Prevention of healthcare associated infections: a descriptive study.

BACKGROUND: This study aims to verify whether there are, and to which degree, knowledge and adherence to guidelines on the prevention and control of healthcare associated infections by nursing staff. Study design. A descriptive study was conducted on a sample of nurses in the areas of medicine, surgery, and its own specialties of the Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico in Milan from 1st December 2015 to 29th February 2016. METHODS: The knowledge of the nursing staff have been investigated through the use of questionnaires with anonymous self-reporting method; inspections in the wards using observational grids were carried out in order to verify adherence to best-practice principles. The data collected concern, both for the knowledge and for the practice, the following macro-areas: a) Cleaning, disinfection and sterilization, b) Hand hygiene, c) Standard and isolation precautions, d) Prevention of catheter-related urinary tract infections, e) Prevention of catheter-related bacteremia, f) Prevention of surgical site infections, g) Prevention of respiratory tract infections. Statistical analyzes were performed using Microsoft Office Excel and STATA software. RESULTS: 245 nurses from 16 wards were involved. In each wards 4 inspections were conducted. 128 completed questionnaires were returned, all considered for the analysis of data; the adhesion was 52.2%. The participants achieved an overall score of 15.0 ± 4.1 (mean ± SD) on a maximum achievable score of 23 and >75% of them have reached a sufficient level. Among the most positive results, it must be underlined that nurses have demonstrated a higher level of knowledge for hand hygiene, with >81% correct answers; that the lumens of central venous catheters, when not in use, were kept covered with a protective cap in more than 99% of cases; that, for patients bearers of urinary catheter, the urinary drainage bag was maintained below the level of the bladder, as recommended, in more than 91% of the cases. On the contrary, as a very negative result, we found the greatest knowledge gap as regards cleaning, disinfection and sterilization, with a number of incorrect answers approaching 50%; furthermore, 64% of nurses wore jewels on their wrists, and / or hands when in action; finally, the alcohol-based handrub device could be easily reached from at least one of the beds of the room in less than 13% of the cases. CONCLUSION: Some knowledge gaps and differences with respect to adherence to best-practice principles for the prevention and control of healthcare associated infections was highlight by the present study.

Evaluation of tumorigenic risk of tissue-engineered oral mucosal epithelial cells by using combinational examinations.

Recently, oral mucosal epithelial cells were proposed as a cell source of the autologous cell transplant therapy for corneal trauma or disease. The question addressed is to know if the biological conditions of grafting could induce certain cellular, molecular, and genetic alterations that might increase the risk of mutations and possibly of cellular transformation. Recent progress in cancer research enables us to depict the generation mechanisms and basic characteristics of human cancer cells from molecular, cytological, and biological aspects. The aim of this study is to evaluate the risk of tumorigenicity of the oral mucosal epithelial culture process in order to mitigate that risk, if any, before clinical application. Oral mucosal epithelial cells from three different human donors were investigated by combinational examinations to detect possible tumorigenic transformation. We investigated (i) clonogenic and karyology types, (ii) the validation of proliferation rate, (iii) the epithelial-mesenchymal transition, (iv) anchorage-independent growth potential, and (v) tumorigenicity on nude mice. Results show that the culture process used in this study presents no risk of tumorigenicity.

Validation of gefitinib effectiveness in a broad panel of head and neck squamous carcinoma cells.

Recently improved understanding of the pathogenesis of human head and neck squamous cell carcinoma (HNSCC) has led to the development of new, molecular-based therapeutic strategies, one of the more promising is the utilisation of tyrosine kinase (TK) inhibitors, targeting epidermal growth factor receptor (EGFR). In this study, we tested for gefitinib effectiveness in a broad panel of 12 newly established HNSCC cell lines, investigating its ability to reduce cell growth, to induce apoptosis and to modulate cell cycle and various EGFR pathway-related targets. Gefitinib IC50 values ranged between 0.064 and 33 microM, its capability to induce apoptosis and cell accumulation in G0/G1 phase was cell line-specific, and the main EGFR-related pathway involved in gefitinib activity was PI3K/Akt/mTor. We characterised our in vitro panel extensively, with the aim to identify predictive factors for gefitinib effectiveness; all cell lines were free of human papillomavirus infection, two were positive for Fhit expression, four expressed wild-type p53, and all of them variously expressed the other two p53 family members, p63 and p73. The comparison between the targets analysed and gefitinib effectiveness evidenced the absence of a clear relationship, excluding them as predictive factors for gefitinib efficacy. Our results confirmed the in vitro efficacy of an anti-EGFR approach, but other targets than those analysed here should be characterised in order to identify valid predictive factors for gefitinib utilisation.

Loss of p53 or p73 in human papillomavirus type 38 E6 and E7 transgenic mice partially restores the UV-activated cell cycle checkpoints.

We have previously shown that human keratinocytes expressing E6 and E7 from the cutaneous human papillomavirus (HPV) type 38 have high levels of a specific form of p53, which in turn activate the transcription of DeltaNp73 gene. Expression of HPV38 E6 and E7 in mouse skin also promotes p53 and DeltaNp73 accumulation. Interestingly, keratinocytes of these mice do not undergo cell cycle arrest after skin ultraviolet (UV) irradiation. Here, we provide several lines of evidence that DeltaNp73 expression and lack of the UV response are directly linked. Loss of p53 gene in HPV38 E6/E7 transgenic mice abolished DeltaNp73 expression and partially restored the UV-activated cell cycle checkpoints. Similarly, loss of p73, and consequently DeltaNp73, led to restoration of the p53 pathways. In fact, keratinocytes of p73-/- HPV38 E6/E7 transgenic mice upon UV irradiation express high levels of p21(WAF1) and are cell cycle arrested. Thus, HPV38 E6 and E7, via DeltaNp73 accumulation, are able to alter the regulation of cell cycle checkpoints activated by UV radiation. These data suggest that UV and HPV may cooperate in skin carcinogenesis.

[Hemodynamic and coronary angiographic performance at a center with medium-low activity: organization model, activity indicators, and costs]. / Performance emodinamica e coronarografica in un centro a medio-basso volume di attività: modello organizzativo, indicatori di attività e costi.

BACKGROUND: In order to evaluate the cost-effectiveness of coronary angiography performed in a low volume Center, we examined our 1-year activity. METHODS: The organizational model of the multipurpose cardiac catheterization laboratory is described. In this type of facility both coronary angiographic and electrophysiological studies are performed. To evaluate the laboratory performance we examined the utilization level, the appropriateness of the studies, the complication rates and the number of studies that had to be repeated because of inadequate data or image quality. The costs were calculated for the in-house laboratory setting (the actual scenario) and for the 25 km distant laboratory setting (the historical scenario). RESULTS: The laboratory caseload of coronary angiography was 342 studies, 46% of the overall laboratory activity; 175 patients (51%) underwent non-pharmacological therapy, 129 patients (38%) were treated with medical therapy; the percentage of patients with normal coronary arteries was 11%. Two patients (0.58%) had vascular complications, 1 patient (0.29%) developed an acute myocardial infarction 2 hours after coronary angiography without any evidence of angiographic modifications at the repeated study. In no patient the study had to be repeated because of inadequate data or image quality. The mean cost of a coronary angiography was Lit. 512,000 (265 Euro) for the actual scenario; it would have been Lit. 694,000 (359 Euro) for the historical scenario, with Lit. 182,000 (94 Euro) saved. CONCLUSIONS: These findings are consistent with the accepted criteria of good laboratory performance and cost-effectiveness. Thus coronary angiography can be performed effectively and efficiently in a low volume Center.

The TDS: a new device for comparing active and passive-guided touch.

A problem when comparing active and passive tactile perception of two-dimensional (2-D) stimuli is matching the active and passive tasks on all variables except the one of interest--active versus passive touch. A new computer-controlled device--the tactile display system (TDS)--has been developed to deal with this problem. The TDS tracks an "active" subject's fingertip movements during exploration of a raised line drawing and digitally records this spatio-temporal information. It then guides a passive participant's fingertip over the same path, matching for location and speed. Any difference in performance can thus be attributed to the different conditions (active versus passive) because other variables are held constant.

Pharmacological atrial defibrillation via temporarily occluded coronary sinus: first clinical experience and implications for an implantable device.

UNLABELLED: The aim of this paper is to report the first experience of pharmacological atrial defibrillation in humans via a temporarily occluded coronary sinus. PATIENTS AND METHODS: In 6 patients (3 women, 3 men; mean age 57.8y, min 31, max 71), with clinical recurrences of atrial fibrillation, an occlusive coronary venogram was carried out in order to establish the origin of the Vein of Marshall. Atrial fibrillation was then induced by atrial pacing in all the patients and after an adequate waiting period to assure that the atrial fibrillation episode was persistent and stable, a bolus of a very low dose of an antiarrhythmic drug was delivered in 3-4 seconds into the temporarily balloon occluded coronary sinus near the orifice of the vein of Marshall. For both the venogram and the pharmacological test a Baim-Turi (USCI-Bard, Billerica MA) or a Vueport (Cardima, Fremont CA) catheter was used. RESULTS AND COMMENTS: In five patients a single dose of 7 mg of propafenone was immediately effective in restoring the sinus rhythm. In the remaining patient 2 doses of 7mg of propafenone failed to interrupt the arrhythmia, which was subsequently interrupted by a bolus of 0.1mg of ibutilide fumarate given after a waiting period of 20 minutes. Retroperfusion of the left atrium could account for these results; in fact the Vein of Marshall has no valvular apparatus in contrast with other coronary sinus tributary veins which are equipped with an uni- or bicuspidal valve. CONCLUSIONS: Pharmacological atrial defibrillation with a minimal dose of an antiarrhythmic drug delivered near the orifice of the Vein of Marshall via the temporarily occluded coronary sinus is feasible and effective. This new pharmacological atrial defibrillation can offer interesting opportunities in developing an implantable pharmacological atrial defibrillator.

[Heart arrest caused by ventricular fibrillation in acute biliary pancreatitis: a case report and etiopathogenetic hypothesis]. / Arresto cardiaco da fibrillazione ventricolare in corso di pancreatite acuta biliare: descrizione di un caso clinico e ipotesi eziopatogenetiche.

Acute pancreatitis and/or gallbladder disease precipitating angina pectoris, or producing arrhythmias or ST-T wave changes on electrocardiography in the absence of coronary artery disease, have frequently been mentioned. Many attempts have been made to explain the etiology of these findings. To the authors' knowledge, this report is the most dramatic expression of pathogenetic mechanisms which are still considered hypothetical.

[Efficacy of treatment with rt-PA of massive pulmonary embolism in patients with contraindications for thrombolytic therapy]. / Efficacia del trattamento con rt-PA dell'embolia polmonare massiva in pazienti con controindicazioni alla terapia trombolitica.

Pulmonary embolism is a life-threatening condition that is accompanied by significant morbidity and mortality. In massive pulmonary embolism, where restoration of pulmonary arterial flow is urgently required, the only options available are surgical thromboembolectomy and/or thrombolytic therapy. Unfortunately, a large part of thromboembolic diseases is also considered as an absolute or relative contraindication to thrombolysis. The purpose of this paper was to emphasize the possibility of new thrombolytic agents of disregarding, according to circumstances, the contraindications to thrombolytic treatment.

[Myocardial infarct with ST segment depression: an absolute contraindication to thrombolytic therapy?]. / Infarto miocardico con sottoslivellamento del tratto ST: una controindicazione assoluta alla terapia trombolitica?

The benefit of thrombolytic reperfusion has been demonstrated widely in patients who present with ST segment elevation and develop myocardial infarction. Instead, the role of thrombolytic therapy in patients who present with ST segment depression and develop myocardial infarction is still unresolved. The purpose of this paper is to review the literature on the subject and give rise to reconsideration of thrombolytic therapy in this subgroup of patients who are usually excluded from receiving thrombolytic agents because of the absence of indications and the presence of contraindications.

Electropharmacological testing by transoesophageal atrial pacing in inducible supraventricular tachyarrhythmias. A good approach for selection of long-term anti-arrhythmic therapy.

Sixty-eight patients with disabling episodes of inducible supraventricular tachyarrhythmia were tested electropharmacologically by transoesophageal atrial pacing. Using this technique we induced clinical arrhythmia in 67 (98.5%); 26 (38.8%) had a reciprocating tachycardia due to AV node reentry and 41 (61.2%) a by-pass tract. In the latter we induced a reciprocating tachycardia in 12 (29.3%), atrial fibrillation in 25 (36.5%) and both in 14 (34.2%). We then performed an anti-arrhythmic drug test and a transoesophageal reevaluation either after acute intravenous drug administration or during oral steady state. Altogether we tested 111 drugs or a combination of drugs before the results were considered positive; all patients tolerated the procedure well and were discharged with the drug or combination of drugs judged effective. At follow-up of 16.6 +/- 8.5 months, 42 patients (62.7%) were symptom-free, 17 (25.3%) had minor and non-disabling relapses, six (9%) stopped the drug because of inefficacy (1-1.5%) or side effects (5-7.5%); two (3%) dropped out. We conclude that electropharmacological testing with transoesophageal pacing constitutes a very good approach for inducible supraventricular tachyarrhythmias: it permits selection of optimal long-term anti-arrhythmic treatment and is well tolerated, only slightly invasive and without adverse effects.

Direct visualization of aorto-coronary bypass grafts by two-dimensional echocardiography: a new clinical application.

An attempt was made to assess noninvasively the patency of aorto-coronary bypass grafts by two-dimensional echocardiography (2-D echo) in 21 patients who underwent myocardial revascularization. Fifteen patients had one graft while the other six had two grafts. All 21 patients underwent angiography 6-18 months after operation. A day before angiography a 2-D echo was performed with the aim of visualizing the bypass grafts. In 18 patients with 23 grafts (13 with 1 graft and 5 with 2 grafts) it was possible to visualize the tract of the graft by 2-D echo; 16 were judged patent on 2-D echo and confirmed by selective angiography, while 5 grafts were considered occluded both on 2-D echo and angiography. The other 2 grafts were considered to be occluded on 2-D echo but angiographic control displayed their patency. In 3 patients 2-D echo failed to visualize grafts that were patent angiographically. These data must be considered preliminary and need validation in a larger number of patients. However it is reasonable to conclude that 2-D echo has a reliable capacity to predict graft patency. Such an application may be of value in sequential control of patients with aorto-coronary bypass surgery, especially when combined with other clinical and/or technical data.

Regression of cardiac hypertrophy after antihypertensive therapy with nifedipine and captopril.

The effects of two antihypertensive agents, nifedipine (N) and captopril (C), on left ventricular (LV) mass and volume were studied in 16 patients with essential hypertension (8 treated with N and 8 with C for 6 months) by means of a complete M-mode echocardiogram monitored by two-dimensional echocardiography. Both N and C induced a significant reduction in end-diastolic, but not systolic, posterior wall and septum thickness and an increase in end-diastolic volume, but not in end-systolic volume. A significant increase in the contribution of rapid filling together with a simultaneous reduction in the contribution of atrial systole to end diastolic volume were also observed. The reduction in LV wall thickness and mass after both C and N might be attributed to an improvement in diastolic function and to a reduction in wall tension, rather than to an effective regression of LV hypertrophy.

Two-dimensional echocardiography in the diagnosis of intracardiac masses: a prospective study with anatomic validation.

The accuracy of two-dimensional echocardiography in the detection of intracardiac masses was verified in 334 patients who underwent cardiac catheterization in our laboratory over 21 consecutive months. A complete two-dimensional echocardiographic (2DE) examination was performed a day before catheterization. The presence or absence of a mass was verified at surgery in 77 patients who successively underwent mitral or aortic valve replacement (51), left ventricular aneurysmectomy with or without myocardial revascularization (25), and resection of atrial myxoma (2). In 32 patients 2DE revealed the presence of a mass-left or right atrial thrombi in 12, left atrial myxoma in 2, left ventricular thrombi in 16, and endocardial vegetations in 2. The other 45 patients were free of intracardiac masses on 2DE. Anatomic verification at surgery revealed the presence of an intracardiac mass in 34 patients. In 30 (true positives) of these, 2DE revealed the mass as well, and in 4 (false negatives) the presence of a mass had not been identified by 2DE. In 2 patients (false positives) the predicted mass was not found at surgery. Absence of a mass was correctly predicted by 2DE in 41 patients (true negatives). Thus 2DE detected intracardiac masses with sensitivity of 88.2% and a specificity of 95.3%. We recommend that 2DE be performed in all patients prior to hemodynamic study and/or cardiac surgery to enable safer management of patients with intracardiac masses during cardiac catheterization and/or cardiac surgery.

Hemostatic Balance Index in TIA patients: sex-related changes.

In order to evaluate the occurrence of hemostatic disorders, 37 patients with transient ischemic attacks (TIAs) and 50 control subjects were studied by means of the Hemostatic Balance Index (H.B.I.) derived from Raby's Thrombodynamic Potential Index (T.P.I.) and Fearnley's Whole Blood Diluted Lysis Time (W.B.D.L.T.). Results showed a significant increase in T.P.I. and a tendency to a decrease in fibrinolytic activity in the TIA group: H.B.I. was shown to be significantly increased, thus indicating a pro-thrombotic imbalance in these patients. The occurrence of similar changes in TIA females when compared to male patients marks the importance of plasmatic factors in the mechanism of thrombotic disorders in females with cerebrovascular disease.

Parkinsonism caused by chronic subdural hematoma. A case report.

A 48 year-old man with chronic subdural hematoma presented with a parkinsonian syndrome. Removal of the hematoma was followed by gradual disappearance of the extrapyramidal symptoms, as in other, rare, published cases.

Pastoral care staff participate on treatment team.

Clinical department members at Marianjoy Rehabilitation Center identified problems with their staffing conferences, in which they plan patient care. The problems included a deemphasis on social and spiritual aspects and an overemphasis on billing concerns. To correct these difficulties, the hospital adopted the Patient Evaluation Conference System (PECS), adding a pastoral care component. Central to the new system is the addition of pastoral care data from scales that assess patient status in four areas: (1) awareness of spiritual dimension of disability, (2) knowledge of spiritual resources, (3) skill in spiritual self-management, and (4) use of spiritual resources. Pastoral care staff write evaluations in easily understood language so other staff members can understand pastoral care's purpose. They formulate specific short-term objectives in order to delineate the pastoral services needed. Integration with the treatment team has resulted in greater accountability for the pastoral care staff. Patient progress charts now include specific pastoral care goals, and a daily report of pastoral care services is included on patient bills, although no fee is charged. Program evaluation and feedback systems to enable pastoral care staff to make more accurate assessments are planned. The new system has enhanced staff communication, service documentation, discharge planning, and the quality of pastoral care.