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101. From Distress Screening to Uptake: An Italian Multicenter Study of Cancer Patients

Author

Meggiolaro, Elena, primary, De Padova, Silvia, additional, Ruffilli, Federica, additional, Bertelli, Tatiana, additional, Bragagni, Marina, additional, Prati, Sabrina, additional, Pisotti, Lidia, additional, Massa, Ilaria, additional, Foca, Flavia, additional, Tamberi, Stefano, additional, De Giorgi, Ugo, additional, Zerbinati, Luigi, additional, Tiberto, Elisa, additional, and Grassi, Luigi, additional

Published
2021
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106. Renal Function, Cardiovascular Diseases, Appropriateness of Drug Prescription and Outcomes in Hospitalized Older Patients

Author

Antonietta, Gigante, Marco, Proietti, Enrico, Petrillo, Pier Mannuccio Mannucci, Alessandro, Nobili, Maurizio, Muscaritoli, Antonello, Pietrangelo, Francesco, Perticone, Francesco, Violi, Gino Roberto Corazza, Salvatore, Corrao, Alessandra, Marengoni, Francesco, Salerno, Matteo, Cesari, Mauro, Tettamanti, Luca, Pasina, Carlotta, Franchi, Laura, Cortesi, Gabriella, Miglio, Ilaria, Ardoino, Alessio, Novella, Domenico, Prisco, Elena, Silvestri, Giacomo, Emmi, Alessandra, Bettiol, Irene, Mattioli, Gianni, Biolo, Michela, Zanetti, Giacomo, Bartelloni, Massimo, Vanoli, Giulia, Grignani, Edoardo Alessandro Pulixi, Graziana, Lupattelli, Vanessa, Bianconi, Riccardo, Alcidi, Domenico, Girelli, Fabiana, Busti, Giacomo, Marchi, Mario, Barbagallo, Ligia, Dominguez, Vincenza, Beneduce, Federica, Cacioppo, Giuseppe, Natoli, Salvatore, Mularo, Massimo, Raspanti, Marco, Zoli, Maria Laura Matacena, Giuseppe, Orio, Eleonora, Magnolfi, Giovanni, Serafini, Angelo, Simili, Giuseppe, Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Giovanna, Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia, Scaramellini, Paolo Dionigi Rossi, Sarah, Damanti, Marta, Clerici, Simona, Leoni, Alessandra Danuta Di Mauro, Antonio Di Sabatino, Emanuela, Miceli, Marco Vincenzo Lenti, Martina, Pisati, Costanza Caccia Dominioni, Roberto, Pontremoli, Valentina, Beccati, Giulia, Nobili, Giovanna, Leoncini, Luigi, Anastasio, Maria, Carbone, Francesco, Cipollone, Maria Teresa Guagnano, Ilaria, Rossi, Gerardo, Mancuso, Daniela, Calipari, Mosè, Bartone, Giuseppe, Delitala, Maria, Berria, Alessandro, Delitala, Alessio, Molfino, Antonella, Giorgi, Christian, Gracian, Giuseppe, Zuccalà, Gabriella, D’Aurizio, Giuseppe, Romanelli, Andrea, Volpini, Daniela, Lucente, Antonio, Picardi, Umberto Vespasiani Gentilucci, Paolo, Gallo, Giorgio, Annoni, Maurizio, Corsi, Giuseppe, Bellelli, Alessandra, Bonfanti, Franco, Arturi, Elena, Succurro, Bruno, Tassone, Federica, Giofrè, Maria Grazia Serra, Maria Antonietta Bleve, Antonio, Brucato, Teresa De Falco, Fabrizio, Fabris, Irene, Bertozzi, Giulia, Bogoni, Maria Victoria Rabuini, Tancredi, Prandini, Manfredini, Roberto, Fabbian, Fabio, Boari, Benedetta, DE GIORGI, Alfredo, Ruana, Tiseo, Giuseppe, Paolisso, Maria Rosaria Rizzo, Claudia, Catalano, Claudio, Borghi, Enrico, Strocchi, Eugenia, Ianniello, Mario, Soldati, Silvia, Schiavone, Alessio, Bragagni, Carlo, Sabbà, Francesco Saverio Vella, Patrizia, Suppressa, Giovanni Michele De Vincenzo, Alessio, Comitangelo, Emanuele, Amoruso, Carlo, Custodero, Luigi, Fenoglio, Andrea, Falcetta, Fracanzani, Anna L., Silvia, Tiraboschi, Annalisa, Cespiati, Giovanna, Oberti, Giordano, Sigon, Flora, Peyvandi, Raffaella, Rossio, Giulia, Colombo, Pasquale, Agosti, Valter, Monzani, Valeria, Savojardo, Giuliana, Ceriani, Giada, Pallini, Fabrizio, Montecucco, Luciano, Ottonello, Lara, Caserza, Giulia, Vischi, Nicola Lucio Liberato, Tiziana, Tognin, Francesco, Purrello, Antonino Di Pino, Salvatore, Piro, Renzo, Rozzini, Lina, Falanga, Maria Stella Pisciotta, Francesco Baffa Bellucci, Stefano, Buffelli, Giuseppe, Montrucchio, Paolo, Peasso, Edoardo, Favale, Cesare, Poletto, Carl, Margaria, Maura, Sanino, Ludovica, Perri, Luigina, Guasti, Luana, Castiglioni, Andrea, Maresca, Alessandro, Squizzato, Leonardo, Campiotti, Alessandra, Grossi, Roberto Davide Diprizio, Marco, Bertolotti, Chiara, Mussi, Giulia, Lancellotti, Maria Vittoria Libbra, Matteo, Galassi, Yasmine, Grassi, Maria, Perticone, Rosa, Battaglia, Marco, Filice, Raffaele, Maio, Vincenzo, Stanghellini, Eugenio, Ruggeri, Sara del Vecchio, Andrea, Salvi, Roberto, Leonardi, Giampaolo, Damiani, William, Capeci, Massimo, Mattioli, Giuseppe Pio Martino, Lorenzo, Biondi, Pietro, Pettinari, Salvatore, Minisola, Luciano, Colangelo, Mirella, Cilli, Giancarlo, Labbadia, Antonella, Afeltra, Benedetta, Marigliano, Maria Elena Pipita, Pietro, Castellino, Luca, Zanoli, Alfio, Gennaro, Agostino, Gaudio, Valter, Saracco, Marisa, Fogliati, Carlo, Bussolino, Francesca, Mete, Miriam, Gino, Carlo, Vigorito, Antonio, Cittadini, Guido, Moreo, Silvia, Prolo, Gloria, Pina, Alberto, Ballestrero, Fabio, Ferrando, Sergio, Berra, Simonetta, Dassi, Maria Cristina Nava, Bruno, Graziella, Stefano, Baldassarre, Salvatore, Fragapani, Gabriella, Gruden, Giorgio, Galanti, Gabriele, Mascherini, Cristian, Petri, Laura, Stefani, Margherita, Girino, Valeria, Piccinelli, Francesco, Nasso, Vincenza, Gioffrè, Maria, Pasquale, Leonardo, Sechi, Cristiana, Catena, Gianluca, Colussi, Alessandro, Cavarape, Andea Da Porto, Nicola, Passariello, Luca, Rinaldi, Franco, Berti, Giuseppe, Famularo, Patrizia, Tarsitani, Roberto, Castello, Michela, Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta, Morganti, Andrea, Artoni, Margherita, Grossi, Stefano Del Giacco, Davide, Firinu, Giulia, Costanzo, Giacomo, Argiolas, Giuseppe, Montalto, Anna, Licata, Filippo Alessandro Montalto, Francesco, Corica, Giorgio, Basile, Antonino, Catalano, Federica, Bellone, Concetto, Principato, Lorenzo, Malatino, Benedetta, Stancanelli, Valentina, Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella, Caruso, Patrizia, Mecocci, Carmelinda, Ruggiero, Virginia, Boccardi, Tiziana, Meschi, Andrea, Ticinesi, Antonio, Nouvenne, Pietro, Minuz, Luigi, Fondrieschi, Giandomenico Nigro Imperiale, Mario, Pirisi, Gian Paolo Fra, Daniele, Sola, Mattia, Bellan, Massimo, Porta, Piero, Riva, Roberto, Quadri, Erica, Larovere, Marco, Novelli, Giorgio, Scanzi, Caterina, Mengoli, Stella, Provini, Laura, Ricevuti, Emilio, Simeone, Rosa, Scurti, Fabio, Tolloso, Roberto, Tarquini, Alice, Valoriani, Silvia, Dolenti, Giulia, Vannini, Riccardo, Volpi, Pietro, Bocchi, Alessandro, Vignali, Sergio, Harari, Chiara, Lonati, Federico, Napoli, Italia, Aiello, Raffaele, Landolfi, Massimo, Montalto, Antonio, Mirijello, Silvia, Ghidoni, Teresa, Salvatore, Lucio, Monaco, Carmen, Ricozzi, Alberto, Pilotto, Ilaria, Indiano, and Federica, Gandolfo.

Subjects
Drug, medicine.medical_specialty, Hospitalized patients, media_common.quotation_subject, Renal function, Socio-culturale, Kidney, Kidney Function Tests, Drug Prescriptions, Older patients, PEOPLE, Internal medicine, Atrial Fibrillation, Humans, Medicine, Pharmacology (medical), LS4_4, Medical prescription, Aged, media_common, CHRONIC KIDNEY DISEASE, POLYPHARMACY, FRAILTY POPULATION, PEOPLE, ADULTS, DEATH, business.industry, CHRONIC KIDNEY DISEASE, FRAILTY POPULATION, DEATH, ADULTS, Cardiovascular Diseases, Observational study, POLYPHARMACY, Geriatrics and Gerontology, business
Abstract

Reduced estimated creatinine clearance (eCrCl) is prevalent in older patients and impacts on drug prescription. In this study, the burden of eCrCl reduction and its associated factors and impact on outcomes were analyzed. Moreover, the rate of inappropriate drug prescription according to eCrCl and its impact on outcomes were described.Data were obtained from "REgistro POliterapie SIMI" (REPOSI), a prospective observational register enrolling hospitalized patients aged ≥ 65 years. Patients enrolled from 2010-2016 with available data to calculate eCrCl according to the Cockcroft-Gault formula were included in this analysis.A total of 5046 patients were available for analysis. Among these, we found an eCrCl of 45-59 mL/min in 1163 patients (23.0%), an eCrCl of 30-44 mL/min in 1128 (22.4%), an eCrCl of 15-29 mL/min in 702 (13.9%), and an eCrCl 15 mL/min in 152 (3.0%), with several clinical factors associated with decreasing eCrCl. During follow-up, a progressively higher risk for all-cause death, cardiovascular (CV) death, any death/re-hospitalization, and CV death/re-hospitalization was found across the renal function classes. Among patients with hypertension, diabetes mellitus, atrial fibrillation, coronary artery disease, and heart failure, 476 (10.9%) were inappropriately prescribed medications according to eCrCl. During follow-up, inappropriate prescription was associated with increased risk of all-cause death (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.13-1.97) and any death/re-hospitalization (OR 1.30, 95% CI 1.03-1.63).In older hospitalized patients, impaired eCrCl is prevalent and associated with several factors, polypharmacy in particular. Patients with reduced eCrCl have a higher risk of major clinical outcomes, and 10% of them are prescribed an inappropriate drug, with a higher risk for major clinical outcomes.

Published
2021

107. Initiation of Psycholeptic Medication During Hospitalization With Recommendation for Discontinuation After Discharge

Author

Federica, Conti, Dario, Consonni, Sarah, Damanti, Alessandro, Nobili, Luca, Pasina, Pier Mannuccio Mannucci, Matteo, Cesari, Paolo Dionigi Rossi, Domenico, Prisco, Elena, Silvestri, Giacomo, Emmi, Alessandra, Bettiol, Irene, Mattioli, Gianni, Biolo, Michela, Zanetti, Giacomo, Bartelloni, Massimo, Vanoli, Giulia, Grignani, Edoardo Alessandro Pulixi, Graziana, Lupattelli, Vanessa, Bianconi, Riccardo, Alcidi, Domenico, Girelli, Fabiana, Busti, Giacomo, Marchi, Mario, Barbagallo, Ligia, Dominguez, Vincenza, Beneduce, Federica, Cacioppo, Salvatore, Corrao, Giuseppe, Natoli, Salvatore, Mularo, Massimo, Raspanti, Marco, Zoli, Maria Laura Matacena, Giuseppe, Orio, Eleonora, Magnolfi, Giovanni, Serafini, Angelo, Simili, Giuseppe, Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Giovanna, Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia, Scaramellini, Marta, Clerici, Simona, Leoni, Alessandra Danuta Di Mauro, Antonio Di Sabatino, Emanuela, Miceli, Marco Vincenzo Lenti, Martina, Pisati, Costanza Caccia Dominioni, Roberto, Pontremoli, Valentina, Beccati, Giulia, Nobili, Giovanna, Leoncini, Luigi, Anastasio, Lucia, Sofia, Maria, Carbone, Francesco, Cipollone, Maria Teresa Guagnano, Ilaria, Rossi, Gerardo, Mancuso, Daniela, Calipari, Mosè, Bartone, Giuseppe, Delitala, Maria, Berria, Alessandro, Delitala, Maurizio, Muscaritoli, Alessio, Molfino, Enrico, Petrillo, Antonella, Giorgi, Christian, Gracin, Giuseppe, Zuccalà, Gabriella, D'Aurizio, Giuseppe, Romanelli, Alessandra, Marengoni, Andrea, Volpini, Daniela, Lucente, Antonio, Picardi, Umberto Vespasiani Gentilucci, Paolo, Gallo, Giuseppe, Bellelli, Maurizio, Corsi, Cesare, Antonucci, Chiara, Sidoli, Giulia, Principato, Franco, Arturi, Elena, Succurro, Bruno, Tassone, Federica, Giofrè, Maria Grazia Serra, Maria Antonietta Bleve, Antonio, Brucato, Teresa De Falco, Fabrizio, Fabris, Irene, Bertozzi, Giulia, Bogoni, Maria Victoria Rabuini, Tancredi, Prandini, Manfredini, Roberto, Fabbian, Fabio, Benedetta, Boari, DE GIORGI, Alfredo, Ruana, Tiseo, Giuseppe, Paolisso, Maria Rosaria Rizzo, Claudia, Catalano, Claudio, Borghi, Enrico, Strocchi, Eugenia, Ianniello, Mario, Soldati, Silvia, Schiavone, Alessio, Bragagni, Carlo, Sabbà, Francesco Saverio Vella, Patrizia, Suppressa, Giovanni Michele De Vincenzo, Alessio, Comitangelo, Emanuele, Amoruso, Carlo, Custodero, Luigi, Fenoglio, Andrea, Falcetta, Fracanzani, Anna L., Silvia, Tiraboschi, Annalisa, Cespiati, Giovanna, Oberti, Giordano, Sigon, Flora, Peyvandi, Raffaella, Rossio, Giulia, Colombo, Pasquale, Agosti, Valter, Monzani, Valeria, Savojardo, Giuliana, Ceriani, Francesco, Salerno, Giada, Pallini, Fabrizio, Montecucco, Luciano, Ottonello, Lara, Caserza, Giulia, Vischi, Nicola Lucio Liberato, Tiziana, Tognin, Francesco, Purrello, Antonino Di Pino, Salvatore, Piro, Renzo, Rozzini, Lina, Falanga, Maria Stella Pisciotta, Francesco Baffa Bellucci, Stefano, Buffelli, Giuseppe, Montrucchio, Paolo, Peasso, Edoardo, Favale, Cesare, Poletto, Carl, Margaria, Maura, Sanino, Francesco, Violi, Ludovica, Perri, Luigina, Guasti, Luana, Castiglioni, Andrea, Maresca, Alessandro, Squizzato, Leonardo, Campiotti, Alessandra, Grossi, Roberto Davide Diprizio, Marco, Bertolotti, Chiara, Mussi, Giulia, Lancellotti, Maria Vittoria Libbra, Matteo, Galassi, Yasmine, Grassi, Alessio, Greco, Angela, Sciacqua, Maria, Perticone, Rosa, Battaglia, Raffaele, Maio, Vincenzo, Stanghellini, Eugenio, Ruggeri, Sara del Vecchio, Andrea, Salvi, Roberto, Leonardi, Giampaolo, Damiani, William, Capeci, Massimo, Mattioli, Giuseppe Pio Martino, Lorenzo, Biondi, Pietro, Pettinari, Riccardo, Ghio, Anna Dal Col, Salvatore, Minisola, Luciano, Colangelo, Mirella, Cilli, Giancarlo, Labbadia, Antonella, Afeltra, Benedetta, Marigliano, Maria Elena Pipita, Pietro, Castellino, Luca, Zanoli, Alfio, Gennaro, Agostino, Gaudio, Valter, Saracco, Marisa, Fogliati, Carlo, Bussolino, Francesca, Mete, Miriam, Gino, Carlo, Vigorito, Antonio, Cittadini, Guido, Moreo, Silvia, Prolo, Gloria, Pina, Alberto, Ballestrero, Fabio, Ferrando, Roberta, Gonella, Domenico, Cerminara, Sergio, Berra, Simonetta, Dassi, Maria Cristina Nava, Bruno, Graziella, Stefano, Baldassarre, Salvatore, Fragapani, Gabriella, Gruden, Giorgio, Galanti, Gabriele, Mascherini, Cristian, Petri, Laura, Stefani, Margherita, Girino, Valeria, Piccinelli, Francesco, Nasso, Vincenza, Gioffrè, Maria, Pasquale, Leonardo, Sechi, Cristiana, Catena, Gianluca, Colussi, Alessandro, Cavarape, Andea Da Porto, Nicola, Passariello, Luca, Rinaldi, Franco, Berti, Giuseppe, Famularo, Patrizia, Tarsitani, Roberto, Castello, Michela, Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta, Morganti, Andrea, Artoni, Margherita, Grossi, Stefano Del Giacco, Davide, Firinu, Giulia, Costanzo, Giacomo, Argiolas, Giuseppe, Montalto, Anna, Licata, Filippo Alessandro Montalto, Francesco, Corica, Giorgio, Basile, Antonino, Catalano, Federica, Bellone, Concetto, Principato, Lorenzo, Malatino, Benedetta, Stancanelli, Valentina, Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella, Caruso, Patrizia, Mecocci, Carmelinda, Ruggiero, Virginia, Boccardi, Tiziana, Meschi, Andrea, Ticinesi, Antonio, Nouvenne, Pietro, Minuz, Luigi, Fondrieschi, Giandomenico Nigro Imperiale, Mario, Pirisi, Gian Paolo Fra, Daniele, Sola, Mattia, Bellan, Massimo, Porta, Piero, Riva, Roberto, Quadri, Erica, Larovere, Marco, Novelli, Giorgio, Scanzi, Caterina, Mengoli, Stella, Provini, Laura, Ricevuti, Emilio, Simeone, Rosa, Scurti, Fabio, Tolloso, Roberto, Tarquini, Alice, Valoriani, Silvia, Dolenti, Giulia, Vannini, Riccardo, Volpi, Pietro, Bocchi, Alessandro, Vignali, Sergio, Harari, Chiara, Lonati, Federico, Napoli, Italia, Aiello, Raffaele, Landolfi, Massimo, Montalto, Antonio, Mirijello, Maria Angela Iseni, Silvia, Ghidoni, Teresa, Salvatore, Lucio, Monaco, Carmen, Ricozzi, Alberto, Pilotto, Ilaria, Indiano, and Federica, Gandolfo.

