Recenti progressi in medicina
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The management of chronic pain still represent a challenge for physicians. Opioids are the main stem in the treatment of chronic severe pain, not only for their potency, but as they act as central drugs. The main limit to their utilization in clinical practice is the prevalence of side effects, in particular in the gastrointestinal tract, whose constipation represents the most common. ⋯ In the case of TAP PR, instead, 0.31 QALYs were gained with additional savings due to the reduction of drug side effects, hospitalizations and emergency department access. Therefore, the use of TAP PR implies an average saving of € 31.6 per patient. These data are the results of a pharmacoeconomic model and require a further validation in clinical practice.
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"Rare" diseases are a family of different disorders or conditions affecting fewer than 1/2000 in the general population. Among them, 150 involve respiratory system. ⋯ The aim of our review is to describe a possible global approach to the management of these diseases trying to take a picture of the overall complexity of the field. We also want to highlight the role played by research on rare diseases pathogenesis in revealing, at least in part, mechanisms underlying many of "more common" disorders with the purpose to update the current state of knowledge.
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The effectiveness of the World Health Organization's (WHO) surgical safety checklist (SSCL) in decreasing mortality and morbidity of surgical procedures was firstly suggested in 2009; the checklist is now strongly recommended internationally for adoption as a highly effective yet economically simple intervention. However, since 2009 several published studies have reported inconsistent results, besides many issues concerning local implementation. Drawing on the recently published experience carried out in Ontario, a concise overview of the current debate is presented, with some comments on implications for the national healthcare system in Italy. More generally, the need to include the implementation of the SSCL in a larger effort addressing safety in surgery is pointed out.
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For the past decade decision makers worldwide have endorsed the use of neuraminidase inhibitors. They spent billions of pounds stockpiling the two anti-influenza drugs oseltamivir and zanamivir from the mid-2000s as part of a global effort to be prepared for an influenza pandemic. When the H1N1 pandemic emerged in 2009 the drugs were rolled out around the globe for treatment and prevention of influenza and its complications. ⋯ What should have been a routine review got complicated as the validity of a key study that underpinned the evidence on efficacy was unclear. Our three and half year battle for data has resulted in the drug manufacturers providing us with full clinical study reports and unveiled a story in which no party has taken full responsibility for ensuring the validity of the evidence underlying its decisions. We hope that the publication of our systematic review of the trials, alongside all the source clinical study reports, will change the way such decisions are made.
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Pain is one of the most frequent symptom in elderly people with dementia and despite of this, it is still under-acknowledged and under-treated. The best approach to pain assessment is to evaluate it with the most appropriate scale. While in the elderly suffering mild-moderate cognitive impairment, it's possible to use self-report scales, in the elderly with severe cognitive impairment the use of observational scales is recommended. ⋯ All keywords were linked using AND and OR boolean operators. Altogether 5 self-report scales and 17 observational scales were retrieved, 7 of which available in Italian validated versions. The review analyzes potential and limitations of each assessment tool, in order to assist the clinician to make the most appropriate choice when using it in health care contexts.