121 research outputs found
Il comfort dei pazienti sottoposti a chirurgia generale e vascolare
No full textObiettivi: Descrivere il grado di comfort dei pazienti nel pre e post intervento chirurgico; esplorare i bisogni dei pazienti sottoposti ad intervento chirurgico in anestesia generale, locale e locoregionale; individuare le strategie adottate dal personale infermieristico per ridurre il disagio determinato dal freddo nel post operatorio; verificare l’attenzione prestata dagli operatori al dolore nel post-operatorio e quali interventi sono stati messi in atto per ridurlo; esplorare la qualità percepita dal paziente riguardo l’informazione in vista della dimissione.Metodi. A 61 pazienti (campione di convenienza) è stato somministrato il “General Comfort Questionnaire” a 24 item di Kolcaba, autrice della “Comfort Theory”. La somministrazione è avvenuta solo nel periodo post intervento, prima della dimissione per evitare di sovraccaricare lo stato emotivo già compromesso. La rilevazione del comfort fa riferimento alla percezione soggettiva del paziente nella fase pre e post operatoria immediata. Sono state aggiunte alcune domande aperte per rilevare ulteriori bisogni e alcune variabili potenzialmente determinanti il grado di comfort (sesso, età, frequenza interventi). Risultati. La media del comfort percepita dal campione nel preoperatorio è pari a 127,27, quella nel post è di 134,32. che risulta più elevato ed è statisticamente significativo (p=0,0001). La differenza osservata nel pre tra i soggetti che eseguono l’anestesia generale e quelli che ricevono altri tipi di anestesia è statisticamente significativa (p=0,02). Non vi sono differenze statisticamente significative di grado medio di comfort in relazione al sesso, fasce d’età, frequenza degli eventi chirurgici, sia nel pre che nel post e in relazione alla somministrazione di antidolorifico (post). La maggior parte dei pazienti nella fase pre ha avvertito bisogni di informazione, comfort fisico, rispetto dei tempi e sostegno emotivo; 1/3 dei partecipanti ha accusato una sensazione di freddo nel post e la maggior parte dei pazienti ha ricevuto dagli operatori sanitari attenzione al dolore postoperatorio
The Hook Test Is More Accurate Than the Trampoline Test to Detect Foveal Tears of the Triangular Fibrocartilage Complex of the Wrist
No full textPurpose: To evaluate the accuracy of the trampoline and hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared with arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ). Methods: In total, 135 patients (97 male, 38 female, mean age 43.5 years) were divided into 2 groups: (1) 80 patients with chronic ulnar-sided wrist pain and positive fovea sign and (2) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy and by the trampoline and hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity, and likelihood ratio of the 2 diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference. Results: The trampoline and the hook tests showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the trampoline test was similar for distal (69%), proximal (66%), and complete (73%) TFCC tears. The hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for the trampoline and hook tests was 75.00% and 0.00% (P <.001) for distal tears and 78.85% and 100.00% (P <.001) and 58.33% and 100.00% (P <.001) for complete or isolated proximal tears, respectively. Specificity for the trampoline and hook tests was 67.27% and 96.36% (P <.001) respectively. Conclusions: The trampoline and hook tests can assure accurate diagnosis of peripheral TFCC tear. The hook test shows greater specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a greater probability to detect foveal laceration of peripheral TFCC for the hook test than for the trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal incompetence of the TFCC, if the hook test is positive. Level of Evidence: Level II, retrospective diagnostic trial
COST-EFFECTIVENESS EVALUATION OF A CARE BUNDLE INTERVENTION FOR PREVENTING FALLS AMONG ITALIAN AGED INPATIENTS IN A STEPPED-WEDGE CLUSTER RANDOMIZED CONTROLLED TRIAL
No full textObjectives: Falls among hospitalized elderlies represent a frequent (20-30%) adverse event. About 30% of falls lead to injuries with different types of severity and can provoke long-time disability or death. The prevention of falls in the hospital is possible through the adoption of multimodal strategies. This study aimed at identifying the potential reduction in falls due to the Care Bundle implementation and its cost-effectiveness in real clinical environment Methods: 10 clusters (hospital units) of Bologna USL and University Hospital were randomized in a stepped-wedge design including 4 steps over the years 2015 and 2016. Incidence rates of falls in both the control and intervention periods were calculated considering the patientdays of exposure. The overall crude relative risk (RR) was calculated with its 95% confidence interval. The overall crude incremental cost-effectiveness ratio (ICER) per fall prevented has been calculated. The difference in the rate of patient falls during the intervention period compared with the control period was in the denominator of the ICER. The difference in intervention vs control costs (associated with implementation of the Care Bundle program, length of stay and hospital services provided to patients attributable to falls) was in the nominator. Results: A total of 11844 patients were randomized in this trial (intervention group n=6600, mean(SD) age=80.93(11.62); control group n=5244, mean(SD) age=78.14(12.68)) throughout the overall period. A 13% reduction (RR=0.87 (95% CI: 0.71-1.07)) in falls due to the Care Bundle intervention was observed, though it did not reach statistical significance. The overall ICER was €617.55 for fall prevented. Conclusions: The preliminary analyses showed a positive effect of Care Bundle intervention for preventing falls among aged inpatients at relatively low cost for fall prevented. Deeper statistical analyses to estimate precise cost-effectiveness of the Care Bundle intervention will be conducted shortly
Postural control in childhood: Investigating the neurodevelopmental gradient hypothesis
No full textNeurodevelopmental disorders (NDDs) have been suggested to lie on a gradient con-tinuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 chil-dren/adolescents aged 5–17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurode-velopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis
Predictors of lung function decline: a retrospective study in COPD patients
No full textIntroduction: There is considerable controversy on the possible predictors of lung function decline in COPD. Aims: To evaluate wheter clinical and anthropometric characteristics and white blood cell count may be associated with the decline in FEV1 in COPD. Methods: We retrospectively selected 240 subjects referring to our outpatient clinic between 2010 and 2013 with a minimum follow-up of 34 months. We included in the study patients with baseline and follow-up information about: spirometric data, white blood cell count, anthropometric characteristics, smoking status, dyspnea (mMRC scale), chronic bronchits (cough and pleghm), history of AECOPD, treatment. Statistical analysis were performed by multivariate linear regression model, using FEV1% annual change as outcome, and age, sex, BMI, smoking status, eosinophils and neutrophils count, symptoms, AECOPDs and treatment as possible determinants. Results: A total of 70 patients were included (age 70,7±6,8yrs, 18 women, FEV1 1,56±0,68L/min, GOLD stage I, II, III+IV, 21, 32 and 17 pts respectively). Five subjects were active smokers. The BMI was 27,0±3,22 and the white blood cell count resulted normal in all subjects. The mean annual FEV1 decline was 0,014 L. In our model, eosinophil count (B 16.9; CI 0.94,32.8; p=0.039) and age were positively associated to FEV1 decline, i.e. the higher the eosinophil count and the age, the greater the functional decline. On the contrary, there was a negative association with BMI (B -0.34; CI -0.66,-0.022). p=0.037). Conclusions: Blood eosinophils, although in the normal range, are related to a faster decline in lung function. Moreover, a higher BMI may protect against FEV1 decline over the time
Incidence of asthma and mortality in a cohort of young adults: a 7-year prospective study
No full textBACKGROUND: Few longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults. METHODS: The life status of a cohort of 6031 subjects, aged 20-44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the history of asthma was subsequently sent to the 5236 subjects who were still alive and residents in the areas of the study. 3880 subjects (74%) replied to the second questionnaire. RESULTS: The incidence of adult-onset asthma was 15.3/10,000/year (95%CI: 11.2-20.8). The presence of asthma-like symptoms (IRR: 4.17; 95%CI: 2.20-7.87) and allergic rhinitis (IRR: 3.30; 95%CI: 1.71-6.36) at baseline were independent predictors of the onset of asthma, which was more frequent in women (IRR: 2.32; 95%CI: 1.16-4.67) and increased in the younger generations. The subjects who reported asthma attacks or nocturnal asthma symptoms at baseline had an excess mortality risk from all causes (SMR = 2.05; 95%CI: 1.06-3.58) in the subsequent seven years. The excess mortality was mainly due to causes not related to respiratory diseases. CONCLUSION: Asthma occurrence is a relevant public health problem even in young adults. The likelihood of developing adult onset asthma is significantly higher in people suffering from allergic rhinitis, in women and in more recent generations. The presence of asthma attacks and nocturnal symptoms seems to be associated with a potential excess risk of all causes mortality
Correction to: Oxidative stress and Nrf2 expression in peripheral blood mononuclear cells derived from COPD patients: an observational longitudinal study
No full textAn amendment to this paper has been published and can be accessed via the original article. Correction to: Respir Res 21, 37 (2020
Dietary fat in respiratory diseases: A multi-case control study
No full textEpidemiological studies provide some evidence that dietary fat intake is important in asthma and other respiratory diseases, even though the results are often conflicting. In the frame of the Genes Environment Interaction in Respiratory Diseases, an Italian population-based multi-case control study, we studied the associations between respiratory diseases and intake of total, animal, vegetal, saturated, monounsaturated and polyunsaturated dietary fat. The European Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary assessment in controls (n=345) and in subjects with asthma (past, n=76, or current, n=147), rhinitis (allergic, n=303, or non allergic, n=164) and chronic bronchitis (n=77).The associations between fat and respiratory diseases were estimated by means of multinomial (for asthma and rhinitis) or logistic (for chronic bronchitis) regression models. The estimates were adjusted for age, gender, centre, BMI, smoking habits, alcohol intake, physical activity, educational level and total energy intake. Current asthma risk was inversely related to the intake of vegetable fat (RRR=0.49, 95% CI 0.27–0.91 for the highest quartile as compared with the lowest one, p for trend=0.036). Monounsaturated fat showed a trend similar to vegetable fat but this trend was not statistically significant (p=0.139). A significant increased risk of allergic rhinitis was observed with increasing saturated fat (RRR = 1.92, 95% CI 1.17–3.16 for the highest quartile, p for trend=0.030). No other significant association was found between fat and respiratory diseases. Our results suggest that vegetable fat is protective for asthma, whereas saturated fat is a possible risk factor for allergic rhinitis
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