Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy.

BACKGROUND: A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED. METHODS: This was an observational retrospective cohort study based on data collected in 2011 by the local health authority No. 4 in the Veneto Region (Italy). After distinguishing between patients contacting the OOH service who were or were not referred to the ED, and checking for patients actually presenting to the ED within 24 hours thereafter, these patients' medical management was judged as potentially appropriate or inappropriate. RESULTS: The analysis considered 22 662 OOH service contacts recorded in 2011. The cases of potentially inappropriate non-referral to the ED were 392 (1.7% of all contacts), as opposed to 1207 potentially inappropriate referrals (5.3% of all contacts). Age, nationality, type of disease and type of intervention by the OOH service were the main variables associated with the appropriateness of patient management. CONCLUSIONS: These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management by OOH services and thus contribute to improving the deployment of healthcare and the quality of care delivered by OOH services.

[Effects of residents' care needs classification (and misclassification) in nursing homes: the example of SOSIA classification]. / Effetti della classificazione (e mis-classificazione) del case- mix nella rappresentazione dei bisogni degli ospiti delle Re- sidenze Socio-Assistenziali per Anziani non Autosufficienti (RSA): l'esempio della Scheda di OSservazione Intermedia dell'Assistenza (SOSIA).

Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty. In the present study the agreement between SOSIA classification and other well documented instruments, including Barthel Index, Mini Mental State Examination and Clinical Dementia Rating Scale is evaluated in 100 nursing home residents. Only 50% of residents with severe dementia have been recognized as seriously impaired when assessed with SOSIA form; since misclassification errors underestimate residents' care needs, they determine an insufficient reimbursement limiting nursing home possibility to offer care appropriate for the case-mix.

[Prevalence of HCV in health care workers in Southern Italy]. / Prevalenza dell'HCV negli operatori sanitari del Sud Italia.

PURPOSE: To assess the prevalence of hepatitis C virus (HCV) in the population exposed to biological risk of two hospitals in southern Italy. PATIENTS AND METHODS: All health care workers of two main hospitals of Sicily, potentially exposed to biological risk underwent health surveillance. Health care personnel were arranged into seven occupational group, and five age bands (< 30, 31-40 years, 25-30 years, 41-50, 51-60 years, > 60 years). We estimated the prevalence of hepatitis C infection in 1800 healthcare workers by means of nucleic acid amplification and genotype by means of sequencing, the workers were also tested for liver function. RESULTS: The overall prevalence of anti-HCV was 2.1%, corresponding to 39 persons. The prevalence in health workers was higher in nurses than in surgeon, group perceived to be at greatest risk of occupational exposure, and higher in elderly workers (> 45 years) than in younger ones. CONCLUSION: Prevalence of anti-HCV in our study was higher than in blood donors, and lower than in general population in southern of Italy. The 45% of HCV infected healthcare workers were unaware of their condition and their potential to infect patients. Testing for HCV infection should be routinely performed for health care workers to detect the infection, which frequently results in a chronic asymptomatic carrier state for many years before the development of symptomatic liver disease, and perform precocious therapy with interferon.

[Environmental monitoring of occupational exposure to glutaraldehyde at a hospital]. / Monitoraggio ambientale dell'esposizione professionale ad aldeide glutarica in una azienda ospedaliera.

BACKGROUND: To evaluate the air pollution in operating theatres of a Sicily Hospital produced by 2% alkaline solutions of glutaraldehyde, which is used to disinfect flexible endoscopy units, filling tanks and cleaning surfaces. Personnel reported subjective symptoms as: headache, dizziness, anxiety, drowsiness on the job, loss of attention, irritation of the skin and respiratory tract. METHODS: Environmental valuation of glutaraldehyde was made by infrared photoacustic spectroscopy. RESULTS: The final results is not very comforting infact we found value of glutaraldehyde which exceeded the upper limit value (0.05 ppm) due to behavioral rules, to not well ventilated workplaces and to not automated washing units.

[Occupational exposure to formaldehyde at a service of pathologic anatomy]. / Esposizione occupazionale a formaldeide in un servizio di anatomia patologica.

OBJECTIVE: Aim of the present study is to evaluate the air pollution produced by formaldehyde in pathological anatomy. METHODS: This study was made with instrumental approach based on environmental evaluation of 10% formaldehyde used in pathological anatomy, by an infrared gas analyser (Brüel & Kjaer), and clinical approach of pathological anatomy personnel. RESULTS: The final result is not very comforting because we found values of formaldehyde during specific activities which exeeded the current limits proposed by industrial hygienist, infact we found in a different settings 1.81 ppm, 3.78 ppm, 8.3.05 ppm. The personnel exposed reported subjective symptoms as reactive airway symptoms, headache, skin problems. CONCLUSIONS: To reduce air pollution we have indicated technical precautions as forced ventilation which is a major engineering control for reducing risk from chemical agents, use of personal protective equipment (PPE) as last resort for protection, behavioral rules and health surveillance.

[Environmental monitoring and health monitoring for personnel exposed to inhalation anesthetics]. / Monitoraggio ambientale e sorveglianza sanitaria per il personale esposto ad anestetici inalatori.

OBJECTIVES: The aim of this study is to verify the results of medical surveillance for personnel exposed to inhaled anaesthetics in operating rooms (300 exposed), and estimate the level of pollution in operating theatres of a university hospital. METHOD: Determination of the baseline and final value of the environmental anaesthetics by infrared photoacoustic spectroscopy; medical check-up and blood tests. RESULTS: During our observation we found in all rooms (new rooms and older rooms) values of nitrous oxide and isoflurane acceptable, all the anaesthetic's concentration are below the limits proposed by C.M. number 5 of the 14/03/89. Personnel reported subjective symptoms especially anxiety, but no blood alteration related to exposure were found. CONCLUSIONS: Technical precautions as use of low flow system, replacement of nitrous oxide with air, careful check of anaesthetic machine, and behavioral rules have decreased the emission of anaesthetics in the environment. Blood tests are found are not a valid index of possible damage caused by exposure. A large percentage of anaesthesiologists are found to have anxiety.