54 research outputs found
An open, phase 2 ongoing study with recombinant alpha-2-interferon (rIFNA) in refractory multiple myeloma (MM).
No full textLimite delle cure nell’emergenza: scienza, diritto e morale nell’albero decisionale del medico
No full textMieloma multiplo e gammapatie monoclonali: quadri clinici, acquisizioni eziopatogenetiche e progressi terapeutici
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Electrophysiologic monitoring in neurointensive care
No full textCumulative evidence of potential benefits of electroencephalography (EEG) and evoked potentials in the management of patients with acute cerebral damage has been confirmed. Continuous EEG monitoring is the best method for detecting nonconvulsive seizures and is strongly recommended for the treatment of status epilepticus. Continuously displayed, validated quantitative EEG may facilitate early detection of secondary cerebral insults and may play a decision-making role in the management of patients with head injury, stroke, or subarachnoid hemorrhage. Long-latency auditory evoked potentials and cognitive components constitute a new field of interest for the progress of comatose patients. Motor evoked potentials may become clinically important both in acutely injured and elective postoperative patients. In the neurointensive care units adequate techniques can be selected to answer targeted clinical questions. The efficacy can be improved by implementing educational projects based on ad hoc training of nurses and neurointensive care specialists
Attitude, intention and will expression on post-mortem organ donation in the Italian population
No full textBackground: More than 8000 people are waiting for organ transplantation in Italy. Even though most of the population has a positive attitude towards organ donation, the percentage of consent to donation remains low (only 68.2% of the expressions in 2021). Exploring different points of view and variables that might play a role in this process is very important to foster a culture of organ donation and specific policy implementation.
Methods: A mixed-method study was conducted in 2021 in collaboration with the National Centre for Transplantation and involved 353 participants (healthcare professionals, citizens, opinion leaders, registry office employees) that completed a questionnaire to assess their attitudes towards organ donation and will expression before and after participating to a focus group on the topic. Statistical analyses were conducted with SPSS.
Findings: Results showed that 93.8% of participants reported a positive attitude towards donation, which significantly increased participating in the focus group (p<.001). Only 50.4% of the sample expressed their will at the time of the study. Significant correlations were found between a positive attitude and being a woman (p <.045), higher education (p<.004), familiarity with donation (p<.001); and between having expressed one’s will and familiarity with donation (p <.024) and being registered to donation associations (p<.001).
Discussion: Differences in attitude and will expression in each group (especially opinion leaders and registry office employees) underline the need to implement targeted interventions and policies to foster the creation of a culture of donation and to support citizens in expressing their will consciously
Ethical tensions and professional attitudes toward circulatory death organ donation in the ICU: a systematic review
No full textPurpose: Donation after circulatory death (DCD) represents a valuable opportunity to expand the organ donor pool. However, its implementation in intensive care units (ICUs) remains ethically and emotionally complex. ICU healthcare professionals (HCPs) play a pivotal role in this process, yet their attitudes, knowledge, and perceived challenges are not fully understood. This systematic review aimed to explore ICU HCPs’ attitudes (as defined by Rosenberg and Hovland) toward controlled DCD (cDCD). Methods: We conducted a systematic review of studies published until March 2025 in four databases. Eligible studies included original research reporting ICU-specific data on HCPs’ attitudes toward DCD. Study quality was assessed using the Mixed Methods Appraisal Tool. A structured narrative synthesis was performed. Results: Twenty-five studies involving 3,878 HCPs were included. Overall, support for DCD was evident though it remained lower than for donation after brain death. Ethical concerns focused on potential conflicts of interest between the withdrawal of life-sustaining treatment and the pursuit of organ donation, the timing of withdrawal, the urgency of organ retrieval, and the challenge of balancing compassionate end-of-life care with procedural imperatives. Common barriers included the lack of standardized protocols, insufficient training, and uncertainty surrounding death determination. Conclusions: While ICU HCPs generally support DCD, significant ethical tensions and systemic barriers persist. Institutional efforts should focus on implementing clear protocols, promoting interprofessional education, and providing emotional support to ensure ethical integrity and staff well-being. Future research should explore differences in attitudes between uDCD and cDCD and work toward the development of validated tools to assess professional attitudes
Life beyond life: Perceptions of post‐mortem organ donation and consent to donate—A focus group study in Italy
No full textObjectives: Many factors such as personal and cultural beliefs, misinformation, fear of death and inadequate will registering procedures can influence post-mortem organ donation. The present study aimed to explore the perceptions, beliefs and information around post-mortem donation and will expression in different groups of the Italian population, to orient future interventions and raise awareness.Design: Qualitative research with focus groups.Methods: A total of 38 focus groups involving 353 participants including the general population (young adults: 18-39, mature adults: 40-70), local and hospital health professionals, critical area health professionals (emergency room and intensive care), registry office employees and opinion leaders, were conducted in six regions from different parts of Italy between June and November 2021. Thematic analysis was conducted with the use of Atlas.ti9.Results: Five overarching themes were identified: dilemmas regarding donation, resistance to donation, facilitators of donation, difficulties in terms of will expression and proposals to encourage will expression. Possible facilitators were having personal and professional experiences with organ donation, feeling useful for society, having reliable information and trust in the health care system. Potential barriers to donation were doubts and fears about brain death, bodily integrity concerns, religious beliefs, misinformation and distrust in the health care system.Conclusions: These results highlighted the significance of a bottom-up perspective with regard to identifying the personal perceptions and beliefs with regard to donation, underlining the urgency of creating tailored interventions to sensitize different groups of the population in terms of promoting an informed choice and a culture of donation
Organ donor screening for carbapenem-resistant gram-negative bacteria in Italian intensive care units: the DRIn study
No full textThe 759 cases of brain death declaration (BDD [Italian law, 6 hours of observation time]) that occurred in 190 Italian intensive care units (ICUs) between May and September 2012 were studied to quantify carbapenem-resistant gram-negative bacteria (CR-GN) isolated in organ donors, to evaluate adherence to national screening guidelines, and to identify risk factors for CR-GN isolation. Mandatory blood, bronchoalveolar lavage, and urine cultures were performed on the BDD day in 99% of used donors. Because results were rarely made available before transplant, >20% of transplants were performed before obtaining any microbiological information, and organs from 15 of 22 CR-GN cases were used. Two (lung-liver) of the 37 recipients died, likely because of donor-derived early CR-GN sepsis. ICU stay >3 days (odds ratio [OR] = 7.49, P = .004), fever (OR = 3.11, P = .04), age <60 years (OR = 2.80, P = .06), and positive ICU epidemiology (OR = 8.77, P = .07) were associated with CR-GN isolation. An association between single ICU and risk of CR-GN was observed, as a result of differences across ICUs (ICC = 29%; 95% confidence interval [CI] 6.5%-72%) probably related to inadequate practices of infection control. Continuous education aimed at implementing priority actions, including stewardship programs for a rational use of antimicrobials, is a priority in healthcare systems and transplant networks. Improved awareness among ICU personnel regarding the importance of early CR-GN detection and timely alert systems might facilitate decisions regarding organ suitability and eventually save recipient lives
Pharmacokinetics of colistin in cerebrospinal fluid after intraventricular administration of colistin methanesulfonate
No full textAbstract
Intraventricular colistin, administered as colistin methanesulfonate (CMS), is the last resource for the treatment of central nervous system infections caused by panresistant Gram-negative bacteria. The doses and daily regimens vary considerably and are empirically chosen; the cerebrospinal fluid (CSF) pharmacokinetics of colistin after intraventricular administration of CMS has never been characterized. Nine patients (aged 18 to 73 years) were treated with intraventricular CMS (daily doses of 2.61 to 10.44 mg). Colistin concentrations were measured using a selective high-performance liquid chromatography (HPLC) assay. The population pharmacokinetics analysis was performed with the P-Pharm program. The pharmacokinetics of colistin could be best described by the one-compartment model. The estimated values (means ± standard deviations) of apparent CSF total clearance (CL/Fm, where Fm is the unknown fraction of CMS converted to colistin) and terminal half-life (t(1/2λ)) were 0.033 ± 0.014 liter/h and 7.8 ± 3.2 h, respectively, and the average time to the peak concentration was 3.7 ± 0.9 h. A positive correlation between CL/Fm and the amount of CSF drained (range 40 to 300 ml) was observed. When CMS was administered at doses of ≥5.22 mg/day, measured CSF concentrations of colistin were continuously above the MIC of 2 μg/ml, and measured values of trough concentration (C(trough)) ranged between 2.0 and 9.7 μg/ml. Microbiological cure was observed in 8/9 patients. Intraventricular administration of CMS at doses of ≥5.22 mg per day was appropriate in our patients, but since external CSF efflux is variable and can influence the clearance of colistin and its concentrations in CSF, the daily dose of 10 mg suggested by the Infectious Diseases Society of America may be more prudent
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