Transcription of rat mitochondrial NADH-dehydrogenase subunits: Presence of antisense and precursor RNA species

AbstractWe have characterized the transcriptional pattern of the rat mitochondrial ND6-containing region in vivo. We have identified a stable polyadenylated RNA species complementary for the full length of the ND6 mRNA. The analysis of the ND5 region has revealed the presence of an antisense RNA only at its 3′ end. The presence of these stable antisense species complementary to structural genes is intriguing and suggests a possible regulatory function. The quantitative analyses have demonstrated that the H transcripts, both codogenic and non-codogenic, are more stable than the L transcripts. We have defined the 5′ end of the ND6 mRNA at the level of the ATG downstream of the tRNAGlu. The mapping of the ND1 5′ end has demonstrated that GTG is the first codon of the mRNA. Our findings suggest that the post-transcriptional mechanisms involved in the expression of the mt genome are much more numerous and complex than those already described in the literature

Accountability and Public Reporting: Publication of Performance to Improve Quality.

Accountability and Public Reporting: in Performance to Improve Quality towards Promoting patient engagement and participation for effective healthcare refor

Interventions to evaluate fitness to drive among people with chronic conditions: Systematic review of literature

When an health condition has been identified, the question of whether to continue driving depends not on a medical diagnosis, but on the functional consequences of the illness. The complex nature of physical and mental impairments and their relationship with safe driving make the availability of evidence based tools necessary for health professionals. The review aims at identifying and summarizing scientific findings concerning the relationship between neuropsychological and clinical screening tests and fitness to drive among people with chronic conditions. Studies were searched for driving ability evaluation by road test or simulator, clinical/ neuropsychological examinations of participants with chronic diseases or permanent disablement impairing driving performance, primary outcomes as fatal/non-fatal traffic injuries and secondary outcomes as fitness to drive assessment. Twenty-seven studies fulfilled the inclusion criteria. Some studies included more than one clinical condition. The illness investigated were Alzheimer Disease (n = 6), Parkinson Disease (n = 8), Cardiovascular Accident (n = 4), Traumatic Brain Injuries (n = 3), Sleep Apnea Syndrome (n = 2), Narcolepsy (n = 1), Multiple Sclerosis (n = 1) and Hepatic Encephalopathy (n = 1), comorbidities (n = 3). No studies match inclusion criteria about Myasthenia Gravis, Diabetes Mellitus, Renal Diseases, Hearing Disorders and Sight Diseases. No studies referred to primary outcomes. The selected studies provided opposite evidences. It would be reasonable to argue that some clinical and neuropsychological tests are effective in predicting fitness to drive even if contrasting results support that driving performance decreases as a function of clinical and neuropsychological decline in some chronic diseases. Nevertheless we found no evidence that clinical and neuropsychological screening tests would lead to a reduction in motor vehicle crashes involving chronic disabled drivers. It seems necessary to develop tests with proven validity for identifying high-risk drivers so that physicians can provide guidance to their patients in chronic conditions, and also to medical advisory boards working with licensing office

La variabilit\ue0 della pratica clinica in Italia.

In Italia, la variabilit\ue0 nella pratica clinica \ue8 comune e rappresenta una delle maggiori preoccupazioni per pazienti, professionisti e decisori. Attraverso la selezione di tre aree cliniche (gravidanza e parto, trattamento con Angioplastica Coronarica Transluminale Percutanea - PTCA nei pazienti con infarto miocardico acuto e gestione del diabete), gli autori sottolineano come vi sia, in ciascuna delle tre aree, una ingiustificata variabilit\ue0, che non pu\uf2 essere spiegata solo dalla frequenza/gravit\ue0 della malattia o da altri fattori relativi al paziente. Al fine di descrivere la variabilit\ue0 tra le Regioni italiane, gli autori hanno scelto sia indicatori di processo (esempio volumi) sia di risultato (esempio mortalit\ue0, complicanze). L\u2019incidenza di tagli cesarei \ue8 particolarmente elevata in Italia rispetto agli altri Paesi europei. Pi\uf9 che altrove, le pressioni legate alla cosiddetta medicina difensiva, la pianificazione del parto per ragioni di convenienza sia dei medici che dei pazienti e, pi\uf9 in generale, i cambiamenti nel rapporto medico-paziente sono probabilmente responsabili dell\u2019induzione di pratiche inappropriate. Inoltre, importanti variazioni si osservano a livello intraregionale, in particolare per quanto riguarda il tipo di ospedale (privato, pubblico e universitario). Anche l\u2019esecuzione tempestiva della PTCA \ue8 caratterizzata da una variabilit\ue0 interregionale che ancora una volta non pu\uf2 essere spiegata solo da fattori clinici. In particolare, si osserva un\u2019estrema variabilit\ue0 tra strutture appartenenti alla stessa Regione nella percentuale di PTCA eseguite entro 48 ore. Per quanto riguarda il diabete, sono state osservate differenze rilevanti nel consumo di farmaci, nel controllo metabolico dei pazienti e nei ricoveri per complicanze a breve e a lungo termine, che sono considerate un proxy della gestione dei pazienti a livello territoriale. Tale gestione genera disuguaglianze nel campo della salute, con effetti rilevanti sulla sostenibilit\ue0 finanziaria e allocativa dei sistemi vista anche l\u2019elevata prevalenza della patologi

Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don\u2019t we need a value-based approach?

Introduction: The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods: MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly 6565 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results: Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion: We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services

Appropriateness of antibiotic prophylaxis in the surgical wards of a Teaching Hospital in Rome

Background Surgical site infections (SSIs) are a major contributor to patient injury, mortality and health care costs. There is a strong evidence of effectiveness of antimicrobial prophylaxis and the spread availability of national and international guidelines, its use is often suboptimal. Classically inappropriateness in antibiotic prophylaxis is associated with lower safety, efficiency and higher cost. Our study evaluates the appropriateness of prescription of antibiotics prophylaxis in surgical hospitalized patients in a big Italian research and teaching hospital (R&TH). Methods An observational-retrospective study was conducted through the investigation of the medical records of all the patients undergoing surgery in two not-consecutive weeks period from March to April 2013. Medical records were investigated on day 3 and 7 after surgery in order to evaluate the appropriateness of administration of antibiotic prescription. Patients with a suspected or established infection before surgery were excluded from the evaluation. Appropriateness was measured in terms of adherence to type, time and duration according to surgical antimicrobial prophylaxis guidelines (Bratzler 2013). Results 672 surgical procedures were evaluated. We observed in 12.9% of the cases a prophylaxis not performed even if indicated by guidelines. Conversely, an antibiotic prophylaxis was performed, even if not indicated in 21% of cases. A complete adherence to guidelines was observed in 57.3% of the cases. The right type of antimicrobial agent, according to guidelines, was chosen in 94.1% of the cases. The appropriateness of \u201ctiming\u201d (from 180 to 15 minutes before the procedure) was detected in 71.4% of the records while the appropriateness of duration (one-shot therapy in almost all the operations but cardiac surgery) was found in 69.3% of the cases. Conclusion The appropriateness of antibiotic prophylaxis in the R&TH, even if comparable with other international experiences, still needs to be implemented. Importantly, the issue of prophylaxis given when not indicated (excess of therapy), or not given when indicated (defect of therapy), other than type-time-duration appropriateness, needs to be always take into consideration while evaluating the correct use of antibiotic prophylaxis for surgery. Key messages Healthcare providers should be aware of their key role in reducing inappropriate prescription in surgical antimicrobial prophylaxis. Adherence to guidelines ought to be explored also through the evaluation of excess or defect of prescription, alongside appropriateness in terms of type, duration and time

Implementazione della stewardship in sanità pubblica: proposta di una metodologia valutativa applicabile al piano nazionale della prevenzione

The stewardship model has been adopted as a system of governance in several countries. In Italy, the Ministry of Health has proposed the use of the stewardship model for implementing the activities of the National Prevention Plan 2010-2012. The authors present the conceptual foundations and methodology used in the development of an assessment tool (audit tool) for evaluating the level of implementation of the stewardship model with regards to the activities of the national prevention plan in all Italian regions