Knowledge and attitudes towards the use of antibiotics in the paediatric age group: a multicenter survey in Italy.

Background: : The misuse of antibiotics is one of the leading causes of antibiotic resistance. Paediatric patients are highly involved in this issue, as they are those who receive the largest amount of prescriptions of these drugs. Therefore, this study aimed to investigate the general knowledge regarding the use of antibiotics, as well as the attitudes related to the administration of these drugs to children, amongst parents of children in the paediatric age-group. : In 2014, a multicentre cross-sectional study was conducted amongst parents of children aged 0-14. A questionnaire made up of 33 items was administered in waiting rooms of outpatient departments. Multivariable logistic regression models were performed, in order to assess the potential predictors of a better knowledge about antibiotics. : A total of 1247 parents took part to the survey. Around 33% of the samples declared that antibiotics are useful for viral infections, 20.6% that antibiotics are useful for every kind of pain and inflammation, while 14% of the parents stated that they stop giving antibiotics to their children when they start feeling better. Multivariable models showed that males, unemployed and those with lower levels of education are less prone to answer correctly to the questions about antibiotics. : The present study demonstrates that parents have a lack of knowledge regarding the use of antibiotics, which results in bad habits and inappropriate attitudes when it comes to giving antibiotics to their children. Attention should be particularly focused on disadvantaged parents.

The impact of electronic health records on healthcare quality: a systematic review and meta-analysis.

OBJECTIVE: To assess the impact of electronic health record (EHR) on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic. METHODS: PubMed, Web of Knowledge, Scopus and Cochrane Library databases were searched to identify studies that investigated the association between the EHR implementation and process or outcome indicators. Two reviewers screened identified citations and extracted data according to the PRISMA guidelines. Meta-analysis was performed using the random effects model for each indicator. Heterogeneity was quantified using the Cochran Q test and I2 statistics, and publication bias was assessed using the Egger's test. RESULTS: Of the 23 398 citations identified, 47 articles were included in the analysis. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of -22.4% [95% confidence interval (CI) = -38.8 to -6.0%; P < 0.007]. EHR resulted also associated with a higher guideline adherence with a risk ratio (RR) of 1.33 (95% CI = 1.01 to 1.76; P = 0.049) and a lower number of medication errors with an overall RR of 0.46 (95% CI = 0.38 to 0.55; P < 0.001), and adverse drug effects (ADEs) with an overall RR of 0.66 (95% CI = 0.44 to 0.99; P = 0.045). No association with mortality was evident (P = 0.936). High heterogeneity among the studies was evident. Publication bias was not evident. CONCLUSIONS: EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. Strategies for EHR implementation should be therefore recommended and promoted.

[Burden of medical errors in Italy: an analysis of the literature]. / Burden epidemiologico ed economico dell'errore medico: analisi della letteratura nel nostro Paese.

INTRODUCTION: Medical malpractice and litigation have a significant impact on the Italian National Health Service. The aim of this study was to analyze the state of the art of medical errors in Italy, in particular, assessing which specialties are most affected. METHODS: We performed a literature search in PubMed, Google Scholar; institutional websites (Ministry of Health, Higher Institute of Health, National Agency for Regional Health Services, National Institute of Statistics, National Research Council, Court of Auditors), gray literature and specialized magazines. RESULTS: Results show that data regarding the frequency of medical errors and the effectiveness of prevention measures in Italy are scarce. Most papers published on this topic refer to a few specialties, including Surgery, Radiology, Cardiology, and Laboratory medicine. Surgery is the specialty most affected. CONCLUSIONS: Despite a growing attention towards patient safety and quality of healthcare, medical errors continue to occur in clinical practice. Most errors are not due to individual incompetence or negligence but they are rooted in system breakdowns. A systematic approach is therefore required, based on: an analysis of critical aspects in the system; the selection and implementation, at different levels of the system, of appropriate and evidence-based risk management interventions involving all stakeholders; a context analysis to identify barriers and facilitators for change; a performance assessment to verify results and identify actions for improvement.

Twenty-five-gauge vitrectomy versus 23-gauge vitrectomy in the management of macular diseases: a comparative analysis through a Health Technology Assessment model.

Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.

A retrospective analysis of the costs and management of genital warts in Italy.

BACKGROUND: In Italy the prevalence of genital warts in women (15-64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont. METHODS: This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients' medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode. RESULTS: A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was €158.46 ± 257.77; the mean costs were €79.13 ± 57.40 for diagnosis and €79.33 ± 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was €111.39 ± 76.72, that for home treatment was €160.88 ± 95.69, and that for hospital care was €2825.94. CONCLUSIONS: The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system.

Humanisation in the emergency department of an Italian hospital: new features and patient satisfaction.

OBJECTIVES: The goal of this study was to describe and analyse interventions performed in the emergency department (ED) of an Italian hospital with the aim of humanising the patient care pathway. The actions taken are described and the changes analysed to determine whether they resulted in an increased level of patient satisfaction. METHODS: An observational study was conducted between October 2010 and March 2011. The data were collected via a telephone questionnaire administered to patients who were admitted to the ED before and after humanisation interventions. The respondents were questioned about their general condition and their level of satisfaction. RESULTS: The study population included 297 patients (158 before and 139 after the interventions). The highest overall patient satisfaction after the interventions was highly correlated with the humanisation interventions and not with other factors such as gender, age, educational level or the severity code triage. Specifically, in patients who went to the ED after the changes had been made, there was a greater level of satisfaction regarding comfort in the waiting room, waiting time for the first visit and the privacy experienced during the triage. CONCLUSION: The results demonstrate that the interventions implemented in this study, designed to humanise the ED, improved overall patient satisfaction. Interventions may be taken to reduce the depersonalisation of patients in the emergency room.

Three methods for estimating days of hospitalization because of hospital-acquired infection: a comparison.

OBJECTIVES: The objective of this study is to compare the three methods internationally used for estimating days of hospitalization attributable to hospital infections by applying them to the same population. The methods are: (1) unmatched comparison group; (2) matched control method-based; and (3) Appropriateness Evaluation Protocol method. A study of the prevalence of infections was performed among patients during hospitalization for an ordinary single sampling department. The survey was completed within eight working days between 15 and 24 October 2007. All patients admitted at least 24 hours to the survey day in each department were included in the study, as well as patients discharged/transferred to another hospital or department. During the prevalence study 621 patients were observed, 70 of which with infection (equal to 11.27%). METHOD: The 70 uninfected patients needed for comparison using method 1 were selected through a procedure based on propensity score on demographic variables and clinical trials of patients. The Shapiro-Wilk test was used to verify the normality of quantitative variables. In comparing the three methods Kruskall-Wallis test was used (alpha = 0.05), while comparisons between pairs of methods were performed with the Mann-Whitney test (alpha = 0.017). RESULTS: Estimation results of recovery days with infection using the three comparison tests showed that there is a statistically significant difference between the three methods (P = 0.016) and there is a significant difference between 1 versus 3 (P = 0.013) and between 2 and 3 (P = 0.017), whereas between 1 and 2 no difference was found (P = 0.82). CONCLUSION: In conclusion, the three methods are not showing the same estimations and thus may not be exchangeable.

Surfing the internet for health information: an italian survey on use and population choices.

BACKGROUND: Recent international sources have described how the rapid expansion of the Internet has precipitated an increase in its use by the general population to search for medical information. Most studies on e-health use investigated either through the prevalence of such use and the social and income patterns of users in selected populations, or the psychological consequences and satisfaction experienced by patients with particular diseases. Few studies have been carried out in Europe that have tried to identify the behavioral consequences of Internet use for health-related purposes in the general population.The aims of this study are to provide information about the prevalence of Internet use for health-related purposes in Italy according to demographic and socio-cultural features, to investigate the impact of the information found on health-related behaviors and choices and to analyze any differences based on health condition, self-rated health and relationships with health professionals and facilities. METHODS: A multicenter survey was designed within six representative Italian cities. Data were collected through a validated questionnaire administered in hospital laboratories by physicians. Respondents were questioned about their generic condition, their use of the Internet and their health behaviors and choices related to Internet use. Data were analyzed using descriptive statistics and logistic regression to assess any differences by socio-demographic and health-related variables. RESULTS: The sample included 3018 individuals between the ages of 18 and 65 years. Approximately 65% of respondents reported using the Internet, and 57% of them reported using it to search for health-related information. The main reasons for search on the Internet were faster access and a greater amount of information. People using the Internet more for health-related purposes were younger, female and affected by chronic diseases. CONCLUSIONS: A large number of Internet users search for health information and subsequently modify their health behaviors and relationships with their medical providers. This may suggest a strong public health impact with consequences in all European countries, and it would be prudent to plan educational and prevention programs. However, it could be important to investigate the quality of health-related websites to protect and inform users.