Vincoli al bilancio di rango costituzionale. Una analisi giuridica comparata tra il modello USA e il modello europeo.

This study highlights the problematics regarding the provisions and the national implementations of the Treaty on Stability, Coordination and Governance. Also called TSCG, this international treaty establishes budget balance rules for the Eurozone States, in order to prevent future instabilities in cases of economic crises. A comparison with the U.S. experience on the subject – regarding both the genesis of these budgetary constraints and their characteristics – is given in order to better explain the gaps left by the European law. Whereas the U.S. budgetary system was established by the independent laws of different States, the TSCG designs a series of norms which have to be implemented in every State of the Eurozone, with a top-down approach, in order to create a harmonized system throughout all the States. Nonetheless, the Treaty itself has many gaps which have been differently filled by national laws. These gaps regard relevant aspects of the discipline: even the characteristics of the constraints themselves are not clearly established. Moreover, the implementation of the TSCG has been conducted in different ways, because of the different stages of development of the national budgetary laws. Germany has always focused on the financial stability of the Federation; Spain urged a reform in financial law because of the crisis; Italy changed its Constitution to comply to the TSCG; France had an ongoing process of modernization of the Constitution. The TSCG is designed to promote financial stability; however, it impedes redistribution policies, creating tensions among the Eurozone States. In this sense, other solutions giving more responsibility and power to the central organs of the EU might be more effective

Tratti evolutivi e questioni aperte nelle politiche anticorruzione. Tra emergenza continua e prospettive di stabilizzazione

Il presente volume raccoglie alcuni contributi frutto dell’attività di formazione e ricerca condotte congiuntamente dal Dipartimento di Scienze Politiche e Sociali dell’Università di Pavia e dalla Fondazione Giandomenico Romagnosi-Scuola di Governo Locale. Esso rappresenta il quarto lavoro collettaneo dedicato al tema dell’anticorruzione nelle pubbliche amministrazioni, con il fine specifico di offrire alcuni spunti d’analisi riguardo alle tendenze evolutive mostrate nell’ultimo quinquennio, ovvero durante un periodo caratterizzato da intensi fattori di rottura e perturbazione che, inevitabilmente, hanno finito per influenzare anche questo campo d’intervento. A tal riguardo, si è fatto riferimento nel titolo di questo scritto introduttivo alla metafora del pendolo, ad indicare un andamento caratterizzato da tendenze oscillatorie polari, continue e incessanti, che non hanno ancora lasciato intravedere una prospettiva di stabilizzazione e sintesi su cui gli operatori economici e le collettività coinvolte possano fare affidamento

Acute Oncologic Complications: Clinical–Therapeutic Management in Critical Care and Emergency Departments

Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient’s admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981–April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study

Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs