A real opportunity to modify cardiovascular risk through primary care and prevention: A pilot study

Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV risk profile and could be further spread to people that, according to their CRS, would benefit more from changes in lifestyles.

The role of resilience and coping among Italian healthcare workers during the COVID-19 pandemic

Objective:

To evaluate the psychological state of healthcare workers (HCWs) in the field of rehabilitation during the COVID-19 pandemic.

Methods:

Cross-sectional observational study. Sample of 334 HCWs including: nurses, medical doctors, therapists, scientists, and clerical workers working at the IRCCS San Raffaele Roma rehabilitation hospital during the second wave of the COVID-19 pandemic. Anonymous web-based questionnaire included 14-item Resilience Scale, Brief-COPE, Hospital Anxiety Depression Scale, Fear of COVID-19 Scale. Occupational and sociodemographic characteristics.

Results:

High levels of resilience, low levels of anxiety, depression, and fear were observed in the study population; the most frequently used coping strategies in the Brief-COPE were acceptance, planning, and active coping. Specifically, 87% of the participants reported a moderate to high level of resilience, with the highest level observed in nurses while physicians show the lowest level. HCWs showed symptoms of anxiety (29%), depressive symptoms (10%), and fear caused by the COVID-19 pandemic (44%). Statistically significant differences were observed between different occupations for fear (p <0.05) and resilience (p <0.01). Levels of anxiety and fear appeared to be higher in female and younger workers. The latter group - who also reported higher levels of depression - showed lower levels of resilience.

Conclusions:

In our study hospital and non-hospital workers show different emotional, cognitive, and behavioural resources when facing stressful situations, like in the case of the SARS-CoV-2 pandemics. Our results support the role of resilience and the proper use of problem-focused and emotion-focused coping strategies as protective factors from psychological distress.

A new model of multidimensional discharge planning: continuity of care for frail and complex inpatients

OBJECTIVE

Delays in patient discharge can adversely affect hospital and emergency room productivity and increase healthcare costs. The discharge should be structured from the hospital admission towards the most appropriate environment. This study aims to investigate the efficacy of the Unit, named "Continuity of Care Center" (CCC), to guarantee a safest and fastest hospital discharge in frail patients and to test the effect of our team-approach on hospital outcomes (length of stay and hospital mortality).

MATERIALS AND METHODS

This is a prospective cohort study carried out in an acute care hospital with 1,558 beds and is equipped with 41 operating theaters. We collected data from October 2016 to June 2019.

RESULTS

The time of patient discharge had an important reduction: 15.5±30.8 in the first 3 months vs. 11.0±20.1 in the last 3 months considered. The median of the time of discharge in all 12 months considered was 12 day. The length of stay presented an important reduction from 33.3±47.5 during the first 3 months vs. 28.8±39.5 in the last 3 months of activity of CCC; and a significant reduction of hospital deaths was recorded from 20% during the first 3 months to 14% in the last 3 months of activity of CCC.

CONCLUSIONS

Results indicate a constant decrease in patient discharge time and length of hospital stay, with a consequent significant reduction of healthcare costs. According to the estimates of Italian Health Ministry concerning Latium region, every hospitalization day has a mean cost of € 674.00. Thus, the CCC activity has contributed to a reduction of approximately 12,832 days of hospitalization, in the considered period, with an estimated hospital saving of € 8,648,761.

Vaccine Hesitancy among Master's Degree Students in Nursing and Midwifery: Attitude and Knowledge about Influenza Vaccination

Influenza vaccination among healthcare workers may reduce morbidity and protect fragile patients. Most of the evidence concerning the vaccine hesitancy of healthcare workers reported lack of knowledge and wrong attitude. The aims of this study were to explore the knowledge and attitudes about influenza vaccination among master's degree students in Nursing and Midwifery, and to evaluate the effectiveness of their involvement in the hospital vaccination campaign in order to increase intention to receive immunization. The students of nurses and midwives were involved in the vaccination sessions of the 2018-19 hospital campaign. They were recruited to complete an online survey. Students of the 2nd year (involved in the vaccination campaign) and the 1st year (not involved) were compared. Descriptive and inferential statistics were performed for data analysis. Students who intend to receive influenza vaccination in the following year registered a percentage of 83.6% and showed an overall attitude of 66.8%. The involvement of the students in the vaccination campaign led to a significant increase in their positive vaccination attitude (80.9% vs. 87.0%) and in their intention to receive flu vaccination in the following year (67.7% vs. 100%). A positive attitude towards vaccinations was observed by nurses and midwives. Their involvement in the planning and activities during the vaccination campaign could positively influence their opinions and intention to receive vaccination.

Multidisciplinary community approach to reduce cardiovascular risk factors in a neighborhood in Rome

Cardiovascular Diseases (CVDs) are one of the main causes of death and morbidity worldwide. To reduce the risk of occurrence it is necessary to promote a healthy lifestyle and consider health as a collective benefit. This study aims to evaluate how the implementation of preventive interventions and health promotion could reduce the impact of CVDs on the involved population.

This prospective study started 1 year ago and will last 18 months (July 2020). Participants have been recruited in General Practice clinic in Torresina neighbourhood in Rome. The intervention was a full year of multidisciplinary meetings scheduled with general practitioners, community nurses, dedicated professionals (nutritionist, physiotherapist, psychologist) and outdoor events with a coach to promote group physical activity, assisted by the use of social networks. Anthropometric data, blood chemistry tests and information about lifestyle, nutritional habits and physical activity were collected at time 0 and every 2-month follow-up and, additionally, the individual cardiovascular risk score (CVRS) was calculated. After 12 and up to 18 months, instead, the self-management ability of a correct lifestyle will be evaluated on the basis of the measured outcomes. Statistical analysis was performed using a paired t test with Jamovi software.

The sample size was 62 patients, 50% male with an average age of 54.6 years (±7.8). During the analyzed period there was a reduction in the percentage of smokers from 30.6% at baseline to 22.6% after 12 months. The baseline CVRS was 4.9% (±6.3). At 12 months the CVRS significantly decreased to 3.8% (±4.0) (p &lt; 0.01). Total cholesterol level was 211.1 mg/dl (±32.8) at baseline, with a significant reduction at 12 months (202.5 ± 37.8) (p = 0.01). The results are preliminary.

Multidisciplinary interventions resulted in a significant reduction of CVRS and cholesterol levels during the study period. Further studies are necessary to evaluate our approach.

Key messages

Cardiovascular Diseases are the main causes of deaths among the population, so primary prevention through tailored educational interventions is fundamental. A multidisciplinary approach has proven to be effective in reducing the risk of cardiovascular disease and the level of cholesterol.

Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units.

This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified.

During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p &lt; 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital.

This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible.

Key messages

It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

Evaluation of Emotional Intelligence among Master's Degree Students in Nursing and Midwifery: A Cross-Sectional Survey

Emotional intelligence is an important skill for nurses and midwives and leads them to cleverly work in various fields and contexts, successfully handling colleagues, patients and their families. The aim of this cross-sectional study is to evaluate the relationship between emotional intelligence, sociodemographic and academic variables in current and former master’s degree students in nursing and midwifery, through the administration of a questionnaire to 71 subjects. Emotional intelligence is significantly related to gender. Females showed higher scores (0.2 points higher than men) for emotional intelligence factors, highlighting an excellent ability to “evaluate and express emotions in relation to others”. Moreover, significant differences in academic performances are shown: both females and midwives demonstrated higher academic performance (a mean degree mark 3.8 points higher than men and a mean degree mark 2.6 point than nurses, respectively). High levels of emotional intelligence in individuals who carried out training activities in the organization area are also evident: These subjects have an ability regarding the “regulation of emotion in the others”, which is significantly higher (p = 0.01) than those interested in other master’s degree areas. Emotional intelligence (EI) is strongly linked to the individual’s characteristics and their personalities and differs from technical and professional skills. EI is also an excellent predictor of professional success.

Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital

BACKGROUND

Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital.

METHOD

In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student's t-test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated.

RESULTS

During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital.

CONCLUSIONS

The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care.

The benefits of a hospital palliative care team

AIM

To investigate the association between a hospital palliative care unit assessment and hospital outcome.

METHODS

This was a prospective cohort study. Data were assessed from all patients treated and followed by the hospital palliative care team (HPCT) from November 2016 until December 2017.

RESULTS

The mean age of the 588 patients was 73.15±13.6 years. All of the patients included in the study were referred to palliative care. A large proportion of patients were affected by cancer, 69.7% (410), while 30.3% (178) were affected by an advanced chronic illness. The three most frequent cancers were: gastrointestinal (n=81, 19.8%), gynaecological (n=66, 16.1%) and lung (n=63, 15.4%); the three most frequent chronic advanced diseases were: advanced dementia (n=45, 25.3%), severe ischaemic/haemorrhagic stroke (n=36, 20.2%) and severe heart failure (n=25, 15.3%). The majority of patients were in clinical wards (n=476, 81.0%) and the average length of stay was 22.9 days. Hospital outcome trends were evaluated in terms of length of stay and number of deaths that occurred in the hospital. In particular, length of stay decreased from 25.8 days to 18.1 days, hospital death from 13 to 0 during the time that the HPCT assessed patients for an appropriate discharge.

CONCLUSION

The HPCT is an effective means of managing patients affected by severe illness, reducing the number of deaths that occur within the hospital, long periods of hospitalisation and instances of readmission. However, further studies are required to fully assess the impact of an HPCT on hospital outcomes.

Flu vaccination coverage in a large Italian teaching hospital: the example of the leaders

Key messages

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. This study shows the growing flu vaccination coverage rate in our teaching hospital and the effectiveness of the example given by the vaccinated leaders in increasing the coverage among all HCWs.

Incidence study of surgical site infections in a large University Hospital in Rome, first results

Background

Surgical Site Infections (SSI) represent about a quarter of healthcare associated infections (HAI), increase the risk of mortality and hospital stay and extend healthcare costs. The aim of this work is to evaluate the incidence of SSI in patients undergoing surgical procedures of Hospital Units in the Fondazione Policlinico A. Gemelli IRCCS (FPG).

Methods

This descriptive observational monocentric study has a 30-months duration: the first phase was conducted between July 2018 and March 2019. Patients undergoing abdominal surgery procedures were enrolled. Active infection surveillance was performed, according to the ECDC, during the hospital stay and the surgical outpatient visits. We also performed a post-discharge surveillance (PDS) at 30 days (or 90 days if an implant has been inserted), through a telephone interview, made by a medical doctor resident in Public Health.

Results

During the first phase were enrolled 431 procedures in 2 Hospital Units, about emergency and hepatobiliary surgery. There were 53 cases of surgical site infection (SSI) highlighted in these procedures. Therefore, SSI’s were reported in 12.09% of the procedures. In particular, in 6.28% of cases, SSIs were diagnosed during the hospital stay. The results of this study showed statistically significant differences (p &lt; 0.005) in incidence rate of emergency (10,70%) and hepatobiliary tract (13,17%) procedures. The average hospital stay was significant higher (p &lt; 0.001) in patients who developed an SSI (17.27 days) than in patients without SSI (4.89 days).

Conclusions

These preliminary results show that the incidence rate of SSI for gastrointestinal procedures is similar to other European Countries (9.6%). The Hospital Health Management of FPG take care to the surveillance of hospital infections and monitor the correct application of the procedures, in line with the standards defined by Joint Commission International for guarantee high level in patients’ care.

Key messages

Performing a survey to measure the incidence of surgical site infections for surgery procedures is very important to define it and to improve surveillance systems of hospital infections in FPG. Active surveillance of surgical site infections may allow to enhance appropriate preventive measures.

Biochemical and nutritional characteristics of buffalo meat and potential implications on human health for a personalized nutrition

The human consumption of food animal products is the main topic of an important debate among professionals in this sector: dietologists, dietitians and nutritional biologists. The red meat provides all the essential amino acids, bioavailable iron, zinc, calcium, lipids and B-group vitamins. A valid alternative to beef could be the buffalo meat. Italy is the largest European producer of buffalo meat and derivatives. The high nutritional characteristics of buffalo meat make it suitable to be included in the Mediterranean diet to customize it in relation to the needs and conditions of the population. Polyunsaturated/saturated fatty acids ratio can be influenced by diet, breed and type of breeding, but muscle tissue fat percentage is the main factor in determining a favorable fatty acid composition. This review focuses on the biochemical and nutritional characteristics of the buffalo meat (content of fats, cholesterol, amino acids, vitamins and minerals), explaining their variability depending on the different breeds, and the favorable implications on the human health. These results suggest that buffalo meat can be a healthier alternative to beef, not only for healthy people in particular physiological conditions (i.e. pregnancy), but also for persons at risk for cardiovascular and cerebrovascular diseases, thus achieving the goal of a personalized nutrition.

Improving Nursing Staff Attitudes toward Vaccinations through Academic Detailing: The HProImmune Questionnaire as a Tool for Medical Management

Vaccinations remain the most effective way of preventing infection, disease, and mortality. Public health institutions consequently recommend vaccines to target groups, including healthcare workers, who are considered to be more at risk of exposure and transmission. The aim of this cross-sectional study is to assess, through the administration of a questionnaire, the nursing staff’s knowledge and attitude towards recommended vaccinations, and to explore the effects of a training course (carried out according to the academic detailing methodology) aimed at increasing operators’ knowledge and outreach on recommended vaccinations among healthcare workers. A total of 85 HCWs (30 nursing coordinators and 55 nurses) completed the questionnaire. Results demonstrate a higher rate of agreement towards vaccinations in nursing staff answers (75%), if compared with results of other studies (62–63%). Statistically significant differences between nursing coordinators and nurses can be found. Regarding vaccination attitudes, nursing coordinators agreed in 86% of the answers on healthcare workers’ vaccination vs 70% of nurses (p < 0.001). Considering immunization for influenza, 57% of nursing coordinators vs 18% of nurses reported for vaccination (p < 0.001). Educational programs, carried out according to academic detailing methods, could impact on vaccination attitudes and raise awareness about recommended vaccinations among healthcare workers. The questionnaire is a useful tool for investigating nursing staff knowledge and attitudes towards vaccinations, and to implement strategies to promoting vaccinations among healthcare workers.

[Control of antimicrobial resistance in the food chain: a narrative review]

A poor environmental management and the deterioration of health and hygiene conditions (lack of awareness and attention to hygienic standards, to measures for preventing transmission of infection, and to appropriate use of antimicrobial therapies) facilitate the selection, release and diffusion of resistant pathogens in the environment, which can very easily contaminate the food chain. Antimicrobial resistance is a major problem worldwide, involving many sectors: medicine, veterinary medicine, breeding, agriculture, economy and commerce. In addition, the expanding globalization and increasing movements of both goods and people across countries and continents have drastically exacerbated the situation. In this difficult context, professionals of both the food and health sectors have an important role to play and their active participation is essential, together with that of citizens and patients themselves. For this very reason, national programs to combat antimicrobial resistance are needed, with a special focus on surveillance, antimicrobial stewardship, training of professionals and citizens, all the while assuring the availability of economic resources to achieve these goals. The "One Health" initiative is intended to strengthen the link between different scientific disciplines, such as human and veterinary medicine, since the phenomenon of antimicrobial resistance may be further aggravated by microbial transmission from animals to humans, directly or indirectly through the consumption of food. The aim of this narrative review is to give an overview of what is known about antimicrobial resistance related to food chain, to illustrate its extent and epidemiology in Italy, in Europe and globally, and to discuss the measures required to fight antimicrobial resistance including good practices on the use of antibiotics.

[Resident physicians' participation to the activities of the hospital hygiene unit in a teaching hospital: a pilot study]

INTRODUCTION

The Hospital Hygiene Unit ensures hospital patient safety, through surveillance and control of environmental conditions of risk. In this context, resident physicians in Hygiene and Preventive Medicine of the Catholic University of the Sacred Heart (UCSC) are required to attend the unit to acquire professional skills, for two months (four weeks in the first year of residency and four weeks in the second year). In the initial phase of the rotation, residents are acquainted with the organization and assigned activities. Ongoing meetings with the tutor take place to verify the progress of activities in which they are involved; verification of acquired skills is performed at the end of the period of attendance. The aim of the study was to evaluate resident doctors' opinions about their training experience, in order to assess the perceived quality and pursue continuous improvement of the training program.

MATERIALS AND METHODS

A questionnaire was administered to resident physicians attending the first three years of residency; the survey consisted of 11 multiple choice questions on organization, attendance, training and overall satisfaction and 3 open-ended questions on strengths, weaknesses and proposals for improvement.

RESULTS

Fourteen of 15 residents (93.3%) completed the questionnaire: seven were male, five were first-year residents, five were second-year and four were third-year residents. Overall, 78% gave a positive assessment of the quality of training; in particular, 11 of 14 residents reported that the experience was very relevant to their training in Hygiene and Preventive Medicine. Responses regarding the training organization were also mostly positive (75%), as were those regarding attendance (57%) and overall satisfaction (67%). Fifty percent reported difficulties in combining this internship with the other activities planned with their tutor.

CONCLUSIONS

Positive opinions prevail in all areas of assessment, although there are some aspects that can be improved, including the possibility to extend the period of attendance. Overall, training activities at the Operative Unit of Hospital Hygiene are appreciated by resident physicians, who consider them an important opportunity for professional growth.

Electromagnetic wave absorption and structural properties of wide-band absorber made of graphene-printed glass-fibre composite

Lightweight composites combining electromagnetic wave absorption and excellent mechanical properties are required in spacecraft and aircraft. A one- dimensional metamaterial absorber consisting of a stack of glass fibre/epoxy layers and graphene nanoplatelets/epoxy films was proposed and fabricated through a facile air-spraying based printing technology and a liquid resin infusion method. The production process allows an optimum dispersion of graphene nanoplatelets, promoting adhesion and mechanical integration of the glass fibre/epoxy layers with the graphene nanoplatelets/epoxy films. According to experimental results, the proposed wide-band absorber provides a reflection coefficient lower than -10 dB in the range 8.5-16.7 GHz and an improvement of flexural modulus of more than 15%, with a total thickness of ∼1 mm. Outstanding electromagnetic wave absorption and mechanical performance make the proposed absorber more competitive in aeronautical and aerospace applications.

The piezoresistive effect in graphene-based polymeric composites

The strain-dependent electrical resistance of polyvinyl ester-based composites filled with different weight fractions of graphene nanoplatelets (GNPs) has been experimentally investigated. The GNP synthesis and nanocomposite fabrication process have been optimized in order to obtain highly homogeneous filler dispersion and outstanding electrical properties. The produced nanocomposites showed a low percolation threshold of 0.226 wt% and electrical conductivity of nearly 10 S m(-1) at only 4 wt% of GNPs. The piezoresistive response of thin nanocomposite laminae has been assessed by measuring the variation of the electrical resistance as a function of the flexural strain in three-point bending tests under both quasi-static monotonic and dynamic cyclic loading conditions. The obtained results showed higher strain sensitivity than traditional metal foil strain gauges or recently investigated carbon-based nanocomposite films.