Frailty screening and assessment tools: a review of characteristics and use in Public Health.

INTRODUCTION: Frailty screening and assessment are a fundamental issue in Public Health in order to plan prevention programs and services. METHODOLOGY: By a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aims to develop an updated framework for the main procedures and measurement tools to assess frailty in older adults, paying attention to the use in the primary care setting. RESULTS: The study selected 10 reviews published between January 2010 and December 2016 that define some characteristics of the main tools used to measure the frailty. Within the selected reviews only one of the described tools met all the criteria (multidimensionality, quick and easy administration, accurate risk prediction of negative outcomes and high sensitivity and specificity) necessary for a screening tool. CONCLUSION: Accurate risk prediction of negative outcomes could be the appropriate and sufficient criteria to assess a tool aimed to detect frailty in the community-dwelling elderly population. A two-step process (a first short questionnaire to detect frailty and a second longer questionnaire to define the care demand at individual level) could represent the appropriate pathway for planning care services at community level.

Frequently asked questions on seven rare adverse events following immunization.

Routine mass immunization programs have contributed greatly to the control of infectious diseases and to the improvement of the health of populations. Over the last decades, the rise of antivaccination movements has threatened the advances made in this field to the point that vaccination coverage rates have decreased and outbreaks of vaccine-preventable diseases have resurfaced. One of the critical points of the immunization debate revolves around the level of risk attributable to vaccination, namely the possibility of experiencing serious and possibly irreversible adverse events. Unfortunately, the knowledge about adverse events, especially rare ones, is usually incomplete at best and the attribution of a causal relationship with vaccinations is subject to significant uncertainties. The aim of this paper is to provide a narrative review of seven rare or very rare adverse events: hypotonic hyporesponsive episode, multiple sclerosis, apnea in preterm newborns, Guillain-Barré syndrome, vasculitides, arthritis/ arthralgia, immune thrombocytopenic purpura. We have selected these adverse events based on our experience of questions asked by health care workers involved in vaccination services. Information on the chosen adverse events was retrieved from Medline using appropriate search terms. The review is in the form of questions and answers for each adverse event, with a view to providing useful and actionable concepts while not ignoring the uncertainties that remain. We also highlight in the conclusion possible future improvements to adverse event detection and assessment that could help identify individuals at higher risk against the probable future backdrop of ever-greater abandonment of compulsory vaccination policies.

Effect of mass media on influenza vaccine coverage in the season 2014/2015: a regional survey in Lazio, Italy.

INTRODUCTION: Adherence to vaccination program for Influenza virus is an important issue of Public Health in presence of many no-vaccine tendencies. The media event about some deaths, occurring after MF59 adjuvanted vaccine administration, has characterized the season 2014/15 vaccination program in Italy. Aim of the study is vaccination adherence assessment of the current season with regards to local health units (LHU) coordinators's perceptions in Lazio Region (IT). METHODS: LHU coordinators's perceptions were collected from a questionnaire that was send via email to the all 12 LHU coordinators. The questionnaire was built with 4 questions concerning the impression about the vaccination adherence of elderly people in the current season. Data from questionnaire was compared with the official coverage rate obtained by the Regional Authority. Severe adverse events were collected by 1 LHU. RESULTS: All the 12 LHU coordinators answered to our questionnaire: 7/12 (50%) predicted a coverage rate of at least 50%; 3/12 (25%) referred a coverage rate around 40-45%; 2/12 (17%) predicted a reduction of 5-10% less than the previous season. Indeed, a mean 49.1% vaccination coverage in the elderly has been reported by the Regional Authority highlighting a reduction of 10% less than the 2013/14 season coverage. No severe adverse events were observed. DISCUSSION: In our survey an important effect of media event on anti-flu vaccination program adherence has been evidenced, with a failure in communication and joint management of Public Health Institutions in Italy about efficacy and safety information of flu vaccine.

The civil liability of paediatric dentists in Italy. Trains of thought on novelties introduced by law n. 24/2017 ("Gelli-bianco" law).

AIM: This study offers an overview regarding news and main themes which have been introduced by Law n. 24/2017 (the so called "Gelli-Bianco" law) in Italy. The normative content deals with the features of civil liability for healthcare professionals. More specifically, this article is referred to the contractual and extra-contractual liability of paediatric dentists. Dentists often provide services combining healthcare and dental procedures as well as aesthetic activities. Thanks to the case law and doctrine tradition, the distinction between contracts of employment and contracts of work is clearly stated. This examination is focused on highlighting methods employed by paediatric dentists to prevent possible actions of suing for compensation.

Nosocomial rotavirus infection: An up to date evaluation of European studies.

Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues.

Primary cerebral lymphoma in two consortial partners afflicted with acquired immune deficiency syndrome.

Two consortial partners presented within 3 weeks of one another with signs and symptoms of neurological dysfunction. Both were found to have acquired immune deficiency syndrome (AIDS) and primary cerebral lymphoma. We found 17 case reports of primary central nervous system (CNS) lymphoma in AIDS patients. Ten of these cases were described sufficiently to enable analysis. Our 2 cases are unique in that this is the first time primary CNS lymphoma has been reported in sexual partners with AIDS. One case includes the use of magnetic resonance imaging. Both patients underwent craniotomy and received radiation therapy.

Lumbar discectomy--percentage of disc removal and detection of anterior annulus perforation.

A prospective study was carried out to estimate the percentage of disc removal at the time of lumbar laminectomy and discectomy. Intraoperative discograms were obtained which afforded a method of calculating the percentage of disc removal. The technique permits localization of the level of discectomy and provides a means of detecting anterior annulus perforation intraoperatively, which we hope will reduce the morbidity of anterior annulus perforation. A comparison between the efficacy of disc removal (microdiscectomy vs. laminectomy) is also presented.

A new method of cranioplasty.

A new method of cranioplasty is described in which the skull defect is exposed and multiple angled holes through the outer cortical bone are made. Methyl methacrylate is molded into the defect continuous with the perforating holes. The major advantage of this technique is the resulting good cosmetic appearance, in addition to the strength and firmness of position it provides.

Traumatic intracranial aneurysm and Gradenigo's syndrome secondary to gunshot wound.

A patient suffering a gunshot wound subsequently developed an intracranial carotid aneurysm and Gradenigo's syndrome secondary to the aneurysm. A review of the related literature is presented.

Euthanasia--the twenty-sixth specialty?

Twenty-five medical specialties currently offer board certification in the United States. The question is, should there be a 26th specialty--that of euthanasia? Physician-assisted suicide has clearly been brought to the forefront of public debate by Dr. Jack Kevorkian, the retired Michigan pathologist, and the passage of the Oregon Proposition. The concern becomes multifold; should physician-assisted suicide be allowed? On whom should it be allowed? Should all physicians be allowed to participate, or only a select few? All physicians take either the Hippocratic Oath or World Health Organization Oath (or both) at medical school commencement, which forbids the taking of a life. How then are we to reconcile physician-assisted suicide? The Dutch have extensive experience with euthanasia assisted by physicians. It has become increasingly clear that a great deal of pressure will be directly or indirectly exerted on physicians to withhold or minimize treatment with terminally ill patients at both spectrums of life. The need to face these decisions will be pushed by economic interests. It is well documented historically that Nazi doctors conducted numerous experiments on concentration camp inmates in the name of research and scientific truth. How did these doctors become part of Hitler's killing machine in the 1940s? By 1942, the Nazified physicians were ready to cure the nation by killing off "useless eaters," and Jews, the "cancer" of the Nordic race. If we are taught that history repeats itself, how can we condone the helping of one patient and assisting another with ending his life? Perhaps it is fitting that Dr. Kevorkian was a pathologist, not directly involved in caring for patients and families. Perhaps we will need the 26th specialty, but the real questions is "Should those of us who took the Hippocratic Oath take the first step?"

Minimally invasive neurosurgery.

The use of the operating microscope revolutionized neurosurgery. The illumination and magnification al- lowed visualization of the desired area of the brain with much less retraction on normal brain. Microinstrumentation flourished. Various lasers and ultrasonic aspirators were adopted.

[Position of the operative team during laparotomy cholecystectomy. Looking for the optimal perspective]. / Disposizione dell'équipe operatoria nella colecistectomia laparotomica. Ricerca di un angolo visivo ottimale.

BACKGROUND: Surgeon's position during open cholecystectomy operation has been standardized since more than 100 years, being traditionally fixed at the right side of the patient. Only a few French authors adopted the "left location" just for the time requested for the common bile duct exploration. METHODS: In this paper a critical evaluation of the optimal visual angle of the Calot's triangle elements is carried out. Laparoscopic experience has taught to those who practice it to forcefully adopt the "left position" thus approaching the anatomic structures from an internal-external point of view (opposite to the usual one). The authors have compared, on the basis of videotaped material, the "right" approach (adopted in conventional open surgery) and the "left" approach (coming from the laparoscopic experience). RESULTS: From the comparative evaluation performed, a conclusion comes out that the left position allows a more accurate observation of the triangle of Calot and a more precise estimate of the "safe limit" from the hepatic artery and the common bile duct. Moreover it is observed that from this point of view the gallbladder infundibulum does not obstruct the vision of the hylus which is best evaluated in his third dimension thus attributing to each structure the right plane. CONCLUSIONS: In conclusion from the data obtained in this paper the authors suggest to adopt the "left position" to approach the gallbladder surgery, particularly in the hylar dissecting phase.

[Atypical metastases from gastric carcinoma. A primary and isolated case localized in the abdominal wall]. / In tema di metastasi atipiche da carcinoma gastrico. Su un caso primitivo ed isolato localizzato alla parete addominale.

The authors report a rare case of gastric carcinoma metastasis localised in the anterior abdominal wall which was an isolated and primary sign of disease. After having underlined the rarity of the case, there is a brief discussion of aspects related to the spread of primary tumours in relation to other cases reported over the past decade; the most important reports of atypical secondary localisations are listed.

[Digestive endometriosis: an isolated case localized in the ileum and occlusive course]. / L'endometriosi digestiva: su un caso a localizzazione ileale, isolata, ad evoluzione occlusiva.

The authors starting from the description of a clinical case of intestinal endometriosis, who underwent emergency surgery for acute intestinal obstruction, take into consideration the incidence, the pathogenesis and the pathological characteristics of intestinal endometriosis. They attempt to define it while accepting that the indications for resection should be extremely limited from both gynecological and intestinal points view.

[Nodular peritoneal mesothelioma: apropos of an occasional report]. / Mesotelioma peritoneale nodulare: a proposito di un reperto occasionale.

The complicated post-operative course of a patient who underwent an inguinal herniotomy, has allowed the diagnosis of peritoneal mesothelioma during laparotomy. This highlight the alternatives of an aggressive procedure, such as laparotomy, or a less invasive one, such as laparoscopy. The diagnostic criterion, should be when the clinical course suggests a peritoneal neoplasia; our more invasive technique allowed to perform an operation on the patient's internal organs which should be performed after laparoscopy anyway.

[The use of an ultrasonic lithotripter during video laparoscopic cholecystectomy]. / Uso del litotritore ad ultrasuoni in corso di colecistectomia videolaparoscopica.

The video laparoscopic cholecystectomy, a new technique recently introduced in surgical surgery, includes, among other complications, also the dimension of stones. Our intention in the present work is to remove this limitation using an ultrasound lithotripter to reduce the dimension of lithiasic formations, avoiding, after all, to resort to minilaparotomy or to the use of dilators which are in contrast at least with two of the principles of methodology, the aesthetic and functional one for the patient.

[Endometriosis of the abdominal wall. A report of a case secondary to cesarean section]. / Endometriosi della parete addominale. Descrizione di un caso secondario a parto cesareo.

The Authors report a case of endometriosis of the surgical scar following caesarean section. The patient, arrived at surgical observation for a doubtful foreign body granuloma, underwent a diagnostic biopsy of the lesion. Histological examination confirmed the endometriosis nature of the lesion. Before surgical removal, adjuvant therapy based on GnRH analog was performed with the aim to reduce the volume of the lesion. After removal a cycle of therapy with GnRH analog was performed in oder to exclude possible residual pathologic microscopic lesions.

Lumbar microdiscectomy in rats.

An operative method for lumbar microdiscectomy in rats is described in general terms so that it may be adapted to any microsurgical laboratory. The operation may be used as an advanced exercise in microsurgery, or to prepare surgeons for clinical lumbar microdiscectomy surgery.