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2. The management of epilepsy in clinical practice: Do the timing and severity of the disease influence the priorities of patients and the caring physicians? Data from the EPINEEDS study

Author

Enia, G., Giussani, G., Bianchi, E., Mecarelli, O., Beghi, E., Pulitano, P., Cagnetti, C., Baldinelli, S., Lattanzi, S., La Neve, A., Tappata, M., Francavilla, T., De Maria, G., Sofia, V., Giuliano, L., Mainieri, G., Fatuzzo, D., Belcastro, V., Elia, M., D'Orsi, G., Lalla, A., Salmaggi, A., Brigo, F., Magaudda, A., Pisani, F., Galletta, S., Pisani, L. R., Raffaele, M., Cosenza, D., Villani, F. S., Quintas, R. M. M., Cervellione, R., Borroni, S., Meletti, S., Ferrarese, C., Barbella, G., Di Francesco, J., Bogliun, G., Beretta, S., Galimberti, C. A., Cantisani, T. A., Cecconi, M., Celani, M. G., Papetti, R., Giorgi, F. S., Aguglia, U., Gasparini, S., Ferlazzo, E., Manganotti, P., Crichiutti, G., Bravar, G., Enia, G, Giussani, G, Bianchi, E, Mecarelli, O, Beghi, E, Pulitano, P, Cagnetti, C, Baldinelli, S, Lattanzi, S, La, N, Tappata, M, Francavilla, T, De Maria, G, Sofia, V, Giuliano, L, Mainieri, G, Fatuzzo, D, Belcastro, V, Elia, M, D'Orsi, G, Lalla, A, Salmaggi, A, Brigo, F, Magaudda, A, Pisani, F, Pisani, L, Raffaele, M, Cosenza, D, Villani, F, Quintas, R, Cervellione, R, Borroni, S, Meletti, S, Ferrarese, C, Barbella, G, Di Francesco, J, Bogliun, G, Beretta, S, Galimberti, C, Cantisani, T, Cecconi, M, Celani, M, Papetti, R, Giorgi, F, Aguglia, U, Gasparini, S, Ferlazzo, E, Manganotti, P, Crichiutti, G, and Bravar, G

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Concordance, Need, Disease, Epilepsy, Needs, Patients, Physicians, Priorities, Newly diagnosed epilepsy, Young Adult, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Seizures, Anticonvulsant, medicine, Humans, 030212 general & internal medicine, Young adult, Aged, Aged, 80 and over, Patient, Prioritie, business.industry, Middle Aged, Caregiver, medicine.disease, Seizure, Clinical Practice, Caregivers, Italy, Neurology, Physician, Recurrent seizures, Family medicine, Population study, Anticonvulsants, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Human
Abstract

Objective The objective of this study was to assess the priorities of patients with epilepsy and their caring physicians with reference to the timing and severity of the disease. Methods This is a national survey in which patients with epilepsy followed in 21 Italian epilepsy centers, and their caring physicians were asked to fill anonymous questionnaires to collect data on different aspects of the disease and their needs and priorities in its management. The collected information included demographics, clinical profile and diagnosis, treatment and outcome of epilepsy. The questions were designed to understand the expectations of the patients and their caring physicians and verify the degree of concordance between patient and doctor. The study population was divided in six prognostic categories: (1) Newly diagnosed epilepsy; (2) Absence of seizures for at least 2 years; (3) Absence of seizures for at least 1 year or occasional seizures; (4) Nondrug-resistant recurrent seizures; (5) drug-resistant seizures; (6) surgical candidate. Results Of the 787 patients enrolled, 432 were women and 355 men aged 15 to 88 years (median 41 years). Disease duration ranged from 6 months to 75 years. The sample included 53 patients with newly diagnosed epilepsy, 283 without seizures for at least 2 years, 162 seizure-free for at least 1 year or with occasional seizures, 123 with nondrug-resistant recurrent seizures, 128 with drug-resistant seizures, and 38 surgical candidates. Significant differences were found between patients and physicians in terms of priorities and needs with reference to the management of the disease. While physicians tend to prioritize the information on the diagnosis and treatment of epilepsy depending on timing and severity, patients focus on the search of the cause, the side effects of drugs, and the effects of any new treatment on the control of seizures regardless of the prognostic category. In addition, physicians tend to undervalue the communication of specific information, like the risk of sudden unexpected death in epilepsy (SUDEP) or the existence of lay associations, which might be of special interest for selected categories of patients. Significance Differences between patients with epilepsy and their caring physicians in terms of needs and priorities and suboptimal communication call for the implementation of programs aimed at addressing the factors deemed most relevant by patients and caregivers for the management of the disease.

Published
2021
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3. Heart rate, age and the risk of progression to kidney failure in patients with CKD

Author

Zoccali, C, Leonardis, D, Enia, G, Postorino, M, D'Arrigo, G, Tripepi, G, Mallamaci, F, MAURO STUDY investigators, Fatuzzo, P, and Rapisarda, F

Subjects
Male, Risk, medicine.medical_specialty, Sympathetic Nervous System, risk factors, CKD, Kidney Failure, Heart Rate, Internal medicine, Heart rate, medicine, Humans, Renal Insufficiency, Renal Insufficiency, Chronic, Risk factor, Aged, Kidney, Proteinuria, business.industry, Proportional hazards model, Hazard ratio, Age Factors, Absolute risk reduction, Middle Aged, Surgery, medicine.anatomical_structure, Nephrology, Cohort, Disease Progression, Cardiology, Female, medicine.symptom, business
Abstract

Background and methods: Since heart rate (HR) is a cardiovascular risk factor and a marker of sympa- thetic activity, we tested the predictive value of HR for progression to kidney failure in a well characterized cohort of 759 patients with stage 2-5 CKD followed up for 29 ± 11 months. Results: Overall, a total of 244 patients had renal events. In an unadjusted analysis by age tertiles the predictive value of HR for renal events was appar- ent only in patients in the third age tertile (older than 68 years) but not in those in the first two tertiles indi- cating effect modification by age of the HR - progres- sion to kidney failure relationship. In a multiple Cox regression model adjusting for potential confounders, a 5 beats/min increase in HR entailed a 16% risk ex- cess (Hazard Ratio = 1.16, P = .004) for renal events in patients in the third age tertile but no excess risk for the same events in patients in the first two tertiles. A statistically significant interaction (P

Published
2012
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4. L’interleuchina-6 è implicata in maniera causale nell’alto rischio cardiovascolare della malattia renale cronica: uno studio di randomizzazione mendeliana

Author

Spoto, B, Leonardis, D, Politi, C, Testa, A., Parlongo, Rm, Pizzini, P, Pisano, A, Sanguedolce, Mc, D’Arrigo, G, Tripepi, G, Mallamaci, F, Zoccali, C, MAURO working group CNR IFC/IBIM, Trapianto, Divisione di Nefrologia Dialisi e., Reggio, Calabria, Italia, MAURO working group: Audino, A, Bruzzese, V, Caglioti, A, Campo, S, Caridi, G, Catalano, F, Chiarella, S, Cicchetti, T, D'Anello, E, Enia, G, Fabiano, F, Fatuzzo, Pasquale Mario, Ferini, S, Garozzo, M, Grandinetti, F, Gullo, M, Mafrica, A, Maimone, I, Mancuso, F, Mannino, M, Marino, F, Natale, G, Palma, L, Papalia, T, Parlongo, G, Pinciaroli, A, Pinna, M, Plutino, D, Postorino, M, Pugliese, A, Rapisarda, Francesco, Santoro, O, and Tramontana, D.

Published
2014

5. The MAURO study: baseline characteristics and compliance with guidelines targets

Author

Leonardis, D, Mallamaci, F, Enia, G, Postorino, M, Tripepi, G, Zoccali, C, Mauro Study Investigators, Fatuzzo, Pasquale Mario, and Rapisarda, Francesco

Subjects
Male, MAURO study, audit, CKD, Blood Pressure, law.invention, Randomized controlled trial, law, Risk Factors, Practice Patterns, Physicians', Hypolipidemic Agents, Proteinuria, Anemia, Middle Aged, Lipids, Quality Improvement, Treatment Outcome, Italy, Nephrology, Cardiovascular Diseases, Research Design, Cohort, Hypertension, Practice Guidelines as Topic, Disease Progression, Female, Guideline Adherence, medicine.symptom, medicine.medical_specialty, Risk Assessment, Phosphates, Internal medicine, Diabetes mellitus, Weight Loss, medicine, Humans, Renal Insufficiency, Chronic, Antihypertensive Agents, Aged, Dyslipidemias, Chi-Square Distribution, business.industry, Sodium, Dietary, Overweight, medicine.disease, Blood pressure, Physical therapy, Calcium, Smoking Cessation, business, Risk Reduction Behavior, Dyslipidemia, Biomarkers, Kidney disease
Abstract

Background: The Multiple Intervention and Audit in Renal Diseases to Optimize Care (MAURO) study was a cluster randomized controlled trial in 22 renal clin- ics which aimed to assess the efficacy of a multimodal quality improvement intervention to increase compli- ance with guideline recommendations for prevention of chronic kidney disease (CKD) progression and car- diovascular (CV) complications. The trial aimed to test whether this multimodal intervention improved adher- ence to recommended targets for a series of surro- gate indicators relevant to blood pressure (BP) control, sodium intake, proteinuria, dyslipidemia, anemia and calcium-phosphate alterations. The trial also tested whether the same intervention slowed CKD progres- sion and prevented CV complications in CKD patients. Method: Twenty-two renal clinics were randomized to 2 arms: an intervention arm applying a multimethod quality improvement intervention and a control arm providing standard care. Surrogate indicators were measured to evaluate blood pressure (BP) control, sodium intake, proteinuria, dyslipidemia, anemia and calcium-phosphate alterations. Results: Notwithstanding the fact that the vast major- ity of patients enrolled in this study (95%) were being treated with antihypertensive drugs, BP goals at base- line (specific for proteinuria level and diabetes) were met only in 45% of nonproteinuric patients and in just 14% and 18% of proteinuric and diabetic patients, respectively. The use of diuretics in hypertensive pa- tients was less than what was needed, and about 80% of patients showed a salt excretion >100 mmol/ 24 hours. Total and low-density lipoprotein cholesterol levels were out of target in over 40% of patients, but only about 60% of these were on statins. A large ma- jority of CKD patients were obese or overweight. The proportion of smokers was relatively small (13%), and 37% of patients had quit smoking, indicating patients' awareness of the health risks of smoking. Conclusions: In our cohort, management of modifiable risk factors for CKD progression and CV disease could be substantially improved.

Published
2012

11. VARIABILITÀ DELLA PRESSIONE ARTERIOSA 'VISIT TO VISIT' E RISCHIO DI EVENTI CARDIO VASCOLARI NEI PAZIENTI CON MALATTIA RENALE CRONICA

Author

Leonardis, D, Mallamaci, F, Tripepi, G, Catalano, F, Pisano, A, Enia, G, Postorino, M, Zoccali, C, NOME DEL GRUPPO DI STUDIO MAURO MAIMONE I, A., Parisi, R, Plutino, D, Santoro, O, Grandinetti, F, Natale, G, Chiarella, S, Pinciaroli, A, Audino, A, Mannino, M, Caridi, G, Marino, F, Parlongo, G, Pugliese, A, Garozzo, M, Caruso, A, Fatuzzo, Pasquale Mario, Rapisarda, Francesco, Papalia, T, Caglioti, A, Reina, A, Danello, E, Bruzzese, V, Fabiano, F, Guido, A, Gullo, M, Fersini, S, Pinna, M, Campo, S, Palma, L, Tramontana, D, and Curti, C.

Published
2011

12. Una variante del gene DDAH-1 predice gli eventi cardiovascolari nella malattia renale cronica

Author

Testa, A, Pisano, A, Spoto, B, Sanguedolce, M. C., Parlongo, R. M., Tripepi, G, Leonardis, D, Mallamaci, F, Postorino, M, Enia, G, Zoccali, C, NOME DEL GRUPPO, A., DI LAVORO DELLO STUDIO MAURO MAIMONE, I, Parisi, R, Plutino, D, Santoro, O, Grandinetti, F, Natale, G, Chiarella, S, Pinciaroli, A, Audino, A, Mannino, M, Caridi, G, Marino, F, Parlongo, G, Pugliese, A, Garozzo, M, Caruso, A, Fatuzzo, P, Rapisarda, Francesco, Papalia, T, Caglioti, A, Reina, A, Danello, E, Bruzzese, V, Fabiano, F, Guido, A, Gullo, M, Fersini, S, Pinna, M, Campo, S, Palma, L, Tramontana, D, and Mancuso, F.

Published
2011

20. Noradrenaline predicts survival and incident cardiovascular events in dialysis patients

Author

Zoccali, C., Mallamaci, F., Benedetto, F. A., Tripepi, G., Bonanno, G., Rapisarda, Francesco, Fatuzzo, Pasquale Mario, Seminara, G., Panuccio, V., Enia, G., Parlongo, S., Cutrupi, S., Stancanelli, B., San Francisco, L. S. M. a. l. a. t. i. n. o. ASN/ISN World Congress of N. e. p. h. r. o. l. o. g. y., California, and 13 17 October 2001

Published
2001

22. Linee Guida per la terapia conservativa dell’insufficienza renale cronica

Author

Barsotti, G, Oldrizzi, L, Gentile, Mg, Del Vecchio, L, De Marchi, S, De Pascale, C, De Vecchi, A, Enia, G, Fuiano, G, Gallucci, M, Garibotto, Giacomo, Maggiore, Q, Mangiacapra, S, Panarello, G, Poggi, A, Quintaliani, G, Salvadori, M, Terracciano, V, Timio, M, and Tizianello, A.

