Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs

Acute glyco-metabolic decompensation during septic shock

Hyper-glycemy is commonly described as a complication in patients affected by septic states, regardless of their having had diabetes. Numerous studies also record the presence of glyco-metabolic decompensations in patients affected by leukemia and lymphoma treated with chemotherapy. The case under study interesting and peculiar as there is no mention of glycemy levels so high to be not suitable for life. It is interesting also the patient's good therapeutical response, their marrow aplasia status and general poor health condition notwithstanding

Factors affecting attitudes and barriers to a medical emergency team among nurses and medical doctors: A multi-centre survey

Aim: To identify factors underlying attitudes towards the medical emergency team (MET) and barriers to its utilisation among ward nurses and physicians. Methods: Multicentre survey using an anonymous questionnaire in hospitals with a fully operational MET system in the Piedmont Region, Italy. Response to questions was scored on a 5-point Likert-type agreement scale. Dichotomised results were included in a logistic regression model. Results: Among 2279 staff members who were contacted, 1812 (79.6%) completed the survey. The vast majority of respondents valued the MET. Working in a surgical vs. medical ward and having participated in either the MET educational programme (MET. al course) or MET interventions were associated with better acceptance of the MET system. Reluctance by nurses to call the covering doctor first instead of the MET for deteriorating patients (62%) was significantly less likely in those working in surgical vs. medical wards or having a higher seniority or a MET. al certification (OR 0.51 [0.4-0.65], 0.69 [0.47-0.99], and 0.6 [0.46-0.79], respectively). Reluctance to call the MET in a patient fulfilling calling criteria (21%), was less likely to occur in medical doctors vs. nurses and in surgical vs. medical ward staff, and it was unaffected by the MET. al certification. Conclusions: The MET was well accepted in participating hospitals. Nurse referral to the covering physician was the major barrier to MET activation. Medical status, working in surgical vs. medical wards, seniority and participation in the MET. al educational programme were associated with lower likelihood of showing barriers to MET activation

Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region

Aims to report the incidence, characteristics, and outcome of in-hospital cardiac arrest (IHCA) in a large Italian region. Setting all hospitals participating in the IHCA Registry Initiative of Piedmont. Methods observational cohort study in adult (>18 year old) inpatients resuscitated from IHCA during three consecutive years (2012\ue2\u80\u932014). The main outcome measures were IHCA incidence and survival to hospital discharge. Results A total of1539 arrests in adult inpatients were recorded in the study period, yielding an overall incidence of 1.51 arrests/1000 admissions. The incidence was highest at day 1 after hospital admission and in the morning hours, with a peak at 9.00 a.m. Median age was 77 (interquartile range 68\ue2\u80\u9383) years. The presenting rhythm was ventricular fibrillation/pulseless ventricular tachycardia in 291/1539 (18.9%) cases. A total of 549/1539 (35.7%) patients achieved recovery of spontaneous circulation (ROSC) and 228/1539(14.8%) survived hospital discharge, with 207 (90.8%) of the latter having good neurological outcome (Cerebral Performance Categories [CPC] 1 or 2).After adjustment for major confounders, a pre-arrest CPC = 1, a cardiac cause of arrest, a shockable presenting rhythm, and a shorter duration of resuscitation were independently associated with a higher likelihood of survival to discharge. Conclusions in this Italian registry the incidence of IHCA and its circadian distribution were comparable to those in the NCAA registry in the UK. Patients were older and had a lower ROSC rate than these observed in other large IHCA registries, but post-ROSC survival rate and factors affecting survival to discharge were similar

Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged  >  65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019

Percorsi creativi di turismo urbano Creative paths of urban tourism I luoghi dell'entertainment nella citt\ue0 del tempo libero

Le specializzazioni funzionali, con mirati interventi di riqualificazione, spesso modificano gli impianti urbani esistenti per destinarli allo svago, alle attivit\ue0 ludiche, ai luoghi della cosiddetta \u201cutopia d\u2019evasione\u201d. Shopping, movida, sport, benessere, parchi urbani, spiagge urbane, acquari e parchi acquatici, bio-zoo, lunapark, water-front sono vere e proprie macchine per il divertimento dove spesso l\u2019artificiale diviene un richiamo irresistibile. Tali tendenze comportano spesso l\u2019innesco di processi di Disneyficazione dei luoghi, un fenomeno complesso con aspetti contrastanti che vanno considerati ed indagati non solo dal punto di vista strettamente turistico ma anche sociale e territoriale. Infatti il linguaggio delle immagini generato dal racconto iconografico delle cartoline, delle foto e oggi da quello narrativo del cinema e delle fiction ha alimentato la diffusione della cultura visuale della citt\ue0. Cos\uec come la Kodakizzazione che genera curiosit\ue0 e interesse per i luoghi producendo spesso delle mappe esperienziali. L\u2019immagine urbana ha da sempre risentito dello sguardo dei cineasti. Al cinema si \ue8 aggiunta oggi la proliferazione delle fiction e serie tv (per es. Don Matteo, Elisa di Rivombrosa, il Commissario Montalbano) con ritorni sorprendenti sotto il profilo delle presenze turistiche. Si tratta di una nuova El Dorado o ancora di illusioni di sviluppo per i territori