[Risk of anxiety and depression in nursing students in Rome (Italy)]. / Il rischio di ansia/depressionenegli studenti infermieri è elevato.

The aim of this study was to evaluate the risk of anxiety and depression among student nurses. If not recognized, this risk can adversely affect student health and learning and the quality of patient care. The study was performed through administration of the twelve-item General Health Questionnaire (GHQ-12) to nursing students attending two universities in Rome (Italy). Forty-seven percent of students attending University A and 38% attending University B were found to be at risk. The risk of anxiety and depression was found to be higher in females with respect to males. In both universities, a higher risk was found in those students who were dissatisfied with their academic grades (University A: p £ 0.001, University B: p = 0.03), or with their family's economic situation (A and B £ p = 0.001), and in those who reported stressful events (A: p = 0.036; B: p = 0.02). Regardless of the university, what emerges is a picture of fragile students with female students showing a greater fragility.

[Satisfaction and critical aspects of inpatients care among patients with psoriasis]. / Soddisfazione e criticità nella gestione del paziente ricoverato affetto da psoriasi.

OBJECTIVES: To evaluate satisfaction with care for psoriatic inpatients. Identify areas in need of interventions and actions to improve the satisfaction with care. METHODS: We analyzed 133 patients with psoriasis and 335 patients affected by other dermatological diseases in their first access at the hospital. Six determinants of satisfaction with care were investigated with a self administered questionnaire. Moreover the overall satisfaction was documented. Descriptive analysis and a multiple logistic regression analysis correcting for confounding factors were performed. Focus groups were conducted with patients to further investigate about specific aspects of relationships between patients and personnel. RESULTS: Psoriatic inpatients were less satisfied than other dermatological inpatients regarding Coordination of care, Information and education, Emotional support. Emotional support was the determinant with the smallest percentage of satisfied patients. Focus groups confirmed what was identified with the questionnaire and suggested necessary interventions. CONCLUSIONS: It is necessary to improve the communication skills of health personnel. Information for patients need to be enhanced and the management of psoriatic patients has to be improved.

[Accreditation of hospital and local health unit management]. / L'accreditamento delle Direzioni Sanitarie di presidî ospedalieri e territoriali.

The authors state that an authoritative Clinical Director of a General Hospital, an active and efficient leadership of a Public Health District or Local Health Unit are very important to allow Italian Health Care System to cope with present and future challenges. The medical management must be professionally specialistic and be object of accreditation. This must be the target of professional training so that Medical Management Staff can have the necessary competence to carry complex management activities correctly out.

[Characteristics of voluntarily discharged patients: some reflections and a proposal]. / Caratteristiche dei pazienti con dimissione volontaria dall'ospedale: alcune riflessioni ed una proposta.

This study compares the characteristics of 492 patients discharged against medical advice from the Istituto Dermopatico dell'Immacolata, a Research Hospital (335 beds) in Rome specialized in Dermatology, Vascular Surgery and Plastic Surgery between 1995 and 1998, with those of 43,110 control patients discharged with physicians' approval according to a case-control model. In the multivariate analysis, male gender (OR 1.65; 95% CI 1.37-1.98) and residence in Rome area (OR 1.22; 95% CI 1.02-1.47) increased the odds of discharge against medical advice. The odds of such discharge decreased with increasing age (OR 0.994 per year; 95% CI 0.990-0.999). The proportion of patients discharged against medical advice decreased from 1.4% in 1995 to 0.4% in 1998. The average length of stay decreased from 1995 to 1998, with the exception of the Plastic Surgery unit. A retrospective review of the charts of 45 patients discharged against medical advice (AMA) within 48 hours from admission ascertained some of the stated reasons for discharge. Personal and family problems or refusal of treatment were reported for 35% of the patients. Of the 25 patients who gave no reasons, 11 asked again for hospitalization and 5 of these were rehospitalized by IDI within 10 days. This study also identified that the information on the medical record of patients who left against medical advice was generally poor. A standardized form for AMA discharges, including patient's understanding of the diagnosis, treatment, alternative therapies, consequences of refusing treatment and stated reasons for leaving against medical advice, might be of benefit to patients, physicians and hospital managers.

Continuous training as a key to increase the accuracy of administrative data.

The aim of this study was to evaluate the impact of a program of training, education and awareness on the accuracy of the data collected from hospital discharge abstracts. Four random samples of hospital discharge abstracts relating to four different periods were studied. The evaluation of the impact of systematic training and education activities was performed by checking the quality of abstracting information from the medical records. The analysis was carried out at the Istituto Dermopatico dell'Immacolata, a research hospital (335 beds) in Rome, Italy, which specializes in dermatology, plastic and vascular surgery. Error rates in discharge abstracts were subdivided into six categories: selection of the wrong principal diagnosis (type A); low specificity of the principal diagnosis (type B); incomplete reporting of secondary diagnoses (type C); selection of the wrong principal procedure (type D); low specificity of the principal procedure (type E); incomplete reporting of procedures (type F). A specific rate for errors modifying classification in diagnosis related groups (DRG) was then estimated and the effect of re-abstracting on the case-mix index evaluated. Error types A, B, C, E and F dropped from 8.5% to 2%, 15.8 to 4.9, 31.8 to 13.1,4.1 to 0.3 and 22 to 2.6%, respectively. Error type D was 0.7 both in the first (the baseline) and fourth periods of analysis. All differences in error types were statistically significant. In 1999 8.3% of cases were assigned to a different DRG after re-abstracting as compared with 24.3% in the third quarter of 1994, 23.8% in the first quarter of 1995 and 5.5% in September-October 1997. Continuous training and feedback of information to departments have shown to be successful in improving the quality of abstracting information at patient level from the medical record. These positive results were facilitated by the introduction of a prospective payment system to finance inpatient hospital activity. The effort to increase administrative data quality at hospital level facilitates the use of those data sets for internal quality management activities.

The quality of abstracting medical information from the medical record: the impact of training programmes.

OBJECTIVE: To evaluate the impact of a programme of training, education and awareness on the quality of the data collected through discharge abstracts. STUDY DESIGN: Three random samples of hospital discharge abstracts relating to three different periods were studied. Quality control to evaluate the impact of systematic training and education activities was performed by checking the quality of abstracting medical records. SETTING: The study was carried out at the Istituto Dermopatico dell'Immacolata, a research hospital in Rome, Italy; it has 335 beds specializing in dermatology and vascular surgery. MEASURES: Error rates in discharge abstracts were subdivided into six categories: wrong selection of the principal diagnosis (type A); low specificity of the principal diagnosis (type B); incomplete reporting of secondary diagnoses (type C); wrong selection of the principal procedure (type D); low specificity of the principal procedure (type E); incomplete reporting of procedures (type F). A specific rate of errors modifying classification in diagnosis related groups was then estimated. RESULTS: Error types A, B and F dropped from 8.5% to 1.3%, from 15.8% to 1.6% and from 22% to 2.6% respectively. Error type D and E were zero in the third period of analysis (September-October 1997) compared with a rate of 0.7% and 4.1% in the third quarter of 1994. Error type C showed a slight decrease from 31.8% in 1994 to 27.2% in 1997. All differences in error types except incomplete reporting of secondary diagnoses were statistically significant. Five and a half per cent of cases were assigned to a different diagnoses related group after re-abstracting in 1997 as compared to 24.3% in the third quarter of 1994 and 23.8% in the first quarter of 1995. DISCUSSION: Training and continuous monitoring, and feedback of information to departments have proved to be successful in improving the quality of abstracting information at patient level from the medical record. The effort to increase administrative data quality at hospital level will facilitate the use of those data sets for internal quality management activities and for population-based quality of care studies.

Psychological aspects of rheumatoid arthritis vis-à-vis osteoarthrosis.

Using objective techniques (M.M.P.I; M.H.P.A.; ANAM; S.T.A.I.), a transverse investigation of two groups of arthritic patients (35 rheumatoid arthritis and 30 oesteoarthrosis) was carried out. The Rheumatoid Arthritis (RA) patients evidence greater depression (p less than 0.02), while the osteoarthrosis (OA) patients had higher levels of manifest aggressivity (p less than 0.01) and more somatic preoccupation (p less than 0.02). The RA group had a higher incidence of loss of a family member as a preceding life event (p less than 0.05), and a greater incidence of psychopathological problems in infancy (p less than 0.05). These findings were used to construct an interpretative hypothetical model which represents a starting point and a stimulus for future research.