Short and long term results of the laparoscopic Heller–Dor myotomy. The influence of age and previous conservative therapies

Analisi dei risultati della terapia chirurgica dell'acalasia esofagea con tecnica di Heller-Dor laparoscopica in pazienti anziani con e senza dilatazione pneumatica pregress

Evaluating the Surgeons' Perception of Difficulties of Two Techniques to Perform STARR for Obstructed Defecation Syndrome: A Multicenter Randomized Trial.

BACKGROUND After initial enthusiasm in the use of a dedicated curved stapler (CCS-30 Contour Transtar) to perform stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS), difficulties have emerged in this surgical technique. OBJECTIVE First, to compare surgeons' perception of difficulties of STARR performed with only Transtar versus STARR performed with the combined use of linear staplers and Transtar to cure ODS associated with large internal prolapse and rectocele; second, to compare the postoperative incidence of the urge to defecate between the 2 STARR procedures. DESIGN AND SETTING An Italian multicenter randomized trial involving 25 centers of colorectal surgery. PATIENTS Patients with obstructed defecation syndrome and rectocele or rectal intussusception, treated between January and December 2012. INTERVENTIONS Participants were randomly assigned to undergo STARR with a curved alone stapler (CAS group) or with the combined use of linear and curved staplers (LCS group). MAIN OUTCOME MEASURES Primary end-points were the evaluation of surgeons' perception of difficulties score and the incidence of the "urge to defecate" at 3-month follow up. Secondary end-points included duration of hospital stay, rates of early and late complications, incidence of "urge to defecate" at 6 and 12 months, success of the procedures at 12 months of follow-up. RESULTS Of 771 patients evaluated, 270 patients (35%) satisfied the criteria. Follow-up data were available for 254 patients: 128 patients (114 women) in the CAS group (mean age, 52.1; range, 39-70 years) and 126 (116 women) in LCS group (mean age, 50.7 years; range, 41-75 years). The mean surgeons' perception score, was 15.36 (SD, 3.93) in the CAS group and 12.26 (SD, 4.22) in the LCS group (P < .0001; 2-sample t test). At 3-month follow-up, urge to defecate was observed in 18 (14.6%) CAS group patients and in 13 (10.7%) LCS group patients (P = .34; Fisher's exact test). These values drastically decrease at 6 months until no urge to defecate in all patients at 12 months was observed. At 12-month follow-up, a successful outcome was achieved in 100 (78.1%) CAS group patients and in 105 (83.3%) LCS group patients (P = .34; Fisher's exact test). No significant differences between groups were observed in the hospital stay and rates of early or late complications occurring after STARR. CONCLUSIONS STARR with Transtar associated with prior decomposition of prolapse, using linear staplers, seems to be less difficult than that without decomposition. Both procedures appear to be safe and effective in the treatment of obstructed defecation syndrome resulting in similar success rates and complications

Un sistema di realtà virtuale per la pianificazione e la guida del trattamento dei tumori epatici.Dottorato di Ricerca in Scienze Chirurgiche e Tecnologie diagnostico-terapeutiche avanzate (XVIII ciclo)

La precisa individuazione del tumore epatico sensibile alla terapia con radiofrequenza costituisce un problema tecnico con importanti riflessi terapeutici. Lo sviluppo delle tecniche di elaborazione tridimensionale delle immagini acquisite strumentalmente (realtà virtuale aumentata) e la possibilità di sovrapporle alle immagini reali ii corso di laparoscopia, permettono di raggiungere l'obiettivo con l'ago della radiofrequenza. Lo studio dimostra la possibilità di utilizzare in vivo la registrazione interattiva che corregge il movimento della respirazione e permette una approssimazione assoluta

Ruolo della ecografia intraoperatoria nello studio della Via Biliare Principale in corso di colecistectomia laparoscopica e confronto con la colangiografia intraoperatoria.Dottorato di Ricerca in Metodologie Diagnostiche Intraoperatorie (XVI ciclo)

Lo studio pone a confronto l'esame ecografico con la colangiografia con mdc intraoperatori per la diagnosi di calcolosi della VBP in corso di colecistectomia per litiasi della colecisti in pazienti a rischio per la positività di reperti di laboratorio e strumentali preoperator

Intellectual capital and performance measurement in healthcare organizations

Purpose – The purpose of this paper is to define a new conceptual framework or model, to measure and manage organizational performance, both financial/non-financial and intellectual capital (IC), in a healthcare organization. Design/methodology/approach – The integrated new model is produced by integrating the common assessment framework (CAF) model with two other frameworks representing the IC and leadership. These already existing models are originated, respectively by the Health Agency of Emilia-Romagna Region (Italy) and the National Healthcare System (NHS – UK). The integration phase is operated by comparing the CAF and IC models so as to assess the determinant factors that are present in both frameworks and eliminating such redundancies. Concerning the leadership determinant factor, the relevant conceptual framework of CAF model is substituted by the new leadership model proposed by the NHS. Findings – A new integrated model is made available for a subsequent step of empirical implementation and validation through its application in a healthcare organization. The main advantage of this model is the ability to measure and manage IC and financial/non-financial performance. Moreover, the use of a single measurement system facilitates the interpretation and coherency assessment of measured data so originated. Originality/value – The added value this work provides will enrich the academic literature regarding performance measurement systems in healthcare organizations, also providing an original integrated model that is able to exhibit the advantages highlighted above

Progettazione e valutazione di un moderno sistema di sorveglianza per la riduzione e la prevenzione delle infezioni legate all'assistenza ospedaliera: a new public health management

Le infezioni ospedaliere sono la complicanza più temibile dell'assistenza sanitaria, in quanto spesso non prevenibili. La strategia più efficace consiste nella sorveglianza basata sulle evidenze scientifiche, riferite alle aree a maggior rischio. Questo studio presenta i risultati di osservazioni effettuate nel corso di due anni in Unità Operative Complesse di differenti discipline prima e dopo l'adozione di un modello formativo aziendale associato con una rete di sorveglianza delle attività che ha dimostrato l'efficacia delle misure adottate intemini di riduzione degli eventi avversi e di precoce isolamento dei germi responsabil