A panel of experts from Italian Comprehensive Cancer Centers defines the recommendations for external quality control programs aimed to accreditation to excellence of these institutes. After definition of the process as a systematic, periodic evaluation performed by an external agency to verify whether a health organization possesses certain prerequisites regarding structural, organizational and operational conditions that are thought to affect health care quality, the panel reviews models internationally available and makes final recommendations on aspects considered of main interest. This position paper has been produced within a special project of the Ministry of Health of the Italian Government aimed to accredit, according to OECI model, 11 Italian cancer centers in the period 2012-2014. The Project represents the effort undertaken by this network of Comprehensive Cancer Centers to find a common denominator for the experience of all Institutes in external quality control programs. Fourteen shared "statements" are put forth, designed to offer some indications on the main aspects of this subject, based on literature evidence or expert opinions. They deal with the need for "accountability" and involvement of the entire organization, the effectiveness of self-evaluation, the temporal continuity and the educational value of the experience, the use of indicators and measurement tools, additionally for intra-and inter-organization comparison, the system of evaluation models used, the provision for specific requisites for oncology, and the opportunity for mutual exchange of evaluation experiences.

No abstract

In seven patients with different types of neoplasm, secondary myocardial infiltration was diagnosed in vivo by two-dimensional echocardiography and confirmed by direct inspection. In all patients, clinical and electrocardiographic findings were suggestive but nonspecific for myocardial involvement. Two patients had cardiac tamponade and three had pericardial effusion. In three patients, the echocardiographic diagnosis made it possible to plan specific therapy. Clinical, electrocardiographic and echocardiographic aspects are discussed. A two-dimensional echocardiographic examination should be performed in all patients when cardiac metastatic involvement is suspected from clinical electrocardiographic findings, because the in vivo diagnosis of such a condition may have important therapeutic implications for such patients.

In a 49-yr-old woman who presented with a cervical mass, a fine-needle specimen without aspiration was suggestive of paraganglioma; there were spindle-shaped cells with pseudoacinar structures and prominent intranuclear vacuoles. Subsequent examination of a mass removed from the vagus nerve clearly identified a schwannoma. The differential diagnosis is discussed, particularly in relation to the presence of intranuclear vacuoles, and it is concluded that this cytological characteristic should not in itself define the diagnosis.

Abstract:The Oncology Reference Center (ORC) of Aviano (Italy) organization principles are based on the criteria of effectiveness efficiency and cost-effectiveness in compliance to clinical autonomy leading to the continuous improvement of services provided and the research activities in order to ensure maximum level of safety for patients and operators. Within these values the adoption of environmental sustainable management voluntary systems such as ISO 14000 and EMAS has been evaluated and proposed. To this note the Initial Environmental Analysis (IEA) is presented allowing basic targets for improvement and implementation of environmental management programs as well as highlighting the effectiveness of the adoption of sustainable management of voluntary EMAS instrument.Phases to define and evaluate the environmental factors were analysed and the relationship between the site and the surrounding zone was performed according to the characteristics of "sensitivity" and "vulnerability" of the affected area. Specifying different degrees of priority which the problems must be managed to a medium priority rating was found for short term interventions Some improvements in the hospital waste management were identified among these the preparation of guidelines applicable to current operational practices are the most reliable.