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Gola M, Johnson AA, La Milia DI, Cadeddu C, Bardini F, Bianconi B, Bisceglia R, Pumpo MD, Genovese C, Grieco A, Piras G, Guerra R, Damiani G, Favaretti C, Montagna MT, Capolongo S, Ricciardi W. Rethinking the Healthcare Facilities: The Role of the Buffer Space. HERD 2024:19375867231222563. [PMID: 38259242 DOI: 10.1177/19375867231222563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVES A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design. BACKGROUND The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients. METHODS The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents. RESULTS 102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds. CONCLUSIONS Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.
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Affiliation(s)
- Marco Gola
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano, Milan, Italy
| | | | - Daniele Ignazio La Milia
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT (IRCCS), Palermo, Italy
| | - Chiara Cadeddu
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bardini
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-medico, Rome, Italy
| | - Barbara Bianconi
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Azienda Usl Toscana Sud-Est, Arezzo, Italy
| | - Raffaella Bisceglia
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Università degli Studi di Perugia, Perugia, Italy
| | - Marcello Di Pumpo
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Azienda ULSS6 Euganea, Regione Veneto, Padova, Italy
| | - Cristina Genovese
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Postgraduate Medical School of Preventive Medicine and Hygiene, University of Messina, Messina, Italy
| | - Albino Grieco
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Piras
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Asl n. 7 Sulcis, Carbonia SU, Italy
| | - Rocco Guerra
- ASL Bari, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Gianfranco Damiani
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Favaretti
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Centre on Leadership in Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Stefano Capolongo
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano, Milan, Italy
| | - Walter Ricciardi
- Post graduate course "Hospital Healthcare Management" (II ed.), Advanced School of Economics and Management of Health Systems (ALTEMS), Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Osti T, Valz Gris A, Corona VF, Villani L, D'Ambrosio F, Lomazzi M, Favaretti C, Cascini F, Gualano MR, Ricciardi W. Public health leadership in the COVID-19 era: how does it fit? A scoping review. BMJ Lead 2023:leader-2022-000653. [PMID: 37709494 DOI: 10.1136/leader-2022-000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.
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Affiliation(s)
- Tommaso Osti
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Angelica Valz Gris
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Valerio Flavio Corona
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Floriana D'Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Marta Lomazzi
- World Federation of Public Health Association, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Carlo Favaretti
- Leadership Research Center, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Fidelia Cascini
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
| | - Maria Rosaria Gualano
- Leadership Research Center, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
- Leadership Research Center, Università Cattolica del Sacro Cuore-Campus di Roma, Rome, Italy
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Gola M, Sapienza M, Slama F, Brundu L, Campus R, Manai S, Nicosanti R, Ogana S, Orrù M, Ortu GM, Piga G, La Milia DI, Cadeddu C, Ferraguzzi G, Mangili S, Damiani G, Favaretti C, Azara AA, Capolongo S, Ricciardi W. Structural accreditation of healthcare facilities: comparison of the requirements by Italian Presidential Decree 14/01/1997 and regional regulations. A proposal for updating the minimum environmental units at national level. Acta Biomed 2023; 94:e2023158. [PMID: 37695187 DOI: 10.23750/abm.v94is3.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND AIM The Decree of the President of the Italian Republic 14/01/1997 is the reference norm related to the accreditation of public and private healthcare structures. This guideline establishes the minimum structural, technological and organizational requirements that each structure operating in the Italian territory must comply with. METHODS In occasion of the project work for the postgraduate training course in healthcare management by ALTEMS School, a team of researchers conducted a survey on the state of updating of the minimum structural requirements indicated in the norm-in particular those relating to hospital facilities- with those adopted by the individual regions through the analysis of the most up-to-date regional regulations. RESULTS Precisely starting from the comparison of regional references and from the regulations on the subject of structural accreditation which suggest strategic environmental units and which address some key-aspects relating to the contemporary design of healing environments (i.e. semi-intensive care units, hybrid operating theatres, etc.), the outcome of the project work is to define a proposal to update the national reference document, also in the light of the currently changing needs in terms of hospital design. CONCLUSIONS The research aims to become a starting milestone for future investigations. The team investigated - in this first phase - the functional areas listed in the norm, and the next step aims to extend the analysis also to the innovative functions (i.e. buffer spaces, hybrid operating theatres, sub-intensive care units, etc.) and/or introduced only the last years which have only been regulated in some regions.
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Affiliation(s)
- Marco Gola
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano.
| | - Martina Sapienza
- School of Specialization in Hygiene and preventive medicine' Università Cattolica del Sacro Cuore.
| | - Faris Slama
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Laura Brundu
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Roberta Campus
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Stefano Manai
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Roberto Nicosanti
- School of Specialization in Hygiene and Preventive Medicine, Università di Cagliari.
| | - Silvia Ogana
- Presidio Ospedaliero Unico Alghero-Ozieri, ASL Sassari.
| | - Marco Orrù
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Giovanni Maria Ortu
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Giulia Piga
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Sassari.
| | - Daniele Ignazio La Milia
- Department Women, children and public health sciences, Mediterranean Institute for Transplantation and Advanced Specialized Therapies.
| | - Chiara Cadeddu
- Dept. Life Sciences and Public Health' Università Cattolica del Sacro Cuore.
| | - Gaia Ferraguzzi
- School of Specialization in Hygiene and Preventive Medicine, Università degli Studi di Milano.
| | - Silvia Mangili
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano.
| | - Gianfranco Damiani
- Dept. Life Sciences and Public Health' Università Cattolica del Sacro Cuore.
| | - Carlo Favaretti
- Centre on Leadership in Medicine, Università Cattolica del Sacro Cuore.
| | | | - Stefano Capolongo
- Design & Health Lab, Department of Architecture, Built environment and Construction engineering (DABC), Politecnico di Milano.
| | - Walter Ricciardi
- Dept. Life Sciences and Public Health' Università Cattolica del Sacro Cuore.
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Beccia F, Di Pilla A, Causio FA, Federico B, Specchia ML, Favaretti C, Boccia S, Damiani G. Narrative Review of the COVID-19 Pandemic's First Two Years in Italy. Int J Environ Res Public Health 2022; 19:15443. [PMID: 36497543 PMCID: PMC9736498 DOI: 10.3390/ijerph192315443] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
Italy was the first country in the western world to be affected by the COVID-19 pandemic, arguably among the worst-affected ones, counting 12 million cases and 150 thousand deaths two years since the first case. Facing new challenges, Italy has enacted different strategies and policies to limit the spread of the SARS-CoV-2 virus and treat those affected by COVID-19. This narrative review provided an overview of factors, measures, and actions that shaped Italy's first two years of the COVID-19 pandemic by investigating epidemiological data and using a mixed-method approach. This narrative review aimed to summarize the most relevant aspects and measures and analyze available data to provide policymakers and healthcare providers with the instruments to learn from this pandemic and improve their preparedness for future pandemic events. The first two years of the pandemic differ in that, during the first year, significant necessary changes to the way health systems were organized were implemented, increasing healthcare spending and adopting social and physical distancing measures that were stricter than the ones adopted in the second year. However, as the pandemic progressed, increased knowledge of the virus and related variants, as well as the introduction of highly effective vaccines, which were not equally available to the whole population, resulted in a stratification of COVID-19 infections and deaths based on factors such as age, vaccination status, and individual susceptibility to the virus.
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Affiliation(s)
- Flavia Beccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Di Pilla
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Andrea Causio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Bruno Federico
- Department of Human Sciences, Society and Health, Università degli Studi di Cassino e del Lazio Meridionale, 03043 Cassino, Italy
| | - Maria Lucia Specchia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Carlo Favaretti
- Centre on Leadership in Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gianfranco Damiani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Garattini SK, Valent F, Minisini AM, Riosa C, Favaretti C, Regattin L, Fasola G. Analysis of workload generated in the two years following first consultation by each new cancer patient: studying the past to plan the future of cancer care. BMC Health Serv Res 2022; 22:1184. [PMID: 36131286 PMCID: PMC9494889 DOI: 10.1186/s12913-022-08573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/06/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Prevalence of cancer patients is dramatically increasing. We aimed at quantifying the oncology workload generated by each new cancer patient in the two years following first consultation. Methods In this record-based retrospective study, we retrieved data of all newly diagnosed patients treated at the Oncology Department of Udine Academic Hospital between 01.01.2012 and 31.12.2017. We calculated mean number and standard deviation of the activity type generated by each new cancer patient during the following 2 years. Results Seven thousand four hundred fifty-two cancer patients generated a total of 85,338 clinical episodes. The two-years mean number of oncology episodes generated was 11.31 (i.e., for every 1,000 new cancer patients, 11,310 oncology activities are generated overall in the following two-year lapse). Patients with advanced disease generated the highest workload (24.3; SD 18.8) with a statistically significant difference compared to adjuvant and follow-up patients (p < 0.001). The workload generated in the period 0–6 and 0–12 months was significantly higher than in the following months (p < 0.001) and it was also higher for patients initially designated to treatment (p < 0.001). Conclusion This is the first study reporting on the mean oncology workload generated during the 2 years following first consultation. Workload is the highest for patient with advanced disease, especially in the first months and in patients in active treatment. A detailed analysis of workloads in oncology is feasible and could be crucial for planning a sustainable framework for cancer care in the next future.
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Affiliation(s)
- S K Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy.
| | - F Valent
- Institute of Hygiene and Clinical Epidemiology, Academic Hospital of Udine ASUFC, 33100, Udine, UD, Italy
| | - A M Minisini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Riosa
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - C Favaretti
- Center for Leadership in Medicine, Catholic University of Sacred Heart, 000168, Rome, RO, Italy
| | - L Regattin
- Medical Director, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
| | - G Fasola
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD, 33100, Italy
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Restivo V, Minutolo G, Battaglini A, Carli A, Capraro M, Gaeta M, Odone A, Trucchi C, Favaretti C, Vitale F, Casuccio A. Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies. Int J Environ Res Public Health 2022; 19:10995. [PMID: 36078706 PMCID: PMC9518077 DOI: 10.3390/ijerph191710995] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Giuseppa Minutolo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alberto Battaglini
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Alberto Carli
- Santa Chiara Hospital, Largo Medaglie d’oro 9, 38122 Trento, Italy
| | - Michele Capraro
- School of Public Health, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Cecilia Trucchi
- Planning, Epidemiology and Prevention Unit, Liguria Health Authority (A.Li.Sa.), IRCCS San Martino Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Carlo Favaretti
- Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
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Lingri D, Petelos E, Zeegers D, Valaris S, Favaretti C. COVID-19 passes and public health law: Considerations for surveillance and social justice. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
The first panellist will focus on the jurists view on the legislative proposal on DCC, discuss proportionality of measure, incl. key considerations for DCC and PLF data combinations. A basic overview on the differences between vaccination, certificates, immunity passports and other passes, and the key characteristics of the DCC will be provided. Feasibility in terms of implementing acts across EU Member-States will be elaborated upon, incl. both potential expiry and revocation, as well as potential remedies in case of emerging issues, i.e., right to DCC, but no vaccine, strong contraindication against vaccination, known issues of reduced immunity despite vaccination, etc.
Critical aspects with relevance for both the European and the global dimensions, i.e., GDPR and data transfer agreements, secondary use of health data, human-rights' issues, implications for vulnerable groups, etc., will also be discussed.
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Affiliation(s)
- D Lingri
- Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
- EHFCN, Brussels, Belgium
| | - E Petelos
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- HSR-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - S Valaris
- Massachusetts General Hospital, Harvard University, Boston, USA
| | - C Favaretti
- Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Restivo V, Gaeta M, Odone A, Trucchi C, Battaglini A, Carli A, Capraro M, Minutolo G, Casuccio A, Favaretti C. The effectiveness of leadership: meta-analysis of trial, cross-sectional, and before after studies. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.654] [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
The clinical and surgical procedures are often based on scientifical evidence but 30-40% of patients do not receive treatment according to evidence based medicine. The main aim of this review and meta-analysis is to assess the effectiveness of leadership in healthcare setting.
Methods
It was conducted a literature research on MEDLINE, Pubmed and Scopus with publication year between 2015 and 2019. The inclusion criteria were studies involving healthcare workers that evaluated effectiveness of opinion leaders in improving behaviour of healthcare workers, according to clinical or patient related outcomes. The quality of studies were assesed with the NHLBI for before after studies and the NOS for other study designs. The effect of leadership was assessed as risk difference for all studies with the exception of cross sectional studies. For the last it was evaluated correlation between leadership level and outcome measurment.
