The challenge of extraabdominal desmoid tumour management in patients with Gardner’s syndrome: radiofrequency ablation, a promising option

Desmoid tumours are benign, myofibroblastic stromal neoplasms common in Gardner's syndrome, which is a subtype of familial adenomatous polyposis characterized by colonic polyps, osteomas, thyroid cancer, epidermoid cysts, fibromas and sebaceous cysts. The primary treatment is surgery, followed by adjuvant radiotherapy, but the local recurrence rate is high, and wide resection can result in debilitating loss of function. We report the case of a 39-year-old man with Gardner's syndrome who had already undergone a total prophylactic colectomy. He developed desmoid tumours localized in the mesenteric root, abdominal wall and dorsal region, which were treated from 2003 through 2013 with several surgical procedures and percutaneous radiofrequency ablation. In 2008 and 2013, RFA was applied under ultrasonographic guidance to two desmoid tumours localized in the dorsal thoracic wall. The outcomes were low-grade pain and one case of superficial skin necrosis, but so far there has been no recurrence of desmoid tumours in these locations. Surgical resection remains the first-line therapy for patients with desmoid tumours, but wide resection may lead to a poor quality of life. Radiofrequency ablation is less invasive and expensive and is a possible therapeutic option for desmoid tumours in patients with Gardner's syndrome

Influenza vaccination coverage among medical residents: An Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P < 0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future. © 2014 Landes Bioscience

A web search on environmental topics: what is the role of ranking?

5Background: Although the Internet is easy to use, the mechanisms and logic behind a Web search are often unknown. Reliable information can be obtained, but it may not be visible as the Web site is not located in the first positions of search results. The possible risks of adverse health effects arising from environmental hazards are issues of increasing public interest, and therefore the information about these risks, particularly on topics for which there is no scientific evidence, is very crucial. The aim of this study was to investigate whether the presentation of information on some environmental health topics differed among various search engines, assuming that the most reliable information should come from institutional Web sites. Materials and Methods: Five search engines were used: Google, Yahoo!, Bing, Ask, and AOL. The following topics were searched in combination with the word ‘‘health’’: ‘‘nuclear energy,’’ ‘‘electromagnetic waves,’’ ‘‘air pollution,’’ ‘‘waste,’’ and ‘‘radon.’’ For each topic three key words were used. The first 30 search results for each query were considered. The ranking variability among the search engines and the type of search results were analyzed for each topic and for each key word. The ranking of institutional Web sites was given particular consideration. Results: Variable results were obtained when surfing the Internet on different environmental health topics. Multivariate logistic regression analysis showed that, when searching for radon and air pollution topics, it is more likely to find institutional Web sites in the first 10 positions compared with nuclear power (odds ratio = 3.4, 95% confidence interval 2.1–5.4 and odds ratio = 2.9, 95% confidence interval 1.8– 4.7, respectively) and also when using Google compared with Bing (odds ratio = 3.1, 95% confidence interval 1.9–5.1). Conclusions: The increasing use of online information could play an important role in forming opinions. Web users should become more aware of the importance of finding reliable information, and health institutions should be able to make that information more visible.nonenoneCOVOLO L; FILISETTI B; MASCARETTI S; LIMINA RM; GELATTI UCovolo, Loredana; Filisetti, Barbara; Mascaretti, Silvia; Limina, Rosa Maria; Gelatti, Umbert

L'impiego di biomarcatori di esposizione, effetto precoce e suscettibiltà per lo studio dei rapporti tra ambiente e salute: dalla ricerca di base alle politiche per la salute .

The use of biomarkers of exposure, early effect and susceptibility for the study of the relationship between environment and human health: from basic research to health policy. We carried out a brief review of studies investigating human effects of environmental exposures which made use of biomarkers of exposure, internal dose and biological effect, with particular regard to air pollution. Among biomarkers of early effect, we have focused the recently developed techniques for investigating gene expression, known as “omics”: genomic (study of genome), transcriptomic (study of transcriptome, including mRNAs), proteomic (study of proteome, the protein output encoded by the genome) and epigenomic (study of structural reversible modifications of DNA), the last one including three mechanisms of activation/ inactivation of genes and their products, i.e. DNA methylation, histone modifications and micro-RNA regulations. Although the studies using these techniques are still far from providing conclusive evidences, they may be useful for validating systems of environmental and biological monitoring, integrating risk assessment procedures and supporting evidence-based decisions of public health policy for reducing the harmful effects of environmental exposures

Il monitoraggio dei mass media in materia di salute e sicurezza. Strumenti per la raccolta e l\u2019analisi delle informazioni

La sinergia tra INAIL (Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro ed Ambientale) ed Alma Mater Studiorum, Universit\ue0 di Bologna, ha dato come frutto il Repertorio Notizie ed una serie di risultati delle attivit\ue0 collaterali. Il Repertorio Notizie \ue8 un data-base relazionale composto da vari archivi, per l\u2019acquisizione ragionata degli articoli tratti dagli organi di informazione, riguardanti gli eventi connessi con la salute e la sicurezza sul lavoro (infortuni, incidenti, malattie professionali e disturbi lavoro-correlati). Esistono gi\ue0 svariate raccolte di casi di infortunio o di malattia professionale all\u2019interno dell\u2019INAIL, al di l\ue0 di quelle ufficiali realizzate solo per scopi istituzionali. Per questo motivo, non si \ue8 voluto realizzare un catalogo simile a quelli gi\ue0 esistenti, ma uno strumento attraverso cui valutare come le notizie relative agli eventi lesivi vengono affrontate, sfruttando le esperienze pregresse. Si punta, infatti, ad un monitoraggio sul modo di riportare i fenomeni da parte dei mezzi di informazione e sulle caratteristiche culturali della comunicazione di massa: entrambi gli obiettivi si raggiungono con specifiche metodologie statistiche e, a posteriori, confrontando i dati con gli elementi ufficialmente forniti dall\u2019INAIL sugli infortuni e le malattie professionali. L\u2019espressione \u201cconoscere per agire\u201d ben si adatta anche al Repertorio Notizie: se si vogliono utilizzare le potenzialit\ue0 che i media hanno per sensibilizzare l\u2019opinione pubblica sulle questioni legate alla sicurezza ed alla prevenzione sul lavoro, allora bisogna far s\uec che diano notizie il pi\uf9 possibile corrette e dettagliate. Nello stesso tempo, gli organi di informazione dovrebbero costruire intorno ai dati ed alle circostanze oggettive - tradotte statisticamente in variabili - un racconto degli eventi che susciti interesse, ma che non cada in errori dovuti alla tendenza al sensazionalismo o alla semplice mancanza di conoscenze tecniche. A tal fine, \ue8 necessario capire quali siano le eventuali carenze su cui intervenire. Il presupposto consolidato (sul quale, comunque, verranno effettuate delle verifiche) \ue8 che i media non danno la medesima rilevanza a tutti gli incidenti, a prescindere da ovvie considerazioni sulla gravit\ue0 dei fatti. Inoltre, la sensazione \ue8 che l\u2019opinione pubblica non avverta la seriet\ue0 del fenomeno, ritenendo anche inevitabile che si verifichino certi eventi, poich\ue9 nelle cronache viene frequentemente rimarcata la circostanza della \u201ctragica fatalit\ue0\u201d. La ben nota regola delle cinque W (who, what, when, where, why), suggerirebbe anche un approfondimento sul \u201cperch\ue9\u201d e, quindi, sulle cause degli avvenimenti che talvolta non compaiono negli articoli riguardanti gli infortuni sul lavoro. L\u2019INAIL, che si propone come Polo della Salute e della Sicurezza sul Lavoro, non pu\uf2 perci\uf2 fare a meno di studiare le caratteristiche della comunicazione su questi temi, anche nel caso in cui essa sia effettuata da operatori non istituzionalmente impegnati sull\u2019argomento. Non si pu\uf2 trascurare l\u2019effetto che mass media e siti web hanno su conoscenze, opinioni e sensibilizzazione delle persone

Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions