1
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Pezzullo AM. Sources of bias in COVID-19 infection fatality rate estimation. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Since the beginning of the devastating COVID-19 pandemic, there has been a great debate about various public health relevant parameters such as the number of people infected with SARS-CoV-2, the number of deaths from COVID-19, and the resulting infection fatality rate (IFR), calculated as a ratio of the number of deaths from COVID-19 and the number of people infected with SARS-CoV-2. Among people dying from COVID-19, the largest burden is carried by the elderly, and locations with an older population will have a higher average IFR. Drawing from a project on the estimation of age-stratified IFR at an international level, in this methodological presentation, I will review the considered sources of bias for COVID-19 IFR calculation and interpretation. Both numerator and denominator can be overestimated or underestimated leading to biased estimates, while different locations can present sources of true variability. The estimation of the number of people infected with SARS-CoV-2 (the denominator of the IFR) presents several challenges. Relying on testing is inadequate due to a substantial undiagnosed proportion, and seroprevalence studies have been used to estimate the number of people infected with COVID-19, but selection bias can arise when the examined population might have a lower or higher risk than the target population. This can be the case when factors such as ethnicity, working status, and comorbidity are not considered in the recruitment. Information bias can result from suboptimal test performance and seroreversion. The number of deaths can be underestimated in situations where testing is not widely available and overestimated by the attribution of COVID-19 deaths to patients that have died with COVID-19 but not from it. Sources of true variability between locations are the population age distribution, protection of the vulnerable populations, as well as the presence of a prepared and efficient healthcare system.
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Affiliation(s)
- AM Pezzullo
- Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore , Rome, Italy
- Meta-Research Innovation Center at Stanford, Stanford University , Stanford, USA
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2
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Tilly MJ, Geurts S, Pezzullo AM, Bramer WM, de Groot NMS, Kavousi M, de Maat MPM. The association of coagulation and atrial fibrillation: a systematic review and meta-analysis. Europace 2022; 25:28-39. [PMID: 35942591 PMCID: PMC9907526 DOI: 10.1093/europace/euac130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS While atrial fibrillation (AF) is suggested to induce a prothrombotic state, increasing thrombotic risk, it is also hypothesized that coagulation underlies AF onset. However, conclusive evidence is lacking. With this systematic review and meta-analysis, we aimed to summarize and combine the evidence on the associations between coagulation factors with AF in both longitudinal and cross-sectional studies. METHODS AND RESULTS We systematically searched for longitudinal cohort and cross-sectional studies investigating AF and thrombosis. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. For cross-sectional studies, we determined pooled standardized mean differences (SMDs) and 95% CIs. A total of 17 longitudinal and 44 cross-sectional studies were included. In longitudinal studies, we found significant associations between fibrinogen (HR 1.05, 95% CI 1.00-1.10), plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00-1.12), and D-dimer (HR 1.10, 95% CI 1.02-1.19) and AF incidence. In cross-sectional studies, we found significantly increased levels of fibrinogen (SMD 0.47, 95% CI 0.20-0,74), von Willebrand factor (SMD 0.96, 95% CI 0.28-1.66), P-selectin (SMD 0.31, 95% CI 0.08-0.54), ß-thromboglobulin (SMD 0.82, 95% CI 0.61-1.04), Platelet Factor 4 (SMD 0.42, 95% CI 0.12-0.7), PAI-1 (1.73, 95% CI 0.26-3.19), and D-dimer (SMD 1.74, 95% CI 0.36-3.11) in AF patients, as opposed to controls. CONCLUSION These findings suggest that higher levels of coagulation factors are associated with prevalent and incident AF. These associations are most pronounced with prevalent AF in cross-sectional studies. Limited evidence from longitudinal studies suggests a prothrombotic state underlying AF development.
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Affiliation(s)
- Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Angelo M Pezzullo
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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3
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Tilly MJ, Geurts S, Pezzullo AM, Bramer WM, Ikram MA, De Groot NMS, Kavousi M, De Maat MPM. The association of coagulation and hemostasis with atrial fibrillation: a systematic review and meta-analysis. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): - Erasmus MC MRace grant- The Netherlands Organization for the Health Research and Development (ZonMw)
Background
Atrial fibrillation (AF) is a highly prevalent cardiac tachyarrhythmia. Recent literature suggests that AF induces a prothrombotic state, ultimately leading to thrombotic events. It is also hypothesized that coagulation underlies AF development through coagulation.
