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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.

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

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.