Quality in emergency departments: a study on 3,285,440 admissions.

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

Arteriosclerotic carotid lesions in hyperlipoproteinemia.

An ultrasonographic study was performed in 187 hyperlipoproteinemia patients to evaluate the incidence of atheromatous lesions in the extracranial carotid tract. A high-resolution, real-time, B-mode instrument with two probes (4- and 8-MHz) was used. Fifty-five subjects had high blood cholesterol levels, 70 high triglyceride values, and 62 both. Arteriosclerotic disease was present at other sites in 39% of the patients. Atheromatous carotid lesions were revealed in 37% of the patients, and there seemed to be no significant correlation with the type of hyperlipoproteinemia. There was also no correlation between blood cholesterol levels and the presence or absence of atheromatous lesions. Increasing age and arteriosclerotic disease at other sites were the factors most frequently associated with atheromatous lesions in the extracranial carotid tract.

Correlation between hemorheologic parameters and carotid atherosclerosis in stroke.

An evaluation of the hemorheologic parameters and an ultrasonographic study of the extracranial carotid tract were performed on 48 patients, age range: sixty to seventy-five years, affected by acute stroke, 23 of whom had hypertension, while 27 were smokers. None of them was suffering from hyperlipidemia, diabetes mellitus, or symptomatic coronary heart or peripheral artery disease. The echotomographic analysis, using B-mode real-time echotomography revealed atherosclerotic lesions in 26 patients. The hemorheologic pattern (hematocrit, fibrinogen, whole blood filterability, whole blood and plasma viscosity) was determined in all the patients three months after the clinical event. Statistical analysis of the results indicates a possible link between atherosclerotic lesions of the extracranial carotid tract and age, fibrinogen levels, and whole blood filterability.

[Evaluation of the Doppler-pulse volume recorder in Raynaud's phenomenon]. / Valutazione Doppler-PVR del fenomeno di Raynaud.

A study was made of 15 patients (10 female and 5 male), between the age of 18 and 65 years, in order to assess the diagnostic efficacy of the combined Doppler-P.V.R. (Pulse Volume Recorder) technique when examining Raynaud's phenomenon. The patients in the study had suffered for at least a year from recurrent episodes of Raynaud's phenomenon and were compared with 15 normal non-smokers. The patients were given a Doppler and plethysmograph exam with P.V.R. in basal conditions and following heat stimulus. It can be said that while the Doppler exam supplies data that is compatible with the variations in peripheral resistance encountered in Raynaud's phenomenon, P.V.R., although able to give useful information on the general condition of the segment examined, does not yet provide exact data on account of the difficulty in interpreting the graph obtained. Interpreting P.V.R. data can be facilitated by combining P.V.R. with heat test.