27 results on '"Farina EC"'
Search Results
2. Hospital-acquired infections in Italy: a region wide prevalence study
- Author
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Zotti, Carla Maria, Messori Ioli, G, Charrier, Lorena, Arditi, G, Argentero, Pa, Biglino, Alberto, Farina, Ec, Moiraghi Ruggenini, A, Reale, R, Romagnoli, S, Serra, R, Soranzo, Ml, Valpreda, M, and Hospital Coordinator Group
- Subjects
Male ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Urinary system ,Antibiotics ,Logistic regression ,Asymptomatic ,Drug Utilization Review ,Risk Factors ,Internal medicine ,Epidemiology ,medicine ,Prevalence ,Humans ,Mechanical ventilation ,Cross Infection ,Hospital-acquired infections ,Hospitals, Public ,Infection Control Practitioners ,business.industry ,Public health ,General Medicine ,Anti-Bacterial Agents ,Infectious Diseases ,Italy ,Urinary Tract Infections ,Population study ,Female ,medicine.symptom ,business ,Hospital Units ,Sentinel Surveillance - Abstract
Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.
- Published
- 2004
3. Procedure di controllo delle infezioni della ferita chirurgica in Regione Piemonte
- Author
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Castella, A, Charrier, Lorena, Di Legami, V, Pastorino, F, Farina, Ec, Zotti, Carla Maria, and Gruppo di Studio Regionale sulle infezioni Ospedaliere
- Published
- 2004
4. Gli immunomodulanti nella chirurgia delle neoplasie del torace
- Author
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Pastore V., Di Crescenzo V. G., Biondo F. G., Ruggiero U., Mele R., Capo G. D. M., SANTINI, Mario, Balbo G , Farina EC, Pastore, V., Di Crescenzo, V. G., Santini, Mario, Biondo, F. G., Ruggiero, U., Mele, R., and Capo, G. D. M.
- Published
- 1988
5. Role of TachoSil® in distal pancreatectomy: a single center experience.
- Author
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Silvestri S, Franchello A, Gonella F, Deiro G, Campra D, Cassine D, Fiore A, Ostuni E, Garino M, Resegotti A, Farina EC, and Fronda GR
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Loss, Surgical statistics & numerical data, Drug Combinations, Female, Humans, Incidence, Italy epidemiology, Length of Stay statistics & numerical data, Male, Middle Aged, Operative Time, Pancreatic Fistula prevention & control, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Prospective Studies, Retrospective Studies, Risk Factors, Treatment Outcome, Fibrinogen administration & dosage, Pancreatectomy adverse effects, Thrombin administration & dosage
- Abstract
Aim: Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP., Methods: From 1996 to 2013, 221 patients have been submitted to distal pancreatectomy (± splenectomy) in our Division. A retrospective analysis has been conducted in a group of 36 consecutive and prospectively collected DP treated with intraoperative placement of TachoSil® on pancreatic stump from 2010 to 2013 (group 1). A control series of 36 consecutive patients (group 2) was matched 1:1 from hystorical database. The variables considered in the analysis were: age, gender, ASA score, pancreatic texture (hard vs. soft), histology, operative time, postoperative mortality, morbility (postoperative pancreatic fistula - POPF, postoperative hemorrage - PPH, delayed gastric emptying - DGE) and hospital stay. Differences between POPF, PPH, DGE and hospital stays between grops were investigated with χ² and t-Student test. Univariate analysis was conducted to determine factors related to POPF development. Statistical analysis was performed using freeware Microsoft Excel based program., Results: Post operative mortality was 0% in both groups. POPF were registered in 36.1% (13/36) and 41.6 % (15/36) in groups 1 and 2, respectively (P=n.s.); in group 1 we didn't observe grade C POPF, while 4 patients in control group developed grade C POPF (P<0,05). No differences were found between two groups in terms of incidence of PPH and DGE. The median duration of postoperative hospital stay in group 1 was 21.8 (7-189) days compared with 31.13 (9-249) days in group 2 (P<0.001)., Conclusion: The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.
- Published
- 2015
6. Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards.
- Author
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Testa M, Stillo M, Giacomelli S, Scoffone S, Argentero PA, Farina EC, and Zotti CM
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Health Care Surveys, Hospitals, Public statistics & numerical data, Humans, Italy, Male, Middle Aged, Practice Guidelines as Topic, Surgery Department, Hospital statistics & numerical data, Young Adult, Anti-Infective Agents therapeutic use, Antibiotic Prophylaxis statistics & numerical data, Guideline Adherence statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data, Surgical Wound Infection prevention & control
- Abstract
Background: Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards., Methods: This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software., Results: Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4 % were not acceptable. The study found an unjustified continuation of antimicrobial prophylaxis in 17.1 % of the 257 cases, an unjustified re-start of antimicrobial therapy in 9.7 % and a re-dosing omission in 7.8 %., Conclusions: The study demonstrated critical problems in antimicrobial prophylaxis management in surgical wards due to a lack of compliance between hospitals and national guidelines, a shortage of specific and updated recommendations for some surgical interventions and incorrect local specific procedures. Coordination between local and national recommendations, strengthening of evidence based decisions and continuous sharing of policy updates are needed.
- Published
- 2015
- Full Text
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7. Antimicrobial prophylaxis in minor and major surgery.
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Bassetti M, Righi E, Astilean A, Corcione S, Petrolo A, Farina EC, and De Rosa FG
- Subjects
- Humans, Surgical Wound Infection prevention & control, Anti-Infective Agents therapeutic use, Antibiotic Prophylaxis methods, Surgical Procedures, Operative methods
- Abstract
Surgical site infections (SSIs) are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these infections, although Gram-negative organisms are also frequently involved. The risk of developing a SSI is associated with a number of factors, including aspects of the operative procedure itself, such as wound classification, and patient-related variables, such as preexisting medical conditions. Antimicrobial prophylaxis (AP) plays an important role in reducing SSIs, especially if patient-related risk factors for SSIs are present. The main components of antimicrobial prophylaxis are: timing, selection of drugs and patients, duration and costs. Compliance with these generally accepted preventive principles may lead to overall decreases in the incidence of these infections. Ideally the administration of the prophylactic agent should start within 30 minutes from the surgical incision. The duration of the AP should not exceed 24 hours for the majority of surgical procedures. The shortest effective period of prophylactic antimicrobial administration is not known and studies have demonstrated that post-surgical antibiotic administration is unnecessary. Furthermore, there were no proven benefits in multiple dose regimens when compared to single-dose regimens. The choice of an appropriate prophylactic antimicrobial agent should be based primarily on efficacy and safety. Broad spectrum antibiotics should be avoided due to the risk of promoting bacterial resistance. Cephalosporins are the most commonly used antibiotics in surgical prophylaxis; specifically, cefazolin or cefuroxime are mainly used in the prophylaxis regimens for cardio-thoracic surgery, vascular surgery, hip or knee arthroplasty surgery, neurosurgical procedures and gynecologic and obstetric procedures. A review of the prophylactic regimens regarding the main surgical procedures is presented.
- Published
- 2015
8. Surveillance of healthcare-associated infections in Piemonte, Italy: results from a second regional prevalence study.
- Author
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Charrier L, Argentero PA, Farina EC, Serra R, Mana F, and Zotti CM
- Subjects
- Adolescent, Aged, Aged, 80 and over, Cross Infection etiology, Cross Infection prevention & control, Cross-Sectional Studies, Female, Hospitals, Public statistics & numerical data, Humans, Intensive Care Units statistics & numerical data, Italy epidemiology, Male, Middle Aged, Population Surveillance methods, Prevalence, Regional Health Planning, Risk Factors, Cross Infection epidemiology
- Abstract
Background: A prevalence survey of healthcare-associated infections (HAIs) was previously performed in the Piemonte region in 2000. In the decade following the survey, many studies were performed at both the regional and hospital levels, and training courses were developed to address issues highlighted by the survey. In 2010, a second regional prevalence study was performed. The aim of this paper is to present the results of the second prevalence study and discuss them within the context of the HAI prevention and control programmes that have been implemented in the decade since the original survey was conducted., Methods: The study involved all public hospitals in the Piemonte region. Uni- and multivariate analyses were performed to assess the main risk factors associated with HAIs, including both overall and site-specific infections., Results: A total of 7841 patients were enrolled: 6.8% were affected by at least one HAI. The highest prevalence of HAIs was found in intensive care units (18.0%, 95% CI 14.0-22.6), while UTIs presented the highest relative frequency (26.7%), followed by respiratory tract infections (21.9%). The age of the patient, hospital size and urinary and central venous catheter status were significantly associated with HAIs., Conclusions: The study results showed an increase in HAI prevalence, despite prevention and control efforts, as well as training implemented after the first regional survey. Nevertheless, these data are consistent with the current literature. Furthermore, despite its limits, the prevalence approach remains an important means for involving healthcare workers, emphasising HAIs and revealing critical problems that need be addressed.
- Published
- 2014
- Full Text
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9. Incidence of surgical-site infections in orthopaedic surgery: a northern Italian experience.
- Author
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Castella A, Argentero PA, Farina EC, Charrier L, Del Prever EM, and Zotti CM
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Follow-Up Studies, Hip Joint surgery, Humans, Incidence, Italy epidemiology, Knee Joint surgery, Male, Middle Aged, Prospective Studies, Cross Infection epidemiology, Orthopedic Procedures adverse effects, Prosthesis-Related Infections epidemiology, Surgical Wound Infection epidemiology
- Abstract
SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4-2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.
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- 2011
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10. Surgical site infections surveillance in northern Italy.
- Author
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Castella A, Argentero PA, Farina EC, Anselmo E, Djiomo A, and Zotti CM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Humans, Incidence, Infant, Infant, Newborn, Italy epidemiology, Middle Aged, Population Surveillance, Young Adult, Cross Infection epidemiology, Surgical Wound Infection epidemiology
- Published
- 2009
- Full Text
- View/download PDF
11. [Role of EUS in a diagnostic and staging algorithm of pancreatic carcinoma: the surgeon point of view].
- Author
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Fronda GR, Maglione V, Campra D, Cucinelli M, Marracino M, and Farina EC
- Subjects
- Algorithms, Biopsy, Fine-Needle methods, Diagnosis, Differential, Humans, Pancreas pathology, Pancreatic Cyst diagnostic imaging, Pancreatic Cyst pathology, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Endosonography methods, Neoplasm Staging methods, Pancreas diagnostic imaging, Pancreatic Neoplasms diagnostic imaging
- Abstract
Survival of pancreatic cancer is improved by surgery and is related to R0 resection. An accurate diagnosis and a careful staging are mandatory. Differential diagnosis must be estabilished between the different pancreatic lesions as carcinoma, chronic pancreatitis, cystic or endocrine neoplasms. Endoscopic ultrasound (EUS) is the best technique for diagnosis and allows cytological examination by fine needle aspiration (FNA). Preoperative resectability is defined by EUS in borderline tumors. EUS is a useful procedure for the surgical strategy of pancreatic cancer.
- Published
- 2007
12. Leiomyosarcoma of the inferior vena cava. Report of two cases and review of the literature.
- Author
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Suffat LP, Mazza L, Farina EC, Cassine D, Merlo M, Limerutt G, and Fronda G
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- Adult, Blood Vessel Prosthesis Implantation, Fatal Outcome, Female, Humans, Leiomyosarcoma pathology, Middle Aged, Neoplasm Recurrence, Local, Vascular Neoplasms pathology, Vena Cava, Inferior pathology, Leiomyosarcoma surgery, Vascular Neoplasms surgery, Vena Cava, Inferior surgery
- Abstract
Introduction: Leiomyosarcoma (LMS) occurs most frequently in the inferior vena cav (IVC). Since Perl's first description in 1871, about 300 cases of IVX have been reported in English literature. The Authors present their personal experience of two case of IVC leiomyosarcoma treated in their Institution., Patients and Methods: Clinical and pathologic data, surgical management, ourcomes and follow-up of two patients admitted nb the Authors' Division respectively on February and November 2004 were collected., Results: There were a 49-years-old female with rare epigastric pain and a 42-years-old female with one-month history of abdominal discomfort and weight loss. After preoperative evaluation, both of the patients had localised and resectable tumors and underwent radical surgical excision, with prosthetic replacement of the IVC in the first patient and ligation of the IVC in the other one. The first patient is still alive but in an advanced disease. The second patient died of recurrence at seven months., Discussion: LMS of IVC is a rare tumor. The diagnosis is often delayed because of non-specificic symptoms. Radical resection with surgical margins free of tumor is the treatment of choice. The extent of venous resection does not seem to affect the survival. The type of IVC reconstruction is based on the extent of venal wall involvement. The prognosis is often poor because of tumor recurrence and/or metastatic disease. The role of chemo and radio therapy is not clear yet., Conclusion: Long term survival is related to an extensive surgery, being surgical margins free of tumor the only prognostic factor with significant influence on patients survival.
- Published
- 2007
13. [Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].
- Author
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Charrier L, Castella A, Di Legami V, Pastorino F, Farina EC, Argentero PA, and Zotti CM
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- Cross Infection prevention & control, Humans, International Agencies, Italy, Operating Rooms legislation & jurisprudence, Risk Factors, Surveys and Questionnaires, Environment, Controlled, Infection Control legislation & jurisprudence, Legislation, Hospital, Operating Rooms standards, Practice Guidelines as Topic, Surgical Wound Infection prevention & control
- Abstract
Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.
- Published
- 2006
14. Surgical site infection surveillance: analysis of adherence to recommendations for routine infection control practices.
- Author
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Castella A, Charrier L, Di Legami V, Pastorino F, Farina EC, Argentero PA, and Zotti CM
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- Data Collection methods, Health Knowledge, Attitudes, Practice, Health Personnel, Humans, Infection Control methods, Italy, Population Surveillance, Surgical Wound Infection etiology, Surgical Wound Infection prevention & control, General Surgery, Guideline Adherence, Hospital Units, Infection Control standards, Surgical Procedures, Operative standards, Surgical Wound Infection epidemiology
- Abstract
Objective: To evaluate the application of surgical site infection control procedures in general surgery departments in hospitals in the Piemonte region of Italy., Design: The descriptive study entailed 1 week of observation in the general surgery departments and 1 week of observation in the operating rooms of 49 hospitals in Piemonte; the survey was conducted in 2003., Methods: Data collection forms were designed to record information about presurgical patient preparation (form 1) and infection control practices routinely used by surgical teams (form 2)., Results: A total of 856 patients were observed; 88% of operations were surgical wound class I or II; 70.6% of patients had hair removed, 28.8% showered the day before the operation; antimicrobial prophylaxis was administered in 63.3% of cases (68.4% on induction of anesthesia and 26% on the day of the operation) and was continued into the postoperative period in 43% of cases. A total of 799 operations were observed; the mean number of healthcare personnel in the operating room was 6; doors were opened an average of 12 times during an operation; 88% of the surgical team members wore a cap/hood and mask correctly; 25% of surgeons and 41% of instrument nurses wore an eye shield; preoperative hand and forearm scrubbing technique was correct in 78% of cases (surgeons, 74.6%; instrument nurses, 86.6%; and anesthesiologists, 73%)., Conclusions: A comparison between the survey data and the international recommendations for SSI prevention highlighted practices that could be improved with corrective interventions. The study provided an opportunity for sharing feedback on appropriate data with healthcare personnel and was an effective instrument to audit infection control practices.
- Published
- 2006
- Full Text
- View/download PDF
15. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn's disease surgery.
- Author
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Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A, Campra D, and Fronda GR
- Subjects
- Adult, Anastomosis, Surgical methods, Female, Humans, Male, Middle Aged, Retrospective Studies, Suture Techniques, Colon surgery, Crohn Disease surgery, Ileum surgery, Postoperative Complications prevention & control, Sutures
- Abstract
Purpose: Anastomotic configuration may influence anastomotic leak rates. The aim of this study was to determine whether a side-to-side stapled ileocolonic anastomosis produces lower anastomotic leak rates than those with a handsewn end-to-end ileocolonic anastomosis after ileocecal or ileocolonic resection for Crohn's disease., Methods: A series of 122 consecutive patients underwent elective ileocecal or ileocolonic resection with ileocolonic anastomosis for Crohn's disease from January 1998 to June 2003: 71 had handsewn end-to-end anastomosis and 51 had side-to-side stapled anastomosis. The choice between the two anastomoses was left to the surgeon's preference. A retrospective analysis was performed to assess if there was any difference in anastomotic leak rates., Results: The two groups were comparable in terms of age, gender, preoperative presence of abscess or fistula, history of smoking, and albumin levels. More patients were taking steroids in the handsewn group than in the stapled group. In the handsewn group there were 10 anastomotic leaks (14.1 percent) and in the stapled group there was 1 anastomotic leak (2.0 percent) (risk difference, +12.1 percent; 95 percent confidence interval, 1.7-22.2; P = 0.02). Anastomotic configuration was the sole variable that influenced anastomotic leak rates at univariate analysis. Mortality was 1.4 percent in the handsewn group and 0 percent in the stapled group. Complications other than anastomotic leak developed in 11 patients in the hand-sewn group and in 6 patients in the stapled group. Mean postoperative hospital stay was 12.3 days in the handsewn group and 9.7 days in the stapled group (P = 0.03). Excluding those patients who had an anastomotic leak, the difference was still present (handsewn group, 10.1 days; stapled group, 9.1 days; P = 0.04)., Conclusion: Although confirmation from randomized, controlled trials is required, side-to-side stapled anastomosis seems to substantially decrease anastomotic leak rates in surgical patients with Crohn's disease, compared with handsewn end-to-end anastomosis. Postoperative hospital stay decreased in the stapled anastomosis group, and this was not entirely a result of decreased anastomotic leak rates.
- Published
- 2005
- Full Text
- View/download PDF
16. Hospital-acquired infections in Italy: a region wide prevalence study.
- Author
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Zotti CM, Messori Ioli G, Charrier L, Arditi G, Argentero PA, Biglino A, Farina EC, Moiraghi Ruggenini A, Reale R, Romagnoli S, Serra R, Soranzo ML, Valpreda M, and Hospital Coordinator Group
- Subjects
- Anti-Bacterial Agents therapeutic use, Cross Infection diagnosis, Cross Infection drug therapy, Cross Infection microbiology, Drug Utilization Review, Female, Hospital Units, Humans, Infection Control Practitioners, Italy epidemiology, Male, Prevalence, Risk Factors, Sentinel Surveillance, Urinary Tract Infections diagnosis, Urinary Tract Infections epidemiology, Urinary Tract Infections microbiology, Cross Infection epidemiology, Hospitals, Public statistics & numerical data
- Abstract
Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.
- Published
- 2004
- Full Text
- View/download PDF
17. [Evaluation of quality of care through hospital discharge reports: an example of rectal cancer surgery].
- Author
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Rosato R, Ciccone G, Farina EC, Gelormino E, Pagano E, Senore C, and Merletti F
- Subjects
- Aged, Aged, 80 and over, Digestive System Surgical Procedures adverse effects, Digestive System Surgical Procedures mortality, Female, Hospital Mortality, Humans, Italy epidemiology, Male, Middle Aged, Odds Ratio, Digestive System Surgical Procedures standards, Hospital Records, Patient Discharge statistics & numerical data, Practice Guidelines as Topic, Quality Indicators, Health Care, Rectal Neoplasms surgery
- Abstract
This study was undertaken to evaluate the usefulness of hospital discharge data for monitoring the impact of a regional practice guideline on treatment of colorectal cancer. The aims of the study were: i) estimating process and outcome indicators; ii) exploring the relationship between patient and hospital characteristics and these indicators. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for all risk factors analysed. All 3,614 patients undergoing potentially curative resection for rectal cancer in 75 hospitals in Piedmont (Italy) between 1997 and 2000 were included. Occurrences of abdominoperineal resections (APR), postoperative complications, reinterventions and hospital mortality were 16.2%, 11.0%, 5.5% and 4.4%, respectively. APR was performed more frequently in patients with distant metastases or urgently admitted and by hospitals with a lower volume of cases (< 25 per year) compared to hospital with more than 50 cases per year (OR = 1.50, CI = 1.16-1.94). The strongest predictors for mortality and complications were: older age, distant metastases and urgency of admission. Incidence of complications and of reinterventions was also increased among males and in patients with lesions of the lower rectum. The rate of complications showed an increasing trend during the period, from 8.5% to 14.5% likely reflecting improvement in coding during time. Low hospital workload was associated to a reduced risk of complications and reinterventions, but there was evidence of underreporting of secondary diagnoses and procedures in smaller hospitals. Outcome indicator based on secondary diagnoses and procedures are of limited value in monitoring improvement of care since they reflect also differences in coding during time and among providers.
- Published
- 2003
18. Castleman disease in differential diagnosis of a pancreatic mass.
- Author
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Campra D, Farina EC, Resegotti A, Longhin R, Burlo P, David E, and Fronda GR
- Subjects
- Adult, Biopsy, Needle, Castleman Disease diagnosis, Castleman Disease surgery, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Immunohistochemistry, Laparotomy, Pancreatectomy methods, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery, Risk Assessment, Treatment Outcome, Castleman Disease pathology, Pancreatic Neoplasms pathology
- Published
- 2002
- Full Text
- View/download PDF
19. Production and pro-apoptotic activity of soluble CD95 ligand in pancreatic carcinoma.
- Author
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Bellone G, Smirne C, Carbone A, Mareschi K, Dughera L, Farina EC, Alabiso O, Valente G, Emanuelli G, and Rodeck U
- Subjects
- Adult, Aged, Carcinoma blood, Cell Separation, Coculture Techniques, Culture Media, Conditioned, Dose-Response Relationship, Drug, Enzyme-Linked Immunosorbent Assay, Fas Ligand Protein, Female, Flow Cytometry, Fluorescent Antibody Technique, Green Fluorescent Proteins, Humans, Immunoblotting, Immunohistochemistry, Jurkat Cells, Luminescent Proteins metabolism, Male, Membrane Glycoproteins blood, Middle Aged, Pancreatic Neoplasms blood, Reverse Transcriptase Polymerase Chain Reaction, T-Lymphocytes metabolism, T-Lymphocytes pathology, Tumor Cells, Cultured, fas Receptor blood, Apoptosis, Carcinoma metabolism, Membrane Glycoproteins biosynthesis, Pancreatic Neoplasms metabolism, fas Receptor biosynthesis
- Abstract
We report here that the progression of pancreatic carcinomas in tumor patients is associated with increased serum levels of both the soluble forms of CD95 ligand (CD95L/FasL) and its receptor, CD95 (Fas). Shedding of proteolytically processed soluble CD95L was also observed in pancreatic carcinoma cells in vitro, thus identifying one possible source of CD95L in patients' sera. Because the secreted forms of both CD95 and CD95L have been implicated previously in protection of cells from CD95-mediated cell death, we assessed the effect of soluble CD95L in supernatants of pancreatic carcinoma cells on viability of Jurkat T lymphocytes. We describe that (a) supernatants derived from cultured pancreatic carcinoma cells caused apoptosis of Jurkat cells; (b) soluble tumor-derived CD95L contributed significantly to this effect; and (c) in comparison to Jurkat cells, pancreatic carcinoma cells themselves revealed increased resistance to apoptosis induction by autocrine soluble CD95L. These results are consistent with the notion that in the microenvironment of pancreatic tumors, tumor-derived shed CD95L exerts paracrine pro-apoptotic effects. In addition, because it is released at high levels into the bloodstream, soluble CD95L may have systemic effects in tumor patients that reach beyond the microenvironment of the tumor site.
- Published
- 2000
20. [Intestinal fistulas in Crohn disease].
- Author
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Fronda GR, Resegotti A, Astegiano M, Farina EC, Patelli E, Giustetto A, and De Paolis P
- Subjects
- Adult, Colonic Diseases etiology, Crohn Disease complications, Duodenal Diseases etiology, Female, Humans, Ileal Diseases etiology, Ileostomy, Intestinal Fistula etiology, Male, Prospective Studies, Sigmoid Diseases etiology, Sigmoid Diseases surgery, Colonic Diseases surgery, Crohn Disease surgery, Duodenal Diseases surgery, Ileal Diseases surgery, Intestinal Fistula surgery
- Abstract
Background: Only a part of patients suffering from Crohn's disease has enteric fistulae and a different behaviour of Crohn's disease with fistulae is reported in the literature. Aim of this paper is to evaluate if enteric fistulae are a factor conditioning mortality, morbidity and overall postoperative course, in patients with Crohn's disease., Methods: Data on the postoperative course of 126 laparotomies for Crohn's disease, performed between November 1993 and July 1998, have been prospectively examined. Moreover, the presence of enteric fistula has been evaluated during surgery., Results: Out of 126 interventions, in 58 (46%) enteric fistulae were present. Mortality (5.2% vs 0), morbidity (14.5% vs 7.3%), necessity for a temporary ostomy (20.4% vs 3.5%) were greater in those patients with fistula, as compared as those without fistula., Conclusions: In conclusion, it is suggested that Crohn's disease with fistulae is a different type of disease, with higher mortality and morbidity rates.
