Emanuela Foglia

Background: This study aims to evaluate the multidimensional implications of introducing glycated albumin (GA) into Italian clinical practice as an innovative glycemic marker for monitoring type 2 diabetes mellitus (T2DM) in patients with stage IV–V chronic kidney disease (CKD), compared with the current gold standard, glycated haemoglobin (HbA1c). Methods: A Health Technology Assessment (HTA) was conducted from the perspective of the Italian National Health Service (NHS), adopting the EUnetHTA Core Model framework and using a comparative approach to assess the clinical and non-clinical domains of clinical pathways with and without the inclusion of GA. The analysis integrated evidence from a systematic literature review, health economics evaluations, and stakeholder perceptions gathered through validated questionnaires. Results: The systematic literature review demonstrated that GA more accurately identifies poor glycaemic control than HbA1c alone (52% vs. 19.2%), with benefits in reducing adverse events, in T2DM patients with advanced CKD. From an economic point of view, GA would lead to an overall economic saving equal to 2.02%, on annual basis, thus representing the strategy with the most favorable trade-off between costs and effectiveness. Healthcare professionals’ perceptions (collected using a 7-point Likert scale, ranging from −3 to + 3), confirmed these findings, with higher ratings for GA in terms of safety (1.60 vs. 1.01) and effectiveness (2.12 vs. 1.02). Improvements were also reported in perceived quality of life for both patients and caregivers (2.00 vs. 0.88). Organizationally, although minimal investments would be required for training and equipment updates, the adoption of GA was associated with a significant enhancement in the management of the patient care pathway (2.25 vs. 0.63). Conclusions: The results highlight the strategic value of GA as a complementary biomarker in the monitoring of glycemic control among T2DM patients with advanced CKD, offering clinical benefits and potential efficiency gains for the healthcare system.

Data Correction: There was an error in the original publication. One of the input parameters used in the economic model, namely the purchase price of one of the technologies included in the analysis, was wrong. A correction has been made to the Results part of the Abstract, Table 1, the whole Results section, the first paragraph of the Discussion section, and the second paragraph of the Conclusions section, Tables A2 and A3. The Results part of the Abstract: Results: The analysis estimated a total European investment of €2.47 billion, with an average PBT of 3.46 years and annual savings of 1.96 billion. The ROI averaged 206%, and the total NPV was 10.68 billion. The major saving driver was the reduction in Medication Administration Errors that has an impact of 37.2% on the total savings. Payback times ranged from 3 years in high-GDP countries to 4 years in lower-GDP nations.

Objective: Microbiology laboratories face increasing challenges related to rising sample volumes, workforce constraints, and the need for improved diagnostic accuracy and efficiency. Total Laboratory Automation (TLA) has emerged as a transformative solution to optimize workflows, enhance safety, and improve resource utilization. This study focuses on urine cultures and the follow-up of positive blood cultures and evaluates the impact of TLA implementation in a microbiology laboratory, assessing efficiency, economic sustainability, and healthcare professionals’ perceptions. Methods: A Health Technology Assessment (HTA) approach was employed, integrating real-life data from a single-center hospital laboratory in Italy before and after TLA implementation. Key performance indicators (KPIs) were defined through a literature review and expert consensus. Real-life data were collected over two time periods: the pre-automation phase (manual workflow) and post-automation phase (TLA) for urine culture and positive blood culture. The economic and organizational impact was assessed by quantifying human resource efforts, while a qualitative survey captured healthcare professionals’ perceptions regarding automation. Results: TLA significantly reduced sample processing times, with a 67% decrease in check-in time and a significant reduction in inoculation (up to 100%) and plate reading (−69%) times, respectively. Economic analysis indicated a 67% reduction in costs for personnel time required to process urine cultures and perform initial workups of positive blood cultures on annual basis with consequent organizational benefits, in terms of time spent in sample processing (−71%). Healthcare professionals reported improved safety and reduced workload, making them more inclined to adopt TLA, perceived as useful and capable to offer high-quality and demonstrable results. Conclusion: Findings emphasize TLA potentialities in the management of microbiology procedures overall improvement, empowering the laboratory efficiency and organizational capacity, allowing better investment of the human resources involved.

In the light of current institutional pressures concerning sustainable development, Circular Economy principles emerge as an opportunity to mitigate environmental impacts, ensuring also economic and societal outcomes. The study investigates the adoption of circular principles within the New Product Development processes of the healthcare manufacturing sector, exploring how companies incorporate circular practices when developing healthcare technologies and identifying the required core competencies and resources. Adopting the theoretical lenses of New Product Development and Resource-Based View, the significance of integrating circular practices throughout the technological development process is highlighted, considering the innovation process and the capabilities required to overcome sector-specific barriers. A multiple case study approach is adopted, and research findings provide a detailed framework prioritizing competencies and resources. Moreover, the study identifies the regulatory context as a contextual input, permeating the innovation process and revealing the necessity to adhere to regulatory standards. Contributing to the knowledge at the intersection between circular economy, innovation and healthcare management, the study shows how the adoption of circular thinking shapes the dynamics of conceiving new healthcare technologies, providing also a practical framework aimed at helping managers to allocate capabilities, designing targeted interventions and guiding both strategic and operational choices in sustainable healthcare technology development.

Healthcare professionals’ well-being is increasingly recognized as a critical organizational priority, given the risks posed by rising workloads, staff shortages, and burnout to the sustainable delivery of high-quality care. However, limited evidence exists on how work environments and technology adoption influence the healthcare professionals’ well-being across hospital settings. This study explores healthcare professionals’ perceptions of psychological and physical safety, professional engagement, and mental well-being. It also assesses the role of technology in fostering a culture of safety and well-being. A cross-sectional qualitative anonymous online survey was distributed across 13 countries in Europe, Middle East and Africa, targeting professionals working in hospital pharmacy, diagnostic laboratory, and ward settings. The questionnaire, available in five languages, included validated items. Data were analyzed using descriptive and inferential statistics, with subgroup analyses by setting and region. Responses were collected between February and August 2024. A total of 449 healthcare professionals participated. The sample presented a positive perception of psychological safety (61%) and professional engagement (55%). However, 27% of responders frequently experienced work-related stress, with 40% feeling exhausted, 25% reporting mental distance, and 23% cognitive impairment. Perceived physical safety was generally high (70%), although ward staff reported higher exposure to stress and interpersonal aggression. Overall, 58% of responders expressed satisfaction with their professional quality of life. Technology was perceived to enhance efficiency, safety, and collaboration. However, its impact was dependent on the quality of implementation and level of organizational support. Results may inform strategic interventions and policies aimed at promoting a resilient and sustainable workforce.

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.

The issue of facility location is of significant importance in numerous systems, where the efficient utilisation of resources is of great importance. Gravity models, which are inspired by Newtonian physics, are commonly employed to address these problems and have a long tradition of being used in healthcare. The objective of this paper is to enhance the comprehension of patients’ decision-making processes in emergency healthcare by introducing an extension to existing gravity models, which includes two novel factors influencing emergency department choice: hospital sizes and patients’ severity. The newly formulated gravity rule, which integrates these factors, demonstrated an extremely high accuracy against real-world data in terms of overall hospital location and flows between cities and hospitals, respectively 98.77% and 98.02%.