Could clustering of comorbidities be useful for better defining the internal medicine patients’ complexity?

Internal medicine patients are mostly elderly with multiple comorbidities, usually chronic. The high prevalence of comorbidity and multimorbidity has a significant impact on both positive responses to treatment and the occurrence of adverse events. Clustering is the process of nosography grouping into meaningful associations with some index disease, so that the objects within a cluster have high similarity in comparison with one another. In the decision-making process it is imperative that, in addition to understanding the immediate clinical problems, we are able to explicit all the contextual factors that have to be taken into account for the best outcome of care. Cluster analysis could be leveraged in developing better interventions targeted to improve health outcomes in subgroups of patients

Lentiviral Hematopoietic Stem Cell Gene Therapy Benefits Metachromatic Leukodystrophy

n/

Management of sepsis: from evidence to clinical practice

Sepsis is one of the leading causes of death in hospitalized patients and its management involves a lot of specialist. Internist is required to demonstrate his competence since the beginning when the diagnosis is not so easy to be clarified. A rapid clinical suspicion permits a prompt management of the patient that means important mortality reduction. However, it is essential to understand the source of infection and echography represents a rapid, economic, useful and widespread tool with whom Internist should become more and more confident. The following review is a practical guide to manage septic patients according to the most recent literature, underlining aspects of antibiotic therapy, hemodynamic stabilization and supportive therapy. To limit sepsis mortality, a valid Internist should be culturally prepared and especially able to cooperate with other specialists, because a strong enemy requires a strong team

Clinical governance and internal medicine: a marriage of convenience?

Amplification in health expectations, increase in new technologies, decrease in economic resources and the breakdown of traditional control systems have led to the development of clinical governance (CG). The aim of the present pilot study was to investigate the application of CG tools in significant sample of Italian internal medicine wards (IMW). A 37-item questionnaire was developed and administered to 39 physicians, within 33 IMWs throughout Italy. Thanks to the data analysis, the perceived usefulness, the utilization rate of CG tools, the correlations between CG use, wards characteristics, and/or localization were studied. We identified at what organizational level the CG tools were applied and used. fifty-two percent of the studied tools were being used in the investigated hospitals. The average utility and utilization rate was different depending on the region of provenance. This research showed that CG is a methodology often used by Italian hospitals physicians, especially for inpatient care. The encouraging results of this pilot study could suggest opportunities to extend the survey at national level, to generalize the results