scholarly journals How we managed elective, urgent, and emergency orthopedic surgery during the COVID-19 pandemic

2020 ◽  
Vol 1 (5) ◽  
pp. 93-97 ◽  
Author(s):  
Pietro Domenico Giorgi ◽  
Enrico Gallazzi ◽  
Paolo Capitani ◽  
Giuseppe Antiono D’Aliberti ◽  
Federico Bove ◽  
...  
Keyword(s):  
Health System ◽  
Metropolitan Area ◽  
Elective Surgery ◽  
Scientific Evidence ◽  
National Health System ◽  
Training Programme ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Healthcare Personnel ◽  
Italian National Health

The COVID-19 virus is a tremendous burden for the Italian health system. The regionally-based Italian National Health System has been reorganized. Hospitals' biggest challenge was to create new intensive care unit (ICU) beds, as the existing system was insufficient to meet new demand, especially in the most affected areas. Our institution in the Milan metropolitan area of Lombardy, the epicentre of the infection, was selected as one of the three regional hub for major trauma, serving a population of more than three million people. The aims were the increase the ICU beds and the rationalization of human and structural resources available for treating COVID-19 patients. In our hub hospital, the reorganization aimed to reduce the risk of infection and to obtained resources, in terms of beds and healthcare personnel to be use in the COVID-19 emergency. Non-urgent outpatient orthopaedic activity and elective surgery was also suspended. A training programme for healthcare personnel started immediately. Orthopaedic and radiological pathways dedicated to COVID-19 patients, or with possible infection, have been established. In our orthopaedic department, we passed from 70 to 26 beds. Our goal is to treat trauma surgery's patient in the “golden 72 hours” in order to reduce the overall hospital length of stay. We applied an objective priority system to manage the flow of surgical procedures in the emergency room based on clinical outcomes and guidelines. Organizing the present to face the emergency is a challenge, but in the global plan of changes in hospital management one must also think about the near future. We reported the Milan metropolitan area orthopaedic surgery management during the COVID-19 pandemic. Our decisions are not based on scientific evidence; therefore, the decision on how reorganize hospitals will likely remain in the hands of individual countries.

scholarly journals How we managed elective, urgent, and emergency orthopedic surgery during the COVID-19 pandemic

2020 ◽  
Vol 1 (5) ◽  
pp. 93-97 ◽  
Author(s):  
Pietro Domenico Giorgi ◽  
Enrico Gallazzi ◽  
Paolo Capitani ◽  
Giuseppe Antiono D’Aliberti ◽  
Federico Bove ◽  
...  
Keyword(s):  
Health System ◽  
Metropolitan Area ◽  
Elective Surgery ◽  
Scientific Evidence ◽  
National Health System ◽  
Training Programme ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Healthcare Personnel ◽  
Italian National Health

The COVID-19 virus is a tremendous burden for the Italian health system. The regionally-based Italian National Health System has been reorganized. Hospitals' biggest challenge was to create new intensive care unit (ICU) beds, as the existing system was insufficient to meet new demand, especially in the most affected areas. Our institution in the Milan metropolitan area of Lombardy, the epicentre of the infection, was selected as one of the three regional hub for major trauma, serving a population of more than three million people. The aims were the increase the ICU beds and the rationalization of human and structural resources available for treating COVID-19 patients. In our hub hospital, the reorganization aimed to reduce the risk of infection and to obtained resources, in terms of beds and healthcare personnel to be use in the COVID-19 emergency. Non-urgent outpatient orthopaedic activity and elective surgery was also suspended. A training programme for healthcare personnel started immediately. Orthopaedic and radiological pathways dedicated to COVID-19 patients, or with possible infection, have been established. In our orthopaedic department, we passed from 70 to 26 beds. Our goal is to treat trauma surgery's patient in the “golden 72 hours” in order to reduce the overall hospital length of stay. We applied an objective priority system to manage the flow of surgical procedures in the emergency room based on clinical outcomes and guidelines. Organizing the present to face the emergency is a challenge, but in the global plan of changes in hospital management one must also think about the near future. We reported the Milan metropolitan area orthopaedic surgery management during the COVID-19 pandemic. Our decisions are not based on scientific evidence; therefore, the decision on how reorganize hospitals will likely remain in the hands of individual countries.

scholarly journals Budget Impact Analysis of Xydalba from the Perspective of Italian National Health System

2016 ◽  
Vol 19 (7) ◽  
pp. A564-A565
Author(s):  
A Marcellusi ◽  
C Bini ◽  
N Petrosillo ◽  
FS Mennini ◽  
P Sciattella
Keyword(s):  
Health System ◽  
National Health ◽  
Impact Analysis ◽  
Budget Impact ◽  
National Health System ◽  
Budget Impact Analysis ◽  
Italian National Health

scholarly journals Reflections on Health Management from a Systems Perspective: A Reinterpretation of the Italian National Health System

2021 ◽  
Vol 16 (5) ◽  
pp. 79
Author(s):  
Armando Masucci ◽  
Antonietta Megaro
Keyword(s):  
Health System ◽  
National Health ◽  
Systems Approach ◽  
Health Management ◽  
Health Sector ◽  
National Health System ◽  
Well Being ◽  
Economic Activities ◽  
Viable Systems ◽  
Italian National Health

The provision of health services represents a set of central activities in the social context since, through the offer of prevention, diagnostic, treatment, care and rehabilitation services, they allow the pursuit of the ultimate goal of any health system, the well-being of the population and public health. The considerable relevance of the topic, supported by the ethical-social purposes that the health system ultimately assumes, make it an important field of analysis in business studies in general, and in management in particular, considering the economic activities developed by the many actors involved in the dispensing process. The importance of these activities and their strategic nature make them a highly regulated context, in which over time the reference legislative framework has developed and articulated for the determination of reciprocal relations between the actors, for the regulation of the flow of resources, for the control of medical activities to protect citizens. However, the proliferation of laws and regulations at the various levels of government (community, national and regional) has contributed to increasing the interpretative complexity of the health system. This work proposes the use of the Viable Systems Approach (VSA) for the interpretation and management of complex phenomena in the health sector, concerning the Italian National Health System (NHS). The deepening of the implications arising from the analysis enables the VSA as a useful approach to the advancement of research in health management, through the understanding of complexity, stimulating the observer with analysis methodologies capable of better understanding the health context under exam.

scholarly journals ANMCO POSITION PAPER: The reorganization of cardiology in times of the SARS-CoV-2 pandemic

2021 ◽  
Vol 23 (Supplement_C) ◽  
pp. C154-C163
Author(s):  
Pasquale Caldarola ◽  
Adriano Murrone ◽  
Loris Roncon ◽  
Giuseppe Di Pasquale ◽  
Luigi Tavazzi ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
System Organization ◽  
National Health System ◽  
Chronic Phase ◽  
Position Paper ◽  
Healthcare Personnel ◽  
Local Health ◽  
New Models ◽  
Acute Wards

Abstract The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic,new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.

scholarly journals Hardships in Italian Prisons During the COVID-19 Emergency: The Experience of Healthcare Personnel

2021 ◽  
Vol 12 ◽  
Author(s):  
Ines Testoni ◽  
Giada Francioli ◽  
Gianmarco Biancalani ◽  
Sandro Libianchi ◽  
Hod Orkibi
Keyword(s):  
Healthcare Workers ◽  
National Health System ◽  
Social Solidarity ◽  
Healthcare Personnel ◽  
Management Skills ◽  
Personal Lives ◽  
Interpersonal Difficulties ◽  
Italian National Health ◽  
The Impact ◽  
Depth Interviews

Background: The recent COVID-19 pandemic has highlighted the deficiencies that characterize the functioning of the Italian national health system. Prisons have always mirrored the most radical expressions of these weaknesses. During the early stages of the pandemic, prison facilities across Italy underwent a series of changes dictated by the need to ensure the safety of the prisoners and staff. The adoption of these rules contributed to a total or partial redefinition of many central facets of life in prison, such as intake procedures for new arrivals and the ways prisoners were allowed to communicate with their families.Objectives: The aim of this qualitative study was to analyze the testimony of penitentiary healthcare workers in prisons throughout Italy to determine the impact of COVID-19 on their professional and personal lives.Participants: Thirty-eight participants were contacted and 20 decided to participate in the interview. The sample was made up of 10 women and 10 men. All the participants were members of the healthcare staff of a penitentiary facility (psychologists, psychiatrists, physicians, and nurses). All were recruited through an Italian association whose mission is the development, promotion, and implementation of social solidarity projects including prisoners' social and health care. This study was facilitated through representatives serving in nine different regions of Italy. The participants were divided according to their professional roles in prisons.Method: In-depth interviews were conducted by telephone or online using telecommunication platforms (e.g., Zoom, WhatsApp, and Skype). The transcribed texts underwent thematic analysis using the Atlas.ti software to identify patterns of meaning across the dataset.Results: Four main themes emerged from the analysis: Interpersonal difficulties, management and operational difficulties, the personal distress and bereavement of healthcare workers, and the distress of inmates. The importance of relationship management skills when interacting with prisoners emerged as a key topic in many interviews, and the participants highlighted the need for adequate training. The increase in prisoners' anxiety made communication more difficult.Conclusions: The findings suggest that healthcare workers in jails need emergency-oriented training. Participants described their feeling of loneliness and quasi-abandonment when carrying out their duties during the pandemic. In particular, they underscored the need for psychological guidance to better manage altered reactions with prisoners and colleagues as a result of heightened death anxiety and isolation.

On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections

2019 ◽  
Vol 74 (8) ◽  
pp. 2405-2416 ◽  
Author(s):  
Taylor Morrisette ◽  
Matthew A Miller ◽  
Brian T Montague ◽  
Gerard R Barber ◽  
R Brett McQueen ◽  
...  
Keyword(s):  
Health System ◽  
Injection Drug Users ◽  
Drug Users ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Off Label

AbstractBackgroundLong-acting lipoglycopeptides (laLGPs) are FDA approved only for acute bacterial skin and skin structure infections (ABSSSIs). However, these antibiotics show promise for off-label use, reductions in hospital length of stay (LOS) and healthcare cost savings.ObjectivesTo assess the effectiveness, safety, impact on LOS and estimated cost savings from laLGP treatment for Gram-positive infections.MethodsRetrospective cohort of adult patients who received at least one dose of laLGPs at the University of Colorado Health system. Descriptive statistics were utilized for analysis.ResultsOf 59 patients screened, 56 were included: mean age 47 years, 59% male and 30% injection drug users/polysubstance abusers (dalbavancin, 71%; oritavancin, 25%; both, 4%). Most common indications for laLGP: ABSSSIs (36%), osteomyelitis (27%) and endocarditis (9%). Most common isolated pathogens: MSSA and MRSA (25% and 19%, respectively), Enterococcus faecalis (11%) and CoNS (11%). Previous antibiotics were administered for a median of 13 days (IQR = 7.0–24.5 days) and laLGPs for a median of one dose (IQR = 1–2 doses). Ten (18%) patients were lost to follow-up. Clinical failure was found in 7/47 (15%) cases with adequate follow-up. Mild adverse effects occurred in six (11%) patients. Projected reduction in hospital LOS and health-system costs were 514 days (9.18 days/person average) and $963456.72 ($17204.58/person average), respectively.ConclusionsProspective trials are needed to validate the use of these antibiotics for Gram-positive infections in practice, with the hope that they will reduce hospital LOS and the need for daily antibiotic infusions to provide alternative options for patients not qualifying for outpatient parenteral antimicrobial therapy.

Italy

2019 ◽  
pp. 189-194
Author(s):  
Claudia Palumbo ◽  
Umberto Volpe
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Health System ◽  
National Health System ◽  
Care Process ◽  
Ministry Of Health ◽  
Free Basis ◽  
Italian Regions ◽  
The World ◽  
Italian National Health

Italy is among countries in the world with the highest population of older people, with Italian elderly people accounting for over 20% of the total population of the country, and ranks second in Europe in terms of the ‘ageing index’ (i.e. the number of people aged 65 and above per 100 youths under the age of 15). In Italy, over 1 million people suffer from dementia, including approximately 600,000 cases of Alzheimer’s disease. Since 2000, a specific National Dementia Plan was initiated and Alzheimer’s Evaluation Units (UVAs) were introduced in all Italian regions to coordinate systematically the complex care process for dementia. Some Italian regions have recently deemed appropriate to change the denomination of UVAs to ‘Evaluation Units of Dementia’ (UVDs) and/or ‘Centres for Cognitive Impairment’. More recently, the Italian Ministry of Health launched an initiative aimed at improving the essential levels of assistance/care (LEA). The LEA represent all activities and services deemed essential to all Italian citizens and that the Italian national health system has to ensure are available, either on a free basis or by paying a participation fee, depending on patients’ situations.

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