Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy.

Background: A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED.

Out-of-hours primary care services: demands and patient referral patterns in a Veneto region (Italy) Local Health Authority.

Purpose: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs.

Setting: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy).

Method: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services.

What determines frequent attendance at out-of-hours primary care services?

Background: A detailed description of the characteristics of frequent attenders (FAs) at primary care services is needed to devise measures to contain the phenomenon. The aim of this population-registry-based research was to sketch an overall picture of the determinants of frequent attendance at out-of-hours (OOH) services, considering patients' clinical conditions and socio-demographic features, and whether the way patients' genaral practitioners (GPs) were organized influenced their likelihood of being FAs.

Methods: This study was a retrospective cohort study on electronic population-based records.

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions.

Background: Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not.

Methods: Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007).

Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database.

The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs).

An update review on risk factors and scales for prediction of deep sternal wound infections.

Surgical site infections are the most common nosocomial infections in surgical patients. The preventable and the unmodifiable risk factors for deep sternal wound infections (DSWI) have been amply assessed in the literature. The aim of this review was to describe the results of the numerous published studies to describe all the DSWI risk factors and the scales devised to predict SWI, with a view to providing an update on this issue.

[Effects of residents' care needs classification (and misclassification) in nursing homes: the example of SOSIA classification].

Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty. In the present study the agreement between SOSIA classification and other well documented instruments, including Barthel Index, Mini Mental State Examination and Clinical Dementia Rating Scale is evaluated in 100 nursing home residents. Only 50% of residents with severe dementia have been recognized as seriously impaired when assessed with SOSIA form; since misclassification errors underestimate residents' care needs, they determine an insufficient reimbursement limiting nursing home possibility to offer care appropriate for the case-mix.

Socio-demographic factors and processes associated with stages of change for smoking cessation in pregnant versus non-pregnant women.

Background: The tobacco control community assumes that the most effective interventions are personalized. Nevertheless, little attention is paid to understanding differences between pregnant and non-pregnant European women in terms of the social factors that influence tobacco use and the processes of change used to quit smoking.

Methods: The study consecutively enrolled 177 pregnant women who acknowledged smoking the year before pregnancy and 177 non-pregnant women who acknowledged smoking the year before their clinic visit for a Pap test.

[Prevalence of HCV in health care workers in Southern Italy].

Purpose: To assess the prevalence of hepatitis C virus (HCV) in the population exposed to biological risk of two hospitals in southern Italy.

Patients And Methods: All health care workers of two main hospitals of Sicily, potentially exposed to biological risk underwent health surveillance. Health care personnel were arranged into seven occupational group, and five age bands (< 30, 31-40 years, 25-30 years, 41-50, 51-60 years, > 60 years).

[Environmental monitoring of occupational exposure to glutaraldehyde at a hospital].

Background: To evaluate the air pollution in operating theatres of a Sicily Hospital produced by 2% alkaline solutions of glutaraldehyde, which is used to disinfect flexible endoscopy units, filling tanks and cleaning surfaces. Personnel reported subjective symptoms as: headache, dizziness, anxiety, drowsiness on the job, loss of attention, irritation of the skin and respiratory tract.

Methods: Environmental valuation of glutaraldehyde was made by infrared photoacustic spectroscopy.

[Occupational exposure to formaldehyde at a service of pathologic anatomy].

Objective: Aim of the present study is to evaluate the air pollution produced by formaldehyde in pathological anatomy.

Methods: This study was made with instrumental approach based on environmental evaluation of 10% formaldehyde used in pathological anatomy, by an infrared gas analyser (Brüel & Kjaer), and clinical approach of pathological anatomy personnel.

Results: The final result is not very comforting because we found values of formaldehyde during specific activities which exeeded the current limits proposed by industrial hygienist, infact we found in a different settings 1.

[Environmental monitoring and health monitoring for personnel exposed to inhalation anesthetics].

Objectives: The aim of this study is to verify the results of medical surveillance for personnel exposed to inhaled anaesthetics in operating rooms (300 exposed), and estimate the level of pollution in operating theatres of a university hospital.

Method: Determination of the baseline and final value of the environmental anaesthetics by infrared photoacoustic spectroscopy; medical check-up and blood tests.

Results: During our observation we found in all rooms (new rooms and older rooms) values of nitrous oxide and isoflurane acceptable, all the anaesthetic's concentration are below the limits proposed by C.