18 research outputs found

    CONVEGNO SPORT E SALUTE 2006 Napoli, Clinic Center Relazioni ed Abstract selezionati

    Get PDF

    Adapted Physical Activity in post-acute stroke rehabilitation: a 12-month follow-up.

    Get PDF
    L’ictus è un importante problema di salute pubblica, è causa di morte e disabilità nella popolazione anziana. La necessità di strategie di prevenzione secondaria e terziaria per migliorare il funzionamento post-ictus e prevenire o ritardare altre condizioni disabilitanti, ha portato l’Italia a sviluppare un intervento di Attività Fisica Adattata (AFA) per l’ictus, che permettesse di migliorare gli esiti della riabilitazione. Obiettivo dello studio è di valutare se l’AFA unita all’Educazione Terapeutica (ET), rispetto al trattamento riabilitativo standard, migliora il funzionamento e la qualità di vita in pazienti con ictus. Studio clinico non randomizzato, in cui sono stati valutati 229 pazienti in riabilitazione post-ictus, 126 nel gruppo sperimentale (AFA+ET) e 103 nel gruppo di controllo. I pazienti sono stati valutati al baseline, a 4 e a 12 mesi di follow-up. Le misure di esito sono il cambiamento a 4 mesi di follow-up (che corrisponde a 2 mesi post-intervento nel gruppo sperimentale) di: distanza percorsa, Berg Balance Scale, Short Physical Performance Battery, e Motricity Index. Le variabili misurate a 4 e a 12 mesi di follow-up sono: Barthel Index, Geriatric Depression Scale, SF-12 e Caregiver Strain Index. La distanza percorsa, la performance fisica, l’equilibrio e il punteggio della componente fisica della qualità di vita sono migliorate a 4 mesi nel gruppo AFA+ET e rimasti stabili nel gruppo di controllo. A 12 mesi di follow-up, il gruppo AFA+ET ottiene un cambiamento maggiore, rispetto al gruppo di controllo, nell’abilità di svolgimento delle attività giornaliere e nella qualità di vita. Infine il gruppo AFA+ET riporta, nell’ultimo anno, un minor numero di fratture e minor ricorso a visite riabilitative rispetto al gruppo di controllo. I risultati confermano che l’AFA+ET è efficace nel migliorare le condizioni cliniche di pazienti con ictus e che gli effetti, soprattutto sulla riabilitazione fisica, sono mantenuti anche a lungo termine.Stroke is one of the main public health concerns, because it is a leading cause of death and long-term disability in elderly people. Responding to the need for secondary and tertiary prevention strategies to improve function post stroke and prevent or delay subsequent strokes as well as other disabling conditions, Italy has pioneered development of Adaptive Physical Activity (APA) for stroke. The aim of this study is to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in stroke survivors. This non-randomized controlled study enrolled 229 patients with mild to moderate hemiparesis, 126 in the experimental group and 103 in the control group. Data were assessed in baseline and at 4 and 12 month follow-up. The outcome measures were 4-month change (that corresponds to 2 months post-intervention in the experimental group) in gait velocity endurance, Short Physical Performance Battery (SPPB), Berg Balance Scale, Barthel Index, Geriatric Depression Scale, the SF-12 and Caregiver Strain Index. Gait endurance, physical performance, balance and the physical component of quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. At 12 month follow-up, the experimental group had a significantly higher improvement on physical performance, quality of life and a lower number of fractures and readmissions compared to the control group. Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients after stroke and suggest that, when combined with TPE, the effects of a post-rehabilitation APA program are enduring

    Identifying areas of improvement in clinical risk management. Study and adaptation of a set of indicators for assessing patient safety in the Italian healthcare system

    Get PDF
    Negli ultimi venti anni, a partire dagli Stati Uniti, e successivamente globalmente, sono stati effettuati significativi sforzi per sviluppare strumenti finalizzati alla rilevazione sistematica degli eventi avversi al fine di migliorare la performance e il profilo di sicurezza in sanità. Fra gli strumenti di maggiore efficacia e successo vi sono i Patient Safety Indicators (PSI), un set di indicatori di sicurezza del paziente sviluppati negli Stati Uniti dall’Agency for Healthcare Research and Quality (AHRQ). L’obiettivo del presente progetto di ricerca è stato lo studio, l’adattamento al contesto italiano e il potenziamento dei PSI. La ricerca è stata articolata su tre studi consequenziali. Il primo studio è consistito in una revisione della normativa vigente negli USA sull’applicazione dei PSI e lo studio dei trend dei PSI nel periodo 2000-2013 su tutte le procedure chirurgiche. Il secondo studio è stato finalizzato all’adattamento degli algoritmi AHRQ al contesto italiano e al confronto fra Italia e USA nell’ambito della chirurgia ortopedica. Il terzo studio ha comportato l’analisi su uno specifico PSI, l’indicatore Trombosi Venosa Profonda/Embolia Polmonare peri-operatoria, su interventi di chirurgia ortopedica dell’arto inferiore, con l’estensione del periodo di osservazione del paziente a 30 giorni dopo l’intervento chirurgico. I risultati della ricerca hanno mostrato come i PSI, implementati su larga scala, possano rappresentare un valido strumento di miglioramento della qualità delle cure aumentandone la sicurezza. L’applicazione dei PSI al contesto sanitario italiano ha mostrato che l’adattamento degli indicatori può essere effettuato con successo. La performance delle strutture italiane è risultata pari o superiore a quella degli ospedali statunitensi su diversi indicatori valutati, sebbene le analisi comparative necessitino ancora di ulteriori sviluppi e applicazioni metodologiche. L’estensione del periodo di osservazione dei casi con TVP/EP ai 30 giorni successivi alla chirurgia, ha mostrato un aumento significativo della capacità dell’indicatore di identificare i casi con TVP/EP post-operatoria.In the last two decades, starting from the United States, and subsequently worldwide, significant efforts have been made to develop tools aimed at the systematic detection of adverse events in order to improve providers’ performance and security. The Patient Safety Indicators (PSI), a set of patient safety indicators developed in the United States by the Agency for Healthcare Research and Quality (AHRQ), are among the most effective tools. The aim of this research project was to study the PSI algorithms, improve and adapt them to the Italian context. The research consisted of three subsequent studies. The first study was a review of the US legislation on PSI and their trends in the period 2000-2013 for all surgical procedures. The second study was aimed at the adaptation of the AHRQ algorithms to the Italian context and the comparison between Italy and the US in orthopedic surgery. The third study was focused on PSI12, perioperative deep venous thrombosis (DVT)/pulmonary embolism (PE), to study the impact of the extension of the observation time on lower limb orthopedic procedures. The results showed that PSIs can be used as a clinical governance tool to curb adverse events incidence. Moreover, PSIs have been successfully adapted and calculated on Italian data. Italian providers showed equal or significantly better outcomes compared to US providers on several indicators, although comparative analyses still require further study and methodological improvement. The analysis on lower limb orthopedic procedures between Italy and the US revealed that the expansion of the observation time for DVT/PE to 30 postsurgical days produced a significant increase in the indicator's ability to identify qualifying events. In conclusion, PSIs are an effective tool and can be a valuable instrument for clinicians, healthcare managers, and policy makers, to build more cost-effective, patient-centered and safe healthcare systems

    IPOTESI DI MODELLO ORGANIZZATIVO E GESTIONALE DELL'AREA DELLE PROFESSIONI SANITARIE SULLA BASE DEL VIGENTE STATUS NORMATIVO, CON SPECIFICO RIFERIMENTO ALL'AREA PROFESSIONALE DIETISTICA

    Get PDF
    La rapida evoluzione negli ultimi anni dello status delle professioni sanitarie ha determinato la nascita di nuovi modelli assistenziali integrati nelle strutture sanitarie pubbliche, con caratteristici connotati di tipo manageriale. Sulla base di ciò le strutture ospedaliere e territoriali hanno istituito nuove aree funzionali, forti già della loro organizzazione interna, ma non senza alcune difficoltà in quanto il ruolo centrale attribuito dalla normativa ai professionisti non medici ha comportato cambiamenti significativi nell’assetto aziendale di ognuna. Inoltre la brevità dei tempi con cui è andato istaurandosi il nuovo modello organizzativo ha determinato adattamenti particolari e in alcuni casi non ottimali in rapporto ad un risultato di un assistenza efficace, efficiente ed economica che si vorrebbe ottenere. Non per questo l’importanza di una modifica epocale deve essere sminuita e sottovalutata, anzi, queste proposte neo-formate stanno già subendo notevoli miglioramenti ed integrazioni che vengono inserite al momento del rinnovo periodico degli atti regionali, locali e aziendali al fine di valorizzare al meglio il senso di ruolo nevralgico nella gestione delle politiche sanitarie. Proprio per questo è necessario analizzare nello specifico il fenomeno e capirne l’essenza per cui è stato pensato e pianificato, perché il ruolo della dirigenza delle professioni sanitarie in prospettiva di medio termine potrebbe rivelarsi importante se non essenziale al fine di una corretta gestione dell’assistenza all’utente sanitario, considerando anche il potenziale sviluppo sul territorio. Di fronte a questi presupposti abbiamo immaginato, secondo i termini di legge, un modello ipotetico di organizzazione, coordinamento e gestione dell’area delle professioni sanitarie nella sua completezza, per poi addentrarsi nello specifico professionale ed arrivare all’area dietistica analizzando le implicazione che comporta una corretta conduzione tecnico-amministrativa della stessa e su quale può essere il ruolo dell’operatore sanitario a capo di tale area. La sperimentazione del modello deriva anche dall’analisi di altre esperienze proposte e già affermate in Italia dove lo staff aziendale apicale ha attribuito notevole rilevanza alla funzione delle professioni sanitarie per competenze, professionalità e funzione specifica

    Development and validation of indicators to measure the experience of neonatal care reported by parents - patient reported experience measures (PREMs). Assessing indicators in clinical practice for improvement in the quality of care.

    Get PDF
    Introduzione: i patient reported experience measure (PREMs) sono indicatori di qualità dell’assistenza e misurano il processo di cura riferito dal paziente. Non sono disponibili questionari PREMs disegnati e validati per descrivere l’esperienza assistenziale durante il ricovero in neonatologia. Obiettivo: costruire un questionario PREMs attraverso un processo di definizione con il metodo Delphi di una lista di domande che investighino l’esperienza dell’assistenza neonatale dal momento del ricovero a quello della dimissione e di validare lo strumento. Materiali e metodi: è stata condotta una revisione rapida della letteratura per identificare questionari sulla percezione dell’assistenza riportati negli studi di validazione pubblicati in 2008-2018. Gli item sull’esperienza, selezionati da ogni questionario incluso, sono stati sottoposti agli stakeholder in 3 round Delphi per il giudizio di rilevanza. I criteri predefiniti di raggiungimento del consenso sono stati applicati alla fine del round 2 e agli item trattenuti è stata attribuita una priorità di inclusione nel questionario, somministrato successivamente, alla dimissione, a genitori di neonati ricoverati in neonatologia. L’analisi fattoriale esplorativa è stata utilizzata per esaminare la struttura dello strumento. Risultati: sono stati identificati 380 studi, 4 sono stati inclusi e 69 item sottoposti al giudizio degli stakeholder (54 genitori e 52 professionisti). Alla fine del processo Delphi, il questionario finale di 18 item è stato validato su un campione di 97 genitori. L’analisi fattoriale con scoring dicotomico degli item ha identificato 2 fattori con buon adattamento al modello: esperienza dell’assistenza durante la degenza ed esperienza di presa in carico e dimissione. Conclusione: il questionario è il primo strumento validato disponibile per misurare l’esperienza dell’assistenza in neonatologia attraverso due indicatori specifici, che consentono di comparare, fra strutture omogenee o all’interno della stessa struttura nel tempo, l’esperienza del processo di cura riferita dai genitori, per identificare aree critiche verso cui orientare interventi di miglioramento della qualità assistenziale.Background: patient reported experience measures (PREMs) are quality indicators of care which measure the patient-reported care process. No PREMs questionnaires have been developed and validated to investigate the experience of care in neonatal units. Objective: to develop a PREMs questionnaire through a process of selection via the Delphi method of a list of questions that investigate the experience of neonatal care from admission to discharge, and to validate this instrument. Materials and methods: a rapid review of the literature was conducted to identify questionnaires on the perception of care reported in validation studies published between 2008-2018. The items referring to experience, selected from each included questionnaire, were submitted to the stakeholders in 3 Delphi rounds for the judgment of relevance. Previously defined consensus criteria were used to reach an agreement at the end of round 2 and the retained items were given a priority for inclusion in the questionnaire. This was administered after discharge to parents of newborns admitted to the neonatal unit. An exploratory factor analysis was used to examine the structure of the instrument. Results: 380 studies were identified, 4 were included and 69 items submitted for the stakeholders’ decision (54 parents and 52 professionals). At the end of the Delphi process, the final 18-item questionnaire was validated using 97 parents. The factor analysis with dichotomous scoring of the items identified 2 factors with that fit the model well: the experience of in-hospital assistance and the experience during admission and discharge. Conclusion: the questionnaire is the first validated instrument to measure the experience of care in neonatal units through two specific indicators, which allow for a comparison of the experience of care reported by the parents between homogeneous structures or within the same structure over time, and to identify critical areas for improvement in the quality of care

    CONTRIBUTO AL PROGETTO OMS DI ERADICAZIONE DELLA POLIOMIELITE: RISULTATI DELLE ATTIVITÀ DI SORVEGLIANZA IN LOMBARDIA.

    Get PDF
    A contribution to the WHO global polio eradication initiative: the results of surveillance activities in Lombardy (Northern Italy), 2012-2015. Although in 2015 poliovirus (PV) transmission has been reported at the lowest levels ever recorded, the virus is still endemic in two countries \u2013 Afghanistan and Pakistan. Until PV transmission is interrupted in these countries, all countries remain at risk of virus importation - especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries. The high levels of immigration flows across the Mediterranean Sea jeopardize Italy for PV reintroduction. The \u201cWHO Strategic Plan of the Global Polio Eradication Initiative\u201d indicates the nationwide surveillance of Acute Flaccid Paralysis (AFP) as the gold standard for detecting cases of poliomyelitis. In addition, systematic Environmental Surveillance (ES), seeking the presence of PV in sewage, is recognized as a powerful tool to confirm PV circulation in absence of AFP cases, especially in polio-free countries. In Italy, nationwide AFP surveillance has been set up in 1997, and ES has been established since 2005 in Milan and other five Italian cities (Bolzano, Parma, Sassari, Napoli and Palermo). This PhD project aimed at evaluating these two public health surveillance systems ongoing in Lombardy (Northern Italy) in the period spanning from 2012 to 2015, in order to improve their quality and efficiency, and to achieve the WHO criteria. The results of surveillance activities were described and the assessment of system attributes (including data quality, sensitivity and timeliness) were discussed. Additionally, in the framework of the ES, the circulation and characterization of non-polio Enterovirus (NPEV) was evaluated in the study population. The surveillance activities were carried out according to WHO guidelines from January 2012 to October 2015. For AFP surveillance, all children <15 years who met the WHO definition of AFP case were enrolled, and the collection of stool and serum samples from each case was requested. For ES, wastewater samples were collected twice a month at the intel of 3 wastewater treatment plants located in Milan. Stool specimens collected from AFP cases and wastewater samples were analyzed to detect PV and NPEVs by virus isolation in RD (human rhabdomyosarcoma) and L20B (murine transgenic L cells) cell cultures, and by PCR assay specific for the 5\u2032 noncoding region [5\u2032NCR] (nucleotide [nt]: 179-575). The identified viruses were genotyped by sequence analysis of the VP1 gene (nt. 2602-2977). In order to define the serological status/immunity against PV, serum samples collected from AFP cases were analyzed by microneutralization assay against PV1, PV2, and PV3. According to WHO, an antibody titre >1:8 was considered protective. From January 2012 to October 2015, 52 AFP cases were reported in Lombardy with an incidence rate of 1.04/100\u2019000 children <15 years of age. The median age of AFP cases was 5.8 years [inter-quartile range (IQR): 10.0 years]; no gender difference was observed. The annual incidence rates were 0.8/100\u2019000 in 2012, 1.5/100\u2019000 in 2013, 1.1/100\u2019000 in 2014, and 0.6/100\u2019000 in 2015 (preliminary data up to October). According to the WHO, the sensitivity of the AFP surveillance system is considered adequate when at least one case of AFP is detected annually per 100\u2019000 children aged less than 15 years. As in 2012 the sensitivity of the surveillance system did not met this criterion, several interventions were implemented to raise awareness among the parts involved in the surveillance. On purpose, reports on the AFP notified weekly by sentinel hospitals were sent out quarterly to all physicians involved in the surveillance system along with epidemiological alerts and bulletins on PV circulation and polio endgame. Phone and e-mail contacts were kept with physicians who reported AFP cases to guarantee the adequacy of notification. Moreover, a workshop on PV and its surveillance system was arranged in collaboration with regional and national (ISS) public health authorities. These actions allowed the sensitivity of the AFP surveillance system to meet the WHO criterion from 2013 onwards. The WHO recommends completing the case investigation by virological analysis of stool samples in at least 80% of AFP cases: during our study, this rate was achieved in 2014 and 2015 (85.7%), whereas in 2012 and 2013 the analysis was completed in 63.6% and 60% of stool samples, respectively. The improvement of virological investigation completeness of AFP cases since 2014 was probably due to the raised awareness of physicians involved in the surveillance. About 40% (21/52) of AFP cases were diagnosed as Guillain-Barr\ue9 syndrome, 23.1% (12/52) and 19.2% (10/52) were ascribed to genetic disease and myelitis, respectively. Most (35/52; 67%) of AFP cases were reported by pediatric wards during summer and winter. According to virological results, no AFP case was caused by a PV infection, even though one AFP case (that occurred in 2014 in a 6-month boy affected by Bruton disease who received the first dose of oral polio vaccine in Albania) was characterized as a vaccine associated paralytic paralysis (VAPP). NPEVs were detected in 6 AFP cases (10.5%): 2 were Echovirus-11, 1 was Echovirus-6, and the remaining 3 were not genotyped. Serological investigation was carried out in 48 (48/52: 92.3%) AFP cases and a protective antibody titre (neutralising antibodies titre 651:8) was detected in 94% (45/48) of individuals. In the framework of the ES, 273 wastewater samples were collected and no PVs were isolated. In contrast, NPEVs were detected in 65.2% (172/273) of tested samples. The proportion of NPEVs detected in sewage by year was 70% (42/60) in 2012, 56.9% (41/72) in 2013, 66.7% (48/72) in 2014 and 68.3% (41/60) in 2015 (up to October). In 2013 the rate of NPEVs detected was significantly lower (p< .05) than those recorded in the other years of study. The WHO declares that at least 30% of samples collected in the ES setting have to be positive for NPEV, thus our results demonstrated the good performance of the ongoing surveillance system in the whole study period. All NPEVs were characterized as EV belonging to species B: Echovirus-11 and Echovirus-6 were the most frequently detected viruses, being the 29.1% (41/141) and 20.6% (29/141) of genotyped NPEVs, respectively. No difference among the NPEV genotypes circulating in the three wastewater treatment plants was identified. It is important to strengthen surveillance of AFP cases at regional and national level in order to detect rapidly any virus importation or emergence and enable a prompt public health response. Although AFP surveillance remains the gold standard, systematic ES is a powerful tool to detect PV in the absence of polio cases, especially in polio-free countries. During our study, AFP surveillance met the WHO criteria for sensitivity from 2013 onwards and the level of completeness of case investigation improved significantly from 2014. Physicians involved in the activities have proved to give special attention to AFP surveillance thanks to several initiatives implemented since 2013, such as the sharing of surveillance reports, epidemiological alerts and updates on polio eradication progress. Epidemiological features of AFP cases were similar to those reported in the current scientific literature and our data confirm adequate levels of immunization in population as well as the absence of wild PV infections. ES was suitable to investigate EV circulation in the population and the high rate of NPEV detected underlines a massive virus circulation. No silent PV reintroduction was noted during ES. As long as in the current polio endgame PV outbreaks reflect serious gaps in immunity to PV due to the weakness of routine immunization coverage in otherwise polio-free countries, all countries should maintain uniformly high immunization coverage at the district level to minimize the consequences of any virus introduction. Keeping strong and encouraging both AFP surveillance and ES all over the world is crucial to ensure the PV will not return unnoticed and, finally, to achieve the global eradication goal

    Rischio igienico sanitario associato al consumo dei molluschi eduli lamellibranchi (M.E.L)

    Get PDF
    Seafood represents a very broad category of food and is a major source of protein in the human diet. The increase of its consumption and the epidemiological data confirm the role of seafood (especially shellfish) as a carrier of foodborne toxinfections and has brought the need for a higher monitoring level and an increase of the studies of their microbiological characteristics. Edible Lamellibranch Molluscs (M.E.L) are frequently involved in food poisoning outbreaks of outstanding severity, due to the fact that they are filter-feeding animals which tend to accumulate any toxic substances or microorganisms already present in their environment. In the context of food security, the main target is to ensure food health by fulfilling specific hygiene requirements and by means of monitoring activities on shellfish conducted on the production chain of mussels and within their own environment. Microbiological eligibility for human consumption (Reg CE 1441/2007) is based on only two fecal contamination bacteriological parameters (Escherichia coli, Salmonella spp) and does not provide the identification of other microorganisms which are naturally present within the marine environment and potentially pathogenic such as those belonging to the genus Vibrio. In accordance with the data provided by the Centre of Disease Control (USA), food poisoning linked to the consumption of shellfish is mainly related to (20%) enteric viruses (Corraine et al., 2007), hepatitis A virus (HAV), norovirus (NV), and marine environment pathogens, such as Vibrio spp, whereas faecal bacteria (Salmonella spp. and Escherichia coli) account just for 4% of the total (Serracca et al., 2007) (Lipp EK, Rose JB, 1997). In order to assess the hygienic quality and health of M.E.L (mussels, clams and oysters) bred in Sardinia, both parameters required by law (Escherichia coli, Salmonella spp) and Vibrios of major public health interest have been investigated in this study. Within the 440 examined samples, 40% contained potentially harmful Vibrios species to human being, while only in 6.4% of the samples, the levels of Escherichia coli were above the Italian legal limit and only within one sample, Salmonella spp was isolated. An interconnection between the presence of micro-organisms of fecal origin and potentially harmful Vibrios to human health was not detected. Vibrio bacterial strains have been identified by means of biochemical techniques. Vibrio cholerae strains have been processed through the use of serological and molecular identification techniques and their toxigenic properties have been evaluated by PCR assay (search for the toxin CT and gene for the toxin NAG-ST). Overall, 14 strains of Vibrio cholerae were isolated which were found to be non-O1 and non-O139 Vibrio cholerae (NCVs) and therefore unable to give epidemic cholera. No strain was found to be producing CT and NAG-ST toxins

    Sicurezza alimentare di prodotti ortofrutticoli di IV gamma

    Get PDF
    Introduction Vegetables are major components of healthy and balanced diet. However, 25% of foodborne diseases are linked to the consumption of vegetables, especially the minimally processed ready to eat (RTE) vegetables. The main foodborne pathogens associated at RTE vegetables are Enterobacteriaceae (E. coli, Salmonella spp. and Yersinia spp.) and psychrophilic microorganisms like Listeria monocytogenes. Aim of study The aim of this work was to assess the microbiological risks associated with consumption of RTE salads, through the quantification of microbiological contamination. In addition we carried out the rapid detection of foodborne pathogens by real time PCR, and molecular characterization of Listeria monocytogenes strain isolated in this study. Microbiological and bio molecular challenge tests was carried out for assess potential growth of Listeria monocytogenes in vegetables stored at different temperatures. Besides, the work was focused on the evaluation of washing process in association to the shelf life of these products. Materials and methods A total of 300 pre-packaged mixed raw vegetable salads collected from retail premises (68%) and production plants (32%) were examined. Microbiological eligibility for human consumption (Reg CE 1441/2007) is based on three bacteriological parameters (Escherichia coli, Salmonella spp and L. monocytogenes). In order to assess the safety of RTE vegetables, all parameters required by law have been investigated. The contamination of vegetables from E. coli O157:H7, L. monocytogenes and Salmonella spp was also investigated by real time PCR. Furthermore, the pathogenic properties of L. monocytogenes have been evaluated by PCR assay (prfA, rrn, hlyA, actA, inlA, inlB, iap, plcA e plcB). The purpose of Challenge test was to provide information especially on the behavior of L. monocytogenes. Results and conclusion Parsley and mixed salads showed the most contaminated panel, however we found high levels of contamination by Enterobacteriaceae in every kind of RTE salads. Salmonella spp. and E. coli O157:H7 have never been isolated, while only a sample of rocket was contaminated by one strain of L. monocytogenes and Yersinia enterocolitica. The PCR assay showed the virulence genes of L. monocytogenes strain (prfA, rrn, actA, inlA, inlB, plcA, plcB). Washing temperature, microbiological quality of water and raw material are basic requirements to achieve high microbiological standards for RTE salads. Listeria monocytogenes shows a growth potential variable in consideration of the different types of products and storage temperatures. Bio molecular challenge tests appear a useful tool for the evaluation of the survival of L. monocytogenes when coltural results seem uncertain (eg. high or low bacterial growth and difficulty in estimating the growth plate)

    The integration of WHO classifications and reference terminologies to improve information exchange and quality of electronic health records: the SNOMED\u2013CT ICF harmonization within the ICD-11 revision process

    Get PDF
    Introduction The Family of International Classifications (WHO-FIC) is a suite of integrated classification products of the World Health Organization (WHO) that can be used to provide information on different aspects of health and the health-care system. These tools and their national modifications allow, together with the related classifications of health interventions, full representation of the volumes of health services provided in the various countries that adopt case mix systems. The use of standardized terminologies in classifications, for the definition of the descriptive characteristics of the disease, is a necessary step to allow full integration between different information systems, making available information about the diagnosed diseases, the performed health procedures and the level of functioning of the person, for very different uses such as, for example, public health, safety of care and quality control. Materials and methods Within the WHO and International Health Terminology Standards Development Organization (IHTSDO) collaboration agreement, a work of independent review was carried out on all the Activities and Participation categories (A&P) of the WHO International Classification of Functioning, Disability and Health (ICF), in order to identify equivalence and gaps to the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) concepts in terms of lexical, semantic (content) and hierarchical matching, to harmonize WHO classifications and SNOMED CT. Results and conclusions The performed mapping suggests that the ICF A&P categories are semantically and hierarchically different from the terms of SNOMED CT thus confirming the high value of the WHO-IHTSDO synergy aiming to frame together, in a joint effort, their respective unique contribution. Recommendations were formulated to WHO and IHTSDO in order to better frame together, in a joint effort, their respective unique contribution ensuring that SNOMED CT and ICF can interoperate in electronic health records
    corecore