Practising Less is More: An Exploration of What it Means to See "This Patient" Not a "Patient Like This".

In the last decade literature focused on a "less is more" approach has been primarily represented by clinical cases describing the excesses of an aggressive, redundant, non-personalized, and non-respectful medicine. Most of these articles focus on a "more is worse" approach and centre around the downstream negative consequences of medical overuse. Having identified a gap in the literature on the experience and practice of less, rather than the harms of excess, we carried out an exploratory qualitative study into how a "less is more" approach works in practice.

[The fox guarding the henhouse. Who decides diagnostic criteria?].

To reduce overprescribing, the consequences due to the invention of new diseases and the systematic reduction of threshold values have been studied, and projects to reduce procedures of low efficacy, the number of prescribed drugs, and procedures at risk of inappropriateness have been developed. The composition of committees establishing diagnostic criteria was never addressed. To avoid this problem (de-diagnosing) four procedures should be implemented: 1) diagnostic criteria should be assigned to a committee of general practitioners, clinical specialists, experts like epidemiologists, sociologists, philosophers, psychologists, economists, and representatives of citizens and patients; 2) experts do not have relevant conflicts of interest; 3) criteria should be set up as recommendations to facilitate discussion between a physician and a patient on the decision whether to begin a treatment and not as a recommendation functional to overprescription; 4) criteria should be periodically revised to approach the process closer to the experiences and needs of physicians and patients.

Improving Recognition of Treatable Rare Neuromuscular Disorders in Primary Care: A Pilot Feasibility Study.

Innovative targeted treatments for neuromuscular disorders (NMDs) can dramatically improve the course of illness. Diagnostic delay, however, is a major impediment. Here, we present a pilot project aimed at assessing the feasibility of a screening program to identify children at high risk for NMDs within the first 30 months of life.

[When medicine is respectful.].

There is a relevant gap between the medicine learned on books and the clinical practice made of suffering humans facing us. Guidelines recommendations don't usually cover this aspect. The Slow Medicine movement, born in 2011, stands as a model a sober respectful and right healthcare.

Use of an Aortic Valve Replacement Simulation Model to Understand Hospital Costs and Resource Utilization Associated With Rapid-deployment Valves.

Purpose: Aortic stenosis (AS) is the most common cause of adult valvular heart disease. In the past decade, minimally invasive surgery (MIS) to treat AS has gained popularity, especially if performed in combination with rapid deployment valves (RDVs), which shorten cross-clamp time (XCT). This study examines specific outcomes and related costs of aortic valve replacement (AVR) before and after the introduction of RDVs.

[Polypharmacy and deprescribing in cardiology].

Inappropriate prescribing of diagnostic procedures and treatments should be avoided for good medical practice. Furthermore, the therapeutic plan of each patient should be regularly revised, activating deprescription procedures to reduce the dosage or to discontinue unnecessary drugs. It has widely been reported that the number of drugs taken by each patient increases over the years and adverse events caused by polypharmacy therapy are increasingly reported.

Correction to: Probiotics' efficacy in paediatric diseases: which is the evidence? A critical review on behalf of the Italian Society of Pediatrics.

An amendment to this paper has been published and can be accessed via the original article.

Probiotics' efficacy in paediatric diseases: which is the evidence? A critical review on behalf of the Italian Society of Pediatrics.

During the last decade several paediatric studies have been published with different possible indications for probiotics, leading to a global increase of probiotics' market. Nevertheless, different study designs, multiple single/combined strains and small sample size still leave many uncertainties regarding their efficacy. In addition, different regulatory and quality control issues make still very difficult the interpretation of the clinical data.

Repeat Surgery in Chronic Aortic Dissection: A New Technique without Touching the Native Aorta.

Background:  Repeat surgery of the chronically dissected aorta following repair of a Type-A acute aortic dissection (AAD) still represents a challenge. The proposed surgical options are as follows: (1) staged procedure with elephant trunk (ET) technique, (2) traditional frozen elephant trunk (FET) intervention, and (3) beating heart cerebral vessel debranching followed by thoracic endovascular aortic repair (TEVAR). However, a marked enlargement of the proximal descending thoracic aorta might make it difficult to perform FET/ET intervention.

Choosing Wisely, the reasons for its success.

The philosophy and the history of the International Choosing Wisely movement, launched in the U.S. in 2012, are described.

Differences in play can illuminate differences in affiliation: A comparative study on chimpanzees and gorillas.

Play behaviour reinforces social affiliation in several primate species, including humans. Via a comparative approach, we tested the hypothesis that play dynamics in a group of lowland gorillas (Gorilla gorilla gorilla) are different from those in a group of chimpanzees (Pan troglodytes) as a reflection of their difference in social affiliation and agonistic support. We selected one group of lowland gorillas and one of chimpanzees, hosted at the ZooParc de Beauval (France), managed in a similar way and living in similar enclosures.

"Hosting" an implantable cardioverter defibrillator: A phenomenological inquiry.

Implantable cardioverter defibrillators (ICDs) can reduce unexpected cardiac mortality, but they also have a dramatic impact on a patient's quality of life. We aimed to explore ICD recipients' experiences in order to foster improvements in the quality of care. Analyses were done using a descriptive phenomenological method, based on qualitative interview data from a purposive sample of 20 ICD recipients.

[Individual response to treatment: from Withering to contemporary medicine].

This is an essay dealing with the 1785 cohort study by William Withering (the "account"), in which he reported the results of the treatment with foxglove (Digitalis purpurea) in 163 patients suffering from various forms of hydropsy (water retention). Withering reported the results of all patients, and classified them into responders and non-responders. He identified the responders as suffering from heart failure.

[Patients facing with the decision to undergo percutaneous coronary intervention].

Percutaneous coronary intervention (PCI) is a common procedure to treat coronary artery stenoses. Several studies had demonstrated that PCI does not reduce the risk of death or myocardial infarction when performed to patients with stable angina. However it has been observed that most patients believe that PCI will reduce their risk for death and myocardial infarction.

[New diagnosis without new treatments].

The improvement of our investigative and diagnostic capability allows us to recognize early stage or mostly stable diseases in asymptomatic individuals and to treat those patients based on research conducted on more severe and acute conditions. Our main concern is avoiding not to treat a patient because of a missed diagnosis, so that we can avoid regrets and legal troubles. Usually, we do not take into account the opposite risk: overtreatment induced by overdiagnosis.

[Choosing wisely: the Top 5 list of the Italian Association of Hospital Cardiologists (ANMCO)].

In recent years, a progressive increase in the number of medical diagnostic and interventional procedures has been observed, namely in cardiology. A significant proportion of them appear inappropriate, i.e.

Single-center experience of a quadripolar pacing lead for cardiac resynchronization therapy.

Aim: Recent studies have shown that a quadripolar left ventricular (LV) lead can result in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and on medium-term follow-up in cardiac resynchronization therapy (CRT). We evaluated the outcomes of CRT patients in whom a quadripolar LV lead was implanted in our institution.

Methods: We studied 45 consecutive heart failure patients (75 % men; age, 70.

Oxygen pulse as a predictor of cardiopulmonary events in lung resection.

Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.

Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide.

Unlabelled: Anthracyclines are among the most active drugs in breast cancer patients. We planned to evaluate the early and 2-year modification of left ventricular ejection fraction (LVEF) and the effects of chemotherapy on troponin I and neurohormonal assessment.

Methods: Patients with early breast cancer surgically treated and eligible to adjuvant chemotherapy were enrolled.

Why are Cochrane hepato-biliary reviews undervalued by physicians as an aid for clinical decision-making?

Background: Cochrane systematic reviews are of higher quality than reviews published in scientific journals, yet are used less than other sources for clinical decision-making.

Aim: To assess whether the characteristics of the Cochrane systematic reviews can account for their scant use by physicians.

Materials And Methods: We analysed the 87 Cochrane hepato-biliary reviews dealing with therapeutic topics posted in the Cochrane Database of Systematic Reviews through December 2008, which we classified according to four characteristics: empty reviews; outdated reviews; content of reviews; implications for practice.

[Management of heart failure in Piedmont Region].

Background: Congestive heart failure (CHF) represents an emerging problem in industrialized countries: it continues to be diagnosed at high rates and has an decreased survival time, raising new problems, such as the need of an adequate medical service organization and resource expenditure. Aim of this analysis was a quantitative evaluation of diagnostic and therapeutic resource use for CHF in outpatient departments in Piedmont, Italy.

Methods: We performed a cross-sectional observational study, based on a two-month data collection in 12 outpatient departments dedicated to congestive heart failure.