[Clinical audit as a quality improvement tool in the emergency setting. A systematic review of the literature]. / L'audit clinico come strumento di miglioramento della qualità nell'ambito delle emergenze. Una revisione sistematica della letteratura.

According to the National Institute for Health and Care Excellence, "Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change…Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery". According to the scientific literature, clinical audit is more commonly used in secondary care with respect to primary care, probably because of the high variability that characterizes the latter. The aim of this study was to investigate, through a systematic literature review, the use and effectiveness of clinical audit in a particular field such as that of healthcare emergency.

Are undocumented migrants' entitlements and barriers to healthcare a public health challenge for the European Union?

Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM's health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs' entitlement and barriers to healthcare and related policies citing evidence from peer-reviewed and grey literature concerning people living in a country within the European Union without the legal right to be/remain in the destination country. A systematic review was performed using several databases and websites, and a total of 54 publications in English, with full text available, were taken into consideration. Between 2000 and 2015, Europe hosted the second largest number of international migrants (20 million, 1.3 million per year) after Asia. Even though there is limited evidence specifically focused on UMs' health, it is possible to state that infectious diseases, chronic illnesses, mental disorders, maternal-child conditions, dental issues, acute illnesses and injuries are the most common pathologies. In most cases across Europe, UMs have access only to emergency care. Even in countries where they are fully entitled to healthcare, formal and informal barriers hinder them from being or feeling entitled to this right. Socio-cultural barriers, such as language and communication problems, lack of formal and informal social and healthcare networks and lack of knowledge about the healthcare system and about informal networks of healthcare professionals are all common impediments. From the healthcare providers' perspective, there can be difficulties in providing appropriate care and in dealing with cultural and language barriers and false identification. Communication strategies play a central role in addressing the inequalities in access to healthcare services, and the definition and provision of specific training, focused on UMs' health needs, would be desirable. Improving access to healthcare for UMs is an urgent priority since the lack of access is proven to have serious consequences for UMs' health and wellbeing. Notwithstanding, few available examples of policies and best practices aimed at overcoming barriers in the delivery of healthcare to UMs are available.

How to choose health technologies to be assessed by HTA? A review of criteria for priority setting.

INTRODUCTION: Health Technology Assessment (HTA) plays a key role in the policy and decision-making process. Nevertheless, it is time- and resource-consuming, and therefore requires proper resource allocation. Priority setting, as a best way to organize effective and explicit resource allocation systems, may be applied even in this field. OBJECTIVE: The aim of this study was to provide an overview of criteria used for priority setting in HTA at European level. METHODS: A systematic review of the scientific literature was performed through PubMed alongside consultation of the websites of the European HTA Agencies belonging to the INAHTA. The search was limited to papers written in English and provided with the full text. Documents were considered eligible if providing criteria for priority setting in HTA. RESULTS: Seven scientific articles were retrieved from PubMed and 14 European HTA Agencies released prioritization criteria were analysed. The most relevant criteria were: frequency/burden of disease, economic impact and costs, potential benefits, impact on ethical, social, cultural and/or legal aspects. CONCLUSION: This work is meant to contribute to supranational discussion on priority setting at European level and shows that, despite the available evidence, work still needs to be done toward harmonization and sharing of the criteria to adopt.

Aetiology, source and prevention of waterborne healthcare-associated infections: a review.

The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the settings and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot-water distribution systems were the primary source of legionnaires' disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.