[Overcrowding in emergency departments: the case of the San Giovanni Battista (Molinette) university hospital in Turin (Italy)]. / Il sovraffollamento dei Dipartimenti di Emergenza: il caso dell'Azienda Ospedaliera Universitaria San Giovanni Battista (Molinette) di Torino.

Overcrowding in Emergency Departments (ED) is a common phenomenon worldwide, especially in metropolitan areas. The main reason for overcrowding is not inappropriate emergency department use by patients but rather a shortage of available hospital beds which results in extended ED stays for patients who need emergency admission. The aims of this study, conducted at the San Giovanni Battista (Molinette) University hospital in Turin (Italy), were a) to verify the existence of overcrowding in the hospital ED and b) to test whether, as stated in the literature, overcrowding is due to restricted access to hospital beds for patients needing emergency admission, and to identify contributing factors. Results show the existence of overcrowding and confirm the hypothesized cause.

[Quality evaluation of informed consent forms: a pilot study]. / La valutazione qualitativa del consenso informato: uno studio pilota.

Informed consent forms must be designed to meet specific requirements but evaluating the structure and content requirements of consent forms from a qualitative point of view is not a simple task. An evaluation tool was therefore developed in the context of a pilot study to evaluate the current quality of informed consent forms at both medical and surgical departments of the San Giovanni Battista Hospital in Turin (Italy). A random sample of 288 medical records of patients hospitalized during 2007-2008 was selected. These were evaluated to determine the presence of a properly executed informed consent form or of a justification for its absence. Each consent form was evaluated based on the presence of a list of requirements. Statistical analysis was conducted by first taking into account all departments and then stratifying by medical and surgical departments. The evaluation tool was found to useful in evaluating, in a standardized and repeatable manner, the adequacy and completeness of informed consent forms in different hospital departments.

[Evaluation of the quality of hospital medical records in a hospital in Turin (Italy)]. / La valutazione qualitativa della cartella clinica: uno studio pilota.

The San Giovanni Battista Hospital in Turin validated a tool for evaluating the quality of hospital patient records. The tool defines the essential contents of patient records, indicators and weights as well as the standard score that must be reached. A pilot study was performed in 2007 to evaluate whether this tool adequately evaluates the quality of hospital patient records in both medical and surgical wards, and whether it can do so in a standardized and repeatable manner. A random sample of 206 medical charts of patients admitted to the San Giovanni Battista Hospital in 2007 was extracted and analysed. The instrument was found to adequately evaluate hospital patient records in a standardisd and repeatable manner.

Metabolic syndrome in older subjects: coincidence or clustering?

The prevalence of the metabolic syndrome (MS) increases with advancing age. However, aging per se is associated with increased prevalence of most of the abnormalities contributing to the MS. Whether MS in older people consistently identifies a true pathophysiological entity or a casual aggregation of aging-associated metabolic abnormalities, remains to be fully elucidated. In the present study, we aimed to evaluate whether in older subjects the aggregation of metabolic components of the MS, as defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), is consistent with a single latent variable. Age, waist circumference, systolic and diastolic blood pressure, metabolic variables were determined in 152 older (>70 years), non-diabetic, healthy men. Cronbach alpha was used to assess the internal consistency of the components contributing to the MS. Structural equation modeling, using the Normed Fit Index (NFI), the Root Mean Square Error of Approximation (RMSEA), the Comparative Fit Index (CFI), and the Tucker-Lewis Index (TLI) was used to assess the fit to a model with a single latent variable. The Cronbach alpha test showed low internal consistency among the metabolic variables (alpha=0.31). The calculated chi(2) values were 28.31 and 32.52 for model entering hypertension as dichotomous variable and for model entering blood pressure values, respectively, both expressing low fit to a model with a single latent variable. In both models, CFI (0.41 and 0.55), NFI (0.59 and 0.55), RMSEA (0.25 and 0.22) and TLI (-0.31 and -0.12) scores showed a low fit of the metabolic alterations to a single latent variable. These findings suggest caution in making diagnosis of MS at older ages, since metabolic and cardiovascular abnormalities being per se extremely common in elderly people, do not appear to cluster together under a single common factor.

The perception of health care risk: patients, health care staff and society.

INTRODUCTION: The Nuovo Zingarelli, dictionary of the Italian language, defines risk as "the possibility of harmful or negative consequences following not always predictable circumstances". A statistical-epidemiological type of definition is far removed from the social and psychological conception that the population attributes to the risk of harm, which is related to interior processes and emotional reactions. Information on risks interacts with knowledge, personal values and beliefs to produce a subjective expression that is perception. MATERIALS AND METHODS: Two years after instituting the Hospital Quality and Risk Management Unit at S. Giovanni Battista Molinette Hospital (Turin, Italy) it became clear that it was necessary to determine the perception of health care risk among nursing staff. Therefore, nursing teams from eight sub-departmental units in six departments were invited to participate in an assessment project. RESULTS: The project was undertaken by four nursing teams composed of four head nurses (project representatives) and 45 professional nurses. The aims of the project were understood by all four groups; three participated with interest, one only in part. Three groups considered that it would be useful to continue the project, while the other group did not discuss this point. CONCLUSIONS: The project on the perception of health care risk by nursing staff revealed that mistaken identification of the patient, errors during the administration of treatment and poor communication among colleagues and with doctors and patients were the risks of error perceived as most important by nurses. Heavy work loads, staff shortages, technical and structural problems, and gaps in professional knowledge were identified as the factors related to the occurrence of adverse events. These data differed from management's perception because no incident report forms had ever been received from these nursing teams.