Diagnostic stewardship based on patient profiles: differential approaches in acute versus chronic infectious

Introduction: New diagnostics may be useful in clinical practice, especially in contexts of high prevalence of multidrug-resistant organisms (MDRO). However, misuse of diagnostic tools may lead to increased costs and worse patient outcome. Conventional and new techniques should be appropriately positioned in diagnostic algorithms to guide an appropriate use of antimicrobial therapy.Areas covered: A panel of experts identified 4 main areas in which the implementation of diagnostic stewardship is needed. Among chronic infections, bone and prosthetic joint infections and subacute-chronic intravascular infections and endocarditis represent common challenges for clinicians. Among acute infections, bloodstream infections and community-acquired pneumonia may be associated with high mortality and require appropriate diagnostic approach.Expert opinion: Diagnostic stewardship aims to improve the appropriate use of microbiological diagnostics to guide therapeutic decisions through appropriate and timely diagnostic testing. Here, diagnostic algorithms based on different patient profiles are proposed for chronic and acute clinical syndromes. In each clinical scenario, combining conventional and new diagnostic techniques is crucial to make a rapid and accurate diagnosis and to guide the selection of antimicrobial therapy. Barriers related to the implementation of new rapid diagnostic tools, such as high initial costs, may be overcome through their rational and structured use

Consensus document on controversial issues in the diagnosis and treatment of prosthetic joint infections

Joint replacement surgery has been on the increase in recent decades and prosthesis infection remains the most critical complication. Many aspects of the primary prevention and clinical management of such prosthesis infections still need to be clarified

Linea Guida SIOT-- Prevenzione delle infezioni in chirurgia ortopedica

La prevenzione delle infezioni del sito chirurgico (ISC) costituisce una priorità nell’ambito degli obiettivi del Sistema Sanitario Nazionale. Le conseguenze negative che le infezioni postoperatorie comportano (morbilità, durata dell’ospedalizzazione, mortalità) rappresentano eventi particolarmente gravi sia per il singolo paziente sia per la collettività, in considerazione delle risorse assistenziali necessarie per trattarle. In un contesto sanitario globale nel quale si è affermata la medicina basata sulle prove di efficacia, cioè la evidence-based medicine (EBM), tutti gli interventi medici vanno riconsiderati alla luce di quanto desumibile dalla letteratura valutata secondo rigorosi criteri metodologici, a maggior ragione quando le prove sono disponibili e unanimemente condivise. L’obiettivo di questo documento è passare in rassegna le evidenze scientifiche desunte da Linee Guida (LG) accreditate e recenti riguardo le varie metodiche di prevenzione delle infezioni, al fine di stabilire quelle che presentano prove affidabili a sostegno e che meritano di essere condivise, implementate e che in definitiva rappresentano un indicatore della qualità dell’assistenza che siamo in grado di fornire ai nostri pazienti. La SIOT, al termine di un percorso complesso che ha coinvolto collaboratori di diverse specialità e ambiti professionali, ha prodotto la presente LG quale strumento valido e aggiornato per gestire al meglio la prevenzione delle ISC perioperatorie

Chapter 2. Skeletal health in Medieval societies: insights from stable isotopes and dental histology

With social and economic systems determining the structure and function of human groups come health repercussions that affect our longevity and quality of life. Consequently, skeletal disorders in the modern world are becoming increasingly problematic as populations experience ageing-driven changes in bone metabolism. Coupled with often poor quality nutrition and largely sedentary lifestyles, skeletal adaptation in contemporary populations is facing more challenges than ever before. As biological anthropologists attempt to understand the interwoven biological and cultural relationships influencing the ways in which we grow and adapt to our environments, the medical realm tackles bone fragility and fracture risk at a patient and society level. Human lifestyle as a research theme appears to unite bio-anthropological and medical queries into bone health