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Ye M, Tang F, Chien CW, Chuang YC, Liou JJH, Qu X. Application of failure mode and effect analysis in ICU admission of potentially COVID-19 infected patients. Am J Infect Control 2024; 52:552-562. [PMID: 38142777 DOI: 10.1016/j.ajic.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND To analyze the admission and treatment process of potentially COVID-19-infected patients in the intensive care unit under normalization, prevention, and control of the pandemic. METHODS A multidisciplinary team was assembled to develop a flowchart of potentially COVID-19-infected patients admitted to the intensive care unit and identify potential failure steps and modes throughout the process using the failure mode and effect analysis method. Through risk priority number (RPN) analysis of each failure mode, those with the highest impact on nosocomial infection were identified, and the priority of implementation was determined. Related corrective measures have been developed to continuously improve clinical practice and management. RESULTS Eighty potential failure modes were identified, and 8 potential failure modes were identified with RPNs greater than 100. These high RPNs of the failure modes were associated with careless inquiries of epidemiological histories by nurses, inadequate implementation of management standards by nursing assistants, and exposure of attending physicians to potentially risky environments. Finally, 18 general corrective measures are proposed. CONCLUSIONS Application of the failure mode and effect analysis method for quality improvement is a powerful tool for predicting potential failures in the process and can suggest corrective measures that could help avoid nosocomial infection during a pandemic.
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Affiliation(s)
- Mao Ye
- Department of Intensive Care Unit, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Fuqin Tang
- Nursing Department, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong, China
| | - Yen-Ching Chuang
- Business College, Taizhou University, Taizhou, Zhejiang, China; Institute of Public Health and Emergency Management, Taizhou University, Taizhou, Zhejiang, China; Key Laboratory of evidence-based Radiology of Taizhou, Linhai, Zhejiang, China.
| | - James J H Liou
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.
| | - Xixi Qu
- Department of Intensive Care Unit, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China.
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2
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Sodhi K, Chanchalani G, Arya M, Shrestha GS, Chandwani JN, Kumar M, Kansal MG, Ashrafuzzaman M, Mudalige AD, Al Tayar A, Mansour B, Saeed HM, Hashmi M, Das M, Al Shirawi NN, Mathias R, Ahmed WO, Sharma A, Agarwal D, Nasa P. Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East. World J Crit Care Med 2023; 12:176-187. [PMID: 37397590 PMCID: PMC10308336 DOI: 10.5492/wjccm.v12.i3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The proficiency of nursing professionals in the infection prevention and control (IPC) practices is a core component of the strategy to mitigate the challenge of healthcare associated infections.
AIM To test knowledge of nurses working in intensive care units (ICU) in South Asia and Middle East countries on IPC practices.
METHODS An online self-assessment questionnaire based on various aspects of IPC practices was conducted among nurses over three weeks.
RESULTS A total of 1333 nurses from 13 countries completed the survey. The average score was 72.8% and 36% of nurses were proficient (mean score > 80%). 43% and 68.3% of respondents were from government and teaching hospitals, respectively. 79.2% of respondents worked in < 25 bedded ICUs and 46.5% in closed ICUs. Statistically, a significant association was found between the knowledge and expertise of nurses, the country’s per-capita income, type of hospitals, accreditation and teaching status of hospitals and type of ICUs. Working in high- and upper-middle-income countries (β = 4.89, 95%CI: 3.55 to 6.22) was positively associated, and the teaching status of the hospital (β = -4.58, 95%CI: -6.81 to -2.36) was negatively associated with the knowledge score among respondents.
CONCLUSION There is considerable variation in knowledge among nurses working in ICU. Factors like income status of countries, public vs private and teaching status of hospitals and experience are independently associated with nurses’ knowledge of IPC practices.
