1,721,003 research outputs found
Evaluation about clinical risk knowledge in Italian medicine students: How to implement the concept of healthcare quality among future doctors
Full text linkThe aim of the study is to offer to all the future health providers an opportunity of education in the specific field of patient's safety and clinical risk management.
The study develops a complete picture of the knowledge of a whole class of future physicians about clinical risk theme, involved 1228 students of a medicine course.
We elaborated a survey (18 explorative questions) that evaluated the levels about basic concepts in clinical risk management and investigated the future doctors' opinion about the use of these instruments. The results emphasize a deep delay compared to international standards about basic notions.
We propose as future target both monitoring the notional trend about investigated themes of the survey and sensitizing the future health operators and decision makers about basic clinical risk concepts. Moreover, we try to give the timing of fundamental steps to improve the awareness and the management of Clinical Risk
Little patients, large risks: An overview on patient safety management in pediatrics settings
Full text linkPatient safety is an emerging healthcare discipline with the ultimate goal to reduce errors and harm to patients by implementing quality health services. In 1999, the well-known “To Err is Human: Building a safer health system” reported that between 2% and 4% of people die annually in United States hospitals for medical errors. Since that publication, the focus on healthcare safety has encouraged efforts by legislators, hospital government, and health professionals to promote policies and behaviors heavily to reduce errors and implement a safe provision of healthcare delivery. In 2019, the World Health Organization (WHO) declared September 17th as Patient Safety Day, confirming that as a global priority.
The increasing interest in patient safety has significant repercussions on scientific publications with an ever-increasing production of studies in the growing interdisciplinary field of public health. New concepts and new terms had born, such as “clinical risk,” which refers to the probability that a patient can be the victim of an adverse event due to medical care, although unintentionally.
The WHO proposed to adopt a “universal vocabulary” thus standardizing the terminology and allowing effective scientific research. In clinical risk, the most explored field is adult patient safety, where growing interest is shown primarily to prevent nosocomial infections, falls, and pressure injuries. Instead, a little-explored area concerns the pediatric population.
This article aims to overview the spread of pediatric clinical risk management and organizational culture for healthcare quality improvement, looking at what has been done and enhancing healthcare practices to implement inpatient safety. The authors have reviewed the main concerns on pediatric patient safety and issued the main medico-legal aspects. After summarizing the relevant literature, the authors addressed their point of view by writing an opinion article
Patient Safety Walkaround: a communication tool for the reallocation of health service resources: An Italian experience of safety healthcare implementation
Full text linkThe study aims to evaluate the use of Patient Safety Walkaround (SWR) execution model in an Italian Hospital, through the adoption of parametric indices, survey tools, and process indicators.In the 1st meeting an interview was conducted to verify the knowledge of concepts of clinical risk management (process indicators). One month after, the questions provided by Frankel (survey tool) were administered.Each month after, an SWR has been carried trying to assist the healthcare professionals and collecting suggestions and solutions.Results have been classified according to Vincent model and analyzed to define an action plan. The amount of risk was quantified by the risk priority index (RPI).An organizational deficit concerns the management of the operating theatre.A state of intolerance was noticed of queuing patients for outpatient visits. The lack of scheduling of the operating rooms is often the cause of sudden displacements. A consequence is the conflict between patients and caregivers. Other causes of the increase of waiting times are the presence in the ward of a single trolley for medications and the presence of a single room for admission and preadmission of patients.Patients victims of allergic reactions have attributed such reactions to the presence of other patients in the process of acceptance and collection of medical history.All health professionals have reported the problem of n high number of relatives of the patients in the wards.Our study indicated the consistency of SWR as instrument to improve the quality of the care
FROM AMENABLE MORTALITY INDEX TO NO BLAME CULTURE: IMPROVE HEALTH CARE IN ITALY
Full text linkThe main aim of the study is to critically analyze the impact of defense medicine in the Italian healthcare system, considering the rapid spread of this phenomenon in the last years and its influence in the everyday medical practice. The authors use the Amenable Mortality Index (i.e. the number of premature deaths which could have been avoided in individuals younger than 74 years of age) to rate the performance status of the analyzed healthcare system and to compare different countries and Italian regions. The result of the study is that the Italian health system is valid, despite the economic difficulties of the last years, but much can be done to ameliorate its status. In fact, the authors want to promote a “no-blame culture” as an important factor for the overall improvement of the NHS, focusing only on patients’ health
Editorial: Medico-legal aspects of clinical risk management and patient safety
Full text linkFrom the 1990s to date, clinical risk management has become an increasingly important issue in healthcare systems. Since the publication of “To err is human” in 2000, scientific evidence has shown the need for a new approach to handling adverse events in health systems. As a result, a new “no blame” culture has developed, and Clinical Risk Management has assumed a crucial role in healthcare systems because of the inherent repercussions on patient safety, optimization of clinical outcomes for patients, and reallocation of resources. [...
Ethical Challenges in Health Care Policy during COVID-19 Pandemic in Italy
Full text linkSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals’ rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system
A singular case of complex suicide by hanging with hesitation marks by axe
No full textWe present a case of complex suicide concerning a 55-year-old man who hanged himself using a rope anchored to a beam on the terrace of his apartment. Multiple parallel linear wounds were observed on his head. At the crime scene, an axe stained with blood and hair was found resting against the wall adjacent to the stairs leading to the upper floor. Forensic investigations identify the cause of death as mechanical asphyxia due to the hanging, in a complex suicide characterized by hesitation marks inflicted on the head with an axe. This specific type of complex suicide has never been described in the literature
Editorial: Errors and biases in modern healthcare: public health, medico-legal and risk management aspects
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Sudden cardiac death and thymic hyperplasia in adults: myth or reality? A case report
Full text linkBackground: Sudden cardiac death is a major public health concern. The incidence of sudden cardiac death in young adults remains unclear and is generally underestimated. Case presentation: This is a case report of a 24-year-old man with a silent pathological history, who suddenly collapsed in a restaurant during dinner with his workmates. Autopsy and ancillary examination revealed focal atrioventricular node fibrosis and thymic hyperplasia. Conclusions: Thymic hyperplasia has been considered a cause of sudden death in the past century. The mode of death was explained through nosographic entities such as status lymphaticus or thymic asthma, which are currently consigned to history books. Nevertheless, recent studies have sought to determine the relationship between thymic hyperplasia and sudden unexpected deaths in adults. Moreover, isolated fibrosis of the atrioventricular node is a rare condition that can remain undiagnosed even after a full autopsy. This report aims to provide a concise review of the existing literature concerning sudden cardiac death and discuss the so-called “thymic death” theory, which is now considered a myth. Was the finding of thymic hyperplasia and atrioventricular node fibrosis a coincidence? Should the myth surrounding “thymic death” be re-examined
A critical review of the anthropological and paleopathological literature on osteopetrosis as an ancient rare disease (ARD)
Full text linkObjective: A reappraisal of the available evidence of osteopetrosis in the archaeological record as first step in promoting new approaches to rare diseases in paleopathology.Materials and methods: Three different approaches are combined: a survey of the last 50 years of bioarchaeological publications; an online search addressing six of the more widely used search engines; macroscopic and radiographic analyses of the human remains from the Neolithic site of Palata 2 (Italy). Results: The combined results of the literature survey and the online search identified six cases of osteopetrosis. The majority of search hits place this disease into differential diagnoses. The investigation of the remains from Palata 2, one of the six cases in literature, indicates a non-specific sclerosis of the cranial vault.Conclusions: Of the six cases of osteopetrosis, only two, one of the autosomal-recessive type (ARO) and one of the autosomal-dominant type (ADO), are supported by direct osteoarchaeological evidence. Therefore, inaccurate differential diagnoses generate an inflated number of cases in the paleopathological record.Significance: This reappraisal calls for a more informed and evidence-based approach to osteopetrosis and, more generally, to rare diseases in paleopathology.Limitations: Lack of specific publications on osteopetrosis; more case studies may be present in "gray literature". Suggestions for further research: Cases of osteopetrosis from archaeological and historical collections as well as medical literature are needed to increase knowledge about this rare disease. More precise differential diagnoses are required, particularly when dealing with rare diseases
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