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Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes to-ward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma.Methods: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neo-adjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neo-adjuvant therapy.Results: The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P < .001). The regret of the commission was diametrically opposite to the regret of omission (P < .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P <=.001). The nonsurgeons working in or with lower surgical volume centers (P = .010) and surgeons (P = .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy.Conclusion: Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy.(c) 2023 Elsevier Inc. All rights reserved.

The current treatment approach in rheumatoid arthritis (RA) follows a stepwise management, starting from early introduction of conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs), moving to biological (b) DMARDs and targeted synthetic (ts) DMARDs. In the last few years, new drugs with different mechanisms of action have demonstrated their efficacy in treating such a disabling condition, and their approval, along with other more "experienced" treatments, has established their effectiveness on disease activity, damage accrual prevention, patients' quality of life improvement, confirming their safety profile. Moreover, new molecular pathways are under investigation as potential targets of new advanced therapies. Clinicians' capability of stratifying treatment strategies and decisions has improved, with several new tools for the optimisation of long-term management of RA; however, a high proportion of patients are refractory to the available drugs. Finally, as RA is a systemic disease, the knowledge in multi-systemic complications of the disease has grown, as well as the possibility in improving extra-articular manifestations of the disease, although certain drugs have potentially relevant non-articular effects, which need to be monitored. This narrative review summarises the most relevant studies published over the last year in the field of treatment of RA, with the major aim to let clinicians and researchers reflect on "what is new", "what is effective" and "what is safe".

The current treatment approach in rheumatoid arthritis (RA) follows a stepwise management, starting from early introduction of conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs), moving to biological (b) DMARDs and targeted synthetic (ts) DMARDs. In the last few years, new drugs with different mechanisms of action have demonstrated their efficacy in treating such a disabling condition, and their approval, along with other more "experienced" treatments, has established their effectiveness on disease activity, damage accrual prevention, patients' quality of life improvement, confirming their safety profile. Moreover, new molecular pathways are under investigation as potential targets of new advanced therapies. Clinicians' capability of stratifying treatment strategies and decisions has improved, with several new tools for the optimisation of long-term management of RA; however, a high proportion of patients are refractory to the available drugs. Finally, as RA is a systemic disease, the knowledge in multi-systemic complications of the disease has grown, as well as the possibility in improving extra-articular manifestations of the disease, although certain drugs have potentially relevant non-articular effects, which need to be monitored. This narrative review summarises the most relevant studies published over the last year in the field of treatment of RA, with the major aim to let clinicians and researchers reflect on "what is new", "what is effective" and "what is safe".

This paper investigates the accuracy of internal rating based (IRB) models in measuring credit risk. We contribute to the growing debate on the current prudential regulatory framework by investigating the use of validated IRB models in promoting efficient risk management practices. Our empirical analysis is based on a novel panel data set of 177 Western European banks observed from 2008 to 2015, in the aftermath of the financial and economic crisis. We find that IRB banks were able to curb the increase in credit risk driven by the macroeconomic slowdown better than banks under the standardized approach. This suggests that the introduction of the internal ratings based approach by Basel II has promoted the adoption of stronger risk management practices among banks, as meant by the regulators.

Il lavoro valuta se la concentrazione presso il sistema bancario italiano dei flussi finanziari verso le imprese renda più complessa la ripresa dell'economia italiana, nel momento in cui l'industria è entrata in crisi; oppure se, invece, tale concentrazione possa facilitare una ricomposizione e riqualificazione del rapporto banca impresa in una logica di Relationship Lending. L'obiettivo è valutare se e a quali condizioni banche di diverse dimensioni sono in grado e hanno convenienza ad operare secondo le logiche del Relationship Lending

This paper investigates the effects of the disclosure of the list published by the FSB/BCBS on SIFIs’ market equity value. Using event study methodology applied to a sample of 70 of the world’s largest banks, we assess whether following the release of information regarding the methodology used to identify SIFIs and the new capital requirements (July 19, 2011), and the disclosure of the list of 29 SIFIs (November 4, 2011), stock prices of SIFIs reacted significantly and differently from those of other large banks. Our work contributes to the ongoing debate concerning the regulation of SIFIs.

Primary gastrointestinal stromal tumors (GISTs) are stromal tumors that arise from the gastrointestinal tract. Both surgical resection and molecular therapy are crucial in the treatment of these tumors. This study analyzes the outcomes of 151 patients with GIST treated at 3 institutions. These institutions comprise the GISTologist Study Group and provided follow-up data.

The focus of this study is on the organizational features of banks operating in the South of Italy, namely major Italian banking groups and local independent banks. In our opinion, in order to evaluate the allocative and operational efficiency of the Southern Italian banking system, the issue to be addressed relates to the potential heterogeneous behavior between banks which are “truly local” – i.e. those banks whose real decisional centres are located in the Southern regions – with respect to those banks operating in the South but which have their decisional centres located in the Centre-North of the country (“outer banks”). The fact that bank strategies are defined in decisional centres located outside the Southern area could indeed explain the reduced credit support perceived by Southern SMEs. Two are the main research questions of the study. First, have the benefits of localism and relationship lending been deeply and negatively affected by the transfer of control rights outside the area (Mezzogiorno)? Second, is the organizational model adopted by local and independent banks (i.e. truly local banks) more effective in dealing with the needs of the local customer base?. Such questions are relevant not only with specific reference to southern Italy, but also to any region which experienced a reduction of locally based banks in favour of foreign banks (i.e. Central Eastern European Countries).

Consolidation in the banking industry has caused concern about the survival of small banks. Empirical evidence, however, shows that small banks are performing better than larger banks in terms of loan growth and profitability. This paper investigates the determinants of such unexpected superior performance; in particular we posit that peculiarities of small banks, like their ability to lever on relationship lending, are good explanatory variables of their recent loan growth

sistema finanziario è un’infrastruttura complessa, composta di intermediari, mercati, strumenti e regole, che svolge un ruolo fondamentale all’interno del sistema economico. Questo volume offre una rappresentazione accurata dell’architettura e delle diverse funzioni dei sistemi finanziari, sistemi che grazie all’elevato tasso di innovazione finanziaria che li caratterizza risultano sempre più articolati e integrati tra loro. Sono poi esaminate, nella prospettiva delle imprese e delle famiglie utenti di servizi finanziari, le caratteristiche economiche e tecniche dei principali strumenti e servizi bancari, mobiliari, assicurativi e previdenziali. Il testo, che si caratterizza per il costante riferimento al sistema finanziario italiano e a quello europeo, costituirà un valido supporto negli insegnamenti introduttivi all’economia degli intermediari finanziari e inoltre potrà essere adoperato proficuamente anche dagli operatori del settore. www.mulino.it/aulaweb docenti e studenti troveranno materiale utile alla didattica e all'apprendimento.