Early Phase Management of the SARS-CoV-2 Pandemic in the Geographic Area of the Veneto Region, in One of the World's Oldest Populations.

The first cases of Coronavirus disease-2019 (COVID-19) were reported on 21 February in the small town of Vo' near Padua in the Veneto region of Italy. This event led to 19,286 infected people in the region by 30 June 2020 (39.30 cases/10,000 inhabitants). Meanwhile, Rovigo Local Health Unit n. 5 (ULSS 5), bordering areas with high epidemic rates and having one of the world's oldest populations, registered the lowest infection rates in the region (19.03 cases/10,000 inhabitants). The aim of this study was to describe timing and event management by ULSS 5 in preventing the propagation of infection within the timeframe spanning from 21 February to 30 June. Our analysis considered age, genetic clusters, sex, orography, the population density, pollution, and economic activities linked to the pandemic, according to the literature. The ULSS 5 Health Director General's quick decision-making in the realm of public health, territorial assistance, and retirement homes were key to taking the right actions at the right time. Indeed, the number of isolated cases in the Veneto region was the highest among all the Italian regions at the beginning of the epidemic. Moreover, the implementation of molecular diagnostic tools, which were initially absent, enabled health care experts to make quick diagnoses. Quick decision-making, timely actions, and encouraging results were achieved thanks to a solid chain of command, despite a somewhat unclear legislative environment. In conclusion, we believe that the containment of the epidemic depends on the time factor, coupled with a strong sense of awareness and discretion in the Health Director General's decision-making. Moreover, real-time communication with operating units and institutions goes hand in hand with the common goal of protecting public health.

Taking decisions on expenditure for high-cost drugs at the regional level: a model for evaluating the overall impact of Trastuzumab in the Veneto Region of Italy.

INTRODUCTION: Cost-effectiveness analysis provides a ratio that indicates the value created per unit of money by a given therapy but says nothing about the total expected costs or net health and social impact of this therapy in a particular population of interest. OBJECTIVE: The main objective of this study is to define a methodology to calculate the effects of interventions from a local perspective. This will help determine parameters that provide information about resource planning and management to local decision makers. METHODS: The described methodology calculates four indicators using local demographic and epidemiological data and a Markovian decision tree approach. RESULTS: The method was applied to evaluate the economic, health and social impact of introducing a new cancer drug, Trastuzumab, for the early treatment of breast cancer in the Veneto Region of Italy. DISCUSSION: The indicators described in this study allow public policy makers to clearly understand the benefits and costs of a particular health intervention in a local population and to compare it with other strategies.

Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection.

OBJECTIVE: To evaluate a new antimicrobial treatment for central venous catheters in comparison with a traditional treatment, by assessing the catheter colonization and catheter-related bloodstream infection rates in two groups of patients. DESIGN: Multiple-center, prospective randomized study. SETTING: The medical and surgical departments of ten institutions. PATIENTS: Patients requiring a central venous catheter for medical or surgical pathologies between June 2000 and November 2001. INTERVENTIONS: Patients in the control group received a conventional benzalkonium-treated double-lumen central venous catheter, while patients in the oligon group received an oligon-treated (polyurethane combined with silver, carbon, and platinum) catheter with the same characteristics. Data collection included demographics, preexisting clinical conditions, main pathology, catheter insertion, and management data. Catheter colonization was defined as the growth of > or = 15 colony-forming units in culture of catheter segments by the roll-plate method, or > or = 1000 colony-forming units for the sonication method, and catheter-related bloodstream infection was defined as isolation of the same organism from the colonized catheter and from the peripheral blood of a patient with clinical signs of bloodstream infection. MEASUREMENTS AND MAIN RESULTS: Data were obtained from 545 catheters. Of these, 132 catheters (24.2%) were positive for colonization. Patients in the oligon group demonstrated a lower risk for catheter colonization in the overall population (relative risk, 0.63; 95% confidence interval, 0.46-0.86; p = .003) and in the surgical subgroup (relative risk, 0.5; 95% confidence interval, 0.33-0.76;p = .001). Significant differences between groups were detected for coagulase-negative staphylococci and Gram-negative bacilli colonization rates. Twenty-one patients (3.8%) were positive for catheter-related bloodstream infection, without significant differences between control and oligon groups. CONCLUSIONS: Oligon treatment is effective in limiting the catheter colonization rate. Due to the limited amount of events, this study lacked the power to detect significant differences in terms of catheter-related bloodstream infection rate.