Impact of patient delay in a modern real world STEMI network

Background: The impact of patient delay on left ventricular ejection fraction (LVEF), when system delay has performance that meets the current recommended guidelines, is poorly investigated. Methods: We evaluated a cohort of STEMI patients treated with primary percutaneous coronary intervention (pPCI) and with an ECG STEMI diagnosis to wire crossing time (ETW) 64120 min. Independent predictors of pre-discharge decreased LVEF ( 6445%) were analyzed. Results: 490 STEMI patients with both ETW time 64120 min and available pre-discharge LVEF were evaluated. Mean age was 64.2 \ub1 12 years, 76.2% were male, 19.5% were diabetics, 42.7% had and anterior myocardial infarction (MI), and 9.8% were in Killip class III\u2013IV. Median time of patient's response to initial symptoms (patient delay) was 58,5 (IQR 30;157) minutes and median ETW time was 78 (IQR 62\u201395) minutes. 115 patients (23.4%) had pre-discharge LVEF 6445%. At multivariable analysis independent predictors of decreased LVEF ( 6445%) were anterior MI (OR 4,659, 95% CI 2,618-8,289, p < 0,001), Killip class (OR 1,449, 95% CI 1,090-1,928, p = 0,011) and patients delay above the median (OR 2,030, 95% CI 1,151\u20133.578, p = 0,014). These independent predictors were confirmed in patients with ETW time 6490 min. Conclusions: When system delay meets the recommended criteria for pPCI, patient delay becomes an independent predictor of pre-discharge LVEF. These findings provide further insights into the potential optimization of STEMI management and identify a target that needs to be improved, considering that still a significant proportion of patients continue to delay seeking medical care

Societal and economic options to support grassland-based dairy production in Europe

peer-reviewedGrassland-based dairy production provides multiple benefits to farmers and to the wider society, but the European grassland area has been significantly reduced during the last decades. This paper aims to explore societal and economic options to support grassland-based dairy production in Europe. In the recent past, several societal initiatives have emerged to stimulate grassland-based dairy production: treaties, premiums and market concepts. When developing stimulating initiatives, the mindset of the farmer should be taken into account. Farmers are key actors when it comes to maintaining and improving grassland-based dairy production systems since they decide on the day-to-day management of the farm. To maintain grassland-based dairy production and to preserve the associated ecosystem services, it is, therefore, necessary to clearly show the importance of this production system for society to the farmers (show the customer perspective) and to support this by valuing the products from these systems accordingly. “New” business models should financially reward farmers for their added value contributions in delivering ecosystem services

Sistemi zootecnici delle aree alpine

Viene presentato il panorama italiano sulla zootecnia alpina, evidenziandone i punti di forza e le criticit\ue0 attraverso le varie aree dell'arco alpino

Home mechanical ventilation patients: a retrospective survey to identify level of burden in real life

Background and Aim. Home care for patients under home mechanical ventilation (HMV) may cause dramatic physical and economic burden in addition to the burden of time on family/caregivers and health care service (HCS) with difficult resource allocation decision-making. Our aims were: 1. To identify conditions causing major care burden in managing HMV patients according to family and payer’s perspectives related to characteristics of the disease, dependency and accessibility; and 2. To find, if any, differences among diseases. Methods. A questionnaire was sent to eight pulmonary centres to identify factors connected with the greater care burden. Retrospective data of 792 patients still alive and in HMV was reviewed. Results. Compared to neuromuscular disorders (NM) and chest wall deformities, the COPD group have presented a statistically greater number of hospitalisations/yr (1.37 ± 0.77), greater length of stay (13 ± 10 days), higher number of outpatient visits/yr (2.55 ± 1.73) or emergency room accesses/ yr (0.74 ± 1.08). Patients with NM diseases need more home care. The prevalence of one, two and three among five selected burden criteria (needs of MV > 12 hrs/day, tracheotomy, high dependency, distance from hospital, frequent hospitalisations) was respectively 19%, 30% and 33% of the cases; the NM was the group most represented. Conclusions. In HMV patients: 1. underlying disease, level of their dependency, hours spent under MV, presence of tracheotomy, home distance from hospital, hospital accesses are the causes of major care burden; and 2. as a novelty we have demonstrated that more than fifty percent of them present two or three contemporaneous criteria selected as care burden, being NM and COPD patients the most representative group necessitating of family’s and HCS’s care respectively

Home mechanical ventilation patients: a retrospective survey to identify level of burden in real life

Background and Aim. Home care for patients under home mechanical ventilation (HMV) may cause dramatic physical and economic burden in addition to the burden of time on family/caregivers and health care service (HCS) with difficult resource allocation decision-making. Our aims were: 1. To identify conditions causing major care burden in managing HMV patients according to family and payer's perspectives related to characteristics of the disease, dependency and accessibility; and 2. To find, if any, differences among diseases. Methods. A questionnaire was sent to eight pulmonary centres to identify factors connected with the greater care burden. Retrospective data of 792 patients still alive and in HMV was reviewed. Results. Compared to neuromuscular disorders (NM) and chest wall deformities, the COPD group have presented a statistically greater number of hospitalisations/yr (1.37 ± 0.77), greater length of stay (13 ± 10 days), higher number of outpatient visits/yr (2.55 ± 1.73) or emergency room accesses/ yr (0.74 ± 1.08). Patients with NM diseases need more home care. The prevalence of one, two and three among five selected burden criteria (needs of MV &gt; 12 hrs/day, tracheotomy, high dependency, distance from hospital, frequent hospitalisations) was respectively 19%, 30% and 33% of the cases; the NM was the group most represented. Conclusions. In HMV patients: 1. underlying disease, level of their dependency, hours spent under MV, presence of tracheotomy, home distance from hospital, hospital accesses are the causes of major care burden; and 2. as a novelty we have demonstrated that more than fifty percent of them present two or three contemporaneous criteria selected as care burden, being NM and COPD patients the most representative group necessitating of family's and HCS's care respectively

Long-term home ventilation of children in Italy: A national survey.

BACKGROUND: Improved technology, as well as professional and parental awareness, enable many ventilator-dependent children to live at home. However, the profile of this growing population, the quality and adequacy of home care, and patients' needs still require thorough assessment. OBJECTIVES: To define the characteristics of Italian children receiving long-term home mechanical ventilation (HMV) in Italy. METHODS: A detailed questionnaire was sent to 302 National Health Service hospitals potentially involved in the care of HVM in children (aged <17 years). Information was collected on patient characteristics, type of ventilation, and home respiratory care. RESULTS: A total of 362 HMV children was identified. The prevalence was 4.2 per 100,000 (95% CI: 3.8-4.6), median age was 8 years (interquartile range 4-14), median age at starting mechanical ventilation was 4 years (1-11), and 56% were male. The most frequent diagnostic categories were neuromuscular disorders (49%), lung and upper respiratory tract diseases (18%), hypoxic (ischemic) encephalopathy (13%), and abnormal ventilation control (12%). Medical professionals with nurses (for 62% of children) and physiotherapists (20%) participated in the patients' discharge from hospital, though parents were the primary care giver, and in 47% of cases, the sole care giver. Invasive ventilation was used in 41% and was significantly related to young age, southern regional residence, longer time spent under mechanical ventilation, neuromuscular disorders, or hypoxic (ischemic) encephalopathy. CONCLUSIONS: Care and technical assistance of long-term HMV children need assessment, planning, and resources. A wide variability in pattern of HMV was found throughout Italy. An Italian national ventilation program, as well as a national registry, could be useful in improving the care of these often critically ill children

From Academia Armena Sancti Lazari to the Establishment of Armenian Studies at Ca’ Foscari

The Armenian Studies have a very long tradition in Italy. However, the establishment of the official teaching of Armenian at Ca’ Foscari is particularly significant. It is a direct continuation of many Armenian traces present in the lagoon city for centuries, such as the birth of the first Casa Armena in Europe in 1245, the prosperous diplomatic relations between the Republic of Serenissima and the Kingdom of Armenia, the printing of the first Armenian book in 1512, the arrival of Armenian merchants from Julfa, who highly contributed to the economy of Venice, and finally the institution of the Mekhitarist Congregation of the Armenian monks on the island of San Lazzaro, recognised by Napoleon as Academia Armena Sancti Lazari. After an historical excursus, the paper will go on to detail some significant periods of Armenian Studies at Ca’ Foscari

Supplemental material Zanon et al. 2023

Supplemental material toQuantifying methane emissions under field conditions under 2 different dairy production scenarios: Low-input versus high-input milk productionThomas Zanon, Greta Fichter, Paul Mittermair, Laura Nocker, Matthias Gauly and Giovanni PeratonerTHIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV