[Emergency department overuse amongst urban and rural areas: a retrospective descriptive analysis in Southern Tuscany.] / Differenze di ricorso al pronto soccorso tra aree urbane e rurali: analisi retrospettiva nella Toscana meridionale.

BACKGROUND: The phenomenon of repeated accesses to the emergency department (ED) by users, the so-called frequent users, is frequent and documented. The totality of the EDs often have to deal with patients who come several times in short periods of time. In this study we try to analyze the characteristics of these users and the differences between the emergency department in rural, zonal or urban areas. METHODS: A retrospective observational multicentre analysis was conducted using the access data in 2018 in the EDs of Southern Tuscany. The EDs have been classified into three different categories based on the urbanization of the considered areas. The data were processed using Microsoft Excel and R Project software. A statistical analysis was carried out by calculating the Chi square (χ2). RESULTS: The results show that frequent users have a higher average age, longer stay times in the emergency rooms, an increase in higher priority access codes (yellow and red) and a higher percentage of hospitalizations and transfers; there are not significant differences with respect to the dropout rates. Among the diagnoses, pregnancy and fever are among the most frequent found among frequent users under-65, while among the over-65 there is a significant presence of diagnoses of congestive heart failure. The characterization of frequent users provided basic information on their peculiarities and on the most frequent problems. CONCLUSIONS: In order to reduce this phenomenon it is important to study the reasons for access and re-access in the EDs so as to optimally plan the territorial Health Services, develop proper interventions and follow the chronical illness.

Coping strategies at the frontline of care: Comparisons between Covid-19 and non-Covid-19 units' nurses and the role of moderator variables.

INTRODUCTION: Relatively few studies focused on the coping strategies adopted by the healthcare workers during the second phase of the pandemic. The present study compared the coping strategies between Italian nurses working in Covid-19 and in other units and it explored whether socio-demographic and work-related variables moderate the relation between the type of unit and coping strategies. METHODS: A web-based questionnaire that included sociodemographic and work-related questions and the Coping Orientation to Problem Experienced-New Italian Version-25 item was administered. Moderation effects between variables and coping strategies were analyzed using generalized linear models. RESULTS: 253 nurses participated. Nurses who worked in a Covid-19 unit had significantly lower scores on Avoidance Strategies subscale and higher scores on Positive Attitude and Social Support subscales than nurses working in other units. DISCUSSION: Gender differences emerged only on the social support coping dimension, with women being more likely to adopt social support than men. No association between the type of unit and the other coping strategies was found. CONCLUSION: Nurses working in Covid-19 units showed better coping strategies than their colleagues: this suggests that support interventions aimed to promote coping strategies should be offered also to Covid-19-free units' nurses.

[Point-of-care blood gas analysis as a tool for COVID-19 patients: a prehospital setting experience.] / L'emogasanalisi point-of-care come strumento discriminante sui pazienti positivi a covid-19: l'esperienza di Arezzo in ambiente preospedaliero.

Portable blood gas analyzers are intended for blood Point-of-care testing (POCT); they make it possible to perform the examination directly at the patient's bed. During the SARS-CoV-2 pandemic, this device proved useful in emergency medical service for the early assessment of respiratory distress, allowing the appropriate care level to be determined for each patient. 25 cases of covid-19 positive patients in the province of Arezzo were analyzed; POCT blood gas analysis made it possible to evaluate and treat at home about half of the patients (52%) and to admit the others directly to the most appropriate ward. However, some critical issues were found; the limited sample size suggest further research to assess the actual impact of this technology.