Borea Hospital

San Remo, Italy

Borea Hospital

San Remo, Italy
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Pupella V.,University of Genoa | Tagliati A.,University of Genoa | Secondo G.,Borea Hospital | Dentone C.,Borea Hospital | And 4 more authors.
2014 IEEE-EMBS International Conference on Biomedical and Health Informatics, BHI 2014 | Year: 2014

In the last century, antibiotics have been one of the most important discoveries for defeating numerous types of bacteria, but in recent times, microbes have become increasingly antibiotic resistant, causing severe consequences for human beings. The scientific community has been operating in this area for many years, developing projects always more focused on a multidisciplinary collaboration among partners. One of the most recent examples is the new cross border project between Italy and France, financed in 2013 by the European Union. It was established with the goal of fighting antibiotic resistances and optimizing antibiotic usage and patients' care in both countries. These goals can only be achieved by comparison of differences between the two countries in prescribing patterns and usage of antibiotics, and related emerging inconveniences and disadvantages. In order to make the evaluation as efficient and automated as possible, a relevant part of this project is placed in the IT field. For this purpose, a highly normalized and standardized database was designed, managed by a web platform that collects data concerning antibiotic resistance and data on surveys among populations at risk. The proposed platform is at a prototypal level, currently available on the internet. 64 patients have already been inserted. © 2014 IEEE.

Locatelli C.,INRCA IRCCS | Piselli P.,INMI L. Spallanzani | Cicerchia M.,INRCA IRCCS | Repetto L.,Borea Hospital
Psycho-Oncology | Year: 2013

Purpose We attempt to shed light on the truth-telling attitudes and practices of oncologists working with a geriatric population in Italy. Participants and method Physicians caring for cancer patients were asked to complete a specific survey centred on their beliefs, attitudes and practices towards truth telling to elderly cancer patients. Results Of 50 physicians surveyed, 68% were men. Physicians practising in the south of Italy were significantly older and more likely to be of male gender in comparison with physicians practising from the north and central areas. Eighty-four per cent of physicians consider the family to be an obstacle to a direct communication with the elderly. Forty-four per cent of male physicians who are faced with a family's request of nondisclosure talk with the patient, whereas 37.5% of female physicians talk with the family. For 60% of interviewed physicians, the reason underpinning the caregiver's choice of nondisclosure is to delay the emotional confrontation. Conclusions We observed that variability of disclosure is related not only to the patient's age but also to the physicians' age and sex and to the geographic area where physicians work. The results also show that both caregivers and physicians are concerned by the emotional aspects related to clinical information. Italian oncologists have to learn and implement 'comprehensive' communication skills and have to promote an integration of the information needs of patient and caregivers, according to their socio-cultural affiliation, within the communication techniques. Copyright © 2012 John Wiley & Sons, Ltd.

Tammaro L.,San Giovanni Addolorata Hospital | Buda A.,University of Padua | Di Paolo M.C.,San Giovanni Addolorata Hospital | Zullo A.,Nuovo Regina Margherita Hospital | And 52 more authors.
Digestive and Liver Disease | Year: 2014

Background: Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding. Aims: To validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality. Methods: In this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score. Results: Overall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p=0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p=0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p=0.3). Conclusions: The T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy. © 2014 Editrice Gastroenterologica Italiana S.r.l.

Binda G.A.,Galliera Hospital | Amato A.,Borea Hospital | Serventi A.,San Giacomo Hospital | Arezzo A.,University of Turin
Digestive Diseases | Year: 2012

Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We report data from revised literature and from our study: a 4-year multicenter retrospective and prospective database analysis of 743 patients hospitalized for acute diverticulitis (AD) treated medically or surgically and then followed for a minimum of 9 years. Results: The literature showed a recurrence rate of 25-35% at 5 years of follow-up, with a reduced risk of severe complications (i.e. perforations), a risk of subsequent emergency surgery of 2-14% and a risk of stoma and related death of 0-2.7%. Several risk factors of recurrence have been advocated: family history, abscess, severe CT stage, comorbidities (renal failure, collagen vascular disease) and nonsteroidal anti-inflammatory drugs. Young age is still a matter of debate. These studies have different limitations: retrospective, lack of definition of AD, small number of patients, long recruiting time, short follow-up, study population or hospital-system based. In our study of 320 followed-up, medically treated patients, 61% were asymptomatic and 22% complained of chronic symptoms: the 12-year actuarial risk of recurrence, emergency surgery, stoma and death was 21.2, 8.3, 1 and 0%, respectively. Recurrence was related to very young age (<40 years) and more than 3 previous episodes of AD. Conclusion: This study confirms the benign course of diverticulitis treated conservatively, with a low long-term risk of serious complications and death, and does not support an aggressive surgical policy to prevent them. Copyright © 2012 S. Karger AG, Basel.

To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip (OTSC) placement.We retrospectively enrolled 20 patients (13 female and 7 male; mean age: 70.6 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Oval-shape perforations were closed by OTSC only by suction and the round-shape by the twin-grasper plus suction.Main perforation diameter was 10.1 4.3 mm (range 3-18 mm). The technical success rate was 100% (20/20 patients) and the clinical success rate was 90% (18/20 patients). Two patients (10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape type-1 perforation and oval-shape type-2 perforation. Eight (40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2 (60%).OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment.

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