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1.
Ann Ig ; 32(4): 395-406, 2020.
Article in English | MEDLINE | ID: mdl-32744298

ABSTRACT

BACKGROUND: Hospitals performing surgery in Italy underwent important transformations in recent years, with decreasing economic resources and higher expected standards of care. Regional authorities acted differently across the country to adapt to the new scenario, generating heterogeneous outcomes. The Rizzoli Orthopedic Institute (ROI) in the Emilia-Romagna region started its reorganization in 2017, after the issue of new regional regulations about surgical activity. Aim of this paper is to describe the actions taken at ROI and discuss their outcomes. STUDY DESIGN: Action-research. METHODS: From 2017 to 2019 an action-research project was developed to introduce organizational changes within ROI and close the existing gaps between regional requirements and actual features of the Institute. Four areas of intervention were identified: surgical scheduling, appropriateness of surgical setting, monitoring and management of the surgical path and accountability. Progress was monitored through the collection of performance indicators and qualitative investigation of the organizational culture. RESULTS: Changes were implemented in all areas of intervention. Key features were the introduction of Operating Room Management (ORM) skills and the establishment of multiprofessional teams to drive the changes. Performance indicators showed a positive trend in the comparison between 2017 and 2018. Improvements were observed in terms of productivity, scheduling, and respect of standard waiting time, while case-mix did not significantly change. CONCLUSIONS: Effective ORM and collaborative practices can successfully drive the change towards a more efficient surgical process without increasing resources consumption.


Subject(s)
Health Care Reform , Orthopedic Procedures/methods , Orthopedics/organization & administration , Adult , Aged , Appointments and Schedules , Efficiency, Organizational , Female , Health Services Research , Hospitals , Humans , Italy , Male , Middle Aged , Operating Rooms/organization & administration , Orthopedic Procedures/standards , Orthopedics/standards , Patient Care Team/organization & administration , Waiting Lists , Young Adult
3.
Chir Organi Mov ; 87(1): 67-76, 2002.
Article in English, Italian | MEDLINE | ID: mdl-12198953

ABSTRACT

The Emilia-Romagna Regional Authority has encouraged the development of day surgery practice in this healthcare program. This study analyzes the results of the program, with particular attention to the field of orthopaedics, with the aim of defining the type of operations that can be carried out in day surgery. There has been a marked increase in the rate of day surgery operations in all fields of surgery on the whole. However, in orthopaedics, the average rate was lower than the general trend. On the other hand, there has been an increased use of day surgery for some types of operations not included in those indicated by the region. Results of the data analyzed suggest that the use of day surgery for orthopaedics can be extended, and so can the regional indications for operations that can be performed by this method of treatment.


Subject(s)
Ambulatory Surgical Procedures , Health Policy , Orthopedics , Ambulatory Surgical Procedures/legislation & jurisprudence , Ambulatory Surgical Procedures/statistics & numerical data , Ambulatory Surgical Procedures/trends , Humans , Italy , Orthopedics/legislation & jurisprudence , Orthopedics/statistics & numerical data , Orthopedics/trends
6.
Minerva Anestesiol ; 67(9 Suppl 1): 217-22, 2001 Sep.
Article in Italian | MEDLINE | ID: mdl-11778120

ABSTRACT

It is well known that the organizational model of day surgery, concerning surgical problems defined by the literature as minor, has the aim of optimising the use of hospital resources and facilitating patients and their families, from a psychological and social point of view, by reducing hospitalisation time and the associated complications, and ensuring the same efficacy and more appropriateness of treatment. This study is firstly aimed at analysing the impact that the healthcare policy of the Emilia Romagna Region has had on the development of day surgery practice. Secondly, it compares the patients treated in orthopaedic day surgery in the hospitals of Bologna, Modena, Ferrara, Parma, Reggio Emilia, Maggiore hospital of Bologna and Rizzoli Orthopaedic Institute of Bologna (II.OO.R). In the period 1997-2000 there was a marked increase in the number of operations carried out in day surgery in all of the above-mentioned hospitals. Also in the unispecialistic orthopaedic hospital there was a surprising increase in the percentage of operations carried out in day surgery with respect to the total number of operations performed. The aim of the Rizzoli Orthopaedic Institute and the Emilia Romagna Region is to further implement this form of healthcare, contextually potentiating the appropriateness of hospital admission and avoiding, when not necessary, other forms of healthcare.


Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Ambulatory Surgical Procedures/trends , Humans , Italy , Orthopedic Procedures/trends
7.
Minerva Anestesiol ; 67(9 Suppl 1): 223-6, 2001 Sep.
Article in Italian | MEDLINE | ID: mdl-11778121

ABSTRACT

OBJECTIVE: Optimize patient management in one day surgery (ODS) by an observative study regarding one day orthopaedic surgery, assessing kind and quantity of intra- and postoperative complications, need for prolonged postoperative assistance postponing discharge, recovery in other hospitals, patients satisfaction index. METHODS: From september 1999 until december 2000 we distributed a questionnaire 1286 consecutive patients. The patients were ASA I (80,7%), ASA II (17%) and ASA III (2,3%). We evaluated intra- and postoperative complications considering type of surgery and anaesthesiologic technique; need and reason for medical consulting; if consulting took place in other institutes. Patients judgement regarding medical and nursing assistance during in hospital stay was assessed. RESULTS: Main surgical procedures: arthroscopy (44,6%), internal fixation removal (21,3%), neurolysis (9,5%), cysts/tumours/nodules removal (7,5%), foot surgery (8,0%). Used anaesthesiologic techniques: neural block (65,6%), plexus block (15,1%), general (12,5%), spinal (4,8%) and local anaesthesia (1,9%). An intraoperative complication (convulsion) was reported twice. Postoperative complications: pain (3,6%) most frequent in foot surgery (5,2%), nausea (0,2%), fever (0,7%), haematoma (0,5%). 5 delayed discharges (beyond 24h) were reported, for surgical reasons. In 5 cases another institute was visited. There were no deads. CONCLUSIONS: The percentage of not planned recoveries (0,1%) is an indication of frequency of major complications. Satisfaction index of patients was high (96%). Kind of surgical procedure and anaesthesiologic technique, considering the minimal intra- and postoperative complications, are adjusted to the ODS regime. Reinforcing analgesic protocols in foot surgery though are necessary. According to our opinion the peripheral block is preferable in orthopaedic ODS.


Subject(s)
Ambulatory Surgical Procedures/adverse effects , Anesthesia , Orthopedic Procedures/adverse effects , Humans , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology
9.
Epidemiol Prev ; 23(2): 98-104, 1999.
Article in Italian | MEDLINE | ID: mdl-10511746

ABSTRACT

Low-back (lumbosacral) injuries are known as one of more important occupational health problems in health care workers, because of high prevalence and impact of socioeconomic costs. To investigate the risk of low-back pain in hospital workers into the Istituti Ortopedici Rizzoli in Bologna (Italy), a retrospective study was carried out. The adapted study design was the matched (1:1 for age) case-control, enlisting the first injuries occurred in the hospital staff like cases, and personnel in force, matched for age and year of happened case, like controls. Information about diagnoses and occupational data was obtained from the current informative systems. Comparison with a control group suggests the validity of the work-relatedness of low-back pain in nursing and health aides (OR: 21.67; LC: 4.69-196.56), in nurses (OR: 20.21; LC: 4.81-177.95), in therapists (OR: 16.36; LC: 2.80-163.54) and in X-ray technicians (OR: 13.64; LC: 2.25-138.99). The risk of occupational injury is not homogeneously allocated into the hospital, and significatively prevails in the orthopaedic wards, in the plaster-rooms, in the operating blocks and in the sterilization plants. Specific manual handling were associated with an increased risk of back pain, while some non occupational factors like cigarette smoking, previous trauma leading to hospital admission, and number of children in female, were resulted weakly associated.


Subject(s)
Hospitals, Special , Low Back Pain/epidemiology , Medical Staff, Hospital/statistics & numerical data , Occupational Diseases/epidemiology , Orthopedics , Adult , Age Distribution , Case-Control Studies , Female , Hospital Bed Capacity, 300 to 499 , Hospitals, Special/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Orthopedics/statistics & numerical data , Prevalence , Recurrence , Risk Factors
10.
J Neurosci ; 19(19): 8244-51, 1999 Oct 01.
Article in English | MEDLINE | ID: mdl-10493725

ABSTRACT

Apoptosis is a very general phenomenon, but only a few reports concern astrocytes. Indeed, astrocytes express receptors for tumor necrosis factor (TNF) alpha, a cytokine demonstrated on many cells and tissues to mediate apoptosis after recruitment of adaptor proteins containing a death effector domain (DED). PEA-15 is a DED-containing protein prominently expressed in the CNS and particularly abundant in astrocytes. This led us to investigate if PEA-15 expression could be involved in astrocytic protection against deleterious effects of TNF. In vitro assays evidence that PEA-15 may bind to DED-containing protein FADD and caspase-8 known to be apical adaptors of the TNF apoptotic signaling. After generation of PEA-15 null mutant mice, our results demonstrate that PEA-15 expression increases astrocyte survival after exposure to TNF.


