Healthcare organizational performance: why changing the culture really matters

An organization may be considered as having three components: a structure, systems and culture. Culture is the most difficult part of the organization to affect. After all, culture has the key role in impacting and improving rganizational performance. The leadership of an organization and its key operations are paramount in shaping the culture. Leadership and organizational culture are inextricably intertwined. They are two sides of the same coin. Culture is a medium through which leadership travels and impacts organizational erformance. If leaders are to fulfil the challenges of the 21st century, they must first understand the dynamics of culture and their role as sculptors through behavioural and cognitive ways

MAP Inference in Probabilistic Answer Set Programs

Reasoning with uncertain data is a central task in artificial intelligence. In some cases, the goal is to find the most likely assignment to a subset of random variables, named query variables, while some other variables are observed. This task is called Maximum a Posteriori (MAP). When the set of query variables is the complement of the observed variables, the task goes under the name of Most Probable Explanation (MPE). In this paper, we introduce the definitions of cautious and brave MAP and MPE tasks in the context of Probabilistic Answer Set Programming under the credal semantics and provide an algorithm to solve them. Empirical results show that the brave version of both tasks is usually faster to compute. On the brave MPE task, the adoption of a state-of-the-art ASP solver makes the computation much faster than a naive approach based on the enumeration of all the worlds

Approximate Inference in Probabilistic Answer Set Programming for Statistical Probabilities

Type 1 statements were introduced by Halpern in 1990 with the goal to represent statistical information about a domain of interest. These are of the form ''x of the elements share the same property''. The recently proposed language PASTA (Probabilistic Answer set programming for STAtistical probabilities) extends Probabilistic Logic Programs under the Distribution Semantics and allows the definition of this type of statements. To perform exact inference, PASTA programs are converted into probabilistic answer set programs under the Credal Semantics. However, this algorithm is infeasible for scenarios when more than a few random variables are involved. Here, we propose several algorithms to perform both conditional and unconditional approximate inference in PASTA programs and test them on different benchmarks. The results show that approximate algorithms scale to hundreds of variables and thus can manage real world domains

Moving a step forward to promote patient safety and quality of care in Europe

Improving safety and quality of care has always been at the heart of national, European and international policies. The premises of such concern have their roots in the times of the Greek physician Hippocrates of Cos, about the 4th century BC, with the directive primum non nocere (“first do no harm”). [...

Italian contribution to University Autonomy in Kazakhstan: the Erasmus+ project “Transition to University Autonomy in Kazakhstan” (TRUNAK)

University autonomy is the capacity of universities to be self-governin

Influenza vaccination coverage among medical residents: An Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P < 0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future. © 2014 Landes Bioscience

Capturing the chance for pneumococcal vaccination in the hospital setting

Introduction: Because of the relevant burden of pneumococcal diseases, people at risk and elderly are recommended vaccination but coverage is still low because of problems in catching them. This study evaluates the proportion of eligible patients in the hospital in the view of assessing its potential role in vaccination campaigns.Methods: this is a retrospective analysis of discharge data from all patients over 49 years of age admitted between 2011 and 2013 to ‘A. Gemelli’ teaching hospital. Eligibility for pneumococcal vaccination was evaluated based on ICD-9 codes.Results: among 65,047 unique patients, 53.2% were eligible for pneumococcal vaccination. Most common eligibility criteria were chronic heart diseases, cancer and diabetes. Considering also age ≥ 65 as an indication to vaccination, the proportion of eligible patients reached 76.8%. In absolute terms the most of eligible patients were seen in medical sciences, general surgery, cardiovascular medicine and neurosciences departments.Conclusions: the proportion of patients eligible to vaccination is high in the hospital and the latter may play an important role in catching them

Hospital efficiency: How to spend less maintaining quality?

INTRODUCTION: The recent global economic crisis is pushing governments worldwide to obtain a more explicit and urgent rationing of resources. The purpose of this study is to provide, through Data Envelopment Analysis (DEA), a methodological framework useful for investigating technical efficiency of hospital care.METHODS: To validate such framework, we compared 50 Italian public hospital trusts (AOs) to identify relative efficient using inputs and outputs from national databases. We also evaluated if, and how, efficiency is affected by various exogenous factors.RESULTS: On average, Italian AOs had an efficiency score of 77% (SD 0.12). Tobit regression model identified a positive association between efficiency and a lower case-mix index, being in the north of the country, in a region with fiscal autonomy, with a higher public and a lower private expenditure on health as % of GDP.CONCLUSIONS: DEA may provide useful and especially objective information regarding the technical efficiency of hospital care and support hospital management and policy makers decisions

Eating episode frequency and fruit and vegetable consumption among Italian university students

Objective: To analyze breakfast consumption, regularity of meals, fruit and vegetable consumption in the Italian University Student population on a national level.Design: Descriptive analysis evaluating data taken from the “Sportello Salute Giovani” questionnaire.Participants: 12.000 university students who self-administered a confidential survey. 8292 questionnaires were analyzed.Variables measured: Age; sex; self-reported economic status; BMI; number of breakfast and portions of vegetables and portions of fruit usually consumed per week; number of eating episodes per day; intended weight loss.Analysis: Descriptive and logistic regression analyses were conducted. Gender and age differences were tested by Chi2 and Mann-Whitney tests.Results: 15.8% of males and 26.3% of females declared to consume at least one portion of fruit every day. Similar results were found for vegetable consumption. Age does not influence fruit or vegetables consumption, frequency of eating episodes or breakfast habit. Both a regular breakfast and a higher number of eating episodes are significantly associated both with a higher frequency of fruit and vegetables intake.Conclusions and implications: This study underlines the need to promote nutritional education campaigns to increase adherence to nutritional guidelines

Does Clinical Governance influence the quality of medical records?

Background. Clinical Governance (CG) is a validated framework for continuous quality improvement in health care settings. Quality medical records may reflect the quality of care delivered and are a viable tool to implement CG skills. Aim. Aim of this study is to investigate the correlation between the level of implementation of CG dimensions and the quality of medical records. Material and methods. A cross-sectional study was carried out in an Italian Teaching Hospital. CG implementation levels were quantified through a systematic methodology (OPTIGOV©). The overall quality of medical records was measured through a revised version of a National-validated scale. A multiple linear regression model was used to test the likely influence of all the variables constituting the OPTIGOV evaluation on the quality of medical records. 47 hospital wards and 1458 medical records were assessed. Results. A significant and positive association between the quality of medical records and the accountability score (β = 0.15; p &lt; 0.01) and the clinical audit score (b = 0.11; p = 0.02), was found. Conversely, the risk management score shown a negative and significant correlation (b = -0.17; p &lt; 0.01). This study confirms that CG plays a central role in driving quality improvement and advocates a systematic implementation of such an approach within healthcare organizations.