Programmazione multilivello dell'economia e condizionalità

The paper deals with the European economic planning as a distinctive element of the measures prepared to face the crisis and to prepare for economic development. Is this a reversal of the trend compared to the past or is it just a situation of temporary flexibility of the rules governing the market economy? A particular impetus has been given to innovation policies, also in the context of the Recovery plan. The guideline seems to be that of a renewed approach to policies for economic development thanks to the compact realized by the European Union and the States, according to the multilevel scheme.Il paper sviluppa il tema della programmazione economica europea quale elemento distintivo delle misure predisposte per fronteggiare la crisi e per preparare allo sviluppo economico. Si tratta di una inversione di tendenza rispetto al passato o soltanto una situazione di temporanea flessibilizzazione delle regole a presidio dell’economia di mercato? Un impulso particolare è stato dato alle politiche per l’innovazione, anche nell’ambito del Recovery plan, anche se permangono le condizionalità. La direttrice sembra essere quella di un approccio alle politiche per lo sviluppo economico grazie al connubio Unione europea-Stati secondo lo schema multilivello, un approccio che, però, andrà testato alla luce delle modalità applicative delle norme di riferimento

Adjuvant treatment for elderly patients with colon cancer. An observational study

Background: Adjuvant. 5-fluoruracil-based chemotherapysignificantly reduces mortality in. patients with: stage II-III colon cancer, but is less prescribed with rising age. In this study we were interested in the pattern of adjuvant treatment and possible effects on survival among elderly patients. Patients and methods: From January to December 2004, 63 questionnaires on the management of stage II-III resected colon cancer patients aged over 70 years, collected from 10 Italian Centres, were retrospectively examined. Determinants of receipt of adjuvant chemotherapy and their relation to survival were considered. Results: The proportion of elderly patients receiving adjuvant chemotherapy was 79.4%, distinct of age, gender, educational level and comorbidities. Grade 3-4 toxicities were the following: haematological in 4 (8.5.%) patients, mucositis in 4 (8.5%), diarrhoea in 2 (4.2%) and nausea in 1 (2.1%). The disease-free survival (DFS) and overall survival (OS) at two years were 79.9% and 95.6%, respectively. Due to the paucity of events, the impact of prognostic factors (patient's age and comorbidity, tumour stage and grade) on DFS and OS could not be assessed. Conclusion: An increasing proportion of elderly patients with colon cancer may be treated with a tolerability and OS similar to those observed in the younger population. Development of age-based guidelines and increased awareness of both physicians and patients through education is important to prevent undertreatment of those elderly patients who are eligible for chemotherapy

Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life

Aim Early palliative care (EPC) in oncology has shown sparse evidence of a positive impact on patient outcomes, quality of care outcomes and costs. Patients and methods Data for this secondary analysis were taken from a trial of 207 outpatients with metastatic pancreatic cancer randomly assigned to receive standard cancer care plus on-demand EPC (standard arm) or standard cancer care plus systematic EPC (interventional arm). After 20 months\u2019 follow-up, 149 (80%) had died. Outcome measures were frequency, type and timing of chemotherapy administration, use of resources, place of death and overall survival. Results Some indices of end-of-life (EoL) aggressiveness had a favourable impact from systematic EPC. Interventional arm patients showed higher use of hospice services: a significantly longer median and mean period of hospice care (P = 0.025 for both indexes) and a significantly higher median and mean number of hospice admissions (both P < 0.010). In the experimental arm, chemotherapy was performed in the last 30 days of life in a significantly inferior rate with respect to control arm: 18.7% versus 27.8% (adjusted P = 0.036). Other non-significant differences were seen in favour of experimental arm. Conclusions Systematic EPC showed a significant impact on some indicators of EoL treatment aggressiveness. These data, reinforced by multiple non-significant differences in most of the other items, suggest that quality of care is improved by this approach. This study is registered on ClinicalTrials.gov (NCT01996540)

Guideline Application in Real world: multi-Institutional Based survey of Adjuvant and first-Line pancreatic Ductal adenocarcinoma treatment in Italy. Primary analysis of the GARIBALDI survey

Background: Information about the adherence to scientific societies guidelines in the ‘real-world’ therapeutic management of oncological patients are lacking. This multicenter, prospective survey was aimed to improve the knowledge relative to 2017-2018 recommendations of the Italian Association of Medical Oncology (AIOM). Patients and methods: Treatment-naive adult patients with pancreatic adenocarcinoma were enrolled. Group A received adjuvant therapy, group B received primary chemotherapy, and group C had metastatic disease. The results on patients accrued until 31 October 2019 with a mature follow-up were presented. Results: Since July 2017, 833 eligible patients of 923 (90%) were enrolled in 44 Italian centers. The median age was 69 years (range 36-89 years; 24% >75 years); 48% were female; 93% had Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1; group A: 16%, group B: 30%; group C: 54%; 72% Nord, 13% Center, 15% South. In group A, guidelines adherence was 68% [95% confidence interval (CI) 59% to 76%]; 53% of patients received gemcitabine and 15% gemcitabine + capecitabine; median CA19.9 was 29 (range 0-7300; not reported 15%); median survival was 36.4 months (95% CI 27.5-47.3 months). In group B, guidelines adherence was 96% (95% CI 92% to 98%); 55% of patients received nab-paclitaxel + gemcitabine, 27% FOLFIRINOX, 12% gemcitabine, and 3% clinical trial; median CA19.9 was 337 (range 0-20220; not reported 9%); median survival was 18.1 months (95% CI 15.6-19.9 months). In group C, guidelines adherence was 96% (95% CI 94% to 98%); 71% of patients received nab-paclitaxel + gemcitabine, 16% gemcitabine, 8% FOLFIRINOX, and 4% clinical trial; liver and lung metastases were reported in 76% and 23% of patients, respectively; median CA19.9 value was 760 (range 0-1374500; not reported 9%); median survival was 10.0 months (95% CI 9.1-11.1 months). Conclusions: The GARIBALDI survey shows a very high rate of adherence to guidelines and survival outcome in line with the literature. CA19.9 testing should be enhanced; nutritional and psychological counseling represent an unmet need. Enrollment to assess adherence to updated AIOM guidelines is ongoing

Le Unioni di comuni nell'attuazione del federalismo

Il lavoro affronta il tema delle Unioni di comuni nello scenario determinatio dalla legge delega sul "federalismo fiscale". Tratta, in particolare, delle Unioni di comuni nel sistema degli enti locali per poi affrontare il tema della natura giuridica di tale ente locale. L'attenzione è poi posta sulle nuove frontiere della unione municipale così come determinata dalle leggi di stabilità e dalla legge sull'obbligatorietà della gestione associata fra enti locali. Il lavoro si conclude con un'analisi del rapporto tra il ridisegno "funzionale" dei territori e la cooperazione comunale

Il futuro delle aggregazioni interlocali: le Unioni di comuni nella l. 7 aprile 2014, n. 56 (c.d. "legge Del Rio"

Nel quadro del riordino complessivo del sistema degli enti locali, l’allocazione delle funzioni amministrative al livello più “adeguato” può essere considerata come una delle tematiche più complesse, e allo stesso tempo controverse, sulle quali il legislatore statale (e regionale) ha avuto modo di confrontarsi, in particolare nell’ultimo decennio, anche al fine di consentire agli enti “del territorio” di rispondere al meglio alle esigenze concrete delle realtà decentrate. Il perimetro spaziale per il “governo” di una determinata funzione, infatti, non necessariamente può, o deve, coincidere con i confini di un singolo ente locale, magari di dimensioni non idonee dal punto di vista della sostenibilità finanziaria. Il principio della uniformità, che ha informato la Costituzione per quel che concerne le funzioni, non sempre consente l’organizzazione efficace ed efficiente dei servizi sul territorio tenuto conto, per l’appunto, delle dimensioni degli enti e delle loro caratteristiche morfologiche e demografiche: basti pensare alla gestione dei servizi pubblici locali o a quella dei rifiuti e così via. Il problema non concerne solo le problematiche connesse ai cosiddetti micro-Comuni, ma anche quelle dell’efficienza dei servizi, complessivamente considerati, della semplificazione e del riordino del sistema degli enti locali, alla cui soluzione, invero, non sempre il legislatore, statale e regionale, è stato in grado di strutturare un assetto definitivo, indugiando su soluzioni a volte sperimentali, altre volte parziali e comunque non risolutive