Papers by Giulio Toccafondi
Clinical Chemistry and Laboratory Medicine (CCLM), 2019
Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antib... more Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improvin...
European Heart Journal: Acute Cardiovascular Care, 2017
Background: Delirium is a frequent in-hospital complication in elderly patients, and is associate... more Background: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases. Methods: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months. Delirium was defined according to the confusion assessment method. Results: During the study period, 726 patients were screened for delirium. The mean age was 79.1±7.8 years. A total of 111 individuals (15.3%) were diagnosed with delirium; of them, 46 (41.4%) showed prevalent delirium (PD), while 65 (58.6%) developed incident delirium (ID). Patients 85 years or older showed a delirium rate o...
… in Computer-Assisted …, 2006
This paper presents the approach of La Piazza project, a study conducted in the framework of the ... more This paper presents the approach of La Piazza project, a study conducted in the framework of the Kalei-doscope Network of Excellence (IST-Technology Enhanced Learning), focusing ICT and intergenera-tional learning in public spaces (museums, community centres, civic ...
Citeseer
Filippo Fanò*, Emanuela Mazzone°, Giulio Toccafondi^, Silvia Torsi^ *Interaction Design Centre, U... more Filippo Fanò*, Emanuela Mazzone°, Giulio Toccafondi^, Silvia Torsi^ *Interaction Design Centre, University of Limerick °Child Computer Interaction Group, Department of Computing, University of Central Lancashire ^Dipartimento di Scienze della Comunicazione, ...
The profound implications of emotions in human cognition and learning disclose novel scenarios an... more The profound implications of emotions in human cognition and learning disclose novel scenarios and challenges in the rapidly evolving field of design for learning. Emotional data sets need to be taken into account not only for descriptive or analytical aims but also for underpinning the design process of learning environments. In the Interaction Design field (IxD) emotional data are considered fundamental both for complementing usability and user centred approaches and for unlocking designers' creativity. Within a design for learning approach we applied the methodological instruments used in interaction design for integrating the emotional data set collected form the research field during the design process of a learning activity. In this paper we present through a design example how emotional and qualitative data collected by way of observations and mood boards fostered the design process of a course aiming at orienting undergraduate students in choosing their future careers.
International Journal for Quality in Health Care
Background In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems... more Background In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. Methods The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery. Results This paper aims to illustrate how adopting a human factors and e...
International Journal for Quality in Health Care
Background The hospital discharge process plays a key role in patient care. Careggi Re-Engineered... more Background The hospital discharge process plays a key role in patient care. Careggi Re-Engineered Discharge (CaRED) aimed at establishing a meaningful relationship among general practitioners (GPs) and patients, throughout the discharge process. Objective The aim is to describe the activities and results in the period 2014–17 of the CaRED. Methods CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy for effective communication. A pre–post survey was launched to assess the GPs’ perceived quality, and patient and family satisfaction. Results A total of 1549 hospitalizations were included, respectively, 717 in the pre and 832 in the post-intervention period. The 30-day hospital readmission rate decreased significantly in the post-intervention period (14.4% v...
Proceedings of the 2005 annual conference on European association of cognitive ergonomics, Sep 29, 2005
ABSTRACT The PhD students working on the continuing education and training project (DiDà) propose... more ABSTRACT The PhD students working on the continuing education and training project (DiDà) propose a collaborative evaluation session on the QB (Question-Based) method as a technique to structure contents for educational processes in traditional educational ...
Italian Network for Safety in Healthcare (INSH), ISQua, 2021
Advances in Intelligent Systems and Computing, 2018
Care transitions are critical moments which may expose patients to adverse events and generate or... more Care transitions are critical moments which may expose patients to adverse events and generate organizational failures. Ineffective care transition processes lead to higher hospital readmission rates and costs and patients can be harmed when the many moving parts of their care process are not effectively coordinated.
Advances in Intelligent Systems and Computing, 2018
Epidemiological data from the literature are few for patient safety in pediatrics and there is a ... more Epidemiological data from the literature are few for patient safety in pediatrics and there is a need for comparing experiences and applied solutions in different contexts. A study published in 2012 underlined that the 79% of adverse events in children happened in intensive care unit, the incidence on admissions is of 6,5 and 44,7% of these adverse events are preventable. The promotion of patient safety in pediatrics requires also patient and family programs of information and education to increase awareness about risk factors and behaviors to prevent harms. The aim of project is to design a multidimensional approach to patient safety and to pilot three patient safety practices: preventing children’s falls through the use of the Modify Humpty Dumpty Fall Scale validated in Italian; the appropriate transition of care and the early evaluation of patient deterioration through the Pediatric Early Warning Score. All pilots have been realized by adopting a systemic approach with solutions...
Diagnosis, 2021
This is a first attempt to integrate the three pillars of infection management: the infection pre... more This is a first attempt to integrate the three pillars of infection management: the infection prevention and control (IPC), and surveillance (IPCS), antimicrobial stewardship (AMS), and rapid identification and management of sepsis (RIMS). The new ‘Sepsis-3’ definition extrapolates the diagnosis of sepsis from our previously slightly naïve concept of a stepwise evolving pattern. In doing so, however, we have placed the transition from infection toward sepsis in the domain of uncertainty and time-dependency. This now demands that clinical judgment be used in the risk stratification of patients with infection, and that pragmatic local solutions be used to prompt clinicians to evaluate formally for sepsis. We feel it is necessary to stimulate the development of a new generation of concepts and models aiming at embracing uncertainty. We see the opportunity for a heuristic approach focusing on the relevant clinical predictors at hand allowing to navigate the uncertainty of infection diag...
Journal of Patient Safety, 2020
Objectives Thirteen suspicious deaths occurred in an intensive care unit of Tuscany, Italy, in 20... more Objectives Thirteen suspicious deaths occurred in an intensive care unit of Tuscany, Italy, in 2015. All patients developed sudden unexplained coagulopathy leading to severe bleeding. None of them had been prescribed heparin, but supertherapeutic concentrations of heparin were found. After a nurse was arrested on suspicion of murdering Human Factor and Ergonomics (HF/E) experts received a mandate to identify system failures. According to the judgment of the Court of First Instance on April 2019, the nurse was found guilty. Methods The HF/E group used a two-pronged safety analysis: understanding the conditions in which the healthcare practitioners were working in the period when the suspicious deaths emerged and reviewing the clinical records. Results Fourteen patients admitted to the intensive care unit in 2014 and 2015 were selected on the basis of markedly abnormal coagulation tests (n = 13) or a family member’s complaint (n = 1). In 13 cases, a massive, abrupt hemorrhage in the presence of an unexpected abnormality of coagulation tests occurred, whereas the fourteenth patient had the only prolongation of coagulation markers without bleeding. All cases examined classified as adverse events related to a coagulation disorder. Human factor and ergonomics analysis identified a number of latent and active failures that contributed to the event and provided a set of important recommendations for safety improvement. Conclusions When presented with a manifest, albeit suspected, wrongdoing with lethal consequences for patients, forensic investigators and safety investigators have distinctly different goals and methods. We believe that a memorandum of understanding between HF/E and forensic investigative teams provides an operative framework for allowing co-existence and fosters collaboration. The pursuit of safe care as a new emerging right for patients and balancing the right to legal justice with the right to safer healthcare merit further investigation and discussion.
Current Pharmaceutical Biotechnology, 2021
Background: Home Parenteral Nutrition (HPN) is a lifesaving clinical care process. However, undet... more Background: Home Parenteral Nutrition (HPN) is a lifesaving clinical care process. However, undetected hazards and vulnerabilities in care transitions from hospital to community care may pose risk to patient’s safety. Avoidable complications and adverse events may hinder the benefits of treatment. Objective: The analysis carried out aims at framing through Human Factors and Ergonomics (HF/E) the critical issues for patient safety related to clinical care practices for HPN in healthcare organization. Methods: We present the results of a proactive risk assessment analysis based on the FMEA methodology (Failure Mode and Effects Analysis) carried out in three different areas of the regional health care system of Tuscany, Italy. The clinical risk management and patient safety unit assessed the risk perception of Healthcare Workers (HWs) in regard to patient safety and situational awareness throughout the HPN patient journey. Results: The analysis revealed heterogeneity in the Risk Priori...
International Journal for Quality in Health Care, 2020
Several of the key organizational issues that we have had to face with the emergence of COVID-19 ... more Several of the key organizational issues that we have had to face with the emergence of COVID-19 crisis are related to human factors/ergonomics (HFE) and the safety culture. During the crisis the main activities of the healthcare services have been profoundly affected. Patient safety and risk management units have also experienced the need to adapt rapidly. What can we do as HFE experts, now that the scenario has completely changed? We contend that: (a) we can favour and support the heuristics that are applied to manage the load of psycho-cognitive stress. (b) We can observe, collect strategies and develop analytic schemes, thereby creating a memory of the organization for improvement in the future. (c) And we can support in educating and engaging the public. This crisis has forced the community of healthcare experts to broaden their reflections: for the future to come, our communities of experts in the field of risk management HF/E, quality and safety of care and public health shou...
Eurosurveillance, 2020
In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacteral... more In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.
Work, 2019
BACKGROUND: The International Ergonomics Association is a professional association for human fact... more BACKGROUND: The International Ergonomics Association is a professional association for human factors and ergonomics (HFE) professionals. Australia and New Zealand are two of 52 Federated Societies within the IEA. OBJECTIVE: This paper describes an Ergonomics and the Future World (EFW) workshop held at the IEA Triennial Congress in 2018 (IEA2018), and reports the findings of the Australia / New Zealand (Southern Cross) Cluster (SCC). METHODS: Four questions were developed by the IEA EFW committee to evaluate the ergonomics state-of-play in various world regions. Southern Cross delegates (N = 17) participated in a 90-minute workshop discussion at IEA2018 (45% participation rate for SCC delegates). A summary was presented during the IEA2018 closing ceremony and as a written report for the IEA. RESULTS: Three themes emerged from the SCC discussions: (i) the impact of technology advances on HFE professional practice;(ii) communication with internal and external stakeholders; and (iii) HFE education. CONCLUSIONS: The workshop findings are similar to issues raised at local discussions in Australia and New Zealand over past decades and mirror comments and opinions published by authors in the HFE profession. They provide a benchmark for current SCC opinion and may provide direction for future discussion of these recurring issues.
Diagnosis, 2018
[no abstract available
Recenti progressi in medicina, 2018
Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorg... more Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies. This may result in important advancement in time-critical care pathways for septic patients. Nevertheless, RDTM are costly and if not rationally positioned may consume resources and hinder the efficacy of AS programs. In this regard, Tuscany Region is engaged in designing, through a systemic approach, an effective high-quality clin...
Journal of critical care, Jan 26, 2017
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Papers by Giulio Toccafondi