A checklist-based survey for early mobilization of stroke unit patients in an Italian region.

BACKGROUND: Although early mobilization (EM) is recommended by most guidelines in acute stroke patients, there is a paucity of tools to perform a standardized patient risk assessment prior to EM in stroke units (SUs). OBJECTIVE: This survey aimed at assessing (1) the usefulness of an ad hoc checklist for a standardized approach to EM in SUs and (2) the relationship between EM achieved by this checklist and SU characteristics. METHODS: This survey was carried out in 10 SUs in Piedmont, Italy. The EM checklist was based on 15 "items", including quantitative/qualitative, clinical and management features. RESULTS: A total of 250 completed checklists were assessed. EM, defined as out-of-bed activity within 72 h of admission, was reached by 174 patients (69.6%), according to the checklist. There was a statistically significant association between the admission NIHSS score and EM. Hypotension at mobilization was observed in 29/250 patients (11.6%) and was significantly associated with EM. A total of 6 falls (2.4%) were reported. Nurses were most frequently involved in EM, either alone (40.8%) or with another professional. CONCLUSION: A large percentage of acute stroke patients managed to achieve a safe EM in the SUs that adopted the novel checklist. These results suggest that this checklist may well be a user-friendly, reliable tool to assist SU professionals in deciding whether to mobilize or not, by means of a standardized approach.

[Surveillance of the health status of the population of the city of Parona (Italy), Phase 2]. / La sorveglianza dello stato di salute della popolazione del Comune di Parona (PV) (II Fase).

This study is part of a prospective study, which started in the year 2000, to monitor the health status of the population of the city of Parona, a previously agricultural area which has been transformed in a prevalently industrial area. This is the second phase of a project regarding the epidemiological surveillance of this population. The aim of the project was to detect changes in the health status of the population, particularly with regard to respiratory diseases associated with air pollution. Data was collected through the use of a questionnaire and a spirometry test. A control group was used in both parts of the study; control subjects lived in the city of Rovescala. In total 1484 subjects were invited by letter to participate and 399 (27%) accepted. The mean age of participants was 48 years (range 15-74 years). Only 149/399 (37%) subjects had participated in part 1 of the study. No significant changes were found in respiratory symptoms during the period considered. Three hundred eighty six subjects underwent spirometry testing, 36 of which (9%) were found to have an abnormal result. A moderately increased prevalence of obstructive airway signs on spirometry was registered in female participants, with respect to the year 2000 (5.9% vs 2.6%). On the other hand, the prevalence of restrictive signs remained similar in both males (1,7% vs 2,4%) and females (2% vs 1,5%). The spirometry changes detected in the149 subjects (65 male and 84 female) who participated in both parts of the study (parts 1 and 2) were most likely age-related. No significant differences were found with respect to the control group, although the prevalence of obstructive signs among males was greater in the city of Parona (9.2% vs 6.9%.

Expression of the E-cadherin-catenins complex in sentinel node is related to tumor morphology but not to spread to nonsentinel nodes.

The sentinel node (SN) technique has gained a key role in breast cancer surgery, allowing for an accurate staging of the axillary status with a minimally invasive resection. In this study, we explored the implication of three proteins (E-cadherin, a- and b-catenins) that form the cadherin-catenin complex, a receptorial structure strictly involved in tumoral vascular invasion and embolization in this biologic event. We studied the immunohistochemical expression of the complex in patients with metastatic SN, matching the group with involved nonsentinel lymph nodes (NSNs) with that having free axillary NSNs. The simultaneous staining of the SN metastases for the three proteins has been considered an indicator of preserved function. Our data confirmed the lack of cadherin-catenin complex in tumors with lobular morphology even in SN metastasis, but statistical evaluation could not prove a significant relation between complex integrity and NSN involvement. Moreover, considering traditional histopathologic parameters, only vascular peritumoral embolization was related to an increased risk of metastatic spread to axillary NSNs.