Few data are available regarding the adherence to treatment guidelines in individuals with type 2 diabetes mellitus (T2DM) admitted to Internal Medicine Wards (IMW) while no information is available concerning the possible efficacy of an educational intervention aimed at improving adherence in this setting. To explore guidelines adherence and the associated impact on glycemic control in subjects with T2DM hospitalized in IMW before and after an educational intervention, we conducted a 3-phase, cluster-randomized, multicenter study. During Phase 1, we retrospectively collected data from patients with T2DM hospitalized for any cause in IMW for ≥5 days. In Phase 2, an educational training, based on the method of the educational outreach visits (EOV), was developed in 36 out of the 54 centers involved. In Phase 3, conducted 6 months after the training, we replicated the collection of data performed in Phase 1. Overall, we analyzed data from 1909 and 1662 individuals with T2DM during Phase 1 and Phase 3 of the study, respectively. No changes were observed in the difference between mean fasting glycemia levels at discharge vs at admission in Phase 3 comparing EOV vs NO EOV groups. A statistically significant increase in adherence to guidelines was observed from Phase 1 to Phase 3 and a trend toward higher adherence was detected when comparing the EOV and the no EOV groups. A structured educational intervention improves adherence to guidelines for managing T2DM in individuals admitted to IMW but has no effect on short-term glycemic control.
We evaluated a Remote Surgical Training model (ReST) in which the tutor operates a second da Vinci Xi console from an adjacent room while preserving integrated audio and the ability to take over control. A comparative feasibility study was conducted at RAIN (A. Cardarelli Hospital, Naples, Italy) between March 2021 and April 2023 using a porcine model. Thirty training sessions were analysed (15 ReST, 15 in-room dual-console controls). Trainee performance was assessed with the Global Evaluative Assessment of Robotic Skills (GEARS); post-session surveys captured perceptions, tutor-trainee agreement (weighted Cohen’s κ), priority rankings (Kemeny aggregation with τX) and satisfaction. GEARS internal consistency was acceptable (Cronbach’s α overall 0.805; control 0.837; ReST 0.768). No statistically significant differences were observed for the GEARS total score (Mann-Whitney U = 105, p = 0.595) or domains (p = 0.074–0.683). Tutor-trainee agreement was significant for three interaction items: ease of teaching/training (p = 0.004), ability to follow the trainee’s actions (p = 0.011) and overall interaction quality (p = 0.014). Priority rankings in both roles emphasised clarity of instruction and takeover capability, while physical proximity ranked lowest. Tutors and trainers reported high satisfaction in both groups; one trainee reported low satisfaction in the ReST group. Adjacent-room ReST with takeover capability was feasible in this porcine-model training setting and showed no observed performance decrement compared with conventional in-room dual-console training. These findings should not be interpreted as proof of equivalence or as validation of true long-distance teleproctoring; further work is required for larger samples, participant-level baseline adjustment, and longer-distance configurations.
Background Immune checkpoint inhibitor doublet (ICI–ICI) and ICI plus tyrosine kinase inhibitor (ICI–TKI) regimens are the cornerstone of treatment for metastatic renal cell carcinoma (mRCC), although no head-to-head comparisons are currently available. This study aimed to compare the real-world effectiveness of ICI-ICI vs ICI-TKI combinations in patients with intermediate- and poor-risk mRCC according to International Metastatic RCC Database Consortium (IMDC). Methods The Meet-URO 33 study is a multicentre retrospective-prospective registry collecting real-world data on patients with mRCC. Multivariable logistic and Cox models were built for objective response rate (ORR), PFS and OS, with a propensity score (PS) adjustment for baseline imbalances. Results Among 1497 patients, 755 were intermediate-risk (199 ICI-ICI, 556 ICI-TKI) and 312 poor-risk (77 ICI-ICI, 212 ICI-TKI). Median follow-up was 14.2 months (8.0 months and 14.5 months in poor- and intermediate-risk subgroups, respectively). In poor-risk patients, median OS was 20.3 vs 12.9 months (HR 0.87, 95% CI: 0.59–1.28, p = 0.49), and median PFS was 6.7 vs 8.7 months (HR 1.10, 95% CI: 0.79–1.54, p = 0.53), for ICI–ICI vs ICI–TKI, respectively. In the intermediate-risk patients treated with ICI-ICI vs ICI-TKI, median OS was 37.8 vs 35.5 months (HR: 1.08; 95% CI: 0.77–1.50; p = 0.65), and median PFS was 17.8 vs 18.6 months (HR 1.29, 95% CI: 1.00–1.66, p = 0.050). ORR was 42.9% vs 45.8% in poor-risk patients (OR 0.72, 95% CI: 0.39–1.34, p = 0.303) and 48.1% vs 54.3% in intermediate-risk patients (OR 0.71, 95% CI: 0.48–1.04, p = 0.075). Conclusions No statistically significant differences in survival or response were observed between ICI-ICI and ICI-TKI combinations in patients with IMDC intermediate- and poor-risk mRCC.
Benralizumab improves outcomes in severe eosinophilic asthma patients regardless of smoking history, with former smokers achieving similar benefits in exacerbation reduction, oral corticosteroid sparing, asthma control and lung function to never-smokers https://bit.ly/4grFy7e.
Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening condition, most commonly associated with underlying infectious, haematological, vascular, or neoplastic processes. Clinical presentation is often non-specific, which may lead to delayed diagnosis. Imaging, particularly contrast-enhanced computed tomography (CECT), plays a pivotal role in confirming splenic injury, identifying predisposing lesions, and guiding management. We present the case of a woman aged in her seventies with chronic atrial fibrillation on antiplatelet therapy who developed spontaneous splenic rupture secondary to an occult splenic hamartoma. Ultrasound demonstrated heterogeneous perisplenic fluid and altered splenic echotexture. CT showed a 3.5 cm laceration, moderate haemoperitoneum, and a solid lesion with delayed enhancement and no active bleeding. Follow-up CT revealed progressive organisation of haemoperitoneum and stable lesion morphology. The patient was initially managed non-operatively due to haemodynamic stability, but elective splenectomy was performed given the presence of a structural lesion and the need for chronic anticoagulation. The purpose of this article is to illustrate the diagnostic and management principles of SSR through a representative clinical case and to provide an updated review of imaging strategies, including emerging applications of radiomics and artificial intelligence (AI).
