Abobotulinumtoxina and rehabilitation vs rehabilitation alone in post-stroke spasticity: A cost-utility analysis

Objective: To investigate costs and quality-adjusted life years of rehabilitation combined with abobotulinumtoxinA (aboBoNT-A) (rehab/aboBoNT-A) vs rehabilitation alone (rehab) in post-stroke spasticity in Italy. Design: Based on both Italian National Health Service and societal perspectives, a 2-year cost-utility analysis model was performed. Subject/patients: The cost-utility analysis model considered hypothetical patients. Methods: The cost-utility analysis model was populated with data concerning demographics, disease severity, healthcare and non-healthcare resource consumption. Data were collected via a questionnaire administered to 3 highly experienced Italian physiatrists (864 out of 930 post-stroke spasticity patients on rehab/aboBoNT-A in total). Costs are expressed in Euro (\u20ac) based on the year 2018. Results: The cost to society (rounded to the nearest whole \u20ac) was \u20ac22,959 (rehab/aboBoNT-A) vs \u20ac11,866 (rehab). Italian National Health Servicefunded cost was \u20ac7,593 (rehab/aboBoNT-A) vs \u20ac1,793 (rehab). Over a period of 2 years rehab/aboBoNT-A outperforms rehab in terms of qualityadjusted life years gained (1.620 vs 1.150). The incremental cost-utility ratio was \u20ac12,341 (Italian National Health Service viewpoint) and \u20ac23,601 (societal viewpoint). Sensitivity analyses confirmed the robustness of the baseline results. Conclusion: Despite some limitations, the higher number of quality-adjusted life years gained vs rehab and the high probability of reaching a cost-utility ratio lower than the Italian informal acceptability range (\u20ac25,000-40,000) make rehab/aboBoNT-A a cost-effective healthcare programme for treating patients with post-stroke spasticity in Italy

3D City Models and urban information: Current issues and perspectives

Considering sustainable development of cities implies investigating cities in a holistic way taking into account many interrelations between various urban or environmental issues. 3D city models are increasingly used in different cities and countries for an intended wide range of applications beyond mere visualization. Could these 3D City models be used to integrate urban and environmental knowledge? How could they be improved to fulfill such role? We believe that enriching the semantics of current 3D city models, would extend their functionality and usability; therefore, they could serve as integration platforms of the knowledge related to urban and environmental issues allowing a huge and significant improvement of city sustainable management and development. But which elements need to be added to 3D city models? What are the most efficient ways to realize such improvement / enrichment? How to evaluate the usability of these improved 3D city models? These were the questions tackled by the COST Action TU0801 “Semantic enrichment of 3D city models for sustainable urban development”. This book gathers various materials developed all along the four year of the Action and the significant breakthroughs

Opportunities for Volunteered Geographic Information Use in Spatial Planning

This chapter highlights two types of georeferenced User-Generated Content (geo-UGC) that show considerable potential for fruitful usage in spatial planning in practice: Volunteered Geographic Information (VGI) and Social Media Geographic Information (SMGI). By describing selected case studies, the chapter illustrates how geo-UGC can be used at different stages of spatial planning processes, supporting a more pluralist understanding of places, fostering the collaboration between decision-makers and contributing to a more participatory practice in spatial planning. The Geodesign approach is used as the framework for underpinning the discussion. Selected case studies developed by the authors are presented showing how geo-UGC can be beneficial for building knowledge on current urban and territorial dynamics, for identifying possible alternative futures and for finding agreement on preferable future developments. In all the selected cases, large numbers of users were involved in collecting volunteered content. The findings are also interpreted within the Smart Cities paradigm, where participation is an essential factor for building successful smart communities

Coronary Microvascular Dysfunction in Patients With Heart Failure: Characterization of Patterns in HFrEF Versus HFpEF.

Coronary microvascular dysfunction (CMD) is involved in heart failure (HF) onset and progression, independently of HF phenotype and obstructive coronary artery disease. Invasive assessment of CMD might provide insights into phenotyping and prognosis of patients with HF. We aimed to assess absolute coronary flow, absolute microvascular resistance, myocardial perfusion, coronary flow reserve, and microvascular resistance reserve in patients with HF with preserved ejection fraction and HF with reduced ejection fraction (HFrEF). Single-center, prospective study of 56 consecutive patients with de novo HF with nonobstructive coronary artery disease divided into HF with preserved ejection fraction (n=21) and HFrEF (n=35). CMD was invasively assessed by continuous intracoronary thermodilution and defined as coronary flow reserve <2.5. Left ventricular and left anterior descending artery-related myocardial mass was quantified by echocardiography and coronary computed tomography angiography. Myocardial perfusion (mL/min per g) was calculated as the ratio between absolute coronary flow and left anterior descending artery-related mass. Patients with HFrEF showed a higher left ventricular and left anterior descending artery-related myocardial mass compared with HF with preserved ejection fraction (P<0.010). Overall, 52% of the study population had CMD, with a similar prevalence between the 2 groups. In HFrEF, CMD was characterized by lower absolute microvascular resistance and higher absolute coronary flow at rest (functional CMD; P=0.002). CMD was an independent predictor of a lower rate of left ventricular reverse remodeling at follow-up. In patients with HF with preserved ejection fraction, CMD was mainly due to higher absolute microvascular resistance and lower absolute coronary flow during hyperemia (structural CMD; P≤0.030). Continuous intracoronary thermodilution allows the definition and characterization of patterns with distinct CMD in patients with HF and could identify patients with HFrEF with a higher rate of left ventricular reverse remodeling at follow-up

Diastolic dysfunction, frailty and prognosis in elderly patients with acute coronary syndromes

reserved14noThe study was an investigator-driven clinical trial conducted by the University of Ferrara.Background To investigate the relationship between 1-year outcome and diastolic dysfunction (DD) and frailty and/or physical performance (PP) in older adults admitted to hospital for acute coronary syndrome (ACS). Methods and results Older (age ≥ 70 years) hospitalized for ACS and receiving coronary artery angiography ± percutaneous coronary intervention were included. Before discharge a complete transthoracic echocardiogram (TTE) was performed with the assessment of DD, following the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging algorithm. Seven different scales of frailty and PP were assessed. The relationship between DD and tests of frailty and PP was investigated, as well as the association with the 1-year occurrence of all-cause death or re-hospitalization. Overall, 329 patients were included in the analysis. Patients were stratified in two groups: DD grade 0–1 versus 2–3. Those with undetermined degree of DD have been excluded by the analysis (n = 106). Mean age of the groups was 77 ± 5 vs 79 ± 6 years, respectively. Scales of frailty and/or PP were significantly poor in patients with DD grade 2–3 compared to the others. After multivariate Cox regression (considering age, female sex, haemoglobin, albumin, clinical presentation, LVEF and SPPB) DD (degree 2–3 vs. 0–1) emerged as an independent predictor of the composite endpoint (HR 1.69, 95%CI 1.04–2.75, p = 0.033). This was mainly driven by 1-year re-hospitalization (HR 2.01, 95%CI 1.22–3.27, p < 0.001). Conclusions In older ACS patients the assessment of DD is related to parameters of frailty and PP and it is an independent predictor of 1-year outcome.mixedPavasini R.; Cardelli L.S.; Piredda A.; Tonet E.; Campana R.; Vitali F.; Cimaglia P.; Maietti E.; Caglioni S.; Morelli C.; Serenelli M.; Rapezzi C.; Ferrari R.; Campo G.Pavasini, R.; Cardelli, L. S.; Piredda, A.; Tonet, E.; Campana, R.; Vitali, F.; Cimaglia, P.; Maietti, E.; Caglioni, S.; Morelli, C.; Serenelli, M.; Rapezzi, C.; Ferrari, R.; Campo, G