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The Royal College Comprehensive Objective Examination in Neurology provides certification for Canadian neurologists and consists of a written examination and the Observed Structured Clinical Encounter (OSCE). The OSCE portion of the certification involves residents visiting several patient stations where they address case scenarios with an examiner. Unfortunately, residents lack exam preparation time due to demanding work hours. In response to resident needs, we created a novel, virtual preparation OSCE program – “prepOSCE” – and evaluated its efficacy. The prepOSCE program employed a proprietary virtual solution from CTC Communications Corp. Ten virtual sessions accommodated 70 residents totally. Seven Canadian physicians and two co-chairs created case scenarios for the stations. On session day, seven residents arrived in a virtual plenary room for briefing followed by assignment to a station by CTC. Residents then moved virtually through prepOSCE stations a different examiner and case scenario in each. Following their session, residents and evaluators were surveyed to capture experiences. The average program rating was 4.22 out of 5 (n = 36 residents of 70 residents who participated in the program) and 4.35 (n = 17 evaluators). Ninety-two percent of residents agreed or strongly agreed that they would recommend this program to their peers; they would like prepOSCE to continue next year; and the program was relevant and added value to their studies. The positive feedback received from prepOSCE participants indicates there is a need for a program like prepOSCE. This model has potential for expansion and it is hoped that specialties outside of neurology could benefit from a similar program.

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

Talora ammantata da un alone mitico e sempre celebrata dalla storiografia di età moderna, la fondazione delle cattedrali al tempo della dominazione normanna costituisce per l’architettura religiosa in Sicilia un vero e proprio anno zero. Il primato nell’ambito della tipologia basilicale, per un verso, e il configurarsi come luoghi di attualità operativa, per altro verso, hanno fatto delle stesse i termini di riferimento privilegiati per l’architettura religiosa al principio dell’età moderna. Ciò si osserva, in particolare, in un’ampia e variegata casistica di chiese realizzate nel corso del XVI secolo, che ripropongono e reinterpretano temi compositivi e spaziali propri delle suddette cattedrali, quali la predilezione per i sostegni colonnari e la creazione di ampi transetti bipartiti, declinati di sovente in contesti di ibridazione linguistica che sfuggono a qualsiasi classificazione stilistica. Un fenomeno analogo si riscontra in Puglia, soprattutto nel territorio denominato terra di Bari, con una varietà di esiti sorprendente e solo parzialmente accostabile alla casistica siciliana. Tuttavia, in entrambi i contesti, la riproposizione di specifiche soluzioni progettuali, più che una lunga inerzia, configura dei veri e propri revival che appare possibile interpretare attraverso una comune chiave di lettura. Sometimes cloaked in a mythical halo and always celebrated by the historiography of the early modern age, the foundation of the cathedrals at the time of the Norman domination for the religious architecture in Sicily is a true year zero. The primacy in the basilica typology, on the one hand, and their role as places of topicality, on the other hand, made those cathedrals the privileged terms of reference for religious architecture at the beginning of the early modern age. This can be noted, in particular, in a wide and varied series of churches created during the sixteenth century, which re-propose and reinterpret compositional and spatial themes of the aforementioned cathedrals, such as the preference for columnar supports and the creation of large bipartite transepts. These solutions are often declined in contexts of linguistic hybridization that escape any stylistic classification. A similar phenomenon can be traced in Apulia, especially in the area called Terra di Bari, with a surprising variety of outcomes, only partially comparable to the Sicilian ones. However, in both contexts, the re-proposal of specific design solutions, rather than a long inertia, configures real revivals that can be interpreted through a common reading key.

Introduction To explore the reported variability in the surgical management of ileocolonic Crohn’ s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn’s disease. Methods Anonymous videos demonstrating the small bowel walkthrough and anonymised patients’ clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Results Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87.5%. There was 87.7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57.4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. Conclusions The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy.

Relationships between energy consumption and characteristic data of the urban water system in Italy have been researched.

MMPI-2 test is widely used in psychodiagnostic evaluation as well as in the evaluation of psychic pathologies related to psychosocial adversative events in working activities. A more efficacious use of MMPI-2 test in the working context can be achieved by the individuation of indexes able to facilitate the evaluation of mobbing syndrome. This work is based on the analysis of 150 cases (39.7% women and 60.7% men, 30 to 60 years of age), evaluated through an accurate examination of working history and a series of clinic conversations, followed by psychodiagnostic evaluation. The average of T-scores on the clinical scale, the content scale, the PK addition scale and the validation scale were calculated from tests. Pathologic high T-scores on the scales Hs, D. Hy e Pa were found in subjects having positive mobbing anamnesis. These results strongly indicate the presence of clinical specificities in workers exposed to working harassments, and that these specificities can be efficaciously evidenced by the MMPI-2 test.

The aim of the present work is to analyze bubble stability in the film blowing processing of copolyamide based nanocomposites and to investigate the effect of uniaxial film drawing on nanostructure and final properties. Nanocomposite films with different loadings of nanoclay were produced by film blowing equipment and collected at different draw ratios. Oxygen barrier and mechanical properties of the films were investigated and correlated to the resulting nanomorphology and polymer crystal structures.

To evaluate the efficacy and safety of gabapentin (Neurontin; GBP) as add-on therapy for refractory partial seizures in paediatric patients aged 3-12 years.After a 6-week baseline period, 247 patients (54 centres) entered a 12-week double-blind phase and were randomized to receive either GBP (t.i.d., titrated to 23-35 mg/kg/ day) or placebo. Seizure activity and type were recorded daily. Efficacy variables included Response Ratio (RRatio), responder rate, and percentage change in frequency (PCH) for all partial seizures; PCH and RRatio for individual types of partial seizures; and investigator and parent/guardian global assessments of seizure frequency and patient well-being.RRatio for all partial seizures was significantly lower (better) for GBP-treated patients (p = 0.0407). Responder rate favored GBP, but the difference between treatment groups was not statistically significant. Median PCH for all partial seizures for the GBP treatment group (-17.0%) was better than that for the placebo group (-6.5%). Median PCH for specific seizure types showed GBP to be most effective in controlling complex partial seizures (-35%) and secondarily generalized seizures (-28%) when compared with placebo (-12%, +13%, respectively). A greater percentage of GBP-treated patients exhibited improvement according to investigator and parent/guardian global assessments, with a statistically significant difference observed in the parent/guardian global assessment of seizure-frequency reduction (p = 0.046). Three GBP patients and one placebo patient were seizure free during the double-blind treatment period. GBP was well tolerated.GBP was effective and well tolerated as an add-on therapy for partial seizures in paediatric patients with previously drug-resistant seizures.

Pain is the most disturbing symptom of diabetic peripheral neuropathy. As many as 45% of patients with diabetes mellitus develop peripheral neuropathies.To evaluate the effect of gabapentin monotherapy on pain associated with diabetic peripheral neuropathy.Randomized, double-blind, placebo-controlled, 8-week trial conducted between July 1996 and March 1997.Outpatient clinics at 20 sites.The 165 patients enrolled had a 1- to 5-year history of pain attributed to diabetic neuropathy and a minimum 40-mm pain score on the Short-Form McGill Pain Questionnaire visual analogue scale.Gabapentin (titrated from 900 to 3600 mg/d or maximum tolerated dosage) or placebo.The primary efficacy measure was daily pain severity as measured on an 11-point Likert scale (0, no pain; 10, worst possible pain). Secondary measures included sleep interference scores, the Short-Form McGill Pain Questionnaire scores, Patient Global Impression of Change and Clinical Global Impression of Change, the Short Form-36 Quality of Life Questionnaire scores, and the Profile of Mood States results.Eighty-four patients received gabapentin and 70 (83%) completed the study; 81 received placebo and 65 (80%) completed the study. By intent-to-treat analysis, gabapentin-treated patients' mean daily pain score at the study end point (baseline, 6.4; end point, 3.9; n = 82) was significantly lower (P.001) compared with the placebo-treated patients' end-point score (baseline, 6.5; end point, 5.1; n = 80). All secondary outcome measures of pain were significantly better in the gabapentin group than in the placebo group. Additional statistically significant differences favoring gabapentin treatment were observed in measures of quality of life (Short Form-36 Quality of Life Questionnaire and Profile of Mood States). Adverse events experienced significantly more frequently in the gabapentin group were dizziness (20 [24%] in the gabapentin group vs 4 [4.9%] in the control group; P.001) and somnolence (19 [23%] in the gabapentin group vs 5 [6%] in the control group; P = .003). Confusion was also more frequent in the gabapentin group (7 [8%] vs 1 [1.2%]; P = .06).Gabapentin monotherapy appears to be efficacious for the treatment of pain and sleep interference associated with diabetic peripheral neuropathy and exhibits positive effects on mood and quality of life.

We evaluated the efficacy and safety of gabapentin administered as monotherapy in an 8-day, randomized, double-blind, dose-controlled, parallel-group, multicenter study comparing dosages of 300 and 3,600 mg/d gabapentin in 82 hospitalized patients whose antiepileptic medications had been discontinued for seizure monitoring. Seizures under study were complex partial seizures with or without secondary generalization. Patients exited the study if they experienced a protocol-defined exit event indicating lack of efficacy. Time to exit was significantly longer (p = 0.0001) and completion rate was significantly higher (53% versus 17%; p = 0.002) for patients receiving 3,600 mg/d gabapentin. Gabapentin was well tolerated by patients in both dosage groups, and no patients exited the study due to adverse events, despite rapid initiation of full dose within 24 hours. These results demonstrate that gabapentin has anticonvulsant activity and is well tolerated when administered as monotherapy in patients with refractory partial seizures.

Objectives: To determine the accuracy and cost-effectiveness of nuclear scintigraphy for the diagnosis and localization of gastrointestinal (GI) bleeding and to determine whether nuclear scintigraphy accurately predicts the results of angiography. Design: Retrospective chart review. The following data were obtained from the medical records: age; diagnosis before scintigraphy; duration of bleeding; hemoglobin and hematocrit values; number and duration of blood transfusions; results of angiography and GI endoscopy; location of bleeding as determined by angiography, endoscopy, and nuclear scintigraphy; treatment received by patients; actual site of bleeding as documented in the medical record; and outcome of treatment. Setting: Community hospital in a city with a population of approximately 100 000 and a catchment area of approximately 500 000. Patients: One hundred fifty-five patients undergoing 161 nuclear scintigraphic examinations because of GI bleeding between January 1, 1989, and December 31, 1992. Main Outcome Measures: Diagnosis and location of GI bleeding as determined by nuclear scintigraphy and angiography and actual site of GI bleeding as confirmed by operative intervention or endoscopy. Results: Of 114 scintigraphic examinations for which the diagnosis and localization of GI bleeding were definite, results were positive in 56 (49.1%); of these 56, a definite location of the bleeding was shown in 51 cases (91.1%), and the bleeding was localized to its exact site in 22 cases (19.3%). Of the scintigraphic examinations for which results were positive, results of angiograms were positive in 7 cases, which gives nuclear scintigraphy a 39% positive predictive value for angiography. Conclusion: The routine use of nuclear scintigraphy is neither accurate nor cost-effective for determining the site of GI bleeding in the community hospital. Arch Surg. 1997;132:196-199

To determine the accuracy and cost-effectiveness of nuclear scintigraphy for the diagnosis and localization of gastrointestinal (GI) bleeding and to determine whether nuclear scintigraphy accurately predicts the results of angiography.Retrospective chart review. The following data were obtained from the medical records: age; diagnosis before scintigraphy; duration of bleeding; hemoglobin and hematocrit values; number and duration of blood transfusions; results of angiography and GI endoscopy; location of bleeding as determined by angiography, endoscopy, and nuclear scintigraphy; treatment received by patients; actual site of bleeding as documented in the medical record; and outcome of treatment.Community hospital in a city with a population of approximately 100,000 and a catchment area of approximately 500,000.One hundred fifty-five patients undergoing 161 nuclear scintigraphic examinations because of GI bleeding between January 1, 1989, and December 31, 1992.Diagnosis and location of GI bleeding as determined by nuclear scintigraphy and angiography and actual site of GI bleeding as confirmed by operative intervention or endoscopy.Of 114 scintigraphic examinations for which the diagnosis and localization of GI bleeding were definite, results were positive in 56 (49.1%); of these 56, a definite location of the bleeding was shown in 51 cases (91.1%), and the bleeding was localized to its exact site in 22 cases (19.3%). Of the scintigraphic examinations for which results were positive, results of angiograms were positive in 7 cases, which gives nuclear scintigraphy a 39% positive predictive value for angiography.The routine use of nuclear scintigraphy is neither accurate nor cost-effective for determining the site of GI bleeding in the community hospital.