Papers by Giovanni Guarrera
![Research paper thumbnail of [The implementation of the week surgery in an orthopedic and urology ward and assessment of its impact]](https://a.academia-assets.com/images/blank-paper.jpg)
Assistenza infermieristica e ricerca : AIR
. The implementation of the week surgery in an orthopedic and urology ward and the assessment of ... more . The implementation of the week surgery in an orthopedic and urology ward and the assessment of its impact. The week surgery (WS) is one of the models organized according the intensity of care that allows the improvement of the appropriateness of the hospital admissions. To describe the implementation and the impact of the WS on costs and levels of care. The WS was gradually implemented in an orthopedic and urology ward. The planning of the surgeries was modified, the wards where patients would have been transferred during the week-end where identified, the nurses were supported by expert nurses to learn new skills and clinical pathways were implemented. The periods January-June 2012 and 2013 were compared identifying a set of indicators according to the health technology assessment method. The nurses were able to take vacations according to schedule; the cost of outsourcing services were reduced (-4.953 Euros) as well as those of consumables. The nursing care could be guaranteed employing less (-5) full-time nurses; the global clinical performance of the ward did not vary. Unfortunately several urology patients could not be discharged during the week-ends. A good planning of the surgeries according to the patients' length of staying, together with interventions to increase the staff-skill mix, and the clinical pathways allowed an effective and efficient implementation of the WS model without jeopardizing patients' safety.
Italian Journal of Public Health, 2005
Background: robotic assisted radical Prostatectomy (raLP) is one of the most expensive urological... more Background: robotic assisted radical Prostatectomy (raLP) is one of the most expensive urological innovations. Prices of the "da Vinci System" range from € 761,105 to € 1,902,762 for each unit, without taking into account the cost of maintenance and the use of additional devices. We evaluated outcomes, and costs retrospectively, comparing raLP to open retro-pubic radical prostatectomy (rrP) performed in our hospital between december 2009 and december 2010. MethodS: We compared 53 raLPs, and 50 rrPs in terms of costs, and clinical outcomes. We also implemented a Break even analysis in order to evaluate if the public reimbursement covered the total cost of raLP. reSuLtS: according to our analysis, raLP showed lower hospitalization (p < 0.0001), higher early continence rate (p < 0.0001), better potency rate in nerve sparing procedures (p < 0.0142), and required no transfusions. excluding the cost of purchasing and maintenance, single case costs were € 6,046.08 for raLP and € 4,834.11 for rrP, respectively. considering the affordability of the technology, the point where the total revenue is sufficient to cover the total costs is an average of 60 cases performed per year, only in presence of additional reimbursement. concLuSionS: although our clinical analysis shows better results in favour of raLP, the economical analysis shows that raLP's costs are consistently higher than rrP. considering also the purchasing costs, we demonstrated that the health gain of the technology does not necessarily offset the higher costs, even in a large, university hospital (1,000 beds). e 1 0 2 3 4 -1
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2007
The study aims to define the technical, ethical, juridical and economic issues involved in the as... more The study aims to define the technical, ethical, juridical and economic issues involved in the assessment of a reprocessing policy for single-use interventional cardiac devices (SUDs). The feasibility of reprocessing was evaluated for cardiac electrophysiology catheters by comparing the chemical, physical and functional properties of new and reprocessed devices. The issue of hygiene was addressed by developing microbiological tests for the quantification of bioburden, sterility and pyrogenic load. The results of more than 1500 tests, conducted on 531 catheters, suggested a precautionary number of regenerations of five cycles. The ethical aspects were reviewed and the European juridical framework was assessed, revealing a need for harmonization. Applying a specific economic model, potential savings were calculated for a representative cardiology department and estimated at national and European level. Potential savings of 41.2% and 32.9% were calculated for diagnostic and ablation ca...
Microbiologia Medica, 2006
La medicina moderna fa largo uso di tecnologie minimamente invasive basate su dispositivi medici ... more La medicina moderna fa largo uso di tecnologie minimamente invasive basate su dispositivi medici monouso (SUDs), ma il crescente numero di interventi e il conseguente carico economico per il sistema sanitario, ha indotto molti paesi all'adozione di una politica di rigenerazione . Da un'analisi della letteratura emergono dati contrastanti circa la sicurezza e l'efficacia di un possibile riutilizzo dei SUDs . Al giorno d'oggi, la cardiologia interventistica rappresenta uno dei campi in cui questa procedura sembra maggiormente indicata per sicurezza ed efficacia. Tuttavia vi è carenza di studi europei sulla fattibilità del riutilizzo e di convalida di procedu-re di rigenerazione. Questa scarsità di prove tecniche e cliniche si riflette su una mancanza di approccio armonizzato della Comunità Europea nei confronti di una politica di rigenerazione. In Italia è stata diffusa una Circolare del Ministero della Salute del 1 aprile 2005 che scoraggia la pratica di rigenerazione e riutilizzo dei dispositivi medici monouso, riconoscendo nel medesimo tempo l'assenza di un esplicito, specifico divieto nella normativa vigente in materia di dispositivi medici (4). Per un riutilizzo dei dispositivi in condizioni di sicurezza e efficienza, la procedura di rigenerazione deve garantire il riapprontamento di tutte le caratteristiche igieniche e funzionali proprie di un disposi-volume 21, numero 2, 2006 LA STERILITÀ DEI DISPOSITIVI MONOUSO RIGENERATI Microbiologia M e d i c a 74 La sterilità dei dispositivi monouso rigenerati. Studio su cateteri per cardiologia interventistica dopo riutilizzo simulato Sterility evaluation after simulated use and reprocessing of interventional cardiology disposable catheters
La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine, 2013
Questo capitolo descrive l e esperienze di governance clinica sviluppate presso l'Azienda Provinc... more Questo capitolo descrive l e esperienze di governance clinica sviluppate presso l'Azienda Provinciale per i Servizi Sanitari (APSS) della Provincia Autonoma di Trento. Contiene inoltre una riflessione sui concetti di governance clinica e di governance integrata.
Journal of Biomedical Materials Research Part B: Applied Biomaterials, 2006
The need of health costs control has prompted the reuse of devices originally manufactured for si... more The need of health costs control has prompted the reuse of devices originally manufactured for single use only. To assess reprocessing feasibility of disposable medical devices, hygienic, technical, and functional aspects must be taken into account, besides economical, ethical, and legal implications. This study aims to characterize percutaneous transluminal coronary angioplasty catheters and to evaluate performance changes induced by reprocessing. Multiple testing, including crossing profile, slipperiness, compliance and burst pressure tests, were performed at different steps of the protocol on 21 catheters, reprocessed up to two times.
International Journal of Technology Assessment in Health Care, 2009
The aim of this study was to review the history of health technology assessment (HTA) in Italy. M... more The aim of this study was to review the history of health technology assessment (HTA) in Italy. Methods: Founded in 1978, the Italian National Health Service (NHS) has been strongly regionalized mainly after a constitutional reform, which started a devolution process. HTA started in the 1980s at the National Institute of Health and in a few University Hospitals, with a focus on big ticket technology: that process was driven by clinical engineers. Results: In recent years, HTA is becoming an important tool for decision-making processes at central, regional, and local levels. In particular, the National Agency for Regional Health Services (AGENAS) and five regions (of twenty-one) are strongly committed to develop HTA initiatives connected with the planning process. Conclusions: At the local level, the hospital-based HTA activity is probably the most important peculiarity of the country and the real driver of the HTA movement.
International Journal of Hygiene and Environmental Health, 2006
Electrophysiology and ablation cardiac catheters, which come in contact with blood during 3 clini... more Electrophysiology and ablation cardiac catheters, which come in contact with blood during 3 clinical use, are required to be nonpyrogenic (<20 EU/device). This study aimed to quantify the 4 residual endotoxin load in reprocessed devices as a mandatory step to guarantee a safe reuse. We 5 monitored the pyrogenic status of the device (N=61) in three fundamental steps of the 6 reprocessing protocol: after clinical use, after decontamination-cleaning treatments and after 7 complete reprocessing, including sterilization by hydrogen peroxide gas plasma. Finally a 8 depyrogenation test was produced for evaluating the depyrogenation efficiency of the sole 9 hydrogen peroxide sterilization treatment. 10
Infection Control and Hospital Epidemiology, 2006
Objective: To assess performances and limitations of a reprocessing protocol for non-lumen electr... more Objective: To assess performances and limitations of a reprocessing protocol for non-lumen electrophysiology catheters by testing the sterility of regenerated devices and defining the maximum number of regeneration cycles sustainable by the device in hygienically safe conditions. Settings: Microbiology and virology department of the public health diagnostic laboratory.
carlofavaretti.it
La gestione delle risorse umane è uno degli ambiti operativi più complessi e strategici di una or... more La gestione delle risorse umane è uno degli ambiti operativi più complessi e strategici di una organizzazione, intesa come un insieme di persone, risorse e processi coordinati, interdipendenti e finalizzati al raggiungimento di determinati scopi. Pur essendo conteggiate in termini numerici come le risorse materiali, va ricordato, qualora ce ne fosse bisogno, che le "risorse umane" sono in realtà "persone"
Politiche …, 2010
PubMed, banca dati primaria per eccellenza della National Library of Medicine, è una delle poche ... more PubMed, banca dati primaria per eccellenza della National Library of Medicine, è una delle poche risorse gratuite. Ne consegue che le Aziende ospeda-Il presente lavoro fa seguito al comunicato presentato in occasione del 2°Congresso Nazionale SIHTA, Roma, 4-5 giugno 2009.
Applied Surface Science, 2004
The increasing demand in interventional cardiology urges for reprocessing of single use-labelled ... more The increasing demand in interventional cardiology urges for reprocessing of single use-labelled medical devices. To fulfil this aim, accurate and validated regeneration protocols are mandatory to guarantee sterility, functionality and safeness. The reprocessing protocol was realized by decontamination with chloro-donors, cleaning with enzymatic solutions and hydrogen peroxide gas plasma sterilization. Reprocessing effects on ablation and electrophysiology catheters were evaluated by assessing physical-chemical changes on surfaces and bulks, as a function of the reprocessing cycles number. Conventional Optical Microscopy and Environmental Scanning Electron Microscopy (ESEM) underlined the presence of micro-scratches on the polyurethane shaft surface. A clear correlation was found between surface damages and number of reprocessing cycles. Atomic Force Microscopy (AFM) confirmed the occurrence of physical-chemical etching of the polyurethane shaft caused by the hydrogen-peroxide plasma sterilization, with increasing of nanoroughness at increasing number of the reprocessing cycles. UV-Vis spectra performed on the incubation solution of polymeric shaft sample, showed an absorbance increase at about 208 nm. This fact could be attributed to the water elution from the polymer of low molecular weight oligomers. The presence of hydrolysis products of the polymeric shaft after incubation demands both the characterization of the products released in the solution and the chemical characterization of the water exposed surface. PACS codes: 81.70 -methods of material testing and analysis 87.62 -medical equipment 87.90 -other topics in biophysics and medical physics
International Journal of Health Care Quality Assurance, 2015
Il presente documento viene fornito attraverso il servizio NILDE dalla Biblioteca fornitrice, nel... more Il presente documento viene fornito attraverso il servizio NILDE dalla Biblioteca fornitrice, nel rispetto della vigente normativa sul Diritto d'Autore (Legge n.633 del 22/4/1941 e successive modifiche e integrazioni) e delle clausole contrattuali in essere con il titolare dei diritti di proprietà intellettuale.
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Papers by Giovanni Guarrera