"SOTTOVENTO". I TRAFFICI VENEZIANI CON LA SPONDA OCCIDENTALE DEL MEDIO-BASSO ADRIATICO

Η βάση της εμπορικής ισχύος της Γαληνότατης, όχι λιγότερο από την πολιτικήκαι τη στρατιωτική ισχύ, εδραιωνόταν στον έλεγχο της Αδριατικής, όπου οι εμπορικέςτης δραστηριότητες διεξάγονταν με πυκνότητα και συνέχεια αρκετά μεγαλύτερεςαπ' ότι εκείνες που γίνονταν σε περισσότερο μακρινές περιοχές. Διαφορετικάαπό την ανατολική ακτή, όπου οι στρατηγικές απαιτήσεις την οδήγησαν ναεγκαθιδρύσει μια άμεση κυριαρχία, στη δυτική - στη λεγόμενη «υπήνεμη ζώνη»(sottovento) - η Βενετία περιορίστηκε να ασκήσει έμμεσο έλεγχο μέσω διμερώνσυμφωνιών που ενσωμάτωναν τα ναυτικά κέντρα της κεντρικής και νότιας Ιταλίαςστη δική της σφαίρα επιρροής.Αυτά τα κέντρα ήταν συνδεμένα μεταξύ τους με ένα μικρό εμπόριο ακτοπλοΐας,που μόλις ανταποκρινόταν στην έλλειψη χερσαίων οδών επικοινωνίας.Αποκομμένα από τις μεγάλες μεσογειακές γραμμές, χρησιμοποιήθηκαν ως τόποιπρομήθειας αγροτικών προϊόντων για τη βενετική αγορά και εισαγωγής ειδών μεταποίησης(υφάσματα, υαλικά, σιδηρουργικά).Στη φάση της παρακμής, μπροστά στην αναπόφευκτη αναπροσαρμογή του διεθνούςοικονομικού της ρόλου, η Βενετία επιχείρησε να υπερασπιστεί τον αδριατι-κό εμπορικό χώρο, που τον απειλούσαν τα «ελεύθερα λιμάνια» της Αγκώνας καιτης Τεργέστης, εγκαθιδρύοντας ένα προνομιακό τελωνειακό σύστημα: τη «υπήνεμηδιαμετακόμιση» (transito sottevento). Η λογική που ήθελε τη δημιουργία τουνέου τελωνείου ήταν εκείνη που ευνοούσε τη διοχέτευση προς το λιμάνι της Βενετίαςκαι από εκεί προς τους απώτερους προορισμούς της «υπήνεμης ζώνης» τωνπροερχόμενων από τη Γερμανία και από τη βενετική ενδοχώρα εμπορευμάτων,που απειλούσαν ότι θα έπαιρναν δρόμους περισσότερο ανταγωνιστικούς.Χάρη στις απαλλαγές που προβλέπονταν από το νέο τελωνειακό καθεστώς, αυτάτα εμπορεύματα και κυρίως τα «σιδηρουργικά» (ferrarezze) της Καρινθίας συνέχισαννα τροφοδοτούν ένα αρκετά σημαντικό εμπόριο με τις ιταλικές περιοχές τηςκεντρικής και νότιας ζώνης της Αδριατικής. Οι βενετικές επανεξαγωγές δημιουργούσαν«φορτία επιστροφής» όχι πια αναγκαία για τη διαβίωση, αφού αυτή, τον 18οαιώνα, εξασφαλιζόταν με τη γεωργική ανάπτυξη της ενδοχώρας, αλλά ωστόσο πάντοτεπολύτιμα για τη διατήρηση του χαρακτήρα της πόλης ως εμπορικού κέντρου

Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life : study protocol for a phase 3 cluster randomized controlled trial

Background: The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life. Methods and design: A cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life. Discussion: This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care

"SOTTOVENTO". I TRAFFICI VENEZIANI CON LA SPONDA OCCIDENTALE DEL MEDIO-BASSO ADRIATICO

Η βάση της εμπορικής ισχύος της Γαληνότατης, όχι λιγότερο από την πολιτικήκαι τη στρατιωτική ισχύ, εδραιωνόταν στον έλεγχο της Αδριατικής, όπου οι εμπορικέςτης δραστηριότητες διεξάγονταν με πυκνότητα και συνέχεια αρκετά μεγαλύτερεςαπ' ότι εκείνες που γίνονταν σε περισσότερο μακρινές περιοχές. Διαφορετικάαπό την ανατολική ακτή, όπου οι στρατηγικές απαιτήσεις την οδήγησαν ναεγκαθιδρύσει μια άμεση κυριαρχία, στη δυτική - στη λεγόμενη «υπήνεμη ζώνη»(sottovento) - η Βενετία περιορίστηκε να ασκήσει έμμεσο έλεγχο μέσω διμερώνσυμφωνιών που ενσωμάτωναν τα ναυτικά κέντρα της κεντρικής και νότιας Ιταλίαςστη δική της σφαίρα επιρροής.Αυτά τα κέντρα ήταν συνδεμένα μεταξύ τους με ένα μικρό εμπόριο ακτοπλοΐας,που μόλις ανταποκρινόταν στην έλλειψη χερσαίων οδών επικοινωνίας.Αποκομμένα από τις μεγάλες μεσογειακές γραμμές, χρησιμοποιήθηκαν ως τόποιπρομήθειας αγροτικών προϊόντων για τη βενετική αγορά και εισαγωγής ειδών μεταποίησης(υφάσματα, υαλικά, σιδηρουργικά).Στη φάση της παρακμής, μπροστά στην αναπόφευκτη αναπροσαρμογή του διεθνούςοικονομικού της ρόλου, η Βενετία επιχείρησε να υπερασπιστεί τον αδριατι-κό εμπορικό χώρο, που τον απειλούσαν τα «ελεύθερα λιμάνια» της Αγκώνας καιτης Τεργέστης, εγκαθιδρύοντας ένα προνομιακό τελωνειακό σύστημα: τη «υπήνεμηδιαμετακόμιση» (transito sottevento). Η λογική που ήθελε τη δημιουργία τουνέου τελωνείου ήταν εκείνη που ευνοούσε τη διοχέτευση προς το λιμάνι της Βενετίαςκαι από εκεί προς τους απώτερους προορισμούς της «υπήνεμης ζώνης» τωνπροερχόμενων από τη Γερμανία και από τη βενετική ενδοχώρα εμπορευμάτων,που απειλούσαν ότι θα έπαιρναν δρόμους περισσότερο ανταγωνιστικούς.Χάρη στις απαλλαγές που προβλέπονταν από το νέο τελωνειακό καθεστώς, αυτάτα εμπορεύματα και κυρίως τα «σιδηρουργικά» (ferrarezze) της Καρινθίας συνέχισαννα τροφοδοτούν ένα αρκετά σημαντικό εμπόριο με τις ιταλικές περιοχές τηςκεντρικής και νότιας ζώνης της Αδριατικής. Οι βενετικές επανεξαγωγές δημιουργούσαν«φορτία επιστροφής» όχι πια αναγκαία για τη διαβίωση, αφού αυτή, τον 18οαιώνα, εξασφαλιζόταν με τη γεωργική ανάπτυξη της ενδοχώρας, αλλά ωστόσο πάντοτεπολύτιμα για τη διατήρηση του χαρακτήρα της πόλης ως εμπορικού κέντρου

Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs) and effectiveness

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life

Pelvic Organ Prolapse Repair with and without Concomitant Burch Colposuspension in Incontinent Women: A Randomised Controlled Trial with at Least 5-Year Followup

The aim of this study was to reevaluate and update the followup of a previously published randomized controlled trial (RCT) on the impact of Burch Colposuspension (BC), as an anti-incontinence procedure, in patients with UI and POP, who underwent POP repair. Forty-seven women were randomly assigned to abdominal POP repair and concomitant BC (24 patients; group A) or POP repair alone without any anti-incontinence procedure (23 patients; group B). Median followup was 82 months (range 60–107); from over 47 patients, 30 reached 6-year followup. Two patients were lost at followup. In group A, 2 patients showed a stage I rectocele. In group B, 2 patients had a stage I rectocele and 1 a stage II rectocele. In group A, 13/23 (56.5%) were still incontinent after surgery compared with 9/22 patients (40.9%) in group B (P = 0.298). No significant changes were observed between the first and the current followup. The update of long-term followup confirmed that BC did not improve outcome significantly in incontinent women when they undergo POP repair

Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC)

<p>Abstract</p> <p>Background</p> <p>The palliative services and programs have been developed with different intensity and modalities in all countries. Several studies have reported that a geographic variation in the availability and provision of palliative care services between and within countries exists, and that a number of vulnerable groups are excluded from these services. This survey estimates the distribution of places of care for Italian cancer patients during the last three months of their lives, the proportion receiving palliative care support at home and in hospital, and the factors associated with the referral to palliative care services.</p> <p>Methods</p> <p>This is a mortality follow-back survey of 2,000 cancer deaths identified with a 2-stage probability sample, representative of the whole country. Information on patients' experience was gathered from the non-professional caregiver through an interview, using an adapted version of the VOICES questionnaire. A section of the interview concerned the places of care and the palliative care services provided to patients. Multivariate logistic regression analyses were conducted to identify the determinants of palliative care service use.</p> <p>Results</p> <p>Valid interviews were obtained for 67% of the identified caregivers (n = 1,271). Most Italian cancer patients were cared for at home (91%) or in hospital (63%), but with substantial differences within the country. Only 14% of Italian cancer patients cared for at home against 20% of those admitted to hospital, received palliative care support. The principal determinants identified for receiving these service were: an extended interval between diagnosis and death (P = 0.01) and the caregiver's high educational level (P = 0.01) for patients at home; the low patient's age (P < 0.01) and the caregiver's high educational level (P = 0.01) for patients in hospital.</p> <p>Conclusion</p> <p>In Italy palliative care services are not equally available across the country. Moreover, access to the palliative care services is strongly associated with socio demographic characteristics of the patients and their caregivers. Italian Policy-makers need to equalise palliative care provision and access across the country to meet the needs of all cancer patients.</p

Ki-67 Labeling Index in Primary Invasive Breast Cancer from Sudanese Patients: A Pilot Study

Ki-67 labeling index has been linked to patient outcome in breast cancer patients. However, very few published reports have examined Ki-67 labeling index in African breast cancer patients. Sixty-two Sudanese breast cancer patients with primary invasive tumors were immunostained for Ki-67, ER, PR, Her-2/neu, CK5/6, and CK17. Ki-67 labeling index ranged from 0% to 50%, with a median of 5% (interquartile range 0–10). Low Ki-67 labeling index (immunostaining < 10%) was detected in 43/62 (69.4%) with a median of 0 (interquartile range 0–5), whereas high Ki-67 labeling index (immunostaining ≥ 10%) was revealed in 19/62 (30.6%) with a median of 20 (interquartile range 12–26). Ki-67 labeling index was significantly associated with tumor grade (P=0.022, Mann-Whitney U Test). There were no significant group differences between Ki-67 labeling index and ER (P=0.43), PR (P=0.7), Her-2/neu (P=0.45), CK5/6 (P=0.29), CK17 (P=0.55), pathologic stage (P=0.4), tumor histology (P=0.99), breast cancer subtypes (P=0.47), tumor size (P=0.16), and age at diagnosis (P=0.6). These results suggested that Ki-67 labeling index correlates with tumor differentiation and not with the tumor size or any other tested marker in Sudanese breast cancers. Thus, Ki-67 labeling index could be considered as a reliable measure of tumor proliferative fraction in Sudan

Ki-67 Labeling Index in Primary Invasive Breast Cancer from Sudanese Patients: A Pilot Study

Ki-67 labeling index has been linked to patient outcome in breast cancer patients. However, very few published reports have examined Ki-67 labeling index in African breast cancer patients. Sixty-two Sudanese breast cancer patients with primary invasive tumors were immunostained for Ki-67, ER, PR, Her-2/neu, CK5/6, and CK17. Ki-67 labeling index ranged from 0% to 50%, with a median of 5% (interquartile range 0–10). Low Ki-67 labeling index (immunostaining < 10%) was detected in 43/62 (69.4%) with a median of 0 (interquartile range 0–5), whereas high Ki-67 labeling index (immunostaining ≥ 10%) was revealed in 19/62 (30.6%) with a median of 20 (interquartile range 12–26). Ki-67 labeling index was significantly associated with tumor grade (P=0.022, Mann-Whitney U Test). There were no significant group differences between Ki-67 labeling index and ER (P=0.43), PR (P=0.7), Her-2/neu (P=0.45), CK5/6 (P=0.29), CK17 (P=0.55), pathologic stage (P=0.4), tumor histology (P=0.99), breast cancer subtypes (P=0.47), tumor size (P=0.16), and age at diagnosis (P=0.6). These results suggested that Ki-67 labeling index correlates with tumor differentiation and not with the tumor size or any other tested marker in Sudanese breast cancers. Thus, Ki-67 labeling index could be considered as a reliable measure of tumor proliferative fraction in Sudan

Tumori dell’intestino tenue: nostra esperienza in urgenza

I tumori dell’intestino tenue sono neoplasie relativamente rare. Sintomi di natura aspecifica ed esami diagnostici di basse sensibilità e validità sono complessivamente responsabili di una diagnosi ritardata e, in caso di malignità, di malattia spesso avanzata e per lo più incurabile con l’intervento. Uno studio retrospettivo è stato effettuato in 42 casi con presentazione clinica di acuzie, dal 1972 al 2001; l’età media dei pazienti è stata di 52 anni (range 14-79 anni); c’è stata una lieve prevalenza del sesso femminile (57.1% vs 42.9%). La presentazione acuta più comune è stata l’occlusione (57.1%), seguita da sanguinamento gastrointestinale (23.8%), perforazione (14.3%) e occlusione/perforazione (4.8%). I tumori benigni si sono presentati nel 38.1% (16 casi), l’adenoma rappresenta il tipo più comune; le forme maligne sono state il 61.9% (26 casi), l’adenocarcinoma e i linfomi rappresentano l’istotipo più comune. La chirurgia radicale è stata possibile solo nel 57% delle forme maligne (24 pazienti): la morbidità è stata del 4.8% (2 casi: 1 deiscenza anastomotica e 1 ascesso subfrenico); la mortalità è stata del 14.3%. Dal nostro studio retrospettivo possiamo affermare che la sopravvivenza per le lesioni maligne è strettamente dipendente dalla precocità della diagnosi TNM e dalla possibilità di una procedura chirurgica radicale, prima che la lesione diventi non resecabile, come è accaduto nel 42% dei nostri casi. Un indice di sospetto estremamente elevato nella valutazione di sintomi, spesso aspecifici, integrato con studi diagnostici specifici, potrebbe rappresentare l’approccio più appropriato. La prognosi per le forme benigne è invece eccellente in tutti i casi