Статті в журналах з теми "Azienda ospedaliera di Padova"

Questo studio è volto alla valutazione degli outcomes audiometrici e logopedici dei pazienti anziani portatori di impianto cocleare durante il primo anno di utilizzo del dispositivo. Sono stati valutati 42 pazienti impiantati tra marzo 2010 e settembre 2014 presso l’UO ORL dell’Azienda Ospedaliera Universitaria di Padova. Sono stati inclusi nello studio pazienti affetti da sordità bilaterale postlinguale di grado severo-profondo impiantati unilateralmente. I soggetti sono stati divisi in tre gruppi in base all’epoca della chirurgia: 14 soggetti con impianto fra i 35 e i 49 anni, 14 fra i 50 e i 64 anni e 14 impiantati a un’età superiore di 65 anni. Tutti i pazienti sono stati valutati prima e dopo la chirurgia (a 1, 3, 6 e 12 mesi di follow-up) attraverso l’esecuzione di: audiometria tonale, audiometria vocale, test logopedici e somministrazione del questionario delle categorie percettive (CAP). L’analisi statistica è stata effettuata attraverso il Student’s t-test. La totalità dei soggetti nei tre gruppi hanno dimostrato significativi miglioramenti all’audiometria tonale e vocale ai controlli post chirurgici rispetto alle performance ottenute precedentemente all’impianto. In particolare si sono verificati miglioramenti della soglia audiometrica media (PTA) senza differenze statisticamente significative tra i tre gruppi. risultati ottenuti nei test logopedici e dalla somministrazione del CAP hanno dimostrato evidenti miglioramenti in tutti i tre gruppi in studio. Abbiamo riscontrato, però, che i soggetti più giovani hanno raggiunto maggiori punteggi ai controlli post impianto rispetto a quelli più anziani. Concludendo, possiamo affermare che l’impianto cocleare è un trattamento efficace per soggetti affetti da ipoacusia severa-profonda senza differenze significative nelle performance audiologiche e logopediche in relazione all’età di impianto. Anche se più lentamente, i pazienti impiantati dopo i 65 anni di età raggiungono performance ottimali e possono essere ritenuti dei candidati ottimali all’intervento.

337 Background: The development of Prostate Cancer Units (PCUs) determined a paradigm shift in the treatment of this disease based on multidisciplinary management and shared clinical pathways among several specialists, but activities of PCUs are rarely reported. The Multi-Institutional PCU of Padova was decreed on Nov 2020 and involves Istituto Oncologico Veneto (IOV IRCCS), Azienda Ospedaliera-University of Padova (AOPD UNIPD) and Casa di Cura of Abano Terme. Padova PCU achieved the ISO 9001 certification on Dec 2020 and performance indicators were identified. Methods: We assessed clinical indicators of coordination, process and outcome of our PCU from 1st Jan 2021 to 30 Jun 2022. Data were extracted from the Electronic Medical Record ONCOSYS and from HEALTHMEETING, the software dedicated to register clinical information of patients, shared therapeutic decisions and participation of specialists to the PCU meetings. Results: A total of 739 consecutive pts were managed by the PCU in 18 months, generating a total of 1002 case discussions in 76 meetings, for a mean of 12,8 case discussions per week. Three Urology units performed 500 prostatectomies per year. Presence of at least one specialist for each core team specialty (either in presence of teleconference) was almost 100% with the exception of the pathologists, who were consulted mainly on demand. Waiting time for case discussion was always less than 2 weeks. Pts were presented by urologist, oncologist, radiation oncologist or other specialist in 46,3, 39,8, 10,5 and 3,4% of cases, respectively. They had localized/locally advanced, biochemically recurrent, metastatic castration-sensitive or castration-resistant disease in 43.3, 8, 28.2 and 20.5% of cases, respectively. Decision by the PCU was eventually carried out in 75,5% of cases, was changed due to pt’s preference of other reasons in 6.5%, or was still pending or not assessable in 18% of cases. Median time to completion of pathology report of prostatic biopsies was 8 days, median time from surgery to adjuvant radiotherapy was 5 months. Clinical trials with investigational drugs were proposed to 17% of pts with metastatic disease. Several process and outcome indicators (e.g., rate of active surveillance, rate of combined systemic therapy in men with metastatic castration sensitive cancer, survival of patients with metastatic castration resistant disease, etc.) could not be verified yet because they could not be extracted as aggregate data from institutional software and administrative databases. Conclusions: The volumes of Padova PCU and participation rate of core team specialists fulfill international requirements. Institutional software should be implemented in order to allow for aggregate data collection for the assessment of pre-defined performance indicators of PCU instead of reviewing the clinical chart of each prostate cancer pt.

Roberto Buzzetti, Angelo Carcione, Cecilia Lugarà, Eloisa Gitto a nome del gruppo dei partecipanti al percorso* Azienda Ospedaliera e Universitaria G. Martino, Messina; Scuola di Specializzazione in Pediatria, Università di Messina

- Turnover is a considerable problem for health care organizations: therefore, literature dedicates special attention to intention to leave the workplace (ITL), identified as main antecedent of factual organizational turnover rate. The present study has the aim to analyze the relationship between ITL and some psychosocial variables influencing it. The research (N = 604) has been carried out in a North of Italy Health care organization. Multiple regression analysis shows ITL as influenced by: satisfaction for development opportunities, satisfaction for workload, and quality of internal communication. Analysis of variance shows significant differences in ITL depending on professional qualification and age. Considering these two variables together allows to identify some groups of the organizational population with higher risks of turnover.Keywords: health worker, hospital, intention to leave the workplace, job satisfaction, organizational citizenship.Parole chiave: personale sanitario, azienda ospedaliera, intenzione di lasciare l'azienda, soddisfazione lavorativa, cittadinanza organizzativa.

Lo scopo del presente contributo è analizzare l'evoluzione delle progettualità di Information and Communication Technologies (ICT) dell'AUSL di Reggio Emilia, con particolare riferimento all'implementazione della cartella informatizzata. Sin dai primi anni Duemila, le preesistenti Azienda Territoriale e Azienda Ospedaliera di Reggio Emilia hanno sviluppato una cultura e una strategia ICT integrate, basate su tre punti cardine: 1) allineamento alla strategia aziendale; 2) approccio di project management; 3) misurazione dei risultati e del valore prodotto dall'implementazione delle innovazioni ICT. È stato costituito il Comitato di Pianificazione Strategica IT con compiti di definizione delle strategie triennali ICT e di monitoraggio dei risultati dei progetti. Tra questi ultimi, uno dei più rilevanti è stato il progetto di cartella clinica informatizzata "Matilde", attivato inizialmente sull'Azienda Ospedaliera nel 2013 ed esteso, dopo la fusione aziendale del 2017, sugli altri 5 ospedali. Tale progetto, concluso nel 2021, si è posto come obiettivo la completa gestione digitale sia della componente documentale della cartella sia di ogni operatività clinica, creando uno strumento unico di gestione del percorso clinico ospedaliero. Durante la pandemia da Covid-19, l'utilizzo della cartella clinica è stato esteso alle cliniche private e alle strutture territoriali pubbliche e private accreditate. Oggi, l'AUSL di Reggio Emilia sta intraprendendo un percorso di implementazione di una cartella clinica, sociale e socio-sanitaria, condivisa da tutti i soggetti pubblici e privati della provincia.

Abstract Introduction: Previous studies demonstrated that sickle cell disease (SCD), HIV and Tuberculosis (TB) represent high, yet under recognized health issues in Guinea Bissau, West Africa. A public National Reference Center for TB, Hospital Raoul Follereau (HRF) managed by the Italian NGO AHEAD is present in the capital city of Bissau with specialized local health staff capable of managing HIV and TB; the hospital has a SCD Clinic. Access to health services for rural population is limited and in some villages basic health care and routine screening are also seldom available due to lack of resources, specialized staff or diagnostic capacity. Therefore, people are not diagnosed or diagnosed late for SCD, HIV, TB. Nevertheless, rapid tests for both HIV and SCD are available on the market and one for TB is being developed. Simultaneous screening of three big diseases at the point of care (POC) in rural areas would allow saving of time and resources, while identifying people in need of further specialized diagnostic or follow up. Objectives: To evaluate the feasibility of simultaneous screening of HIV, SCD and TB at the POC in a rural area of Guinea Bissau through rapid tests for HIV and SCD and a standardized clinical questionnaire (Figure 1) with clinical examination for TB. To identify patients with HIV, SCD or both and enroll them in appropriate follow up programs; to identify suspects of TB eligible for in depth diagnostic screening. Methods: During the first phase of the project a temporary outreach health post was organized for 10 days in March 2018 in the village of Fanhè, by the NGO AGB already operating in the village. 1) The chiefs of the rural community village informed all the households through collective meetings and home visits regarding the objectives and modalities of the health project after accepting the proposal made by the NGOs and the HRF staff (February-March 2018); 2) the local chiefs organized a schedule of visits according to households; 3) 3 nurses and 2 physicians from the HRF in Bissau, linguistically competent for Creole and local dialects, administered the standardized questionnaire and the physical examination respectively; 3) 2 pediatric residents from Italy aided in clinical examination, a nurse and 2 other physicians in performing the rapid tests for HIV (Determine®) and SCD (Sickle Scan, Biomedomics) after informed consent; patients with Sickle Scan positive results were immediately collected another blood sample on Guthrie card for molecular analysis confirmation to be performed in Italy at the Azienda Ospedaliera Università di Padova. During the second phase of the project (April-May 2018) subjects with suspect of TB and/or HIV received free transportation to the HRF for TB diagnostic evaluation according to the national protocol and second HIV confirmatory test. Results: All 898 inhabitants (32 families) accepted the screening and performed clinical examination with clinical questionnaire; all performed the finger prick for HIV and SCD rapid test. At SickleScan 16 were HbSA (children 9/16); none were HbAC or HbSS. All received information on the carrier state. At Determine 61 were HIV positive (children 9/61). 93 presented clinical suspect of TB (children 33/93). 12 had a suspected of TB and were HIV positive(children: 2/12). For subjects with a suspect of TB or who were HIV positive free transportation was arranged to the HRF for complete TB diagnostic workup and second HIV confirmatory Rapid Test. All HIV positive tests were confirmed and patients enrolled in clinical care in a nearby village; 30% of patients with TB suspect had the diagnosis confirmed by Xray/sputum smear examination and were enrolled in appropriate care programss. All 16 Sicklescan positive HbSA samples underwent molecular analysis and the results were confirmed. Conclusions: This pilot study demonstrate the feasibility of a simultaneous population screening at the POC in rural areas for three "big diseases" (SCD, HIV and TB) through a temporary outreach clinic organized by local specialized staff in collaboration with local communities and international Academic Institutions and NGOs. The simultaneous screening with rapid test and standardized clinical examination is a model that could replicated in other rural settings in low resource countries. A further pilot study which will include a rapid test for TB, HIV and SCD is currently being planned. Figure. Figure. Disclosures Colombatti: NOVARTIS: Consultancy; Global Blood Therapeutics: Consultancy; BlueBirdBio: Consultancy; ADDMEDICA: Consultancy.

 l PICC è un dispositivo che consente l’accesso vascolare centrale. Si è affermato nell’ultimo ventennio e la sua diffusio-ne è stata possibile grazie alla praticità d’impianto e gestione, costo efficacia e formazione di PICC Team che ha reso protagonista l’infermiere. Con questo lavoro viene analizzato il primo anno di lavoro del PICC Team presso l’Azienda Ospedaliera di Perugia e valutata l’effi-cacia e l’efficienza per confermare le nuove competenze dell’infermiere specializzato

Nel contesto del dibattito sui fabbisogni di posti letto per acuti, la riflessione sulla potenzialità di un miglioramento della efficienza del percorso di ricovero è particolarmente rilevante. La degenza medica è ancora soggetta a fenomeni di eccessiva variabilità e di scarsa standardizzazione. Nell'ambito di un Dipartimento Internistico di una Azienda Ospedaliera abbiamo progettato la riorganizzazione della degenza medica attraverso: "1", l'indagine sui fattori che ostacolano il processo; "2", la costruzione di un sistema di reporting che ne consenta il governo; "3", l'intervento esteso a tutte le strutture mediche. Sono descritti i miglioramenti del processo e l'ottenimento di una riduzione significativa della durata media della degenza. L'esperienza documenta la possibilità di intervenire in modo trasversale attraverso un percorso di miglioramento organizzativo.

L’articolo presenta il Servizio di Bioetica dell’Azienda Ospedaliera di Padova collocandolo nel contesto internazionale della consulenza etico-clinica, della quale fornisce un quadro generale e sintetico. La consulenza etico-clinica, sviluppatasi soprattutto nel Nord America a partire dalla fine degli anni Sessanta, può essere definita come un servizio fornito da un consulente singolo, da un team o da un comitato avente come oggetto le questioni etiche coinvolte in uno specifico caso clinico. La storia della consulenza etico-clinica è strettamente connessa con quella dei Comitati Etici Ospedalieri, anche nel senso che essa costituisce in parte un tentativo di superamento di alcuni limiti ravvisati in tale forma di comitati e di ridefinizione delle loro funzioni. In quest’ottica, alcuni propongono la presenza, negli ospedali, sia di servizi di consulenza che di comitati, con ruoli complementari focalizzati rispettivamente sulla consulenza e sull’elaborazione di linee guida, e con ruoli formativi distinti. Il Servizio di Bioetica di Padova, che è attivo dal settembre 1996, è unico nel suo genere in Italia, soprattutto con riferimento al fatto di non riportare ad un comitato etico. Le sue finalità principali sono: consulenza etica sui casi clinici rivolta agli operatori sanitari; formazione etica degli operatori sanitari; elaborazione di linee guida in collaborazione con i comitati etici presenti nel contesto sanitario padovano; definizione di un progetto per la costituzione di un Comitato etico dell’Azienda. L’attività del Servizio di Bioetica ha finora interessato le funzioni di consulenza e formazione, volutamente scelte come prioritarie, ed il bilancio è positivo sotto entrambi i profili.

RIASSUNTOScopo – Lo scopo dello studio era quello di verificare, tramite la rilevazione dei costi diretti dei trattamenti terapeutico-riabilitativi, la presenza di associazioni tra quattro gruppi diagnostici (schizofrenia, psicosi affettive, paranoia e disturbi nevrotici) e i loro costi, complessivi e per specifici fattori di costo (assistenza territoriale, attività di riabilitazione e assistenza ospedaliera). Setting – Dipartimento di Salute Mentale e Centro di Salute Mentale (CSM) "Scalo", Azienda USL della Città di Bologna, Emilia-Romagna. Disegno – Sono stati calcolati i costi diretti annui di un campione (n = 75) di tutti i pazienti (n = 745) che durante l'anno hanno avuto più di quattro contatti con il CSM e quelli dei quattro gruppi randomizzati per diagnosi (n = 30 pazienti per gruppo). Principali misure utilizzate – Sono stati calcolati i costi medi unitari di 15 tipi di prestazioni, selezionate sulla base del numero annuo delle prestazioni erogate e del tempo impiegato da ciascuna figura professionale e rilevati i costi dell'assistenza ospedaliera (pubblica e privata). Risultati – Le analisi statistiche effettuate, tramite il Kruskal-Wallis test, hanno evidenziato costi complessivi significativamente più elevati nei pazienti schizofrenici rispetto a quelli del campione e a quelli con diagnosi di disturbo nevrotico; inoltre, i costi delle attivita di riabilitazione dei pazienti schizofrenici sono risultati differire significativamente da quelli rilevati nel campione e nei gruppi diagnostici "paranoia" e "disturbi nevrotici", mentre nessuna differenza significativa tra i gruppi è emersa nei costi dell'assistenza ospedaliera ed in quelli relativi al consumo di farmaci. Conclusioni – I risultati della nostra ricerca dimostrano che i costi dei trattamenti differiscono a seconda della diagnosi (costi diretti più alti nel caso dei pazienti schizofrenici e più bassi in quelli con disturbi nevrotici) e che l'analisi dei costi può consentire di pervenire all'assegnazione di adeguate risorse finanziarie ai Dipartimenti di Salute Mentale per i trattamenti terapeutico-riabilitativi di una vasta gamma di disturbi psichiatrici.

Nel contesto ospedaliero le forme organizzative più idonee per consentire l'integrazione sono quelle che prevedono l'istituzione di Servizi o Unità di Psicologia con funzioni di coor-dinamento per l'ottimale utilizzazione delle competenze psicologiche ai diversi livelli e per le attività necessarie ad una adeguata implementazione ed aggiornamento dei professionisti, della loro integrazione nelle diverse strutture operative ospedaliere e della collaborazione interprofessionale. La politica sanitaria centrata sul concetto di azienda come luogo in grado di gestire processi in modo efficace e efficiente presuppone una adeguata attenzione a quei fattori soggettivi che possono incidere sui costi e sulla produttività. Si tende ad una Psicologia Ospedaliera che sappia tenere insieme questi diversi bisogni, collocandoli in un orizzonte di analisi ed interventi specifici, fortemente integrati, che renda visibile la strategia "sistemica" e su questa costruisca sinergie ed alleanze. In campo scientifico e professionale si è affermato e consolidato il concetto che la salute sia un fenomeno multidimensionale, per cui occorre costruire una alleanza e una sinergia tra ricerca e intervento che abbia obiettivi condivisi e chiari. L'articolo resoconta dell'esperienza di collaborazione multiprofessionale nell'area delle malattie croniche nel contesto ospedaliero e pome la questione dei setting di lavoro e di ricerca congiunti come spazi dove diviene possibile costruire modelli di lavoro transdisciplinari.

La nutrizione è considerata dalla legislazione sanitaria corrente parte integrante della prevenzione e terapia clinica, e quindi del processo assistenziale. In questa ottica il servizio di ristorazione di un ospedale rappresenta un potente ausilio terapeutico ed educazionale. Il servizio di ristorazione della nostra Azienda Ospedaliera-Universitaria Pisana si basa sul Dietetico, una raccolta di diete standardizzate a composizione bromatologica definita, nel quale vengono indicate anche le finalità e le caratteristiche dei pazienti a cui si rivolge. Questo articolo riporta la nostra esperienza in questo settore, con particolare riguardo alle diete speciali per i pazienti nefropatici. Le diete speciali, come la dieta ipoproteica (0.6 g/kg p.c./die) ipofosforica, la dieta ipoproteica (0.7 g/kg p.c./ die) vegetariana e la dieta fortemente ipoproteica (0.3 g/kg p.c./die) ipofosforica sono prescritte dal medico, elaborate dal dietista e formulate per il singolo paziente. Sin dalla sua preparazione la dieta speciale ipoproteica presenta diversi punti critici (elaborazione-confezionamento e distribuzione della dieta, mancata personaliz-zazione, prodotti artificiali aproteici). Allo scopo di migliorare il servizio dietetico abbiamo rilevato l'effettivo consumo e la gradevolezza dei pasti speciali ipoproteici distribuiti durante la degenza mediante la compilazione di due schede consegnate ai pazienti nel corso della degenza. Nel complesso i risultati indicano una buona accettazione delle diete da parte dei pazienti, ma con un ridotto consumo in particolare riguardante il pane aproteico.

Background - The emergency department (ED) is an important site of care in which inappropriate antibiotic prescribing and the consequent impact of antibiotic-resistant bacteria can be reduced. Objective - The aim of this retrospective study was to investigate the pattern of antibiotic prescriptions for upper respiratory tract infections in children examined in 3 different ED located in Azienda Ospedaliera Bergamo-Est and to highlight the possibilities for a reduction and a more appropriate use of this class of drugs, overprescribed in paediatric age. Methods - A retrospective observational study was performed on children younger than 18 years of age, who were examined in a general hospital near Bergamo from January 2020 to September 2022. The proportion and type of antibiotic prescription according to demographic, clinical, laboratory and imaging data were determined. Results - 4,731 children were included in the study and 894 (18.9%) received an antibiotic prescription. The prevalence of antibiotic prescription varies with age, with a peak at 1-5 years (21.7%), and depending on the diagnosis, from 2.5 % in children with influenza to 78.4% in children with otitis. Amoxicillin/clavulanate was the most prescribed antibiotic (47% of antibiotic prescriptions), while the percentage of amoxicillin prescription was low (36%). In patients examined for pharyngotonsillitis, amoxicillin was prescribed to 43% of those treated with antibiotics. Conclusions - This study supports the need for a new comprehensive approach to ensure successful antibiotic stewardship. A guide to the use of new diagnostic tests (molecular biology, genome sequencing and immunoenzymatic assays) in a “diagnostic stewardship” perspective may be helpful; however, clinical evaluation remains of fundamental and central importance.

Background/Aim. Inflammatory bowel disease (IBD) is a chronic disorder affecting patients’ quality of life and increasing their disability. The aim of our study was to evaluate clinical and pharmacological factors associated with impaired quality of life and disability in a large cohort of IBD patients during IBD treatment. Methods. We consecutively and prospectively recruited all IBD patients referred to the IBD Unit of the “Azienda Ospedaliera” of Padua. Demographics and clinical information were collected, and all patients completed the IBD questionnaire (IBDQ) and the IBD-Disability Index (IBD-DI) questionnaire. A multivariate regression model and Spearman’s rank correlation coefficient were applied for detecting IBD-related variables relevant to disability and quality of life. Results. We included 435 IBD patients. Multivariate regression modelling identified active disease, anaemia, presence of extraintestinal manifestations, and Crohn subtype as independent predictors for both disability and poor quality of life. We observed a strong positive correlation between IBD-DI and IBDQ (r=0.84, p<0.001), while there was no association with ongoing therapy or other clinical features disease-related. Conclusions. Our study showed that disability and quality of life are both associated with active disease, anaemia, presence of extraintestinal manifestations, and Crohn phenotype while ongoing therapy seems not to be associated with disability and QoL during disease management.

The development of biomaterials in recent years has made it possible to broaden their use in the surgical field. Although iliac crest bone graft harvesting currently remains the gold standard as an autograft, the properties of hydroxyapatite bone substitutes appear to be beneficial. The first fundamental step to consider is the safety of using these devices. The purpose of this retrospective cohort study is to consider all the adverse events observed in our population and assess their relationships with the bone substitute device. The population analyzed consisted of patients undergoing trauma osteosynthesis with at least one implanted porous hydroxyapatite device. We considered a court of 114 patients treated at “Azienda Ospedaliera Universitaria di Ferrara—U.O. di Ortopedia e Traumatologia” in the period from January 2015 to December 2022. Upon analyzing our population, no adverse events related to the device emerged. Taking into consideration different study groups from other National Hospital Centers, no critical issues were detected except for three cases of extrusion of the biomaterial. It is necessary to clarify that bone substitutes cannot replace compliance with the correct principles linked to the biomechanics of osteosynthesis. This report outlines a safety profile for the use of these devices as bone substitutes in trauma orthopedic surgery.

RIASSUNTOScopo – Conoscere dati quantitativi e caratteristiche del comportamento suicidario nell'area nord della Provincia di Varese, comprendente il capoluogo ed i comuni limitrofi (Valceresio, valli del luinese e nord-Verbano), al fine di individuare interventi preventivi. Disegno – Studio epidemiologico-descrittivo. Sono state utilizzate le schede di morte ISTAT del Registro di Mortalità dell'ex Azienda USSL di Varese negli anni 1995-97. Sono stati inclusi i soggetti che al momento del suicidio risultavano residenti. Successivamente i casi delle schede ISTAT sono stati ricercati negli archivi dei servizi psichiatrici, per valutare eventuali contatti. Per costoro sono state rilevate informazioni, quali tentativi suicidari, patologia psichiatrica, data del primo contatto. Setting – Distretti di Arcisate, Cittiglio, Luino e Varese, corrispondenti al bacino di utenza delle Unità Operative di Psichiatria 1 e 2 dell'Azienda Ospedaliera Universitaria Macchi di Varese. Principali misure utilizzate – Sono stati calcolati i tassi di suicidio deH'area e tramite standardizzazione diretta sono stati confrontati i tassi dei singoli distretti. Risultati – I suicidi sono stati 78 (24 femmine e 54 maschi), con un tasso dell'8.2 per 100.000. In analogia all'andamento nazionale si osserva una diminuzione generale del fenomeno negli ultimi anni, ma non per i più giovani. Ci sono alcune aree geografiche (distretti di Luino e di Arcisate) da monitorare nel tempo, perche una casistica più ampia potrebbe rivelare un rischio più elevato. La fascia d'età giovane e anziana è più colpita nei maschi, e per i due sessi sono particolarmente a rischio i 55-64enni. I mezzi utilizzati differiscono per fasce d'età. Un'alta percentuale di soggetti sono non coniugati o con scarsa istruzione. Meno di un terzo dei casi era entrato in contatto con i servizi psichiatrici. Conclusioni – I dati consentono un confronto con la casistica nazionale e una riflessione sulle caratteristiche del suicidio nell'area di riferimento, al fine di elaborare strategie preventive orientate da un approccio multidimensionale, la cui efficacia potrà essere validata nel tempo attraverso l'attivazione di un osservatorio provinciale.

Abstract Immunological predictors of nodal response in breast cancer patients undergoing neoadjuvant therapy Maria Luisa Gasparri1, Ilary Ruscito2, Filippo Bellati2, Fabio Corsi3, Rosa Di Micco4, Oreste D. Gentilini4, Thorsten Kuehn5, Andrea Papadia1, Donatella Caserta2, Lorenzo Rossi6, Arianna Calcinotto7 1 Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland 2 Department of Medical and Surgical Science and Translational Medicine, Sapienza University of Rome, Azienda Ospedaliera Sant’Andrea, Rome, Italy 3 Breast Unit, Department of Surgery, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università di Milano, Milan, Italy 4 Breast Surgery Unit, San Raffaele University Hospital, Milan, Italy 5 Interdisciplinary Breast Center, Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany 6 Oncology Institute of Southern Switzerland, Bellinzona, Switzerland 7 Cancer Immunotherapy lab, IOR Institute of Oncology Research, Bellinzona, Switzerland Background: Almost 20% of breast cancer patients present at diagnosis with clinically positive nodes. Most of these patients undergo neoadjuvant therapy in order to de-escalate the axillary surgery in case of response (sentinel lymph node biopsy, targeted axillary dissection or targeted axillary dissection, instead of an axillary lymphadenectomy). The conversion from positive to negative nodes after neoadjuvant therpy is expected in approximately the 60% of the cases, depending by tumor subtypes. Several models have been proposed with the goal of identifying predictors of nodal response prior to neoadjuvant treatment. The immune system plays a pivotal role in cancer invasion and progression. Its role in treatment response is currently under investigation in several settings. Primary endpoint: to identify a preoperative immune profiling of breast cancer patients with nodal involvement at diagnosis and to correlate the immune changes after neoadjuvant therapy with the nodal response (macrometastases, micrometastasis, isolated tumor cells, complete response). Trial design: It is an international prospective cohort study including breast cancer patients undergoing standard neoadjuvant therapy, who present initially with biopsy-proven axillary lymph node metastasis. Ten immune markers will be analyzed using immunohistochemistry and tissue microarray in primary tumor and nodal tissue samples (tumor associated neutrophils, CD4 lymphocytes, CD8 lymphocytes, T regulatory cells, Macrophages, Follicular dendritic cells(DC), plasmocytoid DC, interdigitant DC, mature DC, Lysosomal associated membrane protein 3). The tissue analysis will be performed on the biopsy collected at diagnosis (prior to neoadjuvant therapy) and during the axillary surgery (after neoadjuvant therapy). Target accrual/sample size: 210 patients Statistical analysis: To compare the distribution of immune cells according to the state of lymph node metastasis, Student’s t test will be performed. Pearson’s chi-square test will be used to evaluate the correlation between immune profile and nodal response, based on clinic-pathological features. Odds ratios (ORs) and 95% confidence intervals (CIs) will be calculated using logistic regression analysis. Multivariable analysis will be performed using the multivariable logistic regression model. Logistic regression models will be used to identify the clinical, pathologic and immunological variables associated with the nodal response. P-values less than 0.05 will be considered significant. Analyses will be performed using Microsoft IBM SPSS® version 20.0 for Mac. Current status: Recruitment has not started yet. Contact information: marialuisa.gasparri@eoc.ch Citation Format: Maria Luisa Gasparri, Ilary Ruscito, Filippo Bellati, Fabio Corsi, Rosa Di Micco, Oreste Davide Gentilini, Thorsten Kuehn, Andrea Papadia, Donatella Caserta, Lorenzo Rossi, Arianna Calcinotto. Immunological predictors of nodal response in breast cancer patients undergoing neoadjuvant therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-12-01.

IntroductionSurgical site infections still remain a major public health challenge and have become an increasing universal risk, especially for the implantation of orthopaedic devices.Unfortunately, the discovery and increasingly widespread use (especially the misuse) of antibiotics have led to the rapid appearance of antibiotic-resistant strains today; more and more infections are caused by microorganisms that fail to respond to conventional treatments.Oxygen-ozone therapy has been extensively used and studied for decades across various potential medical applications and has provided consistent effects with minimal side effects.This study aims to determine the superiority of oxygen-ozone therapy in combination with oral antibiotic therapy in patients with wound infections after an orthopaedic device implantation when compared with antibiotic therapy alone.Methods and analysisThis is an open-label, multicentre, randomised, parallel-group study that aims to assess the efficacy and safety of oxygen-ozone therapy in combination with oral antibiotic therapy to treat infections in patients (male or female aged ≥18 years) having undergone surgery for the implant of an orthopaedic device. Patients must have at least one (but no more than three) postoperative wounds in the site of surgery (ulcers, eschars and sores) and at least one symptom (pain, burning, redness and malodour) and at least one sign (erythema, local warmth, swelling and purulent secretion) of infection of at least moderate intensity (score ≥2) in the target lesion at the screening visit (patients with wounds without signs of localised infection or with undermining wounds will be excluded).Patients (n=186) will be recruited from five Italian hospitals and studied for 7 weeks. All will be assigned to one of the two treatment groups according to a web-based, centralised randomisation procedure and placed into either the (1) intervention: oxygen-ozone therapy 2–3 times a week for 6 weeks (for a maximum of 15 sessions) simultaneously with an appropriate oral antibiotic therapy prescribed at baseline or (2) control: oral antibiotic therapy prescribed at baseline.The primary outcome is the efficacy and superiority of the treatment (ozone and oral antibiotic therapies); secondary outcomes include the resolution of signs and symptoms, modifications in lesion size and the treatment’s safety and tolerability.Ethics and disseminationThis study has been reviewed and approved by the responsible Independent Ethics Committee (IEC) of COMITATO ETICO CAMPANIA NORD, located at ‘Azienda Ospedaliera San Giuseppe Moscati di Avellino’.After completion of the study, the project coordinator will prepare a draft manuscript containing the final results of the study on the basis of the statistical analysis. The manuscript will be derived by the co-authors for comments, and after revision, it will be sent to a major scientific journal. Findings will be disseminated via online and print media, events and peer-reviewed journals.Trial registration numberNCT04787575.

Background: Myoma removal remains a challenge hysteroscopically including for the “IBS®” Intrauterine Bigatti Shaver technique. Objective: To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. Materials and methods: This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions. Main outcome measures: Complete resection rates, total operation time, resection time and used fluid volume. Results: Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003). Conclusion: For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time. What is new? Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.

In the article “Percorso diagnostico-terapeutico e modello organizzativo per l’erogazione della terapia genica nelle distrofie retiniche ereditarie in real-life ” (1), published in Volume 10, Issue 1 of AboutOpen Ophthalmology, authors Francesco Saverio Mennini and Ugo Trama were inadvertently omitted from the authors list. The authors and their affiliations have now been corrected in the article. Below is the updated list of authors and corresponding affiliations: Francesco Bandello1, Maurizio Battaglia Parodi1, Leonardo Colombo2, Fabrizio Giansanti3, Francesco Saverio Mennini4, Marcello Pani5, Francesco Parmeggiani6,7, Ugo Procoli8, Stanislao Rizzo5,9, Annalisa Scopinaro10, Andrea Sodi11, Annamaria Staiano12, Giovanni Staurenghi13, Ugo Trama14, Francesca Simonelli15 1Clinica Oculistica, Università Vita-Salute, IRCCS San Raffaele, Milano - Italy; 2Ospedale San Paolo, ASST Santi Paolo e Carlo, Milano - Italy;3Azienda Ospedaliero Universitaria Careggi, Firenze - Italy; 4Centre for Economics and International Studies – Economic Evaluation and Health Technology Assessment, Faculty of Economics, University of Rome “Tor Vergata”, Rome - Italy; 5Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Roma - Italy; 6Dipartimento di Medicina Traslazionale, Università di Ferrara, Ferrara - Italy; 7Centro per la Retinite Pigmentosa della Regione Veneto (Rete ERN-EYE), Ospedale di Camposampiero, Azienda ULSS6 Euganea, Padova - Italy; 8Azienda Ospedaliera Policlinico consorziale di Bari, Bari - Italy; 9Università Cattolica del Sacro Cuore, Roma - Italy; 10UNIAMO, Federazione Italiana Malattie Rare, Roma - Italy;11Clinica Oculistica, Università degli studi di Firenze, Firenze - Italy; 12Università degli Studi “Federico II”, Napoli - Italy; 13Ospedale Luigi Sacco, ASST Fatebenefratelli e Sacco, Milano - Italy; 14Politica del Farmaco e dei Dispositivi Regione Campania, Napoli - Italy; 15Università degli Studi della Campania Luigi Vanvitelli, Napoli - Italy We apologize with the authors and with the readers. The final version of this article is available online and includes a reference to this correction.

AbstractPatients suffering from chronic anemia can benefit from scheduled transfusions of packed red blood cells (PRBCs), while urgent transfusions have specific indications. These patients frequently seek medical attention in the emergency department (ED), where they can be inappropriately transfused, but research in this field is limited. This study aimed to assess the appropriateness of PRBCs transfusions in chronic anemic patients in the ED. A retrospective analysis was performed on patients who accessed the ED of the Azienda Ospedaliera di Padova (Padova, Italy) between 2016 and 2019 and received PRBCs transfusions. Patients aged ≥ 18 years old and with chronic anemia were included, while those with acute anemia or admitted to the hospital after the transfusion were excluded. Chronic anemia was defined as satisfying one of the following in the past medical history: diagnosis of chronic anemia; two or more previous blood samplings demonstrating anemia; periodic transfusions. As primary outcome, the appropriateness of transfusions was assessed according to the American Association of Blood Banks (AABB) 2016 criteria, using the recommended threshold of 7 g/dL for hemodynamically stable adults and 8 g/dL for patients with pre-existing cardiovascular disease. Out of 1153 transfusions, 344 transfusions were included in the study. According to our criteria, 139 (40.4%) patients were inappropriately transfused, resulting in a total estimated cost of 54,528.71 € in the study period. This study showed that transfusions in chronic anemic patients are recurrent events in the ED and are frequently inappropriate. A possible explanation could be the lack of a well-structured primary care network granting periodic transfusions in ambulatory centers. In the future, implementing and improving chronic anemic patients’ access to transfusion services through dedicated pathways could reduce the burden on the ED and also decrease costs.

Abstract Aims Despite improved awareness and advances in cardiac imaging, cardiac amyloidosis (CA) is a substantially underdiagnosed disease. ATTRwt amyloidosis may be responsible for as many as 30% of HF with preserved ejection fraction in patients &gt;75 years old. Contemporary estimates of its epidemiology in Italy are poorly provided. The aim of this study is to retrospectively analyse yearly inpatient claims consistent with amyloidosis in a single centre of Veneto region (Azienda Ospedaliera—Università di Padova). Methods Inpatient claims were counted in the series in each year if they had at least 1 principal or secondary International Classification of Diseases, Ninth revision—clinical modification (ICD-9, CM) code for amyloidosis (27730-27739), from January 2009 to February 2021. Primary outcome was to clarify if an increase in claims went hand in hand with novel and wider awareness of the disease. Secondary outcome was to identify major comorbidities determining or accompanying acute conditions leading to hospitalization. Results During the study period, there was a total of 328 claims containing ICD9-CM code for amyloidosis; 139 of them (42%) registered before 2015, 189 (58%) after 2015. Mean number of hospitalizations increased during time, starting from 20 claims per year between 2009 and 2015, to 36.8 from 2015 to 2020 (excluded current year). Considering main discharge diagnosis, 84 (25.6%) was related to cardiological condition, of them 56 (66%) was about acute or acute on chronic heart failure, 9 (10.7%) to arrhythmias, both brady- and tachyarrhythmia, 6 (7.1%) to coronary disease, 4 (4.8%) to aortic stenosis. The other most frequent discharge diagnoses, 36 (10.9%) were due to neurological condition, mostly neurovascular disease, 26 (7.9%) were due to haematological disease, mostly multiple myeloma, 14 (4.2%) were about nephrological condition, mostly related to advanced or pre-dialysis renal disease. Regarding related discharge diagnoses, the most frequent were cardiological conditions, appearing in 205 (62.5%) claims. 128 (62.4%) of them were due to acute or chronic heart failure, 10 (4.1%) to brady-tachyarrhythmias, 9 (4.4%) to ischaemic heart disease, and 6 (2.9%) to aortic valve disease. About other associated conditions reported in ICD9-CM codes used 84 (25.6%) were related to haematological diseases, 68 (20.7%) to neurological disease, 52 (15.8%) to renal disease, 23 (7%) to gastroenterological diagnoses (mostly GI bleeding). Conclusions Over the last years, there have been a substantial increase in amyloidosis diagnosis in our centre. This appears to go hand in hand with an increase in clinicians’ CA awareness, as confirmed by the fact that main discharge diagnosis is related to cardiac condition, and more specifically heart failure. Heart is again the most important comorbidity in patients hospitalized for other conditions, mostly related to nephrological, neurological, haematological affections confirming its role as main prognostic determinant in a complex disease, and the necessity to search for it, find it and quickly cure it.

The article presents history of “Cardinale Giovanni Pani­co” the hospital which was transformed into Hospital-Cor­poration “Pia fondazione di culto e religione ‘Cardinale Giovanni Panico’” in Tricase, Italy. The Hospital Corporation arose from the Vatican diplomat Giovanniego Panico’s idea and initiative. The activity of the International Institute of Sisters Marcellin (Istituto Internazionale delle Suore Marcel­line) led to its actual functioning and constant development with continual help of suitable church and secular authorities. The future cardinal was sensitive to people’s suffering and lack of suitable health care; his work in many diplomatic agencies in different countries, usually poor and neglected, led to the idea of opening a small hospital in his hometown. The article is an attempt to show in an chronological order history and achievements of one of many Italian hospital corporations. However, the presented institution deserves special attention. The text shows how the private nursing home brought to life in 1963 (casa di cura privata) developed into an important Hospital Corporation in Italy which is defined as the only hospital-medical consortium classified as religious (ospedale religioso classificato). In the article the author does not only present mentioned chronology and achievements of the powerful medical facility, but also the role and need of transplanting on the ground of medical care catholic values as those which help to come back to physical health. The author also presents educational values of suffering in the Christian point of view.

Il dolore toracico acuto non traumatico costituisce una delle maggiori cause di accesso in Pronto Soccorso inItalia e può rappresentare la prima manifestazione clinica di severe patologie pleuro-polmonari e mediastiniche,specie le sindromi aortiche acute, vere e proprie emergenze medico-chirurgiche, in quanto gravate da un elevatotasso di mortalità (25%) nelle prime 24 ore. Lo scopo del nostro lavoro è quello di riportare i dati di incidenza ei reperti radiologici riscontrati nel corso degli anni 2014-2018 nei pazienti adulti pervenuti presso il DEA dellanostra Azienda Ospedaliera “Sant’Anna e San Sebastiano” di Caserta, soffermandoci inoltre sul ruolo centralenell’iter diagnostico di questa sintomatologia della TC multistrato eseguita con mdc ev e con adeguati parametri diacquisizione e protocolli di studio.

Le conseguenze a livello cognitivo, psicologico, comportamentale e sociale dell’epilessia in età evolutiva hanno un ruolo importante nell’inquadramento diagnostico, nel monitoraggio e nella predisposizione di interventi successivi. Nel presente lavoro viene effettuata una panoramica delle principali caratteristiche cognitive e psicologiche dei bambini e adolescenti con epilessia, con particolare riferimento alla valutazione neuropsicologica e psico-comportamentale effettuata presso l’SSD di Psicologia di questa Azienda Ospedaliera. Tale lavoro si inserisce all’interno di un continuum, con un richiamo alle radici scientifiche e cliniche da cui il gruppo di lavoro ha preso l’avvio, verso prospettive future di assessment e intervento, con denominatore comune il concetto di una presa in carico globale del soggetto e della sua famiglia.

Il dolore toracico acuto non traumatico costituisce una delle maggiori cause di accesso in Pronto Soccorso in Italia e può rappresentare la prima manifestazione clinica di severe patologie pleuro-polmonari e mediastiniche, specie le sindromi aortiche acute, vere e proprie emergenze medico-chirurgiche, in quanto gravate da un elevato tasso di mortalità (25%) nelle prime 24 ore. Lo scopo del nostro lavoro è quello di riportare i dati di incidenza e i reperti radiologici riscontrati nel corso degli anni 2014-2018 nei pazienti adulti pervenuti presso il DEA della nostra Azienda Ospedaliera “Sant’Anna e San Sebastiano” di Caserta, soffermandoci inoltre sul ruolo centrale nell’iter diagnostico di questa sintomatologia della TC multistrato eseguita con mdc ev e con adeguati parametri di acquisizione e protocolli di studio.

This contribution examines the inadmissibility of a preliminary reference order submitted by the Court of Padua, Italy to the Court of Justice of the European Union (CJEU). The case involved the suspension of a worker, who, while legally obliged, declined to have the Covid-19 vaccine. The Italian court temporarily halted proceedings initiated by the worker's appeal. The author provides a comprehensive analysis facts of the case, the applicable national legislation, and the content of the preliminary reference order. The order scrutinised the compatibility of the conditional authorisation issued by the European Commission for the release of vaccines in circulation at that time. Additionally, it explored potential discrimination against workers who, by refusing vaccination, faced suspension from work without pay, as per explicit legal provisions. The contribution concludes by addressing the specific details of the inadmissibility ruling from the CJEU. Case: Judgment of the Court (Second Chamber) of 13 July 2023. D. M. v Azienda Ospedale-Università di Padova. Request for a preliminary ruling from the Tribunale Ordinario di Padova. Reference for a preliminary ruling – Public health – National legislation imposing a vaccination obligation on health professionals – Suspension from duty without pay for personnel refusing the vaccine – Regulation (EC) No 726/2004 – Medicinal products for human use – Vaccines against Covid-19 – Regulation (EC) No 507/2006 – Validity of conditional marketing authorisations – Regulation (EU) 2021/953 – Prohibition of discrimination between vaccinated and unvaccinated persons – Inadmissibility.

Aim: To assess midwives' evaluation of a real-life neonatal resuscitation and their opinion on importance of resuscitation interventions.Methods: Multicenter, multi-country study.Setting: Beira Central Hospital (Mozambique) and Azienda Ospedale-Università di Padova (Italy).Subjects: Sixteen Mozambican midwives and 18 Italian midwives.Interventions: Midwives' assessment was evaluated by using a predefined score, which graded each resuscitation intervention (0–2 points) and summed to a total score for each step (initial steps, bag-mask ventilation, and chest compressions). All scores were compared with referral scores given by two expert neonatologists.Results: Both Mozambican and Italian midwives overestimated their performance regarding of initial steps taken during resuscitation, chest compressions, high-oxygen concentrations (p &lt; 0.01), and underestimated the importance of stimulation (p &lt; 0.05). Mozambicans overestimated suctioning (p &lt; 0.001). Participants agreed with experts about the importance of equipment preparation, using a warmer, drying the newborn, removing wet linen and heart rate assessment.Conclusion: Mozambican and Italian midwives overestimated the performance of a real-life neonatal resuscitation, with heterogeneous evaluation of the importance of several aspects of neonatal resuscitation. These findings may be useful for identifying educational goals.

Abstract Background Incident reporting (IR) is one of the most used systems to gain knowledge of AEs and to identify sources of risk. During COVID-19 pandemic, several organizational changes have been implemented to respond adequately and effectively to the emergency; this required the suspension of most deferrable activities. The aim of this study is to investigate whether incident reporting attitude of health workers has been reduced during the pandemic event. Method A retrospective analysis was conducted at the Azienda Ospedale – Università di Padova (Italy), considering IR of years 2019 and 2020. To standardize the effects of the decrease in admissions, we considered the number of incidents per 1,000 admissions. Results Data shows that during the first (March-May 2020) and second waves (October-December 2020) of the COVID-19 pandemic there was a statistically significant reduction in the rate of incident reporting for every 1,000 admissions (p=0.001 – Wilcoxon test), especially for adverse events and in COVID-19 units. Conclusion This study shows a reduction in incident reporting especially during the first and second pandemic waves of COVID-19 in year 2020. Education and training interventions could be fundamental to raise awareness of the importance of incident reporting in health workers, as this could provide opportunities to understand what is impacting on safety in a particular healthcare context and enable continuous improvement.

Abstract Background The most common hospital safety incidents are Hospital-Acquired-Infections (HAI) and among these Surgical Site Infections (SSIs). Our study proposes the use of a proactive system to manage risk combining the new Risk Identification Framework by WHO (IPCAF), the Lean method and the hospital’s Procedure Analysis. Each of the methods has pros and cons, and there is no existing literature that researches the concurrent use of all three methods. We focused on analysing patients’ surgical route to demonstrate that using an integrated system for preventing SSIs delivers enhanced results and significantly contibutes to a reduction in occurence of SSIs. Methods We conducted a retrospective observational study from 18 March 2019 to 20 April 2019 at Azienda Ospedaliera Universitaria Federico II di Napoli, Italia (Europa). The study is structured in 3 phases: Phase 1- application of proactive risk management tools (18 March- 15 April 2019); Phase 2-integration of results with the elaboration of a single system for proactive risk management (15-20 April 2019); Phase 3- collection of epidemiologic data concerning SSI. We used the incidence of surgical site as efficiency indicator (1-10 March 2022). The endpoints identified were: Primary Endpoint: a reduction of infection occurrence in surgical sites Secondary Endpoint: identification of critical points and control points within the surgical process with relevant corrective measures Results The rate of incidence of SSIs was selected as the efficacy indicator for the system. Our study recorded a 2.40% incidence rate for SSIs in 2020, compared to an incidence rate of 3.80% in 2018 and of 3.5% in 2017. Conclusions Considering the economic impact of the infections, along with the increased incidence of mortality and morbidity, employing all available tools to try and reduce SSIs incidence becomes paramount. A small reduction can produce significant cost savings that can be invested in other prevention programs. Key messages • Integrated system in proactively and promptly identifying risks related to patients’ surgical routes is effectiveness. • The system can be adapted to different healthcare settings, to prevent adverse incidents by employing a risk management strategy, and to further enhance existing strategies.

The aim of this pilot retrospective study was to test the Rehabilitation complexity scale (RCS-E v13) in patients from 15 Italian pulmonary rehabilitation (PR) units and correlate RCS-E v13 to the most used clinical and functional outcome measures. At admission and discharge, clinical data [comorbidities with the Cumulative Illness Rating Scale (CIRS)], Barthel Index (BI), Barthel Index dyspnea (BI-d), COPD Assessment Test (CAT), and six-minute walking test (6MWT) were collected, and RCS-E total score calculated. Two-hundred nineteen patients [30.6% COPD, 43.4% chronic respiratory failure (CRF), and 26% with invasive ventilation (IV)], aged 69.9 (11.2) years were considered. RCS-E at admission 8.63 (1.69), 11.06 (2.50), 16.56 (2.97) and discharge 0.84 (1.02), 2.19 (1.5), 7.09 (1.47)] for COPD, CRF and IV respectively were statistically differed among groups (ANOVA p = <0.0001). RCS-E v13 total score strongly negatively correlated with 6MWT [(rho= -0.7305 (-07883; -0.6598)] and BI [(rho= - 0.6989 ( -0.7626; - 0.6217)]) while weakly with CAT [(rho = 0.2939 (0.1601; 0.4170)] and BI-d [(rho = 0.3512 (0.2243; 0.4663)]. Change in RCS-E v13 total score [(mean change of -8.70 (95% IC -9.00; -8.40)] ) as in all single RCS-E v13 items [care -0.59 (95%IC -0.69, -0.48); risk -0.56 (95%IC -0.78;-0.46); nursing needs -2.11 (95%IC -2.22;-2.01); medical needs -2.29 (95%IC -2.39;-2.18); therapy disciplines -1.45 (95%IC -1.57; -1.33); therapy intensity -2.00 (95%IC -2.07; -1,93); equipment -0.23( 95%IC -0.30; -0.16)] was found significant after PR. The RCS-E v13 application for patients with respiratory diseases is feasible and highlights a huge difference among different conditions. Its application seems to present an important care burden and relation with motor disability and effort tolerance but a lower relation with dyspnea during activities of daily living, comorbidities, and disease impact. A more robust sample and prospective analysis on the usefulness of the RSC-E v13 in patients with respiratory diseases during rehabilitation are welcomed. @ The Rehabilitation Complexity Scale in respiratory patients - Italian Network Michele Vitacca, MD, FERS ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Lumezzane, Brescia, Italy Luca Bianchi, MD Fondazione Don Carlo Gnocchi ONLUS, “Centro Spalenza”, Respiratory rehabilitation, Rovato, Brescia, Italy Piero Ceriana, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Pavia, Italy Francesco Gigliotti, MD Fondazione Don Carlo Gnocchi ONLUS, IRCCS "Don Carlo Gnocchi", Respiratory rehabilitation Firenze, Italy Rodolfo Murgia, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Montescano, Pavia, Italy Alessia Fumagalli, MD Istituto nazionale Riposo e Cura per Anziani di Casatenovo, Respiratory rehabilitation, Casatenovo, Lecco, Italy Antonio Spanevello, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Tradate, Varese, Italy Giuseppe La Piana, MD Ospedale "Santa Marta" di Rivolta d'Adda, Respiratory rehabilitation Rivolta d'Adda, Cremona, Italy Bruno Balbi, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Veruno Veruno, Novara, Italy Sara Forlani, MD, Presidio Ospedaliero di Sant'Angelo Lodigiano, Respiratory rehabilitation Sant'Angelo Lodigiano, Lodi, Italy Maria Aliani, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Bari, Italy Gianfranco Beghi, MD Ospedale Villa Pineta, Respiratory rehabilitation, Pavullo nel Frignano, Modena, Italy Mauro Maniscalco, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Benevento, Italy Giuseppe Fiorentino, MD Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Respiratory rehabilitation, Napoli, Italy Paolo Banfi, MD Fondazione Don Carlo Gnocchi ONLUS, IRCCS “Centro S. Maria Nascente”, Respiratory rehabilitation, Milano, Italy

This essay aims to show some approaches in the understanding of the lifelong learning concepts, knowledge, competence, from a literature review with the contributions of Dewey, Bruner, Freire, Schon and Tardif among others. Coming from theoretical studies carried out by Italian researchers and a Brazilian researcher, through their Research Centers/Laboratories and international collaborative partnership between Brazilian and Italian Universities, this text addresses from the undertake scientific literature, key terms which support the held studies. From the considerations, it is highlighted the regular understanding around lifelong learning concept, which considers the human condition for the permanent learning and valuing experiences from different contexts, such as family and school (basic and higher education). In view of this, the approximation between the concepts of competence and knowledge was also highlighted, recognized and valued as fundamental elements for the learning process and for the development of critical and reflexive thinking, and consequently transforming daily problems and challenges. The task reinforces the research network, pursuing the improving theoretical knowledge to subsidize the scientific research production in the educational field, besides Brazilian or Italian academic walls.SommarioQuesto saggio ha l’obiettivo di presentare gli approcci sulla definizione dei concetti di apprendimento permanente, saperi e competenze, partendo da una revisione della letteratura, con i contributi,tra gli altri, di Dewey, Bruner, Freire, Schon e Tardif. A partire dall’analisi teorica condotta da ricercatori italiani e una ricercatrice brasiliana, mediante i loro centri di ricerca/laboratório, e l’accordo di collaborazione internazionale tra l’università brasiliana e italiana, questo testo affronta, in base alla letteratura scientifica, i termini chiave che supportano gli studi realizzati. Dalle argomentazioni espresse, emerge la posizione comune sul concetto di apprendimento permanente o per tutta la vita, che considera l’approccio umanistico e la valorizzazione delle esperienze provenienti da diversi contesti come la famiglia e la scuola (in particolare di base e superiore). In questa prospettiva, si mette in evidenzia anche l'approssimazione semantica tra i concetti di competenza e saperi, riconosciuti e valorizzati come elementi fondamentali per il processo di apprendimento e per lo sviluppo del pensiero critico e riflessivo, e di conseguenza trasformatore rispetto ai problemi e alle sfide quotidiane della vita. 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