L'impatto del ruolo delle Emergency Nurse Practitioners nella gestione clinica dei pazienti nel contesto di un Dipartimento di Emergenza Urgenza nel Regno Unito

RIASSUNTOAll'interno di Strutture per la gestione delle Emergenze-Urgenze, diverse figure professionali sanitarie intervengono nella gestione e nel trattamento del paziente che presenta livelli di gravití  clinica diversi. In questo studio si descrive ed analizza il ruolo di figure infermieristiche che hanno acquisito livelli di formazione diversi e che si integrano con lo staff medico nella gestione di pazienti con codici di bassa e media priorití  al trattamento. La metodologia utilizzata è la case study research. Si propongono tre casi clinici gestiti all'interno del Servizio See and Treat e nella Major Area del Wishaw General Hospital, Glasgow, Scozia. Attraverso la descrizione e l'analisi dei casi clinici è possibile fornire elementi di approfondimento e di discussione di modelli di gestione clinica ed organizzativa innovativi, in cui infermieri specializzati si integrano all'interno dell'équipe, in modo non conflittuale assumendo responsabilití  cliniche, oltre che assistenziali in totale o parziale autonomia dal medico. Parole chiave: Emergency Nurse Practitioner, Dipartimento di Emergenza-Urgenza, Servizio "Vedi e Tratta", Pratica infermieristica avanzataABSTRACTVarious professional health figures participate in the management and treatment of patients in Emergency-Casualty structures presenting diverse levels of clinical severity. This study describes and analyses the role of nursing figures who have acheived different levels of training who collaborate with medical staff in the management of low and medium priority patients, using the case study research method. Three cases treated in the See and Treat Service and in the Major Area of the Wishaw General Hospital, Glasgow, Scozia are described.Key words: Emergency Nurse Practitioner, Emergency-Casualty Department, "See and Treat" Service, Advanced Nursin

Bullying in Ticino’s healthcare contexts: Impact on employee’s well being and organization

INTRODUCTION: Bullying in health care setting has a globally prevalence between 1% and 87% and it’s in constant increase described by ”WHO” as: “Bullying is a major public health problem”.  It is defined as a repeated ill-treatment, harmful for the health of one or more individuals by one or more people. There are different types of behaviours and they vary from verbal abuse, offensive conduct, humiliating and intimidating attitudes. Those attitudes won’t help you doing your job. Different are the outcomes that those actions have on victims: anxiety, sleep disturbances, generalized pain and reduced attention. The objective of the study was to investigate the presence of the phenomenon within the Ticino (Swiss Canton) on healthcare contexts and to explain its experiences.  METHODS: A qualitative study was conducted on a sample of healthcare professionals who are active in the Ticino (Switzerland) healthcare context through 18 semi-structured interviews and their thematic analysis.  RESULTS: The results that emerged shows how the problem is also relevant in Ticino`s healthcare contexts, sometimes with different modalities and outcomes, moreover, experiencing these situations during one's working career leads to re-proposing such behaviours, as it is considered a rite of passage.  What emerges in a predominant way is the lack of programs or structures aimed to prevent and support the victim and the perpetrator.  CONCLUSION: It has emerged that the presence of bullying in Ticino healthcare’s sector is relevant and it has a negative impact on the bullied care staff and on the outcome of quality care to patients. INTRODUZIONE: Il bullismo nel settore sanitario ha una prevalenza, a livello mondiale, che varia dal 1% al 87%, ed è in continuo aumento, descritto dalla WHO come un “grave problema di salute pubblica”.  Viene definito come ripetuti maltrattamenti dannosi per la salute di uno o più individui da parte di una a più persone. Diverse sono le tipologie di comportamenti e variano da abusi verbali, condotte offensive, atteggiamenti umilianti e intimidatori che impediscono di svolgere il proprio lavoro. Come diversi sono gli esiti che tali azioni hanno sulle vittime: ansia, disturbi del sonno, dolori generalizzati e ridotta attenzione.  L’obiettivo dello studio è stato indagare la presenza del fenomeno all’interno dei contesti sanitari ticinesi ed esplicitarne i vissuti.  METODI: È stato condotto uno studio di tipo qualitativo ad un campione di professionisti attivi nel contesto sanitario ticinese (Svizzera) attraverso 18 interviste semi-strutturate e l’analisi tematica delle stesse.  RISULTATI: I risultati emersi evidenziano che la problematica è presente anche nei contesti sanitari ticinesi con modalità ed esiti talvolta differenti, inoltre che sperimentare queste situazioni durante la propria carriera lavorativa porta a riproporre tali comportamenti, in quanto ritenuto un rito di passaggio.  Ciò che è emerge in maniera preponderante è la mancanza di programmi o strutture volte alla prevenzione e al sostengo sia della vittima che del carnefice.  CONCLUSIONE: Le esperienze emerse hanno confermato la presenza del bullismo nel settore sanitario ticinese e come le conseguenze abbiano un impatto negativo sia sul personale curante bullizzato sia sulla qualità delle cure erogate ai pazienti.  &nbsp

Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used.

