L. Scalone, M. Carminati, P. Bonhoeffer, P. Cortesi, L. Mantovani, G. Cesana, J. Hess
Background : patients with congenital heart defects, developing right ventricular outflow tract (rVoT) dysfunction, can face repeated open chest interventions over their lifetime. repeating surgery increases difficulties and procedural risks, and exposes patients to burdensome and long recovery times that may induce them to postpone the treatment, with possible severe and irreversible consequences for their health. The percutaneous procedure was introduced to delay the need for open chest surgery. uncertainties still exist regarding the lifelong consequences that may result from adopting different treatment strategies. current decisions on treatment depend on patients’ clinical needs, but also on physicians’ experience and opinion, patients’ preferences, and procedural costs. The objective is to identify which treatment characteristics influence decisions on how to treat patients with rVoT dysfunction. Methods : a literature review was conducted, followed by a discussion with a panel of experts. Ten treatment characteristics, potentially relevant for treatment, were identified and rated in a survey, according to the importance assigned to each characteristic by specialist physicians, patients and/or their caregivers. Results : while some characteristics appear to be more important (risk of severe complications associated with intervention delays) or less important (scar) to both physicians and patients/caregivers, other characteristics are rated differently in importance depending on subjects consulted, e.g., risk of complications during the months post intervention was among the most important characteristics for patients/caregivers, but the fifth most important characteristic for physicians. Conclusions : to optimize benefits and efficiency of the treatment strategies, perceptions and opinions from the different subjects involved, together with patients’ clinical needs and overall costs, should be considered in decision-making....
{"title":"Patients' and physicians' needs, experiences and preferences in the treatment of right ventricular outflow tract dysfunction","authors":"L. Scalone, M. Carminati, P. Bonhoeffer, P. Cortesi, L. Mantovani, G. Cesana, J. Hess","doi":"10.2427/6342","DOIUrl":"https://doi.org/10.2427/6342","url":null,"abstract":"Background : patients with congenital heart defects, developing right ventricular outflow tract (rVoT) dysfunction, can face repeated open chest interventions over their lifetime. repeating surgery increases difficulties and procedural risks, and exposes patients to burdensome and long recovery times that may induce them to postpone the treatment, with possible severe and irreversible consequences for their health. The percutaneous procedure was introduced to delay the need for open chest surgery. uncertainties still exist regarding the lifelong consequences that may result from adopting different treatment strategies. current decisions on treatment depend on patients’ clinical needs, but also on physicians’ experience and opinion, patients’ preferences, and procedural costs. The objective is to identify which treatment characteristics influence decisions on how to treat patients with rVoT dysfunction. Methods : a literature review was conducted, followed by a discussion with a panel of experts. Ten treatment characteristics, potentially relevant for treatment, were identified and rated in a survey, according to the importance assigned to each characteristic by specialist physicians, patients and/or their caregivers. Results : while some characteristics appear to be more important (risk of severe complications associated with intervention delays) or less important (scar) to both physicians and patients/caregivers, other characteristics are rated differently in importance depending on subjects consulted, e.g., risk of complications during the months post intervention was among the most important characteristics for patients/caregivers, but the fifth most important characteristic for physicians. Conclusions : to optimize benefits and efficiency of the treatment strategies, perceptions and opinions from the different subjects involved, together with patients’ clinical needs and overall costs, should be considered in decision-making....","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":"73-83"},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68880921","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}
Betti Silvia, A. Boccia, S. Boccia, C. Casella, A. Ciminello, A. Cocchella, Amelia Compagni, D. Coviello, E. D’Andrea, C. Vito, V. Stefano, E. Maria, M. Pietro, E. Giorgio, M. Gualano, G. Ivaldi, A. Izzotti, L. Manzoli, C. Marzuillo, A. Melegaro, Anna Miani, W. Ricciardi, E. Rossi, B. Simone, R. Tarricone, A. A. Teleman, V. Uliana, M. Vercelli, P. Villari, T. Za
Venous thromboembolism (VTE) is a condition in which a thrombus (a solid mass of blood constituents) forms in a vein. VTE represents an extremely common medical problem manifested as either deep venous thrombosis (DVT) or pulmonary embolism (PE) affecting apparently healthy as well as hospitalized patients. Often PE is the physiopathological consequence of the DVT of low extremities vessels, in particular of the calve......
