Systematic review of telemonitoring in COPD: an update

Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease (COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of telemedicine in this patients. The aim of this study is to provide an update on the effectiveness of telemedicine in reducing adverse clinical outcomes. We searched the Pubmed database for articles published between January 2005 and December 2014. We included only randomized controlled trials exclusively focused on patients with COPD and with a telemedicine intervention arm. Evaluated outcomes were number of exacerbations, ER visits, COPD hospitalizations, length of stay and death. We eventually included 12 randomized controlled trials. Most of them had a small sample size and was of poor quality, with a wide heterogeneity in the parameters and technologies used. Most studies reported a positive effect of telemonitoring on hospitalization for any cause, with risk reductions between 10% and 63%; however only three studies reached statistical significance. The same trend was observed for COPD-related hospital admission and ER visits. No significative effects of telemedicine was evidenced in reducing length of hospital stay, improving quality of life and reducing deaths. In conclusion, our study confirms that the available evidence on the effectiveness of telemedicine in COPD does not allow to draw definite conclusions; most evidence suggests a positive effect of telemonitoring on hospital admissions and ER visits. More trials with adequate sample size and with adequate consideration of background clinical services are needed to definitively establish its effectiveness.Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease (COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of telemedicine in this patients. The aim of this study is to provide an update on the effectiveness of telemedicine in reducing adverse clinical outcomes. We searched the Pubmed database for articles published between January 2005 and December 2014. We included only randomized controlled trials exclusively focused on patients with COPD and with a telemedicine intervention arm. Evaluated outcomes were number of exacerbations, ER visits, COPD hospitalizations, length of stay and death. We eventually included 12 randomized controlled trials. Most of them had a small sample size and was of poor quality, with a wide heterogeneity in the parameters and technologies used. Most studies reported a positive effect of telemonitoring on hospitalization for any cause, with risk reductions between 10% and 63%; however only three studies reached statistical significance. The same trend was observed for COPD-related hospital admission and ER visits. No significative effects of telemedicine was evidenced in reducing length of hospital stay, improving quality of life and reducing deaths. In conclusion, our study confirms that the available evidence on the effectiveness of telemedicine in COPD does not allow to draw definite conclusions; most evidence suggests a positive effect of telemonitoring on hospital admissions and ER visits. More trials with adequate sample size and with adequate consideration of background clinical services are needed to definitively establish its effectiveness

Systematic review of telemonitoring in COPD: an update.

Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease (COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of telemedicine in this patients. The aim of this study is to provide an update on the effectiveness of telemedicine in reducing adverse clinical outcomes. We searched the Pubmed database for articles published between January 2005 and December 2014. We included only randomized controlled trials exclusively focused on patients with COPD and with a telemedicine intervention arm. Evaluated outcomes were number of exacerbations, ER visits, COPD hospitalizations, length of stay and death. We eventually included 12 randomized controlled trials. Most of them had a small sample size and was of poor quality, with a wide heterogeneity in the parameters and technologies used. Most studies reported a positive effect of telemonitoring on hospitalization for any cause, with risk reductions between 10% and 63%; however only three studies reached statistical significance. The same trend was observed for COPD-related hospital admission and ER visits. No significative effects of telemedicine was evidenced in reducing length of hospital stay, improving quality of life and reducing deaths. In conclusion, our study confirms that the available evidence on the effectiveness of telemedicine in COPD does not allow to draw definite conclusions; most evidence suggests a positive effect of telemonitoring on hospital admissions and ER visits. More trials with adequate sample size and with adequate consideration of background clinical services are needed to definitively establish its effectiveness

Cardiac amyloidosis awareness among residents/specialists in Geriatrics: an Italian national survey

Objective. Cardiac amyloidosis (CA) among older adults is less infrequent than usually considered, and often underdiagnosed. Geriatricians' awareness and knowledge of CA is unknown. Objectives of the study are to assess actual CA knowledge among residents/specialists in Geriatrics, and their usual clinical practice in managing suspected CA. Methods. In this Nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in April-August 2020, we administered to residents/specialists in Geriatrics a questionnaire divided in three sections: socio-demographical, procedural and knowledge. Results were stratified by qualification (resident/specialist) and by performance (best/worst performers). Results. 289 residents and 104 specialists participated. The overall proportion of correct answers was 57.9% (58.4% residents, 56.1% specialists); knowledge about clinical (89% of correct answers, 91% residents and 84% specialists, P = 0.062), ECG (72% of correct answers, no differences between groups), and echocardiographic (86% of correct answers, no differences between groups) signs of CA was good. However, only 8% participants knew how to diagnose ATTRwt CA (no differences between groups), and 19% which diuretic is indicated in CA (22% residents, 13% specialists, P = 0.069). Only 25% of the participants knew the natural history of ATTRwt (19% residents, 41% specialists, P < 0.001), and 37% was aware of the target of the ATTR treatment. Prevalence of CA was underestimated by 57% specialists and 37% residents (P = 0.001). Conclusions. Knowledge of CA among residents/specialists in Geriatrics is uncomplete. Education campaigns on this topic are desirable, to improve physicians' awareness of CA, thus reducing the number of potential misdiagnosis/delay in correct diagnoses

Platelet Function Testing in Patients with Acute Ischemic Stroke: An Observational Study

Background: The measurement of platelet reactivity in patients with stroke undergoing antiplatelet therapies is not commonly performed in clinical practice. We assessed the prevalence of therapy responsiveness in patients with stroke and further investigated differences between patients on prevention therapy at stroke onset and patients naive to antiplatelet medications. We also sought differences in responsiveness between etiological subtypes and correlations between Clopidogrel responsiveness and genetic polymorphisms. Methods: A total of 624 stroke patients on antiplatelet therapy were included. Two different groups were identified: "non-naive patients", and "naive patients". Platelet function was measured with multiple electrode aggregometry, and genotyping assays were used to determine CYP2C19 polymorphisms. Results: Aspirin (ASA) responsiveness was significantly more frequent in naive patients compared with non-naive patients (94.9% versus 82.6%, P < .0010). A better responsiveness to ASA compared with Clopidogrel or combination therapy was found in the entire population (P < .0010), in non-naive patients (P < .0253), and in naive patients (P < .0010). Multivariate analysis revealed a strong effect of Clopidogrel as a possible "risk factor" for unresponsiveness (odds ratio 3.652, P < .0001). No difference between etiological subgroups and no correlations between responsiveness and CYP2C19 polymorphisms were found. Conclusion: In our opinion, platelet function testing could be potentially useful in monitoring the biological effect of antiplatelet agents. A substantial proportion of patients with stroke on ASA were "resistant", and the treatment with Clopidogrel was accompanied by even higher rates of unresponsiveness. Longitudinal studies are needed to assess whether aggregometry might supply individualized prognostic information and whether it can be considered a valid tool for future prevention strategies

Is Citicoline Effective in Preventing and Slowing Down Dementia?—A Systematic Review and a Meta-Analysis

Background: Cognitive impairment is a staggering personal and societal burden; accordingly, there is a strong interest in potential strategies for its prevention and treatment. Nutritional supplements have been extensively investigated, and citicoline seems to be a promising agent; its role in clinical practice, however, has not been established. We systematically reviewed studies on the effect of citicoline on cognitive performance. Methods: We searched the PubMed and Cochrane Library databases for articles published between 2010 and 2022. Relevant information was extracted and presented following the PRISMA recommendations. Data were pooled using the inverse-variance method with random effects models. Results: We selected seven studies including patients with mild cognitive impairment, Alzheimer’s disease or post-stroke dementia. All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis. Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37–0.75) to 1.57 (95% CI: 0.77–2.37) in different sensitivity analyses. The overall quality of the studies was poor. Discussion: Available data indicate that citicoline has positive effects on cognitive function. The general quality of the studies, however, is poor with significant risk of bias in favor of the intervention. Other: PubMed and the Cochrane Library

Treatment of cancer cachexia in the very advanced or terminal phase: a systematic review

The therapeutic approach to refractory cancer cachexia represents an unmet need and an important research priority in the field of palliative care. Unfortunately, clinical studies in this area are scarce, both regarding nutritional and pharmacological approach. We performed a systematic literature search through Pubmed. The search algorithm considered: the clinical context, the related pathology, the therapeutic approach. The abstracts obtained were entered in a spreadsheet and analyzed in full text. The results were then analyzed according to the PRISMA method. Overall, 258 records were screened: 244 were excluded (not in English, n=44; no abstract, n=12; literature reviews, n=108; not relevant for not advanced phase or phase II studies, n=80). The remaining 14 papers were read in full text: 10 were excluded (4 phase II studies, 4 including patients with a performance status score of ≥70%, 2 including patients concomitantly treated by palliative chemotherapy). The remaining 4 studies of qualitative synthesis included: a study on megestrol acetate; a comparison between supportive treatment with/without melatonin; a placebo-controlled study on intravenous adenosine 5’-triphosphate; a comparison of indomethacin plus erythropoietin with/without nutritional support. The reported data do not allow us to draw any conclusion concerning the efficacy of pharmacological or nutritional treatment for cancer cachexia in very advanced or terminal phase and specific studies are, therefore, awaited

Voltammetric analysis for fast and inexpensive diagnosis of urinary tract infection: a diagnostic study

Abstract Background Dipstick test is widely used to support the diagnosis of urinary tract infections (UTI). It is effective in ruling out UTI, but urine culture is needed for diagnosis confirmation. In this study we compared the accuracy of voltammetric analysis (VA) with that of DT to detect UTI (diagnosed using urine culture), and its usefulness as a second-stage test in people with positive DT. Methods 142 patients were enrolled with no exclusion criteria. VA was performed using the BIONOTE device. Partial Least Square Discrimination Analysis was used to predict UTI based on VA data; diagnostic performance was evaluated using sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LR), accuracy, diagnostic odds ratio (DOR). Results Mean age was 76.6 years (SD 12.6), 57% were male. VA had a better overall performance respect to DT in detecting UTI with accuracy 81.7% vs 75.9%, specificity 90.8% vs 82.5%, PPV 75% vs 61.4%, positive LR 6.68 vs 3.5, DOR 17.7 vs 7.47; sensibility, NPV and negative LR of the two tests were similar. VA had an accuracy of 82.4% in discriminating bacterial from fungal infections. When added as a second-stage test, VA identified 9 of the 17 false positive patients, with a net specificity of 91.7%, sensitivity 54%, PPV 75% and NPV 81%. Conclusions VA is a quick and easy method that may be used as a second stage after DT to reduce the number of urine culture and of inappropriate antibiotic prescriptions

A novel interplay between irisin and PTH: from basic studies to clinical evidence in hyperparathyroidism

CONTEXT: Irisin is a hormonelike molecule that is cleaved and secreted by an unknown protease from fibronectin type III domain-containing protein 5 (FNDC5). It ameliorates bone status and muscle atrophy and influences energy homeostasis. PTH exerts several metabolic effects that may interact with the effects of irisin. OBJECTIVES: To test the hypothesis that irisin and PTH mutually affect their biological action, we evaluated FNDC5 mRNA and protein expression in myotubes treated with PTH (1-34) and parathyroid hormone receptor (PTH-r) mRNA expression in osteoblasts treated with r-irisin. To confirm the in vivo impact of PTH on irisin, we compared irisin serum concentrations in postmenopausal women with primary hyperparathyroidism (PHPT) and control subjects. DESIGN AND INTERVENTION: C2C12 myotubes were treated with short-term and continuous 10-10 M teriparatide and MC3T3-E1 osteoblasts with 100 ng/mL r-irisin for 8 hours. In a cross-sectional open-label trial, we enrolled 26 postmenopausal women with PHPT and 31 age-/body mass index (BMI)‒matched control subjects without impairment of calcium/phosphate metabolism. RESULTS: Teriparatide treatment on myotubes significantly downregulated FNDC5 expression by acting through its own receptor, which in turn activated Erk11/2 phosphorylation. r-Irisin led to a 50% downregulation of PTH-r mRNA expression compared with untreated cells (P &lt; 0.001). Irisin was significantly lower in the PHPT group than in age-/BMI-matched controls (4.5 ± 1.1 vs 12 ± 5.2 µg/mL; P &lt; 0.001). No significant correlation between irisin and bone mineral density or PTH was recorded in the PHPT group. CONCLUSION: Preclinical findings suggest the existence of an interplay between PTH and irisin metabolism that seems to be confirmed by the significant reduction of irisin concentration in postmenopausal women with PHPT. Copyright © 2019 Endocrine Society