Robot-assisted versus open radical prostatectomy: an evidence-based comparison.

OBJECTIVES: A robotic system has been used in tens of thousands of minimally invasive prostate cancer treatment surgeries worldwide. The aim of the paper is to evaluate the effectiveness of the robotic surgery versus traditional surgery for the treatment of early prostate cancer in Italy. METHODS: Since this study is an observational study, we have no control over the treatment assignment. However, the treated (patient who undergo robotic assisted laparoscopic prostatectomy (RALP)) and control groups (patient who undergo open radical prostatectomy (ORP)) may differ significantly prior to treatment in ways that may affect the outcomes under study. In order to avoid erroneous conclusions we have dealt with the problem of significant group differences by using a propensity score matching procedure. RESULTS: The average age at radical prostatectomy for the two groups was similar. 97% of patients have bladder neck sparing during the open prostatectomy versus 77% of patients who belong to RALP group. RALP group presents higher urinary continence and lower blood loss rate with respect to ORP group (86.3% versus 65.6% and 9% versus 31.1% respectively). Among patients who underwent ORP 20.4% were spared nerves versus 4.5% of patients who were treated with RALP. The body mass and self-assessed health for the two groups were similar. In the logistic regression model used for the calculation of Propensity Score, bladder neck sparing and the size of the tumor were significant and presented a negative coefficient. Older age, advanced stage of the tumor, and linfonodal involvement negatively affect the likelihood of robotic technology. From our empirical analysis it arises that the robot technique does not significantly affect the hospital stay, blood loss nor the variables about post-intervention quality of life (urinary continence and self-assessed health). CONCLUSIONS: The robotic system does not seem to present major efficacy with respect to open radical prostatectomy. In particular our findings do not support any significant differences in quality of life, blood loss, hospital stay, and urinary incontinence in patients operated with robot-assisted surgery versus open retropubic radical prostatectomy.

[Organization analysis and health technology assessment: an experiment in San Giovanni Battista University Hospital-Turin]. / Analisi organizzativa e health technology assessment: un progetto sperimentale presso l'Azienda Ospedaliero Universitaria san Giovanni Battista di Torino.

Recent Italian laws emphasise Clinical Governance model as a priority for hospitals and Health Technology Assessment as one of the major tools in order to support local and hospital decisions as far as new health technologies are concerned. Our reported experience suggests managing solutions and appraises clinical issues in terms of effectiveness, efficiency and security of new and emerging technologies in order to plan and to create a system according to up to date Health Technology Assessment principles in San Giovanni Battista University Hospital-Turin. Mini-HTA reports have been realised on "Technology Intelligence" in prostate cancer treatment, percutaneous implantation of aortic valve prosthesis in high-risk patients with aortic valve disease and experimental Home Radiology project. In addition, 1167 health technologies have been evaluated through a database created ad hoc. 65% of the evaluations have been positive, less than 5% negative and the other 30% have been suspended waiting for deeper assessments. The future perspectives predict the realization of further Mini-HTA reports even through a revision of the managing model used.

Meteo-climatic conditions influence the contribution of endotoxins to PM10 in an urban polluted environment.

A decrease in inhalable particulate matter (PM10) pollution is a top priority in urban areas of northern Italy. The sources of PM10 are both anthropogenic and natural. The former have been broadly investigated while the latter are less well known. Endotoxins are natural compounds of PM10 and are potentially toxic. Endotoxins are part of the outer membrane of Gram-negative bacteria. Their health effects are linked to environmental exposure. The effects mainly consist of respiratory symptoms, including pulmonary function decline. The occurrence of endotoxins has been proven in several occupational environments where organic materials supply an optimal substrate for bacteria growth. Knowledge about the presence of these contaminants in the environment is limited. The aim of this work is to evaluate the endotoxin levels of PM10 in the urban air of Turin, and to investigate the influence of seasonal and meteo-climatic factors. The sampling was conducted from January to December 2007. Endotoxin determination was performed by an LAL assay after extraction optimization. The PM10 levels ranged from 11.90 to 104.74 microg/m(3) (48.28 +/- 23.09) while the endotoxin levels ranged between 0.09 and 0.94 EU/m(3) (0.42 +/- 0.23). The seasonal trends of PM10 and endotoxin are inversely proportional. There is a statistically significant correlation between endotoxin and temperature (r = 0.532 p < 0.01), as well as between endotoxin and relative humidity (r = -0.457 p < 0.01). However, temperature has a predominant role. We observed that urban endotoxin concentrations are narrow in range and that the contribution of endotoxins to the total PM10 is only two millionths.

[Evaluation of the appropriateness of public hospital use using AEP in the Abruzzo Region of Italy: results by hospital and ward, main predictors and potential implications]. / Valutazione dell'appropriatezza dei ricoveri ospedalieri pubblici nella regione abruzzo tramite PRuo: risultati per presidio e disciplina, principali predittori e potenziali implicazioni.

In the context of a wide healthcare system reorganization, the Abruzzo Region of Italy used the Appropriateness Evaluation Protocol (AEP) to carry out a systematic evaluation of the appropriateness of the admissions performed during 2006 in all public hospitals. After specific training courses, a sample representative of all ordinary admissions was assessed twice: first by regional investigators (external assessment) then by the local personnel (internal assessment). Random-effect logistic regression was used to evaluate potential inappropriateness predictors. On a total of 13081 hospital days (2393 hospitalizations), 39.7% (95% Confidence interval: 38.9%-40.6%) were inappropriate at the regional assessment; 39.5% at the internal assessment, with high correlation between the two controls (K = 0.73). Another 10.4% of admissions, excluded by the evaluation, was assigned to DRGs at high risk of inappropriateness and should be considered. In single hospitals, the inappropriateness ranged between 17.9% and 57.9%, with large variation across wards. Additional significant predictors of inappropriateness were the day and hour of admission and hospital size, with lower inappropriateness in bigger ones. In 2006, there was a large degree of hospital misuse in public hospitals in the Abruzzo Region. The approach used in the survey may have contributed to the drastic reduction of the number of ordinary admissions observed in the Region between 2006 and 2007.

Drivers involved in road traffic accidents in Piedmont Region: psychoactive substances consumption.

INTRODUCTION: The role played by psychoactive substances in road safety has become object of increasing interest: these substances can reduce driving performance and increase accidents risk. Aims of the study are to establish the dimension of the problem and to describe the characteristics of people involved in accidents under psychoactive substance effects. METHODS: Target population consists of people from 18 to 60-years-old involved in accidents afferent in Emergency Rooms. Subjects were interviewed by surveyors and a urines was collected for psychoactive substances screening. RESULTS: In 18.5% of people we found substance consumption. Cocaine was the most frequently detected substance (9.5%), then benzodiazepines (7.5%), methadone, morphine and marijuana (THC) (3.5%). In 5.5% of subjects more than one substance was found. Considering only illegal substances detected, female have a higher risk to be consumers (OR = 1.36) and the young age (18-35 years) seems to be at higher prevalence and risk for substance use (OR = 1.86). DISCUSSION: Considering all psychoactive substances detected, clearly the problem about substances consumption and driving is not restricted to youngest but involves all age groups. CONCLUSIONS: In order to decrease the number of accidents due to substance use, new prevention programmes able to involve also middle age groups should be planned.