La valutazione della Cultura della Sicurezza nel setting dei poliambulatori chirurgici: risultati di una rilevazione condotta presso l\u2019Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona.

Introduzione La promozione di una cultura della sicurezza nelle organizzazioni sanitarie rappresenta una strategia essenziale per il miglioramento della Patient Safety. Nel contesto della chirurgia ambulatoriale, l\u2019implementazione di tecniche specifiche (briefing/debriefing) pu\uf2 contribuire al miglioramento del clima e dell\u2019efficienza lavorativa, la cui analisi si avvale di appositi strumenti. Il presente studio ha indagato il clima della sicurezza in un campione di professionisti sanitari operanti presso i Poliambulatori chirurgici della AOUI di Verona, con particolare riferimento alla valutazione delle abilit\ue0 non tecniche. Materiali e metodi Il questionario per la cultura della sicurezza nei poliambulatori chirurgici, sviluppato dalla AHRQ e adattato in lingua italiana, include 36 domande volte ad indagare attraverso una scala Likert (1-5) il contesto di lavoro, il livello globale e la percezione della sicurezza (8 dimensioni), la propensione alla segnalazione spontanea e gli scambi informativi in fase pre e post-operatoria. In particolare, 3 item indagano l\u2019esecuzione del briefing preoperatorio, la presenza di una leadership che incoraggia la comunicazione di dubbi/criticit\ue0 prima dell\u2019intervento (diminuzione del gradiente gerarchico) e la discussione di eventuali problematiche in fase post-operatoria (debriefing). La rilevazione si \ue8 svolta nel periodo novembre-dicembre 2018. Per l\u2019analisi \ue8 stata utilizzata la statistica descrittiva valutando le percentuali di risposte positive (PPR; punteggi 4-5) e negative (PNR; punteggi 1-2) per dimensione e per singolo item. Risultati Sono stati compilati 90 questionari sui 151 distribuiti (tasso di risposta: 60%). La percezione globale della sicurezza \ue8 risultata buona/molto buona nel 61% del campione. Si evidenzia una PPR pari al 30%, 29% e 27%, rispettivamente per il briefing, la riduzione del gradiente gerarchico ed il debriefing. Le dimensioni inerenti competenze non tecniche mostrano una PPR compresa nel range 47%-57%. La possibilit\ue0 di segnalare comportamenti insicuri adottati da persone con maggiore autorit\ue0 si dimostra particolarmente critica (PNR = 35%; PPR = 43%), cos\uec come il supporto reciproco all\u2019interno del team (PPR = 36%). Notevolmente positivo risulta lo scambio tempestivo di informazioni chiave sul paziente (PPR = 68%; PNR = 11%), nonch\ue9 l\u2019item \u201cCi sentiamo liberi di fare domande quando qualcosa non sembra andare per il verso giusto\u201d (PPR = 67%). Il 61% degli operatori dichiara di segnalare raramente/mai eventi avversi o near miss, mentre il 21% dichiara di farlo sempre/nella maggioranza dei casi. Conclusioni Lo strumento ha permesso di fornire una fotografia accurata delle principali criticit\ue0/punti di forza inerenti la sicurezza del paziente all\u2019interno del setting indagato. Appare fondamentale che l\u2019organizzazione possa utilizzare i presenti risultati in un\u2019ottica propositiva, allo scopo di implementare le adeguate azioni di miglioramento ed il relativo monitoraggio

Type VI Osteogenesis imperfecta: effect of plasma transfusion on bone metabolism

Background: Type VI Osteogenesis Imperfecta (OI) is caused by homozygous or compound heterozygous null mutations in SERPINF1 gene, coding for pigment-epithelium derived factor (PEDF). Null SERPINF1 mutant patients appear healthy at birth and free from fractures until after 6 months of age, suggesting a protective effect of circulating maternal PEDF during fetal development. Moreover, unaffected asymptomatic heterozygotes parents, have PEDF circulating levels of about 1 mu g/mL, lower than normal concentrations and sufficient for a normal bone metabolism/development. This study aims to evaluate efficacy and safety of plasma administration and provide a minimum amount of PEDF similar to the levels found in heterozygotes in patients affected by type VI OI. Materials and methods: Ten patients (5-18 yrs old) were eligible for the study. Pharmaceutical grade plasma (Plasmasafe) (12-15 mL/Kg) was administered e.v. every month for 6 months. At baseline, before each plasma transfusion, and 6 months after the last plasma transfusion, PEDF, bone metabolic markers (Ca, P, 25-OH Vitamin D, PTH, bone ALP, osteocalcin, P1NP, DKK1, sclerostin, b CTX), iron and ferritin were determined. PEDF, DKK1, Sclerostin and P1NP were repeated 1, 2 and 7 days after first plasma administration to see the effective bloodstream increase and evaluate the short-term response. Results: Of the initial 10 patients, only 4 completed the study. PEDF (5 patients) showed an increase from <0.045 mu g/mL before infusion to 1,357 +/- 0.27 mu g/mL at day 1, returning to <0.045 mu g/mL from day 2 and thereafter. We found a significant decrease in DKK1 (p=0.05) and a non-significant increase in P1NP levels the day after the first transfusion, with a rapid return to previous levels. Biochemical markers of bone turnover and BMD did not show significant changes during the study. Conclusions: Plasma infusion at doses and intervals used in our study produced only a slight and not lasting increase in PEDF circulating levels, not useful to modify bone metabolic markers and BMD. The slight decrease in DKK1 could be an acute effect due to the administration of PEDF, confirming the relationship between PEDF and the Wnt/beta-catenin signaling pathway

COVID-19 pandemic: an Italian single institution's experience and lessons learned by public health residents' workforce

BACKGROUND: The Coronavirus Disease 2019 pandemic has posed incredible challenges to healthcare workers worldwide. The residents have been affected by an almost complete upheaval of the previous setting of activities, with a near total focus on service during the peak of the emergency. In our Institution, residents in public health were extensively involved in leading activities in the management of Coronavirus Disease 2019 pandemic.METHODS: We hereby provide a systematic description of the response actions in which the public health residents' workforce was pivotal, in a large tertiary hospital.RESULT: The key role played by residents in the response to Coronavirus Disease 2019 pandemic is highlighted by the diversity of contributions provided, from cooperation in the rearrangement of hospital paths for continuity of care, to establishing and running new services to support healthcare professionals. Overall, they constituted a workforce that turned essential in governing efficiently such a complex scenario.CONCLUSION: Despite the difficulties posed by the contingency and the sacrifice of many training activities, Coronavirus Disease 2019 pandemic turned out to be a unique opportunity of learning and measuring one's capabilities and limits in a context of absolute novelty and uncertainty

Comorbidities, Cardiovascular Therapies, and COVID-19 Mortality: A Nationwide, Italian Observational Study (ItaliCO)

Background: Italy has one of the world\u2019s oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertensionmedicationsmay increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown. Methods: Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site. Results: A large proportion of participating inpatients were 65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [adjOR = 1.35 (1.2, 1.5) p < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death. Conclusions: This Italian nationwide observational study of COVID-19 inpatients, the majority of which 65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide