"Haematologic home care in Modena: an operating model involving hospital, community health services and fundraising organisation". Abstract presented at the 10th Congress of the Italian Association of Medical Oncology AIOM (Verona, 2008).
The 2005 National French Adverse Event Study: ENEIS. Anne Farge – Broyart. Presentation of the National Study of Adverse Events (Madrid, Ministry of Health and Consumer Affairs, 2006)
Aortic dissection after ramucirumab infusion dz 2019Davide Zenoni
The endothelial dysfunction associated with vascular endothelial
growth factor pathway inhibitors (VPIs) would seem
to be the most plausible explanation for such events:
it causes thromboembolic events and cardiovascular
complications.
"Clinical management of elderly patients with acute myeloid leukemia referred to the A.I.L. hematology home care service in Modena". Abstract presented at the 42nd Congress of the Italian Society of Hematology SIE (Milan, 2009).
"Use of palliative prognostic score (PaP-score) in terminally ill elderly patients with acute myeloid leukaemia referred to a domiciliary program of supportive and palliative care". Poster presented at the 10th Congress of the Italian Society of Experimental Hematology SIES (Bari, 2008).
"Home care for unfit elderly patients with myelodisplastic syndromes:an Italian single-center experience. "Poster presented at the 14th Congress of EHA (Berlin, 2009)".
The 2005 National French Adverse Event Study: ENEIS. Anne Farge – Broyart. Presentation of the National Study of Adverse Events (Madrid, Ministry of Health and Consumer Affairs, 2006)
Aortic dissection after ramucirumab infusion dz 2019Davide Zenoni
The endothelial dysfunction associated with vascular endothelial
growth factor pathway inhibitors (VPIs) would seem
to be the most plausible explanation for such events:
it causes thromboembolic events and cardiovascular
complications.
"Clinical management of elderly patients with acute myeloid leukemia referred to the A.I.L. hematology home care service in Modena". Abstract presented at the 42nd Congress of the Italian Society of Hematology SIE (Milan, 2009).
"Use of palliative prognostic score (PaP-score) in terminally ill elderly patients with acute myeloid leukaemia referred to a domiciliary program of supportive and palliative care". Poster presented at the 10th Congress of the Italian Society of Experimental Hematology SIES (Bari, 2008).
"Home care for unfit elderly patients with myelodisplastic syndromes:an Italian single-center experience. "Poster presented at the 14th Congress of EHA (Berlin, 2009)".
Personalised Medicine in European HospitalsEuroBioForum
HOPE, the European Hospital and Healthcare Federation
PwC’s Global Healthcare practice
(http://www.pwc.com/global-health
www.hope.be)
Hospitals and providers have a clear opportunity to adapt to the new healthcare paradigm and provide services that are targeted to the individual patient.
Presentazione a cura della Dottoressa Rosella Pasqualoni e del dottor Gregorio Reda - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
Hospital Medicine around the World- Taiwan ExperienceHung-Bin Tsai
This is the presentation by Dr. Hung-Bin Tsai to introduce the hospitalist program in National Taiwan University Hospital at International Hospital Medicine Forum of Hospital Medicine 2014.
A protocol for the management of breast cancer developed by the multidisciplinary oncology team at University of Nigeria Teaching Hospital, fully adapted to our environment
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Personalised Medicine in European HospitalsEuroBioForum
HOPE, the European Hospital and Healthcare Federation
PwC’s Global Healthcare practice
(http://www.pwc.com/global-health
www.hope.be)
Hospitals and providers have a clear opportunity to adapt to the new healthcare paradigm and provide services that are targeted to the individual patient.
Presentazione a cura della Dottoressa Rosella Pasqualoni e del dottor Gregorio Reda - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
Hospital Medicine around the World- Taiwan ExperienceHung-Bin Tsai
This is the presentation by Dr. Hung-Bin Tsai to introduce the hospitalist program in National Taiwan University Hospital at International Hospital Medicine Forum of Hospital Medicine 2014.
A protocol for the management of breast cancer developed by the multidisciplinary oncology team at University of Nigeria Teaching Hospital, fully adapted to our environment
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Colonic and anorectal physiology with surgical implications
AIOM 2008
1. session P Annals of Oncology
P26 SECOND-LINE TREATMENT FOR NON-SMALL-CELL LUNG P28 IMPROVING EFFICIENCY OF A MEDICAL ONCOLOGY IN-
CANCER: ARE THE COSTS AFFORDABLE? PATIENT UNIT
Bearz A, Vaccher E, Spina M, Lleshi A, Schioppa O, Giacalone A, Tirelli U Ucci G, Anghilieri M, Villa S, Plebani D, Ferraioli L, Colli A
CRO-IRCCS, Aviano UO Oncologia Medica, Dipartimento di Area Medica e Dipartimento Oncologico,
Azienda Ospedaliera di Lecco. Lecco – Italy
Introduction: Advanced non-small-cell lung cancer (NSCLC) is a major health
problem in Western countries. Overall about 20% of all patients affected by NSCLC Background: Most italian hospitals are organized to fullfill routine diagnostic and
receive second-line chemotherapy. Single agent Docetaxel and Pemetrexed, and the clinical requirements only during week days. This limitation is not usually taken into
tyrosine kinase inhibitor Erlotinib are approved as second-line treatment options by account for admission of elective cases and often patients stay in hospital on the week-
Regulatory Agency in Italy. Moreover, expensive new compounds will be upcoming end waiting for completion of diagnostic/therapeutic procedures. This report
available, in first or further-line setting. summarizes the experience of the medical oncology (MO) of the Lecco Hospital with
We analyzed the costs related to second-line chemotherapy in NSCLC patients treated a flexible organization of admission and discharge of elective cases.
in the context of the Italian health system. Methods: From January to December 2007, in-patient elective and emergent cases were
Patients and Methods: We evaluated the costs as if sustained in Aviano, North-Eastern allowed to reach a total occupancy of 16 beds from Monday to Friday, while only 12
Italy, for a patient with NSCLC in second-line treatment for the three available drugs patients were allowed on the week-end. Oncologic emergencies on the week-end were
respectively. Considering a patient with an average body-surface area of 1.8 m2, we admitted either by MO unit or, temporarily, by the Internal Medicine unit. Patients
compared the costs among the three treatments; Pemetrexed and Docetaxel are usually needs were discussed before admission and diagnostic and therapeutic procedures were
administered in the outpatient setting. strictly programmed; special emphasis was given to agree appropriate protocols for
Results: The table shows the costs in Euro (C) per month of treatment for the three
= patients discharge with house doctors and home care services in order to reassure
available drugs in second-line treatment for NSCLC. patients and their families and ensure continuation of treatment or follow-up within or
outside the hospital. The experimental period was compared to the same period of
2006, when no action was taken in order to allow for the reduced hospital activity on
Docetaxel Pemetrexed Erlotinib the week-end and 16 in-patients were eventually allowed for the whole week.
Drug cost (1 month) 945 2250 1730 (865) Results: Results are summarized in the table below:
Antiemetics 2.50 2.50 À
Chemotherapy daycare Mean pts Total nr. Total Mean duration Mean Total
Nursing 10.7 0.70 À allowed/ of pts days of of admission DRG turnover
Physician 9 9 9 day managed in-patients (days) weight (Eurox1000)
Complication costs
Hospitalization 448 156 À 2006 15,2 781 5468 7,85 1,214 2.463
G-CSF 26 4.20 À 2007 14,8 839 5059 7,01 1,216 2.529
Total 1440.70 2422.40 1730 (865) % À3 +7,4 À7,5 À11 +0,2 +2,6
*In Italy there is an agreement between the pharmaceutical company (Roche), and the
Government for the reimbursement of half the costs of Erlotinib for the first two In addition, a total of 40 nursing hours per week were saved for other offices.
months of treatment only (shown in brackets). Conclusions: Flexible admission and discharge of elective cases to the inpatient ward of
Conclusion: It is difficult to believe that a public health system may afford such a MO unit may improve efficiency and save costs. A motivated staff and compliant
expensive treatments. The costs related to second-line treatment for NSCLC may not territorial services are important.
be affordable, due to the high incidence of NSCLC and the palliative role of those
treatments. In a population of cancer patients with poor prognosis, cost-utility
analyses, or the inclusion of quality indicators in the calculation of costs, would be P29 AN AUDIT OF NON-URGENT ATTENDANCES OF CANCER
important to a better understanding of costs and benefits. PATIENTS (PTS) TO THE EMERGENCY DEPARTMENT (ED) OF A
DISTRICT GENERAL HOSPITAL IN NORTH-EASTERN ITALY
P27 HAEMATOLOGIC HOME CARE IN MODENA: AN OPERATING
MODEL INVOLVING HOSPITAL, COMMUNITY HEALTH SERVICES Follador A1, Fanzutti M2, Adami G2, Merlo V1, Rijavec E1, Belvedere O3,
AND FUNDRAISING ORGANISATION Rizzato S1, Pertoldi F4, Piga A1
1
Dipartimento di Oncologia Azienda Ospedaliero - Universitaria di Udine, Italy;
2
Alfieri Pierluigi, Favale Enzo Day Hospital Oncologico - Dipartimento di Medicina, Ospedale San Daniele del
Servizio di assistenza domiciliare ematologica AIL Modena ONLUS - Divisione di Friuli (Ud), Italy; 3Leeds Institute of Molecular Medicine, St. James’s University
Ematologia - Policlinico di Modena Hospital Leeds, UK; 4Dipartimento di Emergenza Ospedale San Daniele del Friuli
(Ud), Italy
Home care has achieved a relevant role in the global management of cancer patients
improving quality of life and reducing health care costs. In the last decade many efforts Background: Many pts with cancer present to ED at some point during their disease.
