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L'evoluzione delle politiche vaccinali italiane mostra una crescente attenzione verso gli adulti e gli anziani, spostando parzialmente il focus dalle fasce pediatriche. Questo cambio riflette la demografia in trasformazione e il crescente tasso di cronicità e multicronicità tra la popolazione. Le malattie prevenibili tramite vaccino presentano rischi significativi per questi gruppi a causa di complicanze legate alle condizioni di salute preesistenti e alla immunosenescenza. L'ospedale, tipicamente luogo di cure specialistiche, emerge come sede cruciale per l'implementazione delle campagne vaccinali, sottolineando il suo ruolo essenziale nella prevenzione oltre alla cura delle acutezze.

L'ospedale, essenziale nella fornitura di cure specialistiche per pazienti acuti, varia in tipologie e gestione, includendo strutture pubbliche, private e accreditate. La categorizzazione comprende Presidi Ospedalieri, Aziende Ospedaliere, Policlinici Universitari, Aziende Ospedaliere miste, IRCCS, ospedali classificati e istituti privati accreditati. Questi centri devono garantire servizi essenziali come pronto soccorso, degenza, operatori, diagnostica, e farmacia, seguendo modelli organizzativi che favoriscono l'integrazione tra unità operative. Il Decreto Ministeriale 70/2015 enfatizza l'integrazione ospedale-comunità, proponendo una riorganizzazione per ottimizzare l'efficacia assistenziale e contenere i costi.

Introduction: Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. Material and methods: Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. Results: 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. Discussion and conclusions: Delayed discharge may cause a "bottleneck" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organiz

Background: Consumption of sugar-sweetened beverages (SSBs) has been linked to several adverse health outcomes, thus many countries introduced taxation to reduce it. Objectives: To summarize national SSB taxation laws and to assess their association with obesity, overweight and diabetes. Methods: We conducted a systematic scoping review up to January 2022 on PubMed, Web of Science, Embase, and Google Search to identify taxes on SSBs. An interrupted time series analysis (ITSA) was conducted on 17 countries with taxation implemented in 2013 or before to evaluate the level and slope modifications in the rate of change of standardized prevalence rates of overweight, obesity, and diabetes. Random-effects meta-regression was used to assess whether year of entry into force of the law, national income, and tax design affected observed results. Results: We included 76 tax laws issued between 1940 and 2020 by 43 countries, which were heterogeneous in terms of tax design, amount, and taxed products. Among children and adolescents, ITSA showed level or slope reduction for prevalence of overweight and obesity in 5 (Brazil, Samoa, Palau, Panama, Tonga) and 6 (El Salvador, Uruguay, Nauru, Norway, Palau, Tonga) countries out of 17, respectively. No clear pattern of modification of results according to investigated factors emerged from the meta-regression analysis. Conclusions: Taxation is highly heterogeneous across countries in terms of products and design, which might influence its effectiveness. Our findings provide some evidence regarding a deceleration of the increasing prevalence rates of overweight and obesity among children occurring in some countries following introduction of taxation. PROSPERO registration number: CRD42021233309.

Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific data- bases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was euro2,558.91 and euro3,287.40 for subjects with micro- prolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after ini- tial treatment were euro798.13 and euro1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of euro3,201.15 compared to bromocriptine, based on a willingness-to-pay of euro40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic sur- gery was more cost-effective than cabergoline, with an ICER of euro44,846.64. Considering a willingness-to-pay of euro40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.

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.

Importance The diagnosis of rare diseases and other genetic conditions can be daunting due to vague or poorly defined clinical features that are not recognized even by experienced clinicians. Next-generation sequencing technologies, such as whole-genome sequencing (WGS) and whole-exome sequencing (WES), have greatly enhanced the diagnosis of genetic diseases by expanding the ability to sequence a large part of the genome, rendering a cost-effectiveness comparison between them necessary. Objective To assess the cost-effectiveness of WGS compared with WES and conventional testing in children with suspected genetic disorders. Design, Setting, and Participants In this economic evaluation, a bayesian Markov model was implemented from January 1 to June 30, 2023. The model was developed using data from a cohort of 870 pediatric patients with suspected genetic disorders who were enrolled and underwent testing in the Ospedale Pediatrico Bambino Gesu, Rome, Italy, from January 1, 2015, to December 31, 2022. The robustness of the model was assessed through probabilistic sensitivity analysis and value of information analysis. Main Outcomes and Measures Overall costs, number of definitive diagnoses, and incremental cost-effectiveness ratios per diagnosis were measured. The cost-effectiveness analyses involved 4 comparisons: first-tier WGS with standard of care; first-tier WGS with first-tier WES; first-tier WGS with second-tier WES; and first-tier WGS with second-tier WGS. Results The ages of the 870 participants ranged from 0 to 18 years (539 [62%] girls). The results of the analysis suggested that adopting WGS as a first-tier strategy would be cost-effective compared with all other explored options. For all threshold levels above euro29 800 (US $32 408) per diagnosis that were tested up to euro50 000 (US $54 375) per diagnosis, first-line WGS vs second-line WES strategy (ie, 54.6%) had the highest probability of being cost-effective, followed by first-line vs second-line WGS (

Background: Although the long-term consequences of the Coronavirus Disease-2019 (COVID-19) pandemic are yet to be fully comprehended, a syndrome symptomatically akin to the COVID-19 disease has been defined, for children and adolescents, in February 2023 by the World Health Organization (WHO) as ‘post COVID-19 condition’ (PCC). Potential consequences of COVID-19 that affect developmental milestones in children and adolescents should be comprehended in their magnitude and duration. The aim is to investigate the most common symptoms and predictors or risk factors for pediatric PCC. Methods: In this umbrella review, the population of interest was defined as children and adolescents from 0 to 19 years old presenting PCC symptoms as defined by the WHO in the International Classification of Diseases. The intervention considered was general follow-up activity to monitor the patients’ recovery status. No comparator was chosen, and the outcomes were symptoms of PCC and predictors or risk factors of developing PCC. Methodological quality, risk of bias and the level of overlap between studies were assessed. A random- effects meta-analytic synthesis of respective estimates with inverse variance study weighting was carried out, for the primary studies included by the reviews retrieved, regarding predictors or risk factors reported. Results: We identified six eligible systematic reviews, five with meta-analyses, from three databases. The most common symptoms reported were fatigue and respiratory difficulties; female sex and older age were the most reported factors associated with the development of pediatric PCC. Conclusions: A deeper understanding of pediatric PCC requires well- designed and clearly defined prospective studies, symptom differentiation, and adequate follow-up.

Background Evidence on the association between smoke-free policies and per-capita cigarette consumption and mortality due to acute myocardial infarction (AMI) in Europe is limited. Hence, we aimed to assess this association and to evaluate which factors influence it.Methods We performed an interrupted time series analysis, including 27 member states of the European Union and the UK, on per-capita cigarette consumption and AMI mortality. A multivariate meta-regression was used to assess the potential influence of other factors on the observed associations.Methods We performed an interrupted time series analysis, including 27 member states of the European Union and the UK, on per-capita cigarette consumption and AMI mortality. A multivariate meta-regression was used to assess the potential influence of other factors on the observed associations.Results Around half of the smoke-free policies introduced were associated with a level or slope change, or both, of per-capita cigarette consumption and AMI mortality (17 of 35). As for cigarette consumption, the strongest level reduction was observed for the smoking ban issued in 2010 in Poland (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53). Instead, the largest level reduction of AMI mortality was observed for the intervention introduced in 2012 in Bulgaria (RR: 0.38; 95% CI: 0.34, 0.42). Policies issued more recently or by countries with a lower human development index were found to be associated with a larger decrease in per-capita cigarette consumption. In addition, smoking bans applying to bars had a stronger inverse association with both cigarette consumption and AMI mortality.Results Around half of the smoke-free policies introduced were associated with a level or slope change, or both, of per-capita cigarette consumption and AMI mortality (17 of 35). As for cigarette consumption, the strongest level reduction was observed for the smoking ban issued in 2010 in Poland (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53). Instead, th

Current approach to identify BRCA 1/2 carriers in the general population is ineffective as most of the carriers remain undiagnosed. Radiomics is an emerging tool for large scale quantitative analysis of features from standard diagnostic imaging and has been applied also to identify gene mutational status. The objective of this study was to evaluate the clinical and economic impact of integrating a radiogenomics model with clinical and family history data in identifying BRCA mutation carriers in the general population. This cost‐effective analysis compares three different approaches to women selection for BRCA testing: established clinical criteria/family history (model 1); established clinical criteria/family history and the currently available radiogenomic model (49% sensitivity and 87% specificity) based on ultrasound images (model 2); same approach used in model 2 but simulating an improvement of the performances of the radiogenomic model (80% sensitivity and 95% specificity) (model 3). All models were trained with literature data. Direct costs were calculated according to the rates currently used in Italy. The analysis was performed simulating different scenarios on the generation of 18‐year‐old girls in Italy (274,000 people). The main outcome was to identify the most effective model comparing the number of years of BRCA‐cancer healthy life expectancy (HLYs). An incremental cost‐effectiveness ratio (ICER) was also derived to determine the cost in order to increase BRCA carriers‐healthy life span by 1 year. Compared to model 1, model 2 increases the detection rate of BRCA carriers by 41.8%, reduces the rate of BRCA‐related cancers by 23.7%, generating over a 62‐year observation period a cost increase by 2.51 €/Year/Person. Moreover, model 3 further increases BRCA carriers detection (+ 68.3%) and decrease in BRCA‐related cancers (− 38.4%) is observed compared to model 1. Model 3 increases costs by 0.7 €/Year/Person. After one generation, the estimated ICER in the

Unlabelled: Large seasonal outbreaks of bronchiolitis put pressure on healthcare systems and particularly on intensive care units (ICUs). ICU admission is necessary to provide respiratory support to the severest cases, otherwise bronchiolitis can result in substantial mortality. ICU resources are often insufficient and there is scant evidence to guide the ICU clinical management. Most available studies do not cover the ICU-admitted cases and do not consider the associated public health issues. We review this topic through a multidisciplinary approach from both the clinical and public health perspectives, with an analysis based on pathophysiology and cost-effectiveness. We suggest ways to optimise respiratory care, minimise ICU stay, "protect" ICU beds and, whenever possible, make them available for other critically ill children. We also provide guidance on how to prepare ICUs to work under stressful conditions due to outbreaks and to reduce the risk of nosocomial cross-contamination, particularly in ICUs caring for high-risk children. Funding: None.

Il divario tra ricerca e pratica si riferisce ai casi in cui la ricerca fatica a essere applicabile in contesti concreti, come quello sanitario, con un notevole impatto sull’organizzazione dell’assistenza, sull’erogazione dei servizi e sugli esiti di salute. Questo aspetto si somma, nei sistemi sanitari come quello italiano, a una forte variabilità nell’accesso ad assistenza di qualità e negli esiti di salute tra le Regioni e nello stesso territorio. Viene usata l’espressione “trasferimento della conoscenza”1 per spiegare il processo iterativo di sintesi e scambio dai risultati della ricerca sanitaria al miglioramento della qualità nella pratica clinica. Comprendere e applicare tutto ciò risulta essenziale per implementare con tempestività ed efficacia le evidenze scientifiche.

Introduction Surgical site infections still remain a major public health challenge and have become an increasing universal risk, especially for the implantation of orthopaedic devices. Unfortunately, the discovery and increasingly widespread use (especially the misuse) of antibiotics have led to the rapid appearance of antibiotic-resistant strains today; more and more infections are caused by microorganisms that fail to respond to conventional treatments. Oxygen ozone therapy has been extensively used and studied for decades across various potential medical applications and has provided consistent effects with minimal side effects. This study aims to determine the superiority of oxygen ozone therapy in combination with oral antibiotic therapy in patients with wound infections after an orthopaedic device implantation when compared with antibiotic therapy alone. Methods and analysis This is an open-label, multicentre, randomised, parallel group study that aims to assess the efficacy and safety of oxygen ozone therapy in combination with oral antibiotic therapy to treat infections in patients (male or female aged >= 18 years) having undergone surgery for the implant of an orthopaedic device. Patients must have at least one (but no more than three) postoperative wounds in the site of surgery (ulcers, eschars and sores) and at least one symptom (pain, burning, redness and malodour) and at least one sign (erythema, local warmth, swelling and purulent secretion) of infection of at least moderate intensity (score >= 2) in the target lesion at the screening visit (patients with wounds without signs of localised infection or with undermining wounds will be excluded). Patients (n=186) will be recruited from five Italian hospitals and studied for 7 weeks. All will be assigned to one of the two treatment groups according to a web based, centralised randomisation procedure and placed into either the (1) intervention: oxygen ozone therapy 2-3 times a week for 6 weeks (for a

Background. Seasonal influenza has a significant impact on public health, generating substantial direct healthcare costs, production losses and fiscal effects. Understanding these consequences is crucial to effective decision-making and the development of preventive strategies. This study aimed to evaluate the economic and the fiscal impact of implementing an incremental strategy for seasonal influenza prevention using the cell-based quadrivalent influenza vaccine (QIVc) among healthcare workers (HCWs) in Italy.Methods: To estimate the economic impact of implementing this strategy, we performed a cost analysis that considered direct healthcare costs, productivity losses and fiscal impact. The analysis considered a 3-year time horizon. A deterministic sensitivity analysis was also conducted.Results: Assuming a vaccination coverage rate of 30% among HCWs, the analysis considered a total of 203 018 vaccinated subjects. On analysing the overall differential impact (including direct costs, indirect costs and fiscal impact), implementing QIVc vaccination as a preventative measure against influenza among HCWs in Italy would yield societal resource savings of euro23 638.78 in the first year, euro47 277.56 in the second year, and euro70 916.35 in the third year, resulting in total resource savings of euro141 832.69.Conclusions:The study demonstrated that implementing the incremental use of QIVc as part of a preventive strategy for seasonal influenza among HCWs in Italy could yield positive economic outcomes, especially in terms of indirect costs and fiscal impact. The resources saved could be utilized to fund further public health interventions. Policy-makers should consider these findings when making decisions regarding influenza prevention strategies targeting HCWs.

Students in medicine and other health professions are exposed to numerous occupational hazards, primarily biological hazards, during their academic careers at university. The aim of the present study was to investigate the seroprevalence characteristics of anti-HBsAg, anti-Measles, anti-Mumps, anti-Rubella and anti-Varicella IgG antibodies in healthcare students of a large teaching hospital in Rome. Methods: To accomplish the study's aims, antibody serology data were gathered from students of Medicine and Surgery, Dentistry, and Health Professions at the Catholic University of the Sacred Heart (Rome Campus) during their first Health Surveillance visit, that took place from 2013 to 2023. Results: Our study sample included 2523 students, 44.4 % were protected against Hepatitis B, 87.3 % against measles, 85.5 % against mumps, 94.6 % rubella and 95.2 % against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), except for mumps. It found a lower probability of having seronegative anti-HBVs with an older date since the presumed primary vaccination. Conclusion: In our sample, seropositivity rate against vaccine-preventable diseases, especially for Hepatitis B, was often inadequate to prevent possible biological risks connected with the activities carried out on the ward.

The Stroke Pathway performance assessment is a key quality improvement element in healthcare. The aim of this study was to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Northern Italy and the possible impact of the COVID-19 pandemic. Methods: A retrospective observational study was carried out analysing data from 1/01/2010 to 31/12/2020. Data considered were: case volume and characteristics of patients undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and DoorTo-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3m-mRS) and NIHSS score 24hours after the ischemic event onset (24h-NIHSS). The study also compared the pre-COVID-19 pandemic period (MarchDecember 2019) with the one following it (March-December 2020). Results: During the considered 10 years range, 418 patients underwent pharmacological thrombolysis. Treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher baseline disability level (from 0.22 to 1.22; p = 0.000). A statistically significant reduction was found for DTN (from 90 to 61minutes average value; p = 0.000), so that in 2019 more than 50% and in 2020 more than 60% of patients were treated within 60minutes (golden hour). Comparing preand COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS=1.18 vs 0.72, p = 0.048). The OTD increased from 88.13 to 118.48minutes, although without a statistically significant difference (p = 0.197). Conclusions: The study highlighted the Stroke Pathway positive impact, even during the COVID-19 pandemic, both on healthcare processes and patients’ outcomes. Nevertheless, both of them could be further improved through specific changes of the Pathway hospital phase and health communication actions. Key mess

