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A Giangrande

Publications and source records attributed to A Giangrande.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Continuous ambulatory peritoneal dialysis and sclerosing encapsulating peritonitis: tamoxifen as a new therapeutic agent?

Sclerosing encapsulating peritonitis (SEP) is a serious complication of long-term continuous ambulatory peritoneal dialysis (CAPD), very likely related to a persisting expression of the transforming growth factor beta1 (TGFbeta1) gene on peritoneal mesothelial cells. We report the case of a 67-year-old uremic woman who developed SEP eight years after being placed on CAPD, complicated by eight episodes of bacterial peritonitis. CAPD was therefore stopped and the patient transferred to hemodialysis. The diagnosis of SEP was confirmed by physical findings (vomiting, abdominal pain with palpable mass, ileus, cachexia) and CT data. The patient was treated with tamoxifen (10 mg/day) for three months, and gradually recovered, a subsequent CT showing a significant reduction of the thickness of peritoneal and intestinal loops. Tamoxifen probably interferes with TGFbeta1 and may be useful in the treatment of this CAPD complication.

Aged↗
PubMedDate not supplied

[The integrated approach between Health Organisation accreditation and professional excellence accreditation].

Later than in other industrialized areas, Health Organisation accreditation has become popular in our country during the last few years as a result of legislation requiring accreditation for healthcare providers of the National Health Service. Out of the two accreditation models, for regulation and public accountability (institutional) and professional, voluntary self-developed (for excellence), Institutional accreditation process has been slowly growing with the adoption of generic structural and organisational standards, which have been set up and managed directly by government. The recently undertaken second model is a peer review assessment activity that originates from a comparison with explicit standards during reciprocal visits carried out by professional organisations. The basis for the assessment is primarily clinical and patient oriented. The healthcare quality of Institutional accreditation is guaranteed mainly through the achievement of predetermined standards for risk management and organisation. On the other hand, the excellence accreditation, whose aim is to implement the continuous improvement of quality, depends on the context and the changes that result from new knowledge and scientific progress. The model operates according to values, which can change in the long run. It measures the effort to improve performances while special care is required to define standards through peer consensus. Once the prescribed model of accreditation is adopted, as is the case for Health Organisation accreditation, it is essential to have flexible patient-oriented tools ensuring that new knowledge and scientific progress complete the assessment and audit.

Accreditation↗
PubMedDate not supplied

[Update of the Italian Society of Nephrology Project No. 1 of the 2004-2006 SIN programme].

In the last few years the Italian Society of Nephrology has addressed many technical-scientific and management aspects to better patient satisfaction. Project No. 1 of the 2004-2006 programme on 'Quality and Accreditation of National Renal Units' focuses on four essential points. The first is the questionnaire mailed to all the Presidents and Regional Delegates on the relationship between Nephrology units, Local Government Health-System and the Regional Healthcare Agency. The results evidence that the 'political' decision-making power of nephrologists decreases in the absence of a national strategy. The second point, in collaboration with the National Census Group, includes the quality analysis and the standardization of resources (human and structural) and management of the Renal Units. The third point is based on 'Educational Courses for Quality and Accreditation' held in Rome (3-5 October 2005: L'Accreditamento all'Eccellenza dell'Unita' Operativa di Nefrologia, Dialisi e Trapianto; 17-19 October 2005: Il Manuale di Accreditamento della Specialità di Nefrologia). The courses aim at training members responsible for each region to hold courses in their specific region to create a network including each single Renal Unit to create an acceptable homogenous language on the models of analysis and on the correct use of 'The Guide for Excellence Accreditation'. The fourth point concerns both the on-line Guide for Excellence Accreditation and 'Peer Review Accreditation' and the NEQUASY (Nephrology Quality System) project. The manual must be 'user friendly' allowing each Centre to self-evaluate using national and regional standards.

Accreditation↗