Effectiveness of an hospital bed management model: results of four years of follow-up.

BACKGROUND: Several experiences of Bed Management have been published, most of them focusing on Emergency Department organization. Aosta Hospital is 70 km away from the nearest Hospital, so that ambulance diversion is not feasible and patients' admissions from ED need to be managed at the local level solely. Aim of this study was to test efficacy of an innovative Bed Management model. SETTING AND METHODS: Bed Management procedure consisted of an algorithm of both rational outward allocation of patients and support to "difficult" discharges. Hospital indicators of the pre-intervention period (years 2008-2011) were compared with those of the post-intervention period (years 2012-2015), splitting data into ten medical wards mostly admitting patients form ED and seven surgery wards mostly admitting "planned" patients. RESULTS: In the before-after analysis, mean length of stay decreases from 7.84 to 7.41 days (p= 0.000), and bed occupancy from 81% to 77%. Outlier days fell from 6.3% to 5.4% (p= 0.000), and the same did long stay patients (from 5.8% to 5%, p = 0.000). By contrast, ED admissions increased from 16.5% to 17.8%, as very short stays (23.9 to 25.3%, p= 0.000) and the 30 days unplanned readmissions (9.9% to 11.9%, p =0.000). The observed variations were more significant in the medical wards. Finally, waiting times in ED significantly decreased during the study period in the medical wards. CONCLUSIONS: We propose a comprehensive BM model, including governance of difficult discharges within a general hospital perspective. Further organization research on Bed Management is needed, also to propose BM standards, to be adopted in any Hospital.

Octreoscan perspectives in sarcoidosis and idiopathic interstitial pneumonia.

STUDY OBJECTIVES: Clinical, radiological, and serological tests have been proven to be unsatisfactory as markers of activity in sarcoidosis and idiopathic interstitial pneumonia (IIP). We investigated 111In-Octreotide (Octreoscan) scintigraphy as a tool for classifying and assessing disease activity in sarcoidosis and IIP, in comparison of the radiological imaging and dyspnea symptom scores. PATIENTS: Thirty-three patients (pts) of which 16 with sarcoidosis (mean age 43.6, range 30-58 years) and 17 with histologically diagnosed IIP (mean age 62.2, range 35-79 years), were enrolled in the study. Clinical history was taken as well as, physical examination, chest X-ray and pulmonary function tests were assessed. A high-resolution computed tomography scan (HRCT) was carried out in-patients affected by sarcoidosis, who had a normal chest X-ray, and in IIP patients. Both groups were evaluated with the Octreoscan uptake index (U.I.; normal value: < or = 10). RESULTS: In patients affected with sarcoidosis, the Octreoscan U.I. was significantly higher than in patients with IIP (16.35 +/- 3.1 and 10.06 +/- 0.8, respectively; p < 0.01) and was correlated with the radiographic staging (p < 0.01) and with the degree of dyspnea (p < 0.01). In-patients with IIP the Octreoscan uptake index was slightly above the normal limit (range 10.3-11.7) in non-specific interstitial pneumonia (NSIP) and desquamative interstitial pneumonia (DIP), whereas in usual interstitial pneumonia (UIP) Octreoscan uptake index was always within normal limit (< or = 10 U.I.). A negative correlation was observed with histological findings (p < 0.01) and with HRCT appearance (p < 0.01). CONCLUSIONS: Octreoscan U.I. is correlated with the degree of dyspnea in patients affected by sarcoidosis and can quantify more accurately the degree of pulmonary involvement, as compared to radiological assessment. Further studies are necessary to evaluate Octreoscan as an early test for predicting disease progression. Octreoscan U.I. could be helpful in monitoring IIP in specific histological subsets (NSIP and DIP) and substitute HRCT in the assessment of UIP for its excellent accuracy.

[The effect on breastfeeding rate of regional anesthesia technique for cesarean and vaginal childbirth]. / Influenza sulla frequenza di allattamento al seno delle tecniche di anestesia regionale nel parto cesareo e nel parto per via vaginale.

BACKGROUND: To evaluate the influence of regional techniques of anesthesia and analgesia on breastfeeding rate after cesarean section and vaginal delivery. STUDY DESIGN: prospective, area-based. SETTING: Obstetrics and Pediatrics Department at Aosta Valley Regional Hospital. SUBJECTS: all the mothers and their newborns during a three-year period (1993-1995). Maternal wish to breastfeed was the main inclusion criterion. Data recorded: feeding modality at discharge, anesthesia and analgesia modality, maternal/neonatal socio-demographic and clinical data. RESULTS: 2725 records were examined, among them 1920 vaginal deliveries and 355 cesarean sections were statistically analyzed. chi 2 analysis showed a significant greater incidence of breastfeeding after cesarean section under regional anesthesia (spinal or epidural) versus general anesthesia: 95% vs 85.5%, p = 0.002. Breastfeeding rate was not different after vaginal delivery with epidural analgesia versus delivery without analgesia: 96.5% vs 97.8%. Logistic regression confirmed the positive role of regional anesthesia and few other maternal and neonatal variables on breastfeeding rate after cesarean section. CONCLUSIONS: Regional anesthesia seems to be advantageous for breastfeeding after cesarean section, probably because of a faster neonatal-maternal bonding if compared with general anesthesia. Epidural analgesia for vaginal delivery does not adversely affects breastfeeding if compared with delivery without analgesia.

[Treatment using immucytal in children with recurrent respiratory infections: an Italian multicenter experience]. / Terapia con immucytal di bambini affetti da infezioni respiratorie recidivanti: esperienza Italiana policentrica.

120 children, 71 male and 49 female, aged between 2 years and 15 years (mean 6.15 +/- 3.52 years) with recurrent respiratory infections, were treated with Immucytal, an immunomodulator of bacterial origin, based on membrane proteoglycan fractions plus bacterial ribosomes. The children, selected on the basis of the previous year's clinical score, were treated according to a random design with either Immucytal or placebo, using the same dosage of one puff per nostril plus one puff in the oropharyngeal cavity three times a day, as follows: 1st month: two weeks' treatment, one week wash out, one week's treatment. 2nd, 3rd, 4th months: two weeks' treatment, two week's wash out. Monthly throughout the treatment period the frequency and severity of airway infections episodes were assessed using the same score as for admission. Blood chemistry test, immunological assays (circulating Ig, lymphocyte subpopulations, Merieux Multitest in vivo blastization test) and respiratory tests (spirometry using a pneumotachigraph) were done before and after the treatment. 118/120 children completed treatment; the two dropouts were in the placebo group, one for compliance and the other because of headaches. Respiratory symptoms improved significantly in the actively treated children already from the first month, but not in the placebo group. This improvement consisted of reduction of the respiratory infectious episodes in both the upper and lower airways. No changes were noted in respiratory function parameters. From the immunological viewpoint, there were significant rises in serum IgA and IgM and enhanced skin response tot he Multitest; there was no change in the percentages of different circulating lymphocyte subpopulations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Beta-thalassemia risk in the newborn of the Aosta Valley]. / Il rischio di beta-talassemia nei neonati in Valle d'Aosta.

We have studied the probability that the babies born in the Aosta Valley (North Italy) in 1983-84 were affected with minor and major thalassemia, basing our analysis on the ethnic origin of their grandparents, frequently immigrated from Mediterranean Areas. In a sample of 1599 cases, we have found that these frequencies were 2.16% and 0.025%, with a risk of about one homozygous genotype every 4000 live births. These values, similar to those founded in the industrialized north Italy towns, with the fact that marriages often occur in the same ethnic group, indicate the necessity of screening and prenatal diagnosis programs for thalassemia.

[Use of screening for amino acid disorders in the study of the nutrition of the newborn infant: various milk formulas and changes in plasma amino acids]. / Utilizzazione dello "screening" per le aminoacidopatie nello studio dell'alimentazione del neonato: formule lattee diverse e variazioni degli aminoacidi plasmatici.

A sample of 1326 new-born babies has been studied regarding the influence of the milk diet over some plasma-serum amino acids. The Authors have make use of the screening of the congenital errors of the protein metabolism. New-born babies were bled on the fifth or sixth day of life and their blood was analysed at first with the Guthrie test and then with automatic chromatographic determination. New-born babies have been arranged according to their gestational age, birth weight and intrauterine growth. More then 90% of the sample was formed by normal for gestational age new-born babies. We have make use of five different milk formulas: a mixed one (human milk with adapted milks), three powdered milks with three different casein-serum proteins ratio and finally cow's milk with 50% water. The best formula among these ones has been the human milk mixed with adapted milks. The completely artificial formulas, but with casein/serum proteins ratio lower or equal to one, has given rise to a few amino acid alterations, too. On the contrary, the cow's milk mixed with water and the artificial powdered milks with a casein-serum proteins ratio equal to 4.5 shouldn't be utilized in the new-born baby's diet, as they may provoke remarkable alteration in the amino acid metabolism.

[The newborn infant in the Aosta Valley: preliminary statistical analysis of various ethnic and geographic factors]. / Il neonato in Valle d'Aosta: analisi statistica preliminare su alcuni fattori etnico-geografici.

We have examined 976 new-born babies in Aosta Valley retrospectively, in order to determine which risk factors were significantly linked with the high incidence of: hospitalization and infants with below average neonatal and placental weight. The new-borns of native mothers have been compared with those of immigrant mothers, and also the new-borns of parents living in mountains have been compared with those of parents living in town. Results have shown new-born babies of native mother are at a disadvantage, especially regarding: the neonatal and placental average weight and the incidence of small for gestational age infants (SGA). No statistically significant difference has been found from the geographical point of view. Our results have stimulated a desire for deeper knowledge concerning the ethnical distribution of our neonatal sample and the maternal anamnesis before delivery: these are the two problems we are presently concerning ourselves with.