Analysis and improvement of organizational models for the management of patients with type 2 diabetes mellitus: a case study in north-east Italy.

PURPOSE: The study aimed to establish whether the organization for the management of type 2 diabetes mellitus at 9 diabetic units (DUs), in 5 neighboring local health authorities (LHAs), was able to (a) comply with the organizational model prescribed by specific regional standards; (b) ensure adequate clinical management of diabetic patients; (c) assess whether the relationship between primary care physicians (PCPs) and diabetologists (SDs) was instrumental to the needs of patients; (d) optimize specialist treatment at the DUs; (e) optimize drug management; and (f) check whether organizational changes led to variations in clinical results. METHODS: This 6-stage study analyzed procedures, precoded actions, and recordable processes. Stage (1) Defining clinical and organizational endpoints; (2) Drafting flowcharts to describe the actions and work procedures implemented within each LHA; (3) Comparing the flowcharts with the data obtained from related literature; (4) Establishing a protocol shared with PCPs for the management and treatment of patients with type 2 diabetes; (5) Changing the procedures at the DUs; and (6) Evaluating the results. The data were assessed before and after establishing a shared protocol for SDs and PCPs (year 2009 vs 2011). RESULTS: The study shows inconsistencies in the organization of work in the 5 LHAs; however, collaboration with PCPs has guaranteed: (a) unchanged hemoglobin A1C values before and after applying the protocol; (b) a percentage increase in the number of patients with type 2 diabetes who were identified thanks to these protocols; (c) an increase in the use of biguanides compared to the preprotocol period; and (d) no change in the number of patients hospitalized because of acute complications from type 2 diabetes mellitus. CONCLUSIONS: This study confirms how adequate collaboration between SDs and PCPs keeps the risk of complications stable. Nevertheless, shared protocols and clearly defined roles are required.

[Prevalence of erosive osteoarthritis of the hand in a population from Venetian area]. / Prevalenza dell'artrosi erosiva delle mani. Studio in una popolazione del Veneto.

OBJECTIVES: The exact prevalence of erosive osteoarthritis (EOA) is still unknown. Aim of our study was therefore to evaluate the prevalence of osteoarthritis (OA) and EOA of the hand in a representative population from Venetian area. METHODS: All people aged > 40 years of a small town in Venetian area has been considered. A complete clinical evaluation has been performed in all subjects. For those patients with clinical signs or symptoms of OA, radiographic evaluation of the hands has been carried out. RESULTS: The entire population aged >40 years living in Silea entered the study. Signs or symptoms of OA were present in 200 out 640 subjects (31.2%), whereas EOA was diagnosed in 17 (8.5%) all female, mean age 57.5 +/-10.1 years (range 41-74) mean disease duration 5.1 +/-3.8 years (range 1-15). The most frequently involved joint was the second DIP of the right hand. CONCLUSION: The prevalence of EOA in the Venetian area seems to be around 8.5%.

[Prevalence of antibodies against hepatitis C virus in rheumatoid arthritis. Study using second-generation tests]. / Prevalenza degli anticorpi anti-virus C dell'epatite nell'artrite reumatoide. Studio mediante i test di seconda generazione.

In order to evaluate the seroprevalence of anti-hepatitis C virus (HCV) antibody in rheumatoid arthritis (RA), where a high prevalence of false-positive anti-HCV reactions is reported, we studied 79 patients affected with RA. In these subjects we recorded some clinical and anamnestic data (history of blood transfusion, risk factors of liver disease, therapy) and determined, besides a few routine laboratory parameters including rheumatoid factor (RF), AST and ALT, the anti-HCV serology using the 1st (EIA, Ortho and Abbott; Neutralization test, Abbott; RIBA, Chiron-Ortho) and the 2nd generation tests (EIA, Ortho; RIBA, Chiron-Ortho). Four patients (of whom three were RF seronegative) were anti-HCV reactive by the 1st generation EIA tests (5.1%). According to the results of the confirmatory tests, and particularly of the 2nd generation, two patients resulted infected by HCV. These results do not confirm the previously reported high prevalence of false-positive anti-HCV reactions in RA, and demonstrated the usefulness of the 2nd generation tests in diagnosing the HCV infection.

Anti-thyroid microsomal antibody in synovial fluid as a revealing feature of seronegative autoimmune thyroiditis.

Two cases of recurrent monoarthritis are described in which antithyroid microsomal (antiMi) autoantibody (Ab) was found in synovial fluid (SF) before any clinical or serological evidence of thyroid disease. Subsequently, the follow-up of the two patients showed the appearance of thyroiditis within 2-5 years. The presence of anti-Mi Ab in SF might anticipate the appearance of autoimmune thyroiditis even in the absence of serum detectable antithyroid Ab, as was later observed in these two cases.

The influence of intra-articular hyaluronic acid on PGE2 and cAMP of synovial fluid.

Prostaglandin (PG)E2, cyclic adenosine monophosphate (cAMP), white blood cells (WBC), total protein (TP), total complement activity (CH50) and beta-2-microglobulin (beta-2-m) were measured at baseline and after eight days in the synovial fluid (SF) of 16 patients affected with knee-joint effusion due to various arthropathies. The volume of SF was also calculated. Eight patients--4 with rheumatoid arthritis (RA), 2 with recurrent monoarthritis (RM) and 2 with osteoarthritis (OA) were randomly allocated to the treatment with intra-articular injection of Hyalgan (HA, Na-hyaluronate, 20 mg/2 ml), while eight patients having similar arthropathies--4 RA, 2 RM and 2 OA--were not treated (control group). In the patients treated with HA a significant reduction of SF volume (from 28.5 +/- 5.1 ml to 20.5 +/- 4.0 ml; p less than 0.02) and PGE2 (from 96.1 +/- 22.7 pg/ml to 66.2 +/- 14.5 pg/ml; p less than 0.05) was found, whereas cAMP concentration was significantly increased (from 4.5 +/- 0.7 pmol/ml to 7.2 +/- 1.2 pmol/ml; p less than 0.05). No significant variations were observed in the control group. Moreover, no differences in WBC count, TP and beta-2-m and CH50 were found in either group. These data could suggest an anti-inflammatory effect of HA that appears to be mediated by PG-inhibition as well as cAMP stimulation.