[Therapy optimization of heart failure through the evaluation of the plasma concentration variation of B-type natriuretic peptide]. / Ottimizzazione della terapia dello scompenso cardiaco attraverso il monitoraggio delle variazioni delle concentrazioni plasmatiche del peptide natriuretico di tipo B.

AIM: Our research was based over the critical evaluation of the plasmatic concentration variation of B-type Natriuretic Peptide in emergency in patients with heart failure during therapy with diuretics, anti-aldosterone, ACE-inhibitors, beta-blockers and nitroderivates. MATERIALS AND METHOD: We selected 108 patients: 30 control subjects (average 58.40 +/- SD13.32 for 20 M, and 65 +/- SD 14.74 for 10 W), and 78 subjects (average 75.90 +/- SD 9.60 for 41 M, and 77.89 +/- SD 8.62 for 37 W) arrived to the emergency and reception department for dyspnea and/or precordialgia and/or palpitations with heart failure diagnosis according to NYHA Classification. The variation of BNP concentration was evaluated in these subjects at the admission, after 1 week, and 1 month from the beginning of the therapy. RESULTS: Patients with heart failure had a BNP concentration high during all measurements. The values were high during admission, but after 1 week and after 1 month, they reduced reaching the balance. CONCLUSIONS: BNP evaluation is a good indicator for the diagnosis of heart failure and for improving the therapy. The main limit of BNP diagnostic role is the need of knowing in advance the specific values for each patient.

[The Moschkowitz syndrome in emergency department. Case report]. / La sindrome di Moschkowitz nel Dipartimento di Emergenza. Case report.

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disorder of unknown etiology, first described by Moschkowitz in 1924. TTP is a thrombotic microangiopathy characterized by microvascular lesions with platelet aggregation. TTP is more common in adults and is associated with pregnancy; diseases such as HIV, cancer, bacterial infection, and vasculitis; bone marrow transplantation; and drugs TTP is a hematologic emergency. It is a multisystem disease that can cause rapid deterioration of the patient's neurologic, renal, and hematologic status. TTP is an uncommon disease with a high fatality rate if untreated or misdiagnosed. Rapid diagnosis and aggressive treatment by therapeutic plasma exchange are necessary to reduce the risk of a fatal outcome. Current clinical criteria for initiating therapy are: thrombocytopenia, and absence of other disease entities that could explain the thrombocytopenia. Early recognition and management are essential for patient survival. TTP is difficult to diagnose because the patient's presentation can be nonspecific and the characteristic pentad of symptoms may not occur together. Other disease entities can have some of the same symptoms. We discuss a case report of Moschkowitz syndrome in Emergency Department.

Application of the Method of Organizational Congruencies in Substituting Organic Solvents With Vegetable Agents for the Cleaning of an Offset Printing Machine.

The aim of this research is the application of the Method of Organizational Congruencies before and after the substitution of organic solvents with vegetable agents for the cleaning of an offset printing machine in order to assess the organizational changes. A solvent-free process is the goal of the Subsprint Project (Technology Transfer Program of the European Community). This study shows how human and environmental health is improved by using vegetable agents, though this change may lead to some other organizational constraints such as an increase of the time needed, monotony, and repetitiveness of the technical actions involved. The authors underline that the knowledge of the impact of the new technology on health helps a better understanding of the resistance to the change and its further amelioration.

[Organizational analysis of hospital work: identification of constraint elements and hypothesis of their relationship with nurses' wellbeing]. / Analisi organizzativa del lavoro ospedaliero: identificazione degli elementi di costrittività ed ipotesi sulle loro relazioni con il benessere degli infermieri.

The paper reports the results of a research project on hospital work in which the analysis of organized work situations in different contexts was made using a method based on a valid organizational theory, with the objective of an ergonomic study on the relationships between organized work and well-being. From the analysis of these different situations, via the application of the Method of Organizational Congruencies, the greatest individual level of danger for well-being was constantly observed in nurses, not only as regards the traditional risks of exposure to physical or biological agents, but also the psychophysical aspecific discomfort related, particularly, both to imposition and to uncertainty in the coordination and control of technical actions and in the coordination and control of individuals. The use of an instrument of organizational analysis and the contribution of specific disciplinary approaches (the theory on stress by H. Selye and the theory on communication by G. Bateson), satisfied the needs of suggesting and understanding the relationships between organization choices and well-being of nurses, with the aim of reducing the conditions of danger for well-being related to organization choices.