Critical pathways for continuous quality improvement: a multicentric analysis on the management of patients with lung cancer in Italian best performing hospitals.

Introduction: Critical pathways (CPs) are effective change management tools used to improve quality in healthcare nationally implemented in Italy in 2015. This study aims to map the country's state-of-the-art regarding the adoption of CPs and to verify the existence of factors that determine the success of their implementation and the relative entity of their impact, by analysing the management of Lung Cancer (LC) as a case-study. Methods: Our methodology followed the SQUIRE guidelines for quality improvement reporting (2015). Starting from the 2017 ranking table published by the National Outcome Program, we selected and included in our sample all Italian hospitals who, according to Ministerial Decree n. 70/2015, met national quality threshold for LC treatment. To investigate regional-level and hospital-level factors believed to be responsible for the successful implementation of a CP, a Google Modules questionnaire was constructed and sent to the selected facilities; subsequently, a web-based research was carried out for missing data. Associations between variables were tested in STATA by means of correlation tests and a linear regression model. Results: 41 hospitals matched our inclusion criteria. Of these, 68% defined an internal Lung Cancer Critical Pathway (LCCP). Our results confirmed the presence of critical success factors that favour the correct implementation of a LCCP. Conclusions: Notwithstanding the availability of CPs, their adoption in routine clinical practice still lacks consistency, suggesting the necessity to resort to digital solutions, to increment the level of regional commitment and workforce commitment and to reinforce quality standards monitoring.

RandAgiamo™, a Pilot Project Increasing Adoptability of Shelter Dogs in the Umbria Region (Italy).

Current Italian legislation does not permit euthanasia of dogs, unless they are ill or dangerous. Despite good intentions and ethical benefits, this 'no-kill policy' has caused a progressive overpopulation of dogs in shelters, due to abandonment rates being higher than adoption rates. Shelter overcrowding has negative implications for dog welfare and increases public costs. The aim of this paper is to describe the pilot project "RandAgiamo" implemented in a rescue shelter in the Umbria Region and to evaluate its effectiveness on the rate of dog adoption using official data. RandAgiamo aimed to increase adult shelter dogs' adoptability by a standard training and socialization programme. It also promoted dogs' visibility by publicizing them through social media and participation in events. We analysed the official data of the Umbria regional health authorities regarding dog shelters of the Perugia province of the year 2014. In the RandAgiamo shelter, the dog adoption rate was 27.5% higher than that of dogs housed in other shelters located in the same geographical area (P < 0.001). The RandAgiamo project could be beneficial for the dogs' welfare, owner satisfaction, shelter management, and public perception of shelter dogs. However, staff were required to provide dog training and related activities.