{"title":"HTA of genetic testing for susceptibility to venous thromboembolism in Italiy","authors":"Betti Silvia, A. Boccia, S. Boccia, C. Casella, A. Ciminello, A. Cocchella, Amelia Compagni, D. Coviello, E. D’Andrea, C. Vito, V. Stefano, E. Maria, M. Pietro, E. Giorgio, M. Gualano, G. Ivaldi, A. Izzotti, L. Manzoli, C. Marzuillo, A. Melegaro, Anna Miani, W. Ricciardi, E. Rossi, B. Simone, R. Tarricone, A. A. Teleman, V. Uliana, M. Vercelli, P. Villari, T. Za","doi":"10.2427/6348","DOIUrl":"https://doi.org/10.2427/6348","url":null,"abstract":"Venous thromboembolism (VTE) is a condition in which a thrombus (a solid mass of blood constituents) forms in a vein. VTE represents an extremely common medical problem manifested as either deep venous thrombosis (DVT) or pulmonary embolism (PE) affecting apparently healthy as well as hospitalized patients. Often PE is the physiopathological consequence of the DVT of low extremities vessels, in particular of the calve......","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68881251","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}
P. Rossi, L. Camilloni, A. Todini, A. Fortino, L. D. Bernardo, Leonardo Frigerio, Giacomo Furnari, P. Borgia, G. Guasticchi
Background : the aim of the study was to assess the safety, efficacy and cost-effectiveness of negative Pressure wound therapy (nPT) for people with chronic and acute wounds. Methods : the scope and the final draft of the report have been submitted to the stakeholders (producers, payers and patients). safety issues were addressed through a systematic review of the meta-literature. efficacy was addressed through a systematic review and meta-analysis of randomized controlled trials (rcTs) comparing nPT and other standard therapies in patients with chronic or acute lesions. cost-consequence was analyzed through a systematic review of the existing studies. Results : we retrieved 19 studies, 13 of which were included in the meta-analysis. Many studies had biases that may have resulted in a better performance for nPT. nPT showed: a slightly shorter healing time (-10.4 days, p=0.001), with no heterogeneity, apart from one small study with very positive results, and 40% more patients healed (p=0.002, no heterogeneity).We identified 15 original research papers on nPT costs and cost per outcome. The costs-per-patient- treated varied from +29% to -60%, with several studies reporting savings for nPT. Conclusions : despite serious methodological flaws, the body of evidence available was sufficient to prove some clinical benefit of nPT in severe chronic and acute wound treatment. There is a need for independent and contextualized cost analyses....
{"title":"Health Technology Assessment of the Negative Pressure Wound Therapy for the treatment of acute and chronic wounds: efficacy, safety, cost effectiveness, organizational and ethical impact","authors":"P. Rossi, L. Camilloni, A. Todini, A. Fortino, L. D. Bernardo, Leonardo Frigerio, Giacomo Furnari, P. Borgia, G. Guasticchi","doi":"10.2427/6340","DOIUrl":"https://doi.org/10.2427/6340","url":null,"abstract":"Background : the aim of the study was to assess the safety, efficacy and cost-effectiveness of negative Pressure wound therapy (nPT) for people with chronic and acute wounds. Methods : the scope and the final draft of the report have been submitted to the stakeholders (producers, payers and patients). safety issues were addressed through a systematic review of the meta-literature. efficacy was addressed through a systematic review and meta-analysis of randomized controlled trials (rcTs) comparing nPT and other standard therapies in patients with chronic or acute lesions. cost-consequence was analyzed through a systematic review of the existing studies. Results : we retrieved 19 studies, 13 of which were included in the meta-analysis. Many studies had biases that may have resulted in a better performance for nPT. nPT showed: a slightly shorter healing time (-10.4 days, p=0.001), with no heterogeneity, apart from one small study with very positive results, and 40% more patients healed (p=0.002, no heterogeneity).We identified 15 original research papers on nPT costs and cost per outcome. The costs-per-patient- treated varied from +29% to -60%, with several studies reporting savings for nPT. Conclusions : despite serious methodological flaws, the body of evidence available was sufficient to prove some clinical benefit of nPT in severe chronic and acute wound treatment. There is a need for independent and contextualized cost analyses....","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68880839","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}
A. Zanetti, L. Vercellesi, E. Pariani, M. Laccisaglia, Flavia Bruno
Background : in 2009 a novel infective agent, a(H1n1), was recognized by the World Health organization (WHo) as a pandemic virus. Like most European countries, Italy experienced a single pandemic wave during fall-winter 2009. The objective of our study was to evaluate the news reports and the representation of the a(H1n1) pandemic in the Italian newspapers both quantitatively and qualitatively. Methods : from april 24th, 2009 to February 28th, 2010, seven national newspapers were monitored for the quantitative reporting of a(H1n1). In a three month sample period, reports were evaluated quali- tatively by considering their front page presence, tones used for headlines, and images and figures dedicated to the topic. Results : in a ten month window, a total of 1220 articles were published. The reporting period showed four peaks and one hollow, with a similar pattern for all the newspapers. during the three-month sample period, we found a total of 382 articles, 98.4% of which appeared on front pages, 33.8% of which contained headlines using alarming tones, and 47.8% which contained info-graphic elements. Conclusions : the a(H1n1) 2009 pandemic in Italy was mild; nonetheless, newspapers devoted great attention to the new influenza and used alarmist tones. In similar situations, there are several areas where scientists should play a greater role. scientists should support journalists in understanding scientific issues and help them translate scientific information into news items. scientists should also help to contain the anxiety aroused in lay people by a pandemic, and support vaccination efforts dedicated to it....
{"title":"Analysis of a pandemic in the Italian newspapers: the A(H1N1) experience","authors":"A. Zanetti, L. Vercellesi, E. Pariani, M. Laccisaglia, Flavia Bruno","doi":"10.2427/6343","DOIUrl":"https://doi.org/10.2427/6343","url":null,"abstract":"Background : in 2009 a novel infective agent, a(H1n1), was recognized by the World Health organization (WHo) as a pandemic virus. Like most European countries, Italy experienced a single pandemic wave during fall-winter 2009. The objective of our study was to evaluate the news reports and the representation of the a(H1n1) pandemic in the Italian newspapers both quantitatively and qualitatively. Methods : from april 24th, 2009 to February 28th, 2010, seven national newspapers were monitored for the quantitative reporting of a(H1n1). In a three month sample period, reports were evaluated quali- tatively by considering their front page presence, tones used for headlines, and images and figures dedicated to the topic. Results : in a ten month window, a total of 1220 articles were published. The reporting period showed four peaks and one hollow, with a similar pattern for all the newspapers. during the three-month sample period, we found a total of 382 articles, 98.4% of which appeared on front pages, 33.8% of which contained headlines using alarming tones, and 47.8% which contained info-graphic elements. Conclusions : the a(H1n1) 2009 pandemic in Italy was mild; nonetheless, newspapers devoted great attention to the new influenza and used alarmist tones. In similar situations, there are several areas where scientists should play a greater role. scientists should support journalists in understanding scientific issues and help them translate scientific information into news items. scientists should also help to contain the anxiety aroused in lay people by a pandemic, and support vaccination efforts dedicated to it....","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68880974","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}
According to the WHO-European region Tallin-Charter, Stewardship (S) is on the health agenda of many European countries and in particular of those involved in the devolution of powers, as is the case of Italy. Many observers agree that, in such cases, both the configuration and the application of state authority in the health sector should be realigned so as to achieve desired policy objectives.We present an experience of what could be meant by S in practice, applied to the field of planning preventive interventions.The Italian National Preventive Plan 2010-2012 is a comprehensive Plan dealing with many areas of prevention. For all these areas, the main health objectives, the specific regional goals and the intervention - called “central" actions- that the Ministry of Health (MoH) is in charge of carrying out in order to support regional preventive programs, are stated in this Plan. In order to carry out its task, the MoH has referred to the model of stewardship and has reconsidered its role. Therefore, the MoH has matched the sub-functions of S according to the model outlined by Travis et al, and the prior actions that have been proposed by local and national governments, as the main aspects of how to deal with the governance of prevention. Overall, we experienced that the S framework is a suitable and helpful tool to tackle what the challenge of national planning, in the scenario of devolution, is. In doing so, we have learnt some practical lessons about the running of the system and about how to plan according to stewardship, in particular.Among these, given that the steward’s most specific responsibility in planning is to assure stewardship, a sound capacity building is needed as a cornerstone in evolving the culture of the NHS. Furthermore, in order to put this effectively into practice, the Steward must be able to measure S functions, and putting in practice a S model needs international comparison and cultural growth....
{"title":"National preventive plan: putting stewardship into practice","authors":"A. Federici, G. Filippetti, F. Oleari","doi":"10.2427/6345","DOIUrl":"https://doi.org/10.2427/6345","url":null,"abstract":"According to the WHO-European region Tallin-Charter, Stewardship (S) is on the health agenda of many European countries and in particular of those involved in the devolution of powers, as is the case of Italy. Many observers agree that, in such cases, both the configuration and the application of state authority in the health sector should be realigned so as to achieve desired policy objectives.We present an experience of what could be meant by S in practice, applied to the field of planning preventive interventions.The Italian National Preventive Plan 2010-2012 is a comprehensive Plan dealing with many areas of prevention. For all these areas, the main health objectives, the specific regional goals and the intervention - called “central\" actions- that the Ministry of Health (MoH) is in charge of carrying out in order to support regional preventive programs, are stated in this Plan. In order to carry out its task, the MoH has referred to the model of stewardship and has reconsidered its role. Therefore, the MoH has matched the sub-functions of S according to the model outlined by Travis et al, and the prior actions that have been proposed by local and national governments, as the main aspects of how to deal with the governance of prevention. Overall, we experienced that the S framework is a suitable and helpful tool to tackle what the challenge of national planning, in the scenario of devolution, is. In doing so, we have learnt some practical lessons about the running of the system and about how to plan according to stewardship, in particular.Among these, given that the steward’s most specific responsibility in planning is to assure stewardship, a sound capacity building is needed as a cornerstone in evolving the culture of the NHS. Furthermore, in order to put this effectively into practice, the Steward must be able to measure S functions, and putting in practice a S model needs international comparison and cultural growth....","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68881031","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}
If animals may be a source of hazards for humans, the reverse is equally true. The main sources of hazards from humans to animals, are the impact of human introduction of transboundary animal diseases, climate change, globalisation, introduction of invasive species and reduction of biodiversity.There is also a trend toward reducing genetic diversity in domestic animals, such as cattle; there are presently around 700 different breeds of cattle many of which at the verge of extinction (less than 100 reproductive females). The impact of humans is also indirect through detrimental effects on the environment. It is therefore urgent to implement the new concept of “one health"....
{"title":"Reducing hazards for animals from humans","authors":"P. Pastoret","doi":"10.2427/6337","DOIUrl":"https://doi.org/10.2427/6337","url":null,"abstract":"If animals may be a source of hazards for humans, the reverse is equally true. The main sources of hazards from humans to animals, are the impact of human introduction of transboundary animal diseases, climate change, globalisation, introduction of invasive species and reduction of biodiversity.There is also a trend toward reducing genetic diversity in domestic animals, such as cattle; there are presently around 700 different breeds of cattle many of which at the verge of extinction (less than 100 reproductive females). The impact of humans is also indirect through detrimental effects on the environment. It is therefore urgent to implement the new concept of “one health\"....","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68880692","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}
Pathogens that are capable of infecting more than one host, more than one taxonomic order and wild hosts, all present a higher relative risk of (re-)emergence. A long environmental persistence gives pathogens a more selective advantage. In case of an emerging or re-emerging zoonosis, the prevalence of infection in animals and the exposure determine the incidence in humans. Human exposure to zoonotic agents depends on lifestyle and occupation (e.g., veterinarians and farmers are more at risk for zoonoses related to livestock). Efforts to increase awareness, provide information on prevention, and apply biosecurity are essential. Moreover, a substantial decline in the incidence of human disease implies the prevention, the control or the elimination of zoonoses in the animal compartments. The only way to prevent health hazards is to adapt the existing systems of health governance at global, regional, national and local levels in a harmonised and coordinated manner. To achieve such a goal, the One Health strategy was recently developed to expand interdisciplinary collaborations and communications on all aspects of health care for humans and animals, veterinary, human medical, public health professionals and stakeholders....
{"title":"Reducing hazards for humans from animals: emerging and re-emerging zoonoses","authors":"C. Saegerman, F. D. Pozzo, M. Humblet","doi":"10.2427/6336","DOIUrl":"https://doi.org/10.2427/6336","url":null,"abstract":"Pathogens that are capable of infecting more than one host, more than one taxonomic order and wild hosts, all present a higher relative risk of (re-)emergence. A long environmental persistence gives pathogens a more selective advantage. In case of an emerging or re-emerging zoonosis, the prevalence of infection in animals and the exposure determine the incidence in humans. Human exposure to zoonotic agents depends on lifestyle and occupation (e.g., veterinarians and farmers are more at risk for zoonoses related to livestock). Efforts to increase awareness, provide information on prevention, and apply biosecurity are essential. Moreover, a substantial decline in the incidence of human disease implies the prevention, the control or the elimination of zoonoses in the animal compartments. The only way to prevent health hazards is to adapt the existing systems of health governance at global, regional, national and local levels in a harmonised and coordinated manner. To achieve such a goal, the One Health strategy was recently developed to expand interdisciplinary collaborations and communications on all aspects of health care for humans and animals, veterinary, human medical, public health professionals and stakeholders....","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68880679","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}
Obiettivi : fornire uno strumento per la ricostruzione della catena epidemiologica di diffusione della patologia, dall’esterno all’interno della struttura ospedaliera interessata. Metodo: si caratterizza per l’elaborazione di una scheda di valutazione da aggiungere alla attuale scheda di accesso al Pronto Soccorso. La nuova scheda raccogliera dell’utente, le seguenti informazioni: Data di accesso al Pronto Soccorso Generalita Sintomatologia (per definire il caso) Abitudini di vita, di lavoro e mezzi di trasporto utilizzati nei dieci giorni antecedenti l’accesso al Pronto Soccorso. In particolare, una sezione sara dedicata alla raccolta, delle generalita di tutto il Personale Ospedaliero che ha avuto un contatto diretto col paziente, con indicati gli eventuali DPI adottati dal personale stesso (per una attivita di tutela /controllo). Informazioni che, laddove il caso di SARS venisse confermato, saranno importantissime per l’ identificazione degli elementi della catena epidemiologica. Risultati e conclusioni: al momento la scheda e in corso di validazione, in quanto ad oggi non si sono verificati presso il nostro ospedale, accessi di pazienti con sintomi riconducibili a SARS. Ipotizziamo, tuttavia, che in caso di necessita si potranno fornire con tempestivita alla struttura ospedaliera di riferimento regionale e ad altre autorita sanitarie, elementi utili alla ricostruzione della catena epidemiologica di diffusione del contagio. Inoltre, si potra monitorare selettivamente il personale ospedaliero venuto a contatto con il paziente sospetto, e gestirlo secondo le modalita piu consone ai successivi sviluppi del caso.
{"title":"Adozione di una cartella per la raccolta di informazioni epidemiologiche nei casi sospetti di SARS a completamento della scheda di accesso al Pronto Soccorso","authors":"E. Scalise","doi":"10.2427/6198","DOIUrl":"https://doi.org/10.2427/6198","url":null,"abstract":"Obiettivi : fornire uno strumento per la ricostruzione della catena epidemiologica di diffusione della patologia, dall’esterno all’interno della struttura ospedaliera interessata. Metodo: si caratterizza per l’elaborazione di una scheda di valutazione da aggiungere alla attuale scheda di accesso al Pronto Soccorso. La nuova scheda raccogliera dell’utente, le seguenti informazioni: Data di accesso al Pronto Soccorso Generalita Sintomatologia (per definire il caso) Abitudini di vita, di lavoro e mezzi di trasporto utilizzati nei dieci giorni antecedenti l’accesso al Pronto Soccorso. In particolare, una sezione sara dedicata alla raccolta, delle generalita di tutto il Personale Ospedaliero che ha avuto un contatto diretto col paziente, con indicati gli eventuali DPI adottati dal personale stesso (per una attivita di tutela /controllo). Informazioni che, laddove il caso di SARS venisse confermato, saranno importantissime per l’ identificazione degli elementi della catena epidemiologica. Risultati e conclusioni: al momento la scheda e in corso di validazione, in quanto ad oggi non si sono verificati presso il nostro ospedale, accessi di pazienti con sintomi riconducibili a SARS. Ipotizziamo, tuttavia, che in caso di necessita si potranno fornire con tempestivita alla struttura ospedaliera di riferimento regionale e ad altre autorita sanitarie, elementi utili alla ricostruzione della catena epidemiologica di diffusione del contagio. Inoltre, si potra monitorare selettivamente il personale ospedaliero venuto a contatto con il paziente sospetto, e gestirlo secondo le modalita piu consone ai successivi sviluppi del caso.","PeriodicalId":89162,"journal":{"name":"Italian journal of public health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68878665","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}
M. Rapellino, I. Raciti, A. Scarmozzino, F. Ripa, M. Azzolina, R. Arione, P. Panarisi
Introduzione : i dati italiani stimano 300.000 persone ogni anno in Italia vittime di errori in Ospedale, 12.000 cause tra penali e civili intentate da pazienti, 413 milioni di Euro i risarcimenti pagati dalle Assicurazioni (1999-2000), 35.000 pazienti deceduti in seguito ad un generico rischio medico-sanitario. Obiettivo : per l’importanza del problema, a livello dell’ASO S. Giovanni Battista di Torino si e creata una specifica struttura con il compito di valutare e gestire il rischio sanitario in Ospedale. Metodologia : la struttura ha identificato e categorizzato i rischi in cui possono incorrere gli utenti, basandosi su alcune pubblicazioni rilevanti (To err is human: Building a safer health system; 2000, The National Academy of Sciences e altri riferimenti bibliografici internazionali). Con uno studio retrospettivo sono quindi stati valutati gli errori sanitari dal 2000 al 2002 assumendo come fonti: l’Ufficio Legale (cause civili e penali), il Patrimonio (richieste risarcimento), l’URP (segnalazioni). Sono state identificate alcune categorie di errori piu frequenti o piu significativi: problemi di intubazione per intervento, ustioni in sala operatoria, difetti estetici dopo interventi chirurgici vari, lesione di nervi periferici da posizionamento sul letto operatorio, ritardo di diagnosi, infezioni postoperatorie, problemi legati alla mancanza di vigilanza (tentativi di suicidio, smarrimento protesi dentarie, cadute da letto o carrozzine, furti), decessi improvvisi durante o dopo interventi chirurgici o pratiche invasive. Risultati e conclusioni : molti di questi eventi sono dovuti a deficit di tipo organizzativo, per cui apposite commissioni hanno studiato procedure precise per la riduzione del rischio specifico. E stato impostato un sistema di autoanalisi a livello degli operatori (revisione del percorso, valutazione random di cartelle cliniche e infermieristiche, audit clinico). E in fase di strutturazione un sistema di “voluntary reporting” che riferisca ad una apposita Commissione Aziendale gli eventi avversi generali, quelli prevedibili e quelle situazione di rischio presunto o di “quasi errore”, che sono spesso alla base delle piu gravi e frequenti criticita conclamate.
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M. Bavuso, C. Castaldi, M. Gentili, A. Ottaviani, E. Scalise, L. Sciannamea, D. Ghirelli, F. Vaia, R. Testa
Obiettivo : sviluppare un modello di gestione informatizzata delle liste di attesa, specificamente per l’assistenza ospedaliera in regime di ricovero ordinario e diurno. Questo consentira di tastare in tempo reale il “polso” della situazione, garantendo peraltro quanto previsto dalle disposizioni legislative in materia, anche attraverso un controllo diretto della Direzione Medica di Presidio, che garantisca la complessiva gestione del registro secondo criteri di eticita e trasparenza. Metodi : creare un database per le liste di attesa, condivisibile nell’ambito della rete ospedaliera e accessibile tramite password, contenente i seguenti record: • Codice identificativo U.O.C. • Codice Identificativo Procedura • Generalita paziente • Data visita • Codice di Criticita (descrive l’urgenza del ricovero) • Medico che ha effettuato la visita • Data del ricovero • Note Conclusioni: la partecipazione, a vari livelli di responsabilita e di operativita, di varie figure professionali, e l’elemento fondante di un percorso legato alla definizione di procedure chiare, attuabili e condivise da tutti gli attori del processo. L’informatizzazione del sistema potrebbe permettere una visualizzazione in tempo reale per ciascuna U.O.C. delle liste di attesa, classificando i casi secondo un criterio di urgenza del ricovero. Allo stesso tempo la Direzione Medica avrebbe costantemente sotto controllo le liste di attesa, vigilando sull’osservanza degli obblighi di trasparenza ed eticita sanciti dalle disposizioni legislative. L’accesso ai dati limitato al solo personale medico, ottenuto attraverso la gestione informatica protetta, garantirebbe infine il rispetto della privacy.
目的:发展一种电脑化的等候名单管理模式，特别适用于普通及日间医院护理。这将使我们能够实时监测局势的“脉搏”，同时确保有关立法的规定得到遵守，包括直接控制普列西迪奥医疗理事会，以确保登记册的全面管理符合道德和透明度的标准。方法:建立一个数据库来医院等候名单,支持网络内,并可通过密码,其中载有以下记录:•id U。O . C .••诉讼法id Generalita病人••Criticita代码访问日期(描述)•住院医生的紧迫性,进行了住院••日起访问结论说明:在不同的责任和业务级别上，不同的专业人员的参与是一条道路的基石，这条道路与确定明确、可行和所有参与这一进程的人都同意的程序有关。该系统的计算机化可以实时显示每个ua的等待名单，并根据紧急情况对病例进行分类。与此同时，医疗管理部门将不断监测等待名单，并确保遵守法律规定的透明度和道德义务。通过受保护的计算机管理，仅对医务人员访问数据将确保隐私得到尊重。
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