Internal and emergency medicine
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Review
Identification and management of invasive mycoses in internal medicine: a road-map for physicians.
Invasive mycoses are a rising problem, not only in traditional categories of patients like hematologic or neutropenic ones, but also in elderly non-neutropenic patients admitted to internal medicine wards. Patients being admitted to medical wards are usually older, have multiple comorbidities, e.g., liver cirrhosis or chronic obstructive respiratory disease, may be malnourished or receive peripheral or total parenteral nutrition, and frequently are undergoing chronic corticosteroid therapy, chemotherapy for cancer or monoclonal antibodies for autoimmune diseases. ⋯ Both candidemia and invasive aspergillosis carry significant morbidity and mortality. The aim of this paper is to provide a simple guide to physicians for a prompt identification and treatment of patients with possible or suspected invasive mycoses.
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Communication failures in the pre-hospital/hospital interface have been identified as a major preventable cause of patient harm. This interface has not adequately been studied in Italy. ⋯ We adapted existing handover communication tools for local use and developed a checklist for the evaluation of handover communication that had good inter-rater reliability. Lectures coupled with high-fidelity simulation exercises on handover did result in a statistically significant improvement in handover communication.