A program of professional accreditation of hospital wards by the Italian Society of Internal Medicine (SIMI): self- versus peer-evaluation.

The Italian Society of Internal Medicine has developed a voluntary program of professional accreditation of the medical units run by its constituency. Participation in the program, which is meant to foster staff involvement in clinical governance, includes all the medical personnel and nurses. Accreditation is awarded provided the candidate unit is able to adhere to a pre-established set of quality standards, meet a number of clinical and organizational requirements and monitor specific indicators. Self-evaluation is the first step in the program, followed by a site visit by a team of peer internists experienced in quality auditing. The program, which has involved so far 19 units, has considered a number of clinical requirements related to the three most frequent diseases in Italian internal medicine wards: chronic heart failure (CHF), exacerbation of chronic obstructive pulmonary disease (COPD) and hepatic cirrhosis with ascites (HCA). The comparison between self- and peer-evaluation witnessed less discrepancies for disease-related than for organizational requirements, the latter being met to a smaller degree by most units. In particular, concordance was higher for requirements and indicators pertaining to CHF and HCA than to COPD. This program of professional accreditation developed by the Italian Society of Internal Medicine has the potential to describe, monitor and improve clinical and organizational performances in internal medicine. It should also be seen as a contribution to implement the strategy of professional governance in hospitals.

[Cystic fibrosis in adults]. / La fibrosi cistica nell'età adulta.

In the last two decades the life expectancy of patients with cystic fibrosis (CF) has improved enormously: it is now estimated at around 30 years, but some patients reach an older age and one third of all patients with CF currently reach adulthood. Once considered a pediatric disease, CF now is a disease of adults too. As a consequence, internists must be highly knowledgeable about all the clinical patterns of this multifarious disease, must be better qualified to recognize its complications and must be highly trained to treat them. This review is dedicated to internists and general practitioners and not to the specialists in the research and clinical field of CF, until now only pediatricians; it briefly summarizes the medical history of CF and the current knowledge at the molecular, genetic and clinical levels about this disease; it reports up-to-date epidemiological data and it illustrates the clinical patterns which are more frequently encountered in adult patients. The true target of this review is to stimulate a greater interest and participation in this clinical field by adult caregivers, as a development of a medical care system for adults with CF is now crucial. Therefore, a growing number of internists will be increasingly involved in providing care for patients with this disorder.