Artículos de revistas: "Piedmont Hospital"

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Amerio, M. L., B. Pogliano, P. C. Durelli, G. Cornarino, M. M. Tinivella y A. Pezzana. "Hospital Food Wastage Evaluation Project in Piedmont Region". Journal of Nutritional Ecology and Food Research 4, n.º 1 (1 de junio de 2017): 1–5. http://dx.doi.org/10.1166/jnef.2017.1153.

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Becker, Thomas. "Psychiatric Reform in Italy—How does it Work in Piedmont?" British Journal of Psychiatry 147, n.º 3 (septiembre de 1985): 254–60. http://dx.doi.org/10.1192/bjp.147.3.254.

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Psychiatric reform in Piedmont following new mental health legislation in Italy (1978) is described. The process of reform is characterised by a drastic reduction in psychiatric hospital populations and the setting-up of a new system of community-based services. The number of hospital admissions remains stable, but the character of inpatient care has changed. The reform involves problems of care for chronic patients.

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ANSELMINO, M. "529 Hospital admissions for congestive heart failure in Piedmont - Italy: 1996?2001 trend". European Journal of Heart Failure Supplements 3, n.º 1 (junio de 2004): 137. http://dx.doi.org/10.1016/s1567-4215(04)90394-3.

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Dell’Era, Valeria, Riccardo Dosdegani, Paolo Aluffi Valletti y Massimiliano Garzaro. "Epistaxis in hospitalized patients with COVID-19". Journal of International Medical Research 48, n.º 8 (agosto de 2020): 030006052095104. http://dx.doi.org/10.1177/0300060520951040.

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Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. We herein present the data of 30 patients with COVID-19 who developed spontaneous epistaxis while hospitalized at Eastern Piedmont Hospital during March and April 2020. All patients received low-molecular-weight heparin during their hospital stay and required supplementary oxygen therapy either by a nasal cannula or continuous positive airway pressure. Both conditions can represent risk factors for developing epistaxis. Prevention of crust formation in patients with rhinitis using a nasal lubricant should be recommended. If any treatment is required, appropriate self-protection is mandatory.

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Golinelli, Davide, Jacopo Lenzi, Emanuele Adorno, Maria Michela Gianino y Maria Pia Fantini. "COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis". PeerJ 9 (31 de agosto de 2021): e12046. http://dx.doi.org/10.7717/peerj.12046.

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Background It is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID-19 pandemic on the quality of care provided to non-COVID-19 patients. The aim of this study is to assess the impact of the COVID-19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, two large regions of northern Italy severely hit by the pandemic. Methods We calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (≈6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no “intervention” (lockdown) in the middle of the observation period. Results Before the lockdown, 2-day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (–0.1%) and 69.3% (–9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significant decline at a weekly rate of –1.29% (95% CI [−1.71 to −0.88]). Divergent trend patterns in the two study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness.

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Davini, Ottavio, Giovanni Digiacomo, Matteo Perusia, Valeria Romano, Chiara Rivoiro, Rosario Servetto, Marika Giacometti et al. "PP170 Health Impact Assessment Of Teleradiology Programs In Disadvantaged Areas". International Journal of Technology Assessment in Health Care 33, S1 (2017): 144–45. http://dx.doi.org/10.1017/s0266462317002987.

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INTRODUCTION:Within the Home Radiology service of the Piedmont Region - R@dhome (1) - it was decided to employ a mobile radiological service to allow minor radiological procedures to be conducted in rural areas. Cortemilia (average age of population 51.6 years, population over 65 years 33.6 percent) is situated in Piedmont (Langhe region) and it is about 40 kilometers, with bad roads, from the nearest hospital. For this reason it's important to optimize the potential offered by telemedicine. The purpose of R@dhome is to provide simple radiological services (ambulatory) to vulnerable patients in outpatient settings. The aim of this work was to implement an assessment, based on Health Impact Analysis (HIA) (2,3) criteria, of the health intervention provided by the R@dhome service.METHODS:From January 2016 to December 2016 the following were assessed: •number of patients examined in the local radiological ambulatory service•inhabitants opinions (using questionnaires)•General Practitioner, Pharmacist, Family nurse opinions (using semi-structured interviews)•stakeholder opinions (Mayor, local politicians, using semi-structured interviews)•number of cars and ambulances used for the transport of patients to the nearest hospital•number of patients who avoided transportation to the nearest hospital•pollutants PM10 (particle size 10) related to cars and ambulance traffic.RESULTS:Forty percent of people interviewed were more than 60 years old, 76 percent needed x-rays (in 2015), 96.8 percent considered it useful to have a closer x-ray service, only 42 percent had a driver's licence but preferred not to drive; GP's said that 50 percent of local patients had trouble reaching the hospital and that 30 percent of local patients need informal or formal care. From Januay to December 2016 we examined (mainly chest and bone x-rays) in 598 patients using as an alternative to private cars and ambulances the radiological mobile station, and the pollutant emissions were shown to be reduced by 85 percent.CONCLUSIONS:This study has provided a comprehensive HIA report which shows that the R@dhome intervention improves patient's QOL, reduces social costs, reduces the number of patients in the Hospital Radiology Department, reduces rate of hospitalization and pollution.

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Djalali, Ahmadreza, Luca Carenzo, Luca Ragazzoni, Massimo Azzaretto, Roberta Petrino, Francesco Della Corte y Pier Luigi Ingrassia. "Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study". Prehospital and Disaster Medicine 29, n.º 5 (5 de agosto de 2014): 441–47. http://dx.doi.org/10.1017/s1049023x1400082x.

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AbstractIntroductionThe assessment of hospital disaster preparedness and response performance is a way to find and remove possible gaps and weaknesses in hospital disaster management effectiveness. The aim of this pilot study was to test the association between the level of preparedness and the level of response performance during a full-scale hospital exercise.MethodThis pilot study was conducted in a hospital during a full-scale exercise in the Piedmont region of Italy. The preparedness evaluation was conducted by a group of three experts, three days before the exercise, and the response evaluation was conducted during the exercise. The functional capacity module was used for preparedness evaluation, and the response performance of the “command and control” function of the hospital was evaluated by nine semiquantitative performance indicators.ResultsThe preparedness of the chosen hospital was 59%, while the response performance was evaluated as 70%. The hospital staff conducted Simple Triage and Rapid Transport (START) triage while they received 61 casualties, which was 90% correct for the yellow group and 100% correct for the green group.ConclusionThis pilot study showed that it is possible to use standardized evaluations tools, to simultaneously assess the relationship between preparedness elements and response performance measures. An experimental study including a group of hospitals, also using more comprehensive evaluation tools, should be done to evaluate the correlation between the level of preparedness and the response performance of a hospital, and the impact of hospital disaster planning, on the outcome of disasters victims.DjalaliA,CarenzoL,RagazzoniL,AzzarettoM,PetrinoR,Della CorteF,IngrassiaPL.Does hospital disaster preparedness predict response performance during a full-scale exercise? A pilot study.Prehosp Disaster Med.2014;29(4):1-7.

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Stobbione, T., M. Amerio, T. Abba y A. Mastinu. "P282 DOES HOSPITALIZATION INCREASE THE MALNUTRITION RISK? AN EXPERIENCE AT ASTI CARDINAL MASSAIA HOSPITAL (PIEDMONT, ITALY)". Clinical Nutrition Supplements 3 (enero de 2008): 149. http://dx.doi.org/10.1016/s1744-1161(08)70344-2.

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Oderda, Marco, Giorgio Calleris, Marco Falcone, Giuseppe Fasolis, Giovanni Muto, Gianluca Oderda, Francesco Porpiglia, Alessandro Volpe, Oscar Bertetto y Paolo Gontero. "How uro-oncology has been affected by COVID-19 emergency? Data from Piedmont/Valle d’Aosta Oncological Network, Italy". Urologia Journal 88, n.º 1 (febrero de 2021): 3–8. http://dx.doi.org/10.1177/0391560320946186.

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Introduction: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d’Aosta, estimating its future impact. Methods: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d’Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. Results: Most centers (77%) declared to be “much”/“very much” affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. Conclusions: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d’Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.

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Bo, Marco, Ivo Casagranda, Lorena Charrier y Maria Michela Gianino. "Availability of emergency contraception: A survey of hospital emergency department gynaecologists and emergency physicians in Piedmont, Italy". European Journal of Contraception & Reproductive Health Care 17, n.º 5 (26 de julio de 2012): 373–82. http://dx.doi.org/10.3109/13625187.2012.692410.

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Cerri, C., E. Cava, F. Butera, A. Collo, G. D'Aloisio, S. A. Passera, E. Albertazzi et al. "WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE 4-YEARS EXPERIENCE AT MAGGIORE DELLA CARITÀ HOSPITAL (NOVARA, PIEDMONT)". Nutrition 87-88 (agosto de 2021): 111322. http://dx.doi.org/10.1016/j.nut.2021.111322.

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Sobrero, Simona, Eva Pagano, Elisa Piovano, Lorenzo Bono, Manuela Ceccarelli, Anna Ferrero, Chiara Macchi et al. "Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit". International Journal of Gynecologic Cancer 26, n.º 9 (noviembre de 2016): 1615–23. http://dx.doi.org/10.1097/igc.0000000000000830.

