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Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. Delayed discharge may cause a \"bottleneck\" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organizational issues (on structure\\system level) and social issues (on patient's level).

Background/Objectives: Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC). The availability of an increasing number of new molecules approved for IBD treatment has increased our ability and aspirations to change the trajectory of the disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) II consensus (2018) is the current suggested strategy for IBD management, which recommends a treat-to-target approach. The primary objective of this study is to describe the clinical history of IBD in the post-STRIDE II era and to quantify the burden of IBD in terms of hospitalisation rate. The secondary objective is to estimate the 6-year risk of intestinal resection among IBD patients. Methods: A population-based time series analysis was conducted on administrative data; retrospective data from January 2011 to December 2021 were collected for the Local Health Authority “Roma 1” population (∼1.5 million residents). Hospitalisation and surgical events were prospectively recorded for patients newly diagnosed between January 2018 and February 2022 (n = 556), with follow-up throughout May 2024. A Kaplan–Mayer survivor analysis was performed to estimate the cumulative surgery risk. Results: In 2021, the IBD prevalence was 218.3 cases/100,000 people (77.2 CD, 141.1 UC). The incidence trend slowly increased during the last decade, up to 5.3 (CD) and 9.4 (UC) cases/100,000 ppl/year. The yearly hospitalisation rate remained stable, near 16.5%. The 6-year cumulative risk of surgery was 36% for CD and 20% for UC. Conclusions: The incidence of IBD has increased in the last few decades, with substantial stability in regard to the incidence of surgery and hospitalisations. Thus, the current IBD management approach has only had a small effect on changing the natural history of the disease.

(1) Introduction: Inflammatory Bowel Disease (IBD) patients may benefit from cannabinoid administration supplementary therapy; currently no consensus on its effect has been reached. (2) Methods: a systematic review of RCTs on cannabinoid supplementation therapy in IBD has been conducted; data sources were MEDLINE, Scopus, ClinicalTrials. (3) Results: out of 974 papers found with electronic search, six studies have been included into the systematic review, and five of them, for a grand total of 208 patients, were included into the meta-analysis. (4) Conclusions: cannabinoid supplementation as adjuvant therapy may increase the chances of success for standard therapy of Crohn’s Disease during the induction period; no statement on its potential usage during maintenance period can be derived from retrieved evidence. Its usage in Ulcerative Colitis is not to be recommended. If ever, low-dose treatment may be more effective than higher dosage. Mean CDAI reduction was found stronger in patients treated with cannabinoids (mean CDAI reduction = 36.63, CI 95% 12.27–61.19) than placebo. In future studies, it is advisable to include disease activity levels, as well as patient-level information such as genetic and behavioral patterns.

PurposeFalse penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea’s injury, with or without lesion of dorsal penile vein. Their presentation is often indistinguishable from true penile fractures (TPF). This overlapping of clinical presentation, and lack of knowledge about FPF, can lead surgeons often to proceed directly to surgical exploration without further examinations. The aim of this study was to define a typical presentation of false penile fractures (FPF) emergency, identifying in absence of “snap” sound, slow detumescence, penile shaft ecchymosis, and penile deviation main clinical signs.MethodsWe performed a systematic review and meta-analysis based on Medline, Scopus and Cochrane following a protocol designed a priori, to define sensitivity of “snap” sound absence, slow detumescence and penile deviation.ResultsBased on the literature search of 93 articles, 15 were included (73 patients). All patients referred pain, most of them during coitus (n = 57; 78%). Detumescence occurred in 37/73 (51%), and all patients described detumescence occurrence as “slow”. The results show that single anamnestic item have a high-moderate sensibility in the diagnosis of FPF, and the highest sensitive item was penile deviation (sensibility = 0.86). However, when more than one item is present, overall sensitivity increases greatly, closing to 100% (95% Confidence Interval 92–100).ConclusionSurgeons can consciously decide between additional exams, a conservative approach, and rapid intervention using these indicators to detect FPF. Our findings identified symptoms with excellent specificity for FPF diagnosis, giving clinicians more useful tools for making decisions.

Italy often experiences major events, such as earthquakes, floods, and migrant shipwrecks. Current and future global challenges for health workers are made up by climate change, pandemics, and wars. In this work, we will assess the state-of-art of training and interest towards these challenges among Italian post-degree public health schools. A cross-sectional survey was conducted in Italy in June 2023 among Italian public health residents. The study investigated training levels and updates regarding emergencies in Italian residencies. It also analyzed interest and importance of topic, impact of the COVID-19 pandemic, and sources of information. Of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest. 90.1% pointed out the lack of dedicated courses and 93.1% of specialized master's programs. Perceived importance in the topic was associated with the desire to attend dedicated conferences. As for COVID-19, 24.6% recognized the importance of this topic pre-pandemic, while 50.9% raised awareness during the pandemic. This survey shows the need for the offer of emergency training programs in Italian public health schools. Professionals in public health can make a great contribution to emergencies, not only in preparedness, but also in response and recovery phases.