Assessing the Training in Neurosurgery with the Implementation of VITOM-3D Exoscope: Learning Curve on Experimental Model in Neurosurgical Practice.

(1) Background: Innovation and continuous demand in the field of visual enhancing technologies and video streaming have led to the discovery of new systems capable of improving visualization and illumination of the surgical field. The exoscope was brought into neurosurgical routine, and nearly ten years later, modern 3D systems have been introduced and tested, giving encouraging results. (2) Methods: In order to evaluate the surgeon's confidence with the exoscope and their increasing ability in terms of time spent and quality of the final achievement since their first encounter with the technique, an experimental trial on 18 neurosurgeons from a single Institution was performed to evaluate the learning curve for the use of the VITOM-3D exoscope in neurosurgical practice on a model of brain and dura mater. (3) Results: A significant improvement in the quality of the performance, number of errors made, and reduction in the time was found after the third iteration of the task, by when almost all the participants felt more comfortable and confident. No significant differences between senior neurosurgeons and resident neurosurgeons were reported. (4) Conclusions: Our results show that three iterations are enough to gain confidence with the exoscope from its first use, regardless of previous experience and training with an operating microscope.

'Z-trip'? A Comprehensive Overview and a Case-series of Zolpidem Misuse.

Although believed safer compared to short-acting benzodiazepines (BZD), in the past few years a growing concern has developed relating to the abuse of Z-drugs, and specifically of zolpidem. Here we aim to review the evidence for the misuse of zolpidem and describe several related cases collected in Italy. A comprehensive overview is here carried by using several databases, and by combining the search strategy of free text terms and exploding a range of MESH headings relating to the topics of Zolpidem and Abuse and/or Misuse as follows: ((Zolpidem[Title/Abstract]) AND (Abuse[Title/Abstract]) OR (Misuse[Title/Abstract])), without time and/or language restrictions. Furthermore, a case series of 8 cases of zolpidem misuse and/or abuse, collected in different Italian psychiatric settings (psychiatric public hospital, psychiatric private rehabilitation clinic, and private practice), have been here described. According to our findings, zolpidem should be prescribed with the same caution as BZDs, especially in patients with a history of drug abuse or in the elderly. Behavioural modifications, including bizarre behaviours, psychomotor agitation, sleep-related complex behaviours have been reported. Monitoring of zolpidem use in selected populations is warranted. Psychiatrists and physicians should be aware of the misuse potential of zolpidem and adopt measures restricting its use.

The Tinnitus Handicap Inventory as a screening test for psychiatric comorbidity in patients with tinnitus.

BACKGROUND: Psychiatric comorbidity is common in patients who seek help for tinnitus. The perceived severity of tinnitus correlates closer to psychological and general health factors than to audiometrical parameters. Audiologists need valid screening tools in order to identify patients with psychiatric disorders and to tailor treatment in a multidisciplinary setting. The tinnitus handicap inventory (THI) has gained widespread acceptance as a self-report measure of tinnitus handicap. In several studies, THI test score correlates with the level of psychopathologic distress. The aim of our study was to investigate the predictive power of the test THI in relation to psychiatric disorders. METHODS: We recruited 156 patients with chronic tinnitus who have requested help at our tinnitus center. All patients underwent psychiatric evaluation, the diagnosis was made in agreement with the DSMIV-TR criteria; all patients filled out the following questionnaires: THI, Symptomatic Check List-90-Revised (SCL-90-R) and Stress-related Vulnerability Scale (VRS). Sensibility and specificity of tests as screening tool for psychiatric disorders was evaluated using Receiver Operating Characteristic (ROC) curve. RESULTS: Sixty-eight patients (prevalence: 43.59%) were found to be affected by a psychiatric disorder. AUC = 0.792 (p > 0.001) shows that THI is a moderately accurate test to individuate psychiatric affected people among our sample. We identified a score of 36 at THI (sensibility = 86.76%; specificity = 59.09%) as an appropriate cut-off point. CONCLUSIONS: If a patient reports a THI score greater than 36, the audiologist should supplement diagnostic studies with a psychiatric evaluation.