Background: Despite advances in precision medicine, the translation of genetic and genomic technologies into routine practice is hampered by a heterogeneous and limited evidence base and the absence of standardized evaluation methodologies. Health Technology Assessment (HTA) plays a critical role in bridging this gap, yet assessment approaches and comprehensiveness vary widely. This systematic review aims to map the landscape of the assessment reports on genetic and genomics applications, analyze their methodological aspects and identify gaps. Methods: PubMed, Scopus, Web of Science, and the international HTA database, were searched for assessment reports of genetic/genomic technologies. Information on reports general characteristics, assessment domains and their components, consulted sources of evidence and reported gaps was extracted. Findings were synthesized narratively. Results: Out of 27,331 screened records, 41 reports were included, predominantly from Canada, the United Kingdom, and Australia, mainly aimed at informing policy making for single or multiple gene tests for cancer patients. Most reports used a generic HTA methodology and assessment domains varied across reports. Key clinical aspects, such as clinical accuracy and safety, suffered from evidence gaps (39.0% and 22.0%), while personal and societal aspects were the least investigated assessment domain (48.8-78.0%). Overall, lack of evidence and limited generalizability of findings were the most commonly reported gaps across multiple domains. Conclusions: The review highlighted significant fragmentation in current evaluation methodologies of genetic and genomic applications, with underassessment of analytical/clinical accuracy, safety, and non-health outcomes, alongside evidence gaps and limited generalizability. These issues compromise both evaluation and decision-making process, underscoring the urgent need for alternative study designs and standardized, comprehensive assessment frameworks to facilitate the successful implementation of emerging genetic and genomic technologies.

Background: Both Health Technology Assessment (HTA) and Performance Management (PM) are clinical governance disciplines that aim to improve the quality, equity, and financial sustainability of health organizations and systems. Although HTA and PM share many features, to the authors' knowledge, few studies have investigated their interplay. This study attempts to fill this gap by analysing how the literature has explored and developed the integration between HTA and PM concepts and tolls within healthcare sector. Methods: To address this gap, this study examines 33 papers selected through a scoping review that explores the inter of HTA and PM within the healthcare sector. In particular, the paper adopted the preferred reporting items for systematic reviews and meta-analysis (PRISMA) methodology to select and analyse articles. Results: The review highlights the dynamic convergence of HTA and PM, emphasizing how combining these frameworks and functions can enhance decision-making in healthcare. This integration ensures that technologies are adopted on the basis of proven effectiveness in pursuing healthcare systems goals and that performance metrics align with evidence-based practices, leading to better resource allocation and improved patient outcomes. The literature review underscores the need for further research to understand the integration between HTA and PM and their combined impact on organizational performance, sustainability, and resilience in the healthcare sector. Conclusion: This study contributes to the literature by providing a comprehensive overview of the current state of research on HTA and PM, offering insights for future studies, and practical recommendations for integrating these disciplines to improve healthcare management and policymaking.

Background: Electrophysiology (EP) procedures, including cardiac implantable electronic devices (CIEDs) and ablations, are widely used to manage arrhythmias and heart failure. These interventions, though effective, require substantial resources, prompting the need for systematic economic evaluations to inform healthcare decision-making. Methods: A systematic review of studies from 2007 to 2024 was conducted in two phases. Phase one assessed trends in economic evaluations of EP procedures, analyzing 129 studies across regions and timeframes. Phase two focused on cost-effectiveness analyses of implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy defibrillators (CRT-Ds), and atrial fibrillation (AF) ablation, examining outcomes like quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), while identifying factors influencing economic results. Results: EP procedures generally demonstrated favorable cost-effectiveness, particularly in high-income regions. Studies on ICDs and CRT-Ds consistently supported their economic value for patients with arrhythmias or heart failure, while AF ablation showed potential for long-term benefits, particularly when compared to medical therapies. However, results varied by region, reflecting differences in healthcare systems, costs, and patient populations. Conclusions: The review highlights the overall cost-effectiveness of EP procedures in many settings but underscores the need for tailored economic evaluations in low- and middle-income countries. Simplified methodologies and greater attention to regional contexts are recommended to guide resource allocation and policy development globally.

Abstract Background: with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing. Methods: we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential). Results: linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned. Discussion: policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants' needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results' robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.

Background: Health Impact Assessment (HIA) procedures can include the assessment of inequalities and inequities associated with the distribution of environmental health risks and benefits, aimed at attenuating the exacerbation of environmental health disparities. This systematic review, conducted as part of the Joint Action Prevent Non-Communicable Diseases initiative, explores methods for assessing health inequalities and equity within HIA frameworks, particularly in local projects affecting the distribution of environmental risks and benefits. Methods: Adhering to the PRISMA guidelines, a systematic review of the scientific literature was conducted using the MEDLINE/PubMed, Scopus, and Embase databases, searching until March 8, 2024. Furthermore, a grey literature analysis encompassed the Institutional Repository for Information Sharing (IRIS) of the World Health Organization, to identify guidelines and recommendations addressing equity considerations in HIAs. Studies were included based on predefined eligibility criteria if they explored issues related to inequalities, inequities, and vulnerabilities within the context of HIAs. Data extraction focused on methodologies that incorporated equity considerations within the HIA framework, particularly concerning local urban planning initiatives, transport infrastructure, and industrial settings. Results: A total of 33 studies met the inclusion criteria. Among these, eight documents from the grey literature, identified as guidelines and guidance, underscored the importance of prioritizing equity to ensure that health impacts are addressed fairly across diverse population groups. The remaining 25 peer-reviewed studies employed a combination of quantitative and qualitative methodologies. Quantitative approaches, including exposure-response modeling and Geographic Information System (GIS) mapping, were utilized to evaluate spatial and demographic health disparities. Qualitative methods, such as focus groups, interviews, and participatory tools, provided insights into the lived experiences of vulnerable populations affected by local interventions. Studies addressing urban and transportation planning predominantly emphasized socioeconomic stratification, whereas those focused on industrial settings highlighted occupational hazards and community vulnerabilities. Conclusion: This review highlights the diverse and fragmented approaches used to address health inequalities and equity in HIA. It underscores the need for interdisciplinary and systematic methodologies that integrate quantitative and qualitative perspectives, ensuring equity remains a central consideration in policymaking and project implementation. Finally, it proposes a practical framework for integrating equity into HIA.

Background: Corporate wellness programs are increasingly using digital technologies to promote employee health. Digital wellness programs (DWPs) refer to initiatives that deliver health interventions through digital tools. Despite a growing body of evidence on DWPs, the literature remains fragmented across multiple health domains. Objective: This study aims to provide a comprehensive synthesis of existing research on the efficacy (eg, impact on employee's physical health, mental well-being, behavioral changes, and absenteeism) and acceptability (eg, engagement, perceived usefulness, and adoption) of employer-provided DWPs. Specifically, we aim to map the extent, range, and nature of research on this topic; summarize key findings; identify gaps; and facilitate knowledge dissemination. Methods: We conducted a meta-review of studies published between 2000 and 2023. We adopted a database-driven search approach, including the MEDLINE, PsycINFO, ProQuest Central, and Web of Science Core Collection databases. The inclusion criteria consisted of (1) review articles; (2) publications in English, French, or German; (3) studies reporting on digital health interventions implemented in organizations; (4) studies reporting on nonclinical or preclinical employee populations; and (5) studies assessing the efficacy and acceptability of employer-provided DWPs. We performed a descriptive numerical summary and thematic analysis of the included studies. Results: Out of 593 nonduplicate studies screened, 29 met the inclusion criteria. The most investigated health domains included mental health (n=19), physical activity (n=8), weight management (n=6), unhealthy behavior change (n=4), and sleep management (n=2). In total, 24 reviews focused on the efficacy of DWPs, primarily in relation to health-related outcomes (eg, stress and weight), while fewer reviews addressed organization-related outcomes (eg, burnout and absenteeism). Four reviews explored the mechanisms of action, and 3 assessed the acceptability of DWPs using various measures. Overall, the findings support the efficacy and acceptability of DWPs, although significant gaps persist, particularly regarding the durability of outcomes, the role of technology, and the causal mechanisms underlying behavioral change. Conclusions: While DWPs show promise across a variety of health domains, several aspects of their effectiveness remain underexplored. Practitioners should capitalize on existing evidence of successful DWPs while acknowledging the limitations in the literature.

Background: Dementia is a group of chronic diseases characterised by cognitive impairment that progressively disrupts daily functioning and requires increasing levels of healthcare, social support, and long-term care. Support for people with dementia can be provided by formal support systems although most of the care process relies upon informal care givers. Despite the availability of formal support systems and healthcare workers, the utilization of dementia care services remains suboptimal. Factors such as non-compliance, lack of awareness, and poor care coordination contribute to this issue. Understanding these barriers is crucial for improving service utilization and alleviating the economic burden on families and national health systems. Methods: This systematic review analysed the literature, published from 2013 to 2023, on barriers in Alzheimer and other dementia healthcare system, conducted on people living with a dementia, their caregivers, or healthcare workers in dementia care settings in Europe, following PRISMA guidelines. Searches in PubMed, Embase, PsycINFO, Health Technology Assessment Database, and Web of Science used terms related to Alzheimer's, dementia, and access barriers. Rayyan AI supported full-text review, with quality assessed via the Mixed Methods Appraisal Tool. Results: Over 1298 articles, 29 studies met the inclusion criteria. These studies highlighted several barriers to dementia care, categorised into information, organizational, cultural, stigma-related, financial, and logistical challenges. Informational and educational barriers included a lack of awareness and knowledge among caregivers. Organizational barriers involved poor care coordination and unclear access procedures. Cultural and stigma-related barriers were linked to societal attitudes towards dementia. Financial barriers were associated with the high costs of care, and logistical barriers included limited availability and accessibility of support services. Conclusions: To enhance the quality of life for individuals living with dementia, it is crucial to address these identified barriers through tailored interventions and management programs. Improving care coordination, communication, and training for healthcare professionals, alongside reducing systemic delays, are essential steps toward more effective dementia care. Easing the burden of care with tailored interventions and management programmes is mandatory to improve the quality of life of persons living with dementia and their families.

Abstract Background & objective: This systematic review evaluates the impact of guidelines on healthcare professionals' behavior and explores the resulting outcomes. Methods: Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis. Results: The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %). Conclusions: The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.

In Europe, most countries are facing common healthcare challenges that lead to a need for innovation, effectiveness and efficiency in the healthcare systems. This is often addressed through actions and intentions including enhanced primary and integrated care. However, these developments seem to be progressing slowly and non-uniformly, nor is there knowledge exchange, and the full implications of these changes on healthcare design are still unfolding. The research presented investigates what are the current trends in healthcare systems and the effects on design transformations, focusing on the Swedish experience. In Sweden, a reform known as "Nära Vård" [Close Care], aims to "reconstruct" the core of the healthcare service around primary care. It strives to bring care "closer" to people and communities concerning access to both care and the facilities where it is delivered. The objective of this paper is to understand what can be learnt from the Swedish experience; the research presented aims at investigating the effects of the Close Care reform on primary care facilities design. The study was conducted from April to July 2023, and it consisted of: i) desk research and literature review; ii) data collection through 12 interviews with experts; iii) data analysis through qualitative content analysis; iv) study visits to local care facilities. From the interviews, 10 factors for change and 9 challenges emerged. Moreover, it appears that the organisational structure of the Swedish healthcare system caters for regional and individual projects' interpretations of how to bring care "closer" to the patients; this variation allows for a broader understanding of the advantages and drawbacks of each organisational model and design, and it reinforces the idea that there is no "one-size-fits-all" for close care. This diversity points to a need for a project evaluation program of the ongoing experiences, aimed at assessing the performance and effectiveness of each approach.

Introduction Breast cancer is the most prevalent malignancy among women worldwide, with an age-standardized rate of 46.8 per 100,000 and represents an important health burden (WHO International Agency for Research on Cancer, 2022). In Italy, the incidence of breast cancer has been steadily increasing, with approximately 55,900 new cases diagnosed in 2022 (Lei et al., 2021; AIRTUM, 2023). HER2-positive breast cancer, characterized by overexpression of the human epidermal growth factor receptor 2, constitutes about 20%–25% of all breast cancer cases and is associated with a more aggressive disease course and poorer prognosis (Slamon et al., 1989; Harbeck et al., 2019). The treatment landscape for breast cancer (von Arx et al., 2023), particularly concerning biologically originated oncological medications, has witnessed significant evolution in recent years. Among these medications, trastuzumab stands as a cornerstone in the management of HER2-positive breast cancer, improving patient outcomes. Anti-HER2 agents target HER2 receptors, inhibiting signal transduction pathways and thereby reducing cellular proliferation in HER2-positive breast neoplasms. Currently, utilized agents include trastuzumab, lapatinib, pertuzumab, trastuzumab emtansine (T-DM1), and trastuzumab deruxtecan (T-Dxd). Additionally, neratinib, a recently introduced anti-HER2 drug, may also be employed for the treatment of HER2-positive disease. In the systemic management of metastatic breast cancer, trastuzumab may be administered in conjunction with pertuzumab and chemotherapy or combined with lapatinib. In subsequent treatment lines, trastuzumab can be formulated as an antibody-drug conjugate (ADC), such as trastuzumab emtansine or trastuzumab deruxtecan. Considering adjuvant therapy, trastuzumab can be utilized alongside chemotherapy, particularly taxanes, with or without endocrine therapy, if the carcinoma is hormone-responsive. The results obtained in patients with advanced disease have provided the rationale for testing the same treatments in earlier stages, where perioperative pharmacological treatments aim to increase the chances of cure. A historical example is the result achieved with the anti-HER2 monoclonal antibody trastuzumab, which, after proving activity in combination with chemotherapy in women with HER2-positive metastatic breast cancer, has also become the standard adjuvant treatment for surgically treated patients with this molecular alteration since 2005 (AIRTUM, 2023). Alongside therapeutic advancements, economic considerations on the utilization of these medications have become increasingly pertinent (Dai et al., 2021). High prevalence of breast carcinoma and the multifaceted spectrum of treatment modalities, coupled with the distinctive profile of trastuzumab as the inaugural HER-2 targeted therapy integrated into the therapeutic armamentarium for breast carcinoma management, encompassing both early-stage and metastatic scenarios, has steered the investigative spotlight onto this seminal agent (Maadi et al., 2021). Amidst the myriad conjugated or combinatory formulations pervading the clinical milieu, trastuzumab ADCs are instigating paradigm shifts in the diverse demographic cohorts they cater to. This delineation underscores the pivotal role of trastuzumab and its derivative formulations in reshaping the landscape of breast cancer therapeutics, heralding a new era of precision medicine tailored to the individualised needs of patients.

Abstract Objective: The objective of the analysis presented is to assess the efficacy of a fast-track pathway for elective hip and knee arthroplasty, compared to the traditional approach, adopted within a research hospital located in Milan (Italy), in terms of length of stay reduction and related direct medical costs. Methods: A monocentric observational retrospective study was implemented considering adult subjects who underwent elective primary total hip or knee replacement, with a diagnosis of primary or secondary osteoarthritis. Exclusion criteria were subjects admitted via emergency department, subjects undergoing knee or hip replacement because of fractures or prosthesis revision. The analysis compared the length of stay and the direct medical costs, assuming the hospital perspective, of subjects admitted in the pre-fast-track period (years 2016/2017) and during the fast-track period (years 2018/2019). Results: Knee replacement mean costs are 5,599 € (±1,158.3 €) in the pre-fast-track period and 4,487 € (±978.4 €) in the fast-track period (-1,112 €; -19.9%). Hip replacement mean costs in the pre-fast-track period are 5,364 € (±1,037.2 €) and 4,450 € (±843.7 €) in the fast-track period (-914 €; -17.0%). The adoption of fast-track pathway led to a statistically significant decrease of days of hospitalization of -2.8 (-37.6%) in knee replacement and of -2.9 (-39.2%) in hip replacement. Conclusion: The fast-track pathway adopted proved to be effective, reducing patients' length of stay, and sustainable and efficient, reducing direct medical costs, for both elective hip and knee replacement surgeries.

Background: We conducted a systematic review and meta-analysis to evaluate the role of High Energy Devices (HEDs) versus conventional clamp and tie technique in thyroidectomy. This work is endorsed by the Italian Society of Surgical Endoscopy (Italian Society of Endoscopic Surgery and new technologies-SICE) in the broader project on the evaluation of the role of HEDs in different surgical settings with the full health technology assessment report. Mehods: Inclusion criteria were adult patients (≥ 18 years old) undergoing Thyroidectomy/Parathyroidectomy conducted with High Energy Devices (as ultrasonic (US), radiofrequency (RF), and hybrid energy (H-US/RF)) in the setting of thyroid surgery (both partial and total) for benign and malign diseases. However, some variability was found in included studies and described in the text. This systematic review and meta-analysis were performed according to the Cochrane handbook for systematic reviews, and the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were pursuit. Selection of abstracts was performed in Ryyan system by 2 independent reviewers, and doubts were solved by another independent reviewer. At the end of literature research, Randomized controlled trials and observational studies were included. Risk of Bias was assessed with ROB2 for RCTs, and New Castle Ottawa Scale for Observational studies. Results: The literature search yielded 47 studies, including 29 RCTs and 18 observational studies. Meta-analysis was performed for 29 randomized clinical trials. Outcomes included in the comparison between High Energy Devise and conventional technique groups were operative time, operative blood loss, overall post-operative drainage volume, length of stay, complications, and costs. HED significantly reduced operative time (28 studies, 3097patients; MD -128.8; 95% CI -34.4 to -23.20; I2 = 96%, p < 0.00001, Random-effect), intra-operative blood loss (13 studies, 642 vs 519 patients; SMD -0.82; 95% CI -1.33 to -0.32; I2 = 93%, p < 0.00001, Random-effect), LOS (22 studies, 2808 vs 2789 patients; MD -0.38, 95% CI -0.59 to -0.17; I2 = 98%, p < 0.00001 Random-effect), and healthcare costs (8 studies, 1138 vs 1129 patients, SMD 1.05; 95% CI -0.06 to 2.16; I2 = 99%, p < 0.00001 Random-effect). The rate of overall intraoperative complications was significantly different between both groups (25 studies, 2804 vs 2775 patients; RR 0.88, 95% CI 0.80 to 0.97; I2 = 38%, p = 0.03 Random-effect), but the sensitivity analysis did not find a statistically significant difference (6 studies, 605 vs 594 patients, RR; 95% CI to; I2 = 0%, p = 0.50, Random-effect). There was no difference in the subgroup analysis for the occurrence of transient and permanent RLN palsy, nor hematoma formation and hypocalcaemia. Discussion: Though findings of our systematic review and metanalysis are limited by heterogeneous data, surgeons, hospital managers, and policymakers should note that the use of High Energy Devices compared to conventional clamp and tie technique have reduced operative times, intra-operative blood loss, length of stay, and hospital costs in patients underwent to tyroid surgery. Future work must explore issues of equity to mitigate barriers to patient access to safe thyroid surgical care and define better this initial results.

Background: Chronic diseases, such as chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, and heart failure, often coexist and contribute to a significant burden on individuals and health systems. The Assessment of Burden of Chronic Conditions (ABCC) tool, already in routine clinical use in the Netherlands, aims to comprehensively assess and visualize disease burden, stimulate self-management, and encourage shared decision-making. This study aims to validate the German and Italian versions of the ABCC tool and evaluate its effectiveness and cost-effectiveness in the South Tyrolean Primary Care setting. Methods: This is a cluster-randomized study involving approximately 400 patients with COPD, asthma, type 2 diabetes, and heart failure who received care from the South Tyrolean General Practices. Initially, the ABCC tool will be translated into German and Italian and validated. Subsequently, half of the participants will use the validated ABCC tool for patient-reported outcome measurement assessments, while the other half will receive usual care. The primary outcome measure is the change in the patients' perception of the quality of care after 18 months. The secondary outcomes included changes in quality of life, self-management behavior, and healthcare utilization. The missing data will be managed using multiple imputations. Additionally, a cost-effectiveness analysis that considers the direct medical costs reimbursed by the National Health Service will be conducted. Discussion: This study provides insights into the application, validation, and efficacy of the ABCC tool in the South Tyrolean healthcare context. The tool's potential to enhance person-centered care, improve the quality of life, and possibly reduce healthcare costs could greatly contribute to sustainable healthcare. The challenges of implementation, such as software integration and the use of an EU data platform, will provide lessons for future international patient care data management. Trial registration: ISRCTN registry, ISRCTN13531607. Registered on August 23, 2023.

Background: Loneliness and social isolation are major public health concerns for older adults, with severe mental and physical health consequences. New technologies may have a great impact in providing support to the daily lives of older adults and addressing the many challenges they face. In this scenario, technologies based on voice assistants (VAs) are of great interest and potential benefit in reducing loneliness and social isolation in this population, because they could overcome existing barriers with other digital technologies through easier and more natural human-computer interaction. Objective: This study aims to investigate the use of VAs to reduce loneliness and social isolation of older adults by performing a systematic literature review and a bibliometric cluster mapping analysis. Methods: We searched PubMed, Embase, and Scopus databases for articles that were published in the last 6 years, related to the following main topics: voice interface, VA, older adults, isolation, and loneliness. A total of 40 articles were found, of which 16 (40%) were included in this review. The included articles were then assessed through a qualitative scoring method and summarized. Finally, a bibliometric analysis was conducted using VOSviewer software (Leiden University's Centre for Science and Technology Studies). Results: Of the 16 articles included in the review, only 2 (13%) were considered of poor methodological quality, whereas 9 (56%) were of medium quality and 5 (31%) were of high quality. Finally, through bibliometric analysis, 221 keywords were extracted, of which 36 (16%) were selected. The most important keywords, by number of occurrences and by total link strength; results of the analysis with the Association Strength normalization method; and default values were then presented. The final bibliometric network consisted of 36 selected keywords, which were grouped into 3 clusters related to 3 main topics (ie, VA use for social isolation among older adults, the significance of age in the context of loneliness, and the impact of sex factors on well-being). For most of the selected articles, the effect of VA on social isolation and loneliness of older adults was a minor theme. However, more investigations were done on user experience, obtaining preliminary positive results. Conclusions: Most articles on the use of VAs by older adults to reduce social isolation and loneliness focus on usability, acceptability, or user experience. Nevertheless, studies directly addressing the impact that using a VA has on the social isolation and loneliness of older adults find positive and promising results and provide important information for future research, interventions, and policy development in the field of geriatric care and technology.

BACKGROUND: Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful. OBJECTIVES: To assess the effectiveness of DM in orthodontic care. ELIGIBILITY: Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orthodontic emergencies and improvement of oral health status. INFORMATION SOURCES: PubMed, Web of Science and Scopus were searched for publications until November 2022. RISK OF BIAS: Quality assessment was performed with the STROBE Checklist. DATA EXTRACTION: Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer. INCLUDED STUDIES: Out of 6887 records screened, 11 studies were included. SYNTHESIS OF RESULTS: DM implemented to the standard orthodontic care was found to significantly decrease the number of in-office visits by 1.68-3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis. CONCLUSIONS: This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investigation team and rigorous methodology are advocated.

This project of Health technology assessment was aimed at defining the impacts of offering a cystic fibrosis (CF) carrier screening to the general population, compared to the current situation, where the test is offered to individuals at high-risk to give birth to a child with CF. Results revealed: i) a lack of robust and updated data; ii) a return on investment up to six years from the screening's introduction, despite important economic and organizational efforts; iii) a general positive attitude of healthcare professionals, people with CF, families and general population; iv) possible issues related to the social impact.

Objectives: Respiratory syncytial virus (RSV) is a frequent cause of acute lower respiratory infection in children, imposing a substantial economic burden on healthcare systems. This systematic review aimed to assess the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. Study design: Systematic review. Methods: A systematic search of PubMed, Embase, Scopus, and the International HTA Database, including studies published in English or Italian, was conducted between January 2000 and July 2022. Inclusion criteria required studies to be conducted in Italy and provide data on the economic costs and healthcare resource utilisation related to RSV infections. Results: Out of 20,845 records screened, 18 articles met the inclusion criteria. Only one study provided comprehensive data on RSV disease costs, including hospitalisation, diagnostic tests, and medical procedures for infants with RSV-bronchiolitis. The mean cost per inpatient was higher for RSV-positive children (€5753.43 ± €2041.62) than that for RSV-negative children. Additionally, five studies reported a median length of hospital stay of 5 days for RSV-infected children, and four studies indicated a higher frequency of intensive care unit admissions for RSV-infected children than for those with other viral infections. Conclusions: This is the first systematic review to examine the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. While limited data were available, the findings underscore the urgency to conduct further research and gather additional evidence on the costs and healthcare resource utilisation associated with RSV infections. Such efforts are essential for informing the development of effective prevention strategies for paediatric RSV infections in Italy.

OBJECTIVES: This Hospital-Based Health Technology Assessment (HB-HTA) report provides a multidisciplinary and systematic assessment of using near-infrared fluorescence-guided surgery using indocyanine green (ICG) as a sentinel lymph node (SLN) mapping procedure for early-stage breast cancer and gynecologic cancer as a substitute for Technesium-99 (TC-99) and Blue Dye (BD) to inform hospital management’s decision on adopting this SLN mapping procedure. METHODS: The report focuses on the hospital perspective in Italy and follows HB-HTA guidelines, covering the most relevant domains: technological aspects, effectiveness, safety, organizational and economic impact, social, legal, and ethical aspects. A systematic review of the existing literature was conducted according to the Cochrane Handbook for Systematic Reviews. Evidence was extracted according to predefined search strategies, inclusion and exclusion criteria, and was summarized in a reference framework based on the state of art HTA models. Results and methodologies were frequently discussed with the advisory board ensuring the reliability of the analysis. Qualitative, quantitative, or mixed assessments of the technology were performed according to the type of evidence investigated in the single domain. RESULTS: The breast cancer analysis included 22 records published between 2002 and 2020. Of the 22 studies, 17 were prospective cohort studies, 5 were randomized control studies, and 4 were retrospective cohort studies. The gynecologic cancer analysis included 19 records published between 2014 and 2020 (20 studies extracted and analyzed). Of the 20 studies, 12 were retrospective cohort studies, and 8 were prospective cohort studies. There is no evidence in the literature about safety issues or significant reactions to ICG. CONCLUSIONS: Studies support the use of ICG as a safe and effective alternative to using TC-99 and BD for SLN mapping for breast cancer and gynecologic cancer patients. ICG prehospitalization costs are also lower than TC-99 prehospitalization costs due to the avoidance of using the nuclear medicine department for the TC-99 injection.

AIMS AND OBJECTIVES: To summarise the evidence published to date regarding nursing core competence in stoma care of any type of ostomy throughout the patient's ostomy surgery candidate care pathway from preoperative to follow-up. BACKGROUND: Nurses should play a key role in all ostomy patient care pathways to help them to adapt to the new physics and psychological conditions from the preoperative phases to the prevention of tardive stomal complications. DESIGN: Scoping review. METHODS: This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. The following databases were queried: PubMed, EMBASE and CINAHL, from August to October 2022. RESULTS: The search strategy in the consulted databases identified 3144 studies. Different types of ostomies were found and investigated: tracheostomy, gastrostomy, jejunostomy, ileostomy, colostomy and urostomy. The results of the included studies helped address the objective that allowed the ostomatherapy skills to be broken down into the different periods of the care pathway. CONCLUSION: Caring for an ostomy patient requires advanced skills and a trusting relationship. The skills outlined in this research suggest how essential the stoma care nurse specialist is in these patients' care.

BACKGROUND: The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. METHODS: In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. RESULTS: The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. CONCLUSIONS: It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives.