Minerva medica
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Multicenter Study
Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy.
The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. ⋯ The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.
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Meta Analysis
Meta-analysis of diagnostic value of serum Carbohydrate antigen 199 in pancreatic cancer.
Carbohydrate antigen 199 (CA199) has been used as a new promising serum biomarker for the diagnosis of pancreatic cancer. But its utility was full of controversies. This study sought to determine the diagnosis value of serum CA199 in pancreatic cancer through enrolling all the related eligible studies. ⋯ The current analyses indicated that CA199 is a valuable marker in the diagnosis of pancreatic cancer.
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Growing evidence demonstrates that a number of clinical disorders may be related to genetic defects in telomeres replication and extensions. Overall, these syndromes are referred to as telomeropathies or telomeres disorders or syndromes; they are increasingly being identified. In adulthood, idiopathic pulmonary fibrosis (IPF) is the most common symptom of telomeropathy. ⋯ In a cohort of patients addressed to lung transplantation, authors were able to demonstrate that subclinical bone marrow and liver abnormalities can be seen in patients with interstitial lung disease (ILD) and short telomeres, in some cases in the absence of clinically significant abnormalities in peripheral blood count and liver function tests. This observation sustains the rationale for further studies aimed to validate telomere length testing as a useful parameter as part of the evaluation for transplant candidacy. A deeper clarification of the complex link between IPF and short telomeres and telomeropathies is required for a new ILD classification, aimed to a fullpersonalized approach to the disease.
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Ahead of Print article withdrawn by publisher.
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Deaths from lung cancer are greater than for any other type of malignancy. Many people present with advanced stage cancer at diagnosis and survival is limited. Low radiation dose CT (LDCT) screening appears to offer part of the solution to this. ⋯ Many of these questions are being answered by ongoing European trials that are reporting their findings. In this review we objectively analyse current research evidence and explore the issues that need to be resolved before implementation, including technical considerations, selection criteria and effective nodule management protocols. We discuss the potential barriers that will be faced when beginning a national screening programme and possible solutions to them.