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Pancreatic cancer is one of the most aggressive malignancies and represents the seventh leading cause of cancer deaths in industrialized countries; in the United States, it is the third leading cause of death from cancer while in Italy it is the fourth. It is expected to become the second cancer death by 2030. The five-year survival rate is 9%, as patients with pancreatic cancer rarely exhibit symptoms until they reach an advanced stage of the disease. Therefore, despite advances in imaging techniques, over 80% of patients receive a diagnosis in the advanced stage of the disease and survival is not high at 5 years from the diagnosis despite the progress of chemotherapy and supportive therapies. An early diagnosis in people at risk is the main objective of clinical research on pancreatic cancer. The purpose of this review is to evaluate the current literature on the possibility and presence of screening programs to prevent, diagnose and treat this silent killer neoplasm.Endoscopic ultrasound (EUS) is rapidly evolving from a diagnostic into a mainly therapeutic procedure, similarly to what previously occurred to endoscopic retrograde cholangio-pancreatography (ERCP). The capability to easily access adjacent organs and structures with a minimally invasive approach as well as the availability of dedicated devices are driving this process. Several therapeutic procedures can be performed under EUS-guidance, such as drainage of pancreatic fluid collections, of the biliary system after ERCP failure, of the gallbladder for acute cholecystitis in high-risk surgical patients, as well as endoscopic gastroenteral-anastomosis creation. The introduction of dedicated lumen-apposing metal stents in the latest years has made these procedures technically easier. However, further improvements of stent design will be required in the next future. Moreover, data on long-term efficacy and safety coming from well-designed randomized multicenter controlled trials are still needed to bring EUS-guided procedures to the next level.Videocapsule endoscopy is, by far, one of the most important milestones in the technological development of endoscopy in the last twenty years. The introduction and spread of videocapsule endoscopy in clinical practice revolutionized the management of small bowel's diseases, allowing a high-quality, extensive examination of its whole mucosal surface. Because of its technical features, videocapsule endoscopy does not allow any direct therapeutic interventions but, compared to other techniques, it is minimally invasive, radiation-free and has an excellent safety profile. The most common indication for videocapsule endoscopy is suspected small bowel bleeding, although other conditions (such as coeliac disease, hereditary polyposis syndromes and, above all, Crohn's disease) may benefit from its use, as highlighted by several studies in recent years. The aim of this paper is to provide a wide overview on indications, limitations and future perspectives of videocapsule endoscopy by 2020, this technique has become a valuable and irreplaceable tool for the study of the small bowel, changing the patients' management in many clinical scenarios.

An Enhanced Recovery After Surgery (ERAS) program in colorectal surgery is able to significantly reduce the morbidity rates and postoperative hospital stay (LOS) related to the intervention. However, it is not clear what modalities and levels of implementation are necessary to achieve these results. The purpose of this work is to analyze the methods and results of the first year of implementation of the program in two centers of the Agenzia Sanitaria Unica Regionale (ASUR) Marche.

After a structured implementation pathway, characterized by the creation of a core team, field training, internal courses and coaching, the details of 196 consecutive cases of patients submitted to colorectal resection over a one-year period in two surgical units of the ASUR Marche were prospectively loaded in a database, considering over 50 variables including adherence to the individual items of the ERAS program. The primary outcomes were overall and major morbidity, mortality and anastomotic dehiscence rates; secondary outcom the program items. All the results showed a significant improvement compared to the previous pre-implementation period and according to the adherence to program items rate.Although randomized clinical trials (RCTs) offer the highest level of scientific evidence, they are unable to evaluate the impact of treatments in the routine clinical practice. The heterogeneity of socio-demographic and clinical characteristics of patients, as well as the complexity of treatments, explain the gap between the effect observed in RCTs and its impact in the real-world setting. As compared to conventional trials, pragmatic RCTs are conducted in a setting as similar as possible to that of clinical practice, but they are not always able to narrow this gap. For this reasons, methods aimed to produce evidence on the impact of healthcare pathways in the real-world (i.e., real-world evidence) are of growing interest. In particular, those based on the Electronic Healthcare Utilization (EHU), including administrative databases on the healthcare services provided to beneficiaries of the National Health System, are receiving increasing consideration from both the scientific community and healthcare decision-makers. In this article, we described characteristics and research areas where EHU databases may be particularly useful, along with strengths and limits of this approach. In conclusion, EHU data should not replace RCTs, but they represent a powerful tool for integrating RCTs and for supporting healthcare decision-makers.The output of medical and scientific literature is on the rise and the health emergency caused by the covid-19 pandemic has led to a further growth in the number of articles published each year in International medical journals. Doxycycline Hyclate Retinoid Receptor agonist Finding your way around this ocean of information is very difficult the critical evaluation of scientific documentation requires time and specific skills, which are not easy to acquire. In addition to doctors and nurses, hospital and clinical pharmacists also struggle to keep up to date. Also for this reason, many institutions and various players in the publishing arena are developing tools that enable health personnel to access the best scientific knowledge, minimizing the risk inherent in the individually performed evaluation of evidence. In any case, it is essential to reconsider and update the methods of continuous education of the hospital pharmacist, also considering the changes that have taken place in his role, now integrated into the clinical teams together with the other professionals who guarantee health care.