Il c.d. pre-contenzioso tra deflazione dei processi ed effettività dei poteri dell’Autorità per la vigilanza sui contratti pubblici di lavori, servizi e forniture

Il saggio esamina la novità dovuta all'evoluzione della disciplina del Codice dei contratti pubblici con riferimento in particolare alla possibilità di iscrivere la tutela pre-contenziosa, riconosciuta all'Autorità per la vigilanza dei contratti pubblici, tra gli strumenti classici di ADR, che vengono sempre più sostenuti in sede europea. Il saggio esamina le caratteristiche di tale tutela, il rapporto con i profili processuali e la natura anche in raffronto con le indicazioni provenienti dall'ordinamento europeo

Pericardial, pleural, and diaphragmatic endometriosis

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How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Il giudice amministrativo e gli strumenti finanziari

L’articolo analizza i problemi correlati all’utilizzo di strumenti di finanza derivata da parte degli Enti locali ed in particolare affronta i temi dell’annullamento in autotutela degli atti prodromici alla stipula dei contratti e dell’attribuzione della competenza giurisdizionale. Tali temi sono stati oggetto di pronunce del giudice ordinario ed amministrativo che hanno condotto a soluzioni contrastanti determinando una situazione di incertezza giuridica a discapito degli operatori e delle Amministrazioni interessate. Nell’attuale momento di crisi economica è, invece, essenziale tutelare gli interessi pubblici e privati, nonché dei risparmiatori garantendo una certezza giuridica che potrebbe derivare da un intervento legislativo.The article analyzes the problems related to the use of swaps and other financial instruments by local authorities. These issues have been the subject of judgments of civil and administrative courts that led to conflicting solutions and to a situation of legal uncertainty against the interests of the operators. In the current time of economic crisis, however, it is essential to protect the public and private interests, as well as ensuring legal certainty of investors by a legislative actio

Un confronto sulle “filosofie” di recepimento delle direttive “appalti” nei paesi dell’Unione europea

L’articolo si occupa, con un approccio comparativistico, delle legislazioni attuative delle direttive “appalti” negli ordinamenti degli Stati membri, sia per fornire un quadro adeguato dell’intervento di adattamento nei diritti interni, sia per cogliere, attraverso gli esempi più emblematici, la valenza culturale delle vicende attuative, nella essenziale dimensione complessiva di sviluppo politico-economico, ancor prima che ordinamentale, e per verificare l’entità dell’incidenza di tale condizionamento rispetto alla ratio riformatrice.The article deals with the implementation of the directives on "public contracts" in the legal systems of the Member States. The purpose of the article is to analyze the cultural value of implementation and the impact on political-economic development and on the national legal order