Current Trends in Volume and Surgical Outcomes in Gastric Cancer

Gastric cancer is ranked as the fifth most frequently diagnosed type of cancer. Complete resection with adequate lymphadenectomy represents the goal of treatment with curative intent. Quality assurance is a crucial factor in the evaluation of oncological surgical care, and centralization of healthcare in referral hospitals has been proposed in several countries. However, an international agreement about the setting of “high-volume hospitals” as well as “minimum volume standards” has not yet been clearly established. Despite the clear postoperative mortality benefits that have been described for gastric cancer surgery conducted by high-volume surgeons in high-volume hospitals, many authors have highlighted the limitations of a non-composite variable to define the ideal postoperative period. The textbook outcome represents a multidimensional measure assessing the quality of care for cancer patients. Transparent and easily available hospital data will increase patients’ awareness, providing suitable elements for a more informed hospital choice

Ecologia Digitale : Per una tecnologia a servizio di persone, società e ambiente

Il digitale è fisico. Questo libro spiega in che modo la rivoluzione digitale impatta su clima, ambiente, lavoratori e società. Un manifesto per il digitale sostenibile

Internal- vs external-connection single implants: A retrospective study in an italian population treated by certified prosthodontists

Purpose: The design of an implant connection that allows prosthetic suprastructures to be attached to implants has long been debated in the dental literature. The goal of this retrospective study was to evaluate the 5-year clinical results for a large number of single implants restored by certified prosthodontists in an attempt to establish whether different clinical outcomes could be detected for external- or internalconnection implants. Materials and Methods: All single implants with internal or external connections inserted in 27 private dental practices from January 1, 2003 to December 31, 2007 were evaluated. An initial statistical analysis was performed to describe the sample population at baseline and then to compare the two types of implant-abutment connection configurations and their clinical outcomes. All data were statistically analyzed with STATA12 (StataCorp). Results: Twenty-eight of the 85 active members of the Italian Academy of Prosthetic Dentistry (AIOP) participated in this study. The sample included 1,159 patients and 2,010 implants. Of the implants, 75 were dropped because there was no information about follow-up. Of the remaining implants, 1,431 (74.0%) were followed for at least 5 years, and 332 implants (17.2%) were followed for more than 8 years. Nearly 99% (98.9%) of the implants survived. The difference between the survival frequencies of the two types of implant-abutment connection configurations was not significant for each negative event (log-rank test, P > .05). There was no difference between the two types of implants regarding restoration fracture, implant screw loosening, and peri-implant disease. Conclusion: Within the limitations of this study, it can be suggested that there is no difference in clinical outcomes of single restorations joined to internal- or external-connection implants

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)