Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease

Car seat comfort assessment based on objective and subjective measurements in elderly population

n important role in ensuring a comfortable driving experience is represented by a properly designed car seat, especially for elderly drivers. A seat prototype with easily interchangeable pads of cushion and backrest (e.g. thickness, lift at 40%) was realized to meet elderly needs. In this study both a subjective assessment, by means of selected surveys and checklists as well as an objective evaluation, throughout a pressure distribution evaluation, of an existing car seat and the new developed one, in three different pads configurations, has been performed. Thirteen healthy elderly subjects aged between 65 and 83 y.o. have been included in the study. Results showed that the new developed seat ensured a minor discomfort, both perceived (i.e. measured throughout the checklists) and objective (i.e. measured throughout pressure distribution measures) one, with respect to the pre-existing seat, for all the tested subjects. One of the tested configuration seemed to perform better in terms of perceived comfort while showing a uniform pressure distribution

Timeline of Authorization and Reimbursement for Oncology Drugs in Italy in the Last 3 Years

Introduction The main purpose of this analysis was to quantify the time elapsed between the validation date of European Medicines Agency (EMA) centralized procedure and the first purchase of a product by at least 1 Italian health care structure, evaluating different variables that affect the process, the number of products approved by the Committee for Medicinal Products for Human Use (CHMP) that are available on the Italian market (July 2016), and the impact of the Cnn class for oncology drugs in Italy. Methods A panel of oncology products has been defined, which considered drugs approved by the EMA between January 2013 and December 2015, and authorized for the treatment of oncology diseases, excluding generics. Data were obtained via the EMA website by the Agenzia Italiana del Farmaco (AIFA; the Italian Medicine Agency) meeting reports, by official administrative acts of marketing authorization, and the date of the first purchase (first day of the first handling month). Results The mean time of EMA evaluation for the considered panel of medicines was about 441 days (standard deviation (SD) 108; range 266-770); the average approval time for AIFA was about 248 days (SD 131; range 85-688). Interestingly, the mean AIFA evaluation time decreased significantly from 264 days for products submitted to AIFA assessment in 2013-2014 to 219 days for products evaluated in 2015-2016. Focusing on the regional access, both the timing and the number of drugs available for patients were widely different from region to region. Discussion A reduction in the approval time in the last 2 years has been observed in Italy. However, several variables influence the efficiency of the process and need to be addressed to make the access to drugs timely and efficient

Palleggiando – Campagna di prevenzione del tumore del testicolo negli atleti del CUS Pavia. Nota 2.

Il tumore del testicolo è la neoplasia più comune tra i giovani uomini (15-40 a.) e la sua incidenza è in crescita. Ad oggi, l’unico intervento di prevenzione possibile è la manovra di autopalpazione. In una precedente nota erano stati riportati i risultati relativi alla prima fase di uno studio rivolto agli atleti del CUS Pavia che aveva previsto la somministrazione di un questionario sulle abitudini di vita e sulle conoscenze del tumore al testicolo, la dimostrazione pratica della tecnica di autopalpazione e una lezione teorica. Obiettivo di questa nota è la valutazione delle conoscenze acquisite e della compliance a distanza di tre mesi da parte degli stessi atleti che avevano partecipato alla prima fase

Peri-implant test is a proposal of a new procedure to prevent peri-implantitis and forensic claims

Implant dentistry has become one of the most successful techniques for oral rehabilitation over the last 20 years. The success rate of implant oral rehabilitation is above 80% while peri-implant disease (PID) is the most important complication of implant dentistry. The main cause of PID is considered bacterial leakage at the implant-abutment connection of a two-piece implant system. Prevention and control of bacterial leakage at the implant-abutment connection is mandatory for reducing inflammation process around implants neck and achieving bone stability. Since bacteria leakage at implant-abutment connection level is the main cause of PID, a microbiological test should be important to identify bacteria that cause PID. According with the conclusion of workshop of the European Federation on Periodontology, a test that detects the most frequent bacterial species involved in the onset of PID (Actinobacillus actinomycetecomitans, Porphyromonas gengivalis, Tannnerella forsythia, Treponema denticola) should be used in clinical practice. In fact, PID progression depends on the typology, quantity and composition of bacterial flora in peri-implant pockets, so controlling PID onset and progression, is a keystone for preventing implant failures and consequently forensic conflicts. The effort to prevent PID and consequently assurance or forensic conflicts have become one of the main focal points of all dental professionals. Behind these efforts lie, above all, ethical but also economic reasons, as well as a desire to prevent PID, improving implant care quality and increasing the legal security of health care professionals themselves. Since the legal decisions in our society influence how we practice dentistry, especially in the fast-evolving field of implant dentistry, using diagnostic tools that will allow dentists to demonstrate that they have acted correctly in accordance with the knowledge of modern medicine, it is of great importance to defend themselves in the case of legal-legal disputes

Additional file 1: of Differences in drug use between men and women: an Italian cross sectional study

Dataset prevalence. Description data: Prevalence data and Risk Ratio. (PDF 11 kb

Alzheimer caffè, l’esperienza di Premosello-Chiovenda

La malattia di Alzheimer è la più comune forma di demenza ed è caratterizzata da disorientamento e disturbi della memoria e del comportamento, fino alla perdita delle normali funzioni fisiologiche e cognitive. In Italia circa 600.000 persone ne sono affette, molte di loro assistite a casa da un familiare. Lo stress cronico a cui sono sottoposti i caregiver ha un impatto negativo sulla loro salute fisica e mentale e per aiutare le famiglie ad accettare e a gestire questa patologia sono nati gli Alzheimer Caffè, ambienti informali dove si possono incontrare persone che vivono gli stessi disagi. Nel 2013 nasce il Caffè di Premosello-Chiovenda (VB), vi partecipano i caregiver e, se possibile, i loro familiari malati. Gli incontri prevedono una prima parte terapeutica ed educativa seguita da un secondo momento conviviale