Knudsen A.K.,Norwegian University of Science and Technology |
Brunelli C.,Instituto Nazionale Dei Tumori |
Klepstad P.,Norwegian University of Science and Technology |
Aass N.,University of Oslo |
And 6 more authors.
Pain | Year: 2012
The overall aim of the present study was to further develop an evidence-based platform for the content of an international cancer pain classification system. Data from a multicentre, observational longitudinal study of cancer patients were analysed. Analyses were carried out in 2 samples: (A) Cross-sectional data of patients on opioids at inclusion, and (B) patients just admitted to palliative care. Outcome measures in the models we investigated were pain on average, worst pain, and pain relief at inclusion, and at day 14, respectively. Uni- and multivariate regression models were applied to test the explicative power on pain outcomes of a series of known pain domains, including incident pain, psychological distress, neuropathic pain, pain localisation, sleep disturbances, total morphine equivalent daily dose (MEDD), and cancer diagnosis. In the 2 analyses, 1529 (A) and 352 (B) patients were included, respectively. Incident pain, pain localisation, MEDD, use of nonsteroidal antiinflammatory drugs, and sleep were associated with one or more of the pain outcomes in analysis A, while initial pain intensity, initial pain relief, incident pain, localisation of pain, cancer diagnosis, and age were predictors in the longitudinal analysis. Identified domains explained 16% to 24% of the variability of the pain outcome. Initial pain intensity emerged as the strongest predictor of pain outcome after 2 weeks, and incident pain was confirmed to be a relevant domain. The regression models explained only a minor part of the variability of pain outcomes. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
PubMed | University of Witwatersrand, Rheumatology Unit, Arcispedale S. M. Nuova IRCCS, Arcispedale S. M. Nuova.IRCCS and 4 more.
Type: | Journal: International ophthalmology | Year: 2017
The role of uveitis, an uncommon ocular disease, is often neglected in research and treatment of autoimmune conditions. The study described the spectrum of uveitis at a referral center in North Italy, and compared that to a previously published series of patients.We reviewed all patients with uveitis diagnosed from 2013 to 2015 at the Immunology Eye Unit, Arcispedale S. M. Nuova-IRCCS, Reggio Emilia, Italy. We examined patient characteristics, disease spectrum, and etiologies.