Subject(s)
Apoptosis/physiology , Arabidopsis Proteins , Astrocytes/cytology , Astrocytes/physiology , Corpus Striatum/cytology , Phosphoproteins/metabolism , Tumor Necrosis Factor-alpha/pharmacology , Amino Acid Sequence , Animals , Apoptosis/drug effects , Apoptosis Regulatory Proteins , Astrocytes/drug effects , Caspase 8 , Caspase 9 , Caspases/chemistry , Caspases/metabolism , Cells, Cultured , Corpus Striatum/physiology , Embryo, Mammalian , Fatty Acid Desaturases/chemistry , Fatty Acid Desaturases/metabolism , Mice , Mice, Knockout , Molecular Sequence Data , Neuroglia/cytology , Neuroglia/physiology , Phosphoproteins/deficiency , Phosphoproteins/genetics , Sequence Alignment , Sequence Homology, Amino Acid
11.
J Biol Chem ; 274(28): 19559-64, 1999 Jul 09.
Article in English | MEDLINE | ID: mdl-10391889

ABSTRACT

The p38/stress-activated protein kinase2 (p38/SAPK2) is activated by cellular stress and proinflammatory cytokines. Several transcription factors have been reported to be regulated by p38/SAPK2, and this kinase is involved in the control of expression of various genes. In human Jurkat T-cells, induction of the early growth response gene-1 (egr-1) by anisomycin is completely inhibited by SB203580, a specific inhibitor of p38/SAPK2a and -b. Northern blot and reporter gene experiments indicate that this block is at the level of mRNA biosynthesis. Using mutants of the egr-1 promoter, we demonstrate that a distal cAMP-responsive element (CRE; nucleotides -134 to -126) is necessary to control egr-1 induction by p38/SAPK2. Pull-down assays indicate that phospho-CRE binding protein (CREB) and phospho-activating transcription factor-1 (ATF1) bind to this element in a p38/SAPK2-dependent manner. In response to anisomycin, two known CREB kinases downstream to p38/SAPK2, MAPKAP kinase 2 (MK2) and mitogen- and stress-activated kinase 1 (MSK1), show increased activity. However, in MK2 -/- fibroblasts derived from mice carrying a disruption of the MK2 gene, the phosphorylation of CREB and ATF1 and the expression of egr-1 reach levels comparable with wild type cells. This finding excludes MK2 as an involved enzyme. We conclude that egr-1 induction by anisomycin is mediated by p38/SAPK2 and probably by MSK1. Phosphorylated CREB and ATF1 then bind to the CRE of the egr-1 promoter and cause a stress-dependent transcriptional activation of this gene.


Subject(s)
Calcium-Calmodulin-Dependent Protein Kinases/genetics , DNA-Binding Proteins/genetics , Immediate-Early Proteins , Mitogen-Activated Protein Kinases , Protein Serine-Threonine Kinases/metabolism , Repressor Proteins , Ribosomal Protein S6 Kinases, 90-kDa , Transcription Factors/genetics , Activating Transcription Factor 1 , Anisomycin/pharmacology , Cyclic AMP/genetics , Cyclic AMP Response Element Modulator , Cyclic AMP Response Element-Binding Protein/genetics , Early Growth Response Protein 1 , Enzyme Activation , Gene Expression Regulation, Enzymologic , Humans , Imidazoles/pharmacology , Intracellular Signaling Peptides and Proteins , Jurkat Cells , Mutation , Phosphorylation , Promoter Regions, Genetic , Pyridines/pharmacology , Regulatory Sequences, Nucleic Acid , p38 Mitogen-Activated Protein Kinases
12.
Pharmacopsychiatry ; 31 Suppl 1: 16-21, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9684943

ABSTRACT

Hydroalcoholic hypericum extract inhibits the synaptosomal uptake of serotonin, norepinephrine, and dopamine with about similar affinities and leads to a significant down-regulation of cortical beta-adrenoceptors and 5-HT2-receptors after subchronic treatment of rats. While neither hypericine nor kaempferol did show any reuptake inhibiting properties, hyperforin was identified as the unspecific reuptake inhibitor of hypericum extracts with half-maximal inhibitory concentrations for the three synaptosomal uptake systems mentioned above between 80 and 200 nmol/l. Moreover, a hyperforin-enriched (38%) CO2 extract also leads to a significant beta-receptor down-regulation after subchronic treatment. The data suggest hyperforin as the active principle of hypericum extracts in biochemical models of antidepressant activity.


Subject(s)
Brain/drug effects , Neurotransmitter Uptake Inhibitors/pharmacology , Perylene/analogs & derivatives , Quercetin/analogs & derivatives , Synaptosomes/drug effects , Xanthenes/chemistry , Xanthenes/pharmacology , Animals , Brain/enzymology , Bridged Bicyclo Compounds , Dopamine/metabolism , Female , Hypericum , Male , Mice , Monoamine Oxidase/metabolism , Neurotransmitter Uptake Inhibitors/chemistry , Neurotransmitter Uptake Inhibitors/metabolism , Norepinephrine/metabolism , Perylene/chemistry , Perylene/pharmacology , Phloroglucinol/analogs & derivatives , Plant Extracts/chemistry , Plant Extracts/pharmacology , Plants, Medicinal , Quercetin/chemistry , Quercetin/pharmacology , Rats , Rats, Wistar , Receptors, Adrenergic, beta/metabolism , Receptors, Serotonin/metabolism , Serotonin/metabolism , Synaptosomes/metabolism , Terpenes/analysis , Terpenes/pharmacology
13.
J Infect ; 35(2): 117-23, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9354344

ABSTRACT

We verified whether a clinical score system developed for renal transplant patients predicts the severity and outcome of cytomegalovirus interstitial pneumonia (CMV IP) in allogeneic bone marrow (BMT) recipients. The score system was retrospectively applied to 20 patients at the estimated date of onset of IP and 10-14 days later. Seven patients received ganciclovir (GCV), seven received GCV plus intravenous immunoglobulin (i.v. Ig), and six received only supportive care. Nine out of 14 patients who received GCV with or without i.v. Ig survived the episode of IP (the median score of these patients at diagnosis of CMV IP was 5 (range 3-8)), while the remaining five patients died of respiratory failure during IP and at the diagnosis had a median score of 10 (range 9-11) (P=0.01). The six patients who received only supportive care survived for a median time of 21 days (range 10-24 days) from the estimated onset of CMV IP, and the median score at the diagnosis of IP was 10 (range 8-12). The overall survival correlates strongly with low initial severity of IP as measured by this score system: 11 out of 20 patients who died of respiratory failure during IP had at the estimated onset of IP a score >8, while of the nine patients who survived IP, eight had at the onset a score <7 and the remaining one a score of 8 (P=0.0007). The sensibility, specificity, predictive positive value and predictive negative value of the score system (with a threshold value of 8) to identify patients who survived IP was: 100%, 88%, 91% and 100%, respectively. The use of ganciclovir alone or in combination was the most important determinant of outcome. These data support the relevance of this score system with a threshold value of 8; if prospective and controlled studies confirm our observations, it would help physicians to identify BMT recipients during CMV IP with high vs. low risk of poor outcome.


Subject(s)
Bone Marrow Transplantation/adverse effects , Cytomegalovirus Infections/virology , Cytomegalovirus , Lung Diseases, Interstitial/virology , Pneumonia, Viral/virology , Severity of Illness Index , Adolescent , Adult , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/pathology , Cytomegalovirus Infections/therapy , Female , Ganciclovir/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Lung Diseases, Interstitial/pathology , Lung Diseases, Interstitial/therapy , Male , Middle Aged , Pneumonia, Viral/pathology , Pneumonia, Viral/therapy , Retrospective Studies
14.
Pharmacopsychiatry ; 30 Suppl 2: 102-7, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9342769

ABSTRACT

Since the mechanism of the antidepressant activity of hypericum extract is not yet understood, we tested possible effects of standardized hypericum extract (LI 160) in several biochemical models relevant for the mechanism of action of other antidepressant drugs. While LI 160 was only a weak inhibitor of MAO-A and MAO-B activity, it inhibited the synaptosomal uptake of serotonin, dopamine and norepinephrine with about equal affinity-2 micrograms/ml). Moreover, subchronic treatment of rats with hypericum extract led to a significant down-regulation of beta-receptors and to a significant up-regulation of 5-HT2-receptors in the frontal cortex. The data might suggest that hypericum extract acts via similar biochemical mechanisms to other antidepressants (e.g. tricyclics).


Subject(s)
Antidepressive Agents/pharmacology , Depression/metabolism , Perylene/analogs & derivatives , Quercetin/analogs & derivatives , Xanthenes/pharmacology , Adrenergic Uptake Inhibitors/pharmacology , Animals , Antidepressive Agents/metabolism , Antidepressive Agents, Tricyclic/pharmacology , Brain/enzymology , Dopamine Uptake Inhibitors/pharmacology , Female , Hypericum , Imipramine/pharmacology , Mice , Monoamine Oxidase/metabolism , Perylene/metabolism , Perylene/pharmacology , Plants, Medicinal , Prefrontal Cortex/drug effects , Prefrontal Cortex/metabolism , Quercetin/metabolism , Quercetin/pharmacology , Rats , Receptors, Adrenergic, beta/drug effects , Receptors, Adrenergic, beta/metabolism , Receptors, Serotonin/drug effects , Receptors, Serotonin/metabolism , Selective Serotonin Reuptake Inhibitors/pharmacology , Synaptosomes/metabolism , Xanthenes/metabolism
15.
Riv Neurol ; 59(1): 19-21, 1989.
Article in English | MEDLINE | ID: mdl-2527405

ABSTRACT

Authors present 36 patients with recurrent sciatica or low-back pain after lumbar disk operation. All patients were submitted to clinical and instrumental devices. CT-scan was performed in 36 patients, 12 underwent myelography and 4 EMG. Authors verified reliability of clinical and instrumental devices on the basis of surgical results. We believe that myelo-CT is actually the first choice investigation in the neuroradiological ones. In the near future MRI will take its place in investigating spinal pathology.


Subject(s)
Back Pain/etiology , Intervertebral Disc Displacement/surgery , Postoperative Complications , Sciatica/etiology , Adult , Aged , Back Pain/diagnostic imaging , Female , Humans , Intervertebral Disc Displacement/diagnostic imaging , Male , Middle Aged , Myelography , Recurrence , Sciatica/diagnostic imaging , Tomography, X-Ray Computed
16.
J Neurosurg Sci ; 33(1): 65-9, 1989.
Article in English | MEDLINE | ID: mdl-2674360

ABSTRACT

It has been recently observed that arachidonic acid (AA) metabolites may modulate many of the mechanisms involved in tumor growth and metastasis. In order to clarify the role played in human brain tumors, authors have determined AA metabolic profiles in 63 surgical specimen of human intracranial tumors (mostly neuroepithelial tumors and meningiomas). The five metabolites via the cyclooxygenase pathway (PGD2, PGE2, TxB2, PGF2a, 6-Keto-PGF1a) were measured by high resolution gas chromatography-mass spectrometry after "ex vivo" metabolism of endogenous AA by tumor homogenates. The overall synthesis capacity of AA metabolites widely varied among different oncotypes, and, except in two cases of dermoid cysts, was higher than in normal brain tissue. AA metabolism seems more active in neuroepithelial tumors with the highest grade of anaplasia; some changes in the percentage of each metabolite is evident when anaplastic features changed. Thromboxane B2 was the most represented and 6-Keto-PGF1a the less abundant metabolite. Meningiomas and neuroepithelial tumors showed different relative proportion of AA metabolites which have in some cases reported to positively or negatively affect tumor growth. In histological subgroups of meningiomas AA metabolites synthesis capacity did not show any statistical difference. In the six cases of brain metastasis there is a wide range of overall synthesis capacity, with predominant synthesis of thromboxane B2 and prostaglandin E2, while the percentage of prostaglandin D2, reported as antimetastatic, is very low.


Subject(s)
Brain Neoplasms/pathology , Prostaglandins/physiology , Arachidonic Acids/metabolism , Brain Neoplasms/metabolism , Humans , Thromboxane B2/physiology
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