Six months follow up of a single intravitreal injection of ocriplasmin for symptomatic vitreomacular adhesion

Purpose: To evaluate the efficacy and the safety of the enzymatic vitreolysis with a single intravitreal injection of ocriplasmin 125 μg across a group of patients with symptomatic vitreomacular adhesion (sVMA) during 6 months follow up. Design: A randomized, placebo-controlled, double-masked, 6-month follow up study. Participants: A total of 28 patients (12 M / 16F) (19 receiving ocriplasmin; 9 receiving placebo), mean aged 71 years old, diagnosed with sVMA, VMT, FTMH e ERM by optical coherence tomography. Methods: A single intravitreal injection of ocriplasmin 125 μg or placebo. Primary endpoint was sVMA resolution or FTMH closure. Secondary endpoint included the integrity of the external membrane and the inner and outer segments of the photoreceptor interface using OCT. The evaluation was carried out at baseline and during 6 months after intravitreal injection of ocriplasmin or placebo. Results: After a 6 months follow-up period, the rate of VMA resolution was 42.1% in the Ocriplasmin group vs the 22% in the placebo group. FTMH closure rate was 50% in the Ocriplasmin group vs 0% in the placebo group. The best results were optained within 28 days from the treatment. No case of uveitis, endophthalmitis, retinal tears, retinal detachment or bleeding during followup were reported. One patient reported floaters and transitional photopsias. Conclusions: The study confirmed the efficacy and safety of Ocriplasmin injection for patients with VMT, including when associated with full-thickness macular holes during six months follow up. Long term studies are certainly needed to confirm these results

Malpractice and patient safety descriptors: an innovative grid to evaluate the quality of clinical records

Introduction: The medical record contains all the health information related to the patient’s clinical condition and its evolution during hospitalization. It was defined by the Italian Ministry of Health in 1992 as "The information tool designed to record all relevant demographic and clinical information about a patient during a single episode of hospitalization". The documents and information in a Medical Record must meet the following criteria: traceability, clarity, accuracy, authenticity, pertinence and completeness. The objectives of our study was to develop a tool capable of assessing the quality of the clinical record and pointed the critical point at the Organizational, Technical - Professional, Managerial level. Methods: To evaluate the quality of the medical documentation, we created an assessment grid composed of 4 sections with a total of 92 criteria. This grid was tested on 200 medical records that were randomly selected from 25 (18 medical and 7 surgical) wards of a teaching hospital in Rome. Results: The grid contains 4 sections. The first part regards administrative and clinical data; the second assesses the quality of hospital stay and surgical/invasive procedures; the third part is concerned with the discharge of the patient and the fourth aims to identify the presence of advisory reports given to the patient. This grid has been validated to verify internal consistency with Cronbach's Alpha = 0,743. Conclusions: Medical records were analyzed using a validated tool with grids to identify critical issues in care activities. Weaknesses in the system were identified in order to improve planning. The sample testing also in terms of ‘self-assessment' represents a tool to introduce activities to improve safety and quality of care, greatly reducing the costs of litigation

Victims of Violence in Accident & Emergency: Reporting Survey of Eleven Emergency Structures Out of Eighteen

Sexual violence is a widespread and common phenomenon in our society, which unfortunately often goes unreported or undetected: a hidden "iceberg" of great dimension. Often the victims arrive to our emergency department where the sanitary workers are not prepared to help them professionally. By this work the authors want to evaluate health workers true understanding of the "problem of violence"; their human and professional capacity to manage it; their capacity to create and promote sensitisation and training programmes for professionals working in the field; and the ability to design and implement protocols and procedures to be utilized when managing victims of violence by a questionnaire compiled and distributed to health professionals working in the critical areas (A&E and DEA) in the region Lazio

Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Conley Scale: assessment of a fall risk prevention tool in a General Hospital

Introduction: Umberto I Teaching Hospital adopted 'Scale of Conley' as internal procedure for fall risk assessment, with the aim of strengthening surveillance and improving prevention and management of impatient falls.Materials and Methods: Case-control study was performed. Fall events from 1st March 2012 to 30th September 2013 were considered. Cases have been matched for gender, department and period of hospitalization with two or three controls when it is possible. A table including intrinsic and extrinsic fall risk factors, not foreseen by Conley Scale, and setted up after a literature overview was built. Univariate analysis and conditional logistic regression model have been performed.Results: 50 cases and 102 controls were included. Adverse event fall were associated with filled Conley scale at the admission to care unit (OR=4.92, 95%CI= 2.34-10.37). Univariate analysis identified intrinsic factors increasing risk of falls: dizziness (OR= 3.22; 95%CI= 1.34-7.75), psychomotor agitation (OR= 2.61; 95%CI= 1.06-6.43); and use of means of restraint (OR=5.05 CI= 1.77-14.43). Conditional logistic regression model revealed a significant association with the following variables: use of instruments of restraint (HR= 5.54, 95%IC= 1.2-23.80), dizziness (OR= 3.97, 95%CI= 1.22-12.89).Discussion: Conley Scale must be filled at the access of patient to care unit. There were no significant differences between cases and controls with regard to risk factors provided by Conley, except for the use of means of restraint. Empowerment strategies for Conley compilation are needed

Patient Safety in eye surgery

useful defense mechanisms, in order to face the consequences in the event of an error occurring. To reduce these events it is necessary to improve the quality of health care through Clinical Governance namely Risk Management or Clinical Risk Management, which aim at identifying, analyzing, evaluating, communicating, eliminating and monitoring risks associated with any health activit

Victims of Violence in Accident & Emergency: Reporting Survey of Eleven Emergency Structures Out of Eighteen

Sexual violence is a widespread and common phenomenon in our society, which unfortunately often goes unreported or undetected: a hidden “iceberg” of great dimension. Often the victims arrive to our emergency department where the sanitary workers are not prepared to help them professionally. By this work the authors want to evaluate health workers true understanding of the “problem of violence”; their human and professional capacity to manage it; their capacity to create and promote sensitisation and training programmes for professionals working in the field; and the ability to design and implement protocols and procedures to be utilized when managing victims of violence by a questionnaire compiled and distributed to health professionals working in the critical areas (A&E and DEA) in the region Lazio

Improving quality through clinical risk management: A triage sentinel event analysis

"Triage" is a useful tool used in emergency departments (EDs) to prioritize the care of patients. Through a methodical process of different sequential steps, the triage nurse assigns a color code which goes from red-critical patient with immediate access to medical examination-to a white code that represents no urgency. Clinical studies have shown that patients can be victims of errors during the process of care, especially in complex systems such as EDs. To reduce errors it is essential to map the risks in order to identify the causes (both individual and organizational); the introduction of corrective changes cannot be postponed. The incorrect assessment at triage represents one of the major errors in EDs. By monitoring this activity, through the analysis of sentinel events we can reduce adverse consequences. Missed recognition of a red code indicates a sentinel event. We used a "root cause analysis" to explain an episode of missed recognition of red code at triage. A nurse without specific training in triage and inexperienced in critical care was identified as the "root cause" of the sentinel event. To make improvements we planned a triage training course (for newly employed nurses and a refresher course for existing staff) and created a team of dedicated triage nurses. © 2011 SIMI

Knowledge of Emergency Department Triage nurses in management of patients with mental health needs: comparisons with the Triage Model of Lazio (TLM)

To refer the current competences of Triage Nurses (TRNs) assessing the person with metal health problems in Emergency Departments (ED), and the impact of the Triage Lazio Model (TLM) upon it

Conley Scale: assessment of a fall risk prevention tool in a General Hospital

"Umberto I" Teaching Hospital adopted 'Conley scale' as internal procedure for fall risk assessment, with the aim of strengthening surveillance and improving prevention and management of impatient falls