Treatment persistence with aripiprazole once monthly: a 4-year follow-up

Objectives: Treatment persistence refers to the act of continuing a treatment as prescribed and reflects the patient's or doctor's judgment about efficacy, tolerability, and acceptability. In patients with schizophrenia, antipsychotic persistence is often poor, because of issues such as lack or loss of efficacy, side effects, and poor adherence, which is often related to the degree to which patients find the medication and overall intervention to be helpful, tolerable, fair, reasonable, appropriate, and consistent with expectations of treatment. Despite the poor antipsychotic persistence that has been reported to date in patients with schizophrenia, we previously observed a relatively high (86%) 6 months persistence with aripiprazole once-monthly (AOM) in a group of patients with schizophrenia, treated in the real world Italian clinical practice. The present study explores the longer term persistence with AOM, over a mean follow-up period of 48 months. Methods: This was a multicenter, retrospective, non-interventional follow-up study, aimed at evaluating the longer term persistence with AOM in a group of patients with schizophrenia who had already shown persistence over a period of at least 6 months. The study included 161 individuals who had participated in our previous study, where 86% of participating individuals had shown persistence with AOM for at least 6 months. Non-persistence was defined as discontinuing the medication for any reason. Baseline demographic and clinical characteristics of patients who continued AOM were then compared to those of patients who discontinued the medication. Results: Study subjects were predominantly male (64.4%) and their mean age was 39.7 (SD: 12.24). Treatment persistence with AOM was 69.6% and 112 out of 161 patients were still receiving AOM treatment at the last follow-up visit. The mean duration of AOM treatment until the last recorded observation was 55.87 months (median 56.17, SD6.23) for the 112 persistent patients and 32.23 (median 28.68.SD 15.09) months for the 49 non-persistent individuals. The mean observation period for all patients (persistent and non-persistent) was 48.78 months (median 52.54, SD 14.64). For non-persistent subjects, the observation period ended with the discontinuation of AOM. Subjects treated with AOM at 400 mg presented a 69.6% lower risk of all-cause treatment discontinuation when compared with patients treated with 300 mg (HR: 0.314; 95% confidence interval [CI] 0.162-0.608; P = 0.001). The main reasons for discontinuation were lack of efficacy (30.6%), patient/caregiver choice (18.4%), physician's choice (16.3%), non-adherence (12.2%) and inconvenience (6.1%). Only 3 patients (6.1%) discontinued AOM for tolerability issues. Conclusions: In subjects with schizophrenia, who had already shown a 6 months persistence with AOM, a high number of patients (69.6%) continued to be persistent over a 4-year follow-up period. This may reflect a favourable profile of efficacy, tolerability, and acceptability. Larger and prospective studies are warranted to confirm our observations

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Genio Rurale Costruzioni

Costruzioni rural

Electroplastic Effect during Tension and Bending in Duplex Stainless Steel

The deformation behavior of duplex stainless steel under tension and bending, accompanied by a pulsed current and when heated by an external source, is investigated. The stress–strain curves are compared at the same temperatures. The contribution to the decrease in flow stresses is greater when using a multi-pulse current at the same temperature, compared to external heating. This confirms the presence of an electroplastic effect. An increase in the strain rate by an order of magnitude reduces the contribution of the electroplastic effect from single pulses to the reduction in flow stresses by 20%. An increase in the strain rate by an order of magnitude reduces the contribution of the electroplastic effect from single pulses to the reduction in flow stresses by 20%. However, in the case of a multi-pulse current, the strain rate effect is not observed. Introducing a multi-pulse current during bending reduces the bending strength by a factor of two and the springback angle to 6.5

Impact of rehabilitation intervention on fatigue,endurance and physical function in patients withfibromyalgia : a case - control study

Background. Fibromyalgia (FM), a chronic condition typically characterized by widespread pain, non restorative sleep, fatigue, cognitive dysfunction and other somatic symptoms, negatively impacts physical function. Rehabilitation is recommended in the management of people with FM. To evaluate the rehabilitation impact on fatigue, endurance and physical function at 6-month follow-up. Methods. Forty-one FM patients (39 female, 2 male, mean age 52.2 \ub1 9.21 yrs), were randomized to an exercise and educationalbehavioural programme group (Experimental Group, EG = 21) or to a control group (GC=20). Both groups maintained their own pharmacological therapy. Each subject was evaluated before, at the end (T1) and after 6 months from the beginning of the rehabilitation treatment using the Health Assessment Questionnaire (HAQ), the Fatigue Severity Scale (FSS), the 6-Minute Walking Test (6MWT) and a pocket goniometer (for spinal active range of motion). The protocol included 20 sessions (twice a week) under physiotherapist\u2019s supervision, consisting in self-awareness, stretching, strengthening, spine flexibility and aerobic exercises, which patients were educated to perform at home. Results. The 2 groups were comparable at baseline. On intergroup comparison at T1, the EG showed improvement, although non statistically significant (p between 0.221 \u2013 0.502) in the HAQ and FSS scales, and significant in the 6MWT and in most spinal active range of motion measurements (p between 0.001 \u2013 0.04). The positive results achieved of the EG were maintained at the 6-month follow-up. Conclusions. FM patients show excellent adherence to exercise and an educational-behavioural programme with beneficial effects on endurance, fatigue and physical function

Effect of Different Austempering Heat Treatments on Corrosion Properties of High Silicon Steel

: A novel high silicon austempered (AHS) steel has been studied in this work. The effect of different austenitizing temperatures, in full austenitic and biphasic regime, on the final microstructure was investigated. Specimens were austenitized at 780 \u25e6C, 830 \u25e6C, 850 \u25e6C and 900 \u25e6C for 30 min and held isothermally at 350 \u25e6C for 30 min. A second heat treatment route was performed which consisted of austenitizing at 900 \u25e6C for 30 min and austempering at 300 \u25e6C, 350 \u25e6C and 400 \u25e6C for 30 min. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) have been used to evaluate the microstructural evolution. These techniques revealed that the microstructures were composed of carbide-free bainite, ferrite, martensite and retained austenite (RA) in different volume fractions (V\u3b3). An aqueous borate buffer solution with 0.3 M H3BO3 and 0.075 M Na2B4O7 0210H2O (pH = 8.4) was used for corrosion tests in order to evaluate the influence of the different volume fractions of retained austenite on the corrosion properties of the specimens. The results showed that when increasing the austenitization temperatures, the volume fractions of retained austenite reached a maximum value at 850 \u25e6C, and decrease at higher temperatures. The corrosion properties were investigated after 30 min and 24 h immersion by means of potentiodynamic polarization (after 30 min) and electrochemical impedance spectroscopy (after both 30 min and 24 h) tests. The corrosion resistance of the samples increased with increases in the volume fraction of retained austenite due to lower amounts of residual stresses

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys