BackgroundSeveral healthcare systems facing respiratory viral infections outbreaks, like COVID-19, have not been prepared to manage them. Public health mitigation solutions ranging from isolation of infected or suspected cases to implementation of national lockdowns have proven their effectiveness for the outbreak’s control. However, the adjustment of public health measures is crucial during transition phases to avoid new outbreaks. To address the need for designing evidence-based strategies, we performed a systematic review to identify healthcare systems interventions, experiences and recommendations that have been used to manage different respiratory viral infections outbreaks in the past.MethodsPubMed, Web of Science, Scopus and Cochrane were searched to retrieve eligible studies of any study design, published in English until 17 April 2020. Double-blinded screening process was conducted by titles/abstracts and subsequently eligible full texts were read and pertinent data were extracted. When applicable, quality assessment was conducted for the included articles. We performed a narrative synthesis of each implemented public health approaches.ResultsWe included a total of 24 articles addressing the public health approaches implemented for respiratory viral infections outbreaks for COVID-19, influenza A H1N1, MERS and severe acute respiratory syndrome . The identified approaches are ascribable to two main categories: healthcare system strategies and healthcare provider interventions. The key components of an effective response on respiratory viral outbreaks included the implementation of evidence-based contextual policies, intrahospital management actions, community healthcare facilities, non-pharmaceutical interventions, enhanced surveillance, workplace preventive measures, mental health interventions and communication plans.ConclusionThe identified healthcare system strategies applied worldwide to face epidemics or pandemics are a useful knowledge base to inform decision-makers about control measures to be used in the transition phases of COVID-19 and beyond.

Background and objectives A summary indicator for evaluating the breast cancer network has never been measured at the regional level. The aim is to design treemaps providing a summary description of hospitals (including breast units) and Local Health Units (LHUs) in terms of their levels of performance within the breast cancer network of the Lazio region (central Italy). The treemap structure has an intuitive design and displays information from both general and specific analyses. Methods Patients admitted to the regional hospitals for malignant breast cancer (MBC) surgery in 2010-2017 were selected in a population-based cohort study. These quality indicators were calculated based on the international guidelines (EUSOMA, ESMO) to assess the performance in terms of volume of activity, surgery procedure, post-surgery assistance and timeliness of medical therapy or radiotherapy beginning. The quality indicators were calculated using administrative health data systematically collected at the regional level and were included in the treemap to represent the surgery or the post-surgery areas of the breast cancer clinical pathway. In order to allow aggregation of scores for different indicators belonging to the same clinical area, up to five evaluation classes were defined using the "Jenks Natural Breaks" algorithm. A score and a colour were assigned to each clinical area based on the ranking of the indicators involved. The analyses were performed on an annual basis, by the LHU of residence and by the hospital which performed the surgical intervention. Results In 2017, 6218 surgical interventions for MBC were performed in the hospitals of Lazio. The results showed a continuous increase of the level of performance over the years. Hospitals showed higher variability in the levels of performance than the LHUs. 36% of the evaluated hospitals reached a high level of performance. An audit of the S. Filippo Neri breast unit

Background Several countries facing the COVID-19 pandemic were not prepared to manage it. Public health mitigation strategies, ranging from isolation of infected cases to implementation of national lockdowns, proved their effectiveness for the outbreaks control. However, the adjustment of public health measures is crucial during transition phases to avoid new outbreaks. To address the need for designing evidence-based strategies, we performed a systematic review, identifying healthcare systems approaches, experiences and recommendations used to manage COVID-19 and other epidemics. Methods PubMed, Web of Science, Scopus and Cochrane were searched to retrieve eligible studies of any study design, published in English until April 17th, 2020. Double-blinded screening process was conducted by titles/abstracts and subsequently eligible full-texts were read and pertinent data were extracted. We performed a narrative analysis of each implemented strategy. Results We included a total of 24 articles addressing the public health strategies implemented for respiratory viral infections outbreaks as COVID-19, influenza A H1N1, MERS and SARS. The identified strategies are ascribable to two main categories: healthcare systems management at a national level and healthcare providers strategies at a local level. The key components of the transition strategies regarded the implementation of evidence-based contextual policies, intrahospital management approaches, community healthcare facilities, non-pharmaceutical interventions, enhanced surveillance, workplace preventive measures, mental health interventions and communication plans. Conclusions The identified healthcare systems strategies applied worldwide to face epidemics or pandemics, are a useful knowledge base to inform decision-makers about control measures to be used in the transition phases of COVID-19 and beyond. Key messages Healthcare systems strategies that can be implemented to manage pandemics/epidemics transition phases are a useful knowledge base to inform policy makers about the most effective solutions to adopt. The evidence reporting the healthcare systems management of respiratory viruses epidemics/pandemics, show the lack of a common and shared approach and more evidence-based research is needed.