X-ray management in electrophysiology: a survey of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC)

Radiation use in medicine has significantly increased over the last decade, and cardiologists are among the specialists most responsible for X-ray exposure. The present study investigates a broad range of aspects, from specific European Union directives to general practical principles, related to radiation management among a national cohort of cardiologists

L'EREDITA' PEDAGOGICA DI DON MILANI (a cura di Dario De Salvo)

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Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Proposta di una metodologia per illuminare i centri storici

La corretta illuminazione di uno spazio urbano non può prescindere da uno studio accurato dei materiali, dei colori e da un'approfondita conoscenza storica ed architettonica del contesto: molto spesso vi sono delle incertezze nel condurre in modo sistematico questi studi preliminari e non vi è una metodologia di riferimento per affrontare la progettazione in contesti così complessi. Per questi motivi in questo articolo si propone una metodologia che rappresenta un tentativo di fornire una guida per progettare la luce rispettando i materiali, i colori e l'architettura di uno spazio urbano. L'illuminazione delle cortine edilizie, delle piazze e dei monumenti differisce profondamente dall'illuminazione stradale che è sottoposta ad altre regole ed esigenze e la metodologia qui presentata è orientata alla progettazione dell'illuminazione per le aree non destinate al traffico veicolare. Per testare questa metodologia si è scelto un caso studio individuato da uno spazio urbano esistente all'interno del centro storico di Napoli: Piazza Sisto Riario Sforza. La scelta di questa piazza è stata fatta in quanto essa è esemplificativa della cattiva illuminazione spesso riscontrabile in simili contesti

The colour of light for urban spaces

Light in urban spaces was first introduced to prevent crimes against both people and properties and, while there is no study that confirms crimes' reduction in lit spaces, it is undeniable that people feel safer in lit urban spaces. Over the years it became evident that light can also improve the liveability of cities and enhance their characteristics, therefore in the last years a growing attention was paid to urban lighting design taking into account the environmental impact and energy saving requirements too. The will to use the lighting design project to improve the liveability of historical centres it’s clear: the city during the night is no more conceived like a sum of lit architectures but, thanks to a good lighting design project, it could complete the image that the city has during the day with perspectives, views and glimpses correctly illuminated, giving a global sense of the environment while making it safer. To properly highlight building facades and monuments, an accurate study of materials and chromaticity needs to be conducted and in this paper a methodology to do so is proposed. This method was developed after a research on the evaluation of chromatic changes of objects lit by sources with different SPDs and it is also based on the concept of visual saliency. Visual saliency is the perceptive quality that makes an object discernible and capable of instantly catching the eyes and mind attention; our brain automatically creates "saliency maps" of everything we see and using an algorithm it is possible to graphically recreate these maps to understand what attracts the eyes' attention in order to enhance it. Luminance is one of the factor that adds or takes saliency to an object: by increasing or decreasing luminance values it is possible to attract or repel the eyes' attention. Today there is a tendency to recommend a specific luminance ratio between an object and its background, using a higher luminance contrast to achieve a higher visibility level and this is typical of objects with a uniform background. However, in urban situations objects have complex backgrounds and it is important to remember that an object's saliency also depends on its background. A single salient target draws the attention irrespective of the number of the other not salient elements on the background, but when these elements increase in luminance, the main target loses visibility and saliency. It is also really important to consider that there may also be different levels of saliency. The methodology was then applied to a case study in the historical centre of Naples

In vivo biophysical characterization of very high power, short duration, temperature-controlled lesions

A very high-power short-duration (vHPSD) strategy of radiofrequency (RF) ablation aims to minimize conductive heating and increase resistive heating. This study aimed to clarify the contribution of contact force (CF) and temperature and their interrelationship in making an adequate lesion with the vHPSD catheter