[Diffusion of clinical governance among the Italian Local Health Units (LHUs). Analysis of the Health Surveys, the Firm Acts and the Health Plans]. / Come sono diffusi gli strumenti della Clinical Governance nelle ASL Italiane? I risultati dell'analisi delle Relazioni Sanitarie, degli Atti Aziendali e dei Piani Sanitari.

The objective of our research is to report on the diffusion of Clinical Governance, as introduced with the National Health Plan 2006-2008, by analysing the planning instruments set up by each Region (Regional Health Plans and Emergency Plans in regions with budget deficit), the organizational frameworks (Atti Aziendali, firm acts), and the surveys on performance and quality of healthcare among the Italian Local Health Units (Health Surveys). Our research was realized on September-December 2007 and consisted of the collection of all retrieved documents available on the web and on the online public access catalog (OPAC SBN) of the National Library Service. Futhermore, each document has been classified and analysed according to Chambers' Clinical Governance definition. A descriptive statistical and inferential analysis by applying the Chi-2 Test was performed to test the correlation between the diffusion of such a classified documents and the geographical partition of each LHU. Our results show a scarce diffusion of Firm acts (43%) and Health Surveys (24.9% of the total). Any remind to Clinical Governance instruments and methods inside each document resulted even poorer among both the organizational and performance surveys and the regional health planning frameworks, respectively.

Can primary care professionals' adherence to Evidence Based Medicine tools improve quality of care in type 2 diabetes mellitus? A systematic review.

BACKGROUND: Our aim is to review the effectiveness of EBM tools available to primary care professionals to improve the quality of Type 2 diabetes disease management. METHODS: A systematic review of RCT was performed according to the Cochrane methods. RESULTS: Starting from an overall number of 1737 references found, a total of 13 studies met all the inclusion criteria. CONCLUSIONS: The adherence to EBM instruments is likely to improve process of care, rather than patient outcomes. In addition, our review outlines that feedback reports and use of ICT devices are likely to be effective in diabetes disease management.

Solid state protein monolayers: morphological, conformational, and functional properties.

We have studied the morphological, conformational, and electron-transfer (ET) function of the metalloprotein azurin in the solid state, by a combination of physical investigation methods, namely atomic force microscopy, intrinsic fluorescence spectroscopy, and scanning tunneling microscopy. We demonstrate that a "solid state protein film" maintains its nativelike conformation and ET function, even after removal of the aqueous solvent.

Structural stability study of protein monolayers in air.

The assessment of the folding and of the structural stability of a protein in air, upon immobilization in the solid state, represents a critical point from both a fundamental point of view and for the development of solid state nanobioelectronics. The recent demonstrations by Rinaldi et al. [R. Rinaldi et al., Adv. Mater. 14, 1453 (2002); Appl. Phys. Lett. 82, 472 (2003); Ann. (N.Y.) Acad. Sci. 1006, 187 (2003)] of protein-based solid state devices and transistors working in air have raised an intriguing question about the behavior of a biomolecule under nonphysiological conditions. The operation principle of the realized devices is based on the physiological electron transfer function of the metalloprotein azurin. This means that azurin should retain its shape and functionality also in the solid state when utilized in air and at room temperature. In this Brief Report, we prove this claim by analyzing the conformational state of the azurin monolayers developed for such devices by means of intrinsic fluorescence spectroscopy. We show that the immobilization of azurins in the solid state under nonliquid conditions, by means of a specific chemisorption process, does not necessarily lead to protein denaturation. This result is of great importance because it opens up interesting perspectives for the development of solid state hybrid nanodevices for electronic applications requiring nonliquid environments.

Self-assembling of proteins and enzymes at nanoscale for biodevice applications.

Different nanotechnological strategies have been selected to implement biomolecular devices following a bottom-up or top-down approach depending on the biomolecule and on its functionality. Biomolecules have particular functionality and self-assembling capabilities that can be exploited for the implementation of both bioelectronic devices and multipurpose engineered biosurfaces. Surface preparation with supramolecular methods and microcontact printing have been developed and optimised to realise suitable functionalised surfaces. These surfaces can be used to link metalloproteins and enzymes for the implementation of nanobioelectronic devices and planar biosensors or to bind cells in order to promote their growth along predefined tracks and grooves. Some possible applications of these biosurfaces are shown and discussed. Results are presented for the realisation of a biomolecular nanodevice working in air based on the metalloprotein azurin immobilised in the solid state, the formation and characterisation of functional glutamate Dehydrogenase monolayers for nanobiosensing applications, the results of soft lithography processes on azurin for biosensor implementation, and the development of physiological self-assembled patterns of laminin-1 for cell culture applications and hybrid devices.