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1.
Medicina (Kaunas) ; 56(12)2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33322462

RESUMO

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system.


Assuntos
/prevenção & controle , Política de Saúde , Direitos do Paciente , Administração em Saúde Pública/ética , Quarentena/ética , /mortalidade , Emergências , Humanos , Itália/epidemiologia , Administração em Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência
2.
Artigo em Inglês | MEDLINE | ID: mdl-32872189

RESUMO

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.


Assuntos
Coleta de Dados/métodos , Erros Médicos/prevenção & controle , Segurança do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão de Riscos/organização & administração , Gestão da Segurança/estatística & dados numéricos , Hospitais Universitários , Humanos , Itália , Auditoria Administrativa , Erros Médicos/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração
3.
Artigo em Inglês | MEDLINE | ID: mdl-32946065

RESUMO

Despite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature.

5.
Hum Vaccin Immunother ; 16(8): 1875-1883, 2020 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-32040350

RESUMO

Since 2006, some Italian Regions introduced the active offer of measles, mumps, rubella, and varicella (MMRV) vaccine for all newborns during the second years of life. In 2011, Italian Drug Authority (AIFA) recommended the discontinuation of the MMRV use for an increased risk of febrile seizures following vaccination; furthermore, some Regions (such as Apulia, that introduced MMRV offer in 2009) chose to continue the use of MMRV and Ministry of Health recommended to guarantee supplemental monitoring of safety of the vaccine. In Italy, the surveillance of Adverse Events following immunization (AEFIs) is currently carried out by AIFA and Regional Health Authorities; this paper aims to summarize the results of MMRV-vaccine surveillance of AEFIs program carried out in Apulia. From the AIFA database, we selected MMRV AEFIs that occurred in Apulia (about 4,000,000 inhabitants) from 2009 to 2017. For serious AEFIs, we applied the WHO causality assessment algorithm, using for cases hospitalized information from individual medical records. In the 8 years of observation, 155 MMRV-AEFIs (reporting rate: 37.9×100,000 doses) occurred of which 26 were classified as serious (6.3×100,000 doses) and 22 led to hospitalization. Performing causality assessment, for 10 the classification was "consistent causal association to immunization" (reporting rate: 2.4×100000 doses), for 2 indeterminate, for 13 "inconsistent causal association to immunization" and for 1 not-classifiable. No case of febrile seizure resulted consistent to vaccination. All consistent serious AEFIs were completely resolved at subsequent follow-up.

6.
Radiol Med ; 125(6): 595-599, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048156

RESUMO

In recent years, the increasing prescription of diagnostic imaging has been noted, due to advances in imaging technology and the development of defensive medicine. Overuse of diagnostic imaging significantly impacts the quality and costs of health care. Therefore, the purpose of this study was to quantify overprescription and investigate its causes through the evaluation of head computer tomography (CT) scan prescriptions. In this study, a set of 100 requests of CT scans was collected and analysed by three experts in guidelines and scientific evidences, evaluating prescription appropriateness. Then, the rate of overprescription was quantified and its causes identified as incorrect adoption of guidelines indications (32%) and as defensive medicine (6%). Therefore, in order to reduce inappropriate investigations, the findings of the present study suggest that the reduction in overprescription could be reached through the improvement of training of health personnel and the propagation of a no-blame culture aimed at minimizing defensive medicine.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Antibiotics (Basel) ; 8(4)2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661804

RESUMO

Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people's loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers' work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections.

8.
Vaccines (Basel) ; 7(4)2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31591347

RESUMO

Since 2012, the Italian Ministry of Health has recommended to improve the surveillance of adverse events following the measles-mumps-rubella-varicella (MMRV) tetravalent vaccine that was provided in the official immunization schedule of some Italian regions for children during the second year of life. This recommendation was based on data from some surveys that showed an additional risk of seizure following the administration of this vaccine. Responding to the Ministry commitment, the Puglia Region launched, from May 2017 to November 2018, a post-marketing active surveillance program of adverse events following MMRV immunization (AEFIs). Immunized children (second year of life) were enrolled on a voluntary basis, AEFIs diaries were used, and their parents were interviewed 25 days after the immunization. There were 2540 children enrolled; 2149/2540 (84.6%) completed the post-vaccination follow-up. Of these, 992 AEFIs were registered with a reporting rate of 46.2 × 100 doses: 883/992 (89.0%) AEFIs were not serious, while 109/992 (11.0%) were serious. For serious AEFIs, the evaluation of causality assessment was performed using the algorithm proposed by the World Health Organisation (WHO): 82/109 consistent causal associations to MMRV immunization were detected (reporting rate of consistent AEFIs: 3.8 × 100 follow-up). All serious AEFIs consistently associated with immunization resulted completely resolved at the follow-up. The reporting rate of seizure consistently associated with immunization was 0.05 × 100, lower than data previous published in the literature that did not report the causality assessment. Because no emerging signals were detected, our data from the active surveillance program confirmed the safety profile of the MMRV vaccine.