Background Many complex intervention trials fail to show an intervention effect. Although this may be due to genuine ineffectiveness, it may also be the result of sub-optimal intervention design, implementation failure or a combination of these. Given current financial constraints and the pressure to reduce waste and increase value in health services research, pre-trial strategies are needed to reduce the likelihood of design or implementation failure and to maximise the intervention’s potential for effectiveness. In this scoping review, we aimed to identify and synthesise the available evidence relating to the strategies and methods used to ‘optimise’ complex interventions at the pre-trial stage. Methods We searched MEDLINE, CINAHL, AMED, PsycINFO and ProQuest Nursing & Allied Health Source for papers published between January 2000 and March 2015. We included intervention development and optimisation studies that explored potential intervention weaknesses and limitations before moving to a definitive randomised controlled trial (RCT). Two reviewers independently applied selection criteria and systematically extracted information relating to the following: study characteristics; intervention under development; framework used to guide the development process; areas of focus of the optimisation process, methods used and outcomes of the optimisation process. Data were tabulated and summarised in a narrative format. Results We screened 3968 titles and 231 abstracts for eligibility. Eighty-nine full-text papers were retrieved; 27 studies met our selection criteria. Optimisation strategies were used for a range of reasons: to explore the feasibility and acceptability of the intervention to patients and healthcare professionals; to estimate the effectiveness and cost-effectiveness of different combinations of intervention components; and to identify potential barriers to implementation. Methods varied widely across studies, from interviews and focus groups to economic modelling and probability analysis. Conclusions The review identifies a range of optimisation strategies currently used. Although a preliminary classification of these strategies can be proposed, a series of questions remain as to which methods to use for different interventions and how to determine when the intervention is ready or ‘optimised enough’ to be tested in a RCT. Future research should explore potential answers to the questions raised, to guide researchers in the development and evaluation of more effective interventions

An Optimized Workflow for the Discovery of New Antimicrobial Compounds Targeting Bacterial RNA Polymerase Complex Formation

Bacterial resistance represents a major health problem worldwide and there is an urgent need to develop first-in-class compounds directed against new therapeutic targets. We previously developed a drug-discovery platform to identify new antimicrobials able to disrupt the protein-protein interaction between the beta' subunit and the sigma(70) initiation factor of bacterial RNA polymerase, which is essential for transcription. As a follow-up to such work, we have improved the discovery strategy to make it less time-consuming and more cost-effective. This involves three sequential assays, easily scalable to a high-throughput format, and a subsequent in-depth characterization only limited to hits that passed the three tests. This optimized workflow, applied to the screening of 5360 small molecules from three synthetic and natural compound libraries, led to the identification of six compounds interfering with the beta'-sigma(70) interaction, and thus was capable of inhibiting promoter-specific RNA transcription and bacterial growth. Upon supplementation with a permeability adjuvant, the two most potent transcription-inhibiting compounds displayed a strong antibacterial activity against Escherichia coli with minimum inhibitory concentration (MIC) values among the lowest (0.87-1.56 mu M) thus far reported for beta'-sigma PPI inhibitors. The newly identified hit compounds share structural feature similarities with those of a pharmacophore model previously developed from known inhibitors

Researching complex interventions in health: the state of the art

CITATION: Craig, P., et al. 2016. Researching complex interventions in health : the state of the art. BMC Health Services Research, 16:101, doi:10.1186/s12913-016-1274-0.The original publication is available at https://bmchealthservres.biomedcentral.comENGLISH SUMMARY : Keynote presentationsPublishers' Versio

Interplay of digital proximity app use and SARS-CoV-2 vaccine uptake in Switzerland : analysis of two population-based cohort studies

