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F La Mura

Publications and source records attributed to F La Mura.

7 recordsLinked to original sources
PubMed2005

E-learning as educational tool in emergency and disaster medicine teaching.

E-learning is a new project for education based on the adoption of new computerised, multimedia and telematic technologies. Its application has deeply changed the concept of a teacher-based teaching to a student-centred educational project. It offers a great flexibility in the educational methodology, in the administration of contents, in the synchronous and/or asynchronous interaction between teachers and students, in the organisation and in the structure of the course, in the educational plans, in the support, the tracking and the evaluation of the student. E-learning could represent a great resource and a possible revolution in the concept of education and in the field of medical education as well. In some specific fields of application, as Emergency and Disaster Medicine, where the interaction between the student, the teacher and the patient, even if of great importance, are difficult to obtain in a quiet setting and have a lot of organizing, technical and economic troubles, e-learning approach could find a fertile field of application. In this paper we present a new program of educational activities we started in the field of Emergency and Disaster Medicine together with a review of the history of the instructional design and related technologies, ranging from the development of computer aided instruction to modern e-learning applications as teaching methodologies, and their impact on pedagogic and operative aspects.

Computer-Assisted Instruction↗
PubMed2004

Post gravidic superior sagittal sinus thrombosis with elevated levels of homocystinemia.

Cerebral ischemia in the young (less than 45 years) is an uncommon finding, its ethiology remaining undefined in up to half of cases even if all the common diagnostic paths have been followed. Pregnancy and puerperium are characterised by an increased risk of ischemic stroke and intracranial venous thrombosis. We present a case of a young woman with post gravidic thrombosis of the superior sagittal sinus, occurred 10 days after eutocic delivery. She presented elevated plasma levels of homocystinemia, a sulphur containing amino acid that induce complex changes within the blood vessel wall, acting with an oxidative stress and with a reduction of nitric oxide availability. This clinical case suggests that a complete screening for thrombophilic risk factors should be an integral part in the diagnostic path of central venous thrombosis in young patients also in the puerperium, because it allows to identify thrombophilic risk factors requiring specific treatment.

Adult↗
PubMed2002

Stroke patients, what to do and what to avoid.

In Italy (130,000 new strokes in the general population per year) ischemic stroke is the third cause of death, after cardiovascular disease and neoplastic disease with a prevalence of 6.5%. Different physicians are involved in the emergent evaluation and treatment of the acute ischemic stroke. As other acute events, the initial evaluation must be addressed to assess the patient's airway and breath-ing and cardiocirculatory conditions. The neurological examination must not be exhaustive and it should be completed in 5-10 minutes and a particular attention should be given to clinical findings leading to the suspect of an intracranial hemorrhages. A plain CT scan of the brain is the most important initial diagnostic study. Emergency therapy must be mainly directed to the correction of hypovolemia, hypoxia and the treatment of severe hypertension, hypoglycemia, intracranial hypertension and seizures. The goal is to achieve and to maintain an adequate cerebral perfusion by lowering the intracranial pressure (treating the cerebral oedema) and by increasing the mean arterial pressure, with an appropriate volemic expansion and/or with inotropic or vasopressor drugs. The thrombolytic therapy with intravenous recombinant tessutal plasminogen activator (r-TPA) when not specifically contraindicated, is recommended within 3 hours of onset of ischemic stroke. The benefit of intravenous r-TPA for acute ischemic stroke beyond 3 hours from the onset has never been proved.

Critical Care↗
PubMed2000

[Changes in acid-base equilibrium and CO2 output induced by bicarbonate infusion].

BACKGROUND: Bicarbonate therapy for metabolic acidosis can cause tissue hypercapnia. We tested the hypothesis that CO2 retention is initially confined to blood and that tissue hypercapnia is consequent to blood hypercapnia. METHODS DESIGN: prospective study. SETTING: general Intensive Care Unit in an University Hospital. PATIENTS: ten patients, aged 34-84, undergoing fixed mechanical ventilation for stroke, respiratory failure, polytrauma, or coma and presenting fairly stabilized circulatory condition were included in the study providing that definite exclusion criteria were absent. Sodium bicarbonate, 0.08, 0.17, and 0.25 mEq/kg, was infused in 5 minutes during stages A, B, and C. During each stage, before and after bicarbonate infusion, heart rate, arterial pressure, central venous pressure, and PetCO2 were registered and arterial and central venous haemogasanalysis were performed. CO2 output was measured during and after bicarbonate infusion and total CO2 output over basal values was calculated. RESULTS: Heart rate, arterial pressure, central venous pressure did not change in any stage, while PetCO2 increased in all. Following bicarbonate infusion, pH increased more in venous than in arterial blood and was significantly affected by the amount of bicarbonate infused. In arterial blood both PCO2 and total CO2 content (TCO2) increased. In venous blood PCO2 did not change while TCO2 increased so that arterial-venous rl CO2 difference was unaffected. CO2 output changed in no patient but two during stage A, and increased by 0.54 +/- 0.16 mL/kg during stage B and by 1.18 +/- 0.26 mL/kg during stage C so that 14.5 +/- 4.3 and 21.2 +/- 4.7% of given bicarbonate was released as CO2 through the lungs. CO2 output increased after a latency that was significantly shorter during stage C (145 +/- 51 sec) than during stage B (226 +/- 53 sec). CONCLUSIONS: Since arterial-venous TCO2 difference was unaffected and haemodynamic parameters were stable, the conclusion is drawn that CO2 and bicarbonate did not diffuse out of vascular compartment during this study. However CO2 and bicarbonate diffusion out of blood would have occurred if bicarbonate infusion had continued, because CO2 excess was released through the lungs after a latency and extended after the infusion. Consequently, tissue hypercapnia during bicarbonate infusion could probably be prevented by improving CO2 release through the lungs, i.e. by hyperventilating the patient.

Acid-Base Equilibrium↗
PubMed2000

[Validity of schintigraphy in the study of neurogenic dysphagia].

The purpose of the present study was to verify the validity and potential application of oropharyngealesophageal scintigraphy in the analysis of neurogenic dysphagia. Scintigraphy was used on 36 patients divided into 2 groups: Group 1 (control) comprised 17 healthy volunteers; Group 2 included 19 patients suffering from various neurological and neuromuscular pathologies (myasthenia gravis, Parkinson's disease, polymyositis, stroke, paralysis of the last cranial nerves). In group 1 scintigraphy provided normal results both for mode of swallowing and transit, and for the values of the various parameters studied. On the other hand, scintigraphy showed that in group 2 all oral, pharyngeal and esophageal phases of swallowing were altered vs the controls with a statistically significant increase in the average values for the oral transit time (OTT) (1.45 sec., p = 0.0005), pharyngeal transit time (OTT) (3.23 sec., p = 0.044), esophageal transit time (ETT) e19.87 sec., p = 0.005) as well as in the corresponding bolus retention indexes ORU (12.95%, p = 0.0003), FIR (15.05%, p = 0.0003) and ERI (28.63%, p = 0.002). Moreover, the quality and means of swallowing also proved altered while tracheobronchial aspiration was only seen in 6 of the 19 patients (maximum value: 90%, average value; 7.66%) with a marked prevalence in the stroke subgroup (4/8). In light of these results and considering the low dose of radiation (0.00043 Gy), the lack of invasiveness and excellent tolerability, scintigraphy has confirmed its clinical validity in the functional, objective and quali-quantitative study of deglutition, even in patients suffering from neurogenic dysphagia.

Adolescent↗
PubMed1999

[Target controlled infusion (TCI): applications of the "TCI visual" program in anesthesia and sedation with propofol].

BACKGROUND: Systems for Target Controlled Infusion accepting not only patient' data, like Diprifusor, but also a pharmacokinetic model have not been available in Italy in the last years. Therefore a program which controls a Pilot Anesthesia Vial pump and accepts any pharmacokinetic model was developed and applied to propofol infusion for anaesthesia and sedation. METHODS: Two versions of the Visual TCI program have been developed. The first, at intervals, supplies the anaesthetist with the values for the pump; the second directly interacts with the pump. The program also supplies the anaesthetist with the current amount of drug in each compartment and with the estimated awakening time. DESIGN: preliminary prospective study. SETTING: operatory theatre and Intensive Care Unit in a University Hospital. PATIENTS: 6 patients undergoing total intravenous anaesthesia with propofol and fentanyl for abdominal surgery; 6 patients undergoing sedation with propofol in an Intensive Care Unit (the first 4-hour period was taken into account). INTERVENTIONS: propofol infusion was regulated by the Visual TCI program. The first version was employed in three patients of each group and the second one in the others. Hypo- and hypertensive episodes (systolic pressure less than 80 mmHg or higher than basal value plus 25%) were recorded during anaesthesia and sedation. Propofol concentration was measured in plasma three times at defined intervals and per cent differences between measured and computer-calculated values (Predictive error, PE) were calculated. RESULTS: No hypo- or hypertensive episodes were recorded. PE was 27.4 +/- 17.9%. CONCLUSIONS: The program was easily employed, caused no inconvenience, and its use was associated with a remarkable cardiovascular stability. PE distribution was acceptable on the ground of the criteria reported in the literature. The program can be applied to drugs other than propofol, with both two and three compartment pharmacokinetic models and the anaesthetist can choose the most suitable model for the patient.

Adult↗