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Castel Guelfo di Bologna, Italy

May C.R.,University of Southampton | Finch T.,Newcastle University | Ballini L.,Agenzia Sanitaria e Sociale Regionale | MacFarlane A.,National University of Ireland | And 4 more authors.
BMC Health Services Research | Year: 2011

Background: Normalization Process Theory (NPT) can be used to explain implementation processes in health care relating to new technologies and complex interventions. This paper describes the processes by which we developed a simplified version of NPT for use by clinicians, managers, and policy makers, and which could be embedded in a web-enabled toolkit and on-line users manual. Methods. Between 2006 and 2010 we undertook four tasks. (i) We presented NPT to potential and actual users in multiple workshops, seminars, and presentations. (ii) Using what we discovered from these meetings, we decided to create a simplified set of statements and explanations expressing core constructs of the theory (iii) We circulated these statements to a criterion sample of 60 researchers, clinicians and others, using SurveyMonkey to collect qualitative textual data about their criticisms of the statements. (iv) We then reconstructed the statements and explanations to meet users' criticisms, embedded them in a web-enabled toolkit, and beta tested this 'in the wild'. Results: On-line data collection was effective: over a four week period 50/60 participants responded using SurveyMonkey (40/60) or direct phone and email contact (10/60). An additional nine responses were received from people who had been sent the SurveyMonkey form by other respondents. Beta testing of the web enabled toolkit produced 13 responses, from 327 visits to http://www. normalizationprocess.org. Qualitative analysis of both sets of responses showed a high level of support for the statements but also showed that some statements poorly expressed their underlying constructs or overlapped with others. These were rewritten to take account of users' criticisms and then embedded in a web-enabled toolkit. As a result we were able translate the core constructs into a simplified set of statements that could be utilized by non-experts. Conclusion: Normalization Process Theory has been developed through transparent procedures at each stage of its life. The theory has been shown to be sufficiently robust to merit formal testing. This project has provided a user friendly version of NPT that can be embedded in a web-enabled toolkit and used as a heuristic device to think through implementation and integration problems. © 2011 May et al; licensee BioMed Central Ltd.

Fabbri A.,Presidio | Servadei F.,Unit Operativa di Neurochirurgia | Marchesini G.,University of Bologna | Negro A.,Agenzia Sanitaria e Sociale Regionale | Vandelli A.,Presidio
Injury | Year: 2010

Objective: To explore the temporal trend of incidence, causes of injury and main characteristics of adolescent and adult subjects with mild head injury (MHI). Design: This study had a retrospective design. Setting: The study was conducted in a longitudinal database of an Italian Emergency Department (ED). Participants: The study comprised 19 124 consecutive subjects who visited and were managed within 24 h from the event, according to a predefined protocol for MHI from 1997 to 2008. Main outcome measures: Incidence, demography, cause of injury and characteristics of any post-traumatic intracranial lesion within 7 days from MHI. Results: The number of subjects with MHI decreased from 2019 per year (1997-1999) to 1232 per year (2006-2008; P for linear trend <0.001), without differences in the total number of subjects visited in the ED. The decrease was observed in all age-decades, in particular, in subjects in the age ranges of 20-29 and 30-39 years. Over time, the age of subjects with MHI lost a bimodal distribution, and the mean age increased from 43 (25-69) years (median (interquartile range)) in 1997-1999 to 56 (33-78) years in 2006-2008 (P < 0.001). The prevalence of falls increased from 36.5% to 55.0%, whereas crashes fell from 53.2% to 31.9%. The incidence of subdural haematoma (SDH) and epidural haematoma (EDH) did not change over time, whereas traumatic subarachnoid haemorrhage (t-SAH) and intra-cerebral haematoma/brain contusion (ICH) increased (from 0.7% to 1.9% and from 2.5% to 3.2%; P for trend: <0.001 for both. Conclusions: The incidence and the clinical characteristics of MHI subjects are rapidly changing in our setting. These data need to be considered in defining the effectiveness of preventive measures and deciding resource allocation. © 2009 Elsevier Ltd. All rights reserved.

Vignali L.,University of Parma | Saia F.,University of Bologna | Belotti L.M.B.,Agenzia Sanitaria e Sociale Regionale | Solinas E.,University of Parma | And 6 more authors.
Catheterization and Cardiovascular Interventions | Year: 2015

Objectives The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry. Background New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification. Methods A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up. Results At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.51-0.82, P = 0.0004) and angiographic ST (0.5% vs. 1.1%, HR = 0.35, 95% CI 0.17-0.72, P = 0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84-1.16, P = 0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR = 0.94, 95% CI = 0.83-1.07, P = 0.35). Conclusions Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Allegranzi B.,First Global Patient Safety Challenge | Gayet-Ageron A.,University of Geneva | Damani N.,Craigavon Area Hospital | Bengaly L.,Hopital Gabriel Toure | And 8 more authors.
The Lancet Infectious Diseases | Year: 2013

Background: Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries. Methods: We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010. Findings: We noted 21884 hand-hygiene opportunities during 1423 sessions before the intervention and 23746 opportunities during 1784 sessions after. Overall compliance increased from 51·0% before the intervention (95% CI 45·1-56·9) to 67·2% after (61·8-72·2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4·67, 95% CI 3·16-6·89; p<0·0001) than in high-income countries (2·19, 2·03-2·37; p<0·0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2·15, 1·99-2·32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18·7 (95% CI 17·8-19·7) to 24·7 (23·7-25·6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up. Interpretation: Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide. Funding: WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists. © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.

Caranci N.,Servizio Sovrazonale di Epidemiologia | Biggeri A.,University of Florence | Grisotto L.,University of Florence | Pacelli B.,Agenzia Sanitaria e Sociale Regionale | And 3 more authors.
Epidemiologia e Prevenzione | Year: 2010

Objective: the study is aimed at developing a nationwide deprivation index at municipality and census block level, based on the 2001 Census data, and meeting epidemiological needs. Setting and participants: The study uses data drawn from the 2001 General Census of Population and Housing. From the 280 variables defined at census block level (352,605 census tracts with average number of inhabitants 169, standard deviation 225; and average area 0.6 km 2, sd 2.4 km2) five traits that operationally combine to represent the multidimensionality of the social and material deprivation concept have been selected; these are: low level of education, unemployment, non-home ownership, one parent family and overcrowding. The index is calculated by summing standardized indicators and it is also available as categorical by quintiles of population. The same procedure is applied to aggregate frequency data at municipality level. The correlation between mortality and deprivation has been evaluated using 2000-2004 general mortality. Results: considering national data, a strong North-South gradient in deprivation was observed. The municipality deprivation index 2001 is highly correlated to the index likewise calculated on the basis of the previous 1991 Census (r=0.91). General mortality was positively correlated to the index (in particular in population up to 64 years and in larger size municipalities). Conclusion: the pattern described by the deprivation index was coherent with what is already known about geographic distribution of poverty and its impact on mortality. Such outcome bears out the index use for epidemiological purposes.

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