Lorena Charrier

Surgical Site Infection Surveillance: Analysis of Adherence to Recommendations for Routine Infection Control Practices

OBJECTIVE To evaluate the application of surgical site infection control procedures in general surgery departments in hospitals in the Piemonte region of Italy. DESIGN The descriptive study entailed 1 week of observation in the general surgery departments and 1 week of observation in the operating rooms of 49 hospitals in Piemonte; the survey was conducted in 2003. METHODS Data collection forms were designed to record information about presurgical patient preparation (form 1) and infection control practices routinely used by surgical teams (form 2). RESULTS A total of 856 patients were observed; 88% of operations were surgical wound class I or II; 70.6% of patients had hair removed, 28.8% showered the day before the operation; antimicrobial prophylaxis was administered in 63.3% of cases (68.4% on induction of anesthesia and 26% on the day of the operation) and was continued into the postoperative period in 43% of cases. A total of 799 operations were observed; the mean number of healthcare personnel in the operating room was 6; doors were opened an average of 12 times during an operation; 88% of the surgical team members wore a cap/hood and mask correctly; 25% of surgeons and 41% of instrument nurses wore an eye shield; preoperative hand and forearm scrubbing technique was correct in 78% of cases (surgeons, 74.6%; instrument nurses, 86.6%; and anesthesiologists, 73%). CONCLUSIONS A comparison between the survey data and the international recommendations for SSI prevention highlighted practices that could be improved with corrective interventions. The study provided an opportunity for sharing feedback on appropriate data with healthcare personnel and was an effective instrument to audit infection control practices.

Quality of Life, Coping Ability, and Metabolic Control in Patients With Type 1 Diabetes Managed By Group Care and a Carbohydrate Counting Program

Group care is a clinical-pedagogic model in which traditional routine visits are substituted by sessions of group education. This approach improves quality of life and metabolic control in patients with type 2 diabetes (1) but only quality of life in those with type 1 diabetes (2). The latter must match multiple daily insulin administrations with blood glucose monitoring, dietary intake, and energy expenditure (3). We hypothesized that to improve their coping strategies, patients with type 1 diabetes need more specific training in the technical aspects of day-to-day management of insulin therapy. To verify this, we studied the effects of embedding a carbohydrate counting program within group care on quality of life, knowledge …

A study of patients' perceptions of diabetes care delivery and diabetes: propositional analysis in people with type 1 and 2 diabetes managed by group or usual care.

OBJECTIVE We investigated the perceptions of diabetes care and diabetes in patients followed long-term by group or usual care. RESEARCH DESIGN AND METHODS Three open questions were administered to 120 patients (43 with T1DM and 77 with T2DM) who had been randomized at least 2 years before to be followed by group care and 121 (41 T1DM and 80 T2DM) who had always been on usual care. The responses were analyzed by propositional analysis, by identifying the focal nuclei, i.e., the terms around which all sentences are organized, and then other predicates, according to their hierarchical relationship to the nuclear proposition. Specific communicative units were arbitrarily classified into three categories: attitudes, empowerment, and locus of control. RESULTS Patients on group care showed more positive attitudes, higher sense of empowerment, and more internal locus of control than those on usual care. In addition, they expressed a wider and more articulated range of concepts associated with the care received and made less use of medical terminology (P < 0.001, all). Higher HbA1c was associated with negative attitudes (P = 0.025) and negative empowerment (P = 0.055). CONCLUSIONS Group treatment reinforces communication and peer identification and may achieve its clinical results by promoting awareness, self-efficacy, positive attitudes toward diabetes and the setting of care, an internal locus of control, and, ultimately, empowerment in the patients.

Treatments and Prescriptions in Advanced Dementia Patients Residing in Long-Term Care Institutions and at Home

Dementia is an incurable condition resulting in a progressive but patchy decay characterized by dementia related events such as recurrence of infections and eating problems, as well as by acute conditions typical of frailty and/ or the worsening of chronic comorbidities. Its duration is reported to range from three to over nine years. Although not everyone will reach the advanced stage, many patients experience a highly severe and persistent disability. Health professionals may not always acknowledge advanced dementia as a terminal disease, and this may result in patients being exposed to aggressive treatments. The prescription regimen should be reconsidered not only to avoid overtreatment and side effects of drugs, but also to improve comfort and symptom control. In far advanced stages, some medications previously prescribed for comorbidities could likely be discontinued to reduce burden, adverse effects, and costs. A model for defining the concept of prescriptions’ appropriateness in advanced dementia was proposed by Holmes and colleagues taking into account factors such as patients’ life expectancy and goals of care. Many patients with advanced dementia are cared for until death in nursing homes (NHs), and studies have shown that drug regimens may be far from optimal. However, others die at home, cared for by home care service (HC). Information on the treatments and prescriptions for patients with advanced-stage dementia cared for at home are scarce. We expected differences, because drug regimes may be critically reconsidered and revised upon admission to institutional long-term care by physicians on staff of NHs. The aim of this paper is to assess and compare treatments and prescriptions of patients with advanced dementia cared for in NHs and in HC and assess their appropriateness from a palliative care perspective.

Carbohydrate counting improves coping ability and metabolic control in patients with Type 1 diabetes managed by Group Care.

Background and aims: To assess, in patients with Type 1 diabetes (T1 DM), the effects of adding a carbohydrate counting programme (CCP) to continuing education by Group Care on coping ability, quality of life (QoL), knowledge of diabetes, and metabolic control. Materials and methods: Out of 56 patients with T1 DM followed by Group Care, 27 were randomized to receive an 8-session CCP and 29 controls continued Group Care without a CCP. QoL, knowledge, and coping ability were assessed at baseline and after 30 months. Glycated hemoglobin (HbA1c), body weight, blood glucose, hypoglycemic episodes, and insulin dosages were checked every 3 months. Results: QoL improved (p<0.0001) in both CCP (88.7±9.2 vs78.0±9.9) and control patients (88.7±12.5 vs 80.4±11.7). At the end of study, patients on CCP had better scores in knowledge [difference 0.72 (95% CI 0.44; 0.99), p<0.0001] and the 3 coping areas [problem solving: 1.75 (1.2; 2.3), p<0.0001; social support seeking: −1.4 (−2.3; −0.48) p<0.005; avoidance: −1.59 (−2.6; −0.56), p<0.005] than controls. All variables showed a greater, although not statistically significant, improvement in patients with poor schooling. At 30 months, HbA1c was lower in the CCP patients than controls (7.2±0.9 vs 7.9±1.4), p<0.05. There were no changes in insulin dosage, hypoglycemic episodes or blood lipids. Conclusions: This study confirms that Group Care improves QoL in people with T1 DM, but suggests that specific educational and psychological supports are needed to modify adaptation to the disease. The CCP we developed appears effective in promoting change, also in patients with poor schooling.

Smoking habits in Italian pregnant women: Any changes after the ban?

A reduction in the prevalence of smoking and tobacco consumption was noted after the enactment in 2005 of new smoking regulations in Italy. To determine the impact of the smoking ban on pregnant women, we compared the results of two retrospective studies on two samples of 300 women, who recently delivered, conducted before and after the regulations went into effect. The comparison showed a marked drop in passive exposure to smoke in the workplace but not in the family environment; however, passive exposure and smoking were associated before and during pregnancy. Nearly all women agreed that the ban on smoking in public was reasonable and stated it had influenced their smoking habit or exposure. Despite this lip service, both studies highlighted that smoking in pregnancy remains a problem for many women, as about 10 per cent did not quit and over 50 per cent relapsed after delivery.

Incidence of surgical-site infections in orthopaedic surgery: a northern Italian experience.

SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4-2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.

Cochlear, auditory brainstem responses in Type 1 diabetes: relationship with metabolic variables and diabetic complications

Few studies have analysed the presence of hearing abnormalities in diabetes. We assessed the presence of subclinical auditory alterations and their possible association with early vascular and neurological dysfunction in young adults with Type 1 diabetes of long duration.

Vision related quality of life in patients with type 2 diabetes in the EUROCONDOR trial.

To evaluate vision related quality of life in the patients enrolled in The European Consortium for the Early Treatment of Diabetic Retinopathy, a clinical trial on prevention of diabetic retinopathy. Four-hundred-forty-nine patients, 153 women, with type 2 Diabetes and no or mild diabetic retinopathy were enrolled in a 2-year multicenter randomized controlled trial. The 25-item National Eye Institute Visual Functioning Questionnaire was used to explore 12 subscales of vision related quality of life. The patients were 62.8 ± 6.7 years old and had 11.1 ± 5.6 years known disease duration. Diabetic retinopathy was absent in 193 (43.0 %) and mild in 256 (57.0 %). Patients without diabetic retinopathy were older, had shorter diabetes duration and used less insulin and glucose-lowering agents but did not differ by gender, best corrected visual acuity or any subscale, except vision specific mental health and vision specific role difficulties. Patients with reduced retinal thickness at the ganglion cell layer (n = 36) did not differ for diabetic retinopathy but were older, had lower best corrected visual acuity and worse scores for ocular pain, color vision and peripheral vision. On multivariable analysis, worse scores for general vision remained associated with reduced retinal thickness, diabetes duration and best corrected visual acuity, and scores for visual specific mental health with diabetic retinopathy and lower best corrected visual acuity. Visual specific role difficulties were only associated with reduced best corrected visual acuity. Scores for driving decreased among females, with worsening of Hemoglobin A1c and best corrected visual acuity. Color vision depended only on reduced retinal thickness, and peripheral vision on both reduced thickness and best corrected visual acuity. The National Eye Institute Visual Functioning Questionnaire could detect subtle changes in patients’ perception of visual function, despite absent/minimal diabetic retinopathy.

Conscientious objection and waiting time for voluntary abortion in Italy

Abstract Objectives This study sought to determine whether a correlation exists in Italy between conscience-based refusal by physicians to perform an abortion and waiting times for elective abortion. Methods Data on the number of objectors and of elective abortions performed within different time intervals were retrieved from annual Italian ministerial reports. Spearmans correlation coefficients were calculated between an indicator of the increase in workload for non-objectors when conscientious objection is exercised by physicians refusing to provide an abortion and the proportion of women whose request for an abortion was met within 14 days, or later, in 13 regions in Italy. Results An inverse correlation emerged between the workload for non-objectors and the proportion of abortions performed within 14 days of the request in seven regions (statistically significant in Emilia-Romagna and Tuscany). There was a direct correlation between increased workload and the proportion of abortions performed later than 21 days in nine regions. The same trends were highlighted at national level. Conclusions Our results suggest that when data spanning at least more than a decade are available, a trend toward an inverse correlation can be noted between the workloads for non-objectors and timely access to elective abortion. This holds organisational and ethical implications. Chinese Abstract 摘要： 目的 本研究的目的是确定意大利因医生的良心拒绝人流与意愿性流产的等待时间之间是否存在相关性。 方法 从每年意大利内阁报告中检索了在不同时间间隔反对流产者和选择性流产数量的数据。Spearman相关系数分析，计算当医生因良心拒绝提供流产时非反对者工作量增加的数量与在意大利的13个地区，流产要求在14天内或更久时间内得到满足的比例之间的关系。 结果 在7个地区内，非反对者的工作量与流产要求在14天内满足的比例呈负相关(在Emilia-Romagna 和Tuscany有统计学意义)。9个地区非反对者工作量的增加与超过21天进行流产的比例直接相关。在全国水平上也呈现同样的趋势。 结论 根据获得的至少超过十年的数据，我们的研究结果表明非反对者工作量增加与选择性流产等待时间呈负相关的趋势。这是组织和伦理的问题。