Results
A total of 3,155 articles were screened and 284 were fully assessed including 22 of them in the final database: 1 randomized trial, 9 cross sectional and 12 before after studies. For the cross-sectional studies there was a correlation of 0.22 (95% CI 0.15-0.28) between leadership level and outcome measurment. In the metaregression analysis the only factor that increased the correlation was private setting (meta regression coefficent =0.52, p = 0.022). The pooled efficacy was 24% (95% CI 10%-17%) for before after studies. Furthermore, a higher effectiveness was revealed in studies conducted on multi professional (24%) than single professional (9%) healthcare workers.
Conclusions
According to results, the guidelines adherence and task performance increased in a setting with leadership implementation. The leadership effectiveness appears comparable to other strategies as audit and feedback used to implement evidence-based practice in worldwide healthcare.
Key messages
The translation of evidence into clinical practice is often difficult but this study suggests that leaderhip can had higher effectiveness in multiprofessional healthcare workers and private setting. The effectiveness of leadership in this review suggests that it can be of help in order to make aware healthcare professionals about effectiveness of comply with evidence-based practice.
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Affiliation(s)
- V Restivo
- Department PROMISE, University of Palermo, Palermo, Italy
| | - M Gaeta
- Department of Public Health, Experimental and Forensic Medic, University of Pavia, Pavia, Italy
| | - A Odone
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - C Trucchi
- Department of Health Sciences, University of Genoa and IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Battaglini
- Department of Health Sciences, University of Genoa and IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Carli
- Department of Medical Direction, Maggiore della Carità University Hospital of Novara, Novara, Italy
| | - M Capraro
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - G Minutolo
- Department PROMISE, University of Palermo, Palermo, Italy
| | - A Casuccio
- Department PROMISE, University of Palermo, Palermo, Italy
| | - C Favaretti
- Centre for Leadership in Medicine, Catholic University of the Sacred Heart, Rome, Italy
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9
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Petelos E, Favaretti C. Discussion: Panel with all the speakers and Q&A from the audience. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.946] [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
Interacting with the audience through Q&A and exploring synergies between HTA and Public Health Emergency Preparedness and Response
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Affiliation(s)
- E Petelos
- University of Crete, University of Crete, Heraklion, Greece
| | - C Favaretti
- Section of Hygiene, Institute of Public Health, Rome, Italy
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10
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Di Macio F, Caricato M, Primieri C, Favaretti C, De Waure C. Developing a roadmap for Health Technology Assessment implementation in public health decisions. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.570] [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
Issue
Although the recognized importance of Health Technology Assessment (HTA) in fostering health policy and management, little is known and differences emerge in the state of the art of HTA development and use in public health decisions.
Description of the Problem
HTA applied to public health interventions could lead to improved population's health, risk factor reduction and high quality services. All these factors represent the basis of health care system sustainability. Nevertheless, there is a lack of evidence about the application of HTA to public health. In this light, the Section on HTA of the European Public Health Association (EUPHA) is conducting a Delphi process in order to define a shared roadmap for the implementation of HTA in public health.
Results
A literature search was first performed on PubMed to identify useful documentation for drafting the roadmap. Taking clues from Kalò et al., who drafted an HTA roadmap scorecard to support HTA implementation in Central and Eastern Europe, a preliminary core set of actions and pillars to pave the way for the implementation of HTA in public health, was identified. Then, a group of HTA experts was invited to participate to the Delphi process with the aim to build consensus on the final set of actions and pillars to include in the roadmap.
Lessons
Evidence on the ways to strengthen the role of HTA in public health decisions is scant and the development of a shared roadmap could be useful to identify milestones to do it.
Key messages
HTA applied to public health could promote an efficient, sustainable, equitable and high-quality health system. Nevertheless, the role of HTA in taking public health decisions should be strengthened. As evidence on the application of HTA in public health is scant, the development of a shared roadmap could enhance fostering its use in taking decisions on public health interventions.
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Affiliation(s)
- F Di Macio
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - M Caricato
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - C Primieri
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - C Favaretti
- Section of Hygiene, Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - C De Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
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11
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de Waure C, Miglietta A, Favaretti C. Addressing the challenge of bringing evidence in decision-making for public health emergencies: can HTA reach out to preparedness? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.943] [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
Preparedness is one of the fundamental public health activities as it allows health systems to effectively manage threats. It can be considered a continuous quality improvement process, therefore requiring an assessment both in planning and checking phase. The assessment should consider several aspects spanning contextual factors but also health technologies being used. In order to manage threats, epidemics in particular, several health technologies are generally deployed. Among them, vaccines, antimicrobials, medical devices (i.e. masks), procedures (i.e. quarantine). Indeed, an early and as much as comprehensive evaluation of their value in the mitigation of epidemics' impact is needed. Health Technology Assessment (HTA) could help doing that. It could be also useful to predict the magnitude of the problem and to shed light on alternatives and needs for organizational reengineering. Anyway, what are the actions required to make HTA reaching out preparedness?
Results
In order to do it, several conditions should be brought about. The first one is the recognition of the importance of HTA in projecting health technologies impacts by health authorities and institutions. The second one is the timeliness of the assessment. In fact, HTA is generally a time and resource consuming approach as it is based on the collection of available evidence and data. Nevertheless, an early interaction with all stakeholders, the availability of flexible computer infrastructures for data collection and the preventive development of impact models might allow developing the assessment in a limited time. Furthermore, having dedicated working teams at supranational/national level could help keep down time and efforts to conduct the assessment.
Conclusions
Based on available experiences, advances and barriers in the use of HTA for preparedness might be highlighted and actions to strengthen the role of HTA in this field can be recognized.
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Affiliation(s)
- C de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - A Miglietta
- EUPHA Infectious diseases control section, Utrecht, Netherlands
| | - C Favaretti
- Section of Hygiene, Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy
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12
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de Waure C, Giacchetta I, Violi S, Martini C, Favaretti C. The application of Health Technology Assessment to health apps: what is the evidence? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1328] [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
In the last years, many health apps have been developed to support citizens' and patients' health management. Nevertheless, a thorough evaluation is necessary to support the decision to incorporate them into healthcare systems. Health technology assessment (HTA) could be considered a valid evaluation tool allowing considering different stakeholders' perspectives. This research aimed to look for studies that applied HTA to health apps and to analyze feasibility and limits of HTA in this field.
Methods
A systematic review was performed considering three databases, namely PubMed, Web of Science (WoS) and University of York-Centre for Reviews and Dissemination database. Being the topic of health app assessment new, articles were considered eligible if they assessed at least two of the domains of the HTA core model suggested by the European network for Health Technology Assessment (EUnetHTA). Furthermore, only articles published in English in the last 5 years were considered.
Results
A total of 850 articles were found: 383 articles from PubMed, 462 from WoS and 5 from York. After removing duplicates, 708 articles remained and 43 were eventually included after the screening process. Seven articles were focused on apps used by healthcare professionals, while 36 dealt with apps aimed to support patients. None of the papers explicitly mentioned HTA as assessment tool. Indeed, not all the domains of the HTA core model were assessed in any article. Apps' technical description, clinical effectiveness and social aspects were the domains considered more often. On the contrary, costs and economic evaluation was clearly faced by one article only.
Conclusions
Even though the scientific literature on health apps is growing, the adoption of standardized methods for their evaluation, such as HTA, is still scant. This might be due to peculiarities of health apps and points out the importance of adapting existing methods in order to let a thorough assessment possible.
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Affiliation(s)
- C de Waure
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - I Giacchetta
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - S Violi
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - C Martini
- Deaprtment of Experimental Medicine, University of Perugia, Perugia, Italy
| | - C Favaretti
- Section of Hygiene, Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy
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13
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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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14
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Rolli FR, Ruggeri M, Kheiraoui F, Drago C, Basile M, Favaretti C, Cicchetti A. Economic evaluation of Zepatier for the management of HCV in the Italian scenario. Eur J Health Econ 2018; 19:1365-1374. [PMID: 29696459 DOI: 10.1007/s10198-018-0980-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a major health issue worldwide. New generation of direct-active antiviral medications is an epoch-making turning point in the management of HCV infections. OBJECTIVE Conducing a cost-effectiveness analysis comparing the combination of elbasvir/grazoprevir and sofosbuvir + pegylated interferon/ribavirin for the management of all HCV patients (even those in the initial stages of fibrosis). METHODS A Markov model was built on the natural history of the disease to assess the efficacy of the alternatives. The outcomes are expressed in terms of quality adjusted life-years (QALYs) and result in terms of incremental cost-effectiveness ratio). RESULTS Elbasvir/grazoprevir implies an expenditure of €21,104,253.74 with a gain of 19,287.90 QALYs and sofosbuvir + pegylated interferon/ribavirin implies an expenditure of €31,904,410.11 with a gain of 18,855.96 QALYs. Elbasvir/grazoprevir is thus a dominant strategy. CONCLUSION Consideration should be given to the opportunity cost of not treating patients with a lower degree of fibrosis (F0-F2).
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Affiliation(s)
- F R Rolli
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy
| | - M Ruggeri
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy
| | - F Kheiraoui
- Istituto di Sanità Pubblica, Sezione Igiene, Catholic University of Sacred Heart, Rome, Italy
- VIHTALI, Value in Health Technology and Academy for Leadership and Innovation Spin-Off of the Catholic University of Sacred Heart, Rome, Italy
| | - C Drago
- "Nicolò Cusano" University, Rome, Italy
| | - M Basile
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy.
| | - C Favaretti
- VIHTALI, Value in Health Technology and Academy for Leadership and Innovation Spin-Off of the Catholic University of Sacred Heart, Rome, Italy
| | - A Cicchetti
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy
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15
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Parente P, Silenzi A, Kheraoui F, Favaretti C. Diabetes value based governance according to 'BREAD 2030' project. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.155] [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)
- P Parente
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Silenzi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Kheraoui
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Favaretti
- Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Nardini S, De Benedetto F, Sanguinetti CM, Bellofiore S, Carlone S, Privitera S, Sagliocca L, Tupputi E, Baccarani C, Caiffa G, Calabrese MC, Capuozzo A, Cauchi S, Conio V, Coratella G, Crismancich F, Dal Negro RW, Dellarole F, Delucchi M, Favaretti C, Forte S, Gallo FM, Giuliano R, Grandi M, Grillo A, Gualano MR, Guffanti E, Locicero S, Lombardo FP, Mantero M, Marasso R, Martino L, Mastroberardino M, Mereu C, Messina R, Neri M, Novelletto BF, Parente P, Pasquinucci S, Pistolesi M, Polverino M, Posca A, Richeldi L, Roccia F, Giustini ES, Salemi M, Santacroce S, Schisano M, Schisano M, Selvi E, Silenzi A, Soverina P, Taranto C, Ugolini M, Visaggi P, Zanasi A. COPD management as a model for all chronic respiratory conditions: report of the 4 th Consensus Conference in Respiratory Medicine. Multidiscip Respir Med 2017; 12:28. [PMID: 29152261 PMCID: PMC5680605 DOI: 10.1186/s40248-017-0109-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable diseases (NCDs) kill 40 million people each year. The management of chronic respiratory NCDs such as chronic obstructive pulmonary disease (COPD) is particularly critical in Italy, where they are widespread and represent a heavy burden on healthcare resources. It is thus important to redefine the role and responsibility of respiratory specialists and their scientific societies, together with that of the whole healthcare system, in order to create a sustainable management of COPD, which could become a model for other chronic respiratory conditions. Methods These issues were divided into four main topics (Training, Organization, Responsibilities, and Sustainability) and discussed at a Consensus Conference promoted by the Research Center of the Italian Respiratory Society held in Rome, Italy, 3–4 November 2016. Results and conclusions Regarding training, important inadequacies emerged regarding specialist training - both the duration of practical training courses and teaching about chronic diseases like COPD. A better integration between university and teaching hospitals would improve the quality of specialization. A better organizational integration between hospital and specialists/general practitioners (GPs) in the local community is essential to improve the diagnostic and therapeutic pathways for chronic respiratory patients. Improving the care pathways is the joint responsibility of respiratory specialists, GPs, patients and their caregivers, and the healthcare system. The sustainability of the entire system depends on a better organization of the diagnostic-therapeutic pathways, in which also other stakeholders such as pharmacists and pharmaceutical companies can play an important role.
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Affiliation(s)
| | | | | | | | | | | | | | - Emmanuele Tupputi
- General Secretary/Treasurer / Italian Respiratory Society-Research Center, Milan, Italy
| | | | | | - Gennaro Caiffa
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | - Silvia Forte
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | - Marco Grandi
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | | | | | | | - Marco Mantero
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | - Laura Martino
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | - Carlo Mereu
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | | | - Paolo Parente
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | | | - Agnese Posca
- Italian Respiratory Society - Research Center, Milan, Italy
| | - Luca Richeldi
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | | | | | - Mario Schisano
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | - Eleonora Selvi
- Italian Respiratory Society - Research Center, Milan, Italy
| | - Andrea Silenzi
- Italian Respiratory Society - Research Center, Milan, Italy
| | | | | | - Marta Ugolini
- Italian Respiratory Society - Research Center, Milan, Italy
| | - Piero Visaggi
- Italian Respiratory Society - Research Center, Milan, Italy
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17
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Parente P, Poscia A, Frisicale ME, La Milia DI, Kheiraoui F, Favaretti C, Silenzi A. Italian Immunization Plan: assessment of vaccine prevention objectives for an effective stewardship. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.167] [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)
- P Parente
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
| | - A Poscia
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
| | - ME Frisicale
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
| | - DI La Milia
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
| | - F Kheiraoui
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
| | - C Favaretti
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
| | - A Silenzi
- Institute of Public Health Catholic University of Sacred Heart, Rome, Italy
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18
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Kheiraoui F, Marino M, Ferriero AF, Melani A, Bellisari A, Di Pietro ML, Mantovani L, Favaretti C. How to control agitation in mental illness: the introduction of Loxapine inhalation powder. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.262] [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: 11/13/2022] Open
Affiliation(s)
- F Kheiraoui
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - M Marino
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - AF Ferriero
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - A Melani
- Respiratory Medicine Unit, Teaching Hospital, Siena, Italy
| | | | - ML Di Pietro
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | | | - C Favaretti
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
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19
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Pastorino R, Parente P, Barbara A, Di Pumpo M, Tognetto A, Kheiraoui F, Pierini A, Capelli G, Boccia S, Favaretti C, Silenzi A. Value BREAST Cancer Care: a pilot project to build a population and value based system of care. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.008] [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: 11/13/2022] Open
Affiliation(s)
- R Pastorino
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - P Parente
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - A Barbara
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - M Di Pumpo
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - A Tognetto
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - F Kheiraoui
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | | | - G Capelli
- Department of Human Sciences, Society and Health (HSSH), Cassino, Italy
| | - S Boccia
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - C Favaretti
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - A Silenzi
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
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20
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Silenzi A, Poscia A, Gualano MR, Parente P, Kheiraoui F, Favaretti C, Siliquini R, Ricciardi W. [An effective clinical leadrship to strenghten the immunization policies in Italy]. Ig Sanita Pubbl 2017; 73:483-496. [PMID: 29433134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Effective governance for health is a prerequisite for implementing a transformation in healthcare. Any change, in order to be fully implemented, requires a strong and transparent leadership. The recent drop in vaccine cover has led our National Health Service to implement a number of changes in health prevention and immunization strategies that make vaccination an optimal paradigm of how healthcare leadership should not remain the focus of few scientists and public health specialists, but it should be more and more widespread at all levels. In fact, as in other areas of health, the implementation of a national evidence-based planning through efficient organization and management is not sufficient to ensure good results, but it is necessary that the whole system - institutions, policy makers, healthcare professionals, media and citizens themselves - is actively involved in driving change, promoting ethical, economic and social value of vaccinations.
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Affiliation(s)
- Andrea Silenzi
- Centro di Ricerca e Studi sulla Leadership in Medicina, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Poscia
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Maria Rosaria Gualano
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Italia
| | - Paolo Parente
- Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Flavia Kheiraoui
- Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Carlo Favaretti
- Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Roberta Siliquini
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Italia
| | - Walter Ricciardi
- Istituto di Sanità Pubblica, Sezione di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia
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21
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Fehr R, Alexanderson K, Favaretti C, de Jong J, La Torre G, Lim TA, Martin-Olmedo P, Mekel OCL, Michelsen K, Rosenkötter N, Verschuuren M, de Waure C, Zeegers Paget D. Health assessments for health governance—concepts and methodologies. Eur J Public Health 2017; 27:609-616. [DOI: 10.1093/eurpub/ckx062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Kheiraoui F, Silenzi A, Cortesi PA, Poscia A, Favaretti C. Management of Breakthrough cancer pain (BTcP) in Italy: needs and options. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Vukovic V, Favaretti C, de Waure C. The HTA evidence on e-health/m-health: which challenges? Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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de Waure C, Vukovic V, Favaretti C, Ricciardi W. Assessing health technologies through the HTA approach: the basic methodology to be used. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Waure C, Favaretti C, Ricciardi W. The contribution of Health Technology Assessment to health policies. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Specchia ML, Favale M, Di Nardo F, Rotundo G, Favaretti C, Ricciardi W, de Waure C. How to choose health technologies to be assessed by HTA? A review of criteria for priority setting. Epidemiol Prev 2015; 39:39-44. [PMID: 26499414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Health Technology Assessment (HTA) plays a key role in the policy and decision-making process. Nevertheless, it is time- and resource-consuming, and therefore requires proper resource allocation. Priority setting, as a best way to organize effective and explicit resource allocation systems, may be applied even in this field. OBJECTIVE The aim of this study was to provide an overview of criteria used for priority setting in HTA at European level. METHODS A systematic review of the scientific literature was performed through PubMed alongside consultation of the websites of the European HTA Agencies belonging to the INAHTA. The search was limited to papers written in English and provided with the full text. Documents were considered eligible if providing criteria for priority setting in HTA. RESULTS Seven scientific articles were retrieved from PubMed and 14 European HTA Agencies released prioritization criteria were analysed. The most relevant criteria were: frequency/burden of disease, economic impact and costs, potential benefits, impact on ethical, social, cultural and/or legal aspects. CONCLUSION This work is meant to contribute to supranational discussion on priority setting at European level and shows that, despite the available evidence, work still needs to be done toward harmonization and sharing of the criteria to adopt.
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Affiliation(s)
- Maria Lucia Specchia
- Istituto Sanità pubblica, Sezione Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marcella Favale
- Istituto Sanità pubblica, Sezione Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Di Nardo
- Istituto Sanità pubblica, Sezione Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanna Rotundo
- Oxford University Hospital, John Radcliffe Stroke Unit, Headington, Oxford, UK
| | - Carlo Favaretti
- Istituto Sanità pubblica, Sezione Igiene, Università Cattolica del Sacro Cuore, Roma, Italy.
- Coordinator of the HTA WG
| | - Walter Ricciardi
- Istituto Sanità pubblica, Sezione Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Chiara de Waure
- Istituto Sanità pubblica, Sezione Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
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de Waure C, Kheiraoui F, Favaretti C, Ricciardi W. Assessing health technologies through HTA: requisites, methods, challenges and perspectives. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pea F, Dose L, Cojutti P, Baraldo M, Fontana F, Favaretti C, Furlanut M. Educational and Organizational Interventions to Improve the Usefulness of Clinical Pharmacological Advice for Personalized Drug Dosing Based on Therapeutic Drug Monitoring. Basic Clin Pharmacol Toxicol 2014; 115:432-7. [DOI: 10.1111/bcpt.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/29/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Federico Pea
- Institute of Clinical Pharmacology; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
- Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
| | - Lucia Dose
- Institute of Clinical Pharmacology; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
| | - Piergiorgio Cojutti
- Institute of Clinical Pharmacology; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
- Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
| | - Massimo Baraldo
- Institute of Clinical Pharmacology; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
- Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
| | - Fabrizio Fontana
- Chief Medical Officer; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
| | - Carlo Favaretti
- Chief Executive Officer; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
| | - Mario Furlanut
- Institute of Clinical Pharmacology; Azienda Ospedaliero-Universitaria Santa Maria della Misericordia; Udine Italy
- Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
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Favaretti C. [Knowledge management and healthcare organizations]. Recenti Prog Med 2013; 104:532-534. [PMID: 24326705 DOI: 10.1701/1349.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The present scenario is characterized by a high "environmental turbulence". Healthcare professionals and organizations must increase their knowledge, skills and attitudes for choosing wisely. Healthcare organizations are complex adaptive systems which should use integrated governance systems: knowledge management should be a strategic goal. These organizations should become learning organizations: they should build and renovate their knowledge in a systematic, explicit and definite way.
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Favaretti C. [Decide wisely: health technology assessment tool to govern innovation and disinvestment]. G Ital Nefrol 2013; 30:gin/30.4.19. [PMID: 24941492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Tessarolo F, Disertori M, Caola I, Guarrera GM, Favaretti C, Nollo G. Health technology assessment on reprocessing single-use catheters for cardiac electrophysiology: results of a three-years study. ACTA ACUST UNITED AC 2008; 2007:1758-61. [PMID: 18002317 DOI: 10.1109/iembs.2007.4352651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study aims to define the technical, ethical, juridical and economic issues involved in the assessment of a reprocessing policy for single-use interventional cardiac devices (SUDs). The feasibility of reprocessing was evaluated for cardiac electrophysiology catheters by comparing the chemical, physical and functional properties of new and reprocessed devices. The issue of hygiene was addressed by developing microbiological tests for the quantification of bioburden, sterility and pyrogenic load. The results of more than 1500 tests, conducted on 531 catheters, suggested a precautionary number of regenerations of five cycles. The ethical aspects were reviewed and the European juridical framework was assessed, revealing a need for harmonization. Applying a specific economic model, potential savings were calculated for a representative cardiology department and estimated at national and European level. Potential savings of 41.2% and 32.9% were calculated for diagnostic and ablation catheters, respectively. Safe and effective reprocessing of SUDs could be pursued if quality control processes and certified procedures are met. A reprocessing policy in EP laboratory could lead to savings of about 27,250 euros per 100,000 population, but the economic benefits are strongly dependent on the maximum number of regenerations and the regeneration rate.
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Affiliation(s)
- F Tessarolo
- Department of Physics, University of Trento, 38050, Povo, Trento, Italy.
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Larcher B, Berloffa F, Demichelis F, Eccher C, Favaretti C, Galvagni M, Martini G, Sboner A, Graiff A, Forti S. An evaluation of the use of and user satisfaction with a teleconsultation system in oncology practice. J Telemed Telecare 2002; 8 Suppl 2:28-30. [PMID: 12217124 DOI: 10.1177/1357633x020080s213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A three-year oncology teleconsulting project was concluded in November 2000. During a six-month study period, 38 clinical physicians and 47 nurses used the system. A total of 617 electronic patient records were created in the oncology department, 297 in dermatology and 24 in gynaecology. There were 45 synchronous teleconsultations involving various participants, lasting a total of 708 min. We conducted surveys of the attitudes of users to the teleconsulting system both before and after its implementation. There were no significant differences between the two surveys and the results showed that users had a positive reaction to the system and high expectations of its future utilization.
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Affiliation(s)
- B Larcher
- Medical Informatics and Telemedicine Laboratory, Istituto Trentino di Cultura - Centro per la Ricerca Scientifica e Tecnologica, Trento.
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Larcher B, Berloffa F, Demichelis F, Eccher C, Favaretti C, Galvagni M, Martini G, Sboner A, Graiff A, Forti S. An evaluation of the use of and user satisfaction with a teleconsultation system in oncology practice. J Telemed Telecare 2002. [DOI: 10.1258/135763302320301902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE To present current scientific statements and practice on mammography, ultrasonography in pregnancy, and PSA within the Italian National Health Service (NHS). METHODS Information on the three screenings was found in several position papers prepared by working groups at national and regional levels. RESULTS For mammography the adjusted mortality rate for breast cancer increased in the last four decades and decreased in the last few years. Only 4.9% of women aged 50-70 years are covered by screening. In 1996 a consensus paper stated that biennial examination for women aged 50-69 years should be offered to reduce breast cancer mortality. A national program for breast cancer screening was launched under the responsibility of regional governments, but data about its implementation are not yet available. Regarding PSA screening, the results show that prostate cancer is the fourth most frequent neoplasm in males. A formal evaluation of prostate cancer screening was done in 1995 by the National Research Council and the Italian Association for Cancer Research; they did not recommend the NHS implement this service. In the National Health Plan 1998-2000, prostate cancer screening is not mentioned. So far, an organized and standardized screening program, based on routine PSA testing, does not exist in Italy. Nevertheless, a lot of PSA tests are performed at the clinical level to detect early prostate cancers. The results with regard to routine ultrasonography in pregnancy show that in 1996 the birth rate was 9.30 per 1,000 inhabitants, with 536,740 live births. In the period from 1992-94, the percentage of babies with a birth weight less than 2,500 gm and less than 1,500 gm were 5.85% and 0.91%, respectively. A formal screening program for detecting fetal growth retardation, based on the routine ultrasonography in the third trimester of the normal pregnancy, doesn't exist in Italy, but this test is widely performed. It is paid for under NHS coverage. CONCLUSION In 1998 the National Health Plan 1998-2000 stated that the NHS should offer only evidence-based preventive and diagnostic interventions and stressed the importance of appropriate use of health technology.
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Mariotto A, Zeni L, Selle V, Favaretti C. Utilization of percutaneous transluminal coronary angioplasty for quality assurance in health care from 1983 to 1996. Int J Technol Assess Health Care 2000; 15:473-9. [PMID: 10874375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To examine the distribution of interventional cardiac catheterization laboratories, their case load, the time trends, and the regional variation of percutaneous transluminal cutaneous angioplasty (PTCA) utilization in Italy. METHODS Analysis of data was provided by the annual reports of the Italian Group of Studies and Interventional Cardiology over the period from 1983 to 1996. RESULTS The number of PTCA facilities and their use steadily increased, mainly in the North. In 1996 the utilization rate was 34 per 100,000 population, but only 60% of labs performed 200 or more procedures. CONCLUSIONS Dramatic time trends and regional variations often took place without an epidemiology and technology assessment-based planning process.
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Abstract
BACKGROUND Fair management of queues for hospital-based services requires consideration of clinical need, but there is no information on public attitudes towards non-clinical factors such as age or work status as determinants of priority. METHODS We asked elderly residents of Padova, Italy, whether, if they were awaiting cardiac surgery or an outpatient cardiology consultant, they would give up their place in line for a younger or self-employed individual. We also elicited responses from a convenience sample of younger health workers asked to imagine themselves as elderly persons facing the same choices. FINDINGS The eligible response rate was 72% (443/616). About half deemed it right to give up their place in line for cardiac surgery to a 45-year-old (51%, 95% CI 46-56) or self-employed person (47%, 95% CI 42-51) Proportions were significantly higher for an outpatient consultation (68%, 95% CI 63-72). In multivariate analyses, married respondents, those closer to age 65, university graduates, and those who were formerly self-employed were significantly less likely to respond affirmatively. In significant contrast for all four scenarios (p<0.0001), the overwhelming majority of non-elderly respondents refused to give up their places in line. INTERPRETATION The majority of elderly citizens were hypothetically willing to cede priority in accessing cardiac care to younger or self-employed persons, but this willingness was attenuated among the "young" elderly and more privileged respondents. Non-elderly respondents were much less self-sacrificing, suggesting that ageing baby-boomers may be more assertive about their continuing rights to health care.
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Affiliation(s)
- A Mariotto
- Unit for Technology Assessment and Quality Assurance, Medical Directorate, Padova, Italy.
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37
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Bressan M, Zanchetta M, Michieletto F, Pedrocco A, Zoppo F, Favaretti C, Mariotto A, Pedon L, Razzolini R, Maiolino P, Stritoni P. [Coronary angiography in two defined populations: Padua and Citadella]. G Ital Cardiol 1998; 28:274-80. [PMID: 9561882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronary angiography is an invasive procedure that is relatively expensive and that requires an appropriate indication. METHODS Utilization rate and the appropriateness of the use of the coronary angiography have been compared in two defined populations, namely residents from the city of Padua (group A), and subjects from the local health unit of Cittadella (group B), who underwent coronary angiography between June 1, 1992 and May 31, 1993. Appropriateness was evaluated both by comparison with the AHA/ACC guidelines and by observation of the outcome following diagnosis one year after the coronary angiogram was performed. RESULTS One hundred and seventy-one patients in group A and 100 patients in group B underwent coronary angiography: both groups had similar age and sex distribution. Utilization rate was 8 per 10,000 inhabitants in group A, and 10 per 10,000 inhabitants in group B. Appropriate coronary angiography, evaluated by comparison with the AHA/ACC guidelines, was 69.9% in group A and 68% in group B. Coronary angiogram showed at least one stenosis > or = 50% in 133 patients from group A and in 66 patients from group B. These patients were followed up for at least 12 months. Of 13 deaths, 12 occurred as fatal cardiac events, while of the 147 surviving patients who had complete follow-up data, 114 (77%) improved. The outcome was measured through symptoms and stress test. In addition, subjective improvement was measured in group A using the "Nottingham Health Profile". CONCLUSIONS Criteria of appropriateness for an invasive diagnostic procedure such as coronary angiography, which is a determinant "entry point" for revascularization procedures, is based on common clinical knowledge that may be evolving with time. Based on these data, it seems that the current guidelines could be modified, especially for indications within the setting of myocardial infarction.
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Affiliation(s)
- M Bressan
- Cattedra di Cardiologia, Complesso Ospedale, Università degli Studi, Padova
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Favaretti C, Stritoni P, Mariotto A, Bressan M, Razzolini R. [The distribution and activities of hemodynamic laboratories in Italy: the implications for the quality of services]. G Ital Cardiol 1994; 24:477-82. [PMID: 8076725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The diffusion of cardiac catheterization laboratories in Italy has been increasing in the last decade, often without a rational planning process evaluating costs, safety, concentration and case loads. METHODS Data have been provided by the 1990 annual report of the Italian Group of Hemodynamic Studies and Interventional Cardiology which includes, following the best estimates, about 90% of public and private labs. These data include all cardiac catheterization visits. In analysis, PTCA's have been separately considered. RESULTS In 1990, 85 laboratories with 101 rooms were active. The distribution of the labs was 58% in the north, 14% in the middle and 28% in the south of the country. The number of labs per million inhabitants was 1.9, 1.1 and 1.2 respectively, with a national average of 1.5. The percentage of labs performing fewer than 300 visits per year was 33% in the country. Within the areas, such percentages were 33%, 17% and 42% respectively. A total of 48,518 exams were performed (61%, 18% and 21% in the three areas) with a rate per 100,000 of 115, 82 and 51 (national rate 86). 5,145 PTCA's were carried out in the same year, about 80% of which were in the north area. CONCLUSIONS Even if data could be underestimated, a great difference in geographical distribution of labs was confirmed. This might be explained by morbidity, population age and mobility of patients across the country. The percentage of labs performing fewer than 300 studies is relevant, in particular in the south and in the Isles. Planning for future requirements should include the amelioration of utilization rates (in a perspective of cost containment and patient safety), a thorough evaluation of demographic and morbidity trends, and an estimate of the proportion of inappropriate procedures.
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Affiliation(s)
- C Favaretti
- Divisione di Cardiologia, Complesso Ospedale Università, Padova
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Bressan M, Stritoni P, Razzolini R, Favaretti C, Bianchi A, Menti L, Mariotto A, Maiolino P, Chioin R. [Coronary angiography in a defined population: a pilot study of the residents of Padua]. Cardiologia 1993; 38:225-9. [PMID: 8343938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In recent years there has been a steady increase in number of coronary angiography procedures and coronary angioplasty. Since these interventions are relatively expensive, we tried to evaluate the appropriateness of coronary angiography indications. A retrospective pilot study was undertaken on all residents in Padua who had had a coronary angiography performed in 1988. In order to take into account patients who, although resident in Padua, had a coronary angiography performed outside Padua or even abroad, all Italian Hemodynamic Centers and the Office for Foreign Cures Authorization of ULSS 21 were contacted. Follow-up was stopped on April, 1991. Patients were first checked if living by consulting the Register's Office of the Community of Padua; they were then interviewed by letter on state of health. One hundred twenty-four patients underwent 138 coronary angiography. Utilization rate is 5.6 per 10,000 people (CI 4.6-6.6). This figure is lower than the present USA utilization rate, and is similar to the rate of late 70's. From patient records, 3 out 8 groups emerged as predominant indication for coronary angiography: unstable angina (37%), valvular heart disease (20%) and recent myocardial infarction (20%). According the ACC/AHA guidelines, indication was considered "appropriate" in 69%, "inappropriate" in 7%, "doubtful" in 20% and impossible to evaluate in 5% of cases. Although this classification may have been built up with incomplete information, it is note-worthy that the percentage of inappropriate indication is comparable to that of other reports. A further observation is that not in every case the treatment assigned at the time of diagnostic angiography was really carried out on the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Bressan
- Cattedra di Cardiologia, Università degli Studi, Padova
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Favaretti C, Selle V, Marcolongo A, Orsini A. The appropriateness of human albumin use in the hospital of Padova, Italy. Qual Assur Health Care 1993; 5:49-55. [PMID: 8457688 DOI: 10.1093/intqhc/5.1.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The authors present the findings of a study in three stages (1989-1991) on the appropriateness of human albumin use at the hospital of Padova, Italy. In the first stage, guidelines for appropriate use were defined and a monitoring system was set up. In the second stage, compliance of the hospital departments with the new guidelines was assessed in a sample of human albumin prescription charts and related medical records. This revealed a reduction in consumption of 25%. Sixty-eight per cent of all albumin was given for indications that are only occasionally appropriate. The information given in the prescription chart agreed with the diagnosis contained in the medical records in 78% of cases. At the end of this stage new regulating mechanisms were introduced. The third stage consisted of a medium-term assessment and produced basically the same results as the previous stage. Crucial steps in the implementation of effective actions in quality improvement processes have been discussed.
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Affiliation(s)
- C Favaretti
- Medical Directorate, Hospital and University Medical Centre, Padova, Italy
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Favaretti C, Mariotto A. The quality improvement system in the hospitals of Padua (Italy). Qual Assur Health Care 1992; 4:97-104. [PMID: 1511152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A quality improvement system has been established in 1989 in the hospital network of Padua and its organization is described. Three selected experiences are reported. (1) Appropriateness of the use of human albumin. After the assessment of the clinical policy, new guidelines were experimentally introduced and an evaluation after 3 months has shown a decrease of the total number of prescriptions (25%) and of inappropriate indications (9% vs 40.1%). (2) Urinary Tract Infections (UTI) and indwelling catheterization. The study showed 49% of conditions related to UTI and some corrigible inadequacies in the process of care: 37.2% of indications were probably not justified; 40% of patients who did not undergo urineculture had indications and 13% who underwent urineculture had no indications to the test. Guidelines for appropriate indications and a continuing education programme have been introduced. (3) Falls by hospitalized patients. The patient fall rate was 0.3/1000. As the reporting system showed inaccuracies (for example, the severity of injury was not collected in 34% of cases), a new notification form was introduced in 1991.
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Orsini A, Castoro M, Mariotto A, Favaretto A, Favaretti C. [Urinary catheterization and its infective complications: preliminary data from a prevalence study performed at the University of Padua Hospital Complex]. Epidemiol Prev 1991; 13:135-7. [PMID: 1843291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A Orsini
- Complesso Ospedale-Università Padova
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Favaretti C, Miotti F, Vanzo A, Marangoni L. [Level of orodental health in young persons in 2 local public health units in Venice]. G Stomatol Ortognatodonzia 1984; 3:410-5. [PMID: 6599013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Miotti A, Miotti F, Tessari E, Favaretti C, Guidetti G. [Statistical study of temporomandibular joint disorders]. Mondo Odontostomatol 1984; 26:17-26. [PMID: 6595499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Caramaschi F, del Corno G, Favaretti C, Giambelluca SE, Montesarchio E, Fara GM. Chloracne following environmental contamination by TCDD in Seveso, Italy. Int J Epidemiol 1981; 10:135-43. [PMID: 6457009 DOI: 10.1093/ije/10.2.135] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Data are presented on the occurrence of chloracne, clinical symptoms and biochemical changes in 164 children following environmental contamination by TCDD from an industrial accident in Seveso, Italy. An overall positive association was found between the territorial distribution of chloracne cases and the different levels of soil contamination in the affected area. Individual risk factors such as condition and length of exposure, intake via contaminated foods, etc. were evaluated; no single factor appeared to be associated with chloracne. Disturbances of the gastrointestinal tract were more frequently observed in children affected with chloracne in those from the same areas having no skin lesions. However, no clinically definable systemic disease has been diagnosed.
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Caramaschi F, del Corno G, Favaretti C, Giambelluca SE, Montesarchio E, Fara GM. Chloracne following environmental contamination by TCDD in Seveso, Italy. Int J Epidemiol 1981. [PMID: 6457009 DOI: 10.2307/3433813] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Data are presented on the occurrence of chloracne, clinical symptoms and biochemical changes in 164 children following environmental contamination by TCDD from an industrial accident in Seveso, Italy. An overall positive association was found between the territorial distribution of chloracne cases and the different levels of soil contamination in the affected area. Individual risk factors such as condition and length of exposure, intake via contaminated foods, etc. were evaluated; no single factor appeared to be associated with chloracne. Disturbances of the gastrointestinal tract were more frequently observed in children affected with chloracne in those from the same areas having no skin lesions. However, no clinically definable systemic disease has been diagnosed.
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Favaretti C. [Multiphasic health screenings (MHS) and their evaluation. II. Evaluation of a biochemical and haematological screening in youths of 14-17 years (author's transl)]. Ann Sclavo 1977; 19:1192-213. [PMID: 618064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Favaretti C. [Multiphasic screenings and their evaluation. I. Bibliographic review]. Ann Sclavo 1977; 19:1074-91. [PMID: 356783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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