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1.
Artigo em Inglês | MEDLINE | ID: mdl-34299975

RESUMO

A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers' wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.


Assuntos
Pessoal de Saúde , Segurança do Paciente , Atitude , Atenção à Saúde , Feminino , Humanos , Qualidade da Assistência à Saúde
2.
Science ; 373(6554): 541-547, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34326236

RESUMO

Repurposing drugs as treatments for COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has drawn much attention. Beginning with sigma receptor ligands and expanding to other drugs from screening in the field, we became concerned that phospholipidosis was a shared mechanism underlying the antiviral activity of many repurposed drugs. For all of the 23 cationic amphiphilic drugs we tested, including hydroxychloroquine, azithromycin, amiodarone, and four others already in clinical trials, phospholipidosis was monotonically correlated with antiviral efficacy. Conversely, drugs active against the same targets that did not induce phospholipidosis were not antiviral. Phospholipidosis depends on the physicochemical properties of drugs and does not reflect specific target-based activities-rather, it may be considered a toxic confound in early drug discovery. Early detection of phospholipidosis could eliminate these artifacts, enabling a focus on molecules with therapeutic potential.


Assuntos
Antivirais/farmacologia , COVID-19/tratamento farmacológico , Reposicionamento de Medicamentos , Lipidoses/induzido quimicamente , Fosfolipídeos/metabolismo , SARS-CoV-2/efeitos dos fármacos , Células A549 , Animais , Antivirais/química , Antivirais/uso terapêutico , Antivirais/toxicidade , COVID-19/virologia , Cátions , Chlorocebus aethiops , Relação Dose-Resposta a Droga , Feminino , Humanos , Camundongos , Testes de Sensibilidade Microbiana , SARS-CoV-2/fisiologia , Tensoativos/química , Tensoativos/farmacologia , Tensoativos/toxicidade , Células Vero , Replicação Viral/efeitos dos fármacos
3.
Artigo em Inglês | MEDLINE | ID: mdl-34064913

RESUMO

Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters' experiences, and implementation challenges. We also explored how these resources incorporate aspects of Safety I and Safety II. We searched six databases up to 19 December 2019 and additional literature, including weekly search alerts until 21 January 2021. Two reviewers independently performed all methodological steps (search, selection, quality assessment, data extraction, formal narrative synthesis). The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Common goals of the support programs (e.g., fostering coping strategies, promoting individual resilience) are consistent with Safety II and may promote system resilience. Investing in second victim support structures should be a top priority for healthcare institutions adopting a systemic approach to safety and striving for just culture.


Assuntos
Adaptação Psicológica , Pessoal de Saúde , Humanos
4.
Recenti Prog Med ; 112(6): 458-464, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34128938

RESUMO

INTRODUCTION: The adherence to recognized guidelines and the constant monitoring of performance throughout quality indicators (QIs) are strategic tools to improve the quality of care. The study is aimed to assess the effect of the EUSOMA (European Society of Breast Cancer Specialists) certification process on the quality of breast cancer care of an EUSOMA certified Breast Unit (BU) of Northern Italy. MATERIALS AND METHODS: Seventeen mandatory and recommended EUSOMA QIs, based on 594, were analysed for the years 2015-2018. Univariate logistic regression models were performed to compare QIs performance in the years before and after obtaining the EUSOMA certification (2015-6 vs. 2017-8). RESULTS: Compared to the years 2015-6, the second period of BU activity showed a higher number of QIs achieving both the minimum standard (15 vs. 11) and the 100% of completeness (6 vs. 1). There was a significant improvement of the two QIs evaluating the proportion of Ductal Carcinoma in situ receiving just an operation (from 76% to 95.2%; p=0.033) and the completeness of the prognostic characterisation of invasive cancers (from 94.6% to 99.5%; p=0.022). Conversely, the QI related to the endocrine-sensitive invasive carcinoma receiving adjuvant hormonal therapy dropped from 92.1% to 85.9% (p=0.042) and was significantly lower for patients over 74 compared to those aged ≤54 (73.8% vs. 94.7%; p<0.0001 Fisher's exact test). CONCLUSIONS: The EUSOMA certification process enhanced the clinical practice, promoting a tailored-patient primary systemic or adjuvant therapy and avoiding unnecessary invasive surgical and local-regional treatments.

5.
JMIR Public Health Surveill ; 7(6): e27189, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34003761

RESUMO

BACKGROUND: During the COVID-19 pandemic, swab tests proved to be effective in containing the infection and served as a means for early diagnosis and contact tracing. However, little evidence exists regarding the correct timing for the execution of the swab test, especially for asymptomatic individuals and health care workers. OBJECTIVE: The objective of this study was to analyze changes in the positive findings over time in individual SARS-CoV-2 swab tests during a health surveillance program. METHODS: The study was conducted with 2071 health care workers at the University Hospital of Verona, with a known date of close contact with a patient with COVID-19, between February 29 and April 17, 2020. The health care workers underwent a health surveillance program with repeated swab tests to track their virological status. A generalized additive mixed model was used to investigate how the probability of a positive test result changes over time since the last known date of close contact, in an overall sample of individuals who tested positive for COVID-19 and in a subset of individuals with an initial negative swab test finding before being proven positive, to assess different surveillance time intervals. RESULTS: Among the 2071 health care workers in this study, 191 (9.2%) tested positive for COVID-19, and 103 (54%) were asymptomatic with no differences based on sex or age. Among 49 (25.7%) cases, the initial swab test yielded negative findings after close contact with a patient with COVID-19. Sex, age, symptoms, and the time of sampling were not different between individuals with an initial negative swab test finding and those who initially tested positive after close contact. In the overall sample, the estimated probability of testing positive was 0.74 on day 1 after close contact, which increased to 0.77 between days 5 and 8. In the 3 different scenarios for scheduled repeated testing intervals (3, 5, and 7 days) in the subgroup of individuals with an initially negative swab test finding, the probability peaked on the sixth, ninth and tenth, and 13th and 14th days, respectively. CONCLUSIONS: Swab tests can initially yield false-negative outcomes. The probability of testing positive increases from day 1, peaking between days 5 and 8 after close contact with a patient with COVID-19. Early testing, especially in this final time window, is recommended together with a health surveillance program scheduled in close intervals.


Assuntos
Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , COVID-19/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Adulto , COVID-19/epidemiologia , COVID-19/transmissão , Busca de Comunicante/métodos , Reações Falso-Negativas , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Fatores de Tempo
6.
PLoS One ; 16(3): e0248714, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33724999

RESUMO

The psychological impact of the Covid 19 pandemic on cancer patients, a population at higher risk of fatal consequences if infected, has been only rarely evaluated. This study was conducted at the Departments of Oncology of four hospitals located in the Verona area in Italy to investigate the psychological consequences of the pandemic on cancer patients under active anticancer treatments. A 13-item ad hoc questionnaire to evaluate the psychological status of patients before and during the pandemic was administered to 474 consecutive subjects in the time frame between April 27th and June 7th 2020. Among the 13 questions, 7 were considered appropriate to elaborate an Emotional Vulnerability Index (EVI) that allows to separate the population in two groups (low versus high emotional vulnerability) according to observed median values. During the emergency period, the feeling of high vulnerability was found in 246 patients (53%) and was significantly associated with the following clinical variables: female gender, being under chemotherapy treatment, age ≤ 65 years. Compared to the pre-pandemic phase, the feeling of vulnerability was increased in 41 patients (9%), remained stably high in 196 (42%) and, surprisingly, was reduced in 10 patients (2%). Overall, in a population characterized by an high level of emotional vulnerability the pandemic had a marginal impact and only a small proportion of patients reported an increase of their emotional vulnerability.


Assuntos
COVID-19/patologia , Neoplasias/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Ansiedade/etiologia , Ansiedade/patologia , COVID-19/epidemiologia , COVID-19/virologia , Emoções , Feminino , Hospitais , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Pandemias , Estudos Prospectivos , SARS-CoV-2/isolamento & purificação , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
7.
Psychother Psychosom ; 90(3): 178-190, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33524983

RESUMO

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers' mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53-76.96), perceived stress (56.77%, 95% CI 34.21-77.95), concerns about own health (45.97%, 95% CI 31.08-61.23), sleeping difficulties (39.88%, 95% CI 27.70-52.72), burnout (31.81%, 95% CI 13.32-53.89), symptoms of depression (25.72%, 95% CI 18.34-33.86), symptoms of anxiety (25.36%, 95% CI 17.90-33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16-31.46), mental health issues (23.11%, 95% CI 15.98-31.10), and symptoms of somatization (14.68%, 95% CI 10.67-19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO-VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.


Assuntos
Epidemias , Pessoal de Saúde/psicologia , Saúde Mental , Pandemias , Transtornos Psicofisiológicos/epidemiologia , Estresse Psicológico/epidemiologia , Ansiedade/epidemiologia , COVID-19/psicologia , Infecções por Coronavirus/psicologia , Estudos Transversais , Depressão/epidemiologia , Doença pelo Vírus Ebola/psicologia , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/psicologia , Estudos Longitudinais , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/psicologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-33494306

RESUMO

The present study aims to prospectively assess the influence of respiratory disorders on smoking cessation and re-initiation. Three population-based Italian cohorts answered a questionnaire on respiratory health and smoking habits during 1998-2001 and after a mean follow-up (SD) of 9.1 (0.8) years. Out of 1874 current smokers and 1166 ex-smokers at baseline, 965 (51.5%) and 735 (63.0%) reported their smoking status at follow-up. From current smokers, 312 had stopped smoking at follow-up, while 86 ex-smokers had resumed smoking. People reporting asthma at baseline were more likely to stop smoking than the other subjects (48.6% vs. 31.7%), while people reporting allergic rhinitis or chronic cough/phlegm had a higher probability to resume smoking (16.7% vs. 10.5% and 20.7% vs. 10.4%, respectively). In the multivariable logistic model, smoking relapse strongly decreased with increasing abstinence duration in people without chronic cough/phlegm (OR for ≥7.5 years vs. <7.5 years = 0.23, 95% CI 0.20-0.27), while no effect was detected in people with chronic cough/phlegm (p for interaction = 0.039). Smoking cessation was enhanced in asthmatic subjects, while people with allergic rhinitis or chronic cough/phlegm were at higher risk to resume smoking. Chronic cough/phlegm blunted the decrease in smoking resumption associated with longer abstinence duration.


Assuntos
Abandono do Hábito de Fumar , Estudos de Coortes , Tosse/epidemiologia , Humanos , Itália/epidemiologia , Fumar/epidemiologia
9.
Altern Ther Health Med ; 27(2): 27-30, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32412916

RESUMO

Context: A reduction in the use of opioids by older adult patients could reduce unpleasant side effects for them. During general anesthesia, binaural beat (BB) listening has been found to reduce intraoperative fentanyl consumption as well as postoperative pain scores and discharge time. Auditory BBs are a perceptual phenomenon occurring when tones of 2 slightly different frequencies are presented simultaneously and separately to each ear. Objective: The study intended to evaluate the ability of BBs, as a nonpharmacological premedication, to reduce postoperative morphine consumption in older adults undergoing total knee replacement surgery and to modify the levels of anxiety and feelings of pain that patients experience. Design: The research team designed a prospective, single-center, randomized controlled study. Setting: The study was conducted in the Orthopedic Department of the Santa Maria Maddalena Hospital (Volterra [Pisa], Italy). Participants: Forty older adults at the hospital who were undergoing total knee joint replacement with spinal anesthesia participated in the study. Intervention: The study included 2 groups (n = 20 each), one receiving BBs stimulation with frequencies of 256 Hz in one ear and 260 Hz in the opposite ear producing a BB of 4 Hz (intervention group), and the other receiving acoustical stimulation at 256 Hz in both ears (control group). BBs, or acoustical stimulation, were administered before the surgical procedure. Both acoustical stimuli, generated with the Gnaural program, were delivered through stereo headphones connected to a laptop in the preoperative holding area. Outcome Measures: The study measured postoperative, cumulative, self-administered morphine consumption, in mg, through a patient-controlled analgesia device. Feelings of anxiety were also assessed using the State-Trait Anxiety Inventory, and feelings of pain were measured every 8 h during the first postoperative day using a numerical rating scale. Results: Patients who received the intervention, consumed almost half of the dosage of morphine during the first postoperative day when compared with the control group's consumption, 5.75 mg ± 5.25 vs 11.85 mg ± 7.71, respectively. The consumption did not correlate to anxiety measures. Regarding pain perception, no differences between the groups were captured. Conclusions: BB stimulation before surgery can be successfully used as a nonpharmacological treatment to reduce morphine consumption in older adults who undergo knee replacement. The use of a noninvasive, safe, and inexpensive BB intervention can result in a positive effect on patients' postoperative recovery.


Assuntos
Artroplastia do Joelho , Morfina , Idoso , Método Duplo-Cego , Humanos , Itália , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos
10.
Nurs Open ; 7(5): 1578-1587, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32802379

RESUMO

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018-January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50-1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of "personal exposure" (4.06, SD 3.78) were reported by third-year students. Higher scores for "perceived benefits" of preventive behaviours (13.6, SD 1.46) were reported by second-year students.


Assuntos
Ferimentos Penetrantes Produzidos por Agulha , Estudantes de Enfermagem , Estudos Transversais , Humanos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Psicometria , Inquéritos e Questionários
11.
Artigo em Inglês | MEDLINE | ID: mdl-32679773

RESUMO

Italy presented the first largest COVID-19 outbreak outside of China. Veneto currently ranks fourth among the Italian regions for COVID-19 confirmed cases (~19,000). This study presents health surveillance data for SARS-CoV-2 in 6100 health workers (HW) employed in a large public hospital. Workers underwent oropharyngeal and nasopharyngeal swabs, with a total of 5942 participants (97.5% of the population). A total of 11,890 specimens were tested for SARS-CoV-2 infection using PCR, identifying the viral genes E, RdRP, and N. Positive tests were returned for 238 workers (cumulative incidence of 4.0%, similar in both COVID and nonCOVID units). SARS-CoV-2 risk was not affected by gender, age, or job type, whereas work setting and occupation were both predictors of infection. The risk was higher in medical wards (OR 2.7, 95% CI 1.9-3.9) and health services (OR 4.3, 95% CI 2.4-7.6), and lower in surgical wards and administration areas. To our knowledge, this study represents the largest available HW case list swab-tested for SARS-CoV-2, covering almost the total workforce. Mass screening enabled the isolation of HW, improved risk assessment, allowed for close contacts of and infected HW to return to work, provided evidence of SARS-CoV-2 diffusion, and presented solid ground to prevent nosocomial SARS-CoV-2 infections. The ongoing concurrent sero-epidemiological study aims to enable the improvement of health surveillance to maintain the safety of HWs and the communities they serve.


Assuntos
Infecções por Coronavirus/diagnóstico , Programas de Rastreamento/métodos , Recursos Humanos em Hospital , Pneumonia Viral/diagnóstico , Adulto , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Medição de Risco , SARS-CoV-2
12.
J Patient Saf ; 16(2): e51-e60, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32168267

RESUMO

OBJECTIVES: Despite the critical need to understand the diverse responses by second victims to adverse events, there has not been a meta-analysis examining coping by second victims. We aimed to analyze the coping strategies applied by second victims in the aftermath of adverse events. METHODS: We performed a systematic search of nine electronic databases up to October 2018 and screened additional sources, such as gray databases. Two independent reviewers conducted the search, selection process, quality appraisal, data extraction, and synthesis. In case of dissent, a third reviewer was involved to reach consensus. Quantitative studies of the frequency with which coping strategies were applied by second victims were eligible for inclusion. We calculated the overall frequency of coping strategies and I statistic using random effects modeling. RESULTS: Of 10,705 records retrieved, 111 full-text articles were assessed for eligibility and 14 studies eventually included. The five most frequent coping strategies were Changing work attitude (89%, 95% confidence interval [CI] = 80-94), Following policies and guidelines more accurately and closely (89%, 95% CI = 54-98), Paying more attention to detail (89%, 95% CI = 78-94) (task oriented), Problem-solving/concrete action plan (77%, 95% CI = 59-89) (task oriented), and Criticizing or lecturing oneself (74%, 95% CI = 47-90) (emotion oriented). CONCLUSIONS: Second victims frequently used task- and emotion-oriented coping strategies and, to a lesser degree, avoidance-oriented strategies. To better support second victims and ensure patient safety, coping strategies should be evaluated considering the positive and negative effects on the clinician's personal and professional well-being, relationships with patients, and the quality and safety of healthcare.


Assuntos
Adaptação Psicológica/fisiologia , Pessoal de Saúde/psicologia , Erros Médicos/psicologia , Humanos
13.
Artigo em Inglês | MEDLINE | ID: mdl-32178426

RESUMO

Seasonal influenza is recognized to be a significant public health problem and a cause of death, especially in fragile persons. In nursing homes (NHs), vaccination for both residents and staff is the best preventive strategy. However, professionals' immunization rates are far from reaching the international recommended values. This study aims to describe the adherence and attitudes of NH staff towards flu vaccination and to explore staff hesitancy. A questionnaire was developed based on a literature review and on the 3Cs (confidence, complacency, convenience) of the WHO framework and administered among the staff of four NHs of a province in the northeast of Italy. Results demonstrated a low adherence towards annual vaccination (i.e., only 3% declared getting the flu vaccination each year). Complacency, confidence and convenience all showed a significant impact on the attitude towards vaccination both in univariate and multivariable analysis, with complacency being the most strongly associated area. The area of confidence resulted in strongly challenging factors. Only 24.8% of interviewees appeared trustful towards the efficacy of receiving immunization and 34% declared safety issues. Insights from the study can support the implementation of effective interventions to improve vaccination adherence in NHs. Specifically, increasing complacency by raising awareness related to the risks of influenza appears to be an essential strategy to effectively promote vaccination uptake.


Assuntos
Vacinas contra Influenza , Influenza Humana , Casas de Saúde , Recursos Humanos de Enfermagem , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Influenza Humana/prevenção & controle , Itália , Casas de Saúde/estatística & dados numéricos , Recursos Humanos de Enfermagem/estatística & dados numéricos , Vacinação
14.
Sci Rep ; 10(1): 2097, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034186

RESUMO

Gene and compound functions are often interrogated by perturbation. However, we have limited methods to capture associated phenotypes in an unbiased and holistic manner. Here, we describe Fluopack screening as a novel platform enabling the profiling of subcellular phenotypes associated with perturbation. Our approach leverages imaging of a panel of fluorescent chemical probes to survey cellular processes in an unbiased and high throughput fashion. Segmentation-free, whole image analysis applied to Fluopack images identifies probes revealing distinct phenotypes upon perturbation, thereby informing on the function and mechanism of action of perturbagens. This chemical biology approach allows to interrogate phenotypes that tend to be overlooked by other methods, such as lipid trafficking and ion concentration inside the cell. Fluopack screening is a powerful approach to study orphan protein function, as exemplified by the characterization of TMEM41B as novel regulator of lipid mobilization.

15.
J Nerv Ment Dis ; 208(5): 353-361, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31977720

RESUMO

This study explores whether clinicians or a statistical model can better identify patients at risk of early readmission and investigates variables potentially associated with clinicians' risk judgment. We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days postdischarge, predicted their postdischarge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. Clinicians' superior performance might be explained by their risk judgment depending on nonmeasurable factors, such as experience and intuition. Patients with a poorer GAF score at discharge and poor assumed compliance were predicted to have a higher risk of readmission.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Transtornos Mentais/terapia , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Unidade Hospitalar de Psiquiatria , Risco Ajustado , Fatores de Tempo , Adulto Jovem
16.
J Patient Saf ; 16(2): e61-e74, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-30921046

RESUMO

OBJECTIVES: Despite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of psychological and psychosomatic symptoms among second victims. METHODS: We conducted a systematic review of nine electronic databases up to February 2017, without restrictions to publication date or language, examining also additional sources (e.g., gray literature, volumes of journals). Two reviewers performed the search, selection process, quality assessment, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. Quantitative studies on the prevalence of psychological and psychosomatic symptoms of second victims were eligible for inclusion. We used random effects modeling to calculate the overall prevalence rates and the I statistic. RESULTS: Of 7210 records retrieved, 98 potentially relevant studies were identified. Full-text evaluation led to a final selection of 18 studies, based on the reports of 11,649 healthcare providers involved in adverse events. The most prevalent symptoms were troubling memories (81%, 95% confidence interval [CI] = 46-95), anxiety/concern (76%, 95% CI = 33-95), anger toward themselves (75%, 95% CI = 59-86), regret/remorse (72%, 95% CI = 62-81), distress (70%, 95% CI = 60-79), fear of future errors (56%, 95% CI = 34-75), embarrassment (52%, 95% CI = 31-72), guilt (51%, 95% CI = 41-62), and sleeping difficulties (35%, 95% CI = 22-51). CONCLUSIONS: Second victims report a high prevalence and wide range of psychological symptoms. More than two-thirds of providers reported troubling memories, anxiety, anger, remorse, and distress. Preventive and therapeutic programs should aim to decrease second victims' emotional distress.


Assuntos
Pessoal de Saúde/psicologia , Erros Médicos/psicologia , Transtornos Mentais/etiologia , Transtornos Psicofisiológicos/etiologia , Humanos , Transtornos Mentais/psicologia , Transtornos Psicofisiológicos/psicologia , Gestão de Riscos
17.
J Vasc Access ; 21(2): 195-203, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31379250

RESUMO

INTRODUCTION: Guidelines recommend hemodialysis graft screening to identify and repair significant (>50%) stenosis at high risk of thrombosis, but there is insufficient evidence to prefer one or other screening tool due to the lack of studies comparing all available options. METHODS: Seeking an optimal screening approach, we compared the performance of all currently used tools (duplex ultrasound to detect significant stenosis (StD) and measure access blood flow (QaD), ultrasound dilution access blood flow (QaU), static venous intra-access pressure ratio (VAPR), dynamic arterial and venous pressures measurement, and monitoring) for diagnosing significant angiography-proven stenosis (StA) and predicting incipient thrombosis (occurring within 4 months) in 62 grafts. All thrombotic and symptomatic acute hypotension episodes were recorded during follow-up. RESULTS: VAPR > 0.70 and QaU < 1600 mL/min were the best indicators to angiography for those aiming to identify the majority of StA (91% sensitivity) and QaU < 1000 mL/min or StD for those aiming to avoid unnecessary angiograms (95%-93% positive predictive value). At Cox's analysis, the only significant thrombosis predictors were acute hypotension episodes (relative risk = 4.4 (95% confidence interval = 2.2-8.8), p < 0.0001) and QaU or QaD (14% (95% confidence interval = 8-21) or 16% (95% confidence interval = 6-25) increased risk per 100 mL/min drop in Qa, p < 0.003). Thrombosis risk (adjusted for acute hypotension) became significantly higher at QaU = 1000-700 mL/min (relative risk = 3.6 (95% confidence interval = 1.6-8.2), p < 0.001) and QaD = 1300-1000 mL/min (relative risk = 3.1 (95% confidence interval = 1.1-12.8), p = 0.031). The proportion of thromboses attributable to acute hypotension was 40% (95% confidence interval = 24-57). CONCLUSIONS: Our comparative study showed that an effective screening for graft stenosis and short-term thrombosis risk can rely on Qa surveillance alone, and suggested that avoiding acute hypotension and correcting stenosis at QaU < 1000 mL/min or QaD < 1300 mL/min can contain thrombosis risk.


Assuntos
Angiografia Digital , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Determinação da Pressão Arterial , Implante de Prótese Vascular/efeitos adversos , Oclusão de Enxerto Vascular/diagnóstico , Hemodinâmica , Diálise Renal , Trombose/diagnóstico , Ultrassonografia Doppler Dupla , Idoso , Pressão Arterial , Derivação Arteriovenosa Cirúrgica/instrumentação , Velocidade do Fluxo Sanguíneo , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia , Trombose/fisiopatologia , Grau de Desobstrução Vascular , Pressão Venosa
18.
Cancer Epidemiol Biomarkers Prev ; 28(11): 1926-1933, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488416

RESUMO

BACKGROUND: The published circulating miRNA signatures proposed for early-stage non-small cell lung cancer (NSCLC) detection are inconsistent and difficult to replicate. Reproducibility and validation of an miRNA simple signature of NSCLC are prerequisites for translation to clinical application. METHODS: The serum level of miR-223 and miR-29c, emerging from published studies, respectively, as a highly sensitive and a highly specific biomarker of early-stage NSCLC, was measured with droplet digital PCR (ddPCR) technique in an Italian cohort of 75 patients with stage I-II NSCLC and 111 tumor-free controls. By ROC curve analysis we evaluated the miR-223 and miR-29c performance in discerning NSCLC cases from healthy controls. RESULTS: Reproducibility and robust measurability of the two miRNAs using ddPCR were documented. In a training set (40 stage I-II NSCLCs and 56 controls), miR-223 and miR-29c, respectively, showed an AUC of 0.753 [95% confidence interval (CI), 0.655-0.836] and 0.632 (95% CI, 0.527-0.729) in identifying NSCLC. Combination of miR-223 with miR-29c yielded an AUC of 0.750, not improved over that of miR-223 alone. Furthermore, in an independent blind set (35 stage I-II NSCLCs and 55 controls), we validated serum miR-223 as an effective biomarker of stage I-II NSCLC (AUC = 0.808; 95% CI, 0.712-0.884), confirming the miR-223 diagnostic performance reported by others in Chinese cohorts. CONCLUSIONS: Using ddPCR technology, miR-223 was externally validated as a reproducible, effective serum biomarker of early-stage NSCLC in ethnically different subjects. Combination with miR-29c did not improve the miR-223 diagnostic performance. IMPACT: Serum miR-223 determination may be proposed as a tool for refining NSCLC risk stratification, independent of smoking habit and age.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/genética , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/genética , MicroRNAs/sangue , Idoso , Biomarcadores Tumorais/sangue , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Estadiamento de Neoplasias
19.
Int J Health Care Qual Assur ; 32(6): 941-957, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31282257

RESUMO

PURPOSE: According to literature, interruptions during drug administration lead to a significant proportion of medication errors. Evidence on the effectiveness of interventions to reduce interruption is still limited. The purpose of this paper is to explore main reasons for interruptions during drug administration rounds in a geriatric ward of an Italian secondary hospital and test the effectiveness of a combined intervention. DESIGN/METHODOLOGY/APPROACH: This is a pre and post-intervention observational study based on direct observation. All nurse staff (24) participated to the study that lead to observe a total of 44 drug dispensing rounds with 945 drugs administered to 491 patients in T0 and 994 drugs to 506 patients in T1. FINDINGS: A significant reduction of raw number of interruptions (mean per round from 17.31 in T0 to 9.09 in T1, p<0.01), interruptions/patient rate (from 0.78 in T0 to 0.40 in T1, p<0.01) and interruptions/drugs rate (from 0.44 in T0 to 0.22 in T1, p<0.01) were observed. Needs for further improvements were elicited (e.g. a greater involvement of support staff). PRACTICAL IMPLICATIONS: Nurse staff should be adequately trained on the risks related to interruptions during drug administration since routine activity is at high risk of distractions due to its repetitive and skill-based nature. ORIGINALITY/VALUE: A strong involvement of both MB and leadership, together with the frontline staff, helped to raise staff motivation and guide a bottom-up approach, able to identify tailored interventions and serve concurrently as training instrument tool.


Assuntos
Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Melhoria de Qualidade , Gestão da Segurança/organização & administração , Idoso , Simulação por Computador , Geriatria , Humanos , Itália , Recursos Humanos de Enfermagem no Hospital/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
20.
BMC Public Health ; 19(1): 976, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331316

RESUMO

BACKGROUND: Data on electronic cigarette (e-cigarette) use among health professional students, who can play a central role in promoting healthy habits and smoking cessation, are sparse. Moreover, the association between e-cigarettes and smoking habits is still debated. The present study aimed to investigate the diffusion of e-cigarette use among nursing students in north-eastern Italy and explore its association with tobacco smoking. METHODS: In 2015, a questionnaire focused on e-cigarette use and tobacco smoking habits was anonymously administered to 2020 students attending nursing courses held by Verona University in 5 different centres. Of these students, 1463 (72.4%) answered the questionnaire. The influence of e-cigarette ever use on both tobacco smoking initiation in all subjects and smoking cessation among ever smokers was investigated by multivariable logistic models. RESULTS: Most responders were female (77.1%), and the mean (SD) age was 23.2 (4.2) years. Nearly all students (94.7%) had heard about e-cigarettes. Approximately one-third (30.3, 95% CI 27.9-32.7%) had ever used e-cigarettes, but only 2.1% (1.5-3.0%) had used e-cigarettes in the last month. Very few (2.1%) of those responders who had never used e-cigarettes were willing to try them. Prevalence values were much higher for tobacco smoking: 40.9% of responders reported being current tobacco smokers, and 10.1% reported being past smokers. Ever use and current use of e-cigarettes were reported by 57.2 and 4.4% of current tobacco smokers and by 12.0 and 0.6% of never or past smokers, respectively (p < 0.001). In multivariable analysis, students who ever used e-cigarettes had 13 times greater odds of being an ever tobacco smoker than never users, whereas they had three times lower odds of being a former smoker. Only 26 students were currently using both electronic and tobacco cigarettes, and most declared that they used e-cigarettes to stop or reduce tobacco smoking. Of note, only three students reported that they had completely stopped smoking thanks to e-cigarette use. CONCLUSION: Use of e-cigarettes seemed to be rather rare among Italian nursing students and was mainly restricted to current smokers. E-cigarette use was not associated with smoking cessation in nursing students.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Enfermagem/psicologia , Vaping/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários , Fumar Tabaco/psicologia , Adulto Jovem
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