Objectives: to set out a method based on the Reed Frost model to delimit over time COVID-19 epidemic waves in Italy. Design: the available national epidemic reports published by the Protezione Civile (Italian civil defence) from 24.02.2020 to 16.022022 were used to collect data on COVID-19 epidemic in Italy. Then, the Reed-Frost model was applied to develop a methodology based on the calculation of the effective contact probability, i.e., the probability of contact. Setting and participants: in Italy, a daily report related to the epidemic was immediately available, including main epidemiological data (point and periodic infection prevalence, mortality, etc), which made it possible for researchers from different institutions to perform analyses about the epidemic. Results: an iterative methodology was developed resulting in the identification of the start-of-wave, end-of-wave, and inter-wave periods and of the starting and ending days of the COVID-19 epidemic waves in Italy (first wave: from 26±2 February 2020 to 28±2 June 2020). Conclusions: this study led to the development of an accessible and reproducible method to determine the start-of-wave and end-of-wave dates of an epidemic, starting only from the number of cases and susceptible people. The main implications of the method mainly consist in allowing benchmarking and forecasting analyses of the epidemic trend to be carried out to support policy and decision-making processes.

Background: About 80% of the roughly 7,000 known rare diseases are single gene disorders, about 85% of which are ultra-rare, affecting less than one in one million individuals. NGS technologies, in particular whole genome sequencing (WGS) in paediatric patients suffering from severe disorders of likely genetic origin improve the diagnostic yield allowing targeted, effective care and management. The aim of this study is to perform a systematic review and meta-analysis to assess the effectiveness of WGS, with respect to whole exome sequencing (WES) and/or usual care, for the diagnosis of suspected genetic disorders among the paediatric population. Methods: A systematic review of the literature was conducted querying relevant electronic databases, including MEDLINE, EMBASE, ISI Web of Science, and Scopus from January 2010 to June 2022. A random-effect meta-analysis was run to inspect the diagnostic yield of different techniques. A network meta-analysis was also performed to directly assess the comparison between WGS and WES. Results: Of the 4,927 initially retrieved articles, thirty-nine met the inclusion criteria. Overall results highlighted a significantly higher pooled diagnostic yield for WGS, 38.6% (95% CI: [32.6 - 45.0]), in respect to WES, 37.8% (95% CI: [32.9 - 42.9]) and usual care, 7.8% (95% CI: [4.4 - 13.2]). The meta-regression output suggested a higher diagnostic yield of the WGS compared to WES after controlling for the type of disease (monogenic vs non-monogenic), with a tendency to better diagnostic performances for Mendelian diseases. The network meta-analysis showed a higher diagnostic yield for WGS compared to WES (OR = 1.54, 95%CI: [1.11 - 2.12]). Conclusions: Although whole genome sequencing for the paediatric population with suspected genetic disorders provided an accurate and early genetic diagnosis in a high proportion of cases, further research is needed for evaluating costs, effectiveness, and cost-effectiveness of WGS and achieving an informe

Obiettivo: individuare proposte di inserimento del pediatra di famiglia nelle attività integrate di assistenza primaria community-oriented, promosse attraverso la costituzione delle case della comunità. Metodi: è stata condotta una revisione narrativa inclusiva di letteratura scientifica e grigia. Risultati: nel contesto della casa della comunità, il pediatra di famiglia può operare in forme aggregate – AFT e UCCP –, all’interno di équipe multidisciplinari e multiprofessionali, in rete integrata con attori sociosanitari di altri setting e stakeholder comunitari. Figura strategica nell’offerta di salute, il pediatra realizza una presa in carico del paziente in età evolutiva, intercettando e rispondendo ai suoi bisogni, attraverso interventi di promozione della salute, prevenzione, cura, riabilitazione e palliazione rivolti al singolo e alla comunità. Conclusioni: la pediatria di famiglia si candida a rappresentare il nucleo motore di un processo sinergico che, con logiche sistemiche di presa in carico, consente di perseguire obiettivi di salute di una comunità, valorizzandone tutte le risorse.

Background: Healthcare university students are exposed to a range of risk factors during their hospital practical training, particularly in relation to biological hazards. Despite being students, they must be paid the same attention as health professionals in relation to the same possibility of transmitting infections to fellow colleagues, patients, and the wider community.The primary aim of this study is to investigate the seroprevalence characteristics of IgG antibodies against main infectious diseases in students enrolled in medical and health-related degree programs in an Italian university. Methods: We conducted a retrospective epidemiological study of health professions students of a university hospital in Rome, collecting sociodemographic information and serology of antibody titers under study (hepatitis B, measles, mumps, rubella and varicella) from 2013 to 2023. After initial description of the study population, bivariate and multivariate analyses were performed to study the association between presence of antibodies with relevant variables. Results: Our study sample included 2523 students (68.5% females; mean age 22.2, SD 3.8), of which 44.4% were protected against HBV, 87.3% against measles, 85.5% against mumps, 94.6% rubella and 95.2% against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), with the exception of mumps. Surprisingly, the prevalence of HBV antibody titer below the seropositivity cutoff appeared to have an inverse correlation with older age (1998-99 OR 0.75 CI 0.61-0.93, 2000-01 OR 0.50 CI 0.41-0.62, 2002-04 OR 0.40 CI 0.31-0.52). Conclusions: Despite several recommendations and campaigns to promote vaccinations, the goal of achieving high immunization rates among healthcare workers still represents a challenge. Public health policies should focus on improving prevention strategies, including serological screening and workplace vaccination for non-immune individuals, especially fo

Osservando i valori di mortalità nelle diverse ondate nelle Regio- ni italiane, si può notare come le prime ondate siano state quelle più drammatiche per il numero di deceduti con diagnosi di Covid-19: in particolare, la prima ondata ha fatto registrare valori di mortalità par- ticolarmente alti in tutto il gruppo delle Regioni del Nord maggior- mente colpite dall’epidemia. In seguito, pur essendo aumentato con- sistentemente il numero di casi a livello nazionale, la mortalità è ri- masta relativamente contenuta: questo è particolarmente evidente per la quarta ondata, che pur registrando i massimi valori di incidenza in tutte le Regioni, non vede valori di mortalità conseguentemente alti.

Nell’ambito del presente capitolo vengono mostrati gli indica- tori di monitoraggio e contagio. I primi casi di infezione di SARS- CoV-2 in Italia sono stati individuati a fine febbraio 2020 nei co- muni di Codogno (Lombardia) e Vo Euganeo (Veneto). Il 9 mar- zo, l’intero territorio italiano è stato sottoposto alla misura del lockdown per limitare la diffusione dell’epidemia, che due giorni dopo veniva dichiarata pandemica dalla World Health Organiza- tion. I principali indicatori presi in considerazione per monitorare l’andamento dei contagi sono stati l’incidenza e la prevalenza dei casi estratti grazie ai dati pubblicati quotidianamente dalla Prote- zione Civile. Per riepilogare gli andamenti generali dei valori re- gistrati – che hanno subito delle fisiologiche oscillazioni legate essenzialmente al flusso dei dati – il calcolo è stato raffinato tra- mite una media mobile.

Il 27 dicembre 2020 è iniziata in Italia la campagna vaccinale anti-Covid-19; con una latenza di circa 20 giorni (dovuta alla pro- grammazione del ciclo vaccinale) inizia anche la somministrazio- ne delle seconde dosi, che segue a distanza l’andamento della somministrazione delle prime dosi. Dopo un periodo di stallo alla fine di gennaio, la somministrazione giornaliera dei vaccini cresce fino all’estate del 2021, arrivando a dei picchi nei mesi di giugno e luglio 2021 e aggiungendo poi a settembre la somministrazione delle terze dosi.

Background: Food insecurity (FI) is a major public health concern, due to its association with a variety of adverse health outcomes. The aim of this study is to provide a picture of the EU policy response and adherence to the international recommendations in terms of FI mitigation and prevention. Methods: A scoping review was carried out based on PRISMA Extension for scoping reviews method. By using specific queries/ keywords, Pubmed and Scopus were searched and also institutional databases: EUR-Lex, WHO Global Database on the Implementation of Nutrition. The search was supplemented by a review of a list of organizations’ official websites, including Cordis, Food and Agriculture Organization of the United Nations, United Nations International Children’s Emergency Fund and World Food Programme. Results: The search on PubMed and Scopus produced a list of 8 articles, 3 concerning agriculture policies in EU, 4 related to intervention on the school lunch and 1 focused on the introduction of a tax on unhealthy drinks. Based on the search on EUR-Lex and WHO Global Database on the Implementation of Nutrition, 4 EU-wide statutory policies were collected covering school meals, food loss reduction, food waste prevention and food crisis and humanitarian aid operations. The institutional website’s review returned 18 documents in the form of ‘soft law’ measures, including action plans, action tools and projects. Conclusions: Preliminary findings suggest that currently, at EU level, a coherent specific policy framework on FI is lacking. The policy fragmentation is mainly due to the multidimensional nature of FI, which has interconnections with multiple and different areas of food system-food availability, food accessibility, food safety and food quality and healthiness. The outputs also show that to date EU has failed to adhere to the international recommendations (above all, WHO recommendations) on FI mitigation and prevention. This has significant implications in terms of public

The Stroke Pathway performance assessment is a key quality improvement element in healthcare. The aim of this study was to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Northern Italy and the possible impact of the COVID-19 pandemic. Methods: A retrospective observational study was carried out analysing data from 1/01/2010 to 31/12/2020. Data considered were: case volume and characteristics of patients undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and DoorTo-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3m-mRS) and NIHSS score 24hours after the ischemic event onset (24h-NIHSS). The study also compared the pre-COVID-19 pandemic period (MarchDecember 2019) with the one following it (March-December 2020). Results: During the considered 10 years range, 418 patients underwent pharmacological thrombolysis. Treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher baseline disability level (from 0.22 to 1.22; p = 0.000). A statistically significant reduction was found for DTN (from 90 to 61minutes average value; p = 0.000), so that in 2019 more than 50% and in 2020 more than 60% of patients were treated within 60minutes (golden hour). Comparing preand COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS=1.18 vs 0.72, p = 0.048). The OTD increased from 88.13 to 118.48minutes, although without a statistically significant difference (p = 0.197). Conclusions: The study highlighted the Stroke Pathway positive impact, even during the COVID-19 pandemic, both on healthcare processes and patients’ outcomes. Nevertheless, both of them could be further improved through specific changes of the Pathway hospital phase and health communication actions. Key mess

Editorial Value Based in Oncology

Objective: To analyze the research status of clinical governance (CG); the most productive authors, countries and organizations; connections among research themes. Methods: We used a ‘funnel model’, consisting of 3 layers describing various CG domains and settings. We retrieved bibliometric data from 1998 to 2021 from the Scopus database. Text mining, visual analysis, descriptive statistics and data visualization were performed. Citation bursts were detected. Results: The total number of studies was 2429. On a global scale, there is a swinging trend in publications, with four peaks detected (2000, 2009, 2013, 2021). Citation burst keywords include: “national health service”, “medical audit”, “psychological aspect”, “quality improvement” and “surveys and questionnaires”. UK is the most productive and cited country. The most active organizations were in the UK, Australia, USA, Italy and Iran. The most productive journals and authors were identified. The most frequent keywords identified were ‘health care quality’, ‘clinical governance’, ‘organization and management’ and ‘medical audit’. Research trends for each CG domain and setting type were reported. Conclusion: By using scientometric methodology, we created a thorough scientific picture on CG, including the mapping of pivotal concepts as a function of time.

Introduction: Critical pathways (CPs) are effective change management tools used to improve quality in healthcare nationally implemented in Italy in 2015. This study aims to map the country's state-of-the-art regarding the adoption of CPs and to verify the existence of factors that determine the success of their implementation and the relative entity of their impact, by analysing the management of Lung Cancer (LC) as a case-study. Methods: Our methodology followed the SQUIRE guidelines for quality improvement reporting (2015). Starting from the 2017 ranking table published by the National Outcome Program, we selected and included in our sample all Italian hospitals who, according to Ministerial Decree n. 70/2015, met national quality threshold for LC treatment. To investigate regional-level and hospital-level factors believed to be responsible for the successful implementation of a CP, a Google Modules questionnaire was constructed and sent to the selected facilities; subsequently, a web-based research was carried out for missing data. Associations between variables were tested in STATA by means of correlation tests and a linear regression model. Results: 41 hospitals matched our inclusion criteria. Of these, 68% defined an internal Lung Cancer Critical Pathway (LCCP). Our results confirmed the presence of critical success factors that favour the correct implementation of a LCCP. Conclusions: Notwithstanding the availability of CPs, their adoption in routine clinical practice still lacks consistency, suggesting the necessity to resort to digital solutions, to increment the level of regional commitment and workforce commitment and to reinforce quality standards monitoring.

The COVID-19 vaccination campaign in Italy started in December 2020, and, due to the Omicron variant's emergence, a second booster dose was recommended for high-risk individuals and healthcare workers from July 2022. The aim of the study was to evaluate the vaccination coverages for the COVID-19 second booster dose and to identify predictors of its acceptance within the population of medical residents (MRs) of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS (FPG) University Hospital. The study was conducted at FPG from October 4th to December 21st, 2022, and COVID-19 second booster dose and influenza vaccines were administered. The study analyzed collected data and conducted multivariate logistic regressions to explore potential predictors of vaccination adherence. The analyses performed were compared with the sample enrolled in FPG residency programs at the start of the COVID-19 vaccination campaign. 1968 MRs were involved in the 2022-2023 vaccination campaign (mean age 28.97, SD 3.44), and the second booster dose of COVID-19 vaccination coverage was low (18.80%). Almost all participants opted for co-administration of COVID-19 and influenza vaccinations, leading to a similar rate of influenza vaccination coverage (16.26%). Being a frontline resident, meaning a direct involvement in managing COVID-19 patients and vaccination campaigns, was the main predictor of vaccination adherence (OR 1.72, 95% CI 1.25-2.17). The dropping in influenza vaccination coverage in 2022-2023 and the low adherence to COVID-19 second booster dose among young physicians is concerning, calling for tailored vaccination campaigns and interventions.

Background: The role of the Mediterranean Diet (MD) in reducing cardiovascular (CV) risk is widely demonstrated and many studies have shown the effectiveness of educational interventions in primary prevention. This study aimed to evaluate the impact of a multidisciplinary educational intervention, that included nutritional, psychological and physical activity coaching, on adherence to MD and on CV risk. Methods: In a Roman neighborhood, general practitioners enrolled 41 subjects to take part in the educational intervention from November 2018 (T0) to November 2019 (T1). Participants' anthropometric measures, haematochemical parameters and CV risk score were assessed before and after the intervention. Furthermore, their adherence to MD was evaluated through the analysis of food frequency questionnaires using Medi-Lite. Results: The study found a significant reduction of 2.5 points in individual CV risk score, and an increase of 2.5 point in adherence to the MD. The stratification by gender showed statistically significant decreases in weight of 1.16 kg, BMI of 0.47, LDL cholesterol of 14.00 mg/dL, and individual CV risk score of 1.16 points among female participants. Conclusions: These results show that a multidisciplinary educational intervention model including the adoption of MD could be an effective strategy in Public Health for CV primary prevention and improvement of people's lifestyles.

The concurrent administration of COVID-19 and influenza vaccines has arisen as a promising approach to bolster protection against respiratory pathogens and improve vaccination rates. However, there remains a lack of data regarding the prevalence of co-administration across several vaccination campaigns, especially among healthcare workers (HCWs). Therefore, this study aims to shed light on the acceptance of co-administration strategies among HCWs during the two campaigns following the introduction of the anti-SARS-CoV-2 vaccine. A retrospective cohort study was conducted among the HCWs of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS, a research hospital in Rome. Hospital administrative databases were accessed to gather information about vaccination for SARS-CoV-2 and influenza during the 2021/2022 and 2022/2023 vaccination campaigns. The study included 7399 HCWs. The co-administration of anti-SARS-CoV-2 and influenza vaccines presented a significant rise in 2022/2023 compared to the previous vaccination campaign (+38%): this was confirmed for every professional category, with the largest increases among resident doctors (+47%) and physicians (+44%), and also for every age category, but it was particularly evident for the youngest health professionals. The probability of co-administration uptake during the 2022/2023 campaign was significantly higher for males, and for those that received co-administration during the 2021/2022 campaign, while the probability was lower for nurses and administrative staff. This study highlights the co-administration procedure as a valuable and effective tool in annual vaccination campaigns for SARS-CoV-2 and influenza. The procedure's safety and streamlined logistics make it increasingly attractive for implementation, particularly among HCWs.

Nel restituire puntualmente una sintesi accurata della performance dell’Assistenza Territoriale (AT), nel corso degli anni ogni Edizione di questo Capitolo ha anche contribuito a caratterizzarne progressivamente l’am- bito concettuale e operativo, secondo logiche e strumenti esplicitati in modo coerente, allineati tanto all’evidenza scientifica quanto alle dinamiche di sviluppo del contesto nazionale. Si è giunti, dunque, a definire l’AT come un “sistema complesso di offerta di salute a destinatario indi- viduale e comunitario, caratterizzato da relazioni evolutive e interdipendenti tra l’assistito, gli stakeholder comu- nitari e gli attori coinvolti nei vari setting assistenziali di una determinata area geo-politica” (1). Un sistema che, oltre alla funzione di primo contatto tesa a fornire risposte al cittadino che sua sponte si rivolge ai servizi territo- riali per problematiche di nuova insorgenza, assolve soprattutto la funzione di presa in carico, garantendo accesso ai servizi più appropriati e continuità dell’assistenza a livello informativo, gestionale e relazionale (1). Come esplicitato nelle precedenti Edizioni di questo Capitolo, la presa in carico non riguarda solo persone affette da con- dizioni di cronicità ma, in un approccio life-course, si estende anche a persone sane o apparentemente tali verso cui indirizzare interventi di prevenzione e promozione della salute (2). In una prospettiva di così ampio raggio, risulta quindi fondamentale sottolineare come la presa in carico, ancor prima che individuale, debba essere di comunità, per garantire piena efficacia e sostenibilità all’intero sistema di offerta di salute. In ciò, appare dirimente il ruolo della governance di sistema che, tramite l’utilizzo integrato di flussi informativi correnti, analizza e stra- tifica i bisogni di salute socio-sanitari dell’intera popolazione, sviluppando programmi e interventi calibrati per ciascun sottogruppo identificato.

While it has been shown that climate change anxiety (emotional distress response to climate change) can enhance pro-environmental behaviours (PEBs) in some subjects, in others it can induce eco-paralysis, thus leading individuals to avoid any form of engagement in actions against climate change. This study aims to clarify which factors influence the relationship between climate change anxiety and the disposition to PEBs, focusing on the role of self-efficacy as a mediating factor. A cross-sectional study was conducted on 394 healthy subjects living in Italy who completed the Pro-Environmental Behaviours Scale (PEBS), the General Self-Efficacy scale (GSE), and the Climate Change Anxiety Scale (CCAS). As a result, the mediation model showed a positive direct effect of the cognitive impairment subscale of CCAS on PEBS and an indirect negative effect of the cognitive impairment subscale of CCAS on PEBS mediated by GSE. These findings show that climate change anxiety has simultaneously two different effects on individuals: it directly encourages PEBs, and indirectly may have detrimental effects on PEBs such as eco-paralysis. Consequently, therapeutic approaches to treat climate change anxiety should not be aimed at rationalising irrational thoughts but rather at helping patients develop coping strategies such as PEBs which, in turn, foster self-efficacy.

Prendersi cura della persona che soffre implica, oggi, combinare le esigenze di efficacia e sostenibilità dell’assistenza con i principi di carità, gratuità e prossimità. Tale sfida passa per l’umanizzazione delle cure, i cui fondamenti sono: la centralità della persona e il perseguimento del “valore” della cura. Il tema del valore declina attenzione alle risorse ed efficacia delle cure secondo la prospettiva del paziente attraverso la lente della dignità della persona, dell’eticità delle scelte e della costante condivisione delle decisioni assistenziali., To take care of suffering people aims at combining effectiveness and sustainability with the principles of charity, gratuitousness and proximity. This challenge involves the humanization of care, whose foundations include each person’s centrality and the pursuit of value of care. The concept of ‘value’, in particular, by matching outcomes that matter to patients with resources, encompasses dignity, ethical nature of choices and ongoing sharing of care decisions.

This study explores the organizational aspects of whole genome sequencing (WGS) implementation for pediatric patients with suspected genetic disorders in Italy, comparing it with whole exome sequencing (WES). Health professionals' opinions were collected through an internet-based survey and analyzed using a qualitative summative content analysis methodology. Among the 16 respondents, most were clinical geneticists performing only WES, while 5 also used WGS. The key differences identified include higher needs for analyzing genome rearrangements following WES, greater data storage and security requirements for WGS, and WGS only being performed in specific research studies. No difference was detected in centralization and decentralization issues. The main cost factors included genetic consultations, library preparation and sequencing, bioinformatic analysis, interpretation and confirmation, data storage, and complementary diagnostic investigations. Both WES and WGS decreased the need for additional diagnostic analyses when not used as last-resort tests. Organizational aspects were similar for WGS and WES, but economic evidence gaps may exist for WGS in clinical settings. As sequencing costs decline, WGS will likely replace WES and traditional genetic testing. Tailored genomic policies and cost-effectiveness analyses are needed for WGS implementation in health systems. WGS shows promise for enhancing genetics knowledge and expediting diagnoses for pediatric patients with genetic disorders.

Background The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. Methods In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. Results The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. Conclusions It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives.

The largest burden of COVID-19 is carried by the elderly, and persons living in nursing homes are particularly vulnerable. However, 94% of the global population is younger than 70 years and 86% is younger than 60 years. The objective of this study was to accurately estimate the infection fatality rate (IFR) of COVID-19 among non -elderly people in the absence of vaccination or prior infection. In systematic searches in SeroTracker and PubMed (protocol: https://osf.io/xvupr), we identified 40 eligible national seroprevalence studies covering 38 countries with pre-vaccination seroprevalence data. For 29 countries (24 high-income, 5 others), publicly available age -stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.034% (interquartile range (IQR) 0.013-0.056%) for the 0-59 years old population, and 0.095% (IQR 0.036-0.119%) for the 0-69 years old. The median IFR was 0.0003% at 0-19 years, 0.002% at 20-29 years, 0.011% at 30-39 years, 0.035% at 40-49 years, 0.123% at 50-59 years, and 0.506% at 60-69 years. IFR increases approximately 4 times every 10 years. Including data from another 9 countries with imputed age distribution of COVID-19 deaths yielded median IFR of 0.025-0.032% for 0-59 years and 0.063-0.082% for 0-69 years. Meta-regression analyses also suggested global IFR of 0.03% and 0.07%, respectively in these age groups. The current analysis suggests a much lower pre-vaccination IFR in non -elderly populations than previously suggested. Large differences did exist between countries and may reflect differences in comorbidities and other factors. These estimates provide a baseline from which to fathom further IFR declines with the widespread use of vaccination, prior infections, and evolution of new variants.

Mega-journals, those that publish large numbers of articles per year,1 are growing rapidly across science and especially in biomedicine. Although 11 Scopus-indexed journals published more than 2000 biomedical full papers (articles or reviews) in 2015 and accounted for 6% of that year’s literature, in 2022 there were 55 journals publishing more than 2000 full articles, totaling more than 300 000 articles (almost a quarter of the biomedical literature that year). In 2015, 2 biomedical research journals (PLoS One and Scientific Reports) published more than 3500 full articles. In 2022, there were 26 such prolific journals. The accelerating growth of mega-journals creates both threats and opportunities for biomedical science.

SARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The "Drummond's checklist" was adopted for quality assessment. A synthesis of the studies was performed through the "dominance ranking matrix tool". Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide.

The COVID-19 pandemic is considered one of the deadliest pandemics in history. Pregnant women are more susceptible to developing serious diseases during COVID-19 than their non-pregnant peers. Pregnant women often express doubt about accepting the vaccination, especially in regard to their security and safety. This study aims to investigate the appreciation of the vaccination offer, and if there are any determinants impacting vaccine hesitancy. A questionnaire was administered to a sample of pregnant women who had just received their immunization against COVID-19 at the vaccination service of a teaching hospital in Rome, from October 2021 to March 2022. A high appreciation of the vaccination services was found, both for the logistic organization and the healthcare personnel, with mean scores above 4 out of 5. The degree of pre-vaccinal doubt was low (41%) or medium (48%) for the largest part of the sample, while the degree of COVID-19 vaccine knowledge was high for 91% of the participants. Physicians were the most decisive information source for the vaccination choice. Our results highlighted that a supportive approach could increase appreciation and improve the setting of vaccinations. Healthcare professionals should aim for a more comprehensive and integrated role of all figures.

Background: Rising incidence and prevalence of end-stage renal disease is a worldwide concern for sustainability of healthcare systems and societies. Living donor renal transplant [LDRT] provides highest health achievements and cost containment than any alternative form of renal replacement therapy. Nonetheless, about 25% of potential LDRTs are missed for causes directly related with inadequate timing in donor assessment. Our quality improvement (QI) project implement process control tools and strategy aiming at reducing total evaluation time for donor candidates and minimizing dialysis exposure for intended recipients, which are the two main determinants of clinical outcomes and costs. Methods: The study includes patients who underwent donor nephrectomy between January 1, 2017 and December 31, 2021. Six Sigma DMAIC approach was adopted to assess Base Case performance (Jan2017-Jun2019) and to design and implement our QI project. Study of current state analysis focused on distribution of time intervals within the assessment process, analysis of roles and impacts of involved healthcare providers and identification of targets of improvement. Improved Scenario (Jul2019-Dec2021) was assessed in terms of total lead time reduction, total pre-transplantation dialysis exposure and costs reduction, and increase in pre-emptive transplantations. The study was reported following SQUIRE 2.0 Guidelines for QI projects. Results: Study population includes 63 patients, 37 in Base Case and 26 in Improved Scenario. Total lead time reduced from a median of 293 to 166 days and this in turn reduced pre-transplantation dialysis exposure and costs by 45%. Rate of potential pre-emptive donors’ loss changes from 44% to 27%. Conclusions: Lean methodology is an effective tool to improve quality and efficiency of healthcare processes, in the interest of patients, healthcare professionals and payers.

Background: Frequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs. Methods: The analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors. Results: A total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001). Conclusion: The FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of

Background: Owing to COVID-19, all stakeholders have recognized the advantages of telehealth and they were available for its permanent implementation, both from the normative and economic point of view. It is, therefore, necessary to understand what were the real benefits created in society through telehealth.Objective: Develop a method to identify a social impact of telemedicine in Italy, considering the reduction on the patient moves with a consequent travel cost, time (opportunity costs), and carbon emission savings.Methods: Since March 2020, we have conducted a quality improvement study in 17 centers, collecting sociodemographic variables. To assess the social impact, we transform the data into outcome measures. The protocol used "Telemedicina Subito" allows the rapid implementation of telemedicine, using operating manual, structured according Health Technology Assessment approach.Results: We collected data related to 2,091 televisits, analyzing three different perspectives. First, one patient with a televisit had a saving equal to the median of EUR 97.16 (interquartile range [IQR]: 64.29-159.69), USD 113.88; considering that the median cost for the visit in presence was EUR 105.91 (p-value <0.05) and after the use of telehealth had a median of EUR 0 (mean: EUR 14.70; p-value <0.05). Second, informal caregivers have a median savings of EUR 65.06 (IQR: 55.52-89.21), USD 76.26. Finally, for one single telemedicine visits we can contribute with a median carbon emission savings of similar to 13 kg (IQR: 6-24).Conclusions: The evaluation of the social impact on telemedicine facilitated the creation of an important framework for decision-makers.