Academic literature on the topic 'Azienda Policlinico Umberto I'

BackgroundThe treatment of Spondyloarthritis (SpA) has enormously improved thanks to bDMARDs, which are usually safe but they still require some caution because of their interference with the immune system homeostasis. ATE is a still evolving method designed to study the causal relationship between treatment and outcome.ObjectivesWe endeavoured to investigate the impact of TNF-inhibitors (TNFi), anti-interleukin17 or interleukin12/23 monoclonal antibodies (anti-IL) on comorbidities among SpA patients enrolled in the Italian GISEA Registry, using an average treatment effect (ATE) analysis.MethodsSpA patients from the GISEA Registry were divided into groups according to pharmacological exposure: no treatment (G0), TNFi (G1) and anti-IL (G2). In each group, the prevalence and incidence of infectious, cardiopulmonary, endocrinological, non-inflammatory gastrointestinal disease (NIGID), oncologic, renal and neurologic comorbidities were evaluated. Thus, each comorbidity was fitted for ATE and baseline features were evaluated for importance.ResultsThis multi-centre Italian GISEA study comprised 4458 SpA patients (G0=495 patients, G1=3113 patients, G2=815 patients). Cardiovascular disease was the most prevalent and incident comorbidity in all groups, with no significant difference between groups. ATE showed no increased risk of solid cancer in G1 and G2 (G1 vs. G0 = 0,42 95% CI 0,20-0,85; G2 vs. G0 = 0,26 95% CI 0,08-0,71), but significantly higher prevalence and incidence in G0 (14.07/1000 patient-years, p=0,0001). Conversely, a significantly higher risk of NIGID and fibromyalgia was found in G1 and G2 vs. G0 (NIGID: G1 vs. G0 =1.56 95% CI 1.06-2.33, G2 vs. G0 =1.91 95% CI 1.05-3.24; fibromyalgia: G1 vs. G0 1.69 95% CI 1.05-2.68, G2 vs. G0 2.13 95% CI 1.14-3.41). No treatment risk modification was observed concerning haematological malignancies, cardiovascular events and endocrinological comorbidities.ConclusionOverall, this study reveals that bDMARDs have only a slight interference of the occurrence of comorbidities in SpA patients, underlining the appropriateness of the use of bDMARDs in current clinical practice. Some caveats pertain to NIGID and fibromyalgia. Importantly, causality may yield more reliable and relevant clinical information, flattening the unbalance between observational data and clinical trials.Table 1.Prevalence and incidence of selected comorbidities in the GISEA Cohort and results of the Average Treatment Effect Analysis (ATE).Incidence of comorbidities (number of events; events/1000 patient-years)ComorbidityNo treatment (G0)N=494TNFi (G1)N =3113AntiIL (G2)N=815P value (ANOVA)Cardiovascular disease10 events; 16.90114 events; 28.8126 events; 26.440,0794Endocrinological disease7 events; 11.3560 events; 9.3015 events; 13.830,6678Fibromyalgia5 events; 6.72102 events; 13.4233 events; 25.190,0095Gastrointestinal (non IBD) disease8 events; 12.41110 events; 16.4833 events; 19.680,0408Haematologic malignancy0 events; 02 events; 0.260 events; 00,6498Solid cancer10 events; 14.0713 events; 1.715 events; 3.790,0001Average treatment effect (ATE) analysisOutcome (comorbidity)RR (CI 95%)TNFi vs. no treatment (G1 vs. G0)antiIL vs. no treatment (G2 vs. G0)antiIL vs. TNFi (G2 vs. G1)Cardiovascular1.41 (0.99-1.99)1.66 (1-2.97)1.16 (0.91-1.55)Endocrinologic1.27 (0.76-2.05)1.41 (0.68-2.72)1.09 (0.74-1.54)Fibromyalgia1.69 (1.05-2.68)2.13 (1.14-3.41)1.25 (0.95-1.51)GI (non IBD)1.56 (1.06-2.33)1.91 (1.05-3.24)1.21 (0.92-1.51)Haematologic malignancy0.78 (0.14-2.88)0.81 (0.04-4.67)0.78 (0.20-1.96)Solid cancer0.42 (0.20-0.85)0.26 (0.08-0.71)0.61 (0.33-0.96)Legend: G0= Group 0, no treatment= no biologic DMARD, G1= Group 1, TNFi= Tumour necrosis factor inhibitors, G2= Group 2, antiIL= anti-interleukin17 and anti-interleukin17/23 monoclonal antibodies, N= numerosity of the group, IBD= inflammatory bowel disease, RR= relative risk, CI 95%= confidence interval 95%. Significant results are in bold characters.AcknowledgementsRoberta Ramonda and Giovanni Lapadula are part of the GISEA Working Group, comprising the Centre of Centre of Bari, Milan (Presidio Ospedaliero Gaetano Pini), Brescia, Catania, Foggia, Rome (Policlinico Umberto I, Policlinico Gemelli and Policlinico Tor Vergata), Cagliari, Modena, Verona, Turin (Azienda Ospedaliero-Universitaria Città della Salute and Ospedale Mauriziano Umberto I), Siena, Pavia, Messina, Ferrara and Padova.Disclosure of InterestsNone Declared.

Background: Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. Methods: An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I “Sapienza” with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. Results: Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, “Sapienza” University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. Conclusions: Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.

In questo articolo gli Autori presentano i risultati preliminari relativi a 20 pazienti con diagnosi di depressione post-partum. Di recente infatti, č stato avviato dalla UOS di Igiene Mentale delle Relazioni Affettive e del post-partum del Policlinico Umberto I di Roma, un progetto intervento sui disturbi dell'umore nel puerperio. I dati raccolti finora indicano la prevalenza di un disturbo di personalitŕ del cluster B e che la depressione post-partum si configura come una difficoltŕ nel processo di separazione-individuazione madre-bambino che appare isomorfa a una indifferenziazione dei partner dalla propria famiglia di origine. Sia a livello individuale materno che della coppia, l'evento nascita, in quanto riedizione di vissuti di antiche separazioni, viene sperimentata come fonte di angosce e di pericolo.

The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED.

Dalbavancin is a lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). The aim of the study was to evaluate the efficacy and safety in all patients who received at least one administration of dalbavancin. Methods: We carried out a retrospective study of the use of dalbavancin in 55 patients at the Azienda Ospedaliera Ospedali Riuniti Umberto I (Ancona, Italy) from February 2017 to May 2020 and compared “on label” and “off label” use of dalbavancin in ABSSSI and non-ABSSSI. Results: A total of 55 patients were included in the study. The median age was 61 years; 51% had ABSSSI; 24% had prosthetic joint infections, and 14% had osteomyelitis. A total of 53% received a single 1500 mg infusion of dalbavancin, and 18% received a second dose 14 days later; 24% of patients received further doses at 14-day intervals. In 91% of cases, patients achieved clinical objectives with dalbavancin: 96% of patients with ABSSSI and 69% of those with prosthetic joint infections. Conclusions: Dalbavancin was shown to have an excellent tolerability profile and to be a highly successful therapeutic approach even in those cases treated “off-label”.

- The studies, conducted on the phenomenon of the Intimate Partner Violence (IPV), report the necessity to use a multidimensional approach which foresees the analysis of the risk and protection factors implicated. The present study is focused on the analysis of the formalities in which the phenomenon of the violence is investigated in different clinical contexts (social services, orders of family leaving, expert legal consultation, Department Alcoholics of the Policlinico Umberto I°, spanish anti-violence centre). For the data collection has been used a Scheme of analysis of histories of violent couples, built ad hoc. The results underline notable discrepancies in the typology of gathered information in the cases of IPV in the different clinical contexts, probably associated to a different formation of the operators and to specific protocols to the objectives of the service. Such discrepancy has solicited the necessity to structure protocols of work that allow a complete and uniform collection of information in different contexts, with the purpose to deepen the understanding of the phenomenon of the IPV. Key words: intimate partner violence; multidimensional approach; protection and risk factors; clinical context.

Minisola S, Romagnoli E, Scarnecchia L, Rosso R, Pacitti MT, Scarda A, Mazzuoli G. Serum carboxyterminal propeptide of human type I procollagen in patients with primary hyperparathyroidism: studies in basal conditions and after parathyroid surgery. Eur I Endocrinol 1994;130:587–91. ISSN 0804-4643 This study was carried out in order to evaluate serum carboxy-terminal propeptide of human type I procollagen (PICP) in patients with primary hyperparathyroidism and to examine its changes following parathyroidectomy. Seventeen patients (four males and 13 famels, aged 53.8 ± 3.1 sem years) were studied in basal conditions; six patients also were investigated after successful parathyroid surgery. Mean serum PICP values of patients with primary hyperparathyroidism (194.5 ± 27 sem μg/l) were significantly higher (p < 0.001) with respect to those found in normal subjects. However, deviations from the norm (Z score values) were significantly less with respect to deviations of serum osteocalcin, alkaline phosphatase and urinary hydroxyproline/creatinine ratio. Following parathyroidectomy, it was possible to observe a discrepancy between markers of bone resorption and those of bone formation. The former tend to decrease, while the latter either do not show any significant change (serum alkaline phosphatase and serum osteocalcin) or increase (serum procollagen). The results of our investigation indicate that in basal conditions the assay of serum procollagen may be of clinical value but it would be better to use it in combination with other biomarkers of skeletal remodelling. The results obtained after parathyroidectomy are the opposite of those obtained following parathyroid hormone infusion and should be ascribed to the effect of acute hormone deficiency on collagen synthesis. The positive biochemical uncoupling following surgery might lend support to the rise of bone mineral density consistently reported in the first few months following parathyroidectomy. S Minisola, Istituto di II Clinical Medica, Policlinico Umberto I, Via del Policlinico 155, 00161 Rome, Italy

Introduction: The emergence and spread of drug-resistant pathogens due to the improper use of antibiotics have become increasingly apparent in recent years. Objective: This retrospective comparative analysis aimed to assess and compare antibiotic prescription trends in Italy across two different regions based on geographic area and healthcare structure. One region represents a large hospital institution, while the other represents a populous local Italian health agency. The study also examined the impact of documented antibiotic stewardship programs and efforts to promote responsible antibiotic use at all levels, in alignment with international goals. Antibiotic consumption data were collected from the Umberto I Polyclinic Hospital and the ASL Napoli 3 South Local Health Agency. Methods: To compare consumption between regions, a standardized comparison using the Defined Daily Dose (DDD) was employed. The internal management system of each healthcare facility records all prescriptions and drug dispensations, and these data were extrapolated for this retrospective study. Results: A comparative assessment between the first half of 2022 and 2023 (January–June) highlighted a significant increase in beta-lactam antibiotic consumption, showing a twofold rise compared to the previous year’s term. Regarding prescription averages, there was a noticeable increase of +29.00% in hospitalizations and +28.00% in hospital discharges within the ASL Napoli 3 South. Conversely, at Policlinico Umberto I, there was a marginal increase of +1.60% in hospitalizations and a decrease of −7.40% in hospital discharges. Conclusions: The study offers valuable insights into expenditure patterns and antibiotic consumption, underscoring the need for enhanced prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings stress the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.

Il progetto ha lo scopo di proporre soluzioni migliorative all'attuale gestione dei processi di supporto, all'attività sanitaria, nel Policlinico. Il modus operandi adottato si ispira agli affermati principi del Business Process Reengineering.

Il lavoro che viene di seguito presentato sviluppa il tema della responsabilità professionale medico-sanitaria alla luce dell’ultima riforma apportata con la legge dell’8 marzo 2017, la cosiddetta “Gelli-Bianco” e dei suoi elementi di novità rispetto all’esistente quadro normativo, nonché all’attesa decretazione attuativa, declinandolo nel contesto specifico delle attività del Comitato Valutazione Sinistri (CVS) delle due aziende ospedaliere in convenzione con l’Università Sapienza nella Città di Roma. In premessa sono stati analizzati i passaggi di interesse della legge, quindi la puntualizzazione sulle attività di risk mangement aziendale e l’attuale definizione dei diversi obblighi assicurativi di settore, con una particolare attenzione alla ricostruzione storica del complesso e composito iter legislativo che ha sviluppato nell’ultimo decennio il diritto su entrambi gli argomenti. In quanto alla prima tematica è importante sottolinearne l’attualità che emerge assai chiaramente dall’entità degli sforzi internazionali che si stanno compiendo per un globale ripensamento da parte delle Amministrazioni, ma soprattutto delle politiche di governo, alla luce di un comune obiettivo di elevazione degli standard di sicurezza delle cure che, grazie alla nuova legge, assurge a piena integrazione del più generale diritto alla salute . Il problema del “rischio” correlato all’erogazione delle prestazioni sanitarie, infatti, si è rapidamente ingrandito, quasi paradossalmente, proprio per l’incremento complessivamente inteso della qualità, perlomeno potenziale, dell’assistenza. Da un lato, infatti, le competenze si sono ampliate ed approfondite, seppur secondo una direttrice prevalentemente settoriale, dall’altro la complessità di sistema è incrementata su tutti i livelli, dalla maggior definizione dei bisogni assistenziali del singolo paziente alla sofisticazione degli “strumenti”, estensivamente contemplati, sia diagnostici che terapeutici, passando per le dinamiche di partecipazione multidisciplinare e multi-professionale grazie al coinvolgimento di figure nuove con competenze specifiche al fianco di medici ed infermieri. In questo scenario la dimensione di rischio verso cui si orientano le attività di clinical risk management è quella che descrive la probabilità dell’evento avverso o dell’incidente, e più specificamente quello che può essere messo in dipendenza da un errore o “quasi-errore”. L’oggetto e l’obiettivo di queste attività, dunque, è proprio l’indagine sistematica di tali problematiche e la pianificazione ed attuazione delle misure necessarie al contenimento di quanto prevenibile e, quindi, evitabile. Strettamente embricato al problema della “sicurezza” e, ancor più in generale, della “qualità” è il tema del dilagante contenzioso medico-legale, comunemente riassunto nel sintagma anglosassone di “med-mal”, abbreviazione per medical malpractice. Tralasciando i pur legittimi argomenti sul semplicismo di simile definizione sintetica, nell’esame delle fonti e nell’inquadramento della norma è stato di primo interesse l’analisi dell’introduzione di un regime compiuto di assicurazione obbligatoria anche nell’ambito della responsabilità professionale medica, per cui è immediato un parallelismo, seppur limitato, con il settore della RC-auto . Il piano condiviso, d’altronde, tra gestione del rischio clinico e del contenzioso inerente presunta responsabilità medico-sanitaria ben si esplica all’interno dei CVS in qualità di organismi collegiali multidisciplinari afferenti a tutte le aree direttive aziendali competenti.

The history of the Veronese hospitals constitutes one of the most important and interesting chapters of the urban events. St. Zeno in his sermon on the avarice, already praised the Veronese inhabitants for their great availability toward suffering and sick people, to the point that almost every monastery and parishes became a reception centre for pilgrims, distressed and sick people. Population growth implied to improve the health initiatives. The events happened in Verona at the beginning of the twentieth century are a precious proof of the contribution which doctors and wise administrators offered to the Veronese health care system. It is a history intimately related to the munificent charity thanks to which the local protagonists sustained the birth and the development of the hospital complex (bequest of Alessandri, Cressotti Zorzi, Failoni, Roveda, only for quoting some of them). The hospital administration, together with doctors and inhabitants faced with burning and active debates, the transfer of the civil hospital from its seat, situated in the thin urban fabric of the city centre, to a suburb area: Borgo Trento. Borgo Trento is the hospital which the Veronese feel like their own hospital, characterized by a system of pavilions, long tree-lined avenue and luxuriant gardens. A new hospital complex, Borgo Roma Policlinico, was born in the 1970s in the south suburb of the city, offering great town planning and charitable opportunities. The integration of the two hospitals and the constitution of the Azienda Ospedaliera Integrata Verona are most recent history (2010), but seems follow the steps of the union between the Alessandri Children’s Hospital and the Sant’Antonio Civil Hospital, as a prosecution of the troubled hospital history of fusions, transfers and divisions.