Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Development of a new in-water-phantom graphite calorimeter for the measurement of absorbed dose to water in medium energy x-ray beams

This paper summarizes the progress on the construction of a graphite calorimeter for the measurement of absorbed dose to water Dw in medium-energy filtered x-ray qualities, as part of the EMRP funded project “Metrology for radiotherapy using complex radiation fields” (MetrExtRT, http://radiotherapyemrp.eu/). The design and the construction of a new primary standard for absorbed dose to water (Dw) is shown, together with a presentation of the preliminary estimates of conversion factors, calculated by Monte Carlo using the EGSnrc code, and heat-transport calculations resulting from COMSOL simulations. The vacuum-gap-insulated calorimeter core has a thickness of 2 mm and a diameter of 20 mm. The graphite calorimeter is embedded in a PMMA waterproof sleeve and can be positioned at the desired measurement depth in a water phantom. Once completed, the new calorimeter will participate in an international comparison with other existing standards of absorbed dose to water for medium energy x-rays