Annali dell'Istituto Superiore di Sanità
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Does Clinical Governance influence the quality of medical records?
Get PDFBackground. Clinical Governance (CG) is a validated framework for continuous quality improvement in health care settings. Quality medical records may reflect the quality of care delivered and are a viable tool to implement CG skills. Aim. Aim of this study is to investigate the correlation between the level of implementation of CG dimensions and the quality of medical records. Material and methods. A cross-sectional study was carried out in an Italian Teaching Hospital. CG implementation levels were quantified through a systematic methodology (OPTIGOV©). The overall quality of medical records was measured through a revised version of a National-validated scale. A multiple linear regression model was used to test the likely influence of all the variables constituting the OPTIGOV evaluation on the quality of medical records. 47 hospital wards and 1458 medical records were assessed. Results. A significant and positive association between the quality of medical records and the accountability score (β = 0.15; p < 0.01) and the clinical audit score (b = 0.11; p = 0.02), was found. Conversely, the risk management score shown a negative and significant correlation (b = -0.17; p < 0.01). This study confirms that CG plays a central role in driving quality improvement and advocates a systematic implementation of such an approach within healthcare organizations.
Influenza vaccine effectiveness in an Italian elderly population during the 2016-17 season.
No full textInterim analyses of the 2016-17 influenza vaccine effectiveness showed variable results depending on timing of the analysis and geographical setting. We conducted a population-based retrospective cohort study based on the analysis of health-related administrative data to assess the effectiveness of the 2016-17 influenza vaccine among the elderly population of a North-Eastern Italian area. Data on 64849 subjects ≥65 years of age were analyzed up to April 30, 2017. The influenza vaccine was administered to 53% of the elderly population. No significant effect was observed on the likelihood of Emergency department visits, hospitalizations, or deaths from pneumonia and influenza.
General principles and practice of the ethics of public health surveillance: comments on the situation in Italy
Get PDFThe “WHO guidelines on ethical issues in public health surveillance” were ublished shortly after the Italian Presidency of the Council of Ministers published a Decree (3rd March, 2017) regarding surveillance systems and registries. The WHO document is a comprehensive framework of international import that forms a compendium of ethical principles to underlie public health surveillance. Although the Italian Decree is in line with the guidelines it contains no reference to mechanisms to ensure ethical surveillance, which instead are recommended in the WHO document. Ethics Committees would appear the most suitable candidates to fill this role
The Italian National External Quality Assessment Program in Cytogenetics: 4 years of activity (2013-2016) following the introduction of poor performance criteria
Get PDFBackground. Italian External Quality Assessment (IEQA) Program in Cytogenetics, established in 2001 by the Istituto Superiore di Sanità (ISS), covers both Constitutional and Oncohaematological diagnosis. In 2013, performance criteria were defined and adopted. In this paper, we present the data from the first 4 years of activity (2013-2016) following the introduction of performance criteria. Methods. The enrollment is voluntary, fee-based and open to both public and private Italian laboratories. The scheme is annual and retrospective; a national panel of experts assess technical, analytical and interpretative performance. Results. Overall, 95 distinct Italian laboratories participated in different Cytogenetics IEQA schemes over the 2013-2016 years and most of the laboratories took part in Constitutional diagnosis. General hospitals and local health centers represented 40% of the total participants and the percentage of laboratories from Northern Regions was more than 45% of total participants throughout the 4-year period. As regards the performance evaluation, on average, 11, 9 and 23% of participants were marked as poor performers in Prenatal, Postnatal and Oncohaematological schemes, respectively. With regard to critical errors, ISCN nomenclature in Prenatal and Postnatal schemes, and interpretation in Oncohaematological diagnosis, were identified as main issues. On the other hand, karyotype errors and inadequate analysis decreased strongly, over the 4 years, in Constitutional and Oncohaematological diagnosis, respectively. Conclusions. Our data show that the introduction of poor performance encourages laboratories to address critical issues, and the IEQA participation helps to improve quality in cytogenetic testing.
State of the art and future perspectives for the integrated work in contaminated sites: the Casale Monferrato model Preface
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Knowledge of gestational alcohol drinking risks: results from a survey among Italian secondary school students
Get PDFIntroduction. Ethanol is the most widely used drug worldwide. Its consumption has been increasing, and it is reported even during childbearing. Prenatal exposure to ethanol can lead to irreversible damages of the fetus. Knowledge about this risk could prevent these damages. There is no information about knowledge of the Italian students on this issue. Methods. Therefore the aim of this study was to describe the awareness of the Italian students attending the last year of secondary school about risk of gestational alcohol drinking for the delivering mother and the fetus. An online multiple-choice anonymous survey for students was used and e-mailed to the all Italian secondary schools. Results. The respondents were 9.921 and the obtained results evidenced that that young females are more informed than males, and students in Northern and Central Italy are better informed than those in the South, especially on general aspects. The most of respondents knows that alcohol consumption during pregnancy can damage the fetus. However, many youngsters failed to translate this belief into the practice. Conclusions. In conclusion, interventions are needed to enhance knowledge and prevent these damages, and health professionals, with nurses in the first row are entitled to provide education on this topic
Transitions and trajectories in frailty states over time: a systematic review of the European Joint Action ADVANTAGE
No full textIntroduction. Frailty is a dynamic syndrome and may be reversible. Despite this, little is known about trajectories or transitions between different stages of frailty. Methods. A systematic review was conducted, selecting studies reporting frailty trajectories or transition states for adults in any settings in European ADVANTAGE Joint Action Member States. Results. Only three papers were included. Data were from longitudinal communitybased cohorts in the United Kingdom, Netherlands and Italy. The English study investigated the effect of physical activity on the progression of frailty over a 10-year period. Two presented data on the proportion of participants experiencing at least one frailty transition over time (32.6% in the Italian sample aged ≥ 65 years followed for 4.4 years; 34.3% in the Dutch sample aged 65-75 years, followed for 2 years). Conclusions. Data on frailty trajectories and transition states were limited and heterogeneous. Well-designed prospective studies and harmonized approaches to data collection are now needed
Development and cross-validation of predictive equation for estimating total body lean in children
Get PDFAim. To develop and cross-validate a predictive equation for estimating lean body mass (LBM) in children, based on bioelectrical impedance analysis (BIA) and anthropometric parameters, and to compare our equation with other predictive methods. Methods. We evaluated body composition of 155 children (age 5-14 years) by BIA and dual energy X-ray absorptiometry (DXA). Children were divided in two groups: developing set and cross-validation set. Statistical analysis as multiple regression and Bland-Altman methods were performed. Results. From developing set (105 children) the following predictive LBM (kg) equation was created: (R2=0.96). From the cross-validated set (35 children), our equation was seen to agree with LBM (kg) by DXA. On the contrary, LBM predicted by Schaefer’s equation and BIA did not agree with the criterion measure. Conclusions. This cross-validated equation can be useful in epidemiological studies and also in clinical practice, permitting a better definition and follow up of children’s body composition
Need for ethics support in clinical practice and suggestion for an Ethics Consultation Service: views of Nurses and Physicians working in Italian Healthcare Institutions
Get PDFIntroduction. Ethics Consultation Services (ECS) and Ethical Committees manage several aspects of clinical ethical issues. In Italy there are only Ethical Committees, and, although they should also perform ethical consultations, their activity is limited to approving clinical trial protocols. Aim. To analyse the opinions of a sample of Nurses and Physicians about their motivations to ask for an ethical consultation. Methods. A cross-sectional study was conducted on a sample of Italian Nurses and Physicians. Results. Respondents would request ethical consultations mainly for end-of-life issues and, secondarily, for conflicts with patients’ families. Respondents identified the provision of suggestions for hospital policy, the development of ethical guidelines, and the counselling for individual cases requested by clinicians, patients or families as the most important functions of ECS. Conclusions. ECS activities should focus on counselling and support to decisions in complex ethical situations according to institutional policies and guidelines self-developed.