Subjects
medicine.medical_specialty, Socio-culturale, Psycholeptic, 03 medical and health sciences, 0302 clinical medicine, delirium, deprescribing, medicine, Psycholeptics, Humans, 030212 general & internal medicine, LS4_4, Medical prescription, Cognitive decline, Risk factor, General Nursing, Aged, Retrospective Studies, business.industry, Health Policy, Retrospective cohort study, General Medicine, Length of Stay, Psycholeptics, delirium, dementia, deprescribing, hospitalization, older patients, older patients, Patient Discharge, Discontinuation, Hospitalization, Italy, Emergency medicine, Delirium, Geriatrics and Gerontology, medicine.symptom, Deprescribing, business, 030217 neurology & neurosurgery, dementia
Abstract

Objectives Psycholeptic drugs have been used in the older population for years, especially to control delirium and neuropsychiatric symptoms (NPS) of dementia. However, data from the literature confirm that the prolonged use of psycholeptics may be responsible for adverse reactions in older patients. The aim of this study was (1) to identify how many patients receive the first prescription of a psycholeptic drug during the hospital stay; (2) to evaluate the main sociodemographic and clinical characteristics of these patients; and (3) to verify if the prescribed psycholeptic drugs are continued after 3 months from the hospital discharge. Design Our retrospective study was based on data from the REPOSI (REgistro POliterapie SIMI) registry, a cohort of older patients hospitalized in internal medicine and geriatric wards throughout Italy from 2010 to 2018. Setting and Participants Patients aged 65 years or older who were not on home therapy with psycholeptic drugs were considered in the analyses. Methods We did both univariate and multivariate analyses in order to find the variables associated independently to an increased risk for first psycholeptic prescription at hospital discharge. Results At hospital discharge, 193 patients (5.8%) out of a total sample of 3322 patients were prescribed at least 1 psycholeptic drug. Cognitive impairment was the main risk factor for the introduction of psycholeptic drugs at discharge. Among them, 89.1% were still on therapy with a psycholeptic drug after 3 months from the hospital discharge. Conclusions and Implications Cognitive impairment represents the main risk factor for psycholeptic initiation in hospitalized older patients. The vast majority of these treatments are chronically continued after the discharge. Therefore, special attention is needed in prescribing psycholeptics at discharge, because their prolonged use may lead to cognitive decline. Moreover, their continued use should be questioned by physicians providing post-acute care, and deprescribing should be considered.

Published
2021

113. Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients

Author

Carlotta, Franchi, Giulia, Lancellotti, Marco, Bertolotti, Simona Di Salvatore, Alessandro, Nobili, Pier Mannuccio Mannucci, Chiara, Mussi, Ilaria, Ardoino, Domenico, Prisco, Elena, Silvestri, Giacomo, Emmi, Alessandra, Bettiol, Irene, Mattioli, Gianni, Biolo, Michela, Zanetti, Giacomo, Bartelloni, Massimo, Vanoli, Giulia, Grignani, Edoardo Alessandro Pulixi, Graziana, Lupattelli, Vanessa, Bianconi, Riccardo, Alcidi, Domenico, Girelli, Fabiana, Busti, Giacomo, Marchi, Mario, Barbagallo, Ligia, Dominguez, Vincenza, Beneduce, Federica, Cacioppo, Salvatore, Corrao, Giuseppe, Natoli, Salvatore, Mularo, Massimo, Raspanti, Marco, Zoli, Maria Laura Matacena, Giuseppe, Orio, Eleonora, Magnolfi, Giovanni, Serafini, Angelo, Simili, Giuseppe, Palasciano, Maria Ester Model, Carla Di Gennaro, Maria Domenica Cappellini, Giovanna, Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia, Scaramellini, Matteo, Cesari, Paolo Dionigi Rossi, Sarah, Damanti, Marta, Clerici, Simona, Leoni, Alessandra Danuta Di Mauro, Antonio Di Sabatino, Emanuela, Miceli, Marco Vincenzo Lenti, Martina, Pisati, Costanza Caccia Dominioni, Roberto, Pontremoli, Valentina, Beccati, Giulia, Nobili, Giovanna, Leoncini, Luigi, Anastasio, Maria, Carbone, Francesco, Cipollone, Maria Teresa Guagnano, Ilaria, Rossi, Gerardo, Mancuso, Daniela, Calipari, Mosè, Bartone, Giuseppe, Delitala, Maria, Berria, Alessandro, Delitala, Maurizio, Muscaritoli, Alessio, Molfino, Enrico, Petrillo, Antonella, Giorgi, Christian, Gracin, Giuseppe, Zuccalà, Gabriella, D’Aurizio, Giuseppe, Romanelli, Alessandra, Marengoni, Andrea, Volpini, Daniela, Lucente, Antonio, Picardi, Umberto Vespasiani Gentilucci, Paolo, Gallo, Giuseppe, Bellelli, Maurizio, Corsi, Cesare, Antonucci, Chiara, Sidoli, Giulia, Principato, Franco, Arturi, Elena, Succurro, Bruno, Tassone, Federica, Giofrè, Maria Grazia Serra, Maria Antonietta Bleve, Antonio Brucato Teresa De Falco, Fabrizio, Fabris, Irene, Bertozzi, Giulia, Bogoni, Maria Victoria Rabuini, Tancredi, Prandini, Manfredini, Roberto, Fabbian, Fabio, Benedetta, Boari, DE GIORGI, Alfredo, Ruana, Tiseo, Giuseppe, Paolisso, Maria Rosaria Rizzo, Claudia, Catalano, Claudio, Borghi, Enrico, Strocchi, Eugenia, Ianniello, Mario, Soldati, Silvia, Schiavone, Alessio, Bragagni, Carlo, Sabbà, Francesco Saverio Vella, Patrizia, Suppressa, Giovanni Michele De Vincenzo, Alessio, Comitangelo, Emanuele, Amoruso, Carlo, Custodero, Luigi, Fenoglio, Andrea, Falcetta, Fracanzani, Anna L., Silvia, Tiraboschi, Annalisa, Cespiati, Giovanna, Oberti, Giordano, Sigon, Flora, Peyvandi, Raffaella, Rossio, Giulia, Colombo, Pasquale, Agosti, Valter, Monzani, Valeria, Savojardo, Giuliana, Ceriani, Francesco, Salerno, Giada, Pallini, Fabrizio, Montecucco, Luciano, Ottonello, Lara, Caserza, Giulia, Vischi, Nicola Lucio Liberato, Tiziana, Tognin, Francesco, Purrello, Antonino Di Pino, Salvatore, Piro, Renzo, Rozzini, Lina, Falanga, Maria Stella Pisciotta, Francesco Baffa Bellucci, Stefano, Buffelli, Giuseppe, Montrucchio, Paolo, Peasso, Edoardo, Favale, Cesare, Poletto, Carl, Margaria, Maura, Sanino, Francesco, Violi, Ludovica, Perri, Luigina, Guasti, Luana, Castiglioni, Andrea, Maresca, Alessandro, Squizzato, Leonardo, Campiotti, Alessandra, Grossi, Roberto Davide Diprizio, Maria Vittoria Libbra, Matteo, Galassi, Yasmine, Grassi, Alessio, Greco, Angela, Sciacqua, Maria, Perticone, Rosa, Battaglia, Raffaele, Maio, Vincenzo, Stanghellini, Eugenio, Ruggeri, Sara del Vecchio, Andrea, Salvi, Roberto, Leonardi, Giampaolo, Damiani, William, Capeci, Massimo, Mattioli, Giuseppe Pio Martino, Lorenzo, Biondi, Pietro, Pettinari, Riccardo, Ghio, Anna Dal Col, Salvatore, Minisola, Luciano, Colangelo, Mirella, Cilli, Giancarlo, Labbadia, Antonella, Afeltra, Benedetta, Marigliano, Maria Elena Pipita, Pietro, Castellino, Luca, Zanoli, Alfio, Gennaro, Agostino, Gaudio, Valter, Saracco, Marisa, Fogliati, Carlo, Bussolino, Francesca, Mete, Miriam, Gino, Carlo, Vigorito, Antonio, Cittadini, Guido, Moreo, Silvia, Prolo, Gloria, Pina, Alberto, Ballestrero, Fabio, Ferrando, Roberta, Gonella, Domenico, Cerminara, Sergio, Berra, Simonetta, Dassi, Maria Cristina Nava, Bruno, Graziella, Stefano, Baldassarre, Salvatore, Fragapani, Gabriella, Gruden, Giorgio, Galanti, Gabriele, Mascherini, Cristian, Petri, Laura, Stefani, Margherita, Girino, Valeria, Piccinelli, Francesco, Nasso, Vincenza, Gioffrè, Maria, Pasquale, Leonardo, Sechi, Cristiana, Catena, Gianluca, Colussi, Alessandro, Cavarape, Andea Da Porto, Nicola, Passariello, Luca, Rinaldi, Franco, Berti, Giuseppe, Famularo, Patrizia, Tarsitani, Roberto, Castello, Michela, Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta, Morganti, Andrea, Artoni, Margherita, Grossi, Stefano Del Giacco, Davide, Firinu, Giulia, Costanzo, Giacomo, Argiolas, Giuseppe, Montalto, Anna, Licata, Filippo Alessandro Montalto, Francesco, Corica, Giorgio, Basile, Antonino, Catalano, Federica, Bellone, Concetto, Principato, Lorenzo, Malatino, Benedetta, Stancanelli, Valentina, Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella, Caruso, Patrizia, Mecocci, Carmelinda, Ruggiero, Virginia, Boccardi, Tiziana, Meschi, Andrea, Ticinesi, Antonio, Nouvenne, Pietro, Minuz, Luigi, Fondrieschi, Giandomenico Nigro Imperiale, Mario, Pirisi, Gian Paolo Fra, Daniele, Sola, Mattia, Bellan, Massimo, Porta, Piero, Riva, Roberto, Quadri, Erica, Larovere, Marco, Novelli, Giorgio, Scanzi, Caterina, Mengoli, Stella, Provini, Laura, Ricevuti, Emilio, Simeone, Rosa, Scurti, Fabio, Tolloso, Roberto, Tarquini, Alice, Valoriani, Silvia, Dolenti, Giulia, Vannini, Riccardo, Volpi, Pietro, Bocchi, Alessandro, Vignali, Sergio, Harari, Chiara, Lonati, Federico, Napoli, Italia, Aiello, Raffaele, Landolfi, Massimo, Montalto, Antonio, Mirijello, Silvia, Ghidoni, Teresa, Salvatore, Lucio, Monaco, Carmen, Ricozzi, Alberto, Pilotto, Ilaria, Indiano, and Federica, Gandolfo.

Subjects
Male, multimorbidity, Health state profile, Frail Elderly, Health Status, Socio-culturale, Comorbidity, statins, Cognition, 80 and over, Prevalence, Humans, LS4_4, polypharmacy, Aged, Hypolipidemic Agents, Retrospective Studies, Original Research, Aged, 80 and over, Frailty, Statins, RC952-954.6, Multimorbidity, health state profile, Lipids, health state profile, multimorbidity, polypharmacy, statins, Hospitalization, Logistic Models, Italy, Socioeconomic Factors, Polypharmacy, Guideline Adherence, Practice Guidelines as Topic, Geriatrics, Clinical Interventions in Aging
Abstract

Carlotta Franchi,1 Giulia Lancellotti,2 Marco Bertolotti,2 Simona Di Salvatore,2 Alessandro Nobili,1 Pier Mannuccio Mannucci,3 Chiara Mussi,2,* Ilaria Ardoino1,* On Behalf of the REPOSI (REgistro POliterapie SIMI and Società Italiana di Medicina Interna) Study Group1Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy; 2Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy; 3Scientific Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy*These authors contributed equally to this workCorrespondence: Carlotta FranchiUnit of Pharmacoepidemiological Research in Older People, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milano, 20156, ItalyTel +39 02 39014580Fax +39 02 39001916Email carlotta.franchi@marionegri.itObjective: To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles.Design: This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI – Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards.Setting and Participants: A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018.Methods: Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients’ health state profiles and with short-term mortality.Results: Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76– 5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44– 0.80).Conclusion: The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients’ health state profiles.Keywords: statins, health state profile, multimorbidity, polypharmacy

Published
2021

121. From distress screening to uptake: An italian multicenter study of cancer patients

Author

Elisa Tiberto, Lidia Pisotti, Luigi Zerbinati, Sabrina Prati, Marina Bragagni, Flavia Foca, Silvia De Padova, Ugo De Giorgi, Luigi Grassi, Tatiana Bertelli, Ilaria Massa, Elena Meggiolaro, Federica Ruffilli, and Stefano Tamberi

Subjects
Cancer Research, medicine.medical_specialty, distress screening, cancer patients, psychosocial uptake, referral, screening policy, Referral, Distress screening, media_common.quotation_subject, Psychological intervention, Socio-culturale, Article, Psychosocial uptake, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, RC254-282, media_common, business.industry, Screening policy, Cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Cancer patients, medicine.disease, Distress, Oncology, Telephone interview, Multicenter study, Feeling, 030220 oncology & carcinogenesis, Family medicine, business
Abstract

