30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: a prospective cohort study

Italy was the first European country hit by the COVID-19 pandemic and has the highest number of recorded COVID-19 deaths in Europe. This prospective cohort study of the correlates of the risk of death in COVID-19 patients was conducted at the Infectious Diseases and Intensive Care units of Luigi Sacco Hospital, Milan, Italy. The clinical characteristics of all the COVID-19 patients hospitalised in the early days of the epidemic (21 February -19 March 2020) were recorded upon admission, and the time-dependent probability of death was evaluated using the Kaplan-Meier method (censored as of 20 April 2020). Cox proportional hazard models were used to assess the factors independently associated with the risk of death. Forty-eight (20.6%) of the 233 patients followed up for a median of 40 days (interquartile range 33-47) died during the follow-up. Most were males (69.1%) and their median age was 61 years (IQR 50-72). The time-dependent probability of death was 19.7% (95% CI 14.6-24.9%) 30 days after hospital admission. Age (adjusted hazard ratio [aHR] 2.08, 95% CI 1.48-2.92 per ten years more) and obesity (aHR 3.04, 95% CI 1.42-6.49) were independently associated with an increased risk of death, which was also associated with critical disease (aHR 8.26, 95% CI 1.41-48.29), C-reactive protein levels (aHR 1.17, 95% CI 1.02-1.35 per 50\u2009mg/L more) and creatinine kinase levels above 185 U/L (aHR 2.58, 95% CI 1.37-4.87) upon admission. Case-fatality rate of patients hospitalized with COVID-19 in the early days of the Italian epidemic was about 20%. Our study adds evidence to the notion that older age, obesity and more advanced illness are factors associated to an increased risk of death among patients hospitalized with COVID-19

Assessing and managing organizational climate in healthcare organizations: an Intellectual Capital based perspective

During the past two decades a renewed interest about the role of intangible resources in determining performances of public services organisations has risen. This is particularly valid for HealthCare (HC) services, as they are knowledge intensive services and their performance are closely related, as the vast majority of their outputs, to intangible resources. Recently, scholars have examined the relevance of organisational climate for gathering outstanding performance in HC services. Literature suggests that organisational climate is a multifaceted concept deeply rooted in the intangible domain of an organisation. Several intangible resources intervene to shape organisational climate. Following this, the study shows how Intellectual Capital (IC) provides a useful and fresh frame for analysing intangible components of organisational climate and planning initiatives for their effective management. Especially, the examination of organisational climate through IC lens is proposed both as diagnosing tool for identifying elements which are hindering productivity, effectiveness and quality of HC services, and as tool for supporting managers in designing management initiatives aimed to enhance organisational performances by leveraging organisational climate. The study is based on the Action Research (AR) methodology and illustrates the results of an AR project, carried out at a public hospital