Bisphosphonate related osteonecrosis of the jaw (BRONJ) can occur in patients affected by malignancy associated hypercalcemia, bone metastases of solid tumors or multiple myeloma intaking amino-bisphosphonates or other bone resorption inhibitors.

High Voltage Shore Connection (HVSC) is a technical solution to supply ships at berth in an economic way while reducing air pollution in city ports. The increased power demand of modern cruise ships may reach several tens of MVA, requiring a primary port voltage supply at voltage >100 kV. When a phase-to-ground fault arises on the HV side, safety problems due to increasing ship hull touch voltage may arise. A possible solution is proposed in this paper, based on an HV/HV y-Δ-y transformer with secondary resistance grounded neutral in the distribution power supply utility substation, with the aim to reduce phase-to-ground fault current at port.

Medication errors occur frequently in many clinical settings. Various studies have highlighted that, together with adverse drug events, they represent one of the major causes of adverse events occurring in hospitals. The aim of this study was to perform a detailed retrospective medical record review in order to investigate the incidence of medication errors occurring in the prescription and transcription phases of the medication use process. Overall, 56 medical records were reviewed to determine the incidence of incomplete or incorrect prescriptions and incorrect transcription by nurses of the original medication order. The findings highlight the need to improve medication safety, in particular at the time of prescription and transcription of orders. The study also confirms that the retrospective review of medical records is an effective method for identifying certain types of medication errors that occur during the prescription and transcription phases. However, this type of review is complex and too costly to be used routinely, for continuous monitoring, in clinical practice.

UNLABELLED:What impact does day surgery have on primary treatment?AIMS:highlighting the impact that day surgery has on the system of primary treatment.RESULTS:The study highlighted a lack in continuity of treatment due to a breakdown in communication between hospital specialists and general practitioners. This reflects the growing habit in the medical field whereby hospital surgeons take charge of surgical indications and carrying out the operation, thus focusing their attention on their own limited scope of action. On the other hand general practitioners are called upon merely to hand out prescriptions and certificates. However, it seems obvious that general practitioners should be involved in the selection phase and discharge of the patient, as occurs in countries where one-day surgery is now in widespread use. That is the only way to improve the quality of healthcare assistance and contain costs to the national health service.

AIMS AND BACKGROUND:In the last decades, many epidemiological studies have implicated outdoor environmental carcinogens in the onset of lung cancer. The present investigation evaluated lung cancer mortality in two areas of the Province of La Spezia (Northern Italy) exposed to environmental pollution emitted by a coal-fired power station and other industrial sources, including a waste incinerator.METHODS:In the two exposed areas, lung cancer mortality risk for the 1988-1996 calendar period was evaluated using the whole Province population as referent. The corresponding relative risks (RR) were estimated after controlling for age structure, urban/rural gradient and deprivation factors (occupation, education, home ownership, housing conditions and family structure) by a Poisson regression modeling. The geographic pattern of risk for the whole province was evaluated via the Besag, York and Mollié (BYM) bayesian model.RESULTS:Persons living in urban areas showed the highest rates in both sexes. No statistically significant risk excess was found in the two exposed areas among males, after excluding rural and semi-rural zones from the analyses (RR = 1.03 and RR = 0.77). In contrast, a risk excess was observed for females in both exposed areas, which remained elevated and statistically significant (P <0.05) after restriction to urban/semi-urban municipalities and after controlling for deprivation factors (RR = 1.54 and RR = 2.14, respectively). Bayesian mapping confirmed the rural/urban gradient and the risk excess observed in females near the industrial sites.CONCLUSIONS:The risk observed among females is consistent with pollution measurements and with other epidemiologic findings, whereas a strong confounding from occupational exposures and smoking habit could account for the lack of an excess risk in males. However, the ecologic nature of this investigation prevented drawing a causal inference. The pollution-related risk observed in the female gender is an important clue that deserves further epidemiologic attention.

The Emilia-Romagna Regional Authority has encouraged the development of day surgery practice in this healthcare program. This study analyzes the results of the program, with particular attention to the field of orthopaedics, with the aim of defining the type of operations that can be carried out in day surgery. There has been a marked increase in the rate of day surgery operations in all fields of surgery on the whole. However, in orthopaedics, the average rate was lower than the general trend. On the other hand, there has been an increased use of day surgery for some types of operations not included in those indicated by the region. Results of the data analyzed suggest that the use of day surgery for orthopaedics can be extended, and so can the regional indications for operations that can be performed by this method of treatment.

It is well known that the organizational model of day surgery, concerning surgical problems defined by the literature as minor, has the aim of optimising the use of hospital resources and facilitating patients and their families, from a psychological and social point of view, by reducing hospitalisation time and the associated complications, and ensuring the same efficacy and more appropriateness of treatment. This study is firstly aimed at analysing the impact that the healthcare policy of the Emilia Romagna Region has had on the development of day surgery practice. Secondly, it compares the patients treated in orthopaedic day surgery in the hospitals of Bologna, Modena, Ferrara, Parma, Reggio Emilia, Maggiore hospital of Bologna and Rizzoli Orthopaedic Institute of Bologna (II.OO.R). In the period 1997-2000 there was a marked increase in the number of operations carried out in day surgery in all of the above-mentioned hospitals. Also in the unispecialistic orthopaedic hospital there was a surprising increase in the percentage of operations carried out in day surgery with respect to the total number of operations performed. The aim of the Rizzoli Orthopaedic Institute and the Emilia Romagna Region is to further implement this form of healthcare, contextually potentiating the appropriateness of hospital admission and avoiding, when not necessary, other forms of healthcare.

We carried out an epidemiologic study to assess the effect on human health of living in an area (Zona D) of La Spezia Municipality (Liguria Region, Italy). Zona D is characterized by the presence of factories, industrial plants, shipyards, a coal-fired power-station, a heavily trafficked thoroughfare and urban waste disposal sites. 230 households for target and control populations were randomly selected from Demographic Department files and surveyed by means of a structured questionnaire administrated by trained interviewers in order to obtain information on adverse health outcome prevalence in 1997 (subjective symptoms and other self-reported conditions) and incidence during 1980-1997 (self-reported diseases diagnosed by general practitioners). In addition, residential, housing, household, and individual characteristics were also gathered. Non-responding households totalled nearly 45%, but were homogeneously distributed by area. After adjustment for several confounders, people living in Zona D showed an increased relative risk (RR) of skin and mucous membrane symptoms (RR = 1.25, 95% CI = 1.02-1.53) attributable to airborne pollutants produced by an incinerator located within a disposal site. A rising RR was also observed for anaemia occurrence in both cross-sectional (RR = 2.44, 95% CI = 1.08-5.48) and longitudinal (RR = 3.21, 95% CI = 1.52-6.72) settings. These last results are consistent with the presence of lead ground pollution due to a heavy metal processing plant located in the same area. Analysis of adverse reproductive effects and cause-specific incidence and mortality revealed no remarkable differences between the study groups.

Low-back (lumbosacral) injuries are known as one of more important occupational health problems in health care workers, because of high prevalence and impact of socioeconomic costs. To investigate the risk of low-back pain in hospital workers into the Istituti Ortopedici Rizzoli in Bologna (Italy), a retrospective study was carried out. The adapted study design was the matched (1:1 for age) case-control, enlisting the first injuries occurred in the hospital staff like cases, and personnel in force, matched for age and year of happened case, like controls. Information about diagnoses and occupational data was obtained from the current informative systems. Comparison with a control group suggests the validity of the work-relatedness of low-back pain in nursing and health aides (OR: 21.67; LC: 4.69-196.56), in nurses (OR: 20.21; LC: 4.81-177.95), in therapists (OR: 16.36; LC: 2.80-163.54) and in X-ray technicians (OR: 13.64; LC: 2.25-138.99). The risk of occupational injury is not homogeneously allocated into the hospital, and significatively prevails in the orthopaedic wards, in the plaster-rooms, in the operating blocks and in the sterilization plants. Specific manual handling were associated with an increased risk of back pain, while some non occupational factors like cigarette smoking, previous trauma leading to hospital admission, and number of children in female, were resulted weakly associated.

In this essay, the authors provide a definition for those medical care facilities representing a consolidated alternative to traditional hospitalization. These facilities can be basically ascribed to the following patterns: day case surgery; day-hospital activity; home-care. Day case surgery is a complex and, in most cases, interdisciplinary procedure; this type of activity necessitates a pre-hospitalization period and often also a "protected discharge" or even a home-care service. Some specific criteria regarding day surgery activity have been defined as follows: the main criteria have a clinical nature, but they interact with others belonging to a social and structural-organizational order. The Royal College of Surgeons of United Kingdom has officially recognized in 1985 this medical care typology as one of the constituents of surgical care, and has evaluated that at least 1/3 of the overall operations could be carried out as day care surgery. In the United States, besides hospital and ambulatory surgery activity, a new pattern known as "free-standing center" has been promoted; in 1993, 35% of the operations is expected to be carried out in day case surgery centers. As far as Italy is concerned, in 1988 only day-hospital practice has been adequately recognized as an alternative medical care facility to traditional hospitalization. The Emilia Romagna region, in order to increase day case surgery activity, has issued in 1991 a list of 53 DRGs, in which day bed units treatment was possible. Up to now, however, only a small part of these diseases is treated on a day case surgery basis.