The district operation centres in one of the largest local health authorities in Italy to manage COVID-19 surveillance and homecare. First implementation and results of a survey addressed to general practitioners

Background: COVID-19 pandemic represented a shock for healthcare systems. Italy was one of the first country to deal with a huge number of patients to be diagnosed, isolated, and treated with scarce evidence-based guidelines and resources. Several organizational and structural changes were needed to face the pandemic at local level. The article aims at studying the perceived impact of the newly implemented District Operation Centres (DOCs) of Local Health Authority (LHA) Roma 1 in managing active surveillance and home care of COVID-19 patients and their close contacts in cooperation with general practitioners (GPs). Methods: A questionnaire, developed according to Delphi methodology, was validated by 7 experts and administered to a randomized sample of GPs and family paediatricians (FPs). All medical doctors selected received a phone interview between December 2020 and January 2021. The questionnaire investigated general characteristics of the sample, relations with DOC and its usefulness, and potential developments. A descriptive analysis was performed and inferential statistical tests were used to assess differences. Results: In April 2020 the LHA Roma 1 implemented one DOCs in each local health district. 215 medical doctors were interviewed, reaching the sample target for health districts (80% CL and 10% MOE) and the whole LHA (90% CL and 5% MOE). Several aspects in the management of COVID-19 cases and close contacts of COVID-19 cases, and of the support of DOCs to GPs/FPs were investigated. More than 55% of the GPs and FPs interviewed found the DOCs useful and more than 78% would recommend a service DOC-like to other LHAs. The medical professionals interviewed would use DOCs in the future as support in treating vulnerable patients, utilizing digital health tools, enlisting specialist doctors, establishing networks, and facilitating professional counselling by nurses. Conclusions: This study is an attempt to evaluate an organizational change happened during COVID-19 pandemic. DOCs were created to support GPs and FPs as a link between primary healthcare and public health. Although several difficulties were disclosed, DOCs' experience can help to overcome the fragmentation of the systems and the duality between primary care and public health and make the system more resilient

Generare valore con acquisti e investimenti

Dopo il covid-19, e alla luce del Pnrr, appare evidente come la riqualificazione e il governo strategico dei processi di acquisto e di investimento in sanità siano una priorità assoluta e un fattore determinante per generare cambiamento, innovazione, valore nel servizio sanitario nazionale-ssn. Questo richiede nuove competenze e un nuovo approccio, sia nel pubblico sia nel privato, per lo sviluppo di modelli e soluzioni collaborative pubblico-privato orientati alla creazione di valore, misurabile, per la sanità pubblica

Percorsi di partecipazione per la costruzione della casa della salute

Le Case della Salute sono strutture polivalenti all’interno delle quali operano servizi territoriali finalizzati all’erogazione di prestazioni socio-sanitarie e assistenziali. Esse sono finalizzate alla costruzione di percorsi di promozione della salute calibrati sulle esigenze della popolazione di riferimento e si configurano, sia come luoghi di integrazione tra molteplici professionalità, che come catalizzatori di reti tra l’ambito territoriale e ospedaliero. Fin dalla loro ideazione, le Case della Salute sono state concepite come conte-sti di ascolto e valorizzazione delle esperienze territoriali che avrebbero dovuto prendere forma, e sostanza, grazie alla realizzazione di percorsi partecipativi attraverso i quali dare vo-ce e protagonismo alle necessità della cittadinanza. Nonostante tali linee di indirizzo, la costruzione partecipata delle Case della Salute è una prassi ancora poco diffusa che necessita di essere realizzata e valorizzata al fine di dare vita a spazi socio-sanitari realmente rispondenti alle domande di salute, sia individuali che collettive. A tal fine, è stato ideato il Progetto “Percorsi di partecipazione per la co-costruzione della Casa della Salute”, pensato per la Ex Asl RME e, specificatamente, per il Distretto 19/Municipio 14 del Comune di Roma all’interno del quale, nel corso del 2016, na-scerà una nuova Casa della Salute che verrà situata nel Parco dell’ex manicomio romano del Santa Maria della Pietà. Il progetto, inserendosi all’interno di un paradigma ecologico (Kelly, 2006), enfatizza la cul-tura / contesto locale, la costruzione collaborativa della conoscenza, così come la concezione di un intervento multilivello, basato sulla comunità e incentrato sullo sviluppo delle risorse locali (Prilleltensky, 2012; Trickett, 2009). Coerentemente con il frame work teorico è stato utilizzato un modello di Partecipatory Action Research (PAR) (Kagan, Burton e Siddiquee, 2008). Tale modello di intervento favorisce il coinvolgimento attivo di tutti gli attori locali e ne promuove il senso di responsabilità e di ownership (Kagan, Burton, Duckett, Lawthom, e Siddiquee, 2011). Tutto ciò ha un effetto e-vidente in termini di sostenibilità dello sviluppo implementato

Electrical storm treatment by percutaneous stellate ganglion block: the STAR study

Background and Aims An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these purposes, the STAR study was designed. Methods This is a multicentre observational study enrolling patients suffering from an ES refractory to standard treatment from 1 July 2017 to 30 June 2023. The primary outcome was the reduction of treated arrhythmic events by at least 50% comparing the 12 h following PSGB with the 12 h before the procedure. STAR operators were specifically trained to both the anterior anatomical and the lateral ultrasound-guided approach. Results A total of 131 patients from 19 centres were enrolled and underwent 184 PSGBs. Patients were mainly male (83.2%) with a median age of 68 (63.8-69.2) years and a depressed left ventricular ejection fraction (25.0 +/- 12.3%). The primary outcome was reached in 92% of patients, and the median reduction of arrhythmic episodes between 12 h before and after PSGB was 100% (interquartile range -100% to -92.3%). Arrhythmic episodes requiring treatment were significantly reduced comparing 12 h before the first PSGB with 12 h after the last procedure [six (3-15.8) vs. 0 (0-1), P < .0001] and comparing 1 h before with 1 h after each procedure [2 (0-6) vs. 0 (0-0), P < .001]. One major complication occurred (0.5%). Conclusions The findings of this large, prospective, multicentre study provide evidence in favour of the effectiveness and safety of PSGB for the treatment of refractory ES