Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region

Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants—anxiolytics (11.9%) ranked first, followed by antidepressants—aspirin (7.4%). In outpatients, ACE-inhibitors—non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers—α-blockers (2.4%). Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized

A serum metabolomics classifier derived from elderly patients with metastatic colorectal cancer predicts relapse in the adjuvant setting

Adjuvant treatment for patients with early stage colorectal cancer (eCRC) is currently based on suboptimal risk stratification, especially for elderly patients. Metabolomics may improve the identification of patients with residual micrometastases after surgery. In this retrospective study, we hypothesized that metabolomic fingerprinting could improve risk stratification in patients with eCRC. Serum samples obtained after surgery from 94 elderly patients with eCRC (65 relapse free and 29 relapsed, after 5-years median follow up), and from 75 elderly patients with metastatic colorectal cancer (mCRC) obtained before a new line of chemotherapy, were retrospectively analyzed via proton nuclear magnetic resonance spectroscopy. The prognostic role of metabolomics in patients with eCRC was assessed using Kaplan–Meier curves. PCA-CA-kNN could discriminate the metabolomic fingerprint of patients with relapse-free eCRC and mCRC (70.0% accuracy using NOESY spectra). This model was used to classify the samples of patients with relapsed eCRC: 69% of eCRC patients with relapse were predicted as metastatic. The metabolomic classification was strongly associated with prognosis (p-value 0.0005, HR 3.64), independently of tumor stage. In conclusion, metabolomics could be an innovative tool to refine risk stratification in elderly patients with eCRC. Based on these results, a prospective trial aimed at improving risk stratification by metabolomic fingerprinting (LIBIMET) is ongoing

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Introduction: how best to manage patients with colorectal cancer and synchronous liver metastasis is still controversial, with specific concerns of increased risk of postoperative complications following combined resection. We aimed at analyzing the influence of combined liver resection on the risk of anastomotic leak (AL) following colorectal resection. Methods: we reviewed the iCral prospectively maintained database to compare the relative risk of AL of patients undergoing colorectal resection for cancer to that of patients receiving simultaneous liver and colorectal resection for cancer with isolated hepatic metastases. The incidence of AL was the primary outcome of the analysis. Perioperative details and postoperative complications were also appraised. Results: out of a total of 996 patients who underwent colorectal resection for cancer, 206 receiving isolated colorectal resection were compared with a matched group of 53 patients undergoing simultaneous liver and colorectal resection. Combined surgery had greater operative time and resulted in longer postoperative hospitalization compared to colorectal resection alone. The proportion of overall morbidity following combined resection was significantly higher than after isolated colorectal resection (56.6% vs. 37.9%, p = 0.021). Overall, the two groups of patients did not differ neither on the rate of major postoperative complications, nor in terms of AL (9.4% vs. 6.3%, p = 0.381). At specific multivariate analysis, the duration of surgery was the only risk factor independently associated with the likelihood of AL. Conclusions: combining hepatic with colorectal resection for the treatment of synchronous liver metastasis from colorectal cancer does not increase significantly the incidence of AL

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Improving 3D imaging systems with active pattern illumination.

Three-dimensional reconstruction of real-world objects is a crucial task in computer vision and has a wide variety of applications. One example of an industrial application is 3D inspection in production processes, where the 3D geometry of a produced object is compared with its 3D geometry specifications. Here, a particular challenge is to reconstruct 3D models from image acquisitions of objects with homogeneous surfaces without textures. Without available surface textures, feature-based 3D reconstruction approaches fail to recover the geometry of the object. In this thesis, we propose to project a pattern on surfaces to compensate for the absence of visual texture and consequently enable 3D reconstruction of objects without texture. In particular, two 3D reconstruction approaches covering different domains are studied, a microscopic depth from focus approach and a macroscopic multi-view stereo approach. For both approaches, we analyze the impact of an additional pattern illumination module on the 3D reconstruction quality using synthetic ground truth data as a reference. The qualitative and quantitative results clearly show that the enrichment of textures using a pattern illumination module leads to more accurate 3D reconstructions

Interkulturelle Kompetenzen fördern- Mit praktischen Umsetzungsideen für den Schulzyklus 1

Die vorliegende Bachelorarbeit setzt sich mit der kulturellen Vielfalt in der Schweiz auseinander. Im Fokus stehen die Kompetenzen von Kindern im 1. Schulzyklus, mit dieser Vielfalt umzugehen und die Kompetenz der Lehrpersonen, diese gezielt und optimal zu fördern und eine chancenreiche und positive Haltung gegenüber dieser Vielfalt einnehmen zu können. Das Ziel der Förderung von interkulturellen Kompetenzen im jungen Alter ist das zukünftige Zusammenleben in einer heute schon vorhandenen multikulturellen Gesellschaft in der Schweiz. Der Überblick über die Entstehung und Entwicklung interkultureller Ansätze baut Hintergrundwissen und Verständnis auf. Die Auseinandersetzung mit Begriffen wie «Kultur» oder «interkulturell» schafft Bewusstsein für die Komplexität des Themas und weckt Interesse daran, einen Perspektivwechsel vorzunehmen und verschiedene Sichten auf eine Problematik verstehen zu wollen. Durch das Verstehen der Bedeutung von interkultureller Bildung, das Einnehmen einer klaren Haltung als Lehrperson und somit die Schaffung von Orientierung durch die Vorbildfunktion soll diese Arbeit Lehrpersonen des 1. Schulzyklus ein Bewusstsein für die konkrete Förderung interkultureller Kompetenzen schaffen. Auf der Basis des durch die Auseinandersetzung mit verschiedenen theoretischen Ansätzen errungenem Wissen, sollen beispielhafte Möglichkeiten und Ideen für interkulturelle Pädagogik dienen

Interkulturelle Kompetenzen fördern- Mit praktischen Umsetzungsideen für den Schulzyklus 1

Die vorliegende Bachelorarbeit setzt sich mit der kulturellen Vielfalt in der Schweiz auseinander. Im Fokus stehen die Kompetenzen von Kindern im 1. Schulzyklus, mit dieser Vielfalt umzugehen und die Kompetenz der Lehrpersonen, diese gezielt und optimal zu fördern und eine chancenreiche und positive Haltung gegenüber dieser Vielfalt einnehmen zu können. Das Ziel der Förderung von interkulturellen Kompetenzen im jungen Alter ist das zukünftige Zusammenleben in einer heute schon vorhandenen multikulturellen Gesellschaft in der Schweiz. Der Überblick über die Entstehung und Entwicklung interkultureller Ansätze baut Hintergrundwissen und Verständnis auf. Die Auseinandersetzung mit Begriffen wie «Kultur» oder «interkulturell» schafft Bewusstsein für die Komplexität des Themas und weckt Interesse daran, einen Perspektivwechsel vorzunehmen und verschiedene Sichten auf eine Problematik verstehen zu wollen. Durch das Verstehen der Bedeutung von interkultureller Bildung, das Einnehmen einer klaren Haltung als Lehrperson und somit die Schaffung von Orientierung durch die Vorbildfunktion soll diese Arbeit Lehrpersonen des 1. Schulzyklus ein Bewusstsein für die konkrete Förderung interkultureller Kompetenzen schaffen. Auf der Basis des durch die Auseinandersetzung mit verschiedenen theoretischen Ansätzen errungenem Wissen, sollen beispielhafte Möglichkeiten und Ideen für interkulturelle Pädagogik dienen

Perioperative management

The ERAS method (Enhanced Recovery After Surgery) is a multimodal protocol of perioperative care aimed at ensuring a rapid postoperative recovery. It takes into account the latest available scientific evidences in the various disciplines that operate around the patients requiring major surgery, leading to positively change the response and preserving the physiological functional reserve. In fact it protects patients’ autonomy limiting stress, significantly reducing the length of hospital stay and also the rate of complications and readmission. In the ERAS protocol, the surgical process is totally redesigned, taking into account some important items in the preoperative, intraoperative and postoperative time. As known, elderly patients have specific and different features, multiple diseases, cognitive-behavioral and psychological problems, and a high risk of complications, representing their typical fragility. The ERAS pathway is capable of responding to the needs of the elderly patients, in order to respect the complexity of their multiple health conditions