Variation in care and outcome for fragile hip fracture patients: a European multicentre study benchmarking fulfilment of established quality indicators.

PURPOSE: Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. METHODS: This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. RESULTS: A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7-42.5 h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). CONCLUSION: The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.

A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory.

BACKGROUND: Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. METHODS: This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. RESULTS: Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. CONCLUSIONS: Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. TRIAL REGISTRATION: NCT02965794 . US National Library of Medicine, ClinicalTrials.gov . Registered 4 August 2014.

Defensive practices among non-medical health professionals: An overview of the scientific literature.

INTRODUCTION: Defensive medicine (DM) is used when a doctor deviates from good practices to prevent complaints from patients or caregivers. This is a structured phenomenon that may not only affect the physician, but all healthcare personnel. The aim of this review was to determine whether DM is also performed by Non-Medical Health Professionals (NMHP), and the reasons, features, and effects of NMHP-DM. MATERIALS AND METHODS: The review was conducted according to PRISMA guidelines, and specific inclusion criteria were used to search for relevant documents published up to 12 April 2018 in the main biomedical databases. RESULTS: A total of 91 potentially relevant studies were identified. After the removal of duplicates, 72 studies were screened for eligibility, separately by two of the authors. Finally, 14 qualitative and quantitative studies were considered relevant for the purpose of the present review. These last studies were assessed for their methodological quality. CONCLUSIONS: NMHP-DM is quite similar to DM practiced by doctors, and is mainly caused by fear of litigation. Midwives and nursing personnel practiced both active and passive DM, such as over-investigation, over-treatment, and avoidance of high-risk patients. NMHP-DM could increase risks for patient health, costs, risk of burnout for healthcare employees. Further studies are needed to better understand prevalence and features of NMHP-DM in all health professional fields, in order to apply appropriate preventive strategies to contrast DM among health care personnel.

The impact of social determinants and lifestyles on dietary patterns during pregnancy: evidence from the "Mamma & Bambino" study.

BACKGROUND: During pregnancy, maternal dietary patterns play a critical role in determining maternal and new-born health. Recent evidence highlighted the influence of either social determinants and lifestyles on the adherence to different dietary patterns. STUDY DESIGN: In this cross-sectional analysis, we evaluated the association of social determinants and lifestyles with maternal dietary patterns in the "Mother & Child" cohort, a prospective study that enrols mother-child pairs from Catania, Italy. METHODS: Dietary patterns were derived using Food Frequency Questionnaire and Principal Component Analysis. Logistic regression models were used to evaluate the association between socio-demographic factors (i.e., age, educational level and employment status), lifestyles (i.e., smoking status, body mass index, use of folic acid, multivitamin and multi-mineral supplements) and dietary patterns. RESULTS: Overall, 332 women were enrolled and the following dietary patterns were derived: the "western" dietary pattern, characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks; the second one, named "prudent", characterized by high intake of potatoes, raw and cooked vegetables, legumes, rice and soup. Multivariable analysis showed that young age, low educational level and smoking were positively associated with the adherence to the western dietary pattern. In contrast, pre-gestational body mass index was negatively associated with the adherence to the prudent dietary pattern. CONCLUSION: Our results raise the need of strategies for promoting healthy dietary habits among women in their reproductive age, which might also help control their body weight before and during pregnancy. These strategies should be prioritized to young women of low educational level, who generally share other unhealthy behaviours.

Achieving quadruple aim goals through clinical networks: A systematic review.

INTRODUCTION: Clinical Networks are complex interventions that enable healthcare professionals from various disciplines to work in a coordinated manner in the context of multiple care settings, to provide a high quality response to a specific disease. The aim of this study was to evaluate if clinical networks are able to improve effectiveness, efficiency, patients' satisfaction and professionals' behavior in the health care settings, namely the "quadruple aim" quality goals. MATERIALS AND METHODS: A systematic review of documents published until February 28, 2018, in Medline, Embase and CINAHL was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A specific research strategy was created to identify studies evaluating effectiveness, efficiency, patient satisfaction and professionals well-being obtained through clinical networks implementation. RESULTS: 14249 studies were identified; 12 of these were eligible to the evaluation of "Quadruple Aim" outcomes. 9 studies focused on patients' outcomes improvement and 4 on network efficiency. Professionals' and patients' experience were not considered in any study. CONCLUSIONS: There are some evidences that clinical network can improve patients' outcomes and health funds allocation in a small number of moderate-low quality studies. Further rigorous studies are needed to confirm these findings and to evaluate patients' and professionals' experience, taking into account also networks' structural features that could influence outcomes achievement.

A prospective study of women with ASCUS or LSIL pap smears at baseline and HPV E6/E7 mRNA positive: a 3-year follow-up.

Human papillomavirus (HPV) testing is used in the triage of women with a borderline smear result. The efficiency of testing women with a low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASCUS) is less clear. For this reason we used a new HPV test that detects E6/E7 messenger RNA (mRNA), which might have a higher specificity. The objective of this prospective study was to assess whether HPV E6/E7 mRNA positivity in women with ASCUS and LSIL at baseline, is able to predict those women who have a high risk of developing a histological cervical intraepithelial neoplasia (CIN2) or worse lesion. We took into consideration the women's age and HPV DNA genotype and followed them up for 3 years. Cervical samples from women with high-risk HPV (HR-HPV) DNA-positive ASCUS (n = 90) or LSIL (n = 222) were tested for the presence of HR-HPV E6/E7 mRNA and the women were monitored for the development of histopathologically verified CIN2+. Thirteen patients with ASCUS and 17 with LSIL did not complete follow-up. All patients with LSIL and ASCUS, enrolled in this study, had confirmed lesions at the colposcopic examination. Follow-up was available for 312 women, 193 were positive in the HR-HPV DNA test and 93 had a HPV E6/E7 mRNA positive test. Finally, 22 women positive in the HPV DNA test for high-risk genotypes and with positive E6/E7 mRNA had a histologically confirmed CIN2+. Only two cases with negative HPV E6/E7 mRNA had CIN2+. The study shows that women positive in the HPV E6/E7 mRNA test have a greater risk of malignant progression of cervical lesions and therefore deserve greater attention and earlier check-ups.

Prospective Single-Center Observational Study of the Allergenic Potential of Mercromina Film and Other Common Antiseptics in Patients With Contact Dermatitis. / Estudio observacional de seguridad, prospectivo y unicéntrico para determinar la capacidad alergogénica de Mercromina Film® y otros antisépticos de uso común en pacientes con dermatitis de contacto.

INTRODUCTION: Although Mercromina Film and other topical antiseptics are widely used, they are not included in the standard series recommended by the Spanish Contact Dermatitis and Skin Allergy Research Group for testing suspected allergic contact dermatitis (ACD). Furthermore, no recent studies have investigated the allergenic potential of merbromin. OBJECTIVE: To determine the allergenic potential of merbromin and compare it with that of other topical antiseptics widely used in clinical practice, including povidone-iodine, chlorhexidine, and eosin. MATERIAL AND METHODS: Prospective single-center observational safety study of 105 patients with suspected ACD seen at the dermatology department of our hospital. RESULTS: Of the 105 patients studied, 1.9% had a positive patch test to merbromin and 12.4% were sensitized to povidone-iodine. The differences in the proportion of patients with ACD to Betadine Solución Dérmica (povidone-iodine) compared with the rest of the antiseptics was statistically significant (McNemar test, P<.05). No adverse reactions were observed in any of the patients. CONCLUSIONS: Based on the patch tests conducted, Mercromina Film has very low allergenic potential. The highest allergenic potential was observed for povidone-iodine.

CT Angiography ASPECTS Predicts Outcome Much Better Than Noncontrast CT in Patients with Stroke Treated Endovascularly.

BACKGROUND AND PURPOSE: Noncontrast CT ASPECTS has been investigated as a predictor of outcome in patients with acute ischemic stroke. Our purpose was to investigate whether CTA source images are a better predictor of clinical and radiologic outcomes than NCCT ASPECTS in candidates for endovascular stroke therapy. MATERIALS AND METHODS: CT scans of patients (n = 124) were independently evaluated by 2 readers for baseline NCCT and CTA source image ASPECTS and for follow-up ASPECTS. An mRS of ≤2 at 3 months was considered a favorable outcome. Receiver operating characteristic curve analysis was used to assess the ability of NCCT and CTA source image ASPECTS to identify patients with favorable outcomes. A stepwise multiple regression analysis was performed to find independent predictors of outcome. RESULTS: Baseline CTA source image ASPECTS correlated better than NCCT ASPECTS with follow-up ASPECTS (r = 0.76 versus r = 0.51; P for comparison of the 2 coefficients < .001). Receiver operating characteristic curve analysis showed that baseline CTA source image ASPECTS compared with NCCT ASPECTS can better identify patients with favorable outcome (CTA source image area under the curve = 0.83; 95% CI, 0.76-0.91; NCCT area under the curve = 0.67; 95% CI, 0.58-0.77; P < .001). Finally, the stepwise regression analysis showed that lower age, good recanalization, lower time to recanalization, and good baseline CTA source image ASPECTS, not NCCT ASPECTS, were independent predictors of favorable outcome. CONCLUSIONS: CTA source image ASPECTS predicts outcome better than NCCT ASPECTS; this finding suggests CTA rather than NCCT as a main step in the decision-making process for patients with acute ischemic stroke.

Becoming a "second victim" in health care: Pathway of recovery after adverse event.

INTRODUCTION: The healthcare worker involved in an unanticipated adverse patient event can become second victim. These workers suffer physically and psycho-socially and try to overcome the post-event emotional stress by obtaining emotional support in a variety of ways. The goal of this research was to study second victims among health care providers in Italy. METHODS: This contribution contains the results of 33 interviews of nurses, physicians and other healthcare workers. After institutional approval, the semi-structured interview, composed of 25 questions, was translated from English into Italian. The audio-interviews were transcribed on paper verbatim by the interviewer. It was then verified if the interviewees experienced the six post-event stages of second victim recovery previously described within the literature. RESULTS: The interviewees described the post-event recovery stages described by literature but stages were not detailed in the exact succession order as the American study. All participants clearly remembered the adverse event and referred the physical and psycho-social symptoms. The psychological support obtained by second victims was described as poor and inefficient. DISCUSSION: The post-event recovery pathway is predictable but not always clearly respected as defined within this Italian sample. Future study of the second-victim phenomenon and desired supportive interventions is necessary to understand the experience and interventions to mitigate harm of future clinicians. Every day healthcare workers become second victims and, considering that human resources are the most important heritage of healthcare infrastructures, after an adverse event it is very important to execute valid interventional programs to support and train these workers.

The determinants of defensive medicine in Italian hospitals: The impact of being a second victim.

BACKGROUND: Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear. OBJECTIVE: To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians. DESIGN, SETTING AND PARTICIPANTS: A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event. RESULTS: A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians' experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty. CONCLUSIONS: Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine.

Becoming a 'second victim' in health care: Pathway of recovery after adverse event / Convertirse en 'segunda víctima' en asistencia sanitaria: la vía de la recuperación después de un episodio adverso

Introduction. The healthcare worker involved in an unanticipated adverse patient event can become second victim. These workers suffer physically and psycho-socially and try to overcome the post-event emotional stress by obtaining emotional support in a variety of ways. The goal of this research was to study second victims among health care providers in Italy. Methods. This contribution contains the results of 33 interviews of nurses, physicians and other healthcare workers. After institutional approval, the semi-structured interview, composed of 25 questions, was translated from English into Italian. The audio-interviews were transcribed on paper verbatim by the interviewer. It was then verified if the interviewees experienced the six post-event stages of second victim recovery previously described within the literature. Results. The interviewees described the post-event recovery stages described by literature but stages were not detailed in the exact succession order as the American study. All participants clearly remembered the adverse event and referred the physical and psycho-social symptoms. The psychological support obtained by second victims was described as poor and inefficient. Discussion. The post-event recovery pathway is predictable but not always clearly respected as defined within this Italian sample. Future study of the second-victim phenomenon and desired supportive interventions is necessary to understand the experience and interventions to mitigate harm of future clinicians. Every day healthcare workers become second victims and, considering that human resources are the most important heritage of healthcare infrastructures, after an adverse event it is very important to execute valid interventional programs to support and train these workers (AU)

Introducción. El trabajador sanitario implicado en un episodio adverso imprevisto de un paciente puede convertirse en la segunda víctima. Estos trabajadores sufren física y psicosocialmente, y tratan de superar de varias maneras el estrés emocional posterior al episodio mediante la obtención de apoyo emocional. El objetivo de esta investigación fue estudiar segundas víctimas entre el personal sanitario en Italia. Métodos. Esta contribución contiene los resultados de 33 entrevistas a enfermeras, médicos y otros profesionales sanitarios. Después de la aprobación institucional, la entrevista semiestructurada, compuesta por 25 preguntas, se tradujo del inglés al italiano. El entrevistador transcribió las entrevistas sonoras literalmente. A continuación se comprobó que los entrevistados hubieran experimentado las 6 etapas de recuperación posteriores al episodio de segunda víctima descritas en la bibliografía. Resultados. Los entrevistados describieron las etapas de recuperación posteriores al episodio descritas en la bibliografía, pero las etapas no se presentaron en el orden de sucesión exacto en que aparecieron en el estudio norteamericano. Todos los participantes recordaban claramente el episodio adverso e hicieron referencia a los síntomas físicos y psicosociales. El apoyo psicológico obtenido por las segundas víctimas se describió como deficiente e ineficaz. Discusión. La vía de recuperación posterior al episodio es previsible, pero no siempre se respeta con claridad, como se define en esta muestra italiana. Es necesario un futuro estudio sobre el fenómeno de la segunda víctima y las intervenciones de apoyo deseadas para entender la experiencia y las intervenciones para atenuar el perjuicio de los futuros médicos. Cada día, trabajadores sanitarios se convierten en segundas víctimas, y teniendo en cuenta que los recursos humanos son el patrimonio más importante de las infraestructuras sanitarias, después de un episodio adverso es muy importante ejecutar programas de intervención válidos para apoyar y formar a estos trabajadores (AU)

The determinants of defensive medicine in Italian hospitals: The impact of being a second victim / Los determinantes de la medicina defensiva en hospitales italianos: el efecto de ser una segunda víctima

Background. Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear. Objective. To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians. Design, setting and participants. A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event. Results. A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians’ experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty. Conclusions. Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine (AU)

Antecedentes. La medicina defensiva afecta a los sistemas de salud de todo el mundo. Las preocupaciones y la percepción acerca de la responsabilidad médica podrían llevar a los médicos a ejercer la medicina defensiva. La segunda víctima es un trabajador sanitario que participa en un episodio adverso imprevisto del paciente. Sin embargo, el papel de segunda víctima y otros posibles determinantes de la medicina defensiva son poco claros. Objetivo. Estudiar la situación de segunda víctima como posible determinante de la medicina defensiva entre los médicos hospitalarios italianos. Diseño, entorno y participantes. En este estudio se realizó un análisis secundario de la base de datos de la encuesta nacional sobre prevalencia y costes de la medicina defensiva en Italia, que se había llevado a cabo entre abril y junio de 2014 en 55 hospitales italianos. Se seleccionaron los datos personales del cuestionario, como edad del médico, sexo, especialidad, volumen de la actividad, grado y la variable de ser segunda víctima después de un episodio adverso. Resultados. Se utilizó una muestra total de 1.313 médicos (87,5% de tasa de respuesta) en el análisis de datos. Las características de los participantes incluyeron una media de edad de 49,2 años y 19,4 años de experiencia por término medio. El factor predisponente más importante para la práctica de la medicina defensiva fue la experiencia de los médicos de haber sido segunda víctima después de un episodio adverso (OR=1,88; IC 95%: 1,38-2,57). Otros factores determinantes fueron: edad, años de experiencia, volumen de la actividad y riesgo de la especialidad. Conclusiones. La reforma de la responsabilidad médica, un apoyo efectivo a segundas víctimas en hospitales y un uso sistemático de las guías clínicas basadas en la evidencia se presentaron como posibles recomendaciones para la reducción de la medicina defensiva (AU)

Serious reportable events within the inpatient mental health care: Impact on physicians and nurses / Episodios graves notificables en atención hospitalaria de salud mental: repercusiones en médicos y enfermeras

Objectives. To investigate the prevalence of physicians and nurses involved in an adverse event within mental health. Materials and methods. A quantitative, cross-sectional study was performed. Six Flemish psychiatric hospitals (Belgium) participated in this exploratory cross-sectional study. All psychiatrists and nurses working in these hospitals were invited to complete an online questionnaire in March 2013. Results. 28 psychiatrists and 252 nurses completed the survey. 205 (73%) of the 280 respondents were personally involved at least once in an adverse event within their entire career. Respondents reported that the adverse event with the greatest impact was related to suicide in almost 64% of the cases. About one in eight respondents considered quitting their job because of it. Almost 18% declared that due to the impact of the event, they believed that the quality of the administered care was affected for longer than one month. Respondents stated that they received much support of colleagues (95%), the chief nurse (86%) and the partner (71%). Colleagues seemed to be most supportive in the recovery process. Conclusions. Physicians and nurses working in inpatient mental health care may be at high risk to being confronted with an adverse event at some point in their career. The influence on health professionals involved in an adverse event on their work is particularly important in the first 4-24h. Professionals at those moments had higher likelihood to be involved in another adverse event. Institutions should seriously consider giving support almost at that time (AU)

Objetivos. Investigar la prevalencia de médicos y enfermeras implicados en un episodio adverso en salud mental. Materiales y métodos. Se llevó a cabo un estudio cuantitativo y transversal. Seis hospitales psiquiátricos de Flandes (Bélgica) participaron en este estudio transversal de exploración. Se solicitó a todos los psiquiatras y enfermeras que trabajan en estos hospitales que completaran un cuestionario en línea en marzo de 2013. Resultados. Veintiocho psiquiatras y 252 enfermeras respondieron la encuesta. Doscientos cinco (73%) de los 280 encuestados participaron personalmente, al menos una vez, en un episodio adverso en toda su carrera. Los encuestados informaron de que el episodio adverso con mayores repercusiones estuvo relacionado con el suicidio en casi el 64% de los casos. Aproximadamente, uno de cada 8 encuestados consideró dejar el trabajo a causa de ello. Casi el 18% declaró que, debido a las repercusiones del episodio, creían que la calidad de la atención administrada se vio afectada durante más de un mes. Los encuestados declararon que recibieron mucho apoyo por parte de sus colegas (95%), la enfermera jefe (86%) y la pareja (71%). Al parecer, los compañeros fueron los más comprensivos en el proceso de recuperación. Conclusiones. Los médicos y enfermeras que trabajan en atención hospitalaria de salud mental pueden correr un gran riesgo de enfrentarse a un episodio adverso en algún momento de su carrera. La influencia de los profesionales sanitarios implicados en un episodio adverso en su trabajo es especialmente importante en las primeras 4-24h. Los profesionales en esos momentos tenían mayor probabilidad de verse implicados en otro episodio adverso. Las instituciones deberían considerar seriamente el hecho de prestar apoyo casi en el mismo momento (AU)

Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study / Aspectos personales, situacionales y organizacionales que influyen en la repercusión de incidentes adversos durante una intervención sanitaria: un estudio cualitativo

Objectives. When a patient safety incident (PSI) occurs, not only the patient, but also the involved health professional can suffer. This study focused on this so-called ‘second victim’ of a patient safety incident and aimed to examine: (1) experienced symptoms in the aftermath of a patient safety incident; (2) applied coping strategies; (3) the received versus needed support and (4) the aspects that influenced whether one becomes a second victim. Materials and methods. Thirty-one in-depth interviews were performed with physicians, nurses and midwives who have been involved in a patient safety incident. Results. The symptoms were categorized under personal and professional impact. Both problem focused and emotion focused coping strategies were used in the aftermath of a PSI. Problem focused strategies such as performing a root cause analysis and the opportunity to learn from what happened were the most appreciated, but negative emotional responses such as repression and flight were common. Support from colleagues and supervisors who were involved in the same event, peer supporters or professional experts were the most needed. A few individuals described emotional support from the healthcare institution as unwanted. Rendered support was largely dependent on the organizational culture, a stigma remained among healthcare professionals to openly discuss patient safety incidents. Three aspects influenced the extent to which a healthcare professional became a second victim: personal, situational and organizational aspects. Conclusion. These findings indicated that a multifactorial approach including individual and emotional support to second victims is crucial (AU)

Objetivos. Cuando se produce un incidente adverso durante una intervención sanitaria, no solo puede sufrir el paciente, sino también el profesional sanitario implicado. Este estudio se centró en la conocida como ‘segunda víctima’ de un incidente adverso durante una intervención y su objetivo fue evaluar: 1) los síntomas experimentados a raíz de un incidente adverso durante una intervención sanitaria; 2) las estrategias de afrontamiento que se aplicaron; 3) el apoyo recibido frente al apoyo necesario, y 4) los aspectos que influyeron en que uno se convirtiera en una segunda víctima. Material y métodos. Se llevaron a cabo 31 entrevistas exhaustivas con médicos, enfermeras y comadronas que habían estado involucrados en un incidente adverso durante una intervención. Resultados. Los síntomas se clasificaron por repercusión personal y profesional. Se utilizaron estrategias de afrontamiento centradas en el problema y en la emoción después de un incidente adverso durante una intervención. Las estrategias centradas en el problema, como el análisis de la causa primordial y la oportunidad de aprender de lo sucedido, fueron las más apreciadas, pero las respuestas emocionales negativas, como represión y huida, eran frecuentes. Lo más necesitado era el apoyo de colegas y supervisores que participaron en la misma intervención, partidarios de los compañeros o expertos profesionales. Algunas personas describen el apoyo emocional de la institución sanitaria como no deseado. El apoyo prestado depende, en gran medida, de la cultura organizacional, aunque entre los profesionales sanitarios subsiste el estigma de hablar abiertamente de incidentes adversos durante una intervención. Tres aspectos influyeron en la medida en que un profesional sanitario se convirtió en una segunda víctima: aspectos personales, situacionales y organizacionales. Conclusión. Estos resultados indicaron que es fundamental un enfoque multifactorial que incluya apoyo individual y emocional a la segunda víctima (AU)

Incidence of oncological pathologies 2002-2010 in the southwestern Piedmont area, province of Vercelli, neighbouring municipalities of former nuclear sites.

The Vercelli Province counts two former nuclear installations: a radioactive waste disposal area in Saluggia and a former nuclear power plant in Trino. This study takes also into account four other neighbouring municipalities, counting 20,000 total inhabitants. We studied the incidence of neoplastic pathologies in the 2002-2010 period. The data sources were Hospital Discharge Form (SDO), histological reports from the Registry of Hospital Charts (RHC) and Italy's National Statistics Institute (ISTAT) reports, and the Cancer Register of Turin. The research highlights the excesses for all type of cancers (SIR=1,11; IC 1,04-1,18), including the ones of nervous system (SIR=2,23 IC 1,47-2,98), leukaemia (SIR=1,94 IC 1,35-2,52), and bones (SIR=12,0 IC 9,22-14,7), according to different aggregation levels by age, sex and housing area. Considering such results, previous studies, and the environmental and occupational risk factors in the area, we believe that further epidemiological and environmental studies should be conducted in this area.

Serious reportable events within the inpatient mental health care: Impact on physicians and nurses.

OBJECTIVES: To investigate the prevalence of physicians and nurses involved in an adverse event within mental health. MATERIALS AND METHODS: A quantitative, cross-sectional study was performed. Six Flemish psychiatric hospitals (Belgium) participated in this exploratory cross-sectional study. All psychiatrists and nurses working in these hospitals were invited to complete an online questionnaire in March 2013. RESULTS: 28 psychiatrists and 252 nurses completed the survey. 205 (73%) of the 280 respondents were personally involved at least once in an adverse event within their entire career. Respondents reported that the adverse event with the greatest impact was related to suicide in almost 64% of the cases. About one in eight respondents considered quitting their job because of it. Almost 18% declared that due to the impact of the event, they believed that the quality of the administered care was affected for longer than one month. Respondents stated that they received much support of colleagues (95%), the chief nurse (86%) and the partner (71%). Colleagues seemed to be most supportive in the recovery process. CONCLUSIONS: Physicians and nurses working in inpatient mental health care may be at high risk to being confronted with an adverse event at some point in their career. The influence on health professionals involved in an adverse event on their work is particularly important in the first 4-24h. Professionals at those moments had higher likelihood to be involved in another adverse event. Institutions should seriously consider giving support almost at that time.

Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study.

OBJECTIVES: When a patient safety incident (PSI) occurs, not only the patient, but also the involved health professional can suffer. This study focused on this so-called "second victim" of a patient safety incident and aimed to examine: (1) experienced symptoms in the aftermath of a patient safety incident; (2) applied coping strategies; (3) the received versus needed support and (4) the aspects that influenced whether one becomes a second victim. MATERIALS AND METHODS: Thirty-one in-depth interviews were performed with physicians, nurses and midwives who have been involved in a patient safety incident. RESULTS: The symptoms were categorized under personal and professional impact. Both problem focused and emotion focused coping strategies were used in the aftermath of a PSI. Problem focused strategies such as performing a root cause analysis and the opportunity to learn from what happened were the most appreciated, but negative emotional responses such as repression and flight were common. Support from colleagues and supervisors who were involved in the same event, peer supporters or professional experts were the most needed. A few individuals described emotional support from the healthcare institution as unwanted. Rendered support was largely dependent on the organizational culture, a stigma remained among healthcare professionals to openly discuss patient safety incidents. Three aspects influenced the extent to which a healthcare professional became a second victim: personal, situational and organizational aspects. CONCLUSION: These findings indicated that a multifactorial approach including individual and emotional support to second victims is crucial.

