Tuccio A.,Pronto Soccorso Pediatrico |
Farmeschi L.,Pronto Soccorso Pediatrico |
Bertacca L.,Pronto Soccorso Pediatrico |
Sbrana G.,Anestesia e Rianimazione |
And 2 more authors.
Medico e Bambino | Year: 2013
The paediatric emergency simulation project was created in the hospital setting of Grosseto in 2011 with the main objective to revise theoretical skills and to learn "practical experienced" skills. Simulations took place at the emergency unit shock room and involved all multi-specialist, medical, in training and nursing staff on a rotational basis. They included a theoretical briefing, the management of the clinical setting and the debriefing phase. The staff appreciation and improvement perceived are reported. The aim of this work is to describe the feasibility of a simulation project for the paediatric emergency in a second level hospital, without specific paediatric commitment or educational resources.
PubMed | Pronto Soccorso and UOC Medicina Interna Centro Emostasi e Trombosi
Type: Journal Article | Journal: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis | Year: 2015
Emergency physicians frequently deal with patients on vitamin K antagonists (VKAs) suffering major bleeding events, and rapid reversal of anticoagulation in this setting is of paramount importance. In Italy, given the absence of specific national guidelines, local policies are likely to differ, possibly impacting on clinical outcomes. We decided to perform a telephone survey among Italian emergency physicians to evaluate management strategies for VKAs reversal in patients with major bleeding.We conducted a computer-assisted, 10-minute telephone survey of 15 questions, focusing on the local prevalence, assessment, and management strategies of major and intracranial hemorrhage (ICH) occurring in patients on VKAs. We planned to interview a sample of 320 Italian emergency physicians. Institutions from all geographic areas of Italy were to participate in the survey.Of the 320 physicians contacted, 150 (47%) completed the survey, 95% being employed in public hospitals. Focusing on ICH, only 29% of the responders stated they would reverse anticoagulation irrespective of the international normalized ratio value, and only 27% would use prothrombin-complex concentrate as first-line agent. In patients needing urgent neurosurgical operation, less than 50% would administer prothrombin-complex concentrate before surgery.The average knowledge of management strategies for reversal of anticoagulation displayed by Italian emergency physicians appears to be unsatisfactory. The need for an extensive educational program and for the implementation of specific guidelines, possibly endorsed by Scientific Societies, cannot be underemphasized.
Ghirardo S.,Clinica Pediatrica |
Neri E.,Pronto Soccorso |
Rabach I.,Clinica Pediatrica |
Ventura G.,Clinica Pediatrica |
And 4 more authors.
Medico e Bambino | Year: 2015
In the emergency room the current management of the patient with suspected fracture involves a physical examination of the damaged area, an examination by the specialist and the performance of radiographic projections depending on the clinical suspicion. Analyzing the literature, there is evidence that the ultrasound method can be useful to perform an assessment of the first instance. In fact, the ultrasound diagnosis of fractures is now a method that, if performed by trained staff (also in a short time), has a good specificity and sensitivity. So, it could be performed as a first approach to trauma with suspected fracture, before the specialist examination. The paper highlights that ultrasound, performed by the radiologist, or by a paediatrician after a short specific training, presents good sensitivity and specificity in the diagnosis of fractures of the hands and fingers.
Tomaiuolo R.,CEINGE Biotecnologie Avanzate |
Tomaiuolo R.,University of Naples Federico II |
Bellia C.,University of Palermo |
Caruso A.,University of Palermo |
And 10 more authors.
Journal of Translational Medicine | Year: 2012
Background: Acute myocardial infarction (AMI) in young women represent an extreme phenotype associated with a higher mortality compared with similarly aged men. Prothrombotic gene variants could play a role as risk factors for AMI at young age.Methods: We studied Factor V Leiden, FII G20210A, MTHFR C677T and beta-fibrinogen -455G>A variants by real-time PCR in 955 young AMI (362 females) and in 698 AMI (245 females) patients. The data were compared to those obtained in 909 unrelated subjects (458 females) from the general population of the same geographical area (southern Italy).Results: In young AMI females, the allelic frequency of either FV Leiden and of FII G20210A was significantly higher versus the general population (O.R.: 3.67 for FV Leiden and O.R.: 3.84 for FII G20210A; p<0.001). Among AMI patients we showed only in males that the allelic frequency of the MTHFR C677T variant was significantly higher as compared to the general population. Such difference was due to a significantly higher frequency in AMI males of the MTHFR C677T variant homozygous genotype (O.R. 3.05).Discussion and conclusion: Our data confirm that young AMI in females is a peculiar phenotype with specific risk factors as the increased plasma procoagulant activity of FV and FII. On the contrary, the homozygous state for the 677T MTHFR variant may cause increased levels of homocysteine and/or an altered folate status and thus an increased risk for AMI, particularly in males. The knowledge of such risk factors (that may be easily identified by molecular analysis) may help to improve prevention strategies for acute coronary diseases in specific risk-group subjects. © 2012 Tomaiuolo et al.; licensee BioMed Central Ltd.
