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Breast cancer is a global health problem, and sentinel lymph node biopsy (SLNB) is the standard procedure for early-stage breast cancer. Technetium-99 (TC-99), alone or combined with blue dye (BD) are conventional tracers for SLNB, but they have safety, availability, and cost limitations. Indocyanine green (ICG) is an alternative tracer that has been gaining acceptance among healthcare professionals. This study aimed at assessing the clinical and economic value of ICG in hospital settings, using the health technology assessment (HTA) framework. We conducted a comprehensive evaluation of ICG for SLNB, based on literature sources and data collected from two Italian hospitals that switched from TC-99 to ICG. We analyzed ICG's technical attributes through technology documentation and relevant databases. We performed a systematic literature review of 36 studies to assess the clinical effectiveness and safety of ICG. We obtained organizational insights from clinicians and the clinical engineer involved in the study. We applied Time-Driven Activity-Based Costing (TDABC) and Budget Impact Analysis (BIA) to estimate the economic impact of ICG. The ethical, legal, and social implications of ICG were considered through clinicians' inputs and technology documentation. Our results showed that ICG had equivalent or superior clinical effectiveness compared to TC-99 and BD, with minimal adverse events. ICG simplified the surgical pathways, by streamlining procedures, reducing waiting times, and increasing flexibility in scheduling surgeries. Moreover, the TDABC analysis showed significant cost reductions by avoiding the need for pre-operative lymphoscintigraphy and hospitalization, with average savings per single care pathway of around 18% for ICG compared to TC-99. Finally, ICG improved patient experience, and proved regulatory compliance. This study provided strong evidence for ICG's clinical and economic value for SLNB in breast cancer. It ascertained ICG as a valuable alternative to conventional tracers, ensuring clinical effectiveness along with economic and organizational benefits.

Background: Self-monitoring of blood glucose (SMBG) is of paramount relevance for type 2 diabetes mellitus (T2DM) patients. However, past evidence shows that there are physical and cognitive issues that might limit the usage of glucometers by T2DM patients aged 65 years and over. Objective: Our aim was to investigate the physical and cognitive issues related to the usage of glucometers by T2DM patients aged 65 years and over. Materials and Methods: The extant literature was analysed to define an original framework showing the logical nexus between physical and cognitive issues and quality of life. Then we collected evidence addressing the specific case of the Accu-Chek® Instant glucometer produced by Roche Diabetes Care GmbH, which implements new features claiming to improve usability. We conducted 30 interviews with T2DM patients aged 65 years and over, three interviews with senior nurses, and a focus group with three senior physicians and three senior nurses. Results: From the interviews, both patients and nurses declared that they were generally satisfied with the Accu-Chek® Instant glucometer’s characteristics. In the focus group, the results were commented on and, in the light of some diverging answers, improvements have been set up for future implementation. Conclusions: Our study produces evidence and future suggestions about the usage of glucometers by type 2 diabetes patients aged 65 years and over.

One-hundred-forty-seven volunteer medical students in the 3rd (G1, 24 teams) and 202 in the 4th (G2, 30 teams) received a 15-minute lecture about the ABCDE approach. Then they managed two simulated patients (one with chest pain, and one with acute dyspnoea), with the task of implementing the strategy. In the second scenario, several items of the ABCDE sequence improved among G1 (SO2 measured in 96% in the second scenario versus 69 % in the first one, RR 92 vs. 67%, HR 92% vs. 67%, BP 100% vs. 832%, GCS 88% vs. 58%, Temperature 71% vs. 46%, p<0.05 for GCS and Temperature). The ability to identify “red flags” improved significantly between the first and the second simulation for both subgroups (G1 96% vs. 58%, G2 57% vs. 20%). A brief activity in simulation enabled medical students to assess comprehensively critical patients and to identify the “red flags” of each scenario.

Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by a team of researchers at Politecnico di Milano, AGREE is an exoskeleton for upper limb rehabilitation at the stage gate between translational research and clinical validation. Since the cost of this device is particularly high, the present study aimed to provide a framework for assessing its value. The Social Return on Investment (SROI) method, able to grasp the economic, social and environmental impact of an activity, was applied, using expert opinions of a pool of clinical engineers and healthcare professionals from different Italian hospitals to obtain information. Environmental impacts were estimated through Life Cycle Assessment in terms of CO2 emissions and incorporated in the analysis. Considering a 5-year period, the SROI for a single exoskeleton was 3.75:1, and the SROI for the number of exoskeletons projected to be sold was 2.868:1, thus resulting largely in value for money. This study provides a model for combining economic, social and environmental outcomes that, besides contributing to theory, could be useful for decision-making.

IntroductionRapid advancements in technology are significantly impacting the healthcare system, and decision-making regarding technology adoption occurs at multiple decentralized levels within hospitals. National bodies seek to standardize this process, yet differing visions and strategies hinder centralization. This study explores the relationship between technological innovation and hospital strategies, focusing on scanning and assessment, aiming to assess the feasibility of centralized decision-making.MethodsTo do this, we performed a qualitative analysis through 23 semistructured interviews in seven hospitals in the Netherlands, a country characterized by strong healthcare innovation and decentralization. We interviewed different actors involved in technological innovation, on different levels in the organization: CEOs, medical doctors, medical physicists or similar roles, and innovation managers. Ethics approval was obtained, and interviews were conducted, recorded, transcribed, and shared with participants for accuracy confirmation. Thematic analysis via grounded theory methodology and ATLAS.ti software generated insights on technological innovation’s relationship to hospitals’ strategies. Initial codes were refined into themes relevant to the research question.ResultsHospitals primarily aim to provide optimal patient care, with academic hospitals emphasizing research and education. Some hospitals aspire to be pioneers in adopting new technologies, while patient-centric healthcare is a shared goal. Technological strategies are not precisely designed in hospitals, being shaped by factors like people, financial constraints, or external environments. Hospitals’ scanning of technologies lacks systematization, and evaluations before and after technology adoption are not univocally performed. The need for systematic scanning and assessment practices is recognized by some interviewees, while others emphasize the importance of experimenting without the constraint of evaluation, perceiving it as a hurdle delaying innovation.ConclusionsCentralization could represent a benefit for hospitals, allowing them more streamlined decision-making, but it could also be perceived as a barrier. Involving hospitals’ stakeholders in centralization would be crucial to achieve it through a joint effort. Suggestions for future research could include focusing on a specific hospital, involving more stakeholders, and exploring other decentralized healthcare systems.

Hemiplegia is a form of disability that affects one side of the body and has a prevalence of 0.5–0.7 per 1000 live births. It has consequences not only at the medical level but also on psychological, cognitive, and social aspects, and it prevents children from social participation, especially in sports settings. The studies demonstrating the social impact of sports on the hemiplegic population and, in particular, children, are limited. In addition, previous evaluations of healthcare sports initiatives in the hemiplegic population are not available, and traditional methods of evaluation, which are mostly focused on economic outcomes, are not applicable. Thus, this article employs the social return on investment (SROI) methodology, which is able to determine the socio-economic impacts of an initiative, to evaluate the impact of an innovative ankle–foot orthosis (AFO) for hemiplegic children that was created to promote the possibility of “sports for all”. The model was designed with the involvement of stakeholders in all the phases and with mixed methods to assess the input, outcomes, and impact indicators. The final SROI, computed for a time horizon of three years and with a focus on the Lombardy Region, was equal to 3.265:1. Based on this result, the initiative turned out to be worthy of investment.

Many companies have become increasingly optimistic about prospects for getting back into growth mode. According to a survey of public and private companies conducted by Ernst & Young towards the end of 2009,1 roughly two-thirds of executives believe they will hit their revenue and profitability goals for the next two years. Still, some companies are struggling. More than one-third of respondents (35%) say they are pessimistic about achieving growth targets, and only 43% expect revenue to increase in the coming year. Less than half (45%) expect an increase in overall profitability, while almost one-third (30%) expect layoffs in the next twelve months. Businesses recognize that they are operating in an environment marked by continued uncertainty, weaker demand, margin erosion, capital scarcity, and lower tolerance for risk. This \"new normal\" will, in turn, create a new agenda, one keenly focused on raising new capital needed for corporate growth while preserving the funds a company already has. This new agenda will influence decisions on operational restructurings, potential acquisitions and divestments, and strategic partnerships.

For companies aspiring to enter or remain in the Russell 2000 Index, both the minimum and the median market capitalizations in 2009 are the lowest in sixteen years. These low thresholds create opportunities for smaller, high-growth companies to benefit from membership in the Index. Our analysis also shows that smaller companies weathered the economic downturn better than large ones. The question now is whether that trend toward outperformance by smaller firms will continue when the economy turns around, and whether those companies will be better positioned to capitalize on revived demand. If the markets continue on their recent return to normalcy, all companies (and especially smaller ones) will need to drive their growth through innovation. Coming out of such a pronounced down market, however, they may find it challenging to spend on research and development while focusing on expense reductions to drive earnings. What seems certain is that some companies will move strategically to enhance their innovative capabilities, either organically or through an acquisition or partnership. All that remains to be seen is which companies are up to the challenge.

Healthcare systems are challenged to balance high-quality care with growing demands for green transition. Within the Italian context, PNRR encourages targeted investments and reforms promoting sustainability, resilience, and innovation in healthcare, while hospitals encounter barriers such as regulatory constraints, cultural resistance, and limited resources. This paper investigates how Italian hospitals are integrating environmental sustainability practices in response to increasing institutional pressures on environmental issues and green objectives achievement. Adopting a qualitative multiple case study approach, the paper examines four healthcare organizations varying in size, location, and sustainability degree. Results identify three organizational profiles: pioneers, regulatory responders and fragmented adopters. Sustainable practices mainly involve energy efficiency, waste management, and green mobility, but their implementation is influenced by internal resources, cross-functional competencies, and external incentives. The preliminary results show that sustainability in healthcare requires more than technological solutions, demanding organizational adaptation, skill development, and institutional alignment supporting a systemic and long-term transformation.