Exploration study on mortality trends in the territory surrounding an incineration plant of urban solid waste in the municipality of Vercelli (Piedmont, Italy) 1988-2009.

BACKGROUND: The places, where the incinerators are located, often present problems of heterogeneous people having different environmental factors. It becomes important to evaluate the possible etiologic role of various environmental risk factors and try to quantify as they affect in the excess epidemiological. METHODS: This study considers the ISTAT index mortality due to all causes occurred from 1988 to 2009 referred to ten municipalities at south of Vercelli (Piedmont, North Western Italy) placed nearby the active incinerator from 1977 (10 latent years). The risks were calculated considering this area at risk versus the municipalities placed at North of Vercelli and versus the Vercelli. RESULTS: Some significant statically excesses emerged in the South area such as neoplasia of nervous system, liver and total of tumours. CONCLUSIONS: The study presents some drawbacks, but it is a work creditable of widening by specific research ad hoc such as cohort and/or control where it is possible to verify various environmental, occupational and occasional factors.

Cancer risk among farmers in the Province of Vercelli (Italy) from 2002 to 2005: an ecological study.

BACKGROUND: As the link between agricultural pesticides and numerous types of human cancers is wellknown. Farmers living in the Province of Vercelli (Italy) were observed to verify if they have a higher cancer risk than the rest of the local employed population. Literature showed a well-known excess of cancer morbidity and mortality in the Province of Vercelli, but only few studies focused on cancer incidence in local farmers. Studying farmers could allow to assess the causal importance respectively of environmental pressure and professional exposure factors in explaining cancer excesses in the above-mentioned area. MATERIALS AND METHODS: The present ecological study considered all cancer new cases recorded among the mean employed population with a range of age from 25 to 84 years and resident in the Province of Vercelli during the four-year period 2002-2005. Cancer odds ratios, by gender and type of cancer, between farmers and non-farmers were calculated. RESULTS: Farmers showed a higher risk for the following tumors: colorectal (OR 2.38, IC95%: 1,76-2,87), leaukaemia (OR 2.65, IC95%:2,12-2,89), digestive system (OR 2.16, IC95% 1,92-2,33), lymphoma OR 2.08, IC95%:1,99-2,23), melanoma (OR 2.90, IC95%:2,54-3,15), myeloma OR 3.55, IC95%:3,23-3,70), pancreas OR 3.38, IC95%:3,14-3,61), lung (1.59, IC95%:1,12-2,38) and kidney (2.70, IC95%:2,41-2,99). Males showed a higher risk for lung cancer, females for liver neoplasm, melanoma and lymphoma. CONCLUSIONS: Farmers showed a higher risk for several cancers. Further studies are needed, in order to examine in detail the issue, to encourage the use of personal protective equipment and to promote a more responsible pesticides use.

Geographical and epidemiological analysis of oncological mortality in a Municipality of North-Western Italy Vercelli years 2000-2009.

BACKGROUND: We performed a geographic analysis study on mortality in the town of Vercelli, in order to respond to the concerns of the population and some local administrators. Main reason to carry out a detailed and sophisticated study for a city of medium-small size was represented by the presence of various sources of environmental and industrial pressure (i.e. old-generation incinerator for solid urban waste, industrial site for chemicals production, intense agricultural activity of rice production…). METHODS: The study analyzed census, ISTAT death cards, both from the epidemiological point of view with admirers that SMR standardized spatial analysis using Bayesian models. RESULTS: Overall, both approaches highlighted major risks for the area south of the capital for major cancers such as colorectal and lung and increases worthy of investigation for the young-adult age groups in both genders. And being processed a similar study that considers the incidence oncology. CONCLUSIONS: The imminent elaboration of the cartography by oncological incidence will allow us to confirm, or less, the areas in excess for the death data, and in the meanwhile observe any excesses for low mortality pathologies (e.g., thyroid) or neoplasies whose present therapies allowed complete recovery and/or very long survivals (e.g. leukaemia, lymphomas and testicle).