Sviluppo di un sistema informativo utilizzando un linguaggio infermieristico standard per la realizzazione di un Nursing Minimum Data Set

RIASSUNTOUn sistema informativo infermieristico, dovrebbe fornire dati utili per valutare l'assistenza infermieristica erogata e per descrivere lo stato di salute della popolazione. Attualmente, sia in Italia che in altri paesi, a causa di una documentazione infermieristica poco strutturata, le informazioni sull'assistenza prestata e sui reali bisogni di salute della popolazione, risultano incomplete. Lo sviluppo di sistemi informativi contenenti dei Nursing Minimum Data Set (NMDS) è indispensabile per poter valutare l'assistenza infermieristica. Per poter essere utilizzati nella valutazione dell'assistenza, dei costi e dei bisogni di salute, i dati del NMDS devono essere raccolti tramite l'utilizzo di un linguaggio infermieristico standard. Il futuro prossimo è senz'altro legato all'utilizzo di una documentazione sanitaria informatizzata che utilizzi terminologie standardizzate. La transizione demografica e l'evoluzione epidemiologica impongono al sistema sanitario di favorire la continuití  assistenziale e con essa la creazione di solidi flussi informativi. In quest'ottica si inserisce il progetto, nato da una collaborazione tra l'Universití  Tor Vergata di Roma e l'Agenzia di Sanití  Pubblica della Regione Lazio, per realizzare un sistema informatico utilizzando un linguaggio infermieristico standard. Il software che si intende sviluppare, tramite collegamenti esistenti al suo interno tra accertamento infermieristico, diagnosi infermieristiche, interventi, risultati di assistenza e problemi collaborativi, si propone di fornire un supporto al processo decisionale dell'infermiere ed alla documentazione della sua attivití . I dati forniti dal sistema informatico permetteranno la misurazione delle attivití , dei costi della pratica infermieristica, nonché l'impatto di essa sulla salute dell'assistito. Durante la sperimentazione, determinante sarí  la formazione e il coinvolgimento del personale.Parole chiave: Documentazione infermieristica, Diagnosi infermieristiche, Informatica infermieristica, Documentazione sanitaria elettronica, Sistemi informativi, Nursing Minimum Data SetABSTRACTThe aim of a nursing data set is to provide useful information for assessing the level of care and the state of health of the population. Currently, both in Italy and in other countries, this data is incomplete due to the lack of a structured nursing documentation , making it indispensible to develop a Nursing Minimum Data Set (NMDS) using standard nursing language to evaluate care, costs and health requirements. The aim of the project described , is to create a computer system using standard nursing terms with a dedicated software which will aid the decision-making process and provide the relative documentation. This will make it possible to monitor nursing activity and costs and their impact on patients' health : adequate training and involvement of nursing staff will play a fundamental role. Key words: Nursing documentation, nursing diagnosis, computerized nursing , electronic health documentation, computer systems, Nursing Minimum Data Set

I-scan optical enhancement for the in vivo prediction of diminutive colorectal polyp histology:results from a prospective three-phased multicentre trial

BACKGROUND AND AIMS:Dye-less chromoendoscopy is an emerging technology for colorectal polyp characterization. Herein, we investigated whether the newly introduced I-scan optical enhancement (OE) can accurately predict polyp histology in vivo in real-time. METHODS:In this prospective three-phased study, 84 patients with 230 diminutive colorectal polyps were included. During the first two study phases, five endoscopists assessed whether analysis of polyp colour, surface and vascular pattern under i-scan OE can differentiate in vivo between adenomatous and hyperplastic polyps. Finally, junior and experienced endoscopists (JE, EE, each n = 4) not involved in the prior study phases made a post hoc diagnosis of polyp histology using a static i-scan OE image database. Histopathology was used as a gold-standard in all study phases. RESULTS:The overall accuracy of i-scan OE for histology prediction was 90% with a sensitivity, specificity, positive (PPV) and negative prediction value (NPV) of 91%, 90%, 86% and 94%, respectively. In high confidence predictions, the diagnostic accuracy increased to 93% with sensitivity, specificity, PPV and NPV of 94%, 91%, 89% and 96%. Colonoscopy surveillance intervals were predicted correctly in ≥ 90% of patients. In the post hoc analysis EE predicted polyp histology under i-scan OE with an overall accuracy of 91%. After a single training session, JE achieved a comparable diagnostic performance for predicting polyp histology with i-scan OE. CONCLUSION:The histology of diminutive colorectal polyps can be accurately predicted with i-scan OE in vivo in real-time. Furthermore, polyp differentiation with i-scan OE appears to require only a short learning curve

Recombinant Clostridium difficile Toxin Fragments as Carrier Protein for PSII Surface Polysaccharide Preserve Their Neutralizing Activity

Clostridium difficile is a Gram-positive bacterium and is the most commonly diagnosed cause of hospital-associated and antimicrobial-associated diarrhea. Despite the emergence of epidemic C. difficile strains having led to an increase in the incidence of the disease, a vaccine against this pathogen is not currently available. C. difficile strains produce two main toxins (TcdA and TcdB) and express three highly complex cell-surface polysaccharides (PSI, PSII and PSIII). PSII is the more abundantly expressed by most C. difficile ribotypes offering the opportunity of the development of a carbohydrate-based vaccine. In this paper, we evaluate the efficacy, in naive mice model, of PSII glycoconjugates where recombinant toxins A and B fragments (TcdA_B2 and TcdB_GT respectively) have been used as carriers. Both glycoconjugates elicited IgG titers anti-PSII although only the TcdB_GT conjugate induced a response comparable to that obtained with CRM197. Moreover, TcdA_B2 and TcdB_GT conjugated to PSII retained the ability to elicit IgG with neutralizing activity against the respective toxins. These results are a crucial proof of concept for the development of glycoconjugate vaccines against C. difficile infection (CDI) that combine different C. difficile antigens to potentially prevent bacterial colonization of the gut and neutralize toxin activity

Deciphering the structure–immunogenicity relationship of anti-Candida glycoconjugate vaccines

Elucidation of the molecular immunity of glycoconjugate vaccines has focused on the carbohydrate moiety, herein the effect of the corresponding conjugation sites is studied

Epileptiform patterns predicting unfavorable outcome in postanoxic patients: A matter of time?

Objective: Historically, epileptiform malignant EEG patterns (EMPs) have been considered to anticipate an unfavorable outcome, but an increasing amount of evidence suggests that they are not always or invariably associated with poor prognosis. We evaluated the prognostic significance of an EMP onset in two different timeframes in comatose patients after cardiac arrest (CA): early-EMPs and late-EMPs, respectively. Methods: We included all comatose post-CA survivors admitted to our intensive care unit (ICU) between 2016 and 2018 who underwent at least two 30-minute EEGs, collected at T0 (12-36 h after CA) and T1 (36-72 h after CA). All EEGs recordings were re-analyzed following the 2021 ACNS terminology by two senior EEG specialists, blinded to outcome. Malignant EEGs with abundant sporadic spikes/sharp waves, rhythmic and periodic patterns, or electrographic seizure/status epilepticus, were included in the EMP definition. The primary outcome was the cerebral performance category (CPC) score at 6 months, dichotomized as good (CPC 1-2) or poor (CPC 3-5) outcome. Results: A total of 58 patients and 116 EEG recording were included in the study. Poor outcome was seen in 28 (48%) patients. In contrast to late-EMPs, early-EMPs were associated with a poor outcome (p = 0.037), persisting after multiple regression analysis. Moreover, a multivariate binomial model coupling the timing of EMP onset with other EEG predictors such as T1 reactivity and T1 normal voltage background can predict outcome in the presence of an otherwise non-specific malignant EEG pattern with quite high specificity (82%) and moderate sensitivity (77%). Conclusions: The prognostic significance of EMPs seems strongly time-dependent and only their early-onset may be associated with an unfavorable outcome. The time of onset of EMP combined with other EEG features could aid in defining prognosis in patients with intermediate EEG patterns

In-vivo Axial-strain Sonoelastography Helps Distinguish Acutely-inflamed from Fibrotic Terminal Ileum Strictures in Patients with Crohn's Disease: Preliminary Results

We tested real-time sonoelastography (RTS) in-vivo to differentiate fibrotic from inflammatory terminal ileum strictures in patients with Crohn's disease (CD), using magnetic resonance enterography (MRE) as a reference standard. Sixteen patients (13 male, 3 female; median [interquartile interval] age = 41 [31-48.5] y; median C-reactive protein (CRP) = 0.95 [0-2.23] mg/dL; median disease duration = 108.5 [35-213.75] mo; median Harvey-Bradshaw Index (HBI) = 3 [3-5.25]) with terminal ileum CD were prospectively included. Short-axis scans were performed; each cross-section was ideally sub-divided into eight circular sectors. Color map provided by RTS was translated into semi-quantitative scale (1 = red; 2 = green; 3 = blue). At MRE, inflammation was seen in nine patients and fibrosis in seven. Total median RTS score was significantly lower in patients with inflammatory stricture (16 [16-18]) than in patients with fibrosis (20 [17.5-22]; p = 0.003). The same happened when the four most superficial quadrants of the loop were considered (8 [7-9] vs. 10 [9-11.5]; p = 0.003). No significant correlation was seen between RTS and HBI (r = 0.467; p = 0.686), RTS and CRP (r = -0.750; p = 0.567) or RTS and disease duration (r = 0.238; p = 0.483). RTS of the terminal ileum in patients with CD is feasible in-vivo, potentially differentiating between fibrotic and inflammatory stricture

A Synthetic Disaccharide Analogue from Neisseria meningitidis A Capsular Polysaccharide Stimulates Immune Cell Responses and Induces Immunoglobulin G (IgG) Production in Mice When Protein-Conjugated

Some new phosphonoester-linked oligomers, stabilized analogues of the corresponding phosphate-bridged oligomers of Neisseria meningitidis A (MenA) capsular polysaccharide (CPS), were conjugated to human serum albumin (HSA), as a protein carrier model, and studied for immunological activities. We determined (i) in vitro, their biocompatibility (CAM test) and activity in inducing both T cell proliferation (CFSE method) and IL-2 release (ELISA), and (ii) in vivo, their ability to stimulate specific IgG antibody production (ELISA). All HSA-conjugated compounds induce T cell proliferation (40% of proliferation at 10² μM), whereas only the phosphonodisaccharide was effective (28% of proliferation at 10² μM) among the unconjugated forms. IL-2 release confirmed these results. In addition, the HSA-conjugated showed in vivo the capacity of eliciting the production of specific IgG antibodies. In conclusion, we obtained novel biocompatible, water-stable, and immunoactive MenA CPS analogues. A short disaccharide fragment showed the unusual behavior of triggering T cell proliferation in vitro

Epidemiological features and disease-related concerns of a large cohort of Italian patients with active Crohn\u2019s disease

Background-Aims: The SOLE study was conducted on a large cohort of Italian patients with moderatesevere Crohn\u2019s disease (CD) to assess epidemiological and disease characteristics and their correlation with disease-related worries, treatment satisfaction and adherence, workability. Methods: The following tools were used over 12 months to assess: \u2022 disease-related worries: Rating Form of Inflammatory Bowel Disease Patient Concerns, \u2022 impact on workability: Work Productivity and Activity Impairment-CD, \u2022 satisfaction: Treatment Satisfaction Questionnaire for Medication, \u2022 adherence: Medication Adherence Rating Scale. Results were correlated with demographic and clinical variables with linear regression models. Results: 552 patients with active CD (51% men) were recruited. Higher worries were having an ostomy bag and undergoing surgery. Variables associated with a higher RFIPC score included female sex, higher disease activity, lower treatment adherence (p < 0.001), previous surgical treatments (p = 0.003). 60% of patients claimed difficulties with activities of daily living. Lower VAS scores were reported by patients with disease duration >6years; treatment satisfaction/adherence was higher with anti-TNF- treatment. Decreased hospitalizations during follow-up and improved workability/daily activities occurred with adalimumab, infliximab, azathioprine (p < 0.001). Conclusion: Worries included having an ostomy bag, undergoing surgery, developing cancer: conditions significantly associated with worsened disease activity and low treatment adherence. Higher treatment adherence scores/greater workability improvements were observed in patients treated with anti-TNF- agents

Immunoactivity of Protein Conjugates of Carba Analogues from <i>Neisseria meningitidis</i> A Capsular Polysaccharide

<i>Neisseria meningitidis</i> type A (MenA) is a Gram-negative encapsulated bacterium that is a major cause of epidemic meningitis, especially in the sub-Saharan region of Africa. The development and manufacture of a liquid glycoconjugate vaccine against MenA are hampered by the poor hydrolytic stability of its capsular polysaccharide (CPS), consisting of (1→6)-linked 2-acetamido-2-deoxy-α-d-mannopyranosyl phosphate repeating units. The replacement of the ring oxygen with a methylene group to generate a carbocyclic analogue leads to enhancement of its chemical stability. Herein, we report conjugation of carbocyclic analogue monomer, dimer, and trimer to the protein carrier CRM₁₉₇. After immunization in mice, only the conjugated trimer was able to induce specific anti-MenA polysaccharide IgG antibodies with <i>in vitro</i> bactericidal activity, although to a lesser extent than pentadecamer and hexamer oligomers obtained from mild acid hydrolysis of the native polysaccharide conjugated to the same protein carrier. This study represents the first proof-of-concept that hydrolytically stable structural analogues of saccharide antigens can be used for the development of efficacious antimicrobial preventative therapies. Conjugates with longer carbocyclic oligomers and/or precise acetylation patterns could further increase the induced immune response to a level comparable with those of commercially available anti-meningococcal glycoconjugate vaccines