Task shifting to enhanced physical therapy in musculoskeletal secondary care. An evidence-based narrative review

Background: The World Health Organization defines task shifting as the rational redistribution of tasks among the healthcare workforce teams. The transfer of tasks to physical therapy is well suited for musculoskeletal conditions, either where exercise and physical activity are an important part of the treatment, or to sort the flow of emergency patients.  Methods: What are the benefits, limits and implementation challenges associated to the employment of enhanced physical therapy in the redistribution of secondary healthcare workforce? The aim of this narrative review is to collect evidence from the most recent publications, in order to address clinical studies, policy making and further research.  Results: A clear correlation between healthcare system and type of service was not found, supporting that task shifting can be employed to meet different needs. In emergency departments, enhanced physical therapists are employed to improve the flow of musculoskeletal patients, reduce waiting time, length of stay and free up professionals in support of more complex conditions. Otherwise, enhanced physical therapists are employed to sort the flow of chronic musculoskeletal patients, triaging to orthopaedic surgery, and performing follow-up. Clinical outcomes were equal or better than those achieved by other professionals. Appropriate diagnoses and referrals were also demonstrated, despite two studies show enhanced physical therapy to be effective but dependent by medical support. Specific training is therefore fundamental.  Conclusion: Task shifting is a promising innovation which is worthy introducing in the management of chronic musculoskeletal conditions, when most of the treatments may be repeated under the supervision of medical consultants.&nbsp

On Crossley's contribution to the development of graph based algorithms for the analysis of mechanisms and gear trains

This paper celebrates a particular branch of Crossley's early work dedicated to Mechanism Science, which deals with a rigorous introduction of Graph Theory to the study of some fundamental and intrinsic properties of kinematic chains and mechanisms. Although such idea gave its main outcome in Type and Number Synthesis (which has been much better and extensively described in another paper of the present special issue) some other intriguing side effects appeared, later in Mechanism Science, which yielded several results, and are still in the center of research and industrial world interest, such as, to name but a few, the automatic generation of the equations governing kinematic, static force and dynamic analysis of mechanisms and geared trains, the power flow analysis, the computation of the efficiency and, finally, the never fully explored structure-to-function mapping, which the present contribution points out to be still a challenge in the field

The energy requalification of social housing in the Italian and dutch contexts

In the context of a Post-Doc Research, still in progress (1), renovation of housing built from 1946 to 1970 in Europe has been individualized as a field of research. As a matter of fact it presents, among other issues, high energy consumption and low indoor air quality. Through an analytical comparison between two very different contexts, Italy and the Netherlands, the definition of two tools ̶ one of procedural and one of technical type - for the sustainable renovation of such buildings is identified as a specific goal. The aim is developing a framework of actions to raise awareness of key stakeholders and also a repertory of technical solutions for the building envelope to improve energy performance and indoor air quality

Control and virtual reality simulation of tendon driven mechanisms

In this paper the authors present a control strategy for tendon driven mechanisms. The aim of the control system is to find the correct torques which the motors have to exert to make the end effector describe a specific trajectory. In robotic assemblies this problem is often solved with closed loop algorithm, but here a simpler method, based on a open loop strategy, is developed. The difficulties in the actuation are in keeping the belt tight during all working conditions. So an innovative solution of this problem is presented here. This methodology can be easily applied in real time monitoring or very fast operations. For this reason several virtual reality simulations, developed using codes written in Virtual Reality Markup Language, are also presented. This approach is very efficient because it requires a very low cpu computation time, small size files, and the manipulator can be easily put into different simulated scenarios

Optimization of a High–Speed Deployment Slider–Crank Mechanism: A Design Charts Approach

Mechanical and aerospace applications often require that mechanisms deploy in a quick stable and reliable way. The objective of this study is to implement a general optimization procedure to perform a first stage conceptual design of HSD mechanisms, focusing on both kinematics and dynamics. In particular, the authors will focus on the development of design charts. In the very first part of the work, a parametric lumped-mass system will be modeled in order to reduce the number of parameters for the synthesis phase. A correlation will be established between geometry, inertia and initial position to guarantee the maximum value of acceleration during deployment of the deployable arm by means of the principle of virtual work. In the second part of this work, the influence of important factors such as friction and joint clearance on the overall dynamics of the system will be investigated. Finally, a coupled dynamic and structural analysis of the helical spring, that actuates the mechanism, will be carried out in order to achieve optimal performance. The developed charts will also take into account the space limitation requirement, that are often needed for both aerospace and mechanical applications. A final example will summarize all the points covered by this research effort. Results will be validated using the commercial software ABAQUS.</jats:p

School buildings and indoor air quality: diagnostic procedures and criteria for intervention

The research - referred in this report - comes from a doctoral thesis entitled Indoor air quality control. Intervention criteria for environmental and technological restoration of school buildings; research that has shown the actual relationship between the degradation of school buildings, the levels of indoor air pollution and the effects on the health of the occupants. This study path is subsequently directed to the analysis of unavoidable dependencies that exist between the aspects of the healthiness of the indoor air and the energy performance of buildings in order to provide, through the use of a diagnostic protocol, useful information for the definition of redevelopment interventions

Sfide etiche nell'assistenza agli anziani in contesto acuto e residenziale: una revisione di scopo

Introduction: The discontinuity between the high ideals of nursing education and real-world practice is a major cause of frustration, moral distress and burnout among the youngest, and pushes up to half nurses to change career within two years. These conditions are accentuated in the care of elderly patients with multiple chronic needs. Method: A multidisciplinary team of nurses and philosophers investigated the chronic determinants of ethical issues in aged care nursing, building on insightful experiences from different institu­tional settings, in order to provide evidence for contextualized and patient-oriented professio­nal support. A scoping review protocol was employed at this purpose. Results: Most of the environmental and organizational deteminants of chronical ethical issues are out­side the control of nurses, and most of the relational ones follow as a result in both settings. Many of the them have been confirmed and further aggravated by the COVID-19 pandemic. Discussion: Although there are not universal solutions to the issues described, still it is possible to distin­guish which determinants fall within the control of nurses, to help them prevent or manage their occurrence; and what are beyond, to help them avoid self-blame and transfer constructive information to those who can intervene. Conclusion: Education can help exercise critical thinking and communicate properly. However, once maximized team cooperation, orga­nizational efficiency, and individual soft skills, diminishing room for improvement will be available at increasing human and financial costs. Improving the condition of nurses is an urgent political responsibility and requires a broader socio-cultural change. Keywords: burnout, COVID-19, elderly, moral distress, workplace health promotion.Introduzione: La frattura fra educazione infermieristica e realtà lavorativa quotidiana rappresenta una frequente causa di frustrazione ed esaurimento psicofisico, che spinge fino a metà degli infermieri a ritirarsi entro due anni dal conseguimento del titolo. Tali condizioni sono accentuate nell’assistenza alla persona anziana affetta da bisogni cronici e complessi. Metodo: Un gruppo multidisciplinare di infermieri e filosofi ha studiato i determinanti ambientali, organizzativi e relazionali alla base dei problemi etici che emergono con maggior frequenza nell’assistenza alla persona anziana, sia nelle strutture per acuti, sia nelle strutture di ricovero a lungo termine, alla ricerca di evidenze utili a migliorare le condizioni dei professionisti. A tal proposito è stata una condotta una revisione di scopo. Risultati: La maggior parte dei problemi ambientali e organizzativi risultano essere al di fuori del controllo dei singoli infermieri, e la maggior parte dei problemi relazionali ne rappresentano la conseguenza. Molti di questi problemi sono stati confermati e aggravati dalla pandemia di COVID-19. Discussione: Sebbene non vi siano soluzioni trasversali a tutti i contesti, resta possibile distinguere quali problemi rientrino nel dominio di azione degli infermieri, per aiutarli a prevenirne o gestirne l’occorrenza; e quali invece vadano oltre, onde evitare sentimenti di autoaccusa, e trasferire informazioni utili a coloro che invece possono di volta in volta intervenire. Conclusioni: La formazione può allenare il pensiero critico e la comunicazione fra operatori, pazienti e familiari. Una volta raggiunti i massimi livelli possibili di cooperazione ed efficienza, tuttavia, margini di miglioramento sempre più ridotti saranno acquisiti a costi umani ed economici sempre maggiori. Il miglioramento delle condizioni degli infermieri dipende sempre sempre più da investimenti allocativi e culturali urgenti. Keywords: anziani, COVID-19, esaurimento psicofisico, politiche allocative, salute sul luogo di lavoro

Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS

IntroductionRobotic assisted surgery is a rapidly developing field of minimally invasive bariatric surgery in the last 20 years. Its wide diffusion has led to the development and standardization of robotic assisted approaches for bariatric operations. In this study, we present the first four Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA).MethodsIn January and February 2023, 4 consecutive patients scheduled for minimal invasive Roux-en-Y-Bypass were selected and underwent the procedure robotic-assisted with the new platform. No exclusion criteria were applied.ResultsFour patients, two females and two males, underwent RYGB with a median BMI of 40 Kg/m2 (range: 36–46) and diabetes mellitus in two cases. The median docking time was 8 min (range: 7–8.5) and the median console time was 127.5 min (range: 95–150). A description of the operating theatre, robotic arms and docking setup is provided. Procedures were performed without intraoperative complications and no conversion to laparoscopy or open surgery was noted. No additional ports were needed to be placed. System's function and docking were uneventful. No early post-operative complications were observed.ConclusionsBased on our initial experience, RYGB with the Hugo™ RAS system is feasible. This study provides the configurations necessary to perform RYGB with the Hugo™ RAS system as well as general information and insights from our preliminary experience