10.
Am J Infect Control ; 46(1): e9-e11, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29167031

RESUMO

Subjects affected by at least 1 chronic disease are the target of influenza vaccination strategies because they are at high risk of influenza complications or death. The aim of this cross-sectional study is to evaluate flu and pneumococcal vaccination coverage (VC) in a sample of patients hospitalized at Bari Policlinico General Hospital (South Italy). According to national public health guidelines, these patients should have been vaccinated at hospital discharge by general practitioners. There were 540 patients involved in the study, and the average age was of 46.9 ± 13.4 years (range, 0-64 years). We assessed the vaccination status of 412 of 540 (76.3%) patients. The overall VC was 22.8% (94/412) for influenza and 7.2% (30/412) for pneumococcal vaccine. Doctor recommendation has a pivotal importance in vaccine acceptance, and recent experiences seem to show a high efficacy of the vaccination offer during hospitalization. This model could be helpful to improve influenza and pneumococcal vaccination offers to patient with underlying chronic conditions.


Assuntos
Doença Crônica , Cobertura Vacinal , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Pacientes Internados , Itália , Masculino , Pessoa de Meia-Idade , Vacinas/administração & dosagem , Adulto Jovem
11.
Risk Manag Healthc Policy ; 10: 87-93, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28579841

RESUMO

OBJECTIVES: This study aimed to standardize and rationalize the handover, a critical and essential moment in common health care practices, through the realization of an efficient and standardized checklist, which could be used daily to ensure complete, thorough and effective handover. The principal purpose of the implementation of the handover is to reduce errors due to superficial and insufficient communication. METHODS: The "operative group" defined the phases to the realization of the delineated aims: at first, the direct observation and the consequent realization of a handover checklist model and then, the experimental phases (trials). The handover checklist model was used for a month and it was daily and duly completed by the doctors who took part in the trial. To prove the success of the study, three questionnaires were distributed on different occasions. RESULTS: Analyzing the answers to the questionnaires, the importance of the handover has come to light and that for the most part, the doctors consider it an essential and irreplaceable moment in daily health care work. Moreover, it became obvious that the use of the handover checklist guaranteed a considerable improvement in the traditional handover in terms of security, completeness, care continuity and clarity. The handover checklist was completely appreciated by the majority of the participant doctors who agree with the definitive introduction of it in their unit. CONCLUSIONS: Our study indicated the consistency of the handover checklist as an instrument to implement the handover and, indirectly, to improve the quality of the care.

12.
Medicine (Baltimore) ; 95(41): e4956, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27741109

RESUMO

The study aims to evaluate the use of Patient Safety Walkaround (SWR) execution model in an Italian Hospital, through the adoption of parametric indices, survey tools, and process indicators.In the 1st meeting an interview was conducted to verify the knowledge of concepts of clinical risk management (process indicators). One month after, the questions provided by Frankel (survey tool) were administered.Each month after, an SWR has been carried trying to assist the healthcare professionals and collecting suggestions and solutions.Results have been classified according to Vincent model and analyzed to define an action plan. The amount of risk was quantified by the risk priority index (RPI).An organizational deficit concerns the management of the operating theatre.A state of intolerance was noticed of queuing patients for outpatient visits. The lack of scheduling of the operating rooms is often the cause of sudden displacements. A consequence is the conflict between patients and caregivers. Other causes of the increase of waiting times are the presence in the ward of a single trolley for medications and the presence of a single room for admission and preadmission of patients.Patients victims of allergic reactions have attributed such reactions to the presence of other patients in the process of acceptance and collection of medical history.All health professionals have reported the problem of n high number of relatives of the patients in the wards.Our study indicated the consistency of SWR as instrument to improve the quality of the care.


Assuntos
Comunicação , Pessoal de Saúde , Recursos em Saúde/organização & administração , Serviços de Saúde , Segurança do Paciente/normas , Feminino , Humanos , Itália , Masculino , Projetos Piloto , Estudos Retrospectivos , Inquéritos e Questionários
13.
Am J Infect Control ; 43(11): e79-81, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26315057

RESUMO

This study describes the changes in the performance of health care workers regarding the control of health care-associated infection in a surgical ward of University Hospital Policlinico, Bari, Italy, before and after a training program and adoption of bundles on antibiotic therapy. There were 194 patients recruited (pre: n = 98; post: n = 96), of which 149 (76.8%) had undergone surgery. We documented a change in the proportions of patients who received in-ward prophylactic antibiotics (from 46/98 to 22/96, P < .05), surgical patients undergoing antibiotic prophylaxis in the operating room (from 18/64 to 36/85, P < .05), and average duration of prophylaxis (from 5.9 ± 4.9 to 2.9 ± 2.7 days, P < .0001). Results confirmed correspondence between the intervention and results recorded.


Assuntos
Antibioticoprofilaxia/métodos , Cuidados Pré-Operatórios/métodos , Antibacterianos/uso terapêutico , Hospitais Universitários , Humanos , Itália , Estudos Prospectivos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/prevenção & controle
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