Effects of action observation treatment in recovery after total knee replacement: A prospective clinical trial

We hypothesized that self-administered action observation treatment can increase the effectiveness of inpatient rehabilitation of patients after a primary total knee replacement

Moving forward in fall prevention: An intervention to improve balance among patients in a quasi-experimental study of hospitalized patients

We investigated the effectiveness of three different rehabilitative programs: group exercise, individual core stability or balance training intervention with a stabilometric platform to improve balance ability in elderly hospitalized patients. We used a prospective quasi-experimental study design. Twenty-eight patients, 39.3% women [age (mean +/- SD) 72.4 +/- 6.5 years], known to have had at least a fall in the last 12 months, were consecutively assigned to one of the following three groups: group exercise intervention, individual core stability or balance training with a stabilometric platform (five sessions a week for 3 weeks in each group). Outcomes were collected at baseline and immediately following the intervention period. In each intervention group, patients showed improvement in balance and mobility, shown as an improvement in the three functional tests score (the Tinetti scale, the Berg Balance Scale, and the Time Up and Go test) (all, P<0.05), whereas, generally, the changes in the score of the test of the stabilometric platform (Postural Stability Test and Fall Risk Test) were not significant for all the interventions. No significant group-by-time interaction was detected for any of the intervention groups, which suggests that the groups improved in the same way. These findings indicate that participation in an exercise program can improve balance and functional mobility, which might contribute toward the reductions of the falls of elderly hospitalized patients and the subsequent fall-related costs. Functional scales might be more appropriate than an instrumental test (Postural Stability Test and Fall Risk Test of the Biodex Balance System) in detecting the functional improvement because of a rehabilitative intervention

Association between malnutrition and Barthel Index in a cohort of hospitalized older adults article information

[Purpose] In this study, we sought to evaluate the relationship between the Barthel Index and the Mini Nutritional Assessment Short Form in a cohort of elderly patients hospitalized in the General Rehabilitation Center. [Subjects and Methods] Three hundred and forty-four patients underwent an extensive evaluation, which included the following tests: 1) a Mini Nutritional Assessment Short Form to evaluate nutritional status; and 2) a Barthel Index assessment to evaluate functional status. We categorized patients into three age groups (65-74 yrs, 75-84 yrs, and >85 yrs). Barthel Index cutoff scores were defined as ≥45 out of 100 for better functional status and <45 for worse functional status. [Results] Significant associations between age distribution and the scores obtained with the Barthel Index and Mini Nutritional Assessment Short Form were found; nutritional status measured with Mini Nutritional Assessment Short Form and functional status measured with the Barthel Index were positively related. [Conclusion] This study shows that the Mini Nutritional Assessment Short Form value was associated with the Barthel Index score, and that these scores varied with age

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

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

Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI

The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient

Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly

310nononeBackground: Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards. Methods: While the prevalence of gout was calculated by counting patients with this diagnosis hyperuricemia was inferred in patients taking allopurinol at hospital admission or discharge, on the assumption that this drug was only prescribed owing to the finding of high serum levels of uric acid. A series of clinical and demographic variables were evaluated for their association with gout/hyperuricemia. Results: Of 1380 patients, 139 (10%) had a diagnosis of gout or were prescribed allopurinol. They had more co-morbidities (7.0 vs 5.6; P < 0.0001) and consumed more drugs (6.8 vs 5.0; < b 0.0001). The CIRS (co-morbidity index) was worse in these patients (OR 1.28 95% CI 1.15-1.41). Multivariable regression analysis showed that only renal and heart failures were independently associated with gout/allopurinol intake. Moreover, this combined event was associated with an increased risk of adverse events during hospitalization (OR 1.66, 95% CI 1.16-2.36), but not with the risk of re-hospitalization, length of hospital stay or death. Conclusions: Gout/allopurinol intake has a high prevalence in elderly patients acutely admitted to hospital and are associated with renal and cardiovascular diseases, an increased rate of adverse events and a high degree of drug consumption. In contrast, this finding did not affect the length of hospitalization nor hospital mortality.noneFranchi, Carlotta; Salerno, Francesco; Conca, Alessio; Djade, Codjo D.; Tettamanti, Mauro; Pasina, Luca; Corrao, Salvatore; Marengoni, Alessandra; Marcucci, Maura; Mannucci, Pier Mannuccio; Nobili, Alessandro; Sparacio, Eleonora; Alborghetti, Stefania; Di Costanzo, Rosa; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Barnini, Tommaso; Delitala, Giuseppe; Carta, Stefano; Atzori, Sebastiana; Guarnieri, Gianfranco; Zanetti, Michela; Spalluti, Annalisa; Serra, Maria Grazia; Bleve, Maria Antonietta; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Gasbarrone, Laura; Maniscalco, Giorgio; Gunelli, Massimo; Tirotta, Daniela; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Bernardi, Mauro; Li Bassi, Silvia; Santi, Luca; Agnelli, Giancarlo; Iorio, Alfonso; Marchesini, Emanuela; Mannarino, Elmo; Lupattelli, Graziana; Rondelli, Pamela; Paciullo, Francesco; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baroni, Maria Cristina; Zardo, Marianna; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Salvatore, Teresa; Sasso, Ferdinando Carlo; Utili, Riccardo; Mangoni, Emanuele Durante; Pinto, Daniela; Olivieri, Oliviero; Stanzial, Anna Maria; Fellin, Renato; Volpato, Stefano; Fotini, Sioulis; Barbagallo, Mario; Dominguez, Ligia; Plances, Lidia; D'Angelo, Daniela; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Borghi, Claudio; Strocchi, Enrico; Rinaldi, Elisa Rebecca; Zoli, Marco; Fabbri, Elisa; Magalotti, Donatella; Auteri, Alberto; Pasqui, Anna Laura; Puccetti, Luca; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Sabbà, Carlo; Vella, Francesco Saverio; Marseglia, Alessandro; Luglio, Chiara Valentina; Palasciano, Giuseppe; Modeo, Maria Ester; Aquilino, Annamaria; Raffaele, Pallante; Pugliese, Stefania; Capobianco, Caterina; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Fenoglio, Luigi; Brignone, Chiara; Bracco, Christian; Giraudo, Alessia; Musca, Giuseppe; Cuccurullo, Olga; Cricco, Luigi; Fiorentini, Alessandra; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Fargion, Silvia; Bonara, Paola; Bulgheroni, Mara; Lombardi, Rosa; Magrini, Fabio; Massari, Ferdinando; Tonella, Tatiana; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Moreo, Guido; Ferrari, Barbara; Roncari, Luisa; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Prolo, Silvia; Lilleri, Maria Sole; Micale, Giuliana; Podda, Mauro; Selmi, Carlo; Meda, Francesca; Accordino, Silvia; Monti, Valentina; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Murialdo, Giovanni; Bovio, Marta; Dallegri, Franco; Ottonello, Luciano; Quercioli, Alessandra; Barreca, Alessandra; Secchi, Maria Beatrice; Ghelfi, Davide; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Bergami, Elisabetta; Rizzioli, Emanuela; Cagnoni, Carlo; Bertone, Luca; Manucra, Antonio; Buratti, Alberto; Tognin, Tiziana; Liberato, Nicola Lucio; Bernasconi, Giordano; Nardo, Barbara; Bianchi, Giovanni Battista; Benetti, Giampiero; Quagliolo, Michela; Centenaro, Giuseppe Riccardo; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Gullo, Francesco; Cortellaro, Michele; Magenta, Marina; Perego, Francesca; Meroni, Maria Rachele; Cicardi, Marco; Magenta, Antonio Gidaro Marina; Sacco, Andrea; Bonelli, Antonio; Dentamaro, Gaetano; Rozzini, Renzo; Falanga, Lina; Giordano, Alessandro; Perin, Paolo Cavallo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Montrucchio, Giuseppe; Greco, Elisabetta; Tizzani, Pietro; Fera, Giacomo; Di Luca, Maria Loreta; Renna, Donatella; Perciccante, Antonio; Coralli, Alessia; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Menardo, Giorgio; Bottone, Stefania; Sferrazzo, Elsa; Ferri, Claudio; Striuli, Rinaldo; Scipioni, Rosa; Salmi, Raffaella; Gaudenzi, Piergiorgio; Gamberini, Susanna; Ricci, Franco; Morabito, Cosimo; Fava, Roberto; Semplicini, Andrea; Gottardo, Lucia; Vendemiale, Gianluigi; Serviddio, Gaetano; Forlano, Roberta; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Masala, Cesare; Mammarella, Antonio; Raparelli, Valeria; Fanelli, Filippo Rossi; Delfino, Massimo; Amoroso, Antonio; Violi, Francesco; Basili, Stefania; Perri, Ludovica; Serra, Pietro; Fontana, Vincenzo; Falcone, Marco; Landolfi, Raffaele; Grieco, Antonio; Gallo, Antonella; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; Bellusci, Martino; Setti, Donatella; Pedrazzoli, Filippo; Romanelli, Giuseppe; Pirali, Caterina; Amolini, Claudia; Rosei, Enrico Agabiti; Rizzoni, Damiano; Castoldi, Luana; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Mazzarelli, Chiara; Gallo, Paolo; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Contini, Sara; Molaro, Marta; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bertolotti, Marco; Mussi, Chiara; Scotto, Roberto; Ferri, Maria Alice; Veltri, Francesca; Arturi, Franco; Succurro, Elena; Sesti, Giorgio; Gualtieri, Umberto; Perticone, Francesco; Sciacqua, Angela; Quero, Michele; Bagnato, Chiara; Loria, Paola; Becchi, Maria Angela; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Corinaldesi, Roberto; De Giorgio, Roberto; Serra, Mauro; Grasso, Valentina; Ruggeri, Eugenio; Carozza, Lorenzo Mauro; Pignatti, FabioFranchi, Carlotta; Salerno, Francesco; Conca, Alessio; Djade, Codjo D.; Tettamanti, Mauro; Pasina, Luca; Corrao, Salvatore; Marengoni, Alessandra; Marcucci, Maura; Mannucci, Pier Mannuccio; Nobili, Alessandro; Sparacio, Eleonora; Alborghetti, Stefania; Di Costanzo, Rosa; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Barnini, Tommaso; Delitala, Giuseppe; Carta, Stefano; Atzori, Sebastiana; Guarnieri, Gianfranco; Zanetti, Michela; Spalluti, Annalisa; Serra, Maria Grazia; Bleve, Maria Antonietta; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Gasbarrone, Laura; Maniscalco, Giorgio; Gunelli, Massimo; Tirotta, Daniela; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Bernardi, Mauro; Li Bassi, Silvia; Santi, Luca; Agnelli, Giancarlo; Iorio, Alfonso; Marchesini, Emanuela; Mannarino, Elmo; Lupattelli, Graziana; Rondelli, Pamela; Paciullo, Francesco; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baroni, Maria Cristina; Zardo, Marianna; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Salvatore, Teresa; Sasso, Ferdinando Carlo; Utili, Riccardo; Mangoni, Emanuele Durante; Pinto, Daniela; Olivieri, Oliviero; Stanzial, Anna Maria; Fellin, Renato; Volpato, Stefano; Fotini, Sioulis; Barbagallo, Mario; Dominguez, Ligia; Plances, Lidia; D'Angelo, Daniela; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Borghi, Claudio; Strocchi, Enrico; Rinaldi, Elisa Rebecca; Zoli, Marco; Fabbri, Elisa; Magalotti, Donatella; Auteri, Alberto; Pasqui, Anna Laura; Puccetti, Luca; Pasini, Franco Laghi; Capecchi, PIER LEOPOLDO; Bicchi, Maurizio; Sabbà, Carlo; Vella, Francesco Saverio; Marseglia, Alessandro; Luglio, Chiara Valentina; Palasciano, Giuseppe; Modeo, Maria Ester; Aquilino, Annamaria; Raffaele, Pallante; Pugliese, Stefania; Capobianco, Caterina; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Fenoglio, Luigi; Brignone, Chiara; Bracco, Christian; Giraudo, Alessia; Musca, Giuseppe; Cuccurullo, Olga; Cricco, Luigi; Fiorentini, Alessandra; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Fargion, Silvia; Bonara, Paola; Bulgheroni, Mara; Lombardi, Rosa; Magrini, Fabio; Massari, Ferdinando; Tonella, Tatiana; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Moreo, Guido; Ferrari, Barbara; Roncari, Luisa; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Prolo, Silvia; Lilleri, Maria Sole; Micale, Giuliana; Podda, Mauro; Selmi, Carlo; Meda, Francesca; Accordino, Silvia; Monti, Valentina; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Murialdo, Giovanni; Bovio, Marta; Dallegri, Franco; Ottonello, Luciano; Quercioli, Alessandra; Barreca, Alessandra; Secchi, Maria Beatrice; Ghelfi, Davide; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Bergami, Elisabetta; Rizzioli, Emanuela; Cagnoni, Carlo; Bertone, Luca; Manucra, Antonio; Buratti, Alberto; Tognin, Tiziana; Liberato, Nicola Lucio; Bernasconi, Giordano; Nardo, Barbara; Bianchi, Giovanni Battista; Benetti, Giampiero; Quagliolo, Michela; Centenaro, Giuseppe Riccardo; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Gullo, Francesco; Cortellaro, Michele; Magenta, Marina; Perego, Francesca; Meroni, Maria Rachele; Cicardi, Marco; Magenta, Antonio Gidaro Marina; Sacco, Andrea; Bonelli, Antonio; Dentamaro, Gaetano; Rozzini, Renzo; Falanga, Lina; Giordano, Alessandro; Perin, Paolo Cavallo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Montrucchio, Giuseppe; Greco, Elisabetta; Tizzani, Pietro; Fera, Giacomo; Di Luca, Maria Loreta; Renna, Donatella; Perciccante, Antonio; Coralli, Alessia; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Menardo, Giorgio; Bottone, Stefania; Sferrazzo, Elsa; Ferri, Claudio; Striuli, Rinaldo; Scipioni, Rosa; Salmi, Raffaella; Gaudenzi, Piergiorgio; Gamberini, Susanna; Ricci, Franco; Morabito, Cosimo; Fava, Roberto; Semplicini, Andrea; Gottardo, Lucia; Vendemiale, Gianluigi; Serviddio, Gaetano; Forlano, Roberta; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Masala, Cesare; Mammarella, Antonio; Raparelli, Valeria; Fanelli, Filippo Rossi; Delfino, Massimo; Amoroso, Antonio; Violi, Francesco; Basili, Stefania; Perri, Ludovica; Serra, Pietro; Fontana, Vincenzo; Falcone, Marco; Landolfi, Raffaele; Grieco, Antonio; Gallo, Antonella; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; Bellusci, Martino; Setti, Donatella; Pedrazzoli, Filippo; Romanelli, Giuseppe; Pirali, Caterina; Amolini, Claudia; Rosei, Enrico Agabiti; Rizzoni, Damiano; Castoldi, Luana; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Mazzarelli, Chiara; Gallo, Paolo; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Contini, Sara; Molaro, Marta; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bertolotti, Marco; Mussi, Chiara; Scotto, Roberto; Ferri, Maria Alice; Veltri, Francesca; Arturi, Franco; Succurro, Elena; Sesti, Giorgio; Gualtieri, Umberto; Perticone, Francesco; Sciacqua, Angela; Quero, Michele; Bagnato, Chiara; Loria, Paola; Becchi, Maria Angela; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Corinaldesi, Roberto; De Giorgio, Roberto; Serra, Mauro; Grasso, Valentina; Ruggeri, Eugenio; Carozza, Lorenzo Mauro; Pignatti, Fabi