Nesfatin-1

In this article, we review on the current concepts about Nesfatin-1 as a new anti-obesity treatment and evaluate the existing issues in the context of this knowledge and the available literature. The intent is to enable clinicians to know Nesfatin-1 as a new anti-obesity treatment and make rational decisions based on this perspective as possible clinical application. Future research should seek to clarify whether Nesfatin-1 would be beneficial in the management of obesity

The effectiveness of computerized clinical guidelines in the process of care: a systematic review

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines have been developed aiming to improve the quality of care. The implementation of the computerized clinical guidelines (CCG) has been supported by the development of computerized clinical decision support systems.</p> <p>This systematic review assesses the impact of CCG on the process of care compared with non-computerized clinical guidelines.</p> <p>Methods</p> <p>Specific features of CCG were studied through an extensive search of scientific literature, querying electronic databases: Pubmed/Medline, Embase and Cochrane Controlled Trials Register. A multivariable logistic regression was carried out to evaluate the association of CCG's features with positive effect on the process of care.</p> <p>Results</p> <p>Forty-five articles were selected. The logistic model showed that Automatic provision of recommendation in electronic version as part of clinician workflow (Odds Ratio [OR]= 17.5; 95% confidence interval [CI]: 1.6-193.7) and Publication Year (OR = 6.7; 95%CI: 1.3-34.3) were statistically significant predictors.</p> <p>Conclusions</p> <p>From the research that has been carried out, we can conclude that after implementation of CCG significant improvements in process of care are shown. Our findings also suggest clinicians, managers and other health care decision makers which features of CCG might improve the structure of computerized system.</p

Postoperative Pulmonary Function in Open versus Laparoscopic Cholecystectomy: A Meta-Analysis of the Tiffenau Index

Background: Available scientific literature about open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) does not show univocal results in terms of postoperative pulmonary function. A meta-analysis was carried out to evaluate the postoperative pulmonary function after OC and LC focusing on the Tiffenau index. Methods: Electronic databases were consulted (Cochrane Library, Embase and Pubmed). Standardized mean difference (SMD) with 95% CI was calculated for the Tiffenau Index. The kappa test was performed to evaluate agreement between the reviewers regarding the quality of the selected studies. A sensitivity analysis was carried out to assess the robustness of our study. Heterogeneity among studies was tested by using a χ2 test at 0.05 significance level. A random effects model meta-analysis was performed. Results: Meta-analysis of the 13 articles included, resulted in a SMD of 53% (95% CI 0.04, 1.02) for the Tiffenau Index in favor of laparoscopic cholecystectomy. The χ2 test analysis showed the presence of heterogeneity among studies (Tiffenau index χ2 = 99.97, p = 0.03). The sensitivity analysis confirms the validity of our results. Conclusions: Postoperative pulmonary function is better preserved after laparoscopic cholecystectomy than open cholecystectomy

A measurement system to realize 3-D carotid occlusion measurement from 2-D conventional ultrasonography

A novel measurement system for the 3-D reconstruction of occlusions of the carotid artery is presented. The proposed system can be added onto a conventional diagnostic ultrasonographic system, so that it can be considered as an upgrade for preexisting equipments. It retrieves information from a set of ordinary 2-D ultrasound images and spatial sensors in order to build a 3-D representation of the vessel and of a possible occlusion and to extract measurements of important medical parameters from them. The geometrical modeling of carotid is dealt with. This paper is also concerned with a metrological characterization of the measurement procedure, including the development of a model for the estimation of the uncertainty according to international standards. Experimental results are also reported and discussed. © 2013 IEEE

Lo sviluppo della Day Surgery per il trattamento delle vene varicose in Italia: una analisi dell andamento nazionale e regionale

INTRODUZIONE: Le vene varicose (VV) rappresentano un importante impegno per il Sistema Sanitario Nazionale (SSN) a causa della elevata prevalenza di tale patologia: dal 2% al 76% (donne) e dal 2% al 56% (uomini) nelle diverse fasce di età. Lo sviluppo della chirurgia mini-invasiva consente, per casi selezionati, di effettuare il trattamento in regime di day surgery (DS), permettendo al SSN di risparmiare risorse ospedaliere. Il nostro studio analizza i ricoveri in DS per stripping delle VV a livello nazionale e nelle diverse regioni italiane nel periodo 1999-2005. MATERIALI E METODI: Sono stati selezionati i dati relativi al DRG 119 (legatura e stripping di vene) dal database del Ministero della Salute per il periodo dal 1999 al 2005. È stata calcolata la proporzione di interventi in DS in base all’anno, alla regione ed al tipo di struttura. RISULTATI: La proporzione di interventi in DS per legatura e stripping delle VV è passata dal 19.4% (95% CI=19.2-19.6) del 1999 al 58.9% (95% CI=58.6-59.2) del 2005, con una percentuale di interventi maggiore del 50% a partire dal 2003. Le aziende ospedaliere (69.4% IC95% 69.0%, 69.8%) ed i policlinici universitari (57.7% IC95% 56.9% , 58.6%) ricoverano in DS in proporzione maggiore rispetto alle case di cura accreditate (46.7% IC95% 46.2% 47.2%) e non accreditate (27.3% IC95% 25.3 , 29.3%). La proporzione di interventi in DS presenta un gradiente che diminuisce da Nord a Sud con il valore maggiore in Toscana (94.47% IC95% 93.9% , 95.0%) ed il valore minore in Sardegna (30.25% IC95% 28.0% , 32.5%). DISCUSSIONE: Lo sviluppo della DS per l’intervento di legatura e stripping delle VV è progredito in Italia con un certo ritardo rispetto al panorama internazionale, diventando il regime di scelta solo a partire dal 2003. È inoltre da sottolineare come sia presente una notevole diversità di comportamento a seconda del tipo di struttura sanitaria e di regione esaminata, probabilmente a causa di differenti decisioni a livello gestionale e politico