Cost analysis of planned out-of-hospital births in Italy

Background and aim: In Italy, the main birthplace is a hospital, and only a few women choose an out-of-hospital setting. This study assessed the costs related to delivery in different birthplaces in Italy. Methods: The cost analysis considered direct and amortizable costs associated with mother-child care in physiological conditions. An analysis of the hospital births considered the Diagnoses-Related Groups 373 and 391. To estimate the cost of the births assisted privately by freelance midwives, an evaluation based on an experts’ opinion was carried out. Results: Childbirth hospital care in Italy amounts to € 1832.00, and birth in an out-of-hospital setting accredited with the National Health System has a full cost of € 1345.19 in the ‘maternity home’ and € 909.60 at home. The average cost of the birth in ‘private maternity homes’ amounted to € 3260.00, while at-home births amounted to € 2910.00. Conclusions: Any accreditation of out-of-hospital settings by the NHS would considerably reduce the waste of economic resources compared to hospital childbirth. (www.actabiomedica.it

Nurses' reporting of suspect adverse drug reactions: a mixed-methods study

Objective. To assess nurses’ knowledge, attitudes and practices (KAP) towards spontaneous adverse drug reactions (ADRs) reporting. Methods. The mixed-method study was conducted following a quanti-qualitative sequential approach: a survey (using a KAP questionnaire) followed by a focus group was performed. Results. In the quantitative findings, responders (570 hospital nurses) declared that they were unaware of the pharmacovigilance system (58.1%, n = 331); where to find the reporting form (63.5%, n = 362); how fill it in (71.6%, n = 408); to whom and how to send it (65.8%, n = 375). Only 11.1% (n = 63) reported ADRs. The qualitative phase supported the quantitative findings and provided new information about other factors that condition ADR reporting: misinterpretation of the meaning of “reporting”, unawareness of nurses’ autonomy in ADR reporting and fear of consequences after ADR reporting. Conclusion. Nurses are not fully aware of their role in ADR reporting. We recommend educational interventions and management changes

Management of syncope: clinical and economic impact of a Syncope Unit

Aims Aim of this observational study is to evaluate the clinical performance of a Syncope Unit, in order to assess whether the implemented organization really improves syncope management. Methods and results The study enrolled patients with unexplained syncope who were consecutively referred to our Syncope Unit, either as outpatients or during hospitalization, in a 2-month period. The design of this observational study consists in three phases: a retrospective analysis of their clinical. management in the 9 months prior to the first attendance at the Syncope Unit (phase one), their subsequent clinical management in the Syncope Unit (phase two) and a 9-month follow-up (phase three). The retrospective analysis of phase one showed that 25% of patients had already been hospitalized without diagnosis. After Syncope Unit evaluation, diagnosis was obtained in 82% of patients, with 15% of patients indicated to pacing. In the follow-up, 23% of patients experienced a syncopal recurrence. Our analysis indicated an 85% reduction of hospital costs in the follow-up period. Conclusion The clinical and economic analysis of the three phases of our study demonstrates that a Syncope Unit allows an improved management of patients with syncope

Methodological issues in a cross-sectional survey on cervical cancer screening using telephone interviews in Sicily (Italy): a SWOT analysis

Objective: A cross-sectional study on knowledge, perceptions, and adherence to cervical cancer screening was conducted using telephone interviews of Sicilian women that were performed in 2016. This study aimed to identify areas that need to be addressed to improve the validity of data collection and to minimize possible biases. Methods: We performed a qualitative study through SWOT analysis, which is a multidimensional method based on evaluation of Strengths (S), Weaknesses (W), Opportunities (O), and Threats (T) of the research project. The contents of the SWOT forms underwent categorical, inductive, and deductive data analysis using the long table analysis method. Results: The full availability of an updated address and phone number list was the main organizational aspect to be addressed. Socio-cultural context played a major role for understanding the questions and for acceptability of the topics. In some cases, a family member was a facilitating element, while in others, the family member hindered the interviews. Active involvement of general practitioners was considered essential for success of the interviews. Conclusions: When performing a cross-sectional survey, organizational aspects and active involvement of general practitioners are crucial in the enrolment phase, regardless of the socio-cultural context

[Acute adrenal failure due to adrenal hemorrhagic necrosis secondary to heparin-induced thrombocytopenia]

The authors describe a clinical case with a peculiar sequence of unhealthy events. An operated by osteotomy woman presented a deep venous thrombosis of lever lower extremity with following pulmonary embolism. The patient was treated with heparin. After 5 days, the patient showed a thrombocytopenia, that was not determined by an immune mechanism. The heparin was stopped and the thrombocythemia returned to normal values. But the patient still presented somnolence, asthenia and hypotension. The tests of adrenocortical function showed below normal values. The abdominal CAT showed haemorrhagic necrosis of the suprarenal glands

Factors that condition the spontaneous reporting of adverse drug reactions among nurses: an integrative review

Aim To describe and synthesise previous research on factors conditioning the spontaneous reporting of adverse drug reactions among nurses. Background Spontaneous reports of adverse drug reactions by health-care providers, are a main instrument for the continuous evaluation of the risk–benefit ratio of every drug. Under-reporting of adverse drug reactions by all health-care providers, in particular by nurses, is a major limitation to this system. Evaluation An integrated review of the literature was conducted using MEDLINE, CINAHL, Embase, Scopus databases and Google Scholar. After evaluation for appropriateness related to inclusion/exclusion criteria, 16 studies were included in the final analysis and synthesis. Key Issues Two factors emerged from the study: (1) intrinsic factors related to nurses’ knowledge and attitudes; (2) extrinsic factors related to nurses’ interaction with health-care organisations and to the relationship between nurses and physicians. Nurses’ attitudes that hinder reporting include ignorance, insecurity, fear and lethargy. Conclusions Nurses are not fully aware of their role in adverse drug reaction reporting. Nurses must acquire greater knowledge to implement specific skills into their daily clinical practice. Implications for Nursing Management To improve nurses’ reporting of adverse drug reactions, it is necessary to develop management approaches that modify both intrinsic and extrinsic factors

The Difficulties in Antihypertensive Drug Prescription During Lactation: Is the Information Consistent?

INTRODUCTION: The lack of consistent official information on the use of medications during lactation is probably one of the main reasons leading to an excess of prudence, based on presumption of risk rather than on evidence. The objective of this study was to compare the level of agreement between different official sources available to doctors and women on the use of medications during lactation. MATERIALS AND METHODS: Sources of information included governmental regulatory agencies (RAs) and scientific sources (SS). The package leaflets (PLs) and summaries of product characteristics (SPCs) were retrieved from online databases of the European Union and U.S. RAs. Among the SS, the latest edition of the book Medications and Mothers' Milk by Hale and Rowe and the LactMed database were selected. Information about the use of 11 antihypertensive medications during breastfeeding was analyzed. RESULTS: The PLs and SPCs report a higher risk profile than the one expressed by SS, and they often suggest the interruption of lactation even for compatible medications. CONCLUSIONS: Health professionals should be supported by official, accurate, comprehensive, and consistent information about maternally ingested medication and breastfeeding management to facilitate proper decision-makin

The Association Between Mutuality, Anxiety, and Depression in Heart Failure Patient-Caregiver Dyads: An Actor-Partner Interdependence Model Analysis

BACKGROUND: Heart failure (HF) patient-caregiver dyads experience severe psychological problems, such as anxiety and depression. A variable that has been found to be associated with anxiety and depression in patients and caregivers in severe chronic conditions is mutuality. However, this association has not been explored in HF patient-caregiver dyads to date. OBJECTIVE: The aim of this study was to evaluate the associations among mutuality, anxiety, and depression in HF patient-caregiver dyads. METHODS: This was a cross-sectional study. Mutuality, anxiety, and depression in HF patient-caregiver dyads were assessed using the Mutuality Scale (MS) total and 4 dimension scores and the Hospital Anxiety and Depression Scale, respectively. Data were analyzed using the actor-partner interdependence model to examine how mutuality of patients and caregivers was associated with both the patients' own (actor effect) and their partners' anxiety and depression (partner effect). RESULTS: A sample of 366 dyads of patients with HF (mean age, 72 years; 56% male) and caregivers (mean age, 54 years; 73.3% female) was enrolled. Regarding patient anxiety, we observed only an actor effect between the MS dimension scores of "love and affection" and "reciprocity" and anxiety in patients (B = -1.108, P = .004 and B = -0.826, P = .029, respectively). No actor and partner effects were observed concerning caregiver anxiety. Regarding depression, we observed that only the MS dimension of "love and affection" in patients had both an actor (patient: B = -0.717, P = .032) and a partner (caregiver: B = 0.710, P = .040) effect on depression. CONCLUSIONS: The assessment of MS in HF patient-caregiver dyads is important to formulate interventions aimed at improving anxiety and depression in patients and caregivers

Effectiveness of dyadic interventions to improve stroke patient–caregiver dyads’ outcomes after discharge: A systematic review and meta-analysis study

Background Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor-caregiver dyads after discharge from the rehabilitation hospital to improve outcomes. Aims The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor-caregiver dyads to improve stroke survivor-caregiver dyads' outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective. Methods A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome. Results Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors' and caregivers' outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors' physical functioning (p=0.05), memory (p<0.01) and quality of life (p=0.01) and on caregivers' depression (p=0.05). Conclusions This study provides moderate support for the use of a dyadic intervention to improve stroke survivors' physical functioning, memory and quality of life and caregiver depression