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Biomedical subjects

S Castaldi

Publications and source records attributed to S Castaldi.

15 recordsLinked to original sources
PubMed2003

Factors influencing hospital infection control policies in Italian hospitals.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

Cross Infection↗
PubMed1992

Infections in the surgical setting: epidemiology and effect of treatment with cefotaxime in a multicenter trial including 3,032 patients.

Hospital-acquired infections still represent a serious threat to the surgical patient. A nationwide survey of 259 Italian surgical wards involving 11,343 patients was conducted in October 1988. Hospital-acquired infections were recorded in 565 (5%) patients: the microorganisms most commonly involved were gram-negative rods (60% of all isolates), 41% of the infected patients presented one or more intrinsic predisposing factor, and 65% had undergone some invasive procedure. The studied group represented 23% of all surgical patients in the country on the days of the survey. Following the epidemiologic survey, an open multicenter study was conducted in the same wards to evaluate the efficacy and tolerability of cefotaxime (1 g, 2 or 3 times per day) in the treatment of nosocomial surgical infections. Among 3,032 evaluable patients, 1,295 intra-abdominal, 610 wound and soft tissue, 554 urinary, and 367 respiratory infections were observed. Treatment was judged to be clinically effective in 94% of patients, and side effects, mostly involving the gastrointestinal tract, were observed in 1.4% of patients; but interruption of the treatment was required only in 19 patients (0.6%). This study confirms that cefotaxime, after over a decade of use, retains high efficacy in the treatment for nosocomial infections and induces a low rate of side effects.

Adolescent↗
PubMedDate not supplied

[Evaluation of the appropriateness of hospital use: the case of IRCCS Ospedale Maggiore di Milano, Italy].

In 1999 an Italian version of the AEP was applied to some units of the IRCCS Ospedale Maggiore di Milano and a modified AEP version was used to evaluate the day hospital activity. The main aims of the study were: to establish the appropriateness of the utilisation of beds and of day hospital activity and to calculate the costing of the misuse of hospital resources. 267 admission days were evaluated and 31.5% were not appropriated; whereas of 3,248 days of stay 37% were found not appropriated. The day hospital activity was evaluated through 300 record referred to 570 days of treatment and 13% of them were not appropriated. The cost of the 1,201 not appropriated hospital days was over 351.000. The not appropriated level of hospital utilisation in the IRCCS Ospedale Maggiore di Milano is similar to what is reported in national and international literature. Our study highlights some limits in the application of the AEP protocol at high specialised hospital units.

Adolescent↗
PubMedDate not supplied

[Home care to tracheotomized patients: evaluation of the customer satisfaction in the city of Milano].

Home care for tracheotomised patients appears to be a relevant problem in health care management. In order to allow patients to be cured at home high care standard have to be assured, and a multidisciplinary level of assistance implemented for preventing complications like respiratory infections. This study was conducted in order to assess patients and/or care givers level of satisfaction through a telephone survey. It was aimed at allowing those responsible for the given services to assess whether improvements can be achieved particularly in so far as the actual clinical and managerial pathway is concerned.

Home Care Services↗
PubMedDate not supplied

[Evaluation of the appropriateness of hospital use: the case of IRCCS Ospedale Maggiore di Milano, Italy].

To measure the level of not appropriated hospital use for some DRG's a Lombardia Region AEP version was applied to two units in the Ospedale Maggiore in Milano. The aims of the study was to evaluate the level of appropriateness in Neurology and Dermatology wards for some DRG's which are at risk to be applied in not appropriated way, to study the reasons of not appropriated use, to educate medical doctors in neurology and dermatology to apply for the right level of care for they patients and to highlight some limits of the Lombardia Regional protocol.

Dermatology↗
PubMedDate not supplied

[Evaluation of the urgent outpatient visits in a research and teaching hospital in Milan].

Through a questionnaire it was evaluated the appropriate access for outpatient activities at not urgent level requested by general practitioners in Lombardia Region in a teaching and research hospital in the centre of Milan. The study took place from November 2003 to May 2004. 852 questionnaires were analyzedfor 16 specialties. Without judging the clinical appropriateness of prescriptions, the urgent level at which the visits were requested was, for the most part of them, not appropriated. But the not appropriated prescriptions were 49% of all the visits. In the case of use of inappropriate urgent level of care, patients were sent back to the general practitioner and in the case of right level of emergency patients were scheduled for a visit after some days. Results of the study will send to general practitioners for a righter use of the hospital level of care.

Ambulatory Care↗
PubMedDate not supplied

[The pattern of use of emergency department in the local unit of Como].

The pattern of use of emergency department of hospitals is on the agenda of policy makers at national, regional and local level. It is still difficult to achieve a balance between the claim for improving the accessibility in order to allow people in need to receive this level of care and the possible its inappropriate use. The triage procedure offers the possibility to assess priorities because the "white codex" identifies those whose access to emergency department could potentially be diverted to an other level of care. The use of the Emergency Department is studied in an affluent area of Northern Italy using an "ad hoc" tool and data linkage in order to describe the process and its possible failures. The results are aimed to give decision makers the opportunity to start addressing these issues on sounder bases particularly as far as triage based assessment is concerned.

Adult↗
PubMedDate not supplied

[Evaluation of preoperative activity in a research and teaching hospital].

To shorten the length of stay before the surgical intervention and to increase the performance of the elective surgery, the Ospedale Maggiore di Milano decided to open a preadmission service working as a day hospital setting. This service has to evaluate patients eligible for surgery both from the surgical than for the anesthesiological point of view. The study wants to state the efficacy, the performance, the quality of this service with particular attention on the elaboration of diagnostic protocols. In this study were investigated more than 8.000 accesses registered in two years (2003-2004) from 9 units of surgery. The evaluation wants to improve the level of quality of this structure in order to better identify the anesthesiological patient risk, the diagnostic protocols and the coordination with all the ancillary services in the hospital.

Aged↗
PubMedDate not supplied

[Application of clinical audit to the evaluation of prescription of interferon-alpha in a teaching hospital].

Aim of this study was to evaluate through an audit tool the appropriateness of interferon-alpha (IFN-alpha) prescribing in a teaching hospital. The records of all patients (n.665) treated with IFN-alpha since 1991 were reviewed and the data concerning diagnosis and treatment collected using a standardized from. The data were submitted for peer review to a panel which included the representatives of the different medical specialties which actually prescribed the drug, external experts and members of the health management board of the hospital. The following points were discussed:-adherence to accepted therapeutic indications:-accuracy of the diagnosis prior to treatment:-scheduled doses:-criteria defining non-responders;-length of treatment and criteria for discontinuation. At the end of the study a questionnaire for evaluation of the audit was submitted to all participants. Most patients were treated according to a diagnosis of chronic hepatitis (HCV, n.448; HBV, n.54; HDV, n.22); other indications were chronic myeloid leukemia, thrombocythemia, polycythemia vera, Kaposi's sarcoma, condylomata, melanoma and mycosis fungoides. All indications were approved by the panel: no patient was treated outside established indications (85.6%) or a clinical trial protocol (14.4%). Standard schedules were initially applied to each indication, and were adjusted if needed according to the clinical response. In conclusion, the audit showed that IFN-alpha was correctly prescribed in our teaching hospital; the procedure was well accepted and its application may be useful in modifying prescribing attitudes.

Drug Utilization↗