Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs.

Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients' safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a multicenter pre-post study to assess the impact of a stewardship program in seven Italian intensive care units (ICUs). Each ICU was visited by a multidisciplinary team involving clinicians, microbiologists, pharmacologists, infectious disease specialists, and data scientists. Interventions were targeted according to the characteristics of each unit. The effect of the program was measured with a panel of indicators computed with data from the MargheritaTre electronic health record. The median duration of empirical therapy decreased from 5.6 to 4.6 days and the use of quinolones dropped from 15.3% to 6%, both p < 0.001. The proportion of multi-drug-resistant bacteria (MDR) in ICU-acquired infections fell from 57.7% to 48.8%. ICU mortality and length of stay remained unchanged, indicating that reducing antibiotic administration did not harm patients' safety. This study shows that our stewardship program successfully improved the management of infections. This suggests that policy makers should tackle multidrug resistance with a multidisciplinary approach based on continuous monitoring and personalised interventions.

Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study.

BACKGROUND: Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. PURPOSE: A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. METHODS: In this before-and-after study, data were collected before (T0) and after (T1) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores. RESULTS: The main outcome measure was pain recollection a year after discharge; secondary outcome measures were the use and doses of sedatives and analgesics. A significantly (p = .037) smaller proportion of patients treated after protocol adoption recollected feeling severe pain compared with patients treated before the protocol was introduced. This group also received significantly (p < .001) fewer sedatives and significantly (p = .0028) more anti-inflammatory drugs and analgesics on an "as needed" basis. The administration of strong analgesics was similar in the two groups. The intervention was implemented in 70.5% of patients with intermediate to high pain scores. CONCLUSIONS: Appropriately trained ICU nurses have the potential to help adopt pain relief and prevention measures during nursing care and to contribute to the successful management of sedation and analgesia. Further studies of larger patient samples are needed to monitor the stability of results over time and to explore the efficacy of the approach in other populations, such as pediatric and neonatal ICU patients.

Analysis of the vocal profiles of male seduction: from exhibition to self-disclosure.

The authors analyzed the suprasegmental (temporary) vocal profiles of 19 young men (not married) during their seductive interaction with 19 young women (not married) whom they had not known previously. The aim of the research was to verify the specificity, the sequential temporal stream, and the efficacy of the acoustical features of the seducer's voice during seductive interaction. In an ecological laboratory situation, the male participants were asked to meet their female partners. Participant-by-participant analysis showed that the male seductive voice is characterized by strong variations during the course of the seductive sequence. At the beginning of the sequence it had a higher pitch and an elevated intensity, as well as a faster rate of articulation than it did during normal speech (the exhibition voice). In the following phases it became gradually lower, weaker, and warmer (the self-disclosure voice). The modulation and variability of the vocal profiles during the seductive interaction were significantly stressed in the 9 successful seducers (those who succeeded in arranging a subsequent meeting with the partner), compared with the 10 unsuccessful seducers. The results have been interpreted as an ability to perform an effective local management of seductive communication.

Behind dark glasses: irony as a strategy for indirect communication.

This article outlines the model of irony seen as a "fencing game." The starting point is the metaphor of the "dark glasses" (R. Barthes, 1977), according to which irony is considered as a mask revealing, paradoxically, what it apparently hides. Basing the study on both perspectives of symbolic interactionism and planning communication theory, the authors analyze the social functions of irony (to evade censure in a socially correct way, to safeguard private space, to renegotiate meanings). In this framework, irony is described as a script of actions that people use astutely in order to strike antagonists in a graceful but "stinging" way, just like fencers in a competition. The fencing game model of irony foresees 4 steps: the textual and contextual assumptions (i.e., shared knowledge), the focal event (the trigger of irony), the dialogic comment (the ironic utterance the speaker performs by combining verbal and nonverbal aspects), and the ironic effect referring to the addressee's feedback (denying, misunderstanding, touché). The advantages of the fencing game model of irony are also considered.