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Rizzo P.,University of Ferrara | Ferrari R.,Azienda Ospedaliero Universitaria di Ferrara
European Heart Journal, Supplement

The Notch signalling is a fundamental pathway involved in the modulation of cell proliferation, survival, and in stem cells maintenance. The crucial role played by Notch in tumour onset and progression has made it amenable to cancer therapy. Several clinical trials are currently testing safety and efficacy of combination treatments of existing cancer therapies with Notch inhibitors. Notch receptors and their ligands play a major role in the modulation of a plethora of biological functions of macrophages, endothelial, and vascular smooth muscle cells, particularly under inflammatory conditions. Data obtained by us and other laboratories provide compelling evidence that the Notch signalling, by affecting the biology of each cell type involved in atheromatous plaque formation, has the potential to become a new biomarker and/or therapeutic target in atherosclerosis. © 2015 Published on behalf of the European Society of Cardiology. All rights reserved. Source

The present study analyses how continuity of care is perceived by health professionals and GRACER (Gravi Cerebrolesioni Acquisite Emilia Romagna) patients' caregivers, in order to investigate where the gap between expectations and reality is more heavily felt and which dimension of the continuity of care is the most important both for health professionals and GRACER patients' caregivers. The study has been developed following the Gap Analysis theoretical model. A questionnaire, based on ServQual model, was used to collect data about the three dimensions of the construct of continuity of care related to information, management and relation, declined along the lines of expectations and perception of reality. The questionnaire was administered to health professionals and caregivers of GRACER patients (12-36 months after the event) inside 4 healthcare institutes in Emilia Romagna. The PAI (Piano Assistenziale Individuale) approach was the methodology applied in these 4 sites. To both groups the relational continuity was the most important dimension, followed at a long distance by the informational and the management ones. It has also been noted that to professionals reality is always worse than expectations, with the exception of only two items in the dimension of management continuity. To caregivers reality is worse than expectations in some items in the dimensions of information and management The study has shown that the relational dimension of continuity of care should be more investigated, as confirmed by literature. More research is needed about the professionals' dissatisfaction generated by the negative balance between expectations and perception of reality. Source

Kalra P.R.,Portsmouth Hospitals NHS Trust | Kalra P.R.,Imperial College London | Garcia-Moll X.,Unitat Hospitalitzacio | Zamorano J.,University Hospital Ramon jal | And 11 more authors.

Purpose: To assess the frequency of chronic kidney disease (CKD), define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease. Methods: 22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) were included. Baseline estimated glomerular filtration rate (eGFR) was calculated (CKD-Epidemiology Collaboration formula) and patients categorised according to CKD stage: >89, 60-89, 45-59 and <45 mL/min/1.73 m2. Results: Mean (SD) age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2) was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2); lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers). The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall) and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR. Conclusions: Chronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently in lower eGRF categories. Surprisingly the reverse was seen for angiotensin-receptor blockers. Further evaluation is required to fully understand these associations. The CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) Registry is registered in the ISRCTN registry of clinical trials with the number ISRCTN43070564. http://www.controlled-trials.com/ISRCTN43070564. © 2014 Kalra et al. Source

Maggioni A.P.,Research Center | Van Gool K.,Oecd Nuclear Energy Agency | Van Gool K.,University of Technology, Sydney | Biondi N.,Oecd Nuclear Energy Agency | And 8 more authors.
Value in Health

Objective This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. Methods Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. Results Of 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. Conclusions Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs. © 2015 Published by Elsevier Inc. on behalf of International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Source

Dreno B.,Hotel Dieu | Bettoli V.,Azienda Ospedaliero Universitaria di Ferrara | Perez M.,Clinica Dermatologica de Moragas | Bouloc A.,Saint Jacques Clinical Center | Ochsendorf F.,Goethe University Frankfurt
European Journal of Dermatology

Background: To date, the term ‘acne mechanica’ defines different cutaneous lesions caused by mechanical injury. Objective: To re-define the spectrum of cutaneous lesions caused by mechanical injury by determining their clinical and histological characteristics, to discuss and identify triggering and pathophysiologic elements. Methods: Clinical, histological and pathophysiological differences of 135 published cases of acne mechanica were analysed and compared to cases provided from our clinics. Results and Conclusions: Mechanical factors cause 2 types of mainly inflammatory cutaneous lesions: one presents with inflammatory papules, open comedones or has no comedonal lesions. We propose using the term ‘folliculitis mechanica’. The second type corresponds to a flare-up of acne in areas prone to the condition. These lesions present the typical clinical and histological features of acne vulgaris, comprising inflammatory and retentional lesions. Treatment may include topical products, including adjunctive care for reconstruction of the cutaneous barrier and the microbiome. Conventional acne medication should be used in cases of acne flare-up. © 2015, John Libbey Eurotext. All rights reserved. Source

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