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Papers by Remo Appignanesi

PubMed, 1998

Reported is the incidence of tetanus in the Marches Region of Italy for the period 1992-95. Data ... more Reported is the incidence of tetanus in the Marches Region of Italy for the period 1992-95. Data were obtained from both the regional public health committee's notification forms for infectious diseases and from hospital clinical records. A total of 36 cases were examined, comprising 7 males (19.4%) and 29 females. The raw annual incidence was 6.3 per million population; the standardized incidence for females was four times greater than that for males (9.2 and 2.4 per million population annually, respectively). The patients' ages varied from 31 years to 88 years (median, 73.5 years). The incidence among subjects older than 65 years was approximately ten times greater than that among younger individuals. Chronic wounds, such as trophic lesions, represented the site of tetanus infection in 14.3% of cases whose infection entry point was identified. Treatment of the 36 cases required a total of 1239 hospital days, of which 58.7% were in intensive care and 29.6% were in infectious diseases departments. The raw annual mortality rate for the period considered was 0.7 per million population; the case-fatality ratio was 11%. The results of our study confirm the limits of the current Italian immunization programmes, which exclude a large portion of the population from antitetanus protection.

PubMed, Oct 31, 2018

Background: Healthcare-Associated Infections are a great concern for worldwide healthcare systems... more Background: Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed. Study design: Cross sectional pilot survey. Methods: The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement. Results: 20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17. Conclusion: The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.

Journal of Clinical Oncology, 2012

9098 Background: Optimizing the impact of EoL care on cancer patients (pts) and their caregivers ... more 9098 Background: Optimizing the impact of EoL care on cancer patients (pts) and their caregivers should be a primary goal of an oncology unit. In this study we evaluated satisfaction of family caregivers when the medical oncology team assisted pts until death. Methods: Two oncology units were reorganized to ensure continuity of care; oncologists trained in palliative care medicine assisted pts until EoL. The model assumes that the medical oncologist (MO) is the physician in charge throughout the entire disease trajectory. Relatives of pts assisted at home or at an inpatient hospice underwent a semistructured phone interview conducted by a psychologist or a social worker > 1 month after pts' death. Satisfaction was evaluated for symptoms control, communication, psychological support, overall quality of care and continuity of therapeutic relationship with the MO. A final open-ended question was included for any additional comment. Satisfaction was measured using a five-point Li...

European Journal of Public Health, 2016

Journal of Toxicology and Environmental Health, Part A, 2008

Neural tube defects (NTDs) have a complex and imperfectly understood etiology, in which both gene... more Neural tube defects (NTDs) have a complex and imperfectly understood etiology, in which both genetic and environmental factors might be involved. The aim of the study was to describe an excess of cases of NTDs in a small area in central Italy. Over a 2-wk period in autumn 2002, three diagnoses of anencephaly were made in a 2773-km(2) area. As a consequence of these events, information on known risk factors as well as data on environmental changes, or epidemics of infectious diseases, in 2002-2004, were collected. The NTD rate was estimated for 10,000 births (live and stillborn) in this area. The 95% confidence intervals of rates were estimated assuming Poisson distribution of cases. Six cases of NTD were observed, with an NTD prevalence rate of 18.5 per 10,000 births (95% CI 17.0, 20.12). No evidence of known risk factors was reported. During summer 2002, the local service for environmental surveillance observed that the threshold level of drinking-water bacterial contamination had been exceeded, which probably resulted in an adjustment in the amount of chlorine added. The major difficulty in making hypotheses regarding the causes of birth defects is linking environmental risk factors exposure to fetal outcome. The prompt gathering of data may be essential. Thus, we emphasize the need for the activation of a population-based congenital malformation registry in order to achieve a deeper understanding of these events etiology.

European Journal of Epidemiology, 1997

The importance of anti-diphtheria immunity in adults through periodic booster doses of vaccine is... more The importance of anti-diphtheria immunity in adults through periodic booster doses of vaccine is now increasing after last years diphtheria outbreaks in Newly Independent States (NIS) and Algeria and a few cases found in Europe and USA. Diphtheria cases notified in Italy between 1991–1994 have been reported. In 1995 WHO outlined the need to review vaccination schedules against diphtheria in

Annali di igiene : medicina preventiva e di comunita, 2017

BACKGROUND Healthcare-associated infections (HAIs) are an important issue in terms of quality of ... more BACKGROUND Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation. METHODS An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian conte...

$Research paper thumbnail of APPLICABILIT\uc0 DI UN SET DI CRITERI ED INDICATORI PER LA PREVENZIONE DELLE ICA IN OSPEDALE AI FINI DELL\u2019ACCREDITAMENTO: VALUTAZIONE DI UN CAMPIONE DI AZIENDE SANITARIE ED OSPEDALIERE ITALIANE$

ospedale da proporre ai fini dell\u2019accreditamento. Obiettivo del presente studio pilota \ue8 ... more ospedale da proporre ai fini dell\u2019accreditamento. Obiettivo del presente studio pilota \ue8 verificare l\u2019applicabilit\ue0 di tale sistema di standard ad un campione di Aziende Sanitarie ed Ospedaliere italiane. Metodi: Il sistema include 96 standard derivanti da una revisione dei criteri e requisiti per la prevenzione delle ICA presenti in letteratura, nei principali sistemi di accreditamento internazionali e nei sistemi di accreditamento istituzionale delle Regioni e Provincie Autonome italiane. I criteri e requisiti selezionati sono stati raggruppati in 20 aree e valutati, quando applicabili, su una scala Likert a 4 punti (da 0 \u201cnon risponde al requisito\u201d a 3 \u201csoddisfa pienamente il requisito\u201d). Vengono presentati dati descrittivi sui livelli medi di rispondenza ai requisiti per organizzazione valutando separatamente gli indicatori di esito. Risultati: Hanno partecipato 18 Aziende Sanitarie ed Ospedaliere di diversa tipologia. In media per organizzazi...

ISEE Conference Abstracts

L’analisi delle atrocita commesse nel XX secolo investe direttamente le professioni sanitarie, co... more L’analisi delle atrocita commesse nel XX secolo investe direttamente le professioni sanitarie, considerato il ruolo attivo svolto in tali vicende. La possibilita che persone comuni possano commettere delle atrocita e stato oggetto di analisi, anche in ambito sperimentale, come nell’esperimento di Milgram e in quello di Zimbardo. La disamina di diverse variabili relative alla persona (“docilita” e “razionalita limitata”) e i meccanismi che si innescano quando l’individuo opera all’interno di una organizzazione complessa, impongono una vigilanza per la possibilita che le organizzazioni sanitarie devino dal perseguimento degli obiettivi di salute, anche in rapporto a dinamiche di tipo economico e alla pressione derivante dall’innovazione tecnologica. ---------- The analysis of the atrocities committed during the Twentieth Century directly involves health care professions, if their active role is considered within these events. The possibility that ordinary people can commit atrocities ...