibilità del volontario a coprire i turni H 24 e nel suo legittimo abbandono del ruolo di volontario nel momento stesso di una assunzione stabile in altri enti. Tramite questionario ho valutato il grado di soddisfazione e i punti critici sia da parte del volontario sia da parte del tutor rilevando che nel complesso l'esperienza è stata favorevolmente vissuta da entrambe le parti. Un punto critico evidenziato dai vari attori del processo è stata la difficoltà burocratica all'inserimento nel ruolo di volontario e alla successiva assegnazione. Ho elaborato, per superare questa criticità, una APP: VOLONTA'(ri) intuitiva e di facile uso che permetterebbe di risolvere in pochi passaggi sia l'ingresso dei volontari nella struttura sia la loro successiva assegnazione in base alle necessità. Sottolineo, alla fine di questo mio lavoro che il volontariato resta una risorsa indispensabile e un sostegno a un Sistema Sanitario perfettamente funzionante e non può mai essere la soluzione a carenze strutturali del sistema. Il volontariato è una scelta fatta sulla spinta di motivazioni emotive, ideologiche e culturali. La mia convinzione, suffragata dalla letteratura a riguardo, è che nella scelta del volontario sono indispensabili la valutazione delle intenzioni e la preparazione tecnico-scientifica

Clinical Outcome of Third-Line Pazopanib in a Patient with Metastatic Renal Cell Carcinoma

Background. Renal cell carcinoma accounts for about 2-3% of all malignant tumors. The prevalence of brain metastases from RCC is less than 20% of cases. Traditionally, whole brain radiotherapy as well as the latest stereotactic radiosurgery improves both survival and local tumor control. These treatments also allow stabilization of clinical symptomatology. However, validated treatment guidelines for RCC patients with brain metastases are not yet available on account of the frequent exclusion of such patients from clinical trials. Moreover, limited data about the sequential use of three therapies, changing the class of agent, have been published up to now. Case Report. We report the case of a patient with metastatic RCC who developed disease progression after sunitinib and everolimus as first-line and second-line therapy, respectively. Thus, he underwent a multimodality treatment with pazopanib, as third-line therapy, to control systemic disease and radiosurgery directed on the new brain metastasis. To date, the patient is still receiving pazopanib, with progression-free survival and overall survival of 43 and 103 months, respectively. Conclusion. In a context characterized by different emerging options, with no general consensus on the optimal treatment strategy, the use of pazopanib in pretreated patients could be a suitable choice. PMID: 26798533 PMCID: PMC4698998 DOI: 10.1155/2015/62904

Effect of pH in the synthesis of organo-clays for rare earths removal

Two montmorillonitic clays were modified with N-(methoxy-polyethylene glycol) ethylene diamine and tested as sorbents for removal of Rare Earths (REs) from aqueous solutions. Lanthanum was chosen as representing element of REs family and adsorption tests were performed with the aim of selecting a system with good uptake efficiency for the pollutant abatement in wastewaters. The effects of pH were studied and the properties ofthe obtained final materials were evaluated with simple model systems of the final application. The modified clays were characterized before and after the intercalation, combining the results ofX-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FT-IR), whereas the solutions were analysed by means of Chemical Oxygen Demand to quantify the amount of intercalated polymer and by Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES) to quantify the metal ions concentration. The results showed that the organo-clays have been efficiently prepared while the characterization techniques showed that the intercalation mechanism was strongly dependent on the pH ofthe preparation procedure, affecting the protonation ofthe amino groups

Use of natural clays as sorbent materials for rare earth ions: materials characterization and set up of the operative parameters

Two mineral clays of the montmorillonite group were tested as sorbents for the removal of Rare Earths (REs) from liquid solutions. Lanthanum and neodymium model solutions were used to perform uptake tests in order to: (a) verify the clays sorption capability, (b) investigate the sorption mechanisms and (c) optimize the experimental parameters, such as contact time and pH. The desorption was also studied, in order to evaluate the feasibility of REs recovery from waters. The adsorption–desorption procedure with the optimized parameters was also tested on a leaching solution obtained by dissolution of a dismantled NdFeB magnet of a hard-disk. The clays were fully characterized after REs adsorption and desorption by means of X-ray powder diffraction (XRPD) and X-ray photoelectron spectroscopy (XPS); the liquid phase was characterized via Inductively Coupled Plasma–Optical Emission Spectroscopy (ICP–OES) analyses. The experimental results show that both clays are able to capture and release La and Nd ions, with an ion exchange mechanism. The best total efficiency (capture 50%, release 70%) is obtained when the uptake and release processes are performed at pH = 5 and pH = 1 respectively; in real leached scrap solutions, the uptake is around 40% but release efficiency is strongly decreased passing from a mono-ion system to a real system (from 80% to 5%). Furthermore, a strong matrix effect is found, with the matrix largely affecting both the uptake and the release of neodymium

Tolerability of a new amino acid-based formula for children with IgE-mediated cow's milk allergy

Amino acid-based formula (AAF) is a relevant dietary strategy for paediatric patients affected by cow's milk allergy (CMA). The present study was designed to evaluate the hypoallergenicity of a new AAF in children with immunoglobulin (Ig)E-mediated CMA

Obtención de un nuevo genotipo de Achylocrine satureioides Lam (Asteraceae) por poliploidización in vivo = Obtaining a new genotype tetraploid of Achylocrine satureioides Lam (Asteraceae) by in vivo poliploydization

Achyrocline satureioides (Lam.) DC. es un arbusto originario de América del Sur. Es muy utilizada en la medicina popular, además, por su color y arquitectura, tiene potencial ornamental como planta para decorar parques o jardines. Como la mayoría de las plantas nativas aromáticas-medicinales, sus poblaciones sufren una fuerte erosión genética debido a acciones antrópicas, como la sobreexplotación y el avance de la frontera agrícola o la urbana. Una forma de ayudar a evitar la extinción de poblaciones es comenzar con el proceso de domesticación y mejora de estas especies, para cambiar el paradigma extractivista por el productivo. La obtención de nuevas variedades poliploides es una forma rápida de generar individuos con órganos más grandes y mayor resistencia al estrés, entre otras propiedades que caracterizan a la poliploidía, para utilizarlos directamente o como insumo para un programa de mejoramiento. El objetivo del presente trabajo es obtener y caracterizar individuos poliploides de A. satureioides aplicando colchicina, in vivo, sobre sus yemas laterales.Achyrocline satureioides (Lam.) DC. is a shrub native to South America It is a plant widely used in popular medicine. In addition, due to its colour and architecture, A. satureioides has ornamental potential as a plant to decorate parks or gardens. Like most medicinal aromatic natives, their populations suffer a strong genetic erosion due to anthropogenic actions such as over-exploitation, and the advance of the agricultural frontier. One way to help prevent the extinction of populations is to start with the process of domestication and improvement of these species, to change the extractivist paradigm for the productive one. Obtaining new polyploid varieties, with the advantages they offer, is a quick way to generate individuals with larger organs and greater resistance to stress, among other properties, as input for a breeding program. The goal of the present work is to obtain and characterize polyploid individuals of A. satureioides by applying colchicine, in vivo, onto their lateral buds.Instituto de GenéticaFil: Iannicelli, Jesica. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Genética; ArgentinaFil: Bugallo, Veronica Lucia. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Floricultura; ArgentinaFil: Coviella, Maria Andrea. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Floricultura; ArgentinaFil: Galli, Maria Carolina. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Luis. Agencia de Extensión Rural Concarán; ArgentinaFil: Risso, Oscar Ariel. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Luis. Agencia de Extensión Rural Concarán; ArgentinaFil: Costoya, Susana Beatriz. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Genética; ArgentinaFil: Escandon, Alejandro Salvio. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Genética; Argentin

Use of the North American Nursing Diagnosis Association taxonomies, Nursing Intervention Classification, Nursing Outcomes Classification and NANDA-NIC-NOC linkage in cardiac rehabilitation.

This study aims at creating a standardized language for each patient admitted to Cardiac Rehabilitation Unit (CR) by identifying nursing diagnosis, interventions, results/objectives expected and related correlations. The primary outcome was identifying health needs of all patients admitted to CR. The secondary outcomes were the identification of North American Nursing Diagnosis Association -International diagnoses (NANDA-I), of nursing intervention classification (NIC), of nursing outcomes classification (NOC) and their correlation NANDA-NIC-NOC linkage (NNN linkage) in order to define a standardized language for all nursing staff. This is a retrospective study involving a sample of 168 patients discharged from CR. The NANDA-I, the NIC, the NOC and the most frequently used NNN connections were identified and collected by using structured form including the 11 functional models of Marjory Gordon. Data from 76 patients were analyzed (92.1% male; mean age (± SD) 62.7±9 yrs; IQ range: 42-82). The main NANDA-I nursing diagnosis belongs to psychological sphere, but not to physiological domains. The statement NIC has allowed to put into practice actions of health prevention and education. Nursing care documentation and NNN taxonomic language promotes a wide diffusion of nursing discipline culture and significant qualitative improvement of patient's care, further improving the communication between nurses and other health professionals

Multidisciplinary management of neuroendocrine neoplasia: a real-world experience from a referral center

Purpose: Multidisciplinary approach is widely advised for an effective care of patients with neuroendocrine neoplasia (NEN). Since data on efficacy of multidisciplinary management of NENs patients in referral centers are scanty, this study aimed at analyzing the modality of presentation and clinical outcome of patients with NENs managed by a dedicated multidisciplinary team. Methods. In this prospective observational study, we included all consecutive new patients visiting the Sant'Andrea Hospital in Rome (ENETS-Center of Excellence) between January 2014 and June 2018. Results. A total of 195 patients were evaluated. The most frequent sites were pancreas (38.5%), small bowel (22%), and lung (9.7%). Median Ki67 was 3%. After the first visit at the center, additional radiological and/or nuclear medicine procedures were requested in 163 patients (83.6%), whereas histological data revision was advised in 84 patients (43.1%) (revision of histological slides: 27.7%, new bioptic sampling: 15.4%). After that, disease imaging staging and grading was modified in 30.7% and 17.9% of patients, respectively. Overall, a change in therapeutic management was proposed in 98 patients (50.3%). Conclusions. Multidisciplinary approach in a dedicated team may lead to change of disease imaging staging and grading in a significant proportion of patients. Enhancing referral routes to dedicated-NEN center should be promoted, since it may improve patients' clinical outcome

Delineation and Diagnostic Criteria of Oral-Facial-Digital Syndrome Type VI

Oral-Facial-Digital Syndrome type VI (OFD VI) represents a rare phenotypic subtype of Joubert syndrome and related disorders (JSRD). In the original report polydactyly, oral findings, intellectual disability, and absence of the cerebellar vermis at post-mortem characterized the syndrome. Subsequently, the molar tooth sign (MTS) has been found in patients with OFD VI, prompting the inclusion of OFD VI in JSRD. We studied the clinical, neurodevelopmental, neuroimaging, and genetic findings in a cohort of 16 patients with OFD VI. We derived the following inclusion criteria from the literature: 1) MTS and one oral finding and polydactyly, or 2) MTS and more than one typical oral finding. The OFD VI neuroimaging pattern was found to be more severe than in other JSRD subgroups and includes severe hypoplasia of the cerebellar vermis, hypoplastic and dysplastic cerebellar hemispheres, marked enlargement of the posterior fossa, increased retrocerebellar collection of cerebrospinal fluid, abnormal brainstem, and frequently supratentorial abnormalities that occasionally include characteristic hypothalamic hamartomas. Additionally, two new JSRD neuroimaging findings (ascending superior cerebellar peduncles and fused thalami) have been identified. Tongue hamartomas, additional frenula, upper lip notch, and mesoaxial polydactyly are specific findings in OFD VI, while cleft lip/palate and other types of polydactyly of hands and feet are not specific. Involvement of other organs may include ocular findings, particularly colobomas. The majority of the patients have absent motor development and profound cognitive impairment. In OFD VI, normal cognitive functions are possible, but exceptional. Sequencing of known JSRD genes in most patients failed to detect pathogenetic mutations, therefore the genetic basis of OFD VI remains unknown. Compared with other JSRD subgroups, the neurological findings and impairment of motor development and cognitive functions in OFD VI are significantly worse, suggesting a correlation with the more severe neuroimaging findings. Based on the literature and this study we suggest as diagnostic criteria for OFD VI: MTS and one or more of the following: 1) tongue hamartoma(s) and/or additional frenula and/or upper lip notch; 2) mesoaxial polydactyly of one or more hands or feet; 3) hypothalamic hamartoma