1,720,959 research outputs found
Understanding physician prescription behaviors: a systematic review and meta-analysis of macro, meso, and micro-level influences
Full text linkBackground: Prescription is a complex act that reflects the physician’s expertise and authority. While some factors affecting prescription decisions have been studied, empirical findings often conflict, leaving our understanding of prescription behaviors limited and fragmented. Objective: To assess the factors influencing physicians’ drug prescribing habits by applying Strong Structuration Theory. Factors are categorized at: physician, practice, patient, industry, and system level. Methods: Pubmed, Scopus, and ISI Web of Science were searched from inception to June 2025. Peer-reviewed studies were included if they were published in English, empirical, and assessed at least one factor influencing physicians’ prescribing behaviors. Studies reporting the effect of covariates on prescriptions using Odds Ratios were included in the meta-analysis. Results: 146 studies were selected for the review. At the macro-level, physicians were more likely to prescribe after being exposed to marketing activities by pharmaceutical industries, and for privately insured patients. Meso-level factors, such as practice ownership and setting, showed conflicting results, with no significant effect observed in the meta-analysis. Micro-level influences were the most prevalent in literature. Patient requests had a significant positive effect on prescriptions. Physician-level influences were inconsistent across most variables, except gender, where male physicians were more likely to prescribe. This effect was not confirmed by the meta- analysis, which showed heterogeneity across studies. Conclusion: This study highlights the complexity of prescribing behaviors and the challenges in designing effective micro-level policies. Policymakers should therefore consider the multiple influences on prescribing to design targeted interventions that promote high-quality prescribing practices
Piloting a PREMs and PROMs longitudinal survey on the integration of healthcare services for patients living with hepatitis C in Tuscany region: study protocol
Full text linkIntroduction: Patient-reported measures are an invaluable resource for health systems to improve the quality of healthcare services. Patients with hepatitis C virus (HCV) are an under-represented group within the stream of literature on collecting and using the experiences and outcomes reported by patients to improve healthcare performance. This protocol outlines the methodology to implement a longitudinal survey in Tuscany, Italy, to systematically gather patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) for patients with HCV, with a focus on the integration of primary and hospital care. Methods and analysis: We designed and developed a longitudinal survey to collect HCV PREMs and PROMs. The survey, which lasts 1 year, consists of three questionnaires, starting with the first visit with a specialist/treatment initiation, with follow-ups at 6 and 12 months. It was implemented in six hospitals in Tuscany, Italy, of which three are University Hospitals. The survey was offered to all patients treated for HCV at these healthcare centres, deliberately not applying a specific criterion for patient selection, through both paper based and electronic modes of completion. The data from the three structured questionnaires will be analysed quantitatively. Ethics and dissemination: The Ethics Committee for Clinical Experimentation of Area Vasta Nord Ovest approved the protocol (CEAVNO-CODE 18829). Participation in this study is voluntary. Study results will be disseminated through peer-reviewed publications and academic conferences
The evolution of TAVI performance overtime: an overview of systematic reviews
Full text linkBackground: Transcatheter aortic valve implantation (TAVI) is a well-established treatment for high and intermediate-risk patients with severe aortic stenosis (AS). Recent studies have demonstrated non-inferiority of TAVI compared to surgery in low-risk patients. In the past decade, numerous literature reviews (SLRs) have assessed the use of TAVI in different risk groups. This is the first attempt to provide an overview of SRs (OoSRs) focusing on secondary studies reporting clinical outcomes/process indicators. This research aims to summarize the findings of extant literature on the performance of TAVI over time. Methods: A literature search took place from inception to April 2024. We searched MEDLINE and the Cochrane Library for SLRs. SLRs reporting at least one review of clinical indicators were included. Subsequently, a two-step inclusion process was conducted: [1] screening based on title and abstracts and [2] screening based on full-text papers. Relevant data were extracted and the quality of the reviews was assessed. Results: We included 33 SLRs with different risks assessed via the Society of Thoracic Surgeons (STS) score. Mortality rates were comparable between TAVI and Surgical Aortic Valve Replacement (SAVR) groups. TAVI is associated with lower rates of major bleeding, acute kidney injury (AKI) incidence, and new-onset atrial fibrillation. Vascular complications, pacemaker implantation, and residual aortic regurgitation were more frequent in TAVI patients. Conclusion: This study summarizes TAVI performance findings over a decade, revealing a shift to include both high and low-risk patients since 2020. Overall, TAVI continues to evolve, emphasizing improved outcomes, broader indications, and addressing challenges
Pregnancy vaccination predictive factors and uptake profiles among Italian women: A cross-sectional survey study on a large population
Full text linkObjectives: To assess influenza and Tdap (tetanus, diphtheria, pertussis) vaccine coverage during pregnancy, explore key socioeconomic and maternity pathway-related predictors of vaccination, and detect specific patterns of vaccination uptake. Methods: The authors cross-sectionally analyzed self-reported data obtained from the systematic survey on the maternity pathways of Tuscany. They selected all pregnant women that completed from March 2019 to June 2022 the third-trimester questionnaire (n = 25 160), which included two dichotomous items on influenza and Tdap vaccination, as well as socioeconomic and pathway-related questions. Multilevel logistic models were performed to assess vaccination predictors and cluster analysis to identify vaccination patterns. Results: Vaccination coverage was higher for pertussis (56.5%) than for influenza (18.9%). The main predictors of vaccination were high socioeconomic status, attending private gynecologists, and receiving vaccine information. Three clusters were identified: cluster 1 included women receiving both Tdap and influenza vaccines; cluster 2 included women receiving no vaccinations; and cluster 3 included women receiving only the pertussis vaccine. Although women from cluster 3 were of middle to low education status, vaccine information was the main adherence determinant also in this group. Conclusions: Health workers and policymakers should focus on groups of pregnant women less prone to vaccination to promote vaccination information and encourage wider uptake and coverage
Ruolo del DNA circolante come biomarcatore per il monitoraggio della risposta al trattamento con immunosoppressori in pazienti con trapianto di fegato
No full textAttualmente, la metodica standard utilizzata nella fase post trapianto per sorvegliare lo stato di salute dell’organo trapiantato e per valutare il danno d’organo per tossicità da farmaci immunosoppressivi, è rappresentata dal monitoraggio dei parametri biochimici, dalle concentrazioni plasmatiche dei farmaci e dalle valutazioni delle biopsie tissutali. Tuttavia, queste valutazioni presentano una efficacia ed una specificità diagnostica relativamente bassa, che non consentono di ottenere in tempi accurati la diagnosi di tossicità da farmaci immunosoppressivi o di predire episodi di rigetto acuto o cronico. Inoltre, le biopsie sono procedure invasive e costose e, talvolta, possono causare ulteriori e significative complicanze nel paziente trapiantato. Pertanto, l'utilizzo di nuovi biomarcatori non invasivi, affidabili e predittivi quali il DNA libero circolante, potrebbe fornire un aiuto prezioso ai clinici al fine di prevenire il rischio complessivo di rigetto dell’organo trapiantato e, contemporaneamente, monitorare la terapia immunosoppressiva. Il DNA libero circolante è stato analizzato mediate digital droplet PCR per i genotipi precedentemente identificati mediare Real Time PCR su DNA germinale. L’analisi del DNA libero circolante si è dimostrata utile per il monitoraggio delle concentrazioni plasmatiche di Tacrolimus in seguito a trapianto di fegato
How effective are prescriptive governance tools? Results from the application of AIFA notes
Full text linkIntroduction: Prescription appropriateness is crucial for healthcare, balancing scientific evidence, optimal benefit/risk ratios and cost-effectiveness in alignment with the National Health System (NHS) sustainability. In Italy, various governance tools, including Notes AIFA, regulate drug reimbursements. This research aims to evaluate the impact of the introduction of Notes AIFA in curbing consumption and expenditures and assessing their lasting effects. We evaluate the effect generated by the Notes in terms of prescriptive appropriateness by assessing their effect on reducing overprescribing phenomena for drugs covered by the Notes. Note 96, focused on the prevention and treatment of vitamin D deficiency in adults, is used as a case study to evaluate the short- and long-term effectiveness of these tools on prescribing behaviors. Methods: Using a quasi -experimental approach, administrative data on pharmaceutical consumption in Tuscany over 60 months (22 preand 38 post -Note) were analyzed. Interrupted Time Series (ITS) analysis at regional, and local health authorities (LHAs), and primary care group practices (AFTs) was performed. Results and conclusions: The ITS analysis showed an immediate reduction in consumption rates and spending post -Note 96. This real -world study highlights short-term effectiveness and suggests a positive long-term impact, despite recognizing a physiological increase in consumption at the regional level. The findings emphasize that ongoing continual monitoring of its effectiveness is imperative to promptly identify failures in implementation and mitigate the risk of consumption escalation, potentially reverting to pre -intervention levels
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
Evaluating hepatitis C cascade of care surveillance system in Tuscany, Italy, through a population retrospective data-linkage study, 2015–2021
Full text link: This comprehensive retrospective data-linkage study aimed at evaluating the impact of Direct-Acting Antivirals (DAAs) on Hepatitis C Virus (HCV) testing, treatment trends, and access to care in Tuscany over six years following their introduction. Utilizing administrative healthcare records, our work reveals a substantial increase in HCV tests in 2017, attributed to the decision to provide universal access to treatment. However, despite efforts to eradicate chronic HCV through a government-led plan, the target of treating 6,221 patients annually was not met, and services contracted after 2018, exacerbated by the COVID-19 pandemic. Key findings indicate a higher prevalence of HCV screening among females in the 33-53 age group, influenced by pregnancy-related recommendations, while diagnostic tests and treatment uptake were more common among males. Problematic substance users constituted a significant proportion of those tested and treated, emphasizing their priority in HCV screening. Our paper underscores the need for decentralized HCV models and alternative testing strategies, such as point-of-care assays, especially in populations accessing harm reduction services, communities, and prisons. The study acknowledges limitations in relying solely on administrative records, advocating for improved data access and timely linkages to accurately monitor HCV care cascades and inform regional plans. Despite challenges, the paper demonstrates the value of administrative record linkages in understanding the access to care pathway for hard-to-reach populations. The findings emphasize the importance of the national HCV elimination strategy and the need for enhanced data collection to assess progress accurately, providing insights for future regional and national interventions
Variations on the Author
Full text link“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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