The impact of different rehabilitation strategies after major events in the elderly: the case of stroke and hip fracture in the Tuscany region

<p>Abstract</p> <p>Background</p> <p>On a regional level, our aims were to describe rehabilitation patterns for elderly patients with stroke and hip fracture and to investigate mortality risk during the 6-month post acute period.</p> <p>Methods</p> <p>Data sources included administrative data relative to patients aged 65+ resident in Tuscany admitted in hospital for stroke or hip fracture between 2001 and 2003, traced up to 3 years before and 6 months following index admission. The study design involves computerized linkage of administrative data, and an exploratory analysis of the association between rehabilitation patterns and 6-month mortality, adjusting for clinical, demographic, and acute-related care characteristics using multivariate Cox regression.</p> <p>Results</p> <p>Rehabilitation patterns vary greatly across Tuscany with considerable cost implications. Six month mortality risk for stroke patients is significantly lower among residents of Local Health Authorities where patients are more frequently rehabilitated, specifically in extra-hospital settings.</p> <p>Conclusion</p> <p>Our study, targeting two crucial conditions for elderly patients, found a high variability of rehabilitation patterns across a region, albeit coherent between the two pathologies, associated with remarkable differences in average expenditure. Differences in hazard rates for 6-month mortality after stroke at population level were also found. These results need to be confirmed and further investigated through a more robust information framework.</p

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

L’assistenza ospedaliera e riabilitativa per le fratture osteoporotiche in Toscana

L’osteoporosi è, assieme alle fratture correlate, una delle cause primarie di disabilità, ed è stata definita dall’Oms una malattia sociale. L’obiettivo del presente lavoro consiste nel fornire alcune informazioni sulla rilevanza economica dell’assistenza ospedaliera indotta dalle fratture osteoporotiche e, limitatamente alle fratture del collo del femore, della riabilitazione ospedaliera ed extraospedaliera nel periodo successivo alla frattura stessa. L’analisi si basa sulle informazioni provenienti dall’archivio delle schede di dimissione ospedaliera dei residenti nella regione Toscana dal 1998 al 2001, e dall’archivio delle prestazioni di riabilitazione extraospedaliera della Toscana degli anni 2001 e 2002. I ricoveri per fratture correlate all’osteoporosi o per osteoporosi, di soggetti di età maggiore o uguale a 70 anni residenti in Toscana, nel 2001 sono stati 7844 in regime ordinario e 249 in day hospital. Il valore economico totale nel 2001 è stato di quasi 42 milioni di euro, il valore medio per ricovero di 5296 euro e quello per soggetto ricoverato di 5558 euro; i ricoveri effettuati dalle donne hanno un valore economico superiore. Il 13,2% dei soggetti ricoverati per frattura del collo del femore, e dimessi vivi, ha usufruito nei sei mesi successivi al ricovero di prestazioni di riabilitazione correlabili alla frattura in strutture extraospedaliere, il 13,5% ha effettuato almeno un ricovero ordinario in reparti di riabilitazione, mentre lo 0,7% ha usufruito di riabilitazione in entrambe le modalità. Il valore economico medio per soggetto per la riabilitazione in reparti ospedalieri, nei sei mesi successivi al ricovero, è di circa 6600 euro, mentre quello delle prestazioni di riabilitazione extraospedaliera è pari a circa 1767 euro. La tipologia di assistenza riabilitativa ha quindi implicazioni economiche molto rilevanti. Costi di riabilitazione, frattura del femore, osteoporos

Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care

Abstract Background The chronic care model (CCM) is an established framework for the management of patients with chronic illness at the individual and population level. Its application has been previously shown to improve clinical outcome in several conditions, but the prognostic impact of CCM-based programs for the management of patients with chronic heart failure (HF) in primary care is still to be elucidated. Methods We assessed the prognostic impact of a primary-care, CCM-based project applied in Tuscany, Italy, in 1761 patients with chronic HF enrolled in a retrospective matched cohort study. The project was based on predefined working teams including general practitioners and nurses, proactively scheduled regular follow-up visitations for each patient, counseling for therapy adherence and lifestyle modifications, appropriate diagnostic and therapeutic pathways according to international guidelines, and a key supporting role of the nurses, who were responsible for the practical coordination of the follow-up. A matched group of 3522 HF subjects assisted by general practitioners not involved in the project was considered as control group. The endpoints of this study were HF hospitalization and all-cause mortality. Results Over a 4-year follow-up period, HF hospitalization rate was higher in the CCM group than the controls (12.1 vs 10.3 events/100 patient-years; incidence rate ratio 1.15[1.05-1.27], p = 0.0030). Mortality was lower in the CCM group than the controls (10.8 vs 12.6 events/100 patient-years; incidence rate ratio 0.82[0.75-0.91], p < 0.0001). In multivariable analysis, the CCM status was associated with a 34% higher risk of HF hospitalization and 18% lower risk of death (p < 0.0001 for both). The effect on HF hospitalization was mostly driven by a 50% higher rate of planned HF hospitalization. Conclusions Implementation of a CCM-based program for the management of HF patients in primary care led to reduced mortality and increased HF hospitalization. These findings support the hypothesis that the beneficial effects of CCM on survival might be extended to patients with chronic HF followed in primary care, but also support the need for further strategies aimed at improving the management of these patients in terms of hospitalizations

Position paper sulle politiche per la cronicità e sugli interventi per la gestione dello scompenso cardiaco

The work represents a position paper on chronic diseases policies and management models. It is the result of a Consensus Conference with 14 stakeholders that took place between October and November 2018. After an analysis of chronic diseases policies in 10 Italian regions, the paper focuses on management models for one specific chronic disease, heart failure, around which the regional intervention has centred. This paper aims at: 1) ascertain the state of the art of Italian policies on chronic diseases by mapping regional plans, programs and projects; 2) understand the main trends affecting policies on chronic diseases and heart failure, through a compared analysis of the mapped legislation; 3) identify the characteristics of regional projects related to chronic disease management and, where available, to hearth failure management through the selection of those representing regional tendencies. Our findings show that chronic diseases are developing according to some trends including demand management, comorbidity and frailty management and management of service usage. The paper ends with 8 statements representing the point of view of the expert panel group who took part to the Consensus Conference

Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019

In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region