How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

Artesãos, cartografia e império. A produção social de um instrumento náutico no mundo ibérico, 1500-1650

Explicar cómo y en qué condiciones fueron construidos algunos de los instrumentos científicos más emblemáticos del mundo moderno sigue siendo un desafío para los historiadores de la ciencia y de la tecnología. Este principio afecta también a los instrumentos náuticos. Así, el objetivo del presente artículo es considerar el “cómo” y el “en qué condiciones”, en un sentido amplio, analizando uno de estos artefactos: las cartas náuticas construidas durante la expansión marítima europea. Originalidad: La originalidad del texto no reside únicamente en llevar a cabo una reconstrucción de este instrumento en Portugal y España que aporte nuevos datos sobre su proceso de fabricación y sus fabricantes, sino también en arrojar luz sobre antiguos debates historiográficos que subyacen a la génesis de la ciencia moderna, tales como la difícil colaboración entre hombres prácticos y hombres teóricos; la aportación de comunidades de artesanos al mundo del conocimiento; el papel que los saberes prácticos tuvieron en el establecimiento de nuevas formas de estandarización en ciencia; la adopción de una metodología empírica para el dominio del mundo o la construcción de grandes imperios globales cimentados sobre la base del trabajo manual. Metodología: El análisis de estos debates requiere una aproximación metodológica que atienda a las categorías y los conceptos principales puestos en circulación tanto por la historia como por la filosofía de la ciencia más reciente. En definitiva, se trata de atender a las condiciones que permitieron el establecimiento de acuerdos (y también de controversias) epistemológicos entre diferentes comunidades de conocimiento tomando un instrumento náutico como “mediador”. Conclusiones: El artículo concluye que la consideración de las culturas empíricas del conocimiento y sus realizaciones materiales son una condición sine qua non para entender la génesis de la modernidad científica europea y la construcción de un mundo globalExplaining how and under what conditions some of the most emblematic scientific instruments of the modern world were built remains a challenge for historians of science and technology. This principle also affects nautical instruments. Thus, the objective of this article is to consider the “how” and the “under what conditions”, in a broad sense, by examining one of these devices: the nautical charts developed during the European maritime expansion. Originality: The originality of this article lies not only in the reconstruction of this instrument in Portugal and Spain, providing new information about its development process and its manufacturers, but also in shedding light on old historiographical debates that underlie the genesis of modern science, such as the difficult collaboration between practical men and theoretical men; the contribution of artisan communities to the world of knowledge; the role that practical knowledge played in the establishment of new forms of standardization in science; the adoption of an empirical methodology for achieving mastery of the world or the construction of large global empires founded upon manual labor. Methodology: Analyzing these debates requires a methodological approach that addresses the main categories and concepts put into circulation by the most recent history and philosophy of science. In short, unveiling the conditions that enabled the establishment of epistemological agreements (and also disputes) between different knowledge communities by taking a nautical instrument as “mediator.” Conclusions: The article concludes that examining empirical knowledge cultures and their material achievements are a sine qua non condition to understand the genesis of European scientific modernity and the construction of a global worldExplicar como e em que condições foram construídos alguns dos instrumentos científicos mais emblemáticos do mundo moderno continua sendo um desafio para os historiadores da ciência e da tecnologia. Esse princípio afeta também os instrumentos náuticos. Assim, o objetivo do presente artigo é considerar o “como” e o “em que condições”, em um sentido amplo, e analisar um desses artefatos: as cartas náuticas construídas durante a expansão marítima europeia. Originalidade: A originalidade do texto não reside unicamente na realização de uma reconstrução desse instrumento em Portugal e na Espanha de forma que traga novos dados sobre seu processo de fabricação e de seus fabricantes, mas também em lançar luz sobre antigos debates historiográficos que subjazem à gênese da ciência moderna, tais como a difícil colaboração entre homens práticos e homens teóricos, a contribuição de comunidades de artesãos ao mundo do conhecimento; o papel que os saberes práticos tiveram no estabelecimento de novas formas de padronização na ciência, a adoção de uma metodologia empírica para o domínio do mundo ou a construção de grandes impérios globais cimentados sobre a base do trabalho manual. Metodologia: A análise desses debates requer uma aproximação metodológica que atenda às categorias e aos principais conceitos colocados em circulação tanto pela história quanto pela filosofia da ciência mais recente. Definitivamente, trata-se de atender às condições que permitiram o estabelecimento de acordos (e também de controvérsias) epistemológicos entre diferentes comunidades de conhecimento tomando o instrumento náutico como “mediador”. Conclusões: O artigo conclui que a consideração das culturas empíricas do conhecimento e suas realizações materiais são uma condição sine qua non para entender a gênese da modernidade científica europeia e a construção de um mundo globa

The Impact of the Introduction of the Breast Unit Model in a Northwestern Italian Region

: Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014-2015) and after (2017-2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis-surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality.Breast cancer is the most common tumor in middle-aged and older women. In 2003, the European Parliament recommended to Member States that all women with breast cancer should be treated by a multidisciplinary team and that a network of certified breast centers be organized (the centers have been called Breast Units (BUs)). With the present study, we aim to explore the impact of the introduction of the BU organizational model in the Liguria region, Italy, through different outcome indicators. An explorative retrospective analysis was conducted through the period from 2013 to 2019 to assess the impact of the introduction of the BU model in our region. We identified two periods: before (2014–2015) and after (2017–2018) the introduction of this organizational model to assess its value impact through the definition of six measurable outcome indicators. Length of hospitalization, repeated specialist outpatient diagnostic procedures and the rate of subjects who started radiotherapy treatment within 60 days improved after the introduction of BUs. The passive health migration rate only improved significantly for one local health unit (LHU), while reintervention and diagnosis–surgery time did not show any enhancement after the introduction of the BU model. The BU model seems to provide an increase in several aspects of the healthcare offered to breast cancer patients in Liguria, specifically in those areas where a shared guideline could assist healthcare workers. Future research, such as pilot studies, are needed to assess the impact of the introduction of the BU model in our reality

Incidence of Hospitalisation and Emergency Department Visits for Pneumococcal Disease in Children, Adolescents, and Adults in Liguria, Italy: A Retrospective Analysis from 2012–2018

Streptococcus pneumoniae infection is responsible for significant morbidity and mortality, particularly in young children and older adults. The aim of this study was to investigate the incidence of hospitalisation and emergency department (ED) visits in relation to episodes of pneumococcal disease (PD) following the introduction of pneumococcal conjugate vaccines (PCVs) into the Liguria region of Italy. Between 2012 and 2018, episodes of all-cause pneumonia (80,152), pneumococcal-specific pneumonia (1254), unspecified pneumonia (66,293), acute otitis media (AOM; 17,040), and invasive PD (IPD; 1788) were identified from in-patient claims, ED and hospital discharge records, and the Liguria Chronic Condition Data Warehouse. In children < 15 years of age, pneumococcal pneumonia-related hospitalisations decreased from 35 to 13 per 100,000 person-years during the study period (p < 0.001); this decrease is potentially related to PCV use in children. All-cause pneumonia hospitalisations remained stable, whereas IPD hospitalisations increased and AOM hospitalisations decreased. In adults, hospitalisations for all-cause pneumonia increased from 5.00 to 7.50 per 1000 person-years (+50%; p < 0.001). Pneumococcal and unspecified pneumonia hospital admissions increased significantly during the study period, considerably affecting those ≥ 65 years of age. IPD hospitalisations varied across all age groups, but a significant change was not observed. Despite pneumococcal vaccination, substantial burden remains for PD in children and adults in Liguria, Italy

Economic burden of pneumococcal disease in children in Liguria, Italy

Vaccinations against Streptococcus pneumoniae are included in infant immunization programs globally. However, a substantial burden due to pneumococcal disease (PD) remains. This study aimed to estimate the cost of emergency department (ED) visits and hospitalizations associated with invasive pneumococcal disease, all-cause pneumonia, and acute otitis media in children <15 years of age in the Liguria region of Italy between 2012 and 2018. The retrospective cohort study used data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse, which contain information on hospital stays, outpatient visits, laboratory/imaging techniques, surgical procedures, and pharmaceutical prescriptions. Patients with one or more ED or inpatient claim for PD (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes) were included. Cost of ED visits and hospitalizations were estimated from the diagnosis-related group system and procedures performed in the ED. In Ligurian children <15 years of age during 2012–2018, the median annual number of hospitalizations plus ED visits due to PD was 4,009, and the median estimated annual cost was €3.6 million. All-cause pneumonia accounted for the majority of hospitalization costs during the study period. Number and costs of ED visits and hospitalizations increased from 2012 to 2018. Despite widespread infant immunization in Liguria, economic costs due to PD-associated ED visits and hospitalizations remained high in children 0–14 years of age

Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software.

To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software.Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM.Fifty consecutive patients (mean age, 51 years; range, 35-83 years) underwent both FFDM and DBT. Using a method based on the integral curve, breast density showed higher results on FFDM (68.1 \ub1 12.1 for FFDM and 51.9 \ub1 6.5 for DBT). FFDM overestimated breast density in 16.2\% (P < 0.0001). Using a method based on maximum entropy thresholding, breast density showed higher results on FFDM (68.1 \ub1 12.1 for FFDM and 51.9 \ub1 6.5 for DBT). FFDM overestimated breast density in 11.4\% (P < 0.0001). There was a good correlation among BI-RADS categories on a four-grade scale and the density evaluated with DBT and FFDM (r = 0.54, P < 0.01 and r = 0.44, P < 0.01).Breast density appeared to be significantly underestimated on digital breast tomosynthesis.Breast density is considered to be an independent risk factor for cancer Density can be assessed on full-field digital mammography and digital breast tomosynthesis Objective automated estimation of breast density eliminates subjectivity Automated estimation is more accurate than BI-RADS quantitative evaluation Breast density may be significantly underestimated on digital breast tomosynthesis