Il contributo della SIS Piemonte alla didattica disciplinare

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Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study

ObjectiveSepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes. We aimed to evaluate the impact of a multi-faceted quality implementing program (QIP) on the compliance of a “simplified 1-h bundle” (Sepsis 6) and hospital mortality of severe sepsis and septic shock patients out of the intensive care unit (ICU).MethodsEmergency departments (EDs) and medical wards (MWs) of 12 academic and non-academic hospitals in the Lombardy region (Northern Italy) were involved in a multi-faceted QIP, which included educational and organizational interventions. Patients with a clinical diagnosis of severe sepsis or septic shock according to the Sepsis-2 criteria were enrolled in two different periods: from May 2011 to November 2011 (before-QIP cohort) and from August 2012 to June 2013 (after-QIP cohort).Measurements and main resultsThe effect of QIP on bundle compliance and hospital mortality was evaluated in a before–after analysis. We enrolled 467 patients in the before-QIP group and 656 in the after-QIP group. At the time of enrollment, septic shock was diagnosed in 50% of patients, similarly between the two periods. In the after-QIP group, we observed increased compliance to the “simplified rapid (1 h) intervention bundle” (the Sepsis 6 bundle – S6) at three time-points evaluated (1 h, 13.7 to 18.7%, p = 0.018, 3 h, 37.1 to 48.0%, p = 0.013, overall study period, 46.2 to 57.9%, p < 0.001). We then analyzed compliance with S6 and hospital mortality in the before- and after-QIP periods, stratifying the two patients’ cohorts by admission characteristics. Adherence to the S6 bundle was increased in patients with severe sepsis in the absence of shock, in patients with serum lactate <4.0 mmol/L, and in patients with hypotension at the time of enrollment, regardless of the type of admission (from EDs or MWs). Subsequently, in an observational analysis, we also investigated the relation between bundle compliance and hospital mortality by logistic regression. In the after-QIP cohort, we observed a lower in-hospital mortality than that observed in the before-QIP cohort. This finding was reported in subgroups where a higher adherence to the S6 bundle in the after-QIP period was found. After adjustment for confounders, the QIP appeared to be independently associated with a significant improvement in hospital mortality. Among the single S6 procedures applied within the first hour of sepsis diagnosis, compliance with blood culture and antibiotic therapy appeared significantly associated with reduced in-hospital mortality.ConclusionA multi-faceted QIP aimed at promoting an early simplified bundle of care for the management of septic patients out of the ICU was associated with improved compliance with sepsis bundles and lower in-hospital mortality

Present knowledge on the distribution of Erebia christi (Nymphalidae: Satyrinae) in the Italian Alps

Volume: 21Start Page: 290End Page: 29

CARIE E CLASSE SOCIALE : ESISTE UNA RELAZIONE NEI PRESCHOOLERS?

OBIETTIVO: Correlare l\u2019esperienza di carie con un indicatore di classe sociale in un campione di bambini in et\ue0 prescolare della regione Veneto. MATERIALI E METODI : Nell\u2019area dell\u2019ULSS 15 \u201cAlta Padovana\u201d, nel periodo settembre 2005 - marzo 2006, \ue8 stato condotto uno studio osservazionale di tipo trasversale selezionando con modalit\ue0 random 20 scuole dell\u2019infanzia su un totale di 88. Prima dell\u2019indagine, ai genitori dei 1820 bambini coinvolti nello studio sono stati inviati un modulo per il consenso alla visita (secondo i principi etici stabiliti dalla World Medical Association nella Dichiarazione di Helsinki) ed un questionario atto a definire la posizione lavorativa del padre e della madre. Presso gli istituti scolastici 2 odontoiatri calibrati hanno esaminato 1410 bambini; i 410 soggetti non visitati erano assenti (372) o privi dell\u2019autorizzazione dei genitori (38). La valutazione dell\u2019indice dmft \ue8 stata realizzata secondo i criteri stabiliti dall\u2019 OMS per le indagini odontoiatriche di base .La classe sociale di appartenenza \ue8 stata stabilita in base alla posizione lavorativa migliore tra le due occupate dai genitori. Sono stati restituiti 1205 questionari, con una percentuale di risposta dell\u201985.5%. I bambini sono stati di conseguenza distribuiti secondo quattro gruppi di classe sociale : classe borghese (n. 211), classe media impiegatizia (n. 395), piccola borghesia (n. 200) e classe operaia (n. 399). Per le variabili continue sono state calcolate medie e deviazioni standard, mentre per le variabili categoriche i risultati sono stati forniti come proporzioni. I confronti tra gruppi sono stati effettuati utilizzando il test X2. L\u2019associazione tra l\u2019esperienza di carie e la variabile indipendente classe sociale \ue8 stata valutata mediante un modello di regressione logistica. RISULTATI : La prevalenza di carie e l\u2019indice dmft medio del campione sono risultati pari, rispettivamente, a 23% - 0.8\ub12.1 nella classe borghese, 21% - 0.7\ub12.0 nella classe media impiegatizia, 27% - 1.2\ub12.8 nella piccola borghesia e 36% - 1.7\ub13.2 nella classe operaia. L'occorrenza di carie ha evidenziato un significativo trend lineare tra i quattro gruppi di classe sociale. Il fatto di appartenere ad una classe sociale bassa si \ue8 dimostrato un fattore prognostico circa la presenza di carie, avendo i soggetti appartenenti alla classe operaia un OR pari a 1.9 (I.C. 95% 1.3\u2013 2.8) rispetto ai soggetti della classe borghese. CONCLUSIONI : I dati emersi sottolineano come la classe sociale sia un potente elemento discriminante per ci\uf2 che concerne la salute orale, confermando in questo quanto finora asserito in letteratura internazionale

SOCIAL DIFFERENCES IN TOOTH DECAY OCCURRENCE IN A SAMPLE OF CHILDREN AGED 3 TO 5 IN NORTH-EAST ITALY

Abstract OBJECTIVE: To correlate the occurrence of tooth decay with a social class indicator (occupational level) and the immigrant status in a sample of pre-school children in Veneto region. BASIC RESEARCH DESIGN: Cross-sectional survey. Clinical setting: Twenty nursery schools in the area of Health District n.15. PARTICIPANTS: A total of 1,410 children aged 3 to 5 years old visited between September 2005-May 2006. OUTCOMES: Occurrence of dental caries into dentine threshold was made visually and confirmed with a probe when necessary by two calibrated examiners. Information on immigrant status and occupational level of parents was obtained by a questionnaire. Children were categorized as immigrant or non-immigrant on the basis of their mother's country of origin. Means and standard deviation were calculated for continuous variables; for categorical variables the results were provided as proportions. Comparisons between groups were made using Pearson chi-square test. The association between caries occurrence and the independent variables gender, age, immigrant status and family social class was evaluated by means of a logistic regression model. RESULTS: Caries occurrence was higher among children from lower social class families (1.7 +/- 3.2) than among children from higher social class (0.8 +/- 2.1). The prevalence of dental caries in immigrant preschool children was significantly higher than in indigenous ones (15% vs 40%; p = 0.000) while the severity in immigrants was almost 4 times higher (2.2 +/- 3.6 vs 0.6 +/- 1.8). CONCLUSIONS: Our data on preschoolers confirm the worldwide literature shared statement that social class as well as immigration status are determinants of oral health. PMID: 21046908 [PubMed - indexed for MEDLINE

Efficacy of hepatic computed tomography to detect iron overload in chronic hemodialysis

Efficacy of hepatic computed tomography to detect iron overload in chronic hemodialysis. The diagnostic efficacy of hepatic computed tomography density (HCTD) in comparison with serum ferritin for the detection of iron overload was investigated in uremic patients on maintenance hemodialysis (HD) and in patients with idiopathic hemochromatosis (IHC). Ten IHC patients, 38 HD patients and 40 healthy subjects underwent the CT scanning of the liver and determination of percent saturation of transferrin, serum ferritin concentration and HLA typing. Liver iron content was determined by histochemical grading and direct measurement of liver iron concentration either in IHC patients or in HD patients. Nineteen HD patients were considered to have iron overload on the basis of liver iron concentration exceeding 3.6 µmol/100mg dry weight. The mean ± SD values of HCTD in healthy subjects, IHC patients, HD patients with iron overload and without iron overload were 60.2 ± 5.6, 79 ± 5.6, 71.4 ± 3.6, 58 ± 3.8 Hounsfield units, respectively. HCTD showed positive correlations with liver iron concentration and serum ferritin either in IHC patients or in HD patients. The analysis of the diagnostic efficacy of HCTD in comparison with serum ferritin for the detection of excessive hepatic iron in HD patients demonstrated that HCTD had higher sensitivity, specificity, positive and negative predictive values. Cut-off points were arbitrarily fixed to 66 Hounsfield units for HCTD, 400 µ-g/liter for serum ferritin and 3.6 µmol/100mg dry weight for liver iron concentration. Seventeen HD patients who possessed the histocompatibility antigens associated with IHC, namely HLA-A3 and/or HLA-B7 and/or HLA-B14, had liver iron concentration, serum ferritin and HCTD values higher than those of the HD patients without these “hemochromatosis alleles”. The diagnostic approach to the disorders of excessive iron storage of the liver may evolve to a new level of sophistication with the introduction of the CT scanning. HCTD may be an accurate, non-invasive, alternative to liver biopsy for the detection of hepatic iron overload in HD patients and in IHC patients. In HD patients HCTD is more efficient than serum ferritin in diagnosing iron overload. However, liver biopsy, which permits a definition of the presence of fibrosis and cirrhosis, maintains its importance from a standpoint of prognosis and follow-up. In HD patients the presence of any of the histocompatibility antigens of IHC is associated with an increased risk of iron overload and excessive hepatic iron storage

Produtividade de colmos em clones de cana-de-açúcar

RESUMO O objetivo deste trabalho foi avaliar a produtividade e as características de colmos de 25 clones de cana-de-açúcar, nos cultivos de cana-planta e cana-soca. O experimento foi realizado nos anos agrícolas de 2009-2010 (cana-planta) e 2010-2011 (cana-soca), em Jaguari, RS. O delineamento utilizado foi o de blocos ao acaso, em esquema fatorial (clones e cultivos de cana-planta e cana-soca), com três repetições. Ao final de cada cultivo, foram realizadas avaliações de comprimento, diâmetro, número e produtividade de colmos. Os dados obtidos foram submetidos à análise da variância e, as médias, comparadas pelo teste de Tukey, a 5% de probabilidade A produtividade média de colmos dos clones mais produtivos de ciclo precoce, nos cultivos de cana-planta e cana-soca (96,6 e 123,4 t ha-1, respectivamente) foi semelhante à obtida com os clones mais produtivos de ciclo médio-tardio (101,5 e 128,0 t ha-1, respectivamente). No cultivo de cana-soca, a produtividade média de colmos superou a obtida no cultivo de cana-planta, com 13 dos 25 clones avaliados. Em geral, os clones mais produtivos apresentam valores elevados de número e de comprimento de colmos, sendo observada baixa variação do diâmetro de colmos dos materiais testados. Os clones RB965911, RB925345, RB855156, RB987935, RB935744, RB867515, RB975019, RB925268, RB845210 e RB975329 são os mais adaptados às condições edafoclimáticas da região da Depressão Central do Rio Grande do Sul, apresentando maior produtividade de colmos, com valores acumulados, nos dois cultivos, superiores a 200 t ha-1