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Il volontariato in Italia e nel mondo è ritenuto una risorsa, in moltissime occasioni, insostituibile nel supplire le carenze di una Stato che non riesce più ad erogare , in numerosi settori, un'assistenza adeguata ai fabbisogni della popolazione. In Italia da diversi anni alcune organizzazioni affiancano le competenze del servizio sanitario nazionale, supplendo e sostenendo aree fragili e servizi carenti. In questo elaborato ho descritto la complessa interazione tra stato sociale e SSN in particolare nella nostra Regione e nella nostra Azienda Ospedaliera. La seconda parte del lavoro mi sono concentrata sull'importanza del reclutamento, della formazione e della validazione del volontario che aspira a prestare la sua opera in ambito ospedaliero e nel far questo mi sono avvalsa dell'esperienza accumulata e dei mezzi fornitimi dai corsi di laurea. Inoltre, il processo di valutazione non è stato mai distaccato dalla esplorazione delle motivazioni del volontario. Si è poi analizzata la carenza assistenziale nei reparti della AOU Federico II e confrontandola con la disponibilità dei volontari, si è organizzato un servizio suppletivo. Ho evidenziato i limiti di questo approccio che possono riassumersi fondamentalmente nella indisponibilità del volontario a coprire i turni H 24 e nel suo legittimo abbandono del ruolo di volontario nel momento stesso di una assunzione stabile in altri enti. Tramite questionario ho valutato il grado di soddisfazione e i punti critici sia da parte del volontario sia da parte del tutor rilevando che nel complesso l'esperienza è stata favorevolmente vissuta da entrambe le parti. Un punto critico evidenziato dai vari attori del processo è stata la difficoltà burocratica all'inserimento nel ruolo di volontario e alla successiva assegnazione. Ho elaborato, per superare questa criticità, una APP: VOLONTA'(ri) intuitiva e di facile uso che permetterebbe di risolvere in pochi passaggi sia l'ingresso dei volontari nella struttura sia la loro successiva assegnazione in base alle necessità. Sottolineo, alla fine di questo mio lavoro che il volontariato resta una risorsa indispensabile e un sostegno a un Sistema Sanitario perfettamente funzionante e non può mai essere la soluzione a carenze strutturali del sistema. Il volontariato è una scelta fatta sulla spinta di motivazioni emotive, ideologiche e culturali. La mia convinzione, suffragata dalla letteratura a riguardo, è che nella scelta del volontario sono indispensabili la valutazione delle intenzioni e la preparazione tecnico-scientifica.

Additional file 1: Supplementary Table 1. Pre-specified scale of allergic symptoms used to assess reactions during the double-blind placebo-controlled food challenge.

Background Amino acid-based formula (AAF) is a relevant dietary strategy for paediatric patients affected by cow’s milk allergy (CMA). The present study was designed to evaluate the hypoallergenicity of a new AAF in children with immunoglobulin (Ig)E-mediated CMA. Methods According to the criteria provided by the American Academy of Pediatrics Subcommittee on Nutrition and Allergic Diseases, we designed a prospective trial in CMA children (aged 1–36 months) aimed to demonstrate the hypoallergenicity of the new AAF in 90% of subjects with 95% confidence during the double-blind, placebo-controlled challenge (DBPCFC). A skin prick test (SPT) with the new AAF was also performed. Results Twenty-nine children [all Caucasian, 55.2% male, mean age (±SD) 16.9 ± 5.7 months] were enrolled. The SPT and the DBPCFC with the new AAF were negative in all study subjects. Conclusions The study results support the hypoallergenicity of the new AAF. This formula could be considered an additional dietary option for non-breastfed children affected by CMA. Trial registration The trial was registered in the ClinicalTrials.gov Protocol Registration System (ID number: NCT03909113).

Dyslipidemia is a widespread risk factor in solid organ transplant patients, due to many reasons, such as the use of immunosuppressive drugs, with a consequent increase in cardiovascular diseases in this population. PCSK9 is an enzyme mainly known for its role in altering LDL levels, consequently increasing cardiovascular risk. Monoclonal antibody PCSK9 inhibitors demonstrated remarkable efficacy in the general population in reducing LDL cholesterol levels and preventing cardiovascular disease. In transplant patients, these drugs are still poorly used, despite having comparable efficacy to the general population and giving fewer drug interactions with immunosuppressants. Furthermore, there is enough evidence that PCSK9 also plays a role in other pathways, such as inflammation, which is particularly dangerous for graft survival. In this review, the current evidence on the function of PCSK9 and the use of its inhibitors will be discussed, particularly in transplant patients, in which they may provide additional benefits.

This study aims at creating a standardized language for each patient admitted to Cardiac Rehabilitation Unit (CR) by identifying nursing diagnosis, interventions, results/objectives expected and related correlations. The primary outcome was identifying health needs of all patients admitted to CR. The secondary outcomes were the identification of North American Nursing Diagnosis Association -International diagnoses (NANDA-I), of nursing intervention classification (NIC), of nursing outcomes classification (NOC) and their correlation NANDA-NIC-NOC linkage (NNN linkage) in order to define a standardized language for all nursing staff. This is a retrospective study involving a sample of 168 patients discharged from CR. The NANDA-I, the NIC, the NOC and the most frequently used NNN connections were identified and collected by using structured form including the 11 functional models of Marjory Gordon. Data from 76 patients were analyzed (92.1% male; mean age (± SD) 62.7±9 yrs; IQ range: 42-82). The main NANDA-I nursing diagnosis belongs to psychological sphere, but not to physiological domains. The statement NIC has allowed to put into practice actions of health prevention and education. Nursing care documentation and NNN taxonomic language promotes a wide diffusion of nursing discipline culture and significant qualitative improvement of patient’s care, further improving the communication between nurses and other health professionals.

Background Neoadjuvant chemoradiotherapy has a significant role in downstaging cancer. It improves the local control of the disease and can make conservative resection of rectal cancer possible. Methods We enrolled 114 patients with subperitoneal rectal cancer who underwent neoadjuvant chemoradio-therapy and radical excision with total mesorectal excision (TME). The primary endpoint was oncological outcomes and the secondary endpoint was surgical outcomes.We evaluate the experience of a multidisciplinary team and the role of neoadjuvant chemoradiotherapy in integrated treatment of cancer of the subperitoneal rectum. Results Surgical procedures performed were abdominal perineal resection in 4 cases (3.5%), anterior resection in 89 cases (78%), Hartmann’s procedure in 5 cases (4.4%), and ultralow resection with coloanal anastomosis and diverting stoma in 16 patients (14%). Local recurrence occurred in 6 patients (5.2%), the overall survival was 71.9% at 5 years and disease-free survival was about 60%. Conclusions The effect of pathological downstaging amounted to 58.8%, including cPR. The pathologic complete remission occurred in 8.8% of cases. The outcomes of neoadjuvant therapy can be achieved when this treatment is associated with correct surgical technique with TME and the prognosis is defined by an anatomopathological examination performed according to Quirke’s protocol.