1,721,043 research outputs found
Sleep deprivation, sleep disorders, fatigue, stress and the risk of occupational injuries and errors among health-care workers: a multi-approach epidemiological study
Full text linkObjectives. The aim of the study was to assess the effects of acute and chronic sleepiness, of sleep disorders, and stress on the risk of occupational injuries and commuting accidents among the workers of the University Hospital of Udine, and the effect of organizational stress at the hospital Unit level on the number of adverse events and near-misses on the patients.
Methods. We used different epidemiological study designs depending on the xposures and outcomes: case-crossover, case-control, ecologic. In addition to the information on exposures collected through interviews with structured questionnaires, we also conducted neurological tests (polysomnographies and maintenance of wakefulness tests) to assess the characteristics of sleep and the ability to stay awake of the workers.
Results. Through the case-crossover study, we identified occupational transient exposures associated with increased risk of injury: fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. Through the case-control design, the number of reported sleep disturbances was positively related with the outcome, whereas no association was found between usual sleep hours and injuries. Chronotype, assessed through the Horne-Ostberg questionnaire, was not significantly associated with injury, although we noticed a decreasing trend from earlier to later chronotypes. The ability to maintain wakefulness appeared reduced among workers who reported injuries. The ecologic study showed that the proportion of female workers in a unit, the average number of sick-leave days and of overtime hours, the number of medical examinations requested by employees, and being a surgical unit were significantly associated with the number of adverse events and near-miss.
Conclusions. This study allowed the identification of individual and environmental stress-related factors associated with increased risk of injuries and adverse events, thus providing useful information for planning preventive interventions and for improving safety in the hospital settingObiettivi. Lo studio si proponeva di valutare gli effetti della sonnolenza acuta e cronica, di disturbi del sonno e di situazioni stressanti sul rischio di infortuni in itinere ed occupazionali tra i dipendenti dell’Azienda Ospedaliero-Universitaria di Udine. Inoltre è stato indagato l’effetto dello stress organizzativo a livello di Struttura/Dipartimento ospedaliero sul rischio di incidenti sui pazienti o near-miss.
Metodi. Sono stati impiegati diversi disegni di studio epidemiologico, a seconda dell’esposizione e dell’outcome considerati: case-crossover, caso-controllo, ecologico. Ad integrazione delle informazioni sulle esposizioni raccolte mediante interviste con questionari strutturati, sono stati condotti anche esami strumentali (polisonnografia) e test neurologici (test di mantenimento della veglia) per valutare le caratteristiche del sonno e le capacità di mantenere la veglia da parte dei lavoratori.
Risultati. Tramite lo studio case-crossover, sono state identificate esposizioni occupazionali transitorie associate ad un significativo aumento del rischio di infortunio sul lavoro: stanchezza, fretta, distrazione, situazioni di emergenza, attività didattiche, pazienti non collaboranti, campo operatorio con sangue, rumore eccessivo, procedure complesse e stati di arrabbiatura. Tramite il disegno caso-controllo, è emerso che il numero di disturbi del sonno riferito dai lavoratori si associa positivamente al rischio di infortunio, mentre il numero medio di ore di sonno non si è associato al rischio di infortunio. Benché non in maniera significativa, I cronotipi più mattutini, identificati tramite questionario di Horne-Ostberg, sembrerebbero a rischio aumentato. La capacità di mantenere la veglia sembrerebbe ridotta nei lavoratori che hanno riferito un infortunio. Lo studio ecologico ha mostrato che la proporzione di lavoratori di sesso femminile in ogni Unità, il numero medio di giorni di malattia e di ore di straordinario, il numero di visite anticipate richieste al medico competente e il tipo di dipartimento di appartenenza sono risultati significativamente associati al numero di eventi avversi e near-miss.
Conclusioni. Questo studio ha permesso di individuare fattori stressanti individuali ed ambientali che si associano ad un aumentato rischio di infortuni tra i lavoratori ed errori sui pazienti, fornendo informazioni utili per la programmazione di interventi di prevenzione e il miglioramento della sicurezza in ambiente ospedalier
A virtual reality methodology for cardiopulmonary resuscitation training with and without a physical mannequin
No full textBACKGROUND: Cardiopulmonary resuscitation (CPR) is an emergency procedure that can increase survival after a cardiac arrest. Performing CPR effectively requires both procedural knowledge and manual skills. Traditional CPR training methodology includes lessons led by instructors and supervised practice on mannequins, thus requiring considerable resources.OBJECTIVE: This paper proposes a new methodology for low-cost CPR training based on virtual reality (VR) with and without the addition of a physical mannequin. Moreover, it describes an experimental evaluation of the methodology that assessed gain in manual skills during training, transfer of procedural knowledge and manual skills in a final assessment, and changes in self-efficacy with three measurements over time (pre-training, post-training, and post-assessment).METHODS: We implemented a VR application that supports the proposed methodology, and can thus be used with or without a mannequin. The experimental evaluation involved 30 participants who tried CPR in VR twice, performing two repetitions of 30 chest compressions per trial. Half participants tried the VR application with the mannequin and half without it. Final assessment required all participants to perform CPR on the mannequin without the assistance of VR. To assess self-efficacy, participants filled in a questionnaire at the three times of measurement.RESULTS: Mixed-design ANOVAs showed effects of repetition, effects of group, or interaction between the two variables on manual skills assessed during training. In the final assessment, participants in both groups correctly remembered most of the steps of the procedure. ANOVAs revealed differences between the two groups only in pressure-related skills (better with mannequin) and in the number of wrong steps added to the procedure (better without mannequin). Mixed-design ANOVA showed a self-efficacy increase in both groups after training, which was maintained after final assessment.CONCLUSIONS: The proposed VR methodology for CPR training has a positive effect on procedural knowledge, manual skills, and self-efficacy, with as well as without the physical mannequin. Trials on a mannequin are required to understand the correct pressure for chest compression. This supports the adoption of the proposed VR methodology to reduce instructor and mannequin time required to teach CPR to trainees
Nursing care based model vs. functional nursing care model at home: effects on terminal ill patients in their three months of life
No full textA Randomized Double-Blind Study to Investigate the Clinical Efficacy of Adding a Non-Migrating Antimicrobial to a Special Silk Fabric in the Treatment of Atopic Dermatitis
No full textBackground: A randomized, double-blind study designed to compare the efficacy of DermaSilk (R) versus a sleeve of similar structure but minus the AEM 5772/5 antimicrobial finish in the treatment of atopic dermatitis (AD). Objective: To evaluate the clinical effect of adding an antimicrobial finish to knitted silk garments on eczema severity and on pruritus in patients with AD. Methods: Thirty patients aged between 3 and 31 years (mean 14.2 +/- 7.7) were enrolled. The inclusion criterion was that the patients presented with active AD with eczematous lesions located on the arms without any sign of infection. Each participant was given a set of 4 pairs of knitted silk tubular sleeves marked with seams of different colours. Only one colour was treated with AEGIS AEM 5772/5. This information was unknown to both the clinicians and the patients/parents. At baseline (T0) and after 7 (T7), 14 (T14), 21 (T21) and 28 (T28) days, the patients were evaluated using the following methods: photographic assessment, local modified SCORAD index adapted for only the arm, and parent/patient assessment of pruritus measured with a visual analogue scale. Results: The mean local SCORAD index of both the DermaSilk- and the unmodified-silk-covered arms decreased significantly between baseline (T0) and the end of study (T28). However, while the DermaSilk group showed a constant decrease each week, the unmodified-silk group showed a significant decrease only in the first 2 weeks of the study. Also the decrease in pruritus values between T0 and T28 was greater for the DermaSilk group. Conclusions: This study demonstrates the importance of including the AEM 5772/5 finish to the specially knitted silk for a long-term improvement of atopic eczema symptoms
Retrospective cohort study on weight gain among pregnant women of the Italian province of Trento during the 2020 lockdown due to COVID-19
No full textObjective. The lockdown due to COVID-19 has been associated with a reduction of physical activity and a change in eating behaviors, with consequent weight gain, in general and specific populations. The objective of this study was to assess whether women whose pregnancies encompassed the lockdown due to COVID-19 in 2020 had an excess gestational weight gain as compared with those who were pregnant in the same periods of previous years. Materials and Methods. This was a retrospective cohort study based on anonymous data from the Birth Attendance Certificate (CedAP) information flow which is mandatorily collected in all Italian Regions. In the Autonomous Province of Trento, North-Eastern Italy, more information than those required as a minimum data set are collected, including maternal weight at the first gestational obstetric visit, initial body mass index (BMI), and maternal weight at delivery. We calculated mean gestational weight gain for women whose pregnancy encompassed the 2-month lockdown in 2020 and for those who were pregnant in corresponding periods of the years 2016-2019. Linear and logistic regression models were built to assess the association between lockdown and weight gain or excess weight gain, respectively, adjusting for the potential confounding effect of gestational month at the beginning of lockdown or corresponding period and pre-pregnancy body mass index. Results. In 2020, mean gestational weight gain was not significantly different from the previous years, nor was the likelihood of gaining excess weight. Conclusions. Unlike other populations that increased weight during the COVID-19 lockdown, the Italian population of pregnant women described in this study has a gestational weight gain comparable with that of the previous years. Public health and environmental interventions, as well as dedicated programs taking care of women from conception to post-partum may have a role in the health of future mothers and should be promoted
One-year post-ICU discharge survival among patients receiving long-term intensive care in the University Hospital of Udine, Italy
No full textA retrospective epidemiological study on the association of bullous pemphigoid and neurological diseases
No full textBullous pemphigoid is a rare chronic recurrent dermatosis that is often reported in association with various neurological diseases. No investigation involving a large number of patients has ever been carried out to demonstrate such an association. This study was accomplished by analysing the discharge diagnosis of all hospitalized patients, both day-patients and inpatients, during a 5-year period (1995-2000) covering a total population group of 934,023 living in a region of Italy that has approximately 1,200,000 inhabitants. The results support the hypothesis of an association between bullous pemphigoid, multiple sclerosis and Parkinson's disease on a highly significant statistical basis. The aetiopathogenic mechanisms and the causes that induce the loss of immunological tolerance are not yet understood
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