Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Hydraulic Detrusor for Artificial Bladder Active Voiding

: The gold standard treatment for bladder cancer is radical cystectomy that implies bladder removal coupled to urinary diversions. Despite the serious complications and the impossibility of controlled active voiding, bladder substitution with artificial systems is a challenge and cannot represent a real option, yet. In this article, we present hydraulic artificial detrusor prototypes to control and drive the voiding of an artificial bladder (AB). These prototypes rely on two actuator designs (origami and bellows) based either on negative or positive operating pressure, to be combined with an AB structure. Based on the bladder geometry and size, we optimized the actuators in terms of contraction/expansion performances, minimizing the liquid volume required for actuation and exploring different actuator arrangements to maximize the voiding efficiency. To operate the actuators, an ad hoc electrohydraulic circuit was developed for transferring liquid between the actuators and a reservoir, both of them intended to be implanted. The AB, actuators, and reservoir were fabricated with biocompatible flexible thermoplastic materials by a heat-sealing process. We assessed the voiding efficiency with benchtop experiments by varying the actuator type and arrangement at different simulated patient positions (horizontal, 45° tilted, and vertical) to identify the optimal configuration and actuation strategy. The most efficient solution relies on two bellows actuators anchored to the AB. This artificial detrusor design resulted in a voiding efficiency of about 99%, 99%, and 89%, in the vertical, 45° tilted, and horizontal positions, respectively. The relative voiding time was reduced by about 17, 24, and 55 s compared with the unactuated bladder

An origami-based hydraulic soft artificial detrusor

Objectives: Neurological and non-neurological disorders (e.g. spinal injuries and detrusor ageing) can impair controlled bladder emptying capabilities. Neural stimulators have been proposed to reactivate the associated neural pathways, but they feature severe long term side effects. Artificial detrusor systems might act as an alternative solution, although sparsely approached by researchers. We propose here a novel hydraulic soft bodied artificial detrusor for controlled bladder voiding. Methods: The artificial detrusor is composed of two semispherical units embracing the natural bladder. They consist of a soft silicon skin enclosing a water chamber and a flexible acetate origami skeleton (waterbomb pattern). The origami guides the shape change from domed to flat when a negative pressure is applied. This shift compresses the bladder allowing the voiding. The voiding performances (bladder volume (Vb), voiding efficiency (VE), post-voiding residual volume (PVR), and voiding time (VT)) were assessed ex-vivo on horizontally oriented porcine bladders (i.e. simulating bedridden patients). The performance was compared with both naked bladder and de-activated detrusor ones to assess the role played by spontaneous voiding and gravity, respectively. Three waterbomb detrusor filling levels were evaluated (120, 140 and 160 mL), to investigate their effect on the skeleton contraction. Results: The proposed detrusor proved an average VE of ~90% and a PVR < 20 mL, irrespective of the detrusor filling degree. When non-actuated, VE and PVR varied between 50-70% and 20-50 mL, respectively. The VT lowers from ~400 s (unactuated) to ~200 s (actuated). The Vb ranges from 75 to 100 mL, depending on the detrusor filling. Conclusions: The proposed system could efficiently restore active voiding also in bedridden patients. Design improvements are required to allow more physiological bladder volumes. Acknowledgements: The authors acknowledge INAIL (Istituto Nazionale Assicurazioni Infortuni sul Lavoro) for providing their collaboration in the framework of the BioSUP project

A hydraulic soft robotic detrusor based on an origami design

As a permanent solution for patients who cannot contract their urinary bladder, an artificial detrusor muscle appears a higher outcome approach compared to current sacral neurostimulators featured by severe long-term side effects. In this paper, a novel soft robotic detrusor is presented to overcome the limitations of the state-of-the-art solutions. It is based on two identical origami-based hydraulic actuators, which completely surround the bladder and contract upon water aspiration. Design, manufacturing, and experimental characterization both in terms of contraction capabilities and voiding efficiency on ex vivo swine bladders are reported for two different origami geometries, as well as a proof-of-concept implementation of an autonomous driving circuit as control unit. Results from assisted urination tests outlined very good performances proving an active voiding efficiency of the hydraulic soft robotic detrusor equal to 84.8% ± 7.4% in simulated environment

A Hydraulic Implantable Artificial Detrusor for Controlled Bladder Voiding

Severe spinal cord injuries or detrusor muscle degeneration due to aging can cause the loss of contractility of the urinary bladder. To date, long-term clinical solutions to restore contraction control include neurostimulators with unpleasant long-term side effects. Thus, implantable artificial detrusors turn out to be an urgent promising solution in this field. In this paper, an origami-based fluidic system is proposed as a robotic prosthesis for human bladder voiding. Both on-the-bench and ex vivo tests highlighted promising results with a bladder voiding efficiency range of 75-90%

Correction to: Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

No abstract availabl