1,720,978 research outputs found
[Implementation of Italian guidelines on public health genomics in Italy: a challenging policy of the NHS]
No full textGenomics and related fields are becoming increasingly relevant in health care practice. Italy is the first European country that has a structured policy of Public Health Genomics. Nevertheless, what should be the role of genomics in a public health perspective and how public health professionals should engage with advances in genomics' knowledge and technology, is still not entirely clear
Double coronary artery anomaly in an elderly asymptomatic patient with positive electrocardiogram stress test
No full textLa JPI DEDIPAC e i determinanti dell’attivita’ fisica: una revisione della letteratura scientifica
No full textDEDIPAC (Determinants of Diet and Physical Activity) è un consorzio scientifico multidisciplinare (Joint Programme Initiative) che raggruppa esperti da 46 centri di ricerca in 12 Paesi Europei. L’obiettivo del consorzio è la comprensione e la mappatura dei determinanti della dieta, dell’attività fisica e del comportamento sedentario, e la traduzione di questa conoscenza in efficaci interventi di promozione della salute. Tra i partner del consorzio, la ricerca dei determinanti dell’attività fisica è coordinata dal network italiano LISTANet (Life Style Advancement Network) ed è attualmente effettuata mediante una revisione della letteratura scientifica. Metodi: La ricerca sistematica della letteratura è stata condotta su MEDLINE, ISI Web of Knowledge, SCOPUS e SPORTDiscus, e ha considerato i soli studi pubblicati in lingua inglese nel periodo compreso tra Gennaio 2004 e Marzo 2014. Sono state incluse le sole revisioni sistematiche della letteratura o le meta-analisi che: i) avessero come risultato primario l’attività fisica, l’esercizio fisico, o l’attività sportiva; ii) analizzassero l’associazione tra una qualsiasi variabile che potesse influenzare il risultato primario e il risultato primario stesso. Risultati: Dalla ricerca sistematica sono emersi 10.953 studi. In seguito all’eliminazione dei duplicati, 10.314 studi sono stati
analizzati per l’inclusione secondo i criteri di inclusione. Dalla lettura del titolo, dell’abstract e del testo completo, 268 studi sono stati considerati eleggibili per la revisione e attualmente è in corso l’estrazione di dati utili all’analisi qualitativa e quantitativa.
Conclusioni: Il taglio multidisciplinare e intersettoriale della nostra revisione ombrello della letteratura consentirà un’esaustiva mappatura dei determinanti individuali e ambientali dell’attività fisica in Europa. L’analisi per età, genere, e tipologia di attività
fisica permetterà di comprendere quali sono i determinanti che influenzano lo stile di vita attivo dei gruppi più vulnerabili
Molecular epidemiology tools in the management of healthcare-associated infections: towards the definition of recommendations
No full textHealthcare-Associated Infections (HAIs) are an important cause of morbidity and mortality worldwide and have a significant economic impact for health systems. Molecular epidemiology tools have a central role in HAI prevention programs. In order to give an overview of their specific advantages and disadvantages we reported current and new molecular typing methods for HAI outbreak detection and epidemiological surveillance
[Molecular epidemiology in healthcare-associated infections: guidelines of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI)]
No full textHealthcare-associated infections (HAI) are the most frequent and severe complication acquired in healthcare settings and have a significant impact in terms of morbidity, mortality and costs. This document is aimed at different health professionals and focuses on the role of molecular epidemiology in the prevention and management of these infections. It describes the role of molecular characterization and of bioinformatics archives, the organizational levels of laboratories, the evidence regarding cost-effectiveness, ethical aspects related to HAI, and highlights some specific peculiarities of Italy. Molecular epidemiology is an indispensable tool and should be part of a multidisciplinary approach in the proper management of HAI
Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?
No full textIntroduction: The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods: MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results: Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion: We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services
Molecular epidemiology tools in the management of healthcare-associated infections: towards the definition of recommendations
No full textINTRODUCTION:
Healthcare-Associated Infections (HAIs) are an important cause of morbidity and mortality worldwide and have a significant economic impact for health systems. Molecular epidemiology tools have a central role in HAI prevention programs. In order to give an overview of their specific advantages and disadvantages we reported current and new molecular typing methods for HAI outbreak detection and epidemiological surveillance.
METHODS:
The current review was drafted as a short version of a longer document written by the Public Health Genomics (GSP) working group, and the Italian Study Group of Hospital Hygiene (GISIO), entitled Molecular epidemiology of Healthcare Associated Infections: recommendations from the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). This text considers various aspects related to HAIs: the role of genotyping and bioinformatics, the organizational levels of laboratories, as well as ethical and economic aspects.
CONCLUSIONS:
The use of molecular epidemiology represents a key tool in the management of HAIs, to be used as a complement to conventional control measures. The present contribution aims to increase knowledge on the proper use of such methods, given the major challenge HAI represents for National Health systems
Appropriateness of antibiotic prophylaxis in the surgical wards of a Teaching Hospital in Rome
No full textBackground
Surgical site infections (SSIs) are a major contributor to patient injury, mortality and health care costs. There is a strong evidence of effectiveness of antimicrobial prophylaxis and the spread availability of national and international guidelines, its use is often suboptimal. Classically inappropriateness in antibiotic prophylaxis is associated with lower safety, efficiency and higher cost. Our study evaluates the appropriateness of prescription of antibiotics prophylaxis in surgical hospitalized patients in a big Italian research and teaching hospital (R&TH).
Methods
An observational-retrospective study was conducted through the investigation of the medical records of all the patients undergoing surgery in two not-consecutive weeks period from March to April 2013. Medical records were investigated on day 3 and 7 after surgery in order to evaluate the appropriateness of administration of antibiotic prescription. Patients with a suspected or established infection before surgery were excluded from the evaluation. Appropriateness was measured in terms of adherence to type, time and duration according to surgical antimicrobial prophylaxis guidelines (Bratzler 2013).
Results
672 surgical procedures were evaluated. We observed in 12.9% of the cases a prophylaxis not performed even if indicated by guidelines. Conversely, an antibiotic prophylaxis was performed, even if not indicated in 21% of cases. A complete adherence to guidelines was observed in 57.3% of the cases. The right type of antimicrobial agent, according to guidelines, was chosen in 94.1% of the cases. The appropriateness of “timing” (from 180 to 15 minutes before the procedure) was detected in 71.4% of the records while the appropriateness of duration (one-shot therapy in almost all the operations but cardiac surgery) was found in 69.3% of the cases.
Conclusion
The appropriateness of antibiotic prophylaxis in the R&TH, even if comparable with other international experiences, still needs to be implemented. Importantly, the issue of prophylaxis given when not indicated (excess of therapy), or not given when indicated (defect of therapy), other than type-time-duration appropriateness, needs to be always take into consideration while evaluating the correct use of antibiotic prophylaxis for surgery.
Key messages
Healthcare providers should be aware of their key role in reducing inappropriate prescription in surgical antimicrobial prophylaxis.
Adherence to guidelines ought to be explored also through the evaluation of excess or defect of prescription, alongside appropriateness in terms of type, duration and time
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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