LD-Algebras beyond i0

The algebra of embeddings at the I3 level has been deeply analyzed, but nothing is known algebra-wise for embeddings above I3. In this article, we introduce an operation for embeddings at the level of I0 and above, and prove that they generate an LD-algebra that can be quite different from the one implied by I3

Familiari e badanti: nostri alleati o concorrenti?

Molte Regioni hanno affrontato con vari interventi il sostegno della permanenza a domicilio dei pazienti con malattie croniche invalidanti e bisogni assistenziali complessi. Tali interventi vanno dall\u2019accesso facilitato ai servizi di assistenza domiciliare integrata pubblici o convenzionati, o da forme di assistenza indiretta come l\u2019erogazione di un assegno di cura mensile, ad azioni di formazione rivolte ai soggetti con funzioni di caregiver. Alcune Regioni, in risposta alle richieste delle Associazioni di malati e familiari, hanno assunto delle decisioni per preparare e autorizzare i caregiver a svolgere attivit\ue0 sanitarie. In questo editoriale si propongono alcune riflessioni a partire da una iniziativa della Regione Emilia-Romagna, che ha sollevato un vivace dibattito e che vogliamo utilizzare come occasione per riflettere sui rapporti tra infermieri e caregiver: tematica sulla quale la professione ha molta esperienza nella pratica quotidiana, ma ha ancora molte pagine da scrivere per esplicitare come pensa di relazionarsi nella complessit\ue0 di bisogni e interventi di cui sempre pi\uf9 le famiglie si fanno carico e per cui rivendicano un ruolo pi\uf9 attiv

Predictors and trajectories of ED visits among patients receiving palliative home care services: Findings from a time series analysis (2013-2017)

Background: Current policies recommend integrating home care and palliative care to enable patients to remain at home and avoid unnecessary hospital admission and emergency department (ED) visits. The Italian health care system had implemented integrated palliative home care (IHPC) services to guarantee a comprehensive, coordinated approach across different actors and to reduce potentially avoidable ED visits. This study aimed to analyze the trajectories of ED visit rates among patients receiving IHPC in the Italian healthcare system, as well as the association between socio-demographic, health supply, and clinical factors. Methods: A pooled, cross-sectional, time series analysis was performed in a large Italian region in the period 2013-2017. Data were taken from two databases of the official Italian National Information System: Home Care Services and ED use. A clinical record is opened at the time a patient is enrolled in IHPC and closed after the last service is provided. Every such clinical record was considered as an IHPC event, and only ED visits that occurred during IHPC events were considered. Results: The 20,611 patients enrolled in IHPC during the study period contributed 23,085 IHPC events; ≥1 ED visit occurred during 6046 of these events. Neoplasms accounted for 89% of IHPC events and for 91% of ED visits. Although there were different variations in ED visit rates during the study period, a slight decline was observed for all diseases, and this decline accelerated over time (b = - 0.18, p = 0.796, 95% confidence interval [CI] = - 1.59;1.22, b-squared = - 1.25, p < 0.001, 95% CI = -1.63;-0.86). There were no significant predictors among the socio-demographic factors (sex, age, presence of a non-family caregiver, cohabitant family members, distance from ED), health supply factors (proponent of IHPC) and clinical factors (prevalent disorder at IHPC entry, clinical symptoms). Conclusion: Our results show that use of ED continues after enrollment in IHPC, but the trend of this use declines over time. As no significant predictive factors were identified, no specific interventions can be recommended on which the avoidable ED visits depend

Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy

Objective To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. Methods A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. Results A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). Conclusion The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use