Il rapporto tra la città e i palazzi comunali: alcuni casi studio in area umbro-marchigiana tra Due e Trecento

In relation to the history of the birth, formation and growth of the municipalities, the chapter that is still most in-depth today concerns the Tuscan-Lombard axis. On the historical-architectural level, historiography has highlighted the peculiarities of most of the municipal buildings often located in the Lombardy area, and monographic publications of great interest on the most famous buildings in the Tuscan area can also be included. The framework outlined leaves ample space for studies that analyze, with critical purposes, the palatial architecture of the central area of ​​the peninsula and the relationship between the city and the architecture of some palaces located between the Duchy of Spoleto and the Marca of Ancona. For this chosen area, the difficulty in finding the recurrence of a "model" and the lack of documentation or rather the confusing state in which it finds itself, led to a lack of interest and attention from critics during the twentieth century. The contribution intends to outline the genesis of the three buildings: the town hall of Foligno, of Fabriano and the Palazzo dei Priori of Assisi. These have one or more vaulted passages over public roads. An attempt will be made to understand the socio-political context linked to the construction of the three palaces, trying to overcome the limits of a typological classification which has excluded these areas which have become "marginal" within the historiographical debate.In relazione alla storia della nascita, formazione e crescita dei comuni, il capitolo tutt’oggi maggiormente approfondito riguarda l’asse tosco-lombardo. Sul piano storico-architettonico la storiografia ha messo in luce le peculiarità di gran parte dei palazzi comunali sovente collocati in area lombarda, inoltre si possono annoverare pubblicazioni monografiche di grande interesse sui palazzi più noti di area toscana. Il quadro delineato lascia un ampio spazio a studi che analizzino, con finalità critiche, l’architettura palaziale dell’area centrale della penisola e il rapporto tra la città e l’architettura di alcuni palazzi collocati tra il Ducato di Spoleto e la Marca di Ancona. Per quest’area scelta, la difficoltà nel riscontrare la ricorrenza di un «modello» e la carenza di documentazione o piuttosto lo stato confusionario in cui versa, hanno comportato una mancanza di interesse e attenzione della critica nel corso del XX secolo.  Il contributo intende delineare la genesi dei tre edifici: il palazzo comunale di Foligno, di Fabriano e il palazzo dei Priori di Assisi. Questi presentano uno o più passaggi voltati passanti al di sopra di strade pubbliche. Si tenterà di comprendere il contesto socio politico legato alla costruzione dei tre palazzi, cercando di superare i limiti di una classificazione tipologica che ha escluso queste aree divenute «marginali» all’interno del dibattito storiografico

Patient satisfaction with the use of an enhanced recovery programme for primary arthroplasty

INTRODUCTION: Enhanced recovery programmes (ErPs) are increasingly being used for arthroplasty. One of the core aims of an ErP is to improve the quality of patient experience. However, there is currently no published evaluation of patient satisfaction in relation to this new programme of care within orthopaedic surgery. The aim of this study was to compare the ErP against the standard care programme (SCP) at one centre. METHODS: A satisfaction survey addressing patient opinions on the key objectives of the ErP was conducted by telephone, using a set script. Of the 226 patients contacted, 143 (63.3%) responded (69 from the ErP and 74 from the SCP). Of the respondents, 71 received a total hip arthroplasty and 72 a total knee arthroplasty. Patients were contacted at a mean time from operation to survey of 27.2 weeks. They were asked to rate satisfaction on a five-point scale and complete the EQ-5D™ health questionnaire (EuroQol, rotterdam, Netherlands) to measure healthcare outcomes. RESULTS: The mean patient satisfaction score of 4.07 for speed of recovery in the ErP group was significantly higher than the SCP group's score of 3.68 (p=0.037). Adjusting for the preoperative health score, the postoperative health score was higher for ErP patients at 74.1 compared with 64.7 for SCP patients (p=0.0029). Furthermore, the percentage of patients who had a better than expected recovery was significantly greater in the ErP group at 85.5% compared with 58.1% (p=0.0004) in the SCP group. CONCLUSIONS: We believe that the previously established reduction in length of hospital stay delivered by ErPs is not achieved at the expense of the patient's experience

Ceftolozane/tazobactam for the treatment of serious P. aeruginosa infections: a multicenter nationwide clinical experience

To describe the largest clinical experience using ceftolozane-tazobactam (C/T) for treatment of different type of Pseudomonas aeruginosa infections. A retrospective study was performed at 22 hospitals in Italy from June 2016 to March 2018. All adult patients treated with at least 4 days of C/T were enrolled. A successful clinical outcome was defined as complete resolution of clinical signs and symptoms related to P. aeruginosa infection and lack of microbiological evidence of infection. C/T treatment was documented in 101 patients with diverse infections, including nosocomial pneumonia (31.7%), acute bacterial skin and skin structure infections (30.8%), complicated UTI (13.8%), complicated IAI (12.8%), bone infections (8.9%) and primary bacteraemia (7.9%). Almost half of P.aeruginosa strains were XDR (51%), with 78% of the isolates resistant to at least one carbapenem. C/T was used as first-line therapy in 39 patients (34.6%). When used as second or later line, the most common reasons for discontinuation of previous antibiotics were in vitro resistance of P.aeuruginosa strain and clinical failure of previous therapy. Concomitant antibiotics was reported in 35% of patients. C/T doses were 1.5 grams/8h in 70 patients (69.3%) and 3 grams/8h in 31 patients (30.7%); the median duration of C/T therapy was 14 days. The overall clinical success was 83.2%. Significant lower success rates were observed in patients with sepsis or those receiving continuous renal replacement therapy. Mild adverse events were reported in only three patients. C/T demonstrated a favourable safety and tolerability profile regardless of the type of infection. Clinicians should be aware of the risk of clinical failure with C/T therapy in septic patients receiving continuous renal replacement therapy