Search

Background: Recovery from acute COVID-19 may be slow and incomplete: cases of Post-Acute Sequelae of COVID (PASC) are counted in millions, worldwide. We aimed to explore if and how the pre-existing Socio-economic-status (SES) influences such recovery. Methods: We analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics's model – ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO). Results: Eight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50–69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5–42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7–35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0–22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health (Limitations in physical activities: OR = 0.65; 95%CI = 0.47 to 0.89; p = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes. Conclusions: Recovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions. [ABSTRACT FROM AUTHOR]

Introduction: the Failure Mode Effects And Criticality Analysis (FMECA) is a proactive risk management tool that involves the analysis of a predefined process and the multidisciplinary identification of preventable defects/errors in order to prioritise the changes to be implemented. The Regional Centre for Health Risk Management and Patient Safety of Regione Lombardia (Italy) has drawn up together with the Regional Reference Centre for the Quality of Laboratory Medicine Services, an FMECA model for the management of the process of swabs for the detection of the SARS-CoV-2 virus during the recent pandemic. Methods: the application of FMECA involves several procedural steps, the first of which is the establishment of a multi-disciplinary and multi-professional team. For each process in the FMECA model, the working group identified, by means of a qualitative analysis, the frequency of occurrence, the severity of the effects and their detectability as well. Results: the working group found 118 different possible criticalities (items) in the entire process: 9 belonged to the Request Generation Phase, 35 to the pre-Analytical phase, 46 to the Analytical phase and 28 to the post-Analytical phase. The analysis of the Risk Index (RI), revealed that 81% of the items presented an acceptable risk, subject only to periodic monitoring, while 19% presented a low RI for which planned corrective measures were developed. Discussion: the working group considered the proactive approach useful in intercepting errors before they occur by identifying potentially dangerous situations. The FMECA model made it possible to act proactively on the threats inherent in laboratory processes, stimulating reflection in the identification of improvement actions, ensuring awareness of daily processes and increasing the spread of a preventive risk culture. [ABSTRACT FROM AUTHOR]

Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A survey of hospitals on three continents was performed to assess their infection control preparedness and measures, and their infection rate in hospital health care workers during the COVID-19 pandemic. All surveyed hospitals used similar PPE but differences in preparedness, PPE shortages, and infection rates were reported. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients., Methods: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization., Results: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO 2 /FiO 2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687)., Conclusion: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.

. Prospective assessment of the agreement of instruments for measuring the hospital nursing workload: the Swiss Method, the Karnofsky Performance Status Scale and the subjective perception of the nurses., Introduction: An emerging need of all healthcare organizations is the availability of reliable measures of nursing workload and underlines the problem of the choice of reliable criteria and scores., Aim: To assess the agreement between Swiss Method (SM), Karnofsky Performance Status Scale (K) and Subjective Perception (SP) of nurses in defining the nursing workload., Methods: A prospective observational study was conducted throught computerized compilation of the three scales for each patient in 21 consecutive days, in a large specialized hospital. Nurses were asked to rate the average nursing workload in the last 24 hours. The scales were compared through Cohen's Kappa across different sets of patients., Results: The data were collected for 7.810 patient days on 1.187 patients. At different levels of aggregation there was a strong heterogeneity between the care-related profiles and the levels of concordance that rarely exceeded the "discreet" level. However a reasonable agreement was obtained between K and SP in medical and surgical wards. The formal comparison of the three scales makes it impossible to formulate a preferential judgment for any of the three., Conclusions: Measuring phenomena such as workload requires reliable instruments targeted for specific contexts and to the aims results will be used for. The study directly compared on a hospital representative sample the results of the adoption of instruments- expected to be eterogeneous- and often used to guide the allocation of human and material resources.

Purpose: To identify the main and most significant risk factors for falls and improve the quality of care delivered to pediatric patients by providing indications for interventions for the prevention of falls., Methods: To investigate the correlation between falls and risk factors a retrospective observational case-control study was carried out, the sample was made up by all children who fell from 2004 to 2011 between 0-18 y.o. for which there was a record of the fall., Results: 108 children were included in the study (36 cases and 72 controls). The data showed that 4 drugs have a correlation with falls,on the contrary intravenous therapy seemed to be a factor that protects against the risk of falling., Conclusion: The study confirms the importance of the problem of falls in children. A greater sample size could help to identify additional independent variables. This study may represent a starting point for further analysis.