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Ann Ig [journal]
- Soft qualities in healthcare Method and tools for soft qualities design in hospitals' built environments. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):391-9.
The design of hospital environments is determined by functional requirements and technical regulations, as well as numerous protocols, which define the structure and system characteristics that such environments need to achieve. In order to improve people's well-being and the quality of their experience within public hospitals, design elements (soft qualities) are added to those 'necessary' features. The aim of this research has been to experiment a new design process and also to create health care spaces with high environmental quality and capable to meet users' emotional and perceptual needs.Such needs were investigated with the help of qualitative research tools and the design criteria for one of these soft qualities - colour - were subsequently defined on the basis of the findings. The colour scheme design for the new San Paolo Hospital Emergency Department in Milan was used as case study. Focus groups were fundamental in defining the project's goals and criteria.The issues raised have led to believe that the proper procedure is not the mere consultation of the users in order to define the goals: users should rather be involved in the whole design process and become co-agents of the choices that determine the environment characteristics, so as to meet the quality requirements identified by the users themselves.The case study has shown the possibility of developing a designing methodology made by three steps (or operational tools) in which users' groups are involved in the choices, loading to plan the environments where compliance with expectations is already implied and verified by means of the process itself. Thus, the method leads to the creation of soft qualities in Healthcare.
- Continuity of care of cancer patients. Analysis of theoretical models and survey tools of continuity of care in people with a cancer diagnosis. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):380-90.
The Italian Ministry of Health declared oncology a priority and stressed the importance of ensuring continuity and integration in cancer care pathways. In order to monitor the quality of cancer care pathways, we need to explore patients' experience of the continuity of care, identifying the dimensions that define continuity.We found 886 relevant articles in the Pubmed database from 1987 to 5 November 2013. The search strategy for the electronic database was defined using the Population, Intervention, Comparison and Outcome(s) framework (PICO) to identify keywords. Two researchers independently reviewed records identified through the search strategy, analyzing continuity dimensions, specificity and/or transversal domains.We selected 20 articles that measure the patients' experience of continuity of care: 7 articles including 5 questionnaires [Questionnaire by King et al. 2008; Cancer care coordination Questionnaire (Cccq); Patient Continuity of Care Questionnaire (Pccq); Medical Care Questionnaire (Mcq); Continuity and Coordination of Care Questionnaire (CCCQ)]; 6 articles evaluating the relationship between patient and his/her physician (the same across the care pathway) in terms of frequency and/or dispersion; 6 articles considering one subscale of larger scales designed to evaluate the generic cancer care service patient experience; 1 revealing four organizational indicators of care pathway continuity / discontinuity.We traced 3 transversal dimensions across the individual analyses: informational, organizational, relational continuity. It follows that in order to cater to the needs of cancer patients, we need to simultaneously focus on these three dimensions along the cancer care pathway. In line with these results, we promoted the "R.In.Cu.ORAM.i" study (Networks for Integrated Treatment of colorectal and breast cancer), in Area Vasta Romagna Area (Italy), and developed a continuity of care patient-experience continuity tool.
- Features and organization of Pain Centers in the Lazio Region, Italy, in 2011. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):367-79.
Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region.A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated.CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ2=19.6 p<0.01).In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.
- Cultural adaptation and linguistic validation of the Family Decision Making Self Efficacy Scale (FDMSES). [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):355-66.
Nurses, following their ethical mandate, collaborate with other health and social professionals or people involved in caring activities. Caregivers in this context are becoming more and more significant for the family or the cared person, who for their stable presence and emotional proximity play a pivotal caring role. To maximize the contribution of caregivers, objective tools that emphasize their skill sets are necessary. The cross-cultural adaptation and validation of the Family Decision Making Self-Efficacy Scale is part of a larger project aimed at understanding the resilience of caregivers in the field of palliative care. Self-efficacy is one of the aspects of personality most closely associated with resilience. Self-efficacy is shown in a specific context, therefore, its study and evaluation of its level, require capabilities that enable individuals perceive themselves as effective in a particular circumstance. The Family Decision Making Self- Efficacy Scale assesses the behavior of caregivers of patients at the end of their life.The Family Decision Making Self-Efficacy Scale was translated (forward and back translation) and was adapted to the Italian clinical cultural setting by a research team that included experts in palliative care, native translators with experience in nursing and experts in nursing. A consensus on the wording of each item in relation to semantic, idiomatic, experiential and conceptual equivalence was sought. The clarity of the wording and the pertinence of the items of the scenario with the conscious patient and with the unconscious patient were evaluated by a group of caregivers who tested the instrument.The Italian version of the instrument included 12 items for the scenario with the conscious patient and 12 for the scenario with the unconscious patient. The working group expressed consensus on the pretesting version of the instrument. The pre-testing version of the scale was tested on 60 caregivers, 47 taking care of conscious patients and 13 taking care of unconscious patients. In both cases the content of the items was judged relevant and understandable.The results for the cross-cultural validation were satisfactory and allowed the application of the instrument in the Italian context.
- Outlining job descriptions of the health professions for preventive care: an exploratory study at the Local Health Authority of Milan, Italy. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):344-54.
Job descriptions are detailed descriptions of particular job positions; they are utilized to select and evaluate the personnel, but also to assess the professionals' educational needs; in fact, job descriptions identify which tasks the employee is expected to perform and his/her required characteristics. The aim of this study was to explore suitable methodologies to analyze the job positions in the health professional field, to outline specific job descriptions. More specifically, we intended to study how to outline the job descriptions of the health professions for preventive care (Public Health Nurses, PHN, and Occupational and Environmental Health Officers, OEHO ) employed at the Local Health Authority (LHA) of Milan, in order to contribute to their educational needs assessment.Data were collected in 2012 from a purposive sample of 29 professionals belonging to the population under study (PHN and OEHO employed at the LHA of Milan), and from other 7 healthcare professionals working in the staff (totally 36 participants), through two qualitative methods: focus groups and participant field observations. We used two methods of data gathering to attain triangulation, in order to increase the validity of the results. A thematic analysis was performed by two researchers on focus groups transcriptions and filed notes.A list of 26 activities performed by participants in different contexts of the LHA emerged in the focus groups; ten of those activities were studied in the field through participant observations, which confirmed what informants said in the focus groups. Concerning the methodology for data gathering to outline job descriptions, participants appreciated focus groups, since they gave them the opportunity to reflect on the activities performed at the LHA, highlighting critical aspects of those activities and therefore their educational needs. Participant field observations, conducted by a researcher belonging to the health professions for preventive care, did not encounter any resistance, but were less appreciated by participants than focus groups. From the researcher's point of view, the field observations were less efficient than focus groups.Focus groups have proven to be a valid tool to outline job descriptions of health professions for preventive care, since they are perceived not only as a method for data gathering, but also as a means to identify their educational needs. When triangulated with field observations, data gathered through focus groups enhanced their validity, but participant observations proved to be scarcely efficient. Further research is needed on instruments that allow data gathering on job descriptions to be triangulated with focusgroups, such as questionnaires.
- The Rapid Alert System: Implementation in NA 2 North LHA over the five-year period from 2008 to 2012. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):330-43.
The Rapid Alert System was established by the European Union (EC Regulation 178/2002 Art.50, paragraph 1) for food intended for human consumption and for animal feed, with the aim of ensuring the protection of public, animal and environmental health. The purpose of the Rapid Alert System for Food and Feed (RASFF) is to provide the control authorities with the means of exchanging information on the measures taken to ensure food safety. This system allows for a rapid intervention following the discovery of food or feed already placed on the market and which represent, directly or indirectly, a serious risk for human, animal or environmental health.Our work intends to examine all alert and information notified to the Hygiene Department of Food and Nutrition of what was formerly NA3 LHU in the last 5 years (2008-2012), and is now Naples 2 North LHU, bearing in mind that, according to regional law 16/2008 (10), the Local Health Units in Campania have been redefined. The types of risk regarding the food subject of the alerts received are: chemical, physical and biological. Food frauds (adulteration, counterfeiting, sophistication and alteration) and the poor state of preservation were considered separately.Out of 146 cases of non-conformity reported, 87 involved chemical risk, 28 biological risk and 17 included foreign bodies; there were also 7 food frauds and 1 case of poor state of preservation. As for the origin, the food subject of non-conformity were for the most part (61,64%) of national origin, while 34.24% came from abroad. Of these, about 66% were of non-EU origin.The experience gained during the period from 2008 to 2012 allows us to state that the information flow has been improved allowing local services that have been assigned the control to act more rapidly. A critical issue sometimes remains concerning the completeness of the given data, above all regarding the type of risk that, when well reported, provides a valuable contribution to the success of a comprehensive and responsible risk management programme. The encouraging fact that emerges from this study, however, is that, despite the premises made about the characteristics of the area examined, the number of alerts we received involving production sites located in the area of the LHU jurisdiction is less than what we might have expected.
- Workers of the printing industry and hepatic damage. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):321-9.
Typesetting industry is still the primary instrument of communication, despite the development of new technological systems. This study focuses on the analysis of the hepatic effects induced by the use of some organic solvents employed in the printing industry.We studied a group of 194 workers: 93 exposed and 101 not exposed. The level of the exposure to chemical pollutants were assessed through the environmental monitoring of blood concentrations and the analysis of airborne substances. The health survey was performed through the collection of the medical history and the use of hepatic tests, which were evaluated by calculating Mean, Standard Deviation, Student's t-test and X² test with Yates Correction, to investigate statistically significant differences in some hepatic parameters: AST, ALT, ALP, GGT, fractional and total bilirubin. The environmental data sometimes exceeded the TLV-TWA.The clinical evaluation of the hepatic parameters showed statistically significant differences as to the hematic concentrations of AST, ALT, GGT.The results we obtained support the hypothesis of a risk among the printing industrial workers attributable to the hepatotoxic solvents. This risk seems to be related to the use of a mixture of solvents, although at low doses, and the analysis of the results obtained confirms the validity of the investigation for the health screening protocol adopted in order to identify subjects and/or population at risk of hepatotoxicity.
- Urinary hydroxypyrene and estradiol in an occupationally exposed "outdoor" population. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):311-20.
Polycyclic aromatic hydrocarbons (PAHs) are widely present in the air pollution. The urinary hydroxypyrene (1-HOPu) is considered the main biological biomarker currently available to measure the exposure to PAH. It is supposed responsible of an increase of estradiol levels in males. Aim of this study is to verify whether there is a relation between 1-HOPu and plasmatic estradiol in non-smoker male workers.The study was conducted on a sample of 122 non-smoker policemen in a large Italian city; we monitored their levels of 1-HOPu and the values of estradiol. The sample was divided into three groups according to the levels of urinary hydroxypyrene. The indices of correlation (r) and multiple linear regression (β), between levels of 1-HOPu and estradiol were calculated. It was also calculated the student's t-test among the groups to check the differences.We found statistically significant correlations and multivariate linear regressions between 1-HOPu and estradiol in the total sample and in group III (levels of 1-HOPu above the 75th percentile). The average levels of estradiol in group III was statistically and significantly higher than in the group I (levels of 1-HOPu below the 25th percentile) and group II (levels 1-HOPu between 25th and the 75th percentile).1-HOPu in non-smoker male workers is related with an increase of plasmatic estradiol. We believe that PAHs, of which 1-HOPu is the main biomarker, can interact with the hypothalamic-pituitary axis. The preliminary results suggest that the topic needs further research on male and female as well.
- Non Tuberculous Cutaneous Mycobacteriosis in a primary school in Rome: epidemiological and microbiological investigation. [JOURNAL ARTICLE]
- Ann Ig 2014 Jul-Aug; 26(4):305-310.
During the school years 2009-2010 and 2010-2011 a total of 25 cases of Non Tuberculous Cutaneous Mycobacteriosis (NTCM) were notified in children attending the same school with a swimming pool in Rome. Environmental microbiological and epidemiological investigations (only for suspected outbreaks in 2009-2010) were conducted. We screened students with skin lesions, and environmental samples were collected from the school area and the swimming pool. During the school year 2009-10 18 cases were clinically identified among 514 primary school children (3.50%) and all cases attended the swimming pool. Only 2 out of 18 cultures were positive for Mycobacterium chelonae complex (Group III, M. abscessus). Attack Rate for swimming pool use was 13,10% (17/130), with a Relative Risk 54,70 (95% CI: 9,4 - ∞). In February 2011 additional 7 cases of cutaneous NTM among children - who attended the same primary school and swimming pool were notified to the local public health authority followed by environmental microbiological investigation. Environmental samples were positive for NTM but not for M. abscessus. Mycobacteria are not included in water-quality criteria in Italy for this reason it is important to collect evidences of NTM cases caused by these infrequent pathogens, to be able to perform rapid risk assessment and to identify the best practices in prevention and management of such a risk.
- Role of empirical and targeted therapy in hospitalized patients with bloodstream infections caused by ESBL-producing Enterobacteriaceae. [Journal Article]
- Ann Ig 2014 Jul-Aug; 26(4):293-304.
Bloodstream infection (BSI) due to extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are a major cause of in-hospital mortality. The effect on survival of empirical and targeted antibiotic therapy in these patients remains controversial.A prospective cohort study was conducted analyzing data from 94 patients (age 59 ± 21 years) with BSI due to ESBL producing strains (Sixty-one E. coli, 26 K. pneumoniae, 4 Proteus spp and 3 Enterobacter spp).Risk factors associated with 21-day mortality at univariate analysis were: recent administration of antibiotic therapy (p=0.049), higher SOFA score (p=0.05), ICU stay (p <0.01), hypotension at presentation (p =0.001) or septic shock (p <0.001) and bacteremia from source other than urinary tract (p=0.03). Regardless of antibiotic class used, no differences in survival were noted between patients receiving or not adequate initial antimicrobial treatment (37.1% vs 23.7% p=0.23); on the other hand, compared with the administration of other in vitro active antibiotics, the use of carbapenem as definitive therapy was associated with a significantly lower 21-day mortality (54.3% vs 28.5% p=0.02).These findings suggest that the administration of an adequate initial therapy is not associated with mortality in hospitalized patients with BSI due to Enterobacteriaceae. The severity of clinical conditions at presentation and the administration of carbapenems as definitive therapy seems to be really important in affecting the outcome of patients with BSI due to ESBL producing strains.