Giovanni Boccia

GHPSS multicenter Italian survey: Smoking prevalence, knowledge and attitudes, and tobacco cessation training among third-year medical students

AIMS AND BACKGROUND Healthcare professionals have an important role to play both as advisers - influencing smoking cessation - and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach. METHODS AND STUDY DESIGN A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows. RESULTS Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03-3.97). CONCLUSIONS This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Sepsis and septic shock: New definitions, new diagnostic and therapeutic approaches

Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era.

From directive to practice: are pictorial warnings and plain packaging effective to reduce the tobacco addiction?

OBJECTIVES Tobacco packaging represents an important form of promotion of tobacco products and for this reason plain packaging (PP) can be considered an additional tobacco control measure. In Italy the current tobacco packaging is branded with textual warnings. The study investigated the perception of PP with textual warnings (PPTWs) and pictorial warnings (PPPWs) in Italy. STUDY DESIGN Cross-sectional. METHODS The study was conducted on adults who were current, never and former smokers. The participants watched out three types of packages (current packaging, PPTWs and PPPWs) and eight pictorial warnings, and indicated which they considered the most effective ones to motivate smoking cessation or reduction and to prevent the onset. RESULTS 1065 subjects were recruited. The PPPWs were considered the most effective in motivating to quit, reduce and prevent the smoking habits (ranged 83.4%-96.1%) in all tobacco users and age groups (≤40/>40 years) (P < 0.005). In general PP does not seem to be very effective in quitting for three-quarters of the smokers and 60% declared that they would have still started smoking with PP. The younger group believed less than the older one that PP gives a motivation to quit (29.4% vs 39.1%, P = 0.002). The pictures perceived as most effective in communicating the smoking effects were lung cancer and gangrene (about one-third of the sample). CONCLUSIONS The textual warnings on tobacco products are a measure of control now outdated. Countries still using them should consider the idea of replace them with pictorial warnings that seem to be more effective. It is also desirable in the near future that these countries introduce the PPPWs.

Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of Skin and Soft Tissue Infections (SSTIs)

Thirty-two patients affected by SSTIs including DFIs were enrolled between 2013 and 2014. Superficial swab was obtained before and after cleansing with sterile saline, and after ultrasonic debridement; deep tissue biopsy was obtained from ulcer base. Samples were diluted with 1 mL of saline, serial 10-fold dilutions to 10−6 were made and 50 μL of each dilution was plated onto appropriate media. Bacteria were identified by Vitek II system. Microbial load was expressed as CFU/mL. Statistical analysis was performed by χ2. Incidence of Gram positives was higher than Gram negatives (S. aureus and P. aeruginosa being the most frequent); concordance (same bacteria isolated before and after debridement) never exceeded 60%. Ultrasonic debridement significantly reduced bacterial load or even suppressed bacterial growth. While reliability of superficial swab is poor for microbiological diagnosis of SSTIs, swabbing after ultrasonic debridement and biopsy of the ulcer base may be equally reliable.

Internet Addiction: a prevention action-research intervention

The aim of this paper was to present an action-research intervention for the prevention of Internet addiction (IA) in schools. Applying a pre-experimental research design model, a total of 90 young subjects (45 males and 45 females) were treated using a peer education programme. The Internet Addiction Test was used as a screening tool pre- and post-treatment and analysed using a paired t-test. The results showed a significant positive difference in the post-treatment values for both males and females. This research highlights the link between IA and cultural and social aspects of the disease in addition to discussing the difficulties of IA prevention.

A multicenter study on the appropriateness of hospitalization in obstetric wards:application of Obstetric Appropriateness Evaluation Protocol (Obstetric AEP)

Abstract The cross-sectional study has been based on the implementation of the Obstetric Appropriateness Evaluation Protocol (OAEP) in seven hospitals to determine inappropriate hospital admissions and days of stay. The outcomes were: inappropriateness of admission and “percentage of inappropriateness” for one hospitalization. A total number of 2196 clinical records were reviewed. The mean percentage of inappropriateness for hospitalization was 22%. The percentage of inappropriateness for the first 10 d of hospitalization peaked in correspondence of the fourth (42%). The logistic regression model on inappropriated admission reported that emergency admission was a protective factor (OR = 0.4) and to be hospitalized in wards with ≥30 beds risk factor (OR = 5.12). The second linear model on “percentage of inappropriateness” showed that inappropriated admission and wards with ≥30 beds increased the percentage (p < 0.001); whereas the admission in Teaching Hospitals was inversely associated (p < 0.001). The present study suggests that the percentage of inappropriate admission depends especially on the inappropriate admission and the large number of beds in obstetric wards. This probably indicates that management of big hospitals, which is very complex, needs improving the processes of support and coordination of health professionals. The OAEP tool seems to be an useful instrument for the decision-makers to monitor and manage the obstetric wards.

Diagnostic and therapeutic appropriateness in bone and joint infections: results of a national survey

The impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.

Inconsistency of Sentinel Events and No Gender Difference in the Measurement of Work-Related Stress

Usually, sentinel events and gender are useful variables to propose appropriate intervention strategies for promoting public health. The Italian legislation has incorporated aspects of the scientific literature of stress into law 81/08 and the ministerial circular of November 18, 2010, obliging the detection of work-related stress with specific reference to gender and working environment characteristics. Specifically, the Italian law requires the discovery of sentinel events in the working environment. This study evaluates the role of sentinel events in the detection of work-related stress in relation to gender. The sample includes 249 Italian subjects of a debt collection company divided into two groups (male and female) and distributed in two different categories: Inside Sentinel Events and Outside Sentinel Events. A multifactorial questionnaire, the Organizational and Psychosocial Risk Assessment (OPRA), was administered. The application of two-way ANOVA did not show any statistically significant differences due to gender between the subjects who belonged to the sentinel events group and those who did not belong, as assessed by the Risk Index, the Inventory of Source of Risk, and variables linked to work conditions (work function and seniority). Significant differences were found between men and women only on the index of physical and mental health. Subsequently, three performed linear regression confirm the same results.

Identification of homogeneous risk classes in work-related stress: A methodological proposal

Identification of homogeneous risk classes in work-related stress: A methodological proposal through a Sentinel Events Database The European Agreement signed on 8 October 2004 defines the condition of work-related stress and obliges it be detected. Italian Law n. 81/08 and the Ministerial Circular of 18/11/2010 oblige Italian companies to detect work-related stress, with particular reference to Sentinel Events. This paper deals with a methodological proposal for the measurement of work-related stress, where legal restrictions are applied through the WSED-Stress method. It shows how the homogeneous classes of psychophysical risk can be detected as required by the law. The case-study shows how these risk classes may affect the measurement of work-related stress, with the OPRA test.

How to simplify and improve incident and near miss reporting in wards:I.R.G.E. (Incident Reporting with Gravity Effect) system

In this paper, an improved system that allows a simplified reporting of errors and near misses in wards, and permits operators to accurately manage all data recorded, is presented. IRGE (Incident Reporting with Gravity Effect) System is based on the use of a paper form for reporting accidents and near misses. The severity of an error can be evidenced through the choice of a color similar to the well-known method used in the emergency medicine triage, thus leading to the most evident and immediate understanding of the magnitude of error. In addition, the system is provided with a report form for its users to be compiled with the highest completeness of information. A dedicated software for the storage of records and data analysis has been created, which gives one the possibility of alerting key figures within the health facility promptly. The system allows us to store and share records among different care units and also among different hospitals, thus providing a basis for a national database. Moreover, through this system, it is possible to assess the “risk attitude” of the health facility monitored.