Chiara Guglielmetti

Interprofessional team dynamics and information flow management in emergency departments.

AIM In Emergency Departments, fragmentation and breakdown in information exchange can be important factors leading to adverse events. This article aims to consider the critical aspects of collaborative teamwork in Emergency Departments that may have an impact on the information flow. BACKGROUND On the basis of Distributed Cognition Theory, we have assumed that cognitive outcomes in critical-care settings are not confined to the thoughts of isolated individuals; rather, they are better understood as properties of a distributed cognitive system across the minds of the clinical team members and across the technological artefacts. DESIGN We report on an exploratory ethnographic study of two Emergency Departments. METHODS Data were collected over a period of four months in 2008 via observation and interviews. RESULTS The results highlight a specific distribution of cognitive work between physicians and nurses. The nurses roles as information highlighter, memory keeper and process organizer helped to ensure the information flow and to overcome some of the problems identified with the computer-assisted communication process. Such distribution of cognitive work improved care quality, but it crossed established professional boundaries. CONCLUSION As cross-boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast-moving contexts. To realize an interprofessional working system, practice-based training is required, aimed at developing a deep understanding of team cognition.

Health care services and the coproduction puzzle : filling in the blanks

This qualitative study analyzes an Italian hospital’s endeavor to introduce a coproduction practice and the critical factors that affect its efficacy and efficiency. The empirical evidence shows that the meaningful engagement of the patient can be achieved only by factoring in the socioorganizational conditions of all stakeholders; that no divide exists between organizational production and client coproduction, rather, it is a relationship of interdependence that in turn raises critical issues; and that formalized and effective “practices-in-use” cannot work unless there is strong managerial commitment and enforcement of the new coproduction initiative.

La relazione con i pazienti in sanità: quali risorse lavorative per attenuare l’impatto degli stressor sociali?

Ricerche nazionali e internazionali hanno mostrato che gli operatori sanitari si trovano ad affrontare episodi di violenza verbale e fisica con sempre maggior frequenza. Evidenze empiriche supportano l’ipotesi che comportamenti aggressivi dei pazienti possono generare processi di burnout. Scarsi sono pero gli studi sulle risorse lavorative che consentono di attenuare l’impatto di tale stressor sociale sul benessere degli operatori nei contesti ospedalieri. Nel nostro contributo abbiamo analizzato se e in quali circostanze differenti tipi di risorse, emotive (supporto dei colleghi, supporto dei superiori) e cognitive (autonomia decisionale, significato del lavoro), moderino l’effetto negativo dell’aggressivita verbale su burnout e benessere affettivo. Lo studio, di tipo trasversale, ha coinvolto il personale sanitario di un dipartimento chirurgico (133 operatori con un tasso di partecipazione del 67%). Lo strumento di rilevazione e stato un questionario self-report. Le analisi, effettuate attraverso una regressione gerarchica moderata, hanno evidenziato l’effetto diretto dei comportamenti aggressivi come importanti predittori del burnout e del benessere affettivo. Il supporto dei colleghi e dei superiori e, in misura minore, l’attribuzione di significato al lavoro moderano l’impatto negativo sull’esaurimento emotivo. Il benessere affettivo risulta essere moderato dal supporto dei colleghi e dalla percezione di autonomia lavorativa. Inoltre si e riscontrato che l’attribuzione di significato al proprio lavoro influenza positivamente il benessere nel caso di alta aggressivita dei pazienti. Lo studio contribuisce a evidenziare gli aspetti socioorganizzativi che svolgono un’azione protettiva rispetto agli stressor sociali legati alla relazione con i pazienti nei contesti sanitari.

Detection of cellular prion protein in exosomes derived from ovine plasma

Prion protein (PrP) is present at extremely low levels in the blood of animals and its detection is complicated by the poor sensitivity of current standard methodologies. Interesting results have been obtained with recent advanced technologies that are able to detect minute amounts of the pathological PrP (PrPSc), but their efficiency is reduced by various factors present in blood. In this study, we were able to extract cellular PrP (PrPC) from plasma-derived exosomes by a simple, fast method without the use of differential ultracentrifugation and to visualize it by Western blotting, reducing the presence of most plasma proteins. This result confirms that blood is capable of releasing PrP in association with exosomes and could be useful to better study its role in the pathogenesis of transmissible spongiform encephalopathies.

Verbal Aggression from Care Recipients as a Risk Factor among Nursing Staff: A Study on Burnout in the JD-R Model Perspective

Among nursing staff, the risk of experiencing violence, especially verbal aggression, is particularly relevant. The present study, developed in the theoretical framework of the Job Demands-Resources model (JD-R), has two main aims: (a) to examine the association between verbal aggression and job burnout in both nurses and nurses aides and (b) to assess whether job content, social resources, and organizational resources lessen the negative impact of verbal aggression on burnout in the two professional groups. The cross-sectional study uses a dataset that consists of 630 workers (522 nurses and 108 nurses aides) employed in emergency and medical units. High associations were found between verbal aggression and job burnout in both professional groups. Moderated hierarchical regressions showed that, among nurses, only the job content level resources moderated the effects of the verbal aggression on job burnout. Among nurses aides, the opposite was found. Some resources on the social and organizational levels but none of the job content level resources buffered the effects of verbal aggression on workers burnout. The study highlights the crucial role of different types of resources in protecting nursing staff from the detrimental effects of verbal aggression on job burnout.

Fertilizing a patient engagement ecosystem to innovate healthcare: Toward the first Italian Consensus conference on patient engagement

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide “system” inertia—really difficult to be overcome—and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of “fertilizing a patient engagement ecosystem”: an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient “disengagement” is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

Co-production in Healthcare: Moving Patient Engagement Towards a Managerial Approach

The pressure toward co-produced health services is increasing as an answer to quality improvement and system sustainability. However, the reflection and the empirical knowledge on the nature of co-production and on how healthcare practices change in order to manage effective partnerships between clients and professionals remain scant. The chapter addresses this gap by analysing how the concept of co-production is used and investigated in the healthcare literature. Specifically, it focuses on two key perspectives that vary significantly on the issues of who the co-producing health authors are; what the domains of co-production are; and how to stimulate and support patients in their role of co-producers. The first perspective frames co-production as focusing on individual patient engagement and on the bilateral clinical dimension of relations with the medical staff. The second recognises co-production as a complex system of multiple relations between a cast of both single (patients, informal caregivers, clinical staff) and collective actors (the healthcare providers such as hospitals, trusts, local health communities), that involves patients in different service delivery phases and focuses on the change in the production processes when value is co-produced.

Rapid Screening Technique To Identify Sudan Dyes (I to IV) in Adulterated Tomato Sauce, Chilli Powder, and Palm Oil by Innovative High-Resolution Mass Spectrometry

Sudan dyes are synthetic azo dyes used by industry in a variety of applications. Classified as carcinogenic, they are not allowed in foodstuffs; however, their presence as adulterants in food products has been regularly reported. Here, we describe an innovative screening method to detect Sudan I, II, III, and IV in tomato sauce, palm oil, and chilli powder. The method entails minimal sample preparation, completely avoiding the liquid chromatography phase, followed by detection and identification through atmospheric pressure chemical ionization time-of-flight mass spectrometry, in positive ionization mode. Analytes were efficiently identified and detected in samples, fortified both with individual analytes and with their mixture, with an error in mass identification less than 5 ppm. Limits of identification of the analytes in the fortified samples were 0.5 to 1 mg/kg, depending on the dye and matrix. The method had a linear range of 0.05 to 5 mg/kg and good linear relationships (R2 > 0.98). Repeatability was satisfactory, with a coefficient of variation lower than 20%. The method was applied to detect the dyes in real adulterated chilli samples, previously found positive by confirmatory high-performance liquid chromatography-mass spectrometry and ELISA, and in commercial products purchased from supermarkets. In all positive samples, analytes were correctly identified with an error in mass identification lower than 5 ppm, while none of the 45 commercial samples analyzed were found to be contaminated. The proposed new assay is sensitive, with a limit of identification, for all the three matrices, complying with the limits defined by the European Union (0.5 to 1 mg/kg) for analytical methods. Compared with conventional methods, the new assay is rapid and inexpensive and characterized by a high throughput; thus, it could be suitable as screening technique to identify Sudan dyes in adulterated food products.

Promuovere l’engagement dei pazienti con malattie croniche: un percorso di ricerca collaborativa

L’engagement dei pazienti e riconosciuto come un elemento essenziale per la qualita dei servizi per le patologie croniche. Il contributo si propone di esplorare le dinamiche socioorganizzate che favoriscono l’engagement dei pazienti e la loro trasformazione da consumatori passivi di cura a partner. Sara presentata una ricerca collaborativa, realizzata con due servizi di un grande ospedale del Nord Italia, in cui pazienti e personale sanitario hanno cooperato per valutare e riorientare i percorsi diagnostico-terapeutici verso processi di lavoro partecipati centrati sul paziente. Strumenti di analisi delle pratiche sono stati l’analisi proattiva del rischio clinico (HFMEA) e l’analisi psicosociale degli snodi decisionali, applicati nell’ambito di focus group misti (pazienti, medici, infermieri, psicologi, assistenti sociali). I risultati hanno consentito di evidenziare l’intrecciarsi di aspetti clinici e organizzativi nelle rappresentazioni della natura dell’engagement e la sua caratterizzazione come un processo oscillante e instabile. Inoltre, attraverso l’analisi del processo d’indagine, e stato possibile identificare assunti e valori professionali che rischiano di dar vita ad una partecipazione apparente. La ricerca offre indicazioni per la progettazione di pratiche di gestione collaborativa dei percorsi di cura.

Lysine at position 222 of the goat prion protein inhibits the binding of monoclonal antibody F99/97.6.1.

Prion protein (PrP) is encoded by the PRNP gene, which is highly polymorphic in goats, with polymorphisms encoding amino acid substitutions at the protein level. In the current study, the reactivity of monoclonal antibody (mAb) F99/97.6.1 in binding PrP from goats polymorphic at PRNP codon 222 was investigated. Nervous tissue from 30 scrapie-negative goats with 3 different genotypes (222Q/Q, 222Q/K, and 222K/K) was analyzed by Western blot using mAbs P4 and F99/97.6.1. Although PrP was detected in all 30 samples by mAb P4, detection of PrP by mAb F99/97.6.1 was limited to 222Q/Q (12/12). No PrP was detected by mAb F99/97.6.1 in the 222K/K samples (n = 6), and the signal intensity of mAb F99/97.6.1 for PrP was lower for the 222Q/K samples (12/12 samples). To further investigate these results, additional Western blot analyses were performed, and the PrP signals detected by mAbs F99/97.6.1 and SAF84 were then quantified. The mean F99/SAF84 ratio (± standard deviation) calculated for the 222Q/Q group was 0.73 ± 1.26, and the mean for the 222Q/K group was 0.27 ± 1.31. Statistical analysis of these values evidenced statistically significant differences between the 222Q/Q and 222Q/K samples. The results of the study thus revealed an inhibition by lysine at position 222 on the binding of mAb F99/97.6.1 to goat PrP. This has implications for the use of mAb F99/97.6.1 for diagnostic purposes. Because the 222K allele could be a target for genetic selection in goats, the differential reactivity of mAb F99/97.6.1 could be exploited with a genotyping test setup.