Emergency Medical Service Information System:the ARES 118 experience.

BACKGROUND: In this paper we describe ARES 118, the prehospital Emergency Medical Service of the Region Lazio, Italy, focusing on its data system used to populate a data warehouse and to create ad hoc reports. ARES 118 is a regional public mono-specialized health company, established in 2004, that manages the emergency care throughout the Region Lazio. METHODS: Being a peculiar company in its kind, and being the first experience of this kind in Italy, ARES 118 has begun to equip itself, in an autonomous way, with a corporate information system, starting from what already existed as data collection from the individual provincial operating Centers and then by activating a unique information system at a regional and company level by deploying a data warehouse. All operations were carried out using open source software. RESULTS: Currently, ARES 118 is equipped with a business information system that enables data collection with its storage, management and processing of the same in fairly and easy way. The system allows the production of specific reports and measures modulated on the user requests in order to highlight the different aspects of the activity. CONCLUSIONS: The production of ad hoc reports, with the possibility of developing specific indicators, allows the identification and analysis of critical areas/processes in order to implement any corrective actions and monitor the effectiveness of the sam.

[Risk management in therapeutic procedures: the integrated flowsheet. Experience in a CQI context]. / La gestione del rischio nel processo terapeutico: la scheda di terapia integrata. Una esperienza in un'ottica di miglioramento continuo della qualità (MCQ).

UNLABELLED: Medication errors are an important problem in healthcare organizations. The Health Ministry and other government bodies have advised personnel directly involved in the care process as well as hospital management to adopt methods to prevent clinical risk. For this reason, the Sant'Andrea hospital of Rome , after analyzing the problem , decided to resolve it by introducing some corrective measures such as the integrated medication flowsheet. GOALS: To integrate the competence and knowledge necessary to fulfill patients' needs while safeguarding the different professional areas; to obtain better standards of quality , safety and patient satisfaction while enhancing job satisfaction and integration in all the professionals of the équipe.

Evaluation of a western blot serum test for the diagnosis of Mycobacterium tuberculosis infection.

This study was designed to evaluate the possibility of monitoring Mycobacterium tuberculosis infection using a serological assay. A discriminant score comprising antigen fractions of 38, 28, 24 and 19 kDa, identified in western blots using the Mycobacterium bovis bacille Calmette-Guérin (BCG) A60 antigen complex was established in a sample of 57 purified protein derivative (PPD)-negative and 47 PPD-positive individuals. It was then tested in a group of 140 subjects undergoing BCG vaccination as a model of tuberculosis complex infection and in a group of human immunodeficiency virus (HIV)-infected individuals as a model of cell-mediated immunodeficiency-related risk of tuberculosis. The discriminant score identified 57 out of 57 (100%) PPD-positives and none (0%) of the 47 PPD-negatives. In the BCG vaccinated subjects, 1.4% tested positive before vaccination and 90% after vaccination. In the HIV-positive subjects, 90% of the PPD-positive and 5% of the PPD-negative subjects had a positive score. This study suggests that the western blot discriminant score is an accurate test to survey M. tuberculosis infection in serum samples.

Immunogenicity and safety of a recombinant hepatitis B vaccine produced in mammalian cells and containing the S and the preS2.

A group of 273 health care workers, at risk of HBV infection, underwent vaccination with recombinant HBsAg produced in mammalian cells and containing protein sequences coded by both the S and pre-S2 regions (Genhevac B). Preliminary results show that a very early pre-S2 response occurred which may be useful in post-exposure prophylaxis. This observation, in addition to reduced influence by the vaccination protocol, provides grounds for optimism in spite of the fact that the efficiency spectrum of this vaccine was not superior to that of recombinant vaccines produced in yeast.

Development of a cell with dendritic morphology from a precursor of B lymphocyte lineage.

Cells developing dendritic morphology were detected in cultures of highly purified human B cells incubated with 4 beta-phorbol 12-myristate 13-acetate (PMA). After 72 hr of culture, 2 to 7% of the cells had assumed a dendritic shape provided that contact with a plastic or glass surface also occurred. Dendritic cells developed in cultures of B cells prepared by positively selecting cells that stained with the B cell-specific monoclonal antibody B1 with the fluorescence-activated cell sorter. By contrast, dendritic cells could not be detected in cultures of cells obtained from patients with Bruton's type agammaglobulinemia that lacked B cells. Cells with dendritic morphology were nonspecific esterase negative and not phagocytic. They expressed HLA-DR, DQ, and DP antigens, receptors for interleukin 2 and transferrin, and were stained by B1 and 60.3, an antibody that identifies the beta-chain common to lymphocyte function associated antigen-1, complement receptor 3, and the p150,95 antigen, but not by monoclonal antibodies to monocytes, complement receptors 2 or 3, NK cells, T cells, or Langerhans' cells. Formation of dendritic cells was inhibited by microtubule poisons (vinblastine, colchicine), a microfilament inhibitor (cytochalasin B), and the 60.3 monoclonal antibody, but not by inhibition of DNA synthesis. These data indicate that a subset of B cells is capable of assuming dendritic morphology after stimulation with phorbol esters and attachment to a surface. These dendritic cells exhibit characteristics that are quite similar to the interdigitating cells found in T cell-dependent areas of lymph nodes.