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BACKGROUND: Gli Infermieri hanno la responsabilità della somministrazione della terapia. La prevenzione degli errori rappresenta un momento fondamentale del processo di cura. Il Risk Management ha sviluppato un sistema di procedure per prevenire gli eventi avversi. La segnalazione spontanea degli eventi non è capillare in ambito sanitario nonché l’utilizzo degli strumenti di rischio clinico. OBIETTIVI: L’obiettivo dello studio è stato quello di rilevare quali sono i gap o le difficoltà nella segnalazione degli eventi avversi, durante la gestione della terapia farmacologica. MATERIALI E METODI: Studio quantitativo monocentrico nei dipartimenti medico e chirurgico. È stato utilizzato un questionario. RISULTATI: Sono stati considerati 103 questionari. La quasi totalità del campione conosce l’ambito del Clinical Risk Management, fornendone una giusta definizione. Più della metà (n=67, 65%) dichiara di essere incorso in un errore o quasi-errore di terapia durante la carriera lavorativa. Trentanove Infermieri (38%) utilizzano la scheda di Incident Reporting, mentre sessantaquattro (62%) comunicano oralmente eventi occorsi al Coordinatore Infermieristico, medico o collega; coloro che non utilizzano lo strumento di Incident Reporting dichiarano di non aver mai segnalato errori. CONCLUSIONI: Gli Infermieri nel contesto d’indagine riconoscono l’importanza della gestione del rischio clinico attraverso l’utilizzo delle procedure e della Incident Reporting Form. Tuttavia, più della metà del campione dichiara di non utilizzarla per le segnalazioni degli errori e quasi errori di terapia farmacologica. Le barriere alla segnalazione suggeriscono la necessità di rinforzare le conoscenze dello strumento e di promuovere il miglioramento del clima organizzativo attraverso la promozione della non colpevolizzazione versus trasparenza tra professionisti.

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Excessive growth hormone (GH) has been shown to promote joint degeneration in both preclinical and clinical studies. Little is known about the effect of disrupted GH or GH receptor (GHR) on joint health. The goal of this study is to investigate joint pathology in mice with either germline (GHR -/- ) or adult inducible (iGHR -/- ) GHR deficiency. Knee joints from male and female GHR -/- and WT mice at 24 months of age were processed for histological analysis. Also, knee joints from male and female iGHR -/- and WT mice at 22 months of age were scanned by micro-CT (μCT) for subchondral bone changes and characterized via histology for cartilage degeneration. Joint sections were also stained for the chondrocyte hypertrophy marker, COLX, and the cartilage degeneration marker, ADAMTS-5, using immunohistochemistry. Compared to WT mice, GHR -/- mice had remarkably smooth articular joint surfaces and an even distribution of proteoglycan with no signs of degeneration. Quantitatively, GHR -/- mice had lower OARSI and Mankin scores compared to WT controls. By contrast, iGHR -/- mice were only moderately protected from developing aging-associated OA. iGHR -/- mice had a significantly lower Mankin score compared to WT. However, Mankin scores were not significantly different between iGHR -/- and WT when males and females were analyzed separately. OARSI scores did not differ significantly between WT and iGHR -/- in either individual or combined sex analyses. Both GHR -/- and iGHR -/- mice had fewer COLX + hypertrophic chondrocytes compared to WT, while no significant difference was observed in ADAMTS-5 staining. Compared to WT, a significantly lower trabecular thickness in the subchondral bone was observed in the iGHR -/- male mice but not in the female mice. However, there were no significant differences between WT and iGHR -/- mice in the bone volume to total tissue volume (BV/TV), bone mineral density (BMD), and trabecular number in either sex. This study identified that both germline and adult-induced GHR deficiency protected mice from developing aging-associated OA with more effective protection in GHR -/- mice., (© 2024. The Author(s).)

Background: Neurological disorders as a risk factor for Takotsubo syndrome (TTS) are not well characterized. The aim of the study was to evaluate TTS-associated neurological phenotypes and outcome., Methods and Results: Patients with TTS enrolled in the international multicenter GEIST (German Italian Spanish Takotsubo) registry were analyzed. Prevalence, clinical characteristics, and short- and long-term outcomes of patients with TTS were recorded. A subgroup analysis of the 5 most represented neurological disorders was performed. In total, 400 (17%) of 2301 patients had neurological disorders. The most represented neurological conditions were previous cerebrovascular events (39%), followed by neurodegenerative disorders (30.7%), migraine (10%), epilepsy (9.5%), and brain tumors (5%). During hospitalization, patients with neurological disorders had longer in-hospital stay (8 [interquartile range, 5-12] versus 6 [interquartile range, 5-9] days; P <0.01) and more often experienced in-hospital complications (27% versus 16%; P =0.01) mainly driven by cardiogenic shock and in-hospital death (12% versus 7.6% and 6.5% versus 2.8%, respectively; both P <0.01). Survival analysis showed a higher mortality rate in neurological patients both at 60 days and long-term (8.8% versus 3.4% and 23.5% versus 10.1%, respectively; both P <0.01). Neurological disorder was an independent predictor of both the 60-day and long-term mortality rate (odds ratio, 1.78 [95% CI, 1.07-2.97]; P =0.02; hazard ratio, 1.72 [95% CI, 1.33-2.22]; both P <0.001). Patients with neurodegenerative disorders had the worst prognosis among the neurological disease subgroups, whereas patients with TTS with migraine had a favorable prognosis (long-term mortality rates, 29.2% and 9.7%, respectively)., Conclusions: Neurological disorders identify a high-risk TTS subgroup for enhanced short- and long-term mortality rate. Careful recognition of neurological disorders and phenotype is therefore needed.