Adult Patient Education: A Readability Analysis of Hospital University Campus Bio-Medico’s Patients Information Materials (PIMs)

The UCBM’s nurses and doctors have produced patients information material under the form of brochures that we delivered to patients in order to help them better understand their pathology, therapeutic path and procedure to which they will have to undergo. With the Covid-19, doctors necessarily spend less time with patients. This means that patients tend to (mis)inform themselves on internet. We analyzed the PIM’s text readability with the Gulpease index. We submitted a qualitative questionnaire to 100 patients to evaluate the clarity of presentation and the communicative effectiveness and how much these allowed or not them to face their procedure with greater clarity and serenity. Brochures aroused interest in 77% of patients, where 87% declared that «The concepts are clear and I could understand them», 55% indicated that «The information is useful for understanding my condition». None of the them reach 40 pt. of the Gulpease index. Furthermore, the institutional font size was too small. Education of adult patient is a transversal area of pedagogy, medical clinic and communication. Experts from various fields (including patient associations) should collaborate to create informative materials that are useful for both patients and doctors/nurses

From COVID-19 Pandemic to Patient Safety: A New "Spring" for Telemedicine or a Boomerang Effect?

During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine

Effects of Reactive Oxygen Species on Mitochondrial Content and Integrity of Human Anastomotic Colorectal Dehiscence: A Preliminary DNA Study

BACKGROUND: Anastomotic dehiscence is one of the most severe complications of colorectal surgery. Gaining insight into the molecular mechanisms responsible for the development of anastomotic dehiscence following colorectal surgery is important for the reduction of postoperative complications. OBJECTIVE: Based on the close relationship between surgical stress and oxidative stress, the present study aimed to determine whether a correlation exists between increased levels of reactive oxygen species and colorectal anastomotic dehiscence. METHODS: Patients who underwent surgical resection for colorectal cancer were divided into three groups: patients with anastomotic dehiscence (group 1); patients without dehiscence who underwent neoadjuvant radiochemotherapy (group 2); and patients without anastomotic dehiscence who did not undergo neoadjuvant radiochemotherapy (group 3). Quantitative polymerase chain reaction and real-time polymerase chain reaction assays were performed to measure nuclear DNA and mitochondrial DNA (mtDNA) content, and possible oxidative damage to nonmalignant colon and rectal tissues adjacent to the anastomoses. RESULTS: mtDNA content was reduced in the colon tissue of patients in groups 1 and 2. Rectal mtDNA was found to be more damaged than colonic mtDNAs in all groups. The 4977 bp common deletion was observed in the mtDNA of tissues from both the colon and rectum of all patients. DISCUSSION: Patients in groups 1 and 2 were more similar to one another than to group 3, probably due to higher levels of reactive oxygen species in the mitochondria; the greater damage found in the rectum suggests that dehiscence originates primarily from the rectal area. CONCLUSIONS: The present study of mtDNA analyses of normal human colon and rectal tissues from patients with colorectal cancer is among the first of its kind

From syndemic lesson after COVID-19 pandemic to a “systemic clinical risk management” proposal in the perspective of the ethics of job well done

The syndemic framework proposed by the 2021–2030 World Health Organization (WHO) action plan for patient safety and the introduction of enabling technologies in health services involve a more effective interpretation of the data to understand causation. Based on the Systemic Theory, this communication proposes the “Systemic Clinical Risk Management” (SCRM) to improve the Quality of Care and Patient Safety. This is a new Clinical Risk Management model capable of developing the ability to observe and synthesize different elements in ways that lead to in-depth interventions to achieve solutions aligned with the sustainable development of health services. In order to avoid uncontrolled decision-making related to the use of enabling technologies, we devised an internal Learning Algorithm Risk Management (LARM) level based on a Bayesian approach. Moreover, according to the ethics of Job Well Done, the SCRM, instead of giving an opinion on events that have already occurred, proposes a bioethical co-working because it suggests the best way to act from a scientific point of view

Ethical Criteria for the Admission and Management of Patients in the ICU Under Conditions of Limited Medical Resources: A Shared International Proposal in View of the COVID-19 Pandemic

Introduction The present pandemic has exposed us to unprecedented challenges that need to be addressed not just for the current state, but also for possible future similar occurrences. It is worth pointing out that discussions on the allocation of medical resources may not necessarily refer to an exception, but, unfortunately, to a regular condition for a large part of humanity (1). The criteria for admission to an Intensive Care Unit (ICU) setting generally take into account multiple factors. There must be a diagnostic and prognostic basis for the decisions made, considering both biological factors and patient values and wishes. Furthermore, the decision-making process should, whenever possible, respect the patient's advance directives as well as the relationship with the patient's family or attorney. Therapeutic neglect should be avoided. Having applied standard clinical evaluation criteria for the appropriate treatment of patients with COVID-19, including consideration of prognosis, if a hospital then finds itself unable to provide optimal treatment (e.g., due to a disproportion between the number of patients and the availability of beds, healthcare providers, ventilators, and drugs in the ICU), it becomes necessary to evaluate, case by case, how to achieve justice and the best possible good for the greatest number of patients. It is therefore mandatory to explore alternative solutions; these include increasing available beds and healthcare providers, implementing alternative, though suboptimal, approaches (where appropriate), transferring patients to other clinical units, etc. Making these decisions properly also involves the recovery of the political role of medicine and science (2). If the imbalance between needs and resources reaches a critical level, an emergency triage protocol, following the operational and ethical indications of “disaster medicine,” should be activated. These have been deployed in major and serious natural (earthquakes or tsunamis for example) and technological (factory explosions, public transport accidents for example) disasters, as well as following terrorist attacks (3, 4). The question of the feasibility of developing a clinical evaluation algorithm to support the decision-making of the triage team remains open, though many such protocols have been written. According to the above, we propose the following five ethical criteria for the triage of patients in conditions of limited resources, such as the COVID pandemic. They are the result of an interdisciplinary and intercultural dialogue between specialists from different disciplines. Several of the authors are working in the main epicenters of the crisis and currently are playing a central role in the bioethical, clinical, social and legal aspects of the management of the COVID-19 pandemic

Educazione e simulazione nelle Facoltà universitarie. Una review

La pedagogia medica è stata oggetto di studio sempre più crescente soprattutto dagli anni ’90. Il numero di pubblicazioni è passato da una media di 255 annue (tra il 1943-1962) ad una media di più di 6.110 pubblicazioni (2010-2017). Abbiamo focalizzato l’attenzione sul tema della formazione tramite la simulazione, abbiamo svolto un breve excursus storico e abbiamo condotto una ricerca sul tasso di sviluppo della pedagogia medica tramite l’analisi delle pubblicazioni censite dal sito più importante al mondo per i medici e i docenti universitari sanitari (PubMed). Dalla ricerca sulle 6 parole chiave individuate (Medical education; Patient simulation; Standardized patient; Medical simulation; Virtual reality simulation; Healthcare simulation) è emerso che la letteratura dedicata alla pedagogia medica (in particolare la simulazione) negli ultimi 27 anni, 1990-2017, è aumentata del 193% per gli articoli relativi alle Medical Education e di più del 1.146% per quel che riguarda il “Patient simulation”. Un grande incremento di pubblicazioni su riviste con Impact Factor che ci dimostra quanto la medicina stia puntando intensamente all’innovazione anche nel campo della didattica.Medical education has been the subject of increasingly growing study especially since the 90s. The number of scientific publications related to Medical Education has increased from an average of 255 publications per year (1943-1962) to an average of more than 6,110 publications (2010-2017). In this contribution we focused on medical and health professions education through simulation. We made a brief historical overview on the simulation and we did a research on the rate of development of medical pedagogy through the analysis of the publications recorded by the world’s most important website for physicians and Faculty teachers (PubMed). The data obtained from our research on the 6 key words we have identified (Medical education; Patient simulation; Standardized patient; Medical simulation; Virtual reality simulation; Healthcare simulation) showed us that the literature dedicated to Medical education, in the last 27 years, 1990-2017, it is increased by 193% for the articles related to Medical Education and by more than 1,146% for the “Patient simulation”. A great publications increase in scientific journal with Impact Factor that show us how much medicine is focusing intensely on innovation in the field of teaching

Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones

Objective: To examine the mechanisms of action of ursodeoxycholic acid ( UDCA) on gallbladder ( GB) muscle cells in patients with symptomatic cholesterol gallstones (GSs) as it reduces the incidence of acute cholecystitis. Design and patients: A double-blind study was performed on 15 patients, 7 randomised to UDCA and 8 to placebo, treated for 4 weeks before cholecystectomy. Muscle contraction induced by cholecystokinin (CCK)8, acetylcholine (ACh) and potassium chloride (KCl) was determined in enzymatically isolated GB muscle cells, and cholesterol levels were determined in plasma membranes. H2O2, lipid peroxidation, platelet-activating factor (PAF)-like lipids, prostaglandin E-2 (PGE(2)) and catalase activity were determined as biochemical markers of oxidative stress and inflammation in muscle cells. Results: UDCA significantly increased GB muscle cell contraction induced by all concentrations of CCK-8, ACh and KCl, and reduced the plasma membrane cholesterol (mean (SD) 0.32 (0.16) vs 0.72 (0.5) mmol/mg of protein) compared with placebo. In GB muscle cells, UDCA treatment significantly decreased the levels of H2O2 (4.4 (1.9) vs 13.7 (5.3) mmol/mg of protein), lipid peroxidation (malondialdehyde levels 1.3 (0.4) vs 2.52 (0.7) nmol/100 mg of protein), PAF-like lipids (8.9 (4.9) vs 29.6 (7.1) pg/mg of protein) as well as the production of PGE(2) (142 (47) vs 365 (125) pg/mg of protein) and catalase activity (14.5 (9.4) vs 35.8 (12.7) units/mg of protein) when compared with placebo. Conclusion: These studies suggest that UDCA treatment improves GB muscle contractility by decreasing the cholesterol content in the plasma membrane of muscle cells, and the biochemical parameters of oxidative stress, thus explaining its possible therapeutic mechanisms in patients with symptoms of cholesterol GSs

Continuing Education through the Campus Game: A Sustainable Gamification Project to Improve Doctors’ and Nurses’ Knowledge of Quality and Clinical Risk Management

The COVID-19 disease has dramatically changed lives worldwide, including education. This is a challenge for traditional learning. In fact, the European Higher Education Area poses the challenge of boosting the quality of teaching through active methodologies supported by digital pedagogy. Gamification is one of these tools and it has considerable attention in the healthcare literature. We aimed to create a game in the Campus Bio-Medico University Hospital Foundation in order to offer continuing education on Quality and Clinical Risk procedures to our staff. The 2021 “Campus Game” (178 players) introduced the “Badge Challenge” (Team Building, Procedures, and Security) and 73 questions. The leaderboard of every single match was posted in some of the hospital’s strategic areas and also published online on the company intranet to ensure engagement and competitiveness. Gamification has spontaneously promoted teamworking and a virtuous process of multiprofessional education. We found that, during the Campus Game, there was a 4.9% increase in access to the intranet page containing information on Quality and Patient Safety and an 8% increase in access to the Hospital Policies and Procedures. In the near future, we wish to expand this game, involving hospitals with similar types of activity and levels of attention to quality and safety issues, and also to enhance the network of partners and the principles of Q&S management itself