UN MODELLO DI RETE PER LA GESTIONE INTEGRATA DELLA PATOLOGIA DIABETICA

A network care model for the management of diabetic patients A feasibility study (approved for funding by the Italian Ministry of Health) has been designed to evaluate an innovative care model for diabetes, based on the Outpatient Day Service (ODS), in term of quality of healthcare, compliance, social and health costs and patient's quality of life and satisfaction. We enrolled eight Diabetes Unit of major regional hospitals. ODS has been defined as an innovative health care modality, which is part of the specialist ambulatory service operating at the territorial level and is aimed at the management of clinical conditions. It requires numerous, multidisciplinary and often complex laboratory and instrumental procedures as defined by a specific diagnostic and therapeutic path centred on the clinical problem, rather than on the individual procedure. ODS includes a basic package and packages for micro and macro vascular chronic complications. It has been investigated the feasibility to insert a "Clinical Pathway" for diabetic patients into the Local Health Authority database SISS (Sistema Informativo Socio Sanitario, Health and Social Informative System), as an Electronic Health Record (EHR) service. The EHR is a virtual healthcare repository that gathers all the citizen's information and clinical documents produced by doctors and health professionals, making them available even when they are produced in different institutes. The Clinical Pathway has been organized as a "virtual folder". The term "folder" expresses the concept of a binder issued to the patient for the specific pathology (in this case diabetes), used to gather structured documents; the term "virtual" describes that the folder filling is shared amongst the different actors that collaborate on the pathway. The clinical pathway implementation is essentially made as a clinical documents collection that belongs to the same subject. Additionally aim of the study is to evaluate whether sharing of a minimum data set across the levels of care can improve the integration between primary and secondary care. Structure indicators, Process indicators, Outcomes, Therapy indicators, Costs, Quality of life and patient satisfaction have been created. A preliminary analysis of the database has been carried out for evaluate data quality and the effective possibility of obtain the indicators. Project help the systematic management of diabetic patients by General Practitioner (primary care) and hospital diabetes facilities and improve integration between first and second care levels

The National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 Recommendations

Aim: Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), and Department of Defense (DoD), the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of clinical research studies and clinical treatment outcomes, increase data quality, facilitate data sharing across studies, reduce study start-up time, more effectively aggregate information into metadata results, and educate new clinical investigators. Materials/Methods: The SRC CDE Working Group consisted of 34 worldwide experts in concussion from varied fields of related expertise, divided into three Subgroups: Acute (3 months post-concussion). To develop CDEs, the Subgroups reviewed various domains, and then selected from, refined, and added to existing CDEs, case report forms and field-tested data elements from national registries and funded research studies. Recommendations were posted to the NINDS CDE Website for Public Review from February 2017 to April 2017. Results: Following an internal Working Group review of recommendations, along with consideration of comments received from the Public Review period, the first iteration (Version 1.0) of the NINDS SRC CDEs was completed in June 2017. The recommendations include Core and Supplemental ? Highly Recommended CDEs for cognitive data elements and symptom checklists, as well as other outcomes and endpoints (e.g., vestibular, oculomotor, balance, anxiety, depression) and sample case report forms (e.g., injury reporting, demographics, concussion history) for domains typically included in clinical research studies. Interpretation: The NINDS SRC CDEs and supporting documents are publicly available on the NINDS CDE website https://www.commondataelements.ninds.nih.gov/. Widespread use of CDEs by researchers and clinicians will facilitate consistent SRC clinical research and trial design, data sharing, and metadata retrospective analysis

How appropriate is the use of rehabilitation facilities? Assessment by an evaluation tool based on the AEP protocol

L'utilizzo delle strutture riabilitative, in Nord Italia, viene valutato utilizzando uno strumento basata sul PRUO.Background. During the last few decades, an increasing attention has been drawn to public health expenditure and resource use. The increasing aging population has highlighted the need to deliver post-acute care and to assess its appropriateness. The "PRUO rehab" (Protocollo di Revisione dell'Utilizzo dell'Ospedale riabilitativo) protocol was realized and validated to assess the appropriateness of use of rehabilitation units. The aims of this study were to test the validity of the PRUO-rehab tool and to analyse the causes for Inappropriate Hospital Stay (IPS) in rehabilitation units. Methods. The PRUO rehab tool was retrospectively applied to the medical records of 502 patients who stayed at least overnight in one of ten different rehabilitation units set in Northern Italy, during 2007. Results. The tool was valid and the inappropriate patient stay (IPS) score was 25.0%. Conclusion. Although reasonably low, the IPS indicates that the rehabilitation structures analysed could be used more efficiently

