Sublingual sufentanil, a new opportunity for the improvement of postoperative pain management in Italy

Despite the availability of national and international guidelines, adequate postoperative pain (POP) management is still a challenge in Italy. One of the potential reasons for the high incidence of surgical patients complaining moderate to severe pain is the difficult application of the currently recommended analgesic techniques in clinical practice. In particular, morphine, the most commonly used systemic opioid in the POP treatment, has some unfavorable pharmacodynamic and pharmacokinetic characteristics for POP management, suggesting a potential relevant improvement by using different opioids. Many of sufentanil properties make it particularly suitable for POP control: a high affinity for the µ opioid receptor, the highest therapeutic index compared to any other opioid used in clinical practice and the absence of clinically relevant active metabolites. The elevated potency, together with the high lipophilicity of sufentanil, allow the preparation of a nanotablet, 3 mm of diameter and 0.75 mm of thickness, containing 15 µg of active drug. The sublingual route allows a longer time of drug plasmatic permanence in comparison to IV route, overcoming the need for continuous dosing. The patient-controlled system, considered in the present review, is preprogrammed to deliver one sublingual tablet of sufentanil with a 20-minute lockout period with a radiofrequency identification thumb tag allowing only the patient to activate the on demand button. Phase II and III studies have assessed the efficacy of this system in POP management, showing that it was considered more satisfactory than the IV PCA morphine system by both patients and nurses. The introduction of this simple and innovative system of patient-controlled analgesic administration could represent an opportunity for Italy to update the current practice in POP management

The healthcare organization in COVID-19 age: An evaluation framework for the performance of a telemonitoring model

Telemedicine services (TS) are not only supportive for healthcare professionals, but managers also see them as essential for the provision of an efficient, effective, and sustainable healthcare service. Several systems make TS available in different ways and contexts. However, no commonly accepted framework meets the need to draw conclusions about which TS can efficiently be measured. For this purpose, a framework is proposed in order to define a dynamic method of performance evaluation that can be used to improve the sustainable management of a telemonitoring model for COVID-19 patients. A case study analysis based on the experience of three telemedicine networks in different locations providing telemonitoring services (northern, central, and southern Italy) was performed. A total of four phases (1. Identification of the target population; 2. Identification of health needs; 3. Definition of the operational plan; and 4. Monitoring of the service by indicators), and seven indicators have been identified. Despite the differences raised in the Italian contexts, applying a performance evaluation framework could help the managerial sector to understand if the service is working as intended and what effects the service is producing on the healthcare organization. Considering the long-term field experience, this framework is an easy-to-use tool that will allow healthcare organizations to evaluate the performance of their telemonitoring model, and improve it according to new needs. Providing a healthcare service in an efficient context is fundamental for the sustainability of the health system as a whole

Austerity, Competitiveness and Neoliberalism Redux: Ontario Responds to the Great Recession

This article examines the deepening integration of market imperatives throughout the province of Ontario. We do this by, first, examining neoliberalism’s theoretical underpinnings, second, reviewing Ontario’s historical context, and third, scrutinizing the Open Ontario Plan, with a focus on proposed changes to employment standards legislation. We argue that contrary to claims of shared restraint and the pressing need for public austerity, Premier McGuinty’s Liberal’s have re-branded and re-packaged core neoliberal policies in such a manner that costs are socialized and profits privatized, thereby intensifying class polarization along with its racialized and gendered diversities. Cet article analyse l’intégration de plus en plus profonde des impératifs du marché dans la province de l’Ontario. Nous faisons cette analyse, premièrement, en analysant les bases théoriques du néolibéralisme, deuxièmement, en décrivant le contexte historique de l’Ontario, et troisièmement, en examinant le “Open Ontario Plan”, sous l’angle particulier des propositions de changement de la législation sur le droit du travail. Nous soutenons que sous le couvert de discours prônant le partage de l’austérité et l’impérieuse nécessité de restreindre les dépenses publiques, les Libéraux du Premier McGuinty ont ré-étiqueté et reformulé les politiques néolibérales de façon que les coûts soient socialisés et les profits privatisés, aggravant ainsi la polarisation des classes ainsi que les inégalités liées à la race et au genre

Indicators and criteria for efficiency and quality in public hospitals: A performance evaluation model

In many countries, the public sector is currently characterised by the need to improve its performance. The implementation of performance measurement systems is essential to generate better results, especially in the public health sector. In healthcare practice, clinical indicators are part of a performance measurement system, and are a way of assessing the quality of care by investigating the frequency of specific results. Through a clinical audit process, this study aims to define the criteria and key performance indicators for minimally invasive endovascular surgical treatment. This type of treatment is chosen because aortic pathologies are an important European issue in cardiovascular surgery. A model of criteria and indicators used in a large public Italian hospital was constructed in order to assess the level of performance achieved with this service

Ecological indicators applied to urban and suburban floras

Among the many approaches to ecological indicators, ecological indicators derived from the floristic composition of a site (i.e. Raunkiaer’s forms spectrum or the percentage of different geographical distribution types-chorotypes) are well established in botanical and ecological literature. Nonetheless their relationship with other indicators, such as Ellenberg’s ecological indicators, or the Grime model [Grime, J.P., 2002. Plant Strategies, Vegetation Processes and Ecosystem Properties. Wiley, Chichester] and the Hemeroby index [Kowarik, I., 1990. Some responses of flora and vegetation to urbanization in Central Europe. In: Sukopp, H., Hejny, S., Kowarik, I. (Eds.), Urban Ecology. Plants and plant communities in urban environments. SPB Academic Publishing, The Hague] is still poorly explored. We concentrated on an urban ecosystem because such areas, due to heir high degree of artificialization, are particularly well suited for studying the interaction of anthropical disturbance with other processes of the ecosystems. This paper attempts to select a small indicator frameset of many already proposed indicators which best express the variability of the sites studied. A floristic-ecological investigation has been carried out in 10 urban sites, of which 6 were archeological, located in the centre of Rome and 4 suburban, semi-natural, in the NE of the town. Ecological indicators have been calculated on this data set. The Pearson correlation test was then applied to verify whether the indicators were independent, while stepwise regression analysis was done to evaluate the statistical weight of each ecoindicator. Disturbance and temperature are the main factors shaping the composition of the sites studied. They are largely interacting and are well expressed with the help of a small subset of the initial set of 19 indicators, namely, by indicators related to life forms and to the geographical distribution of species: Therophytes/Hemicryptophytes, Mediterranean/large distribution, Eurasiatic/large distribution, Mediterranean/Eurasiatic species. The information provided by Ellenberg’s indicators values and Grime’s life strategies are largely summarized by these chorological indicators

A systematic review and meta-analysis of hepatitis E virus (HEV) in wild boars

This systematic review and meta-analysis summarize the available information on Hepatitis E virus (HEV) -specific antibody seroprevalence and HEV RNA prevalence in wild boar, one of the most abundant game species worldwide. A literature search (CAB Abstracts, Web of Science, Embase and Scopus) was performed to find relevant peer-reviewed works published during the period 1990–2020. A random-effect model was carried out to calculate the pooled HEV-specific antibody seroprevalence and HEV RNA prevalence estimates with 95% confidence intervals, and I2 statistic was used to assess the heterogeneity of the data. Values by subgroups were compared according to the geographical area, age class (≤ 12 months old and > 12 months old), and sample type (bile, faeces, liver, meat/muscle, serum). Sixty-nine publications were selected, with the majority of the studies from Southern Europe (n = 27). The pooled HEV-specific antibody seroprevalence in wild boar was 28% (CI95% 23–34) and the HEV RNA prevalence 8% (CI95% 6–10). The analysis highlighted a significant heterogeneity among the estimates from the included studies (I2 = 98% and I2 = 95% for HEV-specific antibody seroprevalence and viral prevalence respectively). The moderator analysis indicated a statistically significant difference (p-value = 0.03) for the HEV RNA prevalence according to the sample type, with the highest value in bile (17%, CI95% 9–27), followed by liver (10%, CI95% 7–14), serum (7%, CI95% 4–10), faeces (5%, CI95% 2–9), and meat/muscle (3%, CI95% 0.04–10). Finally, the HEV RNA prevalence in Europe (8.7, CI95% 6.7–11) was significantly (p-value = 0.04) higher than in Asia (4, CI95% 0.6–8). The analysis highlights the important role of wild boar in the epidemiology of HEV