Azienda Ospedaliero Universitaria di Modena

Modena, Italy

Azienda Ospedaliero Universitaria di Modena

Modena, Italy
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Gagliotti C.,Agenzia Sanitaria e Sociale Regionale Emilia Romagna | Cappelli V.,Agenzia Sanitaria e Sociale Regionale Emilia Romagna | Carretto E.,Azienda Ospedaliera di Reggio Emilia | Marchi M.,Agenzia Sanitaria e Sociale Regionale Emilia Romagna | And 83 more authors.
Eurosurveillance | Year: 2014

Starting in 2010, there was a sharp increase in infections caused by Klebsiella pneumoniae resistant to carbapenems in the Emilia-Romagna region in Italy. A region-wide intervention to control the spread of carbapenemase-producing K. pneumoniae (CPKP) in Emilia-Romagna was carried out, based on a regional guideline issued in July 2011. The infection control measures recommended to the Health Trusts (HTs) were: phenotypic confirmation of carbapenemase production, active surveillance of asymptomatic carriers and contact isolation precautions for carriers. A specific surveillance system was activated and the implementation of control measures in HTs was followed up. A significant linear increase of incident CPKP cases over time (p<0.001) was observed at regional level in Emilia-Romagna in the pre-intervention period, while the number of cases remained stable after the launch of the intervention (p=0.48). Considering the patients hospitalised in five HTs that provided detailed data on incident cases, a downward trend was observed in incidence after the release of the regional guidelines (from 32 to 15 cases per 100,000 hospital patient days). The spread of CPKP in Emilia-Romagna was contained by a centrally-coordinated intervention. A further reduction in CPKP rates might be achieved by increased compliance with guidelines and specific activities of antibiotic stewardship. © 2014, European Centre for Disease Prevention and Control (ECDC). All rights reserved.

De Bernardi B.,Instituto Giannina Gaslini | Quaglietta L.,AORN Santobono Pausilipon | Haupt R.,Instituto Giannina Gaslini | Castellano A.,Ospedale Pediatrico Bambino Gesu | And 12 more authors.
Pediatric Blood and Cancer | Year: 2014

Background: Symptoms of epidural compression (SEC) in children with neuroblastoma (particularly infants) may be misinterpreted, leading to delay in diagnosis. Patients and Methods: Clinical, imaging and follow-up data of 34 infants with neuroblastoma and SEC diagnosed between 2000 and 2011 at Italian AIEOP centers were retrieved and reviewed. Results: Median age at initial SEC was 104 days (IQR 47-234). Main symptoms included motor deficit (85.3%), pain (38.2%), bladder and bowel dysfunctions (20.6% each). In the symptom-diagnosis interval (S-DI) (median, 12 days; IQR 7-34), the frequency of grade 3 motor deficit increased from 11.8% to 44.1% and that of bladder dysfunction from 20.6% to 32.4%. S-DI was significantly longer (P=0.011) for patients developing grade 3 motor deficit. First treatment of SEC was neurosurgery in 14 patients, and chemotherapy in 20. SEC regressed in 11 patients (32.3%), improved in 9 (26.5%), and remained stable in 14 (41.2%), without treatment-related differences. Median follow-up was 82 months. At last visit, 11 patients (32.3%) were sequelae-free while 23 (67.7%) had sequelae, including motor deficit (55.9%), bladder (50.0%) and bowel dysfunctions (28.4%), and spinal abnormalities (38.2%). Sequelae were rated severe in 50% of patients. Severe sequelae scores were more frequent in patients presenting with spinal canal invasion >66% (P=0.039) and grade 3 motor deficit (P=0.084). Conclusions: Both neurosurgery and chemotherapy provide unsatisfactory results once paraplegia has been established. Sequelae developed in the majority of study patients and were severe in a half of them. Greater awareness by parents and physicians regarding SEC is warranted. © 2014 Wiley Periodicals, Inc.

Mancini T.,University of Parma | Caricati L.,University of Parma | Bellini S.,Settore Formazione | Bianconcini M.,Referente Processo Sviluppo Professionale | And 8 more authors.
Mecosan | Year: 2013

Despite a growing interest on the concept of Safety Culture may be recognized in Italy, the effectiveness of safety governance policies that have been recently activated inside hospitals cannot ignore the knowledge of the way in which healthcare specialists identify safety. Through free-word association to the stimulus «safety is», healthcare specialists' beliefs about what safety should be, the way in which safety should be put in place and on what safety depends have been explored. Results indicate that the concept of «safety» refers more to the individual actions than to a deep-rooted and shared culture permeating health care environment. Professionals are aware that their actions must be oriented to the patient safety, but they share a limited view of the construct of safety culture.

Gagliotti C.,Agenzia Sanitaria e Sociale Regionale Emilia Romagna Area | Sarti M.,Nuovo Ospedale di Modena S. Agostino Estense | Sabia C.,University of Modena and Reggio Emilia | Gargiulo R.,Nuovo Ospedale di Modena S. Agostino Estense | And 10 more authors.
New Microbiologica | Year: 2011

This study aimed to evaluate the accuracy of routine systems (Vitek2 cards AST-N022 and AST-N026; Kirby Bauer, E-test) for susceptibility testing of Pseudomonas aeruginosa to piperacillin and piperacillin-tazobactam. Vitek2 (card AST-N022) showed the worst performance; the other three methods (Vitek2 card AST-N026, Kirby-Bauer and E-test) performed comparably but never fulfilled the minimal standard proposed by FDA.

Bertolini F.,Azienda Ospedaliero Universitaria di Modena | Rossi G.,Pathology Section | Fiocchi F.,Radiology Institute | Giacometti M.,Azienda Ospedaliero Universitaria di Modena | And 7 more authors.
Tumori | Year: 2011

In this report we describe the case of a young woman with familial adenomatous polyposis who developed metastatic rectal cancer during pregnancy. At diagnosis, we decided to perform a transabdominal laparoscopic adrenalectomy, because of the high risk of bowel obstruction, and to define the origin of the adrenal gland lesion, suspected to be primary on the basis of imaging results. The histological specimen showed a collision tumor between an adrenal metastasis of a rectal tumor and a primary adrenal gland carcinosarcoma. The peculiarity of the case is due not only to its clinical presentation during pregnancy, but also to the presence of this uncommon adrenal collision tumor. A particular challenge for the clinician is to define the priority between these two tumors: the presence of two distinct and colliding aggressive neoplasms poses a problem in the choice of the best therapeutic approach, also given the impossibility to biopsy all metastatic sites. However, we decided to treat the patient as having a metastatic rectal cancer, because we had a solid histological confirmation of metastases.

Maffei N.,Azienda Ospedaliero Universitaria di Modena | Maffei N.,University of Bologna | Guidi G.,Azienda Ospedaliero Universitaria di Modena | Guidi G.,University of Bologna | And 13 more authors.
Medical Physics | Year: 2016

Purpose: A susceptible-infected-susceptible (SIS) epidemic model was applied to radiation therapy (RT) treatments to predict morphological variations in head and neck (H&N) anatomy. Methods: 360 daily MVCT images of 12 H&N patients treated by tomotherapy were analyzed in this retrospective study. Deformable image registration (DIR) algorithms, mesh grids, and structure recontouring, implemented in the RayStation treatment planning system (TPS), were applied to assess the daily organ warping. The parotids warping was evaluated using the epidemiological approach considering each vertex as a single subject and its deformed vector field (DVF) as an infection. Dedicated IronPython scripts were developed to export daily coordinates and displacements of the region of interest (ROI) from the TPS. MATLAB tools were implemented to simulate the SIS modeling. Finally, the fully trained model was applied to a new patient. Results: A QUASAR phantom was used to validate the model. The patients validation was obtained setting 0.4 cm of vertex displacement as threshold and splitting susceptible (S) and infectious (I) cases. The correlation between the epidemiological model and the parotids trend for further optimization of alpha and beta was carried out by Euclidean and dynamic time warping (DTW) distances. The best fit with experimental conditions across all patients (Euclidean distance of 4.09±1.12 and DTW distance of 2.39±0.66) was obtained setting the contact rate at 7.55±0.69 and the recovery rate at 2.45±0.26; birth rate was disregarded in this constant population. Conclusions: Combining an epidemiological model with adaptive RT (ART), the authors novel approach could support image-guided radiation therapy (IGRT) to validate daily setup and to forecast anatomical variations. The SIS-ART model developed could support clinical decisions in order to optimize timing of replanning achieving personalized treatments. © 2016 American Association of Physicists in Medicine.

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