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Nurses' perception of the organisational context of nursing homes: a descriptive study.The increasing number of the elders admitted to nursing homes (NH) requires a particular emphasis on improving the quality of nursing care. The evaluation of the organizational context has recently received growing interest, for its contribution to understanding of care outcomes and staff's needs.To describe the characteristics and the nurses'perception of organizational context of NHs in which they work.A cross-sectional study was conducted in 50 NHs in the Piedmont and Aosta Valley regions. The following data were collected: sociodemographic information on nurses, years of work experience, contract type, and work-hour profile; organizational information included ownership, size, occupancy rate; and for the organizational context, the Alberta Context Tool was administered.Of the 312 nurses, 266 (85%) participated in the study; 79% had a university degree. Perceived organisational context scored low (median values 2.5) in terms of the availability of Interactions (Formal and Informal), Resources, Personnel and time, but good with median values above 3.5/5 on Leadership, Culture, Evaluation, Social Capital and Space, with differences according to years of experience, type and size of facility; for example, nurses working in private facilities perceived their organisational context as better than those working in public facilities.NHs are workplaces that are still not frequently chosen by nurses and essentially considered as places of transition or end of the career. In spite of organizational contexts perceived as positive, tangible efforts are needed to improve working conditions and the perception of nurses' role.

OBJECTIVE: To analyse the trajectories of hip-fracture surgery rates within 2 days of admission to the hospital and the ratios of procedures initiated within the same day (Day 0) and the following day (Days 0-1) to procedures performed on the 2nd day. To study the association between socioeconomic, health input variables and early surgery. DESIGN: A pooled, cross-sectional, time-series analysis was used to evaluate secondary data from 15 European countries, during 2000-13. RESULTS: The rate of patients aged ≥65 years that were operated on within 2 days of hip-fracture has changed over time with an EU average annual increase of 0.42% (95% CI = 0.25, 0.59; P < 0.001) and with a significant linear trend. Multiple slopes from all the countries compete with this result. In contrast, the ratios of procedures initiated within the same day (Day 0) and the following day (Days 0-1) compared to procedures performed on the 2nd day are constant.No association was found between the rate of patients treated within 2 days of admission and demographic structure, health expenditure, health resources. However, the rate of patients treated within 2 days of admission is significantly associated with surgical volumes. CONCLUSIONS: As the early surgery rate is growing, policy makers should be encouraged to undertake further policies to support the quality of care, and the providers should be driven to improve their organizational effectiveness by taking actions aimed at acting on specific organizational and logistical causes that represent a barrier to early surgery.

Informed consent forms must be designed to meet specific requirements but evaluating the structure and content requirements of consent forms from a qualitative point of view is not a simple task. An evaluation tool was therefore developed in the context of a pilot study to evaluate the current quality of informed consent forms at both medical and surgical departments of the San Giovanni Battista Hospital in Turin (Italy). A random sample of 288 medical records of patients hospitalized during 2007-2008 was selected. These were evaluated to determine the presence of a properly executed informed consent form or of a justification for its absence. Each consent form was evaluated based on the presence of a list of requirements. Statistical analysis was conducted by first taking into account all departments and then stratifying by medical and surgical departments. The evaluation tool was found to useful in evaluating, in a standardized and repeatable manner, the adequacy and completeness of informed consent forms in different hospital departments.

The San Giovanni Battista Hospital in Turin validated a tool for evaluating the quality of hospital patient records. The tool defines the essential contents of patient records, indicators and weights as well as the standard score that must be reached. A pilot study was performed in 2007 to evaluate whether this tool adequately evaluates the quality of hospital patient records in both medical and surgical wards, and whether it can do so in a standardized and repeatable manner. A random sample of 206 medical charts of patients admitted to the San Giovanni Battista Hospital in 2007 was extracted and analysed. The instrument was found to adequately evaluate hospital patient records in a standardisd and repeatable manner.

In Healthcare systems, to overcome the problem of the fragmented response to the medical needs of patients, new theoretical models and operative approaches have been proposed; the process-based approach is one of the solutions more appreciated. This approach has been adopted in different ways in different healthcare systems: typically the Case management, the Disease management and, in Italy, the Healthcare profiles. These three healthcare models that share in the logic of a process-based approach present similarities and dissimilarities. This article aims to describe the features of Healthcare profiles compared to Case and Disease management, using a comparison scheme which contains items capable to distinguish the different Healthcare models.

Objective To update amenable mortality in 32 OECD countries at 2013 (or last available year), to describe the time trends during 2000–2013, and to evaluate the association of these trends with various geographic areas. Data Sources Secondary data from 32 countries during 2000–2013, gathered from the World Health Organization Mortality Database. Study Design Time trend analysis. Data Collection Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0–74 years per 100,000 inhabitants. We performed a mixed-effects polynomial regression analysis on the annual SDRs to determine whether specific geographic areas were associated with different SDR trajectories over time. Principal Findings The OECD average annual decrease was 3.6/100,000 (p

Background: The aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation. Methods: A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014. Results: The results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term = 0.40; p = 0.210; 95% CI = - 0.25, 1.06; coefficient for the quadratic term = - 0.07; p = 0.027; 95% CI = - 0.14, - 0.01), while the cervical screening trend is essentially stable (coefficient for the linear term = 0.39, p = 0.312, 95% CI = - 0.42, 1.20; coefficient for the quadratic term = 0.02, p = 0.689, 95% CI = - 0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD = 16.7, p < 0.001; SD = 14.4, p < 0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women (≤ 49 years) and a higher Gini index (that is, higher income inequality). Conclusions: In conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.

Objectives To analyze trajectories of cataract surgery rates and to confirm the switch between inpatient cases and day surgery or outpatient cases. Design Pooled, cross-sectional, time series analysis. Methods Data on 20 European countries from 2004 to 2014 retrieved from the OECD. Results The number of cataract surgery cases per 100,000 population has increased since 2004 (b = 31.1, p < 0.001, 95% CI = 26.7, 35.6). A reversal of the inpatient cases and same-day cases was found: the first ones decreased (b = –14.7, p < 0.001, 95% CI = –17.7, –11.8) while day surgery and outpatient cases increased (b = 37.5, p < 0.001, 95% CI = 31.6, 43.4, and b = 8.3, p = 0.001, 95% CI = 3.6, 13.1, respectively). Since 2004, the ratio of day surgery and outpatient cases to inpatient cases has grown significantly (b = 3.3, p < 0.001, 95% CI = 2.5, 4.0), reaching a share of 31.7 in 2014. However, this slope of 3.3 was not constant and slowed over the years: from 4.5 per year during the first five years to 1.9 in the second five. No association was found between cataract surgery rate and two regressors: elderly people, and health care expenditure per capita. Conclusion EU countries have preserved cataract surgery, and this preservation is probably affected by the switch from inpatient to same-day surgery, thanks to the decrease in the cost and equivalent clinical outcomes. However, the slope of the switch slowed over time. Consequently, health care systems must support this process of change especially through reforms in financial and organizational fields.