Liguria Region Of Italy Research Articles

Violence against healthcare workers during the phases of the COVID-19 Pandemic: a descriptive observational study from 2018 to 2023 in the metropolitan city of Genoa (North-Western Italy).

Violence against healthcare workers is an escalating public health concern, affecting the quality of care, and causing significant psychological and physical effects on healthcare professionals. This study analysed the trend in aggressions in healthcare settings in the pre-pandemic, pandemic, and post-pandemic periods. An observational descriptive study was conducted to analyse reports of violence against healthcare workers from January 2018 to June 2023 at a Local Health Authority "ASL3" in the Liguria region of Italy. The study considered variables such as the severity of aggression, professional category involved, and location of incident. Episodes of violence were classified according to severity by means of a colour-coded system. We used multinomial logistic regression to examine any associations between the pandemic phase and the various factors, while controlling for relevant variables. The number of reported aggressions rose from 48 in 2018 to 90 in 2022, with a partial count of 35 in the first half of 2023. The pandemic phase saw a rise in incidents classified as Green codes, which accounted for 58.3%, and a significant involvement of District Services. The post-pandemic phase showed a reversion to pre-pandemic levels but with an increase in Yellow codes (5.6%). Nurses were the most frequent victims, with figures ranging from 50.8% to 95.6% over the years. The Emergency Department and Psychiatric Services emerged as the most critical settings of aggressions, with incidents recorded in these areas constituting over half of the total number. However, an increase in violence was also recorded in district healthcare settings during the post-pandemic phase. There is an urgent need for comprehensive strategies for the prevention of violence in healthcare settings. The increasing trend in violence, especially during the pandemic, necessitates integrated approaches that encompass training, psychological support, security policies, and a strong organizational culture to promote safety and respect. Protecting healthcare workers is crucial to their wellbeing and the quality of healthcare delivery.

Tuberculosis Infection Control: Experiences and Considerations from a Web Based Tool Implementation.

Tuberculosis (TB) remains a significant global health challenge. Indeed, according to the World Health Organization (WHO), TB is classified as the second most common cause of death worldwide due to a single infectious agent in 2022, following COVID-19. To effectively manage tuberculosis patients, it is necessary to ensure accurate diagnosis, prompt treatment initiation, and vigilant monitoring of patients' progress. In 2017, the TB Ge network was implemented and launched in two primary hospitals within the Liguria Region in Italy, with the main purpose to manage tuberculosis infections. This system, organized as a web-based tool, simplifies the manual input of patient's data and therapies, while automating the integration of test results from hospitals' Laboratory Information Systems (LIS), without requiring human intervention. The goal of this paper is to highlight the outcomes achieved through the implementation of the TB Ge network in a period seriously affected by the COVID-19 pandemia and outline future directions. More specifically, the aim is to extend its adoption to all hospitals in the Liguria Region, thus improving the management of tuberculosis infections across healthcare facilities.

Incidence of Hospitalisation and Emergency Department Visits for Pneumococcal Disease in Children, Adolescents, and Adults in Liguria, Italy: A Retrospective Analysis from 2012-2018.

Streptococcus pneumoniae infection is responsible for significant morbidity and mortality, particularly in young children and older adults. The aim of this study was to investigate the incidence of hospitalisation and emergency department (ED) visits in relation to episodes of pneumococcal disease (PD) following the introduction of pneumococcal conjugate vaccines (PCVs) into the Liguria region of Italy. Between 2012 and 2018, episodes of all-cause pneumonia (80,152), pneumococcal-specific pneumonia (1254), unspecified pneumonia (66,293), acute otitis media (AOM; 17,040), and invasive PD (IPD; 1788) were identified from in-patient claims, ED and hospital discharge records, and the Liguria Chronic Condition Data Warehouse. In children < 15 years of age, pneumococcal pneumonia-related hospitalisations decreased from 35 to 13 per 100,000 person-years during the study period (p < 0.001); this decrease is potentially related to PCV use in children. All-cause pneumonia hospitalisations remained stable, whereas IPD hospitalisations increased and AOM hospitalisations decreased. In adults, hospitalisations for all-cause pneumonia increased from 5.00 to 7.50 per 1000 person-years (+50%; p < 0.001). Pneumococcal and unspecified pneumonia hospital admissions increased significantly during the study period, considerably affecting those ≥ 65 years of age. IPD hospitalisations varied across all age groups, but a significant change was not observed. Despite pneumococcal vaccination, substantial burden remains for PD in children and adults in Liguria, Italy.

COVID-19 vaccine-related Guillain-Barré syndrome in the Liguria region of Italy: A multicenter case series

Background and purposeGuillain-Barré-Syndrome (GBS) can follow COVID-19 vaccination, with clinical and paraclinical features still to be precisely assessed. We describe a cohort of patients who developed GBS after vaccination with different types of COVID-19 vaccines. MethodsPatients with post-COVID-19 vaccination GBS, admitted to the six hospitals that cover the whole Liguria Region, Northwestern Italy, from February 1st to October 30th 2021, were included. Clinical, demographic, and paraclinical data were retrospectively collected. ResultsAmong the 13 patients with post-COVID-19 vaccination GBS (9 males; mean age, 64 year), 5 were vaccinated with Oxford-AstraZeneca, 7 with Pfizer-BioNTech, and one with Moderna. Mean time between vaccination and GBS onset was 11.5 days. Ten patients developed GBS after the first vaccination dose, 3 after the second dose. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the predominant GBS variant, mainly characterized by sensory involvement. Bilateral seventh cranial nerve involvement followed AstraZeneca vaccination in two cases. Three patients presented treatment-related fluctuations, and 4 mild symptoms that delayed treatments and negatively affected prognosis. Prognosis was poor (GBS-disability score, ≥3) in 5/13 patients, with a disability rate of 3/13. ConclusionsOur findings confirm that most post-COVID-19 vaccination GBS belong to the AIDP subtype, and occur after the first vaccine dose. Treatment-related fluctuations, and diagnosis-delaying, mild symptoms at onset are clinical features that affect prognosis and deserve particular consideration.

Economic burden of pneumococcal disease in children in Liguria, Italy

ABSTRACT Vaccinations against Streptococcus pneumoniae are included in infant immunization programs globally. However, a substantial burden due to pneumococcal disease (PD) remains. This study aimed to estimate the cost of emergency department (ED) visits and hospitalizations associated with invasive pneumococcal disease, all-cause pneumonia, and acute otitis media in children <15 years of age in the Liguria region of Italy between 2012 and 2018. The retrospective cohort study used data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse, which contain information on hospital stays, outpatient visits, laboratory/imaging techniques, surgical procedures, and pharmaceutical prescriptions. Patients with one or more ED or inpatient claim for PD (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes) were included. Cost of ED visits and hospitalizations were estimated from the diagnosis-related group system and procedures performed in the ED. In Ligurian children <15 years of age during 2012–2018, the median annual number of hospitalizations plus ED visits due to PD was 4,009, and the median estimated annual cost was €3.6 million. All-cause pneumonia accounted for the majority of hospitalization costs during the study period. Number and costs of ED visits and hospitalizations increased from 2012 to 2018. Despite widespread infant immunization in Liguria, economic costs due to PD-associated ED visits and hospitalizations remained high in children 0–14 years of age.

Economic Burden of Pneumococcal Disease in Individuals Aged 15 Years and Older in the Liguria Region of Italy.

Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals ≥15 years of age in the Liguria region of Italy during 2012–2018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory/imaging procedures. A ≥30-day gap between two events defined a new episode, and patients with ≥1 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~€49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was €38,416,440 (per-capita cost: €26.78) and was €30,353,928 (per-capita cost: €20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.

The Prevalence of Multiple Sclerosis in Liguria region, Italy, using the capture–recapture method

Abstract Background In recent years, there has been a growing interest in developing methods based on health administrative databases to estimate prevalence of chronic diseases, hoping that this would lead to more precise and reliable estimates. The capture-recapture method can be used to improve the prevalence of a disease reducing the bias of case underestimation. Objective To assess the prevalence of multiple sclerosis (MS) in the Liguria region in Italy using routinely collected healthcare data. Methods Data from three sources collected in Liguria Health Authority (A.Li.Sa.) databases - hospital discharge records, drug-dispensing records, disease-specific payment exemptions from copayment to health care - and a capture-recapture method with log-linear models were used to estimate the prevalence of MS. The accuracy of the case-finding algorithm was tested using a sample of people residents in Liguria Region with a definite diagnosis of MS extracted from clinical records of Liguria AISM Rehabilitation Service as reference standard. Results The case-finding algorithm to capture people with MS from routinely collected healthcare data used in our study found an observed crude prevalence of MS in Liguria region on 31 December 2017, of 202.4 cases per 100,000 inhabitants (95% CI: 195.3-209.5). After linkage to clinical data, the algorithm showed a sensitivity of 82.7%, with 22.1% of MS cases undetected on capture-recapture models. Consequently, the capture-recapture method prevalence estimate of 259.7 per 100,000 inhabitants (95% CI: 251.7-267.8) suggest that this region constitutes a high-risk area for MS. Conclusions Our initial study of crude MS prevalence showed an overall regional prevalence of MS of 202.4 cases per 100,000, capture-recapture analysis would add another 20%, to those figures. This method could be considered a good alternative to the population-based study design for estimating the prevalence of MS. Key messages Studies based on routinely collected healthcare data could help estimate the prevalence of chronic disease. To reduce the bias of case underestimation, the capture–recapture method can be useful.

COVID-19-related and not related Guillain-Barré syndromes share the same management pitfalls during lock down: The experience of Liguria region in Italy

Recently, during the pandemic infection of the novel SARS-CoV-2, some cases of Guillan-Barré Syndrome (GBS) have been reported.The aim of this work is to report the natural history of patients with GBS, both COVID and not-COVID related, hospitalized in Liguria region, during lock down period, in order to assess clinical features of both groups and possible managements pitfalls due to pandemic emergency.Fifteen GBS patients were admitted to the Hospitals of Liguria, from February 15th to May 3rd 2020, six with SARS-CoV-2 infection and nine without infection.In COVID-19 related GBS five patients presented with classical GBS and one with variant. Two patients presented neurologic symptoms during or shortly after the viral syndrome, suggesting the pattern of a para-infectious profile. Multi-organ involvement, delay in the diagnosis, incomplete work up and start of therapy, were registered in 50% of cases with a GBS-Disability scale ≥4 at follow-up evaluation.In not-COVID-19 related GBS, main problem was diagnostic delay. In three patients the first neurological observation took place after a mean of 33,6 days. Moreover, five patients went to emergency room after an average of 30 days since the onset of neurological symptoms because of fear of contagion.In conclusion, not only SARS-CoV-2 infection can cause GBS, but it can also, due to effects of pandemic on the health organization, affect the outcome of patients with not COVID-19 related GBS.

A Machine Learning-Based Approach for Wildfire Susceptibility Mapping. The Case Study of the Liguria Region in Italy

Wildfire susceptibility maps display the spatial probability of an area to burn in the future, based solely on the intrinsic local proprieties of a site. Current studies in this field often rely on statistical models, often improved by expert knowledge for data retrieving and processing. In the last few years, machine learning algorithms have proven to be successful in this domain, thanks to their capability of learning from data through the modeling of hidden relationships. In the present study, authors introduce an approach based on random forests, allowing elaborating a wildfire susceptibility map for the Liguria region in Italy. This region is highly affected by wildfires due to the dense and heterogeneous vegetation, with more than 70% of its surface covered by forests, and due to the favorable climatic conditions. Susceptibility was assessed by considering the dataset of the mapped fire perimeters, spanning a 21-year period (1997–2017) and different geo-environmental predisposing factors (i.e., land cover, vegetation type, road network, altitude, and derivatives). One main objective was to compare different models in order to evaluate the effect of: (i) including or excluding the neighboring vegetation type as additional predisposing factors and (ii) using an increasing number of folds in the spatial-cross validation procedure. Susceptibility maps for the two fire seasons were finally elaborated and validated. Results highlighted the capacity of the proposed approach to identify areas that could be affected by wildfires in the near future, as well as its goodness in assessing the efficiency of fire-fighting activities.

Analysis of the streamflow extremes and long-term water balance in the Liguria region of Italy using a cloud-permitting grid spacing reanalysis dataset

Abstract. The characterization of the hydro-meteorological extremes, in terms of both rainfall and streamflow, and the estimation of long-term water balance indicators are essential issues for flood alert and water management services. In recent years, simulations carried out with meteorological models are becoming available at increasing spatial and temporal resolutions (both historical reanalysis and near-real-time hindcast studies); thus, these meteorological datasets can be used as input for distributed hydrological models to drive a long-period hydrological reanalysis. In this work we adopted a high-resolution (4 km spaced grid, 3-hourly) meteorological reanalysis dataset that covers Europe as a whole for the period between 1979 and 2008. This reanalysis dataset was used together with a rainfall downscaling algorithm and a rainfall bias correction (BC) technique in order to feed a continuous and distributed hydrological model. The resulting modeling chain allowed us to produce long time series of distributed hydrological variables for the Liguria region (northwestern Italy), which has been impacted by severe hydro-meteorological events. The available rain gauges were compared with the rainfall estimated by the dataset and then used to perform a bias correction in order to match the observed climatology. An analysis of the annual maxima discharges derived by simulated streamflow time series was carried out by comparing the latter with the observations (where available) or a regional statistical analysis (elsewhere). Eventually, an investigation of the long-term water balance was performed by comparing simulated runoff ratios (RRs) with the available observations. The study highlights the limits and the potential of the considered methodological approach in order to undertake a hydrological analysis in study areas mainly featured by small basins, thus allowing us to overcome the limits of observations which refer to specific locations and in some cases are not fully reliable.

Social impact of community projects in Mediterranean schools of architecture

Star system architect concept was promoted by the media and the society during the last decades. Image culture helped to it, where the most ?iconic? works and designs were continuously published. So many Universities saw how the number of students of Architecture was growing up and new Schools of Architecture arose. Recent economic crises in Europe and other countries helped to go back to an important question: what is the role of the architect within the society? It was an excellent opportunity to understand the Architectural education as the reflection of the society from a territorial and urban point of view. Community projects developed within the Architecture curricula helped to get a comprehensive high education levels, especially in the final years of the program. Transformative pedagogies applied to urban planning and architectural design courses bring up the social role of the architect to the students. Practical exercises are proposed, where the final result is even positive for an eventual social extrapolation. The paper presents us the community projects experiences related to urban design in two different Mediterranean schools of Architecture, one of them in Italy and the last two ones in Lebanon. In the first case the students were invited to reflect on improving the quality of life of the citizenship and the tourists visiting Liguria region in Italy. Proposals for joining efforts among the several municipalities and developing new territorial models are done. The second case study shows us two initiatives for the students, developing proposals for UNHABITAT program and municipalities in southern Lebanon and a proposal for regenerating river lines in Byblos, within the 100 resilient cities program powered by Rockefeller Foundation. Finally, the paper presents the new project is being developed currently by American University of Cyprus, about Arabahmet and Karamanzade sectors in Nicosia.

Neonatal emergency transport has played a key role in the regionalisation of perinatal care in the Liguria Region of Italy.

Neonatal emergency transport has played a key role in the regionalisation of perinatal care in the Liguria Region of Italy.

IT readiness in small firms

Purpose – The aim of the paper is to explore conceptually and empirically the application of the concept of IT readiness to small firms. Design/methodology/approach – The approach taken was a questionnaire administered to small manufacturing business owners in the Liguria region of Italy. Data were analysed using factor and cluster analysis. Findings – IT readiness concept appears valid with the emergence of three constructs: strategic vision; project management capability; and IT application infrastructure. The date analysis yielded four distinctive and varying profiles of small business owners. Research limitations/implications – This quantitative study exploring a cross section of small firms suggests antecedents to change have been ignored relative to IT adoption decisions. Practical implications – Provision of policy and support services requires a much more nuanced approach to small businesses. Originality/value – There are very few studies of IT readiness in the literature, making the paper original in its intent. The construction of the IT readiness concept appears robust when subjected to empirical testing and yields a number of specific small business profiles with respect to IT.

Molecular Characterization of the Asian Tiger Mosquito Aedes albopictus (Skuse) (Diptera: Culicidae) in Northern Italy

Polymorphism of the gene COI encoding cytochrome C oxidase subunit I and of the rRNA second internal transcribed spacer (ITS2) was measured in Aedes albopictus collected in three locations in Piedmont region and one location in Liguria region in Italy. According to our data, besides the middle part of the COI gene usually used for analysis, there are also SNPs in the 5′ half of the gene, which can provide additional information about the polymorphism of A. albopictus populations. Based on COI gene, three various mitochondrial haplotypes were identified in A. albopictus from four north Italian sampling sites. Different sources of introductions can be considered. The variability between COI sequences of the north Italian A. albopictus is 0.001 while the variability between them based on the pairwise analysis of ITS2 sequences is 10 time more—0.011. For the first time, a 4% divergence between the populations of A. albopictus of tropical and subtropical origins was found on the basis of analyzing the ITS2. A relatively high level of variability of ITS2 between tropical and subtropical populations can be used to develop new markers for phylogenetic studies. No individuals with mitochondrial and nuclear haplotypes specific to tropical populations were found in the four north Italian sampling sites.

Quantitative Flood Forecasting on Small- and Medium-Sized Basins: A Probabilistic Approach for Operational Purposes

AbstractThe forecast of rainfall-driven floods is one of the main themes of analysis in hydrometeorology and a critical issue for civil protection systems. This work describes a complete hydrometeorological forecast system for small- and medium-sized basins and has been designed for operational applications. In this case, because of the size of the target catchments and to properly account for uncertainty sources in the prediction chain, the authors apply a probabilistic framework. This approach allows for delivering a prediction of streamflow that is valuable for decision makers and that uses as input quantitative precipitation forecasts (QPF) issued by a regional center that is in charge of hydrometeorological predictions in the Liguria region of Italy. This kind of forecast is derived from different meteorological models and from the experience of meteorologists. Single-catchment and multicatchment approaches have been operationally implemented and studied. The hydrometeorological forecasting chain has been applied to a series of case studies with encouraging results. The implemented system makes effective use of the quantitative information content of rainfall forecasts issued by expert meteorologists for flood-alert purposes.

Antipsychotic utilisation and polypharmacy in Italian residential facilities: a survey

To evaluate the prescribing practices in psychiatric residential facilities, with particular focus both on the antipsychotic dose and polypharmacy as well as the variation of antipsychotic patterns during a patient's stay within the facilities. Fifteen residential facilities of Liguria region in Italy were included. Data were collected through a chart review during a one-day census. Frequency of psychotropic patterns was estimated. Different non-parametric tests were used to analyse the changes in prescription patterns as well as the relationship among antipsychotic dose, the number of antipsychotics and anticholinergic use. The study sample includes 362 patients, 61.9% males. On the census day 77.5% of patients received psychotropic polypharmacy and 57.2% antipsychotic polypharmacy. Antipsychotic polypharmacy was related to the total antipsychotic daily dose and to anticholinergic use. A trend towards an increase of antipsychotic and psychotropic polypharmacy and higher doses of antipsychotics over the period of stay within the facilities was noted. This tendency was related to the length of stay in the facility. Compared to earlier studies in the same clinical environment a significant increase in the use of psychotropic and antipsychotic polypharmacy was observed. The risk of prescribed polypharmacy seems to be related to time spent in the facility.

Passive sampling and stir bar sorptive extraction for the determination of endocrine-disrupting compounds in water by GC-MS

A new method using the extraction and preconcentration capabilities of stir bar sorptive extraction, combined with high-resolution gas chromatography and mass spectrometry, was developed for the determination of five selected endocrine-disrupting compounds (4-n-nonylphenol, bisphenol A, estrone, 17beta-estradiol, and 17alpha-ethinylestradiol) in water. In situ derivatization to transform the phenolic compounds into lipophilic and volatile analytes was carried out with acetic anhydride. Two different methods of headspace derivatization to further improve the chromatographic properties of 17beta-estradiol and 17alpha-ethinylestradiol were developed and compared. The optimized method provided good sensitivity (limits of quantitation 1.2-2.6 ng), repeatability (relative standard deviation 2-9%), and reproducibility (relative standard deviation 10-17%). Passive sampling by means of polar organic chemical integrative samplers was applied to monitor river waters used as supply sources for drinking water treatment plants in the Liguria region of Italy. The analytes showed a different distribution at the three sites considered; bisphenol A proved to be the most abundant, ranging from 185 to 459 ng per sampler.

Heavy metals in European soils: A geostatistical analysis of the FOREGS Geochemical database

This paper presents the results of modeling the distribution of eight critical heavy metals (arsenic, cadmium, chromium, copper, mercury, nickel, lead and zinc) in topsoils using 1588 georeferenced samples from the Forum of European Geological Surveys Geochemical database (26 European countries). The concentrations were mapped using regression-kriging (RK) and accuracy of predictions evaluated using the leave-one-out cross validation method. A large number of auxiliary raster maps (topographic indexes, land cover, geology, vegetation indexes, night lights images and earth quake magnitudes) were used to improve the predictions. These were first converted to 36 principal components and then used to explain spatial distribution of heavy metals. The study revealed that this database is suitable for geostatistical analyses: the predictors explained from 21% (Cr) to 35% (Pb) of variability; the residuals showed spatial autocorrelation. The Principal Component Analysis of the mapped heavy metals revealed that the administrative units (NUTS level3) with highest overall concentrations are: (1) Liege (Arrondissement) (BE), Attiki (GR), Darlington (UK), Coventry (UK), Sunderland (UK), Kozani (GR), Grevena (GR), Hartlepool & Stockton (UK), Huy (BE), Aachen (DE) (As, Cd, Hg and Pb) and (2) central Greece and Liguria region in Italy (Cr, Cu and Ni). The evaluation of the mapping accuracy showed that the RK models for As, Ni and Pb can be considered satisfactory (prediction accuracy 45–52% of total variance), marginally satisfactory for Cr, Cu, Hg and Zn (36–41%), while the model for Cd is unsatisfactorily accurate (30%). The critical elements limiting the mapping accuracy are: (a) the problem of sporadic high values (hot-spots); and (b) relatively coarse resolution of the input maps. Automation of the geostatistical mapping and use of auxiliary spatial layers opens a possibility to develop mapping systems that can automatically update outputs by including new field observations and higher quality auxiliary maps. This approach also demonstrates the benefits of organizing standardized joint European monitoring projects, in comparison to the merging of several national monitoring projects.

Decision support system for urban flood management

This paper presents the development of a decision support system (DSS) for flood warning and instantiation of restoration activities in two urban areas, the Liguria Region in Italy and the Greater Athens catchment in Greece, with the potential of extension to other locations with similar flooding problems. The tool is designed to work at the centre of a set of meteorological and hydrologic/hydraulic forecast models together with telemetric data acquisition networks. The study reveals the complexity and uncertainty involved in managing flooding in the study areas. Issues about the validity and extended benefits of the system are also discussed.

Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines

Background In the absence of clinical practice guidelines prior to 1999, the consumption of human albumin in the Liguria region of Italy was very high, despite possible adverse effects, limited supply, and significant cost. Objective The purpose of this study was to assess the impact of comprehensive guidelines on the amount of albumin used in 2 general hospitals and to compare it with that of a third general hospital that did not adopt the guidelines. Methods We analyzed the influence of the guidelines on albumin use in 2 general hospitals (hospitals 1 and 2) in the Liguria region by comparing albumin consumption during the year before the distribution of the guidelines (1999) with consumption in the 2 years after their distribution (2000 and 2001). We compared these data with those of a third general hospital that did not adopt the guidelines (hospital 3). The parameters considered were total consumption of albumin, consumption per bed, consumption per hospital stay, mean time to discharge, expenditure per bed, and mortality rate. Results In the years 2000 and 2001, the adoption of guidelines reduced albumin consumption in hospitals 1 and 2. In hospital 1, where the release of albumin was carefully controlled by the transfusion service, albumin use per hospital stay decreased 8.7% in 2000 and 7.6% in 2001 from 1999; in hospital 2, use decreased 73.8% and 77.4%, respectively, from 1999. In hospital 3, rejection of the guidelines was coupled with an increase of 2.9% and 8.4%, respectively, in the amount of albumin used per hospital stay. In the years 2000 and 2001, the savings in the expenditure for albumin was ∼17,000 euro in hospital 1 and ∼200,000 euro in hospital 2. Conclusion This study confirms that the adoption of guidelines may substantially reduce the inappropriate use of albumin and relative costs.