Risk assessment in ginecology and obstetrics in Sicily: an approach based on Wolff's Criteria

Objectives To apply Wolff’s Criteria to hospital discharge records (HDR) in order to detect adverse events worthy of further study. Methods Gynecology and Obstetrics Units of three Sicilian hospitals were considered and HDR regarding ordinary and day hospital admissions in 2008 were collected. A matched case-control study was designed, by random selection of 10 controls at maximum for each case. Matching was performed on the variables age and speciality of admission (gynecology or obstetrics). Results Out of a total of 7011 HDR examined, 114 cases were identified with Wolff’s Criteria. Multivariate analysis confirmed a statistically significant association with the origin of admission, diagnosis at the acceptance and length of stay: there was a decreased risk of Wolff’s event in patients having urgent admission compared to elective (OR = 0.47, 95% CI = [0.28-0.78]), an increased risk in patients reporting tumor (OR = 5:41, 95 % CI [1.89-15.47]) and other causes (OR = 2.16, 95% CI [1.10-4.24]) compared to delivery diagnosis at acceptance and in patients whose length of stay was more than 6 days (OR = 23.17, 95% CI = [12.56-42.7]) compared to less or equal than 3 days Conclusion Wolff’s Criteria can be applied for the analysis of clinical risk in hospitals with different structural characteristics, on condition that the HDR database is complete and good quality

Knowledge, attitudes and behaviors regarding influenza vaccination among Hygiene and Preventive Medicine residents in Calabria and Sicily.

Vaccinating health care workers is considered to be one of the most important steps in preventing the transmission of the influenza virus to vulnerable patients. Public Health physicians are the main promoters and executors of influenza vaccination campaigns for both healthcare workers and the general population. The objective of the present survey was to analyze the knowledge, attitudes and practices regarding influenza vaccination among Hygiene and Preventive Medicine Residents. 64% of the participants had not been vaccinated against the influenza virus in the past 5 years, and 29% had been vaccinated only occasionally , with only 7.2% of the study popu-lation having been vaccinated every year. 20.3% of those surveyed were vaccinated in the 2010/2011 season. The best strategy to increase vaccination rates among health care workers according to the study participants was the participation of future public health operators to multidisciplinary training (34.8%). the main factors associated with influenza vaccination compliance were having been vaccinated in the previous season for 2011/2012 (OR [95%]: 41.14 [7.56 - 223.87]) and having received the vaccination always or occasionally during the previous 5 years for both 2010/2011 (p-value <0.0001) and 2011/2012 (p-value <0.0001). The findings of this study suggest that future public health physicians with a history of refusing influenza vaccination in previous years usually tend to maintain their beliefs over time. Changing this trend among Hygiene and Preventive Medicine residents is the real challenge for the future, and it can be achieved through organization of multidisciplinary training, improvement of university education and increasing the involvement of Hygiene and Preventive Medicine residents in influenza vaccination campaigns both for the gen-eral population and health care workers

Evaluating the effect of organization and context on technical efficiency: a second-stage DEA analysis of Italian hospitals

Objective: the purpose of this study was to compare the technical efficiency of Italian hospitals at a regional level and to examine if differences could be explained by organisational and contextual factors. Technical efficiency was defined as the ability of the operating units evaluated to use optimal resource levels for their level of output. Methods: the effect of external factors was explored through a second stage Data Envelopment Analysis (DEA). Efficiency scores were calculated for each hospital using the DEA method (Stage I). Through Tobit regression analysis, the estimated efficiency scores were regressed against a set of organisational and contextual characteristics beyond managerial control, which reflected differences in the population demographics and regional health expenditure (Stage II). Stage I and Stage II efficiency scores were compared in order to indirectly assess managerial contribution in relation to hospital efficiency. Results: the highest efficiency (M±SD) was observed in hospitals in the North-West (75.7±15.1), followed by those in the North-East (75.5±15.1), Central Italy (73.9±16.4) and then Southern Italy (70.6±17.9). Hospital Trusts (HTs) were shown to be more technically efficient than Local Public Hospitals (LPHs). Organisational and contextual indicators were statistically significantly different at Tobit regression analysis for HTs and LPHs. Emilia Romagna and Lombardia were the regions whose management contributed to increased efficiency. ConclusionS: in our study, the distribution of regions according to technical efficiency only partly reflected the North-South gradient shown by other studies regarding the gap of expenditure. The important role of organisation and environment in establishing efficiency differences among hospitals was demonstrated

Vaccination against the 2009 pandemic influenza A (H1N1) among healthcare workers in the major teaching hospital of Sicily (Italy)

The aim of the study was to investigate factors involved in vaccination acceptance among healthcare workers (HCWs) and adverse reactions rates associated with pandemic influenza vaccination. The study was carried out in the major teaching hospital of Sicily from November 2009 to February 2010 on 2267 HCWs. A total of 407 (18%) HCWs were vaccinated against the 2009 pandemic influenza A (H1N1). A logistic regression analysis indicates an increased risk of non-vaccination against pandemic influenza in females (OR = 1.6; 95% CI = 1.3-2.1) compared to males, in nurses/technicians/administrative workers (OR = 1.7; 95% CI = 1.3-2.2) compared to doctors/biologists, and in HCWs who were non-vaccinated against seasonal influenza in 2008-2009 (OR = 4.9; 95% CI = 3.7-6.5) compared to vaccinated HCWs. Overall, 302 (74.2%) out of 407 questionnaires distributed to vaccinated HCWs were returned within the observation period. One hundred fifty-two workers (50.3%) experienced at least one adverse reaction (30.1%, local reactions; 6.6% systemic reactions and 13.6% both of them). The most frequent side effect of vaccination was pain at the injection site (43.4%). Twelve (3.9%) out of 302 HCWs stated they experienced influenza-like illness episodes during the follow-up period. The use of an adjuvanted vaccine against pandemic influenza A (H1N1) appears to be an effective and safe preventive strategy, showing a prevalence of both local and systemic adverse reactions not very different from that seen after vaccination with non-adjuvanted seasonal influenza vaccine. Despite this finding, vaccination coverage among HCWs remains very low, suggesting the need to implement educational campaigns directed to groups with lower coverage rate

Idoneità lavorativa nel lavoratore alcolista o tossicodipendente

Scopo del presente lavoro è l’analisi delle procedure e delle modalità di gestione del giudizio d’idoneità da parte del Medico Competente nei confronti dei lavoratori, con problemi di alcol o dipendenza da sostanze stupefacenti, che espletano mansioni ad elevato rischio infortunistico per se stessi e per terzi. Sono stati descritti gli steps secondo cui devono essere avviate le procedure anamnestiche e diagnostiche, necessarie ad identificare un lavoratore con problemi alcol e/o droga correlati. Abbiamo evidenziato le criticità della normativa di riferimento in tema di alcol ed in particolare le difficoltà operative del Medico Competente nell’effettuare i controlli alcolimetrici sui luoghi di lavoro. Sono stati inoltre analizzati i ricorsi avverso giudizio del Medico Competente inoltrati all’U.O.S. “Idoneità Sanitaria Apprendisti, Minori ed Altri” dello S.Pre.S.A.L. dell’ASP di Palermo, nel periodo 2007- 2010, per problemi di alcol-dipendenza e disturbi psichici. L’esito del ricorso è stato variabile in relazione al tipo di mansione svolta dal lavoratore e alle sue problematiche personali: nella maggior parte dei casi è stato confermato il giudizio espresso dal Medico Competente, ad ulteriore conferma di come talora i ricorsi vengano presentati all’Organo competente solo per motivi pretestuosi o con l’intento di dissimulazioni fuorvianti che possono avere comunque delle ripercussioni sulla salute del lavoratore stesso

I SISTEMI DI GESTIONE PER LA QUALITÀ E I MODELLI DI ACCREDITAMENTO VOLONTARIO E DI ECCELLENZA NELLE AZIENDE SANITARIE SICILIANE

Introduzione: Il programma di ricerca è finalizzato allo studio del grado di sviluppo organizzativo dei “modelli sistemici” per la qualità dell’assistenza nelle strutture sanitarie pubbliche e private siciliane, prendendo spunto dalla rilevazione condotta dalla Direzione Generale della Programmazione sanitaria, dei livelli di assistenza e dei principi etici di sistema del Ministero della Salute nel 2007 a livello nazionale. Materiali e Metodi: Il questionario è stato progettato per la compilazione on line, prevedendo domande miranti a rilevare il livello di diffusione degli strumenti e dei metodi per il miglioramento della qualità dell’assistenza, in riferimento all’anno 2013, ed è stato inoltrato tramite e-mail ai Direttori sanitari delle Aziende Sanitarie pubbliche e delle Case di Cura private, nel mese di marzo 2014. Per l’analisi statistica dei dati è stato utilizzato il software R versione 3.0.2. Risultati: Hanno risposto il 64,21% delle strutture sanitarie siciliane. Oltre all’accreditamento istituzionale o a quello previsto dal progetto “Patient Safety” di Joint Commission International (JCI), l’86% del campione afferma di aver adottato uno o più sistemi di gestione per la qualità/ modelli di accreditamento volontario/di eccellenza: tra questi il sistema ISO:9000 è quello più diffuso, confermando i risultati della Rilevazione ministeriale del 2007, seguito dal modello di accreditamento della JCI. La quasi totalità del campione inoltre dichiara di organizzare riunioni e/o corsi di formazione rivolti al personale aziendale per favorire le conoscenze sull’accreditamento istituzionale e/o sui sistemi di gestione per la qualità/modelli di accreditamento volontario/di eccellenza, e la totalità delle strutture partecipanti dichiara di effettuare degli audit interni coinvolgendo diverse figure professionali. Tutte le Aziende sanitarie e Case di cura partecipanti allo studio ritengono inoltre di aver conseguito uno o più obiettivi, tra riduzione di inefficienze e relativi costi, miglioramento del rapporto con l’utenza, riduzione del numero di reclami, riduzione delle non conformità, miglioramento della motivazione personale e del clima interno: anche in questo caso i risultati risultano in linea con quelli della Rilevazione ministeriale, e testimoniano come l’adozione dei sistemi di gestione per la qualità/modelli di accreditamento volontario/ di eccellenza, ed in generale di tutte le iniziative volte al miglioramento della qualità aziendale si traducano nel raggiungimento di obiettivi importanti, sia in termini di assistenza sanitaria che di modus operandi all’interno della realtà aziendale. Uno dei limiti del presente studio è rappresentato dall’uso di un unico questionario per poter paragonare strutture sanitarie molto disomogenee tra di loro sia in termini strutturali che organizzativi. I dati riportati dalla maggior parte delle aziende che hanno preso parte allo studio, testimoniano la sensibilità degli operatori e delle istituzioni verso la tematica del miglioramento della qualità, tuttavia, vi è ancora una limitata attenzione al processo di comunicazione come strumento di progressiva trasparenza verso tutti gli interlocutori del sistema. Proprio perché il governo clinico ha come obiettivo il miglioramento della qualità dell’assistenza, non può non avere una spiccata attenzione all’uso delle informazioni scientifiche ed alla gestione della conoscenza come riferimento per le decisioni cliniche, al fine di orientarle verso una maggiore efficacia ed appropriatezza clinica

Vaccination against the 2009 pandemic influenza A (H1N1) among healthcare workers in the major teaching hospital of Sicily (Italy).

The aim of the study was to investigate factors involved in vaccination acceptance among healthcare workers (HCWs) and adverse reactions rates associated with pandemic influenza vaccination. The study was carried out in the major teaching hospital of Sicily from November 2009 to February 2010 on 2267 HCWs. A total of 407 (18%) HCWs were vaccinated against the 2009 pandemic influenza A (H1N1). A logistic regression analysis indicates an increased risk of non-vaccination against pandemic influenza in females (OR = 1.6; 95% CI = 1.3-2.1) compared to males, in nurses/technicians/administrative workers (OR = 1.7; 95% CI = 1.3-2.2) compared to doctors/biologists, and in HCWs who were non-vaccinated against seasonal influenza in 2008-2009 (OR = 4.9; 95% CI = 3.7-6.5) compared to vaccinated HCWs. Overall, 302 (74.2%) out of 407 questionnaires distributed to vaccinated HCWs were returned within the observation period. One hundred fifty-two workers (50.3%) experienced at least one adverse reaction (30.1%, local reactions; 6.6% systemic reactions and 13.6% both of them). The most frequent side effect of vaccination was pain at the injection site (43.4%). Twelve (3.9%) out of 302 HCWs stated they experienced influenza-like illness episodes during the follow-up period. The use of an adjuvanted vaccine against pandemic influenza A (H1N1) appears to be an effective and safe preventive strategy, showing a prevalence of both local and systemic adverse reactions not very different from that seen after vaccination with non-adjuvanted seasonal influenza vaccine. Despite this finding, vaccination coverage among HCWs remains very low, suggesting the need to implement educational campaigns directed to groups with lower coverage rate