Annali dell'Istituto Superiore di Sanità
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Bed rest after cardiovascular implantable electronic device position: Systematic review and Meta-analysis
No full textBackground. Bed rest is prescribed to all patients after cardiovascular implantable electronic device position, but to a variable extent. Different clinical protocols exists. Aim To assess the effects of different length of bed rest after CIED placement on complications and patient comfort. Methods. We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CINAHL, SCOPUS. We included randomized and quasi-randomized controlled trials. Two authors independently selected trials, assessed the risk of bias and extracted data. Results. We included 2 RCTs. There was no evidence that shorter bed rest was more harmful than longer bed rest in terms of lead displacement (RR 0.681 95%CI [0.063, 7.332]) and haematoma (RR 1.642, 95%CI [0.282, 9.560]). None of the studies reported the assessment of bleeding, back pain or urinary discomfort. Conclusions. Short bed rest appears to be as safe as longer periods of bed rest. However, to confirm these results, further larger trials needs
Healthcare organizational performance: why changing the culture really matters
Get PDFAn organization may be considered as having three components: a structure, systems and culture. Culture is the most difficult part of the organization to affect. After all, culture has the key role in impacting and improving rganizational performance. The leadership of an organization and its key operations are paramount in shaping the culture. Leadership and organizational culture are inextricably intertwined. They are two sides of the same coin. Culture is a medium through which leadership travels and impacts organizational erformance. If leaders are to fulfil the challenges of the 21st century, they must first understand the dynamics of culture and their role as sculptors through behavioural and cognitive ways
Erythrocyte phenotype in a pregnant woman of Sri Lanka. Description of the case and complications related to communication problems
Get PDFBackground. TheBombay phenotype is a rare genetic trait which is characterized by the absence of A, B and H antigens on red cells as well as in body secretions. The serum shows the presence of antibodies against antigen H. Patients with this rare blood type are not easily transfusable. We had observed a woman aged 18, at the 20th week of pregnancy, native ofSri Lanka, with an IgG and IgM class anti-H. We report the case and the clinical issues arisen. Materials and methods. The determination of ABO, Rh[D] group, the indirect antiglobulin test (IAT) were performed in tube techniques and in neutral gel microcolumn. Detection for antibodies was performed using ID-Card LISS-Coombs microtubes, in solid phase and with tube techniques. For molecular analysis, the FUT1 and FUT2 genes were sequenced using BigDye terminator v1.1. The study of FUT2 gene was performed after extraction of mRNA using Qiagen kit RNase and then reverse-transcribed into cDNA. Results. TheBombay phenotype was confirmed by serological and molecular analysis techniques. The patient, in collaboration with a cultural mediator, was informed of her immunohaematological condition and a program of assistance was proposed to her. Unfortunately the patient did not return for the next visit, despite of a telephone reminder. During childbirth a haemorrhage occurred and a request of compatible blood for an urgent transfusion arrived at our transfusion service. Fortunately, the haemorrhage was arrested and the patient didn’t need to have any transfusions. Discussion. This case emphasizes the need for an efficient management of rare blood types that are more and more frequent as a result of migration. It is necessary to organize, in strategic points of the national territory, reference centres with better diagnostic capabilities and implement freezing of red blood cells with rare phenotype for diagnostic and therapeutical use. Communication issues are as well important in dealing with this emerging phenomenon
Certification and evaluation of the clinical ethics consultant. A Proposal for Italy.
Get PDFClinical ethics, as a sub-discipline of bioethics, is subject to growing professionalization in North America, Europe and elsewhere. Since the goal of clinical ethics is the identification, analysis and resolution of ethical dilemmas and conflicts in health care settings, specific competencies for practitioners and criteria to evaluate them are strongly needed. Regarding clinical ethics consultation (CEC) many efforts have been made by American clinical ethicists and scholars to delineate the core knowledge and skills to perform it, to settle specific professional responsibilities and tasks and to identify the fundamental training and quality requirements that candidates and actual professionals should satisfy in order to serve as ethics consultants. Starting from the analysis of two meaningful international experiences, the one American and the other German, the paper discusses the process of certification of the clinical ethics consultant and encourages its implementation in the Italian context trying to outline a model which is suited to it
Medicine use and recurrent complaints among 15-years-old adolescents in Tuscany
Get PDFBackground. The use of medicines to treat common complaints, such as headache, stomachache, difficulty in getting to sleep and nervousness, is widespread among ado-lescents, and is increasing. The aim of this survey was to estimate the prevalence of recurrent specific complaints among 15-year-old adolescents in Tuscany over three years(2006, 2010 and 2014) and that of medicine use to treat these complaints among boysand girls.Methods.The present study is based on data from the Tuscan HBSC studies at threetime points (2006, 2010 and 2014), which involved 2830 adolescents, aged 15 years old(1395 boys and 1435 girls).Results.Overall, the data confirm that adolescents who suffer from recurrent complaintsare more likely to use medicines. The prevalence rates of all complaints were higher ingirls than in boys in the three years considered. Over the whole period, headache, stom-achache and difficulty in getting to sleep increased in girls, while boys displayed signifi-cant decrease in nervousness and stomachache.Conclusion.Our findings underline the fact that the use of medicines in adolescence isa public health concern and constitutes an emerging issue that needs greater attentionand investigation on the part of scientific researchBackground. The use of medicines to treat common complaints, such as headache, stomachache, difficulty in getting to sleep and nervousness, is widespread among adolescents, and is increasing. The aim of this survey was to estimate the prevalence of recurrent specific complaints among 15-year-old adolescents in Tuscany over three years (2006, 2010 and 2014) and that of medicine use to treat these complaints Conclusion. Our findings underline the fact that the use of medicines in adolescence is a public health concern and constitutes an emerging issue that needs greater attention and investigation on the part of scientific research
Ultrasound B-lines for detection of late lung fibrosis in breast cancer patients after radiation therapy
Get PDFBackground and purpose. Radiation therapy (RT) for breast cancer after conservative surgery can be life-saving but remains associated with significant late side effects, including lung fibrosis, detected by chest CT. Aim of this study was to assess whether lung ultrasound (LUS) may detect late lung fibrosis through the biomarker of B-lines. Materials and methods. We evaluated 30 women (median age 67 years, range 46-80 years) about 3-8 years after RT (follow up 38-101 months, median 58 months) for left (n = 12) or right (n = 18) breast cancer (stage 1, n = 24; stage 2, n = 6), treated with total dose 40.5 – 50.00 Gy with/without boost dose). In all, both treated and contralateral hemithorax were evaluated. LUS was performed and B-lines evaluated with a 28-region antero-lateral scan, from second to fifth intercostal spaces, along the mid-axillary, anterior axillary, mid-clavicular, and arasternal lines. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. The sum of B-lines in all spaces generated the B-line score of each hemithorax. Results. Median B-line score was higher in the irradiated site than in the contralateral control hemithorax (9, 1st-3rd quartiles: 2-23 vs 3, 1st-3rd quartiles: 1-4; P < 0.05). In the treated hemithorax, higher mean lung doses ( > median value of 2.7 Gy) were associated with more B-lines when compared to lower doses (< 2.7 Gy): 9 vs 5, p < 0.001. Conclusion. RT in female breast cancer survivors is associated with increase in B-lines in the targeted hemithorax, likely due to lung fibrosis, and related to the lung mean dose. LUS can provide a simple “echo-marker” of lung fibrosis.
The Convention on Human Rights and Biomedicine twenty years later: a look at the past and a step towards the future
Get PDFA document published by the Council of Europe provides practical indications for interpreting Article 21 of the Convention on Human Rights and iomedicine, which asserts that “The human body and its parts shall not, as such, give rise to financial gain”. In Italy the Istituto Superiore di Sanità (ISS, Italian National Institute of Health) is actively committed to comply fully with this imperative ethical requirement
The health needs of women prisoners: an Italian field survey
Get PDFIntroduction. Health care in prisons represents an important part of public health due to the interaction between prisons and society. Women prisoners have needs that distinguish them from male prisoners, however little is known about how those needs are met. The aim of the study was to gather information about the needs of women in prison and to identify which of their needs are the most or the least met. Methods. This study investigated the needs of detained women using a newly developed Questionnaire based on Gordon’s model. In this descriptive study, data were collected from a onvenient sample of women recruited from two Italian prisons. Data analysis used descriptive statistics. Results. Fifty-five women (response rate = 92%) completed the self-reported questionnaire. Our findings showed that physical needs are met worse than psychological and social needs. The majority of physical needs were related to the inability to meet food preferences and the difficulty in respecting food requirements related to disease and by religion. The women experienced a loss of privacy, and they need more time for improving the quality of their relationships. The majority of the participants (65%) declared that they suffer from psychological disorders with an alarming percentage (29%) stating that they had thoughts of self-harm. They commonly consume tobacco (87.3%), and abuse substances (20%). Discussion and conclusions. The recognition of multi-dimensional women’s needs is of primary importance to create opportunities to support incarcerated women and to build health-promoting gender-sensitive interventions.