1,274 research outputs found
Qualità di vita nei servizi sanitari. Parte I: analisi del costrutto e specificità in salute mentale
No full textQualità dei servizi di salute mentale. Manuale questionario per la formazione organizzativa, l’auto-valutazione e l’accreditamento tra pari
No full textQualità di vita nei servizi sanitari. Parte II: rassegna degli strumenti di valutazione
No full textRiproducibilità ed accuratezza nelle diagnosi di CIN in 15 laboratori italiani: progetto pilota nazionale. Messa a punto di nuovi indici clinici di variabilità diagnostica : Gruppo Nazionale di lavoro per il controllo di qualità esterno in Citopatologia cervico-vaginale
No full textOBJECTIVES: To assess reliability and accuracy of cervical smear diagnoses, to evaluate the effectiveness of the participation in a programme of slide exchange in increasing reliability and to re-examine the agreement in discriminating between CIN 2 and CIN 3 (merged in High grade SIL in the Bethesda System). SETTING: 15 laboratories participating on a voluntary basis throughout Italy, for a period of 1 year. METHOD: Phase one: circulation of 40 slides including all main diagnostic categories; discussion of results by representatives of participating centres. Phase two: circulation of another 40 similar slides. For each slide, not only a diagnosis but also recommendations for further examinations and a judgment on diagnostic difficulty were asked. Common measures of reliability and accuracy and (the latter only for slides on which a consensus diagnosis was reached corresponding to the histological diagnosis) were calculated; three new indices of diagnostic variability were also computed. RESULTS: Consensus diagnosis among representatives of participating laboratories on about 90% of the slides was reached both in the first and in the second phase. On 3 slides it was impossible to reach a consensus diagnosis even among external referees. In both phases, the study showed a marked variability among diagnoses, recommendations and judgment on diagnostic difficulty and, on some slides, a worrying lack of reliability in the determination of precancerous lesions. The agreement on discrimination between CIN 1 and CIN 2 was low, but it was slightly better between CIN 2 and CIN 3. No significant relationship between accuracy and workload was found. External quality control or better said, continuous quality improvement activities are essential but should be conducted in a more systematic way with greater involvement of cytotechnicians
Silver sheaves; gathered through clouds and sunshine. In two parts. Part 1st: Civil and military life of the author. Part 2d: Miscellaneous collection of prose and poetry.
No full text2d ed.2 p.l., [9]-360 p
Reliability and accuracy of reporting cervical intraepithelial neoplasia (CIN) in 15 laboratories throughout Italy: phase 1 of a national programme of external quality control in cervical screening
No full textThis paper reports results of a first phase of a pilot study to assess and improve quality of diagnoses in cervical cytological laboratories located throughout Italy. It represents the first phase of an External Quality Assurance programme (EQA). In the first phase, two sets of cervical smears representing a range of diagnoses were circulated among participating laboratories. Responses were recorded on a standardized form. Participants were asked to assess the adequacy of the smear and formulate a diagnosis. They were also asked to recommend management of the patient on the basis of the smear report and judge the degree of diagnostic difficulty of each slide. Crude index of agreement, unweighted and weighted kappas, diagnostic specific kappas, sensitivity and specificity as well as clinical indices of variability were calculated. In the second phase, two additional sets of slides were circulated after discussion of the first phase. There was striking variability between laboratories, both in terms of diagnoses offered and recommendations for management on individual slides. Assessment of the degree of difficulty of each slide was also very variable. Discrimination between CINII and CINIII was poor, confirming the choice of merging these two categories in the Bethesda classification. However, discrimination between CINI and CINII was also unsatisfactory. The results were discussed in workshops and it was possible to reach a consensus diagnosis in 35 of 40 smears. This study confirms the need for external quality control programmes
Intervento multifamiliare di gruppo e schizofrenia: uno studio randomizzato controllato
No full textObjectives
To assess the efficacy of a group intervention for relatives of patients with schizophrenia. To explore the feasibility of a randomized controlled trial of a psychosocial treatment in daily practice.
Methods
The relatives of patients with DSM-III-R schizophrenia were randomized to receive either the experimental intervention plus standard treatment or standard treatment alone. The group intervention for relatives was carried-out in the absence of patients and lasted 22 biweekly sessions. It included giving information on schizophrenia and the stress-vulnerability model, defining realistic objectives, training in communication skills, effective coping strategies, and structured problem-solving. Role playing techniques and homework assignment were widely used, with an emphasis on active learning. In each family, a key relative was asked to complete a baseline and immediately after treatment two validated instruments: the QPF on family burden and perceived support, and the QCV on the patient’s social functioning and psychological conditions.
Results
Initially, the two groups were similar on all outcome measures. After treatment, in the control group, we did not observe a decrease on any measure, while in the experimental group we observed a significant decrease or a statistical trend toward a decrease on all measures. We also observed a significant difference or a statistical trend toward a difference between groups on all measures.
Conclusions
This study suggests that randomized controlled trials are feasible also in routine practice. It supports the controversial claim that family group interventions in the absence of the patient may be effective in reducing family burden and in improving patients’ conditions, if carried out intensively and with an emphasis on active learning principles
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