Headache of Analgesic Abuse as a Cause of New Pain Pathways Development

Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1–2%. It is a severe form of headache where the patients often have a long history of unsuccessful headache treatments. MOH is characterized by chronic headache and the overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for the management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This chapter focuses on an overall discussion of medication abuse as a novel pain pathway in headaches

Che cosa possiamo imparare dalla gestione della comunicazione istituzionale durante l'emergenza Covid-19?

Communication during health emergencies has a crucial role for the effectiveness of the measures implemented. International Health Regulations, as well as the Italian National Prevention Plan, identify risk communication as one of the fundamental capacities to strengthen detection and response systems for threats to public health. The Covid-19 pandemic involved a number of actors in the emergency communication. In Italy, the management of institutional communication has been characterized by fragmented and disjointed messages. There are multiple lessons learned from the Covid-19 emergency, including: the need of an accurate, coordinated and inclusive communication plan; and the integration of communication tools

The Italian health system and the COVID-19 challenge

The article illustrates the response of the Italian Health System to the COvid-19 epidemic challeng

COVID-19: leave no healthcare worker behind

The article comments on guarantees of perosna protection granted to Italian health workers during the Covid-19 epidemi

A pilot study on the impact of known drug-drug interactions in cancer patients

Background: When a patient concomitantly uses two or more drugs, a drug-drug interaction (DDI) can possibly occur, potentially leading to an increased or decreased clinical effect of a given treatment. Cancer patients are at high risk of such interactions because they commonly receive multiple medications. Moreover, most cancer patients are elderly and require additional medications for comorbidities. Aim of this preliminary observational study was to evaluate the incidence of well known and established DDIs in a cohort of cancer outpatients undergoing multiple treatments. Methods: Anamnestic and clinical data were collected for 64 adult patients in the ambulatory setting with malignant solid tumors who were receiving systemic anticancer treatment. Patients also declared all drugs prescribed by other specialists or self-taken in the previous 2 weeks. DDIs were divided into two different groups: 'neoplastic DDIs' (NDDIs), involving antitumoral drugs, and 'not neoplastic DDIs' (nDDIs), involving all other classes of drugs. The severity of DDIs was classified as major, moderate and minor, according to the 'Institute for Pharmacological Research Mario Negri' definition. Results: About 34 % of cancer outpatients within our cohort were prescribed/assumed interacting drug combinations. The most frequent major NDDIs involved the anticoagulant warfarin (33 % of total NDDIs) that, in association with tamoxifen, or capecitabine and paclitaxel, increased the risk of haemorrhage. About 60 % of nDDIs involved acetylsalicylic acid. Conclusions: Overall, 16 % of DDIs were related to an A-level strength of recommendation to be avoided. The lack of effective communication among specialists and patients might have a role in determining therapeutic errors. Our pilot study, although limited by a small cohort size, highlights the urgent need of implementing the clinical management of cancer outpatients with new strategies to prevent or minimize potential harmful DDIs

So close yet so distant: evidence from Lombardy and Veneto to plan COVID-19 recovery strategy

As Italy is approaching a new phase in the response to the COVID-19 epidemic, the analysis of policy choices and their impact offer a useful learning opportunity. Lombardy and Veneto, two neighbouring Regions with comparable socio-economic features, implemented different policies in response to the epidemic, which resulted in divergent outcomes.&nbsp;</p

So close yet so distant: evidence from Lombardy and Veneto to plan COVID-19 recovery strategy

The article analyses the recovery strategy of two Regions in Italy, Lombardy and Veneto, their differences and impact

Polypharmacy and the use of medications in inpatients with acquired brain injury during post-acute rehabilitation: A cross-sectional study

Background: This study assessed the use of medications during inpatient post-acute rehabilitation for acquired brain injury (ABI).Materials and methods: All inpatients with ABI undergoing post-acute rehabilitation in centres identified through the roster of the Italian Society for Rehabilitation Medicine were included. A designated physician in each centre collected information through a structured questionnaire. This study calculated (a) prevalence of medication use, (b) logistic regression Odds Ratio (OR), with 95% confidence interval (95% CI), of polypharmacy ( 65 6 medications).Results: A total of 484 patients (median age = 52 years, 63.4% men, median time from acute event = 18.5 weeks) were included; 33.8% had Rancho Los Amigos Levels of Cognitive Functioning Scale (RLAS) score 1-2, 8.1% had a score of 7-8, of whom 92.0% received medications, 51.8% had a score of 6-10, of whom 83.9% had at least one psychotropic medication and 66.9% had two or more; 51.8% received anti-epileptics, 32.1% anti-depressants, 14.5% anti-psychotics, peaking in RLAS 4 (37.3%) and decreasing in RLAS 7-8. Polypharmacy was directly associated with age (55-64 years, OR = 2.1; 95% CI = 1.1-4.1; 65 65 years, OR = 1.7; 95% CI = 0.9-3.3), inversely with RLAS score (1-2 vs 7-8, OR = 4.3; 95% CI = 1.9-9.8).Conclusion: Polypharmacy and concurrent use of psychotropic medications was common, raising concern about drug-drug interactions. Safety and effectiveness of medications should be monitored, particularly when used concurrently