Implementation of a quality management system according to ISO 9001:2015 standards in an Angiology Unit: an Italian experience.

Background: The International Standardization Organization operates the world's most widely recognized quality management system standard, the ISO 9001:2015. In the healthcare sector, the adoption of this standard within an organization helps to improve the overall performance and provides a foundation for development and continuous progress. Our study aims to describe the implementation process of a quality management system according to the ISO 9001:2015 standards in an Angiology Unit of an Italian Univer-sity hospital. Methods: The project was structured in 5 operational phases, which were carried out during a time frame of 14 months (March 2018-May 2019) and entailed several improvement actions associated with quality and safety outputs such as clinical management, clinical practice, safety, and patient-centeredness. Results: Implementation of the quality management system led to the improvement of many aspects of the processes performed in the Angiology Unit, both in the outpatient and day hospital setting. Overall, the project positively impacted on systems for patient safety, particularly in communication and data transmis-sion, and clinical leadership. Conclusions: The implementation of the ISO 9001 certification is a process that apparently may seem ex-pensive in terms of resources used, commitment, work, comparison, but it leads to substantial and always progressive improvements in the offer of Services to the user, safety both for the users and for the healthcare personnel involved, in addition to the care processes that translate into significant benefits in terms of quality of care for patients, as well as management savings for the organization.

Screening for hepatitis B virus infection among refugees diagnosed with latent tuberculosis in an Italian community.

Background: Refugees are a growing population in the EU-27 area with specific health needs that are to be addressed in the most rapid and effective way at their arrival in the host country. Screening for Hepatitis B Virus infection is offered to specific categories and it could be useful and effective to extend its indications. The aim of this study was to define the epidemiological profile regarding Hepatitis B Virus infection in re-fugees hosted in the Asylum Seekers Centers of Verona (Italy), diagnosed with latent tuberculosis infection and eligible for chemoprophylaxis. Methods: We conducted a retrospective study in 715 refugees diagnosed with latent tuberculosis infection from January 1st, 2015 to December 31st, 2017. Screening for Hepatitis B Virus infection was offered to la-tent tuberculosis infection patients who were due to commence treatment. Subjects were tested for Hepatitis B surface Antigen and Hepatitis B core antigen total antibodies. None of the screened patients reported previous vaccination for hepatitis B. Results: Among the 715 refugees diagnosed with latent tuberculosis infection, 593 were eligible for treatment for latent tuberculosis infection. Of these, 211 (35.6%) accepted to be screened for Hepatitis B Virus infection. One hundred and ninety-five of the 211 (92.4%) came from African countries, and 16 (7.6%) from Asia; the majority (80.9%) were males. Median age was 23 years (95% CI 22-24). Of the 211, 58 individuals (27.5%) were Hepatitis B surface Antigen and Hepatitis B core antigen total antibodies positive; 74 (35.1%) were Hepatitis B surface Antigen negative and Hepatitis B core antigen total antibodies positive; and 79 (37.4%) were Hepatitis B surface Antigen and Hepatitis B core antigen total antibodies negative. Male gender and African origin were associated with a lower probability of being Hepatitis B surface Antigen- and Hepatitis B core antigen total antibodies-negative. Conclusions: Screening for Hepatitis B Virus is of paramount importance not only for the control and prevention of infection, but also in terms of long-term healthcare issues. Making screening more systematic can have an important impact on public health, while always considering cost-effectiveness and promotion of awareness among ethnic groups in order to gain their compliance to treatment/vaccination.

COVID-19 pandemic: an Italian single institution's experience and lessons learned by public health residents' workforce.

Methods: We hereby provide a systematic description of the response actions in which the public health residents' workforce was pivotal, in a large tertiary hospital. Background: The Coronavirus Disease 2019 pandemic has posed incredible challenges to healthcare workers worldwide. The residents have been affected by an almost complete upheaval of the previous setting of activities, with a near total focus on service during the peak of the emergency. In our Institution, residents in public health were extensively involved in leading activities in the management of Coronavirus Disease 2019 pandemic. Results: The key role played by residents in the response to Coronavirus Disease 2019 pandemic is highlighted by the diversity of contributions provided, from cooperation in the rearrangement of hospital paths for continuity of care, to establishing and running new services to support healthcare professionals. Overall, they constituted a workforce that turned essential in governing efficiently such a complex scenario. Conclusions: Despite the difficulties posed by the contingency and the sacrifice of many training activities, Coronavirus Disease 2019 pandemic turned out to be a unique opportunity of learning and measuring one's capabilities and limits in a context of absolute novelty and uncertainty.

Active TB screening among homeless people attending soup kitchens in Verona (Italy).

Background: The hard-to-reach populations, including the homeless, are particularly vulnerable to the development of active tuberculosis. According to the World Health Organization, tuberculosis rates among the homeless in industrialized Countries are up to 20 times higher if compared with the general popula-tion, representing a relevant public health problem. The aim of our study was to describe the results of an active tuberculosis screening applied in order to find out suspected active TB cases among the homeless in Verona. Methods: As part of a partnership between the non-profit association Medici per la Pace and one of the Local Health Units of Veneto Region (ULSS 9 Scaligera) in 2018, a tuberculosis screening, based on thoracic radiographs, was offered to the homeless guests of two Verona's soup kitchens. Results: The studied population included 139 people, and three cases of suspected active tuberculosis, all in males, were observed. Among these, two received a diagnostic confirmation of active tuberculosis (a prevalence of 1.44% - CI: 0,17 - 5,1). Moreover, radiographic patterns of tuberculosis aftermaths were found in six additional subjects. Conclusions: Interventions specifically dedicated to hard-to-reach populations, can be useful in identifying tuberculosis active cases and controlling the disease in low tuberculosis burden countries. In particular, the active research of subjects, the screening carried out with mobile X-ray, and also the constant caring of the patients with active disease, could be the right method to keep under control this relevant public health problem.

Hyperbaric oxygen therapy in Plastic Surgery practice: case series and literature overview.

Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures more than atmospheric. Several approved applications and indications exist for HBOT in the literature. Non-healing wounds, such as diabetic and vascular insufficiency ulcers, have 1 Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University Hospital of Padova, Padova, Italy 2 Department of Physiology, University of Padova, Padova, Italy Corresponding author: Ilaria Tocco-Tussardi, e-mail: ilaria.toccotussardi@gmail.com © Copyright 2019, CIC Edizioni Internazionali, Romabeen a major area of application, and the use of HBOT as an adjunct has been approved by several studies and trials. HBOT is also indicated for acute soft tissue infections like clostridial myonecrosis, necrotising soft tissue infections, as also for traumatic wounds, crush injury, compartment syndrome, and compromised skin grafts and flaps. Another major area of application of HBOT is radiation-induced wounds. With increasing availability of chambers and studies proving the benefits of use, HBOT should be considered as an essential part of the overall management strategy for plastic surgeons.

Ischemic through-and-through necrosis of the lateral wall of the torso and inguinal region subsequent to flame injury and septic shock: a case report and literature review.

Post-burn infections still stand as the most common/serious complication of burn injuries: sepsis accounts for 50-60% of deaths in burn patients despite improvements in antimicrobial therapies. Among the many potential complications of sepsis/septic shock are hemodynamic instability and perfusion failure. We report the case of a patient developing massive soft tissue necrosis after an episode of acute post-burn septic shock, with possible explanation of an overdosage of vasopressors due to significant body weight increase as an effect of the burn resuscitation. The utility of vasopressor agents in the management of septic shock depends on the balance between increased perfusion pressure and the direct effect on the microvasculature. The almost inevitable body weight increase in the acute post-burn phase as an effect of the resuscitation makes this balance more difficult to maintain.

Les infections restent les complications les plus fréquentes et les plus sérieuses des brûlures: le sepsis est responsable de 50 à 60% des morts chez les patients brûlés, malgré les améliorations du traitement antimicrobien. Parmi les nombreuses complications potentielles de l'infection et du choc septique, figurent l'instabilité hémodynamique et l'échec des perfusions. Nous rapportons l'observation d'un patient développant une nécrose massive des parties molles après un épisode de choc septique, chez un brûlé avec comme explication possible, un surdosage de vaso-presseurs lors de la réanimation, responsable d'une augmentation significative du poids corporel. L'efficacité des agents vasopresseurs dans la prise en charge du choc septique dépend de l'équilibre entre l'augmentation de la pression perfusionnelle et l'effet direct sur la micro vascularisation. L'augmentation du poids corporel toujours inévitable lors de la phase aiguë de la brûlure, en relation directe avec la réanimation, rend plus difficile le maintien de cet équilibre.

Antiseptics for burns: a review of the evidence.

The burn patient is easily subject to colonization by microorganisms and infection, due to reduced defence capabilities and immune dysfunction. Moreover, burn units and intensive care units are characterized by a selection of resistant bacterial strains. If the burn patient is not adequately cared for in terms of infection prevention and control, sepsis is inevitable. Nowadays, several different antiseptics and antiseptic dressings are used in the topical treatment of burns, each with positive and negative effects. Topical antiseptics allow control of bacterial load, but they can also cause cytotoxicity and reduce healing rate. Choosing the most effective antiseptic is crucial to preventing infection from compromising wound healing. The present study aims to review the available literature in order to highlight evidence on the use of topical antiseptics in burns.

Les patients brûlés sont facilement colonisés et infectée, en raison de diminution des capacités de défense et de la fonction immunitaire. En outre, les services de réanimation et les CTB ont une prévalence élevée de bactéries multirésistantes. Si les mesures préventives et les soins sont mal conduits, la survenue d'infection est inéluctable. Actuellement, de nombreux antiseptiques et pansements antiseptiques sont disponibles, chacun avec ses avantages et inconvénients. Ils ont en effet la capacité de diminuer la charge bactérienne locale, mais sont susceptibles d'obérer la cicatrisation par cytotoxicité. Le choix de l'antiseptique peut donc être crucial. Cette revue de la littérature a pour but de dégager des données factuelles concernant l'usage des antiseptiques chez les brûlés.

Microsurgery "without borders": new limits for reconstruction of post-burn sequelae in the humanitarian setting.

Post-burn contractures account for up to 50% of the workload of a plastic surgery team volunteering in developing nations. Best possible outcome most likely requires extensive surgery. However, extensive approaches such as microsurgery are generally discouraged in these settings. We report two successful cases of severe hand contractures reconstructed with free flaps on a surgical mission in Kenya. Microsurgery can be safely performed in the humanitarian setting by an integration of: personal skills; technical means; education of local personnel; follow-up services; and an effective network for communication.

Les rétractions après brûlures constituent 50% de l'occupation d'une équipe humanitaire de chirurgie plastique dans les pays en voie de développement. Les meilleurs résultats possibles nécessitent une chirurgie lourde. Cependant certaines de ces approches comme la microchirurgie ne sont généralement pas encouragées dans ce cadre. Nous rapportons deux cas successifs de rétractions majeures de la main, réparées par lambeaux libres dans une mission chirurgicale au Kenya. La microchirurgie peut donc être réalisée en toute sécurité dans le cadre humanitaire, à condition de bénéficier d'une expérience personnelle, de moyens techniques appropriés, de l'éducation du personnel local, des services de suite et enfin d'un réseau effectif de communication.

The instructional value of international surgical volunteerism from a resident's perspective.

The aim of this article is to document the experience of the author who volunteered as a resident for 6 months at a districtlevel hospital in central Kenya. Peculiarities emerging from the report are: specificity of the experience to plastic reconstructive surgery; highly complex reconstructive procedures performed under direct supervision of a qualified mentor; exposure to diverse approaches through collaboration with different volunteer plastic surgeons; enhancement of long-term surveillance; and opportunity to expand surgical knowledge outside one's field of specialty. The humanitarian setting allows maximal exposure and learning and can play a significant role in the resident's education.

Le but de cet article est de rapporter l'expérience de l'auteur, qui a effectué un stage bénévole de résident pendant six mois dans un hôpital régional au centre du Kenya. Les particularités qui ressortent de ce rapport sont: le caractère spécifique de l'expérience en chirurgie plastique et reconstructrice; la complexité des techniques de chirurgie réparatrice réalisées sous la surveillance d'un mentor qualifié; la confrontation avec diverses attitudes chirurgicales à travers la collaboration de différents chirurgiens plastiques bénévoles; l'amélioration de la surveillance à long terme; l'opportunité d'élargir ses connaissances chirurgicales au-delà de son champ habituel. Les conditions de médecine humanitaire permettent un maximum de vision et d'apprentissage, et peuvent jouer un rôle significatif dans la formation du résident.

Late complications of high-voltage electrical injury might involve multiple systems and be related to current path.

Delayed complications of electrical burns are mostly unexpected, and the link between the injury and the symptoms often goes unrecognized. A possible relation between source-ground sites and late clinical manifestations was recently emphasized. We report a unique case of combined intestinal-spinal delayed complications following a high-voltage electrical injury, a possible explanation being a greater current flow through the right hemisoma. The potential for late complications is an additional feature that physicians must consider in managing electrical injuries. Manifestations are variable and presentation is confounding, but current flow path can constitute a precious source of information to predict complications in the late phase of management.

Les complications tardives des électrisations par haut voltage sont le plus souvent inattendues et le lien avec l'accident initial est fréquemment non reconnu. Une relation possible entre le trajet source-terre et les complications tardives a récemment été mise en évidence. Nous rapportons le cas de complication tardive touchant à la fois l'intestin et la moëlle épinière, pouvant être expliqué par le passage préférentiel du courant dans l'hémicorps droit. La possibilité de complications tardives doit être prise en compte des électrisations par haut voltage. Ces manifestations sont variables et la clinique peut être peu claire, mais le trajet supposé du courant peut être un argument permettant de relier l'atteinte initiale et les complications tardives.