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A first step to investigate European patients’mobility: the interregional Italian experience
No full textBackground
The study of patients’ mobility, identifying deficiencies and
imbalances in care supply, is useful for the health planning.
The topic is of great relevance in the international arena, given
the Directive 2011/24/EU on cross-border healthcare, which
promotes the free movement of patients between Member
States of the European Community. The Italian Health System,
consisting of 21 different regional realities with characteristics,
can be taken as a microcosmic test bench, somehow predictive
of possible European dynamics. Our study aims to: 1) describe
the trend of hospital patients’ mobility among the Italian
Regions over a wide time span, 2) show an immediate visual
approach for decision making.
Methods
We used ordinary and day hospital discharge data (HDR) from
1998 to 2011. The study was carried out using: 1) the Gandy’s
Nomogram (NdG), a graphical tool that allows assessing the
power of attraction and the escape’s containment of hospital
regional networks; 2) vector analysis; 3)trend analysis with
Cuzik’s test.
Results
The mean number of annual admissions (1998-2011), in
Italian hospitals, was 11.424.319
decreasing from 2001 to 2011, 7% occurred ‘in mobility’.
We have drawn the different paths of patients’ mobility by
Regions and observed some critical situations, almost in Regions
of Southern and Island Italy, compared with Regions of the
Centre-North which overall appeared in better condition.
Some Regions showed a biphasic trend, having the year of
reversal around 2006.
Conclusions
We have shown the potentialities of a useful tool of assessment,
the NdG, applicable at micro level but also on a large scale (as
the European scenario), in the analysis of hospital patients’
mobility. It can be hypothesized that the reversal of patients’
mobility trends occurred in some Regions might be related to a
government program aimed at restoring the financial balance,
on penalty of compulsory administration.
The observation of the trend of each Region provides
information about policies adopted by hospitals and possible
corrective actions.
Key messages
Our study shows the usefulness of an immediate visual
approach (Gandy’s Nomogram) to the analysis of hospital
patients’ flows at different levels (micro, meso and macro).
Italian inter-regional patients’ mobility trends (predictive of
the possible European scenario induced by the EU Directive
on cross-border migration) provide objective information
for health policy
Longitudinal neurophysiological assessment of intramuscular type-A botulin toxin in healthy humans
No full textThe aim of this study is to assess the neurophysiological abnormalities of type A botulin toxin-infiltrated human muscle, and their evolution over time. Seried cMAP measurements, 3 and 20 Hz repetitive nerve stimulation, EMG, SFEMG over 3 months from toxin injection. Our findings consist in lack of decrement with 3 Hz repetitive nerve stimulation and facilitation with 20 Hz repetitive nerve stimulation; progressive increasing of jitter; early appearance of fibrillations; small and short motor unit action potential in the first 3 weeks, followed by increasing of MUAP amplitude and duration, with polyphasic morphology. Although claimed as highly specific and sensible, neuromuscular junction facilitation is an inconstant finding in human botulism. Therefore, lack of neuromuscular junction facilitation cannot exclude a diagnosis of botulism. Our findings are compatible with a process of acute denervation followed by distal reinnervation, favored by terminal nerve sprouting
The Crucial Role of Surgical Treatment in BIA-ALCL Prognosis in Early- and Advanced-Stage Patients
No full textBackground: Studies on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) are trying to optimize medical and surgical treatments for early and advanced stages of this disease. The aim of this article is to share the experience gathered on the authors' prospectively collected 46 well-documented cases.Methods: Italian physicians are obliged to report BIA-ALCL cases to the Italian Ministry of Health. Because of this cooperation with health care professionals, the competent authority has coordinated and centralized the collection of information for each patient in 46 cases of BIA-ALCL. Statistical analyses with cumulative incidence and corresponding 95 percent confidence interval are provided for each year, dividing the number of new cases that occurred in a defined year and the population at risk of experiencing BIA-ALCL during the same year.Results: The mean time to the onset of symptoms is reduced to 6.4 +/- 3.77 years (range, 1 to 22 years). Increased knowledge has also shortened the average time to diagnosis, at 7.2 +/- 3.71 years (range, 2 to 22 years). A late seroma appears in 91 percent of cases. The patient who died underwent limited surgery. The Italian incidence has been estimated as 2.8 per 100,000 patients receiving implants (95 percent CI, 0.88 to 4.84) in 2015; 2.1 (95 percent CI, 0.43 to 3.86) in 2016; 3.2 (95 percent CI, 1.11 to 5.31) in 2017; and 3.5 (95 percent CI, 1.36 to 5.78) in 2018.Conclusion: Although the number of cases has risen slightly, BIA-ALCL is still a rare disease with a stable incidence, easily recognized and with a favorable prognosis also in advanced stages if complete surgical excision is performed
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