ABSTRACT
Over the past decade, the philosophy of total quality has appeared in all fields of industry in Japan and the USA. This philosophy is now present all over Europe as well, Italy included. In 1993 the Arcispedale Santa Maria Nuova of Reggio Emilia, a town in Northern Italy, began to apply the total quality management philosophy, thus embarking on a course of continuous quality improvement. The present article describes the main steps which led to an external accredited team granting the emergency department of this hospital a quality system certificate in 1997 according to the international quality system requirements UNI EN ISO 9002. The importance of this work lies in the fact than an industrial quality standardization system, whose requirements have little in common with a traditional view of medical practice, can nevertheless be applied to a public health care department.
Subject(s)
Accreditation/organization & administration , Emergency Service, Hospital/standards , Total Quality Management/organization & administration , Feasibility Studies , Guidelines as Topic , Humans , Italy , Job Description , Management Audit , Manuals as Topic , Organizational Objectives , Outcome and Process Assessment, Health Care/organization & administration , Philosophy, Medical , Quality Indicators, Health CareABSTRACT
The frequencies of HLA antigens were studied in 101 Italian patients with psoriatic arthritis. The total group showed a significant increase in frequency of A1 and B38, and a reduction of B5 when compared to healthy controls. No association between DR and/or DQw antigens and PA were demonstrated. The comparisons between the clinical subgroups and normal controls revealed a significant association of B38 with asymmetric peripheral arthritis, B27 and B39 with spondylitis (with or without peripheral involvement). When intergroup comparison were made, the patients with spondylitis had an increase in frequency of B27 and DQw3 as compared to those with symmetric and asymmetric peripheral disease. DR4 and DRw53 were associated with earlier age of onset of arthritis. There were also significant associations between DQw3 and severe disease, and between A9, B5 and presence of erosions and joint space narrowing. No association with DR4 was showed in a subgroup of patients with symmetric polyarthritis without DIP involvement.
Subject(s)
Arthritis, Psoriatic/immunology , HLA Antigens/analysis , Adult , Arthritis, Psoriatic/complications , Female , HLA-A Antigens/analysis , HLA-B Antigens/analysis , HLA-DQ Antigens/analysis , HLA-DR Antigens/analysis , Humans , Italy , Male , Middle Aged , Spondylitis/complicationsABSTRACT
A new case of association between Bartter's syndrome and chondrocalcinosis is reported. The patient was shown to have marked hypomagnesemia. Indomethacin and magnesium therapy was started and resulted in increased magnesemia, even if it did not reach normal levels. There was complete remission of articular symptoms and no progression on the radiological picture after 2 years of continuous magnesium and indomethacin therapy. The 7 available family members were studied to assess the possible presence of a familial form of chondrocalcinosis and/or hypomagnesemia. The literature is reviewed and reports of previously described associations between Bartter's syndrome and chondrocalcinosis are summarized. The possible role of hypomagnesemia in predisposing to deposition of calcium pyrophosphate dihydrate crystal in cartilagine is also discussed.
Subject(s)
Bartter Syndrome/complications , Chondrocalcinosis/complications , Hyperaldosteronism/complications , Magnesium/blood , Adult , Bartter Syndrome/metabolism , Calcium Pyrophosphate/analysis , Cartilage/analysis , Chondrocalcinosis/metabolism , Humans , MaleSubject(s)
Hypothyroidism/diagnosis , Myositis/diagnosis , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Using the Italian version of the McGill Pain Questionnaire (MGPQ), the language of pain was assessed in three chronic rheumatic diseases, namely Fibromyalgia syndrome (FS), Rheumatoid Arthritis (RA) and Osteoarthritis (OA). The Pain Rating Index (PRI) of the MGPQ clearly allowed OA to be distinguished from RA and FS. Words of the affective and sensory subclasses were chosen more frequently in FS, RA and OA respectively. By analyzing words chosen by at least 33% of the patients, a thermal sensory descriptor arose in FS. Data from this study suggest that the MGPQ-PRI might be useful for the assessment of fibromyalgic pain in a clinical setting and during follow-up of the disease.
Subject(s)
Arthritis, Rheumatoid/physiopathology , Language , Muscular Diseases/physiopathology , Osteoarthritis/physiopathology , Pain Measurement/methods , Humans , Self Concept , Surveys and QuestionnairesSubject(s)
Polymyalgia Rheumatica/complications , Synovitis/etiology , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Synovitis/pathologyABSTRACT
Fifteen patients with fibromyalgia syndrome were given EMG-BFB (biofeedback) training sessions because of persistent aches after one year of monthly courses of NSAID. A long-lasting clinical benefit was observed in 56%. The improvement was found in those without overt psychopathological disturbances. In fact, a subgroup of clinically depressed patients responded poorly. Our findings were confirmed in a controlled study. Six patients were allocated into "true EMG-BFB" and 6 into "false EMG-BFB" treatment in a blinded fashion. The rheumatological assessment revealed a significant improvement in most of the variables only in the "true EMG-BFB" group.
