Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. ...Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes.
Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses.
A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers.
Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.
Recent studies have challenged the anxiety-avoidance model of obsessive–compulsive disorder (OCD), linking OCD to impulsivity, risky-decision-making and reward-system dysfunction, which can also be ...found in addiction and might support the conceptualization of OCD as a behavioral addiction. Here, we conducted an exploratory investigation of the behavioral addiction model of OCD by assessing whether OCD patients are more impulsive, have impaired decision-making, and biased probabilistic reasoning, three core dimensions of addiction, in a sample of OCD patients and healthy controls. Methods: We assessed these dimensions on 38 OCD patients and 39 healthy controls with the Barratt Impulsiveness Scale (BIS-11), the Iowa Gambling Task (IGT) and the Beads Task. Results: OCD patients had significantly higher BIS-11 scores than controls, in particular on the cognitive subscales. They performed significantly worse than controls on the IGT preferring immediate reward despite negative future consequences, and did not learn from losses. Finally, OCD patients demonstrated biased probabilistic reasoning as reflected by significantly fewer draws to decision than controls on the Beads Task. Conclusions: OCD patients are more impulsive than controls and demonstrate risky decision-making and biased probabilistic reasoning. These results might suggest that other conceptualizations of OCD, such as the behavioral addiction model, may be more suitable than the anxiety-avoidance one. However, further studies directly comparing OCD and behavioral addiction patients are needed in order to scrutinize this model.
Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural ...inhabitants depending on financial and health vulnerabilities.
Repeated cross-sectional data from 353,523 European citizens (2002-2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors.
In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes.
Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.
Abstract Despite several studies suggested that inattention and impulsivity-compulsivity could represent two core dimensions of hoarding disorder (HD), only a small case series study investigated the ...effectiveness of attention-deficit-hyperactivity-disorder (ADHD) medications in HD. The aim of the present study was to target attentional and inhibitory control networks in HD patients through the ADHD medication atomoxetine, moving from a preclinical investigation on an animal model of compulsive-like behavior (marble burying test) to a clinical investigation on both medicated and unmedicated patients with a primary diagnosis of HD without ADHD. Our preclinical investigation showed that acute administration of atomoxetine significantly reduced the compulsive-like behaviours of mice in the marble burying test without affecting neither locomotor activity and coordination nor exploration behaviours. When compared, atomoxetine and fluoxetine showed similar effects on the marble burying test. However, fluoxetine impaired both locomotor and exploratory activity. In our clinical investigation 12 patients were enrolled and 11 patients completed an open trial with atomoxetine at flexible dose (40–80 mg) for 12 weeks. At the endpoint the mean UCLA Hoarding Severity Scale score decreased by 41.3% for the whole group (p = 0003). Six patients were classified as full responders (mean symptom reduction of 57.2%) and three patients as partial responders (mean symptom reduction of 27.3%). Inattentive and impulsivity symptoms showed a significant mean score reduction of 18.5% from baseline to the endpoint ( F (1,9) = 20.9, p = 0.0013). Hoarding symptoms improvement was correlated to reduction of patients’ disability and increased in their global functioning. These preclinical and clinical data suggest that atomoxetine may be effective for HD and therefore should be considered for future controlled trials.
A newborn female was admitted to the Neonatal Intensive Care Unit 2 days after birth with neonatal abstinence syndrome (NAS). The patient displayed withdrawal symptoms from substance misuse, which ...was passively absorbed in utero via the placenta. This clinical scenario analysis aims to investigate which nursing interventions are dedicated to restoring normal vital functions in NAS patients and which assessment tool is most commonly used to monitor withdrawal symptoms. NAS is a medical condition that affects newborns of drug-abusing mothers. The clinical presentation can involve different organ systems: the central nervous system (CNS), autonomic nervous system (ANS), gastrointestinal (GI) system, and respiratory system. Possible symptoms include excessive or high-pitched crying, agitation, fever, tremors, sleep disturbance, vomiting, weight loss, seizures, sweating, yawning, sneezing, tight muscle tone, tachypnoea, poor feeding, and uncoordinated suction. A NAS diagnosis can be confirmed by verifying the presence of drugs using biological tests and assessment tools to classify and manage the condition. Several biological tests are available to confirm exposure to a misused substance: urine testing, meconium testing, cord blood testing, and baby hair testing. The most commonly used assessment tool is the Finnegan Score. Treatment for an infant with NAS involves both non-pharmacological and pharmacological interventions and a multidisciplinary team. This team works with the parents, particularly the mother, who must be part of the newborn’s healing process.
Carbapenemase-producing Enterobacterales (CPE), particularly those producing metallo-β-lactamases, are among the most challenging antibiotic-resistant pathogens, causing outbreaks of ...difficult-to-treat nosocomial infections worldwide. Since November 2018, an outbreak of New Delhi metallo-β-lactamases-positive CPE (NDM-CPE) has emerged in Tuscany, Italy. In this study, we aimed to investigate the NDM-CPE associated with the outbreak and characterise the responsible Klebsiella pneumoniae clone.
We used whole-genome sequencing and bioinformatic analysis to characterise NDM-CPE isolates that caused bloodstream infections in 53 patients at 11 hospitals in Tuscany and that were collected between Jan 1, 2018, and July 5, 2019 (ie, the early phase of the outbreak and preceding months). The CPE isolates characterised in this study were isolated and identified at the species level and as NDM producers by six diagnostic microbiology laboratories that serve the 11 hospitals. We used comparative genomic analysis, antimicrobial susceptibility testing, plasmid conjugal transfer assays, evaluation of virulence potential in the Galleria mellonella infection model, and serum bactericidal assays to further characterise the clone causing the outbreak.
The outbreak was sustained by an ST147 K pneumoniae producing NDM-1, which had a complex resistome that mediated resistance to most antimicrobials (except cefiderocol, the aztreonam–avibactam combination, colistin, and fosfomycin). The clone belonged to a sublineage of probably recent evolution, occurred by the sequential acquisition of an integrative and conjugative element encoding the yersiniabactin siderophore, an FIB(pQil)-type multiresistance plasmid carrying blaNDM-1, and a transferable chimeric plasmid, derived from virulence elements of hypervirulent K pneumoniae, carrying several resistance and virulence determinants. Infection of G mellonella larvae revealed a variable virulence potential. The behaviour in serum bactericidal assays was different from typical hypervirulent K pneumoniae strains, with variable grades of serum resistance apparently associated with mutations in specific chromosomal loci (csrD, pal, and ramR).
This description of a sublineage of ST147 K pneumoniae with a complex resistome and virulome that is capable of sustaining a large regional outbreak adds to existing research on the evolutionary trajectories within high-risk clones of K pneumoniae. Global surveillance programmes are warranted to track the dissemination of these lineages, and to prevent and control their spread.
Italian Ministry of Health and Department of Experimental and Clinical Medicine, University of Florence.
BackgroundInfection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional ...precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings.MethodsIn the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record ‘order-set’ including AS and AP compliance indicators was designed. We compared the cost–benefit of the audits and the automated indicators for AS and AP compliance.ResultsCompliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested.ConclusionTraining ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
This review analyses the current regulatory procedures for plant biostimulants, both at an EU level and beyond the EU, and explores the future regulation of these substances in the EU. Plant ...biostimulants are defined as products that stimulate plant nutritional processes regardless of the product’s nutrient content, with the sole aim of improving one or more of the following characteristics of the plant and the plant rhizosphere or phyllosphere: the efficiency of nutrient use, tolerance to abiotic stresses, crop quality traits, availability of confined nutrients in the soil and rhizosphere, humification and degradation of organic compounds in the soil. This definition is reported in the proposals for new rules to regulate making CE-marked fertiliser products available on the market. This regulation, which includes a plant biostimulants category, will repeal the existing Fertilisers Regulation (EC) No. 2003/2003. This category of compounds is also used in non-European countries. Currently, as there are different market conditions and different national regulation requirements for plant biostimulants in different countries, the non-harmonised regulatory processes can lead to unfair competition between operators. The assessment of plant biostimulants should be harmonised as far as possible, to avoid fragmentation and ensure a level, reliable playing field. It is essential that a common market is created for these substances.
In a vision of regeneration of the abandoned highway stretch close to Vado (Bologna), the galleries, theme of the project, are planned to be part of a footpath network, since the position of the ...galleries make them reachable both from the small town of Vado and from the new highway. The project’s aim is to offer a space to the community, hence the considered functions are thought as useful both for inhabitants and for tourists. Three galleries, three different characteristics, three different destinations and uses: The first gallery, with only one entrance, is planned to be the identity of the system. The second gallery is a more flexible space, where many functions take place. The third galleryis thought as a fast link to the naturalistic path for who’s arriving from the highway. This flexible wooden structure also creates an entrance and open space out of the galleries giving continuity to the project.
PDF
