Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Use of sign language in paediatric cochlear implant users: whys and wherefores.

[No abstract available

Speech perception results in children implanted with clarion devices: Hi-resolution and Standar resolution modes

Conclusions Formal testing showed that HiRes users seem to make significant use of acoustic information. Furthermore, from observations reported by experienced care-givers, for example, family, teachers and speech therapists, these children learn a lot from their surrounding environment. Incidental learning, which takes place when acquiring skills or knowledge through naturally occurring events, is a key become available to these deaf paediatric cochlear implant recipients. Objective To compare speech perception skills in children with a Clarion® cochlear implant using different speech coding strategies, such as continuous interleaved sampling (CIS), simultaneous analogue stimulation (SAS) and Hi-Resolution (HiRes)™. Read More: http://informahealthcare.com/doi/abs/10.1080/0001648041002301

L’interazione triadica nelle famiglie con bambini sordi con impianto cocleare

La ricerca analizza le relazioni interpersonali nelle famiglie di genitori udenti con bambino sordo, portatore di impianto cocleare (IC), nel periodo di post-protesizzazione, una fase delicata che richiede un intenso impegno da parte dell’intero gruppo familiare. L’obiettivo dello studio è quello di determinare se esistono e quali siano le configurazioni triadiche tipiche, utilizzando il modello del Lausanne Trilogue Play (Fivaz-Depeursinge, Corboz-Warney, 1999). I risultati mostrano che nel gruppo preso in esame esiste una particolare modalità interattiva: tutte le triadi tendono ad interagire nel contesto ludico senza un fine costruttivo comune e le richieste interattive fatte al bambino sono di tipo direttivo e didattico. Si evidenzia inoltre un’eccessiva attenzione focalizzata dei genitori sul figlio ed un basso livello di coordinazione tra i partner. Le famiglie considerate non presentano, tuttavia, alti livelli di disfunzionalità