A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability : the FiND questionnaire

BACKGROUND: The "frailty syndrome" (a geriatric multidimensional condition characterized by decreased reserve and diminished resistance to stressors) represents a promising target of preventive interventions against disability in elders. Available screening tools for the identification of frailty in the absence of disability present major limitations. In particular, they have to be administered by a trained assessor, require special equipment, and/or do not discriminate between frail and disabled individuals. Aim of this study is to verify the agreement of a novel self-reported questionnaire (the "Frail Non-Disabled" [FiND] instrument) designed for detecting non-mobility disabled frail older persons with results from reference tools. METHODOLOGY/PRINCIPAL FINDINGS: Data are from 45 community-dwelling individuals aged 6560 years. Participants were asked to complete the FiND questionnaire separately exploring the frailty and disability domains. Then, a blinded assessor objectively measured the frailty status (using the phenotype proposed by Fried and colleagues) and mobility disability (using the 400-meter walk test). Cohen's kappa coefficients were calculated to determine the agreement between the FiND questionnaire with the reference instruments. Mean age of participants (women 62.2%) was 72.5 (standard deviation 8.2) years. Seven (15.6%) participants presented mobility disability as being unable to complete the 400-meter walk test. According to the frailty phenotype criteria, 25 (55.6%) participants were pre-frail or frail, and 13 (28.9%) were robust. Overall, a substantial agreement of the instrument with the reference tools (kappa\u200a=\u200a0.748, quadratic weighted kappa\u200a=\u200a0.836, both p values<0.001) was reported with only 7 (15.6%) participants incorrectly categorized. The agreement between results of the FiND disability domain and the 400-meter walk test was excellent (kappa\u200a=\u200a0.920, p<0.001). CONCLUSIONS/SIGNIFICANCE: The FiND questionnaire presents a very good capacity to correctly identify frail older persons without mobility disability living in the community. This screening tool may represent an opportunity for diffusing awareness about frailty and disability and supporting specific preventive campaigns

Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

BACKGROUND: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). METHOD: Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). RESULTS: 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. CONCLUSION: Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients

Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey

<p>Abstract</p> <p>Background</p> <p>The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications.</p> <p>Methods</p> <p>A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period.</p> <p>Results</p> <p>Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay.</p> <p>Conclusion</p> <p>Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.</p

Two randomised and placebo-controlled studies of an oral prostacyclin analogue (Iloprost) in severe leg ischaemia [The Oral Iloprost in severe Leg Ischaemia Study Group]

Two separate studies are described using the same prostacyclin analogue in a similar group of patients. Objectives: to assess the tolerability and efficacy of two dose regimens of oral Iloprost compared with placebo in the treatment of patients with ischaemic ulcers, gangrene or rest pain due to severe arterial disease over a period of 4 weeks (Study A) and one year (Study B). Design: multicentre, placebo controlled, double-blind, randomized prospective studies. Subjects & Methods: 178 (study A) and 624 (study B) patients with trophic skin lesions (ulcers or gangrene) or ischaemic rest pain due to severe arterial disease. To confirm severe arterial disease patients were required to have a systolic ankle Doppler pressure of 70 mmHg or less or a toe systolic Doppler pressure of 50 mmHg or less in one leg.In both studies patients were randomly allocated to three treatment groups: placebo, low dose Iloprost (50\u2013100 g twice a day) or high dose (150\u2013200 g twice a day) In Study A the main outcome measures were tolerability of different doses of Iloprost and death, major amputation, healing of trophic lesions and relief of rest pain at the end of the follow up, which was 5 months after the end of the treatment. In Study B the primary end point was time to major amputation and stroke or death up to 12 months. Secondary pre-defined end points included the combined end point of patients alive without amputation, no trophic skin changes, no rest pain and not on regular analgesics. Results: the proportion of patients who completed the 4-week treatment period in Study A at the intended dose was 58%, 43%, 45% respectively in the placebo, low dose and high dose Iloprost groups. In an intention to treat analysis the proportion of patients who survived without major amputation, ulcers or gangrene and had no rest pain was 11% in the placebo group, 19% in the low dose iloprost group and 28% in the high dose Iloprost group. The pooled Iloprost groups showed a statistically significantly better result than the placebo group (p=0.04), as did the high dose Iloprost group compared to the placebo (p=0.014). In Study B there was no treatment benefit in terms of a primary end point of amputation and death. However the secondary combined end point of patients who survived without a major amputation, ulcers or gangrene and had no rest pain, nor a need for regular analgesia was favourable for Iloprost, with 18% of patients in the placebo group reaching this optimal secondary end point, compared to 23% in the low dose Iloprost group and 26% in the higher dose Iloprost group (p<0.05). Conclusions: oral Iloprost administered for a year showed no clear benefit in patients with advanced severe leg ischaemia (PAOD III and IV). The results obtained with 4 weeks\u2019 treatment in Study A and in previous trials of intravenous Iloprost could not be reproduce

Assessing the clinical relevance of improved Quality of life in patients with Intermittent Claudication: A Individual Case Data Meta-Analysis.

Assessment of the clinical relevance of naftidrofuryl in increasing walking distance for Peripheral Arterial Disease. Effect Size and Standard error Measurement techniques.etude de la pertinence clinique du naftidrofuryl dans la claudication intermittente, methode de l' effect size et de l' erreur standard mesuré

NDF degradability of hays measured in situ and in vitro

The NDF degradability (d(NDF)) of hays measured by an in situ method (nylon bag technique) was compared with in vitro fermentation, using the Daisy(II) incubator (Ankom(R), Tech. Co., Fairport, NY, USA). Eighteen hays were produced from mountain areas (about 700 m.s.l.) from plots subjected to different cutting frequencies (two to four cuts per season) and types of N fertilisation (slurry and slurry plus mineral). Hay samples from each cut were incubated (in situ) in the rumens of three cows (incubation times: 2, 4, 8, 16, 24, 48 and 72 h; sample weight: 15 mg/cm(2) of free bag area) or inserted (in vitro) into three different digestion jars Oar volume: 2 1; bag size 5 cm x 3 cm; sample weight: 250 mg per bag) that were placed into the Daisy(11) incubator for 48 h. The forages showed large variation in effective d(NDF) (assumed rumen turn over rate: 3% per hour) which ranged from 38 to 43% for hays with two cuts to 58-65% for the hays with four cuts per season. The d(NDF) obtained in situ (Y, effective) and in vitro (X, after 48 h of incubation) were highly correlated (P < 0.01) and the regression equation was Y = 0.74(+/-0.05)X + 6.39(+/-2.90), n = 18, S.D. = +/-1.96, r(2) = 0.94. The variability (coefficient of variation, CV) of the in vitro measurements (among jar repeatability) was 2.8%, which is close to that generally found for some chemical analyses of feedstuffs and lower than that obtained for the in situ measures (among cow repeatability, CV: 3.7%). The Daisy(II) incubator produces repeatable in vitro d(NDF) data which are highly related to those obtainable with the reference in situ procedure. (C) 2003 Elsevier Science B.V. All rights reserved

Toward a new generation of nanoparticles for therapy and diagnosis

Progress in utilizing inorganic nanoparticles for biomedical applications has advanced rapidly due to the extensive amount of work done in the synthesis and modification of the materials.1 These nanosized materials provide a robust framework in which two or more components can be incorporated to give multifunctional capabilities. An example can be seen in gold nanomaterials.2 Gold nanoparticles are bioinert, nontoxic, and readily synthesized and functionalized.3 They also provide a multifunctional platform for both therapeutic and diagnostic purposes. Indeed, through proper functionalization, these particles can be engineered to accumulate at illness cells using targeting ligands providing a powerful tool, for example, for gene therapy.4 The biophysico-chemical properties of the vehicle, such as size, charge, surface hydrophilicity, and the nature and density of the ligands on their surface, can all impact the circulating half-life of the particles as well as their biodistribution. Innovation may be introduced by controlling the surface properties of the monolayer protecting the gold core. Indeed, recently it has been demonstrated that particles coated with a molecularly ordered ligand shell were able to enter cells directly through the membrane without perforating it basing on a novel physical chemistry phenomenon.6 This property is ideal as it provides the particles with minimal if none genotoxicity. Mixed monolayers composed of mixtures of hydrogenated/fluorurated ligands favor the phase segregation and consequently the ordered morphology of the NP surface. 7 In addition, the introduction in the monolayer of perfluorocarbon ligands might enable, for example, the imaging by 19F MRI techniques of the nanoparticles and, consequently, the tracking in vivo of cell fate. In this communication we will discuss the approaches for the realization of such innovative nanoparticles easy to make, because obtained by self-assembly strategies, but with an unprecedented degree of complexity, with respect to nanotechnology platforms for drug delivery applications know to date, as far as their features is concerned