Surviving COVID-19 in Bergamo province: a post-acute outpatient re-evaluation.

Bergamo province was badly hit by the coronavirus disease 2019 (COVID-19) epidemic. We organised a public-funded, multidisciplinary follow-up programme for COVID-19 patients discharged from the emergency department or from the inpatient wards of 'Papa Giovanni XXIII' Hospital, the largest public hospital in the area. As of 31 July, the first 767 patients had completed the first post-discharge multidisciplinary assessment. Patients entered our programme at a median time of 81 days after discharge. Among them, 51.4% still complained of symptoms, most commonly fatigue and exertional dyspnoea, and 30.5% were still experiencing post-traumatic psychological consequences. Impaired lung diffusion was found in 19%. Seventeen per cent had D-dimer values two times above the threshold for diagnosis of pulmonary embolism (two unexpected and clinically silent pulmonary thrombosis were discovered by investigating striking D-dimer elevation). Survivors of COVID-19 exhibit a complex array of symptoms, whose common underlying pathology, if any, has still to be elucidated: a multidisciplinary approach is fundamental, to address the different problems and to look for effective solutions.

At the peak of COVID-19 age and disease severity but not comorbidities are predictors of mortality: COVID-19 burden in Bergamo, Italy.

BACKGROUND: Findings from February 2020, indicate that the clinical spectrum of COVID-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS: Retrospective observational study of all COVID-19 patients admitted to the main hospital of Bergamo, from February 23 to March 14, 2020. RESULTS: Five hundred and eight patients were hospitalized, predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO2/FiO2: 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N.=171). Thirty-nine percent of patients were treated with continuous positive airway pressure (CPAP), 9.5% with noninvasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to Semi-Intensive Respiratory Care Unit, and 18.9% to Intensive Care Unit. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio [OR], 95% confidence interval [CI]: 38.91 [10.67-141.93], P<0.001; 70-77 years: 17.30 [5.40-55.38], P<0.001; 60-69 years: 3.20 [1.00-10.20], P=0.049), PaO2/FiO2<200 at presentation (3.50 [1.70-7.20], P=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], P<0.001), and blood urea value at admission (1.01 [1.00-1.02], P=0.015). CONCLUSIONS: At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in COVID-19.

Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study.

Orthostatic hypotension (OH) is a multifactorial disorder, often asymptomatic. The prevalence of OH increases with age, ranging from 5 to 11% among middle-aged patients to 55% in the frail elderly depending on age and associated comorbidities. OH is often unrecognized or misdiagnosed and little is known about its prevalence in hospitalized elderly patients. Our aims were: (1) to determine the prevalence of OH in a cohort of elderly patients hospitalized in two internal medicine wards in Italy; (2) and to describe their characteristics and symptoms. During the 5 months from March 1, 2017 to July 31, 2017, the first 85 consecutive patients (65 years or older) admitted in two internal medicine wards were enrolled. Patients were included in the study if they were able to get out of bed alone or with minor assistance, and able to stand up for at least 3 min. The study population comprised 85 patients with a mean age of 79.6 ( ± 7.2) years. OH was found in 64 (75.3%), occasional OH in 41 (48.2%), persistent OH in 23 (27.1%), and 21 (24.7%) patients had no OH. All patients had diastolic OH and 37 (57.8%) also systolic. Patients with persistent OH were oldest, with a higher percentage of renal failure. Twenty-six patients (40.6%) with OH reported symptoms. Dizziness was the most common symptom, especially after breakfast. No association was found between type of medications and risk of OH. Mortality risk was not statistically different between patients with or without OH 3 (p = 0.10) and 6 months after discharge (p = 0.18), but a trend was observed. We found that OH is very common in the patients admitted in the internal medicine wards, particularly diastolic OH. Close attention should be paid to OH and its symptoms, especially dizziness, in the oldest-old patients, and in patients with renal failure.

[Prospective assessment of the agreement of instruments for measuring the hospital nursing workload: the Swiss Method, the Karnofsky Performance Status Scale and the subjective perception of the nurses]. / Valutazione prospettica della comparabilità di misure di impegno assistenziale in ospedale: Metodo Svizzero, Karnofsky Performance Status Scale e Percezione Soggettiva degli infermieri.

. Prospective assessment of the agreement of instruments for measuring the hospital nursing workload: the Swiss Method, the Karnofsky Performance Status Scale and the subjective perception of the nurses. INTRODUCTION: An emerging need of all healthcare organizations is the availability of reliable measures of nursing workload and underlines the problem of the choice of reliable criteria and scores. AIM: To assess the agreement between Swiss Method (SM), Karnofsky Performance Status Scale (K) and Subjective Perception (SP) of nurses in defining the nursing workload. METHODS: A prospective observational study was conducted throught computerized compilation of the three scales for each patient in 21 consecutive days, in a large specialized hospital. Nurses were asked to rate the average nursing workload in the last 24 hours. The scales were compared through Cohen's Kappa across different sets of patients. RESULTS: The data were collected for 7.810 patient days on 1.187 patients. At different levels of aggregation there was a strong heterogeneity between the care-related profiles and the levels of concordance that rarely exceeded the "discreet" level. However a reasonable agreement was obtained between K and SP in medical and surgical wards. The formal comparison of the three scales makes it impossible to formulate a preferential judgment for any of the three. CONCLUSIONS: Measuring phenomena such as workload requires reliable instruments targeted for specific contexts and to the aims results will be used for. The study directly compared on a hospital representative sample the results of the adoption of instruments- expected to be eterogeneous- and often used to guide the allocation of human and material resources.

[Risk factors for falls in the pediatric setting at the Hospital Agency of United Hospitals of Bergamo: a retrospective observational study]. / Fattori di rischio cadute in ambito pediatrico nell'Azienda Ospedaliera Ospedali Riuniti di Bergamo: studio osservazionale retrospettivo.

PURPOSE: To identify the main and most significant risk factors for falls and improve the quality of care delivered to pediatric patients by providing indications for interventions for the prevention of falls. METHODS: To investigate the correlation between falls and risk factors a retrospective observational case-control study was carried out, the sample was made up by all children who fell from 2004 to 2011 between 0-18 y.o. for which there was a record of the fall. RESULTS: 108 children were included in the study (36 cases and 72 controls). The data showed that 4 drugs have a correlation with falls,on the contrary intravenous therapy seemed to be a factor that protects against the risk of falling. CONCLUSION: The study confirms the importance of the problem of falls in children. A greater sample size could help to identify additional independent variables. This study may represent a starting point for further analysis.

[Bibliographic research of efficiency tests: analysis of the validity of the meta-database]. / La ricerca bibliograica delle prove di efficacia Analisi della validità dell'utilizzo dei metadatabase.

AIMS: The use of a meta-database as a first approach to bibliographic research can be just as efficient as interrogating single data-bases of the literature. The advantages and drawbacks of the two strategies are compared . METHOD: A comparison of the results obtained using an identical interrogation made using the TRIP meta-database and different single databases (15 of guide-lines, 4 of systematic reviews, 3 prevalently consisting of primary studies) made it possible to analyse these methods as well as to study 4 meta-databases and identify the most efficient one. RESULTS: Using the same MeSH terms in both strategies, the following results were obtained: 204 publications using TRIP and 475 using different databases. Evaluation demonstrated the pertinence of 142 (69,6%) of the 204 found using TRIP compared to 185 (38,9%) of those elicited by single data-bases. CONCLUSIONS: The TRIP meta-database yields a lower number of documents but with a higher degree of pertinency, meaning that the researcher employs less time finding pertinent documents. With respect to the traditional approach, beginning research by testing the efficiency of the TRIP meta-database proved advantageous.

Why mix-ups don't happen in the nursery: evidence for an experience-based interpretation of the other-age effect.

Adults' face recognition abilities vary across face types, as evidenced by the other-race and other-species effects. Recent evidence shows that face age is another dimension affecting adults' performance in face recognition tasks, giving rise to an other-age effect (OAE). By comparing recognition performance for adult and newborn faces in a group of maternity-ward nurses and a control group of novice participants, the current study provides evidence for an experience-based interpretation of the OAE. Novice participants were better at recognizing adult than newborn faces and showed an inversion effect for adult faces. Nurses manifested an inversion cost of equal magnitude for both adult and newborn faces and a smaller OAE in comparison to the novices. The results indicate that experience acquired exclusively in adulthood is capable of modulating the OAE and suggest that the visual processes involved in face recognition are still plastic in adulthood, granted that extensive experience with multiple faces is acquired.

Patient education in peritoneal dialysis: an observational study in Italy.

This observational study describes the characteristics of the education programmes used in Italian PD-centres, evaluating a possible relationship between programmes and peritonitis rates. The survey involved 150 non-paediatric public dialysis centres in Italy. The data were collected by a questionnaire and evaluated with SPSS software. Descriptive statistics of synthesis were calculated, Kruskal-Wallis, Wilcoxon's test were used to verify the differences in the replies, and association between variables was tested with Pearson correlation and Pearson's chi2 test. 120 dialysis centres took part in the survey and reported a median incidence of peritonitis of 1/29 months. Training occurs in all the centres, while pre-dialysis education, home visits and re-training take place in 38.3%, 50% and 44.2% respectively. A lower peritonitis rates proves to be correlated to these activities rather than to presence of specialised personnel, to ratio nurses-patients or training time.

[Survey of what is published on Italian nursing journals]. / Indagine conoscitiva sulle ricerche pubblicate in sei riviste infermieristiche italiane dal 1998 al 2003.

Nursing research is an important activity for nurses; the main aim is to improve the quality of nursing. Several national and european laws have been issued about it. To develop knowledge about nursing, nurses have to understand the results of researches, implement them in the different situation and sometimes carry out researches. The results can be published in nursing journals which a lot of nurses use to share information. This study reviewed the characteristics of research articles published in italian nursing journals from 1998 to 2003. Phenomena of interest are: areas of enquiry, investigators, methods, research design, sampling and means to gather data. 122 articles have been reviewed: 78% focus on clinical aspects, 55% were carry out by nurses, 92% adopt the quantitative approach, 90% used non experimental design, 89% used convenience selection sampling method and 58% answer ways. The characteristics of this study are similar to other studies about italian nursing publication. There are some limits in this type of literature: lower generalization because of lower representativeness of sample, convenience selection sampling method, and higher risk of interference due to frequent use of non experimental design. However the number of italian nurses that carry out researches is increasing and nursing is the most studied area.