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Il volume è dedicato all'analisi delle modalità di generazione di valore da parte delle associazioni di cittadini e pazienti nonchè degli strumenti preposti alla misurazione dello stesso

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during t

Leaders’ characteristics are among the factors determining organizational results. Knowledge about the characteristics of patient advocacy association leaders remains scarce but is useful to further increase their involvement in decision-making processes. To fill this knowledge gap, using the Mouton and Blake managerial grid, we explored the leadership styles adopted by a sample of patient advocacy association leaders. We aimed to illustrate their profiles, thus offering a useful self-assessment tool. The majority of the 94 surveyed leaders showed the team leader style, and a smaller number presented less mature profiles. This research paves the way for future action to improve their leadership style.

Background: Although children with special health care needs (CSHCN) represent a minority of the population, they go through more hospitalizations, more admissions to the Emergency Department (ED), and receive a major number of medical prescriptions, in comparison to general pediatric population. Objectives of the study were to determine the reasons for admission to the ED in Italian CSHCN, and to describe the association between patient’s demographic data, clinical history, and health services requirements. Methods: Ad hoc web site was created to collect retrospective data of 3479 visits of CSHCN to the ED in 58 Italian Hospitals. Results: Seventy-two percent of patients admitted to ED were affected by a previously defined medical condition. Most of the ED admissions were children with syndromic conditions (54%). 44.2% of the ED admissions were registered during the night-time and/or at the weekends. The hospitalization rate was of 45.6% among patients admitted to the ED. The most common reason for admission to the ED was the presence of respiratory symptoms (26.6%), followed by gastrointestinal problems (21.3%) and neurological disorders (18.2%). 51.4% of the access were classified as ‘urgent’, with a red/yellow triage code. Considering the type of ED, 61.9% of the visits were conducted at the Pediatric EDs (PedEDs), 33.5% at the Functional EDs (FunEDs) and 4.6% at the Dedicated EDs (DedEDs). Patients with more complex clinical presentation were more likely to be evaluated at the PedEDs. CSHCN underwent to a higher number of medical procedures at the PedEDs, more in comparison to other EDs. Children with medical devices were directed to a PedED quite exclusively when in need for medical attention. Subjects under multiple anti-epileptic drug therapy attended to PedEDs or FunEDs generally. Patients affected by metabolic diseases were more likely to look for medical attention at FunEDs. Syndromic patients mostly required medical attention at the DedEDs. Conclusions

Il saggio illustra le caratteristiche dell'ospedale del futuro "lean", sicuro, sostenibile e flessibile.

The contribution deals with the discipline of hospitality in Italy and, in particular, with Albergo Diffuso. A completely Italian type of accommodation by now widespread all over the world and particularly appreciated during the period of the pandemic.

Il volume raccoglie le esperienze e le strategie poste in essere dalle associazioni di cittadini e pazienti durante il periodo pandemico

Background: Accountable care has changed organizational models adopted by health care organizations profoundly and, consequently, the skill set required for doctor-managers who have becomemiddlemanagers and must deal with the operational management of their units. Doctor-managers must carry out clinical tasks as well as tasks related to budgeting, goal setting, and performance evaluation. The performance evaluation bias, defined as the misalignment between a ward unit’s objective performance (as assessed by technical bodies or agencies) and self-assessed performance by the head of the unit, may have serious consequences for individuals and organizations. Purpose: The aim of this study was to identify determinants of performance appraisal bias based on themismatch between self-reported and official performance data. Specifically, we analyzed the role played by managerial behavior, training, engagement, and perceived organizational support at the individual level, as well as the particular unit’s task diversity, complexity, and predictability. Methodology: We collected primary and secondary data referable to a population of ward unit heads in the Italian National Health Service. A linear regression model predicting performance appraisal bias was employed. Findings: High levels of engagement and perceived organizational support were associated with reduced performance appraisal bias, whereas high levels of predictability and task diversity were associated with increased degree of error. Doctor-managers attending training programs in health care management and ward unit task complexity did not affect bias significantly.

Since increased heart rate (HR) is associated with higher mortality in several cardiac disorders, HR is considered not only a physiological indicator but also a prognostic and biological marker. In heart failure (HF), it represents a therapeutic target in chronic phase. The use or up-titration of beta-blockers, a milestone in HF with reduced left ventricular ejection fraction (LVEF) treatment, is at times limited by patients' hemodynamic profile or intolerance. Ivabradine, a HR-lowering drug inhibiting the f-current in pacemaker cells, has been shown to improve outcome in patients with chronic HF, in sinus rhythm with increased HR beyond beta-blocker therapy. The rationale for this review is to update the role of HR as a prognostic biomarker and a potential therapeutic target in other scenarios than chronic HF; namely, in patients with coexisting atrial fibrillation (AF), in HF with preserved LVEF (HFpEF), in acute HF, and in patients discharged after an episode of acute HF. Preliminary studies and case reports that evaluated the use of ivabradine in the setting of acute HF will be summarized. Recent results of HR reduction in the setting of HFpEF with ivabradine will be presented. Finally, data from large registries and trials that evaluated the prognostic impact of HR in patients with acute HF and sinus rhythm or AF will be reviewed, showing that only patients in sinus rhythm may benefit from HR reduction.

Aim: Recent findings show that DNA methylation is susceptible to very preterm (VPT) birth and to the experience of the early stay in the neonatal intensive care unit. The aim of the study was to compare PLAGL1 methylation between VPT and full-term (FT) infants at birth as well as between VPT infants at discharge and FT infants at birth. Methods: DNA was collected from cord blood of 56 VPT and 27 FT infants at birth and from peripheral blood in VPT infants at neonatal intensive care unit discharge. Sociodemographic and neonatal variables were considered. Results: PLAGL1 methylation at birth and at discharge were highly correlated in VPT infants. Lower methylation emerged in VPT infants at birth and discharge compared to FT counterparts. Conclusion: PLAGL1 hypomethylation emerged as a potential epigenetic mark of VPT birth. Future research is warranted to assess the functional consequences of PLAGL1 diminished methylation in VPT infants' development.

Considering the old institution of the transfer of the travel contract, already forseen in the past by the International Convention on travel contract (1970) and in the European Directive 90/314, the objective of the analysis is to verify whether the changes made by the new European Directive 2015/2302 had actually achieved an increse in the protection of travellers.

The chapter deals with the transposition of article 25 of Directive 2015/2302, as implemented in Italy and with reference to the introduction of penalties in case of infringements of the principles contained in the Directive

The article analyses the transposition of art 27 of Directive 2015/2302 in Italy and in particular aims to verify the status of the consumer protection and the possible reflection of the transposition of the provision in our domestic law.

The aim of the present study is to provide a picture of the Italian doctors- managers bargaining style. Starting from the '90s due to the New Public management principles physicians have been enrolled into managerial positions and have been involved into negotiating tasks such as budgetary discussions and similar. We decided to investigate physicians' bargaining styles through the adaptation of the Thomas-Kilmann model (1974). We administered a semi-structured questionnaire to doctors-managers and asked them to answer by using a 5-point Likert scale in order to express their level of agreement/disagreement with the sentences provided. Our sample is composed of 12 physicians differently specialized, enrolled into managerial positions. The majority of them are women. Our results show that interviewed physicians possess more than one bargaining style at the same time. These styles emerge with similar degrees, and this is a peculiarity of our sample. As we have observed in other categories of individuals, is more frequent that just one specific style emerges from one subject. However our sample confirms previous evidence about the effect of gender and bargaining experiences on the adopted style. In particular women-physicians present a lower level of Arrogance style, while experiences tend to increase the consciousness. Our research provides interesting point of reflection about the need to improve negotiating style consciousness, also by offering training programs on this theme.