Search

Background. The introduction of transcatheter aortic valve replacement (AVR) mandates attention to outcomes after surgical AVR (SAVR). The aim of this study was to assess 1-year outcomes in a contemporary large cohort of patients undergoing AVR. Methods. Data from 520 patients who underwent isolated SAVR between October 2016 and April 2019 were prospectively collected. Results. The mean age of the study population was 72.8 ± 10.1 years and the average EuroSCORE II was 1.8 ± 1.5%. SAVR was performed using minimally invasive approaches (MI-AVR) in 306 patients (58.9%). However, the rate of MI-AVR considerably increased over the observational period from 47.9% to 86.7% (p

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to deferral of many non-urgent procedures in most healthcare systems worldwide. With this study we aimed to quantify the impact of COVID-19 on interventional treatment of structural heart disease (SHD) in Italy. METHODS: Numbers of transfemoral transcatheter aortic valve replacement (TAVR), percutaneous mitral valve repair (PMVR), left atrial appendage occlusion (LAAO), patent foramen ovale (PFO) closures performed over a 4-week period during the national lockdown in Italian centers performing over 60 structural heart interventions (SHI)/year were compared with the same 4-week period in 2019. Incidence rate reductions (IRR) were estimated by zero-inflated negative binomial regression. RESULTS: According to our nationwide analysis, SHIs were reduced by 79% as compared to the same period in 2019 (IRR 0.21, 95% confidence interval [CI] 0.15-0.29). This reduction was more substantial for PFO closure (IRR 0.03, 95% CI 0.01-0.07), LAAO (IRR 0.11, 95% CI 0.05-0.25) and PMVR (IRR 0.12, 95% CI 0.04-0.36) as compared to TAVR (IRR 0.31, 95% CI 0.22-0.47). CONCLUSIONS: The COVID-19 pandemic caused a 79% drop in SHI volumes in Italy. PFO closure, LAAO and PMVR decreased more significantly as compared to TAVR. Further studies are needed to evaluate the impact of this reduction on outcomes of patients with SHD.

Background. Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: A) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs. Methods. A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of followup were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out. Results. The mean number of cardiological examinations per patient provided during follow-up was 5, of which 4.4 were routine tests in asymptomatic patients. Routine tests were performed more frequently in patients at low risk compared to those at higher risk. By applying the multidisciplinary protocol to the case mix and by merging clinical visit and stress test or echocardiographic examination, a reduction of 0.87 tests per patient/year would be expected. This reduction would result in a 39[%] decrease in follow-up examinations in this specific clinical setting. Conclusions. This observational study demonstrates that unnecessary cardiological clinical and functional tests are often performed in long-term follow-up of patients submitted to PCI. The application of a standard protocol of follow-up shared with general practitioners may help avoiding unnecessary consultations, thus reducing healthcare costs.

