Anti-HPV vaccination in women treated for HPV-related lesions: effective vaccination strategy for achieving HPV-related diseases control

Human Papillomavirus (HPV) vaccination is able to reduce the risk of relapse in women undergoing surgery for HPVrelated lesions. The surgical treatment of these lesions can correlate with a greater risk of preterm parts. The extension of the recommendation of HPV vaccination to patients treated for a previous HPV-related lesion would entail a lower expense for the Health System. Therefore, an increase in the use of HPV vaccination is desirable also in this target population as well as the implementation of a care pathway dedicated to women treated for HPV lesions that includes vaccination in the prevention activities of relapses

The district operation centres in one of the largest local health authorities in Italy to manage COVID-19 surveillance and homecare. First implementation and results of a survey addressed to general practitioners

Background: COVID-19 pandemic represented a shock for healthcare systems. Italy was one of the first country to deal with a huge number of patients to be diagnosed, isolated, and treated with scarce evidence-based guidelines and resources. Several organizational and structural changes were needed to face the pandemic at local level. The article aims at studying the perceived impact of the newly implemented District Operation Centres (DOCs) of Local Health Authority (LHA) Roma 1 in managing active surveillance and home care of COVID-19 patients and their close contacts in cooperation with general practitioners (GPs). Methods: A questionnaire, developed according to Delphi methodology, was validated by 7 experts and administered to a randomized sample of GPs and family paediatricians (FPs). All medical doctors selected received a phone interview between December 2020 and January 2021. The questionnaire investigated general characteristics of the sample, relations with DOC and its usefulness, and potential developments. A descriptive analysis was performed and inferential statistical tests were used to assess differences. Results: In April 2020 the LHA Roma 1 implemented one DOCs in each local health district. 215 medical doctors were interviewed, reaching the sample target for health districts (80% CL and 10% MOE) and the whole LHA (90% CL and 5% MOE). Several aspects in the management of COVID-19 cases and close contacts of COVID-19 cases, and of the support of DOCs to GPs/FPs were investigated. More than 55% of the GPs and FPs interviewed found the DOCs useful and more than 78% would recommend a service DOC-like to other LHAs. The medical professionals interviewed would use DOCs in the future as support in treating vulnerable patients, utilizing digital health tools, enlisting specialist doctors, establishing networks, and facilitating professional counselling by nurses. Conclusions: This study is an attempt to evaluate an organizational change happened during COVID-19 pandemic. DOCs were created to support GPs and FPs as a link between primary healthcare and public health. Although several difficulties were disclosed, DOCs' experience can help to overcome the fragmentation of the systems and the duality between primary care and public health and make the system more resilient

The Impact of Tumor Boards on Breast Cancer Care: Evidence from a Systematic Literature Review and Meta-Analysis

Breast cancer is the most common malignancy in women, with a complex clinical path that involves several professionals and that requires a multidisciplinary approach. However, the effectiveness of breast cancer multidisciplinary care and the processes that contribute to its effectiveness have not yet been firmly determined. This study aims to evaluate the impact of multidisciplinary tumor boards on breast cancer care outcomes. A systematic literature review was carried out through Scopus, Web of Science and Pubmed databases. The search was restricted to articles assessing the impact of MTB implementation on breast cancer care. Fourteen studies were included in the review. The most analyzed outcomes were diagnosis, therapy and survival. Four out of four studies showed that, with implementation of an MTB, there was a change in diagnosis, and all reported changes in the treatment plan after MTB implementation. A pooled analysis of three studies reporting results on the outcome "mortality" showed a statistically significant 14% reduction in mortality relative risk for patients enrolled versus not enrolled in an MTB. This study shows that MTB implementation is a valuable approach to deliver appropriate and effective care to patients affected by breast cancer and to improve their outcomes

The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes. Updated systematic literature review

Background: Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective: The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods: We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results: Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions: Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency

Continuity of care: models and pillars. Findings of a literature review. Continuità assistenziale: modelli e pilastri. Risultati di una revisione della letteratura

Objectives: the aim of this study has been to review international models and approaches supporting the continuum of care and to identify their main focuses. Methods: a narrative review was performed on Pubmed using the inclusion criteria: continuity of care models application with particular reference to chronicity, comorbidity, disability or frailty areas; systematic reviews written in English or Italian. Results: from 129 initial records, 22 studies were selected. Within these, the most commonly treated is the integrated care model, analysed by 41% of the studies. Moreover, the presence of pillars (founding elements) common to multiple models emerged: “patient engagement and empowerment” (86% of the studies); “multidisciplinarity” (73% of the studies); “coordination of care” (50% of the studies) and “case management” (50% of the studies). Conclusions: the key elements and pillars of the analysed continuum of care models are all interconnected and have to be considered as a part of a holistic care process that aims to respond to the different and complex patient’s health needs. Continuity of care requires the delivery system to adopt a primary health care orientation emphasising the comprehensiveness of the care process and the overall health of the patient and implementing multicomponent and multilevel interventions based approaches

Implementation level of best practice policies by Italian Government for healthier food environments: Healthy Food Environment Policy Index (Food-EPI)

Background. This work aims to identify policies implemented for healthy food environments in Italy within The Healthy Food Environment Policy Index (Food-EPI) project. Methods. Food-EPI tool, which includes two components, thirteen domains and fifty good practice indicators, was adapted for the Italian context. Evidence for implementation was gathered and summarized for all fifty indicators from data sources such as governmental websites, non-government organizations publications and websites and via direct contact with Government officials. Results. The highest level of evidence was found within five domains: food composition (2/2 indicators), labelling (3/4), promotion (4/5), provision (4/5) and leadership (5/5). The domains with less identified evidence were food prices (1/4), food in retail (0/4), trade and investment (0/2) and platforms and interaction (1/4). Conclusions. The evidence summarization and the upcoming stakeholders’ meeting to rate the level of implementation for each indicator in Italy have the potential to improve Government commitment to shape healthier food environments

Strategies to Improve Vaccination among At-Risk Adults and the Elderly in Italy

The World Health Organization (WHO), the United States (US) Centers for Disease Control and Prevention (CDC), the European Center for Disease Control (ECDC), and the immunization guidelines of many countries issue vaccination recommendations for adults and the elderly. However, the uptake of vaccination in these groups is generally low due to several reasons. The present study aimed to identify strategies implemented in Italy in unconventional settings to promote vaccination against influenza, pneumococcal, and herpes zoster virus (HZV) infections among these subjects, i.e., the at-risk adult population and the elderly. We conducted a literature review and a survey of experts. The literature search yielded seven strategies; all of these concerned influenza vaccination, while three also addressed pneumococcal and HZV vaccination. The survey of experts identified 15 strategies; 10 regarded influenza vaccination, while four regarded pneumococcal vaccination and one regarded HZV vaccination. Most of the strategies were implemented in hospital clinics and rest homes. Regarding influenza and pneumococcal vaccinations, the target population mainly comprised at-risk adults, while the elderly represented the main target population for HZV vaccination. Our results show that, in Italy, there are initiatives aimed at promoting vaccination in unconventional settings, but further efforts are required to assess their effectiveness and to further extend them

The impact of the implementation of clinical risk management tools in Pediatric or Neonatal Intensive Care Units: a systematic review

Clinical risk management is a key area in terms of healthcare quality, especially within intensive-care settings and in the case of pediatric patients. The objective of this review is to assess the impact of tools for clinical risk management in pediatric intensive-care settings. Pubmed and Web of Science were queried to carry out a systematic review, using the PICO methodology (June 2019). Primary studies of applicative experiences of clinical risk management that had impacts in pediatric intensive care units were included. A total of 1178 articles were reviewed and 20 were included. Reactive risk management tools were used in 10 studies; proactive tools in 7; both reactive and proactive tools in 3. Sixteen studies out of 20 concerned drugs; other topics included: transition from hospital to primary care, hand hygiene, organizational aspects, human milk administration. Seven studies (35%) reported organizational impacts; Ten studies (50%) reported clinical and organizational impacts; Three studies (15%) reported organizational, clinical and economic impacts. The introduction of clinical risk management tools resulted in changes within the setting considered; combined use of reactive and proactive methodologies was highlighted in various studies, as well as an increasing focus on proactive tools, both drawing a growing trend over time

L\u2019impatto dei team multidisciplinari nella presa in carico delle pazienti con tumore al seno: una revisione di letteratura [Poster]

Background Tra le modalit\ue0 organizzative impiegate nell\u2019ambito dell\u2019assistenza rivolta ai pazienti con patologie oncologiche vi sono i team multidisciplinari (MDT) in cui diversi specialisti (oncologo, chirurgo, radioterapista, istopatologo\u2026) lavorano insieme, condividendo informazioni cliniche dei pazienti presi in carico. Tale modalit\ue0 ha lo scopo di migliorare gli outcome dei pazienti e le performance sanitarie riducendo la variabilit\ue0 nella pratica clinica. L\u2019obiettivo della presente revisione \ue8 quello di valutare l\u2019impatto dei MDT sul processo di presa in carico e sugli outcome di salute delle pazienti con tumore al seno. Metodi I database Pubmed e Scopus sono stati interrogati attraverso una stringa di ricerca con parole chiave quali ad esempio breast cancer, multidisciplinary team, tumor board, outcome, process, evaluation, efficacy, effectiveness, decision making e impact. Sono stati inclusi studi primari in lingua inglese, francese, italiana, spagnola, pubblicati dal 1995 in poi. \uc8 stata, inoltre, eseguita una valutazione della qualit\ue0 con la Newcastle Ottawa Scale (NOS). Risultati Sono stati selezionati 8 studi primari pubblicati dal 2006 al 2018 in Belgio (1), Canada (1), Germania (2), UK (2), USA (2). Tra i risultati preliminari si riportano: cambiamenti nel processo decisionale dopo valutazione collegiale (4 studi), appropriatezza dell\u2019erogazione di terapie chemioterapiche (1), miglioramento della soddisfazione del paziente per le cure ricevute (1), aumento della sopravvivenza (3). Conclusioni La modalit\ue0 organizzativa multidisciplinare ha portato ad un cambiamento del processo decisionale, relativo sia alla valutazione clinica del paziente che al trattamento. Emerge, inoltre, un miglioramento di outcome in termini di salute (sopravvivenza) e di soddisfazione del paziente. Sarebbe auspicabile valutare ulteriormente l\u2019impatto dei MDT, al fine di garantire prestazioni personalizzate e sostenibili

Organisational Model and Coverage of At-Home COVID-19 Vaccination in an Italian Urban Context

The COVID-19 pandemic called for a reorganisation of the methods for providing health services. The aim of this paper is to describe the organisational model implemented by one of Rome’s Local Health Units (LHU), ASL Roma 1, for the “at-home COVID-19 vaccination campaign” dedicated to a target population and to outline data related to vaccination coverage stratified by health districts. A cross-sectional study was designed to describe the strategies implemented by LHU to deliver at-home vaccination programmes. People eligible for the at-home vaccination programme included patients living in the area of the LHU, being assisted by the district home care centre or not transportable or individuals with social situations that make traveling difficult. Priority for vaccination was given to (I) age > 80 years, (II) ventilated patients with no age limit, (III) very seriously disabled people with no age limit. Patients’ data were acquired from regional and LHU databases. From 5 February until the 16 May, 6127 people got at least one dose of Pfizer-Biontech Comirnaty® vaccine, while 5278 (86.14%) completed the necessary two doses. The highest number of vaccines was administered during the first week of April, reaching 1296 doses overall. The number of vaccines administered were similar across the districts. The average number of people vaccinated at home was 6 per 1000 inhabitants in the LHU. This model proved to be extremely complex but effective, reaching satisfying results in terms of vaccination coverage