Digital skills e consapevolezza metacognitiva: prospettive di sviluppo professionale dei docenti universitari neoassunti

La spinta all’innovazione verso ambienti di apprendimento caratterizzati da un uso intensivo della tecnologia, determinata dalla crisi pandemica, costituisce una questione strategica per lo sviluppo dell’alta formazione. In questa direzione, la formazione e professionalizzazione del docente universitario sul versante pedagogico-didattico-valutativo rappresenta un’azione rilevante con potenziale impatto sul sistema universitario nel suo complesso. Il focus specifico del presente contributo riguarda il ruolo della competenza metacognitiva del docente con particolare attenzione all’utilizzo delle tecnologie, delle strategie didattiche evidence-informed e di modalità innovative di valutazione. Lo strumento scelto, somministrato a 119 docenti universitari neo assunti, è articolato in tre sezioni: TPACK, Strategie didattiche e valutative e MAI. L’analisi dei dati ha permesso di indagare alcuni fattori utili alla programmazione di iniziative di faculty development specificatamente dedicate ai docenti neo assunti, finalizzate al miglioramento della qualità della didattica universitaria.There has been a forced innovation towards learning environments which was characterized by intensive use of technology determined by the pandemic crisis. As a result, improving advanced training has become a crucial concern in higher education. For this reason, university professors’ training and professionalization on the pedagogic, didactic and assessment areas imply a relevant action with potential impact on the university system. This research mainly focuses on the role of teachers’ metacognitive competence with particular attention to the use of technologies, educational evidence-informed strategies and innovative assessment methods. To this end, a questionnaire with three sections had been administered to 119 newly recruited university professors: TPACK, Didactic and evaluation strategies and MAI. Data analysis allowed to identify some useful factors to design faculty development initiatives for newly recruited professors and for improving the quality of university teaching

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Introduction: Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism. Presentation of case: An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left subclavian artery (LSA). Discussion: Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years. Conclusions: Our experience using TEVAR with periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe

Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report

Introduction: COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). Presentation of case: An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombectomy and stenting with a good result. Discussion: Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure - gastrointestinal decompression, fluid resuscitation, hemodynamic support. Endovascular management of AMI is preferred over the standard surgical approach due to a reduced mortality and morbidity rates. Imaging findings of intestinal necrosis, however, represent an indication for AMI surgical treatment with explorative laparotomy. Different endovascular solutions have been employed to address AMI including mechanical thrombectomy, local thrombolysis, and PTA-stenting. Conclusion: COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. If a first embolic event occurs, an aggressive anticoagulation treatment could be inefficient to reduce the risk of subsequent embolization events. The limited life expectancy of such revascularization procedures should orientate towards less invasive treatments

Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT's

Objective: The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. / Methods: A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. / Results: Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14–1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33–1.57); P < 0.05). / Conclusions: Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. / Clinical relevance: MIS procedures represent a reliable treatment for isolated intra-bony defect

Optimizing Femoral Access in Emergency EVAR with a Decision-Making Algorithm

Endovascular aneurysm repair (EVAR) has become the preferred approach over open repair for abdominal aortic aneurysms (AAAs) due to its minimally invasive nature. The common femoral artery (CFA) is the main access vessel for EVAR, with both surgical exposure and percutaneous access being utilized. However, in emergent cases, percutaneous access can be challenging and may result in complications such as bleeding or dissection thrombosis, leading to the need for surgical conversion. This study aimed to share experiences in implementing a decision-making algorithm to reduce surgical conversions due to percutaneous access failures. A total of 74 aortic patients treated with EVAR in emergency settings were included in this retrospective study. This study focused on various outcomes such as perioperative mortality, morbidity, procedure time, surgical exposure time, and surgical conversion rate. After the implementation of the decision-making algorithm, decreases in surgical conversions and operating time were observed. Percutaneous access was found to be more challenging in cases with specific anatomical characteristics of the CFA, such as severe atherosclerosis or smaller vessel diameter. This study highlighted the importance of carefully assessing patient anatomical features and utilizing a decision-making algorithm to optimize outcomes in EVAR procedures. Further research is needed to continue improving practices for managing aortic aneurysms and reducing complications in femoral artery access approaches

Enteral and Parenteral Treatment with Caffeine for Preterm Infants in the Delivery Room: A Randomised Trial

Background: Early treatment with caffeine in the delivery room (DR) has been proposed to decrease the need for mechanical ventilation (MV) by limiting episodes of apnoea and improving respiratory mechanics in preterm infants. Our aim was to verify the hypothesis that intravenous or enteral administration of caffeine can be performed in the preterm infant in the DR. Methods: Infants with 25±0–29±6&nbsp;weeks of gestational age were enrolled and randomised to receive 20&nbsp;mg/kg of caffeine citrate intravenously, via the umbilical vein, or enterally, through an orogastric tube, within 10&nbsp;min of birth. Caffeine blood level was measured at 60&nbsp;±&nbsp;15&nbsp;min after administration and 60&nbsp;±&nbsp;15&nbsp;min before the next dose (5&nbsp;mg/kg). The primary endpoint was evaluation of the success rate of intravenous and enteral administration of caffeine in the DR. Results: Nineteen patients were treated with intravenous caffeine and 19 with enteral caffeine. In all patients the procedure was successfully performed. Peak blood level of caffeine 60&nbsp;±&nbsp;15&nbsp;min after administration in the DR was found to be below the therapeutic range (5&nbsp;µg/mL) in 25 % of samples and above the therapeutic range in 3%. Blood level of caffeine 60&nbsp;±&nbsp;15&nbsp;min before administration of the second dose was found to be below the therapeutic range in 18% of samples. Conclusions: Intravenous and enteral administration of caffeine can be performed in the DR without interfering with infants’ postnatal assistance. Some patients did not reach the therapeutic range, raising the question of which dose is the most effective to prevent MV. Clinical Trial Registration: ClinicalTrials.gov identifier NCT04044976; EudraCT number 2018-003626-91