[What, how and why people fall in hospital? Study in a Northern Italian Hospital]. / Quanto, come e perché si cade in ospedale? Indagine in un'ASL piemontese.

INTRODUCTION: According to the World Health Organization (WHO), falls and falls related-injuries are a main issue for health and social systems in Europe and all over the world, particularly considering that life is lengthening. OBJECTIVE: To describe incidence, causes and falls modalities in a Northern Italian Hospital following the organizational changes set up in 2008. METHODS: The survey consists of two steps: 1. definition of expected situation according to the literature and other similar contexts; 2. examination of the fall report forms between July 1, 2010 and June 30, 2011. RESULTS: In this period the incidence of falls has been 0.8% and in 69% of cases patients' intrinsic factors have been identified to be the cause, followed by extrinsic factors (7.4%), organizational factors (5.4%) and inter-professional communication difficulties (3.1%). CONCLUSION: Falls have a multi-factorial etiology, therefore the most effective approach should be multidimensional. A simultaneous action on three levels, organizational, staff/communication and patient, would be needed.

[Nursing managers: study to assess the expectations of nursing coordinators in a Northern Italian Hospital]. / Il dirigente del Servizio Infermieristico: inchiesta sulle attese dei coordinatori infermieristici di un'ASL piemontese.

In modern health-care , nursing managers play a strategic role in improving the quality of care and the skills of carers, since management and leadership strategies are known to be decisive in the deployment of resources and professional development. The aim of this study is to present the opinions and expectations of nursing coordinators regarding their managerial role. During the creation of a nursing service unifying the management of 3 local health authorities in Northern Italy, with different organizational and professional features, nursing coordinators were asked to fill in a questionnaire. Results showed that a priority aspect of the managerial role is to assess the appropriateness of care and the use of resources Their answers showed that they hoped for a style of management founded on aspects related to clinical government. For the style of leadership, they emphasized dedication to work, participation of staff in decision-making, group information and providing support in areas needing improvement. Although the study was territorial , it confirmed international guide-lines regarding the policies which give value to investments in the quality of organization and can be considered a point of reference for planning and creating future nursing services.

Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center.

AIM: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions. METHODS: We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a ten-year period. One hundred and sixty of these were performed for large polyps, those measuring > or = 20 mm. Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption and associated intestinal or extra intestinal diseases were analyzed. For statistical analysis, the Pearson chi2 test, NPC test and a Binary Logistic Regression were used. RESULTS: The mean patient age was 65.9 +/- 12.4 years, with 671 men and 367 women. The mean size of polyps removed was 9.45 +/- 9.56 mm while the size of large polyps was 31.5 +/- 10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon (41.3%). The most frequent histology was tubular adenoma (55.9%) while for the large polyps was villous (92/160 -57.5%). Coexistent malignancy was observed in 28 polyps (2.1%) and of these, 20 were large polyps. There were 17 procedural bleeding (1.3%) and one perforation. The statistical analysis showed that cancer is correlated to polyp size (P < 0.0001); sessile shape (P < 0.0001) and bleeding are correlated to cardiac disease (P = 0.034), tubular adenoma (P = 0.016) and polyp size. CONCLUSION: The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an important risk factor for malignancy and for bleeding.

Serum thrombopoietin in chronic liver disease: relation to severity of the disease and spleen size.

BACKGROUND/AIMS: Thrombopoietin is a thrombopoietic factor mainly synthesized in the liver. Its production is regulated by the mass of megakaryocytes and platelets. Impaired production of thrombopoietin may be responsible for thrombocytopenia in chronic liver disease. METHODOLOGY: We studied thrombopoietin serum concentration in 68 patients with chronic liver disease of various degrees (39 with thrombocytopenia), in 5 patients with thrombocytopenia due to hematological disease, and in 27 healthy controls. RESULTS: Thrombopoietin concentration was higher in patients with liver disease than in controls. Patients with hematological disease had much higher thrombopoietin concentration than patients with liver disease. Among patients with liver disease and thrombocytopenia, thrombopoietin concentration was higher in cirrhosis than in chronic hepatitis. A negative correlation was found between platelet counts and spleen size and between thrombopoietin concentration and spleen size. No correlation was found between thrombopoietin concentration and liver disease severity. CONCLUSIONS: Patients with liver disease and thrombocytopenia have serum thrombopoietin concentration higher than normal controls. It seems therefore that the liver, even seriously diseased, maintains the ability to produce thrombopoietin. In the liver patients the number of circulating platelets and the serum levels of thrombopoietin are inversely correlated with the size of the spleen suggesting that thrombopoietin, although normally produced, might be turned over in platelets sequestrated in the spleen.