Massimo Maurici

Prevention of hepatitis A by vaccination

Inactivated hepatitis A vaccines have been available for more than a decade. Characteristics of the vaccines, comparative data among different formulations and the possibility of combination and association with other vaccines are reviewed in this article. Hepatitis A vaccines show high immunogenicity with different schedules and associations, induce long-term protection irrespective of timing of booster dose, and present an excellent safety profile. Pre-exposure efficacy has been demonstrated in large trials and postexposure protection has been described in family contacts of acute cases. The recommendations for the use of hepatitis A vaccines for immunisation campaigns and for targeted groups, such as travellers and people at risk for occupational and iatrogenic exposure or lifestyle behaviours, are discussed. Aspects related to economic analysis of vaccination strategies are also considered.

Pertussis vaccination for adolescents and adults

Following the introduction of vaccines, the incidence of pertussis declined; however, since 1990, a progressive increase was noted, even in highly immunised populations. Periodic pertussis outbreaks are due to suboptimal efficacy of the vaccine and waning immunity with increasing age. A significant proportion of adolescents and adults with a prolonged cough present Bordetella pertussis, and infection is often transmitted to infants too young to be vaccinated. A high vaccination coverage in the whole population would be necessary to interrupt the circulation of B. pertussis, but immunisation programmes for adolescents and adults have been introduced recently and are accepted with difficulty. The lack of cost–benefit analysis and consistent epidemiological data makes it difficult to assess the role of pertussis elimination among public health priorities. At present, programmes targeted at risk groups for close contacts with infants are the most convenient for adult population, as more epidemiological and economic evidence is needed before a universal strategy can be discussed.

A derivative-free approach for a simulation-based optimization problem in healthcare

Hospitals have been challenged in recent years to deliver high quality care with limited resources. Given the pressure to contain costs, developing procedures for optimal resource allocation becomes more and more critical in this context. Indeed, under/overutilization of emergency room and ward resources can either compromise a hospital’s ability to provide the best possible care, or result in precious funding going toward underutilized resources. Simulation-based optimization tools then help facilitating the planning and management of hospital services, by maximizing/minimizing some specific indices (e.g. net profit) subject to given clinical and economical constraints. In this work, we develop a simulation-based optimization approach for the resource planning of a specific hospital ward. At each step, we first consider a suitably chosen resource setting and evaluate both efficiency and satisfaction of the restrictions by means of a discrete-event simulation model. Then, taking into account the information obtained by the simulation process, we use a derivative-free optimization algorithm to modify the given setting. We report results for a real-world problem coming from the obstetrics ward of an Italian hospital showing both the effectiveness and the efficiency of the proposed approach.

Knowledge and attitude of pregnant women toward flu vaccination: a cross-sectional survey

Abstract Objective: The study was conducted to explore the knowledge of pregnant women about influenza, influenza vaccine during pregnancy and the attitudes regarding immunization. Methods: A questionnaire based on the model proposed by Yudin in 2009 was translated, adapted and administered to 309 pregnant women in the third trimester of pregnancy between October 1 and December 1, 2013 at San Giovanni Calibita Fatebenefratelli hospital of Rome (Italy). Results: Most of the interviewed women (68.9%) answered that influenza is highly contagious, 34.6% of them believed that pregnant women have the same risk of complications as non-pregnant women. Only 5.8% were aware that the vaccine is recommended for women in the second and third trimester of pregnancy and only 14.2% of women answered that the vaccine is safe during pregnancy. Only 3/309 women reported recommendation and offer of vaccination during current pregnancy, but none of them was vaccinated. Conclusions: Overall, knowledge regarding influenza, implications during pregnancy and influenza vaccine was poor among pregnant women. In Italy, the National Vaccine Prevention Plan 2012–2014 recommends influenza vaccine during pregnancy, but only 18/309 were aware of this recommendation. These results suggest that in order to increase influenza vaccine acceptance it is necessary to improve pregnant women knowledge about influenza and to offer education to healthcare providers.

Quality measurement and benchmarking of HPV vaccination services: a new approach.

Background: A new measurement process based upon a well-defined mathematical model was applied to evaluate the quality of human papillomavirus (HPV) vaccination centers in 3 of 12 Local Health Units (ASLs) within the Lazio Region of Italy. The quality aspects considered for evaluation were communicational efficiency, organizational efficiency and comfort. Results: The overall maximum achievable value was 86.10%, while the HPV vaccination quality scores for ASL1, ASL2 and ASL3 were 73.07%, 71.08%, and 67.21%, respectively. Conclusions: With this new approach it is possible to represent the probabilistic reasoning of a stakeholder who evaluates the quality of a healthcare provider. All ASLs had margins for improvements and optimal quality results can be assessed in terms of better performance conditions, confirming the relationship between the resulting quality scores and HPV vaccination coverage. Methods: The measurement process was structured into three steps and involved four stakeholder categories: doctors, nurses, parents and vaccinated women. In Step 1, questionnaires were administered to collect different stakeholders’ points of view (i.e., subjective data) that were elaborated to obtain the best and worst performance conditions when delivering a healthcare service. Step 2 of the process involved the gathering of performance data during the service delivery (i.e., objective data collection). Step 3 of the process involved the elaboration of all data: subjective data from step 1 are used to define a “standard” to test objective data from step 2. This entire process led to the creation of a set of scorecards. Benchmarking is presented as a result of the probabilistic meaning of the evaluated scores.

Mental and physical well-being in oncology-hematology–unit personnel

ABSTRACT Health care workers (HCWs) in university hematology units (UHUs) face high job demand that can have adverse health effects. This cross-sectional study investigated the relationship between some job stressors and health-related quality of life among HCWs of 3 UHUs in Rome. Work-related stress was measured with the Demand–Control Questionnaire; health-related functioning with the mental component score (MCS) and physical component score (PCS) of the Short Form 12 Survey; positivity with the Positivity Scale. Data of 201 respondents were analyzed. Job demand was inversely associated with MCS (p = .05) and PCS (p = .049); job control was directly associated with PCS (p < .001) and MCS (p = .024). A high positivity scale score and high decision latitude score predicted high MCS and PCS. High job demand score predicted low MCS and PCS scores. Reduced job stressors and enhanced positive attitudes can improve HCWs’ health-related quality of life.

A Simulation-Based Multiobjective Optimization Approach for Health Care Service Management

Hospitals are huge and complex systems. However, for many years, the management was commonly focused on improving the quality of the medical care, while less attention was usually devoted to operation management. In recent years, the need of containing the costs while increasing the competitiveness along with the new policies of National Health Service hospital financing forced hospitals to necessarily improve their operational efficiency. In this paper, we focus on a management problem usually arising in health care. In particular, we deal with optimal resource allocation of a ward of a big hospital. To this aim, we propose a simulation-based optimization approach that makes use of a discrete-event simulation model, reproducing the hospital services and combined with a derivative-free multiobjective optimization method. The results obtained on the obstetrics ward of an Italian hospital are reported, showing the effectiveness of the new approach proposed.

INTERMEDIATE CARE UNITS IN PROGRESSIVE PATIENT CARE MODEL: A SYSTEMATIC LITERATURE REVIEW

Background : Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model. Methods : Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review. Results : Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forli, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model. Conclusions : The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.