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Vidiri A, Zaami S, Straface G, Gullo G, Turrini I, Matarrese D, Signore F, Cavaliere AF, Perelli F, Marchi L. Waterbirth: current knowledge and medico-legal issues. Acta Biomed 2022; 93:e2022077. [PMID: 35315386 PMCID: PMC8972863 DOI: 10.23750/abm.v93i1.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
Water immersion during labour and birth has become increasingly popular and widespread in many countries, in particular in midwifery-led care settings. Nevertheless, there is a dearth of quality data about waterbirth, with currently available findings mostly arising from observational studies and case series. The lack of high-quality evidence and the controversial results reported by different studies determined a "behavioral gap" without clearly objective, consistent indications allowing for a sound and evidence-based decision making process. Although water immersion in the first stage of labour is generally considered a safe and cost-effective method of pain management for women in labor, concerns still linger as to the safety of immersion during the second stage of labor and delivery, particularly in terms of neonatal risks and medico-legal implications.
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Affiliation(s)
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Gianluca Straface
- Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy
| | - Giuseppe Gullo
- Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, IVF Public Center, University of Palermo, Palermo, Italy
| | - Irene Turrini
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, Prato, Italy
| | - Daniela Matarrese
- Azienda USL Toscana Centro, Sanitary Direction, Santo Stefano Hospital, Prato, Italy
| | - Fabrizio Signore
- Obstetrics and Gynecology Department, Unità Sanitaria Locale (USL) Roma 2, Sant’Eugenio Hospital, Rome, Italy
| | - Anna Franca Cavaliere
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, Prato, Italy
| | - Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, Florence, Italy
| | - Laura Marchi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, Prato, Italy
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Baccani I, Morecchiato F, Chilleri C, Cervini C, Gori E, Matarrese D, Bassetti A, Bonizzoli M, Mencarini J, Antonelli A, Rossolini GM. Evaluation of Three Immunoassays for the Rapid Detection of SARS-CoV-2 antigens. Diagn Microbiol Infect Dis 2021; 101:115434. [PMID: 34174523 PMCID: PMC8137375 DOI: 10.1016/j.diagmicrobio.2021.115434] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
Three assays for SARS-CoV-2 antigen detection in nasopharyngeal swabs (Lumipulse® G SARS-CoV-2 Ag [LPG], STANDARDTM F COVID-19 Ag FIA [STF] and AFIAS COVID-19 Ag [AFC] were evaluated. Compared to RT-PCR, LPG, AFC and STF showed a variable sensitivity (87.9%, 37.5%, and 35.7%, respectively) and an overall high specificity (> 95%).
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Affiliation(s)
- Ilaria Baccani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Morecchiato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Chilleri
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Chiara Cervini
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | | | | | - Andrea Bassetti
- Azienda USL Toscana Centro, Santa Maria Annunziata Hospital, Bagno a Ripoli, Italy
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Center, Neuromusculosketal and Sensory Organs Department, Careggi University Hospital of Careggi, Florence, Italy
| | - Jessica Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy.
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3
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Stebbing J, Sánchez Nievas G, Falcone M, Youhanna S, Richardson P, Ottaviani S, Shen JX, Sommerauer C, Tiseo G, Ghiadoni L, Virdis A, Monzani F, Rizos LR, Forfori F, Avendaño Céspedes A, De Marco S, Carrozzi L, Lena F, Sánchez-Jurado PM, Lacerenza LG, Cesira N, Caldevilla Bernardo D, Perrella A, Niccoli L, Méndez LS, Matarrese D, Goletti D, Tan YJ, Monteil V, Dranitsaris G, Cantini F, Farcomeni A, Dutta S, Burley SK, Zhang H, Pistello M, Li W, Romero MM, Andrés Pretel F, Simón-Talero RS, García-Molina R, Kutter C, Felce JH, Nizami ZF, Miklosi AG, Penninger JM, Menichetti F, Mirazimi A, Abizanda P, Lauschke VM. JAK inhibition reduces SARS-CoV-2 liver infectivity and modulates inflammatory responses to reduce morbidity and mortality. Sci Adv 2021; 7:eabe4724. [PMID: 33187978 PMCID: PMC7775747 DOI: 10.1126/sciadv.abe4724] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 05/16/2023]
Abstract
Using AI, we identified baricitinib as having antiviral and anticytokine efficacy. We now show a 71% (95% CI 0.15 to 0.58) mortality benefit in 83 patients with moderate-severe SARS-CoV-2 pneumonia with few drug-induced adverse events, including a large elderly cohort (median age, 81 years). An additional 48 cases with mild-moderate pneumonia recovered uneventfully. Using organotypic 3D cultures of primary human liver cells, we demonstrate that interferon-α2 increases ACE2 expression and SARS-CoV-2 infectivity in parenchymal cells by greater than fivefold. RNA-seq reveals gene response signatures associated with platelet activation, fully inhibited by baricitinib. Using viral load quantifications and superresolution microscopy, we found that baricitinib exerts activity rapidly through the inhibition of host proteins (numb-associated kinases), uniquely among antivirals. This reveals mechanistic actions of a Janus kinase-1/2 inhibitor targeting viral entry, replication, and the cytokine storm and is associated with beneficial outcomes including in severely ill elderly patients, data that incentivize further randomized controlled trials.
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Affiliation(s)
- Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, UK.
| | - Ginés Sánchez Nievas
- Department of Rheumatology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Youhanna
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Joanne X Shen
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Sommerauer
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Science for Life Laboratory, Solna, Sweden
| | - Giusy Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luis Romero Rizos
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, University of Pisa, Italy
| | - Almudena Avendaño Céspedes
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Salvatore De Marco
- Department of Internal Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, University of Pisa, Italy
| | - Fabio Lena
- Department of Pharmaceutical Medicine, Misericordia Hospital, Grosseto, Italy
| | - Pedro Manuel Sánchez-Jurado
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | | | - Nencioni Cesira
- Department of Medicine, Misericordia Hospital, Grosseto, Italy
| | | | | | - Laura Niccoli
- Department of Rheumatology, Hospital of Prato, Prato, Italy
| | - Lourdes Sáez Méndez
- Department of Internal Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Delia Goletti
- Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Yee-Joo Tan
- University of Singapore, Infectious Diseases Programme, Immunology Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore and Institute of Molecular and Cell Biology (IMCB), A*STAR (Agency for Science, Technology and Research), Singapore, Singapore
| | - Vanessa Monteil
- Karolinska Institutet, Department of Laboratory Medicine, Unit of Clinical Microbiology, and SE-17177, Stockholm, Sweden
| | - George Dranitsaris
- Department of Hematology, School of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome Tor Vergata, Rome Italy
| | - Shuchismita Dutta
- RCSB Protein Data Bank, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Stephen K Burley
- RCSB Protein Data Bank, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Haibo Zhang
- Departments of Anesthesia, Medicine, and Physiology, University of Toronto, Toronto, ON, Canada
| | - Mauro Pistello
- Virology Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - William Li
- The Angiogenesis Foundation, Cambridge, MA, USA
| | - Marta Mas Romero
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Fernando Andrés Pretel
- Department of Statistics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Rafael García-Molina
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Claudia Kutter
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Science for Life Laboratory, Solna, Sweden
| | | | | | | | - Josef M Penninger
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, Vienna, Austria
- Department of Medical Genetics, Life Science Institute, University of British Columbia, Vancouver, BC, Canada
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ali Mirazimi
- Karolinska Institutet, Department of Laboratory Medicine, Unit of Clinical Microbiology, and SE-17177, Stockholm, Sweden
- National Veterinary Institute, Uppsala, Sweden
| | - Pedro Abizanda
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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4
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Franceschini L, Carli G, Landini G, Matarrese D, Farsi A. Delayed hypersensitivity reactions to edoxaban. Ann Allergy Asthma Immunol 2020; 126:95-96. [PMID: 32866622 DOI: 10.1016/j.anai.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Laura Franceschini
- SOS Allergology and Immunology Unit, Santo Stefano Hospital, Prato, Italy; UOC Gastroenterology and Digestive Endoscopy Unit, Le Scotte Hospital, Siena, Italy
| | - Giulia Carli
- SOS Allergology and Immunology Unit, Santo Stefano Hospital, Prato, Italy
| | - Giancarlo Landini
- Department of Internal Medicine, USL Toscana Centro, Florence, Italy
| | | | - Alessandro Farsi
- SOS Allergology and Immunology Unit, Santo Stefano Hospital, Prato, Italy.
