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Diagnostic and therapeutic appropriateness in different stages of esophageal/GEJ cancers. The FICOG project
No full textBackground: Esophageal cancer is a rare neoplasm, with more than 0.6 million new cases and 0.54 million deaths worldwide in 2020. The distal third of the esophagus and the gastroesophageal junction (GEJ) are mostly involved sites. The diagnosis and therapeutic management of early, locally advanced, and metastatic disease continue to present uncertainties, as existing guidelines may not fully address all clinical questions in these areas. Methods: A group of Italian Experts produced recommendations for early, locally advanced, and metastatic disease management using the RAND/UCLA Appropriateness Method. Statements were generated by a systematic revision of the literature and voted on twice by a panel of 29 expert physicians; the second vote took place during a meeting of the panelists. Results: Several topics covered diagnosis, staging, treatment, and early, localized, and metastatic disease management. Recommendations were stated. Conclusions: Interventions considered appropriate to improve compliance and outcomes of esophageal/GEJ cancer patients were identified
Robotic Single-Port Versus Robotic Single-Site Hysterectomy in Early Endometrial Cancer: A Case Control Study
No full textObjective To compare surgical outcomes of robotic single-port (RSPH) versus single-site (RSSH) hysterectomy in early-stage endometrial cancer.Methods This is a retrospective case-control study, comparing surgical outcomes of RSPH (Cases) and RSSH (Controls) in early-stage endometrial cancer.Results Twenty-five women who underwent RSPH from June 2024 to November 2024 were matched with 50 historical RSSH controls treated at the same institution by the same surgical team between December 2011 and September 2014. Operation time was similar: 110 min in RSPH and 99 min in RSSH (p = 0.76). Blood loss was 50 mL in RSPH and 60 mL in RSSH (p = 0.14). Hospital stay was shorter in RSSH (3.5 days in RSPH and 3 days in RSSH, p = 0.001).Conclusions Our study confirms the safety and feasibility of RSPH for endometrial cancer without major differences from the RSSH in terms of surgical outcomes
Impact of nursing robotic assisted surgery education on Kirkpatrick's four levels
No full textIntroduction As the robotic surgical burden of diseases increases, the development of skilled surgeons and nursing surgery teams is of fundamental importance. The Kirkpatrick Model is a widely recognised evaluation framework that helps educators assess the impact and effectiveness of educational interventions. However, there is little evidence regarding the effectiveness of robotic surgical training programmes for nursing teams. The study aimed to develop an organisational improvement model to identify the profile of a nurse expert in Robotic Assisted Surgery (RAS) and to define a suitable training programme according to Kirkpatrick's evaluation levels. The model also aimed to increase the number of active robotic rooms while maintaining the same number of staff.Methods From January 2023 to December 2024, a single hospital institution developed an organisational improvement project consisting of the following steps:- Identification of the catalogue of competences of the nurse expert in RAS, using the contributions of personnel already active in this field;- Mapping of competences;- Start of a training programme, evaluated according to the Kirkpatrick model;- Remapping of competences at the end of the training;- Gradual increase in the number of active robotic operating theatres by 2024.Results A total of 58 operating room nurses, including the 15 experienced nurses already on staff, had their competencies mapped. At the end of the training programme, 81% of these nurses had achieved the level of competency required to operate a robotic operating room independently, resulting in an overall increase of 154% in the number of active robotic operating rooms per week.Discussion Detailed planning of training activities dedicated to existing operating theatre nurses, eliminating the need for additional recruitment, together with periodic monitoring of newly acquired skills, has enabled the number of active robotic operating theatres to increase, significantly impacting the company's organisational model
Mining Impersonification Bias in LLMs via Survey Filling
Get PDFIn this paper, we introduce a survey-based methodology to audit LLM-generated personas by simulating 200 US residents and collecting responses to socio-demographic questions in a zero-shot setting. We investigate whether LLMs default to standardized profiles, how these profiles differ across models, and how conditioning on specific attributes affects the resulting portrayals. Our findings reveal that LLMs often produce homogenized personas that underrepresent demographic diversity and that conditioning on attributes such as gender, ethnicity, or disability may trigger stereotypical shifts. These results highlight implicit biases in LLMs and underscore the need for systematic approaches to evaluate and mitigate fairness risks in model outputs
Management of neuropathic pain: a survey of the Italian Association for the Study of Pain
Get PDFBACKGROUND: Neuropathic pain significantly impacts the quality of life. This study explores neuropathic pain management practices among members of the Italian Association for the Study of Pain (AISD). METHODS: During the 46th National Congress, 240 physicians affiliated with AISD were surveyed. The data included demographics, clinical settings, diagnostic procedures, treatment approaches, and preferences. The analysis utilized descriptive statistics, treatment rankings, and consensus evaluations. RESULTS: Respondents practicing in pain medicine reported the numbers of cases managed monthly. Neuropathic pain diagnoses relied on clinical findings corroborated by diagnostic tools. Treatment typically commenced within one to two weeks, emphasizing pharmacological interventions, which were often combined with invasive procedures. The leading pharmacological choices included gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Varied rankings were noted for invasive procedures, with nerve and neuraxial blocks particularly favored. Nutraceuticals such as palmitoylethanolamide, alpha-lipoic acid, and vitamin B complex were commonly prescribed, reflecting differences based on the physician's age and specialty. CONCLUSIONS: Generally, practices aligned with guidelines, showing a strong consensus on specific pharmacological treatments. Discrepancies in the rankings of invasive procedures, particularly among specialists, have led to questions regarding their perceived efficacy. These inconsistencies may indicate varying levels of expertise in interventional management, differences in the availability of these techniques, or different views on the current evidence supporting these procedures. The use of nutraceuticals indicated potential gaps in the guidelines
Clinical and genetic landscape of epilepsies with absence seizures and single‐gene etiology
No full textObjective To characterize the clinical, electroencephalographic, and genetic features of epilepsies featuring absence seizures within monogenic etiology, highlighting the diagnostic, treatment and prognostic implications.Methods We conducted a retrospective, multicenter study including patients with monogenic epilepsies and electroencephalography (EEG)-documented absence seizures. We analyzed clinical data, electroclinical findings, neurodevelopmental outcomes, and treatment responses through standardized questionnaires and medical records. We classified genetic variants according to American College of Medical Genetics and Genomics (ACMG) guidelines and performed univariate and multivariate analyses to identify predictors of developmental outcomes.Results We included 160 patients (111 female; median age at last follow-up: 13 years) with absence seizures and confirmed pathogenic or likely pathogenic monogenic variants. The most frequently implicated genes were SLC2A1, SLC6A1, SYNGAP1, CHD2, and SCN1A. Four genes-HESX1, NCKAP1, SON, STARD9-had not been previously associated with absence seizures. In 35% of patients, absence seizures were the only seizure type and in 67% were the initial manifestation. Atypical features included irregular EEG discharges (56%) eyelid myoclonia (42%), and automatisms (33%). Early-onset (before age 3) seizures occurred in 58% and was significantly associated with atypical features (p < .03). Using existing International League Against Epilepsy (ILAE) epilepsy syndrome classification, 60% of patients could not be classified. Developmental delay occurred in 54%, intellectual disability in 65%, and other neurodevelopmental comorbidities in 49%. Predictors of poor developmental outcomes included early developmental delay, drug-resistant epilepsy, and early absence onset. We found no difference in the prevalence of drug resistance across the various genetic etiologies. The most effective medications for absence seizures included valproate, ethosuximide, benzodiazepines, and lamotrigine. Disease-specific therapies (e.g., ketogenic diet in SLC2A1, stiripentol/fenfluramine in SCN1A) were effective in select cases.Significance Absence seizures are a common manifestation of different monogenic epilepsies, often associated with early onset, atypical clinical and/or EEG features, developmental delay or drug resistance. Classification models should incorporate genetic data alongside electroclinical features, especially as next-generation sequencing is increasingly used
Temporality and lifelong education and learning
Get PDFThis editorial’s principal line of argument is based on the premise that the temporal aspects of lifelong education and learning have profound implications for adult education theory, methods, and practices (ESREA, Citation2024). Evidently, more focus – and more time – should be given to analytically incorporating temporality within the field of lifelong education and learning scholarship. Temporality is generally understood in two ways (1) as objective and (2) subjective (Alhadeff-Jones, Citation2017; Decuypere & Vanden Broeck, Citation2020; Frank et al., Citation2024). Although we must be careful not to distract ourselves with binary thinking and the traps of either/or dichotomies, as Alhadeff-Jones (Citation2017) outlines, understandings of time have shaped adult education literature across research, policy, and practice dimensions. However, as we identify in this editorial, the objective understanding has been the dominant temporal view. This dominance has come at the cost of gaining insight into the whole phenomenon of temporality and lifelong education and learning
Castigat ridendo Trump. "South Park" ricorda che il re è nudo (ancora e sempre).
No full textDopo oltre due anni di silenzio (apparente), South Park riemerge dai meandri dell’animazione con Sermon on the ’Mount, primo episodio della ventisettesima stagione e 329esimo della serie, andato in onda il 23 luglio 2025. Come spesso accade nel piccolo mondo di Trey Parker e Matt Stone, l’attualità americana viene presa di mira con la nota caustica irriverenza. Nel mirino non finisce solo il secondo mandato presidenziale di Donald Trump, con il consueto corredo di procedimenti legali, cristianesimo militante e documenti Epstein (Boyle), ma anche – e forse soprattutto – la “montagna” cui allude il titolo
Italian Multicenter Real-World Study on the Twelve-Month Effectiveness, Safety, and Retention Rate of Guselkumab in Psoriatic Arthritis Patients
No full textBackground/Objectives: Psoriatic arthritis (PsA) is a chronic inflammatory condition that primarily affects the musculoskeletal system and skin. While biologic and targeted synthetic DMARDs have improved treatment, many patients still fail to achieve remission. Combining conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) with biologic (b) DMARDs or targeted synthetic (ts) DMARDs shows no added benefit over monotherapy with IL-17, IL-23 inhibitors, or JAK inhibitors, unlike TNFi, which benefit from csDMARD co-administration. Guselkumab (GUS) and risankizumab (RKZ) target IL-23 with high specificity. RCTs (DISCOVER 1 and 2, COSMOS) have confirmed GUS efficacy regardless of methotrexate (MTX) use, though liver toxicity was higher with MTX. Real-world data on GUS remain limited, with gaps in understanding its long-term effectiveness and drug survival. The aim of this study is to assess the following three points within a multicenter Italian real-life cohort of PsA patients treated with guselkumab (GUS) and followed for 12 months: (1) effectiveness and safety of GUS; (2) drug retention rate (DRR) and reasons for discontinuation; (3) impact of comorbidities on achieving minimal disease activity (MDA). Methods: This study utilized data from the GISEA registry, which includes centers in different parts of Italy (north, center, south, and islands), and included patients aged 18 and older diagnosed with PsA according to the CASPAR criteria. Results: Data on 170 PsA patients treated with GUS were collected. In the first 6 months, a prompt mean percentage improvement in all clinimetric indexes was observed compared to the baseline. At 6-month follow-up, ACR 20 was reached by 60% of patients, ACR 50 by 30%, ACR 70 by 15%, MDA by 28%, and DAPSA < 14 by 50% of patients in the overall group. Significant differences were found in the rate of ACR 50 in the bDMARD-naive group (50%) compared to one bDMARDs non-responder (NR) (8%) (p = 0.021). At 12-month follow-up, a notable gap was observed in the rate of patients reaching MDA between bDMARD-naive (60%) and one bDMARDs NR (22%) (p = 0.035) and between bDMARD-naive (60%) and ≥2 bDMARDs NRs (22%) (p = 0.024). By using multivariate binary logistic analysis, the predictors of reaching MDA at 12-month follow-up were naive bDMARDs (OR: 7.9, 95% CI: 1.3-44.8, p = 0.019) and a higher value of pGA at baseline (OR: 1.1, 95% CI: 1-1.5; p = 0.046). The presence of comorbidities, including fibromyalgia and obesity, did not seem to affect the reaching of MDA. At 12-month follow-up, the GUS retention rate was 76%, with a mean survival time of 10.5 months ± 0.2 (95% CI: 10-10.9). No significant differences in GUS survival time were found among bDMARD-naive, one bDMARDs NR, and ≥2 bDMARDs NR patients (in the latter, regardless of the previous mechanism of action: TNFi or other mechanism), as well as between patients treated with GUS in monotherapy and those treated in combination with csDMARDs. A low rate (17%) of discontinuation was found due to both primary NR and secondary NR. The high safety of GUS was recorded. In fact, discontinuation due to adverse events (all definable as minor) was observed in just 4% of patients. By using COX regression multivariate analysis, the factors associated with higher GUS discontinuation risk were a more severe baseline PASI (HR: 1.05, 95% CI: 1-1.1, p = 0.038) and higher baseline ESR (HR:1.06, 95% CI: 1-1.03, p = 0.05). Conclusions: Good performance of GUS was observed in both biologic-naive patients and those with failure of previous bDMARDs (regardless of the mechanism of action of the previous drug: TNFi or non-TNFi), presenting good persistence in therapy even when used as a third mechanism of action. Its high safety profile allows the use of GUS even in particularly complex patients
Internship as a collective learning journey. A Change Lab involving students, faculties, professionals
Get PDFThe relationship between learning and transformation in complex contexts of practice can be understood through a dialogue between theories that allow for the conceptualization of the relationship between epistemic change and the transformation of conditions of oppression (personal, inter-subjective, and systemic) permeating norms and institutions. Activity Theory and its applications make it possible to observe the link between transformative learning, social dimensions and collective agency, offering a model that allows for the analysis of collective actions and their dynamic evolution