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Biomedical subjects

A Stefanini

Publications and source records attributed to A Stefanini.

At least 19 recordsLinked to original sources
PubMed2006

Nurses' knowledge and application of evidence-based guidelines for preventing ventilator-associated pneumonia.

AIM: The aim of the study was to evaluate the nurses' knowledge and to highlight the causes that hinder guidelines implementation. METHODS EXPERIMENTAL DESIGN: descriptive study. SETTING AND PARTICIPANTS: 106 nurses working in the ICUs of a major Italian hospital of national importance. INTERVENTION: administration of a questionnaire listing 21 non-pharmacological strategies considered the most useful in the literature. RESULTS: Eighty-four nurses responded to the questionnaire. Only 19 (22.6%) declared that their knowledge of ventilation associated pneumonia (VAP) and the strategies used to prevent it were satisfactory, whereas 46 (54.8%) declared that they were poorly informed; 68 nurses (80.9%) said that they applied one or more strategies, and 15 (17.9%) that they applied none. The reasons given for not applying the strategies were: method not foreseen in Department protocols (31.5%), lack of the necessary resources (14.3%), disagreement with the method (3.2%), high costs (2.6%), the possibility of causing discomfort (1%) or side effects (0.6%). CONCLUSIONS: In our experience, VAP preventive strategies are widely applied by nurses, but not in a responsible and informed manner. It is important to ensure that nurses receive continuous training and are involved in drawing up and updating Departmental protocols and guidelines for care and behaviour.

Clinical Competence↗
PubMed2003

Regional filter heparinization for continuous veno-venous hemofiltration in liver transplant recipients.

AIM: To study safety, clinical and operative feasibility of continuous veno-venous hemofiltration (CVVH) with anticoagulation only of the filter in patients at risk for bleeding. METHODS: This prospective, comparative, non randomised study was completed at an intensive care unit of a teaching NHS hospital. Sixteen liver transplant (LT) recipients with acute renal failure needing CVVH were treated with a regional anticoagulation protocol (heparin and protamine were administered respectively pre- and post-filter) and compared to 11 critically ill subjects who received a standard low-heparin treatment. Activated coagulation time (ACT) monitoring was used to adjust anticoagulation and heparin neutralization. RESULTS: Mean circuit life was 35.8+/-13.6 hours (95% CI 28.5-43.1) in patients receiving regional anticoagulation and 34.4+/-14 hours in controls (95% CI 25.5-43.3; p=0.7). Fourty-eight circuits (47.5% of the total) in the heparin-protamine group had a life-span longer than 30 hours and other 22 (21.7%) were changed intentionally after 24 hours of use in absence of clots. None of the patients in both the studied groups had bleeding or hemodynamic complications and their azotemic control was always satisfactory. CONCLUSION: In LT recipients, regional anticoagulation can achieve a circuits life-span comparable to that from systemic anticoagulation with satisfactory safety and simplicity of use.

Acute Kidney Injury↗
PubMed1997

The hospital as an enterprise: management strategies.

After introducing the context in which health systems exist in developing as well as in industrialized countries, the author describes the role that hospitals are expected to play as 'enterprises'. The rationale behind such a role is explored and the experience so far available discussed. Evidence from several developing countries suggests caution and trends to discourage radical and indiscriminate introduction of market-oriented reforms, which international donors seem to be spearheading in Africa's health systems. It is likely however, that a limited, gradual introduction of selected elements of these reforms (such as some aspects of contracting out, managerial decentralization, the split between purchasing and providing functions) may find its place and eventually have a positive impact on the performance of the health systems. But 'mystique of markets' must not be allowed to deprive public hospitals of the sense of social utility and of the caring ethos which are essential requisites of a meaningful and effective public health system.

Africa↗
PubMed1995

Sustainability: the role of NGOs.

Development projects supported by nongovernmental organizations (NGOs) should be judged by their contribution to the sustainability of the local system. Institutions and their respective responsibilities need to be clearly defined. Management training must be deeply rooted in local activities. Financing must include a realistic plan for meeting long-term needs. Otherwise much effort will continue to have little lasting effect.

Community Health Planning↗
PubMed1994

District hospitals and strengthening referral systems in developing countries.

An important strategy to make a better use of the scarce resources available to the health sector in developing countries should focus on strengthening the referral system. Hospitals overcrowded with patients who could be more cheaply treated in smaller facilities is a common feature of poorly functioning referral systems. After defining what is meant by referral system, the paper discusses the main problems affecting its implementation within a primary health care strategy in developing countries. The essential prerequisites for an effective referral system are then discussed, emphasizing the need for a clear division of tasks between the different levels of the health delivery system. The paper concludes that efficiency gains and improvement of access are the most likely outcomes of a well-functioning referral system.

Continuity of Patient Care↗
PubMed1989

A study of the interhemispheric correlation during sleep in elderly subjects.

The interhemispheric relationship during sleep in elderly subjects was studied throughout the night by a minute-by-minute computation of two linear correlation coefficients between right and left EEG activities. One of these coefficients (X delta) related to the 1-4-Hz band activity, and the other (X sigma) to the 12.5-14.5-Hz band activity. For five of the six subjects examined, it was found that the rapid-eye-movement (REM) mean values of both coefficients were significantly different from the nonrapid-eye-movement (NREM) values. A comparison between this elderly group and a control group of young subjects, examined previously, did not reveal any significant shift, either for the REM or for the NREM mean values of the coefficients.

Aged↗
PubMed1987

[Human intestinal parasites in Subsaharan Africa. III. Pemba Island (Zanzibar-Tanzania)].

The authors carried out a coprological survey in Pemba Island, analysing, by modified Ritchie technique, 413 stools samples. The specimens were collected among the population from apparently healthy subjects chosen at random in a number equal to 2% of the whole population. The examined subjects were divided in 3 age groups, 211 were males, 202 females. The following results were obtained (in order of prevalence): a) Protozoa: Entamoeba coli 35.6%, Giardia intestinalis 5.6%, Endolimax nana 4.3%, E. histolytica 3.1%, Chilomastix mesnili 2.9%, Iodamoeba buetschlii 4.3%, E. hartmanni 0.7%; b) Helminths: Trichuris trichiura 87.9%, Ancylostomatidae 67.5%, Ascaris lumbricoides 39.7%, Strongyloides stercoralis 18.9%, Schistosoma haematobium 1.9%, S. mansoni 0.2%, S. fuelleborni 0.2%, Enterobius vermicularis 0.2%. The high moisture of soil and the rain distribution during the year could be favouring the high prevalence of T. trichiura and Ancylostomatidae. The case of schistosomiasis due to S. mansoni reported, seems to be imported from the Mainland, while the case of S. fuelleborni could be autochtonous. Totally, 392 subjects (94.4%) were found positive for pathogenic species (Helminths and Protozoa).

Adolescent↗
PubMed1986

Changes in the interhemispheric correlation during sleep in normal subjects.

The correlation coefficients between left and right activity in the various frequency bands of the EEG signal were computed during sleep for 11 normal adults. The values of the correlation during REM sleep were compared with those for NREM sleep. This comparison was performed 'locally,' i.e., during each period of the REM-NREM cycle, as well as over the whole night. For 9 out of the 11 examined subjects, both a visual comparison with the hypnogram and a statistical analysis showed the existence of cyclic variations during the night in the delta and/or sigma correlation coefficient. These variations lasted for the whole night and were synchronized with the REM-NREM cycle. A possible connection between these results and data on the interhemispheric relationship given by amplitude analysis is briefly discussed.

Adult↗
PubMed1983

Measurement of motor conduction velocity with Hopf's technique in myotonic dystrophy.

Hopf's technique was used to measure maximal and minimal motor nerve conduction velocities, and the percentage of fibres with intermediate velocity, in the posterior tibial nerve in patients with myotonic dystrophy. A reduction of maximal and minimal conduction velocities was found. The distribution of fibres with intermediate velocity was nearly identical to that of the control group and the dispersion values were normal. These data do not support the hypothesis that a primary disturbance of the motor neurons is responsible for the muscle changes in myotonic dystrophy. The reduction of the motor nerve conduction velocity, which was an inconstant finding, should not be considered an indication of a neurogenic aetiology of myotonic dystrophy, but only one of the many disorders of a multisystem disease.

Adult↗
PubMed1982

[Syncopal episodes in healthy young athletes. Report of 3 cases in the course of ergometric evaluation].

We report the occurrence of syncope in three healthy athletes during exercise stress testing. In two subjects the syncope occurred in the late recovery stage and was due to inhibition of sinus activity. In the third case a Mobitz type II A-V block developed during hyperventilation, which was followed by a complete A-V block with ventricular asystole and subsequent sinoatrial arrest. We discuss the probable pathophysiological mechanisms of these arrhythmias and their implications in sports practice.

Adult↗
PubMed1981

Measurement of motor conduction velocity with Hopf's technique in the diagnosis of mild peripheral neuropathies.

Hopf's technique was used to measure motor nerve conduction velocity of fibres in the deep peroneal nerve in clinical conditions where damage to the peripheral nervous system was probable. A particular distribution of motor nerve fibre conduction velocity was shown by the analysis of the findings in some of the groups investigated, illustrating the advantages of this method as compared with routine neurophysiological tests.

Adhesives↗