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10. Health Technology Assessment of the Negative Pressure Wound Therapy for the treatment of acute and chronic wounds: efficacy, safety, cost effectiveness, organizational and ethical impact

Author

Rossi, P. G., Camilloni, L., Todini, A. R., Fortino, A., Di Bernardo, L., Frigerio, L., Furnari, G., Borgia, P., and Guasticchi, G.

Subjects
Acute wound, lcsh:Public aspects of medicine, lcsh:R, Systematic review, DOAJ:Public Health, lcsh:Medicine, Chronic Wound, Negative pressure therapy, lcsh:RA1-1270, Health technology assessment, DOAJ:Health Sciences, health care economics and organizations
Abstract

Background: the aim of the study was to assess the safety, efficacy and cost-effectiveness of negative Pressure wound therapy (nPT) for people with chronic and acute wounds.Methods: the scope and the final draft of the report have been submitted to the stakeholders (producers, payers and patients). safety issues were addressed through a systematic review of the meta-literature. efficacy was addressed through a systematic review and meta-analysis of randomized controlled trials (rcTs) comparing nPT and other standard therapies in patients with chronic or acute lesions. cost-consequence was analyzed through a systematic review of the existing studies.Results: we retrieved 19 studies, 13 of which were included in the meta-analysis. Many studies had biases that may have resulted in a better performance for nPT. nPT showed: a slightly shorter healing time (-10.4 days, p=0.001), with no heterogeneity, apart from one small study with very positive results, and 40% more patients healed (p=0.002, no heterogeneity).We identified 15 original research papers on nPT costs and cost per outcome. The costs-per-patient- treated varied from +29% to -60%, with several studies reporting savings for nPT.Conclusions: despite serious methodological flaws, the body of evidence available was sufficient to prove some clinical benefit of nPT in severe chronic and acute wound treatment. There is a need for independent and contextualized cost analyses....

Published
2012

12. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions

Author

Rosano, A., Lauria, L., Viola, G., Burgio, A., Belvis, A. G., Walter Ricciardi, Guasticchi, G., and Zee, J.

Subjects
primary care, avoidable hospitalisation, lcsh:Public aspects of medicine, lcsh:R, DOAJ:Public Health, lcsh:Medicine, lcsh:RA1-1270, ACSC, DOAJ:Health Sciences, ambulatory care sensitive conditions
Abstract

Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs), and their relationship with primary care supply.Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender) and regional risk factors (propensity to hospitalisation and prevalence of specific conditions).Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates(SHR) for ACS chronic conditions (r=-0.50; p=0.02) and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Evenadjusting for potential confounders, differences in hospital admissions for ACSCs among Italian regions were found. Such differences can be appropriately used to assess the effectiveness and/or appropriateness of the primary care provided within different regions.

Published
2011

14. An emergency clinical pathway for stroke patients - results of a cluster randomised trial (Isrctn41456865)

Author

DE LUCA, A, Toni, Danilo, Lauria, L, Sacchetti, Maria Luisa, Giorgirossi, P, Ferri, M, Puca, Emanuele, Prencipe, Massimiliano, Guasticchi, G, and IMPLICA STUDY GROUP IP

Subjects
Male, medicine.medical_specialty, Emergency Medical Services, medicine.medical_treatment, law.invention, Clinical pathway, Randomized controlled trial, law, medicine, Emergency medical services, Cluster Analysis, Humans, Cluster randomised controlled trial, Stroke, Aged, Aged, 80 and over, Intention-to-treat analysis, business.industry, lcsh:Public aspects of medicine, Health Policy, lcsh:RA1-1270, Thrombolysis, Middle Aged, medicine.disease, Italy, Relative risk, Emergency medicine, Critical Pathways, Female, business, Emergency Service, Hospital, Research Article
Abstract

Background Emergency Clinical Pathways (ECP) for stroke have never been tested in randomized controlled trials (RCTs). Objective To evaluate the effectiveness of an ECP for stroke patients in Latium (Italy) emergency system. Methods cluster-RCT designed to compare stroke patient referrals by Emergency Medical Service (EMS) and Emergency Room (ER) health professionals trained in the ECP, with those of non-trained EMS and ER controls. Primary outcome measure was the proportion of eligible (aged ≤ 80 and symptom onset ≤ 6 hours) stroke patients referred to a stroke unit (SU). Intention to treat (ITT) and per-protocol (PP) analyses were performed, and risk ratios (RR) adjusted by age, gender and area, were calculated. Results 2656 patients in the intervention arm and 2239 in the control arm required assistance; 78.3% of the former and 80.6% of the latter were admitted to hospitals, and respectively 74.8% and 78.3% were confirmed strokes. Of the eligible confirmed strokes, 106/434 (24.4%) in the intervention arm and 43/328 (13.1%) in the control arm were referred to the SU in the ITT analysis (RR = 2.01; 95% CI: 0.79–4.00), and respectively 105/243 (43.2%) and 43/311 (13.8%) in the PP analysis (RR = 3.21; 95%CI: 1.62–4.98). Of patients suitable for i.v. thrombolysis, 15/175 (8.6%) in the intervention arm and 2/115 (1.7%) in the control arm received thrombolysis (p = 0.02) in the ITT analysis, and respectively 15/99 (15.1%) and 2/107 (1.9%)(p = 0.001) in the PP analysis. Conclusion Our data suggest potenti efficiency and feasibility of an ECP. The integration of EMS and ERs with SU networks for organised acute stroke care is feasible and may ameliorate the quality of care for stroke patients. Trial registration Current Controlled Trials (ISRCTN41456865).

Published
2009

16. [Organizational appropriateness evaluation of hospital discharges related to DRGs at high risk of inappropriateness in a pediatric observation ward from 2000 to 2004]

Author

Celestini, E, Filocamo, A, Prota, F, Di Roma, S, Passafaro, S, Langiano, T, Fara, G M, and Guasticchi, G

Subjects
Male, Adolescent, Rome, Efficiency, Efficiency, Organizational, Health Services Misuse, Severity of Illness Index, Medical Records, Organizational, Hospital, Humans, Preschool, Child, Diagnosis-Related Groups, Retrospective Studies, Pediatric, Child, Preschool, Emergency Service, Hospital, Female, Hospitalization, Hospitals, Pediatric, Infant, Infant, Newborn, Length of Stay, Patient Discharge, Program Evaluation, Emergency Service, Newborn, Hospitals
Abstract

The aim of the study is to measure and to describe organizational appropriateness of a Paediatric Temporary Observation Ward in the Emergency Department. We selected hospital discharges related to 43 DRGs at high risk of inappropriateness (DPCM 29/11/2001); we studied the relationship between appropriateness and patient's or discharge characteristics. We also investigated the inappropriateness to find tools for improving ward's efficiency. Assessment of selected paediatric clinical records was performed using PRUO protocol and showed that 41.5% of hospital discharges are completely appropriated and only 13.8% are completely not appropriated and, consequently, could be provided in a different organizational setting. Inappropriateness in our study is lower than the expected one; this finding shows that the ward under investigation is able to provide health assistance with good level of appropriateness. The used tool to evaluate appropriateness is a modified PRUO version, specific for pediatric hospital stays. Pediatric PRUO protocol is easy to be applied even if reasonable and shared evaluation criteria do not seem able to recognise some peculiar characteristics of Pediatric Temporary Observation Ward in the Emergency Department.

Published
2007

18. [Colorectal cancer screening: survey of endoscopy center's physicians in Lazio region]

Author

Federici A, Valle S, Paolo Giorgi Rossi, Grassi A, Borgia P, and Guasticchi G

Subjects
Adult, Male, Italy, Attitude of Health Personnel, Surveys and Questionnaires, Humans, Mass Screening, Female, Colonoscopy, Middle Aged, Practice Patterns, Physicians', Colorectal Neoplasms, Aged
Abstract

The aim of the present work is to describe the characteristics of digestive endoscopy centers and the physicians that work there, with particular attention to their attitudes and practices in colorectal cancer screening. A questionnaire was sent to all 80 digestive endoscopy centers in the Lazio region, identified by the annual census of Italian Society of Digestive Endoscopy (Società Italiana di Endoscopia Digestiva, SIED). Seventy-one centers (89%), returned the questionnaire. Screening activity on average represents 14% of the centers' colonoscopy workload. Colonoscopy was considered to be a "very effective" screening test by 96% of physicians, the faecal occult blood test "very effective" by 20%, and flexosigmoidoscopy "very effective" by 11%. Ninety-seven percent (97%) of physicians reported recommending any test for screening: 80% colonoscopy, 61% faecal occult blood test, 14% double contrast barium enema and 11% flexosigmoidoscopy. Despite the fact that almost all physicians reported recommending screening, the centres are only marginally involved in screening practice. Endoscopy centers' physicians tend to have an aggressive strategy for colorectal cancer prevention and exclusive trust in colonoscopy; an attitude more consistent with a clinical-diagnostic approach than with real mass screening of a healthy population.

Published
2006

25. [Injuries in immigrants from non-industrialized countries: analysis of emergency admissions in Lazio, Italy, in the year 2000]

Author

Farchi S, Paolo Giorgi Rossi, Chini F, Baglio G, Cacciani L, Lori G, Borgia P, and Guasticchi G

Subjects
Adult, Male, Adolescent, Accidents, Traffic, Emigration and Immigration, Medical Records, Hospitalization, Injury Severity Score, Italy, Accidents, Humans, Female, Emergency Service, Hospital, Developing Countries
Abstract

Aim of the study is to describe the characteristics of road, home and work-related traumas among adult immigrants born in non-industrialised Countries, and to compare the consequent probability of hospitalisation with Italian adults in Lazio Region, year 2000. Source of data is the Emergency-based Surveillance System, which collects all the emergency ward visits in Lazio region. Accident incidence has been estimated using alternatively the residence permits and the roman resident population born in non-industrialised Countries. The 7.7% of all the emergency visits of immigrants are trauma-related. Road traffic accident visits are more appropriate and urgent. Immigrants have a higher risk of hospitalisation both for road and home accidents compared to the Italians (OR = 1.59 and OR = 1.37 respectively). Immigrants use emergency wards for severe and urgent trauma-related accidents, they have higher probability of hospitalisation compared to the Italians. Our analysis highlights the necessity to improve tools to study immigrant health.

Published
2005

28. [Factors related to in-hospital mortality after stroke in Lazio region, Italy]

Author

Agabiti N, De Luca A, Tancioni V, Agabiti B, Cardo S, Picconi O, Giovanni Baglio, Jf, Osborn, and Guasticchi G

Subjects
Adult, Male, Stroke, Adolescent, Italy, Humans, Female, Hospital Mortality, Middle Aged, Aged, Retrospective Studies
Abstract

The use of hospital discharge abstracts in estimating the outcome of hospital care represents an ongoing interest in public health. However standardized methodologies are still not available. We carried out a retrospective study to estimate the association between demographic and clinical characteristics and in-hospital mortality after stroke by using administrative data from the Hospital Information System in Lazio Region. We also assessed the relationship between the presence of neurology services and the outcome. We found 12,781 incident episodes of stroke (main diagnosis ICD-9: 430-431-434-436) (49.3% male, mean age = 74 years) admitted in 126 hospitals in the Lazio region for the period 1999-2000. From the hospital discharge abstracts we collected patient demographic and clinical data. The hospitals were classified in centres with and without neurology services. Admissions to hospitals with neurology services were evaluated as predictors of in-hospital mortality after adjustment for gender, age, residence, education, source of admission, type of stroke, heart disease, kidney disease and history of atrial fibrillation. In-hospital mortality (within 30 day) was 25.1%. Female gender, advanced age, residence in Rome, urgent transport, kidney disease and history of atrial fibrillation were associated with an increased risk. Hemorrhagic stroke (ICD-9 = 430-431) had a worse outcome than ischemic stroke (ICD-9 = 434) and acute undefined cerebrovascular disease (ICD-9 = 436). Patients admitted to hospitals with neurology services showed a significantly decreased risk (OR = 0.88, IC95% = 0.79-0.98), particularly in occlusion of cerebral artery (ICD-9 = 434) and in undefined cerebrovascular disease (ICD-9 = 436). Demographic and clinical variables are associated with the outcome of hospitalised stroke patients. Admissions of acute stroke patients in specialized hospitals seem to play a role in reducing the risk of in-hospital mortality.

Published
2004

30. Istituzione del premio regionale all'eccellenza in sanitá, I edizione 2002

Author

Caracci, G., Fabio, V., Mantuano, C., Gangale, A., Duranti, G., Casertano, L., Gillespie, F., Scanzano, P., and Guasticchi, G.

Subjects
lcsh:Public aspects of medicine, lcsh:R, DOAJ:Public Health, lcsh:Medicine, lcsh:RA1-1270, DOAJ:Health Sciences
Abstract

Obiettivi: istituire un Premio annuale regionale gestito dall’Agenzia di Sanità Pubblica della Regione Lazio che, formalizzando un riconoscimento alle organizzazioni ed ai professionisti, sostenendo attività di MCQ in tutti gli ambiti dell’organizzazione e la diffusione dei risultati, favorisca l’attuazione delle politiche sanitarie regionali.Metodi: in stretta correlazione con il Piano Sanitario Regionale 2002-2004, il Premio, istituito nel maggio 2002, si rivolge a tutte le strutture sanitarie accreditate del Lazio. Si propone quale strumento di promozione e sensibilizzazione alla cultura della qualità dell’assistenza, coinvolgendo i professionisti in iniziative aziendali od interaziendali sistemiche orientate al paziente. Per partecipare al Premio, ogni Azienda presenta un progetto, scelto tra le iniziative di MCQ ultimate, che rappresenti l’eccellenza raggiunta e documentata. L’intento è quello di favorire un approccio positivo al processo valutativo e di dimostrare lo sforzo continuo delle strutture sanitarie regionali, promovendo il cambiamento, l’empowerment, la learning organization, il confronto tra pari, la responsabilizzazione di tutti i livelli organizzativi. Il Premio costituisce un’incentivazione per il raggiungimento di risultati di eccellenza: un percorso educativo di apprendimento organizzativo. Il processo valutativo del Premio si articola in tre fasi: screening iniziale dell’ASP, cross evaluation e visita da parte di un team di esperti dei finalisti. Come premessa, è stata condotta un’analisi della letteratura esistente in materia: lo Sviluppo Integrato della Qualità di J. Øvretveit, basato sulla centralità del paziente nel processo assistenziale, è stato scelto quale modello teorico.Risultati: successo dell’iniziativa in considerazione dell’adesione di 53 Aziende sulle 115 della Regione, e ricezione dei documenti progettuali di 33 Aziende. Hanno fatto parte della commissione per la visita del team di esperti, membri ASP, ASSR e giornalisti.Conclusioni: l’ASP in virtù dei risultati conseguiti in termini di partecipazione, ha constatato la validità del modello e pertanto, oltre alla prevista cerimonia di premiazione (dicembre 2002), ha avviato la seconda Edizione.

Published
2003

31. L' influenza nella regione Lazio dal 1999 al 2003: casi di sindrome influenzale, ricoveri ospedalieri per malattie respiratorie e coperture vaccinali

Author

Pasquarella, A., Perria, C., Mandolini, D., D’Amato, M., Billi, P., Marceca, M., Volpe, E., and Guasticchi, G.

Subjects
lcsh:Public aspects of medicine, lcsh:R, DOAJ:Public Health, lcsh:Medicine, lcsh:RA1-1270, DOAJ:Health Sciences
Abstract

Obiettivi: 1) Descrivere l’andamento dei ricoveri ospedalieri per patologie respiratorie acute e croniche concomitanti alle epidemie stagionali da virus influenzale dal 1999 al 2003, in relazione con la segnalazione dei casi di sindrome influenzale (ILI) da parte dei medici sentinella. 2) Misurare l’eccesso dell’ospedalizzazione influenza-correlata nelle diverse fasce di età rispetto ai periodi non epidemici. 3) Analizzare le modificazioni del ricorso al ricovero ospedaliero in relazione al tasso di copertura della vaccinazione antinfluenzale nella popolazione anziana, su scala regionale e nelle diverse ASL.Metodi: sono stati estratti dal Sistema InformativoOspedaliero i ricoveri per patologie respiratorieinfluenza-correlate (codici ICD9-CM: 480-487; 460-466; 490-496) relativi agli anni 1999-2003.L’incidenza di ILI è stata stimata sulla base dellesegnalazioni dei medici sentinella afferenti allarete FLU-ISS dell’Istituto Superiore di Sanità.Per il calcolo dei tassi di copertura è stato utilizzato l’archivionominativo dei soggetti vaccinati contro l’influenza,attivo nella regione Lazio dal 1999. Nel periodo considerato sono stati messi in relazione i tassi di ospedalizzazione età-specifici, le incidenze di ILI e le coperture vaccinali. L’eccesso di ospedalizzazione è stato misurato confrontando i tassi relativi ai periodi epidemici e non epidemici.Risultati: i tassi di ospedalizzazione per malattie respiratorie sono risultati costantemente superiori nei periodi di maggiore circolazione virale, in particolare negli ultrasessantaquattrenni. Con il progressivo aumento del tasso di copertura vaccinale regionale (da circa il 25% della stagione 1999-2000 a oltre il 60% della stagione 2002-2003) non si è registrata una corrispondente diminuzione dei ricoveri ospedalieri per patologie influenza-correlate.L’analisi per ASL ha evidenziato differenti livelli di correlazione fra i fenomeni considerati.Conclusioni: la presente analisi descrittiva sottolineail sostanziale impatto delle epidemie di sindrome influenzale sul ricorso ai servizi sanitari della regioneLazio. Contestualmente, l’incremento della copertura vaccinale non sembra correlarsi a una riduzionedell’incidenza di ILI e dei tassi di ospedalizzazione durante le stagioni epidemiche considerate.

Published
2003

32. La Valutazione multidimensionale in Sanità Pubblica

Author

Marceca, Maurizio, Mastromattei, A, Pasquarella, A, Casagrande, S, and Guasticchi, G.

Subjects
non autosufficienza, rete dei servizi territoriali, assistenza domiciliare, anziani, valutazione multidimensionale
Published
2003

37. The relationship between avoidable hospitalization and accessibility to primary care: a systematic review

Author

Rosano, A, Abo Loha, C, Falvo, Roberto, Van Der Zee, J, Ricciardi, Gualtiero, Guasticchi, G, De Belvis, Antonio, Ricciardi, Gualtiero (ORCID:0000-0002-5655-688X), De Belvis, Antonio (ORCID:0000-0003-4456-1937), Rosano, A, Abo Loha, C, Falvo, Roberto, Van Der Zee, J, Ricciardi, Gualtiero, Guasticchi, G, De Belvis, Antonio, Ricciardi, Gualtiero (ORCID:0000-0002-5655-688X), and De Belvis, Antonio (ORCID:0000-0003-4456-1937)

Abstract

BACKGROUND: Avoidable hospitalization (AH) has been widely studied as a possible measure of the performance of primary health care (PHC). However, studies examining the relationship between the efficiency and quality of PHC and AH have found mixed results. Our study aims at highlighting those factors related to the relationship between AH and accessibility to PHC in different countries. METHODS: We conducted a systematic search for peer-reviewed studies published between 1990 and October 2010 in English, German, French, Italian or Spanish and indexed primary electronic databases. RESULTS: The final analysis was conducted on the basis of 51 papers. Of them, 72.5% revealed a significant inverse association between the indicator of PHC accessibility and rates of AH. Indicators of PHC calculated at individual level are more likely to reveal contradictory aspects of the relationship between rates of AH and indicators of quality and PHC accessibility. CONCLUSIONS: Most studies confirmed the expected relationship between indicators of PHC accessibility and hospitalization for ambulatory care sensitive conditions (ACSCs), showing lower hospitalization rates for ACSC in areas with greater access to PHC. The findings support the use of ACSC hospitalization as an indicator of primary care quality, with the precaution of applying appropriate adjustment factors.

Published
2012

38. Meta-analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test

Author

Hassan, Cesare, Rossi, Pg, Camilloni, L, Rex, Dk, Jimenez Cendales, B, Ferroni, Eliana, Borgia, P, Zullo, A, Guasticchi, G, Group, H., Hassan, Cesare, Rossi, Pg, Camilloni, L, Rex, Dk, Jimenez Cendales, B, Ferroni, Eliana, Borgia, P, Zullo, A, Guasticchi, G, and Group, H.

Abstract

BACKGROUND: A variety of tests have been proposed for colorectal cancer (CRC), giving rise to uncertainty regarding the optimal approach. The efficacy and effectiveness of different tests are related to both screenee participation and the detection rate. AIM: To perform a meta-analysis on adherence and detection rates of CRC screening tests. METHODS: Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1999-2012. A previous systematic review was used for the period before 1966-1999. RCTs and controlled studies including a direct comparison of the uptake rates among different options for CRC screening were included. Adherence and detection rates for advanced neoplasia and cancer were extracted. Risk for bias was ascertained according to CONSORT guidelines. Forrest plots were produced based on random-effect models. RESULTS: Fourteen studies provided data on 197 910 subjects. Endoscopic strategies were associated with a lower participation (RR: 0.67, 95% CI: 0.56, 0.80) rate, but a higher detection rate of advanced neoplasia (RR: 3.21, 95% CI: 2.38, 4.32) compared with faecal tests. FIT was superior to g-FOBT with regard to both adherence (RR: 1.16, 95% CI 1.03, 1.30) and detection of advanced neoplasia (RR: 2.28, 95% CI 1.68, 3.10) and cancer (RR: 1.96, 95% CI: 1.2, 3.2). CONCLUSION: The superior accuracy of endoscopy compared with faecal tests minimised any impact of the participation rate in determining the detection rate of advanced neoplasia in a screening setting.

Published
2012

40. Suspected transmission of tuberculosis in a maternity ward from a smear-positive nurse: preliminary results of clinical evaluations and testing of neonates potentially exposed, Rome, Italy, 1 January to 28 July 2011

Author

Borgia, P, Cambieri, Andrea, Chini, F, Coltella, L, Delogu, Giovanni, Di Rosa, E, Fadda, Giovanni, Giorgi Rossi, P, Girardi, E, Goletti, D, Guasticchi, G, Morrone, A, Pezzotti, P, Romagnoli, Costantino, Sacerdote, M, Russo, C, Villani, A, Zarelli, L., Delogu, Giovanni (ORCID:0000-0003-0182-8267), Romagnoli, Costantino (ORCID:0000-0003-1176-2943), Borgia, P, Cambieri, Andrea, Chini, F, Coltella, L, Delogu, Giovanni, Di Rosa, E, Fadda, Giovanni, Giorgi Rossi, P, Girardi, E, Goletti, D, Guasticchi, G, Morrone, A, Pezzotti, P, Romagnoli, Costantino, Sacerdote, M, Russo, C, Villani, A, Zarelli, L., Delogu, Giovanni (ORCID:0000-0003-0182-8267), and Romagnoli, Costantino (ORCID:0000-0003-1176-2943)

Abstract

We report preventive measures adopted after tuberculosis(TB) transmission from a nurse to a newborn assessed in late July 2011. All exposed neonates born between January and July 2011 were clinically evaluated and tested by QuantiFERON TB gold in-tube; newborns testing positive were referred for prophylaxis.Of 1,340 newborns, 118 (9%) tested positive and no other active cases of TB were found. Active surveillance for TB will be continued over the next three years for all those exposed.

Published
2011

41. Continuing medical education and evidence-based clinical pathways. Training emergency health workers in Latium, Italy

Author

De Luca, A., Caprara, A., Barbolini, M., Francia, C., Ferri, M., Mamede, S., Borgia, P., Guasticchi, G., De Luca, A., Caprara, A., Barbolini, M., Francia, C., Ferri, M., Mamede, S., Borgia, P., and Guasticchi, G.

Abstract

Background: In recent decades, studies that evaluate training programmes have shown that continuing education for physicians is not very effective in improving performance and behavioural changes. One of our goals was to create a Continuing Medical Education Programme (CMEP) that would result in changing the behaviour of health professionals. In early 2005, a new CMEP was offered to emergency medical services and emergency room professionals to introduce an Emergency Critical Pathway (ECP) for the management of acute stroke patients. This paper illustrates the main characteristics of the educational model and the strategies and activities adopted to realize it. Methods: The training programme was planned and organized applying the concepts and tools of experiential learning, It was organised in three successive phases: 1.) interviews with health professionals to identify their learning ne-eds; 2) training the ECP coordinators/facilitators in a residential setting; and 3) on-site training in small groups of health professionals (6-8), led by a coordinator/facilitator. Results: The CME involved 324 emergency health professionals, Participants positively evaluated both the educational programme and the clinical indications of the protocols. Over six months of the ECP training, health professionals treated 657 stroke patients: 153 (23.3%) were transferred to the stroke unit where 15 (9.8%) were thrombolysed. In the same period of the previous year, the professionals treated 638 patients: 99 (15.5%) were transferred to the stroke unit and no patients were thrombolysed. Conclusion: The application of the new educational methodology has contributed to improved management of stroke patients in Latium.

Published
2008

43. Vascular access

Author

Coentrao, L., primary, Ribeiro, C., additional, Santos-Araujo, C., additional, Neto, R., additional, Pestana, M., additional, Rahman, E., additional, Rahman, H., additional, Ahmed, D., additional, Mousa, D., additional, El Bishlawi, M., additional, Shibahara, H., additional, Shibahara, N., additional, Takahashi, S., additional, Dupuis, E., additional, Duval, X., additional, Dornic, Q., additional, Bonnal, C., additional, Lucet, J.-C., additional, Cerceau, O., additional, Randoux, C., additional, Balde, C., additional, Besson, F., additional, Mentre, F., additional, Vrtovsnik, F., additional, Koutroubas, G., additional, Malindretos, P., additional, Zagotsis, G., additional, Makri, P., additional, Syrganis, C., additional, Mambelli, E., additional, Mancini, E., additional, Elia, C., additional, Guadagno, V., additional, Facchini, M. G., additional, Zucchelli, A., additional, Grazia, M., additional, Patregnani, L., additional, Santoro, A., additional, Stefan, G., additional, Stancu, S., additional, Capusa, C., additional, Ailioaiei, O. R., additional, Mircescu, G., additional, Anwar, S., additional, Little, C., additional, Kingston, R., additional, Diwakar, P., additional, Kaikini, R., additional, Nikolaou, E., additional, Loukas, G., additional, Sabry, A., additional, Alsaran, K., additional, Al Sherbeiny, S., additional, Abdulkader, M., additional, Kwak, I., additional, Song, S., additional, Seong, E., additional, Lee, S., additional, Lee, D., additional, Kim, I., additional, Rhee, H., additional, Silva, F., additional, Queiros, J., additional, Malheiro, J., additional, Cabrita, A., additional, Rocha, A., additional, Bamidis, P., additional, Liaskos, C., additional, Chryssogonidis, I., additional, Frantzidis, C., additional, Papagiannis, A., additional, Vrochides, D., additional, Lasaridis, A., additional, Nikolaidis, P., additional, Kotwal, S., additional, Muir, C., additional, Hawley, C., additional, Snelling, P., additional, Gallagher, M., additional, Jardine, M., additional, Shibata, K., additional, Toya, Y., additional, Umemura, S., additional, Iwamoto, T., additional, Ono, S., additional, Ikeda, E., additional, Kitazawa, A., additional, Kuji, T., additional, Koguchi, N., additional, Satta, H., additional, Nishihara, M., additional, Kawata, S., additional, Kaneda, T., additional, Yamada, Y., additional, Murakami, T., additional, Yanagi, M., additional, Yasuda, G., additional, Mathieu, S., additional, Yves, D., additional, Jean-Michel, T., additional, Nicolas, Q., additional, Jean-Francois, C., additional, Ibrahim, M., additional, Abdel Salam, M., additional, Awadalla, A., additional, Bichari, W., additional, Zaki, S., additional, Roca-Tey, R., additional, Samon, R., additional, Ibrik, O., additional, Roda, A., additional, Gonzalez-Oliva, J. C., additional, Martinez-Cercos, R., additional, Viladoms, J., additional, Lin, C.