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R M Melotti

Publications and source records attributed to R M Melotti.

12 recordsLinked to original sources
PubMed1998

Predicting outcome in the intensive care unit using scoring systems: is new better? A comparison of SAPS and SAPS II in a cohort of 1,393 patients. GiViTi Investigators (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva). Simplified Acute Physiology Score.

OBJECTIVES: This study sought to compare the performance of the old and new versions of the Simplified Acute Physiology Score, SAPS and SAPS II, in classifying patients according to the risk of hospital mortality. METHODS: To compare the performance of the two systems, measures of association between the scores and observed mortality were adopted, together with discrimination (area under the Receiver Operating Characteristics curve) and calibration (goodness-of-fit statistics) estimates. Subjects were 1,393 eligible patients recruited during 1 month in 1994. The outcome measure was vital status at hospital discharge. RESULTS: SAPS II was associated more strongly with hospital mortality than the earlier version. SAPS II also had better discrimination ability than SAPS (area under Receiver Operating Characteristics curve 0.80 versus 0.74) and predicted an overall number of deaths (416.5) closer to the observed figure (475) than SAPS (267.7). Conversely, neither SAPS nor SAPS II fitted our data. Both P values derived from goodness-of-fit statistics were lower than 0.05. CONCLUSIONS: SAPS II offers a real improvement compared with SAPS in its ability to explain hospital mortality, but its standard parameters do not fit our data from Italy. The role and impact of potential determinants of this lack of fit, such as random errors and confounders related to casemix and/or quality of care should be clarified before this scoring system be used outside formal research projects. Special caution is suggested when SAPS II is adopted to predict mortality to compare intensive care unit performance across different countries and systems of care.

Adult↗
PubMed1996

The performance of SAPS II in a cohort of patients admitted to 99 Italian ICUs: results from GiViTI. Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva.

OBJECTIVE: To assess the validity of SAPS II (new Simplified Acute Physiology Score) in a cohort of patients admitted to a large sample of Italian intensive care units (ICU). DESIGN AND SETTING: The ability of the SAPS II scoring system to predict the probability of hospital mortality was assessed with calibration and discrimination measures obtained using published coefficients. A new logistic regression equation was then developed and further formal calibration and discrimination measures were estimated for the customized model. PATIENTS: From the 2202 consecutive patients recruited during a 1-month period in 99 ICUs, a total of 1393 patients were included in this validation study. RESULTS: When the parameters based on the standard model were applied, the expected probability of mortality did not fit those actually observed in the cohort (p < 0.001), although it showed satisfactory discrimination (area under the receiver operating characteristic curve = 0.80). Such lack of fit yields an overall under prediction of mortality (observed/expected ratio = 1.14) that reflects a uniform pattern across a preselected set of subgroups. Customization allowed new mortality estimates to be calculated, with satisfactory calibration (p = 0.82) and a more uniform pattern across subgroups. CONCLUSIONS: SAPS II maintained its validity in an independent sample of patients recruited in a large network of Italian ICUs only after appropriate adaptation (first-level customization). Whether the determinants of this relatively poor performance are related to differences in unmeasured case-mix, methods of application, or quality of care delivered is a matter for discussion that cannot be solved with the data presently available. However, these findings suggest that caution is warranted before implementing the standard SAPS II scoring system parameters outside formal research projects.

APACHE↗
PubMed1992

[National survey on the action taken at the intensive care units to control hospital infections].

In 1990, a survey of recommended infection control practices in ICUs was carried out in 11 European countries. At the European level, 1005 ICUs returned the questionnaire (response rate = 61.2%), while in Italy only 129 ICUs out of 289 answered (response rate = 45%). The survey showed that the diffusion of recommended infection control practices in Italian ICUs was similar to other European countries, even if infection control resources at the hospital level were scarce: a hospital infection control program was launched ad necessary resources were available in only 14% of the responding Italian ICUs.

Cross Infection↗
PubMed1987

Intensive care units as a source of methicillin-resistant Staphylococcus aureus.

Over a 12 month period, 209 isolates of methicillin resistant Staphylococcus aureus (MRSA) were obtained in 39 patients admitted to an ICU. In 23 patients MRSA was the major pathogen, producing either pneumonia, bacteremia or wound infection. In eight patients death was directly related to the MRSA infection. This study suggests an increasing occurrence of MRSA infections in ICU and the need to adopt control measures.

Adolescent↗
PubMed1985

Demonstration of surfactant phospholipids in frozen sections of the lung.

Saturated phospholipids are known to be the only surface active compounds present in the surfactant system of the lung. Using light microscopy, the identification in situ of pulmonary surfactant has always been hampered by the lack of satisfactory fixatives and dyes which act on saturated phospholipids fast enough to prevent the complete loss of surfactant in the solutions. In this study we adopted the tricomplex flocculation proposed by Elbers et al. (1965) to fix surfactant phospholipids on frozen sections obtained from human, pig and rat lungs. Small pieces of lung tissue were quickly frozen in freon 22 kept at -75 C.; eight micron sections were cut in a cryostat, air dried and immersed for 30s-5m in a 0.05 N Pb(NO3)2 + K3Fe (CN)6 solution in 10% formalin. Lead ions bound to the choline portion of phospholipid molecules were subsequently revealed in a 30 mM ammonium sulfide solution. This procedure delineates a dark brown filmy structure in the respiratory parenchyma, which is very loosely attached to the alveoli and appears to be related to lung surfactant. Preliminary lung lavage or pretreatment of sections with saline, aldehyde fixatives and several organic solvents, fully or partially abolish the stain.

Animals↗
PubMed1979

[Foreign bodies in the airways. Role of endoscopy in their diagnosis and treatment].

The inhalation of foreign bodies gives rise to a symptom picture that will depend on the nature and size of the foreign body, its location in the airways, the age of the patient, and the presence of prior lung affections. Non-invasive removal of such bodies is often enough to resolve both acute and chronic symptomatologies. In view of the striking nature of the symptoms and the imminent risk of complications or exacerbation associated with the continued presence of foreign bodies and the therapeutic strategy to be adopted, many workers consider that treatment should be given in a suitable environment, with proper equipment and an experienced staff. Reference is made to a personal series collected at the Chieti and Bologna resuscitation centres in describing the criteria followed in the diagnosis and management of cases of recently inhaled or latent foreign bodies, and their parenchymal complications. Non-invasive management by means of direct bronchoscopy is advised in all cases except those in which the subsequent intervention of serious, evident and irreversible parenchymal alterations make surgery inevitable.

Adult↗