Association between Patient Outcomes and Joint Commission International (JCI) Accreditation in Italy: An Observational Study

Quality in healthcare is a constantly debated topic and has not found a clear definition to date. If we consider the possible quality standards related to health services, the Joint Commission identifies the main criteria that health organizations must respect in order to guarantee patient safety. The Joint Commission International \u2013 founded in 1994 by the JC \u2013 also accredits organizations in countries other than the USA and Canada to ensure better minimum quality levels. The study investigates the possibility of obtaining a better outcomes of the health structures accredited in Italy by the Joint Commission International compared to the other the other health organizations of the Italian system considering the mortality index as an indicator recognized by the literature as a summary indicator of outcome. The National Outcome Program (PNE) created by the Italian Ministry of Health allows comparative effectiveness researches based on relative risk. This study performs the analysis based on the results of the past three years available and on the volume of activities provided. Given a p-value significance index <0.05, the analysis highlights the absence of a significant difference between accredited and non-accredited structures. The study contributes to the literature on health system outcomes and performance and has relevance considering researches in health tourism and health mobility policies fields

Bibliometrix analysis of medical tourism

Medical tourism is an expanding phenomenon. Scientific studies address the changes and challenges of the present and future trend. However, no research considers the study of bibliometric variables and area of business, management and accounting. This bibliometric analysis discovered the following elements: (1) The main articles are based on guest services, management, leadership principles applied, hotel services associated with healthcare, marketing variables and elements that guide the choice in medical tourism; (2) The main authors do not deal with tourism but are involved in various ways in the national health system of the countries of origin or in WHO; (3)cost-efficiency and analytical accounting linked to medical tourism structures and destination choices are not yet developed topics

Impact of DEL22q11, trisomy 21, and other genetic syndromes on surgical outcome of conotruncal heart defects

ObjectiveGenetic syndromes occur in more than 20% of patients with conotruncal heart defects. We investigated the impact of genetic syndromes on the surgical outcome of conotruncal anomalies in infancy.MethodsThis retrospective study reviews the outcome of 787 patients (median age 6.3 months) who underwent primary (598) or staged (189) repair of a conotruncal defect between 1992 and 2007.ResultsProven genetic syndrome was diagnosed in 211 patients (26.8%), including del22q11 (91 patients), trisomy 21 (29 patients), VACTERL (18 patients), and other syndromes (73 patients). Primary repair was accomplished in 80.9% of nonsyndromic patients and 74.4% of syndromic patients (P = .18) Fifteen-year cumulative survival was 84.3% ± 2.3% in nonsyndromic patients and 73.2% ± 4.2% in syndromic patients (P < .001). Primary and staged repair allowed similar 15-year survival (81.4% ± 4.5% vs 79.1% ± 5.1%, P = .8). Freedom from noncardiac cause of death was significantly lower in syndromic patients (P = .0056). Fifteen-year Kaplan–Meier survival was 87.6% ± 3.9% for del22q11, 95.8% ± 4.1% for trisomy 21, 56.8% ± 6.3% for VACTERL, and 62.3% ± 12.7% for patients with other syndromes (P = .022). Total intensive care unit stay was 10.8 ± 4.9 days in syndromic patients and 5.1 ± 1.7 days in nonsyndromic patients (P < .001). Freedom from reintervention 15 years after repair was 79.6% ± 4.9% in nonsyndromic patients and 62.4% ± 7.4% in syndromic patients (P = .007).ConclusionDel22q11 and trisomy 21 do not represent risk factors for mortality after repair of conotruncal anomalies, whereas other syndromes adversely affect the surgical outcome for predominant noncardiac attrition. Higher morbidity and lower mid-term freedom from reintervention can be predicted in syndromic patients

La stima periodica del valore di carico delle partecipazioni in startup acquisite da parte di fondi e investitori

Il mercato del venture capital e del private equity ha visto nel tempo una crescita significativa, sia a livello europeo, dove rappresenta ormai una realtà consolidata, sia in Italia, la quale è stata caratterizzata negli ultimi anni da cifre record in termini di ammontare investito. Il private equity si configura come una fonte di finanziamento alternativa molto preziosa per le aziende, insieme alle competenze e al network di conoscenze che gli operatori sono in grado di apportare, permettendo alle società in cui investe di espandersi più rapidamente in un mercato sempre più competitivo. L’enorme successo di tale fenomeno ha comportato alcune riflessioni concernenti le modalità secondo cui devono essere espressi i valori sottostanti e in particolare modo, in questo capitolo, come debbano essere effettuate le valutazioni degli investimenti delle partecipazioni che costituiscono il fondo di private equity, con particolare riguardo al finanziamento di imprese che si trovano nelle prime fasi del proprio ciclo di vita/sviluppo (seed, startup ed expansion)

SME funding. The role of shadow banking and alternative funding options

This book explores current financing options for small and medium size enterprises (SMEs), with particular insight into the European market. The authors position SME funding within a risk-averse lending environment with high regulatory costs on business loans, which has arisen from the recent financial crisis and new European bank capital regulations. Chapters in the book demonstrate how and why SMEs may be forced to leave the market and posit that shadow banking and other alternative funding options are viable channels for raising funds. A new and innovative SME credit risk model is also presented. This book will appeal to all who share an interest in sustainable solutions to issues in SME financing

The effect of practice on random number generation task: A transcranial direct current stimulation study

Random number generation (RNG) is a procedurally-simple task related to specific executive functions, such as updating and monitoring of information and inhibition of automatic responses.The effect of practice on executive functions has been widely investigated, however little is known on the impact of practice on RNG. Transcranial direct current stimulation (tDCS) allows to modulate, non-invasively, brain activity and to enhance the effects of training on executive functions.Hence, this study aims to investigate the effect of practice on RNG and to explore the possibility to influence it by tDCS applied over dorsolateral prefrontal cortex. Twenty-six healthy volunteers have been evaluated within single session and between different sessions of RNG using several measures of randomness, which are informative of separable cognitive components servicing random behavior.We found that repetition measures significantly change within single session, seriation measures significantly change both within and between sessions, while cycling measures are not affected by practice. tDCS does not produce any additional effect, however a sub-analysis limited to the first session revealed an increasing trend in seriation measure after anodal compared to cathodal stimulation.Our findings support the hypothesis that practice selectively and consistently influences specific cognitive components related to random behavior, while tDCS transiently affects RNG performance. © 2014 Elsevier Inc

Linking cognitive abilities with the propensity for risk-taking: the balloon analogue risk task

There is great interest about the individual differences that influence the ability of dealing with risky decisions. In this light, an intriguing question is whether decision-making during risk is related to other cognitive abilities, especially executive functions. To investigate, in healthy subjects, the existence of a possible correlation between risk-taking and cognitive abilities, the balloon analogue risk task (BART) has been exploited to assess risk-taking propensity and the random number generation (RNG), to investigate cognitive functions. The risk-taking propensity is significantly correlated with the Cycling factor, a feature of RNG performance specifically related to the ability of updating and monitoring information. In particular, an excessive activity of monitoring (expressed by lower values of Cycling factor) is related to a more risk-averse behavior. An overlapping between the circuits involved in both RNG and BART, centered on the dorsolateral prefrontal cortex, could be the possible neurophysiological substrate for this correlation. This study suggests a relevant contribution of executive functions in risk-taking behavior. This could have relevant implications in neuroeconomics and neuropsychiatry of addiction and pathological gambling