Medical responsibility, insurance policies, new laws and European directives. Is it time to reform the status of Italian medical residents?

In Italy there is an ongoing debate on the need to clarify the legal aspects related to the clinical activities of medical residents. While residents attend university medical schools, specific policies should be implemented to guarantee their proper utilization in health organizations also for the direct and indirect legal responsibilities of patients health and safety. It seems necessary to create an uniform and clearer legal framework to surmount criticism of the utilization of residents. We recommend Ministries of University and Health to change the current training contract into a job-training one, in line with experiences for residents of other European countries. This initiative could promote a no-blame culture and also help Italian specialist doctors of future generations to be trained in order to move and be competitive across European country borders and finally promote the sustainability of the Italian public NHS through a patient-centred and inter-professional integrated approach

Animal welfare policies and human rights in the context of slaughter procedures

Human rights, such as to non-discrimination and freedom of religion, are internationally recognized. In the meantime, the so-called global animal law is becoming more and more important. In this context, religious slaughter is increasingly becoming a matter for debate as a number of special procedures, which avoid stunning methods, may lead to greater suffering for animals. Such procedures are common to Judaism and Islam and involve 25% of the global population, almost 2 billion people. Considering that about 94% of European public opinion in 2015 expressed concern over animal welfare, it is time to evaluate the legal perspective of these special treatments. Indeed, although they seem to violate animal welfare policies, at the same time states have a duty to uphold religious freedom (and its forms of expression) under International and European law. The aim of this study is to evaluate, through a multidisciplinary approach, the complex balance between human rights in general and animal welfare policies, which are gaining importance especially in the European Continent’s legal framework

Validation of the Italian version of wisconsin stone quality of life (WISQOL): a prospective Italian multicenter study

Urolithiasis is a worldwide spread condition that affects patients' Health-Related Quality of Life (HRQOL), which measurement is an important tool for routine clinical and research practice. Disease-specific HRQOL measures demonstrated to perform better in assessing the effects of specific conditions. A disease-specific questionnaire for kidney stones, the WISQOL, has been validated in different languages, but an Italian version is still missing. Our aim is to produce and validate the Italian version of WISQOL (IT-WISQOL). Patients undergoing any elective treatment for upper urinary tract stones were enrolled. A multi-step process with forward- and back-translation was used to translate WISQOL into Italian. Patients were evaluated within 15 days pre-operatively and then at 30-, 90 days post-operatively and administered both IT-WISQOL and SF-36v2. Post-operative data such as 30 days postoperative complications, late stone-related events, successful status, and stone complexity were collected. Cronbach's α was used to evaluate the internal consistency of IT-WISQOL, while Spearman's rho was used for item and inter-domain correlations and IT-WISQOL with SF-36v2 correlation. We found excellent internal consistency across all domains (α ≥ 0.88), particularly when the total score is considered (α = 0.960). Test-retest reliability showed excellent results for the total questionnaire (Pearson correlation value: 0.85). The Inter-domain association ranged from 0.497 to 0.786. Convergent validity was confirmed by a good correlation with subdomains of the SF-36v2 measures. IT-WISQOL is a reliable tool to measure HRQOL in stone patients. It shows analog characteristics if compared to English WISQOL

US Cosmic Visions: New Ideas in Dark Matter 2017: Community Report

This white paper summarizes the workshop "U.S. Cosmic Visions: New Ideas in Dark Matter" held at University of Maryland on March 23-25, 2017.Comment: 102 pages + reference

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Non proliferazione nucleare e diplomazia per la pace, il caso iraniano

Mentre il regime iraniano prosegue con la sperimentazioni nucleare per fini bellici, il Consiglio di sicurezza ONU adotta sanzioni. Indagine su ragioni e prospettive di uno scontro diplomatic

Benessere animale, scienza e diritto nella prospettiva internazionale ed europea

La regolamentazione in materia di benessere animale, parte di un più ampio quadro normativo denominato Global Animal Law, diviene sempre più rilevante ad ogni livello; in particolare sul piano internazionale ed europeo. In questo senso anche i tribunali, nazionali e sovranazionali, acquistano un ruolo decisivo in quanto interpreti di norme spesso ideate per tutelare la salute umana prima di quella animale. Pertanto, mettendo da parte tanto gli aspetti etici quanto le questioni concernenti i presunti diritti degli animali, il presente lavoro intende illustrare l’evoluzione, sul piano internazionale ed europeo, delle politiche di benessere animale con particolare attenzione a quelle concernenti il settore alimentare

La protezione speciale garantita ai minori dal sistema delle Nazioni Unite e il contrasto al loro impiego nei conflitti armati

The involvement of children in armed conflict is an historic problem in the international community. Their participation in war is considered as a violation of International Law. In fact, international community protects children and their special needs as mentioned in many acts adopted since 1924. In this sense, the entire system of the United Nations has played a fundamental role in the creation of a legal framework that, starting with the protection of youth in general, has led to a more specific regulation on this matter. Starting from an analysis of International Law in the field of children in general, and specifically in the time of war, the aim of this is paper is to illustrate how relevant the UN system has been in this field. An important part is played by international criminal tribunals, such as the Sierra Leone one, which has contributed to the creation of a general duty to avoid the involvement of children in war