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BackgroundIn the northwestern Italian region of Piedmont, current statistics on hospitalizations show that surgical treatment for ovarian cancer (OC) is taking place in many small hospitals, as opposed to a more centralized approach. A population-based clinical audit was promoted to investigate whether OC is being managed according to clinical guidelines, identify determinants of lack of adherence to guidelines, and evaluate the association between adherence to guidelines and survival.Patients and MethodsResidents diagnosed with OC in 2009 were identified in the regional hospital discharge records database. All hospitalizations within 2 years from diagnosis were reviewed. Patients were classified according to their initial pattern of care, defined as “with curative intent” (CIPC) if including debulking surgery aimed at maximal cytoreduction. Adherence to guidelines for surgery and chemotherapy and the effects of this adherence on OC survival were investigated with logistic regression and Cox models.ResultsThe final study sample consisted of 344 patients with OC, 215 (62.5%) of whom received CIPC. Increasing age, comorbidities, and metastases were negatively associated with receiving CIPC. In the CIPC group, surgical treatment was adherent to guidelines in 35.2%, whereas chemotherapy was adherent in 87.8%. Surgical treatment that was adherent to guidelines [hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.45–1.15] and absence of residual tumor (HR, 0.55; 95% CI, 0.32–0.94) were associated with better survival in the CIPC group, and chemotherapy that was adherent to guidelines was associated with a significant reduction in the risk of death (HR, 0.49; 95% CI, 0.28–0.87).ConclusionsResults support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.

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Radeschi, Giulio, Andrea Mina, Giacomo Berta, Andrea Fassiola, Agostino Roasio, Felice Urso, Roberto Penso et al. "Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region". Resuscitation 119 (octubre de 2017): 48–55. http://dx.doi.org/10.1016/j.resuscitation.2017.06.020.

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De Rosa, Francesco Giuseppe, Annagloria Palazzo, Tiziana Rosso, Nour Shbaklo, Marco Mussa, Lucio Boglione, Enrica Borgogno et al. "Risk Factors for Mortality in COVID-19 Hospitalized Patients in Piedmont, Italy: Results from the Multicenter, Regional, CORACLE Registry". Journal of Clinical Medicine 10, n.º 9 (1 de mayo de 2021): 1951. http://dx.doi.org/10.3390/jcm10091951.

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Background: CORACLE is a retrospective and prospective, regional multicenter registry, developed to evaluate risk factors for mortality in a cohort of patients admitted with SARS-CoV-2 infection within non-intensive wards. Methods: The primary objective was to estimate the role of several prognostic factors on hospital mortality in terms of adjusted Odds Ratios (aOR) with multivariable logistic regression models. Results: A total of 1538 patients were enrolled; 42% were female, and 58% were >70 years old. Deceased patients were 422 (27%), with a median age of 83 years (IQR (Inter Quartile Range) 76–87). Older age at admission (aOR 1.07 per year, 95%CI 1.06–1.09), diabetes (1.41, 1.02–1.94), cardiovascular disease (1.79, 1.31–2.44), immunosuppression (1.65, 1.04–2.62), estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 (3.53, 2.26–5.51), higher C-reactive protein values and a decreased PaO2/FiO2 ratio at admission were associated with a higher risk of hospital mortality. Amongst patients still alive on day 7, only hydroxychloroquine (HCQ) treatment was associated with reduced mortality (0.57, 0.36–0.90). Conclusions: Several risk factors were associated with mortality in SARS-CoV-2 positive patients. Although HCQ seems to be the only factor significantly associated with reduced mortality, this result is in contrast with evidence from randomized studies. These results should be interpreted in light of the study limitations.

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Garrone, Ornella, Nerina Denaro, Fiorella Ruatta, Paola Vanella, Cristina Granetto, Anna Maria Vandone, Marcella Occelli et al. "Treating patients with cancer amidst the COVID-19 pandemic: experience of a regional hospital in the Piedmont region in northern Italy". Tumori Journal 106, n.º 5 (23 de julio de 2020): 427–31. http://dx.doi.org/10.1177/0300891620942313.

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Background: The coronavirus disease 2019 (COVID-19) pandemic is posing an unprecedented dilemma to oncologists worldwide, forcing them to decide whether to continue or suspend treatments in order to protect their most vulnerable patients from infection. After the first report from China, the outbreak spread rapidly worldwide. To, date no clear indications on how to treat patients with cancer with COVID-19 infection are available. Methods: We report data on 21 patients with cancer referred to a single medical oncology unit of a general hospital from mid-March to April 23, 2020. Results: Nine patients were on active cancer therapy during the infection and all stopped medical treatments. Overall 8 patients developed pneumonia and 6 patients died of COVID-19. Conclusion: The management of patients with cancer during the pandemic should be carefully balanced and discussed among oncologists and other key professionals involved in the treatment of this vulnerable group of patients, in order to balance the risk of treatment and the risk of infection.

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Mannocci, Alice, Claudia Vaschetto, Leda Semyonov, Giuseppina Poppa, Azzurra Massimi, Grace Rabacchi, Antonio Boccia y Giuseppe La Torre. "Maternal Smoking and Socio-Demographic Characteristics in Correlation with Low Birth Weight: A Turin (Piedmont) Study". Slovenian Journal of Public Health 53, n.º 3 (1 de septiembre de 2014): 221–25. http://dx.doi.org/10.2478/sjph-2014-0022.

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Abstract Introduction. 15 to 25% of women smoke during pregnancy. Scientific evidence suggests that exposure to smoking causes decreased birth weight. The aim of this study was to assess the correlation between smoking during pregnancy, maternal sociodemographic characteristics, and low birth weight. Methods. Data were derived from 1572 questionnaires administered to each woman that gave birth at the Gynecology Teaching Hospital “S. Anna” in Turin (Italy) during the period from 2008 to 2010. Multiple logistic analysis was used to evaluate the association between socio-demographic characteristics and birth weight; the stepwise approach with a “backward elimination” procedure was followed, and the goodness of fit of the model was estimated using the Hosmer-Lemeshow test. Results. The univariate analysis revealed that smoking cigarettes (17%), having a lower educational level (13%), and female sex of the infant (13%) seem to be risk factors, as they increase the risk of having a low birth weight child. Logistic regression analysis showed that gestational age and maternal smoking are the statistically associated variables. Conclusions. The results confirmed that birth weight increases proportionally with the length of the gestational age and that maternal smoking and the child’s sex (female) increase the risk of having a lower birth weight. Logistic regression demonstrated that the association between maternal smoking and low birth weight shows an increased risk for the whole population (OR=2.85), for male (OR=3.45) and for female newborns (OR=2.44)

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Manfredi, M., A. Cerbo, S. Zanzani, A. Moriggia, D. Fattori, A. Siboni, V. Bonazza, C. Filice y E. Brunetti. "Prevalence of echinococcosis in humans, livestock and dogs in northern Italy". Helminthologia 48, n.º 2 (1 de junio de 2011): 59–66. http://dx.doi.org/10.2478/s11687-011-0011-9.

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AbstractThe presence of Echinococcus sp. cysts was investigated in 822 sheep, 123 goats and 112,521 cattle from Lombardy region, North Italy. Faecal samples from 40 sheepdogs were also analyzed, with 9 samples containing taeniid eggs (22.5 %), 8 samples being coproantigen-positive (20 %), and one dog from a northern province (Lecco) positively confirmed by PCR. Cystic Echinococcosis (CE) was detected in 0.36 % of sheep and in 0.29 % of cattle in 2004. No goat resulted to be infected. Data from CE patients treated in Lombardy were collected by inspecting hospital discharge records. In 2004, 156 CE-related admissions (62 % male and 38 % female) were reported in Lombardy. Total hospital stay was 1,372 days (1,286 for inpatients, 86 for outpatients). Most patients (72.4 %) were residents in Lombardy and 1.9 % were from Piedmont; the remaining patients were from central and southern Italy. According to acquired data CE resulted hypoendemic in animals in Lombardy. Prevalence rates in humans were higher than expected in this region, usually considered as non-endemic. Assessment of the prevalence of CE in humans remains a difficult, costly, time-consuming and labourintensive task. The present study suggests establishing a National Registry of Cystic Echinococcosis with the aim to highlight regional risk factors and to benefit from its matching both clinical and epidemiological data.

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Campagna, Sara, Maria Delfina Antonielli D’Oulx, Rosetta Paradiso, Laura Perretta, Silvia Re Viglietti, Paola Berchialla y Valerio Dimonte. "Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study". Pain Research and Management 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/6104383.

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Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge.

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Teal, Jan. "Certifiably Excellent". AACN Advanced Critical Care 22, n.º 1 (1 de enero de 2011): 83–88. http://dx.doi.org/10.4037/nci.0b013e318206e112.

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The purpose of this article is to provide a road map for individuals and chapters to use in beginning a certification program. The Heart of the Piedmont Chapter used the mission, vision, and values of the American Association of Critical-Care Nurses to create an environment of safety and expert care for patients and their families. The journey began when our chapter realized that there were only a few certified nurses in our chapter and hospital. As a chapter, we decided to use a survey to determine interest in certification. We invited all interested nurses to attend a certification meeting. Eighty nurses attended. Collaborating with nursing administration, we held study groups, brought in a national speaker, and assisted with payment of the certification examination. This article describes how 1 chapter can make a positive difference in the lives of nurses and patients. Although our chapter’s journey is ongoing, we hope to share our strategies for success with others.

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Montrucchio, Giorgia, Gabriele Sales, Rosario Urbino, Umberto Simonetti, Chiara Bonetto, Erik Cura Stura, Erika Simonato, Giovanni Fuoco, Vito Fanelli y Luca Brazzi. "ECMO Support and Operator Safety in the Context of COVID-19 Outbreak: A Regional Center Experience". Membranes 11, n.º 5 (30 de abril de 2021): 334. http://dx.doi.org/10.3390/membranes11050334.

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Since the beginning of the COVID-19 emergency, the referral Intensive Care Unit for the Extracorporeal Membrane Oxygenation (ECMO) support of Piedmont Region (Italy), in cooperation with infectious disease specialists, perfusionists and cardiac surgeons, developed a protocol to guarantee operator safety during invasive procedures, among which the ECMO positioning or inter-hospital transport. The use of powered air-purifying respirators, filtering facepiece particles (FFP) 2–3 masks, protective suits, disposable sterile surgical gowns, and two pairs of sterile gloves as a part of a protocol seemed effective and feasible for trained healthcare workers and allow all the complex activities connected with the positioning of the ECMO support to be completed effectively. The simulation training on donning and doffing procedures and the presence of a dedicated team member to verify the compliance with the safety procedure effectively reassured operators and likely reduced the risk of self-contamination. From 1 March to 31 December 2020, we used the procedure in 35 severe acute respiratory distress syndrome (ARDS) patients and one acute respiratory failure caused by neoplastic total tracheal obstruction, all positive to COVID-19, to be connected to veno-venous ECMO in peripheral hospitals and centralized for ECMO management. This preliminary experience seems to confirm that the use of ECMO during COVID-19 outbreaks is feasible and the risks associated with its positioning and management are sustainable for the health-care workers and safe for patients.

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Ottino, Maria Chiara, Andrea Argentero, Pier Angelo Argentero, Giacomo Garzaro y Carla Maria Zotti. "Needlestick prevention devices: data from hospital surveillance in Piedmont, Italy—comprehensive analysis on needlestick injuries between healthcare workers after the introduction of safety devices". BMJ Open 9, n.º 11 (noviembre de 2019): e030576. http://dx.doi.org/10.1136/bmjopen-2019-030576.

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ObjectiveNeedlestick and sharps injuries (NSIs) involving healthcare workers (HCWs) are worldwide under surveillance since long time; the implementation of the European Directive 32/2010 regarding the mandatory use of safety-engineered devices (SEDs) seems to have reduced the number of these accidents. Our surveillance investigated the frequency and the modality of SED-related NSIs in the Piedmont region to verify changes in the epidemiology of these events.MethodsWe analysed the exposure records of NSIs, device usage data and structural data of 42 acute care hospitals and compared conventional and safety devices. We calculated the accident rates per 100 000 needles and, as a measure of SED efficacy, the relative risk between the use of safety and non-safety devices with a 95% CI. We also described the dynamics of the NSIs and the most involved professional groups of HCWs, procedures and devices.ResultsTotal and specific device accident rates for 100 000 needles were lower with the use of SEDs. In 2015–2016, there were 1640 NSIs, with a decreasing absolute number during the observation period; 18% were SEDs related. Half of the total accidents with SEDs occurred in the patient’s room, and nurses were involved in 78% of the cases. The most involved devices were the butterfly needles and peripheral venous catheters, and the most involved procedures were venous sampling (40%) and phlebotherapy (16%). The exposures occurred mostly during the procedure, and 45% of the SED-related injuries occurred during the disposal of the device; 92% of the SEDs involved had a manual activation mechanism.ConclusionIn agreement with the results of other European studies, our results show that SEDs reduce the risk of percutaneous exposure of HCWs, but in introducing SEDs, we must select those with a higher level of safety (with a passive activation mechanism) and improve the healthcare staff training programmes.

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Tradori, Vania, Paola De Bernardi y Valerio Brescia. "The Micro-Costing Approach to Foster the Effectiveness of Decision-Making Processes in the Healthcare System–Some Empirical Evidence from the Piedmont Region". International Journal of Business and Management 14, n.º 2 (27 de enero de 2019): 167. http://dx.doi.org/10.5539/ijbm.v14n2p167.

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The study aims to highlight the usefulness of micro accounting approach as tool of clinical governance starting from the data provided by the computerization of services and medical records. The case study takes into account data collected over two years between three departments of the same hospital for the management of patients with acute gastric ulcer with bleeding and variations and acute duodenal ulcer with bleeding and variations. All statistical analyses were performed using STATA V.14.2 (Stata Corp, College Station, Texas, USA, 2013) and p value <0.05 was considered significant for all analyses. The analysis of economic and comorbidity data provides useful insights to guide the choice of the treatment pathway between departments, and provides useful indications for the redefinition of guidelines towards a rationalization of healthcare expenditure.

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Rhew, Sung Han, Julia Kravchenko y H. Kim Lyerly. "Exposure to low-dose ambient fine particulate matter PM2.5 and Alzheimer’s disease, non-Alzheimer’s dementia, and Parkinson’s disease in North Carolina". PLOS ONE 16, n.º 7 (9 de julio de 2021): e0253253. http://dx.doi.org/10.1371/journal.pone.0253253.

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Alzheimer’s disease (AD), non-AD dementia, and Parkinson’s disease (PD) are increasingly common in older adults, yet all risk factors for their onset are not fully understood. Consequently, environmental exposures, including air pollution, have been hypothesized to contribute to the etiology of neurodegeneration. Because persistently elevated rates of AD mortality in the southern Piedmont area of North Carolina (NC) have been documented, we studied mortality and hospital admissions for AD, non-AD dementia, and PD in residential populations aged 65+ with long-term exposures to elevated levels of ambient air particulate matter 2.5 (PM2.5) exceeding the World Health Organization (WHO) air quality standards (≥10μg/m3). Health data were obtained from the State Center for Health Statistics and the Healthcare Cost and Utilization Project. PM2.5 levels were obtained from the MODIS/MISR and SeaWiFS datafiles. Residents in the Study group of elevated air particulate matter (87 zip codes with PM2.5≥10μg/m3) were compared to the residents in the Control group with low levels of air particulate matter (81 zip codes with PM2.5≤7.61μg/m3), and were found to have higher age-adjusted rates of mortality and hospital admissions for AD, non-AD dementia, and PD, including a most pronounced increase in AD mortality (323/100,000 vs. 257/100,000, respectively). After adjustment for multiple co-factors, the risk of death (odds ratio, or OR) from AD in the Study group (OR = 1.35, 95%CI[1.24–1.48]) was significantly higher than ORs of non-AD dementia or PD (OR = 0.97, 95%CI[0.90–1.04] and OR = 1.13, 95%CI[0.92–1.31]). The OR of hospital admissions was significantly increased only for AD as a primary case of hospitalization (OR = 1.54, 95%CI[1.31–1.82]). Conclusion: NC residents aged 65+ with long-term exposures to ambient PM2.5 levels exceeding the WHO standard had significantly increased risks of death and hospital admissions for AD. The effects for non-AD dementia and PD were less pronounced.

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Giorda, Carlo B., Paolo Carnà, Francesco Romeo, Giuseppe Costa, Barbara Tartaglino y Roberto Gnavi. "Prevalence, incidence and associated comorbidities of treated hypothyroidism: an update from a European population". European Journal of Endocrinology 176, n.º 5 (mayo de 2017): 533–42. http://dx.doi.org/10.1530/eje-16-0559.

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Objective Estimates of the prevalence of hypothyroidism in unselected populations date from the late 1990s. We present an update on the prevalence and incidence of overt hypothyroidism in Piedmont, northwest Italy and examine the association between hypothyroidism and multiple chronic comorbidities. Design and methods Data were obtained from drug prescription and hospital discharge databases. Individuals who had received at least two levothyroxine prescriptions in 2012 were defined as having hypothyroidism; those who had undergone thyroidectomy or I131 irradiation in the previous 5 years were defined as having iatrogenic hypothyroidism and those who had either obtained exemption from treatment co-payment or had been discharged from hospital with a chronic comorbidity (diabetes and connective tissue diseases) were identified as having one of these conditions. Results The overall crude prevalence was 31.1/1000 (2.3/1000 for iatrogenic hypothyroidism) and the overall crude incidence was 7/1000. The average daily dose of thyroxine (122 µg) roughly corresponded to 1.7 µg/kg. There was a strong association between hypothyroidism and diabetes (type 1, type 2 or gestational) and with autoimmune diseases, with the odds ratio ranging from 1.43 (1.02–1.99) for psoriatic arthritis to 4.99 (3.06–8.15) for lupus erythematosus. Conclusions As compared with previous estimates, the prevalence of hypothyroidism rose by about 35%, driven mainly by non-iatrogenic forms. The increase may be due to either population aging or improved diagnostic capability or both. The frequent co-occurrence of hypothyroidism with other multiple chronic conditions characterizes it more as a comorbidity rather than an isolated chronic disease.

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Osella, G., P. D'Amelio, M. Ventura, V. Paganin, M. Cravero, P. Bagnasacco, S. Parello, A. Angeli y G. Isaia. "A prospective observational study on a population admitted to a hospital for hip fractures in the Piedmont region, Italy (FEPIS): Preliminary data on about 250 cases". Bone 44 (junio de 2009): S403. http://dx.doi.org/10.1016/j.bone.2009.03.307.

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Migliore, Enrica, Amelia Brunani, Giovannino Ciccone, Eva Pagano, Simone Arolfo, Tiziana Rosso, Marianna Pellegrini et al. "Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study". Nutrients 13, n.º 9 (9 de septiembre de 2021): 3150. http://dx.doi.org/10.3390/nu13093150.

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Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18–60 years, BMI ≥ 40 kg/m2) admitted during 2002–2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27–0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68–0.88 and HR = 0.78; 0.63–0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.

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Magnani, Corrado, Silvia Viscomi, Paola Dalmasso, Cristiana Ivaldi, Dario Mirabelli y Benedetto Terracini. "Survival after Pleural Malignant Mesothelioma a Population-based Study in Italy". Tumori Journal 88, n.º 4 (julio de 2002): 266–69. http://dx.doi.org/10.1177/030089160208800403.

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Aims and Background The study analyzed survival after malignant mesothelioma in the population-based Registry of Malignant Mesothelioma of Piedmont (NW Italy, 4.5 million total population). It focused on possible differences related to period of diagnosis a proxy of changes in diagnostic or therapeutic procedures. Methods Cases were actively searched in pathology units and files of hospital admissions and discharges. In 1990-1998, 693 incident cases were diagnosed in residents in the region: 590 of them had a histologic diagnosis of pleural mesothelioma in life and were included in the study. Vital status was ascertained at the municipality of residence as of January 1, 2000. Results Fifty-eight cases were alive (9.8%) and 20 were lost (3.6%) at the end of the follow-up. Median survival was 0.71 years (95% Cl, 0.64-0.78). Cumulative survival was 35.9% at 1 year (95% Cl, 32.0-39.8) and 14.2% at 2 years (95% Cl, 11.2-17.1). Survival was associated to age (longer survival for younger subjects at diagnosis; P <0.0001) and to histology (longer survival for epithelial mesothelioma, shorter for fibrous and intermediate for mixed or unspecified types; P <0.0001). There was no difference in survival for period of diagnosis. The results were confirmed in multivariate analyses. Analyses according to type of hospital (with vs without thoracic surgery) did not show any statistically significant difference. Discussion The study on survival after malignant mesothelioma is the second largest of the three population-based studies in the world, which showed results similar to ours. Survival measured in published clinical series ranged between 18.4% and 57.6% at 1 year for pleural and 24.1% and 33.8% for peritoneal mesothelioma. The most striking effect of the present study was the absence of improvement in survival with period of diagnosis. Either there was no change in treatment efficacy or the effect was limited to small subgroups and could not be noticed when the analysis included larger categories.

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Gnavi, Roberto, Roberta Picariello, Paolo Emilio Alboini, Paola Cavalla, Maria Federica Grasso, Paola Richiardi, Antonio Bertolotto et al. "Validation of an Algorithm to Detect Multiple Sclerosis Cases in Administrative Health Databases in Piedmont (Italy): An Application to the Estimate of Prevalence by Age and Urbanization Level". Neuroepidemiology 55, n.º 2 (2021): 119–25. http://dx.doi.org/10.1159/000513763.

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Introduction: Italy is considered a high-risk country for multiple sclerosis (MS). Exploiting electronic health archives (EHAs) is highly useful to continuously monitoring the prevalence of the disease, as well as the care delivered to patients and its outcomes. The aim of this study was to validate an EHA-based algorithm to identify MS patients, suitable for epidemiological purposes, and to estimate MS prevalence in Piedmont (North Italy). Methods: MS cases were identified, in the period between January 1, 2012 and December 31, 2017, linking data from 4 different sources: hospital discharges, drug prescriptions, exemptions from co-payment to health care, and long-term care facilities. Sensitivity of the algorithm was tested through record linkage with a cohort of 656 neurologist-confirmed MS cases; specificity was tested with a cohort of 2,966,293 residents presumably not affected by MS. Undercount was estimated by a capture-recapture method. We calculated crude, and age- and gender-specific prevalence. We also calculated age-adjusted prevalence by level of urbanization of the municipality of residence. Results: On December 31, 2017, the algorithm identified 8,850 MS cases. Sensitivity was 95.9%, specificity was 99.97%, and the estimated completeness of ascertainment was 91.9%. The overall prevalence, adjusted for undercount, was 152 per 100,000 among men and 286 among women; it increased with increasing age and reached its peak value in the 45- to 54-year class, followed by a progressive reduction. The age-adjusted prevalence of residents in cities was 15% higher than in those living in the countryside. Discussion/Conclusion: We validated an algorithm based on EHAs to identify cases of MS for epidemiological use. The prevalence of MS, adjusted for undercount, was among the highest in Italy. We also found that the prevalence was higher in highly urbanized areas.

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Massucco, Paolo, Andrea Fontana, Michela Mineccia, Serena Perotti, Giovannino Ciccone, Claudia Galassi, Maria Carmela Giuffrida et al. "Prospective, randomised, multicentre, open-label trial, designed to evaluate the best timing of closure of the temporary ileostomy (early versus late) in patients who underwent rectal cancer resection and with indication for adjuvant chemotherapy: the STOMAD (STOMa closure before or after ADjuvant therapy) randomised controlled trial". BMJ Open 11, n.º 2 (febrero de 2021): e044692. http://dx.doi.org/10.1136/bmjopen-2020-044692.

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IntroductionTemporary ileostomy is a valuable aid in reducing the severity of complications related to rectal cancer surgery. However, it is still unclear what is the best timing of its closure in relation to the feasibility of an adjuvant treatment, especially considering patient-reported outcomes and health system costs. The aim of the study is to compare the results of an early versus late closure strategy in patients with indication to adjuvant chemotherapy after resection for rectal cancer.Methods and analysisThis is a prospective multicentre randomised trial, sponsored by Rete Oncologica Piemonte e Valle d’Aosta (Oncology Network of Piedmont and Aosta Valley-Italy). Patients undergone to rectal cancer surgery with temporary ileostomy, aged >18 years, without evidence of anastomotic leak and with indication to adjuvant chemotherapy will be enrolled in 28 Network centres. An early closure strategy (between 30 and 40 days from rectal surgery) will be compared with a late one (after the end of adjuvant therapy). Primary endpoint will be the compliance to adjuvant chemotherapy with and without ileostomy. Complications associated with stoma closure as well as quality of life, costs and oncological outcomes will be assessed as secondary endpoints.Ethics and disseminationThe trial will engage the Network professional teams in a common effort to improve the treatment of rectal cancer by ensuring the best results in relation to the most correct use of resources. It will take into consideration both the patients’ point of view (patient-reported outcome) and the health system perspective (costs analysis). The study has been approved by the Ethical Review Board of Città della Salute e della Scienza Hospital in Turin (Italy). The results of the study will be disseminated by the Network website, medical conferences and peer-reviewed scientific journals.Trial registration numberNCT04372992.

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Giotta, Nicola, Ercole Biamino y Mario Eandi. "Pharmacoeconomic analysis of long term use of darbepoetin-α in treating chronic nephropathy-induced anemia in dialysed patients". Farmeconomia. Health economics and therapeutic pathways 8, n.º 2 (15 de junio de 2007): 61–69. http://dx.doi.org/10.7175/fe.v8i2.242.

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The main aim of this retrospective study was to perform a pharmacoeconomic analysis of long term use of darbepoetin-α (DARB) after switch from erythropoietin-ß (EPO-ß) in treating chronic nephropathy-induced anemia in dialysed patients. Secondary objective was the assessment of the actual EPO-ß-to-DARB dose conversion factor. We extracted data of 78 patients who have been treated with EPO-ß for at least 6 months and then switched to DARB from the database of the dialysis center of the Asti (Piedmont, Italy) hospital. From these, we selected 47 patients (23 males and 24 females) who completed a 120-weeks follow-up treatment with DARB. All patients were treated with a dose adjustment schedule to keep haemoglobin levels in the range 11-12g/dl. Pre-switch EPO-ß administration was thrice a week, while DARB was administered once a week, both via intravenous. Initial DARB dose has been calculated on the basis of the theoretical 200:1 conversion factor. Actual cumulative EPO and DARB consumption was recorded for all patients. Drug costs were valued according to purchasing prices for the Italian National Health System (October 2006). In the 24 pre-switch weeks the average cost (±SD) per patient for EPO-ß was € 2,309.86 (±1,434.78). In the 120 weeks of follow-up the average cost (±SD) per patient for DARB/24 weeks ranged from a minimum of € 1,487.09 (±1,125.51) to a maximum of € 2,125.73 (±1,546.85). The switch of 47 patients to DARB produced an overall net saving for the dialysis centre estimated in 119,540.72 Euro/120 weeks, under the hypothesis that EPO-ß semester costs remain constant: the conversion from EPO-ß to DARB has the potential to maintain long term good haemoglobin control and induces significant savings for the National Health System. However the dosage should be adjusted on an individual basis in order to avoid excessive fluctuation of Hb concentrations. The actual conversion factor resulted on average higher than theoretical factor settling to 240-280:1.

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Saponara, Maristella, Laura Pala, Fabio Conforti, Marco Rubatto, Ivana De Risi, Francesco Spagnolo, Michele Guida, Paolo Bossi, Pietro Quaglino y Paola Queirolo. "Patients with locally advanced and metastatic cutaneous squamous cell carcinoma treated with immunotherapy in the era of COVID-19: stop or go? Data from five Italian referral cancer centers". Therapeutic Advances in Medical Oncology 12 (enero de 2020): 175883592097700. http://dx.doi.org/10.1177/1758835920977002.

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Since the end of 2019, global healthcare systems have been dealing with the COVID-19 pandemic. In oncology, the biggest questions concern interaction of COVID-19 with pre-existing cancer disease and with systemic anticancer treatments. With regards to immunotherapy, there is uncertainty about its effect in the context of COVID-19 in terms of probability and course of viral infection. Herein, we retrospectively report data of patients with advanced cutaneous squamous cell carcinoma (cSCC) treated with immunotherapy at five Italian referral cancer centers during the pandemic. cSCC is a disease poorly represented in the literature, typically affecting fragile, elderly patients, with multiple comorbidities and often immunosuppressed. Overall, 54 patients were identified, most of them coming from Lombardy and Piedmont, the two regions hit hardest by COVID in Italy. In most cases, our choice was to continue treatment, reserving temporary interruptions only to patients considered particularly at risk for age and comorbidity. A total of 9% of patients developed new-onset symptoms or had chest radiological assessment potentially related to COVID-19. Nasopharyngeal swabs were collected in all suspicious cases and two hospitalized patients were found to be positive. In conclusion, the outbreak of COVID-19 is a major worldwide health concern. Our data indicate that COVID-19 mortality in patients with cancer may be principally driven by advancing age, the presence of other comorbidities, and other cancer-related conditions (i.e. hospitalization). Our data further suggests the safety of continued use of PD-1 blockade during the COVID-19 pandemic (obviously implementing all the safety measures in the hospital environment) also considering the possible negative effects of a prolonged suspension on the course of the tumor evolution. We think it is useful to collect and report case studies coming from reference centers, because they can represent helpful examples for the scientific community of clinical management of patients affected by cancer in this difficult period and guide further research.

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Cappa, Alberto Pier Mario, Giancarlo Bertiond, Alessandro Colombo, Fabrizio Faggiano, Margherita Gussio, Franco Merletti, Benedetto Terracini, Paolo Toniolo y Paolo Boffetta. "Incidence of Breast Cancer in Piedmont: 1979–1981". Tumori Journal 73, n.º 3 (junio de 1987): 219–27. http://dx.doi.org/10.1177/030089168707300303.

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A population-based survey of histologically diagnosed breast cancer was carried out among residents in Piedmont. A total of 5267 incident cases occurring in 1979–1981 was collected, corresponding to an age-standardized (on the world population) incidence rate of 49.5/100,000 per year. Rates (standardized on the population of Piedmont in 1981) were highest in the city of Torino (112.4/100,000 per year) and lowest in the province of Cuneo (67.5), whereas in the other provinces they ranged between 85.3 and 90.0. Estimation of rates in the 54 Local Health Authorities of Piedmont detected up to 2-fold differences between adjacent areas. A correlation was found between rates and size of the population of town of residence. Comparison with age-specific incidence rates from the Cancer Registry of the nearby province of Varese suggested a loss of nonhistologically confirmed cases selectively in older age groups. The distribution of cases diagnosed in 1979 by histologic type is presented. The proportion of diagnoses reported in terms which were consistent with the 1978 WHO Histological Typing of Breast Tumours was 61.3%. It was highest among cases identified in Pathology Services located in University Hospitals and/or diagnosing more than 50 breast cancers per year.

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Sattler, Elisabeth L. P., Sandra B. Dunbar, Arshed A. Quyyumi, Jonathan R. Murrow, Richard D. Lewis, Henry N. Young y Whitni McConnell. "2265 Effect of dietary approaches to stop hypertension (DASH) diet on hemodynamic markers in advanced heart failure patients". Journal of Clinical and Translational Science 2, S1 (junio de 2018): 42. http://dx.doi.org/10.1017/cts.2018.166.

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OBJECTIVES/SPECIFIC AIMS: The central aim of the study is to examine the effect of a Dietary Approaches to Stop Hypertension (DASH) diet on hemodynamic, cardiometabolic, and inflammatory markers in advanced heart failure patients with implanted hemodynamic monitoring devices. METHODS/STUDY POPULATION: This pilot study will employ a clinical feeding trial using a 1-group pre-post test design with an anticipated sample size of n=36 (n=20 plus 44% expected attrition). Heart failure patients 18+ years of age with English language literacy, classified as NYHA functional stage III, regardless of ventricular ejection fraction, who have undergone CardioMEMS™ hemodynamic monitoring device (St. Jude Medical, Atlanta, GA, USA) implantation and have received optimized heart failure therapy for 3+ months will be recruited at Piedmont Athens Regional Hospital in Athens, GA. The study is divided in (a) a calibration (self-selected diet) and (b) a DASH feeding intervention phase (each 21 days in length). The DASH meals will strictly follow meal planning guidelines published by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and be prepared under the supervision of a registered dietitian at the University Health Center in Athens, GA. The DASH diet is a heart-healthy eating pattern that is focused on adequate consumption of fruits, vegetables, whole grains, low-fat dairy, fish, poultry, beans, nuts, and vegetables oils while emphasizing limited intake of foods containing saturated fat, such as fatty red meats, full-fat dairy products, and tropical oils, such as coconut, palm kernel, and palm oils, as well as sugar-sweetened beverages and sweets. Participants will visit the University of Georgia Clinical and Translational Research Unit on 3 occasions at baseline, upon completion of the calibration phase, and following completion of the intervention phase for repeated collection of anthropometric (height, weight, waist and hip circumference, percent body fatness), cardiometabolic (blood pressure, blood glucose, HbA1C, lipid panel, basic metabolic panel, BNP, NT-proBNP, troponin 1, MR-proADM, sST2), functional status (6-min walk test), inflammatory (IL-1a, IL-1b, IL-6, TNF-a), and self-reported measures (demographic and economic characteristics, health, chronic diseases, perceived stress, heart failure-related quality of life, social support, sleep quality, food insecurity, tobacco smoking status, healthcare utilization, medication adherence). Hemodynamic marker (pulmonary artery pressure, heart rate) and pharmacotherapy information (medication count, type, strength, and dosing) will be obtained from through retrospective assessment of EHR data. Descriptive statistics [percentage, mean (SD), median (IQR), mode, range] will be used to describe sample characteristics at each of the study visits, as well as characteristics of participants’ self-selected diets during the calibration phase. To measure changes in hemodynamic, cardiometabolic, and inflammatory markers pre-post DASH diet intervention, we will use paired Student t-tests (normal distribution) or Wilcoxon rank-sum tests (non-normal distribution), as appropriate. Data collection will be carried out between February and November 2018. RESULTS/ANTICIPATED RESULTS: The study builds upon previous studies showing improvement of ventricular function, arterial stiffness, oxidative stress, and blood pressure after short-term consumption of a sodium-restricted DASH diet in heart failure patients with preserved ejection fraction, and will provide new information on the cumulative effect of short-term adherence with a DASH diet on indicators of heart failure complications, including hemodynamic, cardiometabolic, and inflammatory markers. In addition, it will give better insight on heart failure patients’ habitual dietary intake in the context of other sociodemographic, economic, health, and social factors. DISCUSSION/SIGNIFICANCE OF IMPACT: Findings from the proposed study will provide key knowledge of dietary influences on ventricular function in order to define evidence-based diet therapy needed for the early prevention of HF complications in advanced heart failure patients.

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Peters, Marion G., H. W. Hann, Paul Martin, E. Jenny Heathcote, P. Buggisch, R. Rubin, M. Bourliere et al. "Adefovir dipivoxil alone or in combination with lamivudine in patients with lamivudine-resistant chronic hepatitis B 1 1The Adefovir Dipivoxil International 461 Study Group includes the following: N. Afdhal (Beth Israel Deaconess Medical Center, Boston, MA); P. Angus (Austin and Repatriation Medical Centre, Melbourne, Australia); Y. Benhamou (Hopital La Pitie Salpetriere, Paris, France); M. Bourliere (Hopital Saint Joseph, Marseille, France); P. Buggisch (Universitaetsklinikum Eppendorf, Department of Medicine, Hamburg, Germany); P. Couzigou (Hopital Haut Leveque, Pessac, France); P. Ducrotte and G. Riachi (Hopital Charles Nicolle, Rouen, France); E. Jenny Heathcote (Toronto Western Hospital, Toronto, Ontario, Canada); H. W. Hann (Jefferson Medical College, Philadelphia, PA); I. Jacobson (New York Presbyterian Hospital, New York, NY); K. Kowdley (University of Washington Hepatology Center, Seattle, WA); P. Marcellin (Hopital Beaujon, Clichy, France); P. Martin (Cedars-Sinai Medical Center, Los Angeles, CA); J. M. Metreau (Centre Hospitalier Universitaire Henri Mondor, Creteil, France); M. G. Peters (University of California, San Francisco, San Francisco, CA); R. Rubin (Piedmont Hospital, Atlanta, GA); S. Sacks (Viridae Clinical Sciences, Inc., Vancouver, Canada); H. Thomas (St. Mary’s Hospital, London, England); C. Trepo (Hopital Hôtel Dieu, Lyon, France); D. Vetter (Hopital Civil, Strasbourg, France); C. L. Brosgart, R. Ebrahimi, J. Fry, C. Gibbs, K. Kleber, J. Rooney, M. Sullivan, P. Vig, C. Westland, M. Wulfsohn, and S. Xiong (Gilead Sciences, Inc., Foster City, CA); D. F. Gray (GlaxoSmithKline, Greenford, Middlesex, England); R. Schilling and V. Ferry (Parexel International, Waltham, MA); and D. Hunt (Covance Laboratories, Princeton, NJ)." Gastroenterology 126, n.º 1 (enero de 2004): 91–101. http://dx.doi.org/10.1053/j.gastro.2003.10.051.

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Mira, A., G. Radeschi, G. Berta y F. Rubulotta. "In-hospital cardiac arrest in piedmont (ITALY): epidemiology and outcomes". Intensive Care Medicine Experimental 3, S1 (1 de octubre de 2015). http://dx.doi.org/10.1186/2197-425x-3-s1-a197.

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Maina, G., G. Rosso, C. Carezana, E. Mehanović, F. Risso, V. Villari, L. Gariglio y M. Cardano. "Factors associated with involuntary admissions: a register-based cross-sectional multicenter study". Annals of General Psychiatry 20, n.º 1 (7 de enero de 2021). http://dx.doi.org/10.1186/s12991-020-00323-1.

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Abstract Background Despite the EU recommendations on mental health, involuntary admission has been under researched in Italy for a long time and the overall picture of involuntary admission still appears fragmentary. The aims of this study are to evaluate involuntary admission rates in the Piedmont Region (Italy) and to investigate clinical and service-related variables associated with involuntary admission. Methods This is a cross-sectional retrospective multicenter study involving all psychiatric inpatients units of the general hospitals of Piedmont Region. Data on hospitalizations during 2016 were collected by consulting hospital discharge registers. The analyses were performed on two samples: 6018 patients (data analysis was run on first hospitalization during the study period for those with multiple admissions) and 7881 inpatient episodes. The association between involuntary admission and socio-demographic and clinical characteristics was examined through t-test for continuous variables, and Pearson’s Chi-square test for categorical variables. Multilevel modeling was applied in logistic regression models with two levels: for the first model center and participants and for the second model center and inpatient episodes. Results Of 6018 inpatients, 10.1% were admitted involuntarily at first hospitalization, while the overall compulsory treatment rate was slightly lower (9.1%) in the inpatient episodes sample (n = 7881). The involuntary admission rates ranged from 0.8 to 21% among study centers. Involuntary admissions were primarily associated with younger age, diagnosis of schizophrenia or substance use disorders, longer duration of hospital stay, mechanical restraint episodes, and fewer subsequent hospitalizations during the study period. Conclusions The rate of involuntary admission in the Piedmont Region was lower than the mean rate across countries worldwide. There were noteworthy differences in rates of involuntary admission among psychiatric units, although no relationship was found with characteristics of the psychiatric wards or of the areas where hospitals are located.

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Sakano, Ryoichi y Julian Benjamin. "Estimating Cost Savings of Coordinating Regional Non-Emergency Human Transport Services". Journal of the Transportation Research Forum, 13 de octubre de 2010. http://dx.doi.org/10.5399/osu/jtrf.46.3.656.

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Local public transportation agencies provide a nonemergency human transport service to nearby hospitals and doctors' offices. Some users require specialized medical services at a hospital located out of the normal service area. In the Piedmont/Triad region of North Carolina, the Piedmont Authority for Regional Transportation (PART) began PART Connections in April 2004, to provide two daily transportation services between the Piedmont/Triad area and the UNC/Duke medical areas. Using current operating cost data of participating transportation systems, round-trip costs to the UNC/Duke medical areas from each county and to the nearest PART Connections stop are estimated. Given the actual number of passengers served by PART Connections during the first nine-month period of the service, the net saving in the operating cost by participating PART Connections is estimated for each system. Then, the total service hours saved by using PART Connections are estimated for each system, and are used to estimate the number of additional passengers served within the system. It is estimated that PART Connections could provide a net saving of $38,000 on operation expenses annually to the participating four county transportation systems. More importantly, PART Connections would enable the four county systems to provide more than 10,000 additional passenger trips within each county annually, by using the saved resources. In addition, 12 local community transportation providers in 15 western counties of the Piedmont/Triad region, which currently do not participate in PART Connections, are estimated to save a modest $9,600 in total annually, by using PART Connections.

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Ottino, MC, A. D'Ambrosio, A. Argentero, PA Argentero, C. Mamo y CM Zotti. "Needlestick prevention devices: data from a hospital surveillance in Piedmont, Italy". European Journal of Public Health 28, suppl_4 (1 de noviembre de 2018). http://dx.doi.org/10.1093/eurpub/cky214.262.

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Scacchi, A., A. D’Ambrosio, E. Rainero, C. Vicentini, M. F. Furmenti y C. Zotti. "The Bundle approach to reduce SSI rate of colon surgery, Piedmont (Italy): experience of 2012-2017". European Journal of Public Health 29, Supplement_4 (1 de noviembre de 2019). http://dx.doi.org/10.1093/eurpub/ckz185.621.

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Abstract Background According to ECDC, Surgical Site Infections (SSI) are the second most frequent type of Healthcare Associated Infections (HAI) in Europe and in USA, and 9.5% of colon surgical procedures develop SSI. SSIs are associated with prolonged hospital stay, higher costs burden and higher attributable morbidity and mortality. Interventional programs can reduce the risk of SSI. Care bundles are a complex of EBM-based interventions on a specific population and setting, in order to improve clinical outcomes. A bundle is successful only if all its items are properly applied, through the ‘all-or-none’ method. Application of a bundle does not exclude other good clinical practices. Methods Data from 37 hospitals participating in the Regional SSI surveillance of Piedmont (Italy) were collected from 2012 to 2017. In hospitals applying the bundle, 4 bundle items had to be used in all the procedures: Temperature control, preoperative shower, trichotomy, antimicrobial prophylaxis. 6909 patients undergoing colon surgery were followed for 30 post-operative days to detect SSI events (According to ECDC 2016 Protocol). For some procedures, compliance to Bundle item application was ≤ 75%. Results 6909 procedures were assessed: 3631 with no bundle application and 3278 with bundle application; in particular 974 were compliant to all bundle items (100%), while 2304 were compliant to 3 items or less (≤ 75%). We report a SSI risk of 11.20% for surgical procedures performed without bundle application; this risk decreases to 5.63% (OR: 0.49, 95% CI: 0,36-0,67; p < 0.001) when compliance to bundle is 100%. When compliance to bundle is ≤ 75% instead of 100%, SSI risk raises to 8.47% (OR: 1.49, 95% CI: 1.07-2.04; p = 0.002). Conclusions Care bundle, if properly applied, is associated to statistically significant reduction of SSI rate (51%) for colon surgical procedures. Bundle programs should be encouraged and improved in hospitals to reduce healthcare costs and burden of HAIs. Key messages The use of the 4-item Surgical Care Bundle is associated to statistically significant reduction (51%) of SSI rate for colon surgical procedures. Surgical Care Bundle programs should be recommended and improved in every hospital to reduce healthcare costs and burden of HAIs.

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Roveta, A., S. Penpa, R. Di Matteo, C. Bianciardi, M. Bertolotti, M. Betti, T. Bolgeo, F. Viazzi, M. Dacquino y A. Maconi. "THE “UNIT DISEASE”: AN ORGANIZATIONAL MODEL TO PROMOTE AND ENHANCE THE RESEARCH ACTIVITY AT THE PUBLIC HOSPITAL AND THE LOCAL HEALTH AUTHORITY IN ALESSANDRIA". Working Paper of Public Health 9, n.º 1 (2 de agosto de 2021). http://dx.doi.org/10.4081/wpph.2021.9335.

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Objective: to promote and enhance the research activity at the Public Hospital and the Local Health Authority in Alessandria, the translation of results into clinical practice, excellence and constant growth in the medical, health and administrative area, through the creation of research-oriented project groups.Methodology: the system development methodology refers to the Lean Thinking, and in particular to the X-Matrix, a framework in management studies to support the strategy definition and management process.Results: 14 project groups named “disease unit” were created, with own referents and components, planned and timed actions related to specific thematic areas. Members cooperated to increase scientific productivity, to promote the activation of clinical studies, the participation in funding national and European calls, the integration into international and European research networks and collaboration with universities, hospitals and IRCCS.Conclusions: the institution and coordination of the unit disease increased scientific production, supporting the collaboration and integration between the Public Hospital and the Local Health Authority with the University of Eastern Piedmont on the themes of research, innovation, experimentation and training, in relation to the way towards the IRCCS recognition.

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Esdale, Taylor, Grace Davis, Brooke Harvey, Heather Lachiewicz, Jennifer Brecher, Stacia Mcgriff, Whitney Bailey, Deborah Camp y Heidi Woessner. "Abstract NS5: Implementing NICE (Neurological Intensive Care Evaluation) in the CVICU to Identify Neurological Dysfunction More Rapidly in Post-Operative Cardiac Surgery Patients". Stroke 48, suppl_1 (febrero de 2017). http://dx.doi.org/10.1161/str.48.suppl_1.ns5.

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Background: Piedmont Atlanta Hospital identified cardiothoracic surgical (CTS) outcome metrics that were not meeting benchmarks established by the Society for Thoracic Surgeons (STS). Post-operative permanent stroke occurred in 1.303% (8 out of 616 cases) of coronary artery bypass-only patients at Piedmont Atlanta Hospital (PAH) during Fiscal Year 2015. The STS benchmark for all hospitals is 1.3%. Initially, the goal was to reduce the number of post-operative strokes to the standard of care but while reviewing this data, it was noted that there was significant delay in discovering the occurrence of stroke in this patient population. Traditional neurological assessments and stroke scales are difficult to apply to post-operative open heart patients due to intubation, variation in anesthesia recovery times, and the effects of pain management medications. To improve patient outcomes, PAH researched alternatives to standard post-operative neurological assessments to rapidly identify strokes and potential interventional candidates, ultimately reducing the frequency of disabling stroke. Method: A CTS Stroke Pathway was created that included the Neurologic Intensive Care Evaluation (NICE), a novel assessment tool performed by the critical care nurse. NICE was chosen because of the ease of use on post-anesthesia patients. Neurological state was assessed based on the ability to complete one-step commands up to six hours post-op. Results: Prior to NICE being implemented, stroke symptoms were discovered on average 40 hours from last known time well (LKTW). After NICE being implemented, Code Strokes (notification of neurological dysfunction) were initiated on average four hours from patients LKTW. In the first month of utilizing the NICE tool, one of three post-operative stroke patients was able to be transferred to a comprehensive stroke center for a mechanical thrombectomy. Conclusion: Implementing NICE as the standard neurological assessment for immediate post-operative cardiac surgery patients significantly reduced the time to identify neurological changes indicating a stroke. This may lead to more rapid treatment or intervention, reducing the post-operative rate of permanent stroke.

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Garlasco, J., M. C. Ottino, E. Rainero, A. Argentero y C. M. Zotti. "Impact of safety-engineered devices (SEDs) on the prevention of percutaneous injuries". European Journal of Public Health 29, Supplement_4 (1 de noviembre de 2019). http://dx.doi.org/10.1093/eurpub/ckz185.406.

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Abstract Background Needlestick injuries represent a major occupational hazard for healthcare workers as they lead to exposure to biological fluids, with higher risk of bloodborne pathogen infections. In order to minimise this risk, safety-engineered devices (SEDs) have been developed and introduced into the daily hospital practice. An annual survey, conducted by the Department of Public Health Sciences of the University of Turin since 1999, has been evaluating the number of percutaneous accidents in the hospitals of Piedmont (Italy), assessing also the impact of the introduction of SEDs on the injury incidence rate. The aim of this study is therefore to evaluate the efficacy of SEDs in preventing needlestick injuries. Methods Data about percutaneous injuries and needle consumption were obtained from 42 hospitals of Piedmont for the years 2014-2017, concerning all the types of needles and sharps most commonly used in the departments. After considering the overall trend of percutaneous events, standardised rates for 100000 needles were computed for both SEDs and conventional devices. The same analysis was performed considering all sharps except standard needles, which are mainly used for procedures not involving contact with patients (e.g. drug dilution). Results The comparison between the incidence rates with SEDs and conventional devices showed a slightly protective effect of SEDs in 2014, 2016 and 2017, with an incidence rate ratio ranging from 0.78 to 0.97. However, by removing the confounding effect of standard needles, the analysis yielded strong statistical evidence of the protective effect of SEDs for all years (RR = 0.28-0.63). Moreover, the total number of percutaneous events shows a trend of general decrease. Conclusions Safety devices have proved to be significantly effective in the prevention of needlestick injuries, and their introduction into the daily practice is one of the factors who could contribute to a reduction of percutaneous events. Key messages Safety-engineered devices are a very important tool in the prevention of injuries in healthcare workers, and their introduction into hospital practice has reduced the number of percutaneous injuries. Safety-engineered devices are significantly protective against percutaneous injuries compared to conventional ones, especially for procedures involving contact with patients (therefore at high risk).

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Rowen, Neil P., Daniel Kim, Hannah P. Rayala, Andrew H. Reiter y Wayne D. Rosamond. "Abstract MP49: Application Of A Novel Assessment Of County-level Cardiovascular Health Profile And Its Association With County-level Disease Rates". Circulation 143, Suppl_1 (25 de mayo de 2021). http://dx.doi.org/10.1161/circ.143.suppl_1.mp49.

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Background: The AHA’s definition of cardiovascular health (CVH) is based on seven metrics known as Life’s Simple 7 (LS7): smoking, diet, obesity, physical inactivity, high blood cholesterol, high blood pressure, and diabetes. Although used to evaluate CVH at the national and individual level, its use as a local county-level measure of CVH has not yet been studied. Our objective was to create a modification of LS7 using publicly available data to estimate county-level CVH and to determine its association with CVH outcomes in all 100 counties of North Carolina (NC). Methods and Results: Using data on all the LS7 metrics collected by the CDC, USDA, BRFSS, and Community Health Assessments, we created a Modified LS7 scoring system, calculated scores for all 100 counties in NC, and created a regression model that predicts county-level hospital discharge rates for diseases and disorders of the circulatory system (Figure 1). Modified LS7 scores ranged from 60.8 to 80.6 (median = 73.1, SD = 3.9). Hospital discharge rates per 100,000 population ranged from 753.4 to 2223.4 (median = 1345.6, SD = 328.7). We found a negative correlation (R-squared = 0.610) between Modified LS7 scores and county-level hospital discharge rates. Counties in the mountain and piedmont regions had significantly higher mean Modified LS7 scores (74.3, 95% CI: 73.5-75.2; 73.9, 95% CI: 72.8-75.0) and lower mean discharge rates (1167.1, 95% CI: 1074.7-1259.5; 1273.9, 95% CI: 1181.4-1366.2) than counties in the coastal plains region (70.7, 95% CI: 69.4-72.0; 1612.3, 95% CI: 1518.5-1706.1). Studentized residuals and leverage points were used to identify five low performing counties and two high performing counties of interest for further analyses. Conclusions: The coastal region of NC was found to have significantly higher CVH risk and poorer CVH outcomes compared to the piedmont and mountain regions. The Modified LS7 model provides a novel approach to examine county-level variation in CVH that had previously only been reported at the national, state or individual level.

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Lenzi, Jacopo, Stefano Rousset, Maria Pia Fantini y Maria Michela Gianino. "Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy". International Journal of Health Policy and Management, 1 de septiembre de 2021. http://dx.doi.org/10.34172/ijhpm.2021.103.

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Background: To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy. Methods: Interrupted time-series analysis (ITSA) comparing hospitalization rate and timing of hip-fracture surgeries between pre- and post-quarantine period. The same data observed in Piedmont the year before were included as a control time series with no "intervention" (quarantine) in the middle of the observation period. Results: We found that 70.3% and 69.4% of hip-fracture patients received surgery within 2 days of hospital admission in the 16 weeks before and after the national quarantine, respectively. One-day surgery went from 46.0% to 46.5%, and same-day surgery from 13.3% to 12.4%. Unchanged trends were confirmed by ITSA after controlling for the 32-week time-series observed the year before. In the second week of March 2020, there was a borderline significant decrease in weekly hospital admissions for hip fractures as compared with that of the same week of March 2019 (–1.95 per 100 000, 95% CI = –4.10 to 0.21, P value = .075), followed by a weekly significant increase in the hospitalization rate (+0.14 per 100 000, 95% CI = 0.01 to 0.27, P value = .039), although the difference-in-differences of slopes failed to achieve statistical significance (0.19 per 100 000, 95% CI = –0.03 to 0.41, P value = .090). Conclusion: Our study shows that the timing of hip-fracture surgery was unchanged during the lockdown period. This suggests that the healthcare systems can be resilient and able to guarantee a high-quality and safe healthcare to hip-fracture patients, even in the most challenging working conditions.

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Garlasco, J., C. Vicentini, I. N. Emelurumonye, F. Quattrocolo, G. D'Alessandro y C. M. Zotti. "Hand hygiene: are WHO Framework scores consistent with hand rub consumption data? A regional study". European Journal of Public Health 30, Supplement_5 (1 de septiembre de 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.695.

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Abstract Background Hand hygiene represents one of the most effective measures to prevent infection transmission in healthcare facilities and may reduce healthcare-associated infections by up to 15-30%. In Piedmont (a region in North-West Italy), hand hygiene compliance is routinely monitored through the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and each hospital is also required to provide data about alcohol-based hand rub (ABHR) consumption as part of the regional performance indicator surveillance system. The aim of this study is to assess whether these two systems yield consistent results, i.e. whether numerical data matches the self-reported status of hand hygiene compliance. Methods For the years 2015-2018, data on ABHR consumption (in millilitres per patient-day, ml/PD) were collected annually at a facility level (40 hospitals) and then aggregated according to the corresponding local health unit/hospital unit, whereas the HHSAF scores were collected at a health/hospital unit level (18 units). The analysis was performed through logistic regression, by taking the WHO HHSAF score (continuous variable) as predictor and ABHR consumption as response variable, dichotomously considered as “low” or “high” (respectively below or above the 20 ml/PD threshold commonly accepted for good practice in hand hygiene). Results This study found that a high level of ABHR consumption is more likely to be observed in hospitals/health units with higher HHSAF scores, with a 1.14-fold increase in the odds for every 10-point increase in the HHSAF score. Despite the limited number of observations due to data aggregation, the result reached borderline statistical significance (p = 0.05). Conclusions The ABHR consumption surveillance provides feedback heading in the same direction as the results of the HHSAF, therefore the two surveillance systems are consistent. These findings provide further support for the validity of the HHSAF score as a reasonable predictor of hand hygiene compliance. Key messages The WHO Hand Hygiene Self-Assessment Framework score is a reliable predictor of hand hygiene compliance, as a high hand rub consumption is more likely to occur in hospitals with higher HHSAF score. Surveillance through the WHO HHSAF should be encouraged, along with alcohol-based hand rub (ABHR) measurement, and these results should be used to guide action plans to promote hand hygiene.

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Marengo, N., J. Garlasco, V. Bordino, C. Vicentini, C. Mamo, L. Maganuco, T. Viora y C. M. Zotti. "Effectiveness of Oncology Network model in pancreas cancer surgery in Piedmont, IT: a survival study". European Journal of Public Health 30, Supplement_5 (1 de septiembre de 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.536.

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Abstract Background The Oncology Network of Piedmont and Aosta Valley (North-West Italy) was started in 2000 and fully established in 2010 as a regional organisational model offering multidisciplinary care by experienced reference centres for cancer diagnosis and surgical treatment. In particular, the San Giovanni Bosco Hospital in Turin is the regional reference centre for pancreatic cancer since 2015 (50-70 oncologic surgery operations performed annually). The aim of study is to assess the effectiveness of this model for pancreatic cancer surgery by comparing survival outcomes before and after the adoption of the Oncology Network model. Methods The study included 178 patients, aged 37-84, who underwent duodenocephalo- or total pancreatectomy for ductal cancer in the years 2007-2019. Clinical data were retrieved from surgical records, whereas the vital status was ascertained through an application connected to the Regional Registry Office. The Kaplan-Meier method was used to estimate survival and the log-rank test was then used to compare survival rates between the two groups (before vs. after 2015). Cox's regression was employed to assess the difference between the groups, also adjusting for age, sex and ASA score. Results The median survival for included patients was 19 months. No significant differences were found between patients of the two groups (before vs. after 2015), neither considering all patients (p = 0.4) nor for any single ASA or age category (p-values ranging from 0.1 to 0.6). The multivariate Cox model accounting for ASA, age and sex confirmed absence of significant survival differences between the two groups. Conclusions Despite increased case complexity, due to the extension of surgery indication to more critical patients, the Oncology Network model allowed achieving an overall survival in pancreatic cancer surgery that is consistent with international literature and not inferior to survival outcomes previously reached in patients more strictly selected. Key messages This study found survival after pancreatic cancer surgery was similar before and after the center entered an Oncological Network, which led to include patients with an increased severity in case-mix. Promoting the implementation of Oncology Networks should be a public health priority as it allows to improve health outcomes and quality of care.

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Dalmasso, M., U. Falcone, F. Gallo, C. Blengio, A. Di Pasquale, N. Allocco, G. Costa y M. T. Puglisi. "Get to know to prevent: the Local Health Authority of Cuneo takes care of visual disability". European Journal of Public Health 30, Supplement_5 (1 de septiembre de 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.426.

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Abstract Visual impairment has an important economic weight on our society; in addition to this considerable cost, loss of vision imposes physical, financial and quality of life limitations. Preventing visual impairment is not only a social duty but also an economically convenient activity for the national health system. On the basis of this concept, a visual impairment disability campaign was carried out in the ASL CN1 (Southern Piedmont Region) taking into account the guidelines recommended by the WHO (1968 screening guidelines but still applicable) in the most disadvantaged territories of the cross-border and rural area, where people have more difficulties to reach territorial services or hospital. Patients who tested positive for the screening were taken over by the local network for a second-level visit and subsequent follow-up based on the pathology found. In this frame, visual screening represents a promising health policy as it can identify visual disability at an early stage. Through the health information systems (hospital discharge, access to the emergency department and exemptions for pathology), the geographical distribution and demographic characteristics of the subjects with visual disability were described in the ASL CN1 area. The level of detail has reached granularity at the single municipality and single age level. For the year 2018 among 416.000 residents in ASL CN1, about 4.000 visual impaired subjects were identified (3.188 on the basis of the presence of an exemption for glaucoma, 542 from hospital discharge and 535 at the emergency department). Assessing mortality in this subgroup, the mean age at death is slightly higher than that of general population (82,42 vs 81,39 years respectively). This can be suggestive of an efficient handling the local population with visual disability. The developed indicators can be extended to other periods and new areas. Key messages Visual screening represents a promising health policy as it can identify visual disability. Through the health information systems, the geographical distribution and demographic characteristics of the subjects with visual disability were described.

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Grippo, G., T. Bolgeo, G. Carpanese, C. Florio, A. Prosperi, D. Gatti, R. Di Matteo et al. "Methods and tools of the rehabilitation process in a case of acute disseminated encephalomyelitis (ADEM) in the evolutionary age: continuity hospital - territory". Working Paper of Public Health 9, n.º 1 (31 de marzo de 2021). http://dx.doi.org/10.4081/wpph.2021.9251.

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Background: An analysis of the situation of the Piedmont Region and Italy shows a lack of continuity of care due to the difficulties of communication, the fragmentation and incorrect timing of the interventions, the development of ultraspecialized skills and a lack of organizational models. However, program sharing and coordination of interventions are essential for the practical implementation of the rehabilitation, especially in pediatric physiotherapy. Purpose and Objective: Aim of the study is the continuity of care (hospital-territory) for children with acute disseminated encephalomyelitis, in order to achieve a good individual and family compliance in the rehabilitation programme and greater levels of autonomy. This study uses a figure to link the two realities and telerehabilitation. Methods: The project was divided into a first phase, the intensive hospitalization and a second phase, the return to the home withrehabilitation, trainingeducational and organizational interventions. The graduand student has been identified as a point of reference and a “bridge” between the two realities. A web page with “Google Forms” customized for children was created in order to increase compliance and motivation of patients and family. Questionnaires were administered to families, children and healthcare to check the methods and tools used in the study. Results: At the end of the study the rehabilitative intervention was assessed by scales and test scores, and improvements have been achieved. The organizational intervention (web page and hospital and communuty continuity mode), evaluated through questionnaires, has been postively assessed by those who took part in this project. Hospital-Territory continuity is a crucial and important moment for patients: having a physiotherapist who acts as a trait d’union is essential as is the use of telerehabilitation for monitoring and maintaining the autonomy of these children. Conclusions: Continuity of care is still operator-dependent; in rehabilitation this is a crucial and important time, as evidenced by the project. In order to support patients and their families and facilitate positive outcome it would be really important to have a reference organizational model and a referent physiotherapist who represents an interface between the various players in the socio-medical system The problem remains open and each route has its own story.

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d’Errico, Angelo, Jana Zajacova, Anna Cacciatore, Santo Alfonzo, Fabio Beatrice, Fulvio Ricceri y Guido Valente. "Exposure to occupational hazards and risk of sinonasal epithelial cancer: results from an extended Italian case–control study". Occupational and Environmental Medicine, 28 de octubre de 2020, oemed—2020–106738. http://dx.doi.org/10.1136/oemed-2020-106738.

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ObjectivesThere is sufficient evidence for a causal association of sinonasal epithelial cancers (SNEC) only for exposure to wood and leather dusts, nickel compounds and employment in isopropyl alcohol production. The aim of this study was to assess whether other occupational hazards are associated with the risk of SNEC for the main histologic types, namely adenocarcinoma (AD) and squamous cell carcinoma (SCC).MethodsThe study population included 375 incident SNEC cases collected from 1996 to 2014 (79% of all diagnosed SNEC) throughout the Piedmont region by the regional Sinonasal Cancer Registry, and 408 hospital controls. Exposure to 17 occupational agents was assigned through expert assessment based on interviews to the subjects on jobs held throughout their working life. The relationship of SNEC with ever and cumulative exposure to the hazards was assessed through unconditional logistic regression models adjusted for age, sex, area of residence, smoking habit, year of enrolment and coexposures.ResultsAD was associated with both ever and cumulative exposure to wood dust, leather dust and organic solvents, and with cumulative exposure to textiles dusts. SCC risk was significantly increased by ever exposure to nickel, chromium and welding fumes, as well as by cumulative exposure to welding fumes, arsenic and organic solvents. A mixed group of other histological types was associated with both ever and cumulative exposure to wood dust and textile dusts.ConclusionsThe associations of SNEC with wood dust, leather dust and nickel were confirmed, while some new associations were observed for other hazards, which merit further investigation.

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D’Amico Ricci, Giuseppe, Claudia Del Turco, Elena Belcastro, Marco Palisi, Mario R. Romano, Antonio Pinna, Claudio Panico y Carlo La Spina. "Covid-19 and acute conjunctivitis: Controversial data from a tertiary refferral Italian center". European Journal of Ophthalmology, 26 de enero de 2021, 112067212199104. http://dx.doi.org/10.1177/1120672121991049.

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Purpose: Although acute conjunctivitis has been listed from the beginning as a possible sign of COVID-19, the likelihood of this association remains unclear. The aim of this study was to investigate the relationship between COVID-19 and conjunctivitis. Methods: In this retrospective, observational study, we recruited all patients with signs and symptoms of acute conjunctivitis seen at the Eye Emergency Department (ED), Turin Eye Hospital, between 01/01/2020 and 12/05/2020 and cross-checked our data with the Piedmont Region online COVID-19 registry in the same period. Results: Among 10,065 patients seen at our ED during the timespan considered, 88 underwent a nasopharyngeal swab (NS) for SARS-CoV-2 detection within 4 weeks before/after our examination. On average, NS was performed −0.72 ± 1.8 weeks before/after eye examination. Of the 77 patients with a negative NS, 26 (33.8%) had a diagnosis of acute conjunctivitis, whereas the remaining 51 (66.2%) had other eye disorders. Among the 11 patients with COVID-19, 7 (63,6%) had a diagnosis of acute conjunctivitis. We found a non-statistically significant increase in NS positivity rate (21.2%) among cases examined at our ED for acute conjunctivitis, compared to the NS positivity rate (7.3%) in patients examined for all other eye conditions ( p = 0.092). The Odds Ratio of having a positive NS in patients with acute conjunctivitis was 3.43 (95% I.C. = 0.9–12.8, p = 0.06). Considering online-registry data of Turin population during the same time-span, among 2441 positive NS cases only 27 (1.1%) presented with acute conjunctivitis. Conclusion: Our results do not reveal a statistically significant correlation between COVID-19 and acute conjunctivitis. Synopsis The present study analyzes retrospectively data from a tertiary eye referral center to investigate the relationship between COVID-19 infection and conjunctivitis.

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