Cagliano S.,Pronto Soccorso
Recenti Progressi in Medicina | Year: 2015
This article takes its cue from the original work of sir Alexander Fleming on penicillin, published in the first issue of Recenti Progressi in Medicina in 1946 and reproduced here on the occasion of the approaching 70-year anniversary of the journal. In 1928, at the time when penicillin was discovered, it could not be imagined that bacterial resistance to antibiotics would develop so rapidly: the introduction of every new class of antibiotics has been shortly followed by the emergence of new strains of bacteria resistant to that class. Bacterial resistance to antibiotic treatment is a huge concern. In this respect, an action plan against antimicrobial resistance has been devised in the United States that is targeted for a 50% reduction over the next five years.
Admissions for severe hypoglycemia in type 2 diabetes patients: Clinical impact and healthcare costs [Ricoveri per ipoglicemia grave in soggetti con diabete mellito di tipo 2: Impatto clinico e costi sanitari]
Marinelli Andreoli A.,Medicina Interna e Science Endocrine e Metaboliche |
Chiovoloni M.,Pronto Soccorso |
Lucidi P.,Medicina Interna e Science Endocrine e Metaboliche |
Porcellati F.,Medicina Interna e Science Endocrine e Metaboliche |
And 5 more authors.
Giornale Italiano di Diabetologia e Metabolismo | Year: 2015
Severe hypoglycemia (SH) is the most dangerous complication of diabetes treatment and the limiting factor in blood glucose (BG) management. This study retrospectively analyzed the clinical characteristics, causal factors, and medical costs of type 2 diabetic patients (T2DM) admitted for severe hypoglycemia to the emergency department (ED) of Perugia hospital, Italy, from 1 July 2005 to 30 June 2011. SH was defined as an event requiring assistance from another person administering carbohydrates or glucagon to correct hypoglycemia, identified on the basis of capillary BG measured by the ambulance crew or at the ED, using the ICD-9-CM discharge diagnosis code. There were 205 admissions, half of whom (107, 50.5%) were treated in the ED and discharged the same day. The other 98 (49.5%) required hospital admission. The characteristics of these latter were: age 78 ± 10 yrs (mean ± SD), duration of diabetes (15 ± 12 yrs), HbA1c (6.8 ± 1.5%; 51 ± 11,2 mmol/mol), renal function (estimated glomerular filtration rate 56 ± 32 ml/min/1.73 m2), associated comorbid conditions (Charlson Comorbidity Index 5.4 ± 2.1), use of more than three different medications (86%). More than half (57.1%) were using insulin, 41.8% oral agents; of the latter, more than half (61.7%) were taking a sulphonylurea, mainly glibenclamide. SH induced by SU was associated with a longer average length of stay (ALOS) (3.0 vs. 6.0 days) and the estimated average cost per ALOS was greater than that due to insulin (€4,500 vs. €2,250, not including the costs of the emergency telephone service and ambulance). In conclusion, these findings indicate that half of SH events in T2DM presenting to the ED require hospital admission and almost half are due to inappropriate use of SU, with a significant impact on patients’ health and healthcare costs. © 2015 UTET Periodici Scientifici srl. All rights reserved.
Epis O.,Niguarda Ca Granda Hospital |
Filippucci E.,Marche Polytechnic University |
Delle Sedie A.,University of Pisa |
De Matthaeis A.,Pronto Soccorso |
Bruschi E.,Niguarda Ca Granda Hospital
Rheumatology International | Year: 2014
This case series evaluates the clinical and ultrasound response to tocilizumab treatment in patients with rheumatoid arthritis (RA). Six patients with active RA (DAS28 ≥ 3.2) for ≥6 months, refractory to conventional DMARDs or anti-TNF agents, received tocilizumab 8 mg/kg every 4 weeks, as monotherapy or in combination with DMARDs, for 6 months. The following clinical parameters were assessed monthly: number of tender joints (28 and 44 joints), number of swollen joints (28 and 44 joints), DAS28-ESR, DAS28-CRP, VAS score, global health status, health assessment questionnaire, patient global assessment of disease activity, physician global assessment of disease activity, functional assessment of chronic illness therapy (FACIT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All patients also underwent a gray-scale ultrasonography (US) assessment with power Doppler evaluation at each visit. All clinical parameters improved during the study, versus baseline. This improvement was statistically significant for most parameters 2 months following tocilizumab initiation and was sustained to the end of the observation period. The number of tender joints (44-joint evaluation), the FACIT score, and ESR and CRP concentrations were significantly improved versus baseline values after the first month of tocilizumab treatment. The course of US evaluations mirrored that of clinical parameters; a faster and more evident response was observed for foot joints, with respect to hand joints. This case series suggested the rapid clinical benefit of tocilizumab. Ultrasound assessment showed that the onset of this effect was faster in the foot joints than in the hand joints. © 2013 Springer-Verlag.
Morselli S.,Pronto Soccorso |
Colantoni A.,Pronto Soccorso |
Bettelli M.,Pronto Soccorso |
Giovanardi D.,Pronto Soccorso
Giornale di Gerontologia | Year: 2012
Emergency room referral of old citizens victims of trauma, is growing. Aim of the study was to describe this population in the emergency department of a hospital in Modena and to compare the different age groups for characteristics, outcome and severity of presentation. The number of trauma victims decreases as age increases. Nevertheless, hospitalization rate is higher among the elderly. Preexisting diseases and changes related to the aging process make it difficult for these pastents to react to trauma. Often severe trauma in the elderly is underestimated. ER staff must have basic clinical competencies in geriatrics in order to respond in a fast effective mode to the specific needs of these patients.
Folli C.,UO Medicina dUrgenza e Pronto Soccorso IRCCS Fondazione Policlinico Milan |
Consonni D.,UO Medicina dUrgenza e Pronto Soccorso IRCCS Fondazione Policlinico Milan |
Spessot M.,Pronto Soccorso |
Salvini L.,Cardiologia dUrgenza e Pronto Soccorso Centro Cardiologico Monzino |
And 4 more authors.
European Journal of Internal Medicine | Year: 2013
Background: Chest pain is a frequent symptom leading patients to the Emergency Room. Copeptin, the C-terminal fragment of arginin-vasopressin, is a marker of stressful situations. Recent studies showed that normal levels of copeptin combined with normal troponin accurately rule out the diagnosis of acute coronary syndrome (ACS). In this observational, prospective, multicenter study we evaluated if negative levels of copeptin combined with negative troponin (Tn-T) can correctly rule out the diagnosis of ACS and also of other life-threatening causes of chest pain. Results: Of 472 enrolled patients (64.6% males, mean age 60.1 yrs), 28 (5.9%) were diagnosed with ST-elevation myocardial infarction (STEMI), 28 (5.9%) with non ST-elevation myocardial infarction (NSTEMI), 43 (9.1%) with unstable angina (UA), 13 (2.8%) with potentially life-threatening non-ACS pathologies (aortic dissection, pulmonary embolism, pulmonary edema, sepsis), 360 (76.2%) with benign causes of chest pain. Copeptin levels were significantly higher in ACS patients with STEMI and NSTEMI than in those with other diagnoses, but not in those with UA. The combination of copeptin and troponin-T attained a negative predictive value of 86.6% for ACS, of 97.9% for other potentially life-threatening non-ACS diseases and of 85% for all potentially lethal diseases (ACS plus others). Conclusions: The combined use of troponin and copeptin significantly improved the diagnostic accuracy of troponin alone both in ACS (STEMI and NSTEMI) and in other life-threatening diseases. Measurement of this marker might be therefore considered not only for a rule-out strategy but also as a warning sign of a life-threatening disease. © 2012 European Federation of Internal Medicine.