- Published
- 2000
21. Immunological controls of postoperative infections in colorectal tumours.
- Author
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Farina EC, Garino M, Resegotti A, Tapparo A, and Fusi D
- Subjects
- Adult, Aged, Female, Humans, Infections etiology, Male, Middle Aged, Prospective Studies, Treatment Outcome, Adjuvants, Immunologic therapeutic use, Colorectal Neoplasms surgery, Infections drug therapy, Postoperative Complications drug therapy, Thymus Extracts therapeutic use
- Published
- 1995
22. Secondary immunodeficiencies in surgical patients.
- Author
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Balbo G and Farina EC
- Subjects
- Humans, Immunocompetence drug effects, Immunologic Deficiency Syndromes therapy, Skin Tests, Immunologic Deficiency Syndromes immunology, Surgical Procedures, Operative
- Published
- 1992
- Full Text
- View/download PDF
23. Pancreatic somatostatinoma.
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Soldati T, Del Noce G, Garino M, Farina EC, De Paolis P, and Balbo G
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- Humans, Middle Aged, Pancreatic Neoplasms surgery, Somatostatinoma surgery, Pancreatic Neoplasms diagnosis, Somatostatinoma diagnosis
- Abstract
The Authors describe a case of somatostatinoma in the pancreatic tail, characterized by the absence of a specific symptomatology, with the exception of a slight hyperglycaemia. The patient underwent a surgical operation of pancreatic resection and splenectomy, and now enjoys very good health. They have examined literature from 1977 to 1988, and overall the 30 cases of pancreatic localization, describing the symptomatology, the pathological anatomy, the therapy, and evaluating the malignity degree. Then the Authors could notice that the prognosis of these neoplasms is often fatal, both for the frequent tumor metastatization, and for the difficulties in making an early diagnosis. The therapy is essentially surgical.
- Published
- 1990
24. Mezlocillin and prophylaxis of postoperative infections in biliary surgery.
- Author
-
Balbo G, Farina EC, and Garino M
- Subjects
- Adult, Clinical Trials as Topic, Drug Administration Schedule, Humans, Mezlocillin administration & dosage, Random Allocation, Respiratory Tract Infections prevention & control, Urinary Tract Infections prevention & control, Biliary Tract Diseases surgery, Mezlocillin therapeutic use, Postoperative Complications prevention & control, Surgical Wound Infection prevention & control
- Published
- 1987
25. [Chronic peritonitis encapsulans].
- Author
-
Soldati T, De Paolis P, Farina EC, and Garino M
- Subjects
- Aged, Chronic Disease, Humans, Male, Peritoneum pathology, Peritonitis surgery, Peritonitis pathology
- Published
- 1986
26. [Immunosuppression and postoperative infections: a rational approach to the problem].
- Author
-
Farina EC, Garino M, Soldati T, De Paolis P, and Balbo G
- Subjects
- Humans, Preoperative Care, Risk, Skin Tests, Bacterial Infections immunology, Immune Tolerance, Postoperative Complications immunology
- Published
- 1986
27. Thymostimulin prophylaxis of postoperative infections in anergic patients.
- Author
-
Farina EC, Garino M, and Balbo G
- Subjects
- Adjuvants, Immunologic administration & dosage, Bacterial Infections prevention & control, Clinical Trials as Topic, Humans, Injections, Intramuscular, Postoperative Complications prevention & control, Prospective Studies, Random Allocation, Thymus Extracts administration & dosage, Adjuvants, Immunologic therapeutic use, Bacterial Infections immunology, Immune Tolerance drug effects, Postoperative Complications immunology, Thymus Extracts therapeutic use
- Abstract
The rate of postoperative infections is significantly increased in anergic patients. The authors evaluated prospectively, in a controlled, randomized and stratified study, the efficiency of thymostimulin in reducing postoperative infections in 42 such patients. Excluded were those who were malnourished in whom preoperative alimentation corrected the anergy. The incidence of infections was significantly (p less than 0.05) reduced in thymostimulin-treated patients (4.8% versus 28.6%).
- Published
- 1986
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