Design of a wearable device for physiological parameter monitoring in a COVID setting.

The study focuses on the realization of an accurate device for the detection of different physiological parameters. It has been realized a simple portable system containing the necessary electronics and ensuring the monitoring of the blood oxygenation, the body temperature, the air quality, the respiratory rate and the ECG. The main processing unit consists in a Raspberry Pi Zero W connected to the Healthy Pi4. The latter provides the interface for the clinical pulse-oxymeter while the measures of temperature and quality air are provided using the I2C protocol. The Bluetooth module is finally used to provide the ECG and blood rate data. The collected data are elaborated using Matlab and Python. To evaluate the accuracy of the realized device some experimental tests have been conducted on different subjects, comparing subjects working in Covid area with others resting at home. In both cases the monitoring time was 4 hours. Results have shown good performances of the system, detecting accurately the differences of the parameters values between the two situations. The usability of the device was assessed by administering a questionnaire to the healthcare personnel involved in the experimentation. The outcome shows a good usability of the system as well as an acceptable dressing time.

Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience.

BACKGROUND & AIMS: The effect of the COVID-19 infection on nutritional status is not well established. Worldwide epidemiological studies have begun to investigate the incidence of malnutrition during hospitalization for COVID-19. The prevalence of malnutrition during follow-up after COVID-19 infection has not been investigated yet. The primary objective of the present study was to estimate the prevalence of the risk of malnutrition in hospitalized adult patients with COVID-19, re-evaluating their nutritional status during follow-up after discharge. The secondary objective was to identify factors that may contribute to the onset of malnutrition during hospitalization and after discharge. METHODS: We enrolled 142 COVID-19 patients admitted to Careggi University Hospital. Nutritional parameters were measured at three different timepoints for each patient: upon admission to hospital, at discharge from hospital and 3 months after discharge during follow-up. The prevalence of both the nutritional risk and malnutrition was assessed. During the follow-up, the presence of nutritional impact symptoms (NIS) was also investigated. An analysis of the association between demographic and clinical features and nutritional status was conducted. RESULTS: The mean unintended weight loss during hospitalization was 7.6% (p < 0.001). A positive correlation between age and weight loss during hospitalization was observed (r = 0.146, p = 0.08). Moreover, for elderly patients (>61 years old), a statistically significant correlation between age and weight loss was found (r = 0.288 p = 0.05). Patients admitted to an Intensive Care Unit (ICU) or Intermediate Care Unit (IMCU) had a greater unintended weight loss than patients who stayed in a standard care ward (5.46% vs 1.19%; p < 0.001). At discharge 12 patients were malnourished (8.4%) according to the ESPEN definition. On average, patients gained 4.36 kg (p < 0.001) three months after discharge. Overall, we observed a weight reduction of 2.2% (p < 0.001) from the habitual weight measured upon admission. Patients admitted to an ICU/IMCU showed a higher MUST score three months after discharge (Cramer's V 0.218, p = 0.035). With regard to the NIS score, only 7 patients (4.9%) reported one or more nutritional problems during follow-up. CONCLUSIONS: The identification of groups of patients at a higher nutritional risk could be useful with a view to adopting measures to prevent worsening of nutritional status during hospitalization. Admission to an ICU/IMCU, age and length of the hospital stay seem to have a major impact on nutritional status. Nutritional follow-up should be guaranteed for patients who lose more than 10% of their habitual weight during their stay in hospital, especially after admission to an ICU/IMCU.

Validity and reliability of the Italian Constipation Assessment Scale.

Constipation is a common problem among oncology patients and requires careful assessment. Use of validated instruments is important to improving its management. The aim of this study was to validate the Italian translation of the Constipation Assessment Scale (CAS). To test construct validity, patients and apparently healthy adults were asked to complete the CAS. The results indicated that there was a significant difference between the median CAS of the patient group and that of the apparently healthy group. Test-retest reliability was very high (r=0.96; P=0.0001), and the internal consistency as assessed by Cronbach's alpha was 0.768. These findings suggest that the Italian CAS can be used in clinical practice to document the presence and severity of constipation in cancer patients. However, further studies should be conducted in a larger sample of patients to confirm the results.

Vitamin E gel reduces time of healing of digital ulcers in systemic sclerosis.

BACKGROUND: In systemic sclerosis (SSc), digital ulcers (DU) are painful, difficult to heal and frequently infected, thus greatly affecting quality of life and increasing SSc-related disability. Vitamin E has been previously used in cutaneous lesions for its antioxidant and anti-inflammatory effects. OBJECTIVES: To study the healing effect of D-alpha-tocopheryl acetate (acetic ester of alpha-tocopherol) (VE) gel on DU of SSc patients. METHODS: 27 SSc patients with a total of 86 DU were enrolled in an open pilot study. The patients were randomly assigned to two groups: 15 patients were treated until DU healing with the local standard ulcer care protocol with the application of vitamin E gel (experimental group), while 12 patients were treated with standard ulcer care protocol only (control group). In both groups, DU were treated twice a week and pain was scored by a NRS (numeric rating scale). In both groups the cost of medications was analysed. RESULTS: VE induced a faster healing of DU in respect to controls (13.22+/-2.72 weeks, versus 20.94+/-3.65; p<0.0001) with a lower number of medications (26.18+/-5.63 vs. 41.88+/-7.31; p<0.0001). Resolution of pain was faster in experimental (17.82+/-4,59 medications) than in controls (26.26+/-19.16 medications) (p=0.0022). In the experimental group, the cost of medications was significantly lower (6,919.15 euros/patient) than in the control group (11,056.32 euros/patient). CONCLUSION: The application of VE reduces time of healing and has a faster resolution of pain, with a significant reduction of costs. Topical VE may improve the management of DU in SSc.

The management of totally implanted venous ports in the ambulatory oncologic patient.

Totally implanted venous access devices (ports) are widely used in all oncology units, because of the many advantages that they offer if compared to external central venous catheters, particularly in terms of safety. Nonetheless, infection, lumen occlusion and venous thrombosis may still occur, and they are often caused or facilitated by inappropriate insertion or inappropriate management. Reviewing the management protocols of ports in ambulatory patients of 50 Italian oncology units, we have been able to detect the lack of common standardized behavior regarding the technical management of these devices: in addition, some aspects of management differ significantly from what suggested by international guidelines.

[Comparison of two different protocols on change of medication in central venous catheterization in patients with bone marrow transplantation: results of a randomized multicenter study]. / Confronto di due differenti protocolli nell'intervallo del cambio di medicazione per cateteri venosi centrali in pazienti trapiantati di midollo osseo: risultati di uno studio multicentrico randomizzato. Gruppo Italiano di Infermieri Trapianto Midollo Osseo (GITMO).

Care of central venous catheter (CVC) in patients undergoing bone marrow transplantation (BMT) raises significant problems related to the high risk of local infections, to the immunodeficient status, which in itself is a predisposing factor for systematic blood stream infections. Although frequent changes of CVC dressing might theoretically reduce the incidence of infections, they are also accompanied by significant skin toxicity and patient discomfort. No study has yet addressed these points. The objective of this study was to compare two different time interval protocols for CVC dressing, in order to assess the effects on local infections and toxicity. In a multicentre study, 339 bone marrow transplant (BMT) patients with a tunnelled CVC (group A, 230 pts) or a non tunnelled one (Group B, 169 patients) were randomly allocated to receive CVC dressing changes every 5 or 10 days if belonging to group A or 2 or 5 days if in group B. Transparent impermeable polyurethane dressings were used for all patients. The rate of local infection at the site of CVC insertion was assessed by microbiological assay every 10 days, while severity of skin toxicity was measured according to the ECOG scale. Sixty-five per cent of enrolled patients were finally evaluable. Patients (in both groups) receiving CVC dressing changes at longer intervals did not show a significant increase in the rate of local infections, while those who received dressing every two days had a significant increase in local skin toxicity. Longer intervals were accompanied by a reduction in costs. The results of this study demonstrate that the increase in time interval between CVC dressing changes in BMT patients did not increment the risk of local infections, while significantly reducing patients discomfort and costs.

[First aid for multiple trauma patients: investigative survey in the Firenze-Bologna area]. / Il primo soccorso al politraumatizzato: indagine conoscitiva nelle aree di Firenze e Bologna.

Overall mortality ascribable to multiple traumas, that in Italy is responsible for about 8,000 death/year, is strictly dependent on the function of the so called Trauma Care System. This study reports on an epidemiological survey conducted in the urban area of Florence along a 23-month period (from Jan 97 to Nov 99), with the aim to identify the typology of traumas and the first aid care delivered to the person until hospital admission. These data were compared to those collected in the urban area of Bologna because the composition of the first-aid team is different, being nurses, in Bologna, an integral component of the first aid system. On a total of 118 multiple traumas, 17% was represented by isolated head trauma, while in 72% involvement of other organs was present in addition to the head; 11% of cases were abdominal or thoracic traumas, 1% of lower extremities. In 46% the cause of trauma was a car accident. The complexity of care delivered to the person with trauma was less in the Florence survey, as indicated by the immobilization of patients, performed in only 11% of cases as compared to 47% in Bologna, by the application of the cervical collar, applied in 12% versus 62% of traumas. Although the two samples are not strictly comparable, these data suggest that the presence of nurses in the Trauma Care System can be one of the elements of improvement of the quality of delivered care.

[Survey of measures for the prevention of infections in bone marrow transplantation centers]. / Indagine conoscitiva sulle misure adottate per la prevenzione delle infezioni nei centri di trapianto di midollo osseo.

This paper reports on the results of a survey conducted on the organization of bone marrow transplant (BMT) centers in Italy, with particular attention to the measures routinely adopted for the prevention of infectious complications in BMT patients. In 1997, a questionnaire containing 53 questions with multiple-answers and 15 with single-answer was sent to the 65 Italian BMT centers. The topics addressed in the questionnaire were the following: general structural organization of the BMT center; personnel organization; type of transplants (autologous, allogenic, both); type of protective environment; hygiene measures and food; management of central venous catheters; microbiological surveillance. Fifty questionnaires out of 65 (77%) were available. The analysis of data indicated that most centers (more than 60%) use complex and multiple measures for the prevention of infections. These are mainly represented by careful personal hygiene of the patient, protective isolation of the patient from other patients and relatives; careful washing of personnels' hands before entering patients room; extensive microbiological surveillance. Furthermore, 52% of BMT centers adopt additional measures, such as filtered air, while 22% of centers, on the contrary, lack any air-conditioning apparatus. Overall, the results of the survey indicate that there is a substantial variability in the adoption and evaluation of the impact of such different measures on the incidence of infectious complications after BMT.

[Medicated intravascular catheters. Review of the literature]. / I cateteri vascolari impregnati: una revisione della letteratura.

Central Venous Catheters (CVC) are widely used in the setting of intensive care units, but they are associated with an increased risk of CVC-related infections. To prevent infections originated from CVC, a number of devices have been more recently produced, that are characterized by the presence of antiseptic/antibiotic substances in the matrix of the CVC itself ("impregnated" CVC). In this brief review, more recent studies on the topic are discussed, especially in the light of guidelines from the CDC. Although from these studies many suggestions about the efficacy of impregnated CVC in the prevention of CVC-related infections can be derived, notwithstanding the critical role of preventive measures during CVC procedures must be recognized as the principal factor in reducing CVC infections.

[Handling a central venous catheter in a bone marrow transplantation center: retrospective analysis on 203 patients. Experiences at the Florence Transplantation Center]. / Gestione del catetere venoso centrale in un centro di trapianto di midollo osseo: analisi retrospettiva su 203 pazienti. Esperienza del Centro Trapianti di Firenze.

The insertion of a central venous catheter (CVC) is a compulsory invasive technique for bone marrow transplant patients. CVC are in fact used for the administration of treatments (chemotherapy, Total Parenteral Nutrition) and patients monitoring (blood samplings). The study reports on the results of a retrospective analysis on 213 CVCs implanted on 203 patients undergoing bone marrow transplantation in the Bone Marrow Transplant Unit (BMT) in Florence, from 1992 to 1996. Sixty-one per cent of implanted catheters were maintained in situ until the completion of the treatments, while 5% patients needed the CVC replacement. The major cause of CVC loss was spontaneous deiscence (7% of all implanted CVCs). The 80% of implanted CVCs had a satisfactory performance; in 14% a local infusion of urokinase was required to re-establish patency and in 6% of patients a peripheral venous line had to be started. Only 2% catheters had to be removed due to an infection.

[Measures for the prevention of infections in patients with bone marrow transplantations]. / Misure per la prevenzione delle complicanze infettive in pazienti sottoposti a trapianto di midollo osseo. Esperienza del Centro Trapianti di Firenze.

One of the most frequent complications in patients undergoing bone marrow transplantation (BMT) is represented by severe infectious episodes, neutropenia being the most important factor. Among preventive measures, those represented by careful hygenic and environmental procedures are of pivotal importance. In this study, we retrospectively analyzed the infectious episodes in 295 patients subjected to BMT who have been treated with the same caring protocol. In 21.8% of patients an infectious event was recorded during the post-BMT period; in patients subjected to BMT from an unrelated donor the incidence of positive haemocultures was as high as 33.3%. Sixty-five per cent of isolated agents in haemocultures were Gram-positive, 33% Gram-negative and only 2% fungi. In 35% of patients with positive haemocultures, the same infectious agent had previously been isolated in a skin sample. Overall, the incidence of documented infections was lower than in other studies, suggesting that careful protocols of personal and environmental hygene may be very important for the prevention of infectious episodes in BMT patients.

[The role of measures of personal hygiene in the prevention of infections in autologous bone marrow transplantation. Results of a randomized prospective study]. / Ruolo delle pratiche igieniche personali nella prevenzione degli episodi infettivi nel trapianto di midollo osseo autologo. Bisultati di una sperimentazione prospettica randomizzata.

The paper reports on the results of a prospective, randomized trial in which two different regimens of personal hygiene procedures have been compared in 30 patients undergoing autologous bone marrow transplantation. The main aim of the study was to evaluate the incidence of infectious episodes in patients enrolled in the trial arm with the simplified hygiene protocol as compared to the standard one, used in our Unit for patients undergoing allogenic transplant. No significant differences between the two study groups in the incidence of infectious episodes or of positive skin cultures were found. Therefore, we suggest that a simplified hygiene protocol is as effective as the standard one in preventing infectious complications in patients undergoing autologous bone marrow transplantation.

GLC determination of warfarin in human plasma.

A specific and quantitative GLC method for warfarin in human plasma is described. The procedure uses papaverine as the internal standard and involves a dichloroethane extraction of the acidified specimen. The organic extract is evaporated, and the evaporated extract is dissolved in 50 microliter of chloroform. Aliquots of 2-3 microliter are injected into a gas chromatograph equipped with a flame-ionization detector. The sensitivity of the method is such that 0.3 microgram of intact warfarin can be detected in 1 ml of plasma. Statistical analyses indicate a recovery of 97.26 +/- 1.89% SD. The procedure was successfully applied to plasma drug level studies in humans.

Analysis of homatropine methylbromide dosage forms.

A stability-indicating method of analysis of homatropine methylbromide in pharmaceutical formulations was developed. This method is based on the formation of a picric acid-quaternary ammonium complex, which is adsorbed on acid-washed diatomaceous earth in alkaline media followed by on-column chloroform extraction. The picrate complex is measured spectrophotometrically at 365 nm. The method was selective for homatropine methylbromide in that there was no interference from its major hydrolytic decomposition products, tropinium methylbromide and mandelic acid.

Automated analysis of warfarin sodium tablets.

An automated procedure was developed for the determination of warfarin sodium by following the steps of the manual USP procedure. The automated procedure is applicable to single tablets and composites of 20 tablets at different tablet concentrations. Sensitivity, precision, accuracy, and reproducibility are equivalent to the manual USP procedure. Sensitivity was approximately 15 mug/ml, with a coefficient of variation of 0.711%.