Anna University Hospital Research Articles

Special nursing care of patients with orthotopic bladder in the postoperative period

Bladder cancer is one of the main problems in urology in terms of diagnosis and treatment, due to its high in­cidence and its course of development. Bladder cancer ranks fifth as the cause of death from malignant cancer (1.2% for women and 4.0% for men). Radical cystectomy has become the primary method for the treatment of invasive bladder cancer. AIM : The aim of this paper is using the general experience, to make tabular algorithm of early and late postop­erative urological nursing care of patients with radical cystectomy and orthotopic substitution MATERIALS AND METHODS : Our research is based on: Olivia Herdiman et al. and the Clinic of Urology at the St. Anna University Hospital, Varna for the period 2012-2016. Our methods include: a documentary meth­od, observation, and analysis conclusions. Referring to the presented special urological nursing care of the postoperative period of orthopic bladder in the report we can arrive at the conclusion that: Special urological care is intensive and patients need overall treatment. An educated and observant urologic nurse can avoid much of the postoperative complications with timely and quality health care. After cystectomy and orthotopic replacement patients need psychological, family and social support. After cystectomy, patients need to be trained by a urologic nurse to monitor urination, fluid intake and ad­here to a proper diet. The instructions include involving a relative to have as a support outside the hospital. Advantages of the algorithm for early and late postoperative complications: contributes to the analytical and clinical way of thinking of urologic nurses; reduces the period of hospitalization of the patient; reduces the cost of postoperative recovery; provides quality health care; increases confidence in the team; increases the trust of the patient.

Corso FAD sull’interpretazione dell’elettrocardiogramma: Valutazione, Apprendimento ed Impatto nell’Organizzazione

Background. ECG interpretation represents fundamental knowledge to be acquired through training, particularly for nurses and midwives working in an acute care hospital. In fact, quick and accurate interpretation of the ECG is essential for early recognition of alterations that may endanger the patient’s life and alert the doctor to reporting. Previous studies have shown that ECG interpretation skill varies widely among nurses and related early diagnosis may be compromised. The most common training programmes for nurses in ECG interpretation involve lectures and case analysis. Since some studies show the effectiveness of Distance Learning (DL) in the development of knowledge related to ECG interpretation, an e-learning programme has been developed at the University Hospital of Ferrara for the acquisition of this knowledge. The aims of our study are to evaluate the ECG interpretation skills between nurses and midwives following an on-line training course based on lectures and analysis of clinical cases and to measure organisational impact. Materials and methods. The course was created using the Moodle platform that provides a reporting system that can detect and track the learning path of each participant. The population considered in the impact survey is 316 nursing and obstetric staff employed on open-ended and fixed term contracts at the Sant’Anna University Hospital of Ferrara who took part in the DL course from the 4th of November 2013 to the 31st of August 2014. For the evaluation of the course the variables analysed are: gender, course completion time, scores obtained from the learning test, satisfaction questionnaire, organisational impact questionnaire. Results. As for the satisfaction questionnaire, there are 312 participants; since at the time of download the distance training course was still active. The organisational impact questionnaire was sent to all those who had finished the course at least six months ago, 63 nurses joined the survey. The three types of questionnaires evaluated showed quite satisfactory results: 1) almost all the participants, using the satisfaction questionnaire, expressed full satisfaction with the course as it proved to be useful and appreciated. 2) the analysed variables of the learning questionnaire such as the average score obtained by the participants is 17.01/18; the times for completing the questionnaire show a fair distribution in the three work shifts. 3) the variables analysed in the impact questionnaire include the average age of the 46-year-old participants; a distribution of fairly balanced departments between the medical, surgical and emergency departments; the feedback from the participants of the clinical cases treated in the course is quite representative as also the application of the acquired knowledge has achieved an improvement in the quality of the care provided. Discussion. The data analysed are preliminary: at the moment it can be inferred that professionals are interested in increasing their skills in the ECG field and that online training is useful for improving these skills which are applied in clinical practice.

Characteristics of Gender-Based Violence Determined from Emergency Room Visits

Abstract Gender-based violence is recognized as a public health problem worldwide. Nevertheless, in Italy, there are no official epidemiological studies about it. We therefore thought that it was important to conduct a study to describe and quantify the problem in Ferrara. This is one of the first systematic studies to be performed by a regional health service authority. The sample examined was taken from patients presenting to the emergency departments of the Sant'Anna University Hospital in the period from January 1, 2008, to December 31, 2013. The final sample comprised 1,359 patients. Data were collected and analyzed using the following software: (1) SAP, acronym for Systems, Applications and Products in data processing, a management software developed by SAP AG; (2) SAS, acronym for “statistical analysis system,” a set of integrated software products enabling work on the database and specific operations such as data input, search, and management; and (3) Excel. The total number of women patients expo...

Cognitive Status According to Homocysteine and B-Group Vitamins in Elderly Adults.

To determine the association between hyperhomocysteinemia and cognitive function, taking into account the effect of B group vitamin (BGV) deficiency. Cross-sectional. Memory Clinic, S. Anna University Hospital, Ferrara, Italy. Elderly individuals (≥65) (N=318; 44 normal cognition, 127 with cognitive impairment, 147 with dementia) divided into four groups according to plasma homocysteine (high vs normal) and BGV (normal vs deficit) levels. Cognitive, clinical, biochemical, functional, and neuroimaging parameters were evaluated. Hyperhomocysteinemia (>15μmol/L) was associated with a higher prevalence of cognitive and functional impairment and dementia (odds ratio (OR)=1.98, 95% confidence interval (CI)=1.13-3.48), independent of BGV status and other confounders. Participants with hyperhomocysteinemia with normal BGV status had the worst functional status and the highest prevalence of dementia (high homocysteine/normal BGV vs normal homocysteine/normal BGV: OR=3.20, 95% CI=1.65-6.21). Homocysteine levels were correlated negatively with folate and vitamin B12 levels and glomerular filtration rate and positively with free thyroxine and uric acid levels (model coefficient of determination=0.43). Hyperhomocysteinemia was associated with worse cognitive and functional status and dementia independently of BGV levels. Approximately half of participants with hyperhomocysteinemia had normal BGV levels, suggesting that other unmeasured factors might be associated with high homocysteine levels.

Preoperative endoscopic tattooing to mark the tumour site does not improve lymph node retrieval in colorectal cancer: a retrospective cohort study.

BackgroundA direct correlation between number of lymph nodes retrieved and evaluated after a colectomy for colorectal cancer and survival of the patient has been reported, and consensus guidelines recommend to assess at least 12 lymph nodes for adequate staging. Many factors (i.e., patients’ and tumour characteristics, surgeon, and pathologist) may influence the evaluation of the presence of neoplastic disease in lymph nodes as well as the total number of lymph nodes examined. Preoperative endoscopic tattooing to mark the site of the tumour has recently been suggested to facilitate the retrieval of lymph nodes in colorectal specimens. The aim of this study was to investigate its association with adequate lymphadenectomy (≥12 nodes) after colorectal resection for cancer.ResultsAll patients undergoing elective colorectal resection for cancer between 2009 and 2011 at the S. Anna University Hospital in Ferrara, Italy (N = 250) were retrospectively divided into two cohorts according to whether ink tattooing to mark the tumour site was performed during preoperative colonoscopy. The two cohorts were comparable regarding age, gender, body mass index, tumour location and size, TNM staging, and DNA microsatellite instability-high status. No difference between the tattoo (N = 107) and control (N = 143) groups could be detected in the rate of adequate lymphadenectomies performed (78% vs. 79%, p = 0.40). All factors known to influence lymph nodes retrieval from colorectal specimen were specifically evaluated. Rectal and colonic cancers were analysed together and separately. Full adjusted logistic regression analysis in patients who underwent colonic resection showed that right hemicolectomy (OR 4.72; CI95% 1.09-20.36) was the only factor associated to adequate lymphadenectomy. No association between ink tattooing performed preoperatively to mark the site of the tumour and adequate lymphadenectomy after colorectal resection was found with logistic regression analysis.ConclusionThis study shows that preoperative ink tattooing utilized to mark the site of the tumour does not improve adequate lymphadenectomy and lymph nodes yield from colorectal cancer specimens. Further studies are therefore needed to determine if preoperative colonoscopic tattooing to mark the tumour site can refine staging.

Radio-guided selective compartment neck dissection improves staging in papillary thyroid carcinoma: A prospective study on 345 patients with a 3-year follow-up

Prospective uncontrolled study to investigate in papillary thyroid carcinoma (PTC) patients: (1) Distribution of lymph node metastases within the neck compartments, (2) factors predicting lymph nodes metastases, and (3) disease recurrence after thyroidectomy associated with radio-guided selective compartment neck dissection (RSCND). We studied 345 consecutive PTC patients operated on between February 2004 and October 2011 at the S. Anna University Hospital, Ferrara (Italy). Patients with cervical lymph node metastases on preoperative ultrasonography and fine needle aspiration cytology were excluded. All patients underwent total thyroidectomy associated with SLN identification followed by RSCND in the SLN compartment, without SLN frozen section. In patients with lymph node metastases, metastatic nodes were not in the central neck compartment in 22.6% of the cases. The presence of infiltrating or multifocal PTC was a predicting factor for lymph nodes metastases. The median follow-up was 35.5 months. RSCND was associated with a false-negative rate of 1.1%, a persistent disease rate of 0.6%, and a recurrent disease rate of 0.9%. The permanent dysphonia rate was 1.3%. RSCND associated with total thyroidectomy may improve: (1) the locoregional lymph node staging, and (2) the identification of the site of lymphatic drainage within the neck compartments. Thus, considering the high false-negative rate of sentinel lymph node biopsy (SLNB), a radio-guided technique in PTC patients may guide the lymphadenectomy (ie, RSCND) to increase the metastatic yield and improve staging of the disease rather than avoid prophylactic lymphadenectomy (ie, SLNB).

MECHANISM OF INJURY - A SIGNIFICANT COMPONENT IN EVALUATION OF MAXILLOFACIAL TRAUMATIC PATIENTS STATUS

Knowing the injury mechanisms is of extreme importance for correct diagnostic evaluation. Specific injury models can be related to exactly determine trauma mechanisms. Understanding the way of injury may be a key to solving the occult injuries. Thus, some life threatening injuries may be diagnosed without present clinical symptoms at the moment of examination. Purpose: The aim of our study is to analyse the risk factors for arising of associated maxillofacial trauma injuries (AMFI) Material and methods: A total of 352 traumatic patients were retrospectively and prospectively examined for the period 05.2005 - 12.2011, treated at the Department of Oral and maxillofacial surgery at the St. Anna University Hospital, Sofia, whereas AMFI were determined in 129 patients Results: Our study results indicate that most often, RTA are a reason for a combined trauma at the age group of 20-29, followed by the age group of 30-39, and less in the age group of 40-49. The most often reasons for combined traumas are RTA(road traffic accident) and IPV(interpersonal violence), each of which has a relative share, significantly higher than the other reasons (x2, ð<0.001). Our study results indicate that following a RTA, the most common combined trauma is CrT - 31 patients, followed by muscular skeletal system trauma - 11, equal number of eye injuries and polytrauma – 4 patients, spinal cord trauma - 1, and more than one concomitant injury - 1. When analyzing the mutual relation between aetiology and combined trauma, the most common reasons are included (RTA and thrash) as well as combined traumas (neurosurgical, MSS trauma and eye trauma). Conclusion: Data analysis in our study indicates that trauma mechanism is the most important factor that imposes the need of CT examination, especially in intoxicated and disorientated patients, as well as in unconscious patients.

Tibial plateau fractures - standard and specific surgical approaches

PURPOSE: Every surgeon faces multiple problems when treating tibial plateau fractures. The bony and soft tissue anatomy presents few peculiarities. Thin soft tissue envelope has impaired healing capacity and knee joint function is complex and difficult to restore. Congruency of the joint surfaces, correct load distribution, ligamentous stability and a normal biological quality of the cartilage are necessary prerequisites for the normal joint function. Restoration of these parameters must be the main therapeutic goal in any intraarticular fractures of the proximal tibia. The aim of article is to describe in details the approaches to the tibial plateau and the necessity to apply them depending on the different type of fracture. MATERIAL AND METHODS: A total of 21 patients with tibial plateau fractures were followed-up in the Department of Orthopaedics and Traumatology, St. Anna University Hospital of Varna, during a 2-year period (2010-2012). According to the fracture pattern, primarily anterolateral and posteromedial approach or both were used. Anterolateral approach was applied in six patients, posteromedial - in two, combined (anterolateral and posteromedial) - in six, ventral midline and posterolateral (transfibular) - in three each, and direct posterior - in one case. RESULTS: The average time to union of all the fractures was 3.5 months. Nineteen patients had satisfactory articular reduction (d2 mm step/gap) and two patients presented with articular step of 4 mm. All the patients demonstrated satisfactory coronal and sagittal alignment. Dimensions of knee mobility were extension of 2 and flexion of 112°. There was no anterior, posterior, varus, or valgus knee instability. CONCLUSION: High-energy tibial plateau fractures require good surgeon's knowledge of knee anatomy and possible approaches. This enables the selection of the most appropriate operative technique, a standard or a specific one, especially in complex bicondylar fractures. Scripta Scientifica Medica 2013; 45(3): 74-81.

Incidence of lymph node metastases in locally advanced cervical cancer in figo stage ib2-iib - the role of preoperative radiotherapy

This study aims at determining the incidence rate, number, location and type of lymph node metastases in patients with cervical cancer in stage IB2 and IIB as classified by FIGO prior to and after radiotherapy. Between 2003 and 2011, 184 patients with cervical cancer in FIGO clinical stage IB2-IIB were operated on in the Clinic of Gynaecology, St. Anna University Hospital of Varna. Surgery consisted in radical hysterectomy type III and LEP procedure in most cases. Radiotherapy was performed either preoperatively 30 Gy TGT and postoperatively until 52 Gy, or postoperatively - 52 Gy TGT. All the patients were divided into 4 groups according to the stage and order of procedures: group one - 83 patients in stage IB2 with primary surgery; group two - 11 patients in stage IB2 with preoperative radiotherapy and surgery; group three - 31 patients in stage IIB with primary surgery, and group four - 50 patients in stage IIB with preoperative radiotherapy and surgery. The incidence rate of lymph node metastases in these groups was 37.3%, 9%, 38.7%, and 22%, respectively. The incidence rate of macro metastases in lymph nodes in these groups was 20.4%, 9%, 25.8%, and 12%, respectively. Preoperative radiotherapy reduced the incidence rate of lymph node metastases in locally advanced cervical cancer in FIGO stage IB2-IIB. In these patients, lumbosacral, pre-sacral, and para-aortic lymph node dissection should be performed alongside the pelvic lymph node dissection to minimize the risk of distant metastases. The lymph node dissection occupied a central place in the surgical treatment of these patients. In addition to its therapeutic effects, it played a staging role that determined the most appropriate adjuvant treatment. Scripta Scientifica Medica 2012; 44(2): 65-67.

Multidimensional evaluation of performance with experimental application of balanced scorecard: a two year experience

BackgroundIn today's dynamic health-care system, organizations such as hospitals are required to improve their performance for multiple stakeholders and deliver an integrated care that means to work effectively, be innovative and organize efficiently. Achieved goals and levels of quality can be successfully measured by a multidimensional approach like Balanced Scorecard (BSC). The aim of the study was to verify the opportunity to introduce BSC framework to measure performance in St. Anna University Hospital of Ferrara, applying it to the Clinical Laboratory Operative Unit in order to compare over time performance results and achievements of assigned targets.MethodsIn the first experience with BSC we distinguished four perspectives, according to Kaplan and Norton, identified Key Performance Areas and Key Performance Indicators, set standards and weights for each objective, collected data for all indicators, recognized cause-and-effect relationships in a strategic map. One year later we proceeded with the next data collection and analysed the preservation of framework aptitude to measure Operative Unit performance. In addition, we verified the ability to underline links between strategic actions belonging to different perspectives in producing outcomes changes.ResultsThe BSC was found to be effective for underlining existing problems and identifying opportunities for improvements. The BSC also revealed the specific perspective contribution to overall performance enhancement. After time results comparison was possible depending on the selection of feasible and appropriate key performance indicators, which was occasionally limited by data collection problems.ConclusionsThe first use of BSC to compare performance at Operative Unit level, in course of time, suggested this framework can be successfully adopted for results measuring and revealing effective health factors, allowing health-care quality improvements.

Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia

The aim of this study was to investigate the principal discharge diagnosis and related comorbidity in hospitalized older patients affected by dementia. Data from 51,838 consecutive computerized discharge records of the St. Anna University Hospital (Ferrara, Italy) were analyzed. Records included only subjects aged ≥60 years. Number of admissions, length of stay in hospital, primary and secondary discharge diagnosis (by ICD-9-CM code), number of procedures, and possible death were evaluated. Demented patients represented 8.6% of the sample (4466 individuals) and were older and more likely to be female patients compared with controls (47,372 individuals); they were characterized by higher number of admissions to hospital, instrumental clinical investigations, secondary diagnoses, and mortality rate. Among the primary diagnoses, a higher prevalence of cerebrovascular disease, pneumonia, and hip fracture was observed in demented patients. Furthermore, pulmonary embolism, renal failure, septicemia, and urinary infections were frequently reported in demented patients, but not in controls. As regards secondary diagnoses, dementia was associated with an increased risk of delirium, muscular atrophy and immobilization, dehydration, cystitis, and pressure ulcers, whereas the risk for other conditions, including cancer, was reduced. Among older patients, dementia was associated with higher rate of admissions to hospital and mortality. Discharge diagnoses were sensibly different according to the presence of dementia; in particular, a greater load and a different kind of comorbidity were observed in demented patients. On the whole, our data suggest that the adequate management of demented outpatients might help to reduce hospitalization.

Multidimensional evaluation of performance: experimental application of the balanced scorecard in Ferrara university hospital

Background and AimsOne of the best-known performance planning and evaluation techniques utilising both monetary and non-monetary data is the Balanced Scorecard (BSC). This is a means of rationalising the global activity of a business in the attempt to create value, and to translate the company vision into a set of tactical objectives and measurable strategies. The aim of this study was to implement and evaluate the use of BSC in two departments of the St. Anna University Hospital, Ferrara: the Analysis Laboratory and Digestive Endoscopy operating units (OU).Materials and methodsWith the collaboration of the health workers involved, a precise methodological programme was pursued: Definition of the strategic map from 4 perspectives, according to Kaplan and Norton, Definition of the Key Performance Areas (KPA), or macro-objectives, Identification of the cause-effect relationships between KPAs, Identification of the sub-objectives of each KPA, Definition of the Key Performance Indicators (KPI), Definition of the weight/importance of each objective in the global evaluation.ResultsThe information gathered permitted the definition of macro- and sub-objectives for each perspective, as well as determining the relevant indicators, standards, weights, frequency of detection and means of acquisition. Strategic maps showing the cause/effect relationships in each OU were created, as were 'evaluation panels', which describe the global performance of each department. For each perspective, the fundamental data were summarised in one table. Evaluation of each perspective yielded a positive result for the majority of the objectives, and the global result (including all 4 perspectives) was found to be satisfactory.Discussion-ConclusionThe Balanced Scorecard was implemented in the abovementioned OUs of St. Anna University Hospital, Ferrara, after the health workers themselves realised the need for change.In our research the employees were pleased to be evaluated, not only for the financial outcomes, but also for the satisfaction of improving internal procedure, relationships with the community and their own growth/learning. BSC is an ideal point of contact between the financial and clinical dimensions of management. However, difficulties in its application were faced, among these, at least in the initial phase, the lack of information systems able to drive it, and the complexity of the research for specific indicators needed to be overcome. The time factor (on average, at least two years are required) and the availability of technological resources were also limiting factors.The rapid diffusion of BSC among the principal international profit and non-profit organisations is testament to its great potential. This project could be seen as a preparatory phase in the strategical analysis of a subsequent business plan.

The perioperative comparison of efficacy of forced air warmer and radiant warmer

Department of Anaesthesia and Intensive care, St. Anna's University Hospital in Brno, Brno, Czech Republic

The use of a flexible laryngeal mask airway (FLMA) for cleft palate surgery in children

Clinic of Anaesthesiology and Intensive Care Medicine, Saint Anna's University Hospital, Brno, Czech Republic