Management of polytraumatized patient in Emilia Romagna. Data analysis of nontrauma center Hub Emergency Department

Introduction Trauma still has a great impact in term of morbidity and mortality all over the world. In Emilia Romagna, a region of the north of Italy, the Integrated System of Assistance to Trauma (SIAT) was created to ensure the best management of prehospital and early in-hospital trauma patient. Materials and Methods We reporte and discuss the results of an experimental study done in Emergency Department of Ferrara; datas refer to management of prehospital and early in-hospital trauma patient in the biennium 2015-2016. Results Datas show an increase in cases handled in the hub center instead of in the spoke ones; anyway there was an increasing in centralizing patients in the regional Hub Trauma center. Trauma Team was correctly activated, with an increasing trend. In addition, raising percentage of admission in ICU was associated with the raising percentage of patients treated in emergency medicine ward. Conclusions This article allows us to reflect and discuss about prehospital and in hospital polytraumatized patient path. Thanks to this newborn protocol of centralisation, traumatic patients were uniformly managed in the Western Emilia Romagna SIAT; trauma had a multidisciplinary approach and more appropriate admission. This resulted in optimizing the whole process from the income to the outcome of the patient. Moreover, the hospital of the study showed to be ready to cover the amount of trauma, except for those patients who needed to an hyperspecialistic approach

La terapia insulinica sottocutanea continua (CSII) in Italia. Terza indagine nazionale

La diffusione della terapia insulinica sottocutanea continua con microinfusore (CSII) \ue8 in continuo aumento nel mondo, grazie anche al miglioramento della tecnologia degli strumenti. Scopo di questo lavoro \ue8 stato quello di valutare lo stato attuale della CSII in Italia. A tal fine ai responsabili di 272 strutture diabetologiche che seguono pazienti in terapia con microinfusore \ue8 stato inviato un questionario che indagava aspetti clinici, tecnici e organizzativi della terapia con microinfusore. Duecentodiciassette strutture (79,8%) hanno partecipato all\u2019indagine. Dai dati raccolti \ue8 emerso che a fine aprile 2013 in tali strutture vi erano 10.152 pazienti in terapia con microinfusore, quasi tutti (98,2%) affetti da diabete di tipo 1, prevalentemente adulti (82,4%) e di sesso femminile (57%). La diffusione della CSII risultava molto disomogenea tra le diverse Regioni e anche tra le diverse strutture diabetologiche di una stessa Regione: solo il 59% delle strutture seguiva pi\uf9 di 20 pazienti ciascuna. Motivo principale per iniziare la CSII era la ricerca del buon controllo glicemico. Il drop-out (8,65% dei casi), avveniva soprattutto per problemi legati alla portabilit\ue0 della pompa o al mancato raggiungimento del target glicemico. La maggior parte dei pazienti (61%) utilizzava un microinfusore tradizionale, il 39% un microinfusore integrato (32%) o associato (7%) a un dispositivo per il monitoraggio in continuo della glicemia. Le funzioni avanzate del microinfusore venivano mediamente utilizzate solo dal 68% dei pazienti e il sensore era utilizzato mediamente solo per 12 giorni al mese. L\u201981% delle strutture garantiva una reperibilit\ue0 24 ore su 24. Solo nel 40% delle strutture per adulti e nel 50% di quelle pediatriche i pazienti venivano seguiti da un team completo. In conclusione, la CSII si sta sempre pi\uf9 diffondendo in Italia, sia tra i pazienti adulti sia tra quelli pediatrici. \uc8 auspicabile una maggiore uniformit\ue0 tra le diverse Regioni e un uso pi\uf9 adeguato della tecnologia stessa

FIRST LINE AVELUMAB IN PD-L1+VE METASTATIC OR LOCALLY ADVANCED UROTHELIAL CANCER (AUC) PATIENTS UNFIT FOR CISPLATIN (CIS): THE ARIES TRIAL

Background: Avelumab (ave) was approved as maintenance therapy after platinum-based first line (1L) therapy for patients (pts) with aUC based on ph. 3 Javelin Bladder 100 study (NCT02603432), showing significant overall survival (OS) improvement. Here we tested the activity of ave as 1L of therapy in pts with aUC and PD-L1+ve expression. Methods: ARIES is a single-arm, multi-site, open-label phase II trial. Enrolled pts had aUC, were cis-unfit (at least one of: ECOG-PS=2, CrCl <60 mL/min, grade ⩾2 peripheral neuropathy/hearing loss, progression within 6-mos before the end of neo/adj chemo), had not previously received chemo for aUC and PD-L1⩾5% (SP263) centrally assessed. Pts received ave 10 mg/Kg IV Q2W until progression, unacceptable toxicity and withdrawal, whichever occurred first. The primary endpoint was the 1-year OS. Key secondary endpoints were median-OS, -PFS, ORR, DOR and safety. The outcome based on PDL1 expression >10 has also been investigated. Results: A total of 198 eligible cis-unfit pts have been tested for PD-L1 and 71 (35.6%) have been found positive. Among enrolled patients (N=71), median age was 75 y, 35 (49.3%) had visceral disease, and 22 (31.0%) had ECOG-PS=2; 50 (70.4%) had CrCl <60 mL/min and 9 (12.7%) progressed within 6-mos from the end of neo/adj chemo. At the cut-off data (Feb 2, 2022), median follow up was 10.0 mos and 14 patients are still on treatment. The median OS was 10.0 mos (95% CI, 5.5-14.5), and 43.0% of patients were alive at 1-year. The ORR for all patients was 24.0%; complete response, 8.5% (n=6); partial response, 15.5% (n=11). Clinical benefit was 43.6% (n=31). Median PFS was 2.0 mos (95% CI, 1.7-2.3). Among the 17 pts who had tumour response 13 had DOR > 1y and 5 > 2y. A total of 67 patients have been evaluated for CPS and among these 56 (83.6%) have been classified as high expression. The median OS was 11.0 mos (95%CI, 0.1 – 22.9) for those with high CPS and 7.0 mos (95%CI 2.8 – 11.2) for low CPS (p=0.13). The median PFS was 2.0 mos for both high and low CPS (p=0.34). Five (7.0%) grade 3 ave-related adverse events, and no treatment-related death were reported. Conclusions: Ave is active and safe in pts with cis-unfit, PD-L1+ve aUC and poor baseline characteristics

Aurora, 1990

https://commons.emich.edu/aurora/1096/thumbnail.jp

Hedwigia.

v.53 (1913