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Affiliation(s)
- Kanwalpreet Sodhi
- Department of Critical Care, Deep Hospital, Ludhiana 141001, Punjab, India
| | - Gunjan Chanchalani
- Critical Care Medicine, Somaiya Hospital and Research Centre, Mumbai 400001, Maharashtra, India
| | - Muktanjali Arya
- Department of Microbiology and Infection Control, Deep Hospital, Ludhiana 141001, India
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Juhi N Chandwani
- Anaesthesia and Intensive Care Unit, Royal Hospital, Muscat 112, Oman
| | - Manender Kumar
- Department of Cardiac Anaesthesia, Fortis Hospital, Ludhiana 141002, Punjab, India
| | - Monika G Kansal
- Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore 609606, Singapore
| | - Mohammad Ashrafuzzaman
- Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Anushka D Mudalige
- Intensive Care Unit, Colombo North Teaching Hospital, Ragama 11010, Sri Lanka
| | - Ashraf Al Tayar
- Intensive Care Unit and Respiratory Therapy Department, Security Forces Hospital, Damman 34223, Saudi Arabia
| | - Bassam Mansour
- Pulmonary and Critical Care Division, Zahraa Hospital-University Medical Center, Beirut 1007, Lebanon
- Pulmonary Division, Faculty of Medical Sciences, Lebanese University, Beirut 1007, Lebanon
| | - Hasan M Saeed
- Department of Critical Care, Salmaniyah Medical Complex, Manama 323, Bahrain
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi 75530, Pakistan
| | - Mitul Das
- Anaesthesia and Critical Care, Swasti Hospital, Rangia 781354, India
| | - Nehad N Al Shirawi
- Department of Critical Care Medicine, Al Fujairah Hospital, Fujairah 0000, United Arab Emirates
| | - Ranjan Mathias
- Department of Anesthesia and Intensive Care, Hamad Medical Corporation, Doha 974, Qatar
| | - Wagih O Ahmed
- Intensive Care Unit, Sulaiman Al Habib Medical Group, Buraidah 52211, Saudi Arabia
| | - Amandeep Sharma
- Department of Nursing, Deep Hospital, Ludhiana 141001, India
| | - Diptimala Agarwal
- Anesthesia and Intensive Care, Shantived Institute of Medical Sciences, Agra 282007, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
- Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, Abu Dhabi, United Arab Emirates
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Sodhi K, Chanchalani G, Arya M, Shrestha GS, Chandwani JN, Kumar M, Kansal MG, Ashrafuzzaman M, Mudalige AD, Al Tayar A, Mansour B, Saeed HM, Hashmi M, Das M, Al Shirawi NN, Mathias R, Ahmed WO, Sharma A, Agarwal D, Nasa P. Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East. World J Crit Care Med 2023; 12:176-187. [DOI: 10.5492/wjccm.v12.i3.176 sodhi k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
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Nasa P, Modi P, Setubal G, Puspha A, Upadhyay S, Talal SH. Demographic and risk characteristics of healthcare workers infected with SARS-CoV-2 from two tertiary care hospitals in the United Arab Emirates. World J Virol 2023; 12:122-131. [PMID: 37033144 PMCID: PMC10075053 DOI: 10.5501/wjv.v12.i2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/23/2023] [Accepted: 02/22/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Understanding the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers (HCWs) and their social contacts is crucial to plan appropriate risk-reduction measures.
AIM To analyze the socio-demographic risk factors and transmission of SARS-CoV-2 infection among HCWs in two tertiary care hospitals in Dubai, United Arab Emirates.
METHODS The demographic and clinical characteristics were available for all HCWs in both facilities from the human resources department. A cross-sectional survey was conducted from January-April 2022 among HCWs who tested positive through Reverse Transcriptase Polymerase Chain Reaction of the nasopharyngeal swab for SARS-CoV-2 between March 2020 and August 2021 in two tertiary-level hospitals. The survey included questions on demographics, work profile, characteristics of coronavirus disease 2019 (COVID-19), and infection among their household or co-workers. The survey also checked the knowledge and perception of participants on the infection prevention measures related to SARS-CoV-2.
RESULTS Out of a total of 346 HCWs infected with SARS-CoV-2, 286 (82.7%) HCWs consented to participate in this study. From the sample population, 150 (52.5%) of participants were female, and a majority (230, 80.4%) were frontline HCWs, including 121 nurses (121, 42.4%). Only 48 (16.8%) participants were fully vaccinated at the time of infection. Most infected HCWs (85%) were unaware of any unprotected exposure and were symptomatic at the time of testing (225, 78.7%). Nearly half of the participants (140, 49%) had co-infection among household, and nearly one-third (29.5%) had co-infection among three or more household. Another 108 (37.8%) participants reported cross-infection among co-workers. The frontline HCWs were significantly more infected (25.1% vs 8.6%, P < 0.001) compared to non-frontline HCWs. Another significant risk factor for a high infection rate was male sex (P < 0.001). Among the infected frontline HCWs, a significantly higher proportion were male and shared accommodation with family (P < 0.001). COVID-19 vaccination significantly reduced the infection rate (83.2% vs 16.8, P < 0.001) among HCWs. Most participants (99.3%) were aware about importance of appropriate use of personal protective equipment. However, only 70% agreed with the efficacy of the COVID-19 vaccination in preventing an infection and severe disease.
