A new model of multidimensional discharge planning: continuity of care for frail and complex inpatients.

OBJECTIVE: Delays in patient discharge can adversely affect hospital and emergency room productivity and increase healthcare costs. The discharge should be structured from the hospital admission towards the most appropriate environment. This study aims to investigate the efficacy of the Unit, named "Continuity of Care Center" (CCC), to guarantee a safest and fastest hospital discharge in frail patients and to test the effect of our team-approach on hospital outcomes (length of stay and hospital mortality). MATERIALS AND METHODS: This is a prospective cohort study carried out in an acute care hospital with 1,558 beds and is equipped with 41 operating theaters. We collected data from October 2016 to June 2019. RESULTS: The time of patient discharge had an important reduction: 15.5±30.8 in the first 3 months vs. 11.0±20.1 in the last 3 months considered. The median of the time of discharge in all 12 months considered was 12 day. The length of stay presented an important reduction from 33.3±47.5 during the first 3 months vs. 28.8±39.5 in the last 3 months of activity of CCC; and a significant reduction of hospital deaths was recorded from 20% during the first 3 months to 14% in the last 3 months of activity of CCC. CONCLUSIONS: Results indicate a constant decrease in patient discharge time and length of hospital stay, with a consequent significant reduction of healthcare costs. According to the estimates of Italian Health Ministry concerning Latium region, every hospitalization day has a mean cost of € 674.00. Thus, the CCC activity has contributed to a reduction of approximately 12,832 days of hospitalization, in the considered period, with an estimated hospital saving of € 8,648,761.

[The risk of vibrations to the hand-arm system and cumulative trauma disorders in shoe manufacturing: a clinical case report]. / Rischio da vibrazioni al sistema mano-braccio e cumulative trauma disorders nel settore calzaturiero: descrizione di un caso clinico.

The article reports the case of a woman working in a shoe factory who had been using vibrating tools for 5 years. Because of paresthesia in her left hand, in 1989 she underwent various diagnostic trials that revealed an initial carpal tunnel syndrome of the left wrist and a homolateral epicondylitis. Measurement of the vibrations transmitted to the hand from the vibrating tool confirmed the probability of a high risk of exposure for the hand-arm system. Such adverse effects have been described by British authors as "cumulative trauma disorders" and were confirmed in this study. The importance of further studies aimed at estimating the type and degree of exposure to vibrations in shoe manufacturing workers is stressed.

Burkitt-like lymphoid malignancy presenting as a breast tumor.

The authors describe a case of a female patient, who presented with a rapidly expanding mass of the right breast as the first clinical sign of a Burkitt-like lymphoproliferative disorder. Massive bone marrow infiltration with leukemic spillover and limited lymph node involvement were subsequently detected. The difficulties encountered in classifying, according to current schemes, the observed lymphoid neoplasm are emphasized. Moreover, an evaluation of the true rarity of mammary localizations at the onset of lymphoid malignancies, based on a review of the literature, suggests, especially for the most malignant varieties, a higher frequency than supposed.

Bone marrow necrosis: an unusual presenting feature of small cell lung carcinoma.

The authors describe a case of bone-marrow necrosis which represented the initial clinical feature of a "small cell" lung carcinoma with bone metastases.