La valutazione dei costi: uno studio applicato all'unità operativa di diagnostica per immagini

The aim of the analysis was to evaluate the reasons that caused the poor economic results and performances of a Radiology Department located in a public hospital. The models of Decision Support System were utilized in order to conduct the studies. These models represent clearly a current economic situation and allow simulations in order to estimate in a preventive way the economic results of different alternative actions. The economic analysis was conducted according to the extended direct costing method utilizing a single performance (product) as a calculation unit. The simulations were carried out in accordance to the "price-cost-volume analysis" method that identifies the break even point for the families of products. These analysis resulted in a significant improvement of the awareness relative to the economic actions of the operative managerial decisions: the main factor in the process of the decision making for the public healthcare structure is to respond to the needs of the potential users and therefore to satisfy the demand, the increase of which is immediately signalised by the lengthening of the awaiting list. For the structure which is incorporated in the hospital frame there is the necessity to provide the service towards inside the hospital both relative to the patients and to the performances of first aid supported by the emergency department. It is important to stress that, even if limited or conditional, there is a space for improvement: the first step in this direction is to analyse in order to recognize and to measure, if not able to improve that what is unknown and not measured before

Condizioni di conservazione dei suoli su substrati carbonatici assoggettati ad intensa pressione antropica

In Sardinia carbonate environments are present on a surface of 7.2%. In these environments there are phenomena of regression of plant cover (typically Mediterranean) and soil (Alfisol-mollisol-inceptisol-entisol). The causes of the deterioration was due to over-grazing of goats (Capra hircus) of forest cutting and more generally to human activities. The aim of the thesis has been the search for a set of indices of soil degradation and vegetation present in a basin with an area of 3,377 located in Central East Sardinia, in the resort of Cala Gonone, City of Dorgali. The research was conducted at a basin scale and detail with a scale of 8 experimental sites dimensions of 5 x 5 m. The basin scale was investigated with the CORINE Soil Erosion Risk method. It was determined the degree of danger potential and current of erosion of the soil with a scale of values ranging from 1 to 3. The High Risk (Level 3) is present on the 0.13% of the basin and is located where the vegetation is sparse and not very structured, with the aggravating circumstance of high gradients. In basin formation most common vegetable, and ecologically more stable, are the woods of holm oak (Quercus ilex L.) investigated in 8 experimental areas, both in the vegetation (mean height,% cover of soil, density and biological diversity) with subdivision into 4 layers of vegetation (tree layer, shrub layer, herbaceous layer and layer of forest regeneration), and organic matter in soil (pH, conductivity, C, CO,% SOM and humic substances). The holm-oak woods are closed formations dominated the tree layer. The forest regeneration is poor because of grazing, however, shows cyclicality. Lacking all the intermediate stages of forest regeneration and mature forest. In the experimental areas there are reports (133 statistically significant correlations with p-level ≤ 0.05 and with R> of 0.7) between the SOM and plant parameters. At present (Poor bibliography) as a general hypothesis, these relationships are due to nutritional aspect. It was concluded that, in the catchment area of Cala Gonone, you must give more attention to the loads of goats, so the effect on soil and vegetation and in particular on forest regeneration. The lack of an adequate stage of regeneration of the forest trees, in the coming decades, with the death of the forest now present, will be a big problem of soil conservation. The major actions should be aimed at containing the grazing and conversion of different plant formations high trees

Creare Valore Sanitario: nuove prospettive per il management delle aziende sanitarie

The value creation is the primary target of a firm and to this pattern is inspired each managerial instrument, behaviour and action. For particular firms as health companies, the pattern of value creation can be well – grounded, provided that it takes care of their particular attributes. Therefore this article is structured on the following methodology of analysis: first of all the pattern of value creation for private firms is shown making clear the meaning of value creation compared with firm’s strategic targets. Then the particular attributes of health companies and the meaning that value creation can undertake in these circumstances are analysed. If the creation of health value can become the strategic target of a health company, it is essential a valuation of the “key variables” marking out the way to create value. At last the change of classical instruments of management and administration control are described. To create health value is the real strategic target of health companies. After years of prevailing or exclusive orientation to efficiency, now managerial instruments rediscover the efficacy and the quality of medical treatments as “key variables” to program and control. Old management tools, such as the budget or the reporting, can become an excellent support for every operator, first of all the medical class that, because of various motives, was (and is) particularly refractory to these instruments. The pattern of value creation can become the philosophy which has to inspire all the health management instruments, and the common language for all the cultures and the professions inside the health companies. Concluding, the pattern of value creation can be an interesting proposal to innovate control systems of health companies and to put an end to the impasse of most of the health management’s applications, but, it required a new co-operation between managers and medical class. Only if the medical class will accept valuation and measurement systems of activity, the value creation will stop to be just a theory and will become a reality

Effects of waterlogging on the soil structure of some Italian soils in relation to the GAEC cross-compliance standard Maintenance of farm channel networks and field convexity

The aim of this work is to assess the effectiveness of the cross-compliance standard Maintenance of farm channel networks and field convexity with respect to the environmental objective to maintain soil structure through appropriate measures indicated in Annex IV of REG. EC 1782/03. This GAEC standard concerns arable land and obliges the farmer to maintain the farm channel network and the convex shape of fields with a view to the management and preservation of temporary drainage ditches and permanent channels along the edges of the fields, in order to ensure their efficacy and function in draining away water. Experiments have confirmed that maintaining the farm channel networks and giving fields a convex shape has a positive effect in predisposing the soil to ideal conditions for the preservation of its structure. In particular, we have used the data of a newly conducted laboratory study on the effects of the duration of waterlogging on the stability of soil structure, as well as the results of several studies carried out in the past with the following goals: i) assessment of the effects of soil moisture various levels on the stability of the structure; ii) assessment of the effects of several wetting and drying cycles on aggregate stability; iii) determination of aggregate stability under the influence of freezing and thawing under different soil moisture conditions; iv) determination of aggregate stability with an increasing number of freeze/thaw cycles (0, 1, 3, 5, 11 cycles) at field capacity moisture. The tests during which the soil was subjected to freezing and thawing were carried out taking into account the fact that during winter waterlogged soil may freeze, leading to a structure breakdown, due to the expansion of water into the pores during the freezing phase. In general, the results showed that in soils that are sandy and rich in rock fragments, rapid moisture penetration leads to significant disaggregation phenomena compared with soils with higher silt and clay contents. The results also showed that the least extensive disaggregation of the structure occurred with three wetting/drying cycles. This behaviour was more obvious in soils with a greater silt and clay content compared with sandy loam soils. After the third wetting/drying cycle, disaggregation increased with the cycles number increasing. In particular for moisture contents of 50%, this test confirms that maintaining the farm channels efficacy has a beneficial effect on soil structure, as good draining of water, which is ensured by well-functioning ditches, prevents waterlogging and fights the dispersion of clay and silt (when the soil is dry, these two components form a surface crust that disturbs the water and gas exchange as well as plant growth). Disaggregation due to freezing and thawing is linked very closely to the matrix potential (and hence to the moisture) of the aggregates before treatment. In general it can be said that a water content between saturation and field capacity predisposes the soils to a much higher level of disaggregation compared to soil that is air-dry or at the wilting point. The tests that examined the effect of an increasing number of freeze/thaw cycles showed a logarithmic degradation of structural stability in relation to the number of cycles. However, most of the disaggregation occurred after three freeze/thaw cycles. This experiment showed that only few freeze/thaw cycles are necessary to cause a significant structural degradation of soils with high water content and with a texture ranging from loamy to clayey. The results of the studies allow us to deduce that the Standard is efficient in contributing to the preservation of the soil structure. In fact, maintaining the water drainage network in efficient conditions and giving the fields a convex shape are elements that contribute to the removal of excess water, which results in a decrease of both of the possibility of the dispersal of silt+clay microaggregates and of the risk of structural damages due to freezing and thawing

Creazione di valore sanitario e sistemi di finanziamento: il caso del dipartimento di salute mentale

Health-value adding is the new priority and a watchword for all clinicians and health service workers. The creation of health-value requires a team work involving different actors: A. the clinical staff, whose task consists in the creation of treatment models and in their formalization into guidelines and protocols; B. the managers, since effective clinical and therapeutic practices must go along with coherent organizational models and valuable control instruments; C. the public institutions responsible for the definition of health policy guidelines: among these, a prioritary role is played by funding methods, which can affect significantly the results of health-value adding initiatives. This work aims at studying the relationships between funding methods and health-value creation, with particular reference to mental health services. Particular relevance is given to the funding of mental health departments, with a view to putting aside the shortcomings of the current models and proposing the DRG as an alternative funding method for mental health services. The procedures for patients classification and evaluation envisaged in the psychiatric DRG can assist health service managers in evaluating the outcomes and the patients’ health conditions. In other words, the issues concerning funding and management evaluation will be articulated in the same language: this, in turn, will eliminate the lack of integration which can be presently identified as the main fault of most funding methods, and improve the degree of coherence among resource allocation, activities and results. The case of mental health services can therefore be taken as an example of successful and effective cooperation among management, health policy and clinical staff

Apparato genitale femminile dell'ovino sardo: alterazioni anatomo patologiche e ipofecondità

A survey was carried out on ovine female genital tracts collected from slaughtered Sardinian sheep. Of 1177 apparata, 293 showed different lesions in various sites, 76 of which were considered as a cause of sterility or ipofecundity. The AA. report the frequency of trombosis and fribrous calcification in ovarian and uterine arteries

Appropriatezza clinica ed economica: strumenti e modelli di valutazione e gestione dell’attività psichiatrica

The Italian health care system is experiencing a profound reform process: due to the increasing level of expenditures, new models of organizations are being experimented to increase both efficiency and efficacy of the health care delivery system. In this general framework, our group has developed a research project with clinical, statistical and economic implications. The ambitious aim of the project is to improve the allocation and management of resources assigned to Mental Health Departments, on the basis of recent experiences in the Piedmont region. The paper presents the methodology developed to implement the project “ Evaluation of Appropriateness of care and Costs of Psychiatric Disorders”. The project aims at analysing both appropriateness and efficiency of the routine care provided by the various agencies of three Mental Health Departments. We believe that a regular monitoring of both appropriateness and efficiency of care would assist in the development of rational choices for the allocation of funds and the clinical management of patients

Modello di analisi decisionale della gestione terapeutica della polmonite acquisita in comunità e creazione di valore

The pharmacoeconomical analysis of the strategies in the disease management of the Community-Acquired Pneumonia (CAP) is a very good starting point for considering the value creation utility. The value creation represents a basic target for the health area, both in short term management and in strategic management: in fact, creating value means to satisfy people health interests and needs. The cost-benefit analysis (CBA) is the more functional economic valuation method, fitting the value creation model in the best possible way. In fact it examines the greatest number of variables that generates costs and benefits, having an influence on the value creation. In the CAP specific case, the question is if it’s possibile to reduce the average days of stay and/or to reduce the admissions to hospital, considering if this changes can generate a health value creation by causing more benefits than costs. This study presents data and values related to infectious disease hospitalization to analyse the resources economy from days of stay cutback and admission to hospital number

Essiccazione di cultivar di susino del germoplasma della Sardegna mediante l'utilizzo di trattamenti di deceratura

Four cultivars of plums of Sardinian germoplasm have been dried with forced air at 65°C. Fruits have been subjected to dewaxing treatments before processing, in order to remove the wax layer on the fruit surface and reduce the dehydration duration. Dehydration kinetics and some physical-chemicals parameters (pH, total soluble solids, dry matter, water activity and colour) have been determined on fresh, while processing and processed fruits. Results of the present study will be discussed. Frutti di quattro cultivar di susino del germoplasma locale sono stati essiccati in corrente d'aria forzata alla temperatura di 65°C. I frutti prima di essere trasformati, sono stati sottoposti a dei pretrattamenti coadiuvanti di deceratura, al fine di eliminare lo strato ceroso presente sull'epidermide e ridurre i tempi d'essiccazione. Sui frutti freschi, in trasformazione e su quelli essiccati, sono state determinate le cinetiche d'essiccamento e i seguenti parametri chimico-fisici: pH, contenuto di solidi solubili totali, sostanza secca, attività dell'acqua e colore. Nel presente lavoro saranno discussi i risultati relativi alla sperimentazione

Effetto di alcuni trattamenti preliminari sulle cinetiche di essiccamento di frutti di olivo

Olive fruits (Olea europea sativa Hoffm. and Link) of two Sardinian cultivars, after being harvested at full maturation stage, were calibrated and subjected to several preliminary treatments, in order to break the peel, before being dehydrated. Dehydration was carried out at 60°C with a constant flow rate. Fruits were placed on trays according to a completely randomised design. Dehydration kinetics were computed by taking fruits during dehydration, while changes in some chemical-physical parameters (pH, water activity and colour) were assessed by sampling at the start and at the end of the drying step. Results will be discussed. Frutti eli olivo (Olea europea sativa Hoffm. and Link) di due varietà sarde, dopo la raccolta allo stadio di completa invaiatura, sono stati calibrati e hanno subito una serie di trattamenti preliminari, atti a favorire la rottura dell'epicarpo, prima di essere sottoposti ad un processo di essiccamento. La disidratazione è stata condotta alla temperatura di 60°C ed a flusso d'aria costante, disponendo i frutti delle tesi secondo un piano completamente randomizzato. Ad intervalli prestabiliti durante l'essiccamento sono stati effettuati dei prelievi di frutti, al fine di determinare le cinetiche di essiccamento, mentre per la determinazione delle variazioni di alcuni parametri chimico-fisici (pH, attività dell'acqua e colore) è stato fatto un campionamento ad inizio ed a fine processo. Nel presente contributo saranno discussi i dati relativi alla sperimentazione