Nurse perception on ECMO care: A literature review

Objectives: The nursing care is more complex in relation to new technologies, new diseases, new globally emergencies. In relation to technology, nurses acquired more competences in relation to advanced therapy, in respiratory, circulatory, and renal support. The nursing workload increases in complexity and in responsibilities, without a staff increasing in relation to nursing activities. ECMO was widely applied to manage acute respiratory distress syndrome and circulatory failure, in case of cardiac arrest or cardiogenic shock, configuring as a therapy bridge to decision, to restore, to transplant or to nowhere. During the last years, nurses were involved to a rapid and continuous changing, to respond adequately to new health challenges, understanding or not their role and responsibilities in globally health care system. Nurse manages different variables, well represented by nursing activities score, but in nursing ECMO care, these variables are more complicated, in relation to ECMO device and to ECMO patient. What is the globally perception of nurses involved in ECMO care? Methods: A literature review was applied on PubMed. The inclusion criteria were all articles about ECMO, including pediatric and/or adult population, with a publication less than ten years. Result(s): A total of sixteen articles were found, with reduction to ten for relevance. The excluded articles talked about non ECMO care or patient;s perceptions. Articles included in the research talk about nursing perceptions (40%), education (30%), ethics in ECMO care (20%), professional experience in ECMO Covid (10%). Conclusion(s): The nursing perception on ECMO nursing care are different. They recognize the central role in ECMO care, but over workload, without staff increasing, less peer support, a low teamwork and personal differences in technical and non-technical skills increase some barriers to nursing perception of themselves. Nurses allocate their competence on experience and continuous training, but also a good teamwork and a professional recognition by other health care professions or by nursing supervisors can increase nursing perception and reduce the abandonment of nursing profession.

Assessment of the challenges and adaptation strategies of pediatric nurses in charge of caring for children with COVID-19

Background: Coronavirus Disease 2019 (COVID-19) is a pandemic cause severe acute respiratory syndrome. It is a major public health crisis threatening humanity since world war two. Aim(s): This study aimed to assess challenges and adaptation strategies of pediatric nurses in charge of caring for children with COVID-19. Methodology: A descriptive research design was used to conduct this study. Setting(s): This study was carried out at pediatric hospital affiliated to Fayoum university hospitals. A purposive sample of 100 nurses who providing care for children with COVID-19 in the previous mentioned setting. A structured interview questionnaire sheet consisted of four parts were used for data collection: Part (1): Assess characteristics of studied sample;Part (2): Assess pediatric nurses' knowledge regarding caring for children with COVID-19;Part (3): Challenges that faced pediatric nurses in caring of children with COVID-19;Part (4): Adaptation strategies used by pediatric nurses to face of COVID-19 of children. Result(s): The results showed that 55% of the studied nurses had unsatisfactory knowledge level of caring for children with COVID-19. Regarding total challenges 75% of studied nurses had psychological challenges and 65% of the studied nurses had high working pressure. Also, regard adaptation strategy 60%, 55% and 51% of the studied nurses not used cognitive and educational adaptation, psychological and emotional adaptation and physical adaptation respectively. Conclusion(s): The present study concluded that, there was highly statistically significant between total challenges of COVID-19 and total adaptation strategies among pediatric nurses in charge of caring for children with COVID-19. Recommendations: Continuous training program for pediatric nurses to improve using of the adaptation strategies of caring for children during the COVID-19.Copyright © 2023 Scientific Publishers of India. All rights reserved.

Comparison of High-Intensity Interval Training to Moderate-Intensity Continuous Training for Functioning and Quality of Life in Survivors of COVID-19 (COVIDEX): Protocol for a Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to compare high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) for feasibility, safety, adherence, and short- and long-term efficacy in improving functioning and health-related quality of life in survivors of coronavirus disease 2019 (COVID-19). METHODS: COVIDEX is a two-pronged, parallel-group, randomized controlled trial with an 8-week training intervention. The study participants will be 94 patients aged >18 years, admitted to a specialized post-COVID center. Participants will be randomized to HIIT (4 × 4 minutes of high-intensity work periods at 85% to 90% of peak heart rate) and MICT (47 minutes at 70% to 75% peak heart rate) groups for biweekly sessions for 8 weeks. The participants will undergo 2 phases of supervised training (phases 1 and 2) of 4 weeks each, in a public, specialized, post-COVID center. In phase 1, we will assess and compare the feasibility, acceptability, and short-term efficacy of HIIT and MICT intervention. In phase 2, the long-term efficacy of HIIT and MICT will be assessed and compared regarding function and health-related quality of life. To prevent any expectation bias, all study participants and assessors will be blinded to the study hypotheses. Group allocation will be masked during the analysis. All statistical analyses will be conducted following intention-to-treat principles. IMPACT: This study is the first randomized controlled trial that will compare the feasibility, safety, adherence, and efficacy of the HIIT and MICT intervention programs in this population. The findings will potentially provide important information and assist in clinical decision making on exercise to optimize the benefits of clinical health care in survivors of COVID-19.

Implications of Corona Virus Disease-19 Pandemic on Cytopathology Laboratory-Challenges and Solutions in Resource Limited Setting

Introduction: Corona Virus Disease-19 (COVID-19) disease which is still showing peaks and plateau with emerging new mutational variants led to modification of working of hospitals and medical institutes. The present study was conducted to study various measures adopted and changes made in the cytopathology laboratory during COVID-19 infection in resource limited setting but catering to large population of covid patients. It was also intended to study methods adopted for effective cytopathology residency training during corona times. Material(s) and Method(s): The study analyzed the working of cytopathology lab during corona times from March 2020 till December 2021 and compared it with pre corona times from March 2018 till December 2019. The different methods adopted for effective cytopathology residency training were also analyzed. Result(s): A decrease of 1.9% of cases was observed during corona with increase of 17.4% for samples of respiratory tract including aspergillosis, mucormycosis and tuberculosis (Table1). There was 10.3% increase in cytological diagnosis of malignant cases during corona times (Table 2). Use of 90% alcohol for fixation, avoiding of pneumatic tube, judicious use of PPE kit along with access of digital cytology slides database was included in the changes made in the lab (Table 3). Conclusion(s): There was marginal decrease of cytopathological diagnosis during COVID-19 with substantial increase in malignancy rate of 10.3% in cytological diagnosis of different organs. Diagnosis of mucormycosis, aspergillus and tuberculer infection in respiratory tract cytology increased during this period. Judicious use of limited available resources led not only to smooth functioning of the cytopathology lab but also prevented any infection in the working health personals. Newer online resources were explored and modified for continuous training of the Cytopathology residents. Emotional support with effective communication was the key to alleviate any psychological stress amongst health professionals in the Cytopathology laboratory.

COVID-19 pandemic: regular physical activity and respiratory exercises at home as prevention and treatment

The main question in the field of exercise and rehabilitation medicine is whether physical activity and therapeutic exercise are suitable activities for CoVid-19 patients who are recovering at home. There have been few public health guidelines provided about what people can do in relationship with exercise and respiratory care. For this reason, it is necessary that physical therapists give some recommendations concerning safe respiratory and physical exercises that could be executed by people with confirmed, suspected, or probable CoVid-19 who stay at home.Copyright © 2022 University School of Physical Education in WrocAaw. All rights reserved.

Investigating the Waste Management Knowledge and Performance of Health Personnel in the COVID-19 Epidemic

Objective: The aim of this study was to investigate the waste management knowledge and performance of health personnel in the COVID-19 epidemic. Method(s): This cross-sectional study was conducted on 470 of personnel in hospitals, health centers, and affiliated subordinate units of Jiroft University of Medical Sciences were selected utilizing the available sampling method from June to December 2020. The researcher-made questionnaire was developed utilizing available articles and books in the field of waste. The results were analyzed by SPSS software version 24 and independent t-test and Kruskal-Wallis tests. Result(s): According to the results of study, the status of information, production, and collection of waste in employees were desirable, but separation, transportation, and recycling were not appropriate. Moreover, there was a statistically significant difference in information (p = 0.000), production (p = 0.000), collection (p = 0.000) and general waste management (p = 0.001) among health centers. Also it was a significant relationship between residence (p = 0.006), education (p = 0.029), and location of work (p = 0.001) with waste management. Samples living in the village had a higher average score than city residents. The location of work also showed that the employees of the Health homes had a higher waste management score than other health centers. Conclusion(s): According to the low performance of employees working in cities and hospitals in the field of waste separation, transportation and recycling, it is recommended that continuous training of employees electronically and virtually (preparing a short video on how to sort and recycle waste, inviting a recycling management specialist for training, role-playing). Also it is importance to improve performance and motivation and the existence of practical rules, instructions and adequate monitoring. Copyright © 2022 Kheirkhah Vakilabad et al.

Il Poct Nello Sviluppo Di Un Network Clinico Assistenziale Nella Medicina Di Prossimita

Point of care (POC) are tests conducted near the site of patient care, outside of laboratory, usually performed by patients or healthcare personnel not trained in laboratory medicine. POC testing (POCT) require small sample volumes, minimize pre-analytical errors, and reduce alterations of labile analytes. Furthermore, when used appropriately, could improve the patient's outcomes providing faster results and earlier therapeutic strategies. Instead, its over or incorrect use could lead to a patient risk and potential increase of healthcare costs.In the Province of Modena, a decentralized and multi-professional POCT diagnostic system was developed to integrate the clinical and diagnostic pathways supporting fast clinical decisions, to improve outcomes and to optimize the clinical patient pathways. We installed 129 POCT (77 emogasanalyzers, 9 coagulometers, 9 instruments for haematological tests, 9 instruments for chemical analyses, 10 counters, 6 for immunoassay, 3 cube-PCR and 6 for rapid diagnosis of COVID-19). These instruments were installed not only in emergency rooms of three Hospitals but also in specific setting as the OSCO-Community hospital, oncological and emergency setting and Neonatal Intensive Care. Furthermore, 264 glucometers were located in various departments of three hospitals. This system provides multiple advantages for: (i) patients reducing waiting time and long-distance travelling from home, (ii) healthcare professionals improving skills, autonomy and responsibility, reducing workload and promoting collaboration, and (iii) the healthcare system giving continuity in the therapeutic and assistance pathways ensuring a high analytical quality and costs reduction. To implement a successful POCT network is vital to develop a multidisciplinary team composed by physicians, nurses and laboratory technicians working together. Furthermore, the continuous training and education of operators guarantees the efficiency and productivity of the system.In conclusion, the POCT network represent an opportunity for the health care system to consolidate the patients-based laboratory medicine, reducing for diagnostic response, clinical decision and the hospitalization.

The Croydon Elective Centre-Surgical Hub supporting patient care and surgical training

Aims: NHSE/I and The RCS England have advocated that The separation of elective and surgical care is fundamental in recovering surgical services. It is suggested that The separation is physical and many Trusts are transforming pathways into elective and emergency hospitals. Croydon Hospital (CHS) have created an alternative, with 'a Hospital within a Hospital', separating these pathways within one estate, and considers whether this is a successful model for The future. Method(s): The day surgery unit On The ground floor was converted into an emergency centre with an ambulatory surgical hub, a hot clinic, clinical space, 4 emergency theatres and an USS room. The main theatre suite was converted into The Croydon Elective Centre (CEC) with a 12-bedded coronary catheter suite, a lift onto The second floor, 10 theatres, a 12 bedded children's day unit, Moorfields' eye unit, a new canteen, an admissions unit as well as a 28-bedded elective ward with a new 4-bedded level 1.5 critical care unit. Result(s): At The end of wave 1, 3,068 patients awaited treatment, an increase of 30.44% of baseline activity with theatre activity at 28% of normal activity. Activity resumed to 100% within 6 weeks of CEC go live. 2/9,606 patients were Covid-19 positive in The first year. During wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098 patients await treatment. Conclusion(s): The implementation of a surgical hub has supported The treatment of patients as well as provided continuous training opportunities for surgical and anaesthetic trainees as well as The theatre team.

Secondary school teachers' uses of ICT

ICT have become ubiquitous in teachers' daily lives as well as in their professional environment. Thus, a legitimate question that arises is to what extent their pedagogical practice mirrors this ubiquity. In that sense, our study would be an answer to this question. A survey of 260 secondary school teachers in the provincial directorate of Rhamna (Morocco), within the context of the COVID-19 crisis, allowed us to stress the following results: The alignment of teachers' personal, professional, and pedagogical uses of ICT, The significant relationship between continuous training and the integration of ICT into teaching practices, and The positive impact of the pandemic on teachers' attitude towards the importance of pedagogical uses of ICT. © 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0) Peer-review under responsibility of the Conference Program Chairs.

Future Online Learning for Public Administration

In this article, we analyze the perspectives of professional training for public administration workers, starting from the insights gained from online courses run during the past two years in the context of the SARS-CoV-2 pandemic. In order to understand the nature, type, and magnitude of the changes brought by the COVID-19 pandemic in the field of continuous professional training for public administration, we carried out a systematic bibliographic analysis, as well as questionnaire-based empirical research conducted among public institution employees in Romania. This article was conducted based on the hypothesis that the professional training activities over the past two years have been organized predominantly online, and we aim to analyze the sustainability of these new teaching systems/methods. The limitations of the study are due to the fact that each administrative system has structural particularities and its own legal framework regarding the professional training of public administration workers;for this reason, the proposed model may not be successfully applied in all countries. We provide a model of online professional training for public administration workers that includes sustainability criteria and is based on experience accumulated over the past two years. © 2022 by the authors.

Assessment of knowledge, practice and compliance eye care guidance in neurocritical care unit

Introduction: Ocular complications in critically ill patients is common. Up to 42% of intensive care unit patients can have signs of damage to the corneal surface of the eye (exposure keratopathy), which can lead to secondary complications and ultimately irreversible visual loss1,2 (Rosenberg and Eisen, 2008;Bird et al, 2017). Emergence of COVID-19 pandemic has meant increased number of critical care admission with inherent risk of ocular complication owing to need for non-invasive ventilation, mechanical ventilation and prone ventilation. All these factors have resurfaced need for increased awareness and adherence to national standards related to eye care in critical care3 (Royal college of Ophthalmology and Intensive Care Society joint Ophthalmic service guidance). Objectives: To study baseline knowledge and awareness of eye care practices in neuro critical care unit. To measure compliance of national eye care guidance. Methods: Structured online survey for critical care nurses. Review of hospital IT software to study snapshot of eye care compliance. Results: We ran baseline survey of neuro critical care nurses on knowledge and current practice of eye care in ICU. Eye care complications in ICU are common with 1 in 5 individual reporting > 3 ocular complications in last 3 months. Three-quarter of individuals reported to have good to very good knowledge of eye care protocol with 66% aware of current national guidance. 86% of respondents assessed lagophthalmos while 76% assessed conjunctiva and cornea routinely. On the flipside however only 60% routinely documented eye care measures in clinical practice. Importantly, 96% responded that they would benefit from education and training in eye care practices. Review of hospital records for eye care compliance and documentation validated the findings on the survey. We found 68% compliance rate for assessment of lagophthalmos in all admitted patient in neuro critical care unit. There was 100% compliance to institution of protective measures and appropriate escalation to medical staff. Graph 1: Baseline survey of knowledge and practice of Eye care in Neuro Critical Care Unit depicting a stepladder pattern in knowledge, practice and documentation of Eye care. Conclusion: Knowledge and awareness of eye care practices fall below national guidance. There is clear gap in knowledge, practice and documentation of eye care practices. Incorporation of eye care module in continuous training program and use of cognitive aids may help to further improve compliance and documentation of eye care practice in future.

ONCE AT THE EPICENTER OF THE PANDEMIC, ELMHURST HOSPITAL LEADING EQUITY FOR DIABETES CARE

STATEMENT OF PROBLEM/QUESTION: Improve diabetes quality and equity during the pandemic. DESCRIPTION OF PROGRAM/INTERVENTION: Elmhurst hospital center is one of 11 acute care hospitals in the NYC H+H network, the largest public health care system in the United States. Elmhurst hospital was at the epicenter of the COVID 19 pandemic in March 2020;providing care for immigrant, uninsured and underinsured patients, including more than 5000 patients with diabetes. As NYC emerged from the first surge, the primary care clinic assessed and addressed care gaps. Difficulties in accessing in-person visits, lab, and the social and economic impact on patients added to the challenges of managing diabetes during the pandemic. Disproportionately burdened were ethnic and racial minorities. An assessment of the diabetes outcome revealed that the control rate of diabetes defined as Hemoglobin A1c (A1c) less than 8% dropped by 8% compared to the pre-pandemic rate. There was a 4% difference in diabetes outcomes between the insured and uninsured patient populations.The clinic leadership implemented a collaborative care model. The collaborative care model consists of clinical pharmacists, registered nurses, a diabetes education-certified dietitian, and the population health team that provides outreach and data analytics support. Patients referred to the collaborative team by the primary care provider who assists in setting the treatment plan and goals. The collaborative care team screens every patient for barriers and social needs, provides diet education and a self-management plan. Each patient receives medication management in either the RN led treat-totarget clinic or by the clinical pharmacist. The referral criteria follow an algorithm based on the A1c level of control, number of medications, and the use of injectables. Cases are discussed weekly in collaboration with the primary care provider. The level of care is adjusted to address patient needs. The team determines the number of visits and time between visits based on the clinical progress. Visits are conducted in person and virtually;tailored to the patient's ability to use telehealth. MEASURES OF SUCCESS: Diabetes control improved by 10% in 8 months. The gap between insured and uninsured was reduced from 4% to 1% at the end of the study project period. FINDINGS TO DATE: A team-based approach using risk stratification that incorporates clinical outcomes and patient social barriers led to significant improvement in diabetes outcomes and closed the inequity gap. KEY LESSONS FOR DISSEMINATION: - High-quality diabetes care requires a multi-disciplinary team approach. - Treat-to-target RN visits improved access and equity in diabetes care. - Clinical Risk algorithms must incorporate social barriers. - Team-based approaches require continuous training and evaluation, with team members empowered for decision making.

Escola da Terra in the municipality of Sao Sebastiao do Uatuma/AM: challenges in the Covid-19 pandemic

This article approaches the experience of the improvement course in "Education of the field: pedagogical practices" developed within the scope of the School of the Earth Program (Pronacampo) worked by the Federal University of Amazonas in the municipality of Sao Sebastiao of Uatuma/AM. The objective of the research is to investigate the trajectories adopted, during the activities of the improvement course, by the trainers and course teachers and present the results achieved. The methodological procedures involved bibliographic and field research, whose discussions were based on the context of the Amazonian field, pedagogical practices oh the teachers and the academic productions of the teachers of the course - highlighting the conditions given by the covid-19 pandemic to the basic education network of that municipality and to the Federal University of Amazonas (UFAM) in offering continuous training to rural teachers. Even with the setbacks of educational policies at the national level, we highlight the School of the Earth Program in the training of rural teachers in the state of Amazonas, and more specifically in Sao Sebastido of Uatuma as fundamental in the construction of the counter-hegemonic praxis of the rural educator in the Brazilian Amazon.

DEVELOPMENT OF HOME DIALYSIS PATIENT SUPPORT SYSTEM USING CLOUD SYSTEM II-ADDITION OF EXERCISE THERAPY FUNCTION

BACKGROUND AND AIMS: The number of patients requiring home dialysis in Japan is increasing due to COVID-19 and the aging of the population. Home haemodialysis has been performed in Japan since the 1960s. However, as of March 2019, there were 720 home haemodialysis patients in Japan, which is only 0.2% of the total number of dialysis patients. The possible causes are as follows. The number of home haemodialysis patients has not increased markedly due to safety concerns as home haemodialysis patients perform dialysis at home, and the out-ofpocket costs are high. In addition, patients and caregivers must be able to manage themselves, and the burden on both patients and caregivers is heavy. Therefore, the Ministry of Health, Labour and Welfare (Japan) has advocated the need for home patients to share information with medical institutions to improve their quality of life, including COVID-19 measures. We have built a system to support home dialysis patients. Here, we have added an exercise therapy function to this system to encourage patients to continue exercising. METHOD: The items recorded/displayed in the patient's home peritoneal dialysis support system included records such as time, blood pressure, blood glucose level, urine volume, meal content, replacement start time, dialysate/plasma ratio, drainage volume, injection volume, water content and water removal and drainage. These inputs were entered via drop-down menus and displayed visually in graphs or by uploading images. The medical staff could see photographs of the affected areas and of meals entered by the patient. Patients could also share their opinions and treatment schedules with the medical staff at the medical institution. In addition, when exercising, the patients used an ergometer that allowed them to sit or lie down. The developed system incorporates records of the patient's exercises. Data were captured directly from the ergometer into the developed system in CSV format and could also be entered manually via drop-down menus. RESULTS: Using the developed system, we were able to enter and view patients' vital data and display photographs showing the color and volume of the drainage pack. By viewing these photographs, the medical staff could confirm the photographs of the affected areas, the color of the packs and the contents of the patients' meals. In addition, displaying the patient's vital records in a graph allowed for visual evaluation over time, which was useful when giving advice to patients. Using the two-way communication function, patients were also able to share their opinions and treatment schedules with the medical staff of the medical institution. Patients can now consult with medical staff, making their homes more like part of the hospital and giving them greater peace of mind. Figure 1 shows an example of the display of the developed system. Figure 2 shows an example of the patient's pedaling exercise results input from the ergometer. The amount of pedal movement performed by the patient was conserved through the dynamo and used to charge mobile devices. This allows the patient to charge their mobile devices while exercising, thus encouraging them to continue exercising. CONCLUSION: We have developed a support system for home haemodialysis patients that allows the input and display of patients' vital records and consultation with medical staff online. We have added a function to the system to encourage home haemodialysis patients to continue exercising. By using the developed system, patients can now perform home dialysis, including continuous exercise safely and with peace of mind, and healthcare professionals can access all medical information of patients, including changes over time. (Figure Presented).

