Community Health Centers for Resilient Communities in the post-COVID-19 era

Background

The synergy between territorial services and hospital organizations plays a crucial role for health promotion. Starting from the recent pandemic, the Community Health Centers (CHCs) could turn out particularly efficient in cases of high emergencies, avoiding the overflow of users in the hospital thanks to health home care management or low and medium-care facilities. The aim of the research is to identify evidence based experiences that supports the efficacy of design and management of CHCs, also during pandemics.

Methods

The methodology is based on the analysis of several European case studies, selected by an extensive analysis of the main EU countries, through a comparative matrix with different criteria related to: a) general information; b) urban relationship with the healthcare territorial network; c) number of inhabitants and population basins; d) building typology, dimensions, flexibility and layout issues; e) healthcare staff involved, the number of workers and volumes of activities; f) sanitary and not sanitary functions before and during the COVID-19 pandemic, and transformations applied.

Results

The analysis gives rise to several correlations due the localization of CHCs and the healthcare territorial network, dimensions and staff involved, sanitary and not sanitary functions -before and during the pandemic- and the flexibility of the CHCs, that permits to list experience based best practices for the design and management of resilient CHCs, as useful strategic lines for professionals in public health and healthcare design. The survey highlights the strategic role of CHCs for the healthcare territorial network with particular evidence during pandemics.

Conclusions

The strategies aim to encourage the introduction of CHCs for the access to care for the population. The outcomes of the analysis are related to the research project Cities and Health Community Centers for Resilient Communities funded by PoliSocial Award 2020 of Politecnico di Milano.

Key messages

definition of design and organizational strategies for Community Health Centers for Resilient Communities in the post-COVID-19 era. qualitative and quantitative data analysis of European Community Health Centers before and during the COVID-19 pandemic.

Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary

BACKGROUND

Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery.

METHODS

A health technology assessment approach was implemented to investigate the economic, social, ethical, and organizational implications related to the adoption of the innovative fluorescence-guided view, with a focus on minimally invasive approach. With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaires and self-reported interviews, considering the dimensions resulting from the EUnetHTA Core Model.

RESULTS

From a systematic search of literature, we retrieved the following studies: 6 on hepatic, 1 on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric surgery. Fluorescence guide has shown advantages on the length of hospitalization particularly in colorectal surgery, with a reduction of the rate of leakages and re-do anastomoses, in spite of a slight increase in operating time, and is confirmed to be a safe, efficacious, and sustainable vision technology. Clinical applications are still presenting a low evidence in the literature.

CONCLUSION

The present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an HTA approach, sustains the use of fluorescence-guided vision in minimally invasive surgery, in the fields of general, gynecologic, urologic, and thoracic surgery, as an efficient and economically sustainable technology.

Health Data for Public Health: Towards New Ways of Combining Data Sources to Support Research Efforts in Europe

Objectives: To present the European landscape regarding the re-use of health administrative data for research. Methods: We present some collaborative projects and solutions that have been developed by Nordic countries, Italy, Spain, France, Germany, and the UK, to facilitate access to their health data for research purposes. Results: Research in public health is transitioning from siloed systems to more accessible and re-usable data resources. Following the example of the Nordic countries, several European countries aim at facilitating the re-use of their health administrative databases for research purposes. However, the ecosystem is still a complex patchwork, with different rules, policies, and processes for data provision. Conclusion: The challenges are such that with the abundance of health administrative data, only a European, overarching public health research infrastructure, is able to efficiently facilitate access to this data and accelerate research based on these highly valuable resources.

Immunosuppressive agents and bone disease in renal transplant patients with hypercalcemia

Renal transplantation is the definitive treatment for many metabolic abnormalities of uremic patients, although it is only partially effective for renal osteodystrophy, which may interact with posttransplant renal osteopathy. Osteopenic-osteoporotic syndrome represents, together with fractures secondary to osteoporosis and osteonecrosis, the bone complication most related to renal transplantation. Several factors contribute to the pathogenesis of posttransplantation osteoporosis, particularly immunosuppressive treatment. In this study, we evaluated the prevalence of factors related to posttransplant renal osteopathy and the clinical impact of immunosuppressive protocols. We studied 24 renal transplant recipients with hypercalcemia. Glomerular filtration rate was >50 mL/min. Mean age, time on dialysis, and time from transplantation were 49.6, 5.4, and 6.9 years, respectively. We evaluated serum and urine calcium and phosphorus, calcitonin, parathormone, bone-specific alkaline phosphatase, osteocalcin, urine deoxypyridinoline, telopeptide of type 1 procollagen, 1,25-(OH)(2) and 25-OH vitamin D, parathyroid ultrasound, and computerized bone mineralometry. The combination of sirolimus and steroids resulted in the most disadvantageous outcomes regarding alkaline phosphatase and mineralometry. Calcineurin inhibitors did not significantly influence bone metabolism markers; mycophenolate mofetil evidenced no effect on bone. According to the literature, steroids account for the abnormalities found in our patients and in severe osteopenia. Several factors may contribute to the development of osteoporosis and fractures in transplantation patients, although they are overcome by the prominent effect of steroids. In patients at high risk of osteoporosis, steroid-free therapy should be considered. Everolimus is indicated for diseases with bone loss. Combined therapy with everolimus and mycophenolic acid without cyclosporine and steroids, seemed to be particularly indicated. Prophylactic treatments should be commenced early. No single marker was useful to diagnose posttransplant renal osteopathy. The definitive diagnosis should be made by bone biopsy during transplantation, and noninvasive procedures, such as densitometry and evaluation of biologic markers, may be useful during follow-up.

[Health-care costs and health technology assessment]

This paper is made up of four sections: a) an overview of the relationship between health-care costs and health technology assessment; b) the state of art of the research into health technology assessment with details on the main fields of research, the results obtained, and the gaps to be bridged; c) an analysis of the techniques for assessing health-care technology (cost-minimization analysis [CMA]; cost-effectiveness analysis [CEA]; cost-utility analysis [CUA]; cost-benefit analysis [CBA]); and d) an overview of the use of the four assessment techniques between 1980 to 2006 in nephrology, with special emphasis on dialysis.