1
|
Vitacca M, Malovini A, Spanevello A, Ceriana P, Paneroni M, Maniscalco M, Balbi B, Rizzello L, Murgia R, Bellazzi R, Ambrosino N. Clusters of individuals recovering from an exacerbation of chronic obstructive pulmonary disease and response to in-hospital pulmonary rehabilitation. Pulmonology 2023; 29:230-239. [PMID: 36717292 DOI: 10.1016/j.pulmoe.2023.01.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Due to the present low availability of pulmonary rehabilitation (PR) for individuals recovering from a COPD exacerbation (ECOPD), we need admission priority criteria. We tested the hypothesis that these individuals might be clustered according to baseline characteristics to identify subpopulations with different responses to PR. METHODS Multicentric retrospective analysis of individuals undergone in-hospital PR. Baseline characteristics and outcome measures (six-minute walking test - 6MWT, Medical Research Council scale for dyspnoea -MRC, COPD assessment test -CAT) were used for clustering analysis. RESULTS Data analysis of 1159 individuals showed that after program, the proportion of individuals reaching the minimal clinically important difference (MCID) was 85.0%, 86.3%, and 65.6% for CAT, MRC, and 6MWT respectively. Three clusters were found (C1-severe: 10.9%; C2-intermediate: 74.4%; C3-mild: 14.7% of cases respectively). Cluster C1-severe showed the worst conditions with the largest post PR improvements in outcome measures; C3-mild showed the least severe baseline conditions, but the smallest improvements. The proportion of participants reaching the MCID in ALL three outcome measures was significantly different among clusters, with C1-severe having the highest proportion of full success (69.0%) as compared to C2-intermediate (48.3%) and C3-mild (37.4%). Participants in C2-intermediate and C1-severe had 1.7- and 4.6-fold increases in the probability to reach the MCID in all three outcomes as compared to those in C3-mild (OR = 1.72, 95% confidence interval [95% CI] = 1.2 - 2.49, p = 0.0035 and OR = 4.57, 95% CI = 2.68 - 7.91, p < 0.0001 respectively). CONCLUSIONS Clustering analysis can identify subpopulations of individuals recovering from ECOPD associated with different responses to PR. Our results may help in defining priority criteria based on the probability of success of PR.
Collapse
Affiliation(s)
- M Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy.
| | - A Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - A Spanevello
- Respiratory Rehabilitation of the Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - P Ceriana
- Respiratory Rehabilitation of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - M Paneroni
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - M Maniscalco
- Respiratory Rehabilitation of the Institute of Telese, Istituti Clinici Scientifici Maugeri IRCCS, Benevento, Italy
| | - B Balbi
- Respiratory Rehabilitation of the Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy
| | - L Rizzello
- Respiratory Rehabilitation of the Institute of Milano Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | - R Murgia
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - R Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy; Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - N Ambrosino
- Respiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| |
Collapse
|
2
|
Vitacca M, Salvi B, Lazzeri M, Zampogna E, Piaggi G, Ceriana P, Cirio S, Rizzello L, Lacala G, Longoni A, Galimberti V, D'Ambrosio P, Pavesi E, La Piana G, Sanniti A, Morandi A, Vallet M, Paneroni M. Respiratory rehabilitation for patients with COVID-19 infection and chronic respiratory failure: a real-life retrospective study by a Lombard network. Monaldi Arch Chest Dis 2021; 92. [PMID: 34964572 DOI: 10.4081/monaldi.2021.1975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
The Lombardy region has been one of the areas most affected by the COVID-19 pandemic since the first months of 2020, providing real-life experiences in the acute phase. It is unclear how the respiratory rehabilitation network responded to this emergency. The aims of this retrospective study were: i) to analyze clinical, functional, and disability data at admission; ii) describe assessment tools and rehabilitative programs; iii) evaluate improvement after rehabilitation. The study was conducted on data collected from ten pulmonary rehabilitation centers in Lombardy, between the period of March 1st 2020 to March 1st 2021, in patients with respiratory failure recovering from COVID-19 both at admission and discharge. The study included demographics, comorbidities, nutritional status, risk of falls, disability status (Barthel index; Short Physical Performance Battery (SPPB); 6 minutes walking test (6MWT), symptoms (dyspnoea with Barthel Dyspnoea and MRC Dyspnoea Scale), length of stay, discharge destination, need for mechanical ventilation, respiratory function, assessment/outcomes indices, and prescribed rehabilitative programs. 413 patients were analyzed. Length of stay in acute and rehabilitative units was less than 30 days. Fifty % of patients used non-invasive ventilation during their stay. Functional status was mildly compromised for forced volumes and oxygenation, while severely compromised for diffusion capacity. Independency was low while physical performance status very low. At discharge, 318 (77%) patients were sent home, 83 (20.1%) were transferred to an acute unit and 12 (2.9%) passed away. Barthel Index and 6MWT were the most used, while MRC score was the least used outcome parameter. The 5 main rehabilitative activities were walking (90.8 %), transfer from bed to armchair (77.5%), limb mobilization in bed (76%), balance (71.2%), and cycle-ergometer or treadmill (43.1%). A huge difference was found in admission, discharge, and delta change among different rehabilitative centers. When available, all outcomes showed a significant improvement. With the limitation of a retrospective study with a clear amount of missing data, COVID-19 subjects admitted to rehabilitative centers presented a reduced physical performance, symptoms of dyspnoea, and severe disability. The 6MWT and Barthel index were the most used measurement.
