Azienda Sanitaria Locale di Asti

Airway management remains a critical aspect of anesthesia, intensive care and emergency medicine, particularly when facing difficult airways. Traditional methods, such as endotracheal intubation via direct laryngoscopy, have evolved with the introduction of advanced tools designed to enhance oxygenation and facilitate airway control. This narrative review presents 10 essential tips for safe up-to-date airway management, emphasizing the importance of a patient-centered, oxygen-focused and strategic approach rather than a purely device-oriented one. By incorporating strategies for assessment, prediction and timely interventions and transition, healthcare professionals can improve patient outcomes and minimize complications during airway management.

Background: Dieulafoy's disease is a rare vascular anomaly of the gastrointestinal tract and an uncommon cause of acute upper gastrointestinal bleeding. Its occurrence during pregnancy is exceptionally rare, and the available literature is limited to isolated case reports that almost invariably describe acute and overt hemorrhagic presentations. As a result, atypical or clinically silent forms of the disease during pregnancy remain poorly characterized. Objective: To report an atypical case of Dieulafoy's disease during pregnancy, presenting exclusively with severe progressive anemia in the absence of gastrointestinal symptoms and to contextualize this observation through a focused narrative review of the literature. Methods: An illustrative clinical case is presented, followed by a narrative review of the available literature on Dieulafoy's disease in pregnancy. Particular attention was given to pregnancy-related physiological and hormonal adaptations, diagnostic challenges, therapeutic strategies, and reported maternal-fetal outcomes. All published cases identified in the literature were reviewed and summarized. Results: In the general population, Dieulafoy's disease typically presents with sudden and overt gastrointestinal bleeding and is most commonly localized in the proximal stomach. In pregnancy, reported cases are rare and have almost exclusively involved acute hemorrhage occurring in the second or third trimester, frequently requiring urgent endoscopic intervention. Mechanical endoscopic hemostasis represents the treatment of choice and is generally associated with favorable maternal and fetal outcomes. In contrast, the illustrative case described herein demonstrates a clinically silent presentation, characterized by severe and progressive anemia without hematemesis, melena, or hematochezia, resulting in delayed diagnosis until upper gastrointestinal endoscopy identified multiple actively bleeding gastric Dieulafoy's lesions. Conclusions: Dieulafoy's disease should be considered in the differential diagnosis of severe, unexplained, or transfusion-dependent anemia during pregnancy, even in the absence of overt gastrointestinal bleeding. Pregnancy-related physiological adaptations may mask classic symptoms and complicate timely diagnosis. When clinically indicated, upper gastrointestinal endoscopy is safe and effective during pregnancy and remains central to both diagnosis and management. Increased awareness of atypical presentations may facilitate earlier recognition and improve maternal and fetal outcomes.

The Mediterranean Diet (MD) has been associated with reduced inflammation and improved immune regulation, suggesting a potential protective role against autoimmune diseases. This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios (HR), or odds ratios (OR), as appropriate. A total of 9 high-quality studies were included. No significant associations were found between high vs. low MD adherence and the incidence of rheumatoid arthritis (RR = 0.99, 95% CI: 0.97-1.01), lupus (HR = 0.97, 95% CI: 0.91-1.03), Crohn's disease (RR = 0.95, 95% CI: 0.84-1.07), or ulcerative colitis (RR = 1.02, 95% CI: 0.97-1.08). A significant inverse association was observed for multiple sclerosis (RR = 0.91, 95% CI: 0.85-0.98) and for Sjögren's syndrome (OR = 0.81, 95% CI: 0.66-0.99). However, the certainty of evidence for all outcomes was rated as low. Promising associations were observed for multiple sclerosis and Sjögren's syndrome, although current evidence does not support a consistent protective effect of the MD across several other autoimmune diseases. Further longitudinal research is needed to confirm these findings and explore underlying mechanisms. Meanwhile, the promotion of MD adherence remains justified within broader public health strategies for chronic disease prevention.

ABSTRACTBackgroundNitrous oxide/oxygen (N2O/O2 50%/50%) is an effective and safe technique for procedural sedation in paediatric settings; however, the knowledge, use and perspectives of healthcare professionals regarding N2O/O2 remain limited.AimTo investigate the knowledge, use and perspectives of healthcare professionals regarding N2O/O2 in maternal–infant and emergency units.Study DesignA cross‐sectional study was conducted (March to December 2024) using (i) a sociodemographic information tool and (ii) a 16‐item questionnaire assessing knowledge, clinical use, perceived barriers and willingness to adopt N2O/O2. Descriptive and multivariate analyses were performed.ResultsOf 113 respondents, 40.7% reported currently using N2O/O2 in their clinical units, while 91.0% of non‐users expressed willingness to adopt it. Barriers included lack of equipment (92.9%) and training (84.1%). 91.1% considered N2O/O2 ethically acceptable, consistent with principles of beneficence, non‐maleficence and child comfort. Employment in emergency units and holding a three‐year nursing degree were significant predictors of N2O/O2 use.ConclusionsLimited Use of N2O/O2 in Italian Paediatrics Contrasts With Strong Professional Interest. Improving Training and Resources Could Enhance Access to Safe Paediatric Sedation.Relevance to Clinical PracticeTraining, equipment and guidelines are needed to translate willingness into real clinical practice, improving the safety and consistency of paediatric sedation.

Introduction: The COVID-19 pandemic has profoundly impacted healthcare systemsglobally, placing operating room (OR) nurses under considerable strain and exposing them to elevated levels of psychological distress. Aim: This study aimed to investigate the prevalence of burnout syndrome (BoS) among Italian OR nurses during the pandemic and examine its association with perceived job performance and patient safety. Methods: A cross-sectional study was conducted between October and November 2020 involving members of the Italian Association of Nurses in Operating Teams (Associazione Italiana Coordinatori Infermieristici or AICO). Data were collected via an anonymous online questionnaire, which included the Maslach burnout inventory and items assessing clinical errors and self-perceived job performance. Results: Of the 238 nurses invited, 233 completed the survey (97.9% response rate). High levels of emotional exhaustion were reported by 39.9 per cent of participants, moderate to high depersonalisation by 56.7 per cent and low personal accomplishment by 38.6 per cent. Additionally, 29.2 per cent reported having encountered risk and/or made a mistake in the past year, while 38.2 per cent reported a decline in their job performance. Both outcomes were significantly associated with higher levels of BoS (p < 0.01). Contributing factors included workplace disorganisation, negative team climate and workload intensity, particularly in general and neurosurgical settings. Conclusion: These findings highlight the need for early identification of BoS and the implementation of targeted organisational strategies to support perioperative nurses. Addressing burnout is essential to safeguard staff wellbeing and maintain patient safety – both during public health crises and in everyday surgical care.

Emergency departments (EDs) are critical healthcare settings that often face challenges related to patient overcrowding and sub-optimal resource use, and these issues have been linked to reduced effectiveness of care and increased patient mortality. This protocol describes a study to enhance electronic health records (EHR) with real-time dashboards developed for healthcare staff, administrators, and other stakeholders in order to address these issues. These dashboards will be analytic tools, fed with data directly from the electronic health records, allowing healthcare indicators to be monitored dynamically and interactively. The indicators will provide a comprehensive overview of patient flow, crowding levels, waiting times, and other key operational metrics to support healthcare providers by enabling real-time monitoring and decision-making. Administrators will also benefit from the dashboards by gaining insight into system bottlenecks and overall ED performance, facilitating more effective management of resources. This study is part of the eCREAM (enabling Clinical Research in Emergency and Acute care Medicine through automated data extraction) project, and 32 EDs from six different European countries will be involved in this 36-month study. A panel of experts will test the usefulness of the dashboards, set up for each end-user type, using questionnaires and semi-structured interviews. The EHRs, integrated with these ad-hoc dashboards, will empower clinical teams and policymakers to understand department operations dynamics better, ultimately contributing to improved patient outcomes and reduced crowding in emergency settings. Trial registration: Clinicaltrials.gov , identifier: NCT06372379.

Reed sensors play an important role in improving the safety, reliability, and efficiency of modern electric vehicles. Our study evaluates their performance by measuring the switching distance under five different configurations of a cylindrical magnet using a 3D-printed test fixture. Statistical analysis revealed that the right-shift-upward configuration yielded the best performance, significantly reducing the release distance. Building on this, a prototype housing was developed using Selective Laser Sintering with polybutylene terephthalate, and a stainless-steel spring was incorporated to enhance sensitivity and reliability. The spring integration reduced the activation distance to 2.3 mm, which is an improvement of up to 60%, and it also significantly improved the consistency of the results. These outcomes demonstrate a practical method for manufacturing more reliable reed sensors for automotive sensing technology.

BackgroundThe Italian National action plan to contrast antimicrobial resistance (PNCAR) was adopted in Italy with the aim of reducing antimicrobial resistance (AMR) rates through a “One Health” approach. The project “Support for the National Plan to Combat Antimicrobial Resistance (SPiNCAR)” was developed to evaluate the level of implementation of actions outlined by the PNCAR, through a self-assessment tool, addressed to regional and local health authorities. This study presents the findings of the first use of the SPiNCAR tool in the Region of Piedmont, detailing the level of implementation as of 31 December 2022.MethodsThe self-assessment questionnaire is divided into 7 central "areas" representing the main actions against AMR: governance, surveillance and monitoring, appropriate use of antimicrobials, healthcare-associated infection (HAI) control and prevention, education and training, alliance among stakeholders, evaluation of the impact and implementation of the program. Areas are structured into two or more items called "standards", subdivided into "criteria”. Different questionnaires were developed for Regional and Local Authorities. Scores were calculated as the percentage of criteria met within each area, aggregated at both regional and local levels.ResultsBy analysing results at the regional level, it was possible to identify domains of strength in the areas of Governance (79%), Appropriate use of antimicrobials (70%), HAI Control and Prevention (68%) and areas for improvement in Alliance among Stakeholders (18%), Training (33%) and Surveillance (41%). Local authorities showed encouraging median results in Surveillance (37%), Appropriate Use of Antimicrobials (22,5%), and HAI Control and Prevention (21,5%), whereas Implementation (10,5%), Education and Training (8%) and Alliance among Stakeholders (2,5%) need to be improved.ConclusionsThe first SPiNCAR assessment offered valuable insights to enhance healthcare quality; the evaluation identified stakeholder engagement and training as priority areas for improvement and targeted interventions for AMR containment.