1,720,985 research outputs found
Vertical Equity in Healthcare Financing: A Progressivity Analysis for the Italian Regions
Full text linkBackground: The aim of this paper is to measure for the first time in Italy the progressivity of healthcare financing systems at the regional level by using the Kakwani index (KI), the most widely used summary measure of progressivity in the healthcare financing literature. Methods: KIs were reported by region and by health financing sources for the year 2015. Results: There were significant vertical inequities in healthcare financing at both national and regional level. OOP (out-of-pocket) payments and value added tax were slightly regressive; income taxation on firms and households was progressive. Conclusions: After the introduction of fiscal federalism during the 90s, the healthcare financing system became regressive. A regional divide emerged: Overall regressivity is higher in the south and lower in the north, partly compensated by the interregional equalization mechanism, based on the redistribution of VAT from northern to southern regions. In times of policy interventions aiming at recovering the economy during the COVID-19 pandemic, it is important to monitor equity in healthcare financing
Case report of a successful multidisciplinary approach to a giant scrotal malformation
No full textCongenital pelvic malformations are rare and represent a difficult therapeutic challenge. Scrotal arteriovenous malformations are quite unusual, with only a few such cases reported in the literature. Only one case of scrotal malformation? due to an arteriovenous fistula resulting in azoospermia has been described
The standard use of Ovation as an alternative to Ch-EVAR and F-EVAR: indication, possibilities and limits
No full text
La valutazione dell’assistenza primaria
No full textAfter some considerations about the need, the development and the evolution of Primary Health Care, the
Authors provide a theoretical and practical framework to evaluate Primary Health Care in Italy, taking into
account both the heterogeneity of primary health care models among Italian Regions and the importance
of the assessment of patients satisfaction levels
Respiratory Rehabilitation in Patients with Abdominal Aortic Aneurysm Submitted to OPEN and EVAR Treatment: Predictive Factors of Postoperative Pulmonary Complications and Clinical Implications
Full text linkBackground: In the conventional surgical treatment of aneurysms, the respiratory physiotherapy is one of the cornerstones of
patient rehabilitation. The endovascular technique, with less invasiveness, has significantly changed the rehabilitative approach
to the operated subject.
Objective of the study: to evaluate and compare the effectiveness of the pre and post-operative rehabilitation treatment
associated with the conventional OPEN surgery compared to the EVAR procedure and their incidence in preventing
postoperative respiratory complications.
Design: Longitudinal case control study to compare patients who have open surgery with patients who do not have the
laparotomy, as in ENDO technique, to look how frequently the postoperative pneumonia and the risk factor was present in
each group to determine the relationship between the risk factor, the type of operation and the pneumonia incidence.
Setting Data were collected from patients admitted consecutively at the Tor Vergata Hospital with diagnosis of an abdominal
aortic aneurysm. Risk factors, type of intervention, pneumonia incidence in postoperative period was evaluted at 30 days.
Population: Three hundred and twenty patient were enrolled.
Materials and methods: From 2005 to 2016, 320 patients suffering from an abdominal aortic aneurysm were treated
consecutively. One hundred eighty one patients were treated using the open technique (group A) and 139 using the EVAR
technique (group B). All patients in OPEN group were submitted to respiratory rehabilitation protocol. Risk factors, type of
intervention, anesthesia and results of treatment with complications, observed mortality, mean hospital stay were studied. Pre
and postoperative respiratory rehabilitation treatment protocol was performed in all of the patients. The data were analyzed
with descriptive statistics and inferential statistics using SPSS 18.0 for Windows.
Results: From 2005-2010, the postoperative stay (days) was significant shorter for EVAR compared to open (6.47 vs. 10.48; P
0.001). From 2011-2016, the postoperative stay (days) was significant shorter EVAR compared open (4.07 vs. 11.41; P 0.001).
The patients treated from 2011 to 2016 for both OPEN and EVAR groups presented an average age 3 years lower compared to
the patients treated in the period from 2005-2011 (75.5 to 72.8 for EVAR and from 71,2 to 68,2). The patients treated from
2011 to 2016 for EVAR group presented an average reduction in post-operative hospitalization of 2.4 days (-37.09%) compared
to 2005-2011 period. There was a significant higher incidence of pneumonia in the open group (P=0.001). The reduction of
the incidence of pneumonia in group A and B during the two different periods from 2005 to 2010 and from 2011 to 2016
was observed. There wasn’t a significant difference in the incidence of pneumonia in patients treated from 2005 to 201
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Oncovascular Surgery-The Multidisciplinary Approach: Surgical Resection of the Musculoskeletal Tumor and Associated Revascularization
Full text linkAbstract
Introduction
The possibility of preserving the limb during the definitive removal operation in the case of sarcoma is a goal pursued in a multidisciplinary perspective. The aim of the study is to report our experience gained in collaboration with the IFO oncology orthopedic division and with the operating units of Orthopedics A and B of the Tor Vergata Policlinico, reporting the results and complications of the procedures performed.
Methods
From 2011 to 2014, 30 patients treated had primitive and secondary musculoskeletal neoplasm with a mean age of 44 years (14-67 years) in 26 cases (86.6%) were required revascularization. Women accounted for 53.84% (14/26), 46.16% were men (12/26). The preoperative study included a biopsy of the lesion and ultrasonography and angio-CT with multiplanar reconstructions for the evaluation of the vascular anatomy and neoplasia extension. Results The average postoperative follow-up was 19.4 months. The reconstruction of the vessels has been implemented in 12/26 (46%) mainly using the autologous saphenous contralateral vein. The use of the prosthesis was performed in the others cases (with PTFE and Dacron K prosthesis). In 4 cases the patients had lower limb edema, with a distance venous patency of 80% and arterial patency of 100%. We had no mortality at 30 days. Two patients underwent VAC therapy. No amputations had at 30 days. In 14 patients were perform chemotherapy or radiotherapy before and after surgery.
Conclusions A long-term evaluation is needed to determine the implications at distance. In case of involvement of arterial and venous vessels, vascular surgery skills allow radical resection and function preservation. The mortality gap depends by the prognosis of neoplasm
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