The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Hospital discharge for stroke patients: Transitional Care is Brain

BACKGROUND: Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden. Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability. This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy). METHODS: In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment. We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients. Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility). RESULTS: Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%). The recanalization rate was 32% (150 on 464 ischemic stroke patients). Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities. About 8% (52 patients) of the overall sample died in hospital. CONCLUSIONS: Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional. Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients. KEY MESSAGES: • A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients. • Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage

COVID-19 impact on familial relationships and mental health in a representative sample of adults

BACKGROUND: Benefits of the stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be weighed against its impact on citizens’ health. In a country with a solid familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have worsened mental health. METHODS: A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April-3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess confinement impact on mental health through validated scales before and during the lockdown. RESULTS: Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR 1.74, 95% confidence interval, CI 1.49-2.03) and quantity (OR 1.50, 95%CI 1.28-1.76), depressive (OR 1.32, 95% CI 1.14-1.53) and anxiety symptoms (OR 1.53, 95%CI 1.32-1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR 2.32, 95%CI 1.76-3.05) and quantity (OR 1.80, 95%CI 1.36-2.37), depressive (OR 1.79, 95%CI 1.39-2.31) and anxiety symptoms (OR 1.90, 95%CI 1.48-2.46) was also associated with reduced babysitting help. In subjects with poorer housing and teleworking, mental health outcomes were worse. CONCLUSIONS: Confinement came along with reduced familial support from parents, negatively impacting mental health. Social networks and support within families provided by older relatives act as a resilience factor and a potential vulnerability that affects mental health outcomes. Health and social services response should be designed to address mental health needs and mitigate long-term health costs caused by the pandemic's unprecedented stressfulness and unknown duration. KEY MESSAGES: National lockdown measures came along with reduced housework help supply for a large proportion of adult parents who presented increased mental health symptoms with unsatisfactory quality of life. A global, multi-level socioeconomic interdisciplinary approach is needed to inform evidence-based family and welfare policies and prevention strategies centred on population wellbeing

Hospital hand hygiene after COVID-19: has the pandemic heightened healthcare workers’ awareness?

BACKGROUND: Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs’ adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities. METHODS: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs’ adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice. RESULTS: Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was “after body fluid exposure risk” (76%), whereas the lowest were “after touching the patient's setting” (40%) and “before touching a patient” (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians’ and nurses’ adherence was respectively 45% and 61%. Audits occasionally revealed non-conformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves). CONCLUSIONS: These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs’ adherence to optimal practices needs specific initiatives to promote correct HH. KEY MESSAGES: • The COVID‐19 pandemic reinforced the importance of handwashing and IPC, showing the key role of the HCWs’ adherence to hand hygiene (HH) procedures. • HH audits play a leading part in clinical governance and IPC, aiming at enhancing the quality of care and patient safety, particularly to strengthen health system resilience in post-COVID era

COVID-19 lockdown impact on familial relationships and mental health in a large representative sample of Italian adults

Purpose: Benefits of national-level stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be carefully weighed against its impact on citizens’ health. In a country with a strong familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have resulted in mental health worsening. Methods: A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April–3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess the impact of confinement on mental health, through validated scales before and during lockdown. Results: Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR = 1.74, 95% confidence interval, CI 1.49–2.03) and quantity (OR = 1.50, 95% CI 1.28–1.76), depressive (OR = 1.32, 95% CI 1.14–1.53) and anxiety symptoms (OR = 1.53, 95% CI 1.32–1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR = 2.32, 95% CI 1.76–3.05), and quantity (OR = 1.80, 95% CI 1.36–2.37), depressive (OR = 1.79, 95% CI 1.39–2.31) and anxiety symptoms (OR = 1.90, 95% CI 1.48–2.46) was also associated with reduced babysitting help. Mental health outcomes were worse in subjects with poorer housing and teleworking during lockdown. Conclusion: Confinement came along with reduced familial support from parents, negatively impacting household members’ mental health. Our findings might inform evidence-based family and welfare policies to promote population health within and beyond pandemic times