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Valentina Perrone,1 Dario Cattaneo,1 Sonia Radice,1 Diego Sangiorgi,2 Augusto B Federici,3 Maria Rita Gismondo,4 Massimo Medaglia,5 Valeria Micheli,4 Stefania Vimercati,5 Enza Pallone,6 Luca Degli Esposti,2 Emilio Clementi1,71Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L Sacco University Hospital, University of Milan, Milan, 2CliCon Srl, Health, Economics and Outcomes Research, Ravenna, 3Hematology and Transfusion Medicine, Department of Clinical Sciences and Community Health, 4Clinical Microbiology Virology and Diagnosis of Bioemergency, 5Pharmaceutical Department, 6Quality Clinical Risk and Accreditation Unit, L Sacco University Hospital, Milan, 7Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, ItalyBackground: Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality in patients infected with human immunodeficiency virus (HIV). Studies have documented high interindividual variability in the pharmacokinetics of antiretroviral drugs, which may impair the success of HAART if not managed properly. Therapeutic drug monitoring (TDM) is a useful diagnostic tool that helps clinicians to optimize drug doses so that drug concentrations associated with the highest therapeutic efficacy are obtained with a reduced risk of concentration-dependent adverse effects. The aim of this study was to assess whether use of TDM improves clinical outcomes and cost of illness.Methods: A retrospective cohort study was conducted at L Sacco University Hospital in Milan, Italy, in HIV-infected patients aged ≥18 years with at least one prescription of antiretroviral drugs for which TDM was applied. The inclusion period was from January 2010 to December 2011, with a follow-up period of up to 12 months. Laboratory and administrative databases were analyzed and matched with each other.Results: The cohort consisted of 5,347 patients (3,861 males and 1,486 females) of mean age 43.9±12.5 years. We found that TDM had been used in 143 of these patients, among whom adherence with therapy was significantly higher than among those in whom TDM had not been used (94% versus 78%). In TDM-controlled patients, the mean length of HIV-related hospitalization stay and mean cost of hospitalization were significantly reduced with respect to those observed in the group in which TDM had not been used (7.21 days versus 29.47 days and €293 versus €688, respectively).Conclusion: Inclusion of TDM as part of routine clinical optimization of drug dosing in HIV-infected patients is associated with higher adherence to therapy, reduced length of hospitalization stay, and reduced cost of illness.Keywords: human immunodeficiency virus, therapeutic drug monitoring, health care costs

The quantitative analysis of graphic gesture in subjects with Parkinson's Disease (PD) was carried out with an approach based on optoelectronic systems. Graphic motor deficits are in fact strongly representative and early detectors of PD. PD subjects were asked to hand draw a spiral while in on and off medication conditions, in order to highlight the effect of levodopa treatment on the graphic performance. Since cognitive decay and dementia often occur with the developing disease the cognitive capabilities were assessed in subjects with PD and subjects with PD and dementia (PDD) by administering the clock drawing test. Markers were put on the pen and sheet and the gesture was acquired with an optoelectronic system. This system was selected as it is suitable for 3D, quantitative and multifactor evaluation of the gesture. The results highlighted the validity of graphic tests in the assessment of both motor and cognitive deficits caused by PD and, moreover, uncovered the possibility to use a new quantitative, not invasive, 3D method for quantifying the kinematic aspects of the graphic gesture. Further research is focussing on the assessment of both graphic and postural aspects during writing and drawing. [ABSTRACT FROM AUTHOR]

The purpose of this chapter is to present the experience of the Posture and Motion Laboratory at the "San Raffaele Cassino" in the field of use of Gait Analysis (GA) in patients with Parkinson's disease (PD) and with Progressive Supranuclear Palsy (PSP). In particular, the effects of levodopa medication on PD vs. PSP patients were quantified, comparing the OFF and ON state in the two different pathological conditions, using functional evaluation and GA. Data of the OFF and ON states in 10 PSP patients and 11 PD patients were compared. The results highlighted that the treatment based on Levodopa treatment had significant effects only on PD group (spatio-temporal parameters, kinematics and kinetics); PSP patients revealed no significant changes after the levodopa therapy. [ABSTRACT FROM AUTHOR]

