Fixed Versus Free Combinations of Antihypertensive Drugs: Analyses Of Real-World Data Of Persistence With Therapy In Italy

Purpose: To analyse the pattern of use and cost of antihypertensive drugs in new users in an Italian population, and explore the patient/treatment factors associated with the risk of therapy discontinuation. Patients and methods: In this retrospective study, information was collected from a population-based electronic primary-care database. Persistence with medication use 1 year from therapy initiation was evaluated for each user using the gap method. Each new user was classified according to his/her pattern of use as: \u201ccontinuer\u201d, \u201cdiscontinuer\u201d \u201cswitching\u201d or \u201cadd-on\u201d. A Cox regression model was used to analyse the factors influencing therapy discontinuation. Primary-care costs comprised specialists\u2019 visits, diagnostic procedures and pharmacologic therapies. Results: Among 14,999 subjects included in persistence analyses, 55.1% of cases initially started on monotherapy were classified as discontinuers vs 36.5% of cases taking combination therapy (42.3% vs 32.7%, respectively, for free and fixed combinations, P < 0.01). Old age, high cardiovascular risk and being in receipt of fixed-combination therapy were associated with greater persistence. Overall, the primary-care cost/person/year of hypertension management was 3c\u20ac95.3 (IQR, 144.9). The monotherapy cost was \u20ac88 per patient (IQR, 132.9), and that for combination therapy was \u20ac151\ub1148.3. The median cost/patient with a fixed combination was lower than that for a free combination (\u20ac98.4 (IQR, 155.3) and \u20ac154.9 (IQR, 182.6), respectively). Conclusion: The initial type of therapy prescribed influences persistence. Prescribing fixed combinations might be a good choice as initial therapy

Urolithiasis in Italy: An epidemiological study

Objectives: Worldwide the urolithiasis is the third most frequent urological disease affecting both males and females. In literature there are not recent Italian epidemiological data about stone disease. The objective of this study is the evaluation of current epidemiology of urolithiasis in Italy using the Health Search/CSD Longitudinal Patient Database (HS) database. Material and methods: An observational, descriptive, retrospective trial was conducted. Inclusion criteria were: family physician- assisted Italian living population member of HS database within 31 December 2012, both genders, age over 17 years, at least two years of clinical history recorded from the beginning the trial. Data were collected by HS database and elaborated by its software Millewin®. Results: In Italy prevalence of urolithiasis in 2012 was 4.14%, it was higher in males than in females (4.53% versus 3.78%) with a positive relation with increasing age. The highest prevalence rate of urolithiasis was reported in the region Campania (6.08%). The general incidence was 2.23 *1000, with the highest incidence in the region Sicilia (3.15 *1000). Incidence was higher in group age 65-74 years (3.18 *1000). Conclusions: In Italy the incidence and prevalence of urolithiasis is increasing with particular distribution in relation to gender, age and regional position

How to assess appearance distress and motivation in plastic surgery candidates: Italian validation of Derriford Appearance Scale 59 (DAS 59)

The Derriford Appearance Scale (DAS) 59 was specifically designed to measure psychosocial adjustment in patients with appearance problems. Previous studies using the DAS59 have proven it to be a reliable method of assessing the appearance-related quality of life after plastic surgery procedures. The aim of this study was to develop a valid and reliable Italian version of the DAS59

Cardiovascular comorbidities and pharmacological treatments of covid-19 patients not requiring hospitalization

Introduction: The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2). Despite the fact that the majority of infected patients were managed in outpatient settings, little is known about the clinical characteristics of COVID-19 patients not requiring hospitalization. The aim of our study was to describe the clinical comorbidity and the pharmacological therapies of COVID-19 patients managed in outpatient settings. Materials and Methods: We performed an observational, retrospective analysis of laboratory-confirmed COVID-19 patients managed in outpatient settings in Naples, Italy between March 9 and May 1, 2020. Data were sourced from the prospectively maintained Health Search (HS)/Thales database, shared by 128 primary care physicians (PCPs) in Naples, Italy. The clinical features and pharmacological therapies of COVID-19 patients not requiring hospitalization and managed in outpatient settings have been described. Results: A total of 351 laboratory-confirmed COVID-19 patients (mean age 54 ± 17 years; 193 males) with outpatient management were evaluated. Hypertension was the most prevalent comorbidity (35%). The distribution of cardiovascular comorbidities showed no gender-related differences. A total of 201 patients (57.3%) were treated with at least one experimental drug for COVID-19. Azithromycin, alone (42.78%) or in combination (27.44%), was the most widely used experimental anti-COVID drug in outpatient settings. Low Molecular Weight Heparin and Cortisone were prescribed in 24.87% and 19.4% of the study population, respectively. At multivariate regression model, diabetes (risk ratio (RR): 3.74; 95% CI 1.05 to 13.34; p = 0.04) and hypertension (RR: 1.69; 95% CI 1.05 to 2.7; p = 0.03) were significantly associated with the experimental anti-COVID drug administration. Moreover, only diabetes (RR: 2.43; 95% CI 1.01 to 5.8; p = 0.03) was significantly associated with heparin administration. Conclusions: Our data show a high prevalence of hypertension, more likely treated with renin– angiotensin–aldosterone system (RASS) inhibitors, among COVID-19 patients not requiring hospitalization. Experimental COVID-19 therapies have been prescribed to COVID-19 patients considered at risk for increased venous thromboembolism based on concomitant comorbidities, in particular diabetes and hypertension

The role of the general practictioner in the management of urinary calculi

Background: The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. Methods: a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. Results: Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. Conclusions: The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care

Leadership e cambiamento organizzativo: il caso AEP Ticketing Solutions.

Il cambiamento è una fase naturale per le organizzazioni moderne ed allo stesso tempo è una delle più critiche. In passato era considerato un fenomeno transitorio, vagamente pianificato e implementato, necessario per l’adattamento del sistema alle mutate condizioni ambientali; oggi invece è un evento che si produce in modo continuativo, mettendo alla prova l’efficacia e l’efficienza delle organizzazioni. Gestire il cambiamento è un processo con elevato livello di criticità per le dinamiche interne che si attivano: la ricerca si è spostata da un livello macro (sistema) ad un livello micro (individuale) al fine di comprendere meglio il ruolo dei fattori individuali nel facilitare o nell'ostacolare i processi di cambiamento. La resistenza rappresenta il principale motivo di fallimento di un processo di cambiamento e spesso, in seguito all'apprendimento della notizia di un cambiamento organizzativo, si generano resistenze ed elevati livelli di stress dovuti, soprattutto, all'incertezza in merito agli obiettivi e agli esiti futuri. Per questa ragione le organizzazioni devono motivare e stimolare le persone ad assumere un’attitudine positiva e a sconfiggere la paura del cambiamento, caratteristica innata dell’essere umano che è per sua natura orientato a conservare quanto ha raggiunto attraverso l’esperienza. La risposta delle persone al cambiamento dipende, in primis, dalla capacità del vertice strategico -il leader incaricato di gestire il cambiamento- di trasmettere le ragioni alla base della necessità del processo di cambiamento. Diventa, quindi, importante per il leader considerare le possibili reazioni delle persone nella scelta degli strumenti e delle metodologie da utilizzare per gestire il cambiamento. Nella tesi si indaga, attraverso lo studio di un caso aziendale, l’impatto del cambiamento organizzativo sulle risorse umane e gli aspetti inerenti il comportamento del leader. Nel primo capitolo è inquadrato il cambiamento organizzativo descrivendone le dimensioni, le tipologie, i modelli ricorrenti in letteratura e i motivi di fallimento; nel secondo si indagano la figura del leader incaricato per la gestione del cambiamento e le conseguenti competenze e stili di leadership; il terzo capitolo è dedicato al “cuore” del cambiamento, le risorse umane: si analizza la motivazione e la comunicazione, elementi imprescindibili nella fase di avvio di un processo di cambiamento; nel quarto ed ultimo capitolo è contenuto lo studio del caso aziendale scelto, la recente acquisizione del ramo Monetica di Leonardo-Finmeccanica da parte di AEP Ticketing Solutions: mediante la somministrazione di due questionari “ad hoc”, si è misurata la consapevolezza e la condivisione del cambiamento, valutando in particolare il comportamento e la capacità di coinvolgimento della figura del superiore durante questo processo

Further Effort Is Needed to Improve Management of Chronic Pain in Primary Care. Results from the Arkys Project

Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs) in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years) had mostly chronic non-cancer pain (87.7%). In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%). Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%). NSAID prescription decreased (12.8%), while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation

Memoria e trauma nella somatizzazione: criticità del sistema diagnostico dei disturbi somatoformi del DSM IV.

La memoria autobiografica è un costrutto multidimensionale che include le informazioni spaziali, temporali e verbali integrate, strategie di ricerca controllate e processi emozionali altamente rilevanti per il Sè. Il recupero autobiografico ha una natura costruttiva, flessibile ed è diretto da fattori motivazionali legati ad obiettivi personali rilevanti, al fine di mantenere il benessere psicologico ed evitare emozioni spiacevoli. Ne deriva che questo sistema di memoria è particolarmente importante per la regolazione emotiva, per la costruzione dell’identità personale e sociale ed è fortemente implicato nell’autoconsapevolezza. Una compromissione della memoria autobiografica è osservata in diverse condizioni psicopatologiche, come i disturbi stress-correlati, i disturbi dell’umore, e i disturbi dissociativi. E’ stato condotto uno studio osservazionale caso-controllo, in cui si è indagato un campione complessivo di 84 soggetti di ambo i sessi, reclutati presso l’Associazione Aplysia in Istituto G.I.F.T. di Medicina Integrata (Pisa), suddivisi in tre gruppi: un gruppo sperimentale di soggetti con disturbi somatoformi (secondo la classificazione diagnostica del DSM-IV), un gruppo di controllo costituito da soggetti sani, e un gruppo di controllo con soggetti con altra psicopatologia (senza disturbi somatoformi). L’obiettivo di ricerca proposto è stato verificare eventuali alterazioni della memoria autobiografica in soggetti con disturbo somatoforme, con particolare riferimento all’indagine della relazione fra le dimensioni legate alla somatizzazione e gli eventi traumatici