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

Analisi dei modelli organizzativi di risposta al COVID-19 in Italia: evidenze da 2 anni di ISTANT REPORT Altems

Sistematizzazione e pubblicazione settimanalmente un report per analizzare in modo sistemico e comparativo i modelli di risposta adottati dalle Regioni in risposta all'emergenza da COVID- 1

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

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

Modelling Framework for Sustainable Co-management of Multi-purpose Exhibition Systems: The “Fiera del Levante” Case

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Buffer spaces in healthcare facilities: strategies for managing and designing strategic areas

Introduction: The recent covid-19 experience highlighted the difficulty of healthcare facilities in responding promptly to emergencies. hospitals had to reorganize their spaces, suspending the ordinary medical activities for ensuring the emergency management of the patients’ surplus. A working group of the postgraduate training course in healthcare management by Altems school in Rome conducted a survey on the buffer space (bs), which could support, in case of emergency, the hospitals. Methodology: The team elaborated a double questionnaire to be administered respectively to healthcare staff and designers with a series of questions aimed at understanding the features of bss. the questions were divided into general information, activities carried out during the pandemic and specific questions on the features of bss. many questions were the same for the two types of participants, while some differed in relation to the respective organizational and design skills of the users. Results: 102 healthcare professionals and 56 designers took part to the survey. the data analysis permitted to highlight a series of specific inputs that the bs project should take in consideration, such as: a) proximity to the emergency department (ed), intensive care (icu) and inpatient wards (iws); b) location within the hospital but separate from other medical areas; c) independent access; d) organizational and spatial features similar to ed, icu and iws; e) configuration of an operational space ready for whatever type of need; f) the bs should host approximately 12% of the ed stations (40 sqm/per station). Conclusions: The research aims to become a starting milestone for future investigations: in fact it is necessary to carry out a widespread analysis at the international level. Although the research was focused in hospital settings, the covid-19 pandemic referred also to the territorial healthcare facilities and therefore some considerations on that issue need to be improved

Ripensare l’Ospedale 4.0: il ruolo dello Spazio Polmone.

Introduzione: L'esperienza pandemica da COVID-19 ha evidenziato la difficoltà delle strutture sanitarie nel saper rispondere tempestivamente alle emergenze. Proprio durante la pandemia, gli ospedali hanno dovuto riorganizzare i propri spazi con accorpamenti e trasferimenti, sospendendo l’erogazione dei servizi ordinari, al solo fine di garantire la gestione emergenziale del sovrannumero di pazienti. Un gruppo di lavoro, a partire dal project work del Corso di Alta Formazione "Direzione sanitaria di presidio ospedaliero" promosso da ALTEMS, ha condotto un’indagine sul ruolo dello Spazio Polmone (SP) che potrebbe supportare – in caso di emergenza – le strutture ospedaliere. Materiali e Metodi. È stato elaborato un doppio questionario, da somministrare rispettivamente a a) staff sanitario e direzioni mediche di presidio e b) progettisti e referenti di uffici tecnici con una serie di quesiti atti a comprendere le caratteristiche che lo SP dovrebbe avere, sia in un edificio esistente che di nuova realizzazione. Le domande sono state così suddivise: a) informazioni generali, b) attività svolte durante la pandemia e c) quesiti puntuali sulle caratteristiche relative allo SP. Molti quesiti sono i medesimi per le due tipologie di partecipanti, mentre alcuni si differenziano in relazione alle rispettive competenze organizzativo/gestionali e spaziali/dimensionali degli utenti. Risultati. Al questionario hanno risposto 102 professionisti sanitari e 56 progettisti. L’elaborazione dei dati ha permesso di evidenziare una serie di input specifici che il progetto dello SP dovrebbe avere, quali: a) prossimità al Pronto Soccorso (PS), Terapia Intensiva (TI) e Degenze; b) localizzazione all’interno dell’ospedale ma separato dalle altre aree funzioni sanitarie; c) accesso autonomo con camera calda; d) caratteristiche organizzative e spaziale similari a PS, TI e Degenze; e) configurazione di uno spazio già operativo pronto all’esigenza; f) lo SP dovrebbe ospitare indicativamente il 12% delle postazioni del PS con dimensioni di circa 40 mq per postazione, come previsto per le TI. Conclusioni. Il lavoro di ricerca vuole essere uno starting point: infatti risulta necessario portare avanti le considerazioni e le strategie ampliando lo studio, magari anche a livello internazionale. Sebbene il lavoro si è focalizzato in ambito ospedaliero non si può trascurare l’emergenza verificatasi anche in ambito territoriale, ovvero in strutture a regime residenziale ormai sempre più diffuse. Pertanto il lavoro condotto dal gruppo di ricerca ha evidenziato possibili strategie che potrebbero essere attuate anche in questi contesti

Supplemental Material, sj-pdf-1-her-10.1177_19375867231222563 - Rethinking the Healthcare Facilities: The Role of the Buffer Space

Supplemental Material, sj-pdf-1-her-10.1177_19375867231222563 for Rethinking the Healthcare Facilities: The Role of the Buffer Space by Marco Gola, Alexander Achille Johnson, Daniele Ignazio La Milia, Chiara Cadeddu, Francesco Bardini, Barbara Bianconi, Raffaella Bisceglia, Marcello Di Pumpo, Cristina Genovese, Albino Grieco, Giuseppe Piras, Rocco Guerra, Gianfranco Damiani, Carlo Favaretti, Maria Teresa Montagna, Stefano Capolongo and Walter Ricciardi in HERD: Health Environments Research & Design Journal</p

Supplemental Material, sj-pdf-2-her-10.1177_19375867231222563 - Rethinking the Healthcare Facilities: The Role of the Buffer Space

Supplemental Material, sj-pdf-2-her-10.1177_19375867231222563 for Rethinking the Healthcare Facilities: The Role of the Buffer Space by Marco Gola, Alexander Achille Johnson, Daniele Ignazio La Milia, Chiara Cadeddu, Francesco Bardini, Barbara Bianconi, Raffaella Bisceglia, Marcello Di Pumpo, Cristina Genovese, Albino Grieco, Giuseppe Piras, Rocco Guerra, Gianfranco Damiani, Carlo Favaretti, Maria Teresa Montagna, Stefano Capolongo and Walter Ricciardi in HERD: Health Environments Research & Design Journal</p

Analisi dei modelli organizzativi di risposta al COVID-19 in Italia: evidenze da 2 anni di ISTANT REPORT Altems

all’anno 2020 la storia dell’umanità ha dovuto fare i conti con la diffusione del Sars-COV-2 che ha generato in Italia, come in molti Paesi del pianeta una emergenza, sanitaria, sociale ed economica. L’Alta Scuola di Economia e Management dei Sistemi Sani- tari della Facoltà di Economia dell’Università Cattolica del Sacro Cuore, in collaborazione con il Dipartimento di Scienze della Vita e Sanità Pubblica (Sezione di Igiene) della Facoltà di Medicina e Chirurgia “A. Gemelli”, Cerismas (Centro di Ricerca e Studi in Management Sanitario), il Gruppo di Organizzazione Aziendale del DiGES Diparti- mento di Giurisprudenza, Economia e Sociologia dell’Università della Magna Graecia di Catanzaro, e il Centro di Ricerca sulla Leadership in Medicina della Facoltà di Medicina e Chirurgia “A. Gemelli” dell’Università Cattolica del Sacro Cuore, ha settimanalmente pubblicato un Report per analizzare in modo sistematico e comparativo i modelli di risposta adottati dalle Regioni in risposta all’emergenza Covid-19, partendo dall’analisi epidemiologica dell’evoluzione della pandemia. A due anni dal primo paziente in Italia con COVID-19 di Codogno, ALTEMS ha voluto elaborare un report che sintetizzasse tutti gli elementi che hanno composto la risposta alla diffusione del virus soffermandosi sui modelli istituzionali ed organizzativi adottati dalle Regioni italiane. Questa serie settimanale, che aveva già visto una Edizione Speciale dell’Instant Report a fine anno 2020 in prossimità dell’avvio della campagna vaccinale, viene presentata in forma diversa rispetto agli 85 report precedenti. Il presente Report è stato strutturato per fornire una sintesi di quanto accaduto negli ultimi 24 mesi fornendo una lettura complessiva degli eventi e delle modalità di risposta adottate dalle Regioni