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The coronavirus disease 2019 (COVID-19) pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of cardiopulmonary resuscitation (CPR) and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year.Data for the years 2019 and 2020 were provided by the records of the Lombardy office of the Regional Agency for Emergency and Urgency. We analysed where the cardiac arrest occurred, when CPR started and whether the bystanders used public access to defibrillation (PAD).During 2020, there was a reduction in CPRs performed by bystanders (odds ratio [OR] = 0.936 [95% confidence interval (CICOVID-19 had a profound impact on the time-dependant OHCA network. During the first pandemic wave, CPR and PAD used by bystanders decreased. The different contexts in which OHCAs occurred may partially explain these differences.

Objectives: During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. Methods: A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. Results: In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49–0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73–1.30; p = 0.325). Conclusions: The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.

Background:During the COVID-19 pandemic, a total lockdown was enforced all over Italy starting on March 9, 2020. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laypersons training courses. The aim of this study was to evaluate the impact of the pandemic on BLS-D laypersons training courses in the Lombardy region.Methods:BLS-D training courses records for the Lombardy region were analyzed. The analysis was conducted from 2016 to 2020 as part of the Hippo project.Results:In the period between 2017 and 2019, BLS-D trained laypersons kept increasing, moving from 53500 trained individuals up to 74700. In 2020, a stark reduction was observed with only 22160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction.Conclusions:Laypersons training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory in the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.

simulation became gradually pivotal in training of health professionals: indeed, it showed an improvement in practical skill of the trainees compared to theoretical lectures. Among others, ACLS (advance cardiovascular life support) courses are now one of the standard learning practices most spread around the world. The primary aim of this study is to evaluate both the level of satisfaction and the clinical thinking that the trainees perceived during an ACLS course. This was performed via the SSE validated scale (Satisfaction with simulation experience scale). The secondary aim was to evaluate if demographics affect the aforementioned perceived satisfaction.a SSE questionnaire was distributed after the ACLS section of practical scenarios, just before the end of the course and of the practical test.72 questionnaires have been collected. The sample was constituted by 68.1% of females, 44,4% by nurses without a master's degree, and 52,8% personnel that works outside of a critical care setting. QTOT Median score was 89 (IQR=86-90), DTOT Median's 45 (IQR= 44.25-45), RTOT Median's 25 (IQR=22-25), LTOT Median was 20 (IQR=19-20). Conclusions: The ACLS course attains a high grade of satisfaction on all of the three aspects evaluated by the questionnaire. The perception was not influenced by the demographics.

(1) Background: Patent foramen ovale (PFO) is a congenital abnormality present in up to 25% of the general population, and it is a relevant cause of cryptogenic stroke. We applied the hospital-based HTA model (AdHopHTA) to conduct a multidimensional assessment of NobleStitch EL, an innovative suture-mediated PFO closure device. We compared it to Amplatzer PFO Occluder (APO) to provide evidence to inform technologies’ governance in hospital settings. (2) Methods: For each AdHopHTA dimension we: systematically retrieved available evidence from the literature applying the PRISMA guidelines and then analyzed original clinical and cost data of a NobleStitch EL device at San Raffaele research hospital in Milan (Italy). The economic dimension was analyzed through activity-based costing and a cost analysis. We conducted semi-structured interviews with selected healthcare professionals to explore the organizational, legal, social, and ethical impact. (3) Results: A single study was included for the NobleStitch EL, with 10 for APO. Both literature data and original data showed comparable safety. Efficacy data analysis found that the PFO closure was at 89% for NobleStitch EL vs. 89–97% for APO. APO has a better impact on the budget and minor process costs. Consulted experts reported that the organizational impact of NobleStitch EL in the short and the long run as null, albeit a better impact under the social and the ethical aspects. (4) Conclusion: We suggest that there is inadequate evidence to conclude the relative efficacy of NobleStitch EL as compared to APO. Nevertheless, this report shows a good safety profile and higher costs for NobleStitch EL, with no organizational or legal impact. Further studies in selected population are recommended.

Telemedicine is the practice of medicine from distance using information technology and include mainly teleconsultation via video and/or chat, teleexpertise to request the opinion of a specialist, and remote patient monitoring to improve the follow-up of patients. The use of telemedicine in mental health and most specially psychiatry has been one of the first use case described in the scientific literature, via video teleconsultation, due to the absence of physical patient examination. One of the oldest telepsychiatry case from the literature was published in 1973 for patients assessed from 1968 with the Massachusetts General Hospital in Boston, USA. Despite its medical and technical ease, telepsychiatry is still not widely spread and integrated into healthcare systems due to organisational and implementation challenges. More recently, telepsychology and other telemedicine interventions in mental health have been growing across the globe, including for mental wellbeing promotion and prevention of mental health conditions in specific environments. The rise of consumer digital healthcare directly through mobile app and dedicated websites is also to be considered in the wide opportunities of telemedicine opportunities to address mental health issues at a global scale. Various models needs thus to be considered between digital only care and blended approach mixing face-to-face and digital ways, as well as telemental health delivered only via the existing healthcare system or via new private digital players. The objective of the presentation is to describe the spectrum of existing telemedicine interventions in mental health, the digital features enabling its adoption and the assessment of its impact on clinical and public health outcomes.

Issue Following the SARS-Cov-2 outbreak in Wuhan, China, the first case of COVID-19 was reported in Codogno, Lombardy, Italy, on 20 February 2020. The ongoing epidemic has exposed the health care system to a severe stress. San Raffaele Hospital (OSR) in Milan, Italy - a leader in the emergency management, may provide a benchmarking experience useful for other countries. Description of the Problem OSR has established a task force including the health care director, the Infections Prevention and Control Committee (IPCC) and the head of ward and outpatients' facilities management area in order to assess the situation and to define a multi-step strategy. The management process has been divided in two steps. Firstly, a preventive phase was devised, in a preparedness perspective, to avoid the spread of the infection to the Healthcare Professionals (HCP). Secondly, a reorganizational phase was implemented to guarantee assistance to infected patients, especially the critical ones. Results Before the outbreak, the IPCC updated OSR's procedures, based on the WHO's, national and regional guidance, planned a lectures series and an online survey to train healthcare professionals and proposed to stack Personal Protective Equipment (PPE) to face the expected shortage. The Head of the facilities management area defined separate pathways in the Emergency Department in order to isolate patients with respiratory symptoms, set up a new ward, with 26 beds and dedicated personnel, as well as two Intensive Care Units, with 13 beds, Some wards were merged and more healthcare workers were moved to the COVID-19 units. Lessons The coordination between task force members has been crucial for translating the multi-step strategy in a quick reorganization of the whole hospital. Despite early preparations, we could not anticipate the evolution of the outbreak and its logistic impact, especially on the PPE procurement. Key messages A major Hospital was proved to be capable to respond to the changing healthcare requests. Organizational flexibility is crucial for proper emergency management.

As smartphone usage is more and more ubiquitous, the app market is flourishing in all fields, including health. Indeed, the availability and use of smartphone apps (SAs) in health has exponentially grown in recent years. It has been estimated that in 2018 there were over 97,000 health apps available and that, 15% and 8% of US phone users aged 18-29 and 30-49 years respectively had health apps installed on their mobile devices. Health apps might potentially support people health paths in multiple ways: channeling health education, enabling personal health data tracking, self-monitoring and goals setting, facilitating access to health records or compliance to treatment, fostering effective communication with healthcare providers and health services, as well as supporting clinical decision-making. Despite such large potential, still scant evidence is available on the impact of SAs on clinical outcomes in different fields of medicine, including mental health. With an estimated prevalence of around 450 million people currently suffering from mental disorders and 1 in 4 people in the world affected at some point in own life, mental disorders are a leading cause of ill-health and disability worldwide whose prevention and care might be enhanced by mHealth technology. The general aim of the presentation is to provide an overview on the use and impact of SAs in the field of mental health. Specific objectives are: i) to present a conceptual framework on how SAs might support mental disorders prevention, diagnosis and treatment, ii) to report on SAs use in mental health in different settings, iii) to collect and pool available evidence from observational and experimental studies on the impact of SAs use on different mental health outcomes, iv) to explore the quality, effectiveness and attributes of top-rated smartphone mental health apps and lastly, v) to suggest gaps in knowledge to be filled by future research.

letter without abstract.

The behavioural response of the sweet potato whitefly, Bemisia tabaci biotype B, to the volatiles emitted by three different species of Callistemon (C. laevis, C. pallidus and C. phoeniceus) was assayed in still-air, and Y-tube olfactometers. B. tabaci adults showed a preference for C. pallidus, while C. laevis and C. phoeniceus were less attractive to the insects when compared to a blank control or to C. pallidus. Volatile organic compounds emitted by the leaves of the three Callistemon species were analysed by solid phase microextraction coupled with GC–MS. 1,8-Cineole was detected in high percentages in C. phoeniceus and C. laevis headspaces, while linalool was abundant in the headspace of C. pallidus. Because of this difference, behavioural tests in the Y-tube olfactometer were carried out also with 1,8-cineole and linalool. Adults of B. tabaci were attracted by linalool, while they were repelled by 1,8-cineole compared with pure air or linalool. These results support the role of these volatiles in the host plant selection process by a herbivorous insect and lay the foundations for the development of sustainable control strategies based on the manipulation of insect pest behaviour.

The Author dedicates this book to his Master Seignior Redi : and, in his Preface to the Reader, mentions another peice he has before him, [concerning the nature of sensitive beings, and by what necessary means they operate;] the titles of several of the chapters in it, are here premised; as a tast of that, of which we hope in a little time, to have a more full enjoyment.