U-CHANGE Project: a multidimensional consensus on how clinicians, patients and caregivers may approach together the new urothelial cancer scenario.

Introduction: Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario). Methods: Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts. Results: Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to ad hoc targeted therapies. Discussion: While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease.

Predicting Healthcare-associated Infections: are Point of Prevalence Surveys data useful?

Introduction: Since 2012, the European Centre for Disease Prevention and Control (ECDC) promotes a point prevalence survey (PPS) of HAIs in European acute care hospitals. Through a retrospective analysis of 2012, 2015 and 2017 PPS of HAIs performed in a tertiary academic hospital in Italy, we developed a model to predict the risk of HAI. Methods: Following ECDC protocol we surveyed 1382 patients across three years. Bivariate logistic regression analyses were conducted to assess the relationship between HAI and several variables. Those statistically significant were included in a stepwise multiple regression model. The goodness of fit of the latter model was assessed with the Hosmer-Lemeshow test, ultimately constructing a probability curve to estimate the risk of developing HAIs. Results: Three variables resulted statistically significant in the stepwise logistic regression model: length of stay (OR 1.03; 95% CI: 1.02-1.05), devices breaking the skin (i.e. peripheral or central vascular catheter, OR 4.38; 95% CI: 1.52-12.63), urinary catheter (OR 4.71; 95% CI: 2.78-7.98). Conclusion: PPSs are a convenient and reliable source of data to develop HAIs prediction models. The differences found between our results and previously published studies suggest the need of developing hospital-specific databases and predictive models for HAIs.

Public Health since the beginning: Neonatal incubators safety in a clinical setting.

BACKGROUND: The role of environmental cleaning as an effective measure to contain the diffusion of Healthcare Associated Infections (HAIs) has already been demonstrated. Among medical devices, neonatal incubators have been recognized as a source of pathogens involved in the spread of HAIs. Aim of the study was to assess the efficacy of a disinfection protocol for neonatal incubators. METHODS: The cross sectional study took place in the "Neonatal Pediatric Unit" of the Teaching Hospital of Siena: twenty incubators, used for critical newborns, were swabbed in 13 sampling points before and after the implementation of the disinfection protocol. Sanitation procedures were performed by trained staff, implementing the product Umonium38® Neutralis as disinfectant. Different culture media for the identification of the microbial contamination were adopted: plates were incubated for the proper time and the results were referred to Colony Forming Units (CFUs)/swab per point. Descriptive statistical analysis was performed. It was also evaluated the 95% confidence interval (C.I.) of the mean and the percentage of CFUs reduction by the bootstrap bias corrected and accelerated resampling method. RESULTS: Matched points analyzed were 313. The average CFUs percentage of reduction was 93.5% [C.I. 90.6-95.9%]: it was higher, 97.0% [C.I. 94.1-99.1%], in points placed inside the incubators structure compared to the 88.4% [C.I. 83.6-93.0%] obtained outside. CONCLUSION: The disinfection protocol achieved good results. Routine surveillance and supervision of the various aspects of the disinfection processes (procedures, staff and disinfectants) could guarantee a safe environment during the first days of babies' life, avoiding harmful conditions for the newborns' health.

Use of a fluorescent marker for assessing hospital bathroom cleanliness.

A fluorescent marker was used to assess the efficacy of daily cleaning in hospital en suite bathrooms. We applied the marker on 218 surfaces and we assigned a score according how completely the mark had been removed. We found significant statistical differences among different surfaces and wards (P < .05). Microbiologic contamination and marker removal score did not seem to be correlated. Differences in cleanliness may indicate discrepancies in cleaning procedures. Fluorescent marker proved to be a practical and effective method and it could be adopted as a first-level control system to assess hospital cleanliness.

Environmental contaminants in hospital settings and progress in disinfecting techniques.

Medical devices, such as stethoscopes, and other objects found in hospital, such as computer keyboards and telephone handsets, may be reservoirs of bacteria for healthcare-associated infections. In this cross-over study involving an Italian teaching hospital we evaluated microbial contamination (total bacterial count (TBC) at 36°C/22°C, Staphylococcus spp., moulds, Enterococcus spp., Pseudomonas spp., E. coli, total coliform bacteria, Acinetobacter spp., and Clostridium difficile) of these devices before and after cleaning and differences in contamination between hospital units and between stethoscopes and keyboards plus handsets. We analysed 37 telephone handsets, 27 computer keyboards, and 35 stethoscopes, comparing their contamination in four hospital units. Wilcoxon signed-rank and Mann-Whitney tests were used. Before cleaning, many samples were positive for Staphylococcus spp. and coliforms. After cleaning, CFUs decreased to zero in most comparisons. The first aid unit had the highest and intensive care the lowest contamination (P < 0.01). Keyboards and handsets had higher TBC at 22°C (P = 0.046) and mould contamination (P = 0.002) than stethoscopes. Healthcare professionals should disinfect stethoscopes and other possible sources of bacterial healthcare-associated infections. The cleaning technique used was effective in reducing bacterial contamination. Units with high patient turnover, such as first aid, should practise stricter hygiene.

Low-level laser therapy for pain caused by placement of the first orthodontic archwire: a randomized clinical trial.

INTRODUCTION: The purpose of this study was to clinically evaluate the effect of low-level laser therapy (LLLT) as a method of reducing pain reported by patients after placement of their first orthodontic archwires. METHODS: The sample comprised 60 orthodontic patients (ages, 12-18 years; mean, 15.9 years). All patients had fixed orthodontic appliances placed in 1 dental arch (maxillary or mandibular), received the first archwire, and were then randomly assigned to the experimental (laser), placebo, or control group. This was a double-blind study. LLLT was started in the experimental group immediately after placement of the first archwire. Each tooth received a dose of 2.5 J per square centimeter on each side (buccal and lingual). The placebo group had the laser probe positioned into the mouth at the same areas overlying the dental root and could hear a sound every 10 seconds. The control group had no laser intervention. All patients received a survey to be filled out at home describing their pain during the next 7 days. RESULTS: The patients in the LLLT group had lower mean scores for oral pain and intensity of pain on the most painful day. Also, their pain ended sooner. LLLT did not affect the start of pain perception or alter the most painful day. There was no significant difference in pain symptomatology in the maxillary or mandibular arches in an evaluated parameter. CONCLUSIONS: Based on these findings, we concluded that LLLT efficiently controls pain caused by the first archwire.

[A Survey About Immunization Coverage In A Sample Of Children Born In The First Semester 1999] / Indagine sulla copertura vaccinale in un campione di nati nel primo semestre 1999.

In compliance with the WHO recommendations, the Livorno ASL n degrees 6 (Local Health Unit - Tuscany, Italy) has carried out a survey about immunization coverage so as to improve its knowledge of the local situation. The study concerned immunization coverage and breastfeeding of resident children between 24 and 30 months of age. The authors used a questionnaire that was filled in by the children's parents. The immunization coverage turned out to be similar to the ICONA study as regards mandatory vaccinations (over 95% at the 24th month of age), and better than the ICONA study as regards recommended vaccinations. Breastfeeding was better than previous Italian studies (87.9% at discharge). The authors consider this study a good method for recognizing local situations and organizing specific educational strategies.