A nudge intervention to improve hand hygiene compliance in the hospital.

Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

Are the forearm muscles excited equally in different, professional piano players?

BACKGROUND AND OBJECTIVES: Professional pianists tend to develop playing-related musculoskeletal disorders mostly in the forearm. These injuries are often due to overuse, suggesting the existence of a common forearm region where muscles are often excited during piano playing across subjects. Here we use a grid of electrodes to test this hypothesis, assessing where EMGs with greatest amplitude are more likely to be detected when expert pianists perform different excerpts. METHODS: Tasks were separated into two groups: classical excerpts and octaves, performed by eight, healthy, professional pianists. Monopolar electromyograms (EMGs) were sampled with a grid of 96 electrodes, covering the forearm region where hand and wrist muscles reside. Regions providing consistently high EMG amplitude across subjects were assessed with a non-parametric permutation test, designed for the statistical analysis of neuroimaging experiments. Spatial consistency across trials was assessed with the Binomial test. RESULTS: Spatial consistency of muscle excitation was found across subjects but not across tasks, confining at most 20% of the electrodes in the grid. These local groups of electrodes providing high EMG amplitude were found at the ventral forearm region during classical excerpts and at the dorsal region during octaves, when performed both at preferred and at high, playing speeds. DISCUSSION: Our results revealed that professional pianists consistently load a specific forearm region, depending on whether performing octaves or classical excerpts. This spatial consistency may help furthering our understanding on the incidence of playing-related muscular disorders and provide an anatomical reference for the study of active muscle loading in piano players using surface EMG.

"Pandemic fatigue" or something worse?

The second pandemic wave flooded Italy and Europe. There are many reasons to be concerned but, as health care workers, we want to emphasize something particular. We reacted with enormous sacrifices during the first pandemic wave, despite the uncertainty, despite the inexperience, despite the structural and managerial inadequacies (partly unavoidable). In the following months the overwhelming wave turned into a slow but continuous dripping, we had to deal with. The World Health Organization (WHO) introduced the term "pandemic fatigue" to indicate the widespread feeling of distress in the entire population as a reaction to a prolonged state of crisis whose end cannot be foreseen. Health workers are no stranger to the general population, although they perceive the world from a particular standpoint. The first concern is that doctors and nurses might not be able to make up for the flaws (largely avoidable at this point) of the health care system in case of further waves. Because the strengths are breaking down and because public support, crucial in previous months, is waning. The second concern relates to the discomfort that could affect a large part of health care workers. A state of discontent and anger never seen before between doctors and nurses is spreading all around us. The fear that "pandemic fatigue" will turn into "pandemic consumption" is real and alarming.

An Eminent Absence: Agenesis of Inferior Vena Cava Underlying Bilateral Iliac Vein Thrombosis.

Among thrombophilic risk factors for deep venous thrombosis (DVT), agenesis of the inferior vena cava (AIVC) is very rare, but it must be considered in specific settings. Here, we present the case of an 18-year-old woman who was admitted to the Emergency Department with swelling and pain of her left leg. Clinical examination and ultrasonography detected extensive proximal DVT of the left leg. After attempted mechanical thrombectomy failed, an abdominal CT scan was obtained, which demonstrated bilateral thrombosis of the iliac-femoral axis in the context of congenital AIVC. LEARNING POINTS: Agenesis of the inferior vena cava is a rare risk factor for deep venous thrombosis.Agenesis of the inferior vena cava requires lifetime follow-up and treatment.Idiopathic deep venous thrombosis, especially in young patients, requires additional diagnostic investigation that considers congenital anomalies.

[Open doors, closed ports: can medicine suggest something to society?] / Porte aperte, porti chiusi: la medicina può suggerire qualcosa alla società?

Western countries are today experiencing a profound mutation of their immigration policies. Integration and hospitality have been taken over by closure and rejections. The policy of "closed ports" gained ground as never before. Traditionally, hospitals have imposed rules and restrictions to patients and visitors, ruling and limiting the space and the time offered. In the last two decades, though, a radical change in perspectives of some medical centres allowed a profound transformation of hospitals from closed realms to open spaces where communication and interaction with visitors is desired and encouraged. The policy of "open doors" became widespread and showed benefits in a lot of ways. Noticeably, a profound asymmetry exists between the idea of "closed ports" and "open doors", both representing - albeit in different contexts - opposite solutions for similar issues. It is possible to make a comparison? Can medicine suggest something to society?