48 results on '"Toccafondi G"'
Search Results
2. Patient Safety in Pediatrics: Ergonomic Solutions for Safer Care of Children
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Albolino, S., Beleffi, E., Ranzani, F., Toccafondi, G., Savelli, A., Biermann, K. P., De Masi, S., Frangioni, G., Festini, F., Dagliana, G., Sforzi, I., Merello, G., Guagliardi, S., Kacprzyk, Janusz, Series Editor, Pal, Nikhil R., Advisory Editor, Bello Perez, Rafael, Advisory Editor, Corchado, Emilio S., Advisory Editor, Hagras, Hani, Advisory Editor, Kóczy, László T., Advisory Editor, Kreinovich, Vladik, Advisory Editor, Lin, Chin-Teng, Advisory Editor, Lu, Jie, Advisory Editor, Melin, Patricia, Advisory Editor, Nedjah, Nadia, Advisory Editor, Nguyen, Ngoc Thanh, Advisory Editor, Wang, Jun, Advisory Editor, Bagnara, Sebastiano, editor, Tartaglia, Riccardo, editor, Albolino, Sara, editor, Alexander, Thomas, editor, and Fujita, Yushi, editor
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- 2019
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3. Patient Safety in Pediatrics: Ergonomic Solutions for Safer Care of Children
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Albolino, S., primary, Beleffi, E., additional, Ranzani, F., additional, Toccafondi, G., additional, Savelli, A., additional, Biermann, K. P., additional, De Masi, S., additional, Frangioni, G., additional, Festini, F., additional, Dagliana, G., additional, Sforzi, I., additional, Merello, G., additional, and Guagliardi, S., additional
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- 2018
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4. Safe Transitions of Care: A Participatory Human Factors Approach for Improving Safety in the Communication of Healthcare Organizations
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Toccafondi, G., primary, Albolino, S., additional, Bellandi, T., additional, Savelli, A., additional, Frangioni, G., additional, Elisei, O., additional, Baroni, M., additional, and Molisso, A., additional
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- 2018
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5. Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions
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Johnson, Julie K, Farnan, Jeanne M, Barach, Paul, Hesselink, Gijs, Wollersheim, Hub, Pijnenborg, Loes, Kalkman, Cor, Arora, Vineet M, Venneri, F, Molisso, A, Albolino, S, Toccafondi, G, Barach, P, Gademan, P, Göbel, B, Johnson, J, Kalkman, C, Pijnenborg, L, Wollersheim, H, Hesselink, G, Schoonhoven, L, Vernooij-Dassen, M, Zegers, M, Boshuizen, E, Drachsler, H, Kicken, W, van der Klink, M, Stoyanov, S, Kutryba, B, Dudzik-Urbaniak, E, Kalinowski, M, Kutaj-Wasikowska, H, Suñol, R, Groene, O, Orrego, C, Öhlén, G, Airosa, F, Bergenbrant, S, Flink, M, Hansagi, H, Olsson, M, Lilford, R, Chen, Y-F, Novielli, N, and Manaseki-Holland, S
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- 2012
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6. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers
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Hesselink, Gijs, Flink, Maria, Olsson, Mariann, Barach, Paul, Dudzik-Urbaniak, Ewa, Orrego, Carola, Toccafondi, Giulio, Kalkman, Cor, Johnson, Julie K, Schoonhoven, Lisette, Vernooij-Dassen, Myrra, Wollersheim, Hub, Venneri, F, Molisso, A, Albolino, S, Toccafondi, G, Barach, P, Gademan, P, Göbel, B, Johnson, J, Kalkman, C, Pijnenborg, L, Wollersheim, H, Hesselink, G, Schoonhoven, L, Vernooij-Dassen, M, Zegers, M, Boshuizen, E, Drachsler, H, Kicken, W, van der Klink, M, Stoyanov, S, Kutryba, B, Dudzik-Urbaniak, E, Kalinowski, M, Kutaj-Wasikowska, H, Suñol, R, Groene, O, Orrego, C, Öhlén, G, Airosa, F, Bergenbrant, S, Flink, M, Hansagi, H, Olsson, M, Lilford, R, Chen, Y-F, Novielli, N, and Manaseki-Holland, S
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- 2012
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7. Conducting a multicentre and multinational qualitative study on patient transitions
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Johnson, Julie K, Barach, Paul, Vernooij-Dassen, Myrra, Venneri, F, Molisso, A, Albolino, S, Toccafondi, G, Barach, P, Gademan, P, Göbel, B, Johnson, J, Kalkman, C, Pijnenborg, L, Wollersheim, H, Hesselink, G, Schoonhoven, L, Vernooij-Dassen, M, Zegers, M, Boshuizen, E, Drachsler, H, Kicken, W, van der Klink, M, Stoyanov, S, Kutryba, B, Dudzik-Urbaniak, E, Kalinowski, M, Kutaj-Wasikowska, H, Suñol, R, Groene, O, Orrego, C, Öhlén, G, Airosa, F, Bergenbrant, S, Flink, M, Hansagi, H, Olsson, M, Lilford, R, Chen, Y-F, Novielli, N, and Manaseki-Holland, S
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- 2012
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8. Recommendations for general surgery activities in a pandemic scenario (SARS-CoV-2)
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Di Marzo, F, primary, Sartelli, M, additional, Cennamo, R, additional, Toccafondi, G, additional, Coccolini, F, additional, La Torre, G, additional, Tulli, G, additional, Lombardi, M, additional, and Cardi, M, additional
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- 2020
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9. [The interplay of diagnostic and antimicrobial stewardship for the management of septic patients: the Tuscan model.]
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Forni, S., Toccafondi, G., Viaggi, B., Grazzini, M., D'Arienzo, S., Gemmi, F., Vannucci, A., Tulli, G., Rossolini, G. M., Pecile, P., Cusi, M. G., Cresti, S., Barnini, S., Mattei, R., Salamone, D., Petricci, P., Vettori, C., Bianchi, L., degli Innocenti, R., Dodi, C., Rebuffat, A., Batignani, T., Galanti, I., Valentini, S., D'Andrea, M. M., and Covello, B.
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Antimicrobial Stewardship ,Microbial ,Anti-Infective Agents ,Italy ,Drug Resistance, Microbial ,Humans ,Laboratories ,Sepsis ,Drug Resistance ,Settore MED/07 - Microbiologia e Microbiologia Clinica ,Settore BIO/19 - Microbiologia Generale - Abstract
Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies. This may result in important advancement in time-critical care pathways for septic patients. Nevertheless, RDTM are costly and if not rationally positioned may consume resources and hinder the efficacy of AS programs. In this regard, Tuscany Region is engaged in designing, through a systemic approach, an effective high-quality clinical microbiological service grid. In order to develop a sustainable and equitable model for integrating diagnostic and antimicrobial stewardship we conducted a survey in the regional network of 14 microbiological laboratories. The results shows that in order to develop a sustainable service we need to improve the communication at the interface between laboratories and care unit, harmonize the time windows for processing samples and to devise a robust score for stratifying patient with suspected sepsis.
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- 2018
10. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use
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Schuetz, P., primary, Beishuizen, A., additional, Broyles, M., additional, Ferrer, R., additional, Gavazzi, G., additional, Gluck, E. H., additional, Castillo, J., additional, Jensen, J.-U., additional, Kanizsai, P. L., additional, Lay Hoon Kwa, A., additional, Krueger, S., additional, Luyt, C.-E., additional, Oppert, M., additional, Plebani, M., additional, Shlyapnikov, S. A., additional, Toccafondi, G., additional, Townsend, J., additional, Welte, T., additional, and Saeed, K., additional
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- 2019
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11. Integrazione dei percorsi clinico assistenziali
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Toccafondi, G. and Niccolai, Francesco
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- 2013
12. Improving patient discharge and reducing hospital readmissions by using Intervention Mapping
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Hesselink, G.J., Zegers, M., Vernooij-Dassen, M.J.F.J., Barach, P., Kalkman, C.J., Flink, M., Ohlen, G., Olsson, M., Bergenbrant, S., Orrego, C., Sunol, R., Toccafondi, G., Venneri, F., Dudzik-Urbaniak, E., Kutryba, B., Schoonhoven, L., Wollersheim, H.C., et al., Hesselink, G.J., Zegers, M., Vernooij-Dassen, M.J.F.J., Barach, P., Kalkman, C.J., Flink, M., Ohlen, G., Olsson, M., Bergenbrant, S., Orrego, C., Sunol, R., Toccafondi, G., Venneri, F., Dudzik-Urbaniak, E., Kutryba, B., Schoonhoven, L., Wollersheim, H.C., and et al.
- Abstract
Contains fulltext : 138258.pdf (publisher's version ) (Open Access), BACKGROUND: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge. METHODS: The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance. RESULTS: Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavi
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- 2014
13. Organizational culture: an important context for addressing and improving hospital to community patient discharge
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Hesselink, G.J., Vernooij-Dassen, M.J.F.J., Pijnenborg, L., Barach, P., Gademan, P., Dudzik-Urbaniak, E., Flink, M., Orrego, C., Toccafondi, G., Johnson, J.K., Schoonhoven, L., Wollersheim, H.C.H., et al., Hesselink, G.J., Vernooij-Dassen, M.J.F.J., Pijnenborg, L., Barach, P., Gademan, P., Dudzik-Urbaniak, E., Flink, M., Orrego, C., Toccafondi, G., Johnson, J.K., Schoonhoven, L., Wollersheim, H.C.H., and et al.
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Item does not contain fulltext, BACKGROUND: Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. OBJECTIVES: To explore aspects of organizational culture to develop a deeper understanding of the discharge process. RESEARCH DESIGN: A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data. SUBJECTS: In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses. RESULTS: Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices. CONCLUSIONS: On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.
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- 2013
14. The key actor: a qualitative study of patient participation in the handover process in Europe
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Flink, M., Hesselink, G.J., Pijnenborg, L., Wollersheim, H.C.H., Vernooij-Dassen, M.J.F.J., Dudzik-Urbaniak, E., Orrego, C., Toccafondi, G., Schoonhoven, L., Gademan, P., Johnson, J.K., Ohlen, G., Hansagi, H., Olsson, M., Barach, P., Flink, M., Hesselink, G.J., Pijnenborg, L., Wollersheim, H.C.H., Vernooij-Dassen, M.J.F.J., Dudzik-Urbaniak, E., Orrego, C., Toccafondi, G., Schoonhoven, L., Gademan, P., Johnson, J.K., Ohlen, G., Hansagi, H., Olsson, M., and Barach, P.
- Abstract
Contains fulltext : 109871.pdf (publisher's version ) (Open Access)
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- 2012
15. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers
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Hesselink, G.J., Flink, M., Olsson, M., Barach, P., Dudzik-Urbaniak, E., Orrego, C., Toccafondi, G., Kalkman, C.J., Johnson, J.K., Schoonhoven, L., Vernooij-Dassen, M.J.F.J., Wollersheim, H.C.H., Hesselink, G.J., Flink, M., Olsson, M., Barach, P., Dudzik-Urbaniak, E., Orrego, C., Toccafondi, G., Kalkman, C.J., Johnson, J.K., Schoonhoven, L., Vernooij-Dassen, M.J.F.J., and Wollersheim, H.C.H.
