Modeling Cholecystectomy Hospital Stay Through a Linear Approach.

Cholecystectomy is among the most frequent procedures in general surgery. In the healthcare facility organization, it is important to evaluate all interventions and procedures that have a great impact on health management and that have a clear effect on the Length of Stay (LOS). The LOS represents, in fact, an indicator of performance and measure the goodness of a health process. This study was conducted with the aim of providing LOS for all patients undergoing cholecystectomy at the "A.O.R.N. A. Cardarelli" of Naples. Data were collected in the two years 2019 and 2020 and included 650 patients. A MLR model is created in the work to predict the value of LOS as a function of the following variables: gender, age, pre-operative LOS, presence of comorbidities and complication during surgery. The results obtained are as follows: R=0.941 and R2=0.885.

Prediction of Hospital Length Stay for Patients Undergoing Mastectomy.

The prolonged length of stay is an important aspect to be considered for the healthcare management since this affect both the health-related expenditure of the hospital and the quality of the offered service. In the light of these consideration is important for hospitals to be able to predict the LOS of patients and to work on the principal aspect affecting it in order to reduce LOS as much as possible. In this work we focus on patients undergoing mastectomy. The data were collected form 989 patients who underwent mastectomy surgery in the Surgery Department of the AORN "A. Cardarelli" of Naples. Different models have been tested and characterized and the one with the best performance was identified.

Predicting In-Hospital Mortality During the COVID-19 Pandemic in Patients with Heart Failure: A Single-Center Exploratory Study.

The aim of this study was to investigate whether exposure to the pandemic was associated with increased in-hospital mortality for health failure. We collected data from patients hospitalized between 2019 and 2020 and we assessed the likelihood of in-hospital death. Although the positive association of exposure to the COVID period with an increased in-hospital mortality is not statistically significant, this may underscore other factors that may influence mortality. Our study was designed to contribute to a better understanding of the impact of the pandemic on in-hospital mortality and to identify potential areas for intervention in patient care.

Efficacy of recanalization therapy for ischemic stroke: multicenter hospital network experience.

PURPOSE: Stroke is a leading cause of long-term disability with high mortality rate in the first year after the event. In Campania, mechanical thrombectomy treatment significantly increases in the last 3 years, as well as hospitals delivering acute stroke treatments. The aim of this study is to demonstrate how a full opening of our stroke network improves stroke management and stroked patients' survival in Campania. MATERIAL AND METHODS: In Federico II University Hospital of Naples acting as a HUB center of 7 peripheral SPOKE hospitals in regional territory, 68 patients with acute ischemic stroke were evaluated with NIHSS and m-RS clinical scores and neuroradiological ASPECT scores, from January 1 to December 31, 2021. At hospital discharge, NIHSS score and three months after m-RS score were re-assessed to evaluate the therapeutic effects. RESULTS: Forty-two of 68 patients (63%) admitted to our hub center had ischemic acute stroke at CT evaluation; 29 patients had ASPECT score > 7 (69%), and 6 a score < 7 (14%). At admission, NIHSS score mean value was 10.75, and m-RS score mean value was 0.74. At discharge, NIHSS score mean value was 7.09. After three months, m-RS score mean value was 0.74. DISCUSSION: The inter-company agreement between Federico II University and several peripheral hospitals allows an absolute and relative increase in endovascular mechanical thrombectomy and intravenous thrombolysis procedures, with a relative prevalence of mechanical thrombectomy. A regional implementation of the stroke multi-disciplinary care system is hardly needed to ensure the optimum treatment for the largest number of patients, improving patient's outcome.

Nutritional Screening and Anthropometry in Patients Admitted From the Emergency Department.

BACKGROUND: Due to the high prevalence of malnutrition among hospitalized patients, screening and assessment of nutritional status should be routinely performed upon hospital admission. The main objective of this observational study was to evaluate the prevalence of and the risk for malnutrition, as identified by using three nutritional screening tests, and to observe whether some anthropometric and functional parameters used for nutritional evaluation were related to these test scores. METHODS: This single-center observational study included 207 patients admitted from the emergency department for hospitalization in either the internal medicine or surgery units of our institution from September 2017 to December 2018. The prevalence of malnutrition among this patient sample was evaluated by using the Nutritional Risk Screening (NRS-2002), the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body mass index (BMI), bioimpedance analysis (BIA), handgrip strength (HGS) and calf circumference (CC) assessments were also performed. RESULTS: According to the NRS-2002, 93% of the patients were at no risk or at low nutritional risk (NRS score < 3), and 7% were at a high nutritional risk (NRS score ≥ 3). On the other hand, according to the SGA, 46.3% of the patients were well-nourished (SGA-a), 49.8% were moderately malnourished (SGA-b), and 3.9% were severely malnourished (SGA-c). Finally, according to the GLIM criteria, 18% patients were malnourished. Body weight, body mass index (BMI), phase angle (PhA), CC and HGS were significantly lower in the patients with NRS scores ≥ 3, SGA-c and in patients with stage 1 and stage 2 malnutrition, according to the GLIM criteria. CONCLUSION: The NRS-2002, the SGA and the GLIM criteria appear to be valuable tools for the screening and assessment of nutritional status. In particular, the lowest NRS-2002, SGA and GLIM scores were associated with the lowest PhA and CC. Nevertheless, a weekly re-evaluation of patients with better screening and assessment scores is recommended to facilitate early detection of changes in nutritional status.

Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic.

BACKGROUND: To introduce Lean approach principles in the management of patients undergoing intravitreal injections (IVIs) for wet age-related macular degeneration. METHODS: Retrospective single-centre cohort study. Services location, IVIs scheduling, utilization of staff, data recording methods, ophthalmic examination and surgical procedures were analysed; a new Intravitreal Injection Centre (IVIC) was developed according to Lean principles. Mean number of daily IVIs performed, mean time between registration and discharge, mean turnover time in between patients, percentages of performed IVIs on the monthly scheduled IVIs and of patients rating their experience ⩾8/10 via standardized feedback questionnaires were retrospectively analysed. RESULTS: The mean IVIs number per day increased from 20 ± 4.08 to 50 ± 7.07, and the mean time between registration and discharge of a patient decreased from 240 ± 14.14 to 60 ± 8.16 min (p = 0.00057 and p < 0.00001, respectively). Mean turnover time in between patients decreased from 10 ± 1.41 to 8 ± 2 min (p = 0.055). The percentage of monthly IVIs performed on the total of scheduled IVIs increased from 60% to 100%, and the percentage of satisfied patients who rated IVIC ⩾8/10 increased from 45% to 95% (p = 0.0177 and p < 0.00105, respectively). CONCLUSION: The IVIC improved the quality, efficiency, speed of the overall procedures and clinical capacity of the IVI service through a fast one-way route for patients, limiting time wasted and total distance travelled. This model facilitates the creation of a one-stop clinic through the just-in-time management principle and may be relevant to other ophthalmology services.

[Network references for rare diseases: state of the art for the paroxysmal nocturnal hemoglobinuria]. / I network di riferimento per le malattie rare: lo stato dell'arte per l'emoglobinuria parossistica notturna.

BACKGROUND: recently, healthcare network models have been proposed to improve general awareness of rare diseases for patients and specific knowledge about diagnosis, treatment, and management for healthcare services. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare haematological disease that still has no framing in an official network. OBJECTIVES: to describe the use of network models in diagnosis, treatment, and management of PNH patients both in Italy and abroad and its impact on patients and healthcare service. DISEGN: literature search was performed using the keywords "Hemoglobinuria", "Network", "PHN", and "Screening" in both MedLine and EMBASE. Search was restricted to the articles published in the last 5 years and written in English, French or Italian language. RESULTS: from the total 251 articles of the initial search, only 21 were finally included in our review. None of the included study explicitly described a network model. In general, we were able to identify two different kind of networks implicitly described in the studies: laboratory networks for diagnostic harmonization or screening of the population at risk of PNH (10/21 studies) and PNH registry as network of clinical information to be use for better understanding of the natural history of the disease and to assess therapeutic effectiveness (11/21 studies). CONCLUSIONS: few network approaches in PNH diagnosis, treatment, and management are described in literature. Despite the scarce application of the networks, our review highlights the positive impact that networks have in both patients and healthcare services.

[Organ donation and transplantation: the "friendly access initiative" in the Federico II Hospital (Naples), between nudging and narrative medicine]. / Donazione e trapianto d'organi: l'esperienza dello "sportello amico" dell'AOU Federico II (Napoli), tra nudging e medicina narrativa.

In Italy, to show the willingness to donate one's organs, there is the principle of the explicit consensus (or disagreement) (Law n. 91 of the 01.04.1999, Art. 23; Decree of the Italian Health Ministry of the 08.04.2000). According to data of the Italian Association for the donation of organs, tissues and cells (AIDO), in 2017 in Campania Region (Southern Italy) an average of 12.5 people x1,000,000 donated their organs vs. a national average of 23.7. This negative discrepancy between national and regional data highlights that it is imperative to promote awareness-raising measures to address to the population of Campania Region in order to improve the following of a practice which is still object of preconceptions and scarce knowledge. This paper describes a pilot project started in 2017 by the "Sportello amico trapianti" (friendly access to transplantation) to promote the donation of organs within the university-hospital "Federico II" (Naples, Campania Region). The first phase of this project was based on the nudge theory, that is the "little push" to direct decisional processes of groups and individuals. This phase took place during the "Atelier della salute" (a health workshop), organized by the Medicine and Surgery school of the university-hospital "Federico II": here, a questionnaire was administered to 60 people. The questionnaire consisted in 12 questions, answered by volunteers, which aim was to test the general knowledge about organ donation and transplantation. Analysing the answers, a panel of 7 experts (2 epidemiologists, 1 social worker, 2 experts in public and institutional communication, 1 biologist expert in donation of haematopoietic progenitor cell, 1 transplant surgeon), responsible for the coordination and monitoring of the activities, identified the critical elements to bring attention to in order to raise awareness in the population. The second phase consisted in a literary workshop which aim was to identify nudge cases. The text used was Never let me go by Kazuo Ishiguro, a novel focused on organ donation in a dystopic context where the protagonists are clones created to facilitate the donation of organs. Six students participated in this workshop: all six considered the dystopic scenario as a potential nudge to humanize the approach to organ donation and transplant. In conclusion, we believe that the nudge methodology may be used in order to improve awareness and adherence to donation of organs.

Efficacy of a "contact center-based communication" in optimizing the care of inflammatory bowel diseases.

BACKGROUND: Telephone helplines are a useful vehicle for the management of chronic diseases even though data on how these can ease management of inflammatory bowel disease (IBD) is still scarce. AIM: to analyze our two-years' experience with the first telephone helpline dedicated to IBD in Italy. METHODS: The main outcomes of using a contact center (CC) at our Unit were analyzed; all data was prospectively collected. Patients' requests were classified into medical or non-medical. The percentage of hospitalized patients in the pre-CC period was compared to that after CC activation, to assess the potential clinical gain of using CC. The calls were divided into 5 categories to evaluate a potential correlation between patients' number of calls and risk of hospitalization. RESULTS: The CC received 11,080 calls and handled 11,972 requests. In particular, 63% of patients phoned monthly for a medical consultation, and 37% called for non-medical reasons. In 2012, the followed-up patients were 1658 with 230 IBD-caused hospitalizations (14%); in 2014, the followed-up patients were 1962 with 182 hospitalizations (9%) (p<0.01). The risk of hospitalization exponentially increased with the number of calls: from 3% for 0-5 calls to 41% with >30 calls (p<0.01). CONCLUSION: A dedicated CC could provide additional clinical gain, care, and support for IBD patients.