STRATEGIC AND VIRTUAL NETWORKS – A POSSIBLE INTEGRATION

One of the best known features of the Italian entrepreneurial system is undoubtedly the industrial district, a network of small and medium size enterprises; the object of this survey is to study the integration between the strategic network, identified by the relationship between the companies in a district, and the virtual Internet network.Industrial Districts; Net Economy; Shoes Maker Industry

Giant aortic arch aneurysm in elderly patient

Here we present you a Type II of Crawford classification aortic aneurysm. Our patient 89-year-old woman with history of hypertension, diabetes mellitus, smoking habits and polyposis of descending/sigmoid colon came to our attention for rectorrhagia, asthenia, dyspnoea and dizziness. A computer tomography exam revealed an aortic arch aneurysm, aortic ectasia at a level of aortic hiatus and infra-renal aortic aneurysmal dilation.In accord to aortic team meeting and patient decision, to refer this lady to medical therapy instead to surgery/hybrid treatment for age patient, comorbidities and high mortality relates to intervention. Aortic arch pathologies are unusual and their treatment is challenging.The aetiology of aortic arch diseases is congenital, chronic, post traumatic, inflammatory, infectious, mechanical and anastomotic, but most frequently is degenerative. Furthermore, the improvement in diagnostic imaging and the aging populations, aortic arch aneurysms have increasingly diagnosed.The incidence of aortic arch diseases is 10-11% and many patients were asymptomatic. Otherwise, many patients came to hospital with catastrophic, life-threatening events and urgent treatment is required. Despite the progress and new technologies have produced new therapeutic options for both cardiac and vascular surgeons is important to highlight the primary role of the aortic team, an interdisciplinary assessment, to find the best tailored treatment, both in acute and chronic setting, for the interest of each patient

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions