Adherence of systematic reviews to Cochrane RoB2 guidance was frequently poor : A meta epidemiological study

Objectives To assess whether the use of the revised Cochrane risk of bias tool for randomized trials (RoB2) in systematic reviews (SRs) adheres to RoB2 guidance. Methods We searched MEDLINE, Embase, Cochrane Library from 2019 to May 2021 to identify SRs using RoB2. We analyzed methods and results sections to see whether risk of bias was assessed at outcome measure level and applied to primary outcomes of the SR as per RoB2 guidance. The relation between SR characteristics and adequacy of RoB2 use was examined by logistic regression analysis. Results Two hundred-eight SRs were included. We could assess adherence in 137 SRs as 12 declared using RoB2 but actually used RoB1 and 59 did not report the number of primary outcomes. The tool usage was adherent in 69.3% SRs. Considering SRs with multiple primary outcomes, adherence dropped to 28.8%. We found a positive association between RoB2 guidance adherence and the methodological quality of the reviews assessed by AMSTAR2 (p-for-trend 0.007). Multivariable regression analysis suggested journal impact factor [first quartile vs. other quartiles] was associated with RoB2 adherence (OR 0.34; 95% CI: 0.16-0.72). Conclusions Many SRs did not adhere to RoB2 guidance as they applied the tool at the study level rather than at the outcome measure level. Lack of adherence was more likely among low and very low quality reviews

Overview of DISCOVER22 experiment in the framework of INFN-LNGS Cosmic Silence activity: challenges and improvements in underground radiobiology

One of the most intriguing and still pending questions in radiobiology is to understand whether and how natural environmental background radiation has shaped Life over millions of years of evolution on Earth. Deep Underground Laboratories (DULs) represent the ideal below-background exposure facilities where to address such a question. Among the few worldwide DULs, INFN-Laboratorio Nazionale del Gran Sasso (LNGS) is one of the largest in terms of size and infrastructure. Designed and built to host neutrino and dark matter experiments, since the 1990 s the LNGS has been one of the first DULs to systematically host radiobiology experiments. Here we present the DISCOVER22 (DNA Damage and Immune System Cooperation in VEry low Radiation environment 2022) experiment recently started at LNGS. DISCOVER22 aims at investigating how the low radiation background modulates the Immune System (IS) response in in vitro and in vivo models. Underground radiobiology experiments are particularly complex and tricky to design and perform. In these studies, the accurate characterization of exposure scenarios is mandatory, but a challenging aspect is to understand how the very few ionizing tracks in the ultra-Low Radiation Environment (LRE) interact with the living matter in space and time in order to trigger different biological responses. In this Perspective, we describe these challenges and how we address them through a microdosimetric and a radiobiological approaches. We aim at linking physical microdosimetric measurements and the corresponding biological radiation responses by using radiation biophysical models that could shed light on many as yet unresolved questions

Le conoscenze e l’applicazione della Legge sul consenso informato e le disposizioni anticipate di trattamento: uno studio con metodo misto sugli studenti di infermieristica e gli infermieri

BACKGROUND: In December 2017 the Italian Parliament approved the Law no. 219 “Law on informed consent and advance health care directives”, placing the patient’s will at the center of the care.  OBJECTIVE : This study aims to explore students' knowledge of Law 219, to describe the application of the main contents of the law, such as informed consent, advance health care directives and advance care planning, in clinical settings by nurses, and to compare students' views with those of professionals.  METHODS: A mixed method study with a convergent triangulation design was conducted involving a sample of students from a Bachelor of Science in Nursing and a sample of critical care nurses.  RESULTS: From the analysis of the focus groups, 4 main themes were identified: the time of care, the importance of communication skills, the need for information, and professional and ethical responsibility. According to 73% of nurses, the use of informed consent is currently not adequate for the conditions of the patient. Shared care planning (PCC) is regularly applied in their care setting in 60% of cases. The main difficulties expressed about communication with the patient concern were: lack of time (73%), not knowing exactly what to communicate (30%), not feeling protected (17%).  CONCLUSIONS: This study suggests a stronger focus on education, both academic and professional, to implement knowledge and discussion of informed consent and CCP with the patient and his or her family.  KEYWORDS: “advance care planning”, “advance directives”, “informed consent” e “italian law”INTRODUZIONE: L’Italia ha approvato nel dicembre 2017 la Legge n. 219 “Norme in materia di consenso informato e di disposizioni anticipate di trattamento” (DAT), ponendo al centro del percorso di cura la volontà del paziente.  OBIETTIVO. Questo studio ha come obiettivi di esplorare le conoscenze degli studenti sulla legge 219, di descrivere l’applicazione dei contenuti principali della legge, quali consenso informato, DAT e PCC, nei contesti clinici da parte degli infermieri e di confrontare le visioni dei discenti con quelle dei professionisti.  METODI. È stato condotto uno studio con metodo misto con disegno di triangolazione convergente che ha coinvolto un campione di studenti di un Corso di Laurea in Infermieristica e uno di infermieri di area critica.  RISULTATI. Dall’analisi del focus group sono stati identificati 4 temi principali: il tempo della cura, l’importanza della capacità comunicativa, il bisogno di informazione e la responsabilità professionale e deontologica. Secondo il 73% degli infermieri l’acquisizione del consenso informato non è attualmente adeguata alle condizioni del paziente e la pianificazione condivisa delle cure (PCC) viene applicata regolarmente nel proprio contesto di cura nel 60% dei casi. Le principali difficoltà nella comunicazione al paziente riguardano: la mancanza di tempo (73%), il non sapere esattamente cosa poter comunicare (30%), il non sentirsi tutelato (17%).  CONCLUSIONI. Questo studio suggerisce di concentrarsi maggiormente sulla formazione, sia in ambito accademico che professionale, per implementare la conoscenza e la discussione del consenso informato e della PCC con il paziente e i suoi familiari.  PAROLE CHIAVE: pianificazione anticipata di trattamento, direttive anticipata, consenso informato&nbsp

La rilevazione e il trattamento del dolore durante le procedure di emodinamica e elettrofisiologia: uno studio descrittivo multicentrico

Introduzione. Le procedure di emodinamica ed elettrofisiologia (coronarografie radiali/femorali, impianto di pacemaker/defibrillatore) possono provocare dolore di diverso tipo ed intensití  durante l'esecuzione e nelle ore seguenti. Obiettivi. Valutare l'insorgenza di dolore e ansia in pazienti sottoposti a procedure di emodinamica ed elettrofisiologia. Descrivere la somministrazione, la frequenza, la tempistica e il dosaggio di farmaci analgesici e ansiolitici pre, intra, post procedura e l'esito ottenuto.Metodi. E' stato condotto uno studio descrittivo multicentrico; rilevati dati su ansia, dolore con una scala VAS (0-10) prima, durante, post procedura e sulla soddisfazione del paziente per le informazioni ricevute e il controllo del dolore.Risultati. Sono stati raccolti dati su 230 pazienti, la procedura più eseguita è stata la coronarografia radiale (68.7% dei casi), la più dolorosa (mediana 4, IQR 3-6) e ansiogena (mediana 5, IQR 2-6) l'impianto di pacemaker/defibrillatore. Durante la procedura 13 pazienti hanno ricevuto un'analgesia per un dolore da lieve ad elevato; nelle 24 ore successive 34 (5 sottoposti a coronarografia radiale e 29 ad impianto pacemaker/defibrillatore) hanno riferito un dolore elevato e tutti tranne 5 hanno richiesto un'analgesia. La soddisfazione per il controllo del dolore è stata insufficiente per i pazienti sottoposti ad impianto pacemaker/defibrillatore e 55 pazienti avrebbero desiderato più spiegazioni sul dolore.Conclusioni. L'attenzione al controllo del dolore e la soddisfazione del paziente sono migliorabili. Eventuali stati d'ansia andrebbero indagati maggiormente e si dovrebbero fornire più informazioni sulla procedura. Parole chiave: pain management, percutaneous coronary intervention, implantable cardioverter-defibrillator, pacemaker artificial.Introduction: gestione del dolore, intervento coronarico percutaneo, defibrillatore cardioverter impiantabile, pacemaker artificiale.Measurement and management of pain during coronary interventions and electrophysiology procedures: a multicentric descriptive studyAim: To assess the onset of pain and anxiety in patient undergoing coronary interventions and electrophysiology procedures; to describe the administration (frequency, timing, dosage and outcomes) of analgesics and anxiolytics before, during and after the procedure.Methods: A descriptive multicenter study was carried out. Pain and anxiety were measured with a 10-point visual analogue scale (VAS) before, during, after the procedure and for the following 24 hours. Patient were asked to rate their satisfaction for the information received and pain control.Results: Data on 230 patients were collected. The most performed procedure was the transradial coronary catheterization (68.7%). The pacemaker/defibrillator implantation resulted the most painful procedure (median 4, IQR 3-6) and also the most anxious (median 5, IQR 2-6). 13 Patients received an analgesic during the procedure for a low-to-severe pain; during the following 24 hours 34 patients (5 undergoing transradial coronary catheterization and 29 the implant of pacemaker/cardiac-defibrillator) suffered from severe pain and with the exception of 5, all requested pain relief. Satisfaction for pain control was inadequate for patients who underwent electrophysiology procedures and 55 patients would have needed more information on pain.Conclusions: Pain control and patient satisfaction may be improved, pre-procedural anxiety needs more attention and better information on the procedure should be provided. Key words: pain management, percutaneous coronary intervention, implantable cardioverter-defibrillator, pacemaker artificial

Growth Hormone Deficiency in a Patient with Becker Muscular Dystrophy: A Pediatric Case Report

Objective. To describe a biochemical growth hormone (GH) deficiency and to evaluate therapeutic result in a six-year-old male with Becker muscular dystrophy (BMD). Methods. GH peak was evaluated after response to arginine and insulin. Bone age was evaluated according to Greulich and Pyle method. Results. The GH-supplementary therapy was very effective in terms of growth gain. Conclusion. The possibility of a growth hormone deficiency and treatment with GH in patients with BMD cannot be excluded, especially considering the good therapeutic response

On the resource utilization of multi-connectivity transmission for URLLC services in 5G new radio

Abstract Multi-connectivity with packet duplication, where the same data packet is duplicated and transmitted from multiple transmitters, is proposed in 5G New Radio as a reliability enhancement feature. This paper presents an analytical study of the outage probability enhancement with multi-connectivity, and analyses its cost in terms of resource usage. The performance analysis is further compared against conventional single-connectivity transmission. Our analysis shows that, for transmission with a given block error rate target, multi-connectivity results in more than an order of magnitude outage probability improvement over the baseline single-connectivity scheme. However, such gains are achieved at the cost of almost doubling the amount of radio resources used. Multi-connectivity should thus be selectively used such that its benefits can be harnessed for critical users, while the price to pay in terms of resource utilization is simultaneously minimized