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Background Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. Methods Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. Results 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p  = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO 2 /FiO 2 was similar between men and women (228 [IQR, 134–273] vs 238 mmHg [150–281], p  = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p  = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men ( p  = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis ( p  = 0.898). Accordingly, the Kaplan–Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference ( p  = 0.687). Conclusion Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.

Healthcare systems have to protect citizens' health by developing models combining concepts of efficiency, effectiveness and quality of care. The post-Covid-19 pandemic context has highlighted the relevance of efficiently managing and allocating human resources. In this scenario, the analysis and calculation of personnel needs take on strategic importance. The project aims to suggest a methodology to define the needs of Biomedical Scientists. The goal is to create a standard model adaptable to different contexts. This project, developed in cooperation with the Italian Society of Clinical Biochemistry and Clinical Molecular Biology, has created a new format following the \"Activity Based Management\" approach. It is characterized by continuous improvements, based on analysis of processes, broken down into sub-processes and activities. After the phase of format development, a phase of application to different contexts, such as biochemistry and the hematology sectors, followed. The suggested methodology allows to estimate the number of Full Time Equivalents necessary for the management of the laboratory processes. Furthermore, an objective and analytical data is obtained, because it is based on timely numerical surveys that included productivity and execution times of the different activities. Using the format had a relevant impact on the analysis of the processes, their efficiency, and their possible improvement. This method allowed to evaluate and improve the analytical and \"extra-production\" activities, often underestimated but having a decisive role in the process. The proposed format can be considered a valid tool for laboratory managers to analyze and evaluating the needs of Biomedical Scientists in the laboratory. Activity Based Management allowed us to obtain precise and objective data and, at the same time, to focus on the main objective of any clinical laboratory: to create value for the patient by supporting diagnosis and treatment of paths through safe and reliable laboratory tests, which depends on a correct allocation of human resources.

A survey of hospitals on three continents was performed to assess their infection control preparedness and measures, and their infection rate in hospital health care workers during the COVID-19 pandemic. All surveyed hospitals used similar PPE but differences in preparedness, PPE shortages, and infection rates were reported.

Bergamo province was badly hit by the coronavirus disease 2019 (COVID-19) epidemic. We organised a public-funded, multidisciplinary follow-up programme for COVID-19 patients discharged from the emergency department or from the inpatient wards of ‘Papa Giovanni XXIII’ Hospital, the largest public hospital in the area. As of 31 July, the first 767 patients had completed the first post-discharge multidisciplinary assessment. Patients entered our programme at a median time of 81 days after discharge. Among them, 51.4% still complained of symptoms, most commonly fatigue and exertional dyspnoea, and 30.5% were still experiencing post-traumatic psychological consequences. Impaired lung diffusion was found in 19%. Seventeen per cent had D-dimer values two times above the threshold for diagnosis of pulmonary embolism (two unexpected and clinically silent pulmonary thrombosis were discovered by investigating striking D-dimer elevation). Survivors of COVID-19 exhibit a complex array of symptoms, whose common underlying pathology, if any, has still to be elucidated: a multidisciplinary approach is fundamental, to address the different problems and to look for effective solutions.

Recovery from acute COVID-19 may be slow and incomplete: cases of Post-Acute Sequelae of COVID (PASC) are counted in millions, worldwide. We aimed to explore if and how the pre-existing Socio-economic-status (SES) influences such recovery. We analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics's model - ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO). Eight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50-69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5-42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7-35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0-22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health (Limitations in physical activities: OR = 0.65; 95%CI = 0.47 to 0.89; p = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes. Recovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions.

Background Recovery from acute COVID-19 may be slow and incomplete: cases of Post-Acute Sequelae of COVID (PASC) are counted in millions, worldwide. We aimed to explore if and how the pre-existing Socio-economic-status (SES) influences such recovery. Methods We analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics’s model – ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO). Results Eight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50–69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5–42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7–35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0–22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health ( Limitations in physical activities : OR = 0.65; 95%CI = 0.47 to 0.89; p  = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p  = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes. Conclusions Recovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions.

Post-Normal Science (PNS) was introduced about 30 years ago to address the changing relation between science and governance when science is called upon to provide inputs to policy-related issued. Originally concerned mainly with environmental risks, in the last decades the PNS approach has been applied to a growing and diversified number of issues. It is considered particularly appropriate in situations characterized by: uncertain facts, a plurality of potentially conflicting values, high stakes, and urgent decisions. The objective of this paper is to present a survey that will test the opinions of practitioners and stakeholders on the usefulness of the PNS approach for addressing three emerging issues within the field of radiation oncology: the high and growing number of expected patients, the number of sessions per radiotherapy cycle, and treatment in old age. Respondents will also be asked to indicate which of the typical PNS intervention tools – such as extended and inclusive dialogue, the use of hybrid tools, adaptability and flexibility, and transparency in decision-making –are most suitable, and to what extent. Professionals and stakeholders from one radiotherapy center in northern Italy and two centers in southern Italy will be interviewed.

Post-Normal Science (PNS) was introduced about 30 years ago to address the changing relation between science and governance when science is called upon to provide inputs to policy-related issued. Originally concerned mainly with environmental risks, in the last decades the PNS approach has been applied to a growing and diversified number of issues. It is considered particularly appropriate in situations characterized by: uncertain facts, a plurality of potentially conflicting values, high stakes, and urgent decisions. The objective of this paper is to present a survey that will test the opinions of practitioners and stakeholders on the usefulness of the PNS approach for addressing three emerging issues within the field of radiation oncology: the high and growing number of expected patients, the number of sessions per radiotherapy cycle, and treatment in old age. Respondents will also be asked to indicate which of the typical PNS intervention tools – such as extended and inclusive dialogue, the use of hybrid tools, adaptability and flexibility, and transparency in decision-making –are most suitable, and to what extent. Professionals and stakeholders from one radiotherapy center in northern Italy and two centers in southern Italy will be interviewed.

Il costo, prevalentemente associato all’incremento dei giorni di ospedalizzazione, può variare da 4.000 euro per un paziente ricoverato nel dipartimento di Medicina a 28.000 euro per un paziente ricoverato in Terapia Intensiva.3,4 Proprio le terapie intensive sono le aree ospedaliere con la maggior frequenza di ICA: in questi ambiti assistenziali, quindi, un programma di controllo delle infezioni diventa particolarmente importante sia sotto il profilo clinico che sotto quello economico.2 Il ruolo degli operatori sanitari nella trasmissione di agenti patogeni da paziente a paziente è ben documentato, tuttavia prove crescenti riportano che anche l’ambiente contaminato ha un ruolo significativo nella trasmissione dei patogeni; in particolare, le superfici ad alta frequenza di contatto sono riconosciute come possibile serbatoio di agenti infettivi e la loro contaminazione può rappresentare un rischio anche per la diffusione dei batteri multi-resistenti.5 È quindi importante garantire accurati interventi di pulizia e sanificazione degli ambienti sanitari. Scopo della ricerca L’obiettivo della nostra ricerca è stato quello di valutare l’efficacia del dispositivo Pulsed Xenon Ultraviolet Light (PX-UV) (Xenex Light Strike Germ-Zapping Robot, Xenex Disinfection Services) nel ridurre la contaminazione microbica ambientale quando applicato in aggiunta al protocollo di pulizia e disinfezione standard sia in stanze di degenza che nelle sale operatorie Metodologia Il protocollo per la sperimentazione è stato costruito sulla traccia dell’esperienza pisana di B. Casini et al.6 Lo studio è stato svolto dal settembre 2018 al dicembre 2018, presso l’Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII (1.100 posti letto) di Bergamo. Le camere di degenza delle Unità di Malattie infettive e di Ematologia sono state selezionate secondo criteri di inclusione (occupate per un minimo di 48 ore, recentemente liberate da pazienti che avevano una cultura positiva per MDRO durante l’attuale ricovero) e campionate prima e dopo la sanificazione manuale standard e dopo la disinfezione con PX-UV. La tabella 3 dimostra come nelle degenze si sia ottenuta, dopo un’incubazione delle colture di 48 ore, una riduzione della carica batterica del 78% dopo le procedure standard e del 95% dopo utilizzo di Xenex PX-UV.

Ad esempio, per quanto riguarda il ceppo MRSA ospedaliero (HA-MRSA) fattori di rischio da considerare sono la prolungata degenza in ambienti ospedalieri o in case di cura, pregressi interventi chirurgici, il tipo di gene mec coinvolto, gene che consente ad un batterio di resistere alla meticillina, alla penicillina e ad altri antibiotici beta-lattamici. Se, invece, si considera il ceppo comunitario (CA-MRSA), le caratteristiche che consentono di discriminare tra ceppo MRSA comunitario e ceppo MRSA ospedaliero sono la positività alla tossina Leucocidina Panton-Valentine (PVL, una citotossina che aumenta la virulenza aggressiva dei ceppi che la producono), i quadri clinici, frequentemente caratterizzati da casi di polmonite grave, e la tipologia di gene mec coinvolto. Un’ulteriore problema per la decolonizzazione è rappresento dai pazienti critici, ricoverati in Terapia intensiva e con presidi medici invasivi (p.es. ventilazione assistita): secondo alcuni autori sono necessari e urgenti ulteriori studi che dimostrino l’efficacia del trattamento di decolonizzazione in questa tipologia di paziente.14 L’esperienza britannica ha anche dimostrato come l’approccio multimodale sia stato utile per controllare la diffusione di MRSA nel Regno Unito:17 oltre alla diffusione dei test di screening e alla decolonizzazione è fondamentale applicare correttamente il protocollo per l’igiene delle mani in accordo alle indicazioni dell’OMS, le precauzioni standard, il corretto uso degli antibiotici e disporre di un adeguato numero di personale dedicato. Il nostro progetto ha previsto un programma di sorveglianza attiva delle infezioni e colonizzazioni da MRSA nei reparti più critici e un rafforzamento del protocollo di igiene delle mani con l’ausilio di corsi di formazione a distanza (FAD) per tutti i dipendenti e per tutti i neo assunti.