[Pharmaceutical prescription of proton pump inhibitors and ranitidine in the general population living in the area of the Healthcare Authority and University of Udine (Friuli Venezia Giulia, Northeastern Italy)]. / La prescrizione farmaceutica territoriale di inibitori di pompa protonica e ranitidina nella popolazione residente nell'area della Azienda sanitaria universitaria integrata di Udine.

OBJECTIVES: to describe the use of proton pump inhibitors (PPI) and ranitidine in the general population living in the area of the Healthcare Authority and University of Udine (Friuli Venezia Giulia, Northeastern Italy) and to evaluate whether there are any cases of co-prescription of medications in those classes. DESIGN: analysis of health-related administrative databases (list of potential healthcare beneficiaries, prescriptions of medications, exemption from medical charges because of chronic conditions, list of general practitioners). SETTING AND PARTICIPANTS: population of the Italian area of the Healthcare Authority and University of Udine (approximately 250,000 inhabitants) ≥1 year of age as of January 1st, 2016. MAIN OUTCOME MEASURES: prevalence of PPI or H2RA use (>1 prescription in 2016), overall and stratified by drug, age class and sex; duration of the theoretical period covered by prescriptions; prevalence of co-prescriptions; association of co-prescriptions and clinical and demographic characteristics of patients (odds ratio and 95% confidence intervals). RESULTS: in 2016, 162 persons per 1,000 used those medications; in particular, 158/1,000 used PPIs. Prevalence of use increased with age, as did the median treatment duration with PPIs. Co-prescription of two medications of the same class were observed in 0.43% of antacid users. The likelihood of receiving co-prescriptions was higher among non-elderly subjects, long-term PPI users, and those with chronical diseases, such asthma. CONCLUSION: in the considered Italian area, PPIs and ranitidine were frequently used, although less than in the rest of Italy. We observed occasionally non-recommended practices, such as the co-prescription of different medications of the same class or with the same indications.

Professional quality improvement project in vaccination services: results of a 5-year survey.

A voluntary professional quality improvement project involving preventive departments and vaccination centres of an Italian region was carried out through two surveys (in 2001 and in 2006) performed using a quality assessment manual including 12 standards and 157 criteria. After the first survey, a feedback was sent to all participating centres. All six local health authorities participated, as well as all regional vaccination centres, 48 in 2001 and 41 in 2006. The overall adherence rate to the criteria was 56.0% (3258/5820) in 2001 and 74.4% (3784/5085) in 2006. The improvement was obtained without mandatory interventions from regional authorities.

[Clinical and organizational guidelines in university hospitals: a model for classification and analysis of hospital records]. / Atti di indirizzo clinico ed organizzativo di un'azienda ospedaliero universitaria: proposta di un modello di classificazione ed analisi.

Clinical and organizational guidelines in university hospitals: a model for classification and analysis of hospital records.

Italian nurse students' and clinical preceptors' perceptions about clinical practice experiences: a questionnaire survey.

Aims of the study was to compare perception of both clinical preceptors and nursing students in relation to clinical nursing practice in Italy. The recent introduction of primary level nursing education to Italian University primed many changes in processes and required to think new methods and contents. Special attention was adopted on revaluation of clinical practice. The study was part of a large investigation conducted from 2005 until 2006 as prevalence survey throughout two questionnaire addressed to nurses student and to clinical guides. Participants were all students (tot. 172) from one School of Nursing and their clinical guides (tot.120) working in a high specialization hospital located in a large urban area in Northern Italy. Students' and nurses' perceptions differed in these fields: knowledge of students' learning objectives, explanation of students' competences and objectives already reached, prevalence execution of assistance activity, organization of briefing/debriefing meetings, planning of a learning programme with students at the beginning of tutorship, choosing occasions related to nursing subjects discussed in classroom, filling an intermediate evaluation of the student tutorship in addiction to the final. The perceptions of the students and preceptors were opposite on several factors. This means that students and clinical guides approach the clinical experience from individualized viewpoints.

Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.

BACKGROUND: The frequency of drug prescription errors is high. Excluding errors in decision making, the remaining are mainly due to order ambiguity, non standard nomenclature and writing illegibility. The aim of this study is to analyse, as a part of a continuous quality improvement program, the quality of prescriptions writing for antibiotics, in an Italian University Hospital as a risk factor for prescription errors. METHODS: The point prevalence survey, carried out in May 26-30 2008, involved 41 inpatient Units. Every parenteral or oral antibiotic prescription was analysed for legibility (generic or brand drug name, dose, frequency of administration) and completeness (generic or brand name, dose, frequency of administration, route of administration, date of prescription and signature of the prescriber). Eight doctors (residents in Hygiene and Preventive Medicine) and two pharmacists performed the survey by reviewing the clinical records of medical, surgical or intensive care section inpatients. The antibiotics drug category was chosen because its use is widespread in the setting considered. RESULTS: Out of 756 inpatients included in the study, 408 antibiotic prescriptions were found in 298 patients (mean prescriptions per patient 1.4; SD +/- 0.6). Overall 92.7% (38/41) of the Units had at least one patient with antibiotic prescription. Legibility was in compliance with 78.9% of generic or brand names, 69.4% of doses, 80.1% of frequency of administration, whereas completeness was fulfilled for 95.6% of generic or brand names, 76.7% of doses, 83.6% of frequency of administration, 87% of routes of administration, 43.9% of dates of prescription and 33.3% of physician's signature. Overall 23.9% of prescriptions were illegible and 29.9% of prescriptions were incomplete. Legibility and completeness are higher in unusual drugs prescriptions. CONCLUSION: The Intensive Care Section performed best as far as quality of prescription writing was concerned when compared with the Medical and Surgical Sections.Nevertheless the overall illegibility and incompleteness (above 20%) are unacceptably high. Values need to be improved by enhancing the safety culture and in particular the awareness of the professionals on the consequences that a bad prescription writing can produce.

Educational programmes and sharps injuries in health care workers.

BACKGROUND: Sharps injuries in health care personnel still represent a significant problem worldwide. Many studies show a reduction in sharps injuries following the introduction and use of different protection devices, but few studies focus on the role of training programmes in the prevention of such injuries. AIMS: To analyse the influence of training programmes on sharps injuries in health care workers (HCW). METHODS: The study was carried out in a 350-bed university hospital in north-eastern Italy with 700 HCW. Training courses on biological risk for physicians, nurses, ancillary operators and laboratory technicians have been in place since 1998. Data on all sharps injuries reported by HCW between 1998 and 2006 were analysed together with information on HCW who attended the training courses. RESULTS: Between 1998 and 2006, there was a reduction in the incidence of sharps injuries from 11 to 4% (P < 0.01). During the same period, the number of trained HCW increased from 26 to 69% (P < 0.01). Trained personnel had a statistically significant lower relative risk (RR) for injury with RR = 0.06 (95% CI 0.02-0.18). CONCLUSIONS: A continuous educational effort for HCW leads to a reduction of sharps injuries.

Italian public school: a survey to estimate teachers' knowledge and perception on prevention and management of nutrition related pathologies.

AIMS: This study aims to estimate the current knowledge of nursery and primary school reference teachers about nutrition related pathologies, their prevention and control. METHODS: The study was conducted during April-June 2006 sending a questionnaire to 24 School Directions of nursery and primary schools in a Northern Italian region (Friuli Venezia Giulia). RESULTS: Considering all the schools we obtained a global response rate of 82.3% (115/142): 73.7% (42/57) of nursery schools and 85.9% (73/85) of primary school. 86.1% (99/115) of teachers thought that doing programmes aimed to improve nutrition behaviours is effective. 98.3% (113/115) of teachers answered that favourite fats in the diet are vegetables, 23.5% (27/115) that 55%-60% of the total caloric intake in children diet should consist in carbohydrates, 37.4% (43/115) ticked correct definition of diabetes. 75.7% (87/115) of interviewed teachers explain the term Body Mass Index correctly and 42.6% (49/115) know the cut-off between normal weight and overweight. CONCLUSION: analysing the levels of importance attributed by teachers to nutrition issues, it emerges a noteworthy interest on this topic. This should be a stimulus to promote projects and training courses on this topic.

Italian public school: a pilot study about disorders related to nutrition and their management.

OBJECTIVE: To know how Italian nursery and primary schools survey and manage children with food-related problems. DESIGN: A pilot study during the period March-May 2005, filling out a questionnaire. SETTING: All nursery and primary schools in a Northern Italian region (Friuli Venezia Giulia). SUBJECTS: There were 479 eligible schools RESULTS: Global response rate was of 29.6%. In 77.5% (110/142) of the schools there were children with food-related pathologies. Programs about nutrition were carried out by 44.4% (63/142) of the schools in the previous two years; 9.5% (6/63) dealt with food-related pathologies and 57.1% (36/63) required the intervention of outside experts to have these projects realized. In the same period training courses about nutrition for teachers were conducted in 9.2% (13/142) of the schools. CONCLUSIONS: Data provide a first overview of the situation in Italy on food-related topics in children attending nursery and primary schools. Therefore many programs could not rely on funds to be developed, but had to use internal resources of the school.

Surveillance of hospital-acquired infections: a model for settings with resource constraints.

BACKGROUND: Surveillance activities have been considered of paramount importance for effective infection control programs in health care organizations. OBJECTIVES: Our objective was to design a capture system able to assure surveillance of hospital-acquired infections (HAI) in acute hospitals with few resources devoted to infection control. METHODS: We performed 4 biweekly repeated prevalence studies to identify major HAI (urinary tract infections, surgical site infections, lower respiratory tract infection, bloodstream infections) as defined by the Centers for Disease Control and Prevention (CDC) criteria in 3 large hospitals in northeastern Italy (6 internal medicine departments, 5 general surgery departments, 3 intensive care units, and 1 bone marrow transplant unit). RESULTS: One thousand five hundred fifty-four patients were screened (63.9% in medical wards, 27.5% in surgical wards, and 8.5% in intensive care units and bone transplant unit). The overall prevalence of infection was 4.9% (77/1,554); 4.5% (70/1,554) of patients were infected. A capture system based on the presence of fever >or=38 degrees C, antibiotic use, and presence of devices guarantees 100% sensitivity in detecting HAI but requires an assessment of 62% of the population. Using the presence of fever and devices as criteria guarantees a sensitivity of 98%, requiring an assessment of 41.4% of patients, whereas presence of fever and antibiotic use has the same sensitivity but requires an assessment of 50% of patients. Using nursing records, physician records, and direct patient examination as sources of documentation guarantees that all necessary data are collected while requiring a mean of 4 minutes and 42 seconds per patient (standard deviation, 1 minute and 30 seconds). CONCLUSION: A capture system based on biweekly repeated prevalence studies that select patients for the presence of fever, antibiotics, and medical devices ensures the detection of all HAI in a resource-limited environment.

Prevention of healthcare associated infections: medical and nursing students' knowledge in Italy.

BACKGROUND: The training of health workers is a key issue for the prevention of healthcare associated infections. OBJECTIVES: To evaluate knowledge of nursing and medical students concerning the prevention of healthcare associated infections. DESIGN: A cross-sectional study. SETTING: University hospitals in nine Italian cities. PARTICIPANTS: One thousand four hundred sixty one healthcare students (607 medical students and 854 nursing students). METHODS: The study was performed using a questionnaire investigating 3 areas, each having different possible points: standard precautions=12; hand hygiene=8; healthcare associated infections=5, for an overall perfect score of 25. Scores that met a cutoff ≥17.5 were considered to be indicative of an acceptable level of knowledge. Factors associated with an acceptable level of knowledge were analyzed using a logistic regression model. RESULTS: Mean overall score (±SD) was 18.1 ± 3.2. Nursing students (18.6 ± 2.9) obtained a higher overall score than medical students (17.4 ± 3.5) (p<0.001). Weighed scores (±SD) by area were: 10.3 (±2.0) for standard precautions, 5.0 (±1.3) for hand hygiene and 2.8 (±1.1) for healthcare associated infections. Knowledge level concerning the three areas was different between medical and nursing students (p<0.001). The probability of finding acceptable knowledge was smaller for medical students (OR: 0.54 p<0.0001) and for students aged ≥24 years (OR: 0.39 p<0.0001). CONCLUSION: The overall score showed an acceptable level of knowledge for the whole sample; but, considering separately the two curricula, only nursing students reached the minimum acceptable score. It seems important to investigate what is working better in nursing than in medical education in order to implement and validate new teaching approaches.

Level of burnout among nurses working in oncology in an Italian region.

PURPOSE/OBJECTIVES: To estimate the level of burnout among nurses working on oncology wards and to identify the risk factors of burnout and the strategies used to prevent and deal with stress. DESIGN: Descriptive study. SETTING: Oncology wards in public hospitals in a northeastern Italian region. SAMPLE: 100 nurses working on oncology wards. METHODS: Head nurses of the oncology wards were personally informed about the aims of the study and were asked to distribute a questionnaire among the staff nurses and collect them after completion. The questionnaire had 58 items divided into three parts: sociodemographic and job characteristics of the population, the Maslach Burnout Inventory modified for Italian healthcare workers, and the respondents' perceptions about coping mechanisms and strategies adopted by the organization to help the nurses cope with stress. MAIN RESEARCH VARIABLES: Levels of burnout according to the Maslach Burnout Inventory. FINDINGS: The global response rate was 71% (100 of 140); 35% of the nurses had a high level of emotional exhaustion, 17% had a high level of depersonalization, and 11% had a high level of personal achievement. Significantly high levels of emotional exhaustion were found in nurses older than 40 with a working seniority of more than 15 years, those who had chosen to work on an oncology ward, and those who wanted another work assignment. The mean emotional exhaustion in subjects who identified lack of coordination (disorganization) as an important cause of stress was 24.5 (SD = 10.6), whereas the mean score in the nurses who did not cite disorganization as a cause of stress was 18.3 (SD = 12.0). CONCLUSIONS: An important cause of stress reported by nurses is poor organization; therefore, hospitals should focus attention on specific organizational aspects. IMPLICATIONS FOR NURSING: Knowledge of the mechanisms of burnout and strategies to prevent and deal with them are important for nurses' psychophysical health and constitute a fundamental requirement in a policy that aims to improve quality in health services.