Pain after earthquake.

INTRODUCTION: On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. OBJECTIVES: This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009). METHODS: 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. RESULTS: A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. CONCLUSIONS: This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations.

[Analysis of violence against health care workers through medical surveillance at the workplace in a 8-yr period]. / Analisi della violenza contro i lavoratori della Sanità durante la sorveglianza sanitaria in un periodo di 8 anni.

Physical and moral violence against the workers of a local public health unit is perspectively studied in the period 2005-2011. Data were collected during periodic medical surveillance of all workers exposed to risk and with more than one year of seniority. The prevalence of the phenomenon is constant in the period under review. On average, each year a worker in ten is physically assaulted, and one in five is subjected to verbal abuse. The professional groups most exposed to violence are nurses (OR 2.67 IC95% 1.63-4.39) and doctors (OR 2.44 IC95% 1.34-4.46). The areas at greatest risk are the psychiatric care (OR 25.7, IC95% 11.1-59.6) and emergency and first aid (OR 8.8, CI95% 3.8-20.5). The workplace violence against health workers requires urgent preventive interventions.

Cross-subtype immunity against avian influenza in persons recently vaccinated for influenza.

Avian influenza virus (H5N1) can be transmitted to humans, resulting in a severe or fatal disease. The aim of this study was to evaluate the immune cross-reactivity between human and avian influenza (H5N1) strains in healthy donors vaccinated for seasonal influenza A (H1N1)/(H3N2). A small frequency of CD4 T cells specific for subtype H5N1 was detected in several persons at baseline, and seasonal vaccine administration enhanced the frequency of such reactive CD4 T cells. We also observed that seasonal vaccination is able to raise neutralizing immunity against influenza (H5N1) in a large number of donors. No correlation between influenza-specific CD4 T cells and humoral responses was observed. N1 may possibly be a target for both cellular and humoral cross-type immunity, but additional experiments are needed to clarify this point. These findings highlight the possibility of boosting cross-type cellular and humoral immunity against highly pathogenic avian influenza A virus subtype H5N1 by seasonal influenza vaccination.

Assessment of risk in radiology using malpractice RVU.

INTRODUCTION: Analysis on the causes and remedies needed to reduce the incidence of malpractice has been under continual studies, although limited data is available regarding quantitative evaluation of the risk. OBJECTIVES: To determine radiological risk in a preventive and quantitative manner and verify if the malpractice relative value units (MP-RVU) are a good indicator of associated risk factors. MATERIALS AND METHODS: Radiological examinations executed by our Radiology Department in 2000-2004 have been codified according to nomenclature HCPCS (Healthcare Common Procedure Coding System) used by United States of America Centers for Medicare and Medicaid Services (CMS). For every examination was calculated the annual weight of malpractice. The data has been groupped in macroaggregates by methodology. The ratio MP-RVU/no. examinations has been considered as an index of insurance risk (MP index) RESULTS: A total of 133,005 examinations were performed, which produced 25,252 MP-RVU points, the total mp index was 0.193. Traditional radiology represents 38% of the examinations, accounting for 8% of MP-RVU with a MP index=0.039. Ultrasound represents 35% of the examinations, accounting for 23% of MP-RVU with a MP index=0.125. CT represents 13% of the examinations, accounting for 28% of MP-RVU with a MP index=0.434. MR represents 11% of the examinations, accounting for 39% of MP-RVU with a MP index=0.667. CONCLUSIONS: Malpractice relative value units (MP-RVU) are indicative of the risk considered globally and when subgrouped. MP index correlates this risk with number of exams carried out divided by methodology. This model providing quantitative data for projects concerning risk management and in allowing the correlation between data obtained in different departments.

Comparison between indicators for the measurement of radiology activity volumes (Italy-USA).

PURPOSE: Different evaluation systems and indicators have recently been used to measure the activity volumes of Italian hospital departments, and in particular of Diagnostic Imaging Units. These measurements have mostly been based on more or less complex and repeatable indicators such as total accesses, accesses per imaging modality, type and number of exams. The aim of this study was to compare four models for measuring and evaluating productivity to assess their features and propose a common method for measuring activity volumes in a Diagnostic Imaging Unit. The models considered are: a) the numerical count, b) the model proposed by SNR-SAGO-SIRM, c) the model based on transfer prices in use in the Emilia Romagna Region (RER), d) the model used by the U.S. Health Care Financing Agency (HCFA-USA), based on a complex system of weights named RVUs (Relative Value Units). MATERIALS AND METHODS: The period under review considers two years of activity (2000-2001) at our Diagnostic Imaging Unit. The data were collected by grouping the radiological procedures into homogeneous groups (macroaggregates) which were then assessed with the four models. The reference parameters considered in order to produce homogeneous data were: the number of procedures per physician hour, the score per hour according to the SNR-SAGO-SIRM model, the score per hour according to the RER model, the number of work-RVUs per hour worked. With regard to the HCFA-USA system, the following indicators were used: the work component (work-RVU), the insurance component (malpractice RVU) and the technical component (practice expense-RVU), the equivalent units of physician time (FTE: Full Time Equivalent), such as the number of procedures per FTE, the difficulty index, and the number of RVUs per FTE. RESULTS: a) The total number of procedures was 55,884, the number of procedures per hour ranged from 2.43 (August 2000) to 4.20 (March 2000); based on the numerical count conventional radiology accounted for the most of the Unit's activity (40%). b) The total score according to the SNR-SAGO-SIRM model was 147,358; the weight of each physician hour ranged from 6.37 (August 2000) to 9.80 (October 2001). The SNR-SAGO-SIRM model indicates that the most significant macroaggregate in the Unit's activity was ultrasound (42%). c) The total score according to the RER model was 4,313,047, the weight of each physician hour varied between 159 (August 2000) and 316 (April 2000). Based on the RER model, CT (42%) accounted for most of the Unit's activity. d) According to the RVU model, the total number of work-RVUs was 37,619, and the physician weight per hour ranged from 1.45 (August 2000) to 2.86 (March 2000). The predominant method was ultrasound (35%); the number of total practice expense-RVUs was 192,749; the month with the highest score was March 2000 (9,398), while the one with the lowest score was August 2000 (4,710); the total number of malpractice RVUs was 9,940, and the months with the highest scores were April 2000 (487) and March 2000 (487), while the month with the lowest score was August 2000 (243), and the modality carrying the highest insurance risks was MRI (38%). We also calculated the number of procedures per FTE (6,141), the number of work-RVUs per FTE (4,134); the difficulty index resulting from the ratio between work-RVUs and number of procedures (0.67); the number of work-RVUs per hour worked (3.06). CONCLUSIONS: Based on the numerical count, conventional radiology and ultrasound play a predominant role (40% and 34%, respectively, total 74%). This approach therefore fails to reflect the weight of more technologically advanced procedures. The SNR-SAGO-SIRM model gives adequate importance to the combination ''number- weight of patients'' among the macroaggregates analysed. The RER model rewards the use of more expensive technologies, as it assesses the overall weight of the service and not only the weight of the radiologist's activity. The RVU model, with its distribution of weights, differentiates the different work, cost, and insurance components of the macroaggregates. It also introduces an important aspect that is new to our professional and scientific culture: evaluation of the ''insurance component'', whose role will become increasingly important in Italy. The difficulty index (work-RVUs/no. of procedures), which expresses the ratio between the number of modalities and their complexity, is particularly interesting. This index, adjusted to reflect the Italian situation, might help to assess the true technological and scientific content of the department's activity.