The ERM experience of the Lombardy Region as a tool for improving the safety of the regional health care system.

The Regional Center for Healthcare Risk Management and Patient Safety of the Lombardy Region, with the technical partnership of Aon, designed an innovative Healthcare Enterprise Risk Management Model (hereafter HERM) to meet the following objectives: 1) Improve the safety of the Regional Healthcare System through the implementation of methods and tools aimed to identify, analyze and mange in an integrated way all the risks to which are exposed the healthcare companies. 2) Preserve the creation of social value in the medium-long term and the sustainable achievement of strategic and operational objectives. 3) Optimize risk management costs. 4) Reduce/mitigate adverse events in all business processes. 5) Enable the ability to anticipate and react to changes. 6) Establish sound long-term and risk-based strategies. This paper describes the structuring of the overall HERM Model Framework, and the related information flows, the tools supporting the Healthcare Enterprise Risk Management Methodology (such as the Risk Model and the Assessment Metrics) and presents the preliminary result of first experience of Healthcare ERM in Italy.

Impact of energy-based devices in pediatric thyroid surgery.

BACKGROUND: Energy-based devices are surgical devices increasingly utilized for thyroid surgery, owing to a reduction of operative time and surgical related complications. The aim of the study is to evaluate whether the use of energy-based devices could improve the complication rate in pediatric thyroid surgery. METHODS: This is a retrospective observational study. We identified 177 consecutive pediatric patients (Group A) with thyroid diseases, surgically treated by energy-based devices and 237 patients (Group B) treated by conventional clamp and tie technique and matched for sex, age and indication for surgery. Transient and permanent complications rate, operative time and length of hospital stay were compared between the two groups. RESULTS: Patients of Group A experienced a lower complication rate compared to Group B. Particularly, transient (11.3 vs. 19% p < 0.05) and permanent post operative hypoparathyroidism (1.7 vs. 5.5%, p < 0.05) were lower in Group A. Moreover, operative time was also shorter in Group A compared to Group B and this difference was statistically significant in patients who performed total thyroidectomy alone and total thyroidectomy associated with central compartment neck dissection (p < 0.05). Length of hospital stay was lower in Group A than in Group B, but this difference was statistically significant only for microfollicular lesion (p < 0.05). CONCLUSION: The use of energy-based devices has a key role in reducing surgical related complications, particularly transient and permanent hypoparathyroidism, operative time and length of hospital stay in pediatric patients treated with thyroid surgery. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Retrospective comparative study.

Sarcina Ventriculi infection: a rare but fearsome event. A Systematic Review of the Literature.

OBJECTIVES: This study is aimed to report a case of SV-related gastritis and the results of a systematic literature review of SV infections. METHODS: Following a case presentation, we systematically searched different databases (MEDLINE, PubMed, Scopus, Web of Science, EMBASE, google scholar) for the items "sarcina," "ventriculi," "clostridium" with AND/OR. RESULTS: A total of 55 articles reporting 65 cases of Sarcina Ventriculi were found. Thus, 66 patients, including our case, were reviewed. The median age was 51 years (IQR: 0-87 years). Females accounted for 51% of cases. 68% of patients had one or more comorbidities. SV was isolated in the gastrointestinal tract (88%), respiratory (5%), urine (4%), and bloodstream (3%) systems. Upper endoscopy was performed in 52 patients (79%). Biopsies were obtained in all 52 cases and were normal in 23%. Surgery was warranted in 15 patients (23%), and specific antimicrobial therapy was delivered in 34 (52%) patients. Mortality was 14%. At follow-up, 88% of patients showed complete eradication of the SV infection. CONCLUSIONS: Upper gastrointestinal biopsy positive for SV should prompt an evaluation of the clinical conditions, considering the risk of gastric perforation is not negligible. Antibiotic therapy may eradicate the infection and prevent complications. Emergency surgery is required in case of source control.