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Background: WHO affirms that post-partum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide. The first step to recognize, prevent and diagnose this complication is to define it. The aim of this work is to identify risk factors for PPH. Methods: A case-control study was conducted at the Hospital of Siena (Italy), including all females who have given birth from 2016 to 2018. In relation to presence of PPH (blood loss of 500 ml), the sample was divided into two groups. Analyzed variables were: age, parity, use of epidural, stimulation of labour with oxytocin or prostaglandins, episiotomy, manual removal of the retained placenta, medically assisted procreation (MAP), fetal weight, pre-pregnancy BMI (body mass index), placental localization and gestational age (GA). Statistical analysis was carried out using Stata 14. Results: The sample was composed of 1490 women: 56% nulliparas, 18% had epidural, 34% had broken membranes, 22.6% had stimulation of labour, 1.5% had MAP. 8% older than 40 years, 32% of babies were ≥3500g; 5.1% had BMI≥ 30; 11.2% had episiotomy; 2% had manual removal of the retained placenta, 3% had lateral placenta, 47.5% had GA ≥ 40th weeks. PPH occurred in 15%; mostly in nulliparas (17.7% vs.12.4% p < 0.01), those that used epidural (20% vs. 14.5% p < 0.05), MAP (32% vs.15.2%; p < 0.05), those had manual removal placenta (71.9% vs.14.4%, p < 0.05)in mothers of babies ≥3500g (21% vs. 13%; p < 0.05), in those with BMI ≥ 30 (27% vs. 15%; p < 0.05), those with lateral placenta (26% vs. 12.3%; p < 0.05), and GA ≥ 40th weeks (17.3% vs. 13.6%; p < 0.05). Conclusions: PPH is one of the most studied obstetric emergencies being the leading cause of maternal mortality in the world. It is important to closely monitor during labour and childbirth to modify risk factors where possible. Key messages: Postpartum bleeding is an obstetric emergency that causes mortality and morbidity in pregnant women. There are no effective treatments yet, so it is important to recognise the associated risk factors and prevent them. [ABSTRACT FROM AUTHOR]

Delineating patients' health profiles is essential to allow for a proper comparison between medical care and its results in patients with comorbidities. The aim of this work was to evaluate the concordance of health profiles outlined by ward doctors and by epidemiologists and the effectiveness of training interventions in improving the concordance. Between 2018 and 2021, we analyzed the concordance between the health profiles outlined by ward doctors in a private hospital and those outlined by epidemiologists on the same patients' medical records. The checks were repeated after training interventions. The agreement test (Cohen's kappa) was used for comparisons through STATA. The initial concordance was poor for most categories. After our project, the concordance improved for all categories of CIRS. Subsequently, we noted a decline in concordance between ward doctors and epidemiologists for CIRS, so a new training intervention was needed to improve the CIRS profile again. Initially, we found a low concordance, which increased significantly after the training interventions, proving its effectiveness.

The relationship between general practitioners and patients is privileged. The aim of this study was to assess the concordance between the health profile perceived by the patient and the one described by the doctor. We conducted a cross-sectional study between 2019-2020. Patients completed the 5d-5L (EQ-p) and clinicians completed it "from the patient's perspective" (EQ-d), also consulting the clinical diary. Statistical analysis was performed using Stata 14 (Cohen's kappa; Fisher's exact test). The sample consisted of 423 patients. The mean age was 56.7 ± 19.2. There were significant differences by gender in usual activities, pain, and anxiety/depression (74.6% of men had no limitation in usual activities versus 64.5% of women ( p < 0.01), 53.9% of men had no pain versus 38.5% of women ( p < 0.01), and 60.3% of men had no anxiety/depression versus 38.5% of women ( p < 0.01)). Physicians did not detect these differences. The concordance between EQ-p and EQ-d was substantial for mobility (k = 0.62; p < 0.01), moderate for self-care (k = 0.48; p < 0.01) and usual activities (k = 0.50; p < 0.01). Concordance was fair for pain/discomfort (k = 0.32; p < 0.01), anxiety/depression (k = 0.38; p < 0.01), and EQ Index (k = 0.21; p < 0.01). There was greater agreement for "objective "dimensions (mobility, self-care, and usual activities). A good doctor, to be considered as such, must try to put himself in the "patient's pajamas" to feel his feelings and be on the same wavelength.

The aim of this systematic review was to investigate the effectiveness of various disinfection methods available for stethoscopes. In March 2019, we performed a search in PubMed and Scopus using the search terms: "reducing stethoscopes contamination" and "disinfection stethoscopes"; the Mesh terms used in PubMed were "Decontamination/methods" or "Disinfection/methods" and "Stethoscopes/microbiology". Selection criteria were: English language; at least one disinfection method tested. A total of 253 publications were screened. After title, abstract, and full-text analysis, 17 papers were included in the systematic review. Ethanol at 90%, Ethanol-Based Hands Sanitizer (EBHS), triclosan, chlorhexidine, isopropyl alcohol, 66% ethyl alcohol, sodium hypochlorite, and benzalkonium chloride have been proven to lower the presence of bacteria on stethoscopes' surfaces. In addition, alcohol wipes show effective results. A wearable device emitting ultraviolet C by Light-Emitting Diode (LED) resulted efficacious against common microorganisms involved in Healthcare Associated Infections. The cover impregnated with silver ions seemed to be associated with significantly higher colony counts. Instead, copper stethoscopes surface reduced bacterial load. The disinfection of stethoscopes appears to be essential. There are many valid methods available; the choice depends on various factors, such as the cost, availability, and practicality.

Despite the absence of responsiveness during anesthesia, conscious experience may persist. However, reliable, easily acquirable and interpretable neurophysiological markers of the presence of consciousness in unresponsive states are still missing. A promising marker is based on the decay-rate of the power spectral density (PSD) of the resting EEG. We acquired resting electroencephalogram (EEG) in three groups of healthy participants (n = 5 each), before and during anesthesia induced by either xenon, propofol or ketamine. Dosage of each anesthetic agent was tailored to yield unresponsiveness (Ramsay score = 6). Delayed subjective reports assessed whether conscious experience was present ('Conscious report') or absent/inaccessible to recall ('No Report'). We estimated the decay of the PSD of the resting EEG-after removing oscillatory peaks-via the spectral exponent β, for a broad band (1-40 Hz) and narrower sub-bands (1-20 Hz, 20-40 Hz). Within-subject anesthetic changes in β were assessed. Furthermore, based on β, 'Conscious report' states were discriminated against 'no report' states. Finally, we evaluated the correlation of the resting spectral exponent with a recently proposed index of consciousness, the Perturbational Complexity Index (PCI), derived from a previous TMS-EEG study. The spectral exponent of the resting EEG discriminated states in which consciousness was present (wakefulness, ketamine) from states where consciousness was reduced or abolished (xenon, propofol). Loss of consciousness substantially decreased the (negative) broad-band spectral exponent in each subject undergoing xenon or propofol anesthesia-indexing an overall steeper PSD decay. Conversely, ketamine displayed an overall PSD decay similar to that of wakefulness-consistent with the preservation of consciousness-yet it showed a flattening of the decay in the high-frequencies (20-40 Hz)-consistent with its specific mechanism of action. The spectral exponent was highly correlated to PCI, corroborating its interpretation as a marker of the presence of consciousness. A steeper PSD of the resting EEG reliably indexed unconsciousness in anesthesia, beyond sheer unresponsiveness., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Job quality and evaluation of workers' health have both medical and social important implications. We studied health-related quality of life (HRQL) in nurses who perform their activity in night shifts., Methods: A cross-sectional study was conducted between October and November 2014. Nurses who attended night shift in the Siena Teaching Hospital (Azienda Ospedaliera Universitaria Senese - AOUS) were sampled using EpiInfo software (confidence interval 95%) and investigated using the SF-36 Questionnaire. Our results were compared with the Italian general population (Apolone, 1997). A Descriptive analysis was conducted. Wilcoxon test, Pearson coefficient, t-test, Wilcoxon signed-rank test and logistic regression were used for the statistical investigation., Results: 197 questionnaires were analyzed. Females were 71.7%; mean age was 39.2 years (DS 8.6); smokers were 37.8%. Males scores were higher than those of females in all dimensions of physical and mental health (p <0.05). The time taken to reach the place of work appeared to influence the dimension of General Health (coeff. -0.17); we found a worsening of 0.17 points of this dimension for every minute spent in travel. Men and nurses with more working years had a better score in Physical Pain dimension. AOUS nurses scored significantly (p <0.05) less compared with the correspondent Italian general population in General Health, Energy-fatigue, Social functioning, Physical functioning and Bodily pain., Conclusions: There is a significant relationship between night work and HRQL of nurses. The health profile of AOUS nurses' ranks below the values of the Italian general population in various dimensions.

