Is there an association between Stevens-Johnson Syndrome and vaccination? A systematic review.

AIMS AND BACKGROUND: It is essential to make sure that vaccines are safe, effective, and of good quality. In the past years, there have been some reports of adverse effects regarding vaccination. One of these adverse effects is the development of Stevens-Johnson syndrome. Stevens-Johnson syndrome is a rare, severe, skin disorder, that usually occurs after medication. In Europe, its estimated incidence is of 2-3 cases/million population/year. Therefore, the aim of this study was to investigate, through a systematic review, the association between vaccination and the development of Stevens-Johnson syndrome. MATERIALS AND METHODS: We performed a systematic review using PubMed, Scopus and Web of Science databases. We included studies dated between January 2000 and February 2018. The main selection criterion was the reporting of the disease, following vaccination. RESULTS: Ten studies were selected, from a total of 391 studies. Of these, 5 were case reports, 3 were cohort studies and 2 were case-control. All the studies were regarding cases of Stevens-Johnson syndrome after vaccination. The selected studies reported cases following vaccines such as influenza vaccine, smallpox, anthrax and tetanus vaccine, MMR vaccine, varicella vaccine, DTaP-IPV vaccine or rabies vaccine. None of the cohort studies reported statistically significant associations between vaccination and the syndrome. In the case-control studies, it was not observed significant increased risk for the Stevens-Johnson syndrome following the administration of vaccines. Regarding the case reports, there was not sufficient evidence to form a positive association between these two factors, and more studies are needed. CONCLUSIONS: In this review it was not possible to establish a positive relation between vaccination and the development of Stevens-Johnson syndrome.

Conley Scale: assessment of a fall risk prevention tool in a General Hospital.

INTRODUCTION: "Umberto I" Teaching Hospital adopted 'Conley scale' as internal procedure for fall risk assessment, with the aim of strengthening surveillance and improving prevention and management of impatient falls. MATERIALS AND METHODS: Case-control study was performed. Fall events from 1st March 2012 to 30th September 2013 were considered. Cases have been matched for gender, department and period of hospitalization with two or three controls when it is possible. A table including intrinsic and extrinsic 'fall risk' factors, not foreseen by Conley Scale, and setted up after a literature overview was built. Univariate analysis and conditional logistic regression model have been performed. RESULTS: 50 cases and 102 controls were included. Adverse event 'fall' were associated with filled Conley scale at the admission to care unit (OR = 4.92, 95%CI = 2.34-10.37). Univariate analysis identified intrinsic factors increasing risk of falls: dizziness (OR = 3.22; 95%CI = 1.34-7.75), psychomotor agitation (OR = 2.61; 95%CI = 1.06-6.43); and use of means of restraint (OR = 5.05 95%CI = 1.77-14.43). Conditional logistic regression model revealed a significant association with the following variables: use of instruments of restraint (HR = 5.54, 95%CI = 1.2- 23.80), dizziness (OR = 3.97, 95%CI = 1.22-12.89). DISCUSSION: Conley Scale must be filled at the access of patient to care unit. There were no significant differences between cases and controls with regard to risk factors provided by Conley, except for the use of means of restraint. Empowerment strategies for Conley compilation are needed.

The case of Patient Safety Indicator 12 (PSI12): use of administrative data to estimate the incidence of "Postoperative Pulmonary Embolism or Deep Vein Thrombosis". A pilot study in a General Hospital.

INTRODUCTION: The AHRQ Quality Indicators (QIs) were created in order to both identify the performance and to track the improvement of patient safety. Patient Safety Indicator 12 (PSI12) is relative to the risk of Post Operatory Pulmonary Embolism or Deep Venous Thrombosis (PO DVT/PE). This pilot study has three main objectives. Firstly, to perform an analysis of the performance of different hospital wards by using administrative data; secondly, to analyze defects in the process that led to the occurrence of the adverse event; thirdly, reviewing the single PO DVT/PE. METHODS: Data were extracted from a Hospital Information data flow (SIO) and compared to Clinical Discharge Record. PSI12 estimates were computed before and after the screening. Control Charts allowed the static analysis of performance between different hospital wards in 2014. The Ishikawa diagram was drawn for the analysis of the underlying causal process. RESULTS: The number of PSI12 cases provided by DRGs through SIO data flow decreased from 45 to six after the comparison with the correspondent clinical records. Four clinical records provided full information allowing the analysis of process. The Ishikawa Diagram identified the defects in the process of prophylaxis that resulted into a PO DVT/PE. DISCUSSIONS: The clinical records screening revealed a lower incidence of PO DVT/PE with respect to the DRGs statistics. Overall the PO DVT/PE occurrence in 2014 fell into the control limits, although the result could be undermined by the low quality of clinical records compilation. The failure in the prophylaxis procedure was imputable to pitfalls in the health care management and to the individual attitude towards patient safety procedures. In conclusion, the reliability and validity of administrative data in monitoring quality and safety are worthy to be explored in the context of further validation studies.

Errors in Medicine: perception of healthcare professionals in the Lazio Region.

INTRODUCTION: The error in medicine is always the subject of debate in the scientific debates. The purpose of this study is to evaluate the degree knowledge, attitudes and behaviors of health workers towards the error in the health sector. METHODS: A survey was carried out involving 435 health profes- sionals working in health facilities of the Lazio region, of which 312 females (71%) and 123 males (28%) with an age between 21 and 68 years. A structured questionnaire was administered for investigating the experiences and opinions about the errors found in medical prac- tice, the causes underlying them and the mistakes that should never be committed. Data were collected, stratified by sex, age, marital status, year of graduation, years of service and the workplace (medical or surgical). The statistical significance was set at p≤0.05. RESULTS: The 5 errors found more frequently in the clinical prac- tice by health professionals were as follows: errors related to the request for examination (60.9%); errors in the collection of samples (37.5%); errors relating to the delivery of the reports (35.2%); errors due to reporting of examinations (31.7%); errors of history (29.2%). The five cases considered to be the most frequently responsible for such errors were: disorganization (52%); fast (46.4%); tiredness due to excessive workloads, stress (44.6%); negligence and carelessness (41.6%); inattention (41.1). With regard to the errors that you should never commit they were more frequently: exchange of patient or misidentification of the patient (49.2%); administration errors of therapies or medications (47.6%); errors related to surgery (41.6%); errors of prescription therapies or medications (39.3); errors in the reporting of exams (33.6%). CONCLUSIONS: The results of this study shows the importance of a culture of error in medicine among healthcare professionals, those who have already gained practical experience in health care and therefore better able to perform a critical analysis and evaluation of the errors that occur every day. The continuous training of health professionals is fundamental for promoting patient safety and quality in the healthcare sector.

The role of Pap test screening against cervical cancer: a systematic review and meta-analysis.

OBJECTIVE: The first aim of this article is to quantify the role of Pap test in cervical cancer prevention, updating the pool of available studies included in a previous meta-analysis. Potential sources of meta-analysis heterogeneity were investigated as second aim. Further evidence of cost-effectiveness has been provided about age and best time interval to perform Pap test screening. DATA SOURCES: The articles' search was conducted using four medical electronic databases: PubMed, Google Scholar, ISI Web, and Scopus. Papers published until the 30th November 2013 were included. The research on Google Scholar was limited to the first 10 pages of web for each study design. METOD OF STUDY SELECTION: A systematic review/meta-analysis was performed according to PRISMA Statement. New-Castle-Ottawa Scale and Jadad have been adopted for articles quality assessment. From 4143 screened articles, 34 met eligibility criteria and 30 case-control studies were included in meta-analysis. Meta-analysis was carried out using StatsDirect2.8.0. Heterogeneity was investigated with qualitative and quantitative approaches in sensitivity-analysis. TABULATION, INTEGRATION AND RESULTS: Despite a great heterogeneity (Cochran Q=504.466, df=29, p<0.0001; I²=94.3%; 95%CI=93.1%-95.1%), a significant protective effect of Pap test has been identified (OR=0.33; 95%CI=0.268-0.408, P <0.00011) through the meta-analysis. Sensitivity analysis did not provide significant results (R=0.358 R2=0.128 p<0.469). CONCLUSIONS: The protective role of Pap test against cervical cancer has been confirmed especially among women <40 years. Annual screening still remains the most cost-effective preventive strategy.

Knowledge of Emergency Department Triage nurses in management of patients with mental health needs: comparisons with the Triage Model of Lazio (TLM).

OBJECTIVES: To refer the current competences of Triage Nurses (TRNs) assessing the person with metal health problems in Emergency Departments (ED), and the impact of the Triage Lazio Model (TLM) upon it. MATERIALS AND METHODS: An anonymous questionnaire was administered to ED TRNs of the Lazio Region. Standardized Cronbach's alpha was used for reliability estimation. RESULTS: The Cronbach's alpha was 0.4. Two hundred ninety-nine TRNs were interviewed: 66% women, 47% aged 31-40 years, 60% followed TLM. The consideration of the patient as 'one who comes out of the normal', 'a person with altered functions of mind or mental function' and as 'hostile, aggressive and unpredictable' was reported more by females in comparison to the males (OR=1.76; OR=3.50; OR=1.79); TRNs who have not followed the course on TLM had higher probability to consider 'hostile, aggressive and unpredictable' the psychiatric patients (OR=1.87) in comparison with other Triage courses; those who have taken a course on Triage but at least 3 years ago, had a lower probability to consider as 'one who comes out of the normal' (OR=0.55). CONCLUSIONS: having followed the course TLM, having participated in a recent triage course, male gender, and the seniority in this job appear to be contributing factors for a proper management of psychiatric patients. Continuous improvement of specific knowledge and skills for the management of patients with mental health needs are mandatory.

Ulcera gastrica: conduta cirurgica em face dos indices de malignidade. / Gatric ulcer: surgical procedure in the face to malignancy indices

Em um periodo de 11 anos, 70 pacientes do sexo feminino foram tratados de ulcera gastrica: 29 clinicamente e 41 cirurgicamente. Entre as operadas, detectaram-se 8 casos de ulceras malignas (19,5%). EM face deste significativo indice de malignidade, indica-se a resseccao da ulcera, qualquer que seja a operacao a ser executada. E por apresentar a menor incidencia de recidiva ulcerosa, a gastrectomia parcial e recomendada, apesar de haver situacoes em que a vagotomia superseletiva sem piloroplastia ou a vagotomia troncular + piloroplastia tenham indicacoes satisfatorias.Nestas ultimas, todavia deve haver sempre a ulcerectomia associada, pois este e o artificio mais seguro para que nao passe despercebida uma ulcera maligna