Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio
Introduction: Chronic Pain has been recognized by the World Health Organization as one of the major global public health issues. The condition has debilitating consequences from physical, psychological, and socio-relational perspectives due to its highly disabling nature. Spinal Cord Stimulation (SCS) involves the placement of one or more electrodes in the epidural space through surgical means, connected to a fully implantable battery that electrically stimulates the spinal nerve structures. This treatment is indicated for patients suffering from intractable chronic pain in the trunk and limbs, particularly demonstrating efficacy in treating neuropathic pain. This method has been in use since the mid-1970s. The study lasted 24 months, with the initial 8 months involving patient recruitment and the subsequent 16 months devoted to the follow-up period. Its purpose was to evaluate the cost-benefit ratio of SCS in patients with chronic pain, treated at the Pain Therapy Hub of San Giuliano Hospital, ASL Napoli 2 Nord. The primary goal was to assess the effectiveness of Spinal Cord Neurostimulation (SCS) when applied to these patients. By conducting a comparative assessment 16 months after the implantation, the study evaluated the reduction in pain and disability among patients treated with SCS. Additionally, the study analysed the costs incurred by the National Health Service (SSN) and the corresponding benefits achieved in treating patients with chronic pain using SCS. The study is aimed to assess the effectiveness of this treatment in terms of improving patients' health status and quality of life. Materials and Methods: The observational study is retrospective and single cantered, conducted at the regional Pain Therapy Hub of San Giuliano Hospital, ASL Napoli 2 Nord. The study lasted for 24 months, with the initial 8 months dedicated to patient recruitment and the subsequent 16 months for the follow-up period.A total of 39 adult patients capable of managing or tolerating the devices used in SCS were recruited. These patients had a diagnosis of chronic back and/or leg pain and were non-responders to pharmacological therapy and other therapeutic treatments. The patients were provided with information about this study.Sixteen patients were excluded due to psychological or psychiatric disorders, progressive neurological conditions, or being recipients of an intrathecal pump for pain-relief drug infusion or an IPG. The remaining 23 patients received the implantation of a pulse generator and two electrode catheters. This group constituted our cohort, to which questionnaires were administered to evaluate the level of disability using the Oswestry Disability Index (ODI) and pain measurement using the Visual Analog Scale (VAS). Data were collected at Time 0 (T0) and during the subsequent 16 months from the start of treatment (Follow Up). Only 4 out of the 23 patients removed the neurostimulator before the 16-month term due to incompatibility. Quality of life
{"title":"EFFICACY AND PHARMACOECONOMICS STUDY OF SPINAL CORD STIMULATION (SCS) CONDUCTED AT THE PAIN THERAPY HUB, SAN GIULIANO HOSPITAL ASL NAPOLI 2","authors":"Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio","doi":"10.36017/jahc202353247","DOIUrl":"https://doi.org/10.36017/jahc202353247","url":null,"abstract":"Introduction: Chronic Pain has been recognized by the World Health Organization as one of the major global public health issues. The condition has debilitating consequences from physical, psychological, and socio-relational perspectives due to its highly disabling nature. Spinal Cord Stimulation (SCS) involves the placement of one or more electrodes in the epidural space through surgical means, connected to a fully implantable battery that electrically stimulates the spinal nerve structures. This treatment is indicated for patients suffering from intractable chronic pain in the trunk and limbs, particularly demonstrating efficacy in treating neuropathic pain. This method has been in use since the mid-1970s. The study lasted 24 months, with the initial 8 months involving patient recruitment and the subsequent 16 months devoted to the follow-up period. Its purpose was to evaluate the cost-benefit ratio of SCS in patients with chronic pain, treated at the Pain Therapy Hub of San Giuliano Hospital, ASL Napoli 2 Nord. The primary goal was to assess the effectiveness of Spinal Cord Neurostimulation (SCS) when applied to these patients. By conducting a comparative assessment 16 months after the implantation, the study evaluated the reduction in pain and disability among patients treated with SCS. Additionally, the study analysed