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Item does not contain fulltext
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- 2012
16. From 'La Piazza' to 'Puente': How place, people and technology make intergenerational learning
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Decortis, F., primary, Ackermann, E., additional, Barajas, M., additional, Magli, R., additional, Owen, M., additional, and Toccafondi, G., additional
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- 2008
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17. Role of p53 gene mutations and bcl-2 oncoprotein expression in radiodermatitis and radiation induced cutaneous carcinomas of the head and neck area.
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Franchi, A., primary, Gallo, O., additional, Chiarelli, I., additional, Porfirio, B., additional, Toccafondi, G., additional, Paglierani, M., additional, and Santucci, M., additional
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- 1997
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18. Spontaneous in vitro differentiation of a myoepithelial cell line (PA 16/23) from a pleomorphic adenoma of the parotid gland is associated with reduced production of the autocrine growth factor interleukin 6
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Gallo, O, primary, Bani, D, additional, Giudizi, MG, additional, Biagiotti, R, additional, Almerigogna, F, additional, Toccafondi, G, additional, Fini-Storchi, O, additional, and Romagnani, S, additional
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- 1994
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19. Organizational culture: an important context for addressing and improving hospital to community patient discharge.
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Hesselink G, Vernooij-Dassen M, Pijnenborg L, Barach P, Gademan P, Dudzik-Urbaniak E, Flink M, Orrego C, Toccafondi G, Johnson JK, Schoonhoven L, Wollersheim H, and European HANDOVER Research Collaborative
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- 2013
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20. Characterization of a novel cell line from pleomorphic adenoma of the parotid gland with myoepithelial phenotype and producing interleukin-6 as an autocrine growth factor.
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Gallo, Oreste, Bani, Daniele, Toccafondi, Geri, Alnzerigogna, Fabio, Storchi, Omero Fini, Gallo, O, Bani, D, Toccafondi, G, Almerigogna, F, and Storchi, O F
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- 1992
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21. ALTERAZIONI DELLA MOTILITA' ESOFAGEA IN PAZIENTI CON DIVERTICOLI DELL'ESOFAGO MEDIO-TORACICO
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Pandolfo, N, Nebiacolombo, C, Borgonovo, Giacomo, and Toccafondi, G.
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- 1981
22. Careggi Re-Engineered Discharge project: standardize discharge and improve care coordination between healthcare professionals.
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Paolini D, Bonaccorsi G, Lorini C, Forni S, Tanzini M, Toccafondi G, D'arienzo S, Dannaoui B, Niccolini F, Tomaiuolo M, Bussotti A, Petrioli A, and Morettini A
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- Aftercare, Delivery of Health Care, Hospitalization, Humans, Continuity of Patient Care, Patient Discharge
- Abstract
Background: The hospital discharge process plays a key role in patient care. Careggi Re-Engineered Discharge (CaRED) aimed at establishing a meaningful relationship among general practitioners (GPs) and patients, throughout the discharge process., Objective: The aim is to describe the activities and results in the period 2014-17 of the CaRED., Methods: CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy for effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction., Results: A total of 1549 hospitalizations were included, respectively, 717 in the pre and 832 in the post-intervention period. The 30-day hospital readmission rate decreased significantly in the post-intervention period (14.4% vs. 19.4%, χ2(1) = 8.03, P < 0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post-survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1) = 0.56, P = 0.03) and on what to do if conditions change (χ2(31) = 19.0, P < 0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3) = 19.6, P < 0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post-survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P < 0.01)., Conclusions: CaRED significantly improved the discharge process and became a benchmark for local improvements in communication patterns with GPs., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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23. Independent, Differential Effects of Delirium on Disability and Mortality Risk After Hip Fracture.
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Cartei A, Mossello E, Ceccofiglio A, Rubbieri G, Polidori G, Ranalli C, Cammilli A, Curcio M, Cavallini MC, Mannarino GM, Ungar A, Toccafondi G, Peris A, Marchionni N, and Rostagno C
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- Activities of Daily Living, Aged, Aged, 80 and over, Female, Geriatric Assessment methods, Hospitalization, Humans, Risk Factors, Delirium epidemiology, Hip Fractures surgery
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Objectives: To assess the independent effect of delirium on mortality and disability after 1 year of follow-up, in consecutive older patients with hip fracture hospitalized for surgical repair., Design: This is a prospective observational study., Setting and Participants: Patients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between March and October 2014., Methods: Patients were evaluated by a multidisciplinary team. A comprehensive geriatric assessment was performed on admission. Delirium was assessed before and after surgical repair according to the Confusion Assessment Method. Mortality and disability status were collected at 3 months and 1 year after hospital discharge., Results: Of 411 patients with hip fracture, 387 (mean age 82 years, female 72%) were enrolled. Delirium was assessed in 50% of the enrolled population. Patients with delirium were older, frequently affected by dementia, severe prefracture disability, history of falls, and polypharmacy. One-year mortality was 19% in all populations, and higher in patients with delirium, although delirium did not show an independent association with mortality, in multivariable analysis. Conversely, delirium was identified as an independent prognostic factor of long-term disability (B-1.605, SE 0.211, P < .001)., Conclusion and Implications: This study identifies delirium as an independent long-term disability generator, regardless of associated clinical conditions and premorbid cognitive and functional status. This emphasises the importance of delirium prevention through a multidisciplinary approach and the potential role of systematic treatment of risk factors in reducing functional decline, even in subjects with preexistent disability and dementia. Moreover, these data call for research on rehabilitation interventions specifically targeted to these complex patients, with the aim of identifying approaches effective in reducing long-term disability. Conversely, a high level of clinical alertness is required in patients with delirium, as an appropriate treatment of acute diseases should reduce their high mortality risk., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2022
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24. Safety Analysis of 13 Suspicious Deaths in Intensive Care: Ergonomics and Forensic Approach Compared.
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Tartaglia R, Prineas S, Poli D, Albolino S, Bellandi T, Biancofiore G, Bertolini G, and Toccafondi G
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- Critical Care, Ergonomics, Hemorrhage chemically induced, Humans, Heparin therapeutic use, Hospitalization
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Objectives: Thirteen suspicious deaths occurred in an intensive care unit of Tuscany, Italy, in 2015. All patients developed sudden unexplained coagulopathy leading to severe bleeding. None of them had been prescribed heparin, but supertherapeutic concentrations of heparin were found. After a nurse was arrested on suspicion of murdering Human Factor and Ergonomics (HF/E) experts received a mandate to identify system failures. According to the judgment of the Court of First Instance on April 2019, the nurse was found guilty., Methods: The HF/E group used a two-pronged safety analysis: understanding the conditions in which the healthcare practitioners were working in the period when the suspicious deaths emerged and reviewing the clinical records., Results: Fourteen patients admitted to the intensive care unit in 2014 and 2015 were selected on the basis of markedly abnormal coagulation tests (n = 13) or a family member's complaint (n = 1). In 13 cases, a massive, abrupt hemorrhage in the presence of an unexpected abnormality of coagulation tests occurred, whereas the fourteenth patient had the only prolongation of coagulation markers without bleeding. All cases examined classified as adverse events related to a coagulation disorder. Human factor and ergonomics analysis identified a number of latent and active failures that contributed to the event and provided a set of important recommendations for safety improvement., Conclusions: When presented with a manifest, albeit suspected, wrongdoing with lethal consequences for patients, forensic investigators and safety investigators have distinctly different goals and methods. We believe that a memorandum of understanding between HF/E and forensic investigative teams provides an operative framework for allowing co-existence and fosters collaboration. The pursuit of safe care as a new emerging right for patients and balancing the right to legal justice with the right to safer healthcare merit further investigation and discussion., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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25. Medication Reconciliation During Hospitalization and in Hospital-Home Interface: An Observational Retrospective Study.
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Volpi E, Giannelli A, Toccafondi G, Baroni M, Tonazzini S, Alduini S, Biagini S, Gini R, Bellandi T, and Emdin M
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- Aged, Drug Prescriptions, Hospitalization, Hospitals, University, Humans, Retrospective Studies, Medication Reconciliation, Patient Admission
- Abstract
Objective: Medication errors are one of the leading causes of patient harms. Medication reconciliation is a fundamental process that to be effective, it should be embraced during each single care transition. Our objectives were to investigate current medication reconciliation practices in the 2 Fondazione Toscana Gabriele Monasterio hospitals and comprehensively assess the quality of medication reconciliation practices between inpatient and outpatient care by analyzing the medication patterns 6 months before admission, during hospitalization, and 9 months after discharge for a selected group of patients with cardiovascular diseases., Methods: A retrospective observational study was conducted in the Cardiothoracic Department of the Fondazione Toscana Gabriele Monasterio hospitals. Medication history was reviewed for all the patients admitted from and discharged to the community, from January to March 2013. Patients were excluded if they had less than 4 drugs or less than 2 drugs for cardiovascular system in their prescription list at admission or if they died during follow-up. We selected 714 patients, and we obtained the clinical charts and all drug prescriptions collected during patients' hospitalization by the electronic clinical recording system. We also analyzed the list of prescriptions of this sample of patients, from 6 months before admission to 9 months after discharge, extracted from the regional prescription registry. In the resulting sample, prescriptions were analyzed to assess unintentional discrepancies., Results: The study included 298 patients (mean age, 71.2 years), according to the inclusion and exclusion criteria. Among 14,573 prescriptions analyzed, we found 4363 discrepancies (14.6 discrepancies per patient). Among these discrepancies, 1310 were classified as unintentional (4.4 discrepancies per patient). Among unintentional discrepancies, only 63 (4.8%) took place during hospitalization. Although at the hospital-home interface, 33.1% of unintentional discrepancies were detected through the comparison between the patients' declared therapy and the previous medication consumption and 62.1% were identified in the comparison between the prescription at the discharge and the following medication pattern at home., Conclusions: Medication errors have important implications for patient safety, and their identification is a main target for improving clinical practice. The comparison between the medication patterns acquired through the regional prescription registry before and after hospitalization outlined critical touchpoint in the current medication reconciliation process, calling for the definition of shared medication reconciliation standards between hospitals and primary care services to minimize medication discrepancies and enhance patient safety., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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26. Human factors and ergonomics at time of crises: the Italian experience coping with COVID-19.
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Albolino S, Dagliana G, Tanzini M, Toccafondi G, Beleffi E, Ranzani F, and Flore E
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- Hand Hygiene standards, Humans, Italy epidemiology, Organizational Culture, Personal Protective Equipment standards, Quality Indicators, Health Care, SARS-CoV-2, Safety Management standards, Stress, Psychological epidemiology, Ventilation standards, COVID-19 epidemiology, Ergonomics, Infection Control organization & administration, Safety Management organization & administration
- Abstract
Several of the key organizational issues that we have had to face with the emergence of COVID-19 crisis are related to human factors/ergonomics (HFE) and the safety culture. During the crisis the main activities of the healthcare services have been profoundly affected. Patient safety and risk management units have also experienced the need to adapt rapidly. What can we do as HFE experts, now that the scenario has completely changed? We contend that: (a) we can favour and support the heuristics that are applied to manage the load of psycho-cognitive stress. (b) We can observe, collect strategies and develop analytic schemes, thereby creating a memory of the organization for improvement in the future. (c) And we can support in educating and engaging the public. This crisis has forced the community of healthcare experts to broaden their reflections: for the future to come, our communities of experts in the field of risk management HF/E, quality and safety of care and public health should play together an important role from the very beginning, from the time of peace., (© The Author(s) 2020. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2021
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27. Responding to COVID-19: the experience from Italy and recommendations for management and prevention.
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La Regina M, Tanzini M, Fineschi V, Venneri F, Toccafondi G, Lachman P, and Tartaglia R
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- COVID-19 epidemiology, COVID-19 therapy, Communicable Disease Control methods, Communicable Disease Control organization & administration, Humans, Italy epidemiology, Pandemics prevention & control, Pandemics statistics & numerical data, COVID-19 prevention & control
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- 2021
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28. Integrating infection and sepsis management through holistic early warning systems and heuristic approaches: a concept proposal.
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Tulli G and Toccafondi G
- Abstract
This is a first attempt to integrate the three pillars of infection management: the infection prevention and control (IPC), and surveillance (IPCS), antimicrobial stewardship (AMS), and rapid identification and management of sepsis (RIMS). The new 'Sepsis-3' definition extrapolates the diagnosis of sepsis from our previously slightly naïve concept of a stepwise evolving pattern. In doing so, however, we have placed the transition from infection toward sepsis in the domain of uncertainty and time-dependency. This now demands that clinical judgment be used in the risk stratification of patients with infection, and that pragmatic local solutions be used to prompt clinicians to evaluate formally for sepsis. We feel it is necessary to stimulate the development of a new generation of concepts and models aiming at embracing uncertainty. We see the opportunity for a heuristic approach focusing on the relevant clinical predictors at hand allowing to navigate the uncertainty of infection diagnosis under time constraints. The diverse and situated clinical approaches eventually emerging need to focus on the understanding of infection as the unbalanced interaction s of host, pathogen, and environment. In order extend such approach throughout the patient journey we propose a holistic early warning system underpinned by the risk-based categories of hazards and vulnerabilities iteratively fostered by the information gathered by the infection prevention control and surveillance, clinical microbiology, and clinical chemistry services., (© 2021 Giorgio Tulli and Giulio Toccafondi, published by De Gruyter, Berlin/Boston.)
- Published
- 2021
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29. Will the COVID-19 pandemic transform infection prevention and control in surgery? Seeking leverage points for organizational learning.
- Author
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Toccafondi G, Di Marzo F, Sartelli M, Sujan M, Smyth M, Bowie P, Cardi M, and Cardi M
- Subjects
- Anti-Bacterial Agents therapeutic use, Cross Infection prevention & control, Epidemiological Monitoring, Ergonomics methods, Hand Hygiene, Humans, Infection Control standards, COVID-19, Infection Control methods, Surgical Procedures, Operative standards
- Abstract
Background: In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy., Methods: The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery., Results: This paper aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe., Conclusion: For achieving sustainable change in IPCS practices in surgery during COVID-19 and beyond we need to enhance organizational learning potentials., (© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Quality in Health Care.)
- Published
- 2021
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30. Proactive Risk Assessment through FMEA of Home Parenteral Nutrition Care Processes: A Survey Analysis.
- Author
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Toccafondi G, Dagliana G, Fineschi V, Frati P, and Tartaglia R
- Subjects
- Community Health Services standards, Female, Humans, Italy epidemiology, Male, Middle Aged, Parenteral Nutrition, Home adverse effects, Parenteral Nutrition, Home standards, Patient Transfer standards, Risk Assessment standards, Risk Assessment trends, Treatment Failure, Treatment Outcome, Community Health Services trends, Nutritional Status physiology, Parenteral Nutrition, Home trends, Patient Transfer trends, Surveys and Questionnaires
- Abstract
Background: Home Parenteral Nutrition (HPN) is a lifesaving clinical care process. However, undetected hazards and vulnerabilities in care transitions from hospital to community care may pose risk to patient's safety. Avoidable complications and adverse events may hinder the benefits of treatment., Objective: The analysis carried out aims at framing through Human Factors and Ergonomics (HF/E) the critical issues for patient safety related to clinical care practices for HPN in healthcare organization., Methods: We present the results of a proactive risk assessment analysis based on the FMEA methodology (Failure Mode and Effects Analysis) carried out in three different areas of the regional health care system of Tuscany, Italy. The clinical risk management and patient safety unit assessed the risk perception of Healthcare Workers (HWs) in regard to patient safety and situational awareness throughout the HPN patient journey., Results: The analysis revealed heterogeneity in the Risk Priority Index (RPI) expressed by HWs. A lower RPI is associated with a HPN process that deploys in continuity between hospital care and community care. A higher RPI is associated with a quality and safety improvement process that is still ongoing. We also observed HWs expressing low RPI in the areas of the region where HPN has a hospital- focused approach and has limited adherence to patient safety requirements. Low RPI for HPN process may relate both to extensively deployed continuity of care and to jeopardized awareness on HPN phases and coordination. The analysis carried out enabled the definition of a common HPN workflow used as reference schema allowing for the definition of a set of recommendations for improving the quality and safety of the care processes. Moreover, the outcome of the proactive risk assessment laid the groundwork for the advancement of the patient safety regional requirements., Conclusion: The analysis had the role of promoting the contextualization of the culture of quality and safety within the HPN process resulting in an improved awareness of the criticalities and the role of nutrition units throughout the care process., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
- Published
- 2021
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31. A proposal for a comprehensive approach to infections across the surgical pathway.
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Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D'Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D'Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, and Catena F
- Subjects
- Humans, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship, Infection Control standards, Surgical Wound Infection prevention & control
- Abstract
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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- 2020
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32. Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019.
- Author
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Tavoschi L, Forni S, Porretta A, Righi L, Pieralli F, Menichetti F, Falcone M, Gemignani G, Sani S, Vivani P, Bellandi T, Tacconi D, Turini L, Toccafondi G, Privitera G, Lopalco P, Baggiani A, Gemmi F, Luchini G, Petrillo M, Roti L, Pezzotti P, Pantosti A, Iannazzo S, Mechi MT, and Rossolini GM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Drug Resistance, Multiple, Bacterial drug effects, Female, Humans, Infant, Infant, Newborn, Italy epidemiology, Klebsiella Infections drug therapy, Klebsiella pneumoniae enzymology, Klebsiella pneumoniae metabolism, Male, Microbial Sensitivity Tests, Middle Aged, Young Adult, beta-Lactamases drug effects, beta-Lactamases genetics, Anti-Bacterial Agents pharmacology, Carbapenems pharmacology, Disease Outbreaks, Klebsiella Infections epidemiology, Klebsiella Infections microbiology, Klebsiella pneumoniae drug effects, beta-Lactamases metabolism
- Abstract
In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.
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- 2020
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33. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use.
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Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, González Del Castillo J, Jensen JU, Kanizsai PL, Kwa ALH, Krueger S, Luyt CE, Oppert M, Plebani M, Shlyapnikov SA, Toccafondi G, Townsend J, Welte T, and Saeed K
- Subjects
- Adult, Algorithms, Anti-Bacterial Agents therapeutic use, Bacterial Infections diagnosis, Biomarkers blood, Calcitonin therapeutic use, Consensus, Female, Humans, Male, Middle Aged, Procalcitonin physiology, Sepsis diagnosis, Antimicrobial Stewardship methods, Procalcitonin metabolism
- Abstract
Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.
- Published
- 2019
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34. Ergonomics in the Future World: Perspectives from Australia and New Zealand.
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Long J, Edwin M, Albolino S, and Toccafondi G
- Subjects
- Australia, Communication, Education, Humans, New Zealand, Societies, Ergonomics, Forecasting
- Abstract
Background: The International Ergonomics Association is a professional association for human factors and ergonomics (HFE) professionals. Australia and New Zealand are two of 52 Federated Societies within the IEA., Objective: This paper describes an Ergonomics and the Future World (EFW) workshop held at the IEA Triennial Congress in 2018 (IEA2018), and reports the findings of the Australia / New Zealand (Southern Cross) Cluster (SCC)., Methods: Four questions were developed by the IEA EFW committee to evaluate the ergonomics state-of-play in various world regions. Southern Cross delegates (N = 17) participated in a 90-minute workshop discussion at IEA2018 (45% participation rate for SCC delegates). A summary was presented during the IEA2018 closing ceremony and as a written report for the IEA., Results: Three themes emerged from the SCC discussions: (i) the impact of technology advances on HFE professional practice;(ii) communication with internal and external stakeholders; and (iii) HFE education., Conclusions: The workshop findings are similar to issues raised at local discussions in Australia and New Zealand over past decades and mirror comments and opinions published by authors in the HFE profession. They provide a benchmark for current SCC opinion and may provide direction for future discussion of these recurring issues.
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- 2019
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35. Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS).
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Falsini G, Grotti S, Porto I, Toccafondi G, Fraticelli A, Angioli P, Ducci K, Liistro F, Pieroni M, Taddei T, Romanelli S, Rossi R, and Bolognese L
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Delirium epidemiology, Female, Heart Diseases mortality, Humans, Incidence, Italy epidemiology, Length of Stay trends, Male, Prevalence, Prognosis, Prospective Studies, Risk Factors, Survival Rate trends, Delirium etiology, Heart Diseases complications, Intensive Care Units statistics & numerical data, Risk Assessment
- Abstract
Background: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases., Methods: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months. Delirium was defined according to the confusion assessment method., Results: During the study period, 726 patients were screened for delirium. The mean age was 79.1±7.8 years. A total of 111 individuals (15.3%) were diagnosed with delirium; of them, 46 (41.4%) showed prevalent delirium (PD), while 65 (58.6%) developed incident delirium (ID). Patients 85 years or older showed a delirium rate of 52.3%. Hospital stay was longer in delirious versus non-delirious patients. Patients with delirium showed higher in-hospital, 30-day and 6-month mortality compared to non-delirious patients, irrespective of the onset time (overall, ID or PD). Six-month re-hospitalisation was significantly higher in overall delirium and the PD group, as compared to non-delirious patients. Kaplan-Meier analysis showed a significant reduction of 6-month survival in patients with delirium compared to those without, irrespective of delirium onset time (i.e. ID or PD). A positive confusion assessment method was an independent predictor of short and long-term mortality., Conclusions: Delirium is a common complication in elderly CICU patients, and is associated with a longer and more complicated hospital stay and increased short and long-term mortality. Our findings suggest the usefulness of a protocol for the early identification of delirium in the CICU. Clinicaltrials.gov: NCT02004665.
- Published
- 2018
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36. Interruptions, work environment and work load perceptions in laboratory medicine: patient safety is a "moving target".
- Author
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Toccafondi G, Balboni F, Gallo M, Colao MG, Mazzarelli G, Tanzini M, Dagliana G, Tartaglia R, and Lippi G
- Subjects
- Blood-Borne Pathogens isolation & purification, Cross Infection prevention & control, Diagnostic Tests, Routine ethics, Diagnostic Tests, Routine statistics & numerical data, Hepatitis B blood, Hepatitis B diagnosis, Hepatitis B Antigens blood, Hepatitis B Antigens genetics, Hepatitis B Antigens immunology, Humans, Immunoglobulin M blood, Immunoglobulin M immunology, Italy epidemiology, Medical Laboratory Personnel economics, Medical Laboratory Personnel standards, Patient Isolation standards, Patient Safety standards, Renal Dialysis methods, Workplace statistics & numerical data, Medical Laboratory Personnel psychology, Patient Safety legislation & jurisprudence, Risk Management ethics, Workload psychology, Workplace standards
- Published
- 2018
- Full Text
- View/download PDF
37. Sepsis 3 from the perspective of clinicians and quality improvement initiatives.
- Author
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Machado FR, Nsutebu E, AbDulaziz S, Daniels R, Finfer S, Kissoon N, Lander H, Malik I, Papathanassoglou E, Reinhart K, Rooney K, Rüddel H, Toccafondi G, Tulli G, and Hamilton V
- Subjects
- Clinical Protocols, Consensus, Humans, Quality Assurance, Health Care organization & administration, Quality Assurance, Health Care standards, Quality Improvement standards, Sepsis classification
- Published
- 2017
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38. Misidentification in laboratory medicine and diagnostic process: a neglected problem calling for action.
- Author
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Toccafondi G, Tartaglia R, Balboni F, Tomei A, Pasquini V, and Pezzati P
- Subjects
- Humans, Pathology, Clinical, Clinical Laboratory Techniques standards, Diagnostic Errors prevention & control, Medical Errors prevention & control, Patient Identification Systems methods, Safety Management methods, Specimen Handling methods
- Published
- 2016
- Full Text
- View/download PDF
39. Improving patient discharge and reducing hospital readmissions by using Intervention Mapping.
- Author
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Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, Öhlen G, Olsson M, Bergenbrant S, Orrego C, Suñol R, Toccafondi G, Venneri F, Dudzik-Urbaniak E, Kutryba B, Schoonhoven L, and Wollersheim H
- Subjects
- Europe, Focus Groups, Humans, Interviews as Topic, Patient Handoff, Qualitative Research, Hospital Administration, Patient Discharge standards, Patient Readmission, Quality Improvement organization & administration
- Abstract
Background: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge., Methods: The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance., Results: Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change., Conclusions: This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.
- Published
- 2014
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40. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers.
- Author
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Hesselink G, Flink M, Olsson M, Barach P, Dudzik-Urbaniak E, Orrego C, Toccafondi G, Kalkman C, Johnson JK, Schoonhoven L, Vernooij-Dassen M, and Wollersheim H
- Subjects
- Adult, Chronic Disease rehabilitation, Cross-Cultural Comparison, Decision Making, Efficiency, Organizational, European Union, Focus Groups, Health Knowledge, Attitudes, Practice, Health Services Needs and Demand, Humans, Interviews as Topic, Patient Handoff organization & administration, Patient Handoff standards, Patient-Centered Care standards, Qualitative Research, Family psychology, Health Personnel psychology, Patient Discharge standards, Patient-Centered Care organization & administration, Patients psychology
- Abstract
Background: Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients., Objective: The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process., Methods: A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data., Results: The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process., Conclusions: Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients' and families' capabilities, needs and preferences. Future interventions should be directed at healthcare providers' attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.
- Published
- 2012
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41. The collaborative communication model for patient handover at the interface between high-acuity and low-acuity care.
- Author
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Toccafondi G, Albolino S, Tartaglia R, Guidi S, Molisso A, Venneri F, Peris A, Pieralli F, Magnelli E, Librenti M, Morelli M, and Barach P
- Subjects
- Checklist, Data Collection, Europe, Focus Groups, Hospitals, Teaching, Humans, Interviews as Topic, Medical Staff, Hospital standards, Models, Organizational, Patient Care Team, Patient Handoff organization & administration, Quality of Health Care standards, Communication, Continuity of Patient Care standards, Cooperative Behavior, Interprofessional Relations, Patient Handoff standards
- Abstract
Background: Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events., Objectives: We analysed the communications between high-acuity and low-acuity units, their content and social context, and we explored whether common conceptual ground reduced potential threats to patient safety posed by current handover practices., Methods: We monitored the communication of five content items using handover probes for 22 patient transitions of care between high-acuity 'sender units' and low-acuity 'recipient units'. Data were analysed and discussed in focus groups with healthcare professionals to acquire insights into the characteristics of the common conceptual ground., Results: High-acuity and low-acuity units agreed about the presence of alert signs in the discharge form in 40% of the cases. The focus groups identified prehandover practices, particularly for anticipatory guidance that relied extensively on verbal phone interactions that commonly did not involve all members of the healthcare team, particularly nursing. Accessibility of information in the medical records reported by the recipient units was significantly lower than reported by sender units. Common ground to enable interpretation of the complete handover content items existed only among selected members of the healthcare team., Conclusions: The limited common ground reduced the likelihood of correct interpretation of important handover information, which may contribute to adverse events. Collaborative design and use of a shared set of handover content items may assist in creating common ground to enable clinical teams to communicate effectively to help increase the reliability and safety of cross-unit handovers.
- Published
- 2012
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42. The key actor: a qualitative study of patient participation in the handover process in Europe.
- Author
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Flink M, Hesselink G, Pijnenborg L, Wollersheim H, Vernooij-Dassen M, Dudzik-Urbaniak E, Orrego C, Toccafondi G, Schoonhoven L, Gademan PJ, Johnson JK, Öhlén G, Hansagi H, Olsson M, and Barach P
- Subjects
- Chronic Disease rehabilitation, European Union, Female, Focus Groups, General Practitioners standards, Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, Male, Patient Safety, Qualitative Research, Quality Assurance, Health Care, Patient Handoff standards, Patient Participation, Patient Satisfaction, Patients psychology, Physician-Patient Relations
- Abstract
Background: Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better understanding of patient experiences and preferences for participation., Objective: The aim of this paper is to explore the patients' experiences and perspectives related to the handovers between their primary care providers and the inpatient hospital., Methods: A qualitative secondary analysis was performed, based on individual and focus group patient interviews with 90 patients in five European countries., Results: The analysis revealed three themes: patient positioning in the handover process; prerequisites for patient participation and patient preferences for the handover process. Patients' participation ranged from being the key actor, to sharing the responsibility with healthcare professional(s), to being passive participants. For active participation patients required both personal and social resources as well as prerequisites such as information and respect. Some patients preferred to be the key actor in charge; others preferred their healthcare professionals to be the key actors in the handover., Conclusions: Patients' participation is related to the healthcare system, the activity of healthcare professionals' and patients' capacity for participation. Patients prefer a handover process where the responsibility is clear and unambiguous. Healthcare organisations need a clear and well-considered system of responsibility for handover processes, that takes into account the individual patient's need of clarity, and support in relation to his/hers own recourses.
- Published
- 2012
- Full Text
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43. Handover process: how to improve quality and safety through an ergonomic solution.
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Toccafondi G, Albolino S, Bellandi T, and Venneri F
- Subjects
- Communication, Humans, Ergonomics, Patient Handoff organization & administration, Patient Safety, Quality Improvement, Task Performance and Analysis
- Abstract
Patient safety practices for enhancing the quality and safety of handover are context sensitive interventions. In this article we explore the use of cultural probes as a qualitative technique with a twofold objective: eliciting implicit activity pattern and tools that may constitute resources for the design of effective handover solutions and prompting health care practitioners' participation and involvement.
- Published
- 2012
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44. [A prospective study of 106 patients with hemorrhoids treated with PPH stapler. Early and long-term results].
- Author
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Castagnola M, De Silva GM, Muià R, Ciferri E, Bertirotti S, Toccafondi G, Municinò O, and Bondanza GS
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Reoperation, Time Factors, Hemorrhoids surgery, Surgical Staplers
- Abstract
Muco-mucosal resection with a PPH stapler according to Longo allows repair of arterial hyperaemia, venous dilation and mucosal prolapse. From September 1 1997 to October 31 2000 a prospective study was conducted in 106 patients. The results show that the Longo haemorrhoidectomy technique is well tolerated and almost painless, and is characterised by a low complication rate and good results in the long term.
- Published
- 2002
45. [Hibernoma in an unusual site].
- Author
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Nori J, Toccafondi G, Innocenti P, and Zampa V
- Subjects
- Humans, Magnetic Resonance Imaging, Male, Middle Aged, Oropharynx diagnostic imaging, Oropharynx pathology, Tomography, X-Ray Computed, Lipoma diagnosis, Oropharyngeal Neoplasms diagnosis
- Published
- 1992
46. T lymphocytes from tonsil and peripheral blood show different cytolytic and helper activities.
- Author
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Gallo O, De Carli M, Gallina E, Toccafondi G, Romagnani S, and Del Prete G
- Subjects
- Adolescent, CD4-Positive T-Lymphocytes immunology, Child, Clone Cells, Humans, Interleukins biosynthesis, Lymphocyte Activation immunology, Palatine Tonsil pathology, Tonsillitis pathology, Killer Cells, Natural immunology, Palatine Tonsil immunology, T-Lymphocytes immunology, T-Lymphocytes, Helper-Inducer immunology
- Abstract
T lymphocytes from tonsil (To) and peripheral blood (PB) of 4 tonsillectomized children were subjected to clonal expansion with PHA in order to analyze at single cell level their cytolytic activity and their ability to produce interleukins such as IL-2, IFN-gamma and IL-4. Analyzing all T-cell clones (CD4+ and CD8+) obtained from To in comparison with those from PB, a reduced proportion of cells with lectin-dependent cytolytic activity (LDCC) (25% vs. 42%, p less than 0.01) and natural killer (NK) activity (18% vs. 31%, p less than 0.02) was found. These differences were proportionally related to the lower number of CD8+ T-cells in To than in PB. The proportion of CD4+ clones able to produce IL-2 and/or IL-4 were higher in To (75% and 61%) than in PB (52% and 25%, p less than 0.001 and p less than 0.001, respectively). In contrast, the proportion of CD4+ clones able to produce IFN-gamma was similar (53% and 58%) in both series of clones. According to the patterns of lymphokine synthesis, tonsillar T-cells differed from PB T-cells as follows: 1) the number of Th1-like CD4+ clones producing IL-2 and/or IFN-gamma (but not IL-4) were 23% vs. 44% in PB (p less than 0.001); 2) there was no difference between To and PB in the proportion of CD4+ clones producing IL-4 alone (Th2 clones: 9% vs. 8%); 3) CD4+ clones synthesizing IL-2, IL-4 and IFN-gamma at the same time were more frequent in To than in PB (Th3 clones: 53% vs. 17%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1991
- Full Text
- View/download PDF
47. [Intestinal occlusion caused by congenital internal abdominal hernia: evaluation of 2 cases treated with emergency surgery].
- Author
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Gliori R, Quidaciolu F, Iachino C, and Toccafondi G
- Subjects
- Adult, Aged, Herniorrhaphy, Humans, Intestinal Obstruction surgery, Male, Abdomen, Hernia complications, Intestinal Obstruction etiology
- Published
- 1981
48. [Causes of premature infant death. Statistical study of 676 autopsies].
- Author
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Bettini F, Belisario Cocchi C, and Toccafondi G
- Subjects
- Congenital Abnormalities mortality, Enterocolitis, Pseudomembranous mortality, Hemorrhage mortality, Humans, Infant, Newborn, Infant, Premature, Diseases pathology, Italy, Jaundice, Neonatal mortality, Lung Diseases mortality, Meningitis mortality, Sepsis mortality, Infant, Premature, Diseases mortality
- Published
- 1979
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