Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study

Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23–3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49–79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69–38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38–22.09). Conclusion Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. Trial registration Clinical trial registration number: NCT03354793

Innovation, technology and user experience in museums: insights from scientific literature

Museums play an important role in preserving the heritage and cultural legacy of humanity, however, one of their main weaknesses in regards the user is their static nature. At present, and in the face of the development of diverse technologies and the ease of access to information, museums have upgraded their implementation of technologies aimed at improving the user experience, trying more and more to access younger audiences with a sensitivity and natural capacity for the management of new technologies. This work identifies trends in the use of technological tools by museums worldwide and the effect of these on the user or visitor experience through a review of scientific literature. To complete the work, we performed a search of the publications in the Scopus® referencing database, and downloaded, processed, and visualized the data using the VOSviewer® tool. The main trends identified in this context of analysis are related to the role of museums with the development and improvement of the user experience; orientation to young audiences and innovation driven by the user through Interactive Systems, digital games, QR Codes, apps, augmented reality, virtual reality and gamification, among others. The objective of the implementation of new technologies in the context of museums is to satisfy the needs of contemporary communication, for all types of content and aimed at an increasingly digital audience, in order to ensure positive interaction and feedback from ideas with social and cultural changes

When more is not better: 10 'don'ts' in endometriosis management. An ETIC* position statement

41noETIC Endometriosis Treatment Italian ClubopenA network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.openAlio, L; Angioni, S; Arena, S; Bartiromo, L; Bergamini, V; Berlanda, N; Bonin, C; Busacca, M; Candiani, M; Centini, G; D’Alterio, M N; Di Cello, A; Exacoustos, C; Fedele, L; Frattaruolo, M P; Incandela, D; Lazzeri, L; Luisi, S; Maiorana, A; Maneschi, F; Martire, F; Massarotti, C; Mattei, A; Muzii, L; Ottolina, J; Perandini, A; Perelli, F; Pino, I; Porpora, M G; Raimondo, D; Remorgida, V; Seracchioli, R; Solima, E; Somigliana, E; Sorrenti, G; Venturella, R; Vercellini, P; Viganó, P; Vignali, M; Zullo, F; Zupi, EAlio, L; Angioni, S; Arena, S; Bartiromo, L; Bergamini, V; Berlanda, N; Bonin, C; Busacca, M; Candiani, M; Centini, G; D’Alterio, M N; Di Cello, A; Exacoustos, C; Fedele, L; Frattaruolo, M P; Incandela, D; Lazzeri, L; Luisi, S; Maiorana, Anna; Maneschi, F; Martire, F; Massarotti, C; Mattei, A; Muzii, L; Ottolina, J; Perandini, A; Perelli, F; Pino, Ida; Porpora, M G; Raimondo, D; Remorgida, V; Seracchioli, R; Solima, E; Somigliana, E; Sorrenti, G; Venturella, R; Vercellini, P; Vigano', Paola; Vignali, M; Zullo, F; Zupi,

Museums and the Digital Revolution: Gaming as an Audience Development Tool

This work opens with a brief reflection, of a general nature, on the relationship between museums and new digital technologies which, with specific reference to the Italian situation, is still too often difficult and extemporary. In this context, the article explores the experience conducted by the National Archaeological Museum of Naples which, in an innovative audience development perspective, launched a video game a few years ago. This experience, which was also very successful internationally, not only brought the museum closer to the world of gaming, but has also contributed to strengthen the idea that in order to activate relationships with new audiences it is sometimes necessary to boldly experiment with new solutions. In this perspective, the digital revolution currently underway offers new options, making it possible to use new languages

Le parole del museo

In una società come quella odierna, altamente dinamica e imprevedibile, il museo non può sottrarsi a una riflessione attenta e consapevole sul suo ruolo, attuale e futuro. Sono infatti molteplici e variegate le questioni che si pongono all’attenzione della Direzione di un museo, che si trova oggi a dover governare un’organizzazione sempre più complessa. Adottando una visione trasversale del settore museale, che attraversa gli ambiti del management, delle nuove tecnologie digitali e della sostenibilità, in questo volume Ludovico Solima approfondisce e mette in relazione tra loro 70 diversi argomenti: dall’accessibilità al videomapping, passando per il brand, il crowdfunding, l’intelligenza artificiale, la reputazione e il piano strategico. I numerosi rimandi tra le voci presenti all’interno del testo, come in un caleidoscopico gioco di rifrazioni, conferiscono unità interpretativa a uno scenario altrimenti confuso e frammentato. E proprio sulla base di questo scenario diventa possibile, per il lettore, individuare alcune delle principali criticità con le quali il museo dovrà confrontarsi nel corso dei prossimi anni