Development of the Digital Teaching Competence in University Contexts. A Systematic Review

The process of digitization in higher education brings with it the need for digitally competent teaching staff, which has become even more evident in the face of Covid-19. Universities have implemented various strategies to help faculty develop digital teaching competence and although institutional frameworks and initiatives exist, there is not enough scientific literature describing them. This research aims to analyze the characteristics and results of training strategies to develop the DTC in the university environment. A systematic review of the literature was carried out in the main databases, following the PRISMA methodology. Starting with 322 documents, and after the filtering phases, a total of 20 documents were analyzed in depth. The results indicate that most of these strategies have an impact on areas such as professional competence and the use of technologies in the training process. Likewise, most of the strategies are based on isolated actions, such as courses or seminars, although collaborative, experiential and reflection-based methodologies emerge;aspects that are highly valued by the teaching staff. In conclusion, it should be noted that, beyond isolated actions, it is essential to have appropriate institutional strategies to enhance the value of the digital teaching competence and promote a true digital transformation.

Exercise Training in Patients with Heart Failure: From Pathophysiology to Exercise Prescription

Heart failure (HF) is a chronic, progressive, and inexorable syndrome affecting worldwide billion of patients (equally distributed among men and women), with prevalence estimate of 1–3% in developed countries. HF leads to enormous direct and indirect costs, and because of ageing population, the total number of HF patients keep rising, approximately 10% in patients >65 years old. Exercise training (ET) is widely recognized as an evidence-based adjunct treatment modality for patients with HF, and growing evidence is emerging among elderly patients with HF. We used relevant data from literature search (PubMed, Medline, EMBASE) highlighting the epidemiology of HF; focusing on central and peripheral mechanisms underlying the beneficial effect of ET in HF patients; and on frail HF elderly patients undergoing ET. Since many Countries ordered a lockdown in early stages pandemic trying to limit infections, COVID-19 pandemic, and its limitation to exercise-based cardiac rehabilitation operativity was also discussed. ET exerts both central and peripheral adaptations that clinically translate into anti-remodeling effects, increased functional capacity and reduced morbidity and mortality. Ideally, ET programs should be prescribed in a patient-tailored approach, particularly in frail elderly patients with HF. In conclusion, given the complexity of HF syndrome, combining, and tailoring different ET modalities is mandatory. A procedural algorithm according to patient’s baseline clinical characteristics [i.e., functional capacity, comorbidity, frailty status (muscle strength, balance, usual daily activities, hearing and vision impairment, sarcopenia, and inability to actively exercise), logistics, individual preferences and goals] has been proposed. Increasing long-term adherence and reaching the frailest patients are challenging goals for future initiatives in the field.

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.

Health surveillance program for CoViD-19 in hospital

Background and Aim: In February 2020, the pandemic phase of CoViD-19 began in Italy. Healthcare workers were at the forefront of care and were immediately exposed to the risk of infection. Aim of the study was to evaluate the impact of the health surveillance system on the spread of infections in a health population Materials and Methods: The cases of infection in the period February 2020 - February 2021 were examined, compared to the number of molecular swabs performed on the health personnel of the F. Miulli Regional Hospital, in Acquaviva delle Fonti (BA). Results: A total of 14,133 molecular swabs were performed (on average 1,177 per month), finding 169 positive cases (equal to 1.19% of total swabs), on average 14 cases per month. The program included a schedule for performing swabs based on the level of risk of the healthcare staff. The tracking system put in place by the prevention service made it possible to minimize the spread of the infection. In addition, a continuous training program for operators on the use of personal protective equipment has been established, with random checks on correct use. Discussion: The health surveillance system, through the execution of periodic molecular swabs for all staff, together with the constant use of personal protective equipment, has made it possible to minimize the spread of the infection in the population of health workers with considerable benefits also on the safety level of hospitalized patients.