Patterns of self-care in adults with heart failure and their associations with sociodemographic and clinical characteristics, quality of life, and hospitalizations: A cluster analysis

Background: Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. Objectives: The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. Methods: This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and [chi]2 test were used to examine the characteristics of each cluster. Results: Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. Conclusion: The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients

Off-label long acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off- or on-label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off-label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on- and off-label use. Approximately 1 in 4 patients received an off-label prescription. In the off-label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off-label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co-morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Prospective validation of the CLIP score: a new prognostic system for patient with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection

Could Spinal Epidural Lipomatosis Be the Hallmark of Metabolic Syndrome on the Spine? A Literature Review with Emphasis on Etiology

Spinal epidural lipomatosis is defined by an excessive amount of epidural fat in the spinal canal, usually in the lumbosacral tract: a well-known cause of lumbar pain and spinal stenosis with a possible wide range of neurological symptoms. Recent research data reveal that, nowadays, obesity has become the main cause of spinal epidural lipomatosis. Moreover, this condition was recently recognized as a previously unknown manifestation of metabolic syndrome. Radiological studies (CT and MRI) are the only tools that are able to diagnose the disease non-invasively. Indeed, radiologists play a key role in disease recognition, with subsequent possible implications on patients’ systemic health assessments. Despite its clinical importance, the condition is still underreported and neglected. The current literature review summarizes all the main etiologies of spinal epidural lipomatosis, particularly regarding its linkage with metabolic syndrome. An overview of disease characteristics from diagnosis to treatment strategies is also provided

Nonstandard micro-inertia terms in the relaxed micromorphic model: well-posedness for dynamics

International audienceWe study the existence of solutions arising from the modelling of elastic materials using generalized theories of continua. In view of some evidence from physics of metamaterials, we focus our effort on two recent nonstandard relaxed micromorphic models including novel micro-inertia terms. These novel micro-inertia terms are needed to better capture the band-gap response. The existence proof is based on the Banach fixed-point theorem

A review on wave propagation modeling in band-gap metamaterials via enriched continuum models

International audienc

Combined Use of Skin Needling and Platelet-Rich Plasma in Acne Scarring Treatment.

Platelet-rich plasma (PRP) contains autologous growth factors, which could act synergistically with growth factors induced by skin needling in order to enhance the wound-healing response. The com- bination of treatments, carried out by using skin needling and PRP application, should enhance both efficacy of skin needling and PRP application. The objective of this study is to establish the effectiveness of the combined use of skin needling and PRP application in acne scarring treatment. Twelve patients affected with rolling acne scars were enrolled. Each patient underwent 2 sessions of treatments, each consisting of skin needling followed by PRP application on the right side of the face and skin needling alone on the left side of the face. Digital photographs of all patients were taken. Photographic data were analyzed by using the Sign Test (a,.05). The study showed that the scars severity grade in all patients was greatly reduced on all of the face, but the improvement was more efficient on the side treated with both skin needling and PRP. Our study showed that the combined use of skin needling and PRP is more effective than skin needling alone in improving acne scars

Prime analisi e considerazioni circa i danni rilevati al patrimonio culturale delle Marche a valle del terremoto del Centroitalia (2016)

La sequenza sismica che ha interessato l’Italia centrale a partire dal 24 Agosto 2016 ha provocato danni anche di grave entità a molti edifici di importanza storica e artistica. In particolare, per le peculiarità degli impianti strutturali incapaci di sviluppare un meccanismo resistente scatolare, le chiese sono state la tipologia di edifici storici maggiormente colpita. A seguito dell’emergenza sismica, squadre composte da tecnici esperti hanno eseguito sopralluoghi sulle chiese segnalate con il fine di valutare sia l’entità del danno che lo stato di sicurezza. Le squadre sono state coordinate dal Dipartimento di Protezione Civile (DPC) e dal Ministero dei Beni e delle Attività Culturali e del Turismo (MiBACT), tramite le strutture operanti all'interno della direzione di comando e controllo (Dicomac) e le sedi regionali del MiBACT. Nel presente lavoro, i dati registrati nelle schede A-DC compilate durante i sopralluoghi sono stati rielaborati per un campione di chiese della regione Marche. Operando sul campione si propone una metodologia di analisi che potrà in futuro applicarsi alla totalità dei dati. Partendo dalla suddivisione del campione in tipologie omogenee, sono stati analizzati i meccanismi di danno più ricorrenti. In aggiunta, gli indici di danno globali di ogni chiesa sono stati correlati con i massimi valori di Pseudo Accelerazione Spettrale a 0.30s registrati in sito in conseguenza delle maggiori scosse, nel tentativo di derivare una relazione tra intensità di scuotimento e danno atteso. Infine i danni rilevati nel campione sono stati confrontati con quelli forniti dai modelli empirici di vulnerabilità messi a punto sulla scorta dei dati registrati a seguito del terremoto Umbria-Marche 1997

The Effect of Dalbavancin in Moderate to Severe Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and fistulas, localized to the areas of the folds where apocrine glands are present: the armpits, groin, inframammary region, and genital or perineal region. The management is still challenging, and it includes mainly systemic antibiotics, immunosuppressors, and biologic agents. Antibiotics are frequently used in the management of HS for their anti-inflammatory, immunomodulatory, and antimicrobial properties, but no data have been reported regarding the use of dalbavancin in HS. The aim of our practice was to evaluate efficacy, flare, and disease-free survival after dalbavancin therapy in a selected population with HS. We report the experience of the Ancona Dermatology Clinic in treating HS flare-ups with dalbavancin and its rationale for use. Our observation shows that the use of dalbavancin is an effective and well-tolerated treatment for the management of Hurley stage II-III HS; currently, dalbavancin should be considered as a supportive therapy for selected patients