the costs incurred by the National Health Service (SSN) and the corresponding benefits achieved in treating patients with chronic pain using SCS. The study is aimed to assess the effectiveness of this treatment in terms of improving patients' health status and quality of life. Materials and Methods: The observational study is retrospective and single cantered, conducted at the regional Pain Therapy Hub of San Giuliano Hospital, ASL Napoli 2 Nord. The study lasted for 24 months, with the initial 8 months dedicated to patient recruitment and the subsequent 16 months for the follow-up period.A total of 39 adult patients capable of managing or tolerating the devices used in SCS were recruited. These patients had a diagnosis of chronic back and/or leg pain and were non-responders to pharmacological therapy and other therapeutic treatments. The patients were provided with information about this study.Sixteen patients were excluded due to psychological or psychiatric disorders, progressive neurological conditions, or being recipients of an intrathecal pump for pain-relief drug infusion or an IPG. The remaining 23 patients received the implantation of a pulse generator and two electrode catheters. This group constituted our cohort, to which questionnaires were administered to evaluate the level of disability using the Oswestry Disability Index (ODI) and pain measurement using the Visual Analog Scale (VAS). Data were collected at Time 0 (T0) and during the subsequent 16 months from the start of treatment (Follow Up). Only 4 out of the 23 patients removed the neurostimulator before the 16-month term due to incompatibility. Quality of life","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ci è voluta la mani di dio","authors":"Rosario Tortora","doi":"10.36017/jahc201911244","DOIUrl":"https://doi.org/10.36017/jahc201911244","url":null,"abstract":"meno male che ci siamo riusciti","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134948475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio
Introduction: Pregnancy termination (IG) is a widely practiced clinical procedure and can be therapeutic (IGT), pharmacological (IGF), or surgical (IGS). The analysis of total costs associated with different methods is useful to highlight advantages and disadvantages for the patient and to enable decision-makers to intervene in a precise manner on company policies supported by concrete data. The relevant legislation governing pregnancy termination is Law 194/78, with specific reference to voluntary termination, permitted within the first 90 days of gestation. This deadline can only be exceeded in special cases, such as severe risk to the mother or fetal malformation. The Law 194/78 aims to ensure that the process of voluntary termination (IVG) is guaranteed, and in this sense, family planning clinics serve as a reference service for many women and couples. The organization of IVG services must be such that there is enough professional figures to provide women with access to voluntary pregnancy termination. From the latest reports published by the Ministry, there is a noticeable decrease in voluntary pregnancy terminations, a trend also observed among foreign women. This is undoubtedly influenced by the increased use of emergency contraception – Levonorgestrel (morning-after pill) and Ulipristal acetate (5-day after pill). On the other hand, due to the more frequent use of pharmacological termination (using Mifepristone+Prostaglandins), there is an increased access to termination within the first 8 weeks of gestation, which represents the deadline for undergoing this variant of the procedure. Materials and Methods: The study is retrospective and uncentered, with an evaluation of data from questionnaires administered to patients who underwent Pregnancy Terminations in the years 2020, 2021, and 2022 at San Giuliano Hospital in Giugliano in Campania (Na), which falls within the territory of the Local Health Authority Napoli 2 Nord.From the analysis of the questionnaires, it is possible to reconstruct sensitive patient data, including place and date of birth, residence, domicile, age, origin, education level, as well as all clinical data related to the patient and pregnancy in general. Surgical pregnancy termination compared to pharmacological termination appears to be less common in all three periods considered. The pharmacological method involves taking an antiprogesterone hormone (Mifepristone) followed by an analogue of prostaglandins (Misoprostol). From a cost analysis perspective, the starting point was the Diagnosis Related Group (DRG) of pharmacological and surgical pregnancy terminations in the Campania Region for each method considered. Results: The laboratory tests which the patient must undergo in the preliminary phase are the same in all abortion (IG) procedures. In the surgical treatment, the patient is admitted to the day hospital, and under anaesthesia, the gestational sac is removed (an invasive procedure with associated risks). In th
{"title":"RETROSPECTIVE AND SINGLECENTER STUDY WITH THE AIM OF PHARMAECONOMIC ANALYSIS IN PREGNANCY TERMINATIONS AT SAN GIULIANO HOSPITAL OF ASL NAPOLI 2 NORD.","authors":"Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio","doi":"10.36017/jahc202353248","DOIUrl":"https://doi.org/10.36017/jahc202353248","url":null,"abstract":"Introduction: Pregnancy termination (IG) is a widely practiced clinical procedure and can be therapeutic (IGT), pharmacological (IGF), or surgical (IGS). The analysis of total costs associated with different methods is useful to highlight advantages and disadvantages for the patient and to enable decision-makers to intervene in a precise manner on company policies supported by concrete data. The relevant legislation governing pregnancy termination is Law 194/78, with specific reference to voluntary termination, permitted within the first 90 days of gestation. This deadline can only be exceeded in special cases, such as severe risk to the mother or fetal malformation. The Law 194/78 aims to ensure that the process of voluntary termination (IVG) is guaranteed, and in this sense, family planning clinics serve as a reference service for many women and couples. The organization of IVG services must be such that there is enough professional figures to provide women with access to voluntary pregnancy termination. From the latest reports published by the Ministry, there is a noticeable decrease in voluntary pregnancy terminations, a trend also observed among foreign women. This is undoubtedly influenced by the increased use of emergency contraception – Levonorgestrel (morning-after pill) and Ulipristal acetate (5-day after pill). On the other hand, due to the more frequent use of pharmacological termination (using Mifepristone+Prostaglandins), there is an increased access to termination within the first 8 weeks of gestation, which represents the deadline for undergoing this variant of the procedure. Materials and Methods: The study is retrospective and uncentered, with an evaluation of data from questionnaires administered to patients who underwent Pregnancy Terminations in the years 2020, 2021, and 2022 at San Giuliano Hospital in Giugliano in Campania (Na), which falls within the territory of the Local Health Authority Napoli 2 Nord.From the analysis of the questionnaires, it is possible to reconstruct sensitive patient data, including place and date of birth, residence, domicile, age, origin, education level, as well as all clinical data related to the patient and pregnancy in general. Surgical pregnancy termination compared to pharmacological termination appears to be less common in all three periods considered. The pharmacological method involves taking an antiprogesterone hormone (Mifepristone) followed by an analogue of prostaglandins (Misoprostol). From a cost analysis perspective, the starting point was the Diagnosis Related Group (DRG) of pharmacological and surgical pregnancy terminations in the Campania Region for each method considered. Results: The laboratory tests which the patient must undergo in the preliminary phase are the same in all abortion (IG) procedures. In the surgical treatment, the patient is admitted to the day hospital, and under anaesthesia, the gestational sac is removed (an invasive procedure with associated risks). In th","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio
Introduction:Bleedings can result from insufficient blood coagulation and represent a relevant clinical aspect in medical practice. In most cases, these are genetically determined disorders that persist throughout a person's life, leapractice. In most cases, these are genetically determined disorders that persist throughout a person's life, leading to a significant financial burden on the National Health System and affecting the patient's quality of life.On the other hand, the bleeding phenomenon can be influenced in its potential complications by various factors such as pharmacological therapies, autoantibodies, clinical situations, lifestyle, and other factors related to possible genetic predispositions. These undesirable effects pose a diagnostic and therapeutic challenge that often presents characteristics of urgency and severity due to disruptions in the patient's hemostatic balance.Pharmacological therapy with anticoagulants, whether they are heparin-based or NOACs, can affect the duration and quantity of bleeding. Therefore, it is essential to always inform the surgeon and the general practitioner before any procedure if the patient is on these medications. The replacement or discontinuation of these drugs should only be carried out under medical guidance, even if it's for preparing for minor or major surgical interventions. Stopping bleeding is an essential medical procedure, both in the operating room and in outpatient settings. The choice of hemostatic drug or device to use is based on the type of bleeding to be treated and can be a lifesaver for the patient, expediting the recovery process. Making the most appropriate choice promptly can lead to significant economic savings, making it an effective and efficient practice without wasteful decisions. Materials and Methods: The study is observational and multicentric, spanning over 36 months, with data collected from a cohort of 75,000 patients treated at the departments and clinics of the San Giuliano Hospital within the territory of ASL Napoli 2 Nord in the northern area of the Campania capital. The degree of bleeding from the lesions was classified based on a scale validated by the FDA, dividing the phenomenon into grades ranging from 0 to 4. Grade 0 refers to blood loss <1.0 mL/min, Grade 1 to bleeding between 1.0 < mL/min > 5.0, Grade 2 to bleeding between 5.0 < mL/min > 10.0, Grade 3 to bleeding between 10.0 < mL/min > 50.0, and Grade 4 to bleeding with blood loss > 50 mL/min. This division corresponds to a severity threshold and relative life-threatening risk based on the quantity of bleeding. Medical professionals who intervened or were responsible for follow-up visits were given a mini-questionnaire in which they were asked to classify the outcome success rate based on the percentage, assessing the cessation of bleeding considering the initial severity according to the FDA scale. The obtained responses were classified as perfect, good, sufficient, or failed based on the achieved o
{"title":"OBSERVATIONAL STUDY OF COSTS AND APPROPRIATENESS OF USE OF HEMOSTATIC DEVICES AND DRUGS IN DIFFERENT TYPES OF BLEEDING","authors":"Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio","doi":"10.36017/jahc202353249","DOIUrl":"https://doi.org/10.36017/jahc202353249","url":null,"abstract":"Introduction:Bleedings can result from insufficient blood coagulation and represent a relevant clinical aspect in medical practice. In most cases, these are genetically determined disorders that persist throughout a person's life, leapractice. In most cases, these are genetically determined disorders that persist throughout a person's life, leading to a significant financial burden on the National Health System and affecting the patient's quality of life.On the other hand, the bleeding phenomenon can be influenced in its potential complications by various factors such as pharmacological therapies, autoantibodies, clinical situations, lifestyle, and other factors related to possible genetic predispositions. These undesirable effects pose a diagnostic and therapeutic challenge that often presents characteristics of urgency and severity due to disruptions in the patient's hemostatic balance.Pharmacological therapy with anticoagulants, whether they are heparin-based or NOACs, can affect the duration and quantity of bleeding. Therefore, it is essential to always inform the surgeon and the general practitioner before any procedure if the patient is on these medications. The replacement or discontinuation of these drugs should only be carried out under medical guidance, even if it's for preparing for minor or major surgical interventions. Stopping bleeding is an essential medical procedure, both in the operating room and in outpatient settings. The choice of hemostatic drug or device to use is based on the type of bleeding to be treated and can be a lifesaver for the patient, expediting the recovery process. Making the most appropriate choice promptly can lead to significant economic savings, making it an effective and efficient practice without wasteful decisions. Materials and Methods: The study is observational and multicentric, spanning over 36 months, with data collected from a cohort of 75,000 patients treated at the departments and clinics of the San Giuliano Hospital within the territory of ASL Napoli 2 Nord in the northern area of the Campania capital. The degree of bleeding from the lesions was classified based on a scale validated by the FDA, dividing the phenomenon into grades ranging from 0 to 4. Grade 0 refers to blood loss <1.0 mL/min, Grade 1 to bleeding between 1.0 < mL/min > 5.0, Grade 2 to bleeding between 5.0 < mL/min > 10.0, Grade 3 to bleeding between 10.0 < mL/min > 50.0, and Grade 4 to bleeding with blood loss > 50 mL/min. This division corresponds to a severity threshold and relative life-threatening risk based on the quantity of bleeding. Medical professionals who intervened or were responsible for follow-up visits were given a mini-questionnaire in which they were asked to classify the outcome success rate based on the percentage, assessing the cessation of bleeding considering the initial severity according to the FDA scale. The obtained responses were classified as perfect, good, sufficient, or failed based on the achieved o","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"138 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"THE PHARMAECONOMIC EVALUATION OF PAPER DRUG AND MEDICAL DEVICE UTILIZATION AS A TOOL FOR ASSESSING ORGANIZATIONAL PERFORMANCE","authors":"Lucio Marcello Falconio","doi":"10.36017/jahc202353245","DOIUrl":"https://doi.org/10.36017/jahc202353245","url":null,"abstract":"PREFACE","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio
Introduction: Bacterial infections associated with implanted biomaterials represent the most significant complication in orthopedics, and they constitute the primary reason for the failure of primary hip and knee prostheses.The prevention of infections associated with implanted biomaterials should simultaneously focus on at least two objectives: inhibition of biofilm formation and minimization of suppression of the local immune response.Some of the technologies proposed for this purpose in clinical practice have already shown strong evidence of antibacterial effectiveness, safety, and resistance. The time is ripe for further development and experimentation of these technologies in a clinical context. Material and Methods: The study was conducted by observing wounds within 6 months following the treatments, and the purpose of the work was to evaluate the cost and benefit aspects in patients treated with defensive antibacterial gels during orthopedic prosthetic and/or synthesis surgeries at the P.O. San Giuliano ASL Napoli 2 Nord. The aim was to assess the effectiveness of the treatment applied to patients who underwent orthopedic prosthetic and/or synthesis surgeries. The wound conditions of treated patients and untreated patients were compared at 6 months after orthopedic surgery. Simultaneously, the costs incurred by the National Health Service (SSN) and the related benefits obtained for the treated patients and untreated patients were also analyzed. This observational and retrospective study was conducted over 6 months on a cohort of 60 patients from the orthopedic department and outpatient clinic of P.O. San Giuliano ASL Napoli 2, who underwent post-traumatic interventions. The cohort was divided into two groups: Group A (gA) included 30 operated patients whose wounds and/or devices used were treated with gels designed for decontamination, aiming to prevent infections; Group B (gB) consisted of 30 operated patients who were not treated with any such device. The study involved a 6-month observation of both groups, evaluating the possible onset of infections, their duration (until complete healing, including potential complications), and the average cost of the necessary treatment (monitoring the use of drugs, medical supplies, and devices).A value scale was established based on the average cost incurred and the average treatment duration for each of the 4 levels on the scale. Results: At the end of the study period, 30 patients from the cohort were observed in group gA, and 30 in group gB.Within group gA, 2 patients experienced infections that positioned them in the first two levels of the scale, while in group gB, 8 patients required treatment for infections that placed them at different levels of the scale based on the treatment received and its associated cost. The economic impact is significant and variable, depending on the extent of usage indications (e.g., applying the device alone or as a carrier in combination with antibiotics in all s
{"title":"INCIDENCE ON COST AND DURATION OF THERAPY OF POSSIBLE POSTOPERATIVE WOUND INFECTIONS FROM TRAUMA WITH PROSTHETIC DEVICES, PREVENTIVELY TREATED AND UNTREATED, USING ANTIBACTERIAL GELS AT P.O. SAN GIULIANO, ASL NAPLES 2 NORTH","authors":"Immacolata Filoso, Maria Rosaria Iacolare, Ida Monti, Attilio Tortora, Claudio Contiello, Assunta De Luca, Anna Scarano, Giovanni Gerbi, Gaetano Mignano, Lucio Marcello Falconio","doi":"10.36017/jahc202353250","DOIUrl":"https://doi.org/10.36017/jahc202353250","url":null,"abstract":"Introduction: Bacterial infections associated with implanted biomaterials represent the most significant complication in orthopedics, and they constitute the primary reason for the failure of primary hip and knee prostheses.The prevention of infections associated with implanted biomaterials should simultaneously focus on at least two objectives: inhibition of biofilm formation and minimization of suppression of the local immune response.Some of the technologies proposed for this purpose in clinical practice have already shown strong evidence of antibacterial effectiveness, safety, and resistance. The time is ripe for further development and experimentation of these technologies in a clinical context. Material and Methods: The study was conducted by observing wounds within 6 months following the treatments, and the purpose of the work was to evaluate the cost and benefit aspects in patients treated with defensive antibacterial gels during orthopedic prosthetic and/or synthesis surgeries at the P.O. San Giuliano ASL Napoli 2 Nord. The aim was to assess the effectiveness of the treatment applied to patients who underwent orthopedic prosthetic and/or synthesis surgeries. The wound conditions of treated patients and untreated patients were compared at 6 months after orthopedic surgery. Simultaneously, the costs incurred by the National Health Service (SSN) and the related benefits obtained for the treated patients and untreated patients were also analyzed. This observational and retrospective study was conducted over 6 months on a cohort of 60 patients from the orthopedic department and outpatient clinic of P.O. San Giuliano ASL Napoli 2, who underwent post-traumatic interventions. The cohort was divided into two groups: Group A (gA) included 30 operated patients whose wounds and/or devices used were treated with gels designed for decontamination, aiming to prevent infections; Group B (gB) consisted of 30 operated patients who were not treated with any such device. The study involved a 6-month observation of both groups, evaluating the possible onset of infections, their duration (until complete healing, including potential complications), and the average cost of the necessary treatment (monitoring the use of drugs, medical supplies, and devices).A value scale was established based on the average cost incurred and the average treatment duration for each of the 4 levels on the scale. Results: At the end of the study period, 30 patients from the cohort were observed in group gA, and 30 in group gB.Within group gA, 2 patients experienced infections that positioned them in the first two levels of the scale, while in group gB, 8 patients required treatment for infections that placed them at different levels of the scale based on the treatment received and its associated cost. The economic impact is significant and variable, depending on the extent of usage indications (e.g., applying the device alone or as a carrier in combination with antibiotics in all s","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edoardo Robortella Stacul, Giuseppe Napolitano, Davide Gresia, Lorenzo Morra, Carmen Fiore, Fabiana Saraceno
As part of the broader implementation of the Environmental Remediation and Urban Regeneration Program (PRARU) of the Bagnoli-Coroglio area of relevant national interest (Naples, Italy), one of the priority actions was the completion of the soil remediation interventions of the former Eternit site, focused on the safe removal of soil and materials containing asbestos still present in the area (approximately 25,700 tonnes of hazardous waste).This area has an extension of approximately 157,000 m2 where the production of products containing asbestos had been carried out from 1939 to 1985. In 1997, the first reclamation activities began, consisting of the decommissioning of industrial structures and continuing with the removal of buried materials. These activities were interrupted in 2014 and then resumed in 2020 until completion at the beginning of 2023.The activities, completed to date, were run under the constant control of the territorially competent “ASL Napoli 1”, and with the implementation of a specific shared plan for monitoring airborne fibers both inside the construction site and outside in the surrounding areas.In particular, environmental monitoring activities were performed before, during and post-operation on eight control units, three of which were located within the construction site and five in the surrounding areas at potentially sensitive targets, as well as personal sampling of the exposed operators.The methods for identifying asbestos fibers were both phase contrast microscopy (MOCF) and scanning electron microscopy (SEM).In both cases, the monitoring results never showed that the thresholds established by Italian legislation were exceeded, both in terms of total fibers and asbestiform fiber.
{"title":"MONITORING OF AIRBORNE FIBERS DURING ASBESTOS REMEDIATION: THE CASE STUDY OF THE “ETERNIT” SITE IN THE BAGNOLI-COROGLIO AREA OF RELEVANT NATIONAL INTEREST","authors":"Edoardo Robortella Stacul, Giuseppe Napolitano, Davide Gresia, Lorenzo Morra, Carmen Fiore, Fabiana Saraceno","doi":"10.36017/jahc202352280","DOIUrl":"https://doi.org/10.36017/jahc202352280","url":null,"abstract":"As part of the broader implementation of the Environmental Remediation and Urban Regeneration Program (PRARU) of the Bagnoli-Coroglio area of relevant national interest (Naples, Italy), one of the priority actions was the completion of the soil remediation interventions of the former Eternit site, focused on the safe removal of soil and materials containing asbestos still present in the area (approximately 25,700 tonnes of hazardous waste).This area has an extension of approximately 157,000 m2 where the production of products containing asbestos had been carried out from 1939 to 1985. In 1997, the first reclamation activities began, consisting of the decommissioning of industrial structures and continuing with the removal of buried materials. These activities were interrupted in 2014 and then resumed in 2020 until completion at the beginning of 2023.The activities, completed to date, were run under the constant control of the territorially competent “ASL Napoli 1”, and with the implementation of a specific shared plan for monitoring airborne fibers both inside the construction site and outside in the surrounding areas.In particular, environmental monitoring activities were performed before, during and post-operation on eight control units, three of which were located within the construction site and five in the surrounding areas at potentially sensitive targets, as well as personal sampling of the exposed operators.The methods for identifying asbestos fibers were both phase contrast microscopy (MOCF) and scanning electron microscopy (SEM).In both cases, the monitoring results never showed that the thresholds established by Italian legislation were exceeded, both in terms of total fibers and asbestiform fiber.","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139344958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the pandemic emergency, work-related stress in paramedical professions has reached levels never imagined before. A questionnaire was administered to understand the stress or burnout, generated by the Covid 19 pandemic. The psychological theory reported explains the results that emerged and the correlations with the factors that intensified the impact of stress, to produce burnout situations among health professionals.
{"title":"ANALYSIS AND EVALUATION OF THE IMPACT OF COVID-19 ON THE COMPLEX SYSTEM OF THE 19 TSRM AND PSTRP HEALTH PROFESSIONS.","authors":"Claudia Nissi","doi":"10.36017/jahc202352224","DOIUrl":"https://doi.org/10.36017/jahc202352224","url":null,"abstract":"In the pandemic emergency, work-related stress in paramedical professions has reached levels never imagined before. A questionnaire was administered to understand the stress or burnout, generated by the Covid 19 pandemic. The psychological theory reported explains the results that emerged and the correlations with the factors that intensified the impact of stress, to produce burnout situations among health professionals.","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139358027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanna Albanese, Maria Urbano, Giuseppe Walter Antonucci, Giacinto Abruzzese, Giuseppe Guglielmi
The National Recovery and Resilience Plan (NRP) is a plan approved in 2021 to relaunch the economy after the COVID-19 pandemic and provides for an investment and reform package divided into six Missions, including Health. The recent pandemic has clearly demonstrated how the Hospital/Territory axis has not been able to withstand the impact of an event such as the COVID pandemic. With a view to an overall improvement of the system, the PNRR gives us the opportunity to intervene by completely redesigning the territorial health and the goal is to compensate for the current territorial care inequalities and bridge the distance between the traditional places of care and the daily life of the patient, strengthening the health and social health network in the territory with better primary care services.In this context, Home Radiology, a branch of radiology, is inserted, which deals with all procedures aimed at performing traditional radiographic examinations at the home of the non-ambulatory and / or non-transportable patient on the basis of clinical evaluations.To validate the activity of Home Radiology, in this experimental study, radiographic examinations performed at home were compared with radiographic examinations performed in the hospital with the aim of highlighting that this method is desirable and mature to be spread and used in the Territory.Through a blind analysis by some hospital Radiologists, in fact, it is shown that the examinations performed at the patient’s home are, practically, superimposable to those performed in an outpatient setting.
{"title":"Home Radiology Activities In Asl Bt As An Example Of Integration Between Hospital And Territory. FuturePerspectivesIn The Light Of Pnrr.","authors":"Giovanna Albanese, Maria Urbano, Giuseppe Walter Antonucci, Giacinto Abruzzese, Giuseppe Guglielmi","doi":"10.36017/jahc202351134","DOIUrl":"https://doi.org/10.36017/jahc202351134","url":null,"abstract":"The National Recovery and Resilience Plan (NRP) is a plan approved in 2021 to relaunch the economy after the COVID-19 pandemic and provides for an investment and reform package divided into six Missions, including Health. The recent pandemic has clearly demonstrated how the Hospital/Territory axis has not been able to withstand the impact of an event such as the COVID pandemic. With a view to an overall improvement of the system, the PNRR gives us the opportunity to intervene by completely redesigning the territorial health and the goal is to compensate for the current territorial care inequalities and bridge the distance between the traditional places of care and the daily life of the patient, strengthening the health and social health network in the territory with better primary care services.In this context, Home Radiology, a branch of radiology, is inserted, which deals with all procedures aimed at performing traditional radiographic examinations at the home of the non-ambulatory and / or non-transportable patient on the basis of clinical evaluations.To validate the activity of Home Radiology, in this experimental study, radiographic examinations performed at home were compared with radiographic examinations performed in the hospital with the aim of highlighting that this method is desirable and mature to be spread and used in the Territory.Through a blind analysis by some hospital Radiologists, in fact, it is shown that the examinations performed at the patient’s home are, practically, superimposable to those performed in an outpatient setting.","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135287049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giulia Montigiani, Davide Papi, Lorenzo Proietti, Beatrice Meucci, Mara Taddei, Luca Bucciardini, Mauro Di Bari
In Intensive Care Unit (ICU), failure of extubation, resulting in the need for reintubation, mayoccur in 2-25% of Patients undergoing extubation[1].
The purpose of this review and meta-analysiswas to determine the effectiveness of cough assist in improving success rates of extubation compared with standard treatment.
Inclusion criteria were; Randomized Control Trials, which compared cough assist and conventional therapy in adult population in intensive care unit whith conventional therapy only. Outcomes representing the efficacy of the cough assist were: quantity and quality of secretions (weight, volume, and density), number of reintubation, indices of thoraco-pulmonary function.
The search string produced 764 studies, and only 5 studies eligible for review. Overall, a total of 331 participants were enrolled in the five studies selected.
Of the meta-analyzed outcomes, the calculation of the effect size for the weight of secretions is the one that gave the best results, while no statistical difference was found in the other outcomes. In none of the meta-analysis studies were observed adverse effects in the use of in-exsufflator.
Our systematically review edsuggest sthatcough assist might be feasible and effective in patients intubated in ICU, but studies with larger sample sizes and well-defined outcomes are still required to obtain conclusive evidence.
{"title":"EFFECTIVENESS OF COUGH ASSIST IN THE EXTUBATION OF ADULT PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Giulia Montigiani, Davide Papi, Lorenzo Proietti, Beatrice Meucci, Mara Taddei, Luca Bucciardini, Mauro Di Bari","doi":"10.36017/jahc202351277","DOIUrl":"https://doi.org/10.36017/jahc202351277","url":null,"abstract":"In Intensive Care Unit (ICU), failure of extubation, resulting in the need for reintubation, mayoccur in 2-25% of Patients undergoing extubation[1].
 The purpose of this review and meta-analysiswas to determine the effectiveness of cough assist in improving success rates of extubation compared with standard treatment.
 Inclusion criteria were; Randomized Control Trials, which compared cough assist and conventional therapy in adult population in intensive care unit whith conventional therapy only. Outcomes representing the efficacy of the cough assist were: quantity and quality of secretions (weight, volume, and density), number of reintubation, indices of thoraco-pulmonary function.
 The search string produced 764 studies, and only 5 studies eligible for review. Overall, a total of 331 participants were enrolled in the five studies selected.
 Of the meta-analyzed outcomes, the calculation of the effect size for the weight of secretions is the one that gave the best results, while no statistical difference was found in the other outcomes. In none of the meta-analysis studies were observed adverse effects in the use of in-exsufflator.
 Our systematically review edsuggest sthatcough assist might be feasible and effective in patients intubated in ICU, but studies with larger sample sizes and well-defined outcomes are still required to obtain conclusive evidence.","PeriodicalId":14873,"journal":{"name":"Journal of Advanced Health Care","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135006630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：