[Systems medicine and complexity: rethinking health management and hospital modelling.].

We have reached the awareness that diseases, far from being simple altered health states, are characterized by intrinsic emerging and adaptive properties, requiring an interdisciplinary, global and systemic approach, oriented towards integration and coordination, rather than an atomic and disintegrated logic. A new approach is needed, "systems medicine", defined as an interdisciplinary field of study that looks at the systems of the human body as part of an integrated whole, incorporating biochemical, physiological, and environment interactions. This new kind of medicine addresses diseases and their interrelationships in a scale invariant, holistic and systematic "multi-axial" way, analysing apparati, organs, tissues, cells, molecules, always taking care of the relationships with the relative ecosystem.

[Risk of anxiety and depression in nursing students in Rome (Italy)].

The aim of this study was to evaluate the risk of anxiety and depression among student nurses. If not recognized, this risk can adversely affect student health and learning and the quality of patient care. The study was performed through administration of the twelve-item General Health Questionnaire (GHQ-12) to nursing students attending two universities in Rome (Italy).

[Ockham's razor].

The simple management of complexity, allows the definition of learning and of change strategies based on applying smart copying to innovation.

[Adverse events prevention ability].

The issue of how to address medical errors is the key to improve the health care system performances. Operational evidence collected in the last five years shows that the solution is only partially linked to future technological developments. Cultural and organisational changes are mandatory to help to manage and drastically reduce the adverse events in health care organisations.

Measuring quality of life of patients with different clinical types of psoriasis using the SF-36.

Background: Different specific and generic instruments are used to evaluate quality of life in dermatology, but their interrelationship is not well known.

Objectives: To describe the quality of life in patients with different clinical types of psoriasis using the 36-item short form of the Medical Outcomes Study questionnaire (SF-36), and to study its correlation with dermatology-specific instruments.

Methods: We conducted a cross-sectional study of 380 inpatients with psoriasis.

[Risk of inappropriateness and efficiency assessment of hospitals].

We evaluated with the Data Envelopment Analysis (DEA) 13 decision making units (DMU) at IDI -IRCCS for the years 2000 and 2001. Input variables were: cost for medical personnel, cost for non medical personnel and number of beds; output variables was the number of discharged patients weighted with DRG. Later in a second model we delete the cases considered to be at "high risk" to be inappropriate for treatment as inpatients.

[Satisfaction and critical aspects of inpatients care among patients with psoriasis].

Objectives: To evaluate satisfaction with care for psoriatic inpatients. Identify areas in need of interventions and actions to improve the satisfaction with care.

Methods: We analyzed 133 patients with psoriasis and 335 patients affected by other dermatological diseases in their first access at the hospital.

[Health director and clinical governance].

Measures are needed to enhance health care quality. These measures should be implemented within the field of Clinical Governance. The authors have pointed out the skills required to the person in charge of Clinical Governance as well as the new role that the Health Director should play in case he intends to be in charge of Clinical Governance himself.

[Accreditation of hospital and local health unit management].

The authors state that an authoritative Clinical Director of a General Hospital, an active and efficient leadership of a Public Health District or Local Health Unit are very important to allow Italian Health Care System to cope with present and future challenges. The medical management must be professionally specialistic and be object of accreditation. This must be the target of professional training so that Medical Management Staff can have the necessary competence to carry complex management activities correctly out.

[Characteristics of voluntarily discharged patients: some reflections and a proposal].

This study compares the characteristics of 492 patients discharged against medical advice from the Istituto Dermopatico dell'Immacolata, a Research Hospital (335 beds) in Rome specialized in Dermatology, Vascular Surgery and Plastic Surgery between 1995 and 1998, with those of 43,110 control patients discharged with physicians' approval according to a case-control model. In the multivariate analysis, male gender (OR 1.65; 95% CI 1.

Continuous training as a key to increase the accuracy of administrative data.

The aim of this study was to evaluate the impact of a program of training, education and awareness on the accuracy of the data collected from hospital discharge abstracts. Four random samples of hospital discharge abstracts relating to four different periods were studied. The evaluation of the impact of systematic training and education activities was performed by checking the quality of abstracting information from the medical records.

The quality of abstracting medical information from the medical record: the impact of training programmes.

Objective: To evaluate the impact of a programme of training, education and awareness on the quality of the data collected through discharge abstracts.

Study Design: Three random samples of hospital discharge abstracts relating to three different periods were studied. Quality control to evaluate the impact of systematic training and education activities was performed by checking the quality of abstracting medical records.

Psychological aspects of rheumatoid arthritis vis-à-vis osteoarthrosis.

Using objective techniques (M.M.P.