sabina magalini | Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) (original) (raw)
Papers by sabina magalini
World Journal of Emergency Surgery, 2018
Background: Negative pressure wound therapy is now largely used to treat infected wounds. The pre... more Background: Negative pressure wound therapy is now largely used to treat infected wounds. The prevention and reduction of healthcare-associated infections is a high priority for any Department of Health and great efforts are spent to improve infection control systems. It is assumed that vacuum-assisted closure (VAC®) dressings should be watertight and that all the secretions are gathered in a single container but there is no consistent data on air leakage and possible dispersion of bacteria from the machine. Methods: We have conducted a prospective experimental study on 10 patients with diagnosis of wound infection to verify whether the filtration process is microbiologically efficient. We compared the bacteria population present in the wound to the one present in the air discharged by the VAC® machine. Results: This study shows that the contamination of the VAC® machine is considerably lower than the environment or wound contamination. Conclusions: Negative pressure wound therapy system does not represent a risk factor for healthcare-associated infections.
Transplantation Proceedings, 2008
European review for medical and pharmacological sciences, 2019
OBJECTIVE This study investigated how European first responders and hospital personnel, along wit... more OBJECTIVE This study investigated how European first responders and hospital personnel, along with CBRN experts, approach an overwhelming surge situation after a chemical incident. Surge capacity and capability bottlenecks were discussed. MATERIALS AND METHODS Two chemical warfare agent (CWA) scenarios were developed: in the first, a nerve agent was released indoors; in the second, there was an outdoor explosion containing a blister agent. CBRNE experts, first responders and hospital specialists from across Europe participated in a two-day table-top exercise to discuss pre-hospital and hospital CBRNE preparedness, triage, surge capacity and communication issues. This was followed by a medical response exercise at a level 2 Emergency Department in Italy. RESULTS Several surge capacity challenges and lessons were identified. Critical resources were rapidly exhausted and sourcing from national/international medical stockpiles was not feasible in the time critical scenarios. Secondary c...
European review for medical and pharmacological sciences, May 1, 2017
To describe for the first time in literature the specific methodology of use of negative pressure... more To describe for the first time in literature the specific methodology of use of negative pressure wound therapy (NPWT) for duodenal fistula through clinical cases. The constant increase of use of NPWT for complex surgical situations imposes tailored previously undescribed solutions for the technique. Herein, three cases of high output duodenal fistula successfully treated with Negative Pressure Wound Therapy (NPWT) are reported. The technical details for the application of NPWT to these fistulas are discussed and described. All three patients recovered without the necessity of further surgical operations. When using NPWT, management of high-output duodenal fistulas must rely on some degree of customization of the aspiration systems. The aim of the procedure is to put under depression the duodenal hole and surrounding tissues "all in one" and not to separate the complex wound in sectors as usually indicated. We suggest calling this technique Negative Pressure Fistula Therapy.
Prehospital and Disaster Medicine
Introduction:The European Union Horizon 2020 research and innovation funding program awarded the ... more Introduction:The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects’ objectives, the NIGHTINGALE consortium adapted the Translational Science (TS) process. The aim of this study is to perform the first TS (T1) phase PRISMA scoping review to extract data that will be used to guide the creation of the initial evidence-based second TS phase (T2) modified Delphi statements for a subsequent study.Method:The consortium was divided into three work groups (WGs) MCI triage, Prehospital Life Support and Damage Control (PHLSDC) and Prehospital Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping review with a common research strategy sharing MCI related search terms and then terms specific for each WG. Final included articles went through data extraction ...
European review for medical and pharmacological sciences, 2014
Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a... more Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a difficult management. Vacuum-assisted closure (VAC) therapy is a method utilized for chronic and traumatic wound healing. At first, VAC therapy had been contraindicated in the treatment of intestinal fistulas, but as time went by, VAC therapy revealed itself to be a "Swiss knife multi-tool". This paper presents some clinical cases of enterocutaneous (ECF) and enteroatmospheric fistulas (EAF) treated with VAC therapy™. The history of 8 patients treated for complex fistulas was revised. Four of them presented with enterocutaneous and four with enteroatmospheric fistulas. All were treated with VAC therapy with variations elaborated to help in accelerated closure of intestinal wall lesions. Four out of four ECFs closed spontaneously. In the EAF group, in three cases the fistula turned slowly into an entero-cutaneous fistula, and in one out of four it closed spontaneously. The mean...
European review for medical and pharmacological sciences, 2020
OBJECTIVE Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in p... more OBJECTIVE Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the underlying acute or chronic medical comorbidities. The evidence for this strategy is unclear. MATERIALS AND METHODS We searched PubMed and the Cochrane databases for English-language studies published from January 1979 through December 31, 2019, for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. RESULTS The two randomized studies that have compared PC with cholecystectomy (CCY) or conservative treatment have shown that the clinical outcomes did not differ significantly between the groups. Similar results have been found in the large majority of retrospective cohorts or single-center studies that have compared PC with CCY. CONCLUSIONS PC does not seem to offer any benefit compared with CCY in the treatment of acute cholecystitis in patients with high surgical r...
European review for medical and pharmacological sciences, 2020
European review for medical and pharmacological sciences, 2020
European review for medical and pharmacological sciences, 2020
This study aims at investigating the nature of resilience and stress experience of health care wo... more This study aims at investigating the nature of resilience and stress experience of health care workers during the COVID-19 pandemic. Thirteen healthcare workers from Italian and Austrian hospitals specifically dealing with COVID-19 patients during the first phase of the pandemic were interviewed. Data was analysed using grounded theory methodology. Psychosocial effects on stress experience, stressors and resilience factors were identified. We generated three hypotheses. Hypothesis one is that moral distress and moral injury are main stressors experienced by healthcare workers. Hypothesis two states that organisational resilience plays an important part in how healthcare workers experience the crisis. Organisational justice and decentralized decision making are essential elements of staff wellbeing. Hypothesis three refers to effective psychosocial support: Basic on scene psychosocial support based on the Hobfoll principles given by trusted and well-known mental health professionals ...
Minerva chirurgica, Jan 15, 1985
DIGITAL HEALTH, 2022
Background Phishing is a major threat to the data and infrastructure of healthcare organizations ... more Background Phishing is a major threat to the data and infrastructure of healthcare organizations and many cyberattacks utilize this socially engineered pathway. Phishing simulation is used to identify weaknesses and risks in the human defences of organizations. There are many factors influencing the difficulty of detecting a phishing email including fatigue and the nature of the deceptive message. Method A major Italian Hospital with over 6000 healthcare staff performed a phishing simulation as part of its annual training and risk assessment. Three campaigns were launched at approx. 4-month intervals, to compare staff reaction to a general phishing email and a customized one. Results The results show that customization of phishing emails makes them much more likely to be acted on. In the first campaign, 64% of staff did not open the general phish, significantly more than the 38% that did not open the custom phish. A significant difference was also found for the click rate, with sign...
Journal of the American College of Surgeons, 2020
Prehospital and Disaster Medicine, 2011
IntroductionModern emergencies and disasters are progressively changing from relatively simple, p... more IntroductionModern emergencies and disasters are progressively changing from relatively simple, predictable events controllable with standard management solutions to complex critical situations for which managers and first responders require innovative and affordable tools.MethodsThe European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. Use of simulation technologies offers a significant improvement on current management activities allowing decision makers to confront several organizational alternatives not only with static situations but with evolving scenarios.ResultsSICMA simulates main structural and behavioral elements of maxi emergency and mass casualties, from individual casualties and evolution of their health status, activity of the police force and fire brigade on the accident site, crowd dynamics, sanitary personnel ...
European review for medical and pharmacological sciences, 2018
The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elec... more The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elective) and approach (open vs. laparoscopic) in affecting postoperative pulmonary complications (PPCs) prevalence in patients undergoing abdominal surgery. After local Ethical Committee approval, 409 patients who had undergone abdominal surgery between January and December 2014 were included in the final analysis. PPCs were defined as the development of one of the following new findings: respiratory failure, pulmonary infection, aspiration pneumonia, pleural effusion, pneumothorax, atelectasis on chest X-ray, bronchospasm or un-planned urgent re-intubation. PPCs prevalence was greater in urgent (33%) vs. elective setting (7%) (χ2 with Yates correction: 44; p=0.0001) and in open (6%) vs. laparoscopic approach (1.9%) (χ2 with Yates correction: 12; p=0.0006). PPCs occurrence was positively correlated with in-hospital mortality (Biserial Correlation r=0.37; p=0.0001). Logistic regression showe...
European Healthcare organisations have met growing common challenges. Health services have been i... more European Healthcare organisations have met growing common challenges. Health services have been identified at EU level as essential for the maintenance of critical societal and/or economic activities. Furthermore, patient safety and personal data are at risk in daily operations. ICT penetration and the increasing connectivity of devices within a healthcare organisation inevitably lead to a growing dependency on them. Therefore, a solid, cybersecurity prevention strategy is needed. Solidity depends on its capability to capture the Health Services specificities. The article describes a socio-technical modelling approach, set-up by the H2020 PANACEA project, based on four models (Healthcare Organization (HCOM), Medical Device Lifecycle, Information System Lifecycle, Cybersecurity system). The proposed models can identify cybersecurity aspects, map cybersecurity interventions, and compare cybersecurity solutions for the Healthcare organisations, which, by default, constitute large and c...
2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2021
Healthcare organizations are frequently subject to cybersecurity incidents. The outbreak of a pan... more Healthcare organizations are frequently subject to cybersecurity incidents. The outbreak of a pandemic such as COVID-19 has shown the need for specific operational and organizational measures to be in place in order to reduce the risk of successful cyberattacks. Time will be key: preparation is needed to ensure quick secure set-up of additional resources (IT, staff, medical devices) when the next emergency will hit. The PANACEA Solution Toolkit is a suite of complementary tools to provide Health Care Organizations (HCO) with assessment, guidance, technical and organizational "infrastructure" to address the cybersecurity challenges. It provides support for fortifying health organizations against cyber threats on multiple different levels (technical, behavioral, organizational, strategical) and across a diverse set of workflows and scenarios. In order to determine whether the toolkit satisfies the specific business and users' requirements in the selected use cases, a detailed validation plan and execution roadmap is established taking into account the constraints of the current emergent situation.
Journal of Visualized Experiments, 2021
World Journal of Emergency Surgery, 2018
Background: Negative pressure wound therapy is now largely used to treat infected wounds. The pre... more Background: Negative pressure wound therapy is now largely used to treat infected wounds. The prevention and reduction of healthcare-associated infections is a high priority for any Department of Health and great efforts are spent to improve infection control systems. It is assumed that vacuum-assisted closure (VAC®) dressings should be watertight and that all the secretions are gathered in a single container but there is no consistent data on air leakage and possible dispersion of bacteria from the machine. Methods: We have conducted a prospective experimental study on 10 patients with diagnosis of wound infection to verify whether the filtration process is microbiologically efficient. We compared the bacteria population present in the wound to the one present in the air discharged by the VAC® machine. Results: This study shows that the contamination of the VAC® machine is considerably lower than the environment or wound contamination. Conclusions: Negative pressure wound therapy system does not represent a risk factor for healthcare-associated infections.
Transplantation Proceedings, 2008
European review for medical and pharmacological sciences, 2019
OBJECTIVE This study investigated how European first responders and hospital personnel, along wit... more OBJECTIVE This study investigated how European first responders and hospital personnel, along with CBRN experts, approach an overwhelming surge situation after a chemical incident. Surge capacity and capability bottlenecks were discussed. MATERIALS AND METHODS Two chemical warfare agent (CWA) scenarios were developed: in the first, a nerve agent was released indoors; in the second, there was an outdoor explosion containing a blister agent. CBRNE experts, first responders and hospital specialists from across Europe participated in a two-day table-top exercise to discuss pre-hospital and hospital CBRNE preparedness, triage, surge capacity and communication issues. This was followed by a medical response exercise at a level 2 Emergency Department in Italy. RESULTS Several surge capacity challenges and lessons were identified. Critical resources were rapidly exhausted and sourcing from national/international medical stockpiles was not feasible in the time critical scenarios. Secondary c...
European review for medical and pharmacological sciences, May 1, 2017
To describe for the first time in literature the specific methodology of use of negative pressure... more To describe for the first time in literature the specific methodology of use of negative pressure wound therapy (NPWT) for duodenal fistula through clinical cases. The constant increase of use of NPWT for complex surgical situations imposes tailored previously undescribed solutions for the technique. Herein, three cases of high output duodenal fistula successfully treated with Negative Pressure Wound Therapy (NPWT) are reported. The technical details for the application of NPWT to these fistulas are discussed and described. All three patients recovered without the necessity of further surgical operations. When using NPWT, management of high-output duodenal fistulas must rely on some degree of customization of the aspiration systems. The aim of the procedure is to put under depression the duodenal hole and surrounding tissues "all in one" and not to separate the complex wound in sectors as usually indicated. We suggest calling this technique Negative Pressure Fistula Therapy.
Prehospital and Disaster Medicine
Introduction:The European Union Horizon 2020 research and innovation funding program awarded the ... more Introduction:The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects’ objectives, the NIGHTINGALE consortium adapted the Translational Science (TS) process. The aim of this study is to perform the first TS (T1) phase PRISMA scoping review to extract data that will be used to guide the creation of the initial evidence-based second TS phase (T2) modified Delphi statements for a subsequent study.Method:The consortium was divided into three work groups (WGs) MCI triage, Prehospital Life Support and Damage Control (PHLSDC) and Prehospital Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping review with a common research strategy sharing MCI related search terms and then terms specific for each WG. Final included articles went through data extraction ...
European review for medical and pharmacological sciences, 2014
Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a... more Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a difficult management. Vacuum-assisted closure (VAC) therapy is a method utilized for chronic and traumatic wound healing. At first, VAC therapy had been contraindicated in the treatment of intestinal fistulas, but as time went by, VAC therapy revealed itself to be a "Swiss knife multi-tool". This paper presents some clinical cases of enterocutaneous (ECF) and enteroatmospheric fistulas (EAF) treated with VAC therapy™. The history of 8 patients treated for complex fistulas was revised. Four of them presented with enterocutaneous and four with enteroatmospheric fistulas. All were treated with VAC therapy with variations elaborated to help in accelerated closure of intestinal wall lesions. Four out of four ECFs closed spontaneously. In the EAF group, in three cases the fistula turned slowly into an entero-cutaneous fistula, and in one out of four it closed spontaneously. The mean...
European review for medical and pharmacological sciences, 2020
OBJECTIVE Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in p... more OBJECTIVE Percutaneous cholecystostomy (PC) is used for the treatment of acute cholecystitis in patients with high surgical risk due to the severity of cholecystitis and/or the underlying acute or chronic medical comorbidities. The evidence for this strategy is unclear. MATERIALS AND METHODS We searched PubMed and the Cochrane databases for English-language studies published from January 1979 through December 31, 2019, for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. RESULTS The two randomized studies that have compared PC with cholecystectomy (CCY) or conservative treatment have shown that the clinical outcomes did not differ significantly between the groups. Similar results have been found in the large majority of retrospective cohorts or single-center studies that have compared PC with CCY. CONCLUSIONS PC does not seem to offer any benefit compared with CCY in the treatment of acute cholecystitis in patients with high surgical r...
European review for medical and pharmacological sciences, 2020
European review for medical and pharmacological sciences, 2020
European review for medical and pharmacological sciences, 2020
This study aims at investigating the nature of resilience and stress experience of health care wo... more This study aims at investigating the nature of resilience and stress experience of health care workers during the COVID-19 pandemic. Thirteen healthcare workers from Italian and Austrian hospitals specifically dealing with COVID-19 patients during the first phase of the pandemic were interviewed. Data was analysed using grounded theory methodology. Psychosocial effects on stress experience, stressors and resilience factors were identified. We generated three hypotheses. Hypothesis one is that moral distress and moral injury are main stressors experienced by healthcare workers. Hypothesis two states that organisational resilience plays an important part in how healthcare workers experience the crisis. Organisational justice and decentralized decision making are essential elements of staff wellbeing. Hypothesis three refers to effective psychosocial support: Basic on scene psychosocial support based on the Hobfoll principles given by trusted and well-known mental health professionals ...
Minerva chirurgica, Jan 15, 1985
DIGITAL HEALTH, 2022
Background Phishing is a major threat to the data and infrastructure of healthcare organizations ... more Background Phishing is a major threat to the data and infrastructure of healthcare organizations and many cyberattacks utilize this socially engineered pathway. Phishing simulation is used to identify weaknesses and risks in the human defences of organizations. There are many factors influencing the difficulty of detecting a phishing email including fatigue and the nature of the deceptive message. Method A major Italian Hospital with over 6000 healthcare staff performed a phishing simulation as part of its annual training and risk assessment. Three campaigns were launched at approx. 4-month intervals, to compare staff reaction to a general phishing email and a customized one. Results The results show that customization of phishing emails makes them much more likely to be acted on. In the first campaign, 64% of staff did not open the general phish, significantly more than the 38% that did not open the custom phish. A significant difference was also found for the click rate, with sign...
Journal of the American College of Surgeons, 2020
Prehospital and Disaster Medicine, 2011
IntroductionModern emergencies and disasters are progressively changing from relatively simple, p... more IntroductionModern emergencies and disasters are progressively changing from relatively simple, predictable events controllable with standard management solutions to complex critical situations for which managers and first responders require innovative and affordable tools.MethodsThe European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. Use of simulation technologies offers a significant improvement on current management activities allowing decision makers to confront several organizational alternatives not only with static situations but with evolving scenarios.ResultsSICMA simulates main structural and behavioral elements of maxi emergency and mass casualties, from individual casualties and evolution of their health status, activity of the police force and fire brigade on the accident site, crowd dynamics, sanitary personnel ...
European review for medical and pharmacological sciences, 2018
The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elec... more The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elective) and approach (open vs. laparoscopic) in affecting postoperative pulmonary complications (PPCs) prevalence in patients undergoing abdominal surgery. After local Ethical Committee approval, 409 patients who had undergone abdominal surgery between January and December 2014 were included in the final analysis. PPCs were defined as the development of one of the following new findings: respiratory failure, pulmonary infection, aspiration pneumonia, pleural effusion, pneumothorax, atelectasis on chest X-ray, bronchospasm or un-planned urgent re-intubation. PPCs prevalence was greater in urgent (33%) vs. elective setting (7%) (χ2 with Yates correction: 44; p=0.0001) and in open (6%) vs. laparoscopic approach (1.9%) (χ2 with Yates correction: 12; p=0.0006). PPCs occurrence was positively correlated with in-hospital mortality (Biserial Correlation r=0.37; p=0.0001). Logistic regression showe...
European Healthcare organisations have met growing common challenges. Health services have been i... more European Healthcare organisations have met growing common challenges. Health services have been identified at EU level as essential for the maintenance of critical societal and/or economic activities. Furthermore, patient safety and personal data are at risk in daily operations. ICT penetration and the increasing connectivity of devices within a healthcare organisation inevitably lead to a growing dependency on them. Therefore, a solid, cybersecurity prevention strategy is needed. Solidity depends on its capability to capture the Health Services specificities. The article describes a socio-technical modelling approach, set-up by the H2020 PANACEA project, based on four models (Healthcare Organization (HCOM), Medical Device Lifecycle, Information System Lifecycle, Cybersecurity system). The proposed models can identify cybersecurity aspects, map cybersecurity interventions, and compare cybersecurity solutions for the Healthcare organisations, which, by default, constitute large and c...
2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2021
Healthcare organizations are frequently subject to cybersecurity incidents. The outbreak of a pan... more Healthcare organizations are frequently subject to cybersecurity incidents. The outbreak of a pandemic such as COVID-19 has shown the need for specific operational and organizational measures to be in place in order to reduce the risk of successful cyberattacks. Time will be key: preparation is needed to ensure quick secure set-up of additional resources (IT, staff, medical devices) when the next emergency will hit. The PANACEA Solution Toolkit is a suite of complementary tools to provide Health Care Organizations (HCO) with assessment, guidance, technical and organizational "infrastructure" to address the cybersecurity challenges. It provides support for fortifying health organizations against cyber threats on multiple different levels (technical, behavioral, organizational, strategical) and across a diverse set of workflows and scenarios. In order to determine whether the toolkit satisfies the specific business and users' requirements in the selected use cases, a detailed validation plan and execution roadmap is established taking into account the constraints of the current emergent situation.
Journal of Visualized Experiments, 2021