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Franchi C, Rossio R, Mandelli S, Ardoino I, Nobili A, Peyvandi F, Mannucci PM. Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study. Intern Emerg Med 2024; 19:689-696. [PMID: 38353881 DOI: 10.1007/s11739-023-03528-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/30/2023] [Indexed: 04/24/2024]
Abstract
The aims of this study is to evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, as well as and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia. Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro Politerapuie SIMI-Società Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess the diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs, and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge. Among 5717 cases included (of whom 18.0% with pneumonia), 2915 (51.0%) were prescribed at least one drug among ACE-I, ARBs, and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR = 0.79, 95% CI 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR = 0.67, 95% CI 0.52-0.85). This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions.
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Affiliation(s)
- Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
| | - Raffaella Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Mandelli
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Ilaria Ardoino
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Alessandro Nobili
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Buttinelli E, Ardoino I, Lanzoni M, Domeniconi G, Pugni L, Ronchi A, Mosca F, Biganzoli E, Castaldi S. Epidemiology of Serratia marcescens infections in NICU of a Teaching and Research Hospital in Northern Italy. Minerva Pediatr (Torino) 2023; 75:180-187. [PMID: 29072041 DOI: 10.23736/s2724-5276.17.04856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Serratia marcescens (Sm) is a known cause of infection and colonization in neonates receiving intensive care. The aim of this study was to identify the risk factors for colonization and infection with Sm in Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital. METHODS A case-control study was conducted from January to December 2011 in neonates admitted to the NICU. Cases are patients with a microbiologically confirmed infection or colonization, controls were randomly chosen among patients admitted to the same NICU. RESULTS Globally, 39 acquired infections or colonizations were identified. Among factors related to pregnancy, only premature delivery was independently associated to the risk of infection; as well as mechanical ventilation and catheterization for parenteral nutrition, considering indwelling devices. Prolonged administration with antibiotics were also related to the risk of infection. Among Sm strains which have been tested to antibiotics, all have been resistant to amoxicillin/clavulanic acid and to colistin. CONCLUSIONS This study confirms the association between Sm infection or colonization and low gestational age. Invasive medical devices and medications, strictly necessary in care-support of preterm neonates, are likely related to Sm infection too. Preventive control strategies are expected to be effective in the control of Sm spread in NICUs.
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Affiliation(s)
- Elisa Buttinelli
- Post Graduate School in Public Health, University of Milan, Milan, Italy -
| | - Ilaria Ardoino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Monica Lanzoni
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Domeniconi
- Post Graduate School in Public Health, University of Milan, Milan, Italy
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Ronchi
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Silvana Castaldi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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D'Avanzo B, Ardoino I, Negri E, Serraino D, Crispo A, Giacosa A, Garavello W, Bravi F, Turati F, Bosetti C, Fattore E, La Vecchia C, Franchi C. Canned Fish Consumption and Upper Digestive Tract Cancers. Nutr Cancer 2023; 75:707-712. [PMID: 36495166 DOI: 10.1080/01635581.2022.2154078] [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] [Indexed: 12/14/2022]
Abstract
Canned fish is a widely consumed and affordable food whose effect on cancer risk has been little investigated. We studied its effect on risk of upper digestive tract cancers using data from a network of hospital-based case-control studies from Northern Italy providing information about canned fish consumption as a separate item and including a total of 946 patients with oral cavity and pharynx cancer, 304 patients with esophageal cancer, 230 patients with gastric cancer and 3273 controls. Twenty-three percent of patients with cancer of the oral cavity or pharynx and 26% of those with cancer of the stomach consumed ≥1 serving per week of canned fish, compared to 40% and 49% of the respective control group. Among cases of esophageal cancer and controls 22% consumed ≥1 serving per week of canned fish. Odds ratios for ≥1 vs <1 portion per week were 0.79 (95% Confidence Interval, CI: 0.64-0.97) for cancer of the oral cavity and pharynx, and 0.59 (95% CI: 0.41-0.86) for stomach cancer, whereas there was no inverse association with esophageal cancer. These findings suggest a favorable role of canned fish for selected upper digestive tract cancers.
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Affiliation(s)
- Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ilaria Ardoino
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, Università di Bologna, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico, National Cancer Institute IRCCS, Aviano, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale dei Tumori IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Attilio Giacosa
- Department of Gastroenterology and Clinical Nutrition, Policlinico di Monza, Monza, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy.,Department of Otorhinolaryngology, Faculty of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesca Bravi
- Department of Otorhinolaryngology, Faculty of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elena Fattore
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Carlotta Franchi
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.,Italian Institute for Planetary Health (IIPH), Milan, Italy
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Casula M, Ardoino I, Franchi C. Appropriateness of the Prescription and Use of Medicines: An Old Concept but More Relevant than Ever. Int J Environ Res Public Health 2023; 20:2700. [PMID: 36768066 PMCID: PMC9915431 DOI: 10.3390/ijerph20032700] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The availability of drugs to treat diseases, control symptoms, or prevent their onset is one of the most important resources for maintaining health [...].
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
- IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy
| | - Ilaria Ardoino
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
- Italian Institute for Planetary Health (IIPH), 20156 Milan, Italy
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Ardoino I, Mandelli S, Baviera M, Rossio R, Nobili A, Mannucci PM, Franchi C. Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes. Int J Environ Res Public Health 2023; 20:2607. [PMID: 36767972 PMCID: PMC9915986 DOI: 10.3390/ijerph20032607] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. METHODS Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI-Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. RESULTS Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). CONCLUSION The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription.
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Affiliation(s)
- Ilaria Ardoino
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Sara Mandelli
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Raffaella Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandro Nobili
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
- Italian Institute For Planetary Health (IIPH), 20156 Milan, Italy
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Rossio R, Mandelli S, Ardoino I, Nobili A, Peyvandi F, Mannucci PM, Franchi C. Prescription appropriateness of anticoagulant drugs for prophylaxis of venous thromboembolism in hospitalized multimorbid older patients. Intern Emerg Med 2023; 18:97-104. [PMID: 36241933 DOI: 10.1007/s11739-022-03121-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/02/2022] [Indexed: 02/01/2023]
Abstract
The aims were to assess: the prescription prevalence of anticoagulant drugs for thromboprophylaxis (TP) in hospitalized older patients; the appropriateness of their prescription or non-prescription; the in-hospital mortality in appropriately versus non-appropriately prescribed or not prescribed patients. 4836 patients aged 65 or older, admitted to the Italian internal medicine and geriatric wards participating to the REPOSI register from 2012 to 2019 were assessed for prescription of anticoagulant drugs for TP at admission and/or during hospital stay. The Padua Prediction Score (PPS) and the IMPROVE score were used to assess the thrombotic and bleeding risk. Patients were considered to be appropriately prescribed when had PPS ≥ 4 and IMPROVE < 7, and appropriately not prescribed when PPS < 4. Logistic regression model was used to assess whether appropriateness was associated with in-hospital mortality. Among 4836 patients included, anticoagulants were prescribed for TP in 1233 (25.5%). In all, 4461 patients were assessable for appropriateness: 3136 (70.3%) were appropriately prescribed or non-prescribed according to their thrombotic and bleeding risk. Among 1138 patients receiving prophylaxis, only 360 (31.7%) were appropriately prescribed, while among 3323 non-prescribed patients, 2776 (83.5%) were appropriately non-prescribed. The in-hospital mortality rate was lower in patients appropriately prescribed or non-prescribed than in those inappropriately prescribed or non-prescribed (OR: 0.63; 95% CI: 0.46-0.83). In conclusion, a high prevalence of multimorbid hospitalized patients were appropriately prescribed or non-prescribed for TP with anticoagulants, appropriate non-prescription being mainly driven by a high bleeding risk. The appropriateness of prescription or non-prescription was associated with lower in-hospital mortality.
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Affiliation(s)
- Raffaella Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Mandelli
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Ilaria Ardoino
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Alessandro Nobili
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
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Franchi C, Ludergnani M, Merlino L, Nobili A, Fortino I, Leoni O, Ardoino I. Multiple Medication Adherence and Related Outcomes in Community-Dwelling Older People on Chronic Polypharmacy: A Retrospective Cohort Study on Administrative Claims Data. Int J Environ Res Public Health 2022; 19:5692. [PMID: 35565087 PMCID: PMC9099923 DOI: 10.3390/ijerph19095692] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
Poor medication adherence compromises treatment efficacy and adversely affects patients' clinical outcomes. This study aims to assess (1) multiple medication adherence to the most common drug classes chronically prescribed to older people, (2) the factors associated, and (3) the clinical outcomes. This retrospective cohort study included 122,655 community-dwelling patients aged 65-94 years old, newly exposed to chronic polypharmacy, and recorded in the Lombardy Region (northern Italy) administrative database from 2016 to 2018. Multiple medication adherence was assessed for drugs for diabetes, antithrombotics, antihypertensives, statins, and bisphosphonates, by calculating the daily polypharmacy possession ratio (DPPR). One-year mortality, nursing home, emergency department (ED), and hospital admission rates were calculated for 2019. The most prescribed drugs were antihypertensives (89.0%). The mean (std.dev) DPPR was 82.9% (15.6). Being female (OR = 0.85, 95%CI: 0.84-0.86), age ≥85 years (OR = 0.77, 95%CI: 0.76-0.79), and multimorbidity (≥4 diseases, OR = 0.88, 95%CI: 0.86-0.90) were associated with lower medication adherence. A higher DPPR was associated with clinical outcomes-in particular, improved survival (HR = 0.93 for 10/100-point increase, 95%CI: 0.92-0.94) and lower incidence in nursing home admissions (SDHR = 0.95, 95%CI: 0.93-0.97). Adherence to the most common chronic drugs co-prescribed to the older population was high. Better multiple medication adherence was associated with better clinical outcomes.
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Affiliation(s)
- Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy; (A.N.); (I.A.)
| | - Monica Ludergnani
- Direzione Sanitaria—Centro Cardiologico Monzino (I.R.C.C.S.), 20138 Milan, Italy; (M.L.); (L.M.)
| | - Luca Merlino
- Direzione Sanitaria—Centro Cardiologico Monzino (I.R.C.C.S.), 20138 Milan, Italy; (M.L.); (L.M.)
| | - Alessandro Nobili
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy; (A.N.); (I.A.)
| | - Ida Fortino
- Directorate General for Health, Lombardy Region, 20124 Milan, Italy; (I.F.); (O.L.)
| | - Olivia Leoni
- Directorate General for Health, Lombardy Region, 20124 Milan, Italy; (I.F.); (O.L.)
| | - Ilaria Ardoino
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy; (A.N.); (I.A.)
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Franchi C, Ardoino I, Bosetti C, Negri E, Serraino D, Crispo A, Giacosa A, Fattore E, Dolci A, Bravi F, Turati F, La Vecchia C, D’Avanzo B. Inverse Association between Canned Fish Consumption and Colorectal Cancer Risk: Analysis of Two Large Case-Control Studies. Nutrients 2022; 14:nu14081663. [PMID: 35458225 PMCID: PMC9025960 DOI: 10.3390/nu14081663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023] Open
Abstract
Fish is among the foods exerting favourable effects on colorectal cancer (CRC), but the possible role of canned fish has been insufficiently investigated. We aimed to investigate the relationship between canned fish consumption and CRC risk. We analysed data from two case−control studies conducted between 1992 and 2010 in several Italian areas, comprising a total of 2419 incident cases and 4723 hospital controls. Canned fish consumption was analysed according to the weekly frequency of consumption as <1 serving per week (s/w) (reference category), 1 < 2 s/w, and ≥2 s/w. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models, adjusting for several recognised confounding factors. Overall, canned fish consumption was lower among cases than among controls (23.8% vs. 28.6%). An inverse association was found between canned fish consumption and CRC risk with a significant trend in risk (OR = 0.81, 95% CI: 0.71−0.92 for intermediate consumption and OR = 0.66, 95% CI: 0.51−0.85 for the highest one), which was consistent across strata of several covariates. This study is the first to offer a basis of support for canned fish consumption as a component of a healthy diet, and it has relevant public health implications given the high ranking of CRC in incidence and mortality worldwide.
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Affiliation(s)
- Carlotta Franchi
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (I.A.); (B.D.)
- Italian Institute for Planetary Health (IIPH), 20156 Milan, Italy
- Correspondence: ; Tel.: +39-02-39014580; Fax: +39-02-39001916
| | - Ilaria Ardoino
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (I.A.); (B.D.)
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Eva Negri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, Università di Bologna, 40126 Bologna, Italy;
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico, National Cancer Institute IRCCS, 33108 Aviano, Italy;
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale dei Tumori IRCCS, Fondazione G. Pascale, 80131 Naples, Italy;
| | - Attilio Giacosa
- Department of Gastroenterology and Clinical Nutrition, Policlinico di Monza, 20900 Monza, Italy;
| | - Elena Fattore
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Alberto Dolci
- Research and Development Department, Bolton Food SpA, 20124 Milan, Italy;
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milan, Italy; (F.B.); (F.T.); (C.L.V.)
| | - Federica Turati
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milan, Italy; (F.B.); (F.T.); (C.L.V.)
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milan, Italy; (F.B.); (F.T.); (C.L.V.)
| | - Barbara D’Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (I.A.); (B.D.)
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Ardoino I, Casula M, Molari G, Mucherino S, Orlando V, Menditto E, Franchi C. Prescription Appropriateness of Drugs for Peptic Ulcer and Gastro-Esophageal Reflux Disease: Baseline Assessment in the LAPTOP-PPI Cluster Randomized Trial. Front Pharmacol 2022; 13:803809. [PMID: 35418868 PMCID: PMC8996306 DOI: 10.3389/fphar.2022.803809] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Drugs for peptic ulcer and gastro-esophageal reflux disease (GERD) are among the most widely prescribed, frequently without appropriate indications. This represents an important issue, as it leads to risk of adverse events for patients and unnecessary costs for National Health Service. Aim: To assess the prescription appropriateness of drugs for GERD, in the frame of the “Evaluation of the effectiveness of a Low-cost informative intervention to improve the Appropriate PrescripTiOn of Proton PumP Inhibitors in older people in primary care: a cluster-randomized controlled study” (LAPTOP-PPI) (Clinicaltrial.gov: NCT04637750). Methods: The appropriateness of drug prescription was assessed on data collected in administrative databases, by integrating information on concomitant medications, outpatient medical and laboratory procedures and hospital discharge diagnoses, according to the reimbursement criteria provided by the Italian Medicine Agency. We analyzed data of community-dwelling people aged 65 years and over, living in the areas of Bergamo (Northern Italy) and Caserta (Southern Italy), from July 1 to 31 December 2019. Results: Among 380,218 patients, 175,342 (46.1%) received at least one prescription of drugs for GERD. All in all, we found that only 41.2% of patients received appropriate prescriptions. Conclusion: Given the potential risk of adverse drug reactions, especially in older people, educational interventions should be prompted for physicians, in order to improve the quality of prescription of drugs for GERD and, in turn, avoid unfavorable health outcomes and unnecessary costs.
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Affiliation(s)
- Ilaria Ardoino
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Manuela Casula
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.,Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | | | - Sara Mucherino
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Franchi C, Lancellotti G, Bertolotti M, Di Salvatore S, Nobili A, Mannucci PM, Mussi C, Ardoino I. Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients. Clin Interv Aging 2021; 16:1251-1264. [PMID: 34239298 PMCID: PMC8259728 DOI: 10.2147/cia.s305933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles. Design This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI - Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards. Setting and Participants A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018. Methods Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients' health state profiles and with short-term mortality. Results Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76-5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44-0.80). Conclusion The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients' health state profiles.
