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  1. Article ; Online: SARS-CoV-2 management in Emergency Department

    Greta Barbieri / Alessandro Cipriano / Stella Carrara / Stefano Spinelli / Francesco Cinotti / Francesca Foltran / Matteo Filippi / Ferruccio Aquilini / Michele Tonerini / Massimo Santini / Paolo Malacarne / Lorenzo Ghiadoni

    Emergency Care Journal, Vol 17, Iss

    risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital

    2021  Volume 4

    Abstract: SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate ... ...

    Abstract SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome. Objective: A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. Methods: We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age. Results: Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0,05). Mortality rate was higher in patients treated in intensive care units (26,5%) and undergoing endo-tracheal intubation (32,7%), compared to medical area (21,3%). We verified a good concordance (81,7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Conclusion: Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED.
    Keywords COVID-19 ; ventilation ; pneumonia ; emergency department ; management strategy ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-12-01T00:00:00Z
    Publisher PAGEPress Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Ultrasound- versus landmark-guided subclavian vein catheterization

    Anna Sidoti / Etrusca Brogi / Giandomenico Biancofiore / Sergio Casagli / Fabio Guarracino / Paolo Malacarne / Lara Tollapi / Matteo Borselli / Gregorio Santori / Francesco Corradi / Francesco Forfori

    Scientific Reports, Vol 9, Iss 1, Pp 1-

    a prospective observational study from a tertiary referral hospital

    2019  Volume 7

    Abstract: Abstract This was a single-center, observational, prospective study designed to compare the effectiveness of a real-time, ultrasound- with landmark-guided technique for subclavian vein cannulation. Two groups of 74 consecutive patients each underwent ... ...

    Abstract Abstract This was a single-center, observational, prospective study designed to compare the effectiveness of a real-time, ultrasound- with landmark-guided technique for subclavian vein cannulation. Two groups of 74 consecutive patients each underwent subclavian vein catheterization. One group included patients from intensive care unit, studied by using an ultrasound-guided technique. The other group included patients from surgery or emergency units, studied by using a landmark technique. The primary outcome for comparison between techniques was the success rate of catheterization. Secondary outcomes were the number of attempts, cannulation failure, and mechanical complications. Although there was no difference in total success rate between ultrasound-guided and landmark groups (71 vs. 68, p = 0.464), the ultrasound-guided technique was more frequently successful at first attempt (64 vs. 30, p < 0.001) and required less attempts (1 to 2 vs. 1 to 6, p < 0.001) than landmark technique. Moreover, the ultrasound-guided technique was associated with less complications (2 vs. 13, p < 0.001), interruptions of mechanical ventilation (1 vs. 57, p < 0.001), and post-procedure chest X-ray (43 vs. 62, p = 0.001). In comparison with landmark-guided technique, the use of an ultrasound-guided technique for subclavian catheterization offers advantages in terms of reduced number of attempts and complications.
    Keywords Medicine ; R ; Science ; Q
    Subject code 616
    Language English
    Publishing date 2019-08-01T00:00:00Z
    Publisher Nature Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Improving Cleaning and Disinfection of High-Touch Surfaces in Intensive Care during Carbapenem-Resistant Acinetobacter baumannii Endemo-Epidemic Situations

    Beatrice Casini / Anna Righi / Nunzio De Feo / Michele Totaro / Serena Giorgi / Lavinia Zezza / Paola Valentini / Enrico Tagliaferri / Anna Laura Costa / Simona Barnini / Angelo Baggiani / Pietro Luigi Lopalco / Paolo Malacarne / Gaetano Pierpaolo Privitera

    International Journal of Environmental Research and Public Health, Vol 15, Iss 10, p

    2018  Volume 2305

    Abstract: Aims: High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant Acinetobacter baumannii (CRAB) endemo-epidemic situations. We evaluated the effectiveness and ... ...

    Abstract Aims: High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant Acinetobacter baumannii (CRAB) endemo-epidemic situations. We evaluated the effectiveness and residual disinfectant activity of disposable pre-impregnated wipes (Modified Operative Protocol, MOP) in reducing environmental bioburden versus a two-step Standard Operative Protocol (SOP) in a 12-bed Intensive Care Unit. Methods: Five high-touch surfaces were cleaned and disinfected either according to the SOP (alcohol-based cleaning and chlorine-based disinfection) or using quaternary ammonium compounds-based disposable wipes (MOP). Sampling was performed before each procedure and at 0.5, 2.5, 4.5 and 6.5 h after (560 sites). Total viable count (TVC) was evaluated according to Italian hygiene standard (<50 CFU/24 cm2). Clinical and environmental CRAB strains isolated were genotyped. Results: On non-electromedical surfaces the difference between TVC before procedure and at each of the following times was significant only for the MOP (p < 0.05, Wilcoxon test). Using the MOP, only 7.4% (10/135) of sites showed TVC >50 CFU/24 cm2 (hygiene failures) versus 18.9% (25/132) after SOP (p < 0.05, Fisher’s Exact test). On infusion pumps a higher number of hygiene failures was observed after the SOP (7/44, 15.9%) compared with the MOP (4/45, 8.9%). Genotyping highlighted a common source of infection. Conclusion: On high-touch surfaces, the use of disposable wipes by in-house auxiliary nurses may represent a more effective alternative to standard cleaning and disinfection procedure performed by outsourced cleaning services, showing effectiveness in reducing microbial contamination and residual disinfection activity up to 6.5 h.
    Keywords high-touch surfaces ; carbapenem-resistant A. baumannii ; pre-impregnated wipes ; outsourced cleaning services ; Medicine ; R
    Language English
    Publishing date 2018-10-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma

    Daniele Poole / Arturo Chieregato / Martin Langer / Bruno Viaggi / Emiliano Cingolani / Paolo Malacarne / Francesca Mengoli / Giuseppe Nardi / Ennio Nascimben / Luigi Riccioni / Ilaria Turriziani / Annalisa Volpi / Carlo Coniglio / Giovanni Gordini / Trauma Update Working Group

    PLoS ONE, Vol 9, Iss 11, p e

    results from an Italian consensus of experts.

    2014  Volume 113676

    Abstract: Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to ... ...

    Abstract Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field.The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration for 48 hours or more, outweighed potential benefits.When accounting for ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2014-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: A pandemic recap

    Federico Coccolini / Enrico Cicuttin / Camilla Cremonini / Dario Tartaglia / Bruno Viaggi / Akira Kuriyama / Edoardo Picetti / Chad Ball / Fikri Abu-Zidan / Marco Ceresoli / Bruno Turri / Sumita Jain / Carlo Palombo / Xavier Guirao / Gabriel Rodrigues / Mahir Gachabayov / Fernando Machado / Lostoridis Eftychios / Souha S. Kanj /
    Isidoro Di Carlo / Salomone Di Saverio / Vladimir Khokha / Andrew Kirkpatrick / Damien Massalou / Francesco Forfori / Francesco Corradi / Samir Delibegovic / Gustavo M. Machain Vega / Massimo Fantoni / Demetrios Demetriades / Garima Kapoor / Yoram Kluger / Shamshul Ansari / Ron Maier / Ari Leppaniemi / Timothy Hardcastle / Andras Vereczkei / Evika Karamagioli / Emmanouil Pikoulis / Mauro Pistello / Boris E. Sakakushev / Pradeep H. Navsaria / Rita Galeiras / Ali I. Yahya / Aleksei V. Osipov / Evgeni Dimitrov / Krstina Doklestić / Michele Pisano / Paolo Malacarne / Paolo Carcoforo / Maria Grazia Sibilla / Igor A. Kryvoruchko / Luigi Bonavina / Jae Il Kim / Vishal G. Shelat / Jacek Czepiel / Emilio Maseda / Sanjay Marwah / Mircea Chirica / Giandomenico Biancofiore / Mauro Podda / Lorenzo Cobianchi / Luca Ansaloni / Paola Fugazzola / Charalampos Seretis / Carlos Augusto Gomez / Fabio Tumietto / Manu Malbrain / Martin Reichert / Goran Augustin / Bruno Amato / Alessandro Puzziello / Andreas Hecker / Angelo Gemignani / Arda Isik / Alessandro Cucchetti / Mirco Nacoti / Doron Kopelman / Cristian Mesina / Wagih Ghannam / Offir Ben-Ishay / Sameer Dhingra / Raul Coimbra / Ernest E. Moore / Yunfeng Cui / Martha A. Quiodettis / Miklosh Bala / Mario Testini / Jose Diaz / Massimo Girardis / Walter L. Biffl / Matthias Hecker / Ibrahima Sall / Ugo Boggi / Gabriele Materazzi / Lorenzo Ghiadoni / Junichi Matsumoto / Wietse P. Zuidema / Rao Ivatury / Mushira A. Enani / Andrey Litvin / Majdi N. Al-Hasan / Zaza Demetrashvili / Oussama Baraket / Carlos A. Ordoñez / Ionut Negoi / Ronald Kiguba / Ziad A. Memish / Mutasim M. Elmangory / Matti Tolonen / Korey Das / Julival Ribeiro / Donal B. O’Connor / Boun Kim Tan / Harry Van Goor / Suman Baral / Belinda De Simone / Davide Corbella / Pietro Brambillasca / Michelangelo Scaglione / Fulvio Basolo / Nicola De’Angelis / Cino Bendinelli / Dieter Weber / Leonardo Pagani / Cinzia Monti / Gianluca Baiocchi / Massimo Chiarugi / Fausto Catena / Massimo Sartelli

    World Journal of Emergency Surgery, Vol 16, Iss 1, Pp 1-

    lessons we have learned

    2021  Volume 8

    Abstract: Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white ...

    Abstract Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
    Keywords Pandemia ; International ; Thoughts ; Reflection ; Ethics ; Biology ; Surgery ; RD1-811 ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 360
    Language English
    Publishing date 2021-09-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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