La farmacoutilizzazione delle statine nella pratica clinica: risultati di uno studio di popolazione condotto su database amministrativi e di medici di medicina generale

In spite of findings of large-scale clinical trials which showed an overall reduction of morbidity and mortality from coronary heart disease in patients treated with 3-hydroxy-3-metylglutaryl coenzyme-A reductase inhibitors (statins), relatively little is still known about the real prevalence of treatment in general practice setting, particularly in patients with a high cardiovascular risk. The objective of this study was to investigate among patients with cardiovascular risk profile estimated according to the Framingham Heart Prediction Risk Study, the percentage of those exposed to statins, and the proportion of patients reaching total cholesterol (TC) target levels. A cross-sectional analysis was conducted on a large cohort of patients listed in the administrative databases of the Local Health Unit of Ravenna (total resident population of 356,000). In 2001, every single patient who received a prescription for a statin, and/or with a recorded plasma TC level, and/or with a hospital admission for cardiovascular reasons (identified by ICD-9 code), and/or with a clinical appraisal based on the presence of cardiovascular risk factors, was defined eligible. Sebsequently, pharmaceutical, and nosocomial databases, were cross-linked with that of 50 general practitioners in order to assess the pharmacoutilization of statins on a patient-by-patient basis. A cohort of 9,208 patients with a well documented cardiovascular risk profile were analyzed. The mean age of those patients was 57 (SD=17) years and 42% of them was male. On the basis of raised TC levels and cardiovascular risk profiles, patients for whom a statin treatment was suggested amounted to 7,233. However, the number of those who received statins was significantly lower (n = 1,343), corresponding to 18.6%. In those exposed to statins, just a small group of patients reached a level of TC below 190 mg/dl (n = 271), equivalent to 20.2%. In the group of treated who did not achieve recommended TC target levels, 31.7% (n = 340) of patients was at very high cardiovascular risk. Moreover, among all patients with high plasma TC levels (n=5,890), there was a 45.7% (n = 2,690) who did not received any lipid lowering drug even though they had a high cardiovascular risk profile. Results from large population-based administrative databases suggest a remarkable level of undertreatment among patients with cardiovascular risk factors. Furthermore, many patients did not achieve recommended TC target levels with their statin treatment. Pharmacoutilization of statins in general practice reveals the need of a more careful pursuing of therapeutic goals

Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study

open15noAbstract Background: The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature. Methods: We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019. Results: We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%). Conclusions: Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.openAngotti, Rossella; Raffaele, Alessandro; Molinaro, Francesco; Riccipetitoni, Giovanna; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Mattioli, Girolamo; Alberti, Daniele; Boroni, Giovanni; Mariscoli, Francesca; Martino, Ascanio; Pelizzo, Gloria; Maffi, Michela; Messina, Mario; Lima, MarioAngotti, Rossella; Raffaele, Alessandro; Molinaro, Francesco; Riccipetitoni, Giovanna; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Mattioli, Girolamo; Alberti, Daniele; Boroni, Giovanni; Mariscoli, Francesca; Martino, Ascanio; Pelizzo, Gloria; Maffi, Michela; Messina, Mario; Lima, Mari

Improving recognition of odors in a waste management plant by using electronic noses with different technologies, gas chromatography\u2013mass spectrometry/olfactometry and dynamic olfactometry

