Physicians' knowledge of health-related quality of life and perception of its importance in daily clinical practice

Background: Health-related quality of life (QoL) has become a crucial outcome in medical care. However, few studies have assessed physician knowledge of QoL and rate of physicians adopting QoL measures in clinical practice. The present study aimed at assessing the level of knowledge of QoL and the perceived importance of incorporating QoL assessment in clinical practice among physicians of a tertiary level academic hospital in Rome, Italy. Materials and methods: A survey study performed through the distribution of a questionnaire assessing knowledge of QoL studies that used the SF-36 scale, participation in studies evaluating QoL as well as knowledge of journals publishing articles on QoL Physicians and residents at the hospital Policlinico Gemelli, Catholic University of Rome. Results: Three-hundred nine physicians completed the questionnaire. Thirty-eight percent % reported knowing studies on QoL and using their results in clinical practice or for research purposes; 29% reported knowing the SF-36 questionnaire; 30% stated that at least one study assessing QoL had been conducted in their department. Fourty-six percent % stated that QoL must influence much or very much diagnostic choices and an even higher percentage reported that QoL must influence much or very much therapeutic and palliative strategies (70.8% and 91.3%, respectively). Reported barriers to the use of QoL measures in clinical practice were related to time constraints (8.7%) but also to doubts on methodological issues of QoL (30.7%). The large majority of physicians (94.3%) would have used more expensive drugs if these could improve QoL. Conclusions: The present study shows that in a tertiary level academic italian hospital one third of the physicians, reported to know QoL measures and that more than 80% of them would like to use QoL in their daily clinical practice. Future studies are needed to identify the best strategies to implement the use of QoL measures in clinical practice

The role of dalbavancin in the multi-disciplinary management of wound infections in orthopaedic surgery.

Antimicrobial resistance is continuously increasing among bacterial clinical isolates (especially methicillin resistance in Staphylococcus aureus, MRSA), negatively impacting on outcomes of patients with Surgical Site Infections (SSIs). A multi-disciplinary team work is essential for SSIs prevention and for the choice of antibiotic therapy of orthopaedic SSIs. In particular, an Antibiotic Stewardship (AS) approach is recommended for preserving the activity of old and new antimicrobials. Dalbavancin is a novel antimicrobial agent, belonging to the lipoglycopeptides family, recently approved by FDA for the treatment of ABSSSIs (Acute Bacterial Skin and Skin Structure Infections) and can be considered as a candidate for the treatment of orthopaedic superficial SSIs. An antimicrobial activity directed against MRSA and other multi-resistant Gram-positive pathogens, a bactericidal effect and an extremely extended half-life are among key features of this drug. Dalbavancin gives to clinicians the option to provid..

Spontaneous vertebral aspergillosis, the state of art: a systematic literature review

Objective: Vertebral aspergillosis are quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy and, sometimes, surgical treatments. The present investigations was aimed to investigate epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis. Methods: A systematic review of the pertinent English Literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed and Scopus using as search-terms “Aspergillus”, “vertebral osteomyelitis”, “spondylodiscitis”, “spine infection”. A case of vertebral apsergillosis conservatively managed was also reported. Results: Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at last follow-up evaluation; in 7 (6.3%) patients radiological signs of chronic infection were reported, whereas 32 (28.8%) patients died during the follow-up. Conclusion: This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives and their outcomes

3D models acquisition and image processing for virtual musealization of the spezieria di Santa Maria della Scala, Rome

This study was carried out within the project 'Roma Hispana. Nuevas tecnologías aplicadas al estudio histórico, la musealización y la puesta en valor de Patrimonio Cultural español en Roma: la spezieria di Santa Maria della Scala' (Universitat de València Spain), which is funded by the Conselleria d'Innovació, Universitats, Ciència i Societat Digital of the Generalitat Valenciana (2020-2021) and authorized by the Sovrintendenza Speciale Archeologia Belle Arti e Paesaggio (Special Superintendence of Archeology, Fine Arts and Landscape) of Rome, Italy. The spezieria di Santa Maria della Scala was the oldest apothecary in Europe managed by the order of Discalced Carmelite friars. Operating between the second half of the seventeenth century and the mid-twentieth century, over time it acquired great prestige, becoming known as the Pharmacy of the Popes. The aims of the 'Roma Hispana' project are to study, musealize and disseminate the material and immaterial cultural heritage of this historical spezieria by combining physicochemical and cultural studies, new 3D technologies, and artificial intelligence. As a case study, in this paper we report the application of a laser scanner prototype for 3D color imaging of the spezieria's sales room and use a simpler photogrammetry method to collect analogous data in the small nearby storeroom coupled to the high-power capabilities of the ENEA parallel computer facility. Digital data were collected to enable a virtual tour that provides a fully navigable, faithful, high-resolution 3D color model to render this ancient Roman apothecary accessible and usable to interested members of the public and experts in the sector (art historians, restorers, etc.). We also describe the 3D technology used to obtain threedimensional images of the cultural assets of these spaces (mostly drug containers) and its results. The ultimate aim of this study is to achieve the virtual musealization of the heritage complex

New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years

Purpose: Pyogenic spondylodiscitis (PS) is still burdened by a high rate of orthopedic and neurological complications. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. The aim of this study was to propose a clinical-radiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm. Methods: Based on data from 250 patients treated from 2008 to 2015, a clinical-radiological classification of pyogenic spondylodiscitis was developed. According to primary classification criteria (bone destruction or segmental instability, epidural abscesses and neurological impairment), three main classes were identified. Subclasses were defined according to secondary criteria. PS without segmental instability or neurological impairment was treated conservatively. When significant bone loss or neurological impairment occurred, surgical stabilization and/or decompression were performed. All patients underwent clinical and radiological 2-year follow-up. Results: Type A PS occurred in 84 patients, while 46 cases were classified as type B and 120 as type C. Average time of hospitalization was 51.94 days and overall healing rate was 92.80%. 140 patients (56.00%) were treated conservatively with average time of immobilization of 218.17 ± 9.89 days. Both VAS and SF-12 scores improved across time points in all classes. Residual chronic back pain occurred in 27 patients (10.80%). Overall observed mortality was 4.80%. Conclusions: Standardized treatment of PS is highly recommended to ensure patients a good quality of life. The proposed scheme includes all available orthopedic treatments and helps spine surgeons to significantly reduce complications and costs and to avoid overtreatment

Letter: faecal microbiota transplantation in combination with fidaxomicin to treat severe complicated recurrent Clostridium difficile infection

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Dichiarazione ICRP sulle reazioni tissutali ed effetti immediati e tardivi delle radiazioni nei tessuti e negli organi normali - Dosi soglia per le reazioni tissutali nell’ambito della radioprotezione

La pubblicazione ICRP 118 riesamina gli effetti precoci e tardivi delle radiazioni ionizzanti nei diversi organi ed apparati e fornisce stime aggiornate sulle dosi soglia per l'induzione delle numerose reazioni tissutali analizzate. In particolare, a seguito dei progressi nelle conoscenze radiobiologiche e cliniche, pubblicati in numerosi testi specialistici, vengono dettagliatamente presentate le evidenze che hanno condotto alle modificazioni, rispetto alle Raccomandazioni ICRP 103/2007, nella individuazione delle dosi soglia per la induzione della cataratta e delle patologie del sistema circolatorio da parte delle radiazioni ionizzanti. A queste rilevanti considerazioni si affiancano gli approfonditi aggiornamenti sulle conoscenze radiobiologiche e cliniche e le integrazioni delle dosi soglia, individuate in modo più articolato rispetto alle precedenti pubblicazioni, per tutte le altre reazioni tissutali, che rendono questo documento un indispensabile strumento di lavoro e di analisi per tutti coloro che si occupano di radioprotezione, con particolare riferimento agli specialisti di radioprotezione medica. La traduzione in italiano dell’intero testo vuole facilitare la diffusione delle peculiari informazioni contenute nella pubblicazione e motivare una sempre più approfondita ricerca in questo settore che indubbiamente contribuisce a ridurre i rischi derivanti dall’esposizione alle radiazioni ionizzanti. La realizzazione della versione italiana di questa pubblicazione ha richiesto un notevole impegno qualitativo e quantitativo ed è stata possibile per il considerevole e qualificante contributo dei medici dell’AIRM e dei membri del Comitato Internazionale dell'AIRP. A tutti coloro che hanno collaborato alla sua traduzione, revisione e pubblicazione con notevole spirito di sacrificio, è rivolto l'apprezzamento e la riconoscenza delle nostre Associazioni, che riuniscono gli operatori attivi nei vari settori di interesse della radioprotezione

The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus

Objectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of > 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of 72 (87.5 %) included patients. Implant retention during follow-up was the same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %; pCombining double low line0.68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the sinus tract tended to close more often (42 % vs. 13 %; pCombining double low line0.14), and a higher resolution of pain was observed (35 % vs. 14 %; pCombining double low line0.22) in patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed

Performance evaluation of the (1,3)-\u3b2-D-glucan detection assay in non-intensive care unit adult patients

Objectives: To assess the performance of the (1,3)-\u3b2-D-glucan (BDG) detection assay in a large cohort of patients with suspected candidemia who were admitted to non-intensive care unit hospital wards. Methods: This observational, retrospective cohort study was conducted in a 1,100-bed university hospital in Rome, where an infectious disease consultation team has been operational. Two groups of patients were included in the analysis: Group 1, patients with Candida bloodstream infection (BSI) who had at least one BDG test performed \ub148 hours from the first positive blood culture (Candida BSI Group) and Group 2, patients with risk factors for candidemia who had at least one BDG test but had negative blood cultures (Control Group). Both Group 1 and Group 2 did not receive prior antifungal therapy. Different BDG cutoff values were considered: 80, 200, 300, 400, and 65500 pg/mL. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve were calculated. Results: A total of 1,296 patients were studied. Of them, 100 patients (candidemic) were in Group 1 and the remaining 1,196 patients (controls) were in Group 2. There were no differences in demographic characteristics between patients of the two groups. According to the above cutoff values, sensitivity (%) and specificity (%) of the BDG assay ranged from 91 to 60.7 and 87.7 to 97.8, respectively, whereas the PPV (%) and NPV (%) ranged from 38.2 to 68.3 and 99.1 to 97.0, respectively. Conclusion: Serum BDG has a very high NPV in a population with~10% prevalence of candidemia. This NPV may support decisions to discontinue antifungal therapy in those patients who were empirically treated because of the suspect of candidemia