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Management e leadership in sanità
No full textIn questo Capitolo si è parlato della sfida della
gestione della complessità che tutti i professionisti
che lavorano nei servizi sanitari, indipendentemen-
te dal loro livello operativo, dovrebbero accettare e
affrontare attrezzandosi culturalmente al farlo.
Gestire la complessità e guidare il cambiamen-
to quando necessario sono, forse, le caratteristiche
principali dei leader-manager
The contribution of Health Technology Assessment to health policie
No full textIssues/problem
Health Technology Assessment (HTA) provides decision
makers with multidisciplinary and thorough evaluation of
diverse health technologies but how far is it taken into
consideration in the definition of health policies?
Description of the problem
Even though HTA is expected to inform decision-making at
several levels, from micro to macro, concerns still arise on the
translation of research into practice and policies in the real
world. Since HTA is deeply linked to the decision-makers
counterpart and should be not only oriented but also driven by
decision-making, it could really provide valuable insight into the
ways to get a fruitful integration between research and policy.
Results
A broad body of evidence has addressed in the past years the
challenges linked to the translation of HTA results in the
decision-making process. Several factors have been identified as
potential incentives to strengthen the impact of HTA. Among
them, the following may be listed: the early and constant
involvement of all stakeholders, the timeliness and the
appropriateness of the evaluation, the transparency of process,
the proper communication and dissemination of results. The
institutional framework could also influence the impact of HTA
on policy-making. With this respect, this presentation will
address some case studies looking at facilitators and barriers of
the implementation of HTA results into practice.
Lessons
HTA is an important tool to tackle health topics, at national,
regional and local level. Notwithstanding it, information and
best practices on the translation and implementation of HTA
results should be shared and born in mind in order to really
support an informed and evidence based policy
Assessing health technologies through HTA: requisites, methods, challenges and perspectives
No full textIssues/problem
Health Technology Assessment (HTA) allows a multidisciplinary
evaluation of health technologies and is one of the
methods available for decision-making.
Description of the problem: Technology Assessment has
developed in the 1970s and has been applied to fields other
than medicine before being deeply used to assess health
technologies. With respect to them, HTA should rest on
evidence and data and should be adapted in order to be useful
to assess the value of different health technologies.
Results
HTA has been successfully applied to the analysis of the
introduction of drugs, medical devices and equipment. As a
result, several reports are currently available. They have been
commonly provided by institutional organizations and may be
assessed with respect to international checklists and recommendations
which have been released by networks working in
the field of HTA. Notwithstanding the effort of international
networks in standardizing HTA reports, Public Health topics
remain considerably under investigated. The change in
population health need together with the economic crisis
suggest that HTA should be implemented in order to better
allocate resources, in particular in the field of preventive and
Public Health programs which may allow great benefit at
population level.
Lessons
HTA could represent an important tool to tackle Public Health
topics. Notwithstanding researchers as well as decision makers
and companies should work together in order to provide
robust evidence and chance for methods development and
standardization
Management of Breakthrough cancer pain (BTcP) in Italy: needs and options
No full textBreakthrough cancer pain (BTcP) is a transitory exacerbation of pain on abackground of well-controlled pain with a rapid onset and a short duration. Conventional analgesic drugs are generally not effective. Currently, there is controversy among healthcare professionals and patients regarding the use of opioids for BTcP. This study was aimed to present a literature review to analyze the BTcP management in Italy.
A literature review was performed during the period October 2014-March 2015 by consulting the main electronic databases and institutional websites. Specific key words and MeSH terms were used.
There is a lack of precision about important aspects of BTcP including classification, epidemiology and assessment. In Italy epidemiological data reported a prevalence of 59.2% and high heterogeneity among the setting observed: lower rates were reported in hospitals (39.9%) and higher in hospice (80.5%). BTcP episodes generally occur from 1 to 4 times a day, but specific tools for diagnosing need to be developed. Furthermore BTcP intensity is underestimated. BTcP uncontrolled or poorly controlled can cause consuming of more health care resources and represents a social cost in terms of patient and caregivers’ productivity.
Traditionally oral opioids represent the only strategy for treatment with a lot of prejudices that can cause ineffective and inadequate dosage. New drugs have been developed to have rapid onset (10-15 minutes) and good tolerability, nevertheless their consumption are still very low in Italy. After the introduction of the law 38/2010 local networks of palliative care and pain management are implementing in several Italian Regions and university training courses are established to managing analgesia and palliative care among medical practitioners.
Considering the high prevalence of BTcP observed and the underuse of available therapeutic options, Italian healthcare service needs to develop new approaches to improve quality of palliative care for patients.
Key messages:
For the management of BTcP patient’s characteristics, time of onset, intensity, location and particular features need to be accurately assessed and palliative care structures should be strengthened
New drugs can achieve successful outcomes in order to get a better management for patients, doctors and caregiver
I vaccini anti-HPV: le nuove evidenze cliniche
No full textIl contributo passa in rassegna i dati di efficacia dei vaccini anti-HPV nei confronti di endpoint primari e secondari e gli aspetti di sicurezz
Radio-223 nel trattamento del carcinoma della prostata metastatico resistente alla castrazione (mCRPC): risultati di una valutazione di Health Technology Assessment
No full textL'oggetto del presente report di Health Technology Assessment (HTA) è Xofigo, Radio-223 dicloruro (Ra-223), il primo radiofarmaco ad azione specifica sul tessuto osseo in grado di aumentare la sopravvivenza globale dei pazienti con metastasi scheletriche da mCRPC, senza indurre evidenti danni a carico del midollo osseo. Il farmaco si lega al tessuto osseo in accrescimento, come quello neoplastico, emettendo nel tempo particelle radioattive, dette alfa, capaci di determinare una distruzione selettiva delle cellule tumorali. Si tratta quindi di una novità assoluta nello scenario terapeutico del mCRPC, se consideriamo che, fino ad ora, le terapie disponibili ad azione
specifica sull'osso erano farmaci con un ruolo prevalentemente palliativo, volti a controllare la sintomatologia dolorosa e privi di un’attività anti-tumorale vera e propria. Il farmaco è raccomandato dalle principali linee guida italiane e internazionali ed è inoltre
l’unico farmaco per il trattamento del mCRPC ad avere ottenuto il punteggio massimo nella valutazione del beneficio clinico dei farmaci
oncologici di ESMO (ESMO-MCBS) [3-6].
Il processo della valutazione di HTA oggetto di questo report si è sviluppato attraverso la creazione di un gruppo multidisciplinare che
ha analizzato ed elaborato le informazioni disponibili sul nuovo farmaco considerando globalmente l’impatto clinico, economico,
organizzativo ed etico correlato alla sua introduzione e al suo utilizzo. L’obiettivo è stato quello di creare una valutazione
onnicomprensiva sulla tecnologia che ne consentisse una visione globale in tutte le sue dimensioni. Le caratteristiche legate dell’utilizzo di Radio-223 hanno infatti permesso di toccare diversi punti inerenti alle problematiche cliniche del paziente con mCRPC, al ruolo del farmaco in un scenario terapeutico che è notevolmente mutato nel corso degli ultimi anni, a tutti gli aspetti organizzativi, gestionali e normativi associati all’utilizzo di un radiofarmaco, fino a toccare tematiche legate alla sostenibilità economica e di accesso alle cure, di cruciale importanza nel momento in cui una nuova tecnologia si apre al mercato e viene messa a disposizione dei pazienti.La valutazione realizzata ha inoltre previsto il coinvolgimento dell’Associazione Pazienti “Europa Uomo”, per avere un riscontro
immediato della nuova tecnologia da parte dei pazienti. In tal senso, al fine di prendere in considerazione un ulteriore prospettiva e
di provare a dare enfasi al coinvolgimento delle associazioni nei processi decisionali, viene riportato in appendice il punto di vista dell’associazione in merito alla patologia e alla tecnologia oggetto di indagine.
E’ stato redatto infine un capitolo contenente gli elementi chiave per i decisori, per fornire una sintesi dei risultati a supporto delle decisioni operative
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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