3,513 research outputs found
Riflessioni a margine di una proposta di legge sulla liberazione anticipata
No full textThe author examines the bill AC 552 presented by MP Giachetti on the subject of early releases. In particular, he addresses the critical issues of the proposal, both theoretical and practical, in order to contribute to the elimination or correction of its systematic defects
Platelet aggregometry in migraine patients: effect of clonidine, an alpha-2 adrenoceptor agonist
No full textIntroduzione della cartella clinica elettronica nell'ULSS 9 di Treviso - Approccio Metodologico -
No full textSummary
Introduction
We are now witnessing an increasing interest of Public Health Institutions towards the introduction of ICT. However, although several data/information are available, each Aziende Sanitaria and clinical units often employ individual digital systems that are not connected to each other.
With the start of the ESCAPE project the Azienda ULSS 9 in Treviso developed a model for the management of digital signed documents that could be shared between the different clinical units of the Hospitals (Treviso and Oderzo) and the citizens. This first experience of clinical response dematerialization allowed putting the basis for the extension of the process to all the documents associated with hospitalization. In fact, the main objective of this project, named OSCAR (Ospedale Senza CARta), is to extend the digital processes to all the clinical records of patients during his hospital admission, thus helping to move from the Medical Paper (MP), towards the Electronic Health Record (EHR).
Objective
Only few data are available in the literature about the use of ICT in the Health System. In particular, no methodological approaches have been developed to test the introduction in the clinical use of the Electronic Medical Record (EMR). In particular we need to identify tools for the estimation of risk/benefit ratio, and learn how to manage changes within the organization. The scope is to minimize unfavourable responses associated with CCE introduction. How to develop this new approach is the main object of the present study.
Materials and methods
We studied the introduction of EMR in the Cardiology Unit. Analysis of the process furnished valuable data about the presence of criticisms that could limit the diffusion of EMR to all the others clinics.
The methodological approach was based on the following points which in several cases are connected with “Project Management”:
- Study of economic feasibility based on benefit/risk ratio.
- Detailed analysis of software-hardware
- Development of a training program through both frontal lessons and live demonstrations.
We also tested the efficacy of EMR in comparison with the MP. In particular we focused on the following “end points”:
- Comparison of MP and EMR in term of quality (such as clarity, complete drawing up, head for reading). In particular we compared 100 consecutive MP (year 2008) with 100 consecutive EMR (year 2012) of the Cardiology Unit. Analysis of quality was based on the compilation of check lists developed according to “Joint Commission International Quality Standards” and “Accreditation Canada”, criteria.
- To identify, by the use of a questioner, personnel’ prejudices associated with the introduction of EMR.
- Analysis of the risks potentially associated with EMR introduction. The analysis was performed by using FMEA/FMECA approach.
- To evaluate the level and the trend of clinical documents digitalization.
Results
Comparison of quality between MP and EMR showed that the latter was superior in almost all the 34 points of the checklist, reaching the maximum score in 25 over 34.
Questioners about satisfaction of the personnel showed a significant difference between medical doctors and nurses. In fact, while the satisfaction score was optimum in 12 over 15 questions for medical doctors, the level reach by nurses was significantly lower in all the items investigated.
Risk analysis performed by using FMEA/FMECA before and after EMR introduction allowed to identify errors/risks with high index of priority correlated to both the use of MP and EMR. We were able to demonstrate that these errors/risks were different between MP and EMR. In particular errors with high priority associated to MP used were absent after EMR introduction. On the contrary the following same therapy errors were more evident after EMR introduction. Results were used to perform risk re-analysis through periodic team discussion and implementation of preventive measures.
The trend of clinical digitalization was excellent. The high level of participation showed by the personnel involved mainly explains this finding.
Discussion and conclusion
The present study investigated the efficacy of a novel methodological approach for the EMR introduction in the clinical practice. Success is mainly based on a high level of involvement of Direzione Strategica Ospedaliera that is mandatory to obtain enough economic and personnel support for the project development.
EMR showed higher quality level compared to MP according to “Joint Commission International Quality Standards” and “Accreditation Canada”, standards. The analysis of the risks allowed demonstrating that MP and EMR used are associated with profound differences in term of risks related to hospitalization.
The excellent trend observed for the introduction of digitalized clinical documents in the different units represents an encouraging observation. This finding suggests that, by using adequate planning, training and appropriate methodological approaches (mainly based on appropriate risks evaluation) digitalization can be introduced in the everyday clinical practice without experiencing significant obstacles and improving the quality of health care
Identification of Listeria monocytogenes by colony hybridization test using the virulence-associated hly and inlA genes as probes.
No full textWe developed a method of identification of Listeria monocytogenes based on colony hybridization with nonradioactively labeled DNA probes, represented by the hly and inlA virulence-associated genes. The procedure described in this paper results simple, rapid, specific and reproducible. Since it can be performed in a short time, the above technique can be applied to detect L. monocytogenes from different source and constitutes a noteworthy and alternative tool to identify this gram-positive pathogenic bacterium
Effect of antibiotics on polycation-treated Escherichia coli HB101(pRI203)
No full textIn the present paper, we demonstrated that low concentrations of various polycationic agents sensitize E. coli HB 101 harboring the plasmid pRI203, containing the Y. pseudotuberculosis invasion region, to antibiotics rifampicin, amikacin, ceftazidime and cefotaxime. These antibiotics, known to be excluded, to various degrees, by the bacterial outer membrane, resulted several-fold more active towards polycation-treated bacteria by comparison with controls. This increased permeability to antibiotics of E. coli HB 101 (pRI203) probably depends upon the binding of polycations to the acidic moieties of lipopolysaccharide, as already suggested for other gram-negative bacteria
Application of the IS-MP-IA model to the German economy and policy implications
No full textExtending the IS-MP-IA model developed by Romer (2000) and applying the GARCH (Engle, 1982, 2001) methodology, the author finds that equilibrium GDP in Germany is positively affected by stock market performance and real exchange rate appreciation, and negatively influenced by the expected inflation rate, the government deficit/GDP ratio, and the U.S. federal funds rate. The relatively low deficit/GDP ratio of 1.83% in 2003 indicates that its fiscal condition was healthy. However, some other EU members may need to exercise fiscal discipline. Because real appreciation has a positive impact on output, a stronger euro may not be a concern for Germany but may be worried by those EU member nations which depend upon exports to stimulate their economies.
Hystopathological aspects similar to those of Kikuchi disease in carbamazepine induced lymphadenopathy: Case report and review of literature
No full textWe describe a case of carbamazepine induced lymphadenopathy with a hystopathological picture similar to that of Kikuchi disease. This is a rare cause of benign lymphadenopathy of unknown origin. As far as we know such a connection does not exist in literature, although similar cases do. Kikuchi disease could therefore be more common than thought
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