Management of patients undergoing cataract surgery: An Italian survey

Purpose To investigate the management of patients undergoing cataract surgery in Italy. Setting Italian ocular surgeons, members of the Italian Association of Cataract and Refractive Surgery (AICCER), were invited to participate to this survey. Design Participants had to respond to a questionary including a series of practical questions concerning the management of patients undergoing cataract surgery. Methods A designed questionnaire explored the main issues concerning the practical problems involved in managing patients undergoing cataract surgery. The questionnaire was sent by e-mail and analyzed by descriptive statistics. Results Preoperative prophylaxis was performed by most surgeons. After surgery, several products were used, even simultaneously. Fixed antibiotic-corticosteroid combination (87.2%; 89) and NSAIDs (88.2; 90) were chosen as the most commonly used drug classes. The average duration of prescribed post-surgical therapies was more than two weeks for 52.9% (54) of participants, two weeks for 29.4% (30), and only one week for 5.9% (6). Conclusion This survey confirmed a discrete adherence to the main guidelines but at the same time highlights a discrete inhomogeneity in the use of medications, duration of treatments, and follow-up visits. For this reason, it is appropriate to continue updating and implementing the guidelines and educational pathways. This thought is consistent with the Precision Medicine approach. Every patient should be carefully evaluated to determine the best medication, dosage, and duration. A Personalized Medicine strategy is used on a single patient to optimize treatment clinical efficacy while minimizing side effects

Evidenze della comunicazione in sanità dagli USA: cosa ne possiamo ricavare?

Il presente contributo mostra le risultanze, emerse da una disamina della bibliografia di stampo statunitense, in tema di comunicazione sanitaria. Molti gli spunti di riflessione offerti, ma una cosa è certa: come per le altre procedure sanitarie, le abilità comunicative possono essere apprese e migliorate, anche se questo richiede impegno e pratica.The present article presents the outcomes highlighted by an examination of the US bibliography about the healthcare communication. Relevant food for thought is provided but one thing is certain: like for other healthcare procedures, communication skills can be learnt and improved, even if this needs commitment and practice

Expert consensus on the management of patients undergoing cataract surgery: A Delphi study

Purpose: To define the management of patients undergoing cataract surgery.Setting: Panel of experts on cataract surgery and members of the Italian Association of Cataract and Refractive Surgery (AICCER) participated in the Delphi study.Design: A restricted panel of experts defined the statements concerning the topic and identified a larger panel of experts who voted the statements. The statements concerned a series of practical issues concerning the management of patients undergoing cataract surgery.Methods: An initial web round-table served to develop the statements. The larger panel was constituted by 15 experts which anonymously voted the statements, presented in a web platform, using a 5-point Likert scale. Consensus was defined as at least 80% of agreement.Results: All participants completed the questionnaire. Globally, the total percentage of agreement of all statements was 90.4%. The total mean score was 4.5. Score 4 and score 5 accounted for the 27% and the 68% of the total votes, respectively.Conclusions: The participants felt they could largely agree with and approve the statements proposed by the board. In addition, the Delphi study identified some points that are highly shared and endorsed. In particular, a new model approach can be based on a seven-day course using a fixed high-potency corticosteroid combination with a broad-spectrum antibiotic. At the end of this cycle, the patient should be re-evaluated in some way to continue any treatment in the most appropriate and personalized way possible

The Management of Dry Eye Disease: Proceedings of Italian Dry Eye Consensus Group Using the Delphi Method

Dry eye disease (DED) is a highly prevalent, chronic and progressive condition that affects 5-33% of the world's adult population [...]

Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial

Background: The importance of lung recruitment before surfactant administration has been shown in animal studies. Well designed trials in preterm infants are absent. We aimed to examine whether the application of a recruitment manoeuvre just before surfactant administration, followed by rapid extubation (intubate-recruit-surfactant-extubate [IN-REC-SUR-E]), decreased the need for mechanical ventilation during the first 72 h of life compared with no recruitment manoeuvre (ie, intubate-surfactant-extubate [IN-SUR-E]). Methods: We did a randomised, unblinded, controlled trial in 35 tertiary neonatal intensive care units in Italy. Spontaneously breathing extremely preterm neonates (24 + 0 to 27 + 6 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 h of life were randomly assigned (1:1) with a minimisation algorithm to IN-REC-SUR-E or IN-SUR-E using an interactive web-based electronic system, stratified by clinical site and gestational age. The primary outcome was the need for mechanical ventilation in the first 72 h of life. Analyses were done in intention-to-treat and per-protocol populations, with a log-binomial regression model correcting for stratification factors to estimate adjusted relative risk (RR). This study is registered with ClinicalTrials.gov, NCT02482766. Findings: Of 556 infants assessed for eligibility, 218 infants were recruited from Nov 12, 2015, to Sept 23, 2018, and included in the intention-to-treat analysis. The requirement for mechanical ventilation during the first 72 h of life was reduced in the IN-REC-SUR-E group (43 [40%] of 107) compared with the IN-SUR-E group (60 [54%] of 111; adjusted RR 0·75, 95% CI 0·57–0·98; p=0·037), with a number needed to treat of 7·2 (95% CI 3·7–135·0). The addition of the recruitment manoeuvre did not adversely affect the safety outcomes of in-hospital mortality (19 [19%] of 101 in the IN-REC-SUR-E group vs 37 [33%] of 111 in the IN-SUR-E group), pneumothorax (four [4%] of 101 vs seven [6%] of 111), or grade 3 or worse intraventricular haemorrhage (12 [12%] of 101 vs 17 [15%] of 111). Interpretation: A lung recruitment manoeuvre just before surfactant administration improved the efficacy of surfactant treatment in extremely preterm neonates compared with the standard IN-SUR-E technique, without increasing the risk of adverse neonatal outcomes. The reduced need for mechanical ventilation during the first 72 h of life might facilitate implementation of a non-invasive respiratory support strategy. Funding: None

Assessing the status of amphibian breeding sites in Italy: a national survey

The ecological status of 203 amphibian aquatic breeding sites, selected from the national database of the Societas Herpetologica Italica (SHI), was surveyed in the period 2008-2009 to assess their ecological status. Sites were randomly extracted, after stratification by the three biogeographical regions present in Italy, besides Sardinia and Sicily. The field surveys, conducted by professionals, amateurs and volunteers, showed that since 1979 about 11% of the sites were destroyed or no more suitable for the reproduction of amphibians that bred in the same site in the past. The percentage of destroyed or altered sites was 8%, both in the Mediterranean and Alpine biogeographical regions, and 15% in the Continental one. However, there were no statistical significant differences among the regions, suggesting that the rate of amphibian site loss was similar in different parts of Italy. This nation-wide monitoring project demonstrated that in Italy, during the last thirty years, a relevant proportion of amphibian breeding habitats has been destroyed or altered. The main cause of site alteration were land reclamation and water extraction

Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian neonatal network

Introduction: Variation of respiratory care is described between centers around the world.The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. Methods:We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. Results: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. Conclusions. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement. \ua9 Mattioli 1885

Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian neonatal network

Introduction: Variation of respiratory care is described between centers around the world.The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. Methods:We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. Results: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. Conclusions. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement. © Mattioli 1885