Risk Factors Analysis of Surgical Infection Using Artificial Intelligence: A Single Center Study

Background: Surgical site infections (SSIs) have a major role in the evolution of medical care. Despite centuries of medical progress, the management of surgical infection remains a pressing concern. Nowadays, the SSIs continue to be an important factor able to increase the hospitalization duration, cost, and risk of death, in fact, the SSIs are a leading cause of morbidity and mortality in modern health care. Methods: A study based on statistical test and logistic regression for unveiling the association between SSIs and different risk factors was carried out. Successively, a predictive analysis of SSIs on the basis of risk factors was performed. Results: The obtained data demonstrated that the level of surgery contamination impacts significantly on the infection rate. In addition, data also reveals that the length of postoperative hospital stay increases the rate of surgical infections. Finally, the postoperative length of stay, surgery department and the antibiotic prophylaxis with 2 or more antibiotics are a significant predictor for the development of infection. Conclusions: The data report that the type of surgery department and antibiotic prophylaxis there are a statistically significant predictor of SSIs. Moreover, KNN model better handle the imbalanced dataset (48 infected and 3983 healthy), observing highest accuracy value

Lean six sigma approach for reducing length of hospital stay for patients with femur fracture in a university hospital

Surgical intervention within 48 h of hospital admission is the gold standard procedure for the management of elderly patients with femur fractures, since the increase in preoperative waiting time is correlated with the onset of complications and longer overall length of stay (LOS) in the hospital. However, national evidence demonstrates that there is still the need to provide timely intervention for this type of patient, especially in some regions of central southern Italy. Here we discuss the introduction of a diagnostic–therapeutic assistance pathway (DTAP) to reduce the preoperative LOS for patients undergoing femur fracture surgery in a university hospital. A Lean Six Sigma methodology, based on the DMAIC cycle (Define, Measure, Analyze, Improve, Control), is implemented to evaluate the effectiveness of the DTAP. Data were retrospectively collected and analyzed from two groups of patients before and after the implementation of DTAP over a period of 10 years. The statistics of the process measured before the DTAP showed an average preoperative LOS of 5.6 days (standard deviation of 3.2), thus confirming the need for corrective actions to reduce the LOS in compliance with the national guidelines. The influence of demographic and anamnestic variables on the LOS was evaluated, and the impact of the DTAP was measured and discussed, demonstrating the effectiveness of the improvement actions implemented over the years and leading to a significant reduction in the preoperative LOS, which decreased to an average of 3.5 days (standard deviation of 3.60). The obtained reduction of 39% in the average LOS proved to be in good agreement with previously developed DTAPs for femur fracture available in the literature

Bodybuilding, dietary supplements and hormones use: behaviour and determinant analysis in young bodybuilders

Background Among athletes, bodybuilders are more predisposed to the use of dietary supplements (DS) and hormones (H) to increase in adaptations to physical training and performance. The purpose of the study was to identify social, psychological, and organisational factors that are associated with the use of food supplements and hormones in young bodybuilders of the metropolitan area of Naples. Methods 107 athletes, practicing bodybuilding, were consecutively recruited in 30 gyms, randomly selected in the metropolitan area of Naples. Athletes were administered an anonymous questionnaire. The questionnaire consists of 5 sections (socio-demographic, frequency and reasons for bodybuilding, knowledge, attitudes and behaviours). Descriptive statistics were performed using T-test and Chi-square statistics. A score was created for knowledge, attitudes, behaviours. Multivariable logistic regression models were employed to assess association between each score and the use of DS and H. Statistical analyses were carried out using STATA 15. Results 81.31% of the subjects reported to use DS while 35.51% H. Females are less likely to practise bodybuilding frequently than males (OR 0.18 (95% CI 0.05–0.69), p = 0.01). Subjects who have attended high school or university have a lower probability of taking DS (OR 0.17 (95% CI 0.04–0.65), p = 0.01). H users also use supplements more frequently (OR 61.21 (95% CI 3.99–939.31), p < 0.001). Those who scored higher on knowledge scores are more likely to take DS (OR 1.53 (95% CI 1.11–2.12), p < 0.001). Attitudes are correlated with the use of DS; those who scored higher were less likely to use DS (OR 0.77 (95% CI 0.30–0.98), p = 0.03). People who use DS are 30 times more likely to use H at the same time (OR 30.25 (95% CI 2.51–365.24), p < 0.001). Subjects who have a higher score for knowledge and attitudes are less likely to use H (OR 0.68 (95% CI 0.54–0.87), p < 0.001, OR 0.75 (95% CI 0.62–0.90), p < 0.001). Conclusions Prevalence of H and DS’ use, although lower than reported in the literature, is a worrying public health problem. Better knowledge can lead to an informed use. Gym instructors should be trained to provide accurate and scientifically sound information. Health professionals should combine their expertise to provide more comprehensive guidance to the exercisers

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study

ABSTRACT: Background: Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools. Methods: In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn. Results: Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21\u20130.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62\u20134.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46\u20130.96, p = 0.03; OR: 0.66, CI 95%: 0.46\u20130.95, p = 0.03, respectively). Conclusion: Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened

Use of adjuvanted trivalent influenza vaccine in older-age adults: a systematic review of economic evidence

Seasonal influenza is a very common disease. Yearly vaccination of at-risk population groups is a well-recognized cost-effective/cost-saving preventive measure. It is, however, unclear which available alternative has the most favorable economic profile. Some available options are: trivalent (TIV) and quadrivalent (QIV) inactivated vaccines, adjuvanted TIV (aTIV). Because of immunosenescence, aTIV has been specifically developed for elderly. The present study aimed at assessing the available evidence of aTIV use in elderly from the economic perspective. A systematic literature review targeting aTIV economic evaluations in adults aged ≥65 years was performed using Medline via Ovid, Embase, DARE and NHS/EED. Of a total of 3,654 papers screened, 18 studies (13 full papers, 5 conference abstracts) were included. It emerged that compared with both non-vaccination or non-adjuvanted vaccines, aTIV was cost-effective or cost-saving. The vaccinations strategies incorporating aTIV based on age and/or risk profile are associated with the most favorable economic outcomes

Investigation of the risk of surgical infections at the "federico II" University Hospital by regression analysis using the firth method

Surgical infections (SSIs) are among the most common type of healthcare associated infections (HAIs) and a major cause of morbidity among surgical patients, increase of hospitalization days and of healthcare expenditure In this work, we present a logistic regression model to study the impact that different clinical, demographic and organizational factors have on the risk of occurrence of HAIs in a surgery department. The proposed model regression model is based on the Firth's penalized maximum likelihood logistic regression, a well-suited methodology for the analysis of unbalanced datasets, such as those related to events with a low occurrence rate, which is often the case of hospital infections. The model proved to be able to identify the factors most influencing the risk of SSIs and offers a promising tool for the systematic study of SSIs

The Impact of CoViD-19 on hospital activities: The case of the C.O.U. Otorhinolaryngology

The CoViD-19 pandemic imposed severe social containment measures in all sectors on countries around the world. This led to a general reorganization of the health sector involving all medical specialties. In addition, the growing influx of CoViD-19 patients in serious or critical conditions has led to a reallocation of healthcare personnel and a block of elective procedures deemed deferrable. Therefore, the surgical departments are those that have most undergone a modification of the activity normally provided. In fact, various protocols have been adopted to help doctors identify those cases in which a delay in surgery could cause serious damage to patients and on which it is necessary to intervene, thus also improving the appropriateness of admission. This study was conducted in the Complex Operative Unit (C.O.U.) of Otorhinolaryngology of the University Hospital of Salerno (Italy) "San Giovanni di Dio e Ruggi d'Aragona". Data were collected on patients who entered hospital in 2019 and 2020. Statistical analysis and logistic regression were used to quantify the effect of CoViD-19 on C.O.U.. To do this, the year 2019 was used as a reference of the normal activity of the department and compared with what was achieved in 2020, in the midst of the pandemic. Logistic regression performed on these data showed an increase in length of hospital stay (LOS) and diagnostic related group (DRG) weight in 2020 thus showing increased appropriateness of care offered