Emergency department triage performance timing. A regional multicenter descriptive study in Italy.

OBJECTIVES: We explored the time employed by nurses to perform the ED triage process in the clinical setting. Moreover, we assessed the influences on triage timing performance exerted by variables related to nurses, local EDs' features, and by interruptions. METHODS: This is a multicenter prospective descriptive-explorative study performed in 11 EDs of the Tuscany region (Italy), using a 5 tier triage system. The sample was made up of 1/3 of nurses working in each ED. Sampling was performed by a stratified proportional randomization (length of service classes: <5 years; 5-10 years; >10 years). Triage nurses were observed during their triage work-shift. RESULTS: In 2014, 120 nurses were observed, during 1114 triage processes. The timings of triage phases were: waiting time to triage, median 2.55 min (IQR 1.28-5.03 min; range 0.1-56.25 min); triage duration, median 2.58 min (IQR 1.36-4.35 min; range 0.07-50 min). 400 interruptions were recorded (35.9%). In 9.9% there were 2 interruptions at least. There were significant differences in the medians of triage duration among the years of nurses' triage experience (P < 0.001). The presence of interruption was significantly associated with the increasing of the time intervals in all the triage phases (P < 0.0001). Finally, we recorded significant differences in all the triage time phases between the EDs. CONCLUSION: We found that the nurses triage time performances are similar to other triage systems in the world.

Rice Husk Ash to Stabilize Heavy Metals Contained in Municipal Solid Waste Incineration Fly Ash: First Results by Applying New Pre-treatment Technology.

A new technology was recently developed for municipal solid waste incineration (MSWI) fly ash stabilization, based on the employment of all waste and byproduct materials. In particular, the proposed method is based on the use of amorphous silica contained in rice husk ash (RHA), an agricultural byproduct material (COSMOS-RICE project). The obtained final inert can be applied in several applications to produce "green composites". In this work, for the first time, a process for pre-treatment of rice husk, before its use in the stabilization of heavy metals, based on the employment of Instant Pressure Drop technology (DIC) was tested. The aim of this work is to verify the influence of the pre-treatment on the efficiency on heavy metals stabilization in the COSMOS-RICE technology. DIC technique is based on a thermomechanical effect induced by an abrupt transition from high steam pressure to a vacuum, to produce changes in the material. Two different DIC pre-treatments were selected and thermal annealing at different temperatures were performed on rice husk. The resulting RHAs were employed to obtain COSMOS-RICE samples, and the stabilization procedure was tested on the MSWI fly ash. In the frame of this work, some thermal treatments were also realized in O2-limiting conditions, to test the effect of charcoal obtained from RHA on the stabilization procedure. The results of this work show that the application of DIC technology into existing treatment cycles of some waste materials should be investigated in more details to offer the possibility to stabilize and reuse waste.

[Intestinal hemorrhage from diverticulosis of the jejunum: a case report]. / Emorragia digestiva da diverticolosi del digiuno: Un caso clinico.

The diagnosis of intestinal diverticulosis is difficult to achieve preoperatively because the clinical symptoms are usually non-specific. Intestinal bleeding is a rare complication of jejunal diverticulosis. Its diagnosis and treatment can be difficult and an emergency laparotomy is often needed. We report a case of massive intestinal bleeding from jejunal diverticulosis. The correct diagnosis was first suggested by CT and then confirmed at laparotomy. The treatment was a segmental jejunal resection with primary anastomosis.

[Isolated pancreatic metastasis from kidney carcinoma: report of 2 clinical cases]. / Le metastasi isolate del pancreas da carcinoma del rene: presentazione di due casi clinici.

Isolated metastases to the pancreas are rare. Renal cell carcinoma is one of the few tumours that metastasis to the pancreas. Since 2001 we have observed two cases of isolated metastases to the pancreas from renal cell carcinomas, both of which were surgically resected with a diagnostic and therapeutic intent. The aim of this report was to examine the clinical manifestations and radiological appearances of these metastases through the presentation of our two cases and a review of the literature, in addition to assessing the respective roles of FNAB in the diagnostic phase and of surgery in the therapeutic phase.