Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations.

OBJECTIVE: To validate a set of indicators for quality of diabetes care through their relationship with measurable clinical outcomes. DESIGN: A retrospective cohort study was carried out from 2010 to 2015. SETTING: Population-based study. Data were retrieved from healthcare utilization databases of three Italian regions (Lombardy, Emilia Romagna and Lazio) on the whole covering 20 million citizens. PARTICIPANTS: The 77 285 individuals who were newly taken in care for diabetes during 2010 entered into the cohort. INTERVENTIONS: Exposure to selected clinical recommendations (i.e. periodic controls for glycated hemoglobin, lipid profile, urine albumin excretion, serum creatinine and dilated eye exams) was recorded. MAIN OUTCOMES MEASURES: A composite outcome was employed taking into account hospitalizations for brief-term diabetes complications, uncontrolled diabetes, long-term vascular outcomes and no traumatic lower limb amputation. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. RESULTS: Among the newly taken in care patients with diabetes, those who adhered to almost none (0 or 1), just some (2 or 3) or almost all (4 or 5) recommendations during the first year after diagnosis were 44%, 36% and 20%, respectively. Compared patients who adhered to almost none recommendation, significant risk reductions of 16% (95% CI, 6-24%) and 20% (7-28%) were observed for those who adhered to just some and almost all recommendations, respectively. CONCLUSIONS: Tight control of patients with diabetes through regular clinical examinations must to be considered the cornerstone of national guidance, national audits and quality improvement incentives schemes.

Epidemiological and Molecular Investigation of the Heater-Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy.

BACKGROUND: From 2013 onwards, a large outbreak of Mycobacterium chimaera (MC) invasive infection, which was correlated with the use of contaminated heater-cooler units (HCUs) during open chest surgery, was reported from all over the world. Here, we report the results of the epidemiological and molecular investigations conducted in Italy after the alarm raised about this epidemic event. METHODS: MC strains isolated from patients or from HCU devices were characterized by genomic sequencing and molecular epidemiological analysis. RESULTS: Through retrospective epidemiological analysis conducted between January 2010 and December 2022, 40 possible cases of patients infected with MC were identified. Thirty-six strains isolated from these patients were analysed by whole genome sequencing (WGS) and were found to belong to the genotypes 1.1 or 1.8, which are the genotypes correlated with the outbreak. Most of the cases presented with prosthetic valve endocarditis, vascular graft infection or disseminated infection. Among the cases found, there were 21 deaths. The same analysis was carried out on HCU devices. A total of 251 HCUs were found to be contaminated by MC; genotypes 1.1 or 1.8 were identified in 28 of those HCUs. CONCLUSIONS: To ensure patients' safety and adequate follow-up, clinicians and general practitioners were made aware of the results and public health measures, and recommendations were issued to prevent further cases in the healthcare settings. The Italian Society of Cardiac Surgery performed a national survey to assess the incidence of HCU-related MC prosthetic infections in cardiac surgery. No cases were reported after HCU replacement or structural modification and disinfection and possibly safe allocation outside surgical rooms.

Chest wall infiltration is a critical prognostic factor in breast implant-associated anaplastic large-cell lymphoma affected patients.

BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma is a rare disease with a favourable prognosis if adequately treated. Same staged patients have usually a similar prognosis and outcomes, but in our experience, IIA-staged patients have a wider prognosis with outcomes that vary from complete disease response to death. This study aimed to understand and identify all the factors that could influence the prognosis of this group of patients and verify if their prognosis matches the stage they belong to. MATERIAL AND METHODS: Patients in stage IIA have been divided into two subgroups: IIAb with lymphoma extension towards the glandular tissue and IIAcw with tumour extension towards the chest-wall. The overall survival (OS) and event-free survival (EFS) of 64 BIA-ALCL cases were evaluated for each staged group. RESULTS: Significant differences of OS and EFS between IIAb and IIAcw patients (log-rank p = 0.046 and log-rank p = 0.018, respectively) were observed and poor prognosis joined IIAcw- and IV-staged patients. CONCLUSION: Chest-wall infiltration is a critical prognostic factor in BIA-ALCL patients as it influences the possibility of performing a surgical radical tumour extirpation. Our results could represent valid assistance for the physicians in choosing the most appropriate BIA-ALCL prognostic category and treatment and could promote further wider studies to provide stronger evidence on a possible revision of the MDA TNM classification.

The Crucial Role of Surgical Treatment in BIA-ALCL Prognosis in Early- and Advanced-Stage Patients.

BACKGROUND: Studies on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) are trying to optimize medical and surgical treatments for early and advanced stages of this disease. The aim of this article is to share the experience gathered on the authors' prospectively collected 46 well-documented cases. METHODS: Italian physicians are obliged to report BIA-ALCL cases to the Italian Ministry of Health. Because of this cooperation with health care professionals, the competent authority has coordinated and centralized the collection of information for each patient in 46 cases of BIA-ALCL. Statistical analyses with cumulative incidence and corresponding 95 percent confidence interval are provided for each year, dividing the number of new cases that occurred in a defined year and the population at risk of experiencing BIA-ALCL during the same year. RESULTS: The mean time to the onset of symptoms is reduced to 6.4 ± 3.77 years (range, 1 to 22 years). Increased knowledge has also shortened the average time to diagnosis, at 7.2 ± 3.71 years (range, 2 to 22 years). A late seroma appears in 91 percent of cases. The patient who died underwent limited surgery. The Italian incidence has been estimated as 2.8 per 100,000 patients receiving implants (95 percent CI, 0.88 to 4.84) in 2015; 2.1 (95 percent CI, 0.43 to 3.86) in 2016; 3.2 (95 percent CI, 1.11 to 5.31) in 2017; and 3.5 (95 percent CI, 1.36 to 5.78) in 2018. CONCLUSION: Although the number of cases has risen slightly, BIA-ALCL is still a rare disease with a stable incidence, easily recognized and with a favorable prognosis also in advanced stages if complete surgical excision is performed.

Hospitalization in children eligible for palliative care.

INTRODUCTION: Medical and technological progress allows newborns, children and teenagers suffering from life-limiting and life-threatening illness to survive, but not necessarily to recover. Data on the number of children eligible for pediatric palliative care [PPC] and their needs are useful for health care planning. The main aim of this study was to ascertain the prevalence and the course of children eligible for pediatric palliative care in Italy. METHODS: The data source considered was the hospital discharge records (HDR), containing information on the children's diagnosis, their personal and clinical details, hospital admissions, procedures and discharge. The list of diseases eligible for PPC was based on the ICD IX CM list, according to ACT criteria. All records of hospital admissions in Italy for the years 2001-2003 were processed. The first step was to identify hospital admissions involving individuals 0-17 years old with at least one of the selected life-limiting and life-threatening illnesses. The main features of these hospital admissions were described in terms of duration, frequency, and discharge arrangements, estimating the number of patients eligible for PPC and the number of deaths occurring in hospital. RESULTS: The total number of hospital admissions concerning patients aged 0-17 years amounted to 3,578,649. Our restrictive criteria identified 323,415 hospital admissions in 3 years relating to diseases eligible for pediatric palliative care, which involved approximately 12,000 children. The most common diseases fell respectively into the following sectors: perinatal, neurological, neoplastic and congenital diseases. The number of days spent in hospital for diseases eligible for PPC ranged from 556,075 days/year to 591,983, and concerned 35,000 children every year. CONCLUSIONS: Our data agree with other international surveys on the prevalence and typology of pediatric patients. The HDR could be useful for the estimation of the cases eligible for pediatric palliative care and for monitoring of deaths in hospital.

Epidemiology of Fatal Trauma in Italy in 2002 Using Population-Based Registries.

BACKGROUND: Population-based registries have been proposed for epidemiologic studies and quality assessment in trauma care because they consider the entire population of a given geographic area. PATIENTS AND METHODS: Trauma mortality in pre-hospital and in-hospital settings and death time from injury have been calculated for Italy during 2002 by cross-analyzing two national databases: the death certificates register (DCD) and the hospital discharge register (HDR). All diagnosis codes from 800.0 to 939.9 and from 950.0 to 959.9 in both the DCD and the HDR, with the exclusion of femur fractures (820.0 and 821.9) if older than 65, have been included. RESULTS: The total number of people who died during 2002 as a consequence of trauma in Italy was 15,456; of these, 43.5% were older than age 64, and 35.9% belonged to the 15-44 age group. The overall incidence rate of trauma death was 27.23 per 100,000 inhabitants/ year, with a relative risk to men vs. women of 2.3. An analysis of the time distribution of the trauma deaths showed that 46.8% were pre-hospital mortalities, 18% of the deaths occurred within 48 h after hospital admission (acute mortality), 11.2% of the deaths occurred between three and seven days after admission (early mortality), and 24.0% of the patients died more than seven days after admission (late mortality). Patients who died before they arrived at hospital were younger and the proportion of men was higher than for the deaths that occurred after hospital arrival. CONCLUSION: The use of population-based registries proved to be effective in our study because it allowed us to use currently available data to obtain information useful for trauma system planning and design.

Trends in hospitalization for heart failure in Italy 2001-2003.

BACKGROUND: Heart failure is one of the main causes of hospitalization in Italy. In some industrialized countries since the second half of 1990s a halt in the grow rate of hospitalization for this pathology has been observed, and in some cases a reversal. The aim of this study was to evaluate the trend of hospitalization for heart failure in Italy in the years 2001, 2002 and 2003. MATERIALS AND METHODS: National hospital discharge data for years 2001, 2002 and 2003 were analysed. RESULTS: Heart failure hospitalization increased from 193 042 in 2001 to 205 043 in 2002 (+6.2%) and to 211 183 in 2003 (+3% with respect to 2002). In 2003 heart failure was the primary medical cause of hospitalization (1.6%). Hospitalization for heart failure accounted in 2003 for 2% of global hospitalization costs. CONCLUSIONS: Heart failure is the primary cause of hospitalization in Italy and the rate of hospital admission from 2001 to 2003 continued to increase, as well as related costs. These data indicate the urgent need for implementation of new models for the management of heart failure, based on a healthcare network, including hospital, ambulatory and home care, potentially capable of ameliorating both quality of life and costs of assistance.