The protection of privacy is an increasing concern in our networked society because of the growing amount of personal information that is being collected by a number of commercial and public services. Emerging scenarios of user–service interactions in the digital world are then pushing toward the development of powerful and flexible privacy-aware models and languages. This paper aims at introducing concepts and features that should be investigated to fulfill this demand. We identify different types of privacy-aware policies: access control, release and data handling policies. The access control policies govern access/release of data/services managed by the party (as in traditional access control), and release policies govern release of personal identifiable information (PII) of the party and specify under which conditions it can be disclosed. The data handling policies allow users to specify and communicate to other parties the policy that should be enforced to deal with their data. We also discuss how data handling policies can be integrated with traditional access control systems and present a privacy control module in charge of managing, integrating, and evaluating access control, release and data handling policies. [ABSTRACT FROM AUTHOR]

Describes an automated approach for the derivation of global authorizations according to the policy of decentralized minimum privilege, based on the analysis of authorizations exported by component databases. Architecture and policies of security in a federation; Federation authorization model; Global authorization dictionary.

Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An abstract of the study "ECMO Team for Intra-Hospital Transfers of Patients With ARDS: Report After Seven Years From the Start of the Program," by A. Lucchini et al is presented.

Background: Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality among hospitalized patients. Different studies suggest that the use of disinfectant caps (DCs) significantly reduces the rate of CRBSIs. The first purpose of this study is to analyze, through an in-vitro -model, the antiseptic effect of DCs produced by two manufacturers; the second aim is to assess potential differences in terms of effectiveness between the two manufacturers' products., Methods: A know concentration of thirteen different microorganisms was incubated with the sponge drenched in antimicrobial fluid inside DCs and cultured through several assays to investigate the disinfectant effectiveness of some commercially available caps. Disinfectant properties were evaluated under two different conditions: baseline (DCs placed on the needle-free connectors (NFCs) and stress test (DCs directly applied to the catheter hub)., Results: Both manufacturers overcame the basal tests (fourteen different assays). Regarding stress tests: the only significant bacterial load was found for Serratia marcescens (10 4 CFU/mL in ICU Medical™), both at 90 and 180 minutes after incubation; due to the low load, MDR Acinetobacter baumannii was not considered significant (<10 3 CFU/mL in BD PureHub™)., Conclusions: Our results confirm what was reported in BD PureHub™ datasheet and add data not previously shown by ICU Medical™. Moreover, no difference was observed between the two manufacturers products: the use of both DCs on NFCs was able to reclaim the catheter lumen. These findings support the routine use of DCs with NFCs, as part of a structured bundle of interventions, to reduce the incidence of CRBSIs., Competing Interests: Conflict of interest: The Authors declare no conflicts of interest.

Background: We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV suppression rates in people living with HIV (PLWH) attending a large Italian HIV clinic., Setting: The HIV outpatient clinic of the Infectious Diseases Department of Luigi Sacco Hospital, Milan, Italy, which serves more than 5000 PLWH per year., Methods: A before and after quasi-experimental study design was used to make a retrospective assessment of the monthly trend of HIV-RNA determinations of ≥50 among the PLWH attending our clinic, with "before" being the period from January 1, 2016 to February 20, 2020, and "after" being the period from February 21, 2020 to December 31, 2020 (the COVID-19 period). Interrupted time series analysis was used to evaluate any changes in the trend., Results: During the study period, 70,349 HIV-RNA viral load determinations were made, and the percentage of HIV-RNA viral load determinations of <50 copies/mL increased from 88.4% in 2016 to 93.2% in 2020 (P < 0.0001). There was a significant monthly trend toward a decrease in the number of HIV-RNA determinations of ≥50 copies/mL before the pandemic (β -0.084; standard error 0.015; P < 0.001), and this did not significantly change after it started (β -0.039, standard error 0.161; P = 0.811)., Conclusions: A high prevalence of viral suppression was maintained among the PLWH referring to our clinic, despite the structural barriers raised by the COVID-19 pandemic. The use of simplified methods of delivering care (such as teleconsultations and multiple antiretroviral treatment prescriptions) may have contributed to preserving this continuum., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

