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

Extrahepatic cholangiocarcinoma: clinical features

Extrahepatic cholangiocarcinomas (E-CCAs), are hepatobiliary cancers with features of cholangiocyte differentiations, originating from extrahepatic biliary tree at the bifurcation of the hepatic ducts and also in the distal duct. E-CCAs represent the most common type of cholangiocarcinomas (CCAs) and are characterized by poor overall survival. The principal risk factors for E-CCAs are strictly related to geographic location. Jaundice is the most common physical sign at disease presentation. Other common more non-specific symptoms include hepatomegaly, right upper qudrant mass, weight loss, vomiting, nausea, diarrhoea, malaise and fatigue. Unlike intrahepatic CCA, an incidental asymptomatic presentation occurs in a small percentage of cases. This chapter evaluates the principal clinical features of E-CCAs, briefly discussing its specific risk factors

Progetto di Parco faunistico nel territorio compreso fra i Comuni di Cesate, Limbiate, Senago e Garbagnate nel Parco delle Groane, Milano

Pubblicato in: R. Monteleone, E la borghesia inventò lo zoo per celebrare la propria gloria, in “il moderno”, n.9, febbraio 1986; A. Bugatti, Lo zoo è morto. Facciamo un parco, in “Costruire”, n. 43, settembre 1986; T. Molinari, Saluti dallo Zoo (Milano), in “Abitare”, allegato “il verde” al n. 248, ottobre 1986; V. Vercelloni, (Una storia del giardino europeo) e il giardino a Milano, per pochi e per tutti, 1288-1945, L’Archivolto, Milano 1986

The Effect of Supplementing a Novel n-3 Polyunsaturated Fatty Acids Formulation Containing Schisandra chinensis Extract and Vitamin D3 to a Group of Elite Sport Athletes on Competition Related Stress, Anxiety and Self-confidence

Background. Competitive sport has the potential for high levels of stress and anxiety that may affect performance and increase the risk of injuries. While benefits of pre-training assumption of N-3 polyunsaturated fatty acids are well known, poor data are available on Schisandra chinensis. Schisandra chinensis is a medicinal plant in use in Chinese medicine which increases physical working capacity and affords a stress protective effect. Objectives. We tested, in an open pilot study, the effect on competition related stress, anxiety and self-confidence of a novel formulation containing: PUFAs, Schisandra chinensis extract and vitamin D3. Methods. A novel formulation containing N-3 polyunsaturated fatty acids (PUFAs), Schisandra chinensis extract and vitamin D3, five ml per day was administered to one group of fifteen elite sport athletes (basketball players). Competitive State Anxiety Inventory-2 (CSAI-2) tests were administered at baseline and after 3 months. Results. All subjects completed the 3 months period of the study, all declaring a consumption >75% of daily recommended dose. No adverse event were registered. After intervention, the median cognitive state anxiety score remained mild (score 16) even if with an overall statistically significative decrease (p=0.005); same results were registered after intervention for the somatic state anxiety score (score 16) with an overall statistically significative decrease (p=0.008) and for the self-confidence score (score 22, range 15-30) with an overall statistically significative increase (p=0.008). Conclusion. The results showed the positive effect of the treatment on the control of stress and anxiety and the improvement of self-confidence in a large majority of the subject enrolled. However, further studies are needed to confirm our findings

Attachment and mentalizing abilities in patients with inflammatory bowel disease

Background. Inflammatory bowel diseases (IBD) are associated with stress, poor quality of life, and attachment insecurity. Mentalization is the human ability to perceive and reason about feelings and psychological dispositions of one's self and others. The chronic disorders are believed to affect patients' mentalizing abilities and to determine a shift towards attachment insecurity in patients affected. In this study, the attachment dimensions and mentalization were assessed in IBD patients and healthy controls. Further knowledge about the interplay among IBD, mentalization, and attachment might shed more light into the psychopathological mechanisms leading to insecurity and vulnerability to stress in IBD. Methods. A group of 96 IBD patients and 102 healthy controls completed the attachment style questionnaire (ASQ), the reflective functioning questionnaire (RFQ), and the Eyes test, a performance-based measure of mentalization. Results. Compared to controls, IBD patients have shown more pronounced attachment anxiety and lower scores in the Eyes test. Disease activity was negatively correlated with the Eyes test scores. Conclusion. These findings have suggested a plausible impact of IBD on mentalization abilities and have provided new insights into the interplay between IBD, deficits in mentalization, and attachment insecurity. IBD patients are highly vulnerable to disease-related stress that may promote impairments in mentalization. Low mentalization might play a central role in the development of attachment insecurity and emotional disturbances in IBD. The present study's results might open new scenarios for psychodynamic approaches to the treatment of the emotional disturbances in IBD based on attachment and mentalization theory