Management of psychogenic non-epileptic seizures: a multidisciplinary approach.

The International League against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic non-epileptic seizure (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized and management might differ according to age group. The objective was to reach an expert and stakeholder consensus on PNES management. A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed. The board chose five main topics regarding PNES: diagnosis; ethical issues; psychiatric comorbidities; psychological treatment; and pharmacological treatment. After a systematic review of the literature, the board met in a consensus conference in Catanzaro (Italy). Further consultations using a model of Delphi panel were held. The global level of evidence for all topics was low. Even though most questions were formulated separately for children/adolescents and adults, no major age-related differences emerged. The board established that the approach to PNES diagnosis should comply with ILAE recommendations. Seizure induction was considered ethical, preferring the least invasive techniques. The board recommended looking carefully for mood disturbances, personality disorders and psychic trauma in persons with PNES and considering cognitive-behavioural therapy as a first-line psychological approach and pharmacological treatment to manage comorbid conditions, namely anxiety and depression. Psychogenic non-epileptic seizure management should be multidisciplinary. High-quality long-term studies are needed to standardize PNES management.

The colorectal cancer screening program in the local health unit n. 6 of Livorno: evaluation of the screening activity in the period 2000-2011.

INTRODUCTION: The colorectal cancer screening program in the Local Health Unit n. 6 of Livorno is running since July 2000 and is meant to residents, aged between 50 and 70, who are invited to perform the test for faecal occult blood every 2 years. The aim of this work is an evaluation of the screening activity in the period 2000-2011. METHODS: The evaluation is based on the analysis of the main quality indicators formulated by GISCoR (Italian Group for Colorectal screening). RESULTS: The screening activity extension reached 93% in 2006 and 100% in 2009. The compliance level was maintained above the acceptable GISCoR value (> 45%) with a maximum of 54.9%. Values around 80% were recorded for the compliance to colonoscopy. The detection rate (DR) for cancer and advanced adenoma showed, as expected, the highest values in the early years and then move on values consistently lower than the regional average. In 2011, the raw DR for cancer was 0.9 x 1000 and the raw DR for advanced adenoma 5.3 x 1000. The distribution by stage at diagnosis of screen-detected carcinomas shows that 58.1% of these were identified at stage I while the proportion of cases in stage III+ is 19.5%. CONCLUSIONS: The overall analysis shows a good performance of the program. The proportion of colonoscopies performed on the total number of positive subjects remains a critical point of the system. The distribution by stage of screen-detected cancers shows an excellent diagnostic anticipation of the screening program.

[Incidence of nosocomial rotavirus infections in a pediatric hospital over a 3-year period]. / Incidenza di infezioni nosocomiali da Rotavirus in un Ospedale pediatrico in un periodo di 3 anni.

AIM: To estimate the incidence rate of hospital-acquired rotavirus infections (HRI) in a paediatric hospital in a 3-year period; the risk of HRI associated to age, sex, ward, season; the cost determined by HRI for the healthcare system. METHODS: Retrospective epidemiological study, carried out using hospital datasets, with the analysis of some clinical records. RESULTS: In the 2003-2005 period the HRI incidence rate was 1.9% (mean age 15.2 months, SD 11.8, range 1.5-49), with a decreasing trend over years. Children aged less than 8 months were at higher risk of HRI than others (RR 1.83, CI 95% 1.18-2.85) as well as were children admitted to a 0-18 months pediatric medicine ward (RR=2.84, CI 95% 1.78-4.5) and to an infectious diseases ward (RR=4.9, CI 95% 3.4-7). The incidence of HRI was higher in the winter than in the rest of the year (RR 1.59, CI 95% 1.07-2.36). The hospital stay of children with HRI was prolonged by a mean of 5.2 days compared to age, sex and comorbidity-matched controls. (P=0.02). CONCLUSIONS: The method used in this study is easily reproducible. Data obtained can be used as internal quality indicators and to evaluate the performance of different hospital wards in infection control. Infection prevention activities should involve mothers and families of hospitalized children, as they perform on them a great deal of basic care and hygiene activities which are at risk for hospital cross-infections.