Uncompleted Emergency Department Care (UEDC): A 5-year population-based study in the Veneto Region, Italy

Introduction: Uncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure. Methods: This was a cross sectional study on anonymized administrative data in a population-based ED database. Results: A total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7\u2030, with a slightly higher rate of AMA than of LWBS (15.3\u2030 vs 13.4\u2030). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other). Some characteristics of the hospital structure, such as the type of hospital and the volume of patients managed, could also be associated with UEDC. Conclusion: Cases of UEDC, which may involve patients who leave AMA and those who LWBS, differ considerably from other cases managed at the ED. The present findings are important for the purpose of planning and staffing health services. Decision-makers should identify and target the factors associated with UEDC to minimize walkouts from public hospital EDs

Opening schools and trends in SARS-CoV-2 transmission in European countries

Objectives: Benefits of school attendance have been debated against SARS-CoV-2 contagion risks. This study examined the trends of contagion before and after schools reopened across 26 countries in the European Union. Methods: We compared the average values of estimated R t before and after school reopening, identifying any significant increase with a one-sample t-test. A meta-analysis and meta-regression analysis were performed to calculate the overall increase in R t for countries in the EU and to search for relationships between R t before schools reopened and the average increase in R t afterward. Results: The mean reproduction number increased in 16 out of 26 countries. The maximum increase in R t was reached after a mean 28 days. We found a negative relationship between the R t before school reopening and its increasing after that event. By 45 days after the first day of school reopening, the overall average increase in R t for the European Union was 23%. Conclusion: We observed a significant increase in the mean reproduction number in most European countries, a public health issue that needs strategies to contain the spread of COVID-19

Diabetes management in the Primary Care setting: a comparison of physicians' performance by gender

BACKGROUND: A major shift in the gender of the medical-doctor workforce is now underway, and all over the world it is expected that an average 65% of the medical workforce will be women by 2030. In addition, an aging population means that chronic diseases, such as diabetes, are becoming more prevalent and the demand for care is rising. There is growing evidence of female physicians performing better than male physicians.AimOur study aimed to investigate whether any differences in diabetes process indicators are associated with gender, and/or the interaction between gender and different organizational models.Design and settingA population-based cross-sectional analysis was conducted on a large data set obtained by processing the public health administration databases of seven Italian local health units (LHUs). The seven LHUs, distributed all over the Italian peninsula in seven different regions, took part in a national project called MEDINA, with the focus on chronic disease management in primary care (PC). METHODS: A total score was calculated for the average performance in the previously listed five indicators, representing global adherence to a quality management of patients with diabetes. A multilevel analysis was applied to see how LHUs affected the outcome. A quantile regression model was also fitted. RESULTS: Our study included 2287 Italian general practitioners (586 of them female) caring for a total of 2 646 059 patients. Analyzing the performance scores confirmed that female general practitioners obtained better results than males. The differences between males and females were stronger on the 25th and 75th percentiles of the score than on the median values. The interaction between gender and LHU was not significant. CONCLUSION: Our study evidenced that female physicians perform better than males in providing PC for diabetes independently by the different organizational models. Further research to understand the reasons for these gender differences is needed

Prognosis for Cutaneous Melanoma by Clinical and Pathological Profile: A Population-Based Study

Introduction: Among white people, the incidence of cutaneous malignant melanoma (CMM) has been increasing steadily for several decades. Meanwhile, there has also been a significant improvement in 5-year survival among patients with melanoma. This population-based cohort study investigates the five-year melanoma-specific survival (MSS) for all melanoma cases recorded in 2015 in the Veneto Tumor Registry (North-Est Italian Region), taking both demographic and clinical-pathological variables into consideration. Methods: The cumulative melanoma-specific survival probabilities were calculated with the Kaplan-Meier method, applying different sociodemographic and clinical-pathological variables. Cox’s proportional hazards model was fitted to the data to assess the association between independent variables and MSS, and also overall survival (OS), calculating the hazard ratios (HR) relative to a reference condition, and adjusting for sex, age, site of tumor, histotype, melanoma ulceration, mitotic count, tumor-infiltrating lymphocytes (TIL), and stage at diagnosis. Results: Compared with stage I melanoma, the risk of death was increased for stage II (HR 3.31, 95% CI: 0.94-11.76, p=0.064), almost ten times higher for stage III (HR 10.51, 95% CI: 3.16-35.02, p<0.001), and more than a hundred times higher for stage IV (HR 117.17, 95% CI: 25.30-542.62, p<0.001). Among the other variables included in the model, the presence of mitoses and histological subtype emerged as independent risk factors for death. Conclusions: The multivariable analysis disclosed that older age, tumor site, histotype, mitotic count, and tumor stage were independently associated with a higher risk of death. Data on survival by clinical and morphological characteristics could be useful in modelling, planning, and managing the most appropriate treatment and follow-up for patients with CMM

La gestione del diabete nelle cure primarie: il ruolo del genere nelle performance dei medici di medicina generale

INTRODUZIONE: Negli ultimi anni si sta verificando un cambiamento di genere nella classe lavorativa medica, si prevede infatti che nel 2030 il 65% dei medici in tutto il mondo sarà donna. Questo in concomitanza del ben noto fenomeno della transizione epidemiologica verso le patologie croniche. Diverse evidenze indicano una miglior performance dei medici di genere femminile rispetto a quelle dei medici di genere maschile, ma nessuno studio ha verificato se nell’ambito delle cure primarie e specialmente nel campo della gestione del diabete, il modello organizzativo modifica l’effetto del genere. Il nostro studio ha come scopo la valutazione in diversi contesti organizzativi del ruolo del genere del medico nei risultati della gestione del diabete nel setting delle cure primarie. MATERIALI E METODI: I dati derivano dallo studio MEDINA promosso da AGENAS che ha coinvolto sette distretti di diverse regioni della penisola italiana. È stato effettuato uno studio coorte retrospettivo di popolazione che è stato svolto su un ampio database ottenuto processando banche dati. Sono stati 5 indicatori di processo della presa in carico dei pazienti diabetici ed è stato ricavato uno score complessivo ricavato come media delle performance ottenute nei diversi indicatori di processo. È stata effettuata una analisi multilivello e una regressione quantile. RISULTATI: Lo studio ha incluso 2287 medici di Medicina Generale (di cui 586 donne) che hanno a carico 2,646,059 pazienti. Le analisi delle performance hanno confermato che le donne ottengono migliori risultati dei colleghi di genere maschile. Le interazioni tra genere e modelli organizzativi non si sono rivelate significative. Sono state evidenziate delle differenze di genere maggiori tra coloro che ottengono risultati di performance nel I° e nel III° quartile rispetto a quelli che si collocano nel II° quartile. CONCLUSIONI: Il nostro studio conferma le migliori performance dei medici di genere femminile nella gestione del diabete nellambito delle cure primarie, tale associazioni non è modificata dal modello organizzativo

Effectiveness of pro-active organizational models in primary care for diabetes patients

Background: Demographic changes and chronicity are posing new challenges to health care systems. Our study aimed to examine how effectively the three different types of proactive primary care models adopted by three different regional health care systems in Italy were improving the quality of diabetes management by general practitioners. Methods: A coordinated Italian nationwide project to compare systematically the new proactive organizational models implemented at regional and local level (the MEDINA Project) involved several regions and their local health units (LHUs). A quasi-experimental study was conducted on a large dataset obtained by processing administrative databases. A combined indicator was developed to assess the quality of care delivered by primary care physicians, based on adherence to recommendations concerning patient monitoring and treatment. Result: The study concerned 602 Italian general practitioners (GPs), 174 of them female, who were caring for a total of 753,366 patients (47,575 of them diabetic). Analyzing a total score, representing global adherence to a quality management of patients with diabetes, confirmed that GPs who had adopted the new model of care for their diabetic patients obtained better results than those who had not, so the new policy was generally effective. Conclusion: Our study showed that introducing new, proactive primary care models could sustain efforts made around the world to guarantee good-quality chronic disease management in the primary care setting