Adverse event reporting and patient safety at a University Hospital: Mapping, correlating and associating events for a data-based patient risk management.

BACKGROUND: Reporting adverse events (AE) with a bearing on patient safety is fundamentally important to the identification and mitigation of potential clinical risks. OBJECTIVE: The aim of this study was to analyze the AE reporting systems adopted at a university hospital for the purpose of enhancing the learning potential afforded by these systems. RESEARCH DESIGN: Retrospective cohort study METHODS: Data were collected from different information flows (reports of incidents and falls, patients' claims and complaints, and cases of hospital-acquired infection [HAI]) at an university hospital. A composite risk indicator was developed to combine the data from the different flows. Spearman's nonparametric test was applied to investigate the correlation between the AE rates and a Poisson regression analysis to verify the association among characteristics of the wards and AE rates. SUBJECTS: Sixty-four wards at a University Hospital. RESULTS: There was a marked variability among wards AE rates. Correlations emerged between patients' claims with complaints and the number of incidents reported. Falls were positively associated with average length of hospital stay, number of beds, patients' mean age, and type of ward, and they were negatively associated with the average Cost Weight of the Diagnosis-related group (DRG) of patients on a given ward. Claims and complaints were associated directly with the average DRG weight of a ward's patient admissions. CONCLUSIONS: This study attempted to learn something useful from an analysis of the mandatory (but often little used) data flows generated on adverse events occurring at an university hospital with a view to managing the associated clinical risk to patients.

Problematic cell phone use for text messaging and substance abuse in early adolescence (11- to 13-year-olds).

UNLABELLED: The aim of our study was to examine the association between problematic cell phone use (PCPU) for text messaging and substance abuse in young adolescents. This cross-sectional study was conducted on the basis of an ad hoc questionnaire, during the 2014-2015 school year in a province of the Veneto Region (Italy); it involved a sample of 1156 students in grades 6 to 8 (11 to 13 years old). A self-report scale based on the Short Message Service (SMS) Problem Use Diagnostic Questionnaire (SMS-PUDQ) was administered to assess the sample's PCPU. A multivariate logistic regression model was applied to seek associations between PCPU (as the dependent variable) and independent variables. The proportion of students who reported a PCPU increased with age in girls (13.5% in 6th grade, 16.4% in 7th grade, and 19.5% in 8th grade), but not in boys (14.3% in 6th grade, 18.0% in 7th grade, and 14.8% in 8th grade). Logistic regression showed that drunkenness at least once and energy drink consumption raised the odds of PCPU, whereas reading books, higher average school marks, and longer hours of sleep were associated with lower odds of PCPU in early adolescence. CONCLUSION: our findings confirm a widespread PCPU for text messaging among early adolescents. The odds of PCPU is greater in young people at risk of other substance abuse behavior.

A cost-consequence analysis of hepatitis B screening in an immigrant population.

OBJECTIVE: Screening for HBV among groups at risk, such as migrant populations, has proved to be a cost-effective strategy. With a view to advising local policy-makers, the cost-consequences of HBV screening was assessed using a modeling approach. METHODS: This cost-consequence analysis of an HBV screening strategy was conducted in a cohort of adult migrants in the province of Padua, northern Italy. RESULTS: The population targeted for screening consisted of 65 405 migrants, among whom the weighted rate for the prevalence of HBV was 0.04972, with 3251 people infected. Over a period of 5 years, the screening strategy prevented 565 cases/year of chronic hepatitis, 141 of compensated cirrhosis, 9 of decompensated cirrhosis, 14 hepatocellular carcinomas and 12 deaths. The above data revealed that the incremental cost of the screening strategy compared to no screening strategy was € 7 974 959 over the five year period. The cost per life saved amounted to € 676 709. CONCLUSIONS: The present study provides useful information to policy-makers at local and regional levels.

Is moderate alcohol consumption a risk factor for kidney function decline? A systematic review of observational studies.

OBJECTIVE: The aim of this study was to conduct a systematic review of published observational studies on the association between alcohol consumption and renal functional impairment. METHODS: A search of Medline and Scopus (1985 through June 2013) was performed and supplemented with manual searches of bibliographies. Of the 430 studies considered, 15 were judged eligible for this systematic review. The quality of the studies was scored using a checklist of 22 items recommended by the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS: Among 12 studies on the adjusted association between moderate alcohol consumption and renal function decline, most of the studies with higher quality scores found no such association. This systematic review indicates that moderate alcohol consumption has not been demonstrated to be a risk factor for kidney function decline. CONCLUSION: Although alcohol consumption in selected populations was inversely associated with renal impairment, a beneficial role of alcohol consumption on renal function has not been consistently demonstrated.

Strain and health implications of nurses' shift work.

OBJECTIVES: The study investigated whether nurses' different working schedules are associated with different levels of job-related strain, health symptoms and behavior. No reports have been accessible in the relevant literature on the possible association between shift work and job-related strain in nurses. MATERIALS AND METHODS: This was a cross-sectional study conducted at a large university hospital in North-East Italy, involving 806 nurses working in selected departments. A multilevel logistic regression was applied to assess the association between work shift conditions and selected outcomes. RESULTS: Night shifts were associated not only with higher odds of having a high Job Demand, but also with lower odds of having a high Decision Authority and consequently with a stronger likelihood of having higher levels of Job Strain (high Job Demand score ≥ 38 and Low Decision Authority). The night shift was associated with various symptoms, particularly exhaustion (p = 0.039) and gastric pain (p = 0.020). Nurses' working schedules did not affect their job satisfaction scores. CONCLUSIONS: It has been confirmed that night shifts are a risk factor for nurses' health perception and working night shifts carries a considerable degree of strain. This is a condition that hospital nursing managements need to consider carefully to avoid burnout in nursing personnel and prevent an excessive turnover in this profession, which is a recurring problem for health care organizations.