Objectives: Our study aims to evaluate developments in vaccine uptake and digital proximity tracing app use in a localized context of the SARS-CoV-2 pandemic. Methods: We report findings from two population-based longitudinal cohorts in Switzerland from January to December 2021. Failure time analyses and Cox proportional hazards regression models were conducted to assess vaccine uptake and digital proximity tracing app (SwissCovid) uninstalling outcomes. Results: We observed a dichotomy of individuals who did not use the SwissCovid app and did not get vaccinated, and who used the SwissCovid app and got vaccinated during the study period. Increased vaccine uptake was observed with SwissCovid app use (aHR, 1.51; 95% CI: 1.40–1.62 [CI-DFU]; aHR, 1.79; 95% CI: 1.62–1.99 [CSM]) compared to SwissCovid app non-use. Decreased SwissCovid uninstallation risk was observed for participants who got vaccinated (aHR, 0.55; 95% CI: 0.38–0.81 [CI-DFU]; aHR, 0.45; 95% CI: 0.27–0.78 [CSM]) compared to participants who did not get vaccinated. Conclusion: In evolving epidemic contexts, these findings underscore the need for communication strategies as well as flexible digital proximity tracing app adjustments that accommodate different preventive measures and their anticipated interactions

Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes—A Cohort Study From Switzerland

Objectives: To describe the frequency of and reasons for changes in healthcare utilization in those requiring ongoing treatment, and to assess characteristics associated with change, during the second wave of the pandemic.Methods: Corona Immunitas e-cohort study (age ≥20 years) participants completed monthly questionnaires. We compared participants reporting a change in healthcare utilization with those who did not using descriptive and bivariate statistics. We explored characteristics associated with the number of changes using negative binomial regression.Results: The study included 3,190 participants from nine research sites. One-fifth reported requiring regular treatment. Among these, 14% reported a change in healthcare utilization, defined as events in which participants reported that they changed their ongoing treatment, irrespective of the reason. Reasons for change were medication changes and side-effects, specifically for hypertension, or pulmonary embolism treatment. Females were more likely to report changes [Incidence Rate Ratio (IRR) = 2.15, p = 0.002]. Those with hypertension were least likely to report changes [IRR = 0.35, p = 0.019].Conclusion: Few of those requiring regular treatment reported changes in healthcare utilization. Continuity of care for females and chronic diseases besides hypertension must be emphasized

Interplay of Digital Proximity App Use and SARS-CoV-2 Vaccine Uptake in Switzerland: Analysis of Two Population-Based Cohort Studies

Objectives: Our study aims to evaluate developments in vaccine uptake and digital proximity tracing app use in a localized context of the SARS-CoV-2 pandemic.Methods: We report findings from two population-based longitudinal cohorts in Switzerland from January to December 2021. Failure time analyses and Cox proportional hazards regression models were conducted to assess vaccine uptake and digital proximity tracing app (SwissCovid) uninstalling outcomes.Results: We observed a dichotomy of individuals who did not use the SwissCovid app and did not get vaccinated, and who used the SwissCovid app and got vaccinated during the study period. Increased vaccine uptake was observed with SwissCovid app use (aHR, 1.51; 95% CI: 1.40–1.62 [CI-DFU]; aHR, 1.79; 95% CI: 1.62–1.99 [CSM]) compared to SwissCovid app non-use. Decreased SwissCovid uninstallation risk was observed for participants who got vaccinated (aHR, 0.55; 95% CI: 0.38–0.81 [CI-DFU]; aHR, 0.45; 95% CI: 0.27–0.78 [CSM]) compared to participants who did not get vaccinated.Conclusion: In evolving epidemic contexts, these findings underscore the need for communication strategies as well as flexible digital proximity tracing app adjustments that accommodate different preventive measures and their anticipated interactions

Dry and wet approaches for genome-wide functional annotation of conventional and unconventional transcriptional activators

Transcription factors (TFs) are master gene products that regulate gene expression in response to a variety of stimuli. They interact with DNA in a sequence-specific manner using a variety of DNA-binding domain (DBD) modules. This allows to properly position their second domain, called “effector domain”, to directly or indirectly recruit positively or negatively acting co-regulators including chromatin modifiers, thus modulating preinitiation complex formation as well as transcription elongation. At variance with the DBDs, which are comprised of well-defined and easily recognizable DNA binding motifs, effector domains are usually much less conserved and thus considerably more difficult to predict. Also not so easy to identify are the DNA-binding sites of TFs, especially on a genome-wide basis and in the case of overlapping binding regions. Another emerging issue, with many potential regulatory implications, is that of so-called “moonlighting” transcription factors, i.e., proteins with an annotated function unrelated to transcription and lacking any recognizable DBD or effector domain, that play a role in gene regulation as their second job. Starting from bioinformatic and experimental high-throughput tools for an unbiased, genome-wide identification and functional characterization of TFs (especially transcriptional activators), we describe both established (and usually well affordable) as well as newly developed platforms for DNA-binding site identification. Selected combinations of these search tools, some of which rely on next-generation sequencing approaches, allow delineating the entire repertoire of TFs and unconventional regulators encoded by the any sequenced genome