The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.
Several reports have described the poor quality of care delivered to psychotic patients. However, the context in which care was delivered, including the structure, organization, and performance of the health care system, as a possible determinant of quality of care has received less attention. In this study we explored the relationship between conformance with guidelines and structural and organizational characteristics in 2 departments of Mental Health in Italy. Dosing of antipsychotic drugs in the maintenance phase was investigated in 125 patients. Higher than recommended doses could be explained by the high patient caseload per psychiatrist, leading to insufficient contacts with patients and their families and to excessive reliance upon drug treatment. The analysis of structural and organizational determinants of care at the local level may help to explain insufficient quality and to plan suitable interventions.
The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.
The aim of this work is to assess the effectiveness of the cross-compliance standard Maintenance of farm channel networks and field convexity with respect to the environmental objective to maintain soil structure through appropriate measures indicated in Annex IV of REG. EC 1782/03. This GAEC standard concerns arable land and obliges the farmer to maintain the farm channel network and the convex shape of fields with a view to the management and preservation of temporary drainage ditches and permanent channels along the edges of the fields, in order to ensure their efficacy and function in draining away water. Experiments have confirmed that maintaining the farm channel networks and giving fields a convex shape has a positive effect in predisposing the soil to ideal conditions for the preservation of its structure. In particular, we have used the data of a newly conducted laboratory study on the effects of the duration of waterlogging on the stability of soil structure, as well as the results of several studies carried out in the past with the following goals: i) assessment of the effects of soil moisture various levels on the stability of the structure; ii) assessment of the effects of several wetting and drying cycles on aggregate stability; iii) determination of aggregate stability under the influence of freezing and thawing under different soil moisture conditions; iv) determination of aggregate stability with an increasing number of freeze/thaw cycles (0, 1, 3, 5, 11 cycles) at field capacity moisture. The tests during which the soil was subjected to freezing and thawing were carried out taking into account the fact that during winter waterlogged soil may freeze, leading to a structure breakdown, due to the expansion of water into the pores during the freezing phase. In general, the results showed that in soils that are sandy and rich in rock fragments, rapid moisture penetration leads to significant disaggregation phenomena compared with soils with higher silt and clay contents. The results also showed that the least extensive disaggregation of the structure occurred with three wetting/drying cycles. This behaviour was more obvious in soils with a greater silt and clay content compared with sandy loam soils. After the third wetting/drying cycle, disaggregation increased with the cycles number increasing. In particular for moisture contents of 50%, this test confirms that maintaining the farm channels efficacy has a beneficial effect on soil structure, as good draining of water, which is ensured by well-functioning ditches, prevents waterlogging and fights the dispersion of clay and silt (when the soil is dry, these two components form a surface crust that disturbs the water and gas exchange as well as plant growth). Disaggregation due to freezing and thawing is linked very closely to the matrix potential (and hence to the moisture) of the aggregates before treatment. In general it can be said that a water content between saturation and field capacity predisposes the soils to a much higher level of d...
INTRODUZIONEL'analisi farmacoeconomica effettuata sul caso della polmonite acquisita in comunità può essere un ottimo spunto per fare alcune osservazioni riguardo l'utilità di questo tipo di studi, e di quello sulla CAP in particolare, al fine della creazione di valore sanitario. Questo può essere considerato l'obiettivo fondamentale che il settore sanitario si deve porre sia per la gestione di breve periodo che per quella strategica, in quanto creare valore significa soddisfare gli interessi e i bisogni di salute dell'utenza.Nell'analisi del sistema sanitario la valutazione economica dei diversi atti che sostanziano le prestazioni erogate è diventata, in misura sempre maggiore, una componente obbligatoria ai fini di un approccio razionale che contemperi da un lato l'esigenza di rispondere nel modo migliore possibile ai crescenti bisogni di assistenza della popolazione, e dall'altro la mancata disponibilità di un parallelo incremento delle risorse disponibili. Le risorse scarse a disposizione del sistema sanitario, e più in particolare di un'azienda sanitaria, presentano una pluralità di utilizzi, ognuno dei quali è in grado di generare valore. Il management sanitario, quindi, si trova di fronte ad un insieme di risorse che deve impiegare in modo tale da creare il maggior valore possibile. Si tratta, dunque, di un problema di allocazione. Il fatto è che nel sistema sanitario, così come in tutto il settore pubblico, manca un meccanismo simile a quello di mercato che consenta alle imprese private un certo automatismo per le scelte di allocazione. L'esigenza di elaborare metodi di analisi utili a tale scopo si è imposta poiché quasi sempre le spese sanitarie (e quelle pubbliche, in generale) si svolgono al di fuori dei meccanismi normali dell'economia di mercato e, quindi, non ci si può riferire a valutazioni di mercato, relative ai ricavi del sistema sanitario per stimare i benefici degli interventi. Le tecniche di valutazione economica possono venire utilizzate per diversi scopi ed in particolare: -valutare la convenienza di un determinato progetto di investimento in rapporto alle risorse che esso richiede; -definire una priorità riguardo al perseguimento di differenti obiettivi; -stabilire quale "tecnologia" sia preferibile fra quelle che permettono di raggiungere un determinato obiettivo. Se non si sviluppano corretti strumenti analitici per attuare questi confronti, si corre il rischio (che molte volte è purtroppo una dura realtà) di volere idealisticamente o velleitariamente aumentare il benessere della collettività e il valore generabile dal sistema sanitario, ma poi di compiere delle scelte che vanno a detrimento di tale benessere e valore o che non li accrescono nella misura massima possibile date certe disponibilità di mezzi esistenti. I metodi di valutazione economica, e CREAZIONE DI VALORE ABSTRACTThe pharmacoeconomical analysis of the strategies in the disease management of the Community-Acquired Pneumonia (CAP) is a very good starting point for considering the value creation utility. The value creatio...
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