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Actually, a lot of mental health services in Italy don't give comparable informations about professional risks evaluation, as violent acts against operators during their work activity in Psychiatric services. The most frequent surveys are those derived from medical reports of hospitals (ISTAT modules). However, these surveys are not available to make an analysis purposive for prevention: often the medical reports are incomplete or they are not fill out. Moreover, the reports are often written for generic causes, so they couldn't support quality indicators. On the contrary, the number and the characteristics of violent acts, evaluated with standardized instruments and shared with other services, give informations those could implement the constitution of Quantitative Indicators and support quality indicators. However, our opinion is that cards of free descriptions are not sufficient to evaluate violent acts, because they can be filled out briefly, without attention to important items, as which in the SOAS-R Rating Scale and in two Scales we suggest: a card of anamnestic interview and a card for evaluation of organizing parameters. Essential and inalienable aspect is the obligatoriness of the report, which serves to make the operators to be more unafraid during work time, and can obviate the problem of subjective behaviour of larger tolerance in an operator than in others, and this fact could make invaluable also quality indicators.

Transthoracic echocardiography is advocated by some as a useful diagnostic test for patients with suspected pulmonary embolism (PE), but its diagnostic accuracy is unknown. Recently, the sensitivity and specificity of transthoracic echocardiography in the diagnosis of PE was determined prospectively in unselected patients using pulmonary angiography as a reference diagnostic standard. Echocardiographic criteria for diagnosing PE included the presence of any two of three abnormalities: right ventricular (RV) end-diastolic diameter > 27 mm (without RV wall hypertrophy), tricuspid regurgitation velocity > 2.7 m/s, or RV hypokinesis. These echocardiographic diagnostic criteria for PE yielded a sensitivity of 56% and a specificity of 90%. Because of its inherent poor sensitivity, transthoracic echocardiography should not be used as a routine test to screen patients for suspected PE.

Computed Tomography (CT) has been proved to be the most accurate imaging modality to diagnose emphysema in vivo. Our study was aimed at comparing different CT methods for pulmonary emphysema quantification in patients with severe chronic obstructive pulmonary disease (COPD). Forty-six consecutive inpatients affected with COPD underwent high resolution CT (HRCT). Three scans were acquired at 3 preselected anatomic levels at both full inspiration and expiration. Three different observers were asked to subjectively evaluate, under blind conditions, the extent alone and both the severity and the extent of emphysema on the 6 scans. HRCT findings were also analyzed quantitatively by measuring the mean CT number in Hounsfield Units (HU) and the % of lung area with CT numbers < -900 HU (pixel index). Quantitative CT data were compared with reference values obtained in 7 normal nonsmokers. The CT visual score of emphysema exhibited medium-high interobserver reproducibility with correlation coefficients ranging from 0.80 to 0.96 and a good correlation with pulmonary function tests, particularly relative to the assessment of the extent of emphysema alone as expressed by one observer. CT quantification demonstrated an excellent correlation with functional indices of expiratory airflow, lung volumes and diffusion coefficients (p < 0.001). The expiratory measurements were better than the inspiratory ones while the analysis of both CT number and pixel index gave comparable results. Only the CT expiratory quantitative data allowed to differentiate the patients affected with COPD from the controls. In conclusion, the severity of emphysema as expressed by CT correctly reflects the functional impairment of patients with severe COPD.(ABSTRACT TRUNCATED AT 250 WORDS)

The study of the emotions and their relation with the numerous symptoms of mental pathologies is made extremely difficult given that different meanings have been given to these terms by various authors. The cognitive and affective evaluation of events is decisive for emotional reaction (emotion) which forms part of a complex biological and behavioural system in which there is no causal linearity between event, stress and emotion, but rather an interactive modulatory relationship. Based on their experience and on data published by specialized clinics, the authors affirm that a given temperament or psychopathological condition influences research into the event as well as the emotion experienced.

In this review the authors describe the symptomatology, and the etiopathogenetic hypothesis of alcohol withdrawal syndrome. Many drugs are used in the treatment of alcohol withdrawal syndrome: carbamazepine, clonidine, chlormethiazole, phenytoin and other compounds; actually benzodiazepines are the most important drugs for symptomatic relief to prevent major withdrawal syndrome. Particularly attention is recommended to the period of suspension with the aim of reducing alcohol consumption and correcting alcohol-related psychosocial problems.