Il dimensionamento ottimale delle Unità Farmaci Antiblastici in condizioni di efficienza gestionale

Introduction The Recommendation n. 14 of 2012 of Ministry of Health, regarding the prevention of errors in therapy, in the oncological sector, provides for the institution of a Centralized Unit for cytotoxic drug or the possibility to make covenants with others hospitals where the compounding is made in a centralized way.This study aims to define a methodology to detect reference standard about technological sizing (manual or robotic workstations) and number of professionals working in the Centralized Unit for cytotoxic drug. Materials and Methods A specific model has been made in order to simulate scenarios of sizing based on structural and organizational features, and activities defined by the users. The model allows, in particular, to determine the medium cost of a cytotoxic compound, depending on configuration of Centralized Unit for cytotoxic drug adopted, by defining a reference value or standard cost helpful to regulate the covenants between hospitals. Results Evidently, by increasing the number of compounds the needs in terms of personnel and technologies increases: the simulation model, based on hypothesis described, estimated for the minimum sizing, until 90 compounds per die, 1 pharmacist and 2 technicians/nurses. The maximum one, expected per 230-250 compounds per die was of 3 pharmacists and 7 technicians/nurses; in terms of technological sizing it moved from 1 workstation until 90 compounds per die to 3 when the number of compounds became double. Regarding the compound’s cost there were potential important economies of scale: from € 15.6 with 1 workstation and about 80 compounds per die, to € 13.8 (-11.5%) with 2 workstations and about 160 compounds per die, until € 13.2 (-15.4) with 3 workstations and 230 compounds per die. Conclusions The results obtained through the simulation model agree with the quantitative data reported in regulations, available to date, by ensuring about the correctness of scenarios. They could represent a standard to support the regional and local health planning by allowing an optimal management of centralized compounding of cytotoxic therapies, by ensuring the maximum efficiency

Notulae to the Italian alien vascular flora: 7

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, and status changes for Italy or for Italian administrative regions of taxa in the genera Abies, Actinidia, Alooe, Amaryllis, Anredera, Arctotheca, Bidens, Cardiospermum, Celosia, Commelina, Cotoneaster, Cyclamen, Eclipta, Euphorbia, Grevillea, Hedera, Hibiscus, Impatiens, Juglans, Kalanchoe, Koelreuteria, Lindernia, Melinis, Myriophyllum, Nandina, Nicotiana, Oenothera, Oxalis, Parthenocissus, Phoenix, Phyllanthus, Physalis, Plumbago, Pteris, Quercus, Setaria, Symphytum, Tagetes, and Washingtonia. Nomenclatural and distribution updates, published elsewhere are provided as Suppl. material 1

Notulae to the Italian alien vascular flora: 9

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions. Furthermore, three new combinations are proposed. Nomenclatural and distribution updates published elsewhere are provided as Suppl. material 1

Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database

Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas