Italian Public Hospitals Research Articles

The role of chief medical officers in the Italian context: managers or clinicians?

PurposeDespite the advent of New Public Management theories over three decades ago, doubts persist regarding the practical implementation of these principles in the public health-care context. Challenges arise particularly from the type of system where this phenomenon is analyzed. In the Italian context, for instance, it can be arduous to define universally applicable organizational behaviors, given the interregional disparity that characterizes such a system. Furthermore, the professional identity of clinician-managers influences the perception of what “being a manager” means. This paper, thus, using the Italian context as a reference, aims to delineate what is the perception of Italian public hospitals clinician-middle-managers in terms of their responsibilities and tasks.Design/methodology/approachA survey-questionnaire was distributed to 6,011 Chief Medical Officers (CMOs) in Italian public hospitals, representing 100% of such role holders in the country. With a response rate of 16.7%, 1,005 responses were obtained. The questionnaire assessed CMOs' attitudes toward specific activities relevant to clinician-management, ranked from most to least important. Activities were derived from literature and categorized to discern management styles. Subgroups based on geographical location and professional orientation were also identified to isolate regional effects and professional identity influences.FindingsResults suggested that activities associated with a collaborative approach are perceived as most important. Furthermore, it clearly emerges the difference based on professional orientation of CMOs. However, it could not be appreciated the same level of difference basing the analysis on regional disparities.Originality/valueThe interest in the role of middle management in healthcare organizations has increased over the years. Nevertheless, currently the authors believe that not many studies are focused on defining what “being a manager” means for clinician-managers themselves, rather than explaining what clinician-managers shall do.

Perceived organizational support moderates the effect of job demands on outcomes: Testing the JD-R model in Italian oncology nurses.

The research aimed to test the job demands-resources (JD-R) model on a sample of Italian oncology workers, and the role of perceived organizational support (POS) as a moderator of the effects of JD on outcomes (job satisfaction and burnout [BO]). Based on the JD-R model, a correlational study was designed to investigate the relationships between JD, POS as a job resource, self-esteem (as a personal resource), and job outcomes (BO and job satisfaction); the research involved a sample of oncology nurses (N = 235) from an Italian public hospital, who completed a questionnaire during working hours. Relationships between variables were investigated with multiple regressions and moderation analysis. Results confirmed that JD predict both BO and job satisfaction; POS is a weak predictor of job outcomes, but its mediator role in the JD-outcomes relationship was confirmed: the more the nurses perceive a supportive organization, the weaker the positive relationship between JD and BO. Findings are consistent with other contributions that highlighted that organizational job resources may attenuate the adverse effect of JD on positive and negative outcomes: POS may play a central role in employee well-being and health, acting as a possible moderator, and somehow defusing the positive association between JD and outcomes.

The clinical trial activation process: a case study of an Italian public hospital

Background/aimsIn order to make the centers more attractive to trial sponsors, in recent years, some research institutions around the world have pursued projects to reorganize the pathway of trial activation, developing new organizational models to improve the activation process and reduce its times.This study aims at analyzing and reorganizing the start-up phase of trials conducted at the Research and Innovation Department (DAIRI) of the Public Hospital of Alessandria (Italy).MethodsA project was carried out to reorganize the trial authorization process at DAIRI by involving the three facilities responsible for this pathway: clinical trial center (CTC), ethics committee secretariat (ESC), and administrative coordination (AC).Lean Thinking methodology was used with the A3 report tool, and the analysis was carried out by monitoring specific key performance indicators, derived from variables representing highlights of the trials’ activation pathway.The project involved phases of analysis, implementation of identified countermeasures, and monitoring of timelines in eight 4-month periods.The overall mean and median values of studies activation times were calculated as well as the average times for each facility involved in the process.ResultsIn this study, 298 studies both sponsored by research associations and industry with both observational and interventional study design were monitored.The mean trial activation time was reduced from 218 days before the project to 56 days in the last period monitored.From the first to the last monitoring period, each facility involved achieved at least a halving of the average time required to carry out its activities in the clinical trials’ activation pathway (CTC: 55 days vs 23, ECS: 25 days vs 8, AC 29 days vs 10).Average activation time for studies with agreement remains longer than those without agreement (100 days vs. 46).ConclusionsThe reorganization project emphasized the importance of having clinical and administrative staff specifically trained on the trial activation process.This reorganization led to the development of a standard operating procedure and a tool to monitor the time (KPIs of the process) that can also be implemented in other clinical centers.

The Role of Fulfilment and Disillusion in the Relationship between Burnout and Career Satisfaction in Italian Healthcare Workers

Healthcare workers’ stress, burnout, and job dissatisfaction were exacerbated by the COVID-19 pandemic, whose mid-term negative effects are still present. The aim of this work was to consider the effects of burnout (psychophysical exhaustion, relational deterioration, and professional inefficacy) on the career satisfaction of healthcare workers. These relationships were evaluated by considering the direct and mediated effects of disillusion. For these purposes, the Link Burnout Questionnaire (LBQ) and the Career Satisfaction Scale (Occupational Stress Indicator—OSI) were administered to 295 healthcare professionals working at three Italian public hospitals in Cagliari, Italy. The analyses were conducted using the Partial Least Square Structural Equation Model (PLS-SEM) method. Outcomes highlighted that healthcare workers were in a condition of work distress, high risk of burnout, and career dissatisfaction. Also recognized was the direct negative effect of burnout dimensions on career satisfaction. Finally, the mediated negative effect of disillusion in the relationship between burnout and career satisfaction was identified. This study underlines the relevance of the dimension of disillusion, and its “bright side” fulfilment, in healthcare workers, specifically referring to the disregarded relationship between burnout and career satisfaction.

Disclosing the Health Value through Integrated Report: An Explorative Research

This study aims to investigated if the integrated report, according to the IIRC (International Integrated Reporting Council) Framework, has the potential to disclose health information and to address citizens’ expectations. An explorative case was conducted in an Italian public hospital follows the action research approach. Semi-structured interviews were asked by researchers to reach a deep understanding of the phenomenon under study. The results show that Integrated Reporting is able to disclose the value created: the health outcome. There is a need for Integrated Reporting Framework adjustments for health sector purposes: in relation to some capitals of the framework, to the concept of value created in its particular emphasis on health outcome for patients and to the need to find a more effective communication method. The absence of stakeholder engagement activities in the Integrated Reporting adoption process influences the attractiveness of the document. In fact, the Integrated Reporting user appears to be only the financing institution.This study aims to investigated if the integrated report, according to the IIRC (International Integrated Reporting Council) Framework, has the potential to disclose health information and to address citizens’ expectations. An explorative case was conducted in an Italian public hospital follows the action research approach. Semi-structured interviews were asked by researchers to reach a deep understanding of the phenomenon under study. The results show that Integrated Reporting is able to disclose the value created: the health outcome. There is a need for Integrated Reporting Framework adjustments for health sector purposes: in relation to some capitals of the framework, to the concept of value created in its particular emphasis on health outcome for patients and to the need to find a more effective communication method. The absence of stakeholder engagement activities in the Integrated Reporting adoption process influences the attractiveness of the document. In fact, the Integrated Reporting user appears to be only the financing institution.

Institutional health communication and social media: Exploring Italian hospitals' use of social media pages.

Hospitals play a potentially crucial role in public health, and social media can be powerful tools to reach their target audiences but are hospitals exploiting them to their full potential? We retrieved the institutional webpages and the social media profiles (Facebook, Instagram, X (Twitter), YouTube, LinkedIn, WhatsApp and Telegram) of all Italian public hospitals located in regional capitals (N = 194). From 1 March to 30 April 2022, we analysed these profiles, noting the number of followers and of posts published, the date of the last post, and the availability of a social media policy. We selected the most active 53 social media profiles (belonging to 33 hospital facilities) for a closer content analysis. Engagement was measured through numbers of reactions, comments and shares to posts published from 1 to 30 April 2022. About 36.6% of hospitals had a social media profile, and 18.3% had a social media policy. Most (87%) used Facebook as their main platform. They posted most frequently about hospital events and activities (48.3% of the socially active set). Overall, engagement was modest, as on average 0.62% of potential users reacted to a post. The same post often appeared without modifications across different platforms (82.3% of cases for Instagram, 37.8% for X (Twitter) compared to Facebook). Italian public hospitals did not seem to have a clear social media policy nor strategy, and social media remained underused. Italian hospitals, therefore, appeared to be missing valuable opportunities to reach out to their patients and communities.

Lean Six Sigma and quality performance in Italian public and private hospitals: a gender perspective

PurposeLean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.Design/methodology/approachA survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.FindingsThe results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.Research limitations/implicationsThis study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.Practical implicationsThis study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.Originality/valueThis is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

A protocol on patient satisfaction in three national hospital settings: an observational cross-sectional multicentre study

Background: to assess, using the Newcastle Satisfaction with Nursing Scales (NSNS) questionnaire, the degree of patient satisfaction with healthcare services, in patients who were admitted to three obstetrics and gynaecology wards in three different Italian public hospitals. The aim of the study was to understand the correlations between basic organisational characteristics and the perceived quality of care. Materials and Methods: an Italian multi-centered cross-sectional observational study of female patients aged 18 or older with good Italian language skills is ongoing between June 2022 and June 2023.The study excludes patients who access the facility exclusively for outpatient services and visits. The tool in use is a validated questionnaire translated into Italian, already tested internationally; the Newcastle Satisfaction with Nursing Scales (NSNS) questionnaire. The tool guarantees the anonymity of data, a minimum sample size of 465 women is expected, and the ethics committee of the promoting hospital has approved the study. The nurses deliver the questionnaire to all inpatients upon admission, and the completed forms are placed exclusively by patients in a sealed urn on the ward, at discharge. Conclusions: assessment using the Newcastle Satisfaction with Nursing Scales (NSNS) questionnaire, in its validated Italian version, can enable improvements in healthcare processes through important innovations and organizational changes. This study, using the translated and validated questionnaire can add knowledge for a better understanding of the correlations between basic organizational features and the perceived quality of services.

Social Reporting in Healthcare Sector: The Case of Italian Public Hospitals

Social reporting has become a critical area of interest in healthcare systems, and it has also become increasingly important for the academic community and practitioners in recent decades. Recent studies have found the existence of a slow spread of social reporting initiatives in public hospitals and a lack of guidelines and homogeneity in social reporting documents. This study aims to contribute to the literature, offering updated evidence from Italy. Through a document analysis, we (a) assessed the trends of social reporting initiatives in the Italian public hospital sector; (b) analyzed the current forms, contents, and quality, of social reporting documents, in order to isolate common elements, differentiation and emerging trends; (c) analyzed the informational power of social reporting documents for public hospitals stakeholder. Data were extracted from the public hospital website. The results confirm the scarce dissemination and homogeneity of social reporting documents and highlight the need for non-financial reporting standardization in public hospitals.

What Is the Inpatient Cost of Hip Replacement? A Time-Driven Activity Based Costing Pilot Study in an Italian Public Hospital

The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient's concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA.

Italian Dementia-Friendly Hospital Trial (IDENTITÀ): efficacy of a dementia care intervention for hospital staff

Objectives This study investigated the short-term impact and the retention of a dementia care intervention for healthcare staff working in an Italian acute hospital setting. Additionally, we identified the predictors of improvement across the intervention. Method Sixty-two healthcare staff from an Italian public hospital participated in a dementia care intervention consisting of 5 modules delivered in a 5-hour training program focusing on dementia management, knowledge, and care. A pre-test/post-test and six-months follow-up design was used to evaluate participants’ changes in knowledge, attitudes, and confidence in dementia. Results The intervention significantly improved healthcare staff’s dementia knowledge and confidence immediately after the end of the intervention. No significant changes were observed from post-test to follow-up, indicating retention of these outcomes over six months. Regarding attitude to dementia, we found an immediate improvement only in the Recognition of Personhood scale. Looking at the predictors of improvement, healthcare staff with lower levels of knowledge, attitudes, and confidence in dementia at pre-test were those who improved more following the intervention. Conclusion These findings provide further evidence that dementia care interventions are suitable initiatives to promote knowledge and skills required to manage the needs of people with dementia in an acute hospital setting.

