Distribuzione dei farmaci in dose unitaria: studio di fattibilità

Il contenimento dei costi è ormai una costante nelle strategie delle Aziende Sanitarie: l’obiettivo è raggiungibile non solo con i tagli e le esternalizzazioni dei servizi, ma anche e soprattutto attraverso la revisione, la riorganizzazione dei propri metodi e sistemi di lavoro. In questi ultimi anni l’attenzione si è focalizzata anche sull’esigenza di razionalizzare le gestione dei prodotti farmaceutici nei reparti ospedalieri. L’aumento delle tipologie e la “paura atavica” di rimanere sprovvisti di farmaci hanno creato una situazione che obbliga ad una scelta orientata verso una “disruptive innovation”: una modalità innovativa che va a scontrarsi e/o a sostituirsi con l’esistente ma sicuramente più lineare e più snella, a garanzia di maggior sicurezza. Ho così iniziato un percorso partendo dalla revisione della prassi e delle abitudini. Questa analisi ha evidenziato come, nel tentativo di ottimizzare, siano state adottate spesso soluzioni parziali non rapportate all’intero processo rendendo più complesso e alla fine ingestibile una “cosa semplice”. La modalità di richiesta è immutata da almeno venti anni. La richiesta farmaci, compilata in base ad una valutazione individuale dell’infermiere, spesso manca di un reale feed-back sui consumi e il loro andamento. Questo è stato da me riconosciuto come l’iniziale “punto critico” che condiziona poi tutti gli aspetti della gestione dei farmaci: il tempo necessario per le firme, la chiarezza su nomi e dosaggi, le quantità necessarie, le scorte spesso abbondanti che determinano sprechi, la presenza di farmaci scaduti o in scadenza, il controllo dell’inventario. La ricerca ha portato alle proposte di sistemi alternativi come armadi di reparto informatici, robot per la preparazione della monodose che per altro richiedono alti investimenti economici e la preparazione specifica del personale . Una ricerca sul web sul tema “ modalità di rifornimento”, ha indicato che il processo produttivo logistico sia strutturato sui principi della “Lean production” cioè la “Linea snella” tesa a ridurre drasticamente qualsiasi forma di spreco di risorsa umana e/o risorsa materiale che sia. E’ così che i principi della Lean Production possono essere trasferiti nei flussi operativi tra farmacia e reparti. Superando la visione dell’esistente che può rendere miopi, oltrepassando le resistenze al cambiamento, io insieme al personale infermieristico del reparto di Medicina Polispecialistica dell’ASL 4 di Prato abbiamo formato un gruppo di lavoro per realizzare il progetto “Ipotesi di carrello allestito con farmaci a Dose Unitaria”. L’implementazione del modello ha visto gli incontri con gli operatori per informare/formare, lo spostamento/sostituzione degli arredi, un intenso impegno nelle giornate dedicate alla sistemazione dei prodotti e durante l’aggiustamento delle quantità. Tutto questo a favore del sistema che potrà essere esteso a tutti i reparti del Misericordia e Dolce di Prato

Therapeutic Strategies in Pulmonary Hypertension

Pulmonary hypertension (PH) is a life-threatening condition characterized by elevated pulmonary arterial pressure. It is clinically classified into five groups: patients in the first group are considered to have pulmonary arterial hypertension (PAH) whereas patients of the other groups have PH that is due to cardiopulmonary or other systemic diseases. The management of patients with PH has advanced rapidly over the last decade and the introduction of specific treatments especially for PAH has lead to an improved outcome. However, despite the progress in the treatment, the functional limitation and the survival of these patients remain unsatisfactory and there is no cure for PAH. Therefore the search for an “ideal” therapy still goes on. At present, two levels of treatment can be identified: primary and specific therapy. Primary therapy is directed at the underlying cause of the PH. It also includes a supportive therapy consisting in oxygen supplementation, diuretics, and anticoagulation which should be considered in all patients with PH. Specific therapy is directed at the PH itself and includes treatment with vasodilatators such as calcium channel blockers and with vasodilatator and pathogenetic drugs such as prostanoids, endothelin receptor antagonists and phosphodiesterase type-5 inhibitors. These drugs act in several pathogenetic mechanisms of the PH and are specific for PAH although they might be used also in the other groups of PH. Finally, atrial septostomy and lung transplantation are reserved for patients refractory to medical therapy. Different therapeutic approaches can be considered in the management of patients with PH. Therapy can be established on the basis of both the clinical classification and the functional class. It is also possible to adopt a goal-oriented therapy in which the timing of treatment escalation is determined by inadequate response to known prognostic indicators

Technical effectiveness of cement-based mortar for high-reflective building envelope through building energy simulations: preliminary results

In areas with high levels of solar radiation, decreasing the amount of solar energy absorbed by the building envelope is useful to reduce the need of air conditioning and "heat island" effects. Most high-reflective products, however, suffer from low durability. The COOL-IT project is developing an innovative high-reflective cement based mortar for precast products to be used as outer layer in buildings for both vertical and horizontal surfaces, or for road pavement. The mix design is aimed at increasing the durability of this cement-based component while retaining high reflectance to solar radiation. This paper presents the preliminary results of the project, based on the simulation of the energy demand of a residential building, intended as a support to optimize the proposed mixes. The model is analysed in three different locations in Italy, for one year of operation. This allows evaluating the trade-off of the energy demand between the winter increase and the summer reduction

Synergistic effect of gefitinib and rofecoxib in mesothelioma cells

<p>Abstract</p> <p>Background</p> <p>Malignant mesothelioma (MM) is an aggressive tumor that is resistant to conventional modes of treatment with chemotherapy, surgery or radiation. Research into the molecular pathways involved in the development of MM should yield information that will guide therapeutic decisions. Epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) are involved in the carcinogenesis of MM. Combination of COX-2 and EGFR inhibitors, therefore, could be an effective strategy for reducing cell growth in those lines expressing the two molecular markers.</p> <p>Results</p> <p>In order to verify the effect of COX-2 and EGFR inhibitors, five MM cell lines NCI-2452, MPP89, Ist-Mes-1, Ist-Mes-2 and MSTO-211 were characterized for COX-2 and EGFR and then treated with respective inhibitors (rofecoxib and gefitinib) alone and in combination. Only MPP89, Ist-Mes-1 and Ist-Mes-2 were sensitive to rofecoxib and showed growth-inhibition upon gefitinib treatment. The combination of two drugs demonstrated synergistic effects on cell killing only in Ist-Mes-2, the cell line that was more sensitive to gefitinib and rofecoxib alone. Down-regulation of COX-2, EGFR, p-EGFR and up-regulation of p21 and p27 were found in Ist-Mes-2, after treatment with single agents and in combination. In contrast, association of two drugs resulted in antagonistic effect in Ist-Mes-1 and MPP89. In these cell lines after rofecoxib exposition, only an evident reduction of p-AKT was observed. No change in p-AKT in Ist-Mes-1 and MPP89 was observed after treatment with gefitinib alone and in combination with rofecoxib.</p> <p>Conclusions</p> <p>Gefitinib and rofecoxib exert cell type-specific effects that vary between different MM cells. Total EGFR expression and downstream signalling does not correlate with gefitinib sensitivity. These data suggest that the effect of gefitinib can be potentiated by rofecoxib in MM cell lines where AKT is not activated.</p

El mantenimiento para las "Estaciones del Arte" en Nápoles

Las &ldquo;Estaciones del Arte&rdquo; nacen a partir de un proyecto promovido por la Administraci&oacute;n Municipal de N&aacute;poles, junto con la Empresa Metronapoli, para realizar un plan estrat&eacute;gico de fomento y localizar en la l&iacute;nea 1 el eje portador de la movilidad con la construcci&oacute;n de nuevas estaciones, que se convierten en ocasi&oacute;n de recualificaci&oacute;n urbana para algunos puntos neur&aacute;lgicos de la ciudad. De las 34 estaciones del Sistema Metronapoli, 13 son aquellas definidas como &ldquo;Estaciones del Arte&rdquo;, 9 de la l&iacute;nea uno (Tab. 1) y 4 de la l&iacute;nea seis, dise&ntilde;adas por: &Oacute;scar Tusquets Blanca, Karim Rashid, Atelier Mendini, Gae Aulenti, Domenico Orlacchio, Michele Capobianco y Renato Miano. La propuesta de los proyectistas de acuerdo con el cr&iacute;tico de arte Achille Bonito Oliva, encargado por el Ayuntamiento de N&aacute;poles de la direcci&oacute;n art&iacute;stica, ha transformado los espacios de tr&aacute;nsito de las estaciones en lugares de encuentro con el arte contempor&aacute;neo para los ciudadanos que diariamente utilizan las l&iacute;neas 1 y 6. Se trata de una asignaci&oacute;n ins&oacute;lita del arte, en un lugar de paso, definido a menudo como &ldquo;non luogo&rdquo; del transporte p&uacute;blico, que se vuelve una escenograf&iacute;a de una operaci&oacute;n cultural de gran envergadura, en la que se ven implicados los nombres m&aacute;s importantes del arte contempor&aacute;neo. Con su patrimonio art&iacute;stico compuesto por unas 200 obras realizadas por 95 artistas Metronapoli constituye un ejemplo &uacute;nico de museo descentrado y distribuido en el &aacute;rea urbana, que exprime el deseo de querer interactuar e integrarse con el territorio, contribuyendo no solamente a mejorar la movilidad urbana sino tambi&eacute;n a dar un valor adicional a la ciudad desde el punto de vista &eacute;tico y est&eacute;tico, e incidiendo en el &aacute;mbito socio-cultural. Con este proyecto, el arte contempor&aacute;neo encuentra una amplia difusi&oacute;n en la capital de la regi&oacute;n Campania desde el a&ntilde;o 1995, cuando por entonces la administraci&oacute;n promovi&oacute; un proyecto denominado &laquo;gli Annali delle Arti&raquo; y otras iniciativas dirigidas a un p&uacute;blico a menudo poco atra&iacute;do por este g&eacute;nero de arte.Tópico 2: Patrimonio Arquitectónico, Ingenieril y Arqueológico (urbano, rural, industrial, religioso, funerario). Construcciones en Tierra. Intervenciones en construcciones con patologías estructurales (aplicación de refuerzos). Técnicas de limpieza y conservación. Sostenibilidad (iluminación, ventilación, acústica, climatización, etc.) Biodeterioro del Patrimonio y técnicas de intervención sobre distintos sustratos

Molecular analysis of the effects of Piroxicam and Cisplatin on mesothelioma cells growth and viability

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been proposed for prevention and treatment of a variety of human cancers. Piroxicam, in particular, has been recently shown to exert significant anti-tumoral activity in combination with cisplatin (CDDP) on mesothelioma cells. However, the mechanisms through which NSAIDs regulate the cell cycle as well as the signal pathways involved in the growth inhibition, remain unclear. In the present study, using two mesothelioma cell lines, MSTO-211H and NCI-H2452, we have investigated the influence of piroxicam alone and in association with CDDP on proliferation, cell cycle regulation and apoptosis. In both cell lines a significant effect on cell growth inhibition, respect to the control, was observed with all the drugs tested. Moreover, treatment with piroxicam or CDDP alone altered the cell cycle phase distribution as well as the expression of some cell cycle regulatory proteins in both cell lines. These effects were increased, even if in a not completely overlapping manner, after treatment with the association of piroxicam and CDDP. In particular, the two drugs in NCI cell line had a synergistic effect on apoptosis, probably through activation of caspase 8 and caspase 9, while the most evident targets among the cell cycle regulators were cyclin D1 and p21waf1. These results suggest that the association of piroxicam and CDDP specifically triggers cell cycle regulation and apoptosis in different mesothelioma cell lines and may hold promise in the treatment of mesothelioma

A Novel Approach for Determining the Electromagnetic Properties of a Colloidal Fluid With Magnetic Nanoparticles for Hyperthermia Applications

The paper presents a general analytical method for evaluating the magnetic properties of colloidal fluid with magnetic nanoparticles and agar through in vitro specific absorption rate (SAR) measurements. The approach for the determination of magnetic complex susceptibility herein presented reveals itself as simple, rapid, broadband, and accurate enough to compete with alternative conventional direct methods requiring complex and expensive instrumentation. In particular, it makes use of indirect equations based on the single-order Debye model [linear response theory (LRT)] combined with a punctual set of in vitro SAR measurements. The procedure is effective inside the range of validity of the LRT theory, and it can be easily applied in the up-growing field of magnetic hyperthermia studies

Characterization of local products for their industrial use: the case of italian potato cultivars analyzed by untargeted and targeted methodologies

The chemical characterization of local Italian potato cultivars is reported to promote their preservation and use as high quality raw material in food industries. Twenty potato (Solanum tuberosum L.) cultivars from Piedmont and Liguria Italian regions were investigated using NMR (Nuclear Magnetic Resonance) and RP-HPLC-PDA-ESI-MSn (Reversed Phase High-Performance Liquid Chromatography with Photodiode Array Detector and Electrospray Ionization Mass Detector) methodologies. Water soluble and lipophilic metabolites were identified and quantified. With respect to literature data, a more complete 1H (protonic) spectral assignment of the aqueous potato extracts was reported, whereas the 1H NMR assignment of potato organic extracts was reported here for the first time. Phenolics resulted to be in high concentrations in the purple-blue colored Rouge des Flandres, Bergerac, Fleur Bleu, and Blue Star cultivars. Servane, Piatlina, and Malou showed the highest amount of galacturonic acid, a marker of pectin presence, whereas Jelly cultivar was characterized by high levels of monosaccharides. Roseval and Rubra Spes contained high levels of citric acid involved in the inhibition of the enzymatic browning in fresh-cut potato. High levels of the amino acids involved in the formation of pleasant-smell volatile compounds during potato cooking were detected in Rouge des Flandres, Blue Star, Bergerac, Roseval, and Ratte cultivars. These results suggest that each local cultivar is characterized by a proper chemical profile related to specific proprieties that can be useful to obtain high quality industrial products

Forced cohabitation during coronavirus lockdown in Italy: a study on coping, stress and emotions among different family patterns

Background: At the beginning of 2020, a pandemic caused by a new strain of coronavirus occurred. On March 9th, the Italian population was forced to lockdown to prevent the spread of this new virus. This event forced families and cohabitants to spend their entire days and weeks in the same physical space, interacting with partners and children with a very different degree of intimacy than in the earlier situation. The present study investigated the effects of being forced to live together on different family patterns, on various dimensions such as stress, coping strategies, time perception and quality evaluation of cohabitation. Method: A total sample consisting of 1750 individuals was recruited through a random sample of probability across the Italian country. Due to the lockdown condition, an online questionnaire was set up; several validated scales were chosen, and some open-ended items were included for the thoughts of the participants. Results: The results showed statistically significant differences between the three family patterns examined. Conclusion: During the forced period of living together, a positive effect could be inferred as given by the presence of children and the collaborative coping strategies that have been adopted; the results have been discussed according to the literature on the topic

Retarded germination of Nicotiana tabacum seeds following insertion of exogenous DNA mimics the seed persistent behavior

Tobacco seeds show a coat-imposed dormancy in which the seed envelope tissues (testa and endosperm) impose a physical constraint on the radicle protrusion. The germination-limiting process is represented by the endosperm rupture which is induced by cell-wall weakening. Transgenic tobacco seeds, obtained by insertion of exogenous genes codifying for seed-based oral vaccines (F18 and VT2eB), showed retarded germination with respect to the wild type and modified the expression of endogenous proteins. Morphological and proteomic analyses of wild type and transgenic seeds revealed new insights into factors influencing seed germination. Our data showed that the interference of exogenous DNA influences the germination rather than the dormancy release, by modifying the maturation process. Dry seeds of F18 and VT2eB transgenic lines accumulated a higher amount of reserve and stressâ\u80\u93related proteins with respect to the wild type. Moreover, the storage proteins accumulated in tobacco F18 and VT2eB dry seeds have structural properties that do not enable the early limited proteolysis observed in the wild type. Morphological observations by electron and light microscopy revealed a retarded mobilization of the storage material from protein and lipid bodies in transgenic seeds, thus impairing water imbibition and embryo elongation. In addition, both F18 and VT2eB dry seeds are more rounded than the wild type. Both the morphological and biochemical characteristics of transgenic seeds mimic the seed persistent profile, in which their roundness enables them to be buried in the soil, while the higher content of storage material enables the hypocotyl to elongate more and the cotyledons to emerge