Collapse
Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| | - Beatrice Salvi
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| | - Marta Lazzeri
- Department of Cardiothoracic and Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan.
| | | | - Giancarlo Piaggi
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Montescano (PV) .
| | - Piero Ceriana
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia.
| | - Serena Cirio
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia.
| | - Luigino Rizzello
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Milan.
| | - Grazia Lacala
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Milan.
| | | | | | | | | | | | - Antonella Sanniti
- Casa di Cura Ancelle della Carità, Fondazione Teresa Camplani, Cremona.
| | | | - Manoel Vallet
- Casa di Cura Ancelle della Carità, Fondazione Teresa Camplani, Brescia.
| | - Mara Paneroni
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| |
Collapse
|
3
|
Vitacca M, Ceriana P, Balbi B, Bruschi C, Aliani M, Maniscalco M, Fanfulla F, Diasparra A, Rizzello L, Sereni D, Spanevello A. The respiratory rehabilitation Maugeri network service reconfiguration after 1 year of COVID-19. Monaldi Arch Chest Dis 2021; 91. [PMID: 34935324 DOI: 10.4081/monaldi.2021.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/28/2021] [Indexed: 11/22/2022] Open
Abstract
As part of the Italian Health Service the respiratory ICS Maugeri network were reconfigured and several in-hospital programs were suspended to be substituted by workforce and facilities reorganization for acute and post-acute COVID-19 care need. The present review shows the time course variation of respiratory ICS network in terms of admissions diagnosis and outcomes. A comparative review of the admissions and outcome measures data (anthropometric, admission diagnosis, provenience, comorbidities, disability, symptoms, effort tolerance, disease impact, length of stay and discharge destinations) over 1 year period (March 2020-March 2021) was undertaken and compared to retrospective data from a corresponding 1 year (March 2019-March 2020) period to determine the impact of the network relocation on the delivery of pulmonary specialist rehabilitation to patients with complex needs during the pandemic episode. One of the changes implemented at the respiratory Maugeri network was the relocation of the Pulmonary Rehabilitation units from its 351 beds base to a repurposed 247 beds and a reduction in total number of admitted patients (n=3912 in pre-COVID time; n=2089 in post COVID time). All respiratory diagnosis, except COVID sequelae, decreased (chronic respiratory failure-CRF, COPD, obstructive sleep apnoea syndrome-OSAS, interstitial lung disease-ILD, tracheostomized patients and other mixed diseases decreased of 734, 705, 157, 87, 79 and 326 units respectively). During the pandemic time, 265 post COVID sequelae with CRF were admitted for rehabilitation (12.62%), % of patients coming from acute hospital increased, LOS and NIV use remained stable while CPAP indication decreased. Disease impact, dyspnea and effort tolerance as their improvements after rehabilitation, were similar in the two periods. Only baseline disability, expressed by Barthel index, seems higher in the 2° observation time as its improvement. Hospital deaths and transfers to acute hospitals were higher during pandemic crisis while home destination decreased. This review demonstrated impact of coronavirus pandemic situation, specifically the relocation of the respiratory inpatient rehabilitation wards in a huge Italian network.
Collapse
Affiliation(s)
- Michele Vitacca
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | - Piero Ceriana
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | - Bruno Balbi
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | - Claudio Bruschi
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | - Maria Aliani
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | | | | | - Aldo Diasparra
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | | | - Daniela Sereni
- Department of Respiratory Rehabilitation, ICS Maugeri IRCCS.
| | | |
Collapse
|
4
|
Liakos I, Rizzello L, Hajiali H, Brunetti V, Carzino R, Pompa PP, Athanassiou A, Mele E. Fibrous wound dressings encapsulating essential oils as natural antimicrobial agents. J Mater Chem B 2015; 3:1583-1589. [DOI: 10.1039/c4tb01974a] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Essential oils with high antibiotic activity were incorporated into cellulose acetate natural polymer. By using the electrospinning technique, nanofibrous matrices were prepared to be used as effective antimicrobial wound dressings.
Collapse
Affiliation(s)
- I. Liakos
- Smart Materials
- Nanophysics, Istituto Italiano di Tecnologia (IIT)
- 16163 Genoa
- Italy
| | - L. Rizzello
- Center for Biomolecular Nanotechnologies
- Istituto Italiano di Tecnologia @UniLe
- Lecce
- Italy
| | - H. Hajiali
- Smart Materials
- Nanophysics, Istituto Italiano di Tecnologia (IIT)
- 16163 Genoa
- Italy
- DIBRIS
| | - V. Brunetti
- Center for Biomolecular Nanotechnologies
- Istituto Italiano di Tecnologia @UniLe
- Lecce
- Italy
| | - R. Carzino
- Smart Materials
- Nanophysics, Istituto Italiano di Tecnologia (IIT)
- 16163 Genoa
- Italy
| | - P. P. Pompa
- Center for Biomolecular Nanotechnologies
- Istituto Italiano di Tecnologia @UniLe
- Lecce
- Italy
| | - A. Athanassiou
- Smart Materials
- Nanophysics, Istituto Italiano di Tecnologia (IIT)
- 16163 Genoa
- Italy
| | - E. Mele
- Smart Materials
- Nanophysics, Istituto Italiano di Tecnologia (IIT)
- 16163 Genoa
- Italy
| |
Collapse
|
5
|
Rizzello L, Shankar SS, Fragouli D, Athanassiou A, Cingolani R, Pompa PP. Microscale patterning of hydrophobic/hydrophilic surfaces by spatially controlled galvanic displacement reactions. Langmuir 2009; 25:6019-23. [PMID: 19391577 DOI: 10.1021/la900893m] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In this letter, we report the design and fabrication of different metal patterns for the realization of spatially controlled hydrophobic/hydrophilic regions with micrometer resolution. The fabrication procedure, based on a combination of lithographic techniques and wet-chemistry reactions (namely, spontaneous Galvanic displacement reactions) is reliable, undemanding, and highly versatile, allowing the achievement of precise spatial control along with the use of a wide variety of different materials.
Collapse
Affiliation(s)
- L Rizzello
- National Nanotechnology Laboratory of CNR-INFM, IIT Research Unit, Via per Arnesano, 73100 Lecce, Italy
| | | | | | | | | | | |
Collapse
|
6
|
Bonfitto P, Lamorgese V, De Vietro T, Malerba M, Rizzello L, Scoditti S, Zuin R. A randomized trial of cefepime and ceftazidime for the treatment of community-acquired pneumonia. J Chemother 1999; 11:273-7. [PMID: 10465129 DOI: 10.1179/joc.1999.11.4.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We compared the effectiveness and safety of ceftazidime and cefepime in hospitalized patients with community-acquired pneumonia. The 148 enrolled patients received 2 g ceftazidime three times daily or 2 g cefepime twice daily. The clinical success rate was the same for both drugs. Even the microbiological effectiveness was similar. Both drug regimens were well tolerated. We conclude that 2 g ceftazidime three times daily were as effective as 2 g cefepime twice daily for the treatment of community-acquired pneumonia in hospitalized patients. The cost of ceftazidime treatment was, however, higher than the cost of cefepime treatment.
Collapse
Affiliation(s)
- P Bonfitto
- Division of Pneumology - S. Michele M. Laureto Hospital, Putignano, Italy
| | | | | | | | | | | | | |
Collapse
|