Variability by region and method in human brain sodium concentrations estimated by 23Na magnetic resonance imaging: a meta-analysis.

Sodium imaging (23Na-MRI) is of interest in neurological conditions given potential sensitivity to the physiological and metabolic status of tissues. Benchmarks have so far been restricted to parenchyma or grey/white matter (GM/WM). We investigate (1) the availability of evidence, (2) regional pooled estimates and (3) variability attributable to region/methodology. MEDLINE literature search for tissue sodium concentration (TSC) measured in specified 'healthy' brain regions returned 127 reports, plus 278 retrieved from bibliographies. 28 studies met inclusion criteria, including 400 individuals. Reporting variability led to nested data structure, so we used multilevel meta-analysis and a random effects model to pool effect sizes. The pooled mean from 141 TSC estimates was 40.51 mM (95% CI 37.59-43.44; p < 0.001, I2Total=99.4%). Tissue as a moderator was significant (F214 = 65.34, p-val < .01). Six sub-regional pooled means with requisite statistical power were derived. We were unable to consider most methodological and demographic factors sought because of non-reporting, but each factor included beyond tissue improved model fit. Significant residual heterogeneity remained. The current estimates provide an empirical point of departure for better understanding in 23Na-MRI. Improving on current estimates supports: (1) larger, more representative data collection/sharing, including (2) regional data, and (3) agreement on full reporting standards.

Clinical characterization of non-ketotic hyperglycemia-related seizures: A systematic review and individual participant data meta-analysis.

New-onset epileptic seizures and status epilepticus (SE) are the most frequent neurological manifestations of non-ketotic hyperglycemia (NKH), an acute complication of diabetes mellitus (DM). Treatment consists of the correction of the underlying metabolic disorder, whereas anti-seizure medications (ASMs) may even worsen seizures. Evidence on NKH-related seizures is currently restricted to case reports and small case-series. We conducted a systematic review of the PubMed, Embase, and Cochrane Library databases to provide a comprehensive description of NKH-related seizures. Statistical analyses were performed to explore possible associations of glycemic and osmolarity levels with clinical variables. We selected 130 publications and 332 patients (186 males, mean age: 61.1 years). DM was newly-diagnosed in 40%. Mean glycemia and osmolarity levels at presentation were 529.7 mg/dL and 309.6 mmol/mol, respectively; 22.6% showed other neurological symptoms besides seizures. Focal motor seizures were the prominent seizure type (49.4%); non-motor focal seizures (23.2%) most commonly manifested as visual symptoms. Reflex seizures occurred in 10.5%. Brain MRI in 48.7% of cases showed focal T2 subcortical hypodensity and/or overlying cortical T2 hyperintensity with DWI restriction. ASMs were administered in 54.2% of cases, achieving seizure control in just 18.3%. Higher osmolarity levels were associated with newly-diagnosed DM (p = 0.002) and other symptoms at presentation (p < 0.001). Glycemic values were higher in patients with focal aware seizures with motor onset compared to those with focal seizures without motor onset (p = 0.0046) or focal seizures with impaired awareness (p = 0.0306). Lower glycemic values were associated with reflex seizures (p = 0.036) and ASM administration (p < 0.001). NKH-related seizures should be suspected in adults with new-onset clustering focal seizures arising from the motor or posterior cortices, even in the absence of a history of DM. Typical focal changes on brain MRI, while not pathognomonic, can drive the clinical diagnosis. Statistical associations suggest a key role of hyperglycemia in the excitability of higher-energy-demanding cortical areas.

Infections in liver and lung transplant recipients: a national prospective cohort.

Infections are a major complication of solid organ transplants (SOTs). This study aimed to describe recipients' characteristics, and the frequency and etiology of infections and transplant outcome in liver and lung SOTs, and to investigate exposures associated to infection and death in liver transplant recipients. The study population included recipients of SOTs performed in Italy during a 1-year period in ten Italian lung transplant units and eight liver transplant units. Data on comorbidities, infections, retransplantation, and death were prospectively collected using a web-based system, with a 6-month follow-up. The cumulative incidence of infection was 31.7% and 47.8% in liver and lung transplants, respectively, with most infections occurring within the first month after transplantation. Gram-negatives, which were primarily multidrug-resistant, were the most frequent cause of infection. Death rates were 0.42 per 1000 recipient-days in liver transplants and 1.41 per 1000 recipient-days in lung transplants. Infection after SOT in adult liver recipients is associated to an increased risk of death (OR = 13.25; p-value < 0.001). Given the frequency of infection caused by multidrug-resistant microorganisms in SOT recipients in Italy and the heavy impact of infections on the transplant outcome, the reinforcement of surveillance and control activities to prevent the transmission of multidrug-resistant microorganisms in SOT recipients represents a priority. The implementation of the study protocol in liver and lung transplant units and the sharing of results have increased the awareness about the threat due to antimicrobial resistance in the country.

Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007-2008 and 2014.

A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers' knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22-24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007-2008 campaign appeared to be sustained in 2014.

Laboratory procedures for the diagnosis of tuberculosis: a survey in ten Italian Regions.

The characteristics of laboratories performing tuberculosis (TB) diagnostic procedures were investigated in ten Italian Regions, through a mailed questionnaire. Three hundred and eighty laboratories answered (70.8 % response rate), 250 of which performed directly at least one TB diagnostic procedure. Standard criteria concerning microscopy, culture, identification, and drug susceptibility testing were frequently not satisfied, particularly those related to the volume of activity (32 % of laboratories performing microscopy examined 10 samples and 36 % of those performing culture performed 20 cultures per week), processing time, biosafety requirements and participation to internal/external quality control programs. The survey' results highlight the need to promote the adoption of standardized procedures and to centralize the mycobacteriology testing in a reduced number of high quality laboratories, in order to improve diagnostic accuracy, resource management and quality of surveillance data.

The Upper Limb Neurodynamic Test 1: intra- and intertester reliability and the effect of several repetitions on pain and resistance.

OBJECTIVE: The aim of this study is to measure the intra- and intertester reliability of the Upper Limb Neurodynamic Test 1 in asymptomatic subjects with respect to onset of pain, submaximal pain (SP), first resistance (R1), and second resistance, and determine the effect of several repetitions of the test. METHODS: Three physiotherapists evaluated the dominant upper arm of 36 asymptomatic adult subjects 5 times with an electrogoniometer. RESULTS: Intratester reliability for R1 was good with an intraclass correlation coefficient (ICC 3,1) ranging from 0.69 to 0.91. Intertester reliability was fair for R1 (0.48, standard error [SE] = 0.14), second resistance (0.62, SE = 0.011), and SP (0.64, SE = 0.09), but good for onset of pain (0.72, SE = 0.011). The ICCs on 5 repetitions for each observer were higher, ranging from 0.51 (R1, SE = 0.066) to 0.76 (SP, SE = 0.049). Using the data from the 2 more expert physiotherapists, almost all ICCs were in the good range. The effect of 5 repetitions was a statistically significant progressive improvement of range on all parameters from the first to the final repetition. CONCLUSIONS: Our results regarding the reliability are in line with other studies on the reliability of manual therapy tests. Moreover, the cumulative effect of repetition suggests that the Upper Limb Neurodynamic Test 1 may warrant investigation as a treatment technique.

[University education of health professionals: "Core Values" as a valid instrument for evaluating performance values in future practice]. / Formazione universitaria dei Professionisti della Salute: i "Core Values", come efficaci strumenti per una valutazione dei valori della performance nella futura prassi.

UNLABELLED: In the caring professions it is important to be able to assess not only knowledge and competencies but also the behavior of future professionals in the different sectors of health care. The aim of this work is to define and describe the core values of the health professions and shed light on the essential values which act as the basis for future behavior. Many international documents (League of Nursing, American Board of International Medicine), define the Core Values of specific professions as the bases on which teaching and training curricula are founded. The authors intend to find out whether it is possible to improve behavioral learning of professional values. For example, in the USA the Medical Association has proposed a model for this purpose. Before receiving professional abilitation, suitable professional behavior should be practically tested. MATERIALS AND METHODS: A questionnaire was issued to University course Coordinators in Nursing and Obstetrics in Italy, asking them to express their opinion on an existing model of "Core Values" and the need for their assessment. RESULTS: It was generally agreed that behavior should be assessed in the light of the essential values of the profession. The description of "Core Values" thus becomes a tool for identifying which behavior should be assessed. Coordinators did not express a precise opinion regarding the assessment tool proposed. DISCUSSION AND CONCLUSIONS: There was a general consensus regarding the need to assess the values at the basis of behavior in health care students, as well as the "Core Value" proposed. Doubt remained regarding the assessment modalities owing to the fact that the practical test actually used does not always focus on behavioral values.

A three-year population-based study of antibiotic treatments for children.

AIM: To describe the use of systemic antibiotics in the paediatric population of the Emilia-Romagna region (Italy) during the period 2000-2002. METHODS: Data were extracted from the drug prescription database of Emilia-Romagna. RESULTS: Treatment rates were within the range 1016-1151 treatments per 1000 children-years, according to the observed year. Chephalosporins were the most prescribed antibiotic class. CONCLUSION: The paediatric population of Emilia-Romagna is heavily exposed to systemic antibiotics. Further studies are needed to find out determinants of antibiotic overuse.

Rates of surgical-site infection: an international comparison.

OBJECTIVES: To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison. DESIGN: Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation. RESULTS: Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9-3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ-space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population. CONCLUSIONS: The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.