Work Related Violence As A Predictor Of Stress And Correlated Disorders In Emergency Department Healthcare Professionals.

AIMS: The aim of the study was to investigate the frequency, type, causes and consequences of violence and aggression experienced by Emergency Department workers during their interactions with patient, their relatives or companions and whether the phenomenon of violence at work is a specific risk factor predicting stress and possible stress related pathologies in emergency health workers. The study proposes a model of effective intervention for the prevention and management of violence and stress. METHODS: A cross-sectional retrospective study was performed with a sample of 323 healthcare workers at Department of Emergency and Acceptance of Level II and the Psychiatric Services of Diagnosis and Care of the University Hospital Policlinico Umberto I, in Rome, Italy, between June 2016 and February 2017. Data collection was conducted by a psychiatrist by means of a questionnaire method administered to each participant and by carrying out individual interviews. The two questionnaires used, both the Health Violence Questionnaire (QVS) and the Workers' Stress Perception Questionnaire (SPQR) were designed ad hoc, after some test sessions intended for the creation of their content. RESULTS: Eighty-seven percent of emergency healthcare workers experienced workplace violence by patients or their relatives. More than half of healthcare workers reported multiple consequences on their emotional sphere, in particular female healthcare professionals and all those who have suffered frequent incidents of violence. Regarding the effects on lifestyle, one third reported an increase in consumption of tobacco, food and sleep disorders and changes from social relationships to social isolation and avoidance of some places. More than one third of healthcare workers reported consequences on their well-being and health, especially the female workers. Distress was associated with frequent workplace violence. Healthcare workers who experienced frequent violence indicated lack of support from hospital administration and ED management as barriers to reporting workplace violence. CONCLUSIONS: The study confirms the diffusion of the workplace violence by patients and/or their relatives against the emergency healthcare professionals, related to the gender, the professional qualification, the role in the organization and the workplace. Almost all male and female healthcare workers reported they had suffered the effects on lifestyle, working habits and wellbeing and health following the workplace violence. Precipitating factors to violent incidents identified by healthcare professionals are consistent with the research literature. Commitment from hospital administrators, ED managers and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED healthcare workers. Our study emphasizes the importance of analyzing, in addition to general job demands, the specific job demands such as the phenomenon of violence, considered a key risk factor, predictor of stress and possible mental disorders in healthcare workers operating in high-risk environments. This study confirms the importance of application of the modified model by Brough and Biggs of integrated multidimensional intervention on the prevention and management of workplace violence and work stress and shall be implemented on all three levels: individual, organizational and situational. The study also highlights the need to implement support strategies for the victims of violence.

Stress at work: development of the Stress Perception Questionnaire of Rome (SPQR), an ad hoc questionnaire for multidimensional assessment of work related stress.

Stress is an emotional condition, mostly experienced as negative, initially identified and defined by Selye in the mid-thirties of the last Century. Since the first definition, stress concerns the adaptation pro- cess mostly related to environmental changes. An application of stress focuses on the evaluation of its interference on work conditions, and the scientific evidence on work related stress is very ample and rich. We are proposing a new ad hoc questionnaire for the multidimensional assessment of work related stress, called Stress Perception Question- naire of Rome (SPQR) composed of 50 items. The development of this questionnaire is based on a multi-step process: a) Identification of all the relevant topics to work related stress and areas in the scientific evidence and their transformation on specific contents of 60 tentative items; b) Exploratory factor analysis aimed to identify the best items (50) which could guarantee the maximum convergence on single scales (8), and the minimum redundancy between scales; c) Validation of the 8 scales' structure by a confirmatory factor analysis (fully achieved); d) Factor analysis for a second level factor resulting in a single factor identified as the questionnaire total score (Stress Score); d) Reliability analysis of the questionnaire total score and the single scale scores (at optimum level); e) Validation by external criteria of work related stress identified in the presence of personal violence episodes experienced by a group of health workers with different professional profiles and from two different hospitals in Rome. Our results show that the SPQR is a useful and sensitive tool for assessing the presence of emotional stress related problems identifiable in a work environment. The advantage of this questionnaire is that it allows for a multidimensional description of the different components of this problematic area besides its ability to quantify the overall stress level of those who have been administered the SPQR.

Is early recurrence of hepatocellular carcinoma in HCV cirrhotic patients affected by treatment with direct-acting antivirals? A prospective multicentre study.

BACKGROUND: Data on HCV-related hepatocellular carcinoma (HCC) early recurrence in patients whose HCC was previously cured, and subsequently treated by direct-acting antivirals (DAAs), are equivocal. AIM: To assess the risk of HCC early recurrence after DAAs exposure in a large prospective cohort of HCV-cirrhotic patients with previous successfully treated HCC, also looking for risk factors for cancer early recurrence. METHODS: We enrolled 143 consecutive patients with complete response after curative treatment of HCC, subsequently treated with DAAs and monitored by the web-based RESIST-HCV database. Clinical, biological, and virological data were collected. The primary endpoint was the probability of HCC early recurrence from DAA starting by Kaplan-Meier method. RESULTS: Eighty-six per cent of patients were in Child-Pugh class A and 76% of patients were BCLC A. Almost all patients (96%) achieved sustained virological response. Twenty-four HCC recurrences were observed, with nodular or infiltrative pattern in 83% and 17% of patients, respectively. The 6-, 12- and 18-month HCC recurrence rates were 12%, 26.6% and 29.1%, respectively. Main tumour size and history of prior HCC recurrence were independent risk factors for HCC recurrence by Cox multivariate model. CONCLUSIONS: Probability of HCC early recurrence in patients who had HCC previously cured remains high, despite HCV eradication by DAAs. Risk was comparable but not higher to that reported in literature in DAA-untreated patients. Previous HCC recurrence and tumour size can be used to stratify the risk of HCC early recurrence. Further studies are needed to assess impact of DAAs on late recurrence and mortality.

[Violence on health care workers].

OBJECTIVES: The Emergency Department (ED) is vulnerable for workplace violence, but little is known about this and its consequences. Objectives of this study were presence, characteristics and effects of violence from patients and visitors on health care workers in an Emergency Department (ED). MATERIALS AND METHODS: This study was about the Accident and Emergency Department, S. Pertini Hospital, (ASL RMB, Rome, Italy). Data were collected from November 2014 to January 2015 on frequency and type of violent behavior in the past five years experienced by staff members and their level of stress by an ad hoc questionnaire for the evaluation of violent events in health activities (QVS) and a questionnaire on perceived work-related stress (QES). RESULTS: Of the 58 eligible workers, 51 completed the interview. Health care workers were regularly exposed to violence with a consequent severe underreporting to work authorities and only a minor reporting to the police. A diffuse belief that workplace violence is a normal part of the work was also identified. Aggressors were usually patients or their relatives and were mainly males. Health care workers may suffer physical and emotional harm. CONCLUSIONS: Emergency Department health care workers are at risk of experiencing workplace violence and should have specific training and support in the management of violent situations focused on early identification, communication strategies, and de-escalation techniques.

Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for ivacaftor therapy in the context of CFTR genotype.

Cystic fibrosis (CF) is a life-shortening disease arising as a consequence of mutations within the CFTR gene. Novel therapeutics for CF are emerging that target CF transmembrane conductance regulator protein (CFTR) defects resulting from specific CFTR variants. Ivacaftor is a drug that potentiates CFTR gating function and is specifically indicated for CF patients with a particular CFTR variant, G551D-CFTR (rs75527207). Here, we provide therapeutic recommendations for ivacaftor based on preemptive CFTR genotype results.

Vasospastic angina and scombroid syndrome: a case report.

Scombroid syndrome is a fish poisoning characterised by the onset of symptoms compatible with a pseudoallergic reaction; it is rarely also responsible of signs and symptoms of acute coronary syndromes, as demonstrated in this case report.

[Cardiovascular risk markers in hemodialysis]. / Marcatori di rischio cardiovascolare in emodialisi.

PURPOSE: Although maintenance dialysis prevents death from uremia, patient survival remains an important issue. Cardiovascular (CV) events have been considered the main cause of death in hemodialysis (HD) patients. Some authors demonstrated an expected remaining life span of < or =2 yrs in HD patients who had a myocardial infarction. Therefore, it is very important to appraise risk factors and to adopt the correct diagnostic approach to match therapy. Nevertheless, acute myocardial infarction can be misdiagnosed in uremic patients, because typical markers have high false positivity rates. It has been estimated, for example, that 29% of HD patients have elevated serum troponin T concentrations, but do not have evidence of myocardial injury. Troponin T is more frequently elevated than troponin I among asymptomatic patients with renal insufficiency and this could be due to the relatively higher levels of an unbound cytosolic pool of troponin T and its higher molecular weight. Neither the common cardiac markers (LDH, LDH 1, CPK, CK-MB) are sensitive or specific as in the general population, but a recent 2-yr observational study showed that pre-dialytic high serum concentrations of troponin T and CK-MB mass were associated with complete mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). In our study, we evaluated how dialysis influenced serum troponin I and CK-MB mass, and then we assessed serum homocysteine (Hcy), an additional CV risk factor in uremic patients. METHODS: We studied 17 uremic patients (13 males, four females) on standard HD and six patients (four males, two females) on on-line hemodiafiltration (HDF), who were taking folic acid for at least 3 months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. We performed arterial gas-analysis, Na+, K+, Ca++, Mg++, Cl-, P, serum albumin, creatinine (Cr), urea, total homocysteine (tHcy), red blood count (RBC), troponin I and CK-MB mass, both pre and post-dialysis. We assessed urea reduction rate percentage (URR%), Kt/V, Hcy percentage reduction ratio (ORR%), and anthropometric parameters. RESULTS: Anthropometric parameters, pre- and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups, Kt/V and URR%. Even in on-line HDF, ORR% directly correlated with KtV and URR% (r=0.79, p<0.04; r=0.76, p<0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre- vs post-dialysis, both on standard HD and on-line HDF. Nevertheless, in standard HD, post-dialytic troponin I correlated with serum sodium concentration (r=0.93, p<0.000), potassium (r=0.67, p<0.004) and serum chlorine (r=0.92, p<0.92, p<0.000). CK-MB mass showed a correlation with serum chlorine (r=0.49, p<0.05). Post-dialytic CK-MB mass correlated with serum potassium for on-line HDF (r=0.83, p<0.03). CONCLUSIONS: Our study suggests the probability that dialytic adequacy improves CV outcome causing a reduction in the concentration of homocysteinemia and it demonstrates that convective treatments (on-line HDF) are best in reaching this end-point. Our data suggests that hemodialytic treatments, both standard HD and on-line HDF did not modify serum troponin I and CK-MB mass. We can use these parameters as a diagnostic approach in acute or chronic cardiac ischemic disease in HD patients, because they are not influenced by the hemodialytic procedure. This allows the selection of high risk patients, and offers them on-line treatment as the best suitable therapeutic option.

A comparison of dressings in the management of surgical abdominal wounds.

This prospective randomised trial compared the performance of three dressing protocols in the management of 36 dehisced surgical abdominal wounds: a standard alginate; a gauze moistened with sodium hypochlorite (0.05%); and a combine dressing pad. Outcomes assessed were: healing time (cm2 per day and cm3 per day), patient comfort (pain and satisfaction) and cost. There were no statistically significant differences in healing rates between the three groups but there was a trend for the combine dressing pad protocol to produce a greater reduction in wound area. The combine dressing pad protocol performed well when compared with the calcium alginate in terms of healing time, patient comfort and cost. Maximum pain was significantly greater (p = 0.011) and satisfaction significantly lower among patients who received the sodium hypochlorite protocol. Costs during the in-patient phase were also substantially higher for the sodium hypochlorite protocol. Trial results support the view that sodium hypochlorite dressing protocols for surgical wounds should be abandoned.

[Raynaud's phenomenon: effects of terazosin]. / Il fenomeno di Raynaud: effetti della terazosina.

After considering the clinical and physiopathological aspects of Raynaud's phenomenon, the authors have evaluated the medium effects of therazosine in 2 groups of patients, respectively with idiopathic and secondary Raynaud's phenomenon. The results show that the therazosin determines a decrease of number, intensity and duration of vasospastic attacks to the hands as well as an improvement of telethermographic and ultrasonographic findings.