Increase of multidrug-resistant bacteria after the COVID-19 pandemic in a major teaching Hospital in Sicily (2018-2021).

INTRODUCTION: The COVID-19 pandemic has further highlighted the continuing threat of antimicrobial resistance (AMR) to global health and economic development. In the last two decades, AMR has raised increasing concern, with an estimated 4.95 million deaths globally due to bacterial AMR in 2019 alone. The aim of this study was to analyse the impact of the pandemic on the spread of multidrug-resistant organisms (MDROs) using data from the Hospital "P. Giaccone" in Palermo, comparing pre-pandemic and pandemic periods. METHODS: This observational study involved adult patients who were discharged from the hospital between 01 January 2018 and 31 December 2021. Hospital Discharge Cards were linked with microbiological laboratory reports to assess MDRO isolations. SARS-CoV-2 positivity during hospitalisation was evaluated using the National Institute of Health surveillance system. RESULTS: A total of 58 427 hospitalisations were evaluated in this study. Half the patients were aged over 65 years (N=26 984) and most admissions were in the medical area (N=31 716). During the hospitalisation period, there were 2681 patients (5%) with MDROs isolations, and 946 patients (2%) were positive for SARS-CoV-2. Multivariable analyses showed that during 2020 and 2021, there was a significantly increased risk of isolation of Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Age, weight of the Diagnosis-Related Group (DRG), wards with higher intensity of care, and length-of-stay were associated with a higher risk of MDRO isolation. CONCLUSION: This study provides new insights into the impact of the COVID-19 pandemic on MDRO isolation and has important implications for infection control and prevention efforts in healthcare facilities. Age, DRG-weight, and longer hospital stays further increased the risk of MDRO isolation. Thus, it is imperative to improve and follow hospital protocols to prevent healthcare-associated infections.

Music as support to Occupational Therapy.

SUMMARY: Habilitation, rehabilitation and promotion of well-being is the ultimate goal of the occupational therapy process. Occupational therapy interventions take advantages from interdisciplinary approach, implying that classic rehabilitative models are constantly enhanced by updated evidences in rehabilitation literature and enriched with competences from different fields. Recent literature has showed how music interventions can improve clinical and rehabilitative outcomes at different levels. Physical or occupational therapists, caregivers and care staffs are frequently involved in providing music interventions with or without the support of a music therapist. In particular, occupational therapists can use music as support to the rehabilitation of daily living activities and, in general, as a complementary tool of their work. This paper wants to stress the implementation of music and music therapy techniques and related specific training programs in the field of occupational therapy, pointing and summarizing main workable evidence-based approaches with music in occupational therapy settings.

Assessment of functional status and rehabilitative strategies in occupational therapy: role of the Groningen Activity Restriction Questionnaire.

OBJECTIVES: The Groningen Activity Restriction Scale (GARS) is a self-reported non-diseasespecific instrument for measuring patients' disability in Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL). In literature, several studies have demonstrated high psychometric properties of GARS for disability assessment. The aim of this study was to evaluate the use of GARS administered and scored by the occupational therapists, rather than self-reported by the patient, as a tool for measuring disability in adult patients treated with occupational therapy. METHODS: A inter-operator reliability and correlation study was conducted among 31 people (mean age 70.6±13.1 years), admitted to inpatient Occupational Therapy rehabilitation service of ICS Maugeri, Pavia, from May through September 2018. ADL and IADL dependency indices were measured with GARS, which was assessed by three independent occupational therapists during admission of patients to occupational therapy rehabilitation service. Other measures included demographic characteristics and healthcare resource utilization. Therefore, a single occupational therapist performed a second evaluation of patient's performance using GARS at the discharge from treatment, in order to identify any changes in patient's functional abilities after rehabilitation treatment; the results obtained were compared with those detected by the functional independence measures (FIM). Statistical analysis was conducted by Cohen's k coefficient and Pearson's p correlation coefficient. RESULTS: The statistical analysis showed a discrete reliability and responsiveness of GARS (Coen's k = 0.531), due to a moderate correlation between GARS and FIM instruments (Pearson's p = 0.359) for evaluating the effectiveness of occupational therapy interventions. CONCLUSIONS: Even if conducted by occupational therapists, GARS is a useful tool for measuring disability in ADL and IADL, which can help clinicians to develop a customized plan of care in occupational therapy, improving patient's management and clinical outcome.