Could shared decision making affect staying in hospital? A cross-sectional pilot study.

BACKGROUND: Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients' perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region. METHODS: A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test. RESULTS: The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving "good" or "excellent" information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a "shared" decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure. CONCLUSIONS: The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.

Burden of stroke in Italy: an economic model highlights savings arising from reduced disability following thrombolysis.

BACKGROUND: The consequences of stroke must be assessed not only in terms of incidence and mortality rates, but also in terms of disability, which may persist long after the acute phase. Thrombolysis, if timely administered, can effectively reduce post-stroke disability. AIMS: The economic model presented herein aims to evaluate, in eligible patients, the effects of alteplase on post-stroke disability and related costs over three-years. METHODS: The economic analysis was developed on the basis of four key components: clinical outcomes from international trials, economic consequences extracted from cost of illness studies, regulatory data from national and international agencies, and national epidemiological data. A population-level model estimated the difference in disability costs between patients treated with standard care versus those receiving thrombolytic therapy within 4×5 h of acute ischemic stroke. The analysis covered 36 months from discharge. RESULTS: Reduced costs related to post-stroke disability were observed in treated patients compared with those receiving standard care (control). The overall savings were €2330×15 per average patient: €1445×81 during the first 18 months, €362×25 between 18 and 24 months, and €522×09 in the 24-36 months period. The overall savings on 3174 Italian treated patients in 2013 were €7 395 907 over three-years. CONCLUSION: Our study reveals that performing thrombolytic therapy in eligible patients improves economic outcomes compared with patients receiving standard care. This model is useful for decision makers, both within and outside of the Italian national context, as a tool to assess the cost-effectiveness of thrombolysis in both short- and long-term period.

Microbiological contamination of radiological equipment.

BACKGROUND: Important changes have occurred in radiological departments (RDs) over the past 30 years. The procedures have become more complex and the number of patients has increased. This scenario could have important implications for public health and infection control but, to date, the scientific literature has dealt little with matters relating to microbiological monitoring in RDs. PURPOSE: To examine the level of microbiological contamination in the main RDs of Turin, a city in northern Italy, in order to analyze the presence of a possible biological risk. MATERIAL AND METHODS: We analyzed data from 12 RDs. Samples were taken from X-ray tubes, control panels, radiographic cassettes, and imaging plates. We used the French guidelines "Standards NF S 90--351" in order to obtain the threshold values of reference. Through a questionnaire we investigated the use of personal protective equipment by the chiefs of the RDs. RESULTS: We found values out of limits in 41.7% of the X-ray tubes sampled, in 91.7% of the control panels and imaging plates, while only 8% of the radiographic cassettes were contaminated. A total of 58.3% of RDs reported values above the threshold for three out of four samples. In 16.7% of the RDs only one surface presented acceptable values. CONCLUSION: Healthcare-associated infections are a cogent issue for the RDs, and knowledge of how to prevent them is increasingly required by health professionals. This study is meant to be a first analysis of the issue that highlights the need of further investigations, maybe with a more detailed monitoring through the characterization of the microbial species involved. Moreover, the development of shared and maybe official standards for the evaluation of microbiological contamination in RDs is strongly suggested.

An eclipsing-binary distance to the Large Magellanic Cloud accurate to two per cent.

In the era of precision cosmology, it is essential to determine the Hubble constant to an accuracy of three per cent or better. At present, its uncertainty is dominated by the uncertainty in the distance to the Large Magellanic Cloud (LMC), which, being our second-closest galaxy, serves as the best anchor point for the cosmic distance scale. Observations of eclipsing binaries offer a unique opportunity to measure stellar parameters and distances precisely and accurately. The eclipsing-binary method was previously applied to the LMC, but the accuracy of the distance results was lessened by the need to model the bright, early-type systems used in those studies. Here we report determinations of the distances to eight long-period, late-type eclipsing systems in the LMC, composed of cool, giant stars. For these systems, we can accurately measure both the linear and the angular sizes of their components and avoid the most important problems related to the hot, early-type systems. The LMC distance that we derive from these systems (49.97 ± 0.19 (statistical) ± 1.11 (systematic) kiloparsecs) is accurate to 2.2 per cent and provides a firm base for a 3-per-cent determination of the Hubble constant, with prospects for improvement to 2 per cent in the future.

Light echoes reveal an unexpectedly cool η Carinae during its nineteenth-century Great Eruption.

η Carinae is one of the most massive binary stars in the Milky Way. It became the second-brightest star in our sky during its mid-nineteenth-century 'Great Eruption', but then faded from view (with only naked-eye estimates of brightness). Its eruption is unique in that it exceeded the Eddington luminosity limit for ten years. Because it is only 2.3 kiloparsecs away, spatially resolved studies of the nebula have constrained the ejected mass and velocity, indicating that during its nineteenth-century eruption, η Car ejected more than ten solar masses in an event that released ten per cent of the energy of a typical core-collapse supernova, without destroying the star. Here we report observations of light echoes of η Carinae from the 1838-1858 Great Eruption. Spectra of these light echoes show only absorption lines, which are blueshifted by -210 km s(-1), in good agreement with predicted expansion speeds. The light-echo spectra correlate best with those of G2-to-G5 supergiants, which have effective temperatures of around 5,000 kelvin. In contrast to the class of extragalactic outbursts assumed to be analogues of the Great Eruption of η Carinae, the effective temperature of its outburst is significantly lower than that allowed by standard opaque wind models. This indicates that other physical mechanisms such as an energetic blast wave may have triggered and influenced the eruption.

Robot-assisted versus open radical prostatectomy: an evidence-based comparison.

OBJECTIVES: A robotic system has been used in tens of thousands of minimally invasive prostate cancer treatment surgeries worldwide. The aim of the paper is to evaluate the effectiveness of the robotic surgery versus traditional surgery for the treatment of early prostate cancer in Italy. METHODS: Since this study is an observational study, we have no control over the treatment assignment. However, the treated (patient who undergo robotic assisted laparoscopic prostatectomy (RALP)) and control groups (patient who undergo open radical prostatectomy (ORP)) may differ significantly prior to treatment in ways that may affect the outcomes under study. In order to avoid erroneous conclusions we have dealt with the problem of significant group differences by using a propensity score matching procedure. RESULTS: The average age at radical prostatectomy for the two groups was similar. 97% of patients have bladder neck sparing during the open prostatectomy versus 77% of patients who belong to RALP group. RALP group presents higher urinary continence and lower blood loss rate with respect to ORP group (86.3% versus 65.6% and 9% versus 31.1% respectively). Among patients who underwent ORP 20.4% were spared nerves versus 4.5% of patients who were treated with RALP. The body mass and self-assessed health for the two groups were similar. In the logistic regression model used for the calculation of Propensity Score, bladder neck sparing and the size of the tumor were significant and presented a negative coefficient. Older age, advanced stage of the tumor, and linfonodal involvement negatively affect the likelihood of robotic technology. From our empirical analysis it arises that the robot technique does not significantly affect the hospital stay, blood loss nor the variables about post-intervention quality of life (urinary continence and self-assessed health). CONCLUSIONS: The robotic system does not seem to present major efficacy with respect to open radical prostatectomy. In particular our findings do not support any significant differences in quality of life, blood loss, hospital stay, and urinary incontinence in patients operated with robot-assisted surgery versus open retropubic radical prostatectomy.

[Role of the Web on behaviors and health choices in six Italian cities: results of a multicenter study]. / Ruolo del web sui comportamenti e sulle scelte sanitarie in sei città italiane: risultati di uno studio multicentrico.

A cross-sectional, multicenter study was carried out in 6 Italian cities (Cassino, Chieti, Naples, Rome, Siena, Turin) in order to highlight differences in Web use to find out health information and its related consequences on behavioral choices and to describe the distribution of the phenomenon in Italy. Data were collected from October 2009 to September 2010 on a sample of volunteers recruited from laboratory analysis, with face-to-face interview, including information about socio-demographic, health, and Web use to health. Data analysis shows that e-health use is greater in Northern Italy, in women aged 30-41 years, in chronic patients and those who have been caught up medical malpractice. Behavioral changes are associated with the Region; in particular Rome and Cassino show to choose/change professionals and facilities, engaging in alternative therapies and buy drugs online more frequently. Living in Southern Italy, a lower educational level and the infrequent drugs use are associated with a greater probability of incurring in negative behaviors. Positive results on the behavior are instead low and not significant. Given the regional differences, the potentiality and the risks of e-health use, it will be important to identify strategies for risks containment and implementation of the web in prevention.

The dynamical mass of a classical Cepheid variable star in an eclipsing binary system.

Stellar pulsation theory provides a means of determining the masses of pulsating classical Cepheid supergiants-it is the pulsation that causes their luminosity to vary. Such pulsational masses are found to be smaller than the masses derived from stellar evolution theory: this is the Cepheid mass discrepancy problem, for which a solution is missing. An independent, accurate dynamical mass determination for a classical Cepheid variable star (as opposed to type-II Cepheids, low-mass stars with a very different evolutionary history) in a binary system is needed in order to determine which is correct. The accuracy of previous efforts to establish a dynamical Cepheid mass from Galactic single-lined non-eclipsing binaries was typically about 15-30% (refs 6, 7), which is not good enough to resolve the mass discrepancy problem. In spite of many observational efforts, no firm detection of a classical Cepheid in an eclipsing double-lined binary has hitherto been reported. Here we report the discovery of a classical Cepheid in a well detached, double-lined eclipsing binary in the Large Magellanic Cloud. We determine the mass to a precision of 1% and show that it agrees with its pulsation mass, providing strong evidence that pulsation theory correctly and precisely predicts the masses of classical Cepheids.

[Organization analysis and health technology assessment: an experiment in San Giovanni Battista University Hospital-Turin]. / Analisi organizzativa e health technology assessment: un progetto sperimentale presso l'Azienda Ospedaliero Universitaria san Giovanni Battista di Torino.

Recent Italian laws emphasise Clinical Governance model as a priority for hospitals and Health Technology Assessment as one of the major tools in order to support local and hospital decisions as far as new health technologies are concerned. Our reported experience suggests managing solutions and appraises clinical issues in terms of effectiveness, efficiency and security of new and emerging technologies in order to plan and to create a system according to up to date Health Technology Assessment principles in San Giovanni Battista University Hospital-Turin. Mini-HTA reports have been realised on "Technology Intelligence" in prostate cancer treatment, percutaneous implantation of aortic valve prosthesis in high-risk patients with aortic valve disease and experimental Home Radiology project. In addition, 1167 health technologies have been evaluated through a database created ad hoc. 65% of the evaluations have been positive, less than 5% negative and the other 30% have been suspended waiting for deeper assessments. The future perspectives predict the realization of further Mini-HTA reports even through a revision of the managing model used.

[A method to determine hospital costs associated with nosocomial infections]. / Una metodologia di determinazione dei costi delle infezioni nosocomiali.

Several studies on the economic aspect of HAI have two major limitations: (1) the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and (2) the lack of an adequate method for calculating the relative costs. The aim of the study was to test a cost modelling method that could overcome these limitations by applying Appropriateness Evaluation Protocol (AEP) to the medical charts and by using cost-centre accounting. Two types of HAI were chosen: UTI and sepsis. The data analysis showed that using this system the extra-length of stay can be cut down to nil in General Surgery and Intensive Care for sepsis and in Intensive Care for the UTI. Moreover it becomes clear that the weight of the cost for the bed, or for the diagnostic services, or again for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized. Comparing cost of HAI calculated on the basis of the main total cost per day of hospitalization attributable to the HAI we have finally seen that some cases do not produce any costs, whereas others account costs due not to HAI (operating room) or more expensive costs than the really HAl-treatment-attributable ones, as sepsis in Urology ward (Euro 988.18 versus Euro 747.41) or UTI in General Surgery ward (Euro 603.77 versus Euro 479.30), in Neurology (Euro 4242.91 versus Euro 2278.48) and in Orthopedics (Euro 2328.99 versus Euro 1332.81).

A model for calculating costs of hospital-acquired infections: an Italian experience.

PURPOSE: Many approaches on the economic aspect of hospital acquired infections (HAIs) have two major limitations: first, the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and second, the lack of an adequate method for calculating the relative costs. These assume that the resources used by HAI can be determined by measuring the extra days of length of days (LOS) of infected patients versus non-infected patients and attribute to extra-LOS a value to the mean total cost. The aim of the article is to test a cost-modelling method that could overcome these limitations by applying the appropriateness evaluation protocol to the medical charts of patients with hospital-acquired symptomatic urinary tract infection (UTI) or sepsis, and by using cost-centre accounting. DESIGN/METHODOLOGY/APPROACH: The paper explains and tests a model for calculating costs of HAIs. FINDINGS: The data analysis showed that it is not always true that infections protract LOS: five out of 25 sepsis cases have extra-LOS and eight out of 25 UTI cases have extra-LOS, while the cases of sepsis that arose in surgery ward and intensive care units and urinary tract infections in ICU are without prolongation of LOS. The data analysis also showed that, using the mean total cost, the three cases of sepsis in the general surgery and the six in the ICU did not incur costs, nor did the two cases of UTI in ICU, so that they appear to be infections at zero cost. Moreover, the weight of the cost for the bed, or for the diagnostic services, or for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized. ORIGINALITY/VALUE: The method can be applied in any hospital.

[The role of social and demographic variables in the treatment of cardiovascular diseases. The experience of "Azienda Ospedaliera San Giovanni Battista di Torino"]. / L'influenza delle variabili socio-demografiche nel trattamento delle patologie cardiovascolari. L'esperienza dell'azienda Ospedaliera San Giovanni Battista di Torino.

Health resources rationalization needs a carefull control on appropriateness and equity safeguard. For some diseases (f.i. acute cardiovascular diseases) the delivery of effective but resources consuming treatment could be influenced by socio-demographic variables. Aim of this work is to evaluate the effects of age and gender on the course of supplying effective treatments. 386 clinical records (among the 4317 eligible) have been randomized and analized using a protocol designed ad hoc on former international experiences basis. Diagnostic interventions are not statistically related to patient's age and gender but the major use of therapeutic interventions analized (CABG, PTCA, AVR, trombolisis) in younger patients is consistent with their more healthy general conditions even if the 'conservativE behavior of physicians in oldest patients don't seem to be based on EB procedures or specific Guidelines.

Direct detection of a microlens in the Milky Way.

The nature of dark matter remains mysterious, with luminous material accounting for at most approximately 25 per cent of the baryons in the Universe. We accordingly undertook a survey looking for the microlensing of stars in the Large Magellanic Cloud (LMC) to determine the fraction of Galactic dark matter contained in massive compact halo objects (MACHOs). The presence of the dark matter would be revealed by gravitational lensing of the light from an LMC star as the foreground dark matter moves across the line of sight. The duration of the lensing event is the key observable parameter, but gives non-unique solutions when attempting to estimate the mass, distance and transverse velocity of the lens. The survey results to date indicate that between 8 and 50 per cent of the baryonic mass of the Galactic halo is in the form of MACHOs (ref. 3), but removing the degeneracy by identifying a lensing object would tighten the constraints on the mass in MACHOs. Here we report a direct image of a microlens, revealing it to be a nearby low-mass star in the disk of the Milky Way. This is consistent with the expected frequency of nearby stars acting as lenses, and demonstrates a direct determination of a lens mass from a microlensing event. Complete solutions such as this for halo microlensing events will probe directly the nature of the MACHOs.

Solid state NMR study of sodium thiocyanate/poly(ethylene oxide) electrolytes.

1H-, 13C-, 23Na-solid state NMR measurements have been used to characterise the morphology and the dynamics of several NaSCN-PEO mixtures. Selective 13C-MAS experiments allowed to determine the composition of the (PEO)nNaSCN samples in terms of the different phases present, as well as the real stoichiometry of the crystalline complex. 1H- and 13C-spin-lattice relaxation times provided estimates of the dimensions of the different domains and gave information on the dynamics of the polymer chains. 23Na-MAS spectra and 2D nutation experiments allowed to individuate the presence of different environments for the sodium cations on the basis of their quadrupolar interactions.

Anti-tumor properties of the organometallic complex cis-dimethylbis[sulfinylbis[methane]-S]platinum(II).

The water-soluble organometallic complex cis-[Pt(Me)2(Me2SO)2] (Me = methyl; Me2SO = dimethyl sulfoxide) (cis-dimethyl platinum(II); CDMP) was evaluated for its toxicity on the rat and for its efficacy against two tumors of this animal: the Yoshida ascites sarcoma and the T8 sarcoma of Guérin. The lethal dose for 50% of normal animals was 46.4 mg/kg; the predominant toxic effects were loss of weight, decrease in leukocytes and necrosis of the kidneys after i.v. or of the liver after i.p. administration. Doses of drug varying from 2 to 40 mg/kg were administered once by i.p., i.v., i.m. and intra-tumor (i.t.) route from 1 to 7 days after i.p. injection of 10(6) Yoshida ascites sarcoma cells and s.c. implantation of approximately 300 mg of T8 sarcoma of Guérin. The compound showed anti-tumor activity increasing both the average life span and survival of the rats. A comparison between the therapeutic properties of the title complex with those of cis-[PtCl2(NH3)2] (CDDP) reveals that cis-dimethyl platinum(II) exhibits the same anti-tumor activity associated with 6 times reduced toxicity.