Francesca Rosa

Identifying and correcting communication failures among health professionals working in the Emergency Department

OBJECTIVEnThe aim of this study was to identify effective corrective measures to ensure patient safety in the Paediatric Emergency Department (ED).nnnMETHODSnIn order to outline a clear picture of these risks, we conducted a Failure Mode and Effects Analysis (FMEA) and a Failure Mode, Effects, and Criticality Analysis (FMECA), at a Emergency Department of a Childrens Teaching Hospital in Northern Italy. The Error Modes were categorised according to Vincents Taxonomy of Causal Factors and correlated with the Risk Priority Number (RPN) to determine the priority criteria for the implementation of corrective actions.nnnRESULTSnThe analysis of the process and outlining the risks allowed to identify 22 possible failures of the process. We came up with a mean RPN of 182, and values >100 were considered to have a high impact and therefore entailed a corrective action.nnnCONCLUSIONSnMapping the process allowed to identify risks linked to health professionals non-technical skills. In particular, we found that the most dangerous Failure Modes for their frequency and harmfulness were those related to communication among health professionals.

The role of simulation in developing communication and gestural skills in medical students

BackgroundInternational studies have shown that laboratory training, particularly through the application of the principles of simulation learning, is an effective means of developing the communication and gestural skills of healthcare professionals. At the Advanced Simulation Center of the University of Genoa we have therefore established the first clinical skill laboratory with medical school students and an interprofessional team of trainers, as the first step towards developing simulation training of both medical and nursing students at our University.The aim of this study was to assess student satisfaction with laboratory training in an Advanced Simulation Center.MethodsAll of the third-year students of the Medical School (nu2009=u2009261) were invited to participate in the laboratory sessions at the Advanced Simulation Center. They were divided into groups and attended the Center for one week. The team of trainers included medical doctors and nurses involved in teaching at the University Medicine and Nursing programs. At the end of the week, the students were administered an anonymous questionnaire made up of two sections: the first one was on the content of individual laboratory sessions; the second on the training methods, materials used and the trainers. A five-point Likert scale was used to measure satisfaction.ResultsAccording to the students all of the topics covered by the laboratory sessions were irreplaceable. Questionnaire results showed a high level of satisfaction with the methods used, the instruments developed, and with the expertise and approachability of the educators. Almost all of the students wanted to participate in similar laboratory activities in the future.ConclusionsThe study highlighted the need to permanently integrate laboratory training sessions into the curriculum of medical students, who found them very useful and stimulating. The limit of this study was that only the teaching staff was interprofessional, and the students were only 3rd Year students of medicine.In the future, we hope to include also nursing students because they will need to learn how to deal with aspects of their clinical practice that require an interprofessional approach.

Mathematical calculation skills required for drug administration in undergraduate nursing students to ensure patient safety: A descriptive study: Drug calculation skills in nursing students

In the literature we found many studies that confirmed our concerns about nursing students poor maths skills that directly impact on their ability to correctly calculate drug dosages with very serious consequences for patient safety. The aim of our study was to explore where students had most difficulty and identify appropriate educational interventions to bridge their mathematical knowledge gaps. This was a quali-quantitative descriptive study that included a sample of 726 undergraduate nursing students. We identified exactly where students had most difficulty and identified appropriate educational interventions to bridge their mathematical knowledge gaps. We found that the undergraduate nursing students mainly had difficulty with basic maths principles. Specific learning interventions are needed to improve their basic maths skills and their dosage calculation skills. For this purpose, we identified safeMedicate and eDose (Authentic World Ltd.), only that they are only available in English. In the near future we hope to set up a partnership to work together on the Italian version of these tools.

Effects of miRNA-15 and miRNA-16 expression replacement in chronic lymphocytic leukemia: implication for therapy

Chronic lymphocytic leukemia (CLL) clones are characterized by loss of a critical region in 13q14.3, (del(13)(q14)) involving the microRNA (miRNA) cluster miR-15a and miR-16-1. We have investigated the effects of replacement of miR-15a and miR-16-1. CLL cells transfected with these miRNA mimics exhibited a decrease in cell viability in vitro and impaired capacity for engraftment and growth in NOD/Shi-scid,γcnull (NSG) mice. No synergistic effects were observed when the two miRNA mimics were combined. The phenomena were not restricted to CLL with the del(13)(q14) lesion. Similar effects induced by miRNA mimics were seen in cells with additional chromosomal abnormalities with the exception of certain CLL clones harboring TP53 alterations. Administration of miRNA mimics to NSG mice previously engrafted with CLL clones resulted in substantial tumor regression. CLL cell transfection with miR-15a and miR-16-1-specific inhibitors resulted in increased cell viability in vitro and in an enhanced capacity of the engrafted cells to grow in NSG mice generating larger splenic nodules. These data demonstrate that the strong control by miR-15a and miR-16-1 on CLL clonal expansion is exerted also at the level of full-blown leukemia and provide indications for a miRNA-based therapeutic strategy.

Correlation between Choline Peak at MR Spectroscopy and Calcium-Sensing Receptor Expression Level in Breast Cancer: A Preliminary Clinical Study

PurposeThe calcium-sensing receptor (CaSR) is overexpressed in many pathological states including breast cancer. Since choline kinase may be activated in breast cancer cells by CaSR resulting in increased phosphocholine production, we sought to correlate the total choline peak in breast lesions as measured by in vivo proton magnetic resonance spectroscopy (1H-MRS) with the CaSR expression levels in surgical specimens.ProceduresThirty-six patients with breast lesions were MR scanned at 3T scanner. Tumour morphology and DCE-MR kinetics were evaluated. 1H-MRS was applied for Cho detection and compared with the CaSR immunohistochemistry analysis (score 0–5) on surgical breast specimens.ResultsThirty-four lesions demonstrated a DCE malignant kinetics curve (types 2 and 3), while two lesions showed a benign (type 1). Twenty of the 23 breast cancer lesions (87xa0%) with a consistent Cho peak expressed a CaSR score of 3–5, and ten of the 11 breast lesions negative for Cho (91xa0%) had a CaSR score of 1–2. The two benign lesions showed a non-uniform/weak intense expression of the CaSR (score 3) with a consistent Cho peak.ConclusionsThe presence or absence of choline peak evaluated by 1H-MRS, well correlated with the expression of CaSR in patients with breast lesions (pu2009<u20090.01), supports the hypothesis that CaSR may play an important role in the production of choline in breast cancer.

Preliminary testing using Mokken scaling of an Italian translation of the Edinburgh Feeding Evaluation in Dementia (EdFED-I) scale

PURPOSEnTo study the psychometric properties of an Italian version of the Edinburgh Feeding Evaluation in Dementia (EdFED-I) Scale.nnnBACKGROUNDnThe EdFED Scale is the only validated instrument that measures difficulty with feeding in older people with dementia. The original English version of the EdFED had three factors measuring: behavioral aspects of feeding difficulty (obstinacy/passivity); indicators of feeding difficulty; and nursing interventions.nnnMETHODSnParticipants affected by dementia and living in nursing homes (n=210) were selected. Data collectors were trained to observe the residents eating problems and their food intake. The data were analyzed using Mokken scaling and Pearsons correlation.nnnRESULTSnThe Italian version of the EdFED Scale formed a Mokken scale which correlated in the expected direction with measures of residents weight, Body Mass Index, time taken to eat, Mini Mental State Examination score and Barthel Index according to the unmet needs model of Cohen-Mansfield.nnnCONCLUSIONSnThe EdFED-I shows reasonable psychometric properties and can be used for the assessment of feeding difficulty in Italian samples of older people with dementia. However, further work with larger samples is required to test the utility of the whole range of items and the necessity of their inclusion in the EdFED-I.

A non-invasive approach to monitor chronic lymphocytic leukemia engraftment in a xenograft mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI)

Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia among adults. Despite its indolent nature, CLL remains an incurable disease. Herein we aimed to monitor CLL disease engraftment and, progression/regression in a xenograft CLL mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI). Spleen contrast enhancement, quantified as percentage change in signal intensity upon USPIO administration, demonstrated a difference due to a reduced USPIO uptake, in the spleens of mice injected with CLL cells (NSG-CLL, n=71) compared to controls (NSG-CTR, n=17). These differences were statistically significant both after 2 and 4weeks from CLL cells injection. In addition comparison of mice treated with rituximab with untreated controls for changes in spleen iron uptake confirmed that it is possible to monitor treatment efficacy in this mouse model of CLL using USPIO-enhanced MRI. Further applications could include the preclinical in vivo monitoring of new therapies and the clinical evaluation of CLL patients.

Effectiveness of a Clinical Skills Workshop for drug-dosage calculation in a nursing program

BACKGROUNDnMathematical and calculation skills are widely acknowledged as being key nursing competences if patients are to receive care that is both effective and safe. Indeed, weaknesses in mathematical competence may lead to the administration of miscalculated drug doses, which in turn may harm or endanger patients lives. However, little attention has been given to identifying appropriate teaching and learning strategies that will effectively facilitate the development of these skills in nurses. One such approach may be simulation.nnnOBJECTIVESnTo evaluate the effectiveness of a Clinical Skills Workshop on drug administration that focused on improving the drug-dosage calculation skills of second-year nursing students, with a view to promoting safety in drugs administration.nnnDESIGNnA descriptive pre-post test design.nnnSETTINGSnEducational. Simulation center.nnnPARTICIPANTSnThe sample population included 77 nursing students from a Northern Italian University who attended a 30-hour Clinical Skills Workshop over a period of two weeks.nnnMETHODSnThe workshop covered integrated teaching strategies and innovative drug-calculation methodologies which have been described to improve psychomotor skills and build cognitive abilities through a greater understanding of mathematics linked to clinical practice.nnnRESULTSnStudy results showed a significant improvement between the pre- and the post-test phases, after the intervention. Pre-test scores ranged between 0 and 25 out of a maximum of 30 points, with a mean score of 15.96 (SD 4.85), and a median score of 17. Post-test scores ranged between 15 and 30 out of 30, with a mean score of 25.2 (SD 3.63) and a median score of 26 (p<0.001).nnnCONCLUSIONSnOur study shows that Clinical Skills Workshops may be tailored to include teaching techniques that encourage the development of drug-dosage calculation skills, and that training strategies implemented during a Clinical skills Workshop can enhance students comprehension of mathematical calculations.

Functional Activation of Osteoclast Commitment in Chronic Lymphocytic Leukaemia: A Possible Role for RANK/RANKL Pathway

Skeletal erosion has been found to represent an independent prognostic indicator in patients with advanced stages of chronic lymphocytic leukaemia (CLL). Whether this phenomenon also occurs in early CLL phases and its underlying mechanisms have yet to be fully elucidated. In this study, we prospectively enrolled 36 consecutive treatment-naïve patients to analyse skeletal structure and bone marrow distribution using a computational approach to PET/CT images. This evaluation was combined with the analysis of RANK/RANKL loop activation in the leukemic clone, given recent reports on its role in CLL progression. Bone erosion was particularly evident in long bone shafts, progressively increased from Binet stage A to Binet stage C, and was correlated with both local expansion of metabolically active bone marrow documented by FDG uptake and with the number of RANKLu2009+u2009cells present in the circulating blood. In immune-deficient NOD/Shi-scid, γcnull (NSG) mice, administration of CLL cells caused an appreciable compact bone erosion that was prevented by Denosumab. CLL cell proliferation in vitro correlated with RANK expression and was impaired by Denosumab-mediated disruption of the RANK/RANKL loop. This study suggests an interaction between CLL cells and stromal elements able to simultaneously impair bone structure and increase proliferating potential of leukemic clone.

Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review

This paper was a report of the synthesis of evidence on examining the origins and definitions of the concept of resilience, investigating its application in chronic illness management and exploring its utility as a means of understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease.