909 research outputs found
Managerial features and outcome in neonatal intensive care units: results from a cluster analysis
Background: Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes. Methods: The research was conducted in Italy, within the SONAR project. SONARâs aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs. Results: Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the âtraditionalâ model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The âcollaborativeâ model has as key elements professional specialisation and functional coordination. The âindividualisticâ model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness. The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model. Conclusions: Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes
Atmospheric forcing by ALADIN/MFSTEP and MFSTEP oriented tunings
International audienceALADIN/MFSTEP is a configuration of the numerical weather prediction (NWP) model ALADIN run in a dedicated real-time mode for the purposes of the MFSTEP Project. A special attention was paid to the quality of atmospheric fluxes used for the forcing of fine-scale oceanographic models. This paper describes the novelties applied in ALADIN/MFSTEP initiated by the MFSTEP demands, leading also to improvements in general weather forecasting
Indoor exposure to environmental tobacco smoke and dampness: respiratory symptoms in Sardinian children- DRIAS study
Indoorexposuresathome,environmentaltobaccosmoke(ETS)andmould/dampnessadverselyaffect respiratoryhealthofchildren.DisturbiRespiratorinellâInfanziaeAmbienteinSardegna(DRIAS) (RespiratorySymptomsinchildrenandtheEnvironmentinSardegna,Italy)aimsatrelatingthe prevalenceofrespiratoryandallergicsymptomstoindoorexposuresinSardinianchildren. DRIAS,across-sectionalinvestigationofrespiratorysymptoms/diseases,usedamodifiedversionof ISAACquestionnaire,included4122childrenattending29primaryschoolsintheschoolyear 2004â2005. If bothparentssmoketheprevalenceforcurrentwheezeandcurrentasthmaisalmostdoubledin comparisonwithneversmokers,forpersistentcoughandphlegmaroleissuggestedwhenonlymother smokes.Amongmotherssmokinginpregnancy,theprevalenceofcurrentwheezeandcurrentasthmais increased. ExposuretoETSandfamilyatopyhaveajointeffectresultinginanalmosttriplingof prevalenceforcurrentwheezeandmorethanfourtimesforcurrentasthma.Exposuretoââdampnessââ (mouldordampness)bothduringthefirstyearoflifeandcurrentlyisassociatedwithincreased prevalenceofcurrentwheeze,persistentcoughorphlegmandcurrentrhino-conjunctivitis;ifexposure is onlyduringthefirstyearoflifeadoublingormoreofprevalenceisobservedforcurrentwheeze, current asthma,andpersistentcoughorphlegm. DRIASresultsaddevidencetothecausalroleofchildhoodexposuretoETSinthedevelopmentof respiratorysymptoms(cough,phlegm,andwheezing)andasthma.ThejointeffectofETSandfamily atopyiscorroborated.Theresultsstrengthentheevidenceforacausalassociationbetweenââdampnessââ and respiratoryhealth,pointingtoitspossibleindependentroleincausingasthma,along-lasting exposureentailsadoubledprevalenceforbothasthmaticandbronchitissymptoms
Fibroblast proliferation and migration in wound healing by phytochemicals: Evidence for a novel synergic outcome
Wound-healing is a dynamic skin reparative process that results in a sequence of events, including inflammation, proliferation, and migration of different cell types as fibroblasts. Fibroblasts play a crucial role in repairing processes, from the late inflammatory phase until the fully final epithelization of the injured tissue. Within this context, identifying tools able to implement cell proliferation and migration could improve tissue regeneration. Recently, plants species from all over the world are coming out as novel tools for therapeutic applications thanks to their phytochemicals, which have antioxidant properties and can promote wound healing. In this paper, we aimed at investigating antioxidant activity of waste extracts from different medicinal plants, endemic of the Mediterranean area, on fibroblast proliferation and wound healing. We determined the amount of total phenols and anti-oxidant activity by ABTS assay. We then evaluated the cytotoxicity of the compounds and the proliferative capabilities of fibroblasts by scratch assay. Our results showed that waste extracts retain antioxidant and regenerative properties, inducing tissue re-establishment after environmental stress exposure. Taken together, our findings suggest that waste material could be used in the future also in combinations to stimulate wound healing processes and antioxidant responses in damaged skin
Isolating stem cells from skin: designing a novel highly efficient non-enzymatic approach
Stem cells are undifferentiated elements capable to acquire a specific cellular phenotype under the influence of specific stimuli, thus being involved in tissue integrity and maintenance. In the skin tissue self-renewal and wound healing after injury is a complex process, especially in adulthood, due to the aging process and the continuous exposure to damaging agents. The importance of stem cells in regenerative medicine is well known and defining or improving their isolation methods is therefore a primary and crucial step. In the present paper we present a novel method to isolate stem cells from human skin, including the involvement of a novel medium for the maintenance and expansion of in vitro cultures. The biopsies were mechanically digested and put in culture. The migrating cells were positive selected with magnetic cell sorting, characterized by flow-cytometry analysis, and viability detected by MTT assay. Cells exhibited a mesenchymal phenotype, as demonstrated by the positive acquirement of an osteogenic or adipogenic phenotype when cultured in specific conditioned media. Taken together our results disclose a novel method for culturing and expanding stem cells from skin and pave the way for future clinical applications in tissue regeneration
Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes
Background: The NeoChord echo-guided transapical beating heart repair is a promising early-stage
minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction.
The technique has been improved since its inception following procedure standardization, patient selection
optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three
years of our large single center experience.
Methods: All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both
mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were
included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet
prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet
prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular
calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months
and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined
according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR)
severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography
(ASE) and European Society of Cardiology (ESC) guidelines.
Results: Two hundred and three patients were included; median follow-up was 24 months [interquartile
range (IQR), 9â36]. Median age was 64 years (IQR, 54â74 years), median Society of Thoracic Surgeons
(STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32â1.44%). There were 106 Type A patients
(52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival
was 99.0%±0.7% at one and two years and 94.0%±2.9% at three years. At one-year follow-up patient success
was 91.2%±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up
patient success was 81.2%±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success
was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a
significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years.
Conclusions: The NeoChord echo-guided transapical beating heart repair procedure demonstrated good
clinical outcomes and echocardiographic results up to three-year follow-up
Hydrolat of Helichrysum italicum promotes tissue regeneration during wound healing
Wound healing is a dynamic process involving different cell types with distinct roles according to the stages of healing. Fibroblasts and stem cells actively participate in tissue regeneration. A proper stimulation could contribute to enhance wound healing processes. Helichrysum italicum (H. italicum) is a medical plant well described for its pharmacological, antimicrobial, and anti-inflammatory activities. Aim of the present work was to examine the effect of the hydrolate derivate from H. italicum on stem cells isolated from skin and fibroblasts in vitro in presence or absence of tissue damage. The viability and proliferation of all cell types cultured in different conditions were analyzed by MTT and BrdU assays. Cell proliferation after wound was analyzed with scratch test. Also, the expression of the main genes involved in tissue repair was evaluated by RT-qPCR analysis. Here we describe the capability of hydrolate of H. italicum to promote tissue regeneration after scratch test both in stem cells and in fibroblasts. Moreover, the gene expression analysis revealed that, hydrolate of H. italicum is also able to enhance stemness related. In conclusion our results are encouraging, highlighting novel regenerative properties of hydrolate of H. italicum and paving the way for future application of this wasting product in accelerating wound healing
El recien nacido con dolor: el papel del equipo de enfermeria
It's a quantitative, descriptive and cross study conducted with the nurse team working in the field of neonatology at the three hospitals, Alfenas-MG. Aimed to describe the forms of pain assessment of the newborn used by nurse team and analyze the practice of nursing as pain management of neonates. Data were collected through a semi-structured formulary, from August to September 2008, of 42 nurses working. The analyze was performed using SPSS software using descriptive statistics and correlation test. It was observed that the respondents recognize that the newborn is capable of feeling pain and evaluated by physiological and behavioral changes and that there isn't pain assessment scales standardized in the institutions. For the management, carry out pharmacological and nonpharmacological interventions. There is need to train professionals contributing to the assessment and management of pain, promoting of holistic care of the neonate.Estudio cuantitativo, descriptivo y transversal realizado con profesionales de EnfermerĂa que actĂșan en el ĂĄrea de NeonatologĂa en los tres hospitales de Alfenas, Minas Gerais. Se objetivĂł describir las formas de evaluaciĂłn del dolor del reciĂ©n nacido utilizados por el personal de enfermerĂa y analizar la prĂĄctica de la enfermerĂa como el manejo del dolor del neonato. La recolecciĂłn de datos fue hecha por medio de un formulario semiestructurado, entre agosto y septiembre de 2008, con 42 profesionales. El anĂĄlisis fue hecho con el software SPSS, utilizando la estadĂstica descriptiva y la prueba de correlaciĂłn. Los entrevistados reconocen que el neonato es capaz de sentir dolor y esto se evalĂșa a travĂ©s de alteraciones fisiolĂłgicas y de comportamiento, no hay utilizaciĂłn de escalas de evaluaciĂłn del dolor estandarizadas en las instituciones. Para el manejo, realizan intervenciones farmacolĂłgicas y no farmacolĂłgicas. Hay necesidad de capacitar profesionales contribuyendo para la evaluaciĂłn y manejo del dolor, para la promociĂłn del cuidado integral al neonato.Estudo quantitativo, descritivo e transversal realizado com profissionais de enfermagem que atuam em neonatologia nos trĂȘs hospitais de Alfenas-MG. Objetivou descrever as formas de avaliação de dor do recĂ©m-nascido utilizadas pela equipe de enfermagem e analisar a prĂĄtica da enfermagem quanto ao manejo da dor do neonato. A coleta de dados foi feita por meio de formulĂĄrio semiestruturado, de agosto a setembro de 2008, com 42 profissionais. A anĂĄlise foi feita pelo software SPSS utilizando estatĂstica descritiva e teste de correlação. Os entrevistados acreditam que o recĂ©m-nascido Ă© capaz de sentir dor e a avaliam por meio de alteraçÔes fisiolĂłgicas e comportamentais, e que nĂŁo hĂĄ utilização de escalas de avaliação ĂĄlgica padronizadas nas instituiçÔes. Para o manejo, realizam intervençÔes farmacolĂłgicas e nĂŁo farmacolĂłgicas. HĂĄ necessidade de capacitar os profissionais, contribuindo para a avaliação e o manejo da dor, e promovendo o cuidado integral ao neonato.Universidade de SĂŁo Paulo Escola de Enfermagem de Ribeirao Preto Departamento de Enfermagem Materno-infantil e Saude PublicaUniversidade Federal de SĂŁo Paulo (UNIFESP) Departamento de Enfermagem Pediatrica Escola Paulista de EnfermagemUniversidade Federal de Alfenas Escola de Enfermagem Programa de Pos-graduacao em EnfermagemUniversidade de SĂŁo Paulo Escola de Enfermagem de Ribeirao Preto Departamento de Enfermagem Geral e EspecializadaUniversidade Federal de Alfenas Escola de EnfermagemPrograma de Pos-graduacao em Enfermagem Programa de Pos-graduacao em EnfermagemEscola de Enfermagem Escola de EnfermagemUniversidade de SĂŁo PauloUNIFESP, Depto. de Enfermagem Pediatrica Escola Paulista de Enfermagem (EPE)SciEL
Definition of the Prognostic Role of MGMT Promoter Methylation Value by Pyrosequencing in Newly Diagnosed IDH WildâType Glioblastoma Patients Treated with Radiochemotherapy: A Large Multicenter Study
Background. O6âmethylguanine (O6âMeG)âDNA methyltransferase (MGMT) methylation status is a predictive factor for alkylating treatment efficacy in glioblastoma patients, but its prognostic role is still unclear. We performed a large, multicenter study to evaluate the association between MGMT methylation value and survival. Methods. We evaluated glioblastoma patients with an assessment of MGMT methylation status by pyrosequencing from nine Italian centers. The inclusion criteria were histological diagnosis of IDH wildâtype glioblastoma, Eastern Cooperative Oncology Group Performance Status (ECOGâPS) â€2, and radioâchemotherapy treatment with temozolomide. The relationship between OS and MGMT was investigated with a timeâdependent Receiver Operating Characteristics (ROC) curve and Cox regression models. Results. In total, 591 newly diagnosed glioblastoma patients were analyzed. The median OS was 16.2 months. The ROC analysis suggested a cutâoff of 15% for MGMT methylation. The 2âyear Overall Survival (OS) was 18.3% and 51.8% for MGMT methylation <15% and â„15% (p < 0.0001). In the multivariable analysis, MGMT methylation <15% was associated with impaired survival (p <0.00001). However, we also found a nonâlinear association between MGMT methylation and OS (p = 0.002): median OS was 14.8 months for MGMT in 0â4%, 18.9 months for MGMT in 4â40%, and 29.9 months for MGMT in 40â 100%. Conclusions. Our findings suggested a nonâlinear relationship between OS and MGMT promoter methylation, which implies a varying magnitude of prognostic effect across values of MGMT promoter methylation by pyrosequencing in newly diagnosed IDH wildâtype glioblastoma patients treated with chemoradiotherapy
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