A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B.

Objective: The urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital's patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating the relocation of one of the three ICUs for six months. We decided to assess the impact of this transfer on quality of care and patient safety using a set of indicators, primarily considering the incidence of healthcare-associated infections (HAIs) and mortality rates. Methods: We performed a retrospective, observational analysis of structural, process, and outcome indicators comparing the pre- and posttransfer phases. Specifically, we analyzed data between July 2016 and June 2017 for the transferred ICU and examined mortality and the incidence of HAI. Results: Despite significant changes in structural and organizational aspects of the unit, no differences in mortality rates or cumulative incidence of HAIs were observed before/after transfer. We collected data for all 393 patients (133 women, 260 men) admitted to the ICU before (49.4%) and after transfer (50.6%). The mortality rate for 100 days in the ICU was 1.90 (34/1791) before and 2.88 (37/1258) after transfer (p = 0.063). The evaluation of the occurrence of at least one HAI included 304 patients (102 women and 202 men), as 89 of them were excluded due to a length of stay in the ICU of less than 48 h; again, there was no statistical difference between the two cumulative incidences (13.1% vs. 6.9%, p = 0.075). Conclusion: In the case studied, no adverse effects on patient outcomes were observed after urgent transfer of the injured ICU. The indicators used in this study may be an initial suggestion for further discussion.

Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study.

Medical students (MSs) are healthcare workers and must also cope with education-related stressors. This study aims to assess factors associated with perceived stress in Italian MSs. A cross-sectional study was conducted in 12 Italian medical schools (MSCs) in November 2018. A questionnaire assessed socio-demographic characteristics, habits, opinions about MSC, and concerns about the future. Stress was assessed with the PSS-10. Descriptive and univariable tests were performed. A linear model was fitted to find associations of the PSS-10 score with characteristics. There were 2513 collected questionnaires. Median PSS-10 score was 18 (IQR 11). Median age was 22 (IQR 4) and 61% of the sample was female. Female gender, being part of a sexual minority, poor financial situation, competitive atmosphere, having hobbies, resting, and sleeping hindered by MSC were characteristics associated with higher PSS-10 scores. Current relationship, good family relationship, and no concerns about the future were protective factors. Being part of sexual minorities had greater effects in students not living away from home, while in the other group it was not having satisfying friendships. Medical students suffer higher levels of stress than the general population, and many MSC stressors are associated. Living away from home modifies risk and protective factors, offering the possibility to tailor group-specific interventions.

Fattori che influenzano lo screening nutrizionale nei pazienti ricoverati in ospedali per acuti: un'indagine di prevalenza regionale (2017).

BACKGROUND: the prevalence of malnutrition among hospitalized patients varies between 19.8% and 50%, with approximately 31% of all hospital patients considered malnourished or at nutritional risk, both in European and in Italian hospitals. Nutritional screening is necessary to identify nutrition-related problems, but it is not largely performed at the admission or during hospitalization. OBJECTIVES: to identify factors associated with the probability of performing nutritional screening during hospitalization and to describe BMI among inpatients in acute facilities of Friuli Venezia Giulia (FVG) Region (Northern Italy). DESIGN: point prevalence survey. SETTING AND PARTICIPANTS: the study was conducted in all the 18 hospitals of the FVG regional healthcare system; 58 trained surveyors collected data from 2nd to 30th October 2017. MAIN OUTCOME MEASURES: weight and height, presence of parenteral and enteral nutrition data of 2,553 patients were collected. RESULTS: BMI was determinable for 77.2% of people under study. Negative predictors for BMI screening were: spoke hospital (p<0.001), age over 65 years (p=0.005), both 'ultimately fatal' (p<0.001) and 'rapidly fatal' (p<0.001) McCabe score, presence of minimally invasive surgery (p=0.02); major surgery was a positive predictor (p<0.001). Prevalence of parenteral and enteral nutrition prescription was 4.0% and 3.6%, respectively; statistical differences were found according to care units and McCabe score (p<0.001). CONCLUSIONS: globally, BMI for inpatients in the surveyed hospitals is often assessed, but more investigations are needed to understand the reasons why the reported differences exist.

Absences from work among healthcare workers: are they related to influenza shot adherence?

BACKGROUND: The coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017-2018 influenza season. METHODS: We performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test. RESULTS: Influenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p < 0.001); significant differences in absences rates resulted when focusing on the influenza epidemic peak. CONCLUSIONS: Factors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals.

The efficacy and safety of influenza vaccination in older people: An umbrella review of evidence from meta-analyses of both observational and randomized controlled studies.

Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination including systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for influenza/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for influenza/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes.

Factors predicting influenza vaccination adherence among patients in dialysis: an Italian survey.

Introduction: The aim of this study was to investigate knowledge and practices about influenza among patients on dialysis services of Italian hospitals at risk of severe influenza infection and vaccine and to identify predictive factors to vaccination adherence. Methods: A cross-sectional observational study was carried out from January 2017 to July 2017 after the 2016/2017 influenza vaccination campaign. The questionnaire was administered to all patients treated in seven large Italian dialysis services. It consisted of influenza vaccination coverage, knowledge about influenza and its vaccination, perceived risk of influenza complications, recommendations on influenza uptake received by general practitioner (GP) and nephrologist. Results: Response rate was 90% (703/781). Patients' knowledge about influenza infection and vaccine were detected by nine closed questions: 35.6% of responders answered correctly to ≥ 6 sentences, 47.5% of them reported that "influenza vaccine can cause influenza" and 45.7% believed that "antibiotics are a correct strategy to treat influenza". Levels of perceived risks of hospitalisation and death were low in 39.3% and 16.5% of patients respectively. The adherence to the last seasonal influenza vaccination was 57.5%. The multivariate predictors of influenza vaccination uptake resulted: age ≥65, male, consulting TV/radio, asking information to GP and/or nephrologist. Conclusions: The study reveals the low adherence to influenza vaccination and the subotpimal level of knowledge in dialysis patients. Different strategies, including a greater alliance among nephrologists and GPs to prevent influenza should be encouraged to improve the adherence to influenza vaccination in this at risk group.