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

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

The antica Fonte of Boario (Italy): An hydrochemical and isotopic investigation in support of mineral water development

The "Antica Fonte" mineral water is a valuable resource with well-known therapeutic effects due to its high magnesium and sulphate contents. Hydrochemical and isotopic data indicate that the water is recharged at an elevation exceeding 1000 m asl, derives its mineral content by dissolution of Triassic gypsum and dolomite, and partially mixes with present day recharge from the alluvial aquifer. The results of this investigation provide valuable information for a sustainable development of the resource

Dynamics of Mount Nyiragongo lava lake inferred from thermal imaging and infrasound array

Abstract Lava lakes provide a direct observation window into processes which usually remain hidden, such as magma convection and outgassing dynamics. We here report a coupled analysis of thermal infrared footage and infrasound array recordings at Mount Nyiragongo (D. R. Congo), and derive a conceptual model of the lava lake's convective system and outgassing mechanism. We suggest that surface flow results from a horizontal pressure gradient at the surface of the lake, driving the crust from high-pressure regions where hot upwelling magma impinges the surface, to low-pressure regions where cold downwelling magma pulls away from the surface. The ascending current of this convection cell carries gas pockets, which once at the surface, are dragged across the lake into downwelling sinks. Such sinks are characterized by persistent chaotic bubble bursting (spattering), whose intensity and position are tracked from infrasound array analysis. Fluctuations of these are observed, but have not been correlated with oscillations of the lava lake level, nor with the variations of surface velocities, both recorded from infrared footage. We also report the activity of a new eruptive vent, which opened early 2016 near an inner circular fracture of the crater's third terrace. We show that the vent's activity was intermittent, alternating between explosive strombolian activity and effusive activity. The latter produced lava flows which spread on the crater's last terrace before cascading into the active lava lake. Although no significant change in the lake behavior was witnessed while the new eruptive vent was active, increased attention should be addressed as this new activity could reflect over-pressurization of the shallow magmatic system. The variety of phenomena captured by this study complements and expands observations reported at other low-viscosity lava lakes, chiefly Kilauea (Hawai'i) and Erta Ale (Ethiopia). Despite Nyiragongo's more vigorous convective regime (where multiple convective cells can operate simultaneously), we suggest that the mechanisms controlling the surface motion and outgassing are similar at all three systems, pointing to generic processes governing the dynamics of low-viscosity lava lakes

Specific vulnerability of the Caserta plain (It) to nitrogen losses

Nitrogen, vulnerability, LOS, AVI, SINTACS, Caserta Plai

Geochemical tracers in complex hydrogeological settings: the Roccamonfina volcanic vs. mt. massico sedimentary aquifers (southern Italy)

Volcanic aquifers, sedimentary basins, hydrogeochemistry, hydrogeology, isotopic composition

Patient-reported outcome measures (PROMs) after elective hip, knee and shoulder arthroplasty: protocol for a prospective cohort study

Background The number of hip, knee and shoulder arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched an initiative (called PaRIS Initiative) for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the launch of the Initiative in Italy given that IOR hosts the Registry of Orthopedic Prosthetic Implants (RIPO), a region-wide registry which collects joint implant data from all the hospitals in the Emilia-Romagna Region. In this specific geographic area information related to PROMs after joint replacement is unknown. This paper describes the protocol of a study (PaRIS-IOR) that aims to implement the collection of a set of PROMs within an existing implant registry in Italy. The study will also investigate the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. Methods The PaRIS-IOR study is a prospective, single site, cohort study that consists of the administration of PROMs questionnaires to patients on the list for elective arthroplasty. The questionnaires will be administered to the study population within 30 days before surgery, and then at 6 and 12 months following surgery. The study population will consist of consecutive adult patients undergoing either hip, knee or shoulder arthroplasty. The collected data will be linked with those routinely collected by the RIPO in order to assess the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. Discussion The PaRIS-IOR study could have important implications in targeting the factors influencing functional outcomes and quality of life reported by patients after hip, knee and shoulder arthroplasty, and will also represent the first systematic collection of PROMs related to arthroplasty in Italy

The November 2002 degassing event at Panarea Island (Italy): five months of geochemical monitoring

On 3rd November 2002, at about 3 km off-shore of Panarea Island (Aeolian Islands, Southern Italy), a series of gas vents suddenly and violently opened from the seafloor at the depth of 10-15 m, with an unusually high gas flux and superimposing on the already existing submarine fumarolic field. Starting from the 12th November 2002 a discontinuous geochemical monitoring program was carried out. The emissions consisted in an emulsion whose liquid phase derived from condensation of an uprising vapor phase occurring close to the fluid outlets without significant contamination by seawater. The whole composition of the fluids was basically H2O- and CO2-dominated, with minor amounts of typical «hydrothermal» components (such as H2S, H2, CO and light hydrocarbons), atmospheric-related compounds, and characterized by the occurrence of a significant magmatic gas fraction (mostly represented by SO2, HCl and HF). According to the observed temporal variability of the fluid compositions, between November and December 2002 the hydrothermal feeding system was controlled by oxidizing conditions due to the input of magmatic gases. The magmatic degassing phenomena showed a transient nature, as testified by the almost complete disappearance of the magmatic markers in a couple of months and by the restoration, since January 2003, of the chemical features of the existing hydrothermal system. The most striking feature of the evolution of the «Panarea degassing event» was the relatively rapid restoration of the typical reducing conditions of a stationary hydrothermal system, in which the FeO/Fe1.5O redox pair of the rock mineral phases has turned to be the dominating redox controlling system

Solid-state supramolecular organization, established directly from powder diffraction data, and photoluminescence efficiency of rigid-core oligothiophene-S,S-dioxides.

The "rigid-core" material 3,5-dimethyl-2,3'-bis(3-methylthiophene)-dithieno[3,2-b:',3'−d]thiophene-4,4-dioxide (DTTOMe4) has the highest photoluminescence ever reported for thiophene-based molecule..

Patient reported outcomes measures (PROMs) trajectories after elective hip arthroplasty: a latent class and growth mixture analysis

Patient-reported outcome measures (PROMs) are an extensively used tool to assess and improve the quality of healthcare services. PROMs can be related to individual demographic and clinical characteristics in patients undergoing hip arthroplasty (HA). The aim of this study is to identify distinct subgroups of patients with unique trajectories of PROMS scores and to determine patients' features associated with these subgroups

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case-Control Study from a Single Center in Italy

The mortality of hip fracture (HF) patients is increased by concomitant COVID-19; however, evidence is limited to only short follow-up. A retrospective matched case-control study was designed with the aim to report the 90-day mortality and determine the hazard ratio (HR) of concomitant HF and COVID-19 infection. Cases were patients hospitalized for HF and diagnosed with COVID-19. Controls were patients hospitalized for HF not meeting the criteria for COVID-19 diagnosis and were individually matched with each case through a case-control (1:3) matching algorithm. A total of 89 HF patients were treated during the study period, and 14 of them were diagnosed as COVID-19 positive (overall 15.7%). Patients' demographic, clinical, and surgical characteristics were similar between case and control groups. At 90 days after surgery, 5 deaths were registered among the 14 COVID-19 cases (35.7%) and 4 among the 42 HF controls (9.5%). COVID-19-positive cases had a higher risk of mortality at 30 days (HR = 4.51; p = 0.0490) and 90 days (HR = 4.50; p = 0.025) with respect to controls. Patients with concomitant HF and COVID-19 exhibit high perioperative mortality, which reaches a plateau of nearly 30-35% after 30 to 45 days and is stable up to 90 days. The mortality risk is more than four-fold higher in patients with COVID-19