A common endpoint of general anesthetics is behavioral unresponsiveness, which is commonly associated with loss of consciousness. However, subjects can become disconnected from the environment while still having conscious experiences, as demonstrated by sleep states associated with dreaming. Among anesthetics, ketamine is remarkable in that it induces profound unresponsiveness, but subjects often report "ketamine dreams" upon emergence from anesthesia. Here, we aimed at assessing consciousness during anesthesia with propofol, xenon, and ketamine, independent of behavioral responsiveness. To do so, in 18 healthy volunteers, we measured the complexity of the cortical response to transcranial magnetic stimulation (TMS)--an approach that has proven helpful in assessing objectively the level of consciousness irrespective of sensory processing and motor responses. In addition, upon emergence from anesthesia, we collected reports about conscious experiences during unresponsiveness. Both frontal and parietal TMS elicited a low-amplitude electroencephalographic (EEG) slow wave corresponding to a local pattern of cortical activation with low complexity during propofol anesthesia, a high-amplitude EEG slow wave corresponding to a global, stereotypical pattern of cortical activation with low complexity during xenon anesthesia, and a wakefulness-like, complex spatiotemporal activation pattern during ketamine anesthesia. Crucially, participants reported no conscious experience after emergence from propofol and xenon anesthesia, whereas after ketamine they reported long, vivid dreams unrelated to the external environment. These results are relevant because they suggest that brain complexity may be sensitive to the presence of disconnected consciousness in subjects who are considered unconscious based on behavioral responses., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Transcranial magnetic stimulation combined with electroencephalography (TMS/EEG) represents a valuable tool to probe cortical excitability and connectivity. Although several procedures have been devised to abolish TMS-related artifacts, direct evidence that it is possible to record TMS-evoked potentials (TEPs) that purely reflect cortical responses to TMS are still lacking., Objective: To demonstrate that when TMS is delivered on a human head with intact nerves, scalp and ocular muscles, TEPs are present only if a functional portion of cortex is targeted and is absent otherwise., Methods: We performed extensive navigated TMS/EEG mappings in three vegetative state patients and in eight healthy controls. Patients were selected based on the extension of their cortical lesions as revealed by structural/functional imaging: the cerebral cortex was globally damaged in Patient 1 due to cerebral anoxia, Patient 2 showed a traumatic damage affecting one cerebral hemisphere, while Patient 3 was characterized by one left sided and one right-sided focal ischemic lesion., Results: In Patient 1, TMS performed at any targeted cortical site did not elicit statistically significant TEPs. In Patient 2, TEPs were absent when the damaged hemisphere was targeted, while were present over the healthy side. In Patient 3, significant TEPs were absent when cortical lesions were targeted and present otherwise. Significant TEPs were always present in healthy controls., Conclusions: These findings suggest that, provided that appropriate experimental procedures are employed, TEPs are genuine cortical responses detectable only when preserved cortical tissue is stimulated. Hence, a dependable assessment of cortical excitability and connectivity in brain-injured patients requires the use of neuronavigated TMS., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: This review discusses the advantages of transcranial magnetic stimulation combined with high-density electroencephalography (TMS-hdEEG) over other current techniques of brain imaging., Methods and Results: Its application was reviewed, focusing particularly on disorders of consciousness, in the perspective of recent theories of consciousness. Assessment of non-communicative patients with disorders of consciousness remains a clinical challenge and objective measures of the level of consciousness are still needed. Current theories suggest that a key requirement for consciousness is the brain's capacity to rapidly integrate information across different specialized cortical areas. TMS-EEG allows the stimulation of any given cortical area and the recording of the immediate electrical cortical response. This technique has recently been successfully employed to measure changes in brain complexity under physiological, pharmacological and pathological conditions., Conclusions: This suggests that TMS-EEG is a reliable tool to discriminate between conscious and unconscious patients at the single subject level. Future works are needed to validate and implement this technique as a clinical tool.