-C., additional, Yang, W.-C., additional, Kim, Y.-O., additional, Yoon, S.-A., additional, Yun, Y.-S., additional, Song, H.-C., additional, Kim, B.-S., additional, Cheong, M.-A., additional, Ogawa, T., additional, Kiba, T., additional, Okazaki, S., additional, Hatano, M., additional, Iwanaga, M., additional, Noiri, C., additional, Matsuda, A., additional, Hasegawa, H., additional, Mitarai, T., additional, DI Napoli, A., additional, DI Lallo, D., additional, Tazza, L., additional, De Cicco, C., additional, Salvatori, M. F., additional, Chicca, S., additional, Guasticchi, G., additional, Gelev, S., additional, Trajceska, L., additional, Srbinovska, E., additional, Pavleska, S., additional, Oncevski, A., additional, Dejanov, P., additional, Gerasomovska, V., additional, Selim, G., additional, Sikole, A., additional, Wilson, S., additional, Mayne, T., additional, Krishnan, M., additional, Holland, J., additional, Volz, A., additional, Good, L., additional, Nissenson, A., additional, Stavroulopoulos, A., additional, Aresti, V., additional, Maragkakis, G., additional, Kyriakides, S., additional, Rikker, C., additional, Juhasz, E., additional, Tornoci, L., additional, Tovarosi, S., additional, Greguschik, J., additional, Mag, O., additional, Rosivall, L., additional, Golebiowski, T., additional, Watorek, E., additional, Kusztal, M., additional, Letachowicz, K., additional, Letachowicz, W., additional, Madziarska, K., additional, Augustyniak Bartosik, H., additional, Krajewska, M., additional, Weyde, W., additional, Klinger, M., additional, Capitanini, A., additional, Lange, S., additional, Cupisti, A., additional, Schier, T., additional, Gobel, G., additional, Bosmuller, C., additional, Gruber, I., additional, Tiefenthaler, M., additional, Shipley, T., additional, Adam, J., additional, Sweeney, D., additional, Fenwick, S., additional, Mansy, H., additional, Ahmed, S., additional, Moore, I., additional, Vigeral, P., additional, Saksi, S., additional, Flamant, M., additional, Boulanger, H., additional, Park, W.-D., additional, Cheong, M. A., additional, Nikam, M., additional, Tavakoli, A., additional, Chemla, E., additional, Evans, J., additional, Malete, H., additional, Matyas, L., additional, Mogan, I., additional, Lazarides, M., additional, Ebner, A., additional, Shi, Y., additional, Zhang, J., additional, Cheng, J., additional, Frank, L. R., additional, Melanie, H., additional, Dominique, B., additional, Michel, G., additional, Ikeda, K., additional, Yasuda, T., additional, Yotueda, H., additional, Ebah, L., additional, Jayanti, A., additional, Kanigicherla, D., additional, Summers, A., additional, Manley, G., additional, Dutton, G., additional, Chalmers, N., additional, Mitra, S., additional, Checherita, I.-A., additional, Niculae, A., additional, Radulescu, D., additional, David, C., additional, Turcu, F. L., additional, Ciocalteu, A., additional, Persic, V., additional, Buturovic-Ponikvar, J., additional, Ponikvar, R., additional, Touam, M., additional, Menoyo, V., additional, Drueke, T., additional, Rifaat, M., additional, Muresan, C., additional, Abtahi, M., additional, Koochakipour, Z., additional, Joly, D., additional, Baharani, J., additional, Rizvi, S., additional, Ng, K. P., additional, Buzzi, L., additional, Sarcina, C., additional, Alberghini, E., additional, Ferrario, F., additional, Baragetti, I., additional, Santagostino, G., additional, Furiani, S., additional, Corghi, E., additional, Terraneo, V., additional, Rastelli, F., additional, Bacchini, G., additional, Pozzi, C., additional, Adorati Menegato, M., additional, Mortellaro, R., additional, Locicero, A., additional, Romano, A., additional, Manzini, P. P., additional, Steckiph, D., additional, Shintaku, S., additional, Kawanishi, H., additional, Moriishi, M., additional, Bansyodani, M., additional, Nakamura, S., additional, Saito, M., additional, Tsuchiya, S., additional, Barros, F., additional, Vaz, R., additional, Carvalho, B., additional, Martins, P., additional, Likaj, E., additional, Seferi, S., additional, Rroji, M., additional, Idrizi, A., additional, Duraku, A., additional, Barbullushi, M., additional, and Thereska, N., additional

Published
2012
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44. Cardiovascular complications in CKD 5D

Author

Fusaro, M., primary, Fusaro, M., additional, Noale, M., additional, Tripepi, G., additional, D'angelo, A., additional, Miozzo, D., additional, Gallieni, M., additional, Study Group, P.-V., additional, Tsamelesvili, M., additional, Dimitriadis, C., additional, Papagianni, A., additional, Raidis, C., additional, Efstratiadis, G., additional, Memmos, D., additional, Mutluay, R., additional, Konca Degertekin, C., additional, Derici, U., additional, Deger, S. M., additional, Akkiyal, F., additional, Gultekin, S., additional, Gonen, S., additional, Tacoy, G., additional, Arinsoy, T., additional, Sindel, S., additional, Sanchez-Perales, C., additional, Vazquez, E., additional, Merino, E., additional, Perez Del Barrio, P., additional, Borrego, F. J., additional, Borrego, M. J., additional, Liebana, A., additional, Krzanowski, M., additional, Janda, K., additional, Dumnicka, P., additional, Krasniak, A., additional, Sulowicz, W., additional, Kim, Y.-O., additional, Yoon, S.-A., additional, Yun, Y.-S., additional, Song, H.-C., additional, Kim, B.-S., additional, Cheong, M. A., additional, Pasch, A., additional, Farese, S., additional, Floege, J., additional, Jahnen-Dechent, W., additional, Ohtake, T., additional, Furuya, R., additional, Iwagami, M., additional, Tsutsumi, D., additional, Mochida, Y., additional, Ishioka, K., additional, Oka, M., additional, Maesato, K., additional, Moriya, H., additional, Hidaka, S., additional, Kobayashi, S., additional, Guedes, A., additional, Malho Guedes, A., additional, Pinho, A., additional, Fragoso, A., additional, Cruz, A., additional, Mendes, P., additional, Morgado, E., additional, Bexiga, I., additional, Silva, A. P., additional, Neves, P., additional, Oyake, N., additional, Suzuki, K., additional, Itoh, S., additional, Yano, S., additional, Turkmen, K., additional, Kayikcioglu, H., additional, Ozbek, O., additional, Saglam, M., additional, Toker, A., additional, Tonbul, H. Z., additional, Gelev, S., additional, Trajceska, L., additional, Srbinovska, E., additional, Pavleska, S., additional, Amitov, V., additional, Selim, G., additional, Dzekova, P., additional, Sikole, A., additional, Bouarich, H., additional, Lopez, S., additional, Alvarez, C., additional, Arribas, I., additional, DE Sequera, P., additional, Rodriguez, D., additional, Tanaka, S., additional, Kanemitsu, T., additional, Sugahara, M., additional, Kobayashi, M., additional, Uchida, L., additional, Ishimoto, Y., additional, Kotera, N., additional, Tanimoto, S., additional, Tanabe, K., additional, Hara, K., additional, Sugimoto, T., additional, Mise, N., additional, Goldstein, B., additional, Turakhia, M., additional, Arce, C., additional, Winkelmayer, W., additional, Zayed, B. E.-D., additional, Said, K., additional, Nishimura, M., additional, Okamoto, Y., additional, Tokoro, T., additional, Nishida, M., additional, Hashimoto, T., additional, Iwamoto, N., additional, Takahashi, H., additional, Ono, T., additional, Sato, N., additional, Raimann, J., additional, Usvyat, L. A., additional, Sands, J., additional, Levin, N. W., additional, Kotanko, P., additional, Iwasaki, M., additional, Joki, N., additional, Tanaka, Y., additional, Ikeda, N., additional, Hayashi, T., additional, Kubo, S., additional, Imamura, T.-A., additional, Takahashi, Y., additional, Hirahata, K., additional, Imamura, Y., additional, Hase, H., additional, Claes, K., additional, Meijers, B., additional, Bammens, B., additional, Kuypers, D., additional, Naesens, M., additional, Vanrenterghem, Y., additional, Evenepoel, P., additional, Boscutti, G., additional, Calabresi, L., additional, Bosco, M., additional, Simonelli, S., additional, Boer, E., additional, Vitali, C., additional, Martone, M., additional, Mattei, P. L., additional, Franceschini, G., additional, Baligh, E., additional, El-Shafey, E., additional, Ezaat, A., additional, Zawada, A., additional, Rogacev, K., additional, Hummel, B., additional, Grun, O., additional, Friedrich, A., additional, Rotter, B., additional, Winter, P., additional, Geisel, J., additional, Fliser, D., additional, Heine, G. H., additional, Makino, J.-I., additional, Makino, K.-S., additional, Ito, T., additional, Genovesi, S., additional, Santoro, A., additional, Fabbrini, P., additional, Rossi, E., additional, Pogliani, D., additional, Stella, A., additional, Bonforte, G., additional, Remuzzi, G., additional, Bertoli, S., additional, Pozzi, C., additional, Pasquali, S., additional, Cagnoli, L., additional, Conte, F., additional, Buzadzic, I., additional, Tosic, J., additional, Dimkovic, N., additional, Djuric, Z., additional, Popovic, J., additional, Pejin Grubisa, I., additional, Barjaktarevic, N., additional, DI Napoli, A., additional, DI Lallo, D., additional, Salvatori, M. F., additional, Franco, F., additional, Chicca, S., additional, Guasticchi, G., additional, Onofriescu, M., additional, Hogas, S., additional, Luminita, V., additional, Mugurel, A., additional, Gabriel, V., additional, Laura, F., additional, Irina, M., additional, Adrian, C., additional, Bosch, E., additional, Baamonde, E., additional, Culebras, C., additional, Perez, G., additional, El Hayek, B., additional, Ramirez, J. I., additional, Ramirez, A., additional, Garcia, C., additional, Lago, M., additional, Toledo, A., additional, Checa, M. D., additional, Taira, T., additional, Hirano, T., additional, Nohtomi, K., additional, Hyodo, T., additional, Chiba, T., additional, Saito, A., additional, Kim, Y. K., additional, Choi, E. J., additional, Yang, C. W., additional, Kim, Y.-S., additional, Lim, P. S., additional, Ming Ying, W., additional, Ya-Chung, J., additional, Zaripova, I., additional, Kayukov, I., additional, Essaian, A., additional, Nimgirova, A., additional, Young, H., additional, Dungey, M., additional, Watson, E. L., additional, Baines, R., additional, Burton, J. O., additional, Smith, A. C., additional, Yamazaki, K., additional, Bossola, M., additional, Colacicco, L., additional, Scribano, D., additional, Vulpio, C., additional, Tazza, L., additional, Okada, T., additional, Okada, N., additional, Michibata, I., additional, Yura, T., additional, Montero, N., additional, Soler, M., additional, Pascual, M., additional, Barrios, C., additional, Marquez, E., additional, Rodriguez, E., additional, Orfila, M. A., additional, Cao, H., additional, Arcos, E., additional, Comas, J., additional, Pascual, J., additional, Ferrario, M., additional, Garzotto, F., additional, Sironi, T., additional, Monacizzo, S., additional, Basso, F., additional, Cruz, D. N., additional, Moissl, U., additional, Tetta, C., additional, Signorini, M. G., additional, Cerutti, S., additional, Ronco, C., additional, Mostovaya, I., additional, Grooteman, M., additional, Van den Dorpel, M., additional, Penne, L., additional, Van der Weerd, N., additional, Mazairac, A., additional, Den Hoedt, C., additional, Levesque, R., additional, Nube, M., additional, Ter Wee, P., additional, Bots, M., additional, Blankestijn, P., additional, Liu, J., additional, MA, K. L., additional, Zhang, X., additional, Liu, B. C., additional, Vladu, I.-D., additional, Mustafa, R., additional, Cana-Ruiu, D., additional, Vaduva, C., additional, Grauntanu, C., additional, Mota, E., additional, Singh, R., additional, Abbasian, N., additional, Stover, C., additional, Brunskill, N., additional, Burton, J., additional, Herbert, K., additional, Bevington, A., additional, Wu, M., additional, Tang, R.-N., additional, Gao, M., additional, Liu, H., additional, Chen, L., additional, LV, L.-L., additional, Liu, B.-C., additional, Nikodimopoulou, M., additional, Liakos, S., additional, Kapoulas, S., additional, Karvounis, C., additional, Fedak, D., additional, Kuzniewski, M., additional, Paulina, D., additional, Kusnierz-Cabala, B., additional, Kapusta, M., additional, Solnica, B., additional, Junque, A., additional, Vicent, E. S., additional, Moreno, L., additional, Fulquet, M., additional, Duarte, V., additional, Saurina, A., additional, Pou, M., additional, Macias, J., additional, Lavado, M., additional, Ramirez de Arellano, M., additional, Ryuzaki, M., additional, Nakamoto, H., additional, Kinoshita, S., additional, Kobayashi, E., additional, Takimoto, C., additional, Shishido, T., additional, Enia, G., additional, Torino, C., additional, Tripepi, R., additional, Panuccio, V., additional, Postorino, M., additional, Clementi, A., additional, Garozzo, M., additional, Bonanno, G., additional, Boito, R., additional, Natale, G., additional, Cicchetti, T., additional, Chippari, A., additional, Logozzo, D., additional, Alati, G., additional, Cassani, S., additional, Sellaro, A., additional, Zoccali, C., additional, Quiroga, B., additional, Verde, E., additional, Abad, S., additional, Vega, A., additional, Goicoechea, M., additional, Reque, J., additional, Lopez-Gomez, J. M., additional, Luno, J., additional, Cabre Menendez, C., additional, Moles, V., additional, Vives, J. P., additional, Villa, D., additional, Vinas, J., additional, Compte, T., additional, Arruche, M., additional, Diaz, C., additional, Soler, J., additional, Aguilera, J., additional, Martinez Vea, A., additional, De Mauri, A., additional, David, P., additional, Conte, M. M., additional, Chiarinotti, D., additional, Ruva, C. E., additional, De Leo, M., additional, Bargnoux, A.-S., additional, Morena, M., additional, Jaussent, I., additional, Chalabi, L., additional, Bories, P., additional, Dion, J.-J., additional, Henri, P., additional, Delage, M., additional, Dupuy, A.-M., additional, Badiou, S., additional, Canaud, B., additional, Cristol, J.-P., additional, Sironi, E., additional, Pieruzzi, F., additional, Galbiati, E., additional, Vigano, M. R., additional, Anpalakhan, S., additional, Rocha, S., additional, Chitalia, N., additional, Sharma, R., additional, Kaski, J. C., additional, Chambers, J., additional, Goldsmith, D., additional, Banerjee, D., additional, Cernaro, V., additional, Lacquaniti, A., additional, Lupica, R., additional, Lucisano, S., additional, Fazio, M. R., additional, Donato, V., additional, Buemi, M., additional, Segalen, I., additional, Vinsonneau, U., additional, Tanquerel, T., additional, Quiniou, G., additional, Le Meur, Y., additional, Seibert, E., additional, Girndt, M., additional, Zohles, K., additional, Ulrich, C., additional, Kluttig, A., additional, Nuding, S., additional, Swenne, C., additional, Kors, J., additional, Werdan, K., additional, Fiedler, R., additional, Van der Weerd, N. C., additional, Grooteman, M. P., additional, Van den Dorpel, M. A., additional, Nube, M. J., additional, Wetzels, J., additional, Swinkels, D. W., additional, Ter Wee, P. M., additional, Khandekar, A., additional, Khandge, J., additional, Lee, J. E., additional, Moon, S. J., additional, Choi, K. H., additional, Lee, H. Y., additional, Kim, B. S., additional, Tuaillon, E., additional, Rodriguez, A., additional, Chenine, L., additional, Vendrell, J.-P., additional, Sue, Y.-M., additional, Tang, C.-H., additional, Chen, Y.-C., additional, Segura, P., additional, Garcia Cortes, M. J., additional, Gil, J. M., additional, Biechy, M. M., additional, Poulikakos, D., additional, Shah, A., additional, Persson, M., additional, Dattolo, P., additional, Amidone, M., additional, Michelassi, S., additional, Moriconi, L., additional, Betti, G., additional, Conti, P., additional, Rosati, A., additional, Mannarino, A., additional, Panichi, V., additional, Pizzarelli, F., additional, Klejna, K., additional, Naumnik, B., additional, Koc-Zorawska, E., additional, Mysliwiec, M., additional, Dimitrie, S., additional, Simona, H., additional, Mihaela, O., additional, Gabriela, O., additional, Radu, S., additional, Octavian, P., additional, Akdam, H., additional, Akar, H., additional, Yenicerioglu, Y., additional, Kucuk, O., additional, Kurt Omurlu, I., additional, Thambiah, S., additional, Roplekar, R., additional, Manghat, P., additional, Fogelman, I., additional, Fraser, W., additional, Hampson, G., additional, Likaj, E., additional, Caco, G., additional, Seferi, S., additional, Rroji, M., additional, Barbullushi, M., additional, Thereska, N., additional, Serban, A., additional, Carmen, V., additional, Cristian, S., additional, Silvia, L., additional, and Covic, A., additional

Published
2012
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46. Suspected transmission of tuberculosis in a maternity ward from a smear-positive nurse: preliminary results of clinical evaluations and testing of neonates potentially exposed, Rome, Italy, 1 January to 28 July 2011

Author

Borgia, P, primary, Cambieri, A, additional, Chini, F, additional, Coltella, L, additional, Delogu, G, additional, Di Rosa, E, additional, Fadda, G, additional, Giorgi Rossi, P, additional, Girardi, E, additional, Goletti, D, additional, Guasticchi, G, additional, Morrone, A, additional, Pezzotti, P, additional, Romagnoli, C, additional, Sacerdote, M T, additional, Russo, C, additional, Villani, A, additional, and Zarelli, L, additional

Published
2011
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