Odor emissions from waste management plants have long been an environmental and economic issue, but only recently regional authorities in Italy are regulating this sector by imposing control and mitigation of the phenomenon. Electronic noses, initially developed as cheap, easy tools to detect volatiles, may have the required time-resolved coverage of the odor emission phenomenon in a cheap and feasible way with respect to chemical analysis of air. One crucial issue to resolve is to evaluate the discriminant capacity of a sensor array in-field and under working conditions. In this paper the authors have studied the responses of electronic noses of different technologies to odors emitted from a waste management plant, by integrating results obtained with dynamic olfactometry and gas chromatography\u2013mass spectrometry/olfactometry, in the aim to implement a monitoring system and improve cleaner production technologies. Three most impacting odor sources in the waste management plant were detected: biogas, a by-product of mechanical treatment of municipal solid wastes, with low organic fraction and a sludge pressed and dehydrated from treatment of urban wastewater. The most odor impacting source was the sludge and the major responsible of the odor impacts were aromatics (in particular 1,3,5-trimethyl benzene), aliphatic hydrocarbons, terpenes and sulphur volatiles (methyl disulphide, carbon disulphide, dimethyltrisulphide). Ten Metal Oxide Semiconductors and 32 polymer/black carbon (Nano Composite Array) sensors in two electronic noses, were tested for discrimination source capabilities. Results of linear discriminant analysis and cross validation give 86.7% successful recognition for Metal Oxide Semiconductors, 53.3% for Nano Composite Array and 93.3% for a selection of sensors belonging to both technologies chosen according to the selectivity towards the odor active molecules. The containment of odors could also be achieved by spraying a specific product and monitoring the process using selected sensors of the arrays. The results of the in-field work demonstrate strengths and weaknesses of different construction technologies in the e-noses arrays, to characterize and monitor in-site and in real time odor emissions from waste management plants

Farmacoepidemiologia e farmacoeconomia della terapia anti-ipertensiva: uno studio osservazionale della popolazione della Asl di Ravenna

The aim of the paper was to perform a pharmacoepidemiological and pharmacoeconomic analysis of antihypertensive drug treatment. An administrative database kept by the Local Health Unit of Ravenna listing patient baseline characteristics, drug prescriptions and hospital admissions was used to perform a population-based cohort study. The study included all new users of antihypertensive drugs, 20 years of age or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors or angiotensin II antagonists (AIIAs) between January 1st, 2000 and December 31st, 2000. All prescriptions for anti-hypertensive drugs filled during the 12-months follow-up period were considered. Patients were classified as continuers, switchers and discontinuers on the basis of their prescription dynamics. A total of 14.062 patients were included in the study of whom only 39,7% resulted persistent at 12 months. Patients initially prescribed for AIIAs were more likely to continue antihypertensive treatment than those started on other drug classes as well as those with older age, concurrent drug therapies and previous hospitalisation for cardiovascular diseases. The overall cost of the study cohort for antihypertensive drugs amounted to 1.238.752,37 euros of which 80,6% was used for persistent patients. The annual average cost for antihypertensive drugs was 171,73 euro for continuers, 205,10 euros for switchers and 28,29 euros for discontinuers. Factors associated to drug cost were age, pattern of persistence, number of prescribed drug classes, and class prescribed at enrolment. Nonpersistence with antihypertensive pharmacotherapy induced a high cost for the consumption of antihypertensive drug since discontinuers are responsible for a significant percentage of drug resources allocated on subjects exposed to therapy. A correlation between drug therapy cost and persistence with treatment is needed to evaluate the appropriateness of drug utilization and to perform cost-effectiveness analyses between alternative pharmacological agents

Analisi della persistenza e delle risorse allocate nel trattamento farmacologico dell’ipertensione arteriosa

In this study, the persistence with treatment and resources allocated in antihypertensive pharmacotherapy has been evaluated. Administrative databases of the Local Health Unit of Ravenna listing patients baseline characteristics, drug prescriptions and hospital admissions were used to perform a population-based retrospective study. All new users 20 years old or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors or AII-Antagonists between January 1st, 1997 and December 31st, 1997 were included. A one-year follow-up for prescriptions of anti-hypertensive drugs were considered. According to duration of therapy, treated population was divided in persistent patients (continuers and switchers) and non-persistent patients. A total of 16,783 patients was included in the study of whom 64.9% were non-persistents. Persistence with treatment seems to be associated with the class of anti-hypertensive drug initially prescribed, and with patient-related factors. Patients initially prescribed for AII-Antagonists were more likely to persist than those starting on the other antihypertensive classes. Annual antihypertensive treatment cost accounted for • 1,076,053.55 of which 25.4% for non-persistent patients. An appropriate use of claims data may be considered as a powerful tool, providing detailed epidemiological and economic information concerning the antihypertensive treatment

L' impatto del COVID-19 sull'economia. 10 proposte per la ripartenza. Un'analisi fondata sullo studio della provincia di Pisa.

Il presente lavoro, ultimato a inizio luglio 2020, e' il frutto della collaborazione di un gruppo di docenti e ricercatori che operano nei Dipartimenti di Economia e Management, Giurisprudenza e Scienze Politiche dell’Universita' di Pisa. Nato sulla base di una richiesta della Prefettura di Pisa all’Ateneo pisano in piena emergenza sanitaria, esso si propone lo scopo di fornire un’analisi degli effetti che l’emergenza COVID-19 ha avuto sul tessuto economico e sociale della provincia di Pisa e, alla luce dei risultati ottenuti, effettuare alcune “proposte per la ripartenza” per i prossimi mesi. Il convincimento degli autori che questo contributo di analisi e proposte, ancorche' riguardante la realta' territoriale della provincia di Pisa, possa avere una qualche utilita' anche per altre realta' provinciali e regionali, nonche' per quella nazionale. La ragione di tale convinzione e' duplice. Da un lato, l’approccio utilizzato, basato sulla multidisciplinarieta' e sul coinvolgimento delle realtà socio-economiche e istituzionali del territorio, rappresenta un metodo essenziale e generale per la piena comprensione di una realta' nuova e assai complessa quale quella derivante dall’emergenza COVID-19. Gli autori, provenienti da settori scientifici diversi quali l’ambito aziendale, economico, statistico, giuridico e sociolopsicologico, sono stati i primi a rendersi conto di quanto tale metodo di “messa a sistema” delle informazioni e degli attori economici e istituzionali della provincia fosse cruciale, ancorche' inusuale rispetto al carattere tipicamente specialistico delle ricerche in ambito accademico. Dall’altro lato, le proposte contenute nel lavoro, e che sono riportate in modo sintetico val termine di questa introduzione, sono il frutto dell’analisi quantitativa e qualitativa contenuta nei primi capitoli e rappresentano un esempio di come le scienze sociali possano fornire una base informativa essenziale per processi decisionali basati sui fatti (quelli che in ambito scientifico vengono definiti “evidenze empiriche”). In altre parole, le proposte hanno valenza generale, in quanto mettono in evidenza problemi e ipotizzano soluzioni che sono comuni a tutto il territorio nazionale. Il lavoro, organizzato come segue. Il primo capitolo presenta un’analisi strutturalee dinamica dell’economia della provincia di Pisa nel periodo precedente alla crisi sanitaria. Il secondo capitolo contiene una lettura dell’impatto economico, sociale e sanitario dell’emergenza COVID-19 e delle misure di contrasto messe in campo dal governo nei mesi iniziali della crisi (marzo-giugno 2020). Il terzo capitolo contiene un approfondimento dell’analisi economico-aziendale svolta. L’impatto del COVID-19 sull’economia alcuni settori emersi come rilevanti per l’economia provinciale. Il quarto capitolo svolge riflessioni e proposte in ambito giuridico, il quinto capitolo chiude il lavoro presentando alcune proposte di policy. Gli autori desiderano ringraziare il Prefetto di Pisa, per l’attivita' di supporto istituzionale, il Rettore dell’Universita' di Pisa, e tutti gli attori istituzionali e socio-economici che hanno collaborato direttamente – mediante incontri e interviste ‒ o indirettamente – attraverso la messa a disposizione dei dati e informazioni ‒ alla stesura del lavoro

Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, nontransplanted chronic kidney disease patients and low-risk pregnancies: a multicenter nationwide analysis.

BACKGROUND: Kidney transplantation (KT) may restore fertility in CKD. The reasons why materno-foetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling.Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of non-transplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium. METHODS: We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD and 1418 low-risk controls recruited in 2 large Italian Units, in the same period (2000-2014). The following outcomes were considered: maternal and foetal death; malformations; preterm delivery; small for gestational age baby (SGA); need for the neonatal intensive care unit (NICU); doubling of serum creatinine or increase in CKD stage. Data were analysed according to kidney diseases, renal function (staging according to CKD-EPI), hypertension, maternal age, partity, ethnicity. RESULTS: Materno-foetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. KT patients with e-GFR >90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ('progressive CKD') are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 versus 1: RR 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient. CONCLUSIONS: The materno-foetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney diseas

Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer