Implementation of a Poct (Point-Ofcare) System for the Detection of the Antigen of the Sars-Cov2 Virus in Emergency Department and for the Prehospitalization of the Hospitals of the Company Usl Toscana Sud Est

Introduction Following the release of the regional circulars recommending the execution of antigen tests for the diagnosis of Sars-Cov2 infection for all patients entering the emergency Department and in case of pre-hospitalization, it was decided to implement a system of POCT (Point-Of-Care) instruments in hospitals throughout the South-East USL area. Materials and methods The managers of the POCT network have provided each hospital with third generation tests capable of guaranteeing a sensitivity of over 95% and a specificity of 100%.The necessary skills for the staff were then determined and training sessions were planned to cover all the staff concerned thanks to the involvement of the specialized staff of the supplier company and the previously trained laboratory staff.Following the training of over 300 operators, its effectiveness was verified through online self-assessment questionnaires and each user was enabled to use the tool with their own identification. The insertion of the identification code for the individual operators, it was possible to monitor the correct performance of the pre-analytical procedures and to implement any corrective measures where necessary. Results All this has ensured, in addition to an optimal collaboration between the laboratory, the supplier company and the emergency room, a high level of data security related to a very low rate of invalid or discordant results. This resulted in a considerable time and cost saving when compared with the need to carry out repeated tests or confirmations with molecular tests. Conclusions This organization has allowed not only a supply of tests with superior performances, but to have a complete traceability of the results following the connection of the instruments to the systems of the hospitals and in the ability to apply the criteria necessary for an aware training of the operators, in accordance with what is reported in the ISO 9001/2015 standard.

The Lean methodology applied to risk assessment in the Blood Gas Analysis process

INTRODUCTION The BGA (Blood Gas Analysis) is a bedside testing that ensure results in a short time, usually performed in Emergency-Urgency for time-dependent clinical condition. Lean Thinking for 'KAIZEN' or rather, continuous improvement in services provision increasing the value perceived by the user reducing of waste. The aim of the present analysis has been to assess, applying Lean methods, the likelihood of risk in the BGA testing, related to the increase in their use during the COVID19 pandemic. MATERIALS AND METHODS To carry out the risk assessment, the context was studied through the use of distribution maps of the BGA analyzers in the Covid19 and non-Covid19 wards of the San Donato Hospital in Arezzo. Data was collected on the entire BGA process: activities, hours of greatest use, instrumental stops and maintenance, in the year 2020. The spaghetti chart, Lean mapping method, was used to calculate the distances between the instruments (used and backup) and patient beds. In addition, Lean methods were used: the Hishikawa Diagram with the cause-effect matrix, the HFMECA, the Swot, the monitoring indicators of the entire process and the A3 report. RESULTS The analysis carried out using the Lean methodology has shown that the entire ABG process is well governed within the wards. However, there remain the risks associated with the new staff employed and their training on the which much of the implementation plan was focused. The risk is mainly linked to the high turnover, to the reorganization of human resources that had to be used to deal the pandemic. CONCLUSIONS For optimal governance of BGA analyzers and reduce the risk in entire process, it is essential to maintain adequate and continuous training of personnel.

I-PHAN Study - Use of E-learning modules to Promote Physical activity and wellness among Nurses in order to improve mental and physical health: A research protocol for a randomized controlled trial.

AIM: To develop and test the effectiveness of an E-learning program for promoting physical activity (PA) and wellness among nurses. BACKGROUND: Restrictions during the coronavirus (COVID-19) pandemic drastically changed many people's lives. Maintaining a healthy lifestyle is an everyday challenge faced by the general popula-tion. Nurses are one of the health care professionals who are typically well-educated in taking care of patients. There are studies that show that night shifts, extended shifts, and obesity have a correlation with the prevalence of acute low back pain among female nurses. PA is the key factor in the prevention and treatment of many chronic diseases, resulting in an improvement in the quality of life. The impact of social media and technology on our lives is undeniable in the modern era. DESIGN: This study will be a single-centre, single-blind, randomi-zed controlled trial executed on an E-learning platform to provide the control and intervention groups with a distance learning program. Par-ticipants will be randomly assigned to either the control or intervention group. Participants in the control group will only sign up for module 1 of the PA modules, which only comprises information on PA and health promotion. On the other hand, the participants in the intervention group are expected to carry out 3 modules of exercises at home three days a week for a total duration of 8 weeks. The exercises will be performed at moderate intensity (5-6 on the Borg CR10 Scale). ETHICAL ISSUES: This trial will comply with the declaration of Helsinki 1975, as revised in 2000. Informed written consent will be obtained from the participants. The Sapienza University of Rome, institutional ethics committee and review board approval will be requested for this study. CONCLUSION: Establishing an online PA program with good quality, such as a high level of convenience in access and use, simplified, easy to practice, and made available on social media, can minimize the difficulties faced previously in the implementation of an online PA program for nurses, and may enhance the health and wellbeing of many nurses in healthcare institutions.

First wave of COVID-19 pandemic and caesarean delivery rate in Italy

INTRODUCTION When COVID-19 first spread in Europe, it was unclear if the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could be transmitted from mother to fetus. Hence, doubts arose as the best way to deliver considering that caesarean delivery (CD) indeed could prevent vertical transmission. METHODS We calculated CD rate in 5 Italian regions (Lombardy, Emilia-Romagna, Tuscany, Umbria, Sardinia) differently affected by the first wave of the pandemic. Data were retrospectively obtained from each birth center and aggregated by areas (provinces). Data related to March-April 2020, corresponding to first COVID-19 peak in Italy, were compared with the March-April 2019 as well with November-December 2019, and odds ratio (ORs) were calculated. RESULTS A total of 24 provinces were included, covering 21.8% of the Italian population. Overall CD rate did not differ in the three examined periods: neither in the comparison of March-April 2019 (reference period) versus November-December 2019 (OR: 0.98 95% CI 0.93-1.05) nor in the comparison of the reference period versus March-April 2020 (OR: 1.03;95 % CI 0.98-1.09). CD rate did not change even in areas with the highest incidence of COVID-19. Only 17 out of 3.257 CDs was due to direct COVID-19 complications (0.5%;95% CI 0.3-0.8). No pregnant women with COVID-19 proven infection died. CONCLUSIONS The first wave of COVID-19 pandemic did not significantly affect delivery mode in Italy, even in areas with the highest infection rates.