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Rheumatoid arthritis may cause central nervous system complications by means of various mechanisms. We describe the case of a patient with a new diagnosis of rheumatoid arthritis (RA) complicated by normal-pressure hydrocephalus. After treatment with prednisone, the patient improved remarkably as regards mental status, urinary control and gait. We suggest that normal-pressure hydrocephalus may occur as an extra-articular manifestation of RA, caused by a pathogenic inflammatory mechanism. We analyse previous case reports describing a relationship between RA and normal-pressure hydrocephalus, and discuss potential mechanisms underlying this association. [ABSTRACT FROM AUTHOR]

In a context of continuous spread health technologies, in which particular intensive procedures are performed, the use of procedure volume indicators supports the decision making process in monitoring and improving the healthcare quality. The aim of our work focuses on the evaluation of the association between the volume of procedures performed by organizational units inside an Italian University Hospital and the results in terms of mortality and prolonged length of stay (LOS). Volume indicators concerning esophageal resection, pancreatic resection, abdominal aortic aneurysm repair, coronary artery bypass graft and percutaneous transluminal coronary angioplasty were analysed according to the Agency of Health Care Research and Quality's criteria. A retrospective observational study was conducted analysing hospital discharged databases and operating room records for the period 2000-2005. Descriptive and inferential statistical analysis were performed using SPSS software 13.0 version. Regarding prolonged LOS, a statistical significant difference emerged among high and low volume organizational units for pancreatic resections, bypass, and angioplasty with respectively adjusted OR at 2.4 (C.I. 95% 1.04-5.53); 1.67 (C.I. 95% 1.29-2.16) and 3.34 (CI 95% 2.60-4.28). For mortality, a statistical significant difference emerged for abdominal aortic aneurysm repair and bypass with respectively OR at 21.02 (C.I. 95% 2.22-199.64) and 26.55 (C.I. 95% 15.30 - 46.07). The use of procedure volume indicators could help hospital administrators and medical professionals balance competing values such as control of cost and continuous quality improvement.

Our main purpose was to evaluate the organizational appropriateness of admissions made in a university hospital, by comparing two iso-gravity classification systems, APR-DRG and Disease Staging, with the Italian version of AEP (PRUO). Our analysis focused on admissions made in 2001, related to specific Diagnosis Related Groups (DRGs), which, according an Italian Law, would be considered at high risk of inappropriateness, if treated as ordinary admissions. The results obtained by using the 2 classification systems did not show statistically significant differences with respect to the total number of admissions. On the other hand, some DRGs showed statistically significant differences due to different algorithms of attribution of the severity levels used by the two systems. For almost all of the DRGs studied, the AEP-based analysis of a sample of medical records showed an higher number of inappropriate admissions in comparison with the number expected by iso-gravity classification methods. The difference is possibly due to the percentage limits of tolerability fixed by the Law for each DRG. Therefore, the authors suggest an integrated use of the two methods to evaluate organizational appropriateness of hospital admissions.

On the basis of the conception that literature, like science, is an instrument of knowledge, the authors used some texts to underline the importance of dialogue between different disciplines. In particular, the discourse on the ethical significance of biomedicine fluctuates from the more established and deep ethics to the humanistic and anthropological ethics present in literature and vice versa. The aim of the work is to demonstrate that literature is an essential study for medical students. Thus, literature does offer the possibility to deepen the awareness of issues and experiences one cannot or will never have. An understanding of narrative can help clinicians and medical students in developing a dynamic relation with everyday complex stories of medical situations. The authors do believe that practising physicians should be encouraged to read critically; every medical and health care students need to be educated how to read in order to learn how to behave in everyday dialogue with patients and their relatives.

The modern hospital was born in France, at the end of the XVIII century. The article analyzes the debate promoted by the Académie des Sciences to ascertain what was necessary to rebuild the the hotel Dieu, destroyed by fire. This was the occasion to definitively condemn the medical conception of hospital.