Avoidable blindness and value based healthcare: More value with a population approach

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COPD management as a model for all chronic respiratory conditions : report of the 4th Consensus Conference in Respiratory Medicine

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

Aspetti innovativi nella miscelazione in situ di limo e argilla per la copertura di discariche controllate

Il reimpiego dei limi di risulta dagli scavi, o dal lavaggio di inerti da attivit\ue0 estrattive, nei sistemi barriera di discariche controllate e nella messa in sicurezza di siti contaminati, non \ue8 sempre possibile a causa delle loro modeste propriet\ue0 geotecniche. Nell\u2019articolo viene illustrata la possibilit\ue0 di riutilizzo di un siffatto terreno, poco plastico, nella realizzazione della barriera minerale superficiale di una discarica per rifiuti solidi non pericolosi, tramite distinta miscelazione o con bentonite sodica (almeno 5% in peso), o con un\u2019argilla plastica (almeno 20%). E\u2019 stata testata l\u2019efficacia della miscelazione in situ di miscele limo-bentonite e limo-argilla plastica nell\u2019intero volume della copertura, ottenuta impiegando una particolare macchina operatrice, la stabilizzatrice Wirtgen WR2000. E\u2019 stato conseguito un duplice obiettivo: il raggiungimento della plasticit\ue0 minima di progetto (Ip 65 10%) e una significativa diminuzione della conducibilit\ue0 idraulica. Innegabile, infine, il risvolto strategico connesso al reimpiego di notevolissimi volumi di terreni di risulta che, allo stato naturale, non troverebbero proficua collocazione

A New Approach for the Design, Construction and Control of Compacted Mineral Liners of a MSW Landfill Capping

Design parameters typically used for the mineral liner of landfill cover system (e.g. water content w, dry density ρd and hydraulic conductivity k) are often difficult to obtain on site. After construction, these experimental parameters need to be checked against the predicted values. In this paper, a rigorous procedure for design, construction and control of a compacted mineral liner in a capping multilayer system has been developed. The procedure has been schematically subdivided in three phases. The first phase (design) was based on a wide preliminary set of laboratory tests, composed of classification, compaction and permeability tests. An analytical relationship among degree of saturation Sr, dry density ρd and hydraulic conductivity k is also defined. The second phase (construction) was developed through a suitable compaction of the mineral liner planned after the design phase. The last phase (in-site control) consists of checking the design parameters (w, Sr, ρd, k) actually achieved on site. A comparison between coefficients k, obtained through site permeability tests and an analytical relationship obtained in the design phase, was made successfully. Owing to this new approach, it will no longer be necessary to perform in situ permeability tests, but it will be enough to define the above-mentioned analytical relationship during the design phase. In this way, a dangerous damage to the mineral liner, caused by the execution of invasive permeability tests, will be also avoided

HEALTH TECHNOLOGY ASSESSMENT EVIDENCE on E-HEALTH/M-HEALTH TECHNOLOGIES: EVALUATING the TRANSPARENCY and THOROUGHNESS

Objectives: Evaluation is crucial for integration of e-Health/m-Health into healthcare systems and health technology assessment (HTA) could offer sound methodological basis for these evaluations. Aim of this study was to look for HTA reports on e-Health/m-Health technologies and to analyze their transparency, consistency and thoroughness, with the goal to detect areas that need improvement. Methods: PubMed, ISI-WOS, and University of York - Centre for Reviews and Dissemination-electronic databases were searched to identify reports on e-Health/m-Health technologies, published up until April 1, 2016. The International Network of Agencies for Health Technology Assessment (INAHTA) checklist was used to evaluate transparency and consistency of included reports. Thoroughness was assessed by checking the presence of domains suggested by the European network for Health Technology Assessment (EUnetHTA) HTA Core Model. Results: Twenty-eight reports published between 1999 and 2015 were included. Most were delivered by non-European countries (71.4 percent) and only 35.7 percent were classified as full reports. All the HTA reports defined the scope of research whereas more than 80 percent provided author details, summary, discussed findings, and conclusion. On the contrary, policy and research questions were clearly defined in around 30 percent and 50 percent of reports. With respect to the EUnetHTA Core Model, around 70 percent of reports dealt with effectiveness and economic evaluation, more than 50 percent described health problem and approximately 40 percent organizational and social aspects. Conclusions: E-Health/m-Health technologies are increasingly present in the field of HTA. Yet, our review identified several missing elements. Most of the reports failed to respond to relevant assessment components, especially ethical, social and organizational implications