ABSTRACT
OBJECTIVE: To summarise the findings on the effect of the clinical use of 0.1% polyhexanide-propylbetaine (PHMB/betaine) solution/gel on acute and hard-to-heal (chronic) wound healing. METHOD: A literature search was conducted in MEDLINE, CINAHL, Embase, Scopus and the CENTRAL Trials Registry of the Cochrane Collaboration. Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and observational studies. Study quality and risk of bias were not formally evaluated. RESULTS: A total of 17 studies met the eligibility criteria. The findings from 12 studies indicated that the use of 0.1% PHMB/betaine solution/gel had: a low risk of contact sensitivity; could help debridement during wound cleansing; aided effective wound bed preparation; reduced wound size, odour and exudate; improved pain control; reduced microbial load; and enhanced wound healing. The results of three studies indicated that both 0.1% PHMB and saline solution were effective in reducing bacterial load, while another showed that adding 0.1% PHMB to tie-over dressings had no effect on reducing bacterial loads in wounds. Another study concluded that disinfection and granulation of pressure ulcers with hydrobalance dressing with 0.3% PHMB was faster and more effective than using 0.1% PHMB/betaine. CONCLUSION: The findings of this literature review showed that 0.1% PHMB/betaine solution/gel appeared to be useful and safe for wound cleansing, was effective in removing soft debris and slough from the wound bed, and created a wound environment optimal for healing. Although these actions cannot be attributed solely to this treatment modality, these results do highlight the unique action of this combined product. However, more robust studies are needed to confirm these results.
Subject(s)
Betaine , Biguanides , Wound Healing , Humans , Biguanides/therapeutic use , Betaine/therapeutic use , Betaine/administration & dosage , Wound Healing/drug effects , Wounds and Injuries/drug therapy , Gels , Anti-Infective Agents, Local/therapeutic useABSTRACT
A survey of hospitals on three continents was performed to assess their infection control preparedness and measures, and their infection rate in hospital health care workers during the COVID-19 pandemic. All surveyed hospitals used similar PPE but differences in preparedness, PPE shortages, and infection rates were reported.
Subject(s)
COVID-19/epidemiology , Infection Control/methods , Personnel, Hospital/statistics & numerical data , Hospitals , Humans , Internationality , Pandemics , Personal Protective Equipment , Surveys and QuestionnairesABSTRACT
BACKGROUND: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.
Subject(s)
COVID-19/epidemiology , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Continuous Positive Airway Pressure/statistics & numerical data , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Hypoxia/epidemiology , Hypoxia/physiopathology , Hypoxia/therapy , Italy/epidemiology , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/epidemiology , Noninvasive Ventilation/statistics & numerical data , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Smoking/epidemiologyABSTRACT
Bergamo province was badly hit by the coronavirus disease 2019 (COVID-19) epidemic. We organised a public-funded, multidisciplinary follow-up programme for COVID-19 patients discharged from the emergency department or from the inpatient wards of 'Papa Giovanni XXIII' Hospital, the largest public hospital in the area. As of 31 July, the first 767 patients had completed the first post-discharge multidisciplinary assessment. Patients entered our programme at a median time of 81 days after discharge. Among them, 51.4% still complained of symptoms, most commonly fatigue and exertional dyspnoea, and 30.5% were still experiencing post-traumatic psychological consequences. Impaired lung diffusion was found in 19%. Seventeen per cent had D-dimer values two times above the threshold for diagnosis of pulmonary embolism (two unexpected and clinically silent pulmonary thrombosis were discovered by investigating striking D-dimer elevation). Survivors of COVID-19 exhibit a complex array of symptoms, whose common underlying pathology, if any, has still to be elucidated: a multidisciplinary approach is fundamental, to address the different problems and to look for effective solutions.
Subject(s)
COVID-19/mortality , COVID-19/pathology , SARS-CoV-2 , Adult , Aftercare , Aged , Aged, 80 and over , COVID-19/complications , Female , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Patient Discharge , Polymerase Chain Reaction , RNA, Viral/blood , Severity of Illness Index , Young AdultABSTRACT
BACKGROUND: Findings from February 2020, indicate that the clinical spectrum of COVID-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS: Retrospective observational study of all COVID-19 patients admitted to the main hospital of Bergamo, from February 23 to March 14, 2020. RESULTS: Five hundred and eight patients were hospitalized, predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO
Subject(s)
Age Factors , COVID-19/epidemiology , COVID-19/pathology , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , Female , Humans , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness IndexSubject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Emergency Medicine/organization & administration , Hospital Administration/methods , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Age Factors , Antibodies, Viral/blood , Betacoronavirus/pathogenicity , COVID-19 , COVID-19 Testing , Communicable Disease Control , Coronavirus Infections/pathology , Coronavirus Infections/virology , Female , Hospitals , Humans , Hygiene/education , Italy/epidemiology , Lymphopenia , Male , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , RNA, Viral/blood , SARS-CoV-2 , Severity of Illness IndexABSTRACT
. Prospective assessment of the agreement of instruments for measuring the hospital nursing workload: the Swiss Method, the Karnofsky Performance Status Scale and the subjective perception of the nurses. INTRODUCTION: An emerging need of all healthcare organizations is the availability of reliable measures of nursing workload and underlines the problem of the choice of reliable criteria and scores. AIM: To assess the agreement between Swiss Method (SM), Karnofsky Performance Status Scale (K) and Subjective Perception (SP) of nurses in defining the nursing workload. METHODS: A prospective observational study was conducted throught computerized compilation of the three scales for each patient in 21 consecutive days, in a large specialized hospital. Nurses were asked to rate the average nursing workload in the last 24 hours. The scales were compared through Cohen's Kappa across different sets of patients. RESULTS: The data were collected for 7.810 patient days on 1.187 patients. At different levels of aggregation there was a strong heterogeneity between the care-related profiles and the levels of concordance that rarely exceeded the "discreet" level. However a reasonable agreement was obtained between K and SP in medical and surgical wards. The formal comparison of the three scales makes it impossible to formulate a preferential judgment for any of the three. CONCLUSIONS: Measuring phenomena such as workload requires reliable instruments targeted for specific contexts and to the aims results will be used for. The study directly compared on a hospital representative sample the results of the adoption of instruments- expected to be eterogeneous- and often used to guide the allocation of human and material resources.
Subject(s)
Karnofsky Performance Status , Nursing Assessment , Nursing Staff, Hospital , Workload , Female , Humans , Italy , Male , Middle Aged , Nursing Assessment/methods , Personnel Staffing and Scheduling/standards , Prospective Studies , Surveys and QuestionnairesABSTRACT
PURPOSE: To identify the main and most significant risk factors for falls and improve the quality of care delivered to pediatric patients by providing indications for interventions for the prevention of falls. METHODS: To investigate the correlation between falls and risk factors a retrospective observational case-control study was carried out, the sample was made up by all children who fell from 2004 to 2011 between 0-18 y.o. for which there was a record of the fall. RESULTS: 108 children were included in the study (36 cases and 72 controls). The data showed that 4 drugs have a correlation with falls,on the contrary intravenous therapy seemed to be a factor that protects against the risk of falling. CONCLUSION: The study confirms the importance of the problem of falls in children. A greater sample size could help to identify additional independent variables. This study may represent a starting point for further analysis.