Impact of the Implementation of a Trauma Center in a Level III University Hospital: A Single Center’s Experience

Purpose A trauma team (TT) is reported to improve the management and polytraumas outcome. To assess the impact on, the decision-making process in the execution of surgical and interventional procedures, trauma patient results were examined before and after TT introduction. Methods This was a non-randomized single-center retrospective study of major trauma patients who accessed our level III university hospital Shock Room (SR) in the 20 months prior to the establishment of the TT (preTT group) and in the following 20 months (postTT group). Results There were 947 patients (418 preTT, 529 postTT) admitted in the SR due to a traumatic event. Comparing the 2 periods, a significant decreases in time spent in SR (p = 0.008), Sequential Organ Failure Assessment score in the Intensive Care Unit (p = 0.027), and estimated blood loss in Operating Room (p = 0.003) was observed. A significant increase was observed in the number of days of assisted ventilation (p < 0.001), the number of Damage Control Surgery procedures (p = 0.008), and non-operative managements for splenic and liver injuries (p = 0.004). Conclusion A significant change in the type of surgical procedures performed and increase in the number of non-operative managements were observed in the period following the implementation of the computed tomography; this was particularly evident in splenic trauma management where a complete alignment with the World Society of Emergency Surgery guidelines recommendations was reached. These results demonstrated the management of traumatic pathology with a dedicated TT represents the best approach for polytraumas

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Burnout, Reasons for Living and Dehumanisation among Italian Penitentiary Police Officers

The literature on burnout syndrome among Penitentiary Police Officers (PPOs) is still rather scarce, and there are no analyses on the protective factors that can prevent these workers from the dangerous effect of burnout, with respect to the weakening of the reasons for living and de-humanization. This study aimed to examine the relationships between burnout, protective factors against weakening of the reasons for living and not desiring to die and the role of de-humanisation, utilising the Maslach Burnout Inventory (MBI); the Reasons for Living Inventory (RFL); the Testoni Death Representation Scale (TDRS); and the Human Traits Attribution Scale (HTAS), involving 86 PPOs in a North Italy prison. Results showed the presence of a high level of burnout in the group of participants. In addition, dehumanization of prisoners, which is considered a factor that could help in managing other health professional stress situations, does not reduce the level of burnout.</jats:p

Burnout, Reasons for Living and Dehumanisation among Italian Penitentiary Police Officers

The literature on burnout syndrome among Penitentiary Police Officers (PPOs) is still rather scarce, and there are no analyses on the protective factors that can prevent these workers from the dangerous effect of burnout, with respect to the weakening of the reasons for living and de-humanization. This study aimed to examine the relationships between burnout, protective factors against weakening of the reasons for living and not desiring to die and the role of de-humanisation, utilising the Maslach Burnout Inventory (MBI); the Reasons for Living Inventory (RFL); the Testoni Death Representation Scale (TDRS); and the Human Traits Attribution Scale (HTAS), involving 86 PPOs in a North Italy prison. Results showed the presence of a high level of burnout in the group of participants. In addition, dehumanization of prisoners, which is considered a factor that could help in managing other health professional stress situations, does not reduce the level of burnout

Preliminary Results on the Evaluation of Factors Influencing Evapotranspiration Processes in Vineyards

The paper summarizes the preliminary results from the analysis of data collected during the 2008 and 2009 vegetative seasons in a northern Italy vineyard (Vitis vinifera L., Barbera variety) and the simulations carried out in the same period with the land surface model UTOPIA. The aim of the work is to study the influence of the meteorological factors on the plant conditions. We collected a set of standard and advanced meteorological, physiological and physical data and we investigated the performance of UTOPIA in describing the different components of the energy and hydrological processes (in particular the evapotranspiration), with a special focus on the vegetation and soil. The comparison between observed data and UTOPIA simulations showed satisfactory results for the soil variables (RRMSE ranging between 15% and 40%, and correlation coefficients of 0.9). Net radiation and sensible heat fluxes RRMSE (30% and 63% respectively) suggest that both the calibration of the vegetation parameters (including the influence of the grass among vine rows) and the availability of more specific measurements are very important

Preliminary Results on the Evaluation of Factors Influencing Evapotranspiration Processes in Vineyards

The paper summarizes the preliminary results from the analysis of data collected during the 2008 and 2009 vegetative seasons in a northern Italy vineyard (Vitis vinifera L., Barbera variety) and the simulations carried out in the same period with the land surface model UTOPIA. The aim of the work is to study the influence of the meteorological factors on the plant conditions. We collected a set of standard and advanced meteorological, physiological and physical data and we investigated the performance of UTOPIA in describing the different components of the energy and hydrological processes (in particular the evapotranspiration), with a special focus on the vegetation and soil. The comparison between observed data and UTOPIA simulations showed satisfactory results for the soil variables (RRMSE ranging between 15% and 40%, and correlation coefficients of 0.9). Net radiation and sensible heat fluxes RRMSE (30% and 63% respectively) suggest that both the calibration of the vegetation parameters (including the influence of the grass among vine rows) and the availability of more specific measurements are very important

PPAR-gamma2 Pro12Ala variant is associated with greater insulin sensitivity in childhood obesity.

Several genetic variants of peroxisome proliferator-activated receptor-gamma2 (PPAR-gamma2), a molecule known to be involved in transcription of target genes, have been identified. Pro12Ala, a missense mutation in exon 2 of the gene, is highly prevalent in Caucasian populations. Conflicting conclusions about the association between this mutation and complex traits such as obesity, insulin sensitivity, and T2DM have been reported. We have investigated the association of PPAR-gamma2 Pro12Ala polymorphism with measures of insulin sensitivity in a population of Italian obese children (n = 200; mean age, 10.38 +/- 2.8 y) in whom clinical and biochemical analyses were performed. To estimate the insulin sensitivity status, the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated in all subjects. The effect of the Pro12Ala polymorphism on quantitative variables was tested using multiple linear regression analysis. The frequency of Ala carriers was 17%, similar to that reported in other adult Caucasian populations. The X12Ala (either Pro12Ala or Ala12Ala) genotype was associated with significantly lower fasting insulin levels compared with Pro/Pro (p = 0.008). Consistent with this finding, significantly lower HOMA-IR was observed in X12Ala carriers (p = 0.023). In conclusion, our observations demonstrate that the X12Ala variant is significantly associated with greater insulin sensitivity in childhood obesity. Because obesity is one of the most important risk factors for cardiovascular diseases and type 2 diabetes, obese children, who are presumably at a higher risk, may be protected from these diseases by the phenotypic effect of the Ala 12 allele on insulin resistance