Purpose
We aimed to assess the associations between selected coagulation factors with AF in both longitudinal and cross-sectional studies, to give further insight on the interaction of coagulation and AF.
Methods
Through a systematic search of large databases, including Embase, Medline ALL, and Web of Science Core Collection, all longitudinal cohort studies and cross-sectional studies published before 25th of May, 2021 were reviewed. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated through log-transformed HRs and 95% CIs using the generic inverse variance method. For cross-sectional studies the pooled standardized mean differences (SMD) were calculated through inverse variance weighting.
Results
16 longitudinal studies and 44 cross-sectional studies were included. In the longitudinal studies, using complex multivariable models, we found significant associations between fibrinogen (HR1.06, 95% CI 1.01-1.12), Plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00-1.12), and D-dimer (HR 1.10, 95% CI 1.02-1.19), with AF incidence. In cross-sectional studies, we found significant differences between AF patients and controls for fibrinogen (SMD 0.47), D-dimer (SMD 1.74), P-selectin (SMD 0.31), von Willebrand factor (SMD 0.96), PAI-1 (SMD 1.73), ß-thromboglobulin (SMD 0.82), and Platelet Factor 4 (SMD 0.42).
Conclusions
Atrial fibrillation is associated with higher levels of coagulation factors. These associations are most pronounced in cross-sectional analyses, but limited studies are available investigating a prothrombotic state underlying AF initiation. These results further support the hypothesis of "AF begets AF".
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Affiliation(s)
- MJ Tilly
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - S Geurts
- Erasmus University Medical Centre, Department of Epidemiology, Rotterdam, Netherlands (The)
| | - AM Pezzullo
- Erasmus University Medical Centre, Department of Epidemiology, Rotterdam, Netherlands (The)
| | - WM Bramer
- Erasmus University Medical Centre, Medical Library, Rotterdam, Netherlands (The)
| | - MA Ikram
- Erasmus University Medical Centre, Department of Epidemiology, Rotterdam, Netherlands (The)
| | - NMS De Groot
- Erasmus University Medical Centre, Department of Cardiology, Rotterdam, Netherlands (The)
| | - M Kavousi
- Erasmus University Medical Centre, Department of Epidemiology, Rotterdam, Netherlands (The)
| | - MPM De Maat
- Erasmus University Medical Centre, Department of Hematology, Rotterdam, Netherlands (The)
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4
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Cadeddu C, Pezzullo AM, Sapienza M, Castagna C, Regazzi L, Carini E, Messina R, Silenzi A, Villani L, Damiani G, Ricciardi W. Planetary health research: insights from The Lancet Planetary Health original articles. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In 2017, the Lancet group launched The Lancet Planetary Health to promote the dissemination of research conducted in this field. Planetary health was also extensively discussed during the World Congress on Public Health 2020, which underlines the strategic importance recognized to this topic by experts and researchers active in public health at an international level. The aim was to investigate the role of public health university departments in the field of planetary health.
Methods
The Lancet Planetary Health database was queried from the inception to February 2021, to retrieve original articles or reviews whose first and/or last author was affiliated to a University Department of Public Health worldwide. We used the twenty-six EUPHA operational sections to define the research areas of the identified articles. The following data were extracted: study design, EUPHA area, research question, topic, identified gaps in the literature, and key concepts.
Results
Out of 543 entries, 44 original articles and reviews were included. Thirty-two percent studies were conducted in Asia, 20% in America, 13% in Europe, 8% in Oceania, 4% in Africa while 23% in a multicentric global context. The area investigated was mainly environmental and health (68%) followed by infectious disease control (14%). Collaboration across different disciplines is highly present in the authorships. Regarding the study design, 30% of the included articles were cohort studies.
Conclusions
From 2017 till February 2021, the number of studies performed by public health researchers published on The Lancet Planetary Health is gradually increasing.
Since published articles take advantage of the typical research methods and topics of public health and environmental health research, public health university departments can contribute to planetary health science if they seek transdisciplinary collaboration and adopt a planetary health vision.
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Affiliation(s)
- C Cadeddu
- Italian Institute for Planetary Health, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - AM Pezzullo
- Italian Institute for Planetary Health, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Sapienza
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Castagna
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Regazzi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Messina
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Silenzi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Villani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - W Ricciardi
- Italian Institute for Planetary Health, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Lanza TE, D'Ambrosio F, Messina R, Pezzullo AM, Villani L, Rosano A, Ricciardi W, Cadeddu C. Trends in vaccination coverage against influenza in the pediatric population: an Italian overview. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Influenza is a major public health issue for its epidemiological, clinical and economic impact. Children are a relevant age group for the diffusion of the infection in the community as they shed the virus in greater amounts and for longer periods of time than adults of any age. Vaccination is the best strategy to fight the disease. In Italy, until last year, influenza vaccination for the pediatric population was offered free only to children in specific risk categories, while in the last season its was extended also to all subjects from 6 months to 6 years old. The purpose of this work is to analyze the trend of vaccination coverage among children in the last decade in Italy.
Methods
We retrieved vaccination coverage data by the Italian Ministry of Health relating to influenza vaccination in the age groups 0-2, 2-4, 5-8 and 9-14 in the years 2010-2020 and analysed trends in and between regions.
Results
A preliminary analysis shows that vaccination coverage in the age groups considered ranged from a minimum of 1.1% to a maximum of 4.5%. The highest average percentage reached was recorded in the season 2010-11 (3.8%), while the lowest in the 2015-16 (1.5%). The highest average values (12,9%; 10,5%) were found in Puglia and Toscana, while the lowest (0.3%) in Friuli Venezia Giulia. From 2010 to 2015 there was a progressive decline in vaccination coverage, while in the following years there was a slight increase, up to the year 2019-2020, in which the average percentage value was 3%. Further results are expected for next summer, when 2020-21 data will be available.
Conclusions
Our analysis shows that in the Italian regions influenza vaccination coverage in children is variable but still extremely low. Childhood vaccination could provide an opportunity to decrease the burden of disease in this age group but may also help to protect the population at risk of serious complications, such as the elderly, due to the social role children play in the spread of this virus.
Key messages
Influenza vaccination in children is a major public health issue. Additional efforts are needed to make vaccination available for children and improve the stakeholders’ awareness on this topic.
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Affiliation(s)
- TE Lanza
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F D'Ambrosio
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Messina
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - AM Pezzullo
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Villani
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Rosano
- Accademia Romana di Sanità Pubblica, Rome, Italy
| | - W Ricciardi
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Cadeddu
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Carini E, Pezzullo AM, Frisicale EM, Cacciatore P, Pilla AD, Grossi A, Gabutti I, Cicchetti A, Boccia S, Specchia ML. Measuring organizational performance. A review of the dimensions of hospital performance indicators. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patients’ increasing needs and expectations demand for an overall assessment of hospital performances. Several Agencies described sets of performance indicators and there is not a unanimous classification. The ImpactHTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital organizational performance. The aim of this review is to identify the dimensions of quality in which hospital performance indicators are grouped, and to assess if there has been an evolution over time of the above-mentioned dimensions.
Following the PRISMA statement, PubMed, Ovid and Web of Science databases were queried to perform an umbrella review. Articles focusing on secondary care settings, published January 2000-May 2018 were considered. The study design included was systematic review.
3680 records were screened and 6 systematic reviews ranging 2002-2014 were included. The following dimensions were described in at least 50% of the studies: 6 studies classified efficiency (53 indicators analyzed); 5 studies classified effectiveness (12 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (8 indicators) and timeliness (4 indicators). 3 reviews did not specify the indicators related to the dimensions listed, 1 gave a complete definition of the meaning of each dimension and related indicators.
The research shows steady awareness of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions; apparently, there is still not much attention to sustainability, appropriateness and accessibility in terms of indicators measuring, although those dimensions are described in one of the latest review. Another review described a new dimension, resources and capacity, which focuses on the availability of new technologies, underlining the growing importance of the adoption of digitalization in healthcare.
Key messages
Main dimensions of performance indicators: efficiency, effectiveness, patient centeredness, safety. More emphasis to sustainability and appropriateness to align with today’s healthcare challenges.
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Affiliation(s)
- E Carini
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A M Pezzullo
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E M Frisicale
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- ASL Roma 1, Rome, Italy
| | - P Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Grossi
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Gabutti
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Cicchetti
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M L Specchia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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7
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Cacciatore P, Kannengiesser P, Carini E, Di Pilla A, Pezzullo AM, Hoxhaj I, Gabutti I, Cicchetti A, Boccia S, Specchia ML. Balanced Scorecard for performance assessment in healthcare settings: a review of literature. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Balanced-Scorecard (BSC) is a management tool developed in the early 1990s to balance the impact of financial and non-financial parameters and analyse the organisational performance in private companies according to four determinants. The original BSC has spread to different sectors in the last decades, including healthcare services, in numerous amended versions. The aim of our project was to identify potential indicators of BSC for performance evaluation in general hospitals.
Methods
We performed a systematic review of literature on Pubmed and Web of Science using the search string “balanced scorecard AND healthcare AND indicators”. We found 102 papers; 80 papers were removed for irrelevance, absence of full text or performance indicators. We only considered articles that followed the classic structure of BSC (Customer, Internal Processes, Financial, and Learning and Growth). The indicators listed in them were classified according to the four determinants of organisational performance.
Results
Eight articles out of 22 followed the classic structure of the BSC. The most represented category was Internal Processes (59 indicators), followed by Learning and Growth (52), Customer (40) and Financial (33). The number of common/overlapping indicators was low (5 for Internal Processes and 4 for the three other categories).
Conclusions
While BSC has spread to different settings, the list of indicators used in the classic four determinants for performance evaluation is heterogeneous. While common points can be identified between indicators, our review highlighted that every BSC is developed in a unique way which makes it difficult to identify a general framework adaptable to different hospital settings.
Key messages
The use of the Balanced Scorecard as management tool has spread to healthcare settings in the last decade. Indicators in BSC for healthcare settings are heterogeneous and only a limited number follow the standard structure of BSC.
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Affiliation(s)
- P Cacciatore
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Kannengiesser
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Pilla
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A M Pezzullo
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Hoxhaj
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Gabutti
- Alta scuola di Economia e Management dei Sistemi Sanitari (A, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Cicchetti
- Alta scuola di Economia e Management dei Sistemi Sanitari (A, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Boccia
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M L Specchia
- Sezione di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Grossi A, Hoxhaj I, Gabutti I, Carini E, Pezzullo AM, Cacciatore P, Specchia ML, Cicchetti A, Boccia S, de Waure C. Hospital contextual factors affecting the use of health technologies: a systematic review. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Healthcare systems are facing great challenges due to increased share of aging population, growing health needs and economic restraints. To keep a high quality of assistance it is important to invest in health technologies (HTs) that have the potential of improving health outcomes. Even though a lot of guidance does exist on how HTs should be introduced, used and dismissed, there is a surprising gap in literature concerning the awareness of hospitals in the actual utilization of HTs, namely utilization in daily practice after formal adoption.
Methods
We performed a systematic literature review of qualitative and quantitative studies aimed at investigating hospital contextual factors that influence the actual utilization of HTs at hospital level. PubMed, Scopus, Web of Science, Econlit and Ovid were searched to retrieve studies published in English from 1st January 2010 to 31st May 2018.
Results
A total of 33 studies were included mostly addressing information and communication technologies (ICTs). Findings suggest that contextual factors that impact on actual utilization of HTs at hospital level are ascribable to four main families: financial factors, leadership styles, human resource management and hospital infrastructure. It emerges also that involving professionals at all levels and planning people’s work and competencies are major determinants of HTs actual utilization.
Conclusions
The evidence suggests that several contextual factors play a major role in HTs actual utilization at hospital level even though data are mostly referred to ICTs being the other HTs unexplored. Indeed, findings from this study suggest that numerous items should be evaluated when considering to use a new HTs at hospital level. Nevertheless, evidence regarding actual utilization of medical and surgical HTs is still lacking and future research is needed.
Key messages
Financial factors, leadership styles, human resource management, hospital infrastructure are relevant determinants of actual utilization of new HTs at hospital level. The evidence on contextual factors that influence actual utilization of HTs is mostly referred to ICTs and further research is indeed deserved.
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Affiliation(s)
- A Grossi
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Hoxhaj
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Gabutti
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A M Pezzullo
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M L Specchia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Cicchetti
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
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9
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Villani L, Frisicale EM, Parente P, Cacciatore P, Carini E, Gentili A, Grossi A, Pezzullo AM, Favaretti C, Ricciardi W. 1st European Academy for Healthcare Leaders: high training on leadership to manage health systems. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Nowadays having leadership skills is critical to manage healthcare systems. The World Health Organization Collaborating Centre on Health Policy, Governance and Leadership organized the 1st European Academy for Healthcare Leaders in Rome from 15th to 17th November 2018. Senior officials of the Ministries of Health of 16 Members Countries of the WHO European Region attended and actively participated to the event, led by experienced Italian and European experts. The Academy could be considered a moment of high training on leadership and governance of health systems.
Objectives
The event was aimed at creating effective networks among participants to share ideas and strategies to improve leadership skills, providing practical tools to be applied in healthcare systems and to develop a common and transferrable leadership framework in Europe. Frontal lectures and interactive workshops covered three main areas: leadership skills, current challenges of health systems and sustainability of health systems today.
Results
The 3-days event gave the opportunity to discuss the main issues in Public Health highlighting how to be an effective leader in healthcare. Leadership should enable the translation of knowledge into productive action pathways, providing health equity and improving population’s health. At the end of the event, participants filled a survey and the results showed high satisfaction about contents (100% out of 16 participants).
Conclusions
Health systems need to change in order to face the formidable challenges of our times. This event empowered the participants in order to support the creation of strategies and to develop leadership tools to apply at country level. The experiences, ideas and good practices shared during this event strengthened a collaborative network and have been useful to identify common goals and solutions.
Key messages
These kinds of events are fundamental to improve knowledge about leadership in healthcare. Leadership should have a major role to play in healthcare worldwide.
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Affiliation(s)
- L Villani
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E M Frisicale
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
- Local Health Authority, ASL Roma 1, Rome, Italy
| | - P Parente
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
- Local Health Authority, ASL Roma 1, Rome, Italy
| | - P Cacciatore
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Carini
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Gentili
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Grossi
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A M Pezzullo
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Favaretti
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - W Ricciardi
- WHO Collaborating Centre for Health Policy, Governance and Leadership in Europe, Rome, Italy
- Public Health Department, Università Cattolica del Sacro Cuore, Rome, Italy
- Women’s and Children’s Health Sciences and Public Health, Fondazione Policlinico A. Gemelli, Rome, Italy
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10
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Pezzullo AM, Cacciatore P, Carini E, Frisicale EM, Ricciardi W, Specchia ML. Measuring and benchmarking performance in secondary care settings: the state of the art. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- AM Pezzullo
- Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - P Cacciatore
- Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - E Carini
- Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - EM Frisicale
- Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | | | - ML Specchia
- Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, Rome, Italy
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11
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Napolitano V, Pezzullo AM, Zeppa P, Schettino P, D'Armiento M, Palazzo A, Della Pietra C, Napolitano S, Conzo G. Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review. World J Surg Oncol 2013; 11:33. [PMID: 23374143 PMCID: PMC3599514 DOI: 10.1186/1477-7819-11-33] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 01/18/2013] [Indexed: 02/06/2023] Open
Abstract
Gastric duplication cyst (GDC) with a pseudostratified columnar ciliated epithelium is an uncommon malformation supposed to originate from a respiratory diverticulum arising from the ventral foregut. Morphologic appearance of GDCs is variable, depending on the density of their contents. GDCs are often misdiagnosed as solid masses by imaging techniques, and as a consequence they may be wrongly overtreated. We report our case of a 56-year-old man with a 5 cm hypoechoic mass of the gastroesophageal junction, incidentally detected by transabdominal ultrasonography. Neither transabdominal ultrasonography nor magnetic resonance clearly outlined the features of the lesion. The patient underwent endoscopic ultrasound (EUS), which showed a hypoechoic mass arising from the fourth layer of the anterior gastric wall, just below the gastroesophageal junction. According to EUS features, a diagnosis of gastrointestinal stromal tumor was suggested. EUS-guided fine-needle aspiration cytology revealed a diagnosis of GDC with pseudostratified columnar ciliated epithelium. We therefore performed an endoscopically-assisted laparoscopic excision of the cyst. In conclusion, whenever a subepithelial gastric mass is found in the upper part of the gastric wall, a duplication cyst, although rare, should be considered. In this case, EUS-guided fine-needle aspiration cytology could provide a cytological diagnosis useful to arrange in advance the more adequate surgical treatment.
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Affiliation(s)
- Vincenzo Napolitano
- Department of General and Specialistic Surgery, School of Medicine, Second University of Naples, 5 S, Pansini Street, 80100, Naples, Italy
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