In recent years, in Italy, population lengthening of life leads to an higher number of individuals with chronic diseases (Osservatorio, 2010). The hospital which deals with the acute phase of diseases needs to be integrated with primary care. This connection is particularly important for the treatment, care and rehabilitation of patient, as well as a general need for more health and social care integrated tools.At the San Gerardo Hospital in Monza, in the context of the patient's post-acute rehabilitation, we analyze the phase between discharge from hospital and the expected date of hospitalization in facilities providing rehabilitation. The aim of this observational descriptive study is to determine the distribution of days of waiting. Furthermore, several different approach are analysed (i.e. Integrated Home Care) in order to reduce unnecessary days hospitalization and a more intelligent and cost effective use of resources The research question are the follow, to quantify waiting time between discharge and hospitalization in the rehabilitation facility and to ascertain if patients are sent to the correct facility.1083 individuals were taken into account, of those 55% (N=652) were discharged from the hospital later. This leads to a 4505 days of inappropriate hospitalization.Although the use of home care could be beneficial to the hospital, this can be used only for tiny part of the patients and it is not cost effective. A possible solution can be set up a number of low cost bed entirely managed by nurses due to the low level of intensity care.INTRODUZIONE. In Italia negli ultimi anni l’aumento della sopravvivenza della popolazione ha comportato il cambiamento dello stato di salute, che vede l’incremento nella prevalenza delle patologie croniche (Osservatorio, 2011). L’ospedale, riservato alla fase acuta delle patologie, si integra necessariamente con le cure primarie. La continuità assume particolare rilevanza per la cura, assistenza e riabilitazione della persona assistita, così come l’appropriato utilizzo delle diverse tipologie di offerta socio sanitaria assistenziale e riabilitativa. OBIETTIVO. Al San Gerardo di Monza, nell’ambito della riabilitazione del paziente post-acuto, si analizza la fase che intercorre tra la dimissione prevista dall’ospedale e la data di accettazione presso gli istituti di riabilitazione. E’ possibile quantificare i tempi di attesa? L’ allocazione delle persone assistite è appropriata? Scopo dello studio osservazionale descrittivo è accertare la distribuzione dei giorni di attesa. Inoltre si ipotizza il ricorso all’Assistenza Domiciliare Integrata e a soluzioni innovative. Obiettivi sono la diminuzione delle giornate di degenza inappropriate e l’utilizzo delle risorse in modo congruo. RISULTATI. Delle 1083 persone in attesa di riabilitazione il 55% (652), a cui sono associate 4505 giornate “inappropriate”, è stato dimesso dall’ospedale oltre i tempi previsti. CONCLUSIONI. L’utilizzo dell’assistenza domiciliare, vantaggiosa per l’ospedale, può essere utilizzata solo per una minoranza di pazienti e in modo diseconomico. Per abbattere la totalità delle giornate, una soluzione innovativa può essere l’istituzione di posti letto a basso costo. E dato che la maggioranza dei casi sono solo ad alta complessità assistenziale ma a bassa intensità clinica potrebbero essere letti gestiti da infermieri.

The aim of this study is to compare notifications of foodborne diseases in Southern Italy, before and after abolishing mandatory medical and laboratory examination routine. Data were obtained from the National Epidemiological Report of Health Ministry, that includes the annual summaries of foodborne infectious illnesses notified in Italy. The average number of foodborne diseases per million inhabitants per year decreased after the abolishment of health card for all examined conditions. There was a statistically significant reduction in all Regions for Salmonellosis and in Basilicata, Calabria, Campania and Sicily for Brucellosis. Abolishing health card of food handlers workers did not increase trends of foodborne illnesses and foodborne epidemics in Southern Italy. Examined data confirm the substantial effectiveness of food handlers self-control and training as essentials instruments of Evidence Based Prevention.

AIMS: To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tranquilization. METHODS: Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT'S Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services. RESULTS: In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs. About a half of the professionals working in Psychiatric Wards in General Hospital were trained in rapid tranquilization, while procedures on this topic are practically absent and specific care for monitoring intensively the heavily sedated patient was not frequent. CONCLUSIONS: Management of violent behaviour and rapid tranquilization are two critical areas in the care performed by Psychiatric Wards in General Hospital. Training on these topics is more frequent than implementation of procedures. NICE recommendations and SIEP indicators are useful tools for improving the quality of acute psychiatric care

Tissue Doppler is an ultrasound tool representing a useful completion of standard Doppler echocardiographic examination, The placement of pulsed tissue Doppler sample volume at the level of the different sites of the mitral annulus allows to obtain information on left ventricular global longitudinal (systolic and diastolic) function, whereas the sampling of tricuspid lateral annulus gives similar information on the right ventricular chamber. Myocardial early diastolic velocity (Em) is a marker of ventricular diastolic relaxation and the ratio obtainable between transmitral (or transtricuspid) E velocity and annular Em (E/Em ratio) is an accurate index of the level of filling pressure of the assessed ventricular chamber. Myocardial systolic velocity (Sm) as well as the frequency of acceleration of presystolic velocity, occurring during isovolumic contraction time, are indexes of systolic performance and their reduction is evident in several cardiac pathologies. Tissue Doppler-derived systolic and diastolic indexes have a recognized prognostic value in heart failure and after acute myocardial infarction. In these conditions they are able to predict both left ventricular remodeling and mortality.

Purpose. The aim of this study was to assess the value of computed tomography (CT) perfusion parameters in differentiating tissue viability in acute stoke patients. Materials and methods. Thirteen patients (mean age 63.3 years) with nonhaemorrhagic stroke underwent multidetector perfusion CT within 3 h of symptom onset. Images were continuously acquired at the basal ganglia over 40 s during injection of 90 ml of iodinated contrast medium injected at a rate of 9 ml/s with a 9-s delay. Z-axis coverage was 20 mm. All patients underwent diffusion-weighted magnetic resonance imaging (DWI) within 12 h of perfusion CT to define the extent of the infarct. Perfusion CT data were analysed in regions of interests (ROIs) on regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF) and mean transit time (MTT) maps placed in various parts of the perfusiondeficient territory and in the contralateral hemisphere. Statistical analysis was performed using the analysis of variance (ANOVA) test to assess differences in CT perfusion parameters. Receiver operator characteristics (ROC) analysis was performed to assess possible threshold values that predict tissue infarction vs. viability. Results. Normal CT findings with abnormal CT perfusion parameters were seen in the region of infarction and in the viable tissue (penumbra) within a 1.5-cm distance from the infarct margin as outlined on DWI images. Infarcted areas demonstrated significant prolongation of MTT values compared with noninfarcted areas (p6.05 s identify infarcted tissue. © 2007 Springer-Verlag.

As reported by previous literature, the prevalence of musculoskeletal disorders is high in population of local police officers, due to several risk factors, including awkward posture, jolt/vibrations and stress. The results of our study reveal that the most common musculoskeletal symptoms among local police officers are cervicobrachial pain, low back pain and sciatica. Low-back pain is associated with tasks exposing to awkward posture of the spine (traffic policemen and policemen involved in office-based duties); cervical and upper extremity disorders are related to the exposure to vibrations and to the upper limb posture held by motorcycle police. Among postural parameters, anterior scapular plane, flat back and Barre's vertical resulted possible predictive tests of adaptation of the postural system to the symptom pain in subjects with low back pain. In conclusion, it is necessary to adopt organizational, protective and preventive measures in order to occupational health of local police officers. They include: decrease of time periods during which an awkward posture is held, breaks between duties, prescription of ergonomic shoes, use of low-weight and low-volume duty-packs, and planning of periodical osteopathic check-ups as part of the health program, aimed to uncover initial postural alterations related to musculoskeletal disorders.

BACKGROUND: A new "light" maxillo-mandibular fixation system for treatment of mandibular fractures, based on use of special pins, is proposed. METHODS: Fifteen patients with non-displaced mandibular fractures (angle, body and symphysis), have been treated at the Department of Maxillofacial Surgery, S. Paolo University Hospital, Milan. The system is based on pins formed by a no. 1 metal wire and a bead. The free end of the pin is threaded around a tooth and then wound three or four times around the bead to fix it in place and, at the same time, separate it from the gingiva. One pin is usually positioned on each quadrant. Once the pins are in place they are tied to each other using a loop no. 0 to complete the maxillo-mandibular fixation. Particular attention was paid to maintain a correct individual occlusion. The time of maxillo-mandibular block was 10-15 days. RESULTS: Results were good with complete healing of all fractures, restoration of individual occlusion, minimal periodontal lesions and a good compliance for the treatment by the patients. CONCLUSIONS: It is suggested to use this system routinely because quick, economic, easy on periodontium and relatively comfortable for the patients. The contraindication include an unstable occlusion, the absence of a suitable pair of teeth on both sides of the jaws, avulsion or trauma or periodontopathy of one of the teeth needed for the fixation system.