Simple Summary An evaluation process and adequate referrals are an important part of a distress screening program but insufficient consideration is given to referrals and uptake of available supportive services. Identifying the reasons for accepting or refusing help is needed to implement a screening-for-distress policy in a clinical cancer setting, as confirmed in the present study. It is vital to reach and motivate the highest possible number of patients to be referred to psycho-oncology services when needed. A multidisciplinary approach could help to raise awareness of the benefit of screening for distress, the implementation of which would improve uptake. Abstract Introduction: Little consideration is given to the referral and uptake of available supportive services after distress screening. However, identifying the reasons for accepting or refusing help is mandatory for implementing a screening policy. The present study explored the practical usefulness of and potential barriers to the application of distress management. Methods: 406 cancer patients were consecutively selected and asked to complete the Distress Thermometer (DT) and Problem Check List (PL). All patients with a DT score ≥6 were invited for a post-DT telephone interview with a trained psychologist. Results: The 112 patients who refused to take part were more often older, retired, at a more advanced stage of illness, and with no previous experience of psychological intervention with respect to those who accepted. Of the 78 patients with a score ≥6 who were referred to the Psycho-Oncology Service, 65.4% accepted the telephone interview. Twenty-two patients rejected the initial invitation immediately for various reasons including logistic difficulties, physical problems, and feeling embarrassed about opening up to a psychologist. Conclusions: Our study confirms that screening per sé is insufficient to deal with the problem of distress and that more emphasis should be placed on implementing referral and treatment.

Published
2021

124. Design and Characterization of the Interlayer Joint between Low-Field Nb3Sn Conductors of a Layer Wound DEMO TF Coil

Author

Simonetta Turtu, Kamil Sedlak, Riccardo Righetti, Chiarasole Fiamozzi Zignani, A. Anemona, Luigi Muzzi, R. Freda, Antonio della Corte, A. Bragagni, Andrea Formichetti, Mithlesh Kumar, G. Molino, Boris Stepanov, Lucio Merli, Gianluca De Marzi, Massimo Seri, Mohammed Arabi, Pierluigi Bruzzone, Marco Roveta, L. Affinito, G. Roveta, Stefano Galignano, Valentina Corato, Aldo Di Zenobio, S. Chiarelli, Muzzi, Luigi, Affinito, Luigi, Chiarelli, Sandro, Corato, Valentina, Della Corte, Antonio, De Marzi, Gianluca, Di Zenobio, Aldo, Fiamozzi Zignani, Chiarasole, Freda, Rosa, Turtu, Simonetta, Anemona, Alessandro, and Formichetti, Andrea

Subjects
Superconductivity, Materials science, Mechanical engineering, Fusion Magnets, AC loss, Superconducting magnet, Condensed Matter Physics, 7. Clean energy, 01 natural sciences, Electronic, Optical and Magnetic Materials, Conductor, Conceptual design, Electromagnetic coil, Magnet, Cable-in-Conduit-Conductor, 0103 physical sciences, Electrical and Electronic Engineering, 010306 general physics, Electrical conductor, Joint (geology), DEMO, Joint Resistance
Abstract

In the frame of the conceptual design studies for the Toroidal Field (TF) coils of DEMO, a solution based on a layer-wound magnet, rectangular-shaped Cable-in-Conduit conductors and W&R manufacturing approach, is being developed. The feasibility and performance of a large-size Nb3Sn conductor operating at about 82 kA in a 13 T field has been proven in the past. Another key technology to be demonstrated for a layer-wound TF coil, is that of a joint between two different conductor grades, to be possibly manufactured in-line during winding. The proposed joint solution would provide the minimum room occupancy, with the joint embedded within the winding pack volume. A joint between two low-field conductor grades, i.e., constituted of a small number of superconducting strands and a high number of stabilization copper wires, has been designed and manufactured. The two conductor lengths are characterized by a different number of superconducting wires and different outer dimensions. A joint sample has been assembled and instrumented, in the configuration allowing testing at the SULTAN facility of the Swiss Plasma Center. Both DC and AC performance of the joint has been characterized at the DEMO TF operating conditions. The present paper reports the main manufacturing steps for the joint and its main test results. The implications on the performance and design approach of the TF coil are also discussed, based on the outcome of such tests.

Published
2021

126. Comparison between drug therapy-based comorbidity indices and the Charlson Comorbidity Index for the detection of severe multimorbidity in older subjects

Author

Alessio, Novella, Chiara, Elli, Mauro, Tettamanti, Alessandro, Nobili, Aladar, Ianes, Pier Mannuccio Mannucci, Luca, Pasina, Domenico, Prisco, Elena, Silvestri, Giacomo, Emmi, Alessandra, Bettiol, Irene, Mattioli, Gianni, Biolo, Michela, Zanetti, Giacomo, Bartelloni, Massimo, Vanoli, Giulia, Grignani, Edoardo Alessandro Pulixi, Graziana, Lupattelli, Vanessa, Bianconi, Riccardo, Alcidi, Domenico, Girelli, Fabiana, Busti, Giacomo, Marchi, Mario, Barbagallo, Ligia, Dominguez, Vincenza, Beneduce, Federica, Cacioppo, Salvatore, Corrao, Giuseppe, Natoli, Salvatore, Mularo, Massimo, Raspanti, Marco, Zoli, Maria Laura Matacena, Giuseppe, Orio, Eleonora, Magnolfi, Giovanni, Serafini, Angelo, Simili, Giuseppe, Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Giovanna, Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia, Scaramellini, Matteo, Cesari, Paolo Dionigi Rossi, Sarah, Damanti, Marta, Clerici, Simona, Leoni, Alessandra Danuta Di Mauro, Antonio Di Sabatino, Emanuela, Miceli, Marco Vincenzo Lenti, Martina, Pisati, Costanza Caccia Dominioni, Roberto, Pontremoli, Valentina, Beccati, Giulia, Nobili, Giovanna, Leoncini, Luigi, Anastasio, Maria, Carbone, Francesco, Cipollone, Maria Teresa Guagnano, Ilaria, Rossi, Gerardo, Mancuso, Daniela, Calipari, Mosè, Bartone, Giuseppe, Delitala, Maria, Berria, Alessandro, Delitala, Maurizio, Muscaritoli, Alessio, Molfino, Enrico, Petrillo, Antonella, Giorgi, Christian, Gracian, Giuseppe, Zuccalà, Gabriella, D’Aurizio, Giuseppe, Romanelli, Alessandra, Marengoni, Andrea, Volpini, Daniela, Lucente, Antonio, Picardi, Umberto Vespasiani Gentilucci, Paolo, Gallo, Giuseppe, Bellelli, Maurizio, Corsi, Cesare, Antonucci, Chiara, Sidoli, Giulia, Principato, Franco, Arturi, Elena, Succurro, Bruno, Tassone, Federica, Giofrè, Maria Grazia Serra, Maria Antonietta Bleve, Antonio, Brucato, Teresa De Falco, Fabrizio, Fabris, Irene, Bertozzi, Giulia, Bogoni, Maria Victoria Rabuini, Tancredi, Prandini, Manfredini, Roberto, Fabbian, Fabio, Benedetta, Boari, DE GIORGI, Alfredo, Ruana, Tiseo, Giuseppe, Paolisso, Maria Rosaria Rizzo, Claudia, Catalano, Claudio, Borghi, Enrico, Strocchi, Eugenia, Ianniello, Mario, Soldati, Silvia, Schiavone, Alessio, Bragagni, Carlo, Sabbà, Francesco Saverio Vella, Patrizia, Suppressa, Giovanni Michele De Vincenzo, Alessio, Comitangelo, Emanuele, Amoruso, Carlo, Custodero, Luigi, Fenoglio, Andrea, Falcetta, Fracanzani, Anna L., Silvia, Tiraboschi, Annalisa, Cespiati, Giovanna, Oberti, Giordano, Sigon, Flora, Peyvandi, Raffaella, Rossio, Giulia, Colombo, Pasquale, Agosti, Valter, Monzani, Valeria, Savojardo, Giuliana, Ceriani, Francesco, Salerno, Giada, Pallini, Fabrizio, Montecucco, Luciano, Ottonello, Lara, Caserza, Giulia, Vischi, Nicola Lucio Liberato, Tiziana, Tognin, Francesco, Purrello, Antonino Di Pino, Salvatore, Piro, Renzo, Rozzini, Lina, Falanga, Maria Stella Pisciotta, Francesco Baffa Bellucci, Stefano, Buffelli, Giuseppe, Montrucchio, Paolo, Peasso, Edoardo, Favale, Cesare, Poletto, Carl, Margaria, Maura, Sanino, Francesco, Violi, Ludovica, Perri, Luigina, Guasti, Luana, Castiglioni, Andrea, Maresca, Alessandro, Squizzato, Leonardo, Campiotti, Alessandra, Grossi, Roberto Davide Diprizio, Marco, Bertolotti, Chiara, Mussi, Giulia, Lancellotti, Maria Vittoria Libbra, Matteo, Galassi, Yasmine, Grassi, Alessio, Greco, Angela, Sciacqua, Maria, Perticone, Rosa, Battaglia, Raffaele, Maio, Vincenzo, Stanghellini, Eugenio, Ruggeri, Sara del Vecchio, Andrea, Salvi, Roberto, Leonardi, Giampaolo, Damiani, William, Capeci, Massimo, Mattioli, Giuseppe Pio Martino, Lorenzo, Biondi, Pietro, Pettinari, Riccardo, Ghio, Anna Dal Col, Salvatore, Minisola, Luciano, Colangelo, Mirella, Cilli, Giancarlo, Labbadia, Antonella, Afeltra, Benedetta, Marigliano, Maria Elena Pipita, Pietro, Castellino, Luca, Zanoli, Alfio, Gennaro, Agostino, Gaudio, Valter, Saracco, Marisa, Fogliati, Carlo, Bussolino, Francesca, Mete, Miriam, Gino, Carlo, Vigorito, Antonio, Cittadini, Guido, Moreo, Silvia, Prolo, Gloria, Pina, Alberto, Ballestrero, Fabio, Ferrando, Roberta, Gonella, Domenico, Cerminara, Sergio, Berra, Simonetta, Dassi, Maria Cristina Nava, Bruno, Graziella, Stefano, Baldassarre, Salvatore, Fragapani, Gabriella, Gruden, Giorgio, Galanti, Gabriele, Mascherini, Cristian, Petri, Laura, Stefani, Margherita, Girino, Valeria, Piccinelli, Francesco, Nasso, Vincenza, Gioffrè, Maria, Pasquale, Leonardo, Sechi, Cristiana, Catena, Gianluca, Colussi, Alessandro, Cavarape, Andea Da Porto, Nicola, Passariello, Luca, Rinaldi, Franco, Berti, Giuseppe, Famularo, Patrizia, Tarsitani, Roberto, Castello, Michela, Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta, Morganti, Andrea, Artoni, Margherita, Grossi, Stefano Del Giacco, Davide, Firinu, Giulia, Costanzo, Giacomo, Argiolas, Giuseppe, Montalto, Anna, Licata, Filippo Alessandro Montalto, Francesco, Corica, Giorgio, Basile, Antonino, Catalano, Federica, Bellone, Concetto, Principato, Lorenzo, Malatino, Benedetta, Stancanelli, Valentina, Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella, Caruso, Patrizia, Mecocci, Carmelinda, Ruggiero, Virginia, Boccardi, Tiziana, Meschi, Andrea, Ticinesi, Antonio, Nouvenne, Pietro, Minuz, Luigi, Fondrieschi, Giandomenico Nigro Imperiale, Mario, Pirisi, Gian Paolo Fra, Daniele, Sola, Mattia, Bellan, Massimo, Porta, Piero, Riva, Roberto, Quadri, Erica, Larovere, Marco, Novelli, Giorgio, Scanzi, Caterina, Mengoli, Stella, Provini, Laura, Ricevuti, Emilio, Simeone, Rosa, Scurti, Fabio, Tolloso, Roberto, Tarquini, Alice, Valoriani, Silvia, Dolenti, Giulia, Vannini, Riccardo, Volpi, Pietro, Bocchi, Alessandro, Vignali, Sergio, Harari, Chiara, Lonati, Federico, Napoli, Italia, Aiello, Raffaele, Landolfi, Massimo, Montalto, Antonio, Mirijello, Silvia, Ghidoni, Teresa, Salvatore, Lucio, Monaco, Carmen, Ricozzi, Alberto, Pilotto, Ilaria, Indiano, Federica, Gandolfo., Novella, A, Elli, C, Tettamanti, M, Nobili, A, Ianes, A, Mannucci, P, Pasina, L, and Bellelli, G

Subjects
Aging, medicine.medical_specialty, Comorbidity indices, Socio-culturale, Comorbidity, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Internal medicine, Medicine, Humans, LS4_4, 030212 general & internal medicine, Medical prescription, Medical diagnosis, Older adult, Operating characteristic, Disease burden, Aged, Receiver operating characteristic, business.industry, Chronic diseae, Area under the curve, Multimorbidity, medicine.disease, Comorbidity indice, Hospitalization, Italy, Multimorbidiy, Older adults, Chronic Disease, Chronic disease, Comorbidity indices, Multimorbidiy, Older adults, Operating characteristic, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
Abstract

Background: To know burden disease of a patient is a key point for clinical practice and research, especially in the elderly. Charlson’s Comorbidity Index (CCI) is the most widely used rating system, but when diagnoses are not available therapy-based comorbidity indices (TBCI) are an alternative. However, their performance is debated. This study compares the relations between Drug Derived Complexity Index (DDCI), Medicines Comorbidity Index (MCI), Chronic Disease Score (CDS), and severe multimorbidity, according to the CCI classification, in the elderly. Methods: Logistic regression and Receiver Operating Characteristic (ROC) analysis were conducted on two samples from Italy: 2579 nursing home residents (Korian sample) and 7505 older adults admitted acutely to geriatric or internal medicine wards (REPOSI sample). Results: The proportion of subjects with severe comorbidity rose with TBCI score increment, but the Area Under the Curve (AUC) for the CDS (Korian: 0.70, REPOSI: 0.79) and MCI (Korian: 0.69, REPOSI: 0.81) were definitely better than the DDCI (Korian: 0.66, REPOSI: 0.74). All TBCIs showed low Positive Predictive Values (maximum: 0.066 in REPOSI and 0.317 in Korian) for the detection of severe multimorbidity. Conclusion: CDS and MCI were better predictors of severe multimorbidity in older adults than DDCI, according to the CCI classification. A high CCI score was related to a high TBCI. However, the opposite is not necessarily true probably because of non-evidence-based prescriptions or physicians’ prescribing attitudes. TBCIs did not appear selective for detecting of severe multimorbidity, though they could be used as a measure of disease burden, in the absence of other solutions.

Published
2021

130. Conductor manufacturing of the ITER TF full-size performance samples

Author

Di Zenobio, A., della Corte, A., Muzzi, L., Turtu, S., Bragagni, A., Tanguenza, A., Valori, D., Baldini, A., Bessette, D., Devred, A., and Vostner, A.

Subjects
Electrical conduits -- Usage, Niobium -- Magnetic properties, Niobium -- Electric properties, Nuclear reactors -- Design and construction, Technical institutes -- Management, Tin alloys -- Magnetic properties, Tin alloys -- Electric properties, Company business management, Business, Electronics, Electronics and electrical industries, International Thermonuclear Experimental Reactor -- Management
Published
2010

131. Not all that trembles…: a rare case of extrapyramidal impairment

Author

Alessio Bragagni, Claudio Borghi, Matteo Landolfo, and Landolfo M, Bragagni A, Borghi C.

Subjects
Aged, 80 and over, Diagnostic Imaging, Liver Cirrhosis, Male, Pediatrics, medicine.medical_specialty, business.industry, LC, MEDLINE, Diagnosis, Differential, Basal Ganglia Diseases, Rare case, Emergency Medicine, Internal Medicine, porto-systemic shunting computed tomography, Medicine, Humans, business, Neurological impairment
Abstract

An hypertensive and hypercholesterolemic 80-year-old man, with a previous history of peptic ulcer and non-melanoma skin cancer, currently in stable class B Child–Pugh liver cirrhosis (LC) secondary to chronic hepatitis B virus (HBV) infection, was admitted to our emergency department (ED) because of progressive dysarthria and disequilibrium. At admission in the ED, emodynamic was stable (arterial pressure was 110/96 mmHg and heart rate 63 bpm), he was non febrile and alert. The neurological examination was consistent with only mild dysarthria with no lateral deficits and no flapping tremor. Pharmacological history included prazole, carvedilol, atorvastatin, potassium canrenoate, furosemide, lactulose, and entecavir. The recent anamnesis was positive for a hospitalization due to acute hepatic encephalopathy (HE) successfully managed with cathartics, but negative for gastrointestinal bleeding or alteration of the alvus, despite a still high ammonium concentration (156 umol/L). Other laboratory findings were related to mild hepatic failure and portal hypertension (INR 1.72, PLT 66,000/mmc, total bilirubin 1.78 mg/dL, and albumin 2.2 g/dL), in absence of serum electrolyte disorders and any signs of inflammation (WBC 4000/mmc, RCP 0.22 mg/dL). Resting standard 12-lead electrocardiogram (EKG) showed sinus rhythm. First head computed tomography (CT) scan without contrast excluded acute ischemic hypodense lesions, acute or chronic haemorrhagic foci and signs of intracranial hypertension. A definitive diagnosis for the acute neurologic impairment could not be reached, so the patient was admitted to our Internal Medicine department for further investigations

Published
2019

132. Mitigating strategies and nursing response for cancer care management during the COVID-19 pandemic: an Italian experience

Author

S. Prati, M. Bragagni, M. Golinucci, S. Montalti, Mattia Altini, Nicola Gentili, M. Rustignoli, and A. Zeneli

Subjects
Population, Context (language use), Nursing Staff, Hospital, Nurse's Role, Social Distancing, 03 medical and health sciences, Experience From the Field, 0302 clinical medicine, Nursing, COVID‐19 Pandemic, Neoplasms, Occupational Exposure, Pandemic, Health care, Nursing Triage, Humans, Nursing Policy, 030212 general & internal medicine, education, Personal protective equipment, Burnout, Professional, General Nursing, education.field_of_study, 030504 nursing, Cancer Patients, business.industry, Health Policy, COVID-19, Nursing Response, Italy, Action plan, Duty of care, Mitigating Strategies, Business, 0305 other medical science, Risk assessment
Abstract

Aim To describe our response to the COVID-19 emergency in a cancer centre to enable other nursing organizations to determine which elements could be useful to manage a surge of patients in their own setting. Background The COVID-19 pandemic represents one of the most challenging healthcare scenarios faced to date. Managing cancer care in such a complex situation requires a coordinated emergency action plan to guarantee the continuity of cancer treatments for patients by providing healthcare procedures for patients, caregivers and healthcare professionals in a safe environment. Procedures We describe the main strategies and role of nurses in implementating such procedures. Results Nurses at our hospital were actively involved in COVID-19 response defined by the emergency action plan that positively contributed to correct social distancing and to the prevention of the spread of the virus. Implications for nursing and health policies Lessons learned from the response to phase I of COVID-19 have several implications for future nursing and health policies in which nurses play an active role through their involvement in the frontline of such events. Key policies include a coordinated emergency action plan permitting duty of care within the context of a pandemic, and care pathway revision. This requires the rapid implementation of strategies and policies for a nursing response to the new care scenarios: personnel redistribution, nursing workflow revision, acquisition of new skills and knowledge, effective communication strategies, infection control policies, risk assessment and surveillance programmes, and continuous supplying of personal protective equipment. Finally, within a pandemic context, clear nursing policies reinforcing the role of nurses as patient and caregiver educators are needed to promote infection prevention behaviour in the general population.

Published
2020

140. Sepsis and meningoencephalitis due to Listeria monocytogenes in patients with liver cirrhosis: a case of nonhepatic encephalopathy?

Author

Federico Lari, Roberta Bortolotti, Mariaelena Vacchetti, Gianpaolo Bragagni, and Marco Lenzi

Subjects
Liver cirrhosis, Encephalopathy, Bacterial infections, Medicine
Abstract

Introduction The appearance of neurological disorders in a patient with liver cirrhosis initially suggests hepatic encephalopathy, but other causes should be considered, including bacterial infections.Materials and methods An 80-year-old woman suffering from HCV-related cirrhosis was admitted for fever, confusion, and stupor. No improvement was seen after treatment with cephalosporins, lactulose, and fluids.Results Listeria monocytogenes was isolated from blood cultures and subsequently from a cerebrospinal fluid specimen as well. On the basis of the antibiogram, the antibiotic therapy was modified to include ampicillin, but shock and multiorgan failure developed and the patient died one week later.Discussion Bacterial infections are more common and more aggressive in patients with liver cirrhosis, probably because of the immune dysfunction associated with this disorder. The presence of neurological disorders in a patient with liver cirrhosis may be a sign of hepatic encephalopathy, but it is important to recall that there are other potential causes as well, including bacterial infections. In this case, it is possible that the patient's symptoms were the result of the CNS infection with L. monocytogenes, which was particularly aggressive as a result of her cirrhosis.

Published
2012
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141. Development and Characterization of Niosomal Formulations of Doxorubicin Aimed at Brain Targeting

Author

Marco Bragagni, Natascia Mennini, Carla Ghelardini, and Paola Mura

Subjects
Therapeutics. Pharmacology, RM1-950, Pharmacy and materia medica, RS1-441
Abstract

ABSTRACT - Purpose. The aim of the present work was the development and characterization of a niosomal formulation functionalized with the glucose-derivative N-palmitoylglucosamine (NPG) to obtain a potential brain targeted delivery system for the anticancer agent doxorubicin. Methods. Five different methods have been examined for vesicle preparation. Light scattering and transmission electron microscopy were used for vesicle characterization, in terms of mean size, homogeneity and Zeta potential, and selection of the best composition and preparation conditions for developing NPG-functionalized niosomes. Drug entrapment efficiency was determined after separation of loaded from unloaded drug by size exclusion chromatography or dialysis. Preliminary in vivo studies were performed on rats, injected i.v. with 12 mg/kg of doxorubicin as commercial solution (Ebewe, 2mg/mL) or NPG-niosomal formulation. Drug amounts in the blood and in the major organs of the animals, sacrificed 60 min post injection, were determined by HPLC. Results. The selected formulation consisted in Span:cholesterol:Solulan:NPG (50:40:10:10 mol ratio) vesicles obtained by thin-layer evaporation, leading to homogeneous vesicles of less than 200 nm diameter. This formulation was used for preparation of NPG-niosomes loaded with doxorubicin (mean size 161±4 nm, encapsulation efficacy 57.8±1.8%). No significant changes (P>0.05) in vesicle dimensions, Zeta potential or entrapment efficiency were observed after six months storage at room temperature, indicative of good stability. I.v. administration to rats of the NPG-niosomal formulation allowed for reducing drug accumulation in the heart and keeping it longer in the blood circulation with respect to the commercial formulation. Moreover, a doxorubicin brain concentration of 2.9±0.4 µg/g was achieved after 60 min, while the commercial solution yielded undetectable drug brain concentrations (

Published
2012
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142. Tracing Highly Siderophile Elements through Subduction: Insights from High-pressure Serpentinites and 'Hybrid' Rocks from Alpine Corsica

Author

Crossley, Rosalind J., Evans, Katy A., Evans, Noreen J., Bragagni, Alessandro, McDonald, Brad J., Reddy, Steven M., Speelmanns, Iris M., Crossley, Rosalind J., Evans, Katy A., Evans, Noreen J., Bragagni, Alessandro, McDonald, Brad J., Reddy, Steven M., and Speelmanns, Iris M.

Abstract

The highly siderophile elements (HSE) include the economically critical platinum group elements (PGE; Os, Ir, Ru, Rh, Pt, Pd, Au and Re), gold and rhenium. The HSE are redox sensitive in mantle and seafloor environments and have a strong affinity to iron and sulphur, therefore their distribution within the subducted mantle lithosphere record changes to oxidation state and sulphidation. The mobility of the HSE during subduction has important implications for Re-Os isotopic signatures in the mantle, and the formation of Cu-Au arc-related ore deposits. In this study, subducted rock samples from Alpine Corsica are used to track the HSE in serpentinites and hybrid ultramafic-mafic rocks through the subduction cycle. A comparison of bulk-rock HSE concentrations with those in pre-subduction analogues provides insights into the transfer of the HSE throughout the subduction cycle. Serpentinites subducted to blueschist-eclogite-facies conditions have similar HSE concentrations to primitive upper mantle (PUM) concentrations, therefore it is concluded that the HSE are not mobilized from serpentinites on the scale of the whole-rock or greater. Therefore, as suggested in previous studies, crustal lithologies may be more important contributors of the HSE to the sub-arc mantle, particularly Pt, Pd and Re. In contrast, HSE concentrations in hybrid rocks (talc schist and chlorite schist) deviate from protolith concentrations. Rhenium is higher in the talc schist, and Ir and Ru are lower in the chlorite schist than in the PUM, or possible mafic protoliths. Mineral parageneses place temporal constraints on the growth of hosts to the HSE (sulphides, oxides and metal alloys), and record changes to the activities of oxygen and sulphur (aO(2)-aS(2)), and hence redox conditions, from pre-subduction to exhumation. Laser ablation inductively coupled plasma mass spectrometry was used to determine the HSE concentrations in sulphides and oxides, and the detection of small (similar to 2-25 mu m(2

Published
2020

143. Determination of Cu, Zn, Ga, Ag, Cd, In, Sn and Tl in Geological Reference Materials and Chondrites by Isotope Dilution ICP-MS

Author

Braukmueller, Ninja, Wombacher, Frank, Bragagni, Alessandro, Muenker, Carsten, Braukmueller, Ninja, Wombacher, Frank, Bragagni, Alessandro, and Muenker, Carsten

Abstract

Mass fractions of Cu, Zn, Ga, Ag, Cd, In, Sn and Tl were determined via isotope dilution quadrupole ICP-MS in twenty-one geological reference materials (RMs) and the carbonaceous chondrites Orgueil (CI1), Murchison (CM2) and Allende (CV3). The RMs comprise basaltic/mafic (BCR-2, BE-N, BHVO-1, BHVO-2, BIR-1, BRP-1, JB-2, OKUM, W-2, WS-E), intermediate/felsic (AGV-2, G-2, JA-2, RGM-1), ultramafic (DTS-2b, MUH-1, PCC-1, UB-N) and sedimentary (MAG-1, OU-6) rocks. Pressure digestion was applied for nonbasaltic samples to ensure effective sample digestion. For basaltic RMs, hot plate digestion was found to be sufficient for a quantitative recovery of the target elements. To minimise interferences and increase ion beam intensities during isotope ratio analyses by ICP-MS, separation of the target elements was carried out from single sample aliquots using a novel anion exchange procedure. The intermediate precision (2s) estimated from two to four replicate analyses was usually < 4% and results are in agreement with literature data, where available. Especially for Ag and Tl, the intermediate precision was compromised, likely due to low ion beam intensities and, hence, higher background and blank contributions. For ultramafic RMs, nugget effects and incomplete digestion might compromise the intermediate precision. Results for the carbonaceous chondrites Orgueil (CI1), Murchison (CM2) and Allende (CV3) agree well with previously reported data.

Published
2020

144. Tracing highly siderophile elements through subduction: Insights from high-pressure serpentinites and 'hybrid' rocks from alpine corsica

Author

Crossley, R.J., Evans, Katy, Evans, Noreen, Bragagni, A., McDonald, B.J., Reddy, Steven, Speelmanns, I.M., Crossley, R.J., Evans, Katy, Evans, Noreen, Bragagni, A., McDonald, B.J., Reddy, Steven, and Speelmanns, I.M.

Abstract

The highly siderophile elements (HSE) include the economically critical platinum group elements (PGE; Os, Ir, Ru, Rh, Pt, Pd, Au and Re), gold and rhenium. The HSE are redox sensitive in mantle and seafloor environments and have a strong affinity to iron and sulphur, therefore their distribution within the subducted mantle lithosphere record changes to oxidation state and sulphidation. The mobility of the HSE during subduction has important implications for Re-Os isotopic signatures in the mantle, and the formation of Cu-Au arc-related ore deposits. In this study, subducted rock samples from Alpine Corsica are used to track the HSE in serpentinites and hybrid ultramafic-mafic rocks through the subduction cycle. A comparison of bulk-rock HSE concentrations with those in pre-subduction analogues provides insights into the transfer of the HSE throughout the subduction cycle. Serpentinites subducted to blueschist-eclogite-facies conditions have similar HSE concentrations to primitive upper mantle (PUM) concentrations, therefore it is concluded that the HSE are not mobilized from serpentinites on the scale of the whole-rock or greater. Therefore, as suggested in previous studies, crustal lithologies may be more important contributors of the HSE to the sub-arc mantle, particularly Pt, Pd and Re. In contrast, HSE concentrations in hybrid rocks (talc schist and chlorite schist) deviate from protolith concentrations. Rhenium is higher in the talc schist, and Ir and Ru are lower in the chlorite schist than in the PUM, or possible mafic protoliths. Mineral parageneses place temporal constraints on the growth of hosts to the HSE (sulphides, oxides and metal alloys), and record changes to the activities of oxygen and sulphur (aO2-aS2), and hence redox conditions, from pre-subduction to exhumation. Laser ablation inductively coupled plasma mass spectrometry was used to determine the HSE concentrations in sulphides and oxides, and the detection of small (2-25 mm2) platinum group m

Published
2020

145. Re-Os and HSE in individual base metal sulfide grains: Evaluating micro-analytical procedures using a sulfide reference material

Author

Alessandro Bragagni, G. M. Nowell, Alexander Heuser, Iris M. Speelmanns, Ashlea N. Wainwright, D. van Acken, Raúl O.C. Fonseca, and Ambre Luguet

Subjects
chemistry.chemical_classification, 010504 meteorology & atmospheric sciences, Sulfide, Isotope, Ion exchange, Analytical chemistry, Geology, Base metal sulfide, Platinum group, 010502 geochemistry & geophysics, 01 natural sciences, chemistry, Geochemistry and Petrology, Analytical procedures, Mass fraction, Chemical composition, 0105 earth and related environmental sciences
Abstract

Two Fe-Ni sulfides, resembling the chemical composition of a typical mantle base metal sulfide (BMS), were synthesized and used to test micro-analytical procedures (sample digestion and chemical separation) to determine Os-187/Os-188 and highly siderophile element (HSE) mass fractions in single BMS grains. The bulk Os-187/Os-188 and HSE mass fractions of the synthetic sulfides were independently determined after high pressure asher (HPA) digestion and conventional HSE separation (Os solvent extraction and Ir, Ru, Pt, Pd, Re separation via anion exchange chromatography), while the homogenous distribution of HSE was assessed via LA-ICP-MS. Tests were performed following the protocol of Pearson et al. (1998), where sulfides are digested in H2SO4/CrO3 and Os is simultaneously extracted as OsO4. Additional tests were performed adding a pre-digestion step in HBr and/or HCl. The duration and the temperature of the pre-digestion and micro-distillation steps, as well as different chromatographic separations of the HSE were also evaluated. While the majority of the tests yielded Os-187/Os-188 in agreement with that obtained after HPA digestion, HSE mass fractions show large deviations from the reference content, depending on the used procedure. Such variations are interpreted as the result of incomplete sulfide digestion, Os spike loss, and the possible presence of undigested sub-micrometric platinum group minerals (PGM). Overall, the bulk sulfide HSE mass fractions obtained after HPA digestion are best reproduced (mean deviations

Published
2018

148. A carbon-rich lithospheric mantle as a source for the large CO2 emissions of Etna volcano (Italy).

Author

Bragagni, Alessandro, Mastroianni, Filippo, Münker, Carsten, Conticelli, Sandro, and Avanzinelli, Riccardo

Abstract

Etna volcano in Italy releases an exceptional amount of CO2 (9083 t/day) and contributes to 10% of global volcanic emission. The reasons for its extreme CO2 degassing are not yet understood. Using high-precision high field strength element (HFSE) concentrations in magmas from volcanoes in southern Italy, we show that the high Nb/Ta of Etna (up to 26) reveals a mantle source affected by carbonatite metasomatism, which is likely responsible for the large CO2 fluxes. As observed at Etna, carbon-rich mantle domains influence CO2 degassing also outside of continental rifts and therefore play a fundamental role in explaining volcanic CO2 fluxes in different geodynamic settings. Collectively, our study demonstrates that HFSE ratios in magmatic rocks are viable tracers for volcanic carbon degassing that can be used to study present-day settings and, possibly, past emissions. [ABSTRACT FROM AUTHOR]

Published
2022
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