Adoption and Implementation of the Surgical Safety Checklist: Improving Safety in an Italian Teaching Hospital

Although it is known that clinical risk management tools such as the Surgical Checklist lead to greater safety for patients and protection for the operators, clinical risk management units have much work to do to implement and spread the use of quality health care tools

Sepsis and nosocomial infections: The role of medico-legal experts in Italy

Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people’s loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers’ work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections

Undetected patricide: Inaccuracy of cause of death determination without an autopsy

Patricide (killing the father) is uncommon form of homicide. Usually the assaults occur at home in the absence of witnesses and adult sons are frequently involved. Homicides in a domestic context usually do not tend to recurrence, because the motivation for the crime ends with the death of the parent. However, this is not what was observed in the present case study dealing with the death of a 70 years old white man originally misclassified as accident and discovered three years later only after an additional homicide in a family context of a 60 years old white lady. Multiple stab wounds to the neck and thorax were misinterpreted at the external male body examination as blunt trauma falling down stairs. No forensic autopsy was requested and no comparison of medical findings with the results from the death scene, such as a bloodstain analysis was performed by the police officers nor required by the judicial authority. This was quite surprising because an additional but preliminary post-mortem external examination performed by a general practitioner on the male body already raised the suspicion that the external lesions were stab wounds thus requiring a forensic autopsy. Only the exhumation of the elderly body, performed years later, confirmed the diagnostic hypothesis raised by the first physician. The present case is quite representative of a death investigation not run professionally and performed by individuals with no specific training where most of the medico-legal investigations (especially for traumatic and violent deaths) are restricted to an external body examination without subsequent autopsy. Although misinterpretation of external lesions is inevitable and significant discrepancies between external body examination and forensic autopsy are not rare, in the case of contradictory results of postmortem external examination or unclear/suspicious cause and manner of death, investigation should proceed necessarily with a forensic autopsy

IDIOPATIC LIVER RUPTURE: AN ITALIAN CASE REPORT

The liver can be damaged from an impact (such as in a car accident) or from penetrating trauma (such as a stab or gunshot wound). Liver lesions range from relatively small collections of blood (hematomas) to large deep lacerations. Since the liver is supplied with many large blood vessels, the main problem following a liver injury is severe bleeding. Almost all bleeding from a liver injury occurs in the abdominal cavity. Spontaneous rupture of the liver is a rare occurrence. This is often associated with underlying pathological conditions (pregnant women with HELLP syndrome, liver pathologies such as adenoma, hepatic lymphoma, hepatocellular carcinoma HCC, macronodular cirrhosis, hemangioma, metastatic tumors and peliosis hepatis) or following traumatic insults. The authors report a rare case of spontaneous rupture of the liver that occurred in a 72-year-old man without underlying pathologies predisposing this condition, in the absence of evident traumatic lesions in the abdominal area and with a near-negative pathological history of trauma (falls, road accidents, etc.)

Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training

Background: Although surgery is essential in healthcare, a significant number of patients suffer unfair harm while undergoing surgery. Many of these originate from failures in non-technical aspects, especially communication among operators. A surgical safety checklist is a simple tool that helps to reduce surgical adverse events, but even if it is fast to fill out, its compilation is often neglected by the healthcare workers because of unprepared cultural background. The present study aims to value the efficacy of a free intervention, such as a short training about risk management and safety checklist, to improve checklist adherence. Methods: In March 2019, the medical and nursing staff of the General Surgical Unit attended a two-lesson theoretical training concerning surgical safety and risk management tools such as the surgical safety checklist. The authors compared the completeness of the surgical checklists after and before the training, considering the same period (2 months) for both groups. Result: The surgical safety checklists were present in 198 cases (70.97%) before the intervention and 231 cases (96.25%) after that. After the training, the compilation adherence increased for every different type of healthcare worker of the unit (surgeons, nurses, anesthetists, and scrab nurses). Furthermore, a longer hospitalization was associated with a higher surgical checklist adherence by the operators. Conclusions: The results showed that a free and simple intervention, such as a two-lesson training, significantly stimulated the correct use of the surgical safety checklist. Moreover, the checklist adherence increased even for the operators who did not attend the training, maybe because of the positive influence of the colleagues' positive behaviors. As the results were promising with only two theoretical lessons, much more can be done to build a new safety culture in healthcare

Epoxy vitrimers incorporating physical crosslinks produced by self-association of alkyl chains

Epoxy vitrimers were synthesized employing stoichiometric amounts of diglycidyl ether of bisphenol A (DGEBA), sebacic acid (20% eq.) and an n-alkylamine, either octylamine (OA), dodecylamine (DA) or hexadecylamine (HA) (80% eq.). Apart from the chemical crosslinks generated by diester groups formed in transesterification reactions, these vitrimers include physical crosslinks arising from self-association of alkyl chains. The relative fraction and strength of physical crosslinks was high for octylamine (OA), intermediate for dodecylamine (DA) and low for hexadecylamine (HA). This was reflected by rubbery moduli that increased significantly from HA to OA. The covalently bonded tertiary amine generated in the epoxy-amine addition reaction was an efficient catalyst of transesterification reactions. Relatively fast stress relaxation rates were observed driven by transesterification reactions coupled to the dynamic exchange of self-associated alkyl chains. The occurrence of this last mechanism was evidenced by the stress relaxation observed for the linear polymer synthesized with stoichiometric amounts of DGEBA and OA that forms a permanent network up to temperatures close to degradation due to the presence of a high fraction of self-associated n-octyl chains. These vitrimers might find applications in several fields such as soft robotics, electro and magnetorheological elastomers, soft tissues and in additive manufacturing.Fil: Altuna, Facundo Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Casado, Ulises Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Dell'Erba, Ignacio Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Luna, L.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Hoppe, Cristina Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Williams, Roberto Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentin

Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency

Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing “Telemedicine—National guidelines,” approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness

Effect of interchain separation on the photoinduced absorption spectra of polycarbazolyldiacetylenes

The photoinduced absorption spectra of a novel polycarbazolyldiacetylene with long aliphatic chains on the carbazolyl side groups are measured and compared with those of the unsubstituted polyDCHD. The two polymers in the blue form exhibit very similar electronic absorption spectra and Raman frequencies. This fact indicates that the conjugation length of the polydiacetylene backbone is not too affected by the long substituents. In contrast, the near steady-state photoinduced absorption spectra show that different photogeneration mechanisms are involved in the two polymers. This result can be ascribed to the role played by the interchain distance in the dynamics of the relaxation processes in polydiacetylenes

Incident reporting system in an italian university hospital: A new tool for improving patient safety

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor–patient alliance