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BACKGROUND: Using a personal, anonymous questionnaire developed ad hoc, we tried to document the role, the problems and the activities of Italian anaesthetists in postoperative pain control. METHODS: A random selection-stratified by region-was made from a list of 971 hospitals. The final sample was made up of 395 departments of anaesthesia and intensive care from 369 hospitals. The completeness and consistency of each questionnaire were assessed. RESULTS: The response rate achieved was 78.9% (312 centres in 293 hospitals) with 2435 evaluable questionnaires corresponding to 30% of all Italian anaesthesia departments and 25% of Italian anaesthetists. Only 15.2% of anaesthetists are completely responsible for the postoperative analgesia (POA) (prescriptions and evaluations) and an established attitude for POA (protocols/guidelines) exists in 18 departments only. 60% of anaesthetists use routinely the intramuscular route, 55.2% the intravenous route (infusion plus bolus), and 23.7% the spinal/epidural route. Only 6.2% of the anaesthetists use the patient-controlled analgesia system. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used agents (47% NSAID vs 37.9% opioids; NSAID-opioid association 14.7%). A local anesthetics-opioids association is preferred for the spinal/epidural route (15.1%) only (local anaesthetic 4.9% only; opioids alone 2.7%). Lack of time, work organization, technique knowledge/training, trust in nursing-ward staff, difficulty in monitoring the patient on the ward, concern about opioid use leading to ventilatory depression, and administration errors are reported to be the main factors that limit an appropriate approach to postoperative pain (POP), the correct use of analgesics and a free choice of POA technique. CONCLUSION: This survey shows that Italian anaesthetists do not consider the postoperative period to be their own personal work area and that POA is to be considered as a matter of individual choice.
BACKGROUND: Since vaccinations are an effective prevention tool for maintaining the health of society, the monitoring of immunization coverage allows us to identify areas where disease outbreaks are likely to occur, and possibly assist us in predicting future outbreaks. The aim of this study is the investigation of the coverage achieved for compulsory (diphtheria, tetanus, polio, hepatitis B,) and recommended (pertussis, Haemophilus influenzae, measles-mumps-rubella) vaccinations between 1998 and 2002 in the municipality of Bologna and the identification of the subjects not complying with compulsory and recommended vaccinations. METHODS: The statistics regarding vaccinal coverage were elaborated from the data supplied by the Bologna vaccinal registration system (1998-2000) and the IPV4 program (2001-2002). To calculate the coverage for compulsory vaccinations and cases of non-compliance reference was made to the protocol drawn up by the Emilia Romagna Regional Administration. The reasons for non-compliance were divided into various categories RESULTS: In Bologna the levels of immunization for the four compulsory vaccinations are satisfactory: over 95% children completed the vaccinal cycle, receiving the booster for anti-polio foreseen in their 3rd year and for anti-diphtheria, tetanus, pertussis at 6 years. The frequency of subjects with total non-compliance (i.e. those who have not begun any compulsory vaccinations by the age of one year) is generally higher in Bologna than in the region, with a slight increase in 2002 (2.52% and 1.06% in the city and the region respectively). The frequency of the anti-measles vaccination is higher than that of mumps and rubella, which means that the single vaccine, as opposed to the combined MMR (measles-mumps-rubella) was still being used in the period in question. The most common reason for non compliance is objection of parents and is probably due to reduction of certain diseases or anxiety about the possible risks. CONCLUSION: In Bologna the frequency of children aged 12 and 24 months who have achieved compulsory vaccination varied, in 2002, between 95% and 98%. As regards recommended vaccinations the percentage of coverage against Haemophilus influenzae is 93.3%, while the levels for measles, mumps and pertussis range from 84% to approx. 92%. Although these percentages are higher if compared to those obtained by other Italian regions, every effort should be made to strengthen the aspects that lead to a successful vaccinal strategy.
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Throat swab specimens were obtained from 3,227 children with symptoms of acute pharyngotonsillitis. After 14 to 21 days, a second throat swab specimen was obtained at a follow-up visit. Over 42% of the 934 strains of Streptococcus pyogenes isolated in the primary study were resistant to erythromycin, azithromycin, and clarithromycin. Eradication rates among the 668 patients who entered the follow-up study were as follows: 84.1%, penicillin recipients; 82.7%, cephalosporin recipients; and 71.7%, macrolide recipients. Among patients treated with macrolides, the eradication rate was approximately 80% when the infecting organisms were erythromycin-susceptible and approximately 60% when they were erythromycin-resistant. These results indicate substantial in vitro macrolide resistance among Italian isolates of S. pyogenes. However, at least for a minor self-limiting condition such as acute S. pyogenes pharyngitis, our findings point to a limited overall correlation between in vitro susceptibility (to penicillins, cephalosporins, or macrolides) and eradication in patients treated with these drugs and an even weaker correlation between in vitro resistance (to macrolides) and noneradication in patients receiving macrolide therapy.
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OBJECTIVE: The aim of the paper is to report of an empirical retrospective study (1994-1999) on the cost of managing patient with prostate cancer (PC) during the first year after diagnosis in Italy. MATERIAL AND METHODS: In January 2000, a questionnaire on qualitative, quantitative and economic data concerning the clinical path expected for patients with PC (diagnosis; staging; follow-up; drug; surgery; chemotherapy and radiotherapy) was sent to 14 Italian urological wards (UWs), 5 school of medicine-based (Northern Italy: 2; Central Italy: 1; Southern Italy: 2), 4 self-governing hospital-based (Northern Italy: 1; Southern Italy: 3), 5 Health Authorities hospital-based (Northern Italy: 2; Central Italy: 2; Southern Italy: 1). UWs were expected to contribute to analysis with 15 patients' records per year each, for a total amount of 1.260 filled questionnaires. Only medical costs related to patient management have been considered; hospitals and Health Authorities overheads were not taken into account. A cost description was performed considering the hospital viewpoint. RESULTS: We received 416 out of 1.260 expected questionnaires (redemption rate: 33%) from 8 out of 14 UWs: 2 school of medicine-based (Central Italy: 1; Southern Italy: 1); 2 self-governing hospital-based (Southern Italy: 2); 4 Health Authorities hospital-based (Northern Italy: 1; Central Italy: 3). Only 411 out of 416 questionnaires were included in data analysis. Patients' average age at the time of diagnosis was 74.1 years (range: 68.6-76.7). A moderate percentage of neoplasms in patients' relatives was reported (17.8%; 5.6% for PC). The average cost per patient with CP during the first year after diagnosis was Euro 6,575.31 (range: Euro 5,035.65-Euro 12,367.69). The cost-driver was drug therapy (43.07%), followed by surgery (26.41%), diagnosis (12.39%), staging (8.58%); follow-up (8.25%) and radiotherapy (1.30%); no data on chemotherapy was reported. Diagnosis, staging and follow-up tests and procedures were performed mainly in outpatient setting (81.84% 53.30% and 94.72%, respectively) and requested by hospital urologists (70.26%; 52.88% and 67.95%, respectively). Total PSA was the most frequent test for diagnosis (503 out of 2,047 procedures) and follow-up (782 out of 3,351 procedures), as well as bone scan was for staging (337 out of 1,023 procedures). As far as drug therapy is concerned, LHRH-analogue was the most prescribed drug (227 patients). Surgery (lymphoadenectomy: 9; orchidectomy: 20; urinary outlet dysobstruction: 51; prostatectomy: 104) was performed in 179 patients; 5 out of 179 patients underwent more than one surgical intervention. Radiotherapy (338 sessions) was undertaken in 15 out of 411 patients. CONCLUSIONS: Cost of managing patient with PC during the first year after diagnosis in Italy could be reduced by increasing outpatient procedures and decreasing post-surgery hospital stay. Our research may hopefully foster further empirical studies on the health economics of PC in our country.