Beyond Paging: Building a Web-based Communication Tool for Nurses and Physicians

Introduction  The traditional means of communication between nurses and physicians is through paging. This method is disruptive to the workflow of both professions and is too non-specific to be used for all types of messages. Aims  We undertook a quality improvement project to streamline communication between nurses and trainees for urgent and non-urgent matters. We assessed user uptake and satisfaction with the new method. Setting  A General Internal Medicine teaching unit in a tertiary care academic centre. Methods  Through collaborative techniques, we developed a novel communication method that sends non-urgent messages to a Web-based task list and urgent messages to an alphanumeric pager. We implemented this new technology using a collaborative process between nurses and physicians to address all concerns. Evaluation  Post-implementation surveillance indicated a high degree of uptake of the new practice. User surveys and focus groups showed a high level of satisfaction and a perceived decrease in interruptions to the workflow of both nurses and physicians with the new system. Usage data indicated that the new system may increase overall non-urgent communication. Conclusion  A Web-based system to triage urgent and non-urgent messages between nurses and physicians was developed collaboratively and implemented successfully to improve workflow for both groups.     

Maternal Carriage in Late-Onset Group B Streptococcus Disease,Italy

We retrospectively investigated mother-to-infant transmission of group B Streptococcus (GBS) in 98 cases of late-onset disease reported during 2007–2018 by a network in Italy. Mothers with full assessment of vaginal/rectal carriage tested at prenatal screening and at time of late onset (ATLO) were included. Thirty-three mothers (33.7%) were never GBS colonized; 65 (66.3%) were vaginal/rectal colonized, of which 36 (36.7%) were persistently colonized. Mothers with vaginal/rectal colonization ATLO had high rates of GBS bacteriuria (33.9%) and positive breast milk culture (27.5%). GBS strains from mother–infant pairs were serotype III and possessed the surface protein antigen Rib. All but 1 strain belonged to clonal complex 17. GBS strains from 4 mother–infant pairs were indistinguishable through pulsed-field gel electrophoresis. At least two thirds of late-onset cases are transmitted from mothers, who often have vaginal/rectal carriage, positive breast milk culture, or GBS bacteriuria, which suggests heavy maternal colonization.     

Urinary Schistosomiasis in Asylum Seekers in Italy: An Emergency Currently Undervalued

Despite schistosomiasis is one of the most prevalent tropical diseases in developing countries and and large flows of migrants come from countries where the disease is endemic, imported urinary schistosomiasis is still not easily recognized in non-endemic areas, especially if not subjected to specific investigations. Moreover schistosomiasis is currently not reportable in any European public health system. The data presented in this report were collected were collected between asylum seekers by a simple screening method based on a prior or actual history of a macroscopic hematauria. In case of a history of gross hematuria, the patient underwent to specific exams standardized for the diagnosis of urinary schistosomiasis. Our data show that the prevalence of the disease has been largely underestimated by European Surveillance Systems; in fact in a small population of young asylum seekers coming from endemic areas for schistosomiasis, we found a significant number of individuals with symptomatic disease. Given that the disease typically has an insidious course, it is highly probable that a screening procedure is able to identify early asymptomatic or mildly symptomatic subjects and avoid the serious complications that are present in advanced stages of disease. Given the limits and the costs of a late diagnosis and that an effective treatment is available, subjects from endemic areas should be actively screened for urinary schistosomiasis.     

Neurophysiological correlates of cognitive disturbances in multiple sclerosis

Cognitive impairment is common in multiple sclerosis, mostly attributed to involvement of cortico-cortical and cortico-subcortical connections. The latter may be explored using the analysis of bioelectrical activity such as power and coherence of the electroencephalogram at rest and its reactivity to stimulus processing and cognitive activities, such as event-related desynchronization and event-related potentials. Although these methods are very useful for assessing information processing during cognitive tasks and other activities, their value in detecting cognitive impairment concerning sensitivity and specificity needs to be validated and they have been mostly used for understanding the physiopathology of cognitive impairment in different forms and stages of the diseases. Nevertheless, newer applications such as longitudinal monitoring and effects of treatment, although explored only in pilot studies, seem quite promising allowing objective measures potentially useful as secondary endpoints in clinical trials aimed at preserving or improving cognition in MS patients.     

Functional Anatomy of Motor Recovery After Early Brain Damage

Functional magnetic resonance imaging and transcranial magnetic stimulation were used to examine a 34 year-old right-handed patient, who, at the age of 6 years, had experienced sudden right hemiplegia, seizures, and stupor during a bout of measles encephalitis, followed by incomplete distal right motor recovery. Morphological MRI showed massive unilateral enlargement of the left ventricle, associated with extreme thinning of the white and gray matter, with partial preservation of the pyramidal tract. Functional MRI and transcranial magnetic stimulation revealed reorganization of the motor cortices, and integrity of the corticospinal pathway, respectively. Our findings indicate that complete hand motor recovery may require functional connections between the motor cortical areas and cortical-subcortical structures, in addition to the retained integrity of the primary sensorimotor area and pyramidal tract.     

Inner ear abnormalities in four patients with dRTA and SNHL: clinical and genetic heterogeneity

A significant number of patients affected by autosomal recessive primary distal renal tubular acidosis (dRTA) manifest sensorineural hearing loss (SNHL). Mutations in ATP6V1B1 are associated with early onset SNHL, whereas ATP6V0A4 mutations have been described in dRTA and late-onset SNHL. Enlarged vestibular aqueduct (EVA) was described in patients with recessive dRTA and SNHL, and recently, this abnormality has been associated with mutations in the ATP6V1B1 gene. In our study, we evaluated the presence of inner-ear abnormalities in four patients affected by dRTA and SNHL, characterized by molecular analysis. Two patients affected by severe dRTA with early onset SNHL showed the same mutation in the ATP6V1B1 gene and bilateral EVA with a different degree of severity. The other two presented similar clinical manifestations of dRTA and different mutations in the ATP6V0A4 gene: one patient, showing EVA, developed an early SNHL, whereas in the other one, the SNHL appeared in the second decade of life and the vestibular aqueduct was normal. Our study confirms the association of EVA and mutations in the ATP6V1B1 gene and demonstrates that mutations in the ATP6V0A4 gene can also be associated with EVA probably only when the SNHL has an early onset. The pathophysiology of SNHL and EVA are still to be defined.