Patient-Reported Outcomes and Return to Intended Oncologic Therapy After Colorectal Enhanced Recovery Pathway

Objective: To evaluate the influence of enhanced recovery pathway (ERP) on patient-reported outcome measures (PROMs) and return to intended oncologic therapy (RIOT) after colorectal surgery. Background: ERP improves early outcomes after colorectal surgery; however, little is known about its influence on PROMs and on RIOT. Methods: Prospective multicenter enrollment of patients who underwent colorectal resection with anastomosis was performed, recording variables related to patient-, institution-, procedure-level data, adherence to the ERP, and outcomes. The primary endpoints were PROMs (administered before surgery, at discharge, and 6 to 8 weeks after surgery) and RIOT after surgery for malignancy, defined as the intended oncologic treatment according to national guidelines and disease stage, administered within 8 weeks from the index operation, evaluated through multivariate regression models. Results: The study included 4529 patients, analyzed for PROMs, 1467 of which were analyzed for RIOT. Compared to their baseline preoperative values, all PROMs showed significant worsening at discharge and improvement at late evaluation. PROMs values at discharge and 6 to 8 weeks after surgery, adjusted through a generalized mixed regression model according to preoperative status and other variables, showed no association with ERP adherence rates. RIOT rates (overall 54.5%) were independently lower by aged > 69 years, ASA Class III, open surgery, and presence of major morbidity; conversely, they were independently higher after surgery performed in an institutional ERP center and by ERP adherence rates > median (69.2%). Conclusions: Adherence to the ERP had no effect on PROMs, whereas it independently influenced RIOT rates after surgery for colorectal cancer

Effect of pre-seasonal seasonal treatment with budesonide topical nasal powder in patients with seasonal allergic rhinitis

abstract The efficacy and safety of budesonide nasal powder (Rhinocort Turbuhaler®) in seasonal allergic rhinitis when given only at the onset of symptoms during the pollen season or when also given before the pollen season, were compared. The study was carried out in 364 patients from 14 centres in Italy as a randomized, double-blind, parallel-group, placebo- controlled comparison of five alternative treatment regimens given for 4 weeks during the pre-pollen and early pollen season (PPS) and for 6 weeks during the pollen season (PS). It was concluded that either 200 μ g or 400 μ g of budesonide given once daily PPS provides significant control of symptoms experienced during PPS. The 400 μ g dose, however, also provides additional prophylactic protection against symptoms during early PS. When the pollen season is established, the dose of budesonide may be reduced to 200 μ g

Factors Influencing Depression Endpoints Research (FINDER): baseline results of Italian patients with depression

<p>Abstract</p> <p>Background</p> <p>Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective, observational study carried out in 12 European countries aimed at investigating health-related quality of life (HRQoL) in outpatients receiving pharmacological treatment for a first or new depressive episode. Baseline characteristics of patients enrolled in Italy are presented.</p> <p>Methods</p> <p>All treatment decisions were at the discretion of the investigator. Data were collected at baseline and after 3 and 6 months of treatment. Baseline evaluations included demographics, medical and psychiatric history, and medications used in the last 24 months and prescribed at enrolment. The Hospital Anxiety and Depression Scale (HADS), was adopted to evaluate depressive symptoms, while somatic and painful physical symptoms were assessed by using the Somatic Symptom Inventory (SSI) and a 0 to 100 mm visual analogue scale (VAS), HRQoL via 36-item Short Form Health Survey (SF-36), and the European Quality of Life 5-Dimensions (EQ-5D) instrument.</p> <p>Results</p> <p>A total of 513 patients were recruited across 38 sites. The mean ± standard deviation (SD) age at first depressive episode was 38.7 ± 15.9 years, the mean duration of depression 10.6 ± 12.3 years. The most common psychiatric comorbidities in the previous 24 months were anxiety/panic (72.6%) and obsessive/compulsive disorders (13.4%), while 35.9% had functional somatic syndromes. Most patients (65.1%) reported pain from any cause. Monotherapy with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) was prescribed at enrolment in 64.5% and 6.4% of the cases, respectively. The most commonly prescribed agents were sertraline (17.3%), escitalopram (16.2%), venlaflaxine (15.6%) and paroxetine (14.8%). The mean HADS subscores for depression and anxiety were 13.3 ± 4.2 and 12.2 ± 3.9, respectively; 76.4% of patients could be defined as being 'probable cases' for depression and 66.2% for anxiety. The mean total score of VAS-pain in the last week was 42.9 ± 27.1, with highest scores reported in the 'interference of pain with daily activities' and in 'amount of time patient was awake and had pain'. From SF-36, the worst health status was found for role limitations due to emotional problem, mental health and social functioning. A mean score < 50 (that is, below the standardised population norm) was also found in all remaining domains. The SF-36 summary scores and EQ-5D (health status and VAS) were lower in patients with moderate/severe pain than in those with no or mild pain.</p> <p>Conclusion</p> <p>The baseline results of patients enrolled in the FINDER study in Italy show clinical and functional impairments, and poor HRQoL. The results obtained after 6 months of therapy will permit better understanding the effects of different variables on clinical outcomes and HRQoL.</p

Finite-temperature relativistic Landau problem and the relativistic quantum Hall effect

This paper presents a study of the free energy and particle density of the relativistic Landau problem, and their relevance to the quantum Hall effect. We study first the zero temperature Casimir energy and fermion number for Dirac fields in a 2+1-dimensional Minkowski space-time, in the presence of a uniform magnetic field perpendicular to the spatial manifold. Then, we go to the finite-temperature problem, with a chemical potential, introduced as a uniform zero component of the gauge potential. By performing a Lorentz boost, we obtain Hall's conductivity in the case of crossed electric and magnetic fields.Comment: Final version, to appear in Journal of Physics A: Mathematical and Genera

Number of Nevi at a Specific Anatomical Site and Its Relation to Cutaneous Malignant Melanoma

The risk of cutaneous malignant melanoma (CMM) is strongly associated with total number of nevi. Scanty information is available on the association between CMM at a specific anatomical site and number of nevi at the same site. We analyzed data from a case–control study conducted in Italy between 1992 and 1994, on 542 cases of CMM and 538 hospital controls. Cases and controls were examined by trained dermatologists who counted the number of melanocytic nevi. We derived multivariate odds ratios (ORs) and 95% confidence intervals (95% CIs) of site-specific risk of CMM for high versus low number of nevi at the corresponding site. The ORs of CMM for the highest versus the lowest tertile of number of nevi at the corresponding site was 1.4 (95% CIs: 0.7–2.8) at face and neck, 2.3 (95% CIs: 1.1–4.9) at anterior trunk, 4.9 (95% CIs: 2.9–8.4) at posterior trunk, 2.9 (95% CIs: 1.2–6.6) at upper limbs and 5.0 (95% CIs: 2.9–8.5) at lower limbs. In a case–case analysis, comparing CMM cases at a specific site and CMM cases at all other sites, the only excess risk was found for the posterior trunk, the ORs being 2.1 (95% CIs: 1.2–3.6) for the highest versus the lowest tertile of number of nevi. Our data do not support the hypothesis of a specific effect of nevi at each single anatomical site

Peritoneal dialysis in older adults: evaluation of clinical, nutritional, metabolic outcomes, and quality of life

The number of older adults requiring dialysis is increasing worldwide, whereas the use of peritoneal dialysis (PD) in this population is lower respect to younger patients, despite the theoretical advantages of PD respect to hemodialysis. This is most likely due to the concern that older patients may not be able to correctly and safely manage PD. We aimed to prospectively compare clinical, nutritional and metabolic outcomes and measures of quality of life between younger (&lt;65years old) and older (≥65years old) patients on PD. PD patients were enrolled and divided into 2 groups according to age (Group A &lt; 65 years, Group B ≥ 65 years). Clinical and instrumental parameters, and quality of life were evaluated at baseline (start of PD) (T0) and at 24 months (T1). Technique survival, mortality, total number of hospitalizations, and the index of peritonitis (episodes of peritonitis/month) were also evaluated. Fifty-one patients starting PD were enrolled. Group A included 22 patients (48.7±8.3 years), and Group B consisted of 29 patients (74.1 ± 6.4 years). At baseline, the 2 groups showed no differences in cognitive status, whereas Group A showed higher total cholesterol (p=0.03), LDL (p=0.03), and triglycerides (p=0.03) levels and lower body mass index (p=0.02) and carotid intima media thickness (p&lt;0.0001) with respect to Group B. At T1 Group B showed, compared to baseline, a significant reduction in albumin (p&lt;0.0001) and phosphorus (p=0.045) levels, while no significant differences on body composition, technique survival, total number of hospitalizations, index of peritonitis and quality of life indices were observed. Our data do not show clinically relevant barriers to use PD in older adult patients, supporting its use in this population. Nutritional and metabolic parameters should be carefully monitored in older PD patients

Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: Current management

info:eu-repo/semantics/publishedVersio

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study.

Objective: To determine whether early mobilization of patients with severe acquired brain injury, performed in the intensive/neurointensive care unit, influences functional outcome. Design: Prospective observational study. Setting: Fourteen centres in Italy. Subjects: A total of 103 consecutive patients with acquired brain injury. Methods: Clinical, neurological and functional data, including the Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome Scale (GOS), and Functional Independence Measure (FIM) were collected at admission and every 3–5 days until discharge from the intensive/neurointensive care unit. Patients were divided into mobilization and no mobilization groups, depending on whether they received mobilization. Data were analysed by intragroup and intergroup analysis using a multilevel regression model. Results: Sixty-eight patients were included in the mobilization group. At discharge, both groups showed significant improvements in GCS, DRS, LCF and ERBI scores. The mobilization group showed significantly better improvements in FIM cognitive, GOS and ERBI. The patients in the mobilization group stayed longer in the intensive care unit (p = 0.01) and were more likely to be discharged to intensive rehabilitation at a significantly higher rate (p = 0.002) than patients in the no mobilization group. No adverse events were reported in either group. Conclusion: Early mobilization appears to favour the clinical and functional recovery of patients with severe acquired brain injury in the intensive care unit

Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes. An Italian multicenter study

WSTĘP. Celem badania była ocena chorobowości w przypadku, potwierdzonej w biopsji, choroby trzewnej u włoskich dzieci i młodzieży, chorych na cukrzycę typu 1 oraz określenie zależności między wiekiem, w którym ujawniła się cukrzyca typu 1, a rozpoznaniem choroby trzewnej. MATERIAŁ I METODY. Badanie obejmowało grupę kliniczną dzieci i młodzieży w okresie dojrzewania, chorych na cukrzycę typu 1, leczonych w 25 ośrodkach we Włoszech. Co roku wykonywano u nich badania przesiewowe w kierunku celiakii, przy użyciu przeciwciał przeciwgliadynowych IgA/IgG i przeciwciał IgA przeciwko endomysium. WYNIKI. Potwierdzoną w biopsji chorobę trzewną stwierdzono u 292 z 4322 dzieci i młodzieży [chorobowość 6,8%, 95-procentowy przedział ufności (CI, confidendial interval) 6,0-7,6]; ryzyko wystąpienia choroby trzewnej było wyższe u dziewcząt niż u chłopców [współczynnik ryzyka (OR, odds ratio) 1,93; 1,51-2,47]. W 89% przypadków cukrzycę rozpoznano przed ujawnieniem się choroby trzewnej. Analiza regresji logistycznej wykazała, że młody wiek, płeć żeńska i zaburzenia czynności tarczycy były niezależnie związane z ryzykiem zachorowania na cukrzycę lub chorobę trzewną. W porównaniu z osobami, u których cukrzyca ujawniła się powyżej 9. roku życia, u osób, u których początek choroby wystąpił poniżej 4. roku życia, OR wynosił 3,27 (2,20-4,85). WNIOSKI. W niniejszej pracy wykazano, że: 1) chorobowość w przypadku potwierdzonej biopsją choroby trzewnej u dzieci i młodzieży jest wysoka (6,8%); 2) ryzyko wystąpienia obu schorzeń jest 3-krotnie wyższe u dzieci i młodzieży z cukrzycą typu 1, u których ujawniła się ona przed ukończeniem 4. roku życia niż w przypadku, kiedy początek choroby wystąpił powyżej 9. roku życia; 3) ryzyko wystąpienia obu schorzeń u dziewcząt jest wyższe niż u chłopców.INTRODUCTION. To estimate the prevalence of biopsy- confirmed celiac disease in Italian children and adolescents with type 1 diabetes and to assess whether age at onset of type 1 diabetes is independently associated with diagnosis of celiac disease. MATERIAL AND METHODS. The study group was a clinic-based cohort of children and adolescents with type 1 diabetes cared for in 25 Italian centers for childhood diabetes. Yearly screening for celiac disease was performed using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies. RESULTS. Of the 4,322 children and adolescents (age 11.8 &#177; 4.2 years) identified with type 1 diabetes, biopsy-confirmed celiac disease was diagnosed in 292 (prevalence 6.8%, 95% confidence interval [CI] 6.0&#8211;7.6), with a higher risk seen in girls than in boys (odds ratio [OR] 1.93, 1.51&#8211;2.47). In 89% of these, diabetes was diagnosed before celiac disease. In logistic regression analyses, being younger at onset of diabetes, being female, and having a diagnosis of a thyroid disorder were independently associated with the risk of having diabetes and celiac disease. In comparison with subjects who were older than 9 years at onset of diabetes, subjects who were younger than 4 years at onset had an OR of 3.27 (2.20&#8211;4.85). CONCLUSIONS. We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age 9 years; and 3) girls have a higher risk of having both diseases than boys