Energy drink consumption in children and early adolescents.

UNLABELLED: The aim of this study was to investigate the prevalence of energy drink consumption in children and very young adolescents and to study the sociodemographic and environmental-behavioral factors associated with regular, at least once a week, energy drink consumption in early adolescence. This survey was conducted during the 2011-2012 school year in the Province of Rovigo, in the Veneto Region (northeastern Italy), and involved a sample of 916 students. The usage of energy drinks increased significantly with age, from 17.8 % among sixth graders to 56.2 % among eighth graders. Among the male student population, 16.5 % of those in the eighth grade and 6.21 % of those in the sixth grade, respectively, drank them at least once a week. The independent variables conferring a higher likelihood of being at least once-a-week energy drink consumers were smoking and alcohol consumption. Awareness of the damage caused by energy drinks emerged as a protective factor that reduced the likelihood of young students consuming such drinks. CONCLUSIONS: This study showed that energy drink consumption is rising steadily in children and early adolescents. Energy drink consumption was found associated with the abuse of other substances, such as tobacco and alcohol.

Smoking in early and mid-adolescence.

OBJECTIVE: Smoking among young people is declining in many European countries, although in some (particularly Central and Eastern Europe), the rates among young females are increasing. We compared the risk factors and variables for smoking in early- versus mid-adolescence with a view to helping policy makers identify age-specific prevention strategies. METHODS: An anonymous questionnaire on smoking habits was administered to 1383 underage students in the Veneto Region (northeast Italy) in 2010, consisting of multiple-choice questions using words, numbers, and graphical illustrations designed to make it appeal to the adolescent age group. RESULTS: Among 611 sixth-grade students, 93.5% of the boys and 95.3% of the girls had never smoked, although this was true of 53.2% of the boys and only 38.8% of the girls among 772 ninth-grade students. The first cigarette was smoked in different social settings and places, depending on the adolescents' age group. Age also influenced how much adolescents approved of smoking and their perception of how much their parents approved of them smoking. Adherence to the rules of their group of friends was the only variable found associated with smoking in both the age groups considered. CONCLUSION: We found experimental or habitual cigarette smoking rare among sixth graders, but much more common among ninth graders. Focused preventive measures are therefore needed in the intervening years. The transition from middle school to higher education coincides with a sharp drop in the perceived regulation of smoking at school, emphasizing the need for action to establish high schools as smoke-free environments.

An update review on risk factors and scales for prediction of deep sternal wound infections.

Surgical site infections are the most common nosocomial infections in surgical patients. The preventable and the unmodifiable risk factors for deep sternal wound infections (DSWI) have been amply assessed in the literature. The aim of this review was to describe the results of the numerous published studies to describe all the DSWI risk factors and the scales devised to predict SWI, with a view to providing an update on this issue. A comprehensive search of the Medline and Embase databases was performed (considering studies from January 1995 to April 2011); and a manual search was also conducted using references cited in original publications and relevant review articles. There are several risk factors associated with DSWI, which could be classified in four categories as demographic (e.g. sex and age), behavioural (e.g. smoking and obesity), baseline clinical conditions (e.g. diabetes, hypertension and COPD) and surgical operative risk factors (e.g. duration of operation and emergency operation). Six scales for predicting the risk of DSWI are described in the literature: they vary not only in accuracy but also in ease of application and they are applied at different times (some only preoperatively and others also postoperatively). This study provides a broad update on our knowledge of the risk factors for DSWI and the scales for prediction with a view to improving the management of infections at cardiosurgery units.

Underage drinking on saturday nights, sociodemographic and environmental risk factors: a cross-sectional study.

BACKGROUND: Excessive alcohol consumption in underage people is a rising phenomenon. A major proportion of the disease burden and deaths of young people in developed nations is attributable to alcohol abuse. The aim of this study was to investigate social, demographic and environmental factors that may raise the risk of Saturday night drinking and binge drinking among Italian school students. METHODS: The study was conducted on a sample of 845 Italian underage school students, by means of an anonymous, self-test questionnaire. Multivariate logistic regression was applied to identify independent risk factors for alcohol drinking and binge drinking. Ordered logistic regression was used to identify independent risk factors for harmful drinking patterns. RESULTS: The independent variables that confer a higher risk of drinking in underage students are older age classes, male sex, returning home after midnight, belonging to a group with little respect for the rules, or to a group where young people are not seen as leaders. The higher the perception of alcohol consumption by the group, the higher the risk. Spending time in bars or discos coincides with a two-fold or four-fold increase, respectively, in the risk of alcohol consumption. CONCLUSION: Our findings show that certain environmental and social risk factors are associated with underage drinking. The most important role for preventing young people's exposure to these factors lies with the family, because only parents can exert the necessary control and provide a barrier against potentially harmful situations.