Massimiliano Panella

• University of Piemonte Orientale Amedeo Avogadro

Background: Seasonal influenza currently remains a major public health concern for the community and, in particular, the health care worker (HCW). According to the World Health Organization, HCWs are among the high-risk categories for which vaccination is recommended, due to the derived absenteeism, productivity loss, and high probability of transm...

Introduction/Aim: Type 1 Diabetes (T1D) challenges glycemic control, with sleep dis-turbances affecting insulin sensitivity and glucose variability. This study aims to assess sleep quality in T1D patients and its impact on glycemic outcomes, particularly at bed-time. Methods: This retrospective observational study, conducted at an Italian clinical...

Background The second victim (SV) experience limits the performance of health and care workers and places patients at risk. Peer support is recognised as the most effective, feasible and acceptable intervention to mitigate its impact. Objective To define a set of success factors when designing interventions to support SVs in health and care facili...

Background. Worldwide population is ageing rapidly. Lifestyle factors are essential targets for leading to behaviour change interventions that promote healthy aging. Study design. We performed a scoping review aimed to underline the current knowledge and experience on preventive interventions for healthy and active ageing in Italy. Secondly, it int...

Background The impact of a patient safety incident (PSI) on nurses and doctors in hospital settings has been studied in depth. However, the impact of a PSI on general practitioners and how those health care professionals can be supported are less clear. Objectives The objective of this study is to investigate the prevalence of GPs (in training) be...

Patient safety in psychiatric inpatient facilities remains under-researched despite its crucial importance. This study aims to address this gap by using expert opinion to estimate the frequency of diverse patient safety incidents (PSIs) in psychiatric settings and to compare it with the existing literature. Utilizing a seven-step approach, a questi...

Background The second victim phenomenon refers to the emotional trauma healthcare professionals experience following adverse events (AEs) in patient care, which can compromise their ability to provide safe care. This issue has significant implications for patient safety, with AEs leading to substantial human and economic costs. Analysis Current ev...

The second victim phenomenon (SVP) refers to workers negatively impacted by involvement in unanticipated adverse events or errors. While this phenomenon has been extensively studied in healthcare since its acknowledgment over 20 years ago, its presence and management in other high-risk industries have remained unclear. We conducted a scoping review...

Global warming poses a significant threat to our planet, with the food sector contributing up to 37% of total greenhouse gas emissions. This study aimed to assess the climate change impact and healthiness of menus in a long-term care facility in Italy. We analyzed two 28-day cyclical menus using the carbon footprint (CF) and the Modified EAT-Lancet...

Background: Even if robotic assisted total knee arthroplasty (RATKA) is a widely used technique, there is still a gap of knowledge about whether this technology is effective in improving the patient utility. This measure is of paramount importance for conducting cost effectiveness analysis. The aim of this study was to compare the utility measure d...

Objective It has recently been highlighted how a short healthy life-style program (LSP) can improve the functional outcomes of older people admitted to a Long-Term Care (LTC) facility. Although it is known that life-style medicine-based interventions can exert anti-aging effects through the modulation of oxidative stress and mitochondrial function,...

Even though Family and Community Nurses (FCNs) were introduced into the Italian healthcare system in 2000, to date, there is a substantial knowledge gap regarding the implementation of these professional figures within the Primary Care (PC) system. This scoping review aims to provide a comprehensive picture of the role of FCNs in managing older adu...

In healthcare, improvement leaders have been inspired by the frameworks from industry which have been adapted into control systems and certifications to improve quality of care for people. To address the challenge to regain trust in healthcare design and delivery, we propose a conceptual framework, i.e. the “House of Trust”. This House brings toget...

Purpose: Lifestyle medicine interventions combining physical, nutritional, and psychological components have been found effective in general older population. However, evidence from the long-term care (LTC) is scarce. Methods: We conducted a pragmatic, two-arm, parallel group, superiority randomized controlled trial. Residents living in a LTC faci...

According to many national legislations, biological agents represent an occupational hazard that must be managed in order to ensure safety at workplace. Bioaerosols have been associated to many pathological conditions but, despite many efforts, precise threshold limit values (TLV) are still undefined. We planned and conducted an environmental study...

Background Insights around second victims (SV) and patient safety has been growing over time. An overview of the available evidence is lacking. This review aims to describe (i) the impact a patient safety incident can have and (ii) how healthcare professionals can be supported in the aftermath of a patient safety incident. Methods A literature sea...

Review questions • What are the original studies that contribute to the variability of antipsychotic prescribing in LTCFs in older populations? • Which factors contribute to variabilities in antipsychotic prescription in LTCFs, such as prescribing patterns and practices, patient characteristics, geographic locations and policies, facility-level fa...

Background Pandemics such as COVID-19 pose threats to the physical safety of healthcare workers and students. They can have traumatic experiences affecting their personal and professional life. Increasing rates of burnout, substance abuse, depression, and suicide among healthcare workers have already been identified, thus making mental health and p...

Patient safety is high on the policy agenda internationally. Learning from safety incidents is a core component in achieving the important goal of increasing patient safety. This study explores the legal frameworks in the countries to promote reporting, disclosure, and supporting healthcare professionals (HCPs) involved in safety incidents. A cross...

Background: IntraUterine Growth Restriction (IUGR) is a global public health concern and has major implications for neonatal health. The early diagnosis of this condition is crucial for obtaining positive outcomes for the newborn. In recent years Artificial intelligence (AI) and machine learning (ML) techniques are being used to identify risk fact...

Background We performed a secondary exploratory cluster analysis on the data collected from the validation phase of the study leading to the development of the model care pathway (CP) for Myasthenia Gravis (MG), in which a panel of 85 international experts were asked some characteristics about themselves and their opinion about the model CP. Our ai...

Over the last decades, different quadrivalent antimeningococcal vaccine formulations (diphteria toxoid conjugate, MenACWY-D; tetanus toxoid conjugate, MenACWY-TT; CRM 197 protein conjugate, MenACWY-CRM) have been developed. However, their availability varies, both in terms of authorized formulations and of inclusion in vaccination schedules. Furthe...

Background: seasonal influenza in nursing homes is a major public health concern, since in EU 43,000 long term care (LTC) facilities host an estimated 2.9 million elderly residents. Despite specific vaccination campaigns, many outbreaks in such institutions are occasionally reported. We explored the dynamics of seasonal influenza starting from rea...

The concept of second victims (SV) was introduced 20 years ago to draw attention to healthcare professionals involved in patient safety incidents. The objective of this paper is to advance the theoretical conceptualization and to develop a common definition. A literature search was performed in Medline, EMBASE and CINAHL (October 2010 to November 2...

Background: Almost half of antimicrobial prescriptions in long-term care facilities (LTCFs) is inappropriate. This broad use might represent a strong contributor to antimicrobial resistance in these facilities. This study aimed to assess antibiotic use patterns and potential associated factors with a survey of LTCFs in the local health authority (...

Background: The term second victim (SV) describes healthcare professionals who remain traumatized after being involved in a patient safety incident (PSI). They can experience various emotional, psychological, and physical symptoms. The phenomenon is quite common; it has been estimated that half of hospital workers will be an SV at least once in th...

Despite long-term care (LTC) workers having been identified as particularly subject to chronic stress, only a few studies evaluated the impact of the COVID-19 pandemic on stress in this population. As far as the authors know, no studies have investigated the relationship between work-related stress and chronic stress in the LTC setting. This retros...

The COVID-19 pandemic led to the implementation of interventions to provide emotional and psychological support to healthcare workers in many countries. This ecological study aims to describe the strategies implemented in different countries to support healthcare professionals during the outbreak. Data were collected through an online survey about...

PURPOSE Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice...

The use of robotic-assisted rehabilitation has increased significantly. Compared with traditional care, robotic rehabilitation has several potential advantages. Platform-based robotic rehabilitation can help patients recover from musculoskeletal and neurological conditions. Evidence on how platform-based robotic technologies can positively impact o...

Background Patient safety is a priority worldwide. When things go wrong in the provision of patient care, the healthcare professionals involved can be psychologically affected (second victims, SVs). Recently, different initiatives have been launched to address this phenomenon. Aim To identify through the ERNST Pan-European Consortium the current s...

During the last ten years the use of robotic-assisted rehabilitation has increased significantly. Compared with traditional care, robotic rehabilitation has several potential advantages. Platform-based robotic rehabilitation can help patients recover from musculoskeletal and neurological conditions. Evidence on how platform-based robotic technologi...

Objectives: This study aimed to describe the differences and similarities in the reaction of the healthcare worker involved in a patient safety incident or during the COVID-19 pandemic. We also compared the differences in support they need. Methods: A secondary data analysis was performed based on 2 cross-sectional survey studies. One study eval...

Objectives: to investigate lifestyle, health-related behaviours, and nutritional knowledge among a sample of Italian university students and to identify social determinants of - and barriers to - healthier lifestyles. Design: cross-sectional observational study. Setting and participants: students attending degree courses in health professions...

Background/Aims: It is widely known that the imbalance between reactive oxygen species (ROS)/antioxidants and mitochondrial function could play a pivotal role in aging and in the physiopathology of viral infections. Here, we correlated the plasma oxidants/antioxidants levels of the elderly admitted to a long-term care (LTC) unit with clinical data...

Myasthenia Gravis (MG) is a chronic, life-lasting condition that requires high coordination among different professionals and disciplines. The diagnosis of MG is often delayed and sometimes misdiagnosed. The goal of the care pathway (CP) is to add value to healthcare reducing unnecessary variations. The quality of the care received by patients affe...

Blood cancer patients face a relative risk of VTE 28fold higher than the general population. Nevertheless, they also face a significantly higher risk of bleeding than overall cancer patients, thus prevention of VTE is not systematically implemented in this population. A more detailed estimation of VTE risk might support personalized primary prevent...

Newly diagnosed multiple myeloma (MM) who are transplant ineligible (NTE NDMM) are usually treated with multiple-drug combinations including proteasome inhibitors, immunomodulatory drugs and alkylating agents. Recently approved combo therapies including anti-CD38 monoclonal agents and/or lenalidomide improve progression-free survival (PFS) as compa...

Several risk factors are involved in the pathogenesis of venous thromboembolism (VTE) in patients affected by cancer, these include cancer type, central venous catheters placement, chemotherapy, radiotherapy, immunomodulatory drugs. The management of VTE may be quite complex in patients with cancer, this is mainly due to an increased risk of recurr...

Purpose: Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practi...

In ancient civilizations, poor quality was dealt with according to the principle of “an eye for an eye.” In the modern era we have learned from industry what quality really is. Quality includes standards, protocols, system thinking, and an understanding of variation to ensure good outcomes. In the post-COVID era, quality is not all about predefined...

Introduction: Compared to old people who live at home, depressive symptoms are more prevalent in those who live in long-term care facilities (LTCFs). Different kinds of non-pharmacological treatment approaches in LTCFs have been studied, including behavioral and cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief p...

Background There is evidence that the efficiency and effectiveness of care processes can be improved in all countries. Care pathways (CPs) are proposed as a method to improve the quality of care by reducing variation. During the last decades, CPs have been intensively used in practice. The objective of this study is to examine the study designs for...

Artificial Intelligence (AI) and Machine Learning (ML) have expanded their utilization in different fields of medicine. During the SARS-CoV-2 outbreak, AI and ML were also applied for the evaluation and/or implementation of public health interventions aimed to flatten the epidemiological curve.

Artificial Intelligence (AI) and Machine Learning (ML) have expanded their utilization in different fields of medicine. During the SARS-CoV-2 outbreak, AI and ML were also applied for the evaluation and/or implementation of public health interventions aimed to flatten the epidemiological curve. This systematic review aims to evaluate the effectiven...

Workforce aging is becoming a significant public health problem due to the resulting emergence of age-related diseases, such as osteoporosis. The prevention and early detection of osteoporosis is important to avoid bone fractures and their socio-economic burden. The aim of this study is to evaluate the sustainability of a screening workplace progra...

Colorectal cancer care can be standardized by using enhanced recovery protocols. However, adherence to these protocols varies. Using Medical Research Council (MRC) guidance on process evaluations, we examined the experience of health care professionals in the implementation of a care pathway for colorectal surgery, by describing the intervention, c...

This chapter aims to highlight recent advances about the role of natural products usually taken as micronutrients in preventing cutaneous aging. At the basis of skin aging, there would be either intrinsic or extrinsic factors, among which the UV radiation, which is the primary cause of extrinsic skin aging widely known as “photoaging.” In the last...

Objective Understanding how small unexpected acts or gestures by healthcare professionals, known as Mangomoments, are translated into practice, what their preconditions are and what their impact is on patients and families, healthcare professionals and organisations. Design A multi-method design was used based on four phases: (1) A (media)campaign...

Adherence to evidence-based recommendations is variable and generally low. This is also followed in colorectal surgery, despite the availability of the ERAS® protocol. The aim of the study was to evaluate the effect of implementing a care pathway for perioperative care in colorectal cancer surgery on outcomes and protocol adherence. So, we performe...

This study evaluates whether the implementation of an in-hospital care pathway (CP) improves interprofessional teamwork across countries and tests whether improved communications (“relational coordination”) is the mechanism of action. A hospital-based cluster randomized controlled trial in Ireland, Belgium, Italy, and Portugal was performed. Fifty-...

Objectives To describe healthcare providers’ symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the incident. Design Cross-sectional survey. Setting 32 Dutch hospitals that participate in the ‘Peer Support Collaborative’. Participants 4369 healthcare pr...

Introduction: Care pathways are tools to coordinate and integrate care. All care pathways consist of multiple interventions. Adherence to these interventions is sometimes difficult in practice, leading to variation and underuse of care. This leaves room for improvement. An Important-Performance-Analysis (IPA) helps to set the improvement priorities...

The Smart Star model is a five stars rating system able to evaluate the quality of the care in nursing home for elderly. We tested the model in a sample of 16 nursing home in Italy. The Smart Star model showed to be effective in evaluating the performance of the nursing homes in a multidimensional perspective. The major strengthens of the model con...

Objectives: To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction -(STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. Methods: A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. O...

Objective: To evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care. Design: A multicenter pre-post intervention study. Setting: Eleven acute hospitals. Participants: Cardiologists-in-chief, nurse managers, quality staff, quality managers and program managers rep...

Introduction: Clinical Networks are complex interventions that enable healthcare professionals from various disciplines to work in a coordinated manner in the context of multiple care settings, to provide a high quality response to a specific disease. The aim of this study was to evaluate if clinical networks are able to improve effectiveness, eff...

IntroductionDespite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance–performance analysis for prioritizing interventions to improve the in-hospital management of these patients. Materials and methodsA seconda...

Background and aim: Care pathways are complex interventions, consisting of multiple 'active ingredients', to structure care processes around patient needs. Numerous studies have reported improved outcomes after implementation of care pathways. The structure-process-outcome framework and the context-mechanism-outcome framework both suggest that out...

Background: Adherence to guidelines for patients with proximal femur fracture is suboptimal. Objective: To evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes. Design: The European Quality of Care Pathways study is a cluster randomized con...

This study aimed to increase our understanding of processes that underlie the effect of care pathway implementation on reduced 30-day readmission rate. Adherence to evidence-based recommendations, teamwork and burnout have previously been identified as potential mechanisms in this association. We conducted a secondary data analysis of 257 patients...

Background: A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes...

Objective: Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. Methods and Results: A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of card...

Purpose: Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in pra...

An increased need for efficiency and effectiveness in today’s healthcare system urges professionals to improve the organization of care. Care pathways are an important tool to achieve this. The overall aim of this study was to analyze if care pathways lead to better organization of care processes. For this, the Care Process Self-Evaluation tool (CP...

Objective To identify the prevalence of the practice of defensive medicine among Italian hospital physicians, its costs and the reasons for practising defensive medicine and possible solutions to reduce the practice of defensive medicine. Methods Cross-sectional web survey. Main outcome measures Number of physicians reporting having engaged in an...

Rationale, aims, and objectives: During the last decades, perioperative care for patients with colorectal cancer has shifted towards more standardized care, so-called "enhanced recovery after surgery." Those programs aim to optimize interventions in perioperative care to decrease the rate of postoperative complications, improve patients' recovery,...

Actinic keratoses (AK) are intraepithelial skin neoplasms constituted by atypical proliferation of keratinocytes. They develop in photoexposed skin areas; they are considered cutaneous markers of chronic exposure to sunlight. The AK is the most common dysplastic lesions in humans, its incidence is increasing worldwide and is a common condition in t...

Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbatio...

Le istituzioni e i responsabili delle organizzazioni sanitarie dovrebbero comprendere che il fenomeno ”seconda vittima” è rilevante ed attivare reti di supporto per minimizzare i danni sia per gli operatori sanitari sia per l’organizzazione stessa. L’argomento richiede sforzi futuri di ricerca per essere approfondito.

The aim of this observational descriptive study was to identify the main international models evaluating the quality of nursing homes for non self-sufficient elderly persons, and to apply them in the Italian health system. Firstly, a bibliographic search of institutional websites and Pubmed-Medline was performed to identify the main international m...

Objective To examine individual, situational and organisational aspects that influence psychological impact and recovery of a patient safety incident on physicians, nurses and midwives. Design Cross-sectional, retrospective surveys of physicians, midwives and nurses. Setting 33 Belgian hospitals. Participants 913 clinicians (186 physicians, 682...

A second victim was defined as “a healthcare worker involved in an unanticipated adverse patient event, in a medical error and/or a patient related-injury who become victimized in the sense that the worker is traumatized by the event. The goal of this research was to study the “second victims” phenomenon in Italy. 50 interviews were conducted with...

Introduction: Defensive Medicine (DM) affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. The role of other possible determinants remains mostly unclear. Objective: to assess the prevalence of the practice of DM among Italian hospital physicians, its cost...

This population-based case-control study investigated the association between farming (a proxy for pesticide exposure) and cancer in the Vercelli suburban area (NW Italy). The residents, aged 25 to 79 years, in the above-mentioned area during the period 2002-2009 were considered. Cases were all the first hospital admissions for cancer. Controls wer...

Clinical practice variation and the subsequent burden on health care quality has been documented for patients with ST-elevated myocardial infarction (STEMI). Reduction of clinical practice variation is possible by increasing guideline adherence. Care pathway documents can increase guideline adherence by implementing evidence-based key interventions...

Special attention is now placed in the diagnosis of congenital malformations, MC, and several recent studies attest to the role of indicators of injury is inherent is extrinsic to the environmental component. In the Vercelli area recognize different sources of environmental pressure can result in damage potential direct and indirect effects on comm...

Introduction: After an adverse event, not only patients and family members but also health-care professionals involved in the event become victims. More than 50% of all health-care professionals suffer emotionally and professionally after being involved in an adverse event. Support is needed for these "second victims" to prevent a further negative...

"Second victims" are health care providers who remain traumatized and suffer at the psycho-physical level after being involved in a patient adverse event. A systematic review of the literature was conducted to: a) estimate the prevalence of second victims among healthcare workers, b) describe personal and work outcomes of second victims, c) identif...

Cluster randomized trials are increasingly being used in healthcare evaluation to show the effectiveness of a specific intervention. Care pathways (CPs) are becoming a popular tool to improve the quality of health-care services provided to heart failure patients. In order to perform a well-designed cluster randomized trial to demonstrate the effect...

The aim of this paper was to perform a systematic overview of secondary literature studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO-host, and The Cochrane Library were searched. A total of six papers, corresponding to six secondary studies, were included but only four secondary stu...

Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care p...

The health systems of countries of the Former Soviet Union are all based on Semashko's system, which is no longer active since 1991 when the fall of communism occurred. Post-soviet states have tried to create new healthcare systems that maintain universal access to care. The goal of this descriptive study, conducted from August 2009 to June 2012, w...

The objectives of this study were to compare, in a standardized manner, survival of cancer patients residing in this area and to further verify the quality of baseline incidence and mortality data. The survival analysis presented here refers to cases of primary malignant tumors diagnosed for the first time from 2002 to 2004 and followed until 31 De...

CRD summary The review found that care pathways appeared to benefit patients with hip fracture, but the available evidence was too weak for formal recommendations, and more research was needed. The authors' cautious conclusion accurately reflects the inconclusive evidence presented. The overall reliability of the review is unclear due to limitation...

During the decade 2000–2010, the health-care system of the Abruzzo Region, Italy faced a financial crash and subsequent recovery. The extent of both was so large to be a case study, which may help addressing general questions including how much health-care supply can be influenced by cost-containment policies and how such strategies may impact on h...

The chronic care model (CCM) is a theoretical care model for chronic illnesses. The epistemological paradigm of CCM is represented by ‘proactive medicine’. This article aims at presenting the experimentation of some application areas of CCM at the ASL District ‘VC’ of Vercelli, Region Piedmont, with a view to measuring and finding their possible de...

BackgroundOptimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinica...