1,721,024 research outputs found
Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study
No full textIntroduction: Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Design: Observational, retrospective, monocentric study. Methods: A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3–18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Results: Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R2 = 0.361, adjusted R2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. Conclusions: Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. Clinical Relevance: Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses
Health technology assessment of whole genome sequencing in the diagnosis of genetic disorders: a scoping review of the literature
Full text linkObjective: The aim of this scoping review is to map the available evidence about the use of health technology assessment (HTA) in the assessment of whole genome sequencing (WGS).Methods: A scoping review methodology was adopted. The population, concept, and context framework was used to build up the research question and to establish the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was adopted to implement a comprehensive search strategy. Evidence was retrieved from scientific databases and HTA organizations Web sites. Reports were classified as full HTA, mini-HTA, rapid reviews or other.Results: The search strategy identified seven reports. Five HTA organizations from five countries elaborated the reports: one full HTA, four rapid reviews, and two classified as others. The reports were mainly focused on the evaluation of the clinical utility and cost-effectiveness of genome-wide sequencing as well as informing policy questions by providing analyses of organizational and ethical considerations.Conclusions: Few HTA organizations are drafting reports for WGS. It is essential to stimulate a critical reflection during the elaboration of HTA reports for WGS to steer choices of decision makers in the establishment of priorities for research and policy and reimbursement rates
Formulazione di un questionario che indaga gli aspetti organizzativi nell’Health Technology Assessment della Whole Genome Sequencing in maniera accurata e praticabile
No full textObiettivi - Redigere un questionario volto ad indagare il dominio degli aspetti organizzativi (ORG) legati all’implementazione e all’utilizzo della tecnologia diagnostica di Whole Ge- nome Sequencing (WGS).
Metodologia - Successivamente all’estrazione dei risultati delle analisi delle corrispon- denze multiple relative alle tecnologie diagnostiche effettuata da Cacciatore et al., sono state identificate le quattro issue EUnetHTA alle quali far riferimento, secondo l’autore, per studiare il dominio ORG (G0004, G0005, G0006, D0023). Seguendo le indicazioni del Core Model 3.0 di EUnetHTA, con particolare attenzione rivolta alle Assessment element card delle sopracitate issue, ed in seguito allo studio della letteratura e dei report HTA che descrivono gli aspetti organizzativi della WGS, è stato redatto un questionario mediante l’applicazione web Google Forms. Per progettare il questionario è stata inoltre seguita la guida di Boparai et al. Il questionario sarà distribuito a mezzo posta elettronica ai centri clinici italiani che fanno uso della WGS.
Risultati - Le domande risultanti a risposta aperta e a risposta multipla sono distribuite in 6 sezioni, di cui le ultime 4 derivanti in maniera univoca dalle 4 issue predeterminate, ed indagano le seguenti aree concettuali: le caratteristiche del partecipante al questionario (4 domande) e del centro presso cui lavora (2 domande), le attività e le risorse associate all’impiego della WGS (1 domanda), gli attori con i quali il partecipante si interfaccia e le azioni che intercorrono affinché i processi relativi alla WGS (1 domanda) e alla Whole Exo- me Sequencing (WES) (1 domanda) siano eseguiti, i rapporti di cooperazione e/o comuni- cazione con altri centri che ricorrono alla WGS (2 domande), le opinioni sulle facilitazioni o limitazioni nell’accesso alla tecnologia derivanti dalla centralizzazione (2 domande) della stessa, le opinioni sui vantaggi e svantaggi economici e qualitativi derivanti dalla decen- tralizzazione della tecnologia (2 domande), i costi legati alla WGS (1 domanda), l’influenza della WGS sul ricorso ad altri test genetici (1 domanda), le opinioni sulla semplificazione dei percorsi diagnostici derivante da una diffusione di utilizzo della WGS (2 domande), l’utilizzo di WGS come esame genetico di primo livello e le opinioni sulle popolazioni eleg- gibili (2 domande). I destinatari del questionario sono professionisti che lavorano presso centri che fanno uso della WGS: biologi, medici, informatici, tecnici di laboratorio, infer- mieri, consulenti genetici
Analisi costi-efficacia dell’adozione dei pacemaker leadless rispetto ai pacemaker tradizionali
No full textObiettivi - Stimare la costo-efficacia dei pacemaker leadless (PL) rispetto ai pacemaker tradizionali (PT) nella popolazione eleggibile per l’impianto di PL e PT dalla prospettiva del Servizio Sanitario Nazionale (SSN).
Metodologia - Un albero decisionale Bayesiano è stato calibrato per una coorte ipotetica di pazienti divisi equamente nel braccio PL e nel braccio PT, adottando la prospettiva del SSN. Dopo che il paziente è stato impiantato, può incorrere con probabilità prede- terminate in una complicanza. La popolazione target consisteva di pazienti eleggibili per l’impianto di PL e PT e ai quali viene impiantato uno dei due tipi di device. I parametri del modello sono stati ottenuti dalla letteratura scientifica. In particolare, i costi dei device, il costo medio delle complicanze ad essi associate e le probabilità di transizione sono stati derivati rispettivamente da un report statale statunitense [1], uno studio economico nazionale francese [2] e una revisione sistematica con meta-analisi [3]. I costi e i bene- fici sono stati scontati a un tasso annuo del 3%. Per orientare il processo decisionale su quale alternativa supportare è stato scelto il threshold dell’Eurozona, che varia da € 30.000 a € 50.000. L’impatto dell’incertezza sui parametri del modello è stato esplorato attraverso un’analisi di sensibilità probabilistica (PSA), calcolando la curva di accettabilità della costo-efficacia (CEAC) e la frontiera di accettabilità della costo-efficacia (CEAF), e un’analisi del valore dell’informazione (VOI), stimando invece il valore atteso dell’informa- zione perfetta (EVPI). L’inferenza Bayesiana è stata supportata da una serie di algoritmi noti come Markov Chain Monte Carlo (MCMC), tra cui il Gibbs sampler. È stata inoltre valutata la performance dell’algoritmo selezionato attraverso l’impiego di alcune tecni- che diagnostiche (i.e., traceplot, grafici di densità, diagnostica di Gelman-Rubin, funzioni di autocorrelazione della catena). I risultati dell’analisi costi-efficacia sono stati espres- si come costi ed efficacia assoluti e come rapporto incrementale di costo-efficacia per complicanza evitata.
Risultati - L’adozione dei PL nella popolazione eleggibile all’impianto di PL e PT risulte- rebbe in un costo assoluto per il SSN di € 341.662.460, rispetto a € 247.187.180 risultanti dall’adozione dei PT. L’efficacia assoluta dei LP risulterebbe in 12.767 complicanze evi- tate, contro 9.606 per i PT. Nello scenario iniziale, rispetto ai PT, i PL hanno evidenziato un ICER di € 29.882 per complicanza evitata. La PSA ha confermato la robustezza dei risultati del caso base per il threshold scelto. Il grafico a contorno ha evidenziato che il 64% delle simulazioni si trova nel quadrante nord-est del piano di costi-efficacia, in cui i PL apportano maggiori benefici a fronte di costi superiori rispetto ai PT. La CEAC e la CEAF hanno evidenziato che i PL hanno una probabilità del 60% di essere costo-efficaci rispetto ai PT. L’EVPI ammonta a € 5.862 per paziente. Infine, le tecniche diagnostiche hanno indicato che il MCMC ha prodotto risultati robusti, con catene convergenti, elevate dimensioni effettive del campione e distribuzioni posteriori ben stimate, garantendo robu- stezza nella validità e nell’affidabilità dei risultati ottenuti
Ranking Nursing Diagnoses by Predictive Relevance for Intensive Care Unit Transfer Risk in Adult and Pediatric Patients: A Machine Learning Approach with Random Forest
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Exploring the Impact of Medical Complexity on Nursing Complexity of Care in Paediatric Patients: A Retrospective Observational Study
No full textAims: To explore the impact of medical complexity, defined by the number of chronic conditions, on the complexity of care, as described by the frequency of nursing diagnoses (NDs) and nursing actions (NAs), in paediatric patients. Design: Retrospective observational study. Methods: This study was conducted in an Italian university hospital and involved the analysis of electronic health records for neonatal and paediatric patients who were consecutively admitted from January to December 2022. The sample was classified into three categories-non-chronic, single chronic and multimorbid patients-according to their clinical profiles. NDs recorded within the first 24 h from patient hospital admission and NAs performed throughout the hospital stay were counted for each group. Results: Distinct variations in the prevalence and patterns of NDs and NAs were observed across different levels of medical complexity. A significant moderate positive correlation between the number of NDs and NAs was found. However, the frequency of NDs did not directly correlate with the number of chronic conditions. Conversely, a weak but significant negative correlation was identified between the quantity of NAs and the number of chronic conditions. While the frequency of NDs showed a stable but decreasing trend as the number of chronic conditions increased, a higher number of chronic conditions were associated with a lower quantity of NAs. Conclusions: We discovered a notable variation in the complexity of care across varying levels of medical complexity in paediatric patients. Our findings suggest that the complexity of care does not necessarily correspond to the degree of medical complexity. The observed negative relationship between the number of chronic conditions and the quantity of NAs underscores the need for further research to explore this unexpected finding and its implications for clinical practice. Implications for the profession and/or patient care: Without the adoption of standardised nursing terminologies, such as nursing diagnoses (NDs) and nursing actions (NAs), assessing the complexity of care in paediatric settings can be challenging. Integrating clinical nursing information systems that incorporate standardised NDs and NAs into electronic health records is crucial for accurately documenting and analysing the complexity of care and its relationship with medical complexity. Impact: In paediatric patients, the frequency of nursing diagnoses (NDs) at hospital admission is significantly associated with the quantity of nursing actions (NAs) delivered during hospitalisation. However, there is no correlation between the frequency of NDs and medical complexity, as defined by the number of chronic disorders. Specifically, the frequency of NDs decreases with increasing medical complexity, while the quantity of NAs is negatively associated with the number of chronic disorders. This indicates that the complexity of care cannot be inferred solely from medical complexity, and additional factors need to be explored. These findings enhance understanding of how complexity of care relates to medical complexity in paediatric patients. Insights into the prevalence and patterns of NDs and NAs can benefit nurses, managers, researchers and policymakers by informing clinical and organisational decision-making to ensure high-quality care. Reporting method: The study adhered to the RECORD Statement. Patient or public contribution: Patients, service users, caregivers or public members were not directly involved in the design, conduct, analysis and interpretation of data or in writing this paper. Patients contributed only to data collection
The Impact of Socio-Economic Conditions on Individuals’ Health: Development of an Index and Examination of its Association with Three of the Most Frequently Registered Diseases in Lazio Region of Italy
Full text linkThis study examines spatial disparities and associations between the social deprivation
index (SDI) and Type 2 Diabetes, Dementia, and Heart Failure in Italy’s Lazio Region.
The primary goal is to assess how social deprivation impacts health inequalities by analys-
ing SDI-disease correlations. This retrospective study uses 2020 socioeconomic data and
2021 epidemiological indicators in Lazio Region, Italy. The SDI, constructed following
established guidelines, measures social deprivation. Statistical tools, including regression
models, Moran’s I test, and LISA techniques, are used to analyse spatial patterns. Uti-
lizing a retrospective approach, we merge 2020 socioeconomic and 2021 epidemiologi-
cal data for analysis. The SDI is computed using established methods. Spatial disparities
are explored through regression models, Moran’s I test, and LISA techniques. The study
reveals significant disparities in disease incidence. District V in Rome exhibits high Type 2
Diabetes (113.75/1000) and Heart Failure (37.98/1000) rates, while Marcetelli has elevated
Dementia incidence (19.74). Southern municipalities face high unemployment (up to 25%),
whereas bordering areas have higher education levels (30–60%). Disease hotspots emerge
in Rome and centre-north municipalities, aligning with social deprivation patterns. Regres-
sion models confirm the link between disease incidence and socioeconomic indicators. SDI
ranges from − 1.31 to + 10.01. This study underscores a correlation between social depriva-
tion and disease incidence. Further national-level research is essential to deepen our under-
standing of how social deprivation influences health outcomes, with potential implications
for addressing health disparities both regionally and nationally
Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review
No full textCommunity-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05).The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health.The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population
Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study
No full textIntroduction: Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Design: Observational, retrospective, monocentric study. Methods: A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3-18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Results: Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R2 = 0.361, adjusted R2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. Conclusions: Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. Clinical relevance: Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses
Incremental Net Benefit and Incremental Cost-Effectiveness Ratio of COVID-19 Vaccination Campaigns: Systematic Review of Cost-Effectiveness Evidence
Full text linkSARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The “Drummond’s checklist” was adopted for quality assessment. A synthesis of the studies was performed through the “dominance ranking matrix tool”. Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide
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