CONCLUSION The risk profiling of the HCWs infected with SARS-CoV-2 found that working at frontline and being male increase the rate of infection. COVID-19 vaccination can effectively reduce the rate of transmission of SARS-CoV-2 among HCWs.
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Affiliation(s)
- Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
- Department of Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, United Arab Emirates
| | - Payal Modi
- Department of Microbiology, NMC Royal Hospital, Dubai Investment Park, Dubai 7832, United Arab Emirates
| | - Gladys Setubal
- Prevention and Control of Infection, NMC Specialty Hospital, Dubai 7832, Dubai, United Arab Emirates
| | - Aswini Puspha
- Prevention and Control of Infection, NMC Royal Hospital, Dubai Investment Park, Dubai 7832, United Arab Emirates
| | - Surjya Upadhyay
- Department of Anaesthesiology, NMC Royal Hospital, Dubai Investment Park, Dubai 7832, United Arab Emirates
| | - Syed Habib Talal
- Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
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Milner KA. Evolution of Visiting the Intensive Care Unit. Crit Care Clin 2023; 39:541-558. [DOI: 10.1016/j.ccc.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Medina-Dominguez F, Sanchez-Segura MI, de Amescua-Seco A, Dugarte-Peña GL, Villalba Arranz S. Agile Delphi methodology: A case study on how technology impacts burnout syndrome in the post-pandemic era. Front Public Health 2023; 10:1085987. [PMID: 36743161 PMCID: PMC9895364 DOI: 10.3389/fpubh.2022.1085987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction In the post-pandemic era, many habits in different areas of our lives have changed. The exponential growth in the use of technology to perform work activities is one of them. At the same time, there has been a marked increase in burnout syndrome. Is this a coincidence? Could they be two interconnected developments? What if they were? Can we use technology to mitigate this syndrome? This article presents the agile Delphi methodology (MAD), an evolved version of the Delphi method, adapted to the needs of modern-day society. Methods To drive Occupational Health and Safety (OHS) experts to reach a consensus on what technological and non-technological factors could be causing the burnout syndrome experienced by workers in the post-pandemic era, MAD has been used in a specific case study. This study formally presents MAD and describes the stages enacted to run Delphi experiments agilely. Results MAD is more efficient than the traditional Delphi methodology, reducing the time taken to reach a consensus and increasing the quality of the resulting products. Discussion OHS experts identified factors that affect and cause an increase in burnout syndrome as well as mechanisms to mitigate their effects. The next step is to evaluate whether, as the experts predict, burnout syndrome decreases with the mechanisms identified in this case study.
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Affiliation(s)
- Fuensanta Medina-Dominguez
- Computer Science and Engineering Department, Universidad Carlos III de Madrid, Leganés, Madrid, Spain,*Correspondence: Fuensanta Medina-Dominguez ✉
| | | | - Antonio de Amescua-Seco
- Computer Science and Engineering Department, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
| | | | - Santiago Villalba Arranz
- Unidad Técnica de Diseño, Innovación y Desarrollo, Instituto Regional de Seguridad y Salud en el Trabajo de la Comunidad de Madrid, Madrid, Spain
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Boyd S, Nseir S, Rodriguez A, Martin-Loeches I. Ventilator-associated pneumonia in critically ill patients with COVID-19 infection, a narrative review. ERJ Open Res 2022; 8:00046-2022. [PMID: 35891621 PMCID: PMC9080287 DOI: 10.1183/23120541.00046-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/24/2022] [Indexed: 01/08/2023] Open
Abstract
COVID pneumonitis can cause patients to become critically ill. They may require intensive care and mechanical ventilation. Ventilator-associated pneumonia is a concern. This review aims to discuss the topic of ventilator-associated pneumonia in this group. Several reasons have been proposed to explain the elevated rates of VAP in critically ill COVID patients compared to non-COVID patients. Extrinsic factors include understaffing, lack of PPE and use of immunomodulating agents. Intrinsic factors include severe parenchymal damage, immune dysregulation, along with pulmonary vascular endothelial inflammation and thrombosis. The rate of VAP has been reported at 45.4%, with an ICU mortality rate of 42.7%. Multiple challenges to diagnosis exist. Other conditions such as acute respiratory distress syndrome, pulmonary oedema and atelectasis can present with similar features. Frequent growth of gram-negative bacteria has been shown in multiple studies, with particularly high rates of pseudomonas aeruginosa. The rate of invasive pulmonary aspergillosis has been reported at 4–30%. We would recommend the use of invasive techniques when possible. This will enable de-escalation of antibiotics as soon as possible, decreasing overuse. It is also important to keep other possible causes of ventilator-associated pneumonia in mind, such as COVID-19 associated pulmonary aspergillosis, cytomegalovirus, etc. Diagnostic tests such as galactomannan and B-D-glucan should be considered. These patients may face a long treatment course, with risk of re-infection, along with prolonged weaning, which carries its own long-term consequences.
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Conoscenti E, Campanella M, Sala A, Di Stefano MC, Vinci D, Lombardo R, Arena G, Ginestra A, Fiolo R, Tuzzolino F, Ippolito A, Martucci G, Enea G, Luca A. Impact of the Organizational Model Adopted during the COVID-19 Pandemic on the Perceived Safety of Intensive Care Unit Staff. J Clin Med 2022; 11:1487. [PMID: 35329813 PMCID: PMC8955264 DOI: 10.3390/jcm11061487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic had a devastating health, social, and economic effect on the population. Organizational, technical and structural operations aimed at protecting staff, outpatients and inpatients were implemented in an Italian hospital with a COVID-19 dedicated intensive care unit. The impact of the organizational model adopted on the perceived safety among staff was evaluated. METHODS Descriptive, structured and voluntary, anonymous, non-funded, self-administered cross-sectional surveys on the impact of the organizational model adopted during COVID-19 on the perceived safety among staff. RESULTS Response rate to the survey was 67.4% (153 completed surveys). A total of 91 (59%) of respondents had more than three years of ICU experience, while 16 (10%) were employed for less than one year. Group stratification according to profession: 74 nurses (48%); 12 medical-doctors (7%); 11 physiotherapists (7%); 35 nurses-aides (22%); 5 radiology-technicians (3%); 3 housekeeping (1%); 13 other (8%). The organizational model implemented at ISMETT made them feel safe during their workday. A total of 113 (84%) agreed or strongly agreed with the sense of security resulting from the implemented measures. A vast majority of respondents perceived COVID-19 as a dangerous and deadly disease (94%) not only for themselves but even more as vectors towards their families (79%). A total of 55% of staff took isolation measures and moved away from their home by changing personal habits. The organizational model was perceived overall as appropriate (91%) to guarantee their health. CONCLUSION The vast majority of respondents perceived the overall model applied during an unexpected, emergency situation as appropriate.
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Affiliation(s)
- Elena Conoscenti
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Maria Campanella
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Antonino Sala
- Direzione Generale, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (A.S.); (F.T.); (A.L.)
| | - Maria Cristina Di Stefano
- Direzione Sanitaria, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (M.C.D.S.); (D.V.)
| | - Dario Vinci
- Direzione Sanitaria, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (M.C.D.S.); (D.V.)
| | - Rosario Lombardo
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Giuseppe Arena
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Angelo Ginestra
- Ospedale Civico, Via C. Lazzaro 2, 90127 Palermo, Sicily, Italy;
| | - Rosario Fiolo
- Dipartimento BIND, Scuola di Medicina e Chirurgia, Università degli Studi di Palermo, Via del Vespro, 129, 90127 Palermo, Sicily, Italy;
| | - Fabio Tuzzolino
- Direzione Generale, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (A.S.); (F.T.); (A.L.)
| | - Alessia Ippolito
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy
| | - Giuseppe Enea
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Angelo Luca
- Direzione Generale, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (A.S.); (F.T.); (A.L.)
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