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Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giulia Lancellotti
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Bertolotti
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Simona Di Salvatore
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Mussi
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. OBJECTIVES To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. METHODS A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. RESULTS LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. CONCLUSIONS LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
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Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Franchi C, Ardoino I, Ludergnani M, Cukay G, Merlino L, Nobili A. Medication adherence in community-dwelling older people exposed to chronic polypharmacy. J Epidemiol Community Health 2021; 75:854-859. [PMID: 33500324 DOI: 10.1136/jech-2020-214238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/02/2020] [Revised: 11/13/2020] [Accepted: 01/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND To evaluate medication adherence and associated factors of seven of the most common drug classes prescribed to community-dwelling older people. METHODS This is a retrospective cohort study on medication adherence in community-dwelling older people (65-94 years old) on chronic polypharmacy and recorded from 2013 to 2015 in the administrative database of the Lombardy region (Northern Italy). Adherence was assessed for diabetic drugs, antithrombotic agents, drugs acting on the renin-angiotensin system, statins, bisphosphonates, antidepressants and drugs for obstructive airway diseases by calculating the medication possession ratio (MPR). Patients were then divided in fully (MPR ≥80%), partially (40%≤MPR<80%) and poorly adherent (10%<MPR<40%). RESULTS Among 140 537 patients included in the study, only 19.3% was fully adherent to all the therapies considered. Almost 40% of them were poorly adherent to at least one drug class, becoming 50% when patients exposed to four or more drug classes were considered. In adjusted regression model, being women (OR=1.14, 95% CI 1.13 to 1.16) and aged ≥80 years old (OR=1.22, 95% CI 1.20 to 1.24) were associated with an overall lower adherence. Instead, the participation to an experimental healthcare programme was associated with higher adherence (OR=0.92, 95% CI 0.87 to 0.96). Furthermore, being coprescribed with ≥10 drugs was associated with lower adherence to all the drug classes, with different effects (ORs from 0.42 to 0.73). CONCLUSION This study overall shows a low medication adherence in community-dwelling older people on chronic polypharmacy, especially in women and oldest old. The implementation and promotion of healthcare programmes for these patients could help improve overall adherence to chronic drug therapies.
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Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Unit of Pharmacoepidemiological Research in Older People, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Unit of Pharmacoepidemiological Research in Older People, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Monica Ludergnani
- ARIA S.p.A. Azienda Regionale per l'Innovazione e gli Acquisti, Milan, Italy
| | - Gjiliola Cukay
- ARIA S.p.A. Azienda Regionale per l'Innovazione e gli Acquisti, Milan, Italy
| | - Luca Merlino
- Lombardy Regional Health Welfare General Management, Milano, Lombardia, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Unit of Pharmacoepidemiological Research in Older People, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Abstract
INTRODUCTION Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. METHODS In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. RESULTS The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38-2.07). Somatic pain (OR = 1.59, 95% CI 1.23-2.07) and widespread pain (OR = 1.60, 95% CI 0.93-2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28-0.85). CONCLUSIONS Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people.
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Affiliation(s)
- Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Oscar Corli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
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Franchi C, Mannucci PM, Nobili A, Ardoino I. Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people. Eur J Clin Pharmacol 2020; 76:459-465. [PMID: 31853593 DOI: 10.1007/s00228-019-02815-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge. METHODS Patients aged 65 years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48). RESULTS Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3-63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0-47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge. CONCLUSIONS Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
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Montefusco V, Corso A, Galli M, Ardoino I, Pezzatti S, Carniti C, Patriarca F, Gherlinzoni F, Zambello R, Sammassimo S, Marcatti M, Nozza A, Crippa C, Cafro AM, Baldini L, Corradini P. Bortezomib, cyclophosphamide, dexamethasone
versus
lenalidomide, cyclophosphamide, dexamethasone in multiple myeloma patients at first relapse. Br J Haematol 2020; 188:907-917. [DOI: 10.1111/bjh.16287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alessandro Corso
- Division of Hematology Fondazione IRCCS Policlinico San Matteo Università di Pavia PaviaItaly
| | - Monica Galli
- Hematology Papa Giovanni XXIII hospital BergamoItaly
| | - Ilaria Ardoino
- Istituto di Ricerche Farmacologiche “Mario Negri” – IRCCS MilanItaly
| | | | - Cristina Carniti
- Hematology Fondazione IRCCS Istituto Nazionale dei Tumori MilanItaly
| | | | | | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Branch Padua University School of Medicine PaduaItaly
| | | | - Magda Marcatti
- Hematology and Bone Marrow Transplantation Unit IRCCS San Raffaele Scientific Institute MilanItaly
| | - Andrea Nozza
- Oncology and Hematology Department Istituto Clinico Humanitas, Rozzano (MI) MilanItaly
| | | | - Anna Maria Cafro
- Department of Oncology/Hematology Niguarda Ca' Granda Hospital MilanItaly
| | - Luca Baldini
- Hematology/Bone Marrow Transplantation Unit Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Ca'Granda Ospedale Maggiore PoliclinicoUniversity of Milan MilanItaly
| | - Paolo Corradini
- Hematology Fondazione IRCCS Istituto Nazionale dei Tumori MilanItaly
- Department of Oncology and Hematology University of Milan Milan Italy
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Rossio R, Ardoino I, Franchi C, Nobili A, Mannuccio Mannucci P, Peyvandi F. Patterns of infections in older patients acutely admitted to medical wards: data from the REPOSI register. Intern Emerg Med 2019; 14:1347-1352. [PMID: 31444740 DOI: 10.1007/s11739-019-02178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Raffaella Rossio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico UOC Medicina Generale - Emostasi E Trombosi, Milan, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, IRCCS, Istituto Di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS, Istituto Di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS, Istituto Di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy.
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.
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Giovannoni S, Garbi A, Parma G, Lapresa M, Zaccarelli E, Vingiani A, Ardoino I, Pruneri G, Colombo N. Tumour-infiltrating lymphocytes (TILs) in patients with epithelial ovarian cancer undergoing neoadjuvant chemotherapy: A retrospective study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carlotta F, Raffaella R, Ilaria A, Alessandro N, Mannuccio MP, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Caterina C, Biolo G, Zanetti M, Guadagni M, Zaccari M, Chiuch M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Lupattelli G, Mannarino E, Bianconi V, Paciullo F, Alcidi R, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Corrao S, Natoli G, Mularo S, Raspanti M, Cavallaro F, Zoli M, Lazzari I, Brunori M, Fabbri E, Magalotti D, Arnò R, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Bonini G, Ottolini BB, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Pontremoli R, Beccati V, Nobili G, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Valeriani E, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Pes C, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D’Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Manzoni F, Volpini A, Picardi A, Gentilucci UV, Gallo P, Dell’Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Tassone B, Sesti G, Interna M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Scarinzi P, Amabile A, Omenetto E, Prandini T, Manfredini R, Fabbian F, Boari B, Giorgi AD, Tiseo R, De Giorgio R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, Ianniello E, Soldati M, Sabbà C, Vella FS, Suppressa P, Schilardi A, Loparco F, De Vincenzo GM, Comitangelo A, Amoruso E, Fenoglio L, Falcetta A, Bracco C, Fracanzani AL, Fargion S, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Ferrari B, Colombo G, Agosti P, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Peasso P, Favale E, Poletto C, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Dondi G, Pellegrini E, Carulli L, Galassi M, Grassi Y, Perticone F, Perticone M, Battaglia R, FIlice M, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Gabrielli A, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Marigliano B, Pipita ME, Castellino P, Zanoli L, Pignataro S, Gennaro A, Blanco J, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Costanzo G, Montalto G, Licata A, Malerba V, Montalto FA, Lasco A, Basile G, Catalano A, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, La Malfa L, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Napoli F. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients. Eur J Intern Med 2019; 68:e7-e11. [PMID: 31405773 DOI: 10.1016/j.ejim.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
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Contro D, Elli S, Castaldi SI, Formili M, Ardoino I, Caserta AV, Panella L. Continuity of care for patients with hip fracture after discharge from rehabilitation facility. Acta Biomed 2019; 90:385-393. [PMID: 31580331 PMCID: PMC7233737 DOI: 10.23750/abm.v90i3.8872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 01/12/2023]
Abstract
Background and aims of the work: Hip fracture is a dramatic event especially in the elderly and the return to the pre-fracture functional and social state is often difficult to achieve. In the post-acute, the intensive rehabilitation period aims to recover as much autonomy as possible to these patients, but not always its duration is sufficient to ensure an effective and lasting result in returning home, hence the need for additional rehabilitation services. Our aim was to evaluate the use of additional rehabilitation services by patients who underwent hip fracture after an intensive rehabilitation treatment period performed at our hospital. Methods: This is a retrospective cohort study. We involved patients aged 45 years and older, admitted at our intensive rehabilitation, who joined a rehabilitation program for a hip fracture. Results: Our results showed how the use of further physiotherapy is associated with the type of surgical intervention and with higher Cumulative Illness Rating Scale CIRS scores. Similarly, the loss of autonomy is associated with the type of intervention, the increase in CIRS and the duration of the physiotherapy, and negatively associated with the duration of each session. The re-hospitalizations for each cause is positively associated with CIRS and negatively associated with the further use of physiotherapy. Conclusions: Our conclusion is that rehabilitation needs a personalized schedule, because the real discriminating factor in the management of frail patients should therefore be the quality, and not the quantity (i.e. longer session), of the rehabilitative intervention prescribed. (www.actabiomedica.it)
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Affiliation(s)
- Diego Contro
- School of Specialization in Physical and Rehabilitation Medicine, University of Milan.
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Ardoino I, Signoroni S, Malvicini E, Ricci MT, Biganzoli EM, Bertario L, Occhionorelli S, Vitellaro M. Long-term survival between total colectomy versus proctocolectomy in patients with FAP: a registry-based, observational cohort study. Tumori 2019; 106:139-148. [DOI: 10.1177/0300891619868019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The best surgical choice for patients with familial adenomatous polyposis (FAP) is still debated. No prospective trials have been carried out to evaluate the pros and cons of the recommended procedures: total colectomy (ileorectal anastomosis [IRA]) vs restorative proctocolectomy (ileal pouch–anal anastomosis [IPAA]). The aim of this study was to provide a basis for tailored precision surgery in patients with FAP. Methods: We conducted a retrospective review of patients with FAP who underwent surgery and were registered in a dedicated database in Milan, Italy. Twenty-year survival related to surgical approach and prognostic factors were investigated using a Cox regression model. Results: A total of 925 patients underwent surgery between 1947 and 2015: 340 (36.8%) IPAA and 585 (63.2%) IRA. Colorectal cancer (CRC) at surgery was diagnosed in 28.6% of patients and a pathogenic APC variant was identified in 88%. During a median follow-up of 129 months, 150 patients died. The survival probability was significantly higher in the IRA than the IPAA group: 0.82 vs 0.75 (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.42–0.84). Multivariable regression modeling adjusted for propensity scores showed a similar difference, although no longer significant. Multivariable analysis indicated as independent risk factors CRC (HR 4.68, 95% CI 3.04–7.20) and age at surgery (HR 1.03, 95% CI 1.02–1.06). Among patients without cancer, the main risk factor for shorter survival was older age (HR 1.06, 95% CI 1.04–1.09). Conclusion: The study confirms excellent long-term results of surgical approaches with IRA and IPAA, suggesting that the best surgical choice may be an individually and clinically tailored approach, preferably at a young age.
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Affiliation(s)
- Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enzo Malvicini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Maria Teresa Ricci
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elia M. Biganzoli
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lucio Bertario
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Savino Occhionorelli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Colorectal Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Franchi C, Antoniazzi S, Ardoino I, Proietti M, Marcucci M, Santalucia P, Monzani V, Mannucci PM, Nobili A. Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation. Am J Med 2019; 132:e634-e647. [PMID: 31075225 DOI: 10.1016/j.amjmed.2019.03.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. METHODS We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. RESULTS Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. CONCLUSIONS This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03188211.
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Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paola Santalucia
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; IRCCS Centro Neurolesi Bonino Pulejo-Ospedale Piemonte, Messina, Italy
| | - Valter Monzani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Antoniazzi S, Ardoino I, Proietti M, Monzani V, Mannucci PM, Nobili A, Franchi C. Appropriateness of prescription of oral anticoagulant therapy in acutely hospitalized older people with atrial fibrillation. Secondary analysis of the SIM-AF cluster randomized clinical trial. Br J Clin Pharmacol 2019; 85:2134-2142. [PMID: 31218738 DOI: 10.1111/bcp.14029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/21/2018] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS To assess the appropriateness of oral anticoagulant (OAC) prescription and its associated factors in acutely hospitalized elderly patients. METHODS Data were obtained from the prospective phase of SIM-AF (SIMulation-based technologies to improve the appropriate use of oral anticoagulants in hospitalized elderly patients with Atrial Fibrillation) randomized controlled trial, aimed to test whether an educational intervention improved OAC prescription, compared to current clinical practice, in internal medicine wards. In this secondary analysis, appropriateness of OAC prescription was assessed at hospital admission and discharge. RESULTS For 246 patients, no significant differences were found between arms (odds ratio 1.38, 95% confidence interval [CI] 0.84-2.28) in terms of appropriateness of OAC prescription. Globally, 92 patients (37.4%, 95% CI = 31.6-43.6%) were inappropriately prescribed or not prescribed at hospital discharge. Among 51 patients inappropriately prescribed, 82% showed errors on dosage, being mainly under-dosed (n = 29, 56.9%), and among 41 inappropriately not prescribed, 98% were taking an antiplatelet drug. Factors independently associated with a lower probability of appropriateness at discharge were those related to a higher risk of bleeding (older age, higher levels of aspartate aminotransferase, history of falls, alcohol consumption) and antiplatelet prescription at admission. The prescription of OACs at admission was the strongest predictor of appropriateness at discharge (odds ratio = 7.43, 95% CI = 4.04-13.73). CONCLUSIONS A high proportion of hospitalized older patients with AF remains inappropriately prescribed or nonprescribed with OACs. The management of these patients at hospital admission is the strongest predictor of prescription appropriateness at discharge.
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Affiliation(s)
- Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Valter Monzani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Franchi C, Rossio R, Ardoino I, Mannucci PM, Nobili A. Inappropriate prescription of benzodiazepines in acutely hospitalized older patients. Eur Neuropsychopharmacol 2019; 29:871-879. [PMID: 31221501 DOI: 10.1016/j.euroneuro.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
Benzodiazepines (BDZs) are widely prescribed in older people. The aims of the study are to assess the prevalence of inappropriate prescription of BZDs and the associated factors in acutely hospitalized older patients. Patients aged 65 years or more hospitalized from 2010 to 2017 in more than 100 Italian internal medicine and geriatric wards in the frame of the REPOSI register were included if prescribed with BDZs at hospital admission or discharge. Appropriateness of prescription was assessed according to the 2015 Beers criteria and their modified French and German versions. Among 4681 patients discharged from hospital, 15% (N = 710) were discharged with BDZs, and 62% of them (N = 441, 95% CI: 58.5%-65.6%) were inappropriately prescribed, being prescribed with BDZ to be always avoided in the elderly (45%), at higher doses than recommended (31%) or with no appropriate clinical conditions (19%). From admission to discharge the prevalence of inappropriate BDZ prescription decreased by 4%, but 62% of patients inappropriately prescribed at admission were still inappropriately prescribed at discharge. Among the 179 patients first prescribed at the time of discharge, half were inappropriately prescribed. Being female (OR 1.32, 95%CI 0.95-1.85), enrolled in REPOSI during the years 2016 and 2017 (OR 1.94, 95%CI 1.10-3.39; OR 1.57, 95%CI 0.95-2.58) and living in nursing homes (OR 2.04, 95%CI 0.95-4.37) were associated with an increased risk to be inappropriately prescribed. This study shows a high prevalence of inappropriate use of BDZ in acutely hospitalized older patients both at hospital admission and discharge.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - R Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Ardoino I, Mannucci PM, Nobili A, Franchi C. Antibiotic use and associated factors in a large sample of hospitalised older people. J Glob Antimicrob Resist 2019; 19:167-172. [PMID: 31051285 DOI: 10.1016/j.jgar.2019.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/20/2018] [Revised: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. METHODS Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. RESULTS A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. CONCLUSION Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance.
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Affiliation(s)
- I Ardoino
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
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Cesari M, Franchi C, Cortesi L, Nobili A, Ardoino I, Mannucci PM. Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register. Eur J Intern Med 2018; 56:11-18. [PMID: 29907381 DOI: 10.1016/j.ejim.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/08/2018] [Accepted: 06/04/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. METHODS Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. RESULTS Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21-0.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38-1.87) and overall (HR 1.46, 95%CI 1.32-1.62) mortality, also after adjustment for age and sex. CONCLUSIONS The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions.
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Affiliation(s)
- M Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - C Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - L Cortesi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - I Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Gennaro M, Di Cosimo S, Ardoino I, Veneroni S, Mariani L, Agresti R, Daidone MG, de Braud F, Apolone G, Biganzoli E, Demicheli R. Dynamics of the hazard for distant metastases after ipsilateral breast tumor recurrence according to estrogen receptor status: An analysis of 2851 patients. Breast 2018; 40:131-135. [PMID: 29772517 DOI: 10.1016/j.breast.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/22/2017] [Revised: 04/23/2018] [Accepted: 05/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breast cancer (BC) patients with ipsilateral breast tumor recurrence (IBTR) are at high risk of developing distant metastases (DM). We aimed to evaluate the risk pattern of developing DM, with respect to the occurrence of IBTR, in a large series of patients homogeneously treated by conservative surgery (QUART) with a considerably long follow-up. METHODS Piecewise exponential model was used to investigate DM dynamics conditioning on known prognostic factors and IBTR occurrence as time dependent covariate. The model was extended to account for the timescale induced by IBTR, namely the time elapsed since IBTR to the endpoint. RESULTS Among 2851 BCE patients receiving QUART, 209 were assessable for IBTR. After a median follow-up of 129 months, 588 patients presented DM (CCI = 27.3%) as first event and 92 (CCI = 48.8%) following IBTR. Primary tumor size and nodal status confirmed their prognostic value. The hazard for DM was early and high in Estrogen Receptor (ER) negative BC patients; while it was initially low but increases during follow-up in ER positive cases. Patients experiencing IBTR showed DM dynamic similar to that following primary tumor, with a sudden increased risk within 24 months from surgery, regardless the time elapsed since QUART. CONCLUSION BC patients experiencing IBTR showed a sudden and sustained risk of DM following surgery. Our findings are consistent with the hypothesis that IBTR occurrence might act as a "time resector" for risk of DM, and provide a rationale for proper surveillance guidelines and systemic therapy for optimizing BC recurrence and appropriate choice of treatment.
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Affiliation(s)
- Massimiliano Gennaro
- Department of Surgery, Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serena Di Cosimo
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Ardoino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.
| | - Silvia Veneroni
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Agresti
- Department of Surgery, Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Grazia Daidone
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy; Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Romano Demicheli
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
PURPOSE The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient's health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure. PATIENTS AND METHODS We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient's caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient. RESULTS Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland-Altman plot of -2.43, 95% CI=-2.93 to -1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition. CONCLUSION This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient's social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual's care and assistance need to be assembled.
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Affiliation(s)
- Sara Elli
- Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
| | - Diego Contro
- Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Health Management Department, Fondazione IRCCS Ca' Granda OMP, Milan, Italy
| | - Marco Fornili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonello V Caserta
- Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini - CTO, Milan, Italy
| | - Lorenzo Panella
- Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini - CTO, Milan, Italy
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Buttinelli E, Ardoino I, Domeniconi G, Lanzoni M, Pugni L, Ronchi A, Mosca F, Biganzoli E, Castaldi S. Epidemiology of Serratia marcescens infections in NICU of a teaching and research hospital in northern Italy. Minerva Pediatr 2017:S0026-4946.17.04856-3. [PMID: 29072041 DOI: 10.23736/s0026-4946.17.04856-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Serratia marcescens (Sm) is a known cause of infection and colonization in neonates receiving intensive care. The aim of this study was to identify the risk factors for colonization and infection with Sm in Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital. METHODS A casecontrol study was conducted from January to December 2011 in neonates admitted to the NICU. Cases are patients with a microbiologically confirmed infection or colonization, controls were randomly chosen among patients admitted to the same NICU. RESULTS Globally, 39 acquired infections or colonizations were identified. Among factors related to pregnancy, only premature delivery was independently associated to the risk of infection; as well as mechanical ventilation and catheterization for parenteral nutrition, considering indwelling devices. Prolonged administration with antibiotics were also related to the risk of infection. Among Sm strains which have been tested to antibiotics, all have been resistant to amoxicillin/clavulanic acid and to colistin. CONCLUSION This study confirms the association between Sm infection or colonization and low gestational age. Invasive medical devices and medications, strictly necessary in caresupport of preterm neonates, are likely related to Sm infection too. Preventive control strategies are expected to be effective in the control of Sm spread in NICUs.
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Affiliation(s)
- Elisa Buttinelli
- Post Graduate School in Public Health, University of Milan, Milan, Italy -
| | - Ilaria Ardoino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giulia Domeniconi
- Post Graduate School in Public Health, University of Milan, Milan, Italy
| | - Monica Lanzoni
- Quality Unit, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenza Pugni
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Ronchi
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Silvana Castaldi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Quality Unit, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy
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Franchi C, Ardoino I, Nobili A, Pasina L, Mannucci P, Marengoni A, Perticone F. Pattern of in-hospital changes in drug use in the older people from 2010 to 2016. Pharmacoepidemiol Drug Saf 2017; 26:1534-1539. [PMID: 29027300 DOI: 10.1002/pds.4330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- C. Franchi
- Department of Neuroscience; IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - I. Ardoino
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - A. Nobili
- Department of Neuroscience; IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - L. Pasina
- Department of Neuroscience; IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - P.M. Mannucci
- Scientific Direction; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - A. Marengoni
- Department of Clinical and Experimental Sciences; University of Brescia; Brescia Italy
| | - F. Perticone
- Department of Medical and Surgical Sciences; University Magna Graecia of Catanzaro; Catanzaro Italy
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Marcucci M, Franchi C, Nobili A, Mannucci PM, Ardoino I. Defining Aging Phenotypes and Related Outcomes: Clues to Recognize Frailty in Hospitalized Older Patients. J Gerontol A Biol Sci Med Sci 2017; 72:395-402. [PMID: 28364542 DOI: 10.1093/gerona/glw188] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 05/27/2016] [Accepted: 09/07/2016] [Indexed: 12/24/2022] Open
Abstract
Background Because frailty is a complex phenomenon associated with poor outcomes, the identification of patient profiles with different care needs might be of greater practical help than to look for a unifying definition. This study aimed at identifying aging phenotypes and their related outcomes in order to recognize frailty in hospitalized older patients. Methods Patients aged 65 or older enrolled in internal medicine and geriatric wards participating in the REPOSI registry. Relationships among variables associated to sociodemographic, physical, cognitive, functional, and medical status were explored using a multiple correspondence analysis. The hierarchical cluster analysis was then performed to identify possible patient profiles. Multivariable logistic regression was used to verify the association between clusters and outcomes (in-hospital mortality and 3-month postdischarge mortality and rehospitalization). Results 2,841 patients were included in the statistical analyses. Four clusters were identified: the healthiest (I); those with multimorbidity (II); the functionally independent women with osteoporosis and arthritis (III); and the functionally dependent oldest old patients with cognitive impairment (IV). There was a significantly higher in-hospital mortality in Cluster II (odds ratio [OR] = 2.27, 95% confidence interval [CI] = 1.15-4.46) and Cluster IV (OR = 5.15, 95% CI = 2.58-10.26) and a higher 3-month mortality in Cluster II (OR = 1.66, 95% CI = 1.13-2.44) and Cluster IV (OR = 1.86, 95% CI = 1.15-3.00) than in Cluster I. Conclusions Using alternative analytical techniques among hospitalized older patients, we could distinguish different frailty phenotypes, differently associated with adverse events. The identification of different patient profiles can help defining the best care strategy according to specific patient needs.
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Affiliation(s)
- Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri,"Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri,"Milan, Italy
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Italy
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Ardoino I, Rossio R, Di Blanca D, Nobili A, Pasina L, Mannucci PM, Peyvandi F, Franchi C. Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people. Br J Clin Pharmacol 2017; 83:2528-2540. [PMID: 28722184 DOI: 10.1111/bcp.13355] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/27/2016] [Revised: 05/29/2017] [Accepted: 06/11/2017] [Indexed: 12/14/2022] Open
Abstract
AIMS Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. METHODS Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. RESULTS Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5-45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3-34.0%). CONCLUSIONS This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention.
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Affiliation(s)
- Ilaria Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Raffaella Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Luca Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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Gennaro M, Di Cosimo S, Ardoino I, Veneroni S, Mariani L, de Braud F, Daidone MG, Biganzoli E, Demicheli R. Abstract P2-06-07: Risk of metastases after ipsilateral breast tumour recurrence changes overtime according to patient and tumour characteristics: Implications for treatment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-06-07] [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] [Indexed: 11/16/2022]
Abstract
Abstract
To evaluate the risk of systemic disease of early breast cancer (EBC) patients undergoing breast conservative surgery between 1970 - 2000 and experiencing ipsilateral breast tumour recurrence (IBTR). Patients and Methods The study population included EBC patients randomly assigned onto 5 Milan prospective trials (n= 915) or comparably treated outside clinical trials (n= 1060) with quadrantectomy followed by radiotherapy and with known primary tumor characteristics. Multivariable regression analysis was performed via the piecewise exponential. The model accounts other than known prognostic factors, including age, menopausal status, pathologic size, nodal status and time dependent effect for estrogen receptor (ER) for the IBTR occurrence as time dependent covariate (i.e. switching from 0 to 1 at the time of surgery for IBTR). Also the new time scale induced by IBTR occurrence, namely time elapsed since surgery for IBTR to the end-point of interest, was accounted for in the model.
Results Median follow-up was 124 months (IQ Range 96.6 – 179). At the time of analysis, 504 patients were died, 470 presented with systemic disease and 150 with IBTR as first breast cancer event. IBTR was associated with a high risk of systemic disease. This risk was dependent on primary tumor characteristics, including T size, 2 versus 1 (HR 1.79 95% CI 1.46 – 2.21), and nodal status, N1 versus N0 (HR 1.61, 95% CI 1.32 – 1.98), and N2 versus N0 (HR 3.91, 95% CI 3.13 – 4.89). Of note, ER-negative cohort had a slightly earlier and higher hazard of events overtime compared with ER-positive cohort, which, instead, presented higher hazard estimates over the long follow-up period. The most important finding concerned the new timescale induced by IBTR occurrence that revealed to have definite prognostic value, and suggest that patients with IBTR as compared with patients with no IBTR have a sudden and at least 5-fold increase of risk of systemic disease within 2 years following second surgery; of note, this risk decreases thereafter, though it never desappears. Conclusion Breast cancer patients experiencing IBTR are at increased risk of systemic disease. This risk changes overtime and is different according to initial patient and primary tumor characteristics, and hormonal receptor status. The definition of different patterns of BC recurrence can improve BC care through surveillance guidelines and can guide the design of tailored clinical studies.
Citation Format: Gennaro M, Di Cosimo S, Ardoino I, Veneroni S, Mariani L, de Braud F, Daidone MG, Biganzoli E, Demicheli R. Risk of metastases after ipsilateral breast tumour recurrence changes overtime according to patient and tumour characteristics: Implications for treatment [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-06-07.
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Affiliation(s)
- M Gennaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - S Di Cosimo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - I Ardoino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - S Veneroni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - L Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - F de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - MG Daidone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - E Biganzoli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - R Demicheli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Riggio E, Ardoino I, Richardson CE, Biganzoli E. Predictability of anthropomorphic measurements in implant selection for breast reconstruction: a retrospective cohort study. Eur J Plast Surg 2017; 40:203-212. [PMID: 28603385 PMCID: PMC5440532 DOI: 10.1007/s00238-016-1261-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/03/2016] [Accepted: 11/20/2016] [Indexed: 11/26/2022]
Abstract
Background Preoperative implant planning for breast reconstruction is often at risk of being changed perioperatively. This study examined which factors are associated with a change of implant selection. Methods Women who had unilateral two-stage breast reconstruction between 2002 and 2007 were studied. Inclusion criteria were photographic evidence of preoperative skin markings indicating breast dimensions and a selected implant model. Multivariable logistic regression was used to identify variables associated with a changed selection. Results Among the 496 women studied, 308 preoperative implant choices (62.1%) were changed during surgery. A change in plan was significantly associated with symmetrization surgery involving contralateral reduction mammaplasty (OR = 1.92; 95% CI, 1.12 to 3.29) and contralateral mastopexy (OR = 2.26; 95% CI, 1.29 to 3.96), but not with BMI. The required implant width changed more than 0.5 cm in 70 cases (14.1%) while height changed more than 0.5 cm in 215 cases (43.2%). The likelihood of a change was high for large preoperative widths (OR = 9.66 for 15.5 cm) and small preoperative heights (OR = 2.97 for 10.5 cm). At a mean follow-up of 16.6 months, patient satisfaction was good or average in 92.1% of cases and 5.9% of implants had been replaced with another model, indicating that the perioperative implant selection was usually appropriate. Conclusions This study documents the frequency with which implant choices, despite accurate preoperative planning, are changed perioperatively as a result of relatively small differences in anthropomorphic measurements. Perioperative recalculation of breast dimensions may have an advantage in terms of patient reoperation rates. Changes in width were less frequent than changes in height and projection. Contralateral surgery, large width, and small height were the most influential factors. Level of Evidence: Level IV, risk / prognostic study.
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Affiliation(s)
- Egidio Riggio
- Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Ilaria Ardoino
- G.A. Maccacaro Unit of Medical Statistics, Biometry and Bioinformatics, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Caroline E. Richardson
- Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - Elia Biganzoli
- G.A. Maccacaro Unit of Medical Statistics, Biometry and Bioinformatics, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ardoino I, Zangirolami F, Iemmi D, Lanzoni M, Cargnelutti M, Biganzoli E, Castaldi S. Risk factors and epidemiology of Acinetobacter baumannii infections in a university hospital in Northern Italy: A case-control study. Am J Infect Control 2016; 44:1600-1605. [PMID: 27324612 DOI: 10.1016/j.ajic.2016.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/30/2016] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acinetobacter baumannii has emerged as a major cause of outbreaks of hospital-associated infections with increased morbidity and mortality among those affected. METHODS We performed a 1:1 matched case-control study involving 68 cases in a teaching hospital in Northern Italy. Risk factors included general health conditions, comorbidities, diagnostic and therapeutic procedures, and antibiotic therapies. A multiple correspondence analysis (MCA) was performed to highlight possible association patterns among risk factors. After this, a conditional logistic regression model was applied. RESULTS The combined results of the MCA and univariate regression models suggest that invasive procedures performed before intensive care unit admission, in particular bronchoscopy (odds ratio, 48.06) and oxygen therapy (odds ratio, 2.11), are associated with development of an infection. Malnutrition or obesity, lack of self-sufficiency, and severe liver diseases also proved to be significantly associated with infection. When analyzing antibiotic therapies, both the number of molecules administered and duration of therapy were significantly associated. CONCLUSIONS Early recognition of patients at high risk, environmental hygiene control measures, appropriate antibiotic prescriptions, especially regarding carbapenems, and high-quality training of health care workers in all hospital departments are all key aspects for prevention and control of Acinetobacter infection. Further studies are needed to investigate the role of antibiotics on microbial competition dynamics in relation to multidrug-resistant outbreaks.
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Affiliation(s)
- I Ardoino
- Department of Clinical Science and Community, University of Milan, Milan, Italy
| | - F Zangirolami
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - D Iemmi
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - M Lanzoni
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - M Cargnelutti
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - E Biganzoli
- Department of Clinical Science and Community, University of Milan, Milan, Italy
| | - S Castaldi
- Department Biomedical Sciences for Health, University of Milan, Milan, Italy; Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
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Dillekås H, Demicheli R, Ardoino I, Jensen SAH, Biganzoli E, Straume O. The recurrence pattern following delayed breast reconstruction after mastectomy for breast cancer suggests a systemic effect of surgery on occult dormant micrometastases. Breast Cancer Res Treat 2016; 158:169-178. [PMID: 27306422 PMCID: PMC4937089 DOI: 10.1007/s10549-016-3857-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/04/2016] [Indexed: 01/10/2023]
Abstract
The purpose of this study was to characterize the recurrence dynamics in breast cancer patients after delayed reconstruction. We hypothesized that surgical reconstruction might stimulate dormant micrometastases and reduce time to recurrence. All mastectomy breast cancer patients with delayed surgical reconstruction at Haukeland University Hospital, between 1977 and 2007, n = 312, were studied. Our control group consisted of 1341 breast cancer patients without reconstruction. For each case, all patients in the control group with identical T and N stages and age ±2 years were considered. A paired control was randomly selected from this group. 10 years after primary surgery, 39 of the cases had relapsed, compared to 52 of the matched controls. The reconstructed group was analyzed for relapse dynamics after mastectomy; the first peak in relapses was similarly timed, but smaller than for the controls, while the second peak was similar in time and size. Second, the relapse pattern was analyzed with reconstruction as the starting point. A peak in recurrences was found after 18 months, and a lower peak at the 5th-6th year. The height of the peak correlated with the extent of surgery and initial T and N stages. Timing of the peak was not affected, neither was the cumulative effect. The relapse pattern, when time origin is placed both at mastectomy and at reconstruction, is bimodal with a peak position at the same time points, at 2 years and at 5-6 years. The timing of the transition from dormant micrometastases into clinically detectable macrometastases might be explained by an enhancing effect of surgery.
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Affiliation(s)
- Hanna Dillekås
- Department of Oncology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Science, University of Bergen, 5012, Bergen, Norway
| | - Romano Demicheli
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, 20133, Milan, Italy
| | - Ilaria Ardoino
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, 20133, Milan, Italy
| | - Svein A H Jensen
- Department of Plastic- and Reconstructive Surgery, Haukeland University Hospital, 5021, Bergen, Norway
| | - Elia Biganzoli
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, 20133, Milan, Italy
| | - Oddbjørn Straume
- Department of Oncology, Haukeland University Hospital, 5021, Bergen, Norway.
- Centre of Cancer Biomarkers, University of Bergen, 5012, Bergen, Norway.
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Coradini D, Biganzoli E, Ardoino I, Ambrogi F, Boracchi P, Demicheli R, Daidone MG, Moliterni A. p53 status identifies triple-negative breast cancer patients who do not respond to adjuvant chemotherapy. Breast 2015; 24:294-7. [DOI: 10.1016/j.breast.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 11/08/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022] Open
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Rossio R, Franchi C, Ardoino I, Djade CD, Tettamanti M, Pasina L, Salerno F, Marengoni A, Corrao S, Marcucci M, Peyvandi F, Biganzoli EM, Nobili A, Mannucci PM. Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia. Eur J Intern Med 2015; 26:330-7. [PMID: 25898778 DOI: 10.1016/j.ejim.2015.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/27/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). METHODS Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. RESULTS A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. CONCLUSIONS The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.
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Affiliation(s)
- Raffaella Rossio
- Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Ilaria Ardoino
- Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy
| | - Codjo D Djade
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Luca Pasina
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Francesco Salerno
- Department of Medical and Surgery Sciences, IRCCS Policlinico San Donato, University of Milan, Italy
| | | | - Salvatore Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy
| | - Maura Marcucci
- Geriatrics Unit, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Elia M Biganzoli
- Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, IRCCS Ca' Granda Maggiore Hospital Policlinico Foundation, Milan, Italy
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Ardoino I, Lanzoni M, Marano G, Boracchi P, Sagrini E, Gianstefani A, Piscaglia F, Biganzoli EM. Widen NomoGram for multinomial logistic regression: an application to staging liver fibrosis in chronic hepatitis C patients. Stat Methods Med Res 2014; 26:823-838. [PMID: 25413994 DOI: 10.1177/0962280214560045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The interpretation of regression models results can often benefit from the generation of nomograms, 'user friendly' graphical devices especially useful for assisting the decision-making processes. However, in the case of multinomial regression models, whenever categorical responses with more than two classes are involved, nomograms cannot be drawn in the conventional way. Such a difficulty in managing and interpreting the outcome could often result in a limitation of the use of multinomial regression in decision-making support. In the present paper, we illustrate the derivation of a non-conventional nomogram for multinomial regression models, intended to overcome this issue. Although it may appear less straightforward at first sight, the proposed methodology allows an easy interpretation of the results of multinomial regression models and makes them more accessible for clinicians and general practitioners too. Development of prediction model based on multinomial logistic regression and of the pertinent graphical tool is illustrated by means of an example involving the prediction of the extent of liver fibrosis in hepatitis C patients by routinely available markers.
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Affiliation(s)
- Ilaria Ardoino
- 1 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Lanzoni
- 1 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,2 Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Patrizia Boracchi
- 1 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisabetta Sagrini
- 4 Department of Clinical Medicine, University and General Hospital, Bologna, Italy
| | - Alice Gianstefani
- 4 Department of Clinical Medicine, University and General Hospital, Bologna, Italy
| | - Fabio Piscaglia
- 4 Department of Clinical Medicine, University and General Hospital, Bologna, Italy
| | - Elia M Biganzoli
- 1 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,3 Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Romano M, Pontikaki I, Ardoino I, Gattinara M, Del Giudice E, Boracchi P, Lodi Rizzini S, Meroni P, Gerloni V. FRI0550 Drug Survival and Reasons for Discontinuation of the First Course of Biological Therapy in 363 Juvenile Idiopathic Arthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5389] [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: 11/04/2022]
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Romano M, Pontikaki I, Ardoino I, Gattinara M, Del Giudice E, Boracchi P, Lodi-Rizzini S, Meroni P, Gerloni V. FRI0549 Predictive Factors of Remission in Juvenile Idiopathic Arthritis Patients Treated with Biological Therapies. 13-Year Experience of A Single Center. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5504] [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: 11/04/2022]
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Romano M, Pontikaki I, Gattinara M, Ardoino I, Donati C, Boracchi P, Meroni PL, Gerloni V. Drug survival and reasons for discontinuation of the first course of biological therapy in 301 juvenile idiopathic arthritis patients. Reumatismo 2014; 65:278-85. [PMID: 24705031 DOI: 10.4081/reumatismo.2013.682] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/24/2013] [Accepted: 11/23/2013] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to determine long-term effectiveness and safety of 1st biological treatment (BT) in a cohort of 301 juvenile idiopathic arthritis (JIA) patients (pts), non-responders to disease-modifying antirheumatic drugs (DMARDs), in terms of drug survival (continuation rate on therapy) and to identify the baseline predictors of treatment discontinuation. Each JIA pt enrolled in BT is prospectively assessed at the start of treatment and then every 2 months for the evaluation of safety and efficacy according to ACR-Pedi30 criteria. All clinical charts of pts who started a BT between November 1999 and July 2010 have been reviewed. Survival analysis methods suitable for competing risks were used to study time to drug discontinuation due to disease control (defined according to Wallace criteria) or failure [adverse event (AE), lack of efficacy (LaE) or loss of efficacy (LoE) according ACR-Pedi30]. A number of 301 JIA pts, non-responders or intolerant to DMARDs and treated with one or more cycles of BT, were identified. Median disease duration, from onset to the beginning of 1st BT, was 7.8 years (interquartil range 2.21-15.1). In total, there were 294 1st corses with anti-TNF agents, 5 with abatacept and 2 with anakinra. A number of 298 pts were included in the analysis for drug discontinuation (3 pts with no follow-up data after their first dose of BT were excluded). The median follow-up on treatment, before discontinuation due to every cause, was 53.7 months (range 0.45-124.45). One hundred and sixty-five pts discontinued BT: 27 due to disease control, 135 because of failure (78 AEs, 12 LaE and 45 LoE), 3 pts temporarily stopped for pregnancy. Among 135 pts who discontinued for failure, 117 switched to a 2nd BT. Among 27 pts who discontinued due to remission, 13 pts restarted on BT for relapse of disease activity (10 pts restarted with the same BT, 3 switched to a different one). Predictors of discontinuation due to AE were female gender (P=0.01) and longer disease duration (P=0.02). Predictors of discontinuation due to LaE or LoE were systemic onset and polyarthritis FR positive (vs other JIA subtypes) (P<0.05) and use of mAb-anti-TNF (vs sTNFR) (P=0.02). Predictors of discontinuation due to inactive disease were male gender and shorter disease duration (P<0.05). Although only few pts discontinued BT due to a complete and persistent disease control, the majority of them remained on BT for a long time, suggesting that in our cohort of JIA pts, affected by a severe long lasting refractory disease, BT was globally well tolerate and efficacious in controlling the disease.
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Affiliation(s)
- M Romano
- Istituto Ortopedico Gaetano Pini, Cattedra e Dipartimento di Reumatologia, Università degli Studi di Milano.
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Ingegnoli F, Ardoino I, Boracchi P, Cutolo M. Nailfold capillaroscopy in systemic sclerosis: data from the EULAR scleroderma trials and research (EUSTAR) database. Microvasc Res 2013; 89:122-8. [PMID: 23792167 DOI: 10.1016/j.mvr.2013.06.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aims of this study were to obtain cross-sectional data on capillaroscopy in an international multi-center cohort of Systemic Sclerosis (SSc) and to investigate the frequency of the capillaroscopic patterns and their disease-phenotype associations. METHODS Data collected between June 2004 and October 2011 in the EULAR Scleroderma Trials and Research (EUSTAR) registry were examined. Patients' profiles based on clinical and laboratory data were obtained by cluster analysis and the association between profiles and capillaroscopy was investigated by multinomial logistic regression. RESULTS 62 of the 110 EUSTAR centers entered data on capillaroscopy in the EUSTAR database. 376 of the 2754 patients (13.65%) were classified as scleroderma pattern absent, but non-specific capillary abnormalities were noted in 55.48% of the cases. Four major patients' profiles were identified characterized by a progressive severity for skin involvement, as well as an increased number of systemic manifestations. The "early" and "active" scleroderma patterns were generally observed in patients with mild/moderate skin involvement and a low number of disease manifestations, while the "late" scleroderma pattern was found more frequently in the more severe forms of the disease. CONCLUSION These data indicate the importance of capillaroscopy in SSc management and that capillaroscopic patterns are directly related to the extent of organ involvement.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Milano, Italy.
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Ingegnoli F, Ardoino I, Boracchi P, Cutolo M. FRI0499 Nailfold capillaroscopy in systemic sclerosis: data from the eular scleroderma trials and research (EUSTAR) registry. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Romano M, Pontikaki I, Gattinara M, Ardoino I, Donati C, Boracchi P, Meroni P, Gerloni V. THU0326 Drug survival and reasons for discontinuation of the first course of biological therapy in 301 juvenile idiopathic arthritis patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2291] [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: 11/03/2022]
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Romano M, Pontikaki I, Gattinara M, Ardoino I, Boracchi P, Meroni P, Gerloni V. FRI0356 Clinical remission in 291 juvenile idiopathic arthritis patients treated with biological agents. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2813] [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: 11/04/2022]
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Ferraro S, Ardoino I, Bassani N, Santagostino M, Rossi L, Biganzoli E, Bongo AS, Panteghini M. Multi-marker network in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: when and what to measure. Clin Chim Acta 2013; 417:1-7. [PMID: 23246517 DOI: 10.1016/j.cca.2012.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 11/29/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Data on the correlations between biomarkers to suggest cost-effective multi-marker (MM) panels predictive for ST-elevation myocardial infarction (STEMI) patients are lacking. We sought to explore the relationship between cardiac troponin I (cTnI), C-reactive protein (CRP), B-type natriuretic peptide (BNP), and chromogranin A (CgA) accounting for biomarkers' profiles detected within 48h from successful primary percutaneous coronary intervention (PPCI). METHODS In 73 STEMI patients cTnI, CRP, BNP, and CgA were measured before PPCI and 6, 24, and 48h later. STATIS methods generalizing Principal Component Analysis on three-way data sets were employed to extract information about: 1) similarities between patients, 2) contribution of each time of sampling and 3) correlations between biomarkers' profiles. RESULTS STEMI patients who underwent successful PPCI emerged to have a homogeneous profile tailored on biomarkers' evaluation within 48h. Their measurements at 24h contributed the most variability and information both to patients' and to biomarkers' profiles. BNP and cTnI were highly correlated and explained the 40.1% of the total variance, whereas CgA resulted independent and explained the 26.3% of the total variance. CONCLUSIONS Markers' measurements at 24h after PPCI contributed most information to the definition of patients' profile. BNP and cTnI resulted interchangeable in a MM panel for reporting about the extent of necrosis.
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Affiliation(s)
- Simona Ferraro
- Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi, Milano, Italy.
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Demicheli R, Ardoino I, Ambrogi F, Agresti R, Biganzoli E. Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal. Chin J Cancer Res 2013; 25:22-31. [PMID: 23372338 DOI: 10.3978/j.issn.1000-9604.2013.01.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 08/09/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT). METHODS A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. RESULTS In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year). Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. CONCLUSIONS The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.
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Affiliation(s)
- Romano Demicheli
- Scientific Directorate, IRCCS National Cancer Institute, 20133 Milan, Italy
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Colombini A, Perego S, Ardoino I, Marasco E, Lombardi G, Fiorilli A, Biganzoli E, Tettamanti G, Ferraretto A. Evaluation of a possible direct effect by casein phosphopeptides on paracellular and vitamin D controlled transcellular calcium transport mechanisms in intestinal human HT-29 and Caco2 cell lines. Food Funct 2013; 4:1195-203. [DOI: 10.1039/c3fo60099h] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ardoino I, Biganzoli EM, Bajdik C, Lisboa PJ, Boracchi P, Ambrogi F. Flexible parametric modelling of the hazard function in breast cancer studies. J Appl Stat 2012. [DOI: 10.1080/02664763.2011.650685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ferraro S, Ardoino I, Boracchi P, Santagostino M, Ciardi L, Antonini G, Braga F, Biganzoli E, Panteghini M, Bongo AS. Inside ST-elevation myocardial infarction by monitoring concentrations of cardiovascular risk biomarkers in blood. Clin Chim Acta 2012; 413:888-93. [PMID: 22333672 DOI: 10.1016/j.cca.2012.01.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND No information is available on the optimal sampling time to catch the highest increase for biomarkers whose elevation after ST-elevation myocardial infarction (STEMI) is prognostic for adverse events. This study aimed to investigate release kinetics and peak times of cardiac troponin I (cTnI), C-reactive protein (CRP), B-type natriuretic peptide (BNP), chromogranin A (CgA) and cystatin C (CyC) in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). METHODS Blood concentrations of cTnI, CRP, BNP, CgA and CyC were measured before and 6 h, 24 h, and 48 h after PPCI in 84 STEMI patients. The averaged trajectory of marker kinetics was estimated by multivariable regression models adjusted for patient characteristics and orthogonal polynomials were used to describe related releases. RESULTS From the estimated kinetics cTnI peaked at 10 h from symptoms, BNP at 28 h and CRP within 30 h. CyC concentrations did not change, whereas CgA concentrations increased from 6 to 48 h after PPCI. The amount of BNP release was found to be affected by the interaction between gender and age: females<75 years had BNP concentrations fourfold higher than males. CONCLUSIONS According to different release kinetics a single blood sampling for measuring all biomarkers is not recommended.
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