The impact of frailty syndrome and risk scores on emergency cholecystectomy patients.

PURPOSE: Cholecystectomy, which is one of the most common surgical procedures, is also performed in the emergency setting. A number of risk scores have been introduced in recent studies; moreover, over the last few years literature has focused on surgical patients with frailty syndrome. The aim of the present study is to evaluate whether frailty syndrome and the risk scores are correlated with morbidity, post-operative hospital stay and the ICU admission rate following emergency cholecystectomy. METHODS: Eighty-five consecutive patients of >65 years of age who underwent cholecystectomy were selected from 2306 emergency procedures for inclusion in the present study. The patients were assessed for frailty syndrome and their scores were calculated on the basis of chart review. Univariate analyses were performed to compare severe frailty patients to intermediate frailty and robust patients. ROC and logistic regression analyses were performed with the end-points of morbidity, hospital stay and ICU admission. RESULTS: In addition to having worse ASA, inflammatory and risk values than robust patients, frailty syndrome patients also had higher rates of morbidity and ICU admission and longer hospitalization periods. A logistic regression analysis showed that the P-Possum was independently correlated with morbidity. Frailty and open surgery were independently correlated with longer hospitalization, whereas ICU admission was correlated with worse ASA and P-Possum values. CONCLUSIONS: Frailty syndrome significantly impacts the length of hospitalization in patients undergoing emergency cholecystectomy. Although the ORs were limited, the P-Possum value was independently associated with the outcome.

A knowledge-based decision support system to support family doctors in personalizing type-2 diabetes mellitus medical nutrition therapy.

BACKGROUND: Type-2 Diabetes Mellitus (T2D) is a growing concern worldwide, and family doctors are called to help diabetic patients manage this chronic disease, also with Medical Nutrition Therapy (MNT). However, MNT for Diabetes is usually standardized, while it would be much more effective if tailored to the patient. There is a gap in patient-tailored MNT which, if addressed, could support family doctors in delivering effective recommendations. In this context, decision support systems (DSSs) are valuable tools for physicians to support MNT for T2D patients - as long as DSSs are transparent to humans in their decision-making process. Indeed, the lack of transparency in data-driven DSS might hinder their adoption in clinical practice, thus leaving family physicians to adopt general nutrition guidelines provided by the national healthcare systems. METHOD: This work presents a prototypical ontology-based clinical Decision Support System (OnT2D- DSS) aimed at assisting general practice doctors in managing T2D patients, specifically in creating a tailored dietary plan, leveraging clinical expert knowledge. OnT2D-DSS exploits clinical expert knowledge formalized as a domain ontology to identify a patient's phenotype and potential comorbidities, providing personalized MNT recommendations for macro- and micro-nutrient intake. The system can be accessed via a prototypical interface. RESULTS: Two preliminary experiments are conducted to assess both the quality and correctness of the inferences provided by the system and the usability and acceptance of the OnT2D-DSS (conducted with nutrition experts and family doctors, respectively). CONCLUSIONS: Overall, the system is deemed accurate by the nutrition experts and valuable by the family doctors, with minor suggestions for future improvements collected during the experiments.

Prescribing Cartesian Stiffness of Soft Robots by Co-Optimization of Shape and Segment-Level Stiffness.

Soft robots aim to revolutionize how robotic systems interact with the environment thanks to their inherent compliance. Some of these systems are even able to modulate their physical softness. However, simply equipping a robot with softness will not generate intelligent behaviors. Indeed, most interaction tasks require careful specification of the compliance at the interaction point; some directions must be soft and others firm (e.g., while drawing, entering a hole, tracing a surface, assembling components). On the contrary, without careful planning, the preferential directions of deformation of a soft robot are not aligned with the task. With this work, we propose a strategy to prescribe variations of the physical stiffness and the robot's posture so to implement a desired Cartesian stiffness and location of the contact point. We validate the algorithm in simulation and with experiments. To perform the latter, we also present a new tendon-driven soft manipulator, equipped with variable-stiffness segments and proprioceptive sensing and capable to move in three dimensional. We show that, combining the intelligent hardware with the proposed algorithm, we can obtain the desired stiffness at the end-effector over the workspace.

The science of soft robot design: A review of motivations, methods and enabling technologies.

Novel technologies, fabrication methods, controllers and computational methods are rapidly advancing the capabilities of soft robotics. This is creating the need for design techniques and methodologies that are suited for the multi-disciplinary nature of soft robotics. These are needed to provide a formalized and scientific approach to design. In this paper, we formalize the scientific questions driving soft robotic design; what motivates the design of soft robots, and what are the fundamental challenges when designing soft robots? We review current methods and approaches to soft robot design including bio-inspired design, computational design and human-driven design, and highlight the implications that each design methods has on the resulting soft robotic systems. To conclude, we provide an analysis of emerging methods which could assist robot design, and we present a review some of the necessary technologies that may enable these approaches.

Prevalence and characteristics of distress in a sample of large hospital's workers in Rome in a period between two peaks of the covid-19 pandemic.

AIM: The aim of this study has been to measure the distress of workers at a large hospital in Rome, immediately after the lockdown with relaxed national restrictions except the indication to wear masks FP2 and to maintain the interpersonal distance of at least one meter. METHOD: A web-based anonymous survey has been conducted. Of the 324 responders (23-69 years; 78.09% females), 41.05% was nurse, 31.17% medical doctor, 7.72% employee with administrative function, 3.09% psychologist, 1.54% biologist, 13.58% grouped in the "other" category. 60.49% worked in a no-covid-19 ward, 20.37% in the covid-19 ward, 13.58% in outpatient clinics, and 5.56% outside the hospital. 45.06% have been exposed to covid-19 and 7.72% tested positive for covid-19. 66.67% were satisfied with the safety measures taken by the hospital. Post-traumatic stress disorder (PTSD) symptoms, as measured by IES-R, and peritraumatic distress, measured by CPDI, were frequently reported (41.05% and 43.21%, respectively). PTSD resulted independently associated with peritraumatic distress (Adjusted Odds Ratio, AOR 49.83), perception of being avoided by family and/or friends due to work performed (AOR= 4.05), low hope for the future (AOR= 2.25) and female gender (AOR= 2.90). Age and profession were considered confounding variables. RESULTS: These results showed that even in times of reduced restrictions, the prevalence of peritraumatic distress and PTSD is high, regardless of work and professional specialization, length of service, more or less direct contact with covid-19 patients. CONCLUSIONS: Since the biological damage resulting from a PTSD is known, it is important to activate screening programs followed by specific interventions to reduce long-term risks to mental health.

The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry.

Abdominal trauma is present in 7-10% of all trauma victims, and in cases of severe trauma is often found together with orthopedic, thoracic or central nervous system (CNS) injuries. The aim of the present study was to perform a comparative analysis of abdominal trauma and trauma involving other body regions, evaluating the prognostic significance of abdominal injuries in patients with severe trauma, based on data from a multidisciplinary trauma registry. Data from the period from March 1 2006 to December 31 2007 was collected from the trauma registry of the University Hospital Sant'Andrea in Rome, Italy. There were 25.875 patients (31.4%) with the diagnosis of trauma out of a total of 82.293 patients admitted to the emergency department. Eight hundred forty-four patients were selected according to specific inclusion criteria and patients with abdominal injuries were further selected. The following data were investigated: patient age, the trauma mechanism, duration of recovery, Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), type and the incidence of abdominal and extra-abdominal injuries. Morbidity and mortality, especially in patients with spleen and liver injuries, were analyzed. There were 79 patients (9.3%) with abdominal trauma. Their mean ISS was 25.7 +/- 14.3. Sixty-one (77.2%) of these patients had sustained severe trauma (ISS > 15). Forty-one patients (51.8%) underwent surgery. The overall mortality rate was 24.1%, 19 patients all with ISS > 15, so that the mortality rate for patients with severe trauma was 31.2%. Splenic trauma was the most frequent, and was found in 36 patients (45.6%) whose mean ISS was 31.1 +/- 144. Twenty-two patients (61.6%) were treated surgically; a total of 21 splenectomies and one laparoscopic procedure to control bleeding were performed. Overall mortality among patients with splenic trauma was 30.5% (11 patients), with an average spleen AIS of 3.3 +/- 0.8 (died vs. survived p = n.s.). Liver injuries were found in 33 patients (41.7%). The mean ISS was 28.4 +/- 11.6. Sixty-five percent of the patients were given nonsurgical treatment. Overall mortality among liver trauma patients was 24.2% (8 patients) with an average liver AIS of 3.2 +/- 0.3 (died vs. survived p < 0.05). In multivariate analysis, among the general population of trauma patients, the ISS (p < 0.001), patient age (p < 0.003), and an orthopedic (p < 0.002) or CNS injury (p < 0.006) proved to be significant independent predictors of the presence of an abdominal injury. Multivariate analysis showed that in patients with abdominal trauma, only the ISS (p < 0.001) was a significant independent predictor of mortality.

The prognostic significance of thoracic and abdominal trauma in severe trauma patients (Injury severity score > 15).

The aim of the present study was to assess the prognostic significance of thoracic and abdominal trauma in severely injured patients. A retrospective analysis was performed based on data from the period from March 1 2006 to December 31 2007, taken from the Trauma Registry of the University Hospital "SantAndrea" in Rome. A total of 844 trauma patients were entered in a database created for this purpose, and only patients with an Injury Severity Score (ISS) > 15, (163 patients, 19.3%), were selected for the present study. These patients were divided into 2 groups: Group A (103 patients, 63.2%), consisting of patients with at least one thoracic injury, and Group B (46 patients, 28.2%) consisting of patients with concomitant thoracic and abdominal injuries. The impact of thoracic and abdominal trauma was studied by analyzing mortality and morbidity, in relation to patient age, cause and dynamics of trauma, length of hospital stay, and both ISS and New ISS (NISS). In a vast majority of cases, the cause of trauma was a road accident (126 patients, 77.3%). The mean age of patients with ISS > 15 was 45.2 +/- 19.3 years. The mean ISS and NISS were 25.7 +/- 10.5 and of 31.4 +/- 13.1 respectively. The overall morbidity and mortality rates were 18.4% (30 patients) and 28.8% (47 patients) respectively. In Group A the mortality rate was 23.3% (24 patients) and the morbidity rate was 33.9% (35 patients). In Group B mortality and morbidity rates were 369% (17 patients) and 43.5% (20 patients) respectively. It was shown that the presence of both thoracic and abdominal injuries significantly increases the risk of mortality and morbidity. In patients with predominantly thoracic injuries, NISS proved to be the more reliable score, while ISS appeared to be more accurate in evaluating patients with injuries affecting more than one region of the body.

Hollow viscus injury due to blunt trauma. Epidemiology and outcome in a large urban area.

INTRODUCTION: Hollows viscus injury (HVI) is a rare occurrence and represents a clinical challenge because of its subtle and nonspecific clinical findings. The specific aims of this study were to determine the overall frequency of HVI in blunt trauma patients occurring in large urban area, the relative frequency of various hollow organ injuries, and the outcomes of such injuries. MATERIALS AND METHODS: A retrospective trauma registry review was performed by analysing data from the University Hospital Sant' Andrea in Rome and data from the Emergency Surgery and Trauma Care Unit of S. Filippo Neri Hospital in Rome The clinical records of all blunt abdominal trauma observed between January 2006 and December 2014 were blind analysed. Variables considered for analysis were: sex, age, time/type of trauma, associated injuries, timing/characteristics of operative treatment, ISS, AIS, length of hospital stay, morbidity and mortality. RESULTS: Seventy-one, 7.5% of all abdominal trauma recorded, were coded having 89 HVI. The overall morbidity and mortality rates were 29.6% (n=21/71) and 19.7% (n=14/71) respectively. Multivariate analysis indicated that only WBC (p=0.007) was significant independent predictor of morbidity whereas preoperative transfusion (p=0.010) and ISS (p<0.001) were significant risk factors for mortality. DISCUSSION: HVI is rarely found in patients with blunt abdominal trauma and it can be fatal and life-threatening, particularly in patients for whom a pertinent diagnosis is delayed. CONCLUSION: It appears clearly that during an ER evaluation of a blunt abdominal trauma an HIV has nowadays always to be considered to reach a quick diagnosis and prompt surgical intervention. KEY WORDS: Emergency, Hollow Viscus Injury, Surgery, Trauma.

Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d'Urgenza e del Trauma).

BACKGROUND: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. METHODS: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. RESULTS: A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting. CONCLUSIONS: This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases. KEY WORDS: Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel.

The usefulness of a Trauma Registry and the role of the general surgeon in the multidisciplinary approach to trauma patients: 3-year experience at Sant'Andrea University Hospital in Rome.

The purpose of this study is to verify the usefulness of a multidisciplinary Trauma Registry in the evaluation of trauma, particularly in relation to the number of specialists involved, and to analyze the effective role of the general trauma surgeon in an integrated trauma care system. The present study was performed by analyzing data from the Trauma Registry of the University Hospital Sant'Andrea in Rome, which was set up in March 2006. Data recorded between March 2006 and March 2009 was considered for the present study. The severity of trauma was categorized by dividing patients into 4 subgroups based on the value of ISS: minor injuries (ISS 1-8), moderate (ISS 9-15), severe (ISS 16-24) and very severe (ISS> 24). Patients who had an ISS greater than 9 were taken into account for further analysis and comparison. To evaluate the significance of the multidisciplinarity the patients were stratified in subgroups considering the number of specialists involved in relation to the anatomic location of injuries. In the 1386 trauma patients entered in the registry, the mean and median ISS value were 10.7 ± 8.4 and 9 respectively. The overall mortality and morbidity were 4.1% and 7.4% respectively. There was a statistically significant linear relationship between the number of specialists involved and the ISS (multidisciplinarity / ISS r = 0.493, p <0.001). Patients with ISS greater than 9 were 358, 25.8% of all cases. The mean ISS was 21.4 ± 10.3. Mortality and morbidity rates were 9.8% (35 patients) and 22.1% (79 patients) respectively. The average number of specialists involved was 2.4 ± 1.1, median 2 (range 1- 6). Results confirmed the significance of the multidisciplinary treatment for patients with trauma and the central role played by the general surgeon.