have also been made in order to assist patients with blood malignancies who are fragile, Management of non-urgent problems at ED may not be optimal for these pts with
such as elderly and not-self sufficient people, irrespective of disease phase (terminal, estabilished diagnosis of cancer. We report an audit of non-urgent attendances of
chronic, advanced). cancer pts to the ED of San Daniele del Friuli District Hospital in North-Eastern Italy
Here we describe our experience in Modena, where a haematologic home care service is that serves a population of around 50,000 and has a 5-day oncology day unit but not an
active on the basis of a protocol agreed in 1998 by university hospital division inpatient facility.
(Policlinico), community health system (ASL) and the fundraising organisation A.I.L. Methods: To identify non-urgent attendances of cancer pts between January 2004 and
(Italian Association against Leukaemia-Lymphoma-Myeloma). December 2006, we retrospectively searched the ED electronic medical record database
Eligibility criteria are: diagnosis of blood malignancy, age > 18, poor performance using the precoded search strings: ‘‘white code’’ (defined by the Italian 4-level triage
status, distance from university hospital < 15 km, availability of a care-giver, scale as ‘‘non-urgent cases’’), ‘‘common medical problems’’ and ‘‘cancer related
appropriate home logistics. According to the Emilia-Romagna model for integrated problems’’.
domiciliary assistance (ADI) home care team is composed by general practitioner Results: Overall, 315 attendances were identified, accounting for 0.4% of all ED
(therapeutic responsible), community nurses, consultant haematologist and, when attendances. Pts characteristics: M/F 51/49%, median age 71 yrs (range 31-98). Most
needed, by other specialists, psychologist and social assistant. frequent malignancies included gastrointestinal (17%), lung (15%), genitourinary
In the period July 1999 – March 2008 344 patients (median age=75) have been referred (13%), breast (11%) and hepatobiliary/pancreatic (10%) cancers. In all, 74% of pts
to this service (non-Hodgkin’s lymphoma=89, multiple myeloma=65, acute myeloid were judged by ED physicians as having advanced disease. Most frequent symptoms/
leukaemia=56, myelodisplastic syndrome and other anaemias=45, chronic signs included pain (31%); cachexia (31%); gastrointestinal symptoms (20%);
myeloproliferative disorders including chronic myeloid leukaemia=41, chronic respiratory problems (15%); neurological problems (15%); fever (11%); edema/ascites
lymphocytic leukaemia=25, acute lymphocytic leukaemia=11, Hodgkin’s (11%); asthenia (11%); anemia (5%). Most attendances were between 8 am and 8 pm
lymphoma=8, autoimmune thrombocytopenia=4). (78%). While 30% were referred by their general practitioner, 70% of pts self-
Main activity indicators are here reported: median duration of assistance = 190 days; presented. Management/investigation during ED attendance included blood tests
median frequency of haematologist’s visits = 1 every 8 days; total number of blood and (41%); ECG (38%); radiology (30%); 45% received drug therapy and 19% were
platelet transfusions = 2030; median number of hospital admissions = 0.95 per patient; referred for a specialist opinion. Most pts were admitted to hospital, either in the
percentage of patients died at home = 38%. Medical (62%) or Surgical Departments (4%). A further 7% of pts were kept under
This valid integration between hospital and community services is possible thanks to an observation in the ED observation area, 25% were discharged.
efficient operating model, an effective clinical approach and a convenient use of means Conclusion: This audit shows that attendance of cancer pts with non-urgent
and resources. The role of no-profit organisations like A.I.L. is essential to sustain these complaints is not a significant burden on ED. Future prospective studies might help to
programs until a full recognition comes from public health services. identify reasons for the use of ED and to improve medical care sources.
ix124 | session P: organization and pharmacoeconomic aspects, patient care and elderly Volume 19 | Supplement 9 | October 2008