Emotional assistance in thalassaemia: pilot implementation of a standard protocol

This study aims to describe the creation process of standard procedures to make possible multicentre studies related to emotional aspects of thalassaemic patients, their families and caregivers; and the pilot phase of the routine implementation. The objectives defined to perform this goal are: i) develop routines to assess and manage/treat emotional issues; ii) adjust the ABRASTA - Brazilian Association of Thalassaemia computer system to the input of collected data and its compilation; iii) conduct a pilot implementation of the routines; iv) discuss the whole process and propose next steps. Forty patients were assisted following the above mentioned routines of psychological evaluation, follow-up assistance and management of specific emotional issues. Conclusions are that the routines are adequate to enable multicenter research to compare findings and develop specific interventions to Thalassaemia patients, their families and caregivers; information gathered through them is an important means of supporting medical doctors and other members of the professional team, both in the therapeutic planning and in the communication process with patients and families; finally, considering the nature of the information, psychologists and psychiatrists are the most indicated professionals to perform the assessment and the interventions related to emotional issues, due to their professional background, training and specific skills that allow a free and candid communication with the patients and their families.&nbsp;本研究旨在描述标准程序的创造过程，来进行关于地中海贫血患者、其家属和照顾者情感方面可能的多中心研究；以及例程实施的试点阶段。 为实现此目的而定下的目标有： 1）制定例程评估和管理/处理情感问题；2）调整巴西地中海贫血病协会（ABRASTA）计算机系统， 输入收集到的数据并对其进行编辑；3）对例程进行试点实施；4）讨论整个过程并提出下一步行动。 遵照上述特殊情感问题的心理评估、随访协助和管理的例程，曾协助过四十名患者。 结论为该例程足以确保多中心研究，以比较结果和为地中海贫血患者、其家属和照顾者制定具体的干预措施；通过他们收集的信息是支持治疗医生和专业团队的其他成员的重要途径，这些支持体现在治疗计划、以及和患者及其家属交流的过程中；最后，考虑到这些信息的性质，心理专家和精神病专家是最明显的专业人士来进行的有关情感问题的评估和干预，因为他们具备专业背景、专业训练和特殊技能，这些使得他们能够和患者及其家属进行自由和真正的交流。</p

Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan, Lombardy, Italy

Objectives: The management of healthcare workers (HCWs) exposed to confirmed cases of coronavirus disease 2019 (COVID-19) is still a matter of debate. We aimed to assess in this group the attack rate of asymptomatic carriers and the symptoms most frequently associated with infection. Methods: Occupational and clinical characteristics of HCWs who underwent nasopharyngeal swab testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a university hospital from 24 February 2020 to 31 March 2020 were collected. For those who tested positive and for those who tested positive but who were asymptomatic, we checked the laboratory and clinical data as of 22 May to calculate the time necessary for HCWs to then test negative and to verify whether symptoms developed thereafter. Frequencies of positive tests were compared according to selected variables using multivariable logistic regression models. Results: There were 139 positive tests (8.8%) among 1573 HCWs (95% confidence interval, 7.5\u201310.3), with a marked difference between symptomatic (122/503, 24.2%) and asymptomatic (17/1070, 1.6%) workers (p &lt; 0.001). Physicians were the group with the highest frequency of positive tests (61/582, 10.5%), whereas clerical workers and technicians had the lowest frequency (5/137, 3.6%). The likelihood of testing positive for COVID-19 increased with the number of reported symptoms; the strongest predictors of test positivity were taste and smell alterations (odds ratio = 76.9) and fever (odds ratio = 9.12). The median time from first positive test to a negative test was 27 days (95% confidence interval, 24\u201330). Conclusions: HCWs can be infected with SARS-CoV-2 without displaying any symptoms. Among symptomatic HCWs, the key symptoms to guide diagnosis are taste and smell alterations and fever. A median of almost 4 weeks is necessary before nasopharyngeal swab test results are negative