Temporal Patterns of In-Hospital Falls of Elderly Patients.

BACKGROUND: A potentially important factor yet to receive adequate study is the time when hospital falls occur. A prior study conducted before the system-wide introduction of preventive measures revealed a biphasic 24-hour pattern of hospital falls with major peak in the morning. OBJECTIVES: The purpose was to identify the temporal patterning of falls among elderly patients in hospitals with comprehensive fall prevention programs in place. METHODS: A 4-year observational study was conducted by the local health authority in the five nonteaching public hospitals located in the province of Ferrara, Italy. Fall records involving patients of ages ≥65 years hospitalized in the general medical departments were used. Single- and multiple-component cosinor (time series) analyses were used to explore 24-hour, weekly, and annual patterns of falls. RESULTS: A total of 763 falls were experienced by 709 different elderly hospitalized patients. Falls typically took place in the patient's hospital room (72%) and bathroom (23%). Major causes were patient instability (32%) and accident (13%), and most occurred when not wearing footwear (45%) or wearing inappropriate sling-back open-toe shoes (39%). Falls happened while standing (39%), while seated (21%), and while getting into, out of, or laying in bed (32%)-either with the bed rails raised or lowered. Fall outcome usually involved no injury (58%) or slight injury (35%), but some (7%) were disabling. Fall occurrence was higher during the night (46%) compared to either the morning (30%) or afternoon (24%) shift. Patterns across 24 hours were characterized by a single major and one or more minor peaks that seemed to be associated with a variety of scheduled patient, hospital, and nursing activities. Multiple-component cosinor analysis identified significant (p < .05) prominent day-night patterns according to fall location, patient position, cause, injury severity, and type of footwear. Falls were more frequent, but not significantly so, on Fridays, Sundays, and Mondays compared with Tuesdays, and were more frequent in winter and spring (p = .003). DISCUSSION: Documentation by cause and circumstance of these moderate- to high-amplitude temporal patterns in hospital falls of elderly patients advances the knowledge of fall epidemiology by identifying the times of day, week, and year and nursing shifts of elevated risk that is of critical importance to improving hospital patient safety programs

Proactive Implementation of Quantitative Analysis of the Risk FMEA / FMECA in Nuclear Medicine Procedures

Aim. The aim of the present work is to provide improved safety and quality in care procedures, through the analysis of existing processes within the Nuclear Medicine Unit, in order to identify activities at higher risk and set in before they cause harm to the patient. Materials and methods. The first step was the settlement of the team appointed for the analysis: a multi-professional group consisting of 7 operators of Nuclear Medicine Unit and 3 operators trained in the use of FMEA / FMECA (Failure Mode and Effect Analysis / Failure Mode and Critical Effect Analysis) technology. The analysis was conducted using the FMEA/FMECA method applied as follow: mapping of processes in the Nuclear Medicine Unit; systematic description and analysis of each activity; identification of possible sources of error and failure modes for each task mapped; definition of priority index of risk (PIR score i.e. result of the product between the severity, probability and detection); analysis of barriers; analysis of causes that break barriers; identification and definition of potential actions and corrective measures able to reduce the risk of error. Each member of the working group evaluated the questions “what can happen?” “what are we doing to prevent the error?” for each activity, then, risk of error probability, detection and gravity were scored using standardized scales. The PIR score for each identified failure mode was subsequently calculated. The average score assigned to each critical process were calculated for both the near misses and occurred accidents, thus being able to identify priority intervention processes. Eventually the assessment of the effectiveness of the implemented preventive actions was carried out. Results. The process "Clinical Management of Radiopharmaceuticals" has proven to be the "primary process" at major risk and the application of FMEA/FMECA method on it resulted in 43% risk reduction in the activities with high score and in the whole process during a period of about six month. Conclusions. The implementation of the method FMEA/FMECA in "Clinical Management of Radiopharmaceuticals" have reduced significantly the risk of adverse events

When hospital patients fall: preliminary data from Ferrara, Italy.

Falls represent common and serious problems among older people. One-third of subjects aged 65 years and older fall at least one a year, and risk increases with age. Although anedoctal evidence and clinical experience suggest a nocturnal preference for falls events, chronobiological studies are not available. This study was aimed to verify whether hospital falls occur randomly throughout the day or exhibit a rhythmic pattern. We considered all falls occurred from January 1 to December 31, 2009. Based on time of event, total sample and subgroups: gender, age (75 years), modalities (witness, alone, upright, sitting, bed with or without banks, slipped dry or wet floor, stumbled, loss of strength, equilibrium or consciousness; bathroom, room), outcome (lesion, fracture), were categorized into twenty-four 1-hour increments, and analyzed for circadian rhythmicity with validated chronobiological software.8 During 2009, 371 consecutive falls were recorded (mean age 73.8±17.6 years, men 55.8%). A circadian variation was found for the entire population, with significant peaks in morning and late-evening hours (11 AM-24 PM). A significant morning main peak was found for men, subjects falling alone, loss of consciousness, falls in the bathroom, subjects with footwears, and falls with fracture. The evening-night main peak was found for patients with beds with banks, slipped on wet floor, subjects without footwears, falls without lesion. Falls events are among the most common and severe adverse events for hospitalized older patients. This preliminary study shows that falls occur either during nighttime (as expected), but late-morning hours are at high risk as well. Moreover, morning hours are characterized by higher frequency of fractures, maybe due to attempts to rise for lunch or personal hygiene. To the best of our knowledge, there are no studies performed with chronobiologic analysis. Identification of rhythmic patterns of certain events means predicibility of events itself, and when an event is predicible, adequate strategies of prevention may be attempted

Discrimination between Alzheimer dementia and controls by automated analysis of multicenter FDG PET

A new diagnostic indicator of FDG PET scan abnormality, based on age-adjusted t statistics and an automated voxel-based procedure, is presented and validated in a large data set comprising 110 normal controls and 395 patients with probable Alzheimer's disease (AD) that were studied in eight participating centers. The effect of differences in spatial resolution of PET scanners was minimized effectively by filtering and masking. In controls FDG uptake declined significantly with age in anterior cingulate and frontolateral perisylvian cortex. In patients with probable AD decline of FDG uptake in posterior cingulate, temporoparietal, and prefrontal association cortex was related to dementia severity. These effects were clearly distinct from age effects in controls, suggesting that the disease process of AD is not related to normal aging. Women with probable AD had significantly more frontal metabolic impairment than men. The new indicator of metabolic abnormality in AD-related regions provided 93% sensitivity and specificity for distinction of mild to moderate probable AD from normals, and 84% sensitivity at 93% specificity for detection of very mild probable AD (defined by Mini Mental Score 24 or better). All regions related to AD severity were already affected in very mild AD, suggesting that all vulnerable areas are affected to a similar degree already at disease onset. Ventromedial frontal cortex was also abnormal. In conclusion, automated analysis of multicenter FDG PET is feasible, provides insights into AD pathophysiology, and can be used potentially as a sensitive biomarker for early AD diagnosis. (C) 2002 Elsevier Science (USA)

Cystatin C as a marker of renal function immediately after liver transplantation.

To verify whether cystatin C may be of some use as a renal function marker immediately after orthotopic liver transplantation (OLT), we compared serum cystatin C (S(Cyst)), serum creatinine (S(cr)), and creatinine clearance (C(cr)) levels with the glomerular filtration rate (GFR). On postoperative days 1, 3, 5, and 7, S(Cyst) and S(cr) was measured in simultaneously drawn blood samples, whereas C(cr) was calculated using a complete 24-hour urine collection. The GFR was determined on the same days by means of iohexol plasma clearance (I-GFR). The correlation between 1/S(Cyst) and I-GFR was stronger than that of 1/S(cr) or C(cr) (P or = 30% lower than that recorded on the first postoperative day, S(Cyst)(P< 0.0001) and S(cr) (P< 0.01) levels were increased, whereas C(cr) remained unchanged (P = 0.09). Receiver operating characteristic (ROC) area-under-the-curve analysis showed that the diagnostic accuracy of S(cyst) was better than that of S(cr) and C(cr). S(cyst) levels of 1.4, 1.7, and 2.2 mg/L respectively predicted I-GFR levels of 80, 60, and 40 mL/minute/1.73 m. In conclusion, cystatin C is a reliable marker of renal function during the immediate post-OLT period, especially when the goal is to identify moderate changes in GFR

collegArti 1/2019

CollegArti 1/2019 raccoglie i saggi degli studenti del Corso di Laurea Magistrale in Arti Visive che si sono cimentati in una \u201cpalestra di scrittura\u201d dedicata alla critica d\u2019arte con una serie di articoli pubblicati on-line sul sito del Corso di Studi. Si tratta di interviste e recensioni di eventi organizzati durante l\u2019anno accademico 2017-2018 nel Complesso Monumentale di Santa Cristina che accoglie anche la Fondazione Zeri. Gli argomenti trattati rispecchiano, quindi, la molteplicit\ue0 dell\u2019offerta formativa e di terza missione, cio\ue8 di dialogo con la cittadinanza, offerta in Santa Cristina: si va dalla presentazione di lavori di ricerca di studiosi italiani e internazionali, ai resoconti di alcune delle mostre pi\uf9 significative organizzate nel territorio nazionale, fino ad incontri con professionisti che operano a vario titolo nel settore dell\u2019arte. Il volume presenta, cosi, una panoramica che contribuisce a mettere in luce l\u2019articolato ambito di formazione e il contesto di attivit\ue0 collegato alle arti visive ma, soprattutto, costituisce un felice esempio di sperimentazione di didattica complementare rispetto ai percorsi previsti dal Corso di Laurea

The role of the intensive care unit in real-time surveillance of emerging pandemics: the Italian GiViTI experience

The prompt availability of reliable epidemiological information on emerging pandemics is crucial for public health policy-makers. Early in 2013, a possible new H1N1 epidemic notified by an intensive care unit (ICU) to GiViTI, the Italian ICU network, prompted the re-activation of the real-time monitoring system developed during the 2009-2010 pandemic. Based on data from 216 ICUs, we were able to detect and monitor an outbreak of severe H1N1 infection, and to compare the situation with previous years. The timely and correct assessment of the severity of an epidemic can be obtained by investigating ICU admissions, especially when historical comparisons can be made

The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs

BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in five years (2011-2015) to 163 Italian general ICUs. METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analyzed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours. RESULTS: 44,551 elderly patients (19.2%) underwent emergency (47.3%) or elective surgery (52.7%). At least one severe comorbidity was present in 14.6% of them, yielding a higher hospital mortality (32.4%, vs. 21.1% without severe comorbidity). In the models for patients staying in the ICU 24 hours or more, cirrhosis, NYHA class IV, and severe COPD were constant independent predictors of death (adjusted odds ratios [ORs] range 1.67-1.97, 1.54-1.91, and 1.34-1.50, respectively), while dementia was statistically significant in four out of five models (adjusted ORs 1.23-1.28). End-stage renal disease, instead, never resulted to be an independent prognostic factor. For patients staying in the ICU less than 24 hours, chronic comorbidities were only occasionally independent predictors of death. CONCLUSIONS: Our study confirms that elderly surgical patients represent a relevant part of all ICUs admissions. About one of seven bear at least one severe chronic comorbidity, that, excluding end-stage renal disease, are all strong independent predictors of hospital death