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5
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Cantini F, Niccoli L, Matarrese D, Nicastri E, Stobbione P, Goletti D. Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact. J Infect 2020; 81:318-356. [PMID: 32333918 PMCID: PMC7177073 DOI: 10.1016/j.jinf.2020.04.017] [Citation(s) in RCA: 300] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Fabrizio Cantini
- Rheumatology Department, Azienda USL Toscana Centro, Hospital of Prato, Piazza Ospedale 1.
| | - Laura Niccoli
- Rheumatology Department, Azienda USL Toscana Centro, Hospital of Prato, Piazza Ospedale 1
| | | | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, Rome 00149, Italy.
| | - Paolo Stobbione
- AOS Antonio e Biagio e C. Arrigo, Rheumatology Unit - Alessandria, Italy.
| | - Delia Goletti
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, Rome 00149, Italy; Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via Portuense 292, 00149 Rome, Italy.
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6
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Cavaliere AF, Carabaneanu AI, Perelli F, Matarrese D, Brunelli T, Casprini P, Vasarri PL. Universal screening for SARS-CoV-2 in pregnant women admitted for delivery: how to manage antibody testing? J Matern Fetal Neonatal Med 2020; 35:3005-3006. [PMID: 32722953 DOI: 10.1080/14767058.2020.1793317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Franca Cavaliere
- Gynecology and Obstetric Division, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | - Alis Iuliana Carabaneanu
- Gynecology and Obstetric Division, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | - Federica Perelli
- Gynecology and Obstetric Division, Azienda USL Toscana Centro, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Tamara Brunelli
- Clinical Chemistry and Microbiology Laboratory, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | - Patrizia Casprini
- Clinical Chemistry and Microbiology Laboratory, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | - Pier Luigi Vasarri
- Department of Pediatrics, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
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7
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Cantini F, Niccoli L, Nannini C, Matarrese D, Natale MED, Lotti P, Aquilini D, Landini G, Cimolato B, Pietro MAD, Trezzi M, Stobbione P, Frausini G, Navarra A, Nicastri E, Sotgiu G, Goletti D. Beneficial impact of Baricitinib in COVID-19 moderate pneumonia; multicentre study. J Infect 2020; 81:647-679. [PMID: 32592703 PMCID: PMC7313480 DOI: 10.1016/j.jinf.2020.06.052] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 12/24/2022]
Abstract
Baricitinib, an anti-JAK1/JAK2, reduces cytokine release and SARS-Co-V2 entry. In a retrospective multicenter study baricitinib reduces COVID-19 mortality rate. Baricitinib reduces intensive care unit admissions of COVID-19 pneumonia. Baricitinb reduces SARS-CoV-2 viral burden detected by nasopharyngeal swab. Baricitinib used for 2 weeks was not associated with serious adverse events.
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Affiliation(s)
- Fabrizio Cantini
- Rheumatology department, Azienda USL Toscana Centro, Hospital of Prato, Italy.
| | - Laura Niccoli
- Rheumatology department, Azienda USL Toscana Centro, Hospital of Prato, Italy
| | - Carlotta Nannini
- Rheumatology department, Azienda USL Toscana Centro, Hospital of Prato, Italy
| | - Daniela Matarrese
- Sanitary Direction, Azienda USL Toscana Centro, Hospital of Prato, Italy.
| | | | - Pamela Lotti
- II Division of Internal Medicine, Azienda USL Toscana Centro, Hospital of Prato, Italy.
| | - Donatella Aquilini
- Division of Infectious Diseases, Azienda USL Toscana Centro, Hospital of Prato, Italy.
| | - Giancarlo Landini
- Department of Medical Specialties, Division of Internal Medicine, Azienda USL Toscana Centro, S.Maria Nuova Hospital, Florence, Italy.
| | - Barbara Cimolato
- Department of Medical Specialties, Division of Internal Medicine, Azienda USL Toscana Centro, S.Maria Nuova Hospital, Florence, Italy.
| | | | - Michele Trezzi
- Division of Infectious Diseases, Azienda USL Toscana Centro, Hospital of Pistoia, Italy.
| | - Paolo Stobbione
- Rheumatology Unit, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy.
| | - Gabriele Frausini
- Division of Internal Medicine, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano-Pesaro, Italy.
| | - Assunta Navarra
- Clinical epidemiology Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy.
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Rome, Italy.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy.
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Lazzeri G, Troiano G, Porchia BR, Centauri F, Mezzatesta V, Presicce G, Matarrese D, Gusinu R. Waiting times for prostate cancer: A review. J Public Health Res 2020; 9:1778. [PMID: 32550222 PMCID: PMC7282316 DOI: 10.4081/jphr.2020.1778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 11/23/2022] Open
Abstract
Prostate cancer is one of the most common diagnosed cancers in men and the waiting time has become an important issue not only for clinical reasons, but also mostly for the psychological implications on patients. The aim of our study was to review and analyze the literature on waiting times for prostate cancer. In February-March 2019 we performed a search for original peerreviewed papers in the electronic database PubMed (MEDLINE). The key search terms were "prostate cancer AND waiting list", "prostate cancer AND waiting times". We included in our narrative review articles in Italian, English or French, published in 2009-2019 containing original data about the waiting times for prostate cancer. The literature search yielded 680 publications. Finally, we identified 8 manuscripts eligible for the review. The articles were published between 2010 and 2019; the studies involved a minimum of 16 to a maximum of 95438 participants. Studies have been conducted in 6 countries. The waiting times from cancer suspicion to histopathological diagnosis and to treatment had an important reduction in the last years, and this constant decrease could lead to an increase of patients' satisfaction.
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Affiliation(s)
- Giacomo Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena.,Hospital Direction, Azienda Ospedaliera Universitaria Senese
| | | | | | | | | | | | | | - Roberto Gusinu
- Medical Chief Director, Azienda Ospedaliera Universitaria Senese, Italy
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Barletta V, Profili F, Gini R, Grilli L, Rampichini C, Matarrese D, Francesconi P. Impact of Chronic Care Model on diabetes care in Tuscany: a controlled before-after study. Eur J Public Health 2018; 27:8-13. [PMID: 28177456 DOI: 10.1093/eurpub/ckw189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Rosa Gini
- Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Leonardo Grilli
- Department of Statistics, Informatics, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Carla Rampichini
- Department of Statistics, Informatics, Applications "G. Parenti", University of Florence, Florence, Italy
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10
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Rostagno C, Buzzi R, Campanacci D, Boccacini A, Cartei A, Virgili G, Belardinelli A, Matarrese D, Ungar A, Rafanelli M, Gusinu R, Marchionni N. In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team. PLoS One 2016; 11:e0158607. [PMID: 27389193 PMCID: PMC4936690 DOI: 10.1371/journal.pone.0158607] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. Methods In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. Results In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). Conclusions Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italy
- SOD Medicina Interna e post-chirurgica, AOU Careggi, Firenze, Italy
- * E-mail:
| | - Roberto Buzzi
- SOD Ortopedia e Traumatologia, AOU Careggi, Firenze, Italy
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11
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Sinisgalli E, Matarrese D, Aramini L, Profili F, Francesoni P. Impact of Chronic Care Model on type II diabetes and heart failure in Tuscany region, 2010–2014. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Virgili G, Barchielli A, Balzi D, Matarrese D, Paci E, Gusinu R, Zuppiroli A, Gensini GF. [Mortality aftermyocardial infarction: when the health local organization network has a role in interpreting themarkers of theNational Agency for RegionalHealth Services]. Epidemiol Prev 2013; 37:176-179. [PMID: 23851248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Italian National Outcome Programme has assessed the performance of Italian hospitals regarding several clinical performance indicators, including 30-daymortality after admission for acute myocardial infarction. Risk adjustment was obtained using demographic and comorbidity data based on the hospital discharge databases in the index admission, as well as in those of the previous two years. Noticeably, the ICD-9-CM 410.7* classification coding for NSTEMI (Non-ST elevation myocardial infarction)myocardial infarction, i.e. the less severe form, was not used, due to known variability in its use. We found that hospital-specific adjusted relative risk of death versus the national mean, as computed by the programme, is negatively associated with the proportion of NSTEMI infarctions at each Tuscan and Florentine hospital, coherently with the hypothesis of a selection by the emergency network, which addresses STEMI (ST elevation myocardial infarction) patients to hospitals offering haemodynamic laboratory with reperfusive services. Individual level clinical data of 3,200 patients in the AMI-Florence study in the period April 2008-March 2010 found that ICD-9-CM410.7* is underused. The analysis based on hospital discharge diagnoses (410.7* vs. other 410* codes) cannot explain differences in mortality among Florentine hospitals, as opposed to the use of a classification of myocardial infarction type (STEMI vs. NSTEMI) based on clinical data collected in AMI-Florence.
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Affiliation(s)
- Gianni Virgili
- Direzione sanitaria, Azienda ospedaliero-universitaria Careggi, Firenze.
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13
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Staniscia T, Manzoli L, Matarrese D, Di Giovanni P, Cataudo S, Testa P, Schioppa F, Vitullo F, Monastra G, Romano F. [Epidemiology of hospital loads in patients with multiple hospitalizations due to diabetes]. Ann Ig 2005; 17:413-8. [PMID: 16353678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This study describes the results of a retrospective study carried out to evaluate the hospitalizations of patients with type 2 diabetes admitted from January to June 2001 in the teaching hospital "SS. Annunziata" of Chieti. This research evaluates the generic appropriateness using the PRUO manual and the specific appropriateness using the guidelines approved by Italian Diabetes Association, Italian Diabetes Society and Italian College of General Practitioners. A sample of 196 medical charts was examined. The percentage of inappropriate admission was 21.9%. The "critical" clinical conditions of patients were responsible for only 23.7% of inappropriate admissions. The first reason of the inappropriateness of the admission was the execution of diagnostic examinations (60.5%), followed by the execution of medical therapy (23.2%) and waiting for surgical intervention (16.3%). 46.5% of inappropriate hospitalization was prescribed by specialists. Concerning specific appropriateness, 42.3% of hospitalization was inappropriate. These findings suggest that a system for the assessment of disease management of diabetes should be started up in the Abruzzo region. Moreover, guidelines utilization should be implemented in order to get a more correct utilization of acute hospital by specialists and GPs.
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Affiliation(s)
- T Staniscia
- Sezione di Epidemiologia e Sanità Pubblica, Università "G. d'Annunzio" Chieti.
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14
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Carnessale G, Staniscia T, Matarrese D, Seccia G, Schioppa F, Di Giovanni P, Dragani V, Paolantonio E, Rauti I, Romano F. [Appropriateness of hospitalization in the teaching hospital of Chieti using the P.R.U.O. approach]. Ann Ig 2003; 15:117-22. [PMID: 12838827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
This study describes the results of a research carried out to evaluate inappropriate admissions and totally inappropriate hospitalizations (RTI) in the teaching hospital "SS. Annunziata" of Chieti using the 1999 version of the PRUO manual. A random sample of 1218 medical charts, drawn from all the medical charts of patients admitted from June to December 2000 in the units of Medicine, Surgery and Orthopaedics, was selected. The percentage of inappropriate admissions was 38.2%, while totally inappropriate hospitalizations were 18.1%. The highest percentage of inappropriate admissions was in the class of age 55-64 years. Moreover, inappropriate admissions were more frequent in the morning hours (7:00-12:59) and, within the week, on Monday. The first reason of inappropriateness of the admission, was the execution of diagnostic examinations (62.2%), followed by the execution of medical therapy (19.3%) and waiting of surgical intervention (13.4%). Short hospitalizations (2-3 days) are more frequently totally inappropriate as compared to longer hospitalizations. These findings suggest that a system for the assessment of appropriateness of hospitalizations should be established in the Abruzzo region including all accredited public and private hospitals.
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Affiliation(s)
- G Carnessale
- Sez. di Epidemiologia e Sanità Pubblica, Università degli Studi G. d'Annunzio, Chieti
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