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This study aims to analyze the value-based health-care model in defining a strategy to guide the evolution of health-care organizations toward a value-oriented model. To improve the quality of care by ensuring economic sustainability, it is necessary to redefine the concept of competition in healthcare and align it with the concept of maximizing value for patients.

Performance measurement is a crucial aspect of the analysis of health-care organizations. Porter developed an effective analytical technique and presented the measurement of health-care outcomes based on health conditions, the efficiency of health-care organizations and the type of service provided.

Clinical outcomes and data on the costs of care of each patient are essential to evaluate improvement in treatment value over time. Engaging in the evaluation of what happens to patients in their course of care enables the expansion of the measurement of outcomes because it measures all the health services related to it.

Building a health-care system based on the value and continuous improvement of care and services provided is a goal shared by many countries and international organizations. Today, the analysis of outcomes is important for making informed decisions, directing and planning clinical and organizational changes by improving the quality of care and services.

The study objective was to understand if uniformity of approach exists in evaluation methods of public food tender for schools at national and local level. This purpose was divided into three sub-objectives: (1) to extract the main criteria, (2) to document the synthesizing findings process and (3) to prioritize the different decision-making alternatives through pairwise comparisons.

To achieve the sub-objectives (1) and (2), a content analysis of the Italian food tenders was carried out. Analytic hierarchy process was used to evaluate and compare the importance of various food tender evaluation criteria (3). The inclusion criteria were: cities' selection; metro area population; population density; duration of the contract; years.

Six public food tenders were analyzed. The first one concerned the National legislation guidelines. The remaining five food tenders were categorized according to the city investigated. Four macro-categories (Food quality; Sustainability; Resources; Ancillary services) were classified. AHP revealed that “Food quality” and “Resources” categories have greater importance in the evaluation phase of almost all cities investigated.

This study in-depth analyzes each criterion used to evaluate public food tenders, providing a new methodological framework for assigning scores to clusters of criteria. Since the literature search did not reveal any previous study on a quantitative evaluation of elements such as short supply chain, organic food and environmental impacts on public food tenders, this research delivers interesting results and fills this knowledge gap.

This paper aims to provide an insight into recent advancements and developments of robotics for Natural Orifice Transluminal Surgery (NOTES) procedures.

Following an introduction that highlights the evolution from Minimally Invasive Surgery (MIS) to NOTES in the medical field, this paper reviews the main robotics systems that have been designed and implemented for MIS and NOTES, summarising their advantages and limitations and remarking the technological challenges and the requirements that still should be addressed and fulfilled.

The state-of-the-art presented in this paper shows that the majority of the platforms created for NOTES are laboratory prototypes, and their performances are still far from being optimal. New solutions are required to solve the problems confronted by the proposed systems such as the limited number of DOFs, the limited resolution, the optimal fixation and stiffening of the instruments for enabling stable and precise operation, the effective transmission of forces to the tip tools, the improvement of the force feedback feeling and the proper visualization and spatial orientation of the surgical field. Advances in robotics can contribute significantly to the development and future implementation of the NOTES procedure.

This paper highlights the current trends and challenges ahead in robotics applied to NOTES procedure.