RESUMO
Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide "system" inertia-really difficult to be overcome-and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of "fertilizing a patient engagement ecosystem": an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient "disengagement" is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.
RESUMO
BACKGROUND: A prospective trial was designed to evaluate the effect of hyperbaric oxygen (HBO) therapy on organ/space sternal surgical site infections (SSIs) following cardiac surgery that requires sternotomy. METHODS: A total of 32 patients who developed postoperative organ/space sternal SSI were enrolled in this study from 1999 through 2005. All patients were offered HBO therapy. Group 1 included the patients who accepted and were able to undergo HBO therapy (n = 14); group 2 included patients who refused HBO therapy or had contraindications to it (n = 18). RESULTS: The two groups were well matched at baseline with comparable preoperative clinical characteristics and operative factors. Staphylococcus was the most common pathogen for both groups. The duration of infection was similar in groups 1 and 2 (31.8 7.6 vs. 29.3 5.7 days, respectively, p = 0.357). The infection relapse rate was significantly lower in group 1 (0% vs. 33.3%, p = 0.024). Moreover, the duration of intravenous antibiotic use (47.8 +/- 7.4 vs. 67.6 +/- 25.1 days, p = 0.036) and total hospital stay (52.6 +/- 9.1 vs. 73.6 +/- 24.5 days, p = 0.026) were both significantly shorter in group 1. CONCLUSION: Hyperbaric oxygen is a valuable addition to the armamentarium available to physicians for treating postoperative organ/space sternal SSI.