Operations Research in the Red Zone

The EURO Working Group on Operational Research Applied to Health Services (ORAHS) provides a network for researchers involved in the application of systematic and quantitative analysis in the planning and management of the health services sector.</p

The Role of Speckle Tracking Echocardiography in the Evaluation of Advanced-Heart-Failure Patients

Health care is currently showing a fall in heart failure (HF) incidence and prevalence, particularly in developed countries, but with only a subset receiving appropriate therapy to protect the heart against maladaptive processes such as fibrosis and hypertrophy. Appropriate markers of advanced HF remain unidentified, which would help in choosing the most suitable therapy and avoid major compliance problems. Speckle tracking echocardiography (STE) is a good choice, being a non-invasive imaging technique which is able to assess cardiac deformation in a variety of conditions. Several multicenter studies and meta-analyses have demonstrated the clinical application and accuracy of STE in early and late stages of HF, as well as its association with both left ventricular (LV) filling pressures and myocardial oxygen consumption. Furthermore, STE assists in assessing right ventricular free-wall longitudinal strain (RVFWLS), which is a solid predictor of right ventricle failure (RVF) following LV assist device (LVAD) implantation. However, STE is known for its limitations; despite these, it has been shown to explain symptoms and signs and also to be an accurate prognosticator. The aim of this review is to examine the advantages of STE in the early evaluation of myocardial dysfunction and its correlation with right heart catheterization (RHC) parameters, which should have significant clinical relevance in the management of HF patients

RV longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure

Objectives This study was performed to determine the accuracy of right ventricular (RV) longitudinal strain (LS) in predicting myocardial fibrosis in patients with severe heart failure (HF) undergoing heart transplantation. Background RVLS plays a key role in the evaluation of its systolic performance and clinical outcome in patients with refractory HF. Methods We studied 27 patients with severe systolic HF (ejection fraction 25% and New York Heart Association functional class III to IV, despite full medical therapy and cardiac resynchronization therapy) using echocardiography before heart transplantation. RV free wall LS, right atrial LS, sphericity index (SI), and tricuspid annular plane systolic excursion (TAPSE) were all measured. Upon removal of the heart, from the myocardial histologic analysis, the ratio of the fibrotic to the total sample area determined the extent of fibrosis (%). Results RV myocardial fibrosis correlated with RV free wall LS (r = 0.80; p < 0.0001), SI (r = 0.42; p = 0.01) and VO max (r = -0.41; p = 0.03), with a poor correlation with TAPSE (r = -0.34; p = 0.05) and right atrial LS (r = -0.37; p = 0.03). Stepwise multivariate analysis showed that RV free wall LS (β = 0.701, p < 0.0001) was independently associated with RV fibrosis (overall model R= 0.64, p < 0.0001). RV free wall LS was the main determinant of myocardial fibrosis. In the subgroup of patients with severe RV fibrosis, RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (area under the curve = 0.87; 95% confidence interval: 0.80 to 0.94). Conclusions In late-stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate functional measure that correlates with the extent of RV myocardial fibrosis and functional capacity

Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress

This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients

Dapagliflozin Effects on Cardiac Deformation in Heart Failure and Secondary Clinical Outcome

Background: Sodium-glucose cotransporter 2 inhibitors were shown to reduce morbidity and mortality in patients with heart failure. Objectives: This study aims to assess potential effects of dapagliflozin in nondiabetic patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF) on cardiac function assessed by speckle tracking echocardiography (STE). Methods: This randomized, prospective, single-center, open-label trial compared consecutive nondiabetic outpatients with HFrEF or HFmrEF receiving dapagliflozin with patients treated with optimal medical therapy (OMT) except sodium-glucose cotransporter type 2 inhibitors. Primary endpoint was the presence of a significant modification of left ventricular global longitudinal strain, diastolic function (as peak atrial longitudinal strain) and right ventricular function by STE from baseline to 6&nbsp;months. Cardiovascular events and parameters of congestion were assessed as safety-exploratory endpoints. Results: Overall, 88 patients (38% HFmrEF) were enrolled and randomized to start dapagliflozin on top of OMT (n&nbsp;=&nbsp;44) or to continue with OMT (n&nbsp;=&nbsp;44). All STE values improved in the dapagliflozin group after 6&nbsp;months, whereas there was a nonsignificant improvement in OMT group. Moreover, when comparing the modification of STE parameters at follow-up in patients with HFrEF and HFmrEF, only the main treatment effect resulted statistically significant in both groups (P&nbsp;&lt; 0.0001), indicating a significant difference between dapagliflozin and OMT. Conclusions: This study provided randomized data on the beneficial effect of dapagliflozin in nondiabetic patients with HFrEF and HFmrEF in terms of myocardial performance measured by the most sensitive echocardiographic technique, ie, STE. This suggests its usefulness for left ventricular reverse remodeling and better quality of life in patients with HFrEF and HFmrEF. (Effects of Dapagliflozin on cardiac deformation and clinical outcomes in heart failure with reduced and mildly reduced ejection fraction [DAPA ECHO trial]; EudraCT number: 2021-005394-66)

Rapporto 2007. Quadro degli interventi di prevenzione, cura e riabilitazione sul consumo di droghe nella provincia di Rimini.

Report on the state of legal and illegal substances use in the territory of Rimini province.La relazione ? articolata in 3 parti. Nella prima - diffusione delle sostanze - vengono riportati gli ultimi dati relativi alla stima dei consumatori di sostanze psicotrope nella provincia di Rimini attraverso la sintesi di due indagini sulla popolazione generale (indagine Ipsad?) e sulla popolazione studentesca di et? 15-19 anni (indagine Espad-Italia?). Una seconda parte - attivit? dei servizi - in cui vengo descritte non solo le caratteristiche delle persone che accedono ai servizi per le dipendenze pubblici e privati, compresa il Carcere di Rimini, ma anche le risposte fornite in termini di cura e riabilitazione. Una terza parte - interventi sul territorio - in cui vengono descritte le attivit? sia di prevenzione sia di contrasto all\u27uso. Risulta particolarmente interessante una prima valutazione delle attivit? realizzata all\u27interno dei piani di zona dei comuni di Rimini e Riccione

Using the Net-Map tool to analyze stakeholder networks in the city region food systems of seven European cities

The current global food system is characterized by anonymity in the value chain, global food trade, loss of knowledge about food sources, and a distant producer-consumer relationship. In addition, the negative environmental impacts of the agricultural sector, such as pollution, degradation of soil and water quality, loss of biodiversity, and significant greenhouse gas emissions, make this sector a major driver of climate change. In contrast, the city region food system (CRFS) approach captures the complexity of a food system and its actors at the local level. It aims to meet the requirements of sustainable transformation along the food value chain and offers an alternative approach to the challenges of the global food system. However, the actors and their relationships in CRFS are rarely analyzed. To fill this gap, this study focuses on analyzing CRFSs as networks using the Net-Map tool to study different CRFS in seven European cities (Bologna, Naples, Lansingerland, Tenerife, Oslo, Dortmund, and Romainville). The aim of this paper is to concentrate on the method and to show how the Net-Map tool can effectively support the evaluation of the CRFS by identifying different actor roles, recognizing patterns of relationships. Additionally, the strengths and weaknesses of the network can be assessed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. The paper highlights the limitations, advantages, and practical use of the Net-Map tool and discusses potential transferability to other case studies

Novel echocardiographic techniques to assess left atrial size, anatomy and function

Three-dimensional echocardiography (3DE) and speckle tracking echocardiography (STE) have recently applied as imaging techniques to accurately evaluate left atrial (LA) size, anatomy and function. 3DE and off-line quantification softwares, have allowed, in comparison to magnetic resonance imaging, the most time-efficient and accurate method of LA volume quantification. STE provides a non-Doppler, angle-independent and objective quantification of LA myocardial deformation. Data regarding feasibility, accuracy and clinical applications of LA analysis by 3DE and STE are rapidly gathering. This review describes the fundamental concepts of LA 3DE and STE, illustrates how to obtain respective measurements and discuss their recognized and emerging clinical applications