73 research outputs found
Validation of the Italian version of the Patient Reported Experience Measures for intermediate care services
No full textSergio Cinocca,1 Paola Rucci,1 Concetta Randazzo,1 Elizabeth Teale,2 Davide Pianori,1 Emanuele Ciotti,3 Maria Pia Fantini1 1Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Bologna, Italy; 2Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK; 3Bologna Local Health Authority, Bologna, Italy Background: Intermediate care (IC) services are a key component of integrated care for elderly people, providing a link between hospital and home through provision of rehabilitation and health and social care. The Patient Reported Experience Measures (PREMs) are designed to measure user experience of care in IC settings. Objective: To examine the feasibility and the scaling properties of the Italian version of PREMs questionnaires for use in IC services.Methods: A cross-sectional survey was conducted on consecutive users of 1 home-based and 4 bed-based IC services in Emilia-Romagna (Italy). The main outcome measure was the PREMs questionnaire results. PREMs for each home- and bed-based IC services were translated, back-translated, and adapted through consensus among the members of the advisory board and pilot testing of face validity in 15 patients. A total of 199 questionnaires were returned from users of bed-based services and 185 were returned by mail from users of home-based services. The return rates and responses were examined. Mokken analysis was used to examine the scaling properties of the PREMs.Results: Analysis performed on the bed-based PREMs (N=154) revealed that 13 items measured the same construct and formed a moderate-strength scale (Loevinger H=0.488) with good reliability (Cronbach’s alpha =0.843). Analysis of home-based PREMs (N=134 records) revealed that 15 items constituted a strong scale (Loevinger H=0.543) with good reliability (Cronbach’s alpha =0.875).Conclusion: The Italian versions of the bed- and home-based IC-PREMs questionnaires proved to be valid and reliable tools to assess patients’ experience of care. Future plans include monitoring user experience over time in the same facilities and in other Italian IC settings for between-service benchmarking. Keywords: intermediate care, patient-reported experience measures, validation, elderl
NEURAL-NETWORK SEGMENTATION OF MAGNETIC-RESONANCE SPIN-ECHO IMAGES OF THE BRAIN
No full textThis paper describes a neural network system to segment magnetic resonance (MR) spin echo images of the brain. Our approach relies on the analysis of MR signal decay and on anatomical knowledge; the system processes two early echoes of a standard multislice sequence. Three main subsystems can be distinguished. The first implements a model of MR signal decay; it synthesizes a four-echo multiecho sequence, in order to add images characterized by long echo-times to the input sequence. The second subsystem exploits a priori anatomical knowledge by producing an image, in which pixels belonging to brain parenchyma are highlighted. Such anatomical information allows the following submodule to distinguish biologically different tissues with similar water content, and hence similar appearance, which might produce misclassifications. The grey levels of the reconstructed sequence and the output of the second module are processed by the third subsystem, which performs the segmentation of the sequence. Each pixel is assigned to one of five different tissue classes that can be revealed with brain MR spin echo imaging. With a suitable encoding, a five-level segmented image can then be produced. The system is based on feed-forward networks trained with the back-propagation algorithm; experiments to assess its performance have been carried out on both simulated and clinical images
Literal Selection in Switching Lattice Design
No full textSwitching lattices are two-dimensional arrays of four-terminal switches proposed in a seminal paper by Akers in 1972 to implement Boolean functions. Recently, with the advent of a variety of emerging nanoscale technologies based on regular arrays of switches, synthesis methods targeting lattices of multi-terminal switches have found a renewed interest. In this paper we discuss two different combinatorial problems related to the assignment of input literals to switches in a lattice when multiple choices are possible at some switch. We propose and develop efficient heuristic algorithms for both problems and discuss the implication of the different solutions on the layout of switching lattices. Experimental results on a set of known benchmarks confirm the effectiveness of the proposed heuristics
Fashion Culture: Norell: Master of American Fashion
No full textOn February 14, Jeffrey Banks, co-author of "Norell: Master of American Fashion," Ellin Saltzman, former fashion director and senior vice president at firms such as Saks Fifth Avenue, Macy’s and Bergdorf Goodman, Stan Herman, designer and former president of the CFDA, and Ralph Rucci, couturier, artist and author, came together for a sparkling introduction to Norman Norell — the first American designer to employ couture techniques, refined workmanship, and luxurious fabrics — whose dresses, coats, and suits were deemed by critics to be “the equal of Paris.” This panel discussion was moderated by Patricia Mears, deputy director of MFIT
Quality of care in children with chronic diseases
No full textBackground
Improving health care for chronic health conditions is a major goal of contemporary health service delivery systems. To date, the main research focus has been on adults and elderly, while fewer attention has been focused on newborns and children with chronic health conditions. To address the challenges related to the provision of integrated care to children with special health care needs, the Special Needs Kids (SpeNK) project was carried out in Emilia-Romagna Region. The specific aims of this study were: to review the ongoing sheltered discharge procedures, to develop and test instruments to assess the families’ perspective on the continuity of care and to estimate the time devoted by the family pediatrician to care coordination activities.
Materials and methods
The SpeNK project is still ongoing. After reviewing the procedures implemented in the Local Health Authorities of the study area, 10 face-to-face, 3 telephone semi-structured interviews and a focus group with the families at 1-6 months from discharge were conducted by a psychologist. A 20-item questionnaire on continuity of care was then developed, based on the contents of the interview and on Haggerty’s constructs of informational, management and relational continuity. The questionnaire was validated on 102 parents of preterm newborns and then administered by phone to the families of children enrolled in the SpeNK study after 9 months from discharge.
Results
A qualitative analysis of the contents of the semi-structured interviews revealed that families underscored the importance of informational continuity among hospital clinicians and across health care services, set a high value on the information/training received during the hospital stay of children and at discharge, and exhibited a mixed attitude towards involvement in the health care decisions.
Examination of the structure of the questionnaire using factor analysis with oblique rotation identified 5 factors accounting for 61.1% of the variance of items. The factors identified can be interpretable as ‘management continuity’ , ‘informational continuity’ ‘trustful relation with the family pediatrician’, ‘information provided to families’ and ‘family empowerment’.
Conclusions
The preliminary results of the qualitative analysis of the semi-structured interviews suggest the relevance to the families of the hospital experience and some criticalities in the informational continuity among professionals. The questionnaire on continuity of care has a well-defined structure and can be a useful tool to capture problems related to informational continuity and to the interaction of families with the professionals involved in the care of children with special care needs
Effectiveness of clinical decision support systems and telemedicine on outcomes of depression: a cluster randomized trial in general practice
No full textBackground: Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies.
Objectives: Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care.
Methods: This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring >= 11 on Patient Heath Questionnaire and >= 26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview.
Results: Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, chi(2) = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview.
Conclusions: Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression
Semi-Automatic Systematic Literature Reviews and Information Extraction of COVID-19 Scientific Evidence: Description and Preliminary Results of the COKE Project
No full textThe COVID-19 pandemic highlighted the importance of validated and updated scientific
information to help policy makers, healthcare professionals, and the public. The speed in disseminating reliable information and the subsequent guidelines and policy implementation are also essential
to save as many lives as possible. Trustworthy guidelines should be based on a systematic evidence
review which uses reproducible analytical methods to collect secondary data and analyse them.
However, the guidelines’ drafting process is time consuming and requires a great deal of resources.
This paper aims to highlight the importance of accelerating and streamlining the extraction and
synthesis of scientific evidence, specifically within the systematic review process. To do so, this paper
describes the COKE (COVID-19 Knowledge Extraction framework for next generation discovery science) Project, which involves the use of machine reading and deep learning to design and implement
a semi-automated system that supports and enhances the systematic literature review and guideline
drafting processes. Specifically, we propose a framework for aiding in the literature selection and
navigation process that employs natural language processing and clustering techniques for selecting
and organizing the literature for human consultation, according to PICO (Population/Problem, Intervention, Comparison, and Outcome) elements. We show some preliminary results of the automatic
classification of sentences on a dataset of abstracts related to COVID-19
Cost Determinants of Continuum-Care Episodes for Hip Fracture
No full textMany factors affect the healthcare costs and outcomes in patients with hip fracture (HF). Through the construction of a Continuum-Care Episode (CCE), we investigated the costs of CCEs for HF and their determinants. We used data extracted from administrative databases of 5094 consecutive elderly patients hospitalized in 2017 in Emilia Romagna, Italy, to evaluate the overall costs of the CCE. We calculated the acute and post-acute costs from the date of the hospital admission to the end of the CCE. The determinants of costs by type of surgical intervention (total hip replacement, partial hip replacement, open reduction, and internal fixation) were investigated using generalized linear regression models. Regardless of the type of surgical intervention, hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds or not were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs. CCE’s cost and its variability is mainly related to the rehabilitation setting. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with lower overall costs. Intermediate care organizational setting should be privileged when planning integrated care HF pathways
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