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Novel coronavirus disease-2019 (COVID-19) is a new respiratory disease that has spread widely throughout the world. On February 20, 2020, the first Italian case of COVID-19 was reported. The infection rapidly spread across the country, and by August 11, 2020, a total of 250 566 official cases with 32 205 deaths (12.8%) were reported in Italy, counting a total of 96 884 positive cases and 16 833 deaths (17.3%) in the Lombardy region only. A huge demand to handle the COVID-19 outbreak challenged both the health care providers and the ordinary work in the hospital. From the beginning of the crisis, San Raffaele Scientific Institute, a 1318-bed tertiary care university hospital located in Lombardy, Northern Italy, has played a major role in supporting the national health care system for the treatment of COVID-19 cases, and a significant reorganization of the hospital was immediately required. The reorganization was carried out both structurally and with regard to the distribution of medical and nonmedical staff. This article aims to highlight the management strategies for the health care staff subsequent to the pandemic intense workload in San Raffaele Scientific Institute.

Background: Delirium is a serious and common condition that needs an upgrade of the scientific and clinical attention. Aim: To assess the delirium prevalence in an Italian university hospital. Methods: The monocentric 1-day observational study cohort has been conducted on March 15, 2018; the population was composed of adult hospitalized patients. All the eligible patients have been evaluated for the presence of delirium with the 4AT. Results: We enrolled 596 patients. Twenty-nine Acute and 3 Rehabilitation Units were involved in the study. The median age of the sample was 60 (IQR 48–74) and 52% (n = 313) were male. Patients from medical units were 42% (n = 252), from surgery units 41% (n = 249), and from rehabilitation units 15% (n = 95). Results of 4AT showed that 5.4% (n = 32) had delirium (4AT = 4), 12% (n = 73) had cognitive impairment (4AT = 1–3), and 82% (n = 491) had no delirium or cognitive impairment (4AT = 0). We found association between delirium and age, BMI, mortality at 30days, and hospital mortality. Delirium was related with Barthel Index, dementia, and anticholinesterase inhibitors. About devices in use, we observed a correlation of delirium with central venous catheter, feeding tube, and urinary catheter. Physical restraints were also correlated to delirium. Conclusions: We confirmed the presence of delirium across the hospital units, more in medical than in surgical ones. We found associations of delirium with conditions that limit movement, such as dementia, physical restraints, or devices. The development of delirium initiates a cascade of events culminating in the loss of independence and increased morbidity.

Pandemic infection by COVID-19 could be changing the public image of the nursing profession in Italy. Recently, as in any western country, we were being registered with an increase in the number of violence against healthcare professionals. Nevertheless, due to pandemic in the social media, the nursing profession is remembered for competence, determination, courage, and humanity, and it is continually remercied by people, politicians, and journalists. In this paper, we will conduct a phenomenological argument that proposes both phenomena can be explained by Paul Ricoeur's courses of recognition. In cases of violence, patients and their family members reacting because they feel betrayed for a real or alleged injustice-primarily not to be listened to by health professionals. Nurses and other professionals are often unable to take the right grade of involvement for understanding patient's needs. On the other hand, during COVID-19 pandemic, patients and family members perceive the extraordinary daily work of caring, and they react thanking. The principle of the gift is implicated in both cases: the crisis of gift received or donated can be explaining violence; gratitude and thanks can be explaining by gratuitousness of care.

BackgroundLiterature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients’ treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs.MethodsCross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients’ treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions.ResultsObtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99–19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99–34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03–0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81–0.93).ConclusionsHealth literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients’ profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.