In Intensive Care Unit (ICU) survivors, critical illness has an impact on an individual's long-term health status and quality of life. Adults who have recovered from intensive care management could develop muscle weakness, neurocognitive impairment, difficulties in managing activities of daily living and to returning to work, and psychological problems such as depression and anxiety. A prospective, observational study was designed. Data were collected from January to December 2018 from a structured follow-up program, at 3 time points after ICU discharge: at seven days, a visit in the general ward, a phone interview at three months and an ambulatory visit at six months. A total of 95 patients were enrolled, 36% female, with a median age of 65 (55-73) years and a median ICU length of stay of 13 (8-20) days. At the seven days follow-up, patients who had a positive Hospital Anxiety and Depression Scale showed a significantly longer time of intubation ( p = 0.048) and length of ICU stay ( p = 0.023). At three months, we observed a significant relationship between a positive Hospital Anxiety and Depression Scale and a median value of EuroQol-5D ( p = 0.048). At six months, we observed that patients who had a positive Post-Traumatic Symptom Scale were significantly younger than the other group. Findings from the present study suggest that a longer time of intubation and length of ICU stay are associated with a higher level of anxiety and depression immediately after ICU discharge. Follow-up programs are recommended to assess and rehabilitate cognitive function at ICU discharge.

Purpose: The aim of this study was to investigate the implementation of an intensive care unit (ICU) diary in an Italian general ICU., Methods: A mixed-methods pilot study was performed, enrolling all patients who received an ICU diary in an Italian ICU during the study period., Results: Study results are presented in 2 sections: (1) diary evaluation and content themes and (2) follow-up program results. Sixty-six patients were assessed for eligibility. Diary administration was possible in 31 patients (47%). The overall diary entries, in 31 analyzed diaries, were 1331, with a median of 25 entries (interquartile range, 16-57 entries) for each diary. Participants' relatives and friends wrote a median of 1.2 (0.3-1.6), and nurses wrote 1.1 (0.8-1.2). Other ICU staff wrote a total of 24 entries (2%). Follow-up results revealed low incidence of delirium detected in only 1 patient at the 7-day visit (3%). The median value of PTSS-10 (Post Traumatic Stress Symptoms) score was 12 (3.5-12) at the 7-day visit, 6 (1.5-12) at 3 months' telephone interview, and 12 (1.5-17) at 6 months' visit., Conclusions: To our knowledge, this is the first Italian report about the introduction of an ICU diary. The diaries were easily implemented in our clinical practice as a "low-cost" initiative. In our study, nurses and participants' relatives and friends wrote a similar number of entries in each analyzed diary. This project could be effective in reducing survivors' delirium and post-traumatic stress disorder and in implementing mutual understanding between clinical staff and relatives during ICU stay., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Peripherally inserted central catheters are very common devices for short, medium and long-term therapies. Their performance is strictly dependent on the correct tip location, at the junction between the upper caval vein and the right atrium. It is very important to obtain an estimated measure of the catheter, in order to reach the cavo-atrial junction and optimize the catheter length. Estimated measures are often obtained using cutaneous landmarks., Objective: Evaluate the reliability of cutaneous landmark-based length estimation during catheter insertion. Identify any patient's related factors that may affect cutaneous landmarks reliability., Methods: We used two distinct techniques and collected data about cutaneous landmark-based length estimation, electrocardiographic guided intravascular length, age, weight and height. We studied the reliability of possible correcting factors, balancing the error average by regression models, and we found and tested two different models of prediction., Results: A total number of 519 patients were studied. The average bias, between the two studied length assessment by cutaneous landmarks and electrocardiographic guided catheter length, were 3.77 ± 2.44 cm and 3.28 ± 2.57 cm, respectively. The analysed prediction models (deviance explained 43.5%, Akaike information criterion = 1313.67% and 43.4%, Akaike information criterion = 1313.92), fitted on the validation set, showed a root mean square error of 3.07 and 3.06., Conclusion: Landmark-based length estimation for preventive catheter length assessment seems to be unreliable, when associated with post-procedural tip location. They are useful for distal trimming catheters to optimize the 'out of skin' portion when associated with electrocardiographic tip location. Models identified for balancing bias are probably not useful.

SARS-CoV-2 is causing an increasing number of deaths worldwide because no effective treatment is currently available. Remdesivir has shown in vitro activity against coronaviruses and is a possible antiviral treatment for SARS-CoV-2 infection. This prospective (compassionate), open-label study of remdesivir, which was conducted at Luigi Sacco Hospital, Milan, Italy, between February 23 and March 20, 2020, involved patients with SARS-CoV-2 pneumonia aged ≥18 years undergoing mechanical ventilation or with an oxygen saturation level of ≤94 % in air or a National Early Warning Score 2 of ≥4. The primary outcome was the change in clinical status based on a 7-category ordinal scale (1 = not hospitalised, resuming normal daily activities; 7 = deceased). The 35 patients enrolled from February 23 to March 20, 2020, included 18 in intensive care unit (ICU), and 17 in our infectious diseases ward (IDW). The 10-day course of remdesivir was completed by 22 patients (63 %) and discontinued by 13, of whom eight (22.8 %) discontinued because of adverse events. The median follow-up was 39 days (IQR 25-44). At day 28, 14 (82.3 %) patients from IDW were discharged, two were still hospitalized and one died (5.9 %), whereas in ICU 6 (33.3 %) were discharged, 8 (44.4 %) patients died, three (16.7 %) were still mechanically ventilated and one (5.6 %) was improved but still hospitalized. Hypertransaminasemia and acute kidney injury were the most frequent severe adverse events observed (42.8 % and 22.8 % of the cases, respectively). Our data suggest that remdesivir can benefit patients with SARS-CoV-2 pneumonia hospitalised outside ICU where clinical outcome was better and adverse events are less frequently observed. Ongoing randomised controlled trials will clarify its real efficacy and safety, who to treat, and when., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Tocilizumab, a humanized monoclonal antibody, targets IL-6 receptors blocking downstream pro-inflammatory effects of IL-6. In preliminary reports it was suggested to be beneficial in patients with severe COVID-19., Methods: In this open-label prospective study we describe clinical characteristics and outcome of 51 patients hospitalized with confirmed and severe COVID-19 pneumonia treated with tocilizumab intravenously. All patients had elevated IL-6 plasma level (>40 pg/mL) and oxygen saturation <93% in ambient air. Clinical outcomes, oxygen support, laboratory data and adverse events were collected over a follow-up of 30 days., Results: Forty-five patients (88%) were on high-flow oxygen supplementation, six of whom with invasive ventilation. From baseline to day 7 after tocilizumab we observed a dramatic drop of body temperature and CRP value with a significant increase in lymphocyte count (p<0.001). Over a median follow-up time of 34 days from tocilizumab, 34 patients (67%) showed an improvement in their clinical severity class; 31 were discharged; 17 (33%) showed a worsening of their clinical status, of these 14 died (27%). The mortality rate was significantly associated with mechanical ventilation at baseline (83.3% vs 20% of patients on non-invasive oxygen support; p=0.0001). The most frequent side effects were an increase of hepatic enzymes (29%), thrombocytopenia (14%), and serious bacterial and fungal infections (27%)., Conclusion: Tocilizumab exerts a rapidly beneficial effect on fever and inflammatory markers, although no significant impact on the clinical outcome can be inferred by our results. Critically ill patients seem to have a high risk of serious infections with this drug., Competing Interests: Declaration of Competing Interests None., (Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

. Continuous bedside pressure mapping in a general intensive care unit: a prospective observational study., Introduction: A continuous bedside pressure mapping device (PMD) can provide real-time feedback of ideal body position to allow off-loading of high-pressure areas to prevent pressure ulcers development., Objective: To describe the implementation of a PMD to measure tissue interface pressure (PIT) in Intensive Care (ICU) patients., Methods: Prospective observational study in ICU critically ill mechanically ventilated adults, in an Italian University Hospital. Subjects were enrolled in the first 24 hours after ICU admission. A pressure mapping system (M.A.P. System TM) was used and 3 measurements of PIT with patient in supine position, every 6 hours after admission, were performed. The following anti-decubitus surfaces were used: Duo2® - Hill-Rom, Proficare®, Nimbus 3® or Therakair Visio® - Arjohuntleigh, Getinge Group., Results: 27 patients (8 females) were enrolled; average Body Mass Index 27±6 (range: 16-43); 4 patients (14%) were diabetic. The average pressure of the 1215 areas analyzed was 26.7±19.6 mmHg (range: 3-78); the region with the highest contact pressure was the dorsal region (average: 48.7±12.5 mmHg), followed by the occipital (44.7±19.6 mmHg), and sacrum (44.7±10.7 mmHg). The three anti-decubitus surfaces showed different performances in the distribution of PITs, with statistically significant differences for the following factors: body weight (p = 0.017), patient height (p = 0.034), with increased pressures in taller patients, and higher BMI (p <0.0001)., Conclusions: Mean values of PIT were above critical levels, especially in the dorsal, occipital and sacrum region.

Background: Prolonged application time of helmet continuous positive airway pressure (CPAP) leads to better outcomes, but its timing can be influenced by the patient's tolerance., Aims and Objectives: To investigate patients' pain and tolerance experience related to different options of helmet fixing system: 'armpits strap' versus 'counterweights system'., Design: This was a non-randomized crossover study performed in a 10-bed intensive care unit and referral extra corporeal membrane oxigenation (ECMO) centre of an Italian university hospital., Results: Twenty patients were enrolled. For helmet-CPAP cycles performed with the armpit straps option, the mean pain numerical rate on a 0-10 scale was: 0·5 ± 1·4 at T 0 (baseline) , 1·5 ± 2·0 at T 1 (after 1 h) and 2·6 ± 2·5 at T 2 (end of cycle) (p = 0·023). The same analysis was performed for the counterweights fixing option. The mean score was 0·3 ± 0·6 at T 0 , 0·3 ± 0·2 at T 1 and 0·5 ± 0·7 at T 2 (p = 0·069). The mean duration for CPAP cycles performed with armpits strap and counterweights system was 3·0 ± 1·0 and 3·9 ± 2·3 h, respectively (p < 0·001). The mean section of the Basilic vein that was investigated before wearing the helmet was equal to 0·23 ± 0·20 cm 2 . After 1 h of therapy with the counterweight option and armpit straps, the mean increase of the vein's section was 0·27 ± 0·21(p = 0·099) and 0·30 ± 0·25, respectively (p = 0·080)., Conclusions: The fixing system options in use to anchor the helmet during CPAP could worsen the pain experience level and cause device-related pressure ulcers. When compared with the armpit straps option, the counterweights system appears to be a suitable approach to minimize the risks of pressure sores and pain during the treatment., Relevance to Practice: The helmet CPAP is a reliable therapy to manage acute respiratory failure. Major improvements regarding pulmonary alveolar recruitment and oxygen levels are strictly related to a prolonged time of helmet CPAP cycles. Using a counterweight fixing system, where the armpits straps are not necessary, could be helpful in reducing patients' pain experience., (© 2018 British Association of Critical Care Nurses.)

The anesthetic ketamine is often combined with analgesics and benzodiazepines in equine medicine. Therefore, drug-drug interactions are possible. Enzyme kinetics for ketamine N-demethylation were determined using equine CYP3A94, CYP3A95 and CYP3A97, and the effect of medetomidine, diazepam and methadone on the ketamine metabolism was studied in vitro. Ketamine was incubated with the CYPs or equine liver microsomes (ELM) alone or in presence of medetomidine, diazepam and/or methadone for different times. Norketamine levels were determined using enantioselective capillary electrophoresis (CE) with highly sulfated γ-cyclodextrin as chiral selector. The three equine CYPs were demonstrated to be involved in ketamine N-demethylation and the kinetics can be described with the Michaelis-Menten model. V max values calculated for CYP3A94 and CYP3A97 were higher than for CYP3A95. The lowest K m value was found for CYP3A94. In contrast to diazepam and methadone, the α 2 -recepor agonist medetomidine diminished the norketamine formation significantly in CYP3A94 and CYP3A97. In ELM, increasing concentrations of diazepam inhibited the norketamine formation. Despite the differences in ketamine N-demethylation in combination with diazepam and methadone, the effect is unlikely to be of clinical relevance because ketamine and the other drugs do not have a small therapeutic margin., (Copyright © 2018. Published by Elsevier Ltd.)

Purpose: To describe a quick tunnelling technique for peripherally inserted central catheter (PICC) insertion called the "extended subcutaneous route" technique., Methods: The "extended subcutaneous route" technique is described step by step., Results: In 18 consecutive PICCs, inserted with extended route technique in ASST Monza, no complications during insertion were registered. In 969 catheter days observed, we identified only one accidental dislodgement. No other mid-term complications were observed., Conclusions: Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.

In view of the forthcoming long-acting antiretrovirals, measures should be taken to prevent the selection of HIV drug resistance mutations. All subjects who had been switched to boosted protease inhibitors plus maraviroc (bPIs/MVC) with baseline HIV-1 RNA >50 copies/mL between June, 2014, and April, 2015, were retrospectively evaluated. HIV-1 RNA, CD4+ T-cells, serum glucose, creatinine, ALT, and adverse events were controlled every 3 to 4 months. We retrospectively analyzed 44 patients: 18 were taking darunavir/ritonavir (DRV/r) and 26 atazanavir/ritonavir (ATV/r) once daily, plus MVC 300 mg once daily. Seven subjects were in CDC stage C. All had a follow-up of at least 24 weeks, 28 exceeded 48 weeks, and 21 exceeded 72 weeks. All had experienced at least 1 viral failure and had selected at least 1 resistance-associated mutation (RAM). At baseline, 38 had plasma HIV-1 RNA 50-499 copies/mL and 6 had ≥500. At week 24, none had viremia >500 and 30 (68.2%) had suppressed HIV-1 RNA below 50 copies/mL. Of the subgroup with 48 weeks' follow-up, 23 had HIV-1 RNA 50-499 copies/mL, 5 had ≥500, and 20/28 suppressed to <50 copies/mL. Of the longest observed subgroup (72 weeks), 17 had HIV-1 RNA 50-499 copies/mL, and 4 had ≥500 copies/mL and 15/21 (71.4%) suppressed to <50 copies/mL. This combination allowed fair suppression of viral replication, with minor genotypic evolution in 6 subjects, and seems to be a feasible strategy to prevent damaging future options.

Purpose: In the last few years the use of patellar tendon shortening procedure appears to give good results for the treatment of crouch gait in Cerebral Palsy (CP) patients. It offers a secondary approach in cases where conventional hamstrings lengthening failed. The evidence for the effectiveness of knee extensor shortening is poor and only one study quantitatively assessed the effects of this technique performed in addition to other procedures in CP patients. In this case study we used Gait Analysis (GA) to quantify the effects of patellar tendon shortening for the management of crouch gait persisting after hamstring lengthening., Methods: Crouch persisted seven years after a first multilevel procedure including hamstring lengthening in a 15-year old male. Gait was assessed over time (before and from six to 18 months after knee extensor shortening) with Gait Analysis (GA)., Results: Before treatment the patient walked slowly and with a high duration stance phase; sagittal kinematics revealed excessive hip and knee flexion and ankle dorsiflexion during the whole gait cycle. After surgery, data showed progressive significant improvements at all lower limb levels during the follow-ups considered; gait became more physiologic and lower limb joint kinematics improved overall., Conclusions: The results demonstrated that addressing the other side and shortening the antagonists may be a valuable option to treat crouch gait in patients with CP especially if this persists after hamstring and knee extension surgery.

Background: The gait of healthy elderly and of subjects with Parkinson's disease (PD) displays some common features, suggesting that PD may be a model of ageing., Aim: The aim of the study was to quantify highlight the differences and similarities between the gait patterns of young PD and healthy elderly, to uncover if PD could be assumed as a model of ageing., Design: An optoelectronic system was used for 3D gait analysis evaluation., Population and Methods: We compared the gait parameters of 15 young PD (YPD) with the gait of 32 healthy elderly subjects (ES) and 21 healthy subjects age-matched with the PD subjects. RESULTS. Common features between YPD and ES were majorly found in the parameters that reflect the presence of an unstable, uncertain gait, and of corrective strategies employed to reduce instability. On the other side, typical features were present in the gait patterns of PD subjects. CONCLUSION. Our study helped identifying some typical characteristics of the onset disease, and to unravel the symptoms of ageing from those of PD by comparing young PD subjects to elderly healthy subjects., Clinical Rehabilitation Impact: This allows a deeper understanding of the mechanisms underlying the gait in ageing and PD.

Unlabelled: Number of nurses and adverse events: the results of a study. Introduction. Adverse events may be related to an higher workload and a lower nurse staffing level compared to patients needs., Objective: To assess the association between adverse events and lower nurse staffing level compared to patients workload, measured with the Nursing Activity Score (NAS)., Method: The daily workload of patients admitted to the Intensive Care Unit of San Gerardo Hospital (Monza) from December 15, 2009 to May 9, 2010 was measured with the NAS. The scores were correlated with the number of nurses on shift over 24 hours, the bed occupancy rate and the adverse events occurred., Results: Out of a population of 240 patients for a follow-up period of 145 days, 45 adverse events were observed. In the days with events the difference between ideal and actual nurses requirement amounted to -7.68% (±8.84). On days without events, the difference was 0.44% (±7.96) (p value 0.0001). In the days with events patients received less minutes of care than needed -110.66 (±127), and on days without events an excess of minutes of care 6.40 (±115) minutes /patient. The average NAS score of patients with events was 81.88 (±10.00); 73.54 (±13.83) of those without events (p=0.001)., Conclusions: In the period observed adverse events occurred mainly when the difference between patients workload according to NAS and minutes of care provided by nurses on shift was higher.

Objective. To investigate quantitatively and objectively the effects of repeated muscle vibration (rMV) of triceps surae on the gait pattern in a 5-year-old patient with Cerebral Palsy with equinus foot deformity due to calf spasticity. Methods. The patient was assessed before and one month after the rMV treatment using Gait Analysis. Results. rMV had positive effects on the patient's gait pattern, as for spatio-temporal parameters (the stance duration and the step length increased their values after the treatment) and kinematics. The pelvic tilt reduced its anteversion and the hip reduced the high flexion evidenced at baseline; the knee and the ankle gained a more physiological pattern bilaterally. The Gillette Gait Index showed a significant reduction of its value bilaterally, representing a global improvement of the child's gait pattern. Conclusions. The rMV technique seems to be an effective option for the gait pattern improvement in CP, which can be used also in very young patient. Significant improvements were displayed in terms of kinematics at all lower limb joints, not only at the joint directly involved by the treatment (i.e., ankle and knee joints) but also at proximal joints (i.e., pelvis and hip joint).

The clinical assessment of spasticity in stroke patients generally includes descriptive scales, such as the Modified Ashworth Scale (MAS) and the Global Pain Scale (GPS), however these may not be sufficiently sensitive to accurately detect improvements, especially at upper limb level; electromyography (EMG) may be the answer to this clinical requirement. The aim of this study was to quantify the effects of botulinum toxin type A (BTX) in treating upper extremity spasticity in stroke patients, using clinical evaluation (MAS and GPS) and EMG. Ten patients were assessed before, 30 days and 180 days after BTX injection using clinical evaluations and EMG. At 30 days all clinical measures improved significantly. Whereas MAS scores, after recording an improvement at the first evaluation session, were worse at the second assessment, GPS scores improved over time, both at the first and at the second evaluation session. A reduction of EMG activity was found 30 days after injections, in particular at baseline and during passive flexion movement. Our results demonstrated that measurement of EMG activity may be an effective means of detecting functional improvements and of monitoring the effects of treatment in post-stroke patients.

Aims. The realization of an experimental set-up for the quantitative and objective description of drawing using optoelectronic systems, which could be used when a quantification of the realization of specific drawing tests is required. Methods. Healthy subjects, subjects with Parkinson's Disease and subjects with Parkinson's Disease and Dementia were evaluated by the Mini Mental Scale Evaluation and by a new approach to the Clock Drawing Test, based on an optoelectronic acquisition. The new protocol hereby described aims to define a parameter related to the movement kinematics in the Clock Drawing test execution. Results. The experimental set-up revealed to be valid introducing new objective measurements beside the subjective Clock Drawing Test. This paper suggests the applicability of this protocol to other fields of motor and cognitive valuation, as well as the introduction of new parameters related to the graphic movement.

Unlabelled: NEMS and NAS scoring systems allow to calculate the number of nurses needed in an intensive care unit. Aim of the study is the assessment of nursing workload in a polyvalent intensive care unit, the evaluation of easiness of routine use of the systems and the assessment of the number of nurses needed., Method: The NEMS and NAS scores of 752 patients admitted respectively from may 2004 and July 2006 and of 250 patients admitted from August 2006 to July 2007 were analysed and adjusted to the number of inpatients., Result: Mean NEMS score were 32.05 (+/- 2.11) and mean NAS scores 76.17 (+/- 14.66) and minutes of care needed per day 1009 according to NEMS and 1096 according to NAS. Medical patients have an higher workload compared to surgical (NAS Score 84.2 +/- 16.4 vs 79.0 +/- 12.4, p = 0.0047). The workload is influenced by the main illness (extracorporeal circulation: 102.26 +/- 5.70, shock. 88.00 +/- 1 7.48, cardio-circulatory arrest out of the ward: 81.95 +/- 15.46, ARDS 86.62 +/- 14.10) and by the day of admission, being higher at admission., Conclusions: The routine assessment of patients' workload allows to measure the gap between nurses needed and available, to monitor patients with higher workload and to quantify the need of nursing care according to patients case-mix.