Telemonitoring in chronic ventilatory failure: a new model of survellaince, a pilot study

Background and Aim. The efficiency of tele-monitoring or tele-assistance in patients with severe chronic ventilatory failure in home mechanical ventilation (HMV) is still being investigated. Our aim was to test the feasibility of a model which consisted in: 1) once a week nocturnal telemonitoring, supervised by a doctor in charge in a Respiratory Intensive Care Unit, who also provided a telephone-counselling (24/7) on demand; 2) a scheduled visit every two months. Methods. A 2-year observational study was carried out on 16 patients ventilated for at least 1 year and for ≥ 8 hours /day. Once a week patients underwent a nocturnal monitoring during HMV. The compliance was evaluated by regular transmission of data and regular follow-up, the level of satisfaction by a telephonequestionnaire. Results. The adherence to the protocol study was good in 9/16 (56%) and poor in 7/16 (44%) patients. For each patient, the mean number of connections was 46,12 ± 36.39 (70.7% of that expected), in those with good compliance it increased to 63.8 ± 32.7 (114% of that expected). The median hours of connection was 343 (138- 1019) and 89 (0-521) for patients with good and poor compliance respectively, p=0.038. The mean scheduled visits for patient with good compliance was 6.9 ± 4.14 (100% of that expected). Emergency visits were avoided in 62.5% of cases. The satisfaction score was higher in compliant versus non compliant patients (p=0.019). Conclusion. This pilot study showed that the telemonitoring system employed was feasible and effective in more compliant patients who claimed a high rate of satisfaction

The cost-effectiveness of early noninvasive ventilation for ALS patients

BACKGROUND: Optimal timing of noninvasive positive pressure ventilation (NIPPV) initiation in patients with amyotrophic lateral sclerosis (ALS) is unknown, but NIPPV appears to benefit ALS patients who are symptomatic from pulmonary insufficiency. This has prompted research proposals of earlier NIPPV initiation in the ALS disease course in an attempt to further improve ALS patient quality of life and perhaps survival. We therefore used a cost-utility analysis to determine a priori what magnitude of health-related quality of life (HRQL) improvement early NIPPV initiation would need to achieve to be cost-effective in a future clinical trial. METHODS: Using a Markov decision analytic model we calculated the benefit in health-state utility that NIPPV initiated at ALS diagnosis must achieve to be cost-effective. The primary outcome was the percent utility gained through NIPPV in relation to two common willingness-to-pay thresholds: $50,000 and$100,000 per quality-adjusted life year (QALY). RESULTS: Our results indicate that if NIPPV begun at the time of diagnosis improves ALS patient HRQL as little as 13.5%, it would be a cost-effective treatment. Tolerance of NIPPV (assuming a 20% improvement in HRQL) would only need to exceed 18% in our model for treatment to remain cost-effective using a conservative willingness-to-pay threshold of $50,000 per QALY. CONCLUSION: If early use of NIPPV in ALS patients is shown to improve HRQL in future studies, it is likely to be a cost-effective treatment. Clinical trials of NIPPV begun at the time of ALS diagnosis are therefore warranted from a cost-effectiveness standpoint

Diabetic foot infections: a team-oriented review of medical and surgical management

As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting

Contributi per una flora vascolare di Toscana. XI (664-738)

Vengono presentate nuove località e/o conferme relative 75 taxa specifici e sottospecifici di piante vascolari della flora vascolare toscana, appartenenti a 67 generi e 41 famiglie: Delosperma (Aizoaceae), Dysphania (Amaranthaceae), Leucojum, Nothoscordum (Amaryllidaceae), Bupleurum, Coriandrum (Apiaceae), Araujia (Apocynaceae), Lemna (Araceae), Hydrocotyle (Araliaceae), Aristolochia (Aristolochiaceae), Bellevalia (Asparagaceae), Asphodelus (Asphodelaceae), Artemisia, Crepis, Eclipta, Erigeron, Hieracium, Senecio, Symphyotrichum, Tolpis (Asteraceae), Symphytum (Boraginaceae), Alyssum, Cardamine, Eruca, Isatis (Brassicaceae), Valerianella (Caprifoliaceae), Petrorhagia, Scleranthus (Caryophyllaceae), Commelina (Commelinaceae), Dichondra (Convolvulaceae), Sedum (Crassulaceae), Diospyros (Ebenaceae), Moneses (Ericaceae), Euphorbia (Euphorbiaceae), Medicago, Trifolium (Fabaceae), Myriophyllum (Haloragaceae), Juncus (Juncaceae), Salvia, Teucrium (Lamiaceae), Broussonetia (Moraceae), Spiranthes (Orchidaceae), Phelipanche (Orobanchaceae), Papaver (Papaveraceae), Passiflora (Passifloraceae), Cedrus, Pseudotsuga (Pinaceae), Bromopsis, Calamagrostis, Cenchrus, Drymochloa, Melica, Oloptum, Phleum, Sporobolus, Tragus (Poaceae), Stuckenia (Potamogetonaceae), Lysimachia (Primulaceae), Anemone, Aquilegia (Ranunculaceae), Eriobotrya (Rosaceae), Crucianella (Rubiaceae), Verbascum (Scrophulariaceae), Typha (Typhaceae), Urtica (Urticaceae), Viola (Violaceae). Infine, viene discusso lo status di conservazione delle entità e gli eventuali vincoli di protezione dei biotopi segnalati.New localities and/or confirmations concerning 75 specific and subspecific plant taxa of Tuscan vascular flora, belonging to 67 genera and 41 families are presented: Delosperma (Aizoaceae), Dysphania (Amaranthaceae), Leucojum, Nothoscordum (Amaryllidaceae), Bupleurum, Coriandrum (Apiaceae), Araujia (Apocynaceae), Lemna (Araceae), Hydrocotyle (Araliaceae), Aristolochia (Aristolochiaceae), Bellevalia (Asparagaceae), Asphodelus (Asphodelaceae), Artemisia, Crepis, Eclipta, Erigeron, Hieracium, Senecio, Symphyotrichum, Tolpis (Asteraceae), Symphytum (Boraginaceae), Alyssum, Cardamine, Eruca, Isatis (Brassicaceae), Valerianella (Caprifoliaceae), Petrorhagia, Scleranthus (Caryophyllaceae), Commelina (Commelinaceae), Dichondra (Convolvulaceae), Sedum (Crassulaceae), Diospyros (Ebenaceae), Moneses (Ericaceae), Euphorbia (Euphorbiaceae), Medicago, Trifolium (Fabaceae), Myriophyllum (Haloragaceae), Juncus (Juncaceae), Salvia, Teucrium (Lamiaceae), Broussonetia (Moraceae), Spiranthes (Orchidaceae), Phelipanche (Orobanchaceae), Papaver (Papaveraceae), Passiflora (Passifloraceae), Cedrus, Pseudotsuga (Pinaceae), Bromopsis, Calamagrostis, Cenchrus, Drymochloa, Melica, Oloptum, Phleum, Sporobolus, Tragus (Poaceae), Stuckenia (Potamogetonaceae), Lysimachia (Primulaceae), Anemone, Aquilegia (Ranunculaceae), Eriobotrya (Rosaceae), Crucianella (Rubiaceae), Verbascum (Scrophulariaceae), Typha (Typhaceae), Urtica (Urticaceae), and Viola (Violaceae). In the end, the conservation status of the units and eventual protection of the cited biotopes are discussed

Mars- plus Europa-INPPS Flagship Missions with High Power Electric Thrusters and Heavy Science Payload

2020/2021 orbit calculations (DLR Bremen + MAI Moscow): 3 Orbits for one non-human MARS/EUROPA-INPPS flagship 1. Orbit Earth (11 Oct 2026) => Mars (28 Jan 2028); 2. Orbit Mars (22 Sept 2028) => Earth (29 Jul 2029); 3. Orbit Earth (12 Oct 2031) => Jupiter / Europa (6 Dec 2035) 22 ETs (for the INPPS flagship CET): example - gridded CET plate with combined ET