Impact on nurse workload and patient satisfaction of atrioventricular junction ablation performed simultaneously with conduction system pacing using a superior approach from the pocket compared to the conventional femoral approach.

AIMS: Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket, via axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral venous approach (FA) to perform AVJA. In this study we compared the impact of these alternative approaches on the nurse workload (NWL) and on patient satisfaction. METHODS AND RESULTS: Prospective, observational study, enrolling consecutive patients undergoing simultaneous CSP and AVJA. ElectrophysiologyLaboratory (EP Lab) NWL was calculated with a self-developed model. Ward NWL was calculated using the MIDENF® validated scale. Patient satisfaction was collected using the Hospital Consumer Assessment of Healthcare Provider Systems (HCAHPS) questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. Compared to FA, SA was associated with a lower EP Lab NWL (169.8±26.7 vs. 202.7±38.9 minutes; p<0.001), and a lower Ward NWL (474.5±184.8 vs. 808.6±289.9 minutes; p<0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL (hazard ratio 4.60; p=0.001), and of lower Ward NWL (hazard ratio 45.13; p<0.001). Compared to FA, SA was associated with a higher patient-reported rating regarding the experience during hospital stay (p=0.035), and the overall hospital evaluation (p=0.026). CONCLUSIONS: In patients undergoing simultaneous CSP and AVJA, the use of a SA for ablation is a valid alternative to conventional FA. Compared to FA, this approach significantly reduces NWL, and is associated with greater patient satisfaction.

[The management of structured interviews from lay personnel of the European non-emergency call number 116117]. / Gestione dell'intervista strutturata da parte del personale laico all'interno di una Centrale Numero Europeo Armonizzato (NEA) 116117.

. The management of structured interviews from lay personnel of the European non-emergency call number 116117. INTRODUCTION: The 116117 telephone number is the European harmonised number (NEA) for access to non-emergency medical care and other low-intensity/priority community health services. AIM: To describe the model used for handling calls from citizens of the Lombardy Region to the NEA central unit and to compare it with other NEA central unit organisational models. METHODS: The calls received at the centre in 2021 were analysed according to the indicators proposed by a governamental agency (AGENAS). RESULTS: In 2021, 1,415,590 calls were received (approximately 1 in every 10 inhabitants of the Lombardy Region): 2% were transferred to the 118 emergency service; 92% to the Continuity of Care service and 6% were calls requesting information. The response time to the citizen was on average less than 3 minutes, with 90% of calls being handled within 6 minutes. Most of the NEA centres in Italy are managed by lay people and a structured interview model is adopted in all of them. CONCLUSIONS: The model adopted in Lombardy appears to be safe. The calls were handled without incidents. It would be useful to compare the costs and outcomes of centres organised with other models and to make a comparison of the interview patterns adopted.

Traffic Stream Analysis by Radar Sensors on Two-Lane Roads for Free-Moving and Constrained Vehicles Identification.

This paper focuses on the analysis of traffic streams on two-lane highways, which are crucial components of transportation networks. Traffic flow measurement technologies, such as detection stations, radar guns, or video cameras, have been used over the years to detect the level of traffic and the operating conditions. This type of sensor can record a large amount of data which is useful to evaluate and monitor road traffic conditions, and it is possible to identify free-moving and constrained vehicles by processing the collected data. This study introduces an exponential headway model to identify the headway threshold above which vehicles can be considered as unconditioned. However, this value could identify vehicles which still retain some autonomy in their speed and maneuvering. Therefore, an additional criterion to distinguish between apparently and actually conditioned vehicles has been introduced, analyzing the speed differences between a vehicle and the preceding one. Three-month sequences of traffic monitored through radar devices placed on some Italian two-lane roads have been analyzed and an exponential headway model has been introduced, as an illustrative example. The results show that introducing the criterion of maneuvering freedom can significantly improve traffic flow analysis, modifying the starting critical values of 4 and 8 s per each studied section, to 2.5 and 3 s, approaching the values suggested by international manuals for traffic flow quality analysis.

Case management programs in emergency department to reduce frequent user visits: a systematic review.

BACKGROUND AND AIM: Inappropriate visits to the Emergency Department (ED) by frequent users (FU) are a common phenomenon because this service is perceived as a rapid and concrete answer to any health and social issue not necessarily related to urgent matters. Could Case Management (CM) programs be a suitable solution to address the problem? The purpose is to examine how CM programs are implemented to reduce the number of FU visits to the ED. METHODS: PubMed, CINAHL and EMBASE were consulted up to December 2018. This review follows PRISMA guidelines for systematic review, as first outcomes were considered the impact of CM interventions on ED utilization, costs and composition of teams. RESULTS: Fourteen studies were included and they showed patients with common characteristics but the FU definition wasn't the same. Twelve studies provided a reduction of ED utilization and seven studies a cost reduction. The main tool used is the individual care plan with telephone contact, supportive group therapy, facilitated contacts with healthcare providers and informatics system for immediate identification. The CM team composition is heterogeneous, even if nurses are considered the most used professional figures. CONCLUSIONS: In contrast with a standardized method, a customized approach of CM program helps frequent users in finding an appropriate answer to their needs, thus decreasing inappropriate visits to the ED.