CAOS in Italian hospitals during COVID: an analysis of healthcare intangible resources

PurposeThis paper aims to analyse the roles of relational capital (RC) and knowledge management (KM) during the COVID-19 in Italian public and private hospitals, considering that intangible elements are essential during periods of uncertainty.Design/methodology/approachAuthors used a qualitative design in a case study on two Italian hospitals that have different ownership structures, which are located in the epicentre of the pandemic in Lombardy. The study was carried out using the CAOS (“caratteristiche personali”, “ambiente”, “organizzazione” and “start-up”) model (Paoloni, 2021), which allows for comprehending and commenting on RC because of the connections between typical factors that influence an organisation. The model also allows for discussion of the use of a network and how it supports organisations.FindingsFindings of the analysis showed that during the management of the COVID-19 health emergency, ownership structure was not a discriminating factor, the created relationships were similar and they were considered in the same way. The relationships were mainly formal (except for contributions by associations or individuals) and temporary. The RC's reactive role in overcoming crises was confirmed, and the findings indicated that this result was possible also, thanks to the KM's role played within the organisation.Originality/valueTheoretical implications of the work are that it contributes to the sparse healthcare literature on intellectual capital (IC) and on RC and its relationships with KM. The practical implications are related to the creation of new relationships during the healthcare emergency between hospitals and the central government, which can be considered a useful lesson for the future. The theoretical implications derived from the analysis are generalisable to all organisations regardless of their type and location, as well as the practical implications are applicable to the entire national territory.

The dynamic use of a balanced scorecard in an Italian public hospital.

PurposeThis paper aims to analyse the dynamic use of the balanced scorecard (BSC) in an Italian public hospital.Design/Methodology/ApproachA longitudinal case study was conducted at an Italian public teaching hospital over a period of 5 years. The emergence of dynamic use of BSC was traced over a different combination of social, political, economic and organizational realities. A deeper understanding of these realities requires the adoption of a holistic approach to BSC use. Henri's types of system use (i.e., monitoring, attention focussing, strategic decision‐making and legitimizing) frame this approach in a more concrete manner.FindingsThis study adds to the debate on whether BSC is used for aspects other than monitoring in public contexts. The case study offers the first example of a legitimizing use of the system and a first longitudinal case study that traces a dynamic use of BSC: the use evolves from monitoring and attention focussing to monitoring and legitimization. Norms, political parties and top managers play a determining role in this process.Originality/ValueThrough a longitudinal approach, this study presents how BSC can be a dynamic tool steered by legitimacy pressures. The longitudinal study explores how social, political, economic and organizational context shape the implementation and the revision of BSC affecting the use of the tool by top managers. The browse of this dynamism is supported by Henri's type of use along with an in‐depth analysis of the BSC literature evolution in terms of its ‘static, dynamic and expected’ use.

Efficiency and Optimal size of Italian Public Hospitals: Results from Data Envelopment Analysis

Background: One of the major issues discussed in the literature about hospital efficiency is the impact of hospital size on technical efficiency. Many studies have observed that in some cases, hospital technical inefficiency is correlated with an incorrect size. This paper addresses this topic. In particular, we attempt to identify an optimal size of hospitals in terms of beds.
 Methods: The study is organized as follow: first, we performed the Data Envelopment Analysis in order to calculate the technical and scale efficiency scores for a sample of 41 Italian public hospitals during the period 2010-2013; second, we investigated the impact of size on hospital efficiency, identifying the magnitudes of input reductions needed to make inefficient public hospitals efficient. Finally, we calculated the most productive scale size for each hospital in the sample. According to these results, through an overall observation, we attempted to identify an optimal size for hospitals in terms of beds.
 Results: Most of the hospitals were inefficient and most of the inefficiency was the results of the presence of waste in terms of input resources. During the period considered, we found that inputs could be reduced by 22% on average. Economies of scale were found around 200 beds for 20.000 discharges per year.
 Conclusions: The identification of an optimal size of hospitals in terms of beds still requires further efforts in the literature. However, this study contributes to support hospital managers in resource allocation choices through a quantitative approach.

Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems

BackgroundDespite the growing interest in transformational performance improvement among nearly all countries, international benchmarking has rarely been used. Cross-comparative research could allow an appreciation of the extent of Lean’s use in healthcare and a better evaluation of possible cultural influences on Lean implementation. This study provides a comparative international benchmarking of Lean adoption, implementation, and outcomes of hospitals in the US and Italy.MethodsThe National Survey of Lean, developed in 2017 in the US and adapted in Italy in 2019 was used to compare the two healthcare systems along three dimensions: the maturity of adoption, the implementation approach, identifying both strategic and operational activities and tools, and the Lean performance, investigated through patients, employed, and affiliated staff, costs, and service provision areas. Descriptive statistics including T-tests were used to examine differences between the two countries on the study variables.ResultsLean has been adopted less by Italian public hospitals (36%) than US public hospitals (53%). Each country averages 4 years of experience with Lean. Italian hospitals reported being at a higher maturity stage while the US implemented a more system-wide approach, developing Lean in more operational units. The daily management system, leadership commitment, education and training indexes were higher or the same in the US while in Italy, hospitals had a higher self-reported performance index.ConclusionThis exploratory work is one of the first international benchmarking studies on Lean implementation in healthcare systems using a standardized survey with a common set of definitions and questions. The study identifies different forms of Lean implementation that can be adopted, both at strategic and operational levels, with related perceived outcomes. Despite the US public hospitals being more likely to report a higher number of units using Lean, a higher daily management system index and use of Lean tools, Italian hospitals report more achievements primarily due to Lean. Further research can build on these findings by examining the relationship between Lean adoption/implementation and independent, objective performance measures.

Addressing critical failure factors and barriers in implementing Lean Six Sigma in Italian public hospitals

PurposeDuring the past few decades, Lean Six Sigma (LSS) in the health-care sector has received increasing attention from both researchers and practitioners because it plays an imperative role in quality improvement and cost reduction initiatives. Although researchers have often focussed on evidence of model effectiveness through the study of performance indicators, too little attention has been given to the factors that lead to implementation failure and the causal relationships among them. This study aims to investigate the factors that may inhibit the successful implementation of the method by focussing on Italian public hospitals.Design/methodology/approachThrough the use of the Delphi technique and fuzzy cognitive maps, this paper derives new and relevant results for researchers, hospital managers and policymakers.FindingsThe results show the factors with the greatest impact on LSS implementation and provide insight into the causal links and degrees of influence between critical failure factors and performance variables.Practical implicationsThe findings could be considered useful, in particular, to hospital managers and policymakers, who could leverage the suggestions derived from the study to address LSS implementation.Originality/valueThis work overcomes a gap in the literature related to the absence of studies on the causal relationships between factors that determine the success or failure of LSS implementation.

Breast Regional Anesthesia Practice in the Italian Public Health System (BRA-SURVEY): A Survey-Based National Study.

Breast cancer is the most common malignancy in women. Surgery is a mainstay therapy unfortunately burdened by complications as severe postoperative pain. Regional anesthesia may play a role in a multimodal strategy for prevention and treatment of postoperative pain. The main purpose of this survey was to investigate the rate of use of regional anesthesia techniques in patients undergoing breast surgery in the Italian public hospital system. We designed an online survey that consisted of 22 questions investigating the anesthesia management of breast surgery, particularly focused on regional anesthesia. The survey lasted from November 18, 2019 to February 28, 2020. Directors of anesthesia departments of 168 Italian public health system hospitals were contacted and invited to forward the survey to every anesthesiologist in their unit. A total of 935 anesthesiologists received the survey; among them 460 entered the final analysis. Regional anesthesia was not used by 44.6% of the anesthesiologists and lack of experience/training was the main cause (75.6%). Logistic regression models revealed that anesthesiologists with more than 15 years of experience (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.33-0.93) or working most of their days in intensive care unit (ICU) compared to operating theater (OR = 0.25; 95% CI, 0.14-0.43) were less likely to perform regional anesthesia techniques. Low implementation of regional anesthesia techniques in breast surgery emerges from our survey and the major reason cited is a lack of proper training. An improved training program in regional anesthesia, especially in residents' curricula, could be useful to increase its rate of use and to standardize its practice.

Impact of a patient engagement support intervention (PHEinAction) on pre-bariatric surgery patients: a qualitative evaluation study

Literature highlights the need of feasible interventions where psychological, emotional and behavioral support strategies are leveraged to engage bariatric surgery patients taking care for their health. This study explores severe obese patients' self-reported outcomes with a nurse-led intervention providing patient engagement support ("PHEinAction") before bariatric surgery. A qualitative evaluation study through semi-structured interviews and self-report ques-tionnaires was led. in an Italian public hospital. Patient Health Engagement Scale was adminis-tered before, at the end, and three months after the intervention. Individual interviews were conducted within the three months after the intervention. Changes in questionnaires were ana-lyzed using paired t-tests, interviews using a thematic inductive approach. Among 17 partici-pants, there was a significant improvement in engagement scores from 2.7 at baseline to 3.3 at the end and to 3.5 three months later. PHEinAction had an impact on patients awaiting bari-atric surgery, with changes in engagement scores and in how they lived their obesity, their in-terpersonal relationships, and their self-care. This study offers preliminary support that PHEinAction helps patients with obesity on the behavioral change path. It is worthwhile to do a larger-scale randomized trial to evaluate its effect.

What is the performance in public hospitals? A longitudinal analysis of performance plans through topic modeling

BackgroundBoth the concept of performance and the role of hospitals in health systems evolved significantly in the last decades. Today, the performance in health could be defined as the ability to create ‘population value,’ and the hospitals’ role is to support this aim by providing acute care and by integrating and coordinating their activity with other settings of care. This research aims to assess how and with what degree the management of public hospitals have embraced in practice the updated concept of performance and their new role.ResultThe paper analyses 181 performance plans of 48 Italian autonomous public hospitals over a nine-year period through the topic modeling algorithm called Latent Dirichlet Allocation (LDA). This is a method that allows for analysing large textual corpora that generates a representation of the latent topics discussed therein. The concept of performance in public hospitals was framed into 15 topics resulting from the analysis of the hospitals’ performance plans. The prevalence of each topic was analysed through the period considered so as to understand the evolution of performance-related practices over the last decade.ConclusionIn recent years, the concept of performance in hospitals evolved toward the adoption of an outcome-based and population-based perspective. Additional effort should be devoted toward improved collaboration and integration of care with other settings.

Retrospective Study of Salivary Gland Tumor Cases in a Large Italian Public Hospital and Review of the Literature.

A variety of tumors can develop in the salivary glands. The aim of this retrospective study was to describe the demographic characteristics of salivary gland tumors (SGT) in the population of a large area of the city of Rome, ASL RM1, over a 4-year period and compare these data with other epidemiological studies. Forty-nine cases were diagnosed as SGT; 63.2% were males and 32.6% were females. The mean age range was 62.13 years. Forty SGT (81.6%) were benign and 9 (18.4%) were malignant. Among benign tumors, Warthin' s tumor was the most common tumor, comprising 55.1% all SGTs followed by Pleomorphic Adenoma and other less common types. Among malignant tumors, Non-Hodgkin lymphoma was the most frequent type. The results of this study suggest that benign tumors are most common in parotid gland and are mainly represented by Warthin's Tumor. Males are the most affected, especially for benign lesions. Regarding malignant tumors, the incidence by gender is variable, as the incidence of several types worldwide. The findings of this study contribute to the knowledge regarding the incidence of SGT.