Evolution of risk management in health care system: survey on the adverse events occurred in Palermo University Hospital Policlinico "Paolo Giaccone".

Introduction: We aimed at carrying out a quantitative and qualitative analysis of claims for adverse events addressed to Palermo University Hospital Policlinico "Paolo Giaccone" in order to promote evidence-based interventions and increase patient safety. Methods: A retrospective study of 296 claims collected between 1st of January, 2014 and 31st of December, 2017 by Quality and Clinical Risk Management staff unit was performed along with descriptive analysis of any associated determinant factors. Results: The most frequent causes of claims consisted of wrong surgical procedures (33.8%), mistaken diagnoses (18.6%), falls (17.6%), infections (6.4%), postoperative complications (5.4%) and wrong therapies (3.1%). At the end of the survey, the judicial process was not concluded in the majority of cases (82.8%). Claims were closed by receipt payment in 12.2% of cases, without any payment in 5.1%. Conclusions: Clinical risk management plays a pivotal role in providing information and tools to prevent medical adverse events, avoid claims addressed to hospitals and improve the quality of health care.

Anisakis sensitization in different population groups and public health impact: A systematic review.

Anisakis simplex spp. sensitization rates have increased worldwide, with a significant impact on health-care systems. To date, no clear-cut diagnostic criteria and laboratory algorithm have been established, so anisakiasis still represents an under-reported health problem whose clinical manifestations, when present, mimic the much more common allergic and digestive disorders. Aim of the study was to systematically review the available literature on the prevalence of sensitization against Anisakis in the general population and in specific population groups, taking into account the impact of the different available diagnostic techniques on the epidemiological data. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant papers reporting Anisakis sensitization epidemiological data were found covering a period ranging from 1996 to February 2017. Overall, 41 studies comprising 31,701 participants from eleven countries were included in the qualitative synthesis. General asymptomatic population resulted sensitized to Anisakis in 0.4 to 27.4% of cases detected by means of indirect ELISA or ImmunoCAP specific IgE detection, and between 6.6% and 19.6% of the samples by Skin prick test (SPT). Occupationally exposed workers (fishermen, fishmongers and workers of fish-processing industries) documented specific IgE between 11.7% and 50% of cases, whereas SPT positivity ranged between 8% and 46.4%. Symptomatic allergic patients to any kind of allergen were found to be positive to Anisakis specific IgE detection between 0.0% (in children with mastocytosis) to 81.3% (among adults with shellfish allergy). Results highlighted that hypersensitivity prevalence estimates varied widely according to geographical area, characteristics of the population studied, diagnostic criteria and laboratory assays. Further studies are needed to overcome the documented misdiagnosis by improving the diagnostic approach and, consequently, providing more affordable estimates in order to address public health interventions on populations at high risk of exposure to Anisakis and to tailor health services related to specific groups.

Information sources and knowledge on vaccination in a population from southern Italy: The ESCULAPIO project.

Vaccine knowledge of the general population is shaped by different information sources and strongly influences vaccination attitudes and uptake. The CCM-Italian Ministry of Health ESCULAPIO project attempted to identify the role of such information sources, in order to address adequate strategies to improve information on vaccines and vaccine preventable diseases. In the present study, data on 632 adults from Southern Italy regarding information sources were collected, and their perceived and actual knowledge on vaccinations were compared and analyzed in relation to socio-demographic characteristics and information sources. The main reported reference sources were general practitioners (GPs) (42.5%) and pediatricians (33.1%), followed by mass media (24.1%) and the Internet (17.6%). A total of 45.4% reported they believed to be informed (45.4%), while those estimated to be truly informed were 43.8%. However, as showed in the multivariate logistic regression, people having the perception to be correctly informed ascribed their good knowledge to their profession in the health sector (Adj OR 2.28, CI 1.09-4.77, p < 0.05) and to friends/relatives/colleagues (AdjOR 6.25, CI 2.38-16.44, p < 0.001), while the non-informed population thought the responsibility had to be attributed to mass media (AdjOR 0.45, CI 0.22-0.92, p < 0.05). Those showing the real correct information, instead, were younger (AdjOR 1.64, CI 1.04-2.59, p < 0.05), and their main reference sources were pediatricians (AdjOR 1.63, CI 1.11-2.39, p < 0.05) and scientific magazines (Adj OR 3.39, CI 1.51-7.59, p < 0.01). Only 6% knew the "VaccinarSì" portal, developed to counter the widespred antivaccine websites in Italy. The post-survey significant increase of connections to "VaccinarSi" could be ascribed to the counselling performed during questionnaire administration. Strategies to improve information about vaccination should be addressed to fortifying healthcare workers knowledge in order to make them public health opinion leaders. General population should be provided with correct indications on trustworthy websites on vaccines to contrast false information supplied by anti-vaccinists on their own websites or social networks pages and on the mass media.

Treatment of symptoms of erythemato-telangiectatic rosacea with topical potassium azeloyl diglycinate and hydroxypropyl chitosan: Results of a sponsor-free, multicenter, open study.

Thirty-seven adult Caucasian patients (9 males and 28 females), with erythemato-telangiectatic rosacea accompanied by stinging and burning sensation, were treated with a cream containing 5% potassium azeloyl diglycinate and 1% hydroxypropyl chitosan. All patients were previously treated at other centers with topical azelaic acid and/or metronidazole. The cream was applied twice daily for 12 weeks. The objective of the study was the evaluation of the soothing effect of the cream: stinging and burning sensation were measured by means of a 4-point scale (0 = absent, 1 = mild, 2 = moderate, and 3 = severe). All patients were clinically evaluated every 4 weeks. Of 37 patients (81.1%), 30 were considered evaluable. Before the beginning of the study, the total score of stinging and burning sensation was 66 (mean: 2.2 points/patient); at the end of the study, it was 37 points (-29) (mean: 1.2 points/patient), with a reduction of 56.1%. No side effects were reported or observed. This study shows that the fixed combination potassium azeloyl diglycinate - hydroxypropyl chitosan is effective in reducing stinging and burning sensation in patients with erythemato-telangiectatic rosacea.