323,056 research outputs found
I risultati dei laboratorio sul governo del territorio
No full textIl capitolo analizza comparativamente i dati di consumi per ambiti assistenziali di 12 Asl del sistema sanitario nazionale. Questo permette di fotografare la configurazione media del welfare socio sanitario italiano e di analizzare i principali scostamenti interaziendali cercando di definire quelle che potrebbero essere le best practices e i loro driver esplicativi
Definizione di un modello per il governo del territorio
No full textIl capitolo propone di un modello di analisi per ambiti di cura dei consumi di servizi sanitari da parte dei residenti di singoli territori. Il modello di rappresentare in maniera sintetica interpretativa il posizionamento emergente della singola azienda sanitaria locale e dei suoi distretti. Ssso permette di ridefinire i propri profili di produzione e di relazione con gli altri produtti di riferimento per i propri resident
Definizione di un modello per il governo del territorio
No full textIl capitolo propone di un modello di analisi per ambiti di cura dei consumi di servizi sanitari da parte dei residenti di singoli territori. Il modello di rappresentare in maniera sintetica interpretativa il posizionamento emergente della singola azienda sanitaria locale e dei suoi distretti. Ssso permette di ridefinire i propri profili di produzione e di relazione con gli altri produtti di riferimento per i propri resident
Are Public Health Authorities Able to “Steer” rather than “Row”? An Empirical Analysis in the Italian NHS
No full textThe nature of Local Health Authorities (LHA) in the Italian NHS has been deeply reformed during the 1990's by New Public Management reforms introducing decentralization, quasi-market, and managerialism. These reforms implied that the main role of LHAs is to govern the delivery of health services in their area (steer) rather than only directly providing services (row). After more than 15 years from these reforms of Italian healthcare we describe how much the steering vs. rowing dichotomy made an impact on LHAs activity, through an analysis of the management control systems they set up for themselves and the subsequent qualitative analysis of the opinions that a diverse group of managers expressed during eight days of group discussion. Results show that managers of Italian LHAs tend to perceive their steering role as impossible to play and focus on direct delivery, leaving therefore ungoverned a significant part of the services offered to residents.
NPM, therefore, was able to influence the reform of Italian health care, but, as suggested by a postmodernist-inspired interpretation, left managers with change based on inconsistent
assumptions, instead of actionable ideas to manage the change proces
Il processo di budget e il suo impatto sul comportamento dei dirigenti territoriali
No full textIl lavoro analizza l'architettura dei sistemi di programmazione e controllo in un campione di aziende sanitaria e valuta la sua efficacia cognitiva nell'indirizzare i comportamenti dei professionisti sanitari. Vengono proposti indici quantitativi di concordanza e coerenza tra le direttive aziendali e il percepito dei professionisti
Public service management during the Covid-19 lockdown: a qualitative study
No full textThis qualitative study investigates the managerial practices adopted during the Covid-19 emergency in Lombardy, Italy, amidst unforeseen changes in public service ecosystems. Using longitudinal data, we identify seven key practices adopted by public service managers to organize amidst disruption. Our findings underscore the public managers’ role in fostering adaptation, innovation, and coordination among ecosystem actors. Extending roles outlined by Osborne et al. as ‘appreciate, engage, and facilitate’, our study reveals how these roles were interpreted following logics of entrepreneurial stakeholder engagement, rather than citizen-centred services. We discuss conceptual implications to further develop the theory and practice of public service management
Le nuove missioni delle Ausl tra governo della produzione e dei consumi: un'analisi dei sistemi di controllo direzionale
No full textEndovascular preservation of pelvic circulation with external iliac-to-internal iliac artery "cross-stenting" in patients with aorto-iliac aneurysms: a case report and literature review
No full textEndovascular success depends heavily upon anatomical suitability for secure graft placement. Common iliac artery (CIA) aneurysms frequently extend close to the iliac bifurcation, requiring distal fixation in the external iliac artery (EIA), in turn excluding the internal iliac artery (IIA). The preservation of circulation to at least one IIA artery is highly recommended. We report an endovascular technique for complete preservation of the hypogastric arteries of an aorto-iliac aneurysm extending into the iliac bifurcation and hypogastric artery. A left CIA aneurysm involving the iliac bifurcation was excluded with a covered Fluency stent-graft (Bard Inc., New Jersey, USA) deployed from the EIA into the IIA followed by the internal deployment of a Luminex uncovered stent (Bard Inc.) extended into one branch of the hypograstric artery. IVUS evaluation was essential in determining precise aneurysm and sealing zone measurements. Complete preservation of hypogastric circulation was achieved. The placement of the uncovered stent effectively extended the sealing zones without covering either of the hypogastric distal branches and concurrently corrected the Fluency stent kinking due to severe arterial tortuosity. In CIA aneurysms involving the IIA, an uncovered stent can extend the sealing zones, whilst maintaining complete preservation of pelvic circulation and offers support to the covered stent-graft. IVUS seems necessary for precise neck evaluation
Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment.
No full textObjective: A retrospective analysis of immediate outcomes following aneurysm rupture (rAAA) in two groups: patientspreviously treated at our center with primary endovascular repair (EVAR) and patients without previous EVAR forabdominal aortic aneurysms (AAA) in an 8-year period.Methods: Fourteen patients with a confirmed rAAA identified throughout the follow-up period following primary EVARrepair at our center (from a population of 820 AAA treated at our center in election) were retrospectively compared with155 patients without previous EVAR in the same time period, from the introduction of an intention-to-treat protocolwith EVAR for rAAA in January 1999. Primary study outcomes included 30-day mortality and severe systemiccomplications following rAAA correction with both open and EVAR treatments.Results: In the 14 patients secondary interventions were necessary throughout follow-up prior to rupture in 43% (6/14).The mean time to rupture was 50.23 months (9-113). The mean increase in maximum aneurysmal diameter at rupturewas 18.39 mm. Type of endoleaks observed at rupture: 35.7% I proximal, 35.7% III contralateral stump disconnection,14.3% I distal, 14.3% III midgraft tear: treatment at rupture included five EVAR corrections with aortouniiliacendografts, four EVAR corrections with extensions, and five surgical conversions. Thirty-day mortality between the twogroups, 28.5% (patients with prior EVAR) 38.7% (patients without prior EVAR), and severe systemic complications, 50%vs 37.6%, were not found to be statistically significant. Hemodynamic instability, 36% (patients with prior EVAR) 63%(patients without prior EVAR), was found to be an independent predictor of 30-day mortality (P < .0001), whereassevere systemic complications, 50% vs 33.5%, did not influence the same outcome (P .852).Conclusions: In terms of mortality, it would be logical to expect a protection from the endograft in patients with previousEVAR. A trend seems to confirm this assumption, but no statistical significance was found, which may be due to the smallpopulation size
Thoracic endograft for abdominal aortic aneurysms, an unusual application for severe neck angulation: Case report and literature review
No full textPurpose: To achieve complete proximal sealing in an abdominal aortic aneurysm (AAA) with severe neck angulation (SNA) during endovascular treatment (EVAR) of a patient considered unfit for surgery.Basic methods: An 82 year-old patient with an infra-renal AAA of 9.8cm with SNA of 90° was admitted for acute coronary syndrome. Following coronary treatment, the patient was considered unfit for surgery, and therefore evaluated for EVAR. Aneurysm sac exclusion was obtained with a the deployment of a Powerlink bifurcated graft (Endologix Inc, Irvine, California) inside a Relay thoracic endograft (Bolton Medical, Florida, USA) placed just below the most distal renal artery.Principal findings: At 6 months, angio-CT confirmed correct graft placement, complete aneurysm exclusion and a reduction of the aneurysmal sac.Conclusion: In AAA patients with SNA at high risk of EVAR failure, the adaptability of a thoracic endograft could be considered for proximal sealing
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