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Summary Healthcare workers who use or may be exposed to needles are at risk of needlestick injuries, which can lead to serious infections by bloodborne pathogens. These injuries can be avoided by eliminating the unnecessary use of needles and using safety devices. The present study was aimed at evaluating the impact of a safety-engineered device, with passive fully automatic needlestick protection, on the rate of needlestick injuries among healthcare workers. The setting of the study was a network of five public healthcare institutions situated in a Northern Italian Region. Data on the type of device, the number of employees and the number of catheter devices used per year were collected through regular meetings with healthcare workers over a period of five years. The most notable result of this study was the huge risk reduction associated with safety devices. Indeed, the risk of needlestick injuries due to conventional devices was found to be 25-fold higher than that observed for safety devices. However, it is noteworthy that a considerable part of this excess can be explained by the different background number of devices used. Moreover, descriptive analysis suggested that individuals with a poor/moderate training level had a lower risk than those with good/high training, though the difference was not statistically significant. In conclusion, there is convincing evidence of a causal connection between the introduction of safety devices and the reduction in needlestick injuries. This consideration should prompt the introduction of safety devices into daily clinical practice.

In this study the neuropsychological status of patients with Alzheimer's disease (AD) was correlated with quantitative electroencephalography (qEEG) and regional cerebral blood flow (rCBF) both in the cortex and in deep gray matter structures.Forty-three outpatients (mean age 72.4 +/- 7.5 y) with probable AD underwent 99mTc-hexamethyl propyleneamine oxime SPECT with a brain-dedicated gamma camera and qEEG (relative values) within 1 mo. Preliminary factorial analysis with promax rotation identified four qEEG bands (2-5.5, 6-7.5, 8-11.5 and 12-22.5 Hz, with no distinction as to topography) and six SPECT regions (the two thalami together, the two parietal cortices together, the right temporal cortex, the right hippocampus, the left hippocampus and the remaining cortical areas together) as the variables with highest statistical power. All these variables and the Mini-Mental Status Examination score (MMSE, a sensitive marker of neuropsychological deficit) were processed by a final factorial analysis and multivariate analysis of variance.Both the 2-5.5 Hz and the 8-11.5 Hz powers were correlated with the perfusion level in the parietal regions of interest (ROls) (P = 0.0009), whereas the 2-5.5 Hz power was correlated with the right hippocampal perfusion level (P = 0.007). The MMSE score was significantly correlated with the perfusion level, both in the right (P = 0.006) and in the left (P = 0.004) hippocampal ROls and in the parietal ROls (P = 0.01); moreover, it was correlated with both the 2-5.5 Hz (P = 0.0005) and the 8-11.5 Hz (P = 0.004) power.rCBF (bilateral parietal perfusion) and qEEG (especially the slowest frequencies, i.e., 2-5.5 Hz) are confirmed to be good descriptors of AD severity. It is especially noteworthy that bilateral hippocampal CBF was the perfusional index best correlated with the MMSE as well as being significantly correlated to qEEG. Hippocampal SPECT imaging appears to be a promising index to improve characterization of AD in respect to other forms of primary degenerative dementia and may be proposed as a marker for evaluating the effects of pharmacotherapy of AD at the neuronal level.

Concerns about the increasing medical care costs are causing the medical community to focus its attention on the appropriate of diagnostic tests such as echocardiography. Prerequisite to a better utilization of the limited economic resources assigned to our health care system is an analysis of how, why, and with which results diagnostic tests with a widespread use and relevant cost, like echocardiography, are requested. During the last 2 weeks of September 1994, a transversal, observational study was carried out at 13 hospital echocardiographic laboratories. Ordering physician characteristics, reasons for ordering the test, cardiological diagnostic tests previously performed and their relationship with the test results, were evaluated with a questionnaire completed by the physician who performed the test, in all the out-patients undergoing echocardiogram in that fortnight. Five hundred and sixteen consecutive questionnaires were successfully completed. Fourty-five percent of the echocardiograms were ordered by cardiologists, 35% by general practitioners, 10% by internists, and 10% by other specialists. Hypertension (16.4%) and ischemic heart disease (14.8%) were the most common indications for the test, followed by palpitations or arrhythmias (7.5%), mitral valve prolapse or mitral valve disease (7.3%), chest pain or angina pectoris (6.3%), cardiac murmur (5.5%), dyspnea or heart failure (5.2%), aortic valve disease (5%), prosthetic heart valve evaluation (4.6%), others (27%). Before undergoing the echocardiogram, 433 (84%) patients underwent an electrocardiogram, 242 (47%) a cardiological clinical evaluation, 196 (38%) a chest X-ray, and 191 (37%) had had a previous echocardiogram. The most common echocardiographic diagnosis was normal (29.2%) followed by hypertensive heart disease (16.2%), mitral valve disease (12.3%), aortic valve disease (10.5%), ischemic heart disease (9.3%), cardiomyopathy (4.9%) normal prosthetic heart valve function (4.5%), pericardial effusion (3.8%), others (11.3%). Among the echocardiograms ordered by cardiologists, 21.8% were normal in comparison with 35.4% of those ordered by general practitioners (p0.004), 35.3% of those ordered by internists (p = 0.04), 35.3% of those ordered by other specialists (p = 0.04). Among the 284 patients whose echocardiograms were not requested by a cardiologist, only 215 (76%) had undergone an electrocardiogram and only 68 (24%) a clinical evaluation by a cardiologist. In these patients, the frequency of normal echocardiograms was not influenced by having undergone a previous electrocardiogram or a chest X-ray. Conversely, patients in whom the echocardiogram was ordered after a cardiology consult showed a significant lower frequency of normal results compared to patients not evaluated by a cardiologist (23% vs 39%; p0.05). More than 50% of the echocardiograms performed in out-patients are ordered by physicians who are not cardiologists. Among these echocardiograms, about 1 out of 3 results normal. This finding suggests an improper use of echocardiogram as a screening tool by non-cardiologists in out-patients. A preceding clinical evaluation by a cardiologist, but not an electrocardiogram or a chest X-ray alone, may determine a more appropriate use of the test being associated with a reduced frequency of normal results.

Background: Skin cancers, especially melanoma, are steadily increasing in incidence, and primary and secondary prevention measures have been proven to be useful in reducing skin cancer mortality.Aim: to promote a screening campaign among healthcare professionals of an Italian University/Hospital in order to detect not only an earlier recognition of potentially dangerous skin lesions, but also to verify if secondary prevention is useful, well-accepted and easy to perform among potentially more alerted people working in a healthcare background.Methods: The screening campaign was advertised through the Intranet of the Hospital. The screening took place once a week and a mean of 5-6 patients/week were examined. Every patient underwent a full-body skin examination integrated by handheld dermoscope at the Outpatient Clinic, Section of Dermatology, University/ Hospital of San Martino. In the case of clinically or dermoscopically suspicious lesions, an excision and histopathological examination were prescribed.Results: 138 patients (100 females and 38 males) were evaluated in the course of 1 year. 11 lesions were referred for excision and, among these, 1 was a melanoma in situ and 1 an atypical fibroxantoma.Conclusions: The rate of participation in the screening was low. However 2% of the screened patients presented a malignant lesion. We discuss the low adherence to the screening programme and suggest improving some aspects of communication, but we think that this kind of screening is useful because it can involve a good percentage of people who can undergo a check-up very easily in their own workplace.

Two-dimensional echocardiography (2-DE) represents the main tool for detecting and monitoring abnormalities of proximal thoracic aorta. However, previous studies performed to assess the reference values of aortic diameters using this technique are few and, often, involve a small number of subjects. Furthermore, such a study has not been performed on an Italian population.To assess the reference values and the growth curves of the dimensions of the proximal thoracic aorta in an Italian population, we measured aortic diameters at the level of the anulus, of the sinuses of Valsalva and of the supraaortic ridge, by using 2-DE, in 134 healthy volunteers (78 males, 56 females), aged 35 +/- 16 years (range 5-76). Sex, age, weight, height, body surface area (BSA), heart rate, systolic and diastolic blood pressure were analyzed as determinants of proximal thoracic aorta diameters. In addition, to compare the specificity of the reference values, we have obtained with those provided by literature, we studied another independent group of 23 healthy volunteers, aged 32 +/- 15 years (range 11-65).In our study population, mean values and range of aortic 2-DE diameters were 2.1 +/- 0.3 cm (range 1.3-2.9) at the level of the anulus, 2.6 +/- 0.4 cm (range 1.7-3.7) at the level of the sinuses of Valsalva and 2.4 +/- 0.4 cm (range 1.5-3.4) at the level of the supraaortic ridge. At multivariate regression analysis, sex and age emerged as the only independent determinants of the aortic root diameters (r2 = 0.35, 0.43, and 0.52 for aortic diameter at the level of anulus, sinuses of Valsalva, and supraaortic ridge, respectively). On average, aortic root dimensions at the level of the anulus, of the sinuses of Valsalva and of the supraaortic ridge in females were 1.5 mm, 2.8 mm, and 1 mm, respectively, smaller than those of males of comparable age, height and weight. The growth curves showed that proximal thoracic aorta increases in size in the first 30 years of life; thereafter, it remains relatively constant in size up to 55 years, after which the proximal thoracic aorta tends to enlarge gradually. The ratios of sinuses of Valsalva to annular diameter and of supraaortic ridge to annular diameter (1.27 +/- 0.17 and 1.17 +/- 0.16, respectively) were found to be indexes of aortic root dimension independent of sex and age. No correlation was found between aortic root dimensions and systolic blood pressure. M-mode echocardiography systematically overestimated 2-DE aortic diameters at the level of the anulus, as well as at the level of the sinuses of Valsalva and of the supraaortic ridge (+0.8 +/- 0.04 cm, +0.2 +/- 0.04 cm, and +0.4 +/- 0.04 cm, respectively, p0.0001 for all). In the control population, our reference values demonstrated a specificity significantly higher than that of the main reference values reported in literature (97 +/- 2% versus 62 +/- 4%, p0.0001).Our study provides a prospectic, systematic and detailed analysis of 2-DE proximal thoracic aorta diameters in a wide group of healthy Italian subjects. Our data show that: 1) 2-DE aortic root dimensions are influenced by sex and age but not by body size or blood pressure; 2) the ratios of sinuses of Valsalva to annular diameter and of supraaortic ridge to annular diameter are indexes of aortic root dimension which are independent of age and sex; 3) M-mode diameter systematically overestimates 2-DE diameters of the aortic root; and 4) Italian population based reference values showed higher specificity than values provided by literature.