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Marinosci F.,Fondazione San Raffaele Cittadella della Carita | Incalzi R.A.,Biomedical University of Rome
Giornale di Gerontologia | Year: 2014

Urinary tract infections (UTI) are very common in nursing homes. Escherichia coli is the most common pathogen, but a polimicrobial flora prevails in people with indwelling urethral catheter. It is not uncommon to diagnose mycotic UTI. istinguishing asymptomatic bacteriuria from UTI is not always a simple task, even if dedicated diagnostic criteria are used. The high prevalence of asymptomatic bacteriuria carries an important risk of overdiagnosis and overtreatment. On the other hand, UTI may be misdiagnosed in people, e. g. affected by dementia, for whom it is problematic to take a reliable history and collect symptoms. Antibiotic overuse may result in adverse drug reactions and selection of multidrug resistant bacteria, mainly in patient who have indwelling urinary catheter. UTI caused by multidrug resistant bacteria seem to carry an ominous prognosis. If truly needed, antibiotic therapy should be chosen according to clinical considerations strictly tailored to the individual conditions. Source


Andria G.,Polytechnic of Bari | Lanzolla A.M.L.,Polytechnic of Bari | Cavallo G.,L.E.S.S. | Russo G.,Fondazione San Raffaele Cittadella della Carita | And 3 more authors.
2015 IEEE International Symposium on Medical Measurements and Applications, MeMeA 2015 - Proceedings | Year: 2015

The management of age related diseases is one of the most discussed and controverted topic in Healthcare policy: cost-efficient solutions are needed to reduce the economic impact on welfare systems and to improve the quality of life of the patients. This is particularly true for chronic diseases, in which a simple, but continuous monitoring of suitable functional parameters able to evaluate the patient status would allow a consistent reduction of hospitalizations. In this paper we present the experience derived from a 'Living Lab', a novel model of participated innovation in which the end-user plays a crucial role. We co-designed, implemented and tested a m-health solution for remote monitoring of physiological parameters directly from chronic patients' house according to a clinical protocol defined by healthcare professionals. For this aim set of parameters such as Blood Pressure, Body Weight, Heart Rate, Pulse Oximetry was measured and, if needed, the answers to a questionnaire. The proposed system allows to reduce the hospitalization rate and to increase the empowerment of the patient in the self-management of his chronic health condition. © 2015 IEEE. Source


Laudisio A.,Biomedical University of Rome | Marinosci F.,Fondazione San Raffaele Cittadella della Carita | Fontana D.,Biomedical University of Rome | Gemma A.,UOS Accesso e Presa in Carico Assistenziale | And 4 more authors.
Aging Clinical and Experimental Research | Year: 2015

Background: Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host. Aims: The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs. Methods: We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the “Fondazione San Raffaele Cittadella della Carità”, Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI. Results: P-UTIs were detected in 118/299 (39 %) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95 % CI 1.06–2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95 % CI 1.13–3.11; P = .015). Discussion: The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases. Conclusions: Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity. © 2015, Springer International Publishing Switzerland. Source


Andria G.,Polytechnic of Bari | Lanzolla A.M.L.,Polytechnic of Bari | Russo G.,Fondazione San Raffaele Cittadella della Carita | Parabita M.,Fondazione San Raffaele Cittadella della Carita | And 3 more authors.
2015 IEEE International Symposium on Medical Measurements and Applications, MeMeA 2015 - Proceedings | Year: 2015

This paper proposes the development of an innovative measurement system for telerehabilitation with the aim to provide objective evaluation of functional capacity of patients subject to lower limb rehabilitation. In particular the system has based on the set of wearable MEMs sensors which detect the 3D orientation of the limbs and communicate with a Central Remote Unit for storing and elaborating all measurement data. The proposed study has been performed under the research project PRO-DOMO SUD funded by Apulia Region within the Project 'Apulian ICT Living Labs'. © 2015 IEEE. Source


Marinosci F.,Fondazione San Raffaele Cittadella della Carita | Zizzo A.,Fondazione San Raffaele Cittadella della Carita | Coppola A.,Fondazione San Raffaele Cittadella della Carita | Rodano L.,Fondazione San Raffaele Cittadella della Carita | And 3 more authors.
Journal of the American Medical Directors Association | Year: 2013

Objectives: The emergence of antibiotic-resistant urinary pathogens represents a public health care concern. We aimed to detect antibiotic-resistance in elderly nursing home residents with urinary tract infection (UTI) and to assess the impact of carbapenem resistance on mortality. Methods: This cohort study of 196 patients with UTI confirmed by a positive urine culture was conducted in a nursing home in Italy. Data on 6-month mortality was obtained by nursing home records and confirmed by death certificates. Diagnosis of UTI was ascertained by urine culture. Antibiotic resistance was defined according to antibiograms performed by the same laboratory. Cox regression analysis was used to assess the adjusted association between carbapenem resistance and 6-month mortality. Results: Carbapenem resistance was found in 39/196 (20%) patients. After adjusting for potential confounders, carbapenem resistance was associated in Cox regression modeling with 6-month mortality (relative risk= 2.79; 95% confidence interval= 1.17-6.70; P= .021). Conclusions: In elderly in-patients, UTI from carbapenem-resistant germs is an independent risk factor for 6-month mortality, irrespective of the etiologic agent. Further studies are needed to clarify the mechanisms underlying this association. © 2013 American Medical Directors Association, Inc.. Source

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