Subjects
insufficienza renale cronica, linee guida, insufficienza renale cronica, linee guida
Published
1999

24. The management of epilepsy in clinical practice: Do the needs manifested by the patients correspond to the priorities of the caring physicians? Findings from the EPINEEDS Study

Author

Giorgia Giussani, Gabriele Enia, Elisa Bianchi, Oriano Mecarelli, Ettore Beghi, Patrizia Pulitano, Claudia Cagnetti, Sara Baldinelli, Simona Lattanzi, Angela La Neve, Maria Tappatà, Teresa Francavilla, Giovanni De Maria, Vito Sofia, Loretta Giuliano, Greta Mainieri, Daniela Fatuzzo, Vincenzo Belcastro, Maurizio Elia, Giuseppe D'Orsi, Alessandra Lalla, Andrea Salmaggi, Francesco Brigo, Adriana Magaudda, Francesco Pisani, Santi Galletta, Laura R. Pisani, Massimo Raffaele, Domenico Cosenza, Flavio S. Villani, Rui M.M. Quintas, Rosa Cervellione, Simona Borroni, Stefano Meletti, Carlo Ferrarese, Giuseppina Barbella, Jacopo Di Francesco, Graziella Bogliun, Simone Beretta, Carlo A. Galimberti, Teresa A. Cantisani, Michela Cecconi, Maria G. Celani, Rossella Papetti, Filippo S. Giorgi, Umberto Aguglia, Sara Gasparini, Edoardo Ferlazzo, Paolo Manganotti, Giovanni Crichiutti, Giulia Bravar, Giussani, G., Enia, G., Bianchi, E., Mecarelli, O., Beghi, E., Pulitano, P., Cagnetti, C., Baldinelli, S., La Neve, A., Tappata, M., Francavilla, T., De Maria, G., Sofia, V., Giuliano, L., Mainieri, G., Fatuzzo, D., Belcastro, V., Elia, M., D'Orsi, G., Lalla, A., Salmaggi, A., Brigo, F., Magaudda, A., Pisani, F., Galletta, S., Pisani, L. R., Raffaele, M., Cosenza, D., Villani, F. S., Quintas, R. M. M., Cervellione, R., Borroni, S., Meletti, S., Ferrarese, C., Barbella, G., Di Francesco, J., Bogliun, G., Beretta, S., Galimberti, C. A., Cantisani, T. A., Cecconi, M., Celani, M. G., Papetti, R., Giorgi, F. S., Aguglia, U., Gasparini, S., Ferlazzo, E., Manganotti, P., Crichiutti, G., Bravar, G., Giussani, G, Enia, G, Bianchi, E, Mecarelli, O, Beghi, E, Pulitano, P, Cagnetti, C, Baldinelli, S, La Neve, A, Tappata, M, Francavilla, T, De Maria, G, Sofia, V, Giuliano, L, Mainieri, G, Fatuzzo, D, Belcastro, V, Elia, M, D'Orsi, G, Lalla, A, Salmaggi, A, Brigo, F, Magaudda, A, Pisani, F, Galletta, S, Pisani, L, Raffaele, M, Cosenza, D, Villani, F, Quintas, R, Cervellione, R, Borroni, S, Meletti, S, Ferrarese, C, Barbella, G, Di Francesco, J, Bogliun, G, Beretta, S, Galimberti, C, Cantisani, T, Cecconi, M, Celani, M, Papetti, R, Giorgi, F, Aguglia, U, Gasparini, S, Ferlazzo, E, Manganotti, P, Crichiutti, G, and Bravar, G

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Activities of daily living, Adolescent, Patients, Concordance, Satisfaction, Need, Disease, 03 medical and health sciences, Behavioral Neuroscience, Psychiatric comorbidity, Epilepsy, Young Adult, 0302 clinical medicine, Genetic etiology, Seizures, Physicians, Surveys and Questionnaires, Medicine, Humans, Epilepsy Needs, 030212 general & internal medicine, Aged, Aged, 80 and over, Health Services Needs and Demand, Physician-Patient Relations, business.industry, Prioritie, Communication, Needs, Priorities, Disease Management, Middle Aged, medicine.disease, Clinical Practice, Cross-Sectional Studies, Neurology, Italy, Socioeconomic Factors, Etiology, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Purpose The purpose of this study was to assess the priorities of patients with epilepsy and caring physicians and the correspondence between these priorities. Methods In this multicenter cross-sectional study, patients with epilepsy attending 21 Italian epilepsy centers and their caring physicians filled anonymously questionnaires on the needs and priorities in the management of the disease. Included were questions on patients' demographics, diagnosis, treatment, and outcome of epilepsy. The concordance between patients and their physicians was assessed on various aspects of the diagnosis and care of the disease. Patients' satisfaction with communication, services, and patient–doctor relationship was also assessed. Results Included were 432 women and 355 men aged 15 to 88 years (median: 41 years). Disease duration ranged from 6 months to 75 years. A structural/metabolic etiology predominated (52.7%), followed by a (presumed) genetic etiology (33.0%). Seizure remission was present in 56.5% of cases. Comorbidities requiring chronic treatment were present in 27.5%, and comorbidities affecting self-sufficiency in 9.5%. Psychiatric comorbidity was present in 35.0%. Patients' priorities included discovery of the cause (89.1%), use of right drug (98.7%), use of a drug without chronic side effects (94.0%), and a life without restrictions (90.4%). Physicians' priorities included choice of right drug (83.5%) and use of drugs without chronic side effects (86.8%). Priorities varied with patients' age, sex, education, and occupation. Patient–doctor relationships were at least good in most cases. The information imparted was considered unsatisfactory by 21–44% of cases on seizure circumstances and complications, side effects of drugs, limitations of daily activities, and management of physiologic or pathologic conditions. Patients declared overall satisfaction, except for appointments (21.5%) and emergencies (30.8%). Conclusion Patients and physicians' priorities in the management of epilepsy overlap only in part. Patients are satisfied with their caring physicians and less satisfied with communication and management of routine and emergency problems.

Published
2020

25. Long-term visit-to-visit office blood pressure variability increases the risk of adverse cardiovascular outcomes in patients with chronic kidney disease

Author

Giuseppe Conte, Graziella D'Arrigo, Roberto Minutolo, Giovanni Tripepi, Giorgio Fuiano, Francesca Mallamaci, Francesco Rapisarda, Carmine Zoccali, Daniela Leonardis, Giuseppe Enia, Igina Maimone, Domenico Santoro, Luca De Nicola, Teresa Cicchetti, Maurizio Postorino, Mallamaci, F, Minutolo, Roberto, Leonardis, D, D'Arrigo, G, Tripepi, G, Rapisarda, F, Cicchetti, T, Maimone, I, Enia, G, Postorino, M, Santoro, D, Fuiano, G, DE NICOLA, Luca, Conte, Giuseppe, and Zoccali, C.

Subjects
Male, medicine.medical_specialty, Time Factors, Office Visits, Blood Pressure, Comorbidity, Essential hypertension, Kidney, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, CKD, Humans, Blood pressure variabilty, Renal Insufficiency, Chronic, Intensive care medicine, Adverse cardiovascular risks, Antihypertensive Agents, Aged, Proportional Hazards Models, Framingham Risk Score, Chi-Square Distribution, Proportional hazards model, business.industry, Incidence, Hazard ratio, Absolute risk reduction, Blood Pressure Determination, Middle Aged, medicine.disease, Prognosis, Confidence interval, Blood pressure, Italy, Nephrology, Hypertension, Multivariate Analysis, Cardiology, Linear Models, Female, business, Kidney disease, Glomerular Filtration Rate
Abstract

Long-term visit-to-visit blood pressure (BP) variability predicts a high risk for cardiovascular events in patients with essential hypertension. Whether long-term visit-to-visit BP variability holds the same predictive power in predialysis patients with chronic kidney disease (CKD) is unknown. Here we tested the relationship between long-term visit-to-visit office BP variability and a composite end point (death and incident cardiovascular events) in a cohort of 1618 patients with stage 2–5 CKD. Visit-to-visit systolic BP variability was significantly and independently related to baseline office, maximal, and average systolic BPs, age, glucose, estimated glomerular filtration rate, and albumin, and to the number of visits during the follow-up. Both the standard deviation of systolic BP (hazard ratio: 1.11, 95% confidence interval: 1.01–1.20) and the coefficient of variation of systolic BP (hazard ratio: 1.15, 95% confidence interval: 1.02–1.29) were significant predictors of the combined end point independent of peak and average systolic BP, cardiovascular comorbidities, Framingham risk factors, and CKD-related risk factors. Antihypertensive treatment (β-blockers and sympatholytic drugs) significantly abrogated the excess risk associated with high systolic BP variability. Thus, large visit-to-visit systolic BP variability in patients with CKD predicts a higher risk of death and nonfatal cardiovascular events independent of underlying BP levels.

Published
2013

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