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  • 1
    Online Resource
    Online Resource
    The impact of different rehabilitation strategies after major events in the elderly: the case of stroke and hip fracture in the Tuscany region
    Springer Science and Business Media LLC ; 2007
    In:  BMC Health Services Research Vol. 7, No. 1 ( 2007-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2007-12)
    Abstract: On a regional level, our aims were to describe rehabilitation patterns for elderly patients with stroke and hip fracture and to investigate mortality risk during the 6-month post acute period. Methods Data sources included administrative data relative to patients aged 65+ resident in Tuscany admitted in hospital for stroke or hip fracture between 2001 and 2003, traced up to 3 years before and 6 months following index admission. The study design involves computerized linkage of administrative data, and an exploratory analysis of the association between rehabilitation patterns and 6-month mortality, adjusting for clinical, demographic, and acute-related care characteristics using multivariate Cox regression. Results Rehabilitation patterns vary greatly across Tuscany with considerable cost implications. Six month mortality risk for stroke patients is significantly lower among residents of Local Health Authorities where patients are more frequently rehabilitated, specifically in extra-hospital settings. Conclusion Our study, targeting two crucial conditions for elderly patients, found a high variability of rehabilitation patterns across a region, albeit coherent between the two pathologies, associated with remarkable differences in average expenditure. Differences in hazard rates for 6-month mortality after stroke at population level were also found. These results need to be confirmed and further investigated through a more robust information framework.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/1472-6963-7-95
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2007
    detail.hit.zdb_id: 2050434-2
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  • 2
    Online Resource
    Online Resource
    Quality and Predictors of Diabetes Care Among Patients With Schizophrenia: A Danish Nationwide Study
    American Psychiatric Association Publishing ; 2018
    In:  Psychiatric Services Vol. 69, No. 2 ( 2018-02), p. 179-185
    Details
    In: Psychiatric Services, American Psychiatric Association Publishing, Vol. 69, No. 2 ( 2018-02), p. 179-185
    Type of Medium: Online Resource
    ISSN: 1075-2730 , 1557-9700
    URL: Article
    DOI: 10.1176/appi.ps.201600460
    Language: English
    Publisher: American Psychiatric Association Publishing
    Publication Date: 2018
    detail.hit.zdb_id: 2022142-3
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  • 3
    Online Resource
    Online Resource
    The Umbria Diabetes Register
    Elsevier BV ; 2006
    In:  Diabetes Research and Clinical Practice Vol. 74 ( 2006-12), p. S200-S204
    Details
    In: Diabetes Research and Clinical Practice, Elsevier BV, Vol. 74 ( 2006-12), p. S200-S204
    Type of Medium: Online Resource
    ISSN: 0168-8227
    URL: Article
    DOI: 10.1016/S0168-8227(06)70032-8
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 2004910-9
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  • 4
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    Online Resource
    Predictors of bacteremia and death, including immune status, in a large single-center cohort of unvaccinated ICU patients with COVID-19 pneumonia
    Springer Science and Business Media LLC ; 2023
    In:  European Journal of Medical Research Vol. 28, No. 1 ( 2023-07-03)
    Details
    In: European Journal of Medical Research, Springer Science and Business Media LLC, Vol. 28, No. 1 ( 2023-07-03)
    Abstract: We investigated the possible role of the immune profile at ICU admission, among other well characterized clinical and laboratory predictors of unfavorable outcome in COVID-19 patients assisted in ICU. Methods Retrospective analysis of clinical and laboratory data collected for all consecutive patients admitted to the ICUs of the General Hospital of Pescara (Abruzzo, Italy), between 1 st March 2020 and 30 th April 2021, with a confirmed diagnosis of COVID-19 respiratory failure. Logistic regressions were used to identify independent predictors of bacteremia and mortality. Results Out of 431 patients included in the study, bacteremia was present in N  = 191 (44.3%) and death occurred in N  = 210 (48.7%). After multivariate analysis, increased risk of bacteremia was found for viral reactivation (OR = 3.28; 95% CI:1.83–6.08), pronation (3.36; 2.12–5.37) and orotracheal intubation (2.51; 1.58–4.02). Increased mortality was found for bacteremia (2.05; 1.31–3.22), viral reactivation (2.29; 1.29–4.19) and lymphocytes  〈  0.6 × 10 3 c/µL (2.32; 1.49–3.64). Conclusions We found that viral reactivation, mostly due to Herpesviridae, was associated with increased risk of both bacteremia and mortality. In addition, pronation and intubation are strong predictors of bacteremia, which in turn together with severe lymphocytopenia due to SARS-CoV2 was associated with increased mortality. Most episodes of bacteremia, even due to Acinetobacter spp, were not predicted by microbiological evidence of colonization.
    Type of Medium: Online Resource
    ISSN: 2047-783X
    URL: Article
    DOI: 10.1186/s40001-023-01166-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2129989-4
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  • 5
    Online Resource
    Online Resource
    Reliability of predictive models to support early decision making in the emergency department for patients with confirmed diagnosis of COVID-19: the Pescara Covid Hospital score
    Springer Science and Business Media LLC ; 2022
    In:  BMC Health Services Research Vol. 22, No. 1 ( 2022-08-19)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-08-19)
    Abstract: The hospital management of patients diagnosed with COVID-19 can be hampered by heterogeneous characteristics at entry into the emergency department. We aimed to identify demographic, clinical and laboratory parameters associated with higher risks of hospitalisation, oxygen support, admission to intensive care and death, to build a risk score for clinical decision making at presentation to the emergency department. Methods We carried out a retrospective study using linked administrative data and laboratory parameters available in the initial phase of the pandemic at the emergency department of the regional reference hospital of Pescara, Abruzzo, Italy, March–June 2020. Logistic regression and Cox modelling were used to identify independent predictors for risk stratification. Validation was carried out collecting data from an extended timeframe covering other variants of concern, including Alpha (December 2020–January 2021) and Delta/Omicron (January–March 2022). Results Several clinical and laboratory parameters were significantly associated to the outcomes of interest, independently from age and gender. The strongest predictors were: for hospitalisation, monocyte distribution width ≥ 22 (4.09; 2.21–7.72) and diabetes (OR = 3.04; 1.09–9.84); for oxygen support: saturation  〈  95% (OR = 11.01; 3.75–41.14), lactate dehydrogenase≥237 U/L (OR = 5.93; 2.40–15.39) and lymphocytes 〈  1.2 × 10 3 /μL (OR = 4.49; 1.84–11.53); for intensive care, end stage renal disease (OR = 59.42; 2.43–2230.60), lactate dehydrogenase≥334 U/L (OR = 5.59; 2.46–13.84), D-dimer≥2.37 mg/L (OR = 5.18; 1.14–26.36), monocyte distribution width ≥ 25 (OR = 3.32; 1.39–8.50); for death, procalcitonin≥0.2 ng/mL (HR = 2.86; 1.95–4.19) and saturation  〈  96% (HR = 2.74; 1.76–4.28). Risk scores derived from predictive models using optimal thresholds achieved values of the area under the curve between 81 and 91%. Validation of the scoring algorithm for the evolving virus achieved accuracy between 65 and 84%. Conclusions A set of parameters that are normally available at emergency departments of any hospital can be used to stratify patients with COVID-19 at risk of severe conditions. The method shall be calibrated to support timely clinical decision during the first hours of admission with different variants of concern.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-022-08421-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2050434-2
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  • 6
    Online Resource
    Online Resource
    Hyaluronic acid: Perspectives in dentistry. A systematic review
    SAGE Publications ; 2016
    In:  International Journal of Immunopathology and Pharmacology Vol. 29, No. 4 ( 2016-12), p. 572-582
    Details
    In: International Journal of Immunopathology and Pharmacology, SAGE Publications, Vol. 29, No. 4 ( 2016-12), p. 572-582
    Abstract: To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the soft periodontal tissue, gingiva, and periodontal ligament as well as to the hard tissue such as alveolar bone and cementum. Topical hyaluronic acid (HA) has recently been recognized as an adjuvant treatment for chronic inflammatory disease in addition to its use to improve healing after dental procedures. The aim of our work was to systematically review the published literature about potential effects of HA as an adjuvant treatment for chronic inflammatory disease, in addition to its use to improve healing after common dental procedures. Relevant published studies were found in PubMed, Google Scholar, and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 25 relevant publications were included, three of them regarding gingivitis, 13 of them relating to chronic periodontitis, seven of them relating to dental surgery, including implant and sinus lift procedures, and the remaining three articles describing oral ulcers. Not only does topical administration of HA play a pivotal key role in the postoperative care of patients undergoing dental procedures, but positive results were also generally observed in all patients with chronic inflammatory gingival and periodontal disease and in patients with oral ulcers.
    Type of Medium: Online Resource
    ISSN: 2058-7384 , 2058-7384
    URL: Article
    DOI: 10.1177/0394632016652906
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2505963-4
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  • 7
    Online Resource
    Online Resource
    Adherence to General Diabetes and Foot Care Processes, with Prompt Referral, Are Associated with Amputation-Free Survival in People with Type 2 Diabetes and Foot Ulcers: A Scottish National Registry Analysis
    Hindawi Limited ; 2022
    In:  Journal of Diabetes Research Vol. 2022 ( 2022-6-14), p. 1-13
    Details
    In: Journal of Diabetes Research, Hindawi Limited, Vol. 2022 ( 2022-6-14), p. 1-13
    Abstract: Aims. To compare different packages of care across care providers in Scotland on foot-related outcomes. Methods. A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assessed the association between exposure to care processes and major lower extremity amputation and death. Proportional hazards were used for time-to-event univariate and multivariate analyses, adjusting for case-mix characteristics and care processes. Results were expressed in terms of hazard ratios with 95% confidence intervals. Results. 2,243 (32.7%) subjects had a major amputation or death. Exposure to all nine care processes at all ages ( HR = 0.63 ; 95% CI: 0.58-0.69; p 〈 .001 ) and higher foot care attendance in people aged 〉 70 years ( HR = 0.88 ; 0.78-0.99; p = .03 ) were associated with longer major amputation-free survival. Waiting   time ≥ 12 weeks between ulceration and clinic attendance was associated with worse outcomes ( HR = 1.59 ; 1.37-1.84; p 〈 .001 ). In people 〉 70 years, minor amputations were associated with improved major amputation-free survival ( HR = 0.69 ; 0.52-0.92; p = .01 ). Conclusions. Strict adherence to a standardised package of general diabetes care before foot ulceration, timely foot care after ulceration, and specific treatment pathways were associated with longer major amputation-free survival among a large cohort of people with type 2 diabetes in Scotland, with a larger impact on older age groups.
    Type of Medium: Online Resource
    ISSN: 2314-6753 , 2314-6745
    URL: Article
    DOI: 10.1155/2022/7414258
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2711897-6
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  • 8
    Online Resource
    Online Resource
    RECPAM (Recursive Partition and Amalgamation), a novel statistical approach for early prediction of outcome in patients with acute myocardial infarction
    Elsevier BV ; 1996
    In:  Journal of the American College of Cardiology Vol. 27, No. 2 ( 1996-02), p. 250-
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 27, No. 2 ( 1996-02), p. 250-
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/S0735-1097(96)81882-1
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1996
    detail.hit.zdb_id: 1468327-1
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  • 9
    Online Resource
    Online Resource
    The Efficacy of Tolrestat in the Treatment of Diabetic Peripheral Neuropathy: A meta-analysis of individual patient data
    American Diabetes Association ; 1996
    In:  Diabetes Care Vol. 19, No. 10 ( 1996-10-01), p. 1091-1096
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 19, No. 10 ( 1996-10-01), p. 1091-1096
    Abstract: The aim of this meta-analysis was to review the existent evidence on the effectiveness of tolrestat in the treatment of diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS Individual patient data on 738 subjects from the three randomized clinical trials published on this topic were analyzed using changes in motor nerve conduction velocities (NCVs) as endpoints. Nerves investigated included median, ulnar, tibial, and peroneal. RESULTS The pooled analysis of NCV taken as a continuous measurement showed a significant treatment effect, the magnitude of this benefit being approximately equal to 1 m/s for all the nerves investigated. When looking at the proportion of patients experiencing a loss of NCV of at least 1 or 2 m/s in at least two out of the four nerves investigated, it emerged that treatment reduced by & gt; 40% the risk of such outcomes after adjusting for patients' characteristics. The odds ratios relative to the placebo group were 1.82 (1.30–2.52) and 1.70 (1.15–2.48) for a decrease of 1 and 2 m/s, that is, placebo-treated patients have an 82 and 70% increased risk for a loss of nerve function of 1 and 2 m/s, respectively. No statistically significant difference in treatment effect emerged after stratification according to baseline motor NCV and glycated hemoglobin levels. CONCLUSIONS After a treatment duration ranging between 24–52 weeks, patients treated with tolrestat had a reduced risk for developing nerve function loss compared with placebo-treated patients. Future long-term trials are needed to evaluate the impact of the treatment on more clinically meaningful endpoints such as the development of foot complications.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/diacare.19.10.1091
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 1996
    detail.hit.zdb_id: 1490520-6
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  • 10
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    Online Resource
    Stratifying Patients at Risk of Diabetic Complications: An integrated look at clinical, socioeconomic, and care-related factors
    American Diabetes Association ; 1998
    In:  Diabetes Care Vol. 21, No. 9 ( 1998-09-01), p. 1439-1444
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 21, No. 9 ( 1998-09-01), p. 1439-1444
    Abstract: The aim of this study was to identify subgroups of patients for whom the interactions among clinical, socioeconomic, and care-related factors determine a substantial increase in the risk of developing long-term diabetic complications. RESEARCH DESIGN AND METHODS We performed a case-control study aimed at identifying and quantifying the risk factors for the development of major diabetic complications (eye, renal, and lower limb complications) in type 1 and type 2 diabetic patients. A total of 886 patients with renal, eye, or lower limb complications and 1,888 control subjects were enrolled in 35 diabetes outpatient clinics and 49 general practitioners' offices in 17 out of the 20 Italian regions. The main results were obtained using recursive partitioning and amalgamation (RECPAM), a technique that attempts to integrate the advantages of main effect logistic regression and tree-growing. RESULTS The application of RECPAM led to the detection of important interactions involving clinical, socioeconomic, and care-related characteristics and allowed the identification of internally homogeneous subgroups characterized by a marked difference in the risk of developing major complications. In type 1 diabetic patients, the interaction between hypertension and smoking habits led to a dramatic increase in the complication risk, while in type 2 diabetic subjects, a poor compliance with visit scheduling was the most important predictor of complications. Furthermore, a marked difference in the risk profile was associated with patient characteristics (age, years of education, occupation). CONCLUSIONS In the definition of the risk profile for each individual patient, socioeconomic status and level of education need to be taken under serious consideration, since they can determine a complication risk not dissimilar from hard clinical variables, such as hypertension and diabetes duration. Specific educational interventions, targeted to the socially disadvantaged strata of the population, need to be designed and implemented.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/diacare.21.9.1439
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 1998
    detail.hit.zdb_id: 1490520-6
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