No abstract

IntroductionThe real-time continuous monitoring of vital parameters in patients affected by multiple chronic conditions and/or COVID-19 can lead to several benefits to the Italian National Healthcare System (IT-NHS). The UBiquitous Integrated CARE (UBICARE) technology is a novel health digital platform at the validation stage in hospital setting. UBICARE might support the urgent need for digitalisation and early intervention, as well as minimise the face-to-face delivery of care in both hospital and community-based care settings. This research protocol aims to design an early-stage assessment of the multidimensional impact induced by UBICARE within the IT-NHS alongside technology validation in a hospital ward.Methods and analysisThe targeted patients will be medium/high-risk hypertensive individuals as an illustrative first example of how UBICARE might bring benefits to susceptible patients. A mixed-method study will be applied to incorporate to the validation study a multistakeholder perspective, including perceived patient experiences and preferences, and facilitate technology adoption. First, semistructured interviews will be undertaken with a variety of stakeholders including clinicians, health managers and policy-makers to capture views on the likely technology utility, economic sustainability, impact of adoption in hospital practice and alternative adoption scenarios. Second, a monocentric, non-randomised and non-comparative clinical study, supplemented by the administration of standardised usability questionnaires to patients and health professionals, will validate the use of UBICARE in hospital practice. Finally, the results of the previous stages will be discussed in a multidisciplinary-facilitated workshop with IT-NHS relevant stakeholders to reconcile stakeholders’ perspectives. Limitations include a non-random recruitment strategy in the clinical study, small sample size of the key stakeholders and potential stakeholder recruitment bias introduced by the research technique.Ethics and disseminationThe Ethics Committee for Clinical Experimentation of Tuscany Region approved the protocol. Participation in this study is voluntary. Study results will be disseminated through peer-reviewed publications and academic conferences.

The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.

No abstract

I servizi sanitari di prevenzione sono caratterizzati da un'elevata complessita principalmente legata al contesto inter-organizzativo e ambientale in cui operano. Da cio consegue una notevole difficolta nel misurarne e valutarne i risultati. Per tali motivi, il controllo e la gestione della performance delle attivita di prevenzione si avvalgono di diversi meccanismi, formali e informali, che hanno l'obiettivo di orientare i comportamenti e le decisioni degli individui e delle organizzazioni coinvolte verso fini comuni. Lo scopo del presente lavoro e quello di approfondire i sistemi di controllo e gestione della performance impiegati nei servizi di prevenzione che operano in contesti inter-organizzativi - e in particolare nell'ambito dei controlli frontalieri sugli alimenti - al fine di supportare il disegno e l'implementazione degli stessi. Per fare cio, la ricerca si concentra sui casi di studio delle infrastrutture portuali di Genova e Livorno. Parole chiave: prevenzione, controlli condottools. To explore performance management in such contexts, this research suggests the adoption of management control as a "package" approach. Thus, the research's objective is to understand how management control operates in the delivery of preventative services operating in inter-organizational environment. To do so, this study focuses on the cases of Genoa's and Leghorn's ports.