101,938 research outputs found
Vecchi scenari e nuove prospettive della riabilitazione psicosociale: fattori terapeutici e neuroplasticità
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Three-Dimensional versus 2-Dimensional Endoscopic Third Ventriculostomy: Surgical Results of a Preliminary Comparative Study
No full textBackground: Three-dimensional (3-D) endoscopes have been widely used for a large variety of approaches in neurosurgical practice. However, in the last decade, 3-D scopes were barely used for ventricular surgery. In this study, we illustrated our preliminary experience with a 3-D endoscope for third ventriculostomy using new dedicated endoscopic equipment.
Methods: Over a 12-month period, a high-definition 3-D endoscopic third ventriculostomy (ETV) was performed in 14 patients with obstructive hydrocephalus. Patients were followed prospectively and compared retrospectively with a matched group of 16 similar patients who underwent ETV with a standard 2-dimensional (2-D) endoscope. Surgical outcome and intra- and postoperative course were retrospectively reviewed.
Results: 3-D ETV provided excellent surgical results, and no significant difference was shown in terms of outcome, complication, and length of hospitalization between the 2 groups. Moreover, operative time (minutes) was significantly shorter in the 3-D group than the 2-D ETV group (19.9 ± 4.8 vs. 22.9 ± 1.4, respectively; P < 0.05), and the use of the 3-D endoscope provided subjective improvements of depth perception, hand-eye coordination, and surgeon comfort.
Conclusions: Our preliminary study clearly demonstrated the effectiveness of 3-D ETV and provided a significant reduction of operative time. Depth information from the 3-D scope appears to facilitate rapid and stable ETV maneuvers, representing a critical development that may become a valuable tool for neuroendoscopy
Psychosocial Rehabilitation in Italy Today
No full textThe continuity of care in the usual context of subject’s life and the multiprofessional care is the approach to psychiatric care of severe mental disorders prototypically implemented in Italy after the Psychiatric Reform of 1978. In this framework, the practice of psychiatric rehabilitation has been gradually refining and consolidating its paradigms, offering procedures and interventions with selective and targeted objectives. In this position paper, promoted by the Italian Society for Psychosocial Rehabilitation, some relevant statements are presented about the definition of psychosocial rehabilitation, the facilities where it is done and the interventions and activities implemented, the professionals involved and their education and training, and issues of management and organization. Limits and perspectives of this area are also discussed
Is It Time for a Paradigm Shift in the Surgical Management of Trigeminal Schwannomas? Evaluating the Role of the Transorbital Approach: An Anatomo-Clinical Study and Systematic Literature Review
No full textBackground: Endoscopic transorbital approach emerged in recent years as an effective, minimally invasive route to access Meckel's cave area. Several case series proved its effectiveness in the surgical treatment of trigeminal schwannomas. This route provides the advantages of a minimally invasive approach associated with low morbidity rates. In this anatomo-clinical study we illustrate the usefulness of the superior eyelid transorbital approach for the surgical treatment of trigeminal schwannoma guiding the clinical applicability of the anatomical findings into real surgical practice. Methods: Superior eyelid transorbital endoscopic approach was performed on 8 cadaveric specimens, and the surgical results were confirmed in a retrospective review of all the surgical cases of transorbital surgery performed by the senior authors providing an illustrative case. Finally, we performed a literature review of all the case series of trigeminal schwannomas operated through an endoscopic transorbital approach. Results: Stepwise dissection was divided in 3 phases: skin, endo-orbital, and endocranial. The illustrative case provided demonstrate gross total resection of a cavernous sinus type trigeminal schwannomas treated through this route. Literature review revealed 68 cases of trigeminal schwannomas that were successfully treated using the transorbital approach. Conclusions: The endoscopic transorbital approach may offer a valuable alternative for the surgical treatment of trigeminal schwannomas. This technique provides a minimally invasive, direct and natural "interdural" route to the lateral wall of the cavernous sinus and Meckel's cave
The management of long-term treatment of patient with schizophrenia: results of a survey carried out in Italy
No full textThe management plan of patients with schizophrenia includes a multidimensional and integrated approach, consisting of pharmacological, psychological and psychosocial interventions. Among pharmacological approaches, the development of long-acting injectable antipsychotics (LAI) has radically changed the treatment plan of patients with schizophrenia. LAI can be successfully used in patients with multiple episodes, with partial or poor adherence to treatments and are very useful also in first episode patients. LAIs have been proven to be effective and with a good safety and tolerability profile, but they are still used in a few cases in the clinical routine practice. Therefore, the present study aims to evaluate attitudes and preferences of psychiatrists in the Italian routine care towards LAI and to identify the communication skills adopted in the routine care for the prescription of LAI. The final sample consists of 274 clinicians, recruited by phone call (n=257) and online (n=17). The main findings are: the psychoeducational approach is essential for improving patients' adherence to pharmacological treatments and their personal and social functioning; the involvement of family members is essential for improving adherence to treatments; LAIs are frequently used due to their efficacy and good tolerability profile, compared to first generation depot antipsychotics. Based on our findings, the ideal patient to be switched to LAI treatment is represented by a person with poor adherence to treatments, at the onset of the disorder, or with a poor tolerability to side effects
The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review
No full textShared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists. The present paper is a critical appraisal of recent literature on the impact of SDM in improving adherence to pharmacological treatments and in implementing the use of LAIs in the treatment of patients with schizophrenia. SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery. When considering drug treatments, clinicians must evaluate the patient's preferences, expectations and concerns towards the development of a personalized treatment strategy. Moreover, an active involvement in the decision process could reduce the patient's perception of being coerced into the use of LAIs. Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team. SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve
The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review
No full textShared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists. The present paper is a critical appraisal of recent literature on the impact of SDM in improving adherence to pharmacological treatments and in implementing the use of LAIs in the treatment of patients with schizophrenia. SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery. When considering drug treatments, clinicians must evaluate the patient's preferences, expectations and concerns towards the development of a personalized treatment strategy. Moreover, an active involvement in the decision process could reduce the patient's perception of being coerced into the use of LAIs. Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team. SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve
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