Ann Ig [journal]
- Quality Implementation in Health Physics Unit, Cosenza Hospital. Accreditation Program as Quality Improvement instrument. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):304-9.
Achieving high levels of quality in healthcare, which could be measurable, is increasingly important at present and is dictated by the radical changes of the welfare system imposed today by the well known economic constraints. However, even in the ongoing legislation, the practices concerning the verification and review of the quality of health care has had a major impact in the galaxy of Health. On the one hand, the citizen is developing an awareness of the possibilities of choice (Empowerment) between a plurality of providers of healthcare services, on the other hand providers themselves are obliged, within the logic of a global market, to retrain their offers to respond satisfactorily to the needs of citizens. The purpose of this study was to demonstrate how the adoption of Operational Procedures, following the granting of a certificate of accreditation to the Unit of Medical Physics, has changed the approach to the work on the part of health workers, in the direction of a dynamic quality improvement.
- Qualitative and quantitative aspects of drinking water supply in Sardinia, Italy. A descriptive analysis of the ordinances and public notices issued during the years 2010-2015. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):296-303.
The aim of the study is to analyze the regional district ordinances and the warnings regarding qualitative and quantitavive drinking water abnormalities discovered by the Sardinian Municipalities and the Water Managing Authority between 2010 and 2015 in order to describe and identify the causes leading to an interruption or a limitation of the drinking water supply.We carefully reviewed all ordinances and warnings of non-potable water and service interruption published between 2010 and 2015 by the websites of 377 Sardinian Municipalities and by the main regional newspapers, the Water Managing Authority and the Regional Health Trusts.From 2010 to 2015, 738 warnings/ordinances regarding drinking water supply limitation or interruption were issued. The warnings involved more than half (n. 191, 50.7%) of the 377 Sardinian Municipalities. Considering that these Municipalities included the main Sardinian cities we estimated that 80.3% of the population was affected by the issue. During the 6 years we observed a progressive increase of Municipalities involved beginning with 25 and reaching up 110 in 2014. The initial 29 warnings rose to 256 in 2014 along with an increased number of abnormal values, parameters and standards of the drinking water. Regarding the ordinances issued by the 191 Mayors we noticed that the legal limits were exceeded in 23 cases. Among those, we underline the abnormal levels of chlorites and trihalomethanes (22% of cases), the turbidity, the abnormal concentration of total chemical substances and the abnormal level of coliforms, Escherichia coli, manganese, aluminum, nitrites and iron.According to our observations, the Sardinian drinking water supply system is affected by a major inconvenience and the data suggest that qualitative abnormalities are mainly due to water purification treatments used in addition to the poor water supply network in existence. Considering these results, a cooperation between all Authorities involved would be desirable in order to analyze official data and provide a careful evaluation of population exposure and real risks related to the level of every parameter considered.
- Use of a systematic risk analysis method (FMECA) to improve quality in a clinical laboratory procedure. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):288-95.
Risk management is a set of actions to recognize or identify risks, errors and their consequences and to take the steps to counter it. The aim of our study was to apply FMECA (Failure Mode, Effects and Criticality Analysis) to the Activated Protein C resistance (APCR) test in order to detect and avoid mistakes in this process.We created a team and the process was divided in phases and sub phases. For each phase we calculated the probability of occurrence (O) of an error, the detectability score (D) and the severity (S). The product of these three indexes yields the RPN (Risk Priority Number). Phases with a higher RPN need corrective actions with a higher priority.The calculation of RPN showed that more than 20 activities have a score higher than 150 and need important preventive actions; 8 have a score between 100 and 150. Only 23 actions obtained an acceptable score lower than 100.This was one of the first experience of application of FMECA analysis to a laboratory process, and the first one which applies this technique to the identification of the factor V Leiden, and our results confirm that FMECA could be a simple, powerful and useful tool in risk management and helps to identify quickly the criticality in a laboratory process.
- Epidemiology of candidemia in neonatal intensive care units: a persistent public health problem. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):282-7.
Candidemia has become an increasingly important problem in infants hospitalized in the Neonatal Intensive Care Units (NICUs). Candida species are the third most common agents of late-onset infections in critically ill neonates and they are associated with high morbidity and mortality rates. In this study we evaluated the epidemiology of Candida bloodstream infections in the NICU of an Italian university hospital during a 15-year period. Our specific aims were to analyze the change in species distribution and the vitro susceptibility of these yeasts to fluconazole (FCZ) and amphotericin B (AmB).A retrospective study of candidemia in the NICU of a university hospital in southern Italy, covering the years 2000-2014 was carried out. The isolates were identified using the VITEK2 yeast identification system and antifungal susceptibility was determined using the E-test method.Among the 57 patients with confirmed candidemia, 60% were males (n = 34 cases) and 82% (n = 47) had a gestational age of 24-32 weeks. Twenty-seven neonates (47%) had a very low birth weight (<1500 g), 20 (35%) an extremely low birth weight (<1000 g), and 10 (18%) a low birth weight (<2500 g). The most important potential risk factors were the placement of a central venous catheter, total parenteral nutrition, and endotracheal intubation (100%, each). Candida albicans was the most frequent yeast (47%), followed by Candida parapsilosis (44%). The proportion of Candida non-albicans increased slightly, from 46% in 2000-2004 to 71% in 2010-2014 (χ2 test for trend, p = 0.030). All isolates were susceptible to FCZ and AmB.The detection in this epidemiologic study of an increase in Candida non-albicans highlights the importance of correct species-level identification in the rapid diagnosis for an efficient treatment of candidemia. Knowledge of the local epidemiological trends in Candida species isolated in blood cultures will facilitate therapeutic decision-making.
- Point prevalence surveys on healthcare acquired infections in medical and surgical wards of a teaching hospital in Rome. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):274-81.
Healthcare acquired infections (HAI) are an important cause of morbidity and mortality in hospitals worldwide. Aim of the study was to analyze nine years surveillance activity, carried out by point prevalence surveys from 2007 to 2015, in a 450-bed teaching hospital in Rome.Point prevalence surveys were carried out every year in the medical and surgical wards following the same methodology. In accordance with definitions used by the Centers for Disease Control, all infections occurred more than 48 hours after hospital admission were considered HAI, and included in the study. Baseline characteristics, clinical features, isolated pathogens (only for the period 2011-2015) and antimicrobial resistance were recorded.During the nine years point prevalence surveys a total 2,840 patients were enrolled. Overall 136 (4.79%) patients developed 180 (6.34%) HAI. The most frequent HAI were respiratory tract infections (RTI), which accounted for 35.0% of all HAI, followed by surgical site infections (SSI) 22.2%, urinary tract infections (UTI) 19.4%, bloodstream infections (BSI) 17.2%, and others 6.1%. HAI related to major invasive risk procedures were also evaluated. SSI/patients undergoing surgery 3.99%, UTI/ patients with urinary catheter 4.17% and BSI/patients with CVC 9.42%. Over one-half of all patients surveyed (1,532, 53.9%) were receiving antibiotics at the time of our study. Among them 892 (58.2%) for treatment, 641 (41.8%) for prophylaxis. In the latter group, 109 (17.0%) underwent extra-short term, 89 (13.9%) short term and 443 (69.1%) a long term prophylaxis. During the period 2011-2015 out of 110 HAI episodes 71 (64.5%) were confirmed microbiologically. In total 106 pathogens were isolates, Gram-negative bacteria (63.2%) were isolated more frequently than Gram-positive bacteria (28.3%).The overall HAI prevalence in our hospital was consistent with those reported in other studies in Italy. The study underlined the role of Gram-negative bacteria in HAI and the need for antimicrobial stewardship. It also provided useful baseline data for rational priorities in allocation of resources, for further infection control activities.
- The lived experience of adults with heart failure: a phenomenological study. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):263-73.
Although a number of studies have been conducted on patients with Heart Failure (HF), they have not given a rigorous comprehensive description of what it is like to live with HF. The objective of this study was to describe the lived experience of adults with HF.A hermeneutic phenomenological design was used.Cohen's method was used to conduct the study. Thirty HF patients were enrolled between February and July 2014 from an outpatient cardiovascular clinic in Tuscany, Italy. Phenomenological interviews took place at patients' homes, and the investigators analyzed verbatim transcripts. Once data saturation was achieved, to ensure data trustworthiness, participants were asked to confirm all the extracted themes. Atals.ti vers.7 was used for data analysis.The patients were mostly male (67%) with a mean age of 71 (SD 9.15) and an age range of 48-86. Seven themes emerged from the phenomenological analysis: 1) important life changes; 2) social isolation caused by the illness; 3) anger and resignation associated with the disease; 4) relief from spirituality; 5) will to live; 6) uncertainty about the future and 7) the inescapability of disease and death.The meaning that patients attribute to their lived experience helps to create their needs, which are important to direct care. Family support and religious beliefs are an important source for HF patients to better manage their fears and cope with the future. Findings of this study provide nurses with a comprehensive description of what it is like to live with HF, which can be useful in helping to meet patients' needs more effectively and in tailoring interventions.
- An experience of field work learning for healthcare providers: new perspectives between disadvantages and critical issues. [Journal Article]
- Ann Ig 2016 Jul-Aug; 28(4):252-62.
The learning models used in traditional education are not very effective for the continuing education of healthcare providers. Fieldwork learning is an active learning method that is feasible in the workplace and is also suitable for professionals who possess a style of experiential learning. Guardian Angel 2.0® is a fieldwork learning project designed to promote educational skills in nurses to improve the self-care and quality of life in women affected by osteoporosis. The purpose of this article is to present the Guardian Angel 2.0® project and its results.The Guardian Angel 2.0® effort lasted nine months and involved 212 nurses in the north, centre and south of Italy. A socio-demographic questionnaire, an evaluation scale of the learning process and a participants' satisfaction questionnaire were used to evaluate and monitor the fieldwork learning project.Out of the 212 nurses who participated in the project, 119 (70%) completed it. The mean age of these participants was 48 years (± 7.98), and 83.5% were female. About half of the participants (52.0%, 55.4% and 45.0%, respectively) were good (a) at respecting deadlines, (b) at using the methodological instruments and (c) the information tools properly. Almost all nurses considered the project to be very relevant (96.4%). In regards to the project's quality, the nurses perceived it as excellent (51.0%) and very good (48.5%). Finally, the project was considered very useful or useful by 100% of nurses.The general satisfaction of nurses was high. The fieldwork learning was relevant and useful for developing educational skills in nurses. It would therefore be appropriate to use fieldwork learning in clinical settings to improve the existing experience of healthcare providers and thereby reduce the difficulties of transforming the knowledge from a theoretical to a practical level and to promote the development of new behaviours when the existing ones become obsolete or inefficient.
- Italian medical students quality of life: years 2005-2015. [JOURNAL ARTICLE]
- Ann Ig 2016 Jul-Aug; 28(4):245-251.
Quality of Life (QoL) is a concept used to indicate the general wellness of persons or societies. University students report a low quality of life and a worse perception of their health status, because of a situation of greater discomfort in which they live during the course of the study, especially in faculties with an important emotional burden, such as medical schools. The aim of the study was to evaluate the perceived health status of first year medical students.We conducted a cross sectional study in the time span 2005-2015, administering the questionnaire Short Form 36 (SF-36) to first-year students of the School of Medicine of the University of Siena, Italy. In addition to demographic information such as gender and the age we investigated the region of residence, marital status, employment status, and smoking habits; height and weight were required to calculate the body mass index (BMI) to evaluate a possible physical discomfort connected with the perception of health status. The data from the questionnaires were organized and processed by software Stata® SE, version 12.1.1,104 questionnaires were collected. Medical students reported lower SF-36 scores, compared to the Italian population of the same age. Female gender and smoking habits influence negatively the score of several scales. Body Mass Index is positively correlated with the Physical Activity, while Age is negatively correlated with Social Activities.The perceived quality of life of the Italian medical students is lower when compared to the general population. This confirms that the condition of student implies additional problems, as other studies reports. It would be better to improve it, developing students' resilience. It would be interesting to extend this research to students of other years, from other faculties and other locations, to gain a broader view about the QoL of the Italian students.
- Working over 5,000 m: medical check-up. [Journal Article]
- Ann Ig 2016 May-Jun; 28(3):233-42.
Any work activity performed at elevations over 3,000 m above sea level is considered as work at high altitude. The changing environmental conditions result in an adaptation of the human organism, mainly due to a reduced partial pressure of oxygen in the air and a proportional decrease in barometric pressure. We carried out a systematic review of the scientific literature in this field so as to develop a health and risk protocol as well as a procedure of ascent for researchers and staff expected to work in a science research lab at an altitude of 5,100 m asl. We wish to highlight the crucial role that occupational medicine plays in the formulation of a medical protocol used to assess the suitability of staff to work in environments posing high risks to human health, as in this case, and of a protocol of ascent minimizing the risk associated with changes in altitude.
- Risk of jugular compression blocks in workers exposed to prolonged upright posture. [Journal Article]
- Ann Ig 2016 May-Jun; 28(3):227-32.
The working posture affects the peripheral venous circulation, although the current literature does not report any correlation between working posture and the abnormalities of the jugular veins flow. The purpose of this preliminary research is to study, in female workers, the prevalence of Venous Compressive Syndrome (VCS) caused by total block of the internal jugular veins flow, so-called "White Compression". Due to complete compression by postural, muscular, fascial, anatomical or bone anomalies, White Compression is not visible by EchoColorDoppler (ECD) and its flow can only be detected by the rotational movements of the head or by Valsalva's maneuver.We studied a sample of female workers with ECD (n=128), in supine and upright position divided into subgroups according to the obliged posture maintained during working hours: group A, seated work (n = 61; 47.7%); group B, standing work (n = 41; 32.0%); group C, mixed (both standing and seated work) (n = 26; 20.3%). The total sample (n = 128) had the mean age of 46 ± 10 years (minimum 18 and maximum 67 years) and mean Body Mass Index (BMI) of 23 ± 4 kg/m2 (min 16 kg/m2 and a maximum of 42 kg/m2).Group A and group C did not show any White Compression in orthostatic and clinostatic position. The 9.75% (p = 0.0125) of Group B had a White Compression in orthostatic position: two female workers on the left side (4.9%) and two female workers on the right side (4.9%).We conclude that there is a risk of jugular compression blocks in female workers exposed to prolonged upright posture. Yet there is no longitudinal study that identifies the White Compressions as etiology of a chronic neurodegenerative disease. The authors hope that some wider studies can confirm the prevalence of these compressions in standing posture and their patho-physiological consequences.