La didattica della progettazione parte I; La didattica della progettazione parte II.

Effects of clinical and laboratory variables at admission and of in-hospital treatment with cardiovascular drugs on short term prognosis of ischemic stroke. The GIFA study at admission and of in-hospital treatment with cardiovascular drugs on short term prognosis of ischemic stroke. The GIFA study.

INTRODUCTION: No information exists, to our knowledge, about the possible role of cardiovascular drug administration in the acute phase of ischemic stroke and possible effects on stroke outcome. The aim of our study was to evaluate the relationship between in-hospital treatment with cardiovascular drugs in patients with acute ischemic stroke and some outcome indicators. METHODS AND RESULTS: 1096 subjects enrolled in the GIFA study, who had a main discharge diagnosis of ischemic stroke represent the final sample. Drugs considered for the analysis were the following: ACE-inhibitors (ACEI), angiotensin II receptor blockers (ARBs), statins, calcium-channel-blockers (CCBs), antiplatelet (APL) dr…

Cholesterol-adjusted vitamin E serum levels are associated with cardiovascular events in patients with non-valvular atrial fibrillation.

Non-valvular atrial fibrillation is associated with an increase in thromboembolism, i.e. stroke, and atherosclerotic events, i.e. myocardial infarction. Vitamin E possesses anti-coagulant as well as anti-atherosclerotic properties. Our aim was to assess whether vitamin E is associated with cardiovascular events in patients with non-valvular atrial fibrillation.Serum levels of cholesterol-adjusted vitamin E were measured in 1012 patients with non-valvular atrial fibrillation. Patients were followed for a mean time of 27.0 months, and cardiovascular events, such as cardiovascular death and fatal and nonfatal stroke or myocardial infarction, were recorded.During the follow-up period, cardiovas…

Risk factors for hospital readmission of elderly patients

Background: The aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards. Methods: Of the 1178 patients aged 65 years or more and discharged from one of the 66 wards of the 'Registry Politerapie SIMI (REPOSI)' during 2010, 766 were followed up by phone interview 3 months after discharge and were included in this analysis. Univariate and multivariate logistic regression models were used to evaluate the association of several variables with rehospitalization within 3 months from discharge. Results: Nineteen percent of patients were readmi…

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia.

none 22 no Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined t…

Practice guidelines for the treatment of hepatitis C: recommendations from an AISF/SIMIT/SIMAST Expert Opinion Meeting.

It is increasingly clear that a tailored therapeutic approach to patients with hepatitis C virus infection is needed. Success rates in difficult to treat and low-responsive hepatitis C virus patients are not completely satisfactory, and there is the need to optimise treatment duration and intensity in patients with the highest likelihood of response. In addition, the management of special patient categories originally excluded from phase III registration trials needs to be critically re-evaluated. This article reports the recommendations for the treatment of hepatitis C virus infection on an individual basis, drafted by experts of three scientific societies.

Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation

Background Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. Methods Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥ 65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and t…

Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly.

Background: Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards. Methods: While the prevalence of gout was calculated by counting patients with this diagnosis hyperuricemia was inferred in patients taking allopurinol at hospital admission or discharge, on the assumption that this drug was only prescribed owing to the findin…

Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People

Aims: The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older). Methods: Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (n = 1332), 2010 (n = 1380), and 2012 (n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) acc…

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

Abstract Background It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. Methods We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables an…

Schema e progetto

Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI

none 10 no The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiven…

Il percorso didattico e la ricerca

L’articolo evidenzia il senso e il valore del metodo dell’attività svolta attraverso le numerose esperienze di didattica e di ricerca. Le esperienze partono da una continua osservazione della realtà e dall’ascolto dei luoghi. Dalla realtà sono scaturiti temi e questioni che hanno costituito il materiale dei corsi universitari e di altre attività che insieme alla ricerca scientifica costituiscono parte integrante. Il percorso didattico descrive la presenza nei laboratori di quarto anno e di sintesi finale con l’obiettivo di addestrare al progetto. Viene precisata, inoltre, l’importanza di analizzare il presente, attraverso tutte le forme di descrizione indispensabili per l’osservare. Il perc…

Una passeggiata urbana, Palermo 17.12.2007 (fotografie)

18 fotografie a descrizione di una passeggiata urbana a palermo, nella città degli anni '70

Association between clusters of diseases and polypharmacy in hospitalized elderly patients: results from the REPOSI study.

BACKGROUND: Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients. METHODS: This cross-sectional study was held in 38 Italian internal medicine and geriatric wards participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The study sample included 1155 in-patients aged 65 years or older. Clusters of diseases, defined as two or more co-occurring specific chronic diseases, were identified using the odds…

Antibiotic use and associated factors in a large sample of hospitalised older people

Objectives: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy.Methods: Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged >= 65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use.Results: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed anti…

Comparison of Disease Clusters in Two Elderly Populations Hospitalized in 2008 and 2010

<b><i>Background:</i></b> As chronicity represents one of the major challenges in the healthcare of aging populations, the understanding of how chronic diseases distribute and co-occur in this part of the population is needed. <b><i>Objectives:</i></b> The aims of this study were to evaluate and compare patterns of diseases identified with cluster analysis in two samples of hospitalized elderly. <b><i>Methods:</i></b> Data were obtained from the multicenter ‘Registry Politerapie SIMI (REPOSI)' that included people aged 65 or older hospitalized in internal medicine and geriatric wards in Italy during 2008 and 2010. The s…

The stigma of low opioid prescription in the hospitalized multimorbid elderly in Italy.

The primary aim of this study was to evaluate the prevalence of opioid prescriptions in hospitalized geriatric patients. Other aims were to evaluate factors associated with opioid prescription, and whether or not there was consistency between the presence of pain and prescription. Opioid prescriptions were gathered from the REgistro POliterapie Societa` Italiana di Medicina Interna (REPOSI) data for the years 2008, 2010 and 2012. 1,380 in-patients, 65+ years old, were enrolled in the first registry run, 1,332 in the second and 1,340 in the third. The prevalence of opioid prescription was calculated at hospital admission and discharge. In the third run of the registry, the degree of pain was…

Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study

BACKGROUND: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. AIM: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. METHODS: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical prof…

Paesaggi abusivi in Sicilia

La questione dell’abusivismo edilizio in Sicilia si può leggere come parte di un fenomeno più vasto, quello di una espansione poco programmata e costituita da una grande quantità di edifici costruiti prevalentemente a uso residenziale, tra gli anni ‘60 e ’80, da piccoli imprenditori o da privati, e che hanno dato vita a parti di città dimensionalmente rilevanti. Questi edifici o insediamenti urbani, che si presentano ancora frammentati e incompiuti, sono riconoscibili per materiali, per povertà di linguaggio, per tecnica costruttiva prevalente. Una gran parte di essi sono stati realizzati originariamente fuori dalle regole urbanistiche prescritte, ma nel tempo hanno prodotto tessuti e paesa…

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septi…

Cos'è Green? / Waht is green?

Cos’è Green? è la prima di una serie di pubblicazioni con cui ci si propone di attraversare temi e problemi legati alla cultura del progetto. Un modo per interrogarsi sull’architettura e su aspetti del nostro tempo. --- Cos’è Green? Uno stile di vita, una moda, un pensiero? Tutto questo e molto altro ancora. La domanda sta all’origine di un workshop svolto presso la Facoltà di Architettura di Palermo, invitata a partecipare insieme ad altre università italiane al concorsoper studentiCostruire Green Life, bandito dalla rivista INTERNI: un’occasione per formulare delle risposte, informa di progetti, idee e parole, su uno dei temi di maggiore attualità con cui si confrontano architetti e desig…

L’obesità fattore o co-fattore di rischio?

L’obesità rappresenta odiernamente uno dei problemi più rilevanti di salute pubblica al punto che l’Organizzazione Mondiale della Sanità (WHO) sostiene che essa debba essere considerata una vera e propria “epidemia globale” . L’obesità e le malattie ad essa correlate rappresentano nei paesi occidentali una delle cause principali di mortalità precoce e di morbilità. La prevalenza dell’obesità e del sovrappeso nei paesi industrializzati ed in quelli in via di sviluppo è stimata tra il 40% ed il 60%. Negli Stati Uniti d’America, i dati più recenti del National Health and Nutrition Survey (1999-2000) sottolineano come circa il 64.5% degli adulti (67.2% uomini e 61.9% donne) sono in sovrappeso e…