Approccio del Fisioterapista nella presa in carico del paziente con lombalgia cronica: indagine esplorativa presso l'AziendA USL di Reggio Emilia

Background: Chronic Low Back Pain (CLBP) is currently considered a biopsychosocial syndrome, where individual, physical, occupational, psychological and social risk factors coexist. The available research indicates that physiotherapists (PTs) theoretically endorse the proposed biopsychosocial approach to treatment, yet very few are adopting this approach in clinical practice. Aim: The purpose of this exploratory survey is to obtain a detailed view of physiotherapists’ perceptions in their local setting, with specific reference to the operators’ kind of approach and professional skills in the treatment of CLBP. Methods: The survey tool was a focus group, based on a simulated clinical case conducted with expert operators selected on a voluntary basis. The results of the interview were analyzed using a qualitative-inductive method. Results: The analysis shows results related to three interconnected macro areas: the physiotherapists’ professional skills/training, evaluation tools, and organizational structure. Physiotherapists’ skills should be reinforced with training dedicated to communication-relational aspects and supported by assessment tools necessary to screen and evaluate psychosocial factors. As regards organizational structure, it takes the opportunity to design a clinical path or structure specialized in outpatient services for patients with chronic low back pain (CLBP). Conclusion: Some results are aligned with the literature. In particular, the need to reinforce physiotherapists’ inter-relational skills and to support them with the intervention of other specialists (multidisciplinary team) in the case of problems not strictly of their competence. The role of management is to identify organizational solutions to creating clinical pathways to reduce dispersion and to reinforce the professionals’ expertise

Gli infermieri italiani richiamati alle armi nella seconda guerra mondiale: l'epistolario degli anni di prigionia

Scopo: Il presente lavoro ha lo scopo di diffondere la corrispondenza inerente la prigionia di infermieri italiani richiamati alle armi durante la seconda guerra mondiale. Si è voluto conoscere se la professione ne avesse influenzato le condizioni e la liberazione.Metodo: Sono stati analizzati 88 fascicoli personali d'infermieri civili in servizio nell' Ospedale Maggiore di Milano e inviati al fronte nel periodo compreso tra il 1940 e il 1945. I documenti sono stati reperiti nell'archivio storico dell'ospedale milanese dal dicembre 2011 al gennaio 2013. Per l'analisi delle fonti è stato applicato il metodo di ricerca storica secondo Chabod (2012) e per ogni infermiere recluso si è selezionata la presentazione di una lettera olografa originale.Risultati: Si è scoperta la corrispondenza inviata alla famiglia di 4 prigionieri. Dalla trama emerge, oltre all'amore per la Patria e la libertí , il tentativo di rassicurare i propri cari. Si sono inoltre ritrovate istanze inviate dall'amministrazione ospedaliera all'esercito germanico per richiederne il rilascio. A seguito di una di queste, un infermiere è stato liberato.Conclusioni: Il presente contributo delinea come l'essere infermieri di un Ospedale negli anni della seconda guerra mondiale avesse influito sulle condizioni di internamento. Molto vi è ancora da ricercare per restituire la memoria dell'apporto determinato dalla professione in un periodo drammatico della storia del nostro paese.Parole chiave: infermieri, prigionia, seconda guerra mondiale Italian male nurses called to arms in World War II: the letters of the years of imprisonmentAim: During the Second World War the male staff of assistance in the Italia hospitals was called to arms.This work concerns the letters sent by the male nurses who were captured by the Germans and put in prison. The aim is to know whether their profession had somehow affected their living condition in jail and had favoured their release or not.Method: 88 personal files of nurses on duty in Ospedale Maggiore and sent to the front during the period between 1940 and 1945 have been studied. The documents are kept in the historical archive of the Ospedale Maggiore of Milan and the research covered the period from December to January 2013. The sources have been analyzed according to Chabod's method of historical research (2012). 4 prisoners have been found among the 88 files of soldiers and handwritten letter has been selected for each one.Results: These letters the attempt of the prisoners to reassure their loved ones emerges. Moreover, in the files of the prisoners' formal request for their release sent by hospital board were found. As a result one of the prisoners was released.Conclusions:This paper suggests that the fact of being a nurse in a hospital influenced the conditions during tha period of captivity. Much is still to be found to shed light on a dramatic period of our country and to restore the memory of the contribution given by the profession.Keywords: male nurses, imprisonment, World War II

"Sul campo dell'Onore". Ricerca storica in memoria degli infermieri italiani caduti nella Prima Guerra Mondiale

OBIETTIVO: Il presente lavoro ha l'obiettivo di esplorare se e come sono ricordati gli infermieri italiani dipendenti dell'Ospedale Maggiore di Milano caduti nella Grande Guerra. Inoltre, si vuole contribuire a tratteggiare l'identití  professionale nei primi anni del Novecento in Italia.METODO: Si è esaminata la documentazione amministrativa di 127 infermieri in servizio nell'Ospedale Maggiore di Milano e chiamati alle armi tra il 1915 e il 1918. I documenti sono stati rinvenuti nell'Archivio storico dell'ospedale milanese dal luglio 2015 al marzo 2016 e analizzati attraverso l'impiego della metodologia della ricerca storica secondo Chabod (2012).RISULTATI: Si è scoperta la testimonianza di 5 infermieri caduti durante la Prima Guerra Mondiale. Onorati come soldati coraggiosi, sono ricordati per la diligenza, la sollecitudine e il riguardo nella cura dei malati. Per non dimenticarli, la comunití  ospedaliera esprime riconoscenza alle famiglie con contributi economici e li commemora incidendone i nomi in un'epigrafe marmorea.CONCLUSIONI: Dai risultati dell'indagine sono emersi numerosi ricordi d'infermieri civili periti negli anni 1915-1918, dai quali è stato possibile scorgere l'identití  professionale negli anni 20 del Novecento. La partecipazione degli infermieri nella Prima Guerra Mondiale, in concomitanza con la ricorrenza del suo centenario, può essere ulteriormente approfondita.PAROLE CHIAVE: Infermieri italiani, Prima Guerra Mondiale, Storia.ABSTRACTAIM: Several Italian male nurses employed at the Ospedale Maggiore in Milan were among the dead during First World War. This paper investigates whether and in which way these people are remembered. In addition the authors draw a picture of the nursing profession as it were in the early Twentieth Century in Italy.METHOD: The administrative documentation of 127 male nurses on duty at the Ospedale Maggiore in Milan and called to arms between 1915 and 1918 was examined. The documents were found in the historical archive of the Ospedale Maggiore from July 2015 to March 2016 and analyzed using the method of historical research according to Chabod (2012).RESULTS: Documents that witnessed the death of 5 male nurses during the war were found. These people were praised for their courage, self-sacrifice and commitment in attending the sick and the wounded. The hospital community arranged to devolve a sumof money to their families in sign of gratitude and commemorated them by engraving their names in a marble monument.CONCLUSIONS: Many memories of civilian male nurses in the years 1915-1918 emerged from this investigation, and the professional identity of nurses in the 1920s emerged quiteclearly. The participation of male nurses in the First World War, in conjunction with the recurrence of its centenary, could be further deepened.KEYWORDS: Italian Male Nurses, First World War, History

N2FXm, a method for joint nuclear and cytoplasmic volume measurements, unravels the osmo-mechanical regulation of nuclear volume in mammalian cells

Abstract In eukaryotes, cytoplasmic and nuclear volumes are tightly regulated to ensure proper cell homeostasis. However, current methods to measure cytoplasmic and nuclear volumes, including confocal 3D reconstruction, have limitations, such as relying on two-dimensional projections or poor vertical resolution. Here, to overcome these limitations, we describe a method, N2FXm, to jointly measure cytoplasmic and nuclear volumes in single cultured adhering human cells, in real time, and across cell cycles. We find that this method accurately provides joint size over dynamic measurements and at different time resolutions. Moreover, by combining several experimental perturbations and analyzing a mathematical model including osmotic effects and tension, we show that N2FXm can give relevant insights on how mechanical forces exerted by the cytoskeleton on the nuclear envelope can affect the growth of nucleus volume by biasing nuclear import. Our method, by allowing for accurate joint nuclear and cytoplasmic volume dynamic measurements at different time resolutions, highlights the non-constancy of the nucleus/cytoplasm ratio along the cell cycle

A Multicentre Evaluation of Dosiomics Features Reproducibility, Stability and Sensitivity

Dosiomics is a texture analysis method to produce dose features that encode the spatial 3D distribution of radiotherapy dose. Dosiomic studies, in a multicentre setting, require assessing the features’ stability to dose calculation settings and the features’ capability in distinguishing different dose distributions. Dose distributions were generated by eight Italian centres on a shared image dataset acquired on a dedicated phantom. Treatment planning protocols, in terms of planning target volume coverage and dose–volume constraints to the organs at risk, were shared among the centres to produce comparable dose distributions for measuring reproducibility/stability and sensitivity of dosiomic features. In addition, coefficient of variation (CV) was employed to evaluate the dosiomic features’ variation. We extracted 38,160 features from 30 different dose distributions from six regions of interest, grouped by four features’ families. A selected group of features (CV < 3 for the reproducibility/stability studies, CV > 1 for the sensitivity studies) were identified to support future multicentre studies, assuring both stable features when dose distributions variation is minimal and sensitive features when dose distribution variations need to be clearly identified. Dosiomic is a promising tool that could support multicentre studies, especially for predictive models, and encode the spatial and statistical characteristics of the 3D dose distribution

Proton Radiation Therapy for Nasopharyngeal Cancer Patients: Dosimetric and NTCP Evaluation Supporting Clinical Decision

(1) Background: we proposed an integrated strategy to support clinical allocation of nasopharyngeal patients between proton and photon radiotherapy. (2) Methods: intensity-modulated proton therapy (IMPT) plans were optimized for 50 consecutive nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT), and differences in dose and normal tissue complication probability (ΔNTCPx-p) for 16 models were calculated. Patient eligibility for IMPT was assessed using a model-based selection (MBS) strategy following the results for 7/16 models describing the most clinically relevant endpoints, applying a model-specific ΔNTCPx-p threshold (15% to 5% depending on the severity of the complication) and a composite threshold (35%). In addition, a comprehensive toxicity score (CTS) was defined as the weighted sum of all 16 ΔNTCPx-p, where weights follow a clinical rationale. (3) Results: Dose deviations were in favor of IMPT (ΔDmean ≥ 14% for cord, esophagus, brainstem, and glottic larynx). The risk of toxicity significantly decreased for xerostomia (−12.5%), brain necrosis (−2.3%), mucositis (−3.2%), tinnitus (−8.6%), hypothyroidism (−9.3%), and trismus (−5.4%). There were 40% of the patients that resulted as eligible for IMPT, with a greater advantage for T3–T4 staging. Significantly different CTS were observed in patients qualifying for IMPT. (4) Conclusions: The MBS strategy successfully drives the clinical identification of NPC patients, who are most likely to benefit from IMPT. CTS summarizes well the expected global gain