Pain and Frailty in Hospitalized Older Adults

Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

Towards a Heritage Digital Guidelines in Planned Preventive Maintenance (PPM)

The requirements of building sustainability and the use of information technologies have led to the new vision of continuum building design that considers each stage of a building’s life cycle, including the recovery and up-cycling of materials and building components according to the circular economy models. Continuum building design promotes planned preventive maintenance (PPM) and moves away from the current emergency acting on assets compromised by serious pathologies. It allows the optimisation of time and resources and the durability of interventions through sustainable and effective practices. The paper presents the preliminary results of a research activity aimed at identifying and validating guidelines for architectural heritage conservation through the development of an open knowledge platform to dissemination of the best practices currently available. The main goals are promoting preventive and planned maintenance as the main strategy of conservation of the building heritage and overcoming the fragmentation and scarcity of reliable information of scientific and technical literature for diagnostics, interventions and durability monitoring. The guidelines will cover all stagesof the conservation process, from the preliminary phase of knowledge of the building. Moreover, type, extent and cause of degradation will be identified, including their resolution or at least their decrease according to the criterion of minimum intervention and maximum effectiveness with the lowest cost and the lowest environmental impact using sustainable and compatible products. The guidelines of the open digital platform will be identified through the study and critical analysis of interventions on monuments belonging to Italian historical heritage. The monuments chosen as case studies have been affected by various forms of degradation, in many cases triggered by the presence of rising damp. This latter one has been stopped using an already verified economical and sustainable device that uses charge neutralization technology CNT-Domodry®. The research provides for the initial activity of identification of digital standardization protocol, information cataloguing and metadata in order to achieve the final comparison of interventions and the consequent identification of best practices. The cataloguing rules of the ICCD and the digital platform for risk assessment of heritage of the ICR have been taken as a reference. Future developments of the research project will consist in the acquisition and critical processing of information on relevant number of case studies in order to have scientific evidence to proceed toward a Heritage Digital Guidelines in PPM

Strumenti e metodi innovativi per la manutenzione preventiva e programmata per la conservazione del patrimonio culturale

The paper presents a research activity, funded through a doctoral grant (D.M. 352/2022 of PNRR) in collaboration with Leonardo Solutions s.r.l.. The work is focused on preventive and predictive maintenance through the development of innovative tools and methods for the whole conservation process of cultural heritage. In the early 2000s, thanks also to the contribution of studies on the interactions between silicon nanotubes and electromagnetic fields, Domodry has patented and marketed the non-invasive device CNT (Charge Neutralization Technology) for the removal of capillary rising damp, which is one of the most frequent causes of degradation phenomena of heritage building. Unlike traditional electrophysical techniques that reverse the polarity of the masonry by means of costly and invasive interventions with mixed results, the CNT device guarantees the electrical neutrality of the water and prevents its capillary rise in a cheap, non-invasive and durable way. Since 2009, the CNT device has shown its effectiveness and durability in stopping rising damp in numerous cases of buildings. However, rising damp restoration requires a series of right actions concerning the time and method of masonry’s drying, removal of hygroscopic salts, compatible materials and technologies to the restoration of damaged building elements. The objective of the research work is the identification of a protocol of best practices including the important phases of pre-intervention and post-intervention diagnostics through critical analysis of case studies and digital cataloging of restoration work in which CNT technology has been applied. The results obtained will be also used for the development of a digital open knowledge platform for the dissemination of best practices to all stakeholders involved in the conservation of cultural heritage and for the incubation of innovations in preventive and predictive maintenance of the architectural heritage thanks to the sharing of information

Towards a Heritage Digital Guidelines in Planned Preventive Maintenance (PPM)

The requirements of building sustainability and the use of information technologies have led to the new vision of continuum building design that considers each stage of a building’s life cycle, including the recovery and up-cycling of materials and building components according to the circular economy models. Continuum building design promotes planned preventive maintenance (PPM) and moves away from the current emergency acting on assets compromised by serious pathologies. It allows the optimisation of time and resources and the durability of interventions through sustainable and effective practices. The paper presents the preliminary results of a research activity aimed at identifying and validating guidelines for architectural heritage conservation through the development of an open knowledge platform to dissemination of the best practices currently available. The main goals are promoting preventive and planned maintenance as the main strategy of conservation of the building heritage and overcoming the fragmentation and scarcity of reliable information of scientific and technical literature for diagnostics, interventions and durability monitoring. The guidelines will cover all stages of the conservation process, from the preliminary phase of knowledge of the building. Moreover, type, extent and cause of degradation will be identified, including their resolution or at least their decrease according to the criterion of minimum intervention and maximum effectiveness with the lowest cost and the lowest environmental impact using sustainable and compatible products. The guidelines of the open digital platform will be identified through the study and critical analysis of interventions on monuments belonging to Italian historical heritage. The monuments chosen as case studies have been affected by various forms of degradation, in many cases triggered by the presence of rising damp. This latter one has been stopped using an already verified economical and sustainable device that uses charge neutralization technology CNT-Domodry®. The research provides for the initial activity of identification of digital standardization protocol, information cataloguing and metadata in order to achieve the final comparison of interventions and the consequent identification of best practices. The cataloguing rules of the ICCD and the digital platform for risk assessment of heritage of the ICR have been taken as a reference. Future developments of the research project will consist in the acquisition and critical processing of information on relevant number of case studies in order to have scientific evidence to proceed toward a Heritage Digital Guidelines in PPM

A prospective multicentre study of the nutritional status in children on chronic peritoneal dialysis

Abstract The anthropometry-bioimpedance analysis-nutrition (ABN) score is a recently proposed objective method of assessing malnutrition in children on chronic peritoneal dialysis (CPD) that uses nine parameters based on anthropometry, skinfold thickness and bioimpedance analysis. The aim of this prospective, cross-sectional study was to apply it to children treated with CPD in seven Italian paediatric nephrology centres, with a score of <10.33 (the 3rd percentile in a population of 264 healthy children) classifying the children as malnourished. The other considered parameters were age, age at the start of dialysis and duration of dialysis; serum haemoglobin, urea, creatinine, total protein, albumin, transferrin, bicarbonate and C-reactive protein; residual urine output; urinary and peritoneal creatinine clearance; and daily protein and energy intake. The study enrolled 43 patients (mean age 10.2±4.2 years), 21 of whom (48.8%) had an ABN score of <10.33: 15 with mild, five with moderate, and one with severe malnutrition. The malnourished patients started CPD at a younger age (P<0.05) and had a longer duration of dialysis (P<0.01), and a significant worsening in nutritional status was observed in those treated for more than 12 months of dialysis; they also had significantly lower serum albumin, creatinine and haemoglobin levels. In conclusion, protein-calorie malnutrition is common in children receiving CPD. A younger age at the start of dialysis and a longer duration of treatment are clear risk factors, and counterbalance the long-term viability of CPD in paediatric age

Ferromagnetic resonance of Co thin films grown by atomic layer deposition on the Sb2Te3 topological insulator

Interfacing ferromagnetic materials with topological insulators is an intriguing strategy in order to enhance spin-to-charge conversion mechanisms, paving the way toward highly efficient spin-based electronic devices. In particular, the use of large-scale deposition techniques is demanding for a sustainable and cost-effective industrial technology transfer. In this work, we study the magnetic properties of the Co/Sb2Te3 heterostructure, where the ferromagnetic Co layer is deposited by atomic layer deposition on top of the Sb2Te3 topological insulator, which is grown by metal organic chemical vapor deposition. In particular, broadband ferromagnetic resonance is employed to characterize the Co/Sb2Te3 system and the reference Co/Pt heterostructure. For Co/Sb2Te3, we extract an effective magnetic anisotropy constant Keff=4.26∙106ergcm3, which is an order of magnitude higher than in Co/Pt Keff=0.43∙106ergcm3. The large difference in the Keff values observed in Co/Sb2Te3 and Co/Pt is explained in terms of the different Co crystalline structures achieved on top of Sb2Te3 and Pt, respectively. Interestingly, the Co/Sb2Te3 system displays a relatively large Gilbert damping constant (α = 0.095), which we suggest as possibly due to spin pumping from the Co layer into the Sb2Te3 topological insulator