An interplay between nursing’s skills and new technologies in the home care: a case report of a complex ulcer

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Effetti di promozione della salute del carotenoide di origine marina Astaxantina

L’astaxantina è un carotenoide del tipo xantofilla, liposolubile e di colore rosso-arancio, prodotta in larga quantità da una microalga, l’Haematococcus pluvialis, oltrechè da alcune specie di lieviti. Questa molecola ha mostrato in numerose sperimentazioni di poter determinare benefici per la salute dell’uomo. Le evidenze sperimentali suggeriscono che la molecola potrebbe esercitare azioni preventive contro le malattie cardiovascolari aterosclerotiche attraverso la sua capacità di contrastare lo stress ossidativo, l’infiammazione e di modificare il metabolismo lipidico e quello del glucosio. Inoltre, grazie anche alle sue proprietà antiapoptotica e di modulazione immunitaria e all’attività inibitoria versol’Helycobacter pylori, ha guadagnato un crescente interesse come potenziale agente farmacologico contro varie malattie. Questa tesi esamina le attuali prove disponibili riguardanti i potenziali effetti benefici dell’astaxantina per gli esseri umani, che sono alla base di un aumentato uso come integratori di prodotti contenenti questo carotenoide. Astaxanthin is a xanthophyll-type carotenoid, fat-soluble and red-orange in color, produced in large quantities by a microalgae, Haematococcus pluvialis, as well as by some species of yeasts. This molecule has shown in numerous experiments that it can determine benefits for human health. Experimental evidence suggests that the molecule could exert preventive actions against atherosclerotic cardiovascular diseases through its ability to counteract oxidative stress, inflammation and to modify lipid and glucose metabolism. In addition, thanks also to its anti-apoptotic and immune modulating properties and inhibitory activity against Helicobacter pylori, it has gained growing interest as a potential pharmacological agent against various diseases. This thesis examines the current evidence available regarding the potential beneficial effects of astaxanthin for humans, which underlie the increased use of products containing this carotenoid as supplements

Ricerca applicata sull'adozione della buona pratica di misura e gestione del dolore all'interno dell'ASL 2 Lucca

All’interno dell’Azienda ASL 2 di Lucca, è emersa la necessità di intraprendere un percorso di valutazione relativo all’adozione della buona pratica di misura e gestione del dolore. Lo strumento per effettuare la ricerca è un questionario strutturato ad hoc e somministrato al personale medico e infermieristico L’analisi dei risultati sarà effettuata distintamente sul Presidio Ospedaliero di Lucca e su quello della Valle del Serchio, per ciascuno sarà mostrata la collocazione UU.OO. nelle aree funzionali di appartenenza; inoltre abbiamo posto particolare attenzione alle percentuali di professionisti che hanno aderito alla ricerca, per poi concludere con le risposte alle domande sia dei medici che degli infermieri per ogni presidio e gli eventuali scostamenti delle singole aree funzionali. Sulla base delle eventuali criticità rilevate struttureremo progetti di miglioramento specifici, tra i quali la programmazione di eventi formativi mirati a sviluppare negli operatori la cultura di una corretta misurazione e gestione del dolore

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50\ue2\u80\u9375 years with type 2 diabetes inadequately controlled with metformin monotherapy (2\ue2\u80\u933 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15\ue2\u80\u9345 mg) or a sulfonylurea (5\ue2\u80\u9315 mg glibenclamide, 2\ue2\u80\u936 mg glimepiride, or 30\ue2\u80\u93120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57\uc2\ub73 months. The primary outcome occurred in 105 patients (1\uc2\ub75 per 100 person-years) who were given pioglitazone and 108 (1\uc2\ub75 per 100 person-years) who were given sulfonylureas (hazard ratio 0\uc2\ub796, 95% CI 0\uc2\ub774\ue2\u80\u931\uc2\ub726, p=0\uc2\ub779). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0\uc2\ub70001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. Interpretation In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society