Azienda Unità Sanitaria Locale Piacenza

Data on the impact of vertebral fractures on lung function in interstitial lung diseases (ILDs) are limited. This study aimed to evaluate the association between vertebral fractures, quantified by the spinal deformity index (SDI), and pulmonary function parameters, independently of ILD pattern and thoracic morphometric indices. This cross-sectional study included adult patients diagnosed with ILD who underwent high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs). PFTs included absolute and percent predicted values of forced vital capacity (ppFVC), absolute and percent predicted total lung capacity (ppTLC), forced expiratory volume in one second (FEV₁), and percent predicted diffusing capacity of carbon monoxide (ppDLCO). The SDI was calculated from T4 to T12 on sagittal HRCT reconstructions. A total of 200 patients were analyzed: 76 with idiopathic pulmonary fibrosis (IPF), 65 with systemic sclerosis–associated ILD (SSc-ILD), 31 with idiopathic inflammatory myopathy–associated ILD, and 28 with other ILDs. At least one mild thoracic vertebral fracture was detected in 46 subjects (23%). Each one-point increase in SDI was associated with a 2.9% reduction in ppFVC (p < 0.01), a 2.7% reduction in ppTLC (p < 0.01). Absolute FVC and TLC declined by 95.6 mL (p < 0.05) and 199.5 mL (p < 0.05) per SDI point, respectively, with consistent results after multiple imputation. Vertebral fractures quantified by SDI are independently associated with reduced lung volumes in ILD patients, beyond fibrotic pattern and thoracic morphometry. These findings reveal a novel bone–lung interaction and support the inclusion of vertebral assessment in the comprehensive evaluation of ILD.

Objectives. A diagnosis of hematologic malignancy represents a major biographical disruption, affecting emotional, relational, and existential dimensions of patients’ lives. While biomedical care predominates, patients’ lived experiences during the early diagnostic phase remain insufficiently explored. This study protocol aims to investigate whether nurse-led narrative interviews conducted within the first month after diagnosis can strengthen the therapeutic relationship, enhance trust, support emotional expression, and sustain patients’ sense of identity and agency. Trial Design. This study adopts a qualitative, holistic single-case study design, grounded in a constructivist–existentialist epistemological framework. An exploratory approach is used to generate in-depth, context-sensitive insights and inform future larger-scale qualitative research. Participants and Settings. The study will be conducted in the onco-hematology department of a tertiary hospital in Northern Italy. One adult patient (≥18 years) with a first diagnosis of hematologic malignancy within the previous 30 days will be recruited through purposive sampling. A primary caregiver will also be involved to provide a complementary perspective. Inclusion criteria include linguistic competence in Italian and clinical stability to provide informed consent. Interventions. The intervention consists of two nurse-led narrative interviews conducted approximately 15 days apart. Interviews will be guided by open-ended questions and conducted by a trained nurse using attentive, empathetic listening. Additional data sources include reflective writing by both the patient and the nurse following each interview, and a semi-structured interview with the caregiver after the second narrative interview. Primary and Secondary Outcomes. Primary outcomes focus on qualitative indicators of meaning-making, emotional expression, therapeutic alliance, and perceived support as expressed through narratives and reflections. Secondary outcomes include triangulated insights from nurse, caregiver, and researcher perspectives. Data will be analyzed using Reflexive Thematic Analysis, with methodological triangulation to enhance rigor and credibility. Conclusions. This protocol will describe a holistic qualitative single-case study exploring the impact of nurse-led narrative interventions on relational and meaning-making processes in patients newly diagnosed with hematologic malignancies, providing a foundation for future person-centered research and clinical integration.

Abstract Out-of-hospital cardiac arrest (OHCA) is a significant public health challenge. Early defibrillation is crucial to manage fatal arrhythmias. The use of automated external defibrillators (AEDs) is a promising tool in enhancing survival. Progetto Vita (PV) in our city pioneered the first community-based AED project in Europe. We present survival data spanning 23 years for all OHCA cases. A total of 6996 OHCAs were recorded. Among these, 156 case were managed by PV volunteers (PV-group). The PV-group managed a significantly higher proportion of shockable rhythms than the EMS group (69.9% vs. 10.9%). Mean time to arrival was shorter (5.7 vs. 10.2 minutes), and survival rates better (46.2% vs. 2.9%, overall). Survival rates declined with time. However, a higher proportion of patients in the PV-group demonstrated favorable neurological outcomes, even up to 9 minutes from the call. Over the study period, the increasing number of AEDs in fixed public places coincided with a substantial rise in ventricular fibrillation survival in the PV-group patients (22% for 2003–2012 to 73% for 2013–2022, p&amp;lt;0.001). Table 2 shows independent predictors of survival. In conclusion our simplified AED-focused training has shown higher survival rates and emerges as a highly successful strategy in a small city.Figure 1 Independent predictors of survival

Theatre-based methodologies are increasingly recognized as complementary approaches that can enhance nurses’ empathy, communication, critical thinking, and person-centred care, all essential for managing chronic illnesses. This scoping review aimed to map and synthesize evidence on the application of theatre in continuing nursing education. A systematic literature search was conducted across five databases (PubMed, CINAHL, PsycINFO, Scopus, and Education Source) for publications in English and Italian up to 30 December 2024, supplemented by grey literature from ProQuest and reference screening via Google Scholar. Twenty-one studies met the inclusion criteria, identifying two main theatre methodologies, Forum Theatre and Drama, with four variations. These interactive methods were reported to foster reflective practice, enhance person-centred care, and improve interprofessional collaboration. Positive outcomes included improved nurse–patient relationships, quality of care, emotional engagement, cultural competence, teamwork, conflict management, and acceptance of diversity. Key facilitators were institutional support and active participation, while barriers included resistance to change and limited resources. These findings indicate that theatre-based education can serve as an effective complementary strategy to cultivate empathy, creativity, and reflective skills in continuing nursing education, supporting the development of holistic and patient-centred care practices. Further research is needed to explore the sustainability of acquired competencies in clinical practice.

BackgroundCritically ill patients are exposed to several physical and emotional stressors, needing analgesic and sedative drugs to tolerate invasive procedures and the harsh intensive care unit (ICU) environment. However, this pharmacological therapy presents several side effects: guidelines suggest using a light sedation target, keeping critically ill patients calm, conscious, and cooperative. Personalized music therapy (MT) can reduce stress and anxiety, decreasing the need for drugs. The aim of the current investigation is to compare different approaches for MT in the ICU: a personalized approach, with music selected by patients/families and listened through headphones, or a generalized approach, with ambient music chosen by a music therapist and transmitted through speakers. Primary outcome: number of days “free from neuroactive drugs” in the first 28 days after ICU admission. Secondary outcomes: total amount of neuroactive drugs (midazolam, propofol, morphine, fentanyl, haloperidol), stress during ICU stay (sleep at night, anxiety and agitation, use of physical restraints, stressors evaluated at discharge), the feasibility of generalized MT (interruptions requested by staff members and patients/families).MethodsRandomized, controlled trial with three groups of critically ill adults: a control group, without MT; a personalized MT group, with music for at least 2 h per day; a generalized MT group, with music for 12.5 h/day, subdivided into fifteen 50-min periods.DiscussionOne hundred fifty-three patients are expected to be enrolled. This publication presents the rationale and the study methods, particularly the strategies used to build the generalized MT playlist. From a preliminary analysis, generalized MT seems feasible in the ICU and is positively received by staff members, critically ill patients, and families.Trial registrationClinicalTrials.gov Identifier: NCT03280329. September 12, 2017.

The incidence of pancreatic ductal adenocarcinoma (PDAC) increases with age and is frequently diagnosed at an inoperable stage, which limits treatment options. There is limited evidence concerning patients over 75years old, and clinical practice often lacks clear guidance regarding the choice of first-line therapy. The primary objective of this retrospective study was to assess overall survival (OS) in elderly patients receiving first-line monochemotherapy vs combination therapy. Secondary objectives included evaluating progression-free survival (PFS) and safety. This retrospective study analyzed the records of 150 patients aged 75 or older with confirmed PDAC treated with first-line chemotherapy at Piacenza General Hospital, Italy. Of these, 72 patients received monotherapy, while 78 underwent polychemotherapy. The majority of patients (93.3%) were administered reduced doses, and within this group, 67.9% had their doses reduced by more than 20%. Most patients (80%) presented with comorbidities, predominantly hypertension and diabetes. The median overall survival was significantly higher in the polychemotherapy group (8.2 months) compared to the monotherapy group (4.7months), with a P-value of 0.0022. The median PFS was 5.7months for polychemotherapy and 2.8months for monotherapy, showing a statistically significant difference (P = 0.004). In the multivariate analysis, poor performance status, high CA19.9 levels, and monotherapy were significantly associated with worse OS. Patients treated with polychemotherapy had a 37% lower likelihood of death within the year compared to those treated with monotherapy (HR 0.58, P = 0.009). Polychemotherapy may provide a survival advantage over monotherapy in the late-elderly population, although considerations for dose adjustments due to comorbidities and polypharmacy are necessary. These findings suggest that, when feasible, polychemotherapy could offer a balance between effectiveness and tolerability, potentially improving outcomes in this age group.

Stroke represents the third cause of long-term disability in the world. About 80% of stroke patients have an impairment of bio-motor functions and over half fail to regain arm functionality, resulting in motor movement control disorder with serious loss in terms of social independence. Therefore, rehabilitation plays a key role in the reduction of patient disabilities, and 3D printing (3DP) has showed interesting improvements in related fields, thanks to the possibility to produce customized, eco-sustainable and cost-effective orthoses. This study investigated the clinical use of 3DP orthosis in rehabilitation compared to the traditional ones, focusing on the correlation between 3DP technology, therapy and outcomes. We screened 138 articles from PubMed, Scopus and Web of Science, selecting the 10 articles fulfilling the inclusion criteria, which were subsequently examined for the systematic review. The results showed that 3DP provides substantial advantages in terms of upper limb orthosis designed on the patient's needs. Moreover, seven research activities used biodegradable/recyclable materials, underlining the great potential of validated 3DP solutions in a clinical rehabilitation setting. The aim of this study was to highlight how 3DP could overcome the limitations of standard medical devices in order to support clinicians, bioengineers and innovation managers during the implementation of Healthcare 4.0.