Reducing waiting times of elective surgical procedures: effectiveness evaluation of a multi-interventions approach.

Background: Increasing waiting times for elective surgery is a major concern for policymakers and healthcare staff in many countries, due to its effect on health, patient satisfaction and the perceived quality of health-care. Many organizational models to reduce surgical waiting times have been studied, but the international literature indicates that multidimensional interventions on different aspects of the surgical pathway can be more effective in reducing waiting times than interventions focused on optimizing a single aspect. Aim: The aim of the study is to evaluate the effectiveness of a multidimensional intervention in reducing waiting times for elective surgery. Study design: We used a pre-post approach to evaluate the effect of a multidimensional project to reduce waiting times and lists. Methods: In a district general hospital (Italy) with three elective surgery operating rooms open 6 hours/day, 5 days/week (surgery specialties: general surgery, orthopaedics, gynaecology and urology), a project for reducing surgery waiting times was implemented in October 2018. The project focused on three aspects: i) separation of the flow of day surgery from that of ordinary surgery; ii) increasing available operating time by reorganizing the staff; iii) allocation of operating sessions flexibly in proportion to the waiting list. Waiting times for surgery in the periods 1/10/2019-31/12/2019 and 1/10/2018-31/12/2018 were compared by t test. Results: Waiting times for non-high-priority cases shortened significantly for all specialities (p<0.01), ex-cept for urology. For general surgery, orthopaedics and gynaecology, mean waiting times for day surgery decreased from 198 to 100 days (-50%) and for ordinary operations from 213 to 134 days (-37%). Waiting times for high-priority cases also shortened. Conclusions: Our multidimensional project based on reorganization of staff and facilities and on improved scheduling proved effective in reducing waiting times for elective surgery.

Prevalence of tuberculosis infection among teen-agers in Tuscany.

INTRODUCTION: In Tuscany, Tuberculosis incidence is more than triplicate from 1982 to the beginning of the third millennium. The impact of this trend on open population is not known, as updated studies on Tuberculosis prevalence are not available. Tuberculin skin test provides the currently most widely used tool for assessing Tuberculosis transmission in a community and the prevalence of infection as well. The objective of this investigation was the evaluation of tuberculin index by means of the Mantoux test in adolescents eighteen-years old. RESULTS: The study was carried out in 21 secondary schools of Siena and its Province; 1,138 students participated to this survey. The overall prevalence of subjects with a skin reaction size > 5 mm was 1.6%; if the standard cut-off of 10 mm was used, the overall prevalence of a positive skin reaction was 0.4%. Risk factors for a doubtful or positive reaction were previous immunization with BCG and migration from high-endemicity countries. DISCUSSION: In Italy, studies on tuberculin index in young adults are scanty and controversial: our results show a very low Tuberculosis prevalence and an epidemiological pattern typical of countries with low Tuberculosis endemicity. CONCLUSIONS: The slightly increase in Tuberculosis incidence has no impact on the prevalence of latent Tuberculosis infection on our geographical area. We conclude that skin-test screening for Tuberculosis should be addressed to high risk population as migrants from Countries reporting high transmission rate, those recently exposed to an infectious case and health-workers.

Antianemic and potential anti-inflammatory activity of desferrioxamine: possible usefulness in rheumatoid arthritis.

In order to study the role of excessive synovial iron sequestration in the production of anemia in rheumatoid arthritis (RA), the antianemic efficacy and anti-inflammatory effect of desferrioxamine administered in a short-term treatment (14 days), were evaluated in 10 patients suffering from classic or definite RA and hyposideremic anemia. Treatment with desferrioxamine showed an elevated urinary iron excretion, a significant increase of serum iron, UIBC and hemoglobin, and a marked progressive decrease of serum ferritin. A moderate improvement of the pain intensity, morning stiffness and Ritchie's index was also observed. The results obtained suggest that excessive reticuloendothelial iron deposits occur in RA and that the iron uptake can be an important factor in the production of anemia. Desferrioxamine seems to be useful in the treatment of patients suffering from RA and anemia, in order to release iron from synovial tissue, reduce the inflammatory process and improve anemia, changing an anemia which is typically resistant to the martial therapy into an iron-sensitive anemia.

Heparin adsorbing capacities at physiological pH of three poly(amido-amine) resins, and of poly(amido-amine)-surface-grafted glass microspheres.

Three poly(amido-amine)s of similar structure in the form of highly hydrophilic crosslinked resins, have been prepared, and tested for their heparin-adsorbing capacity at physiological pH. They showed different capacities, and their capacities were related to their basicities. One of the same polymers was grafted on the surface of glass microspheres. After treatment, it was shown that the microspheres could adsorb significant amounts of heparin. In all cases most of the adsorbed heparin was hardly eluted with saline, plasma, or blood, but could be recovered by eluting with 0.1 M NaOH. The resins were found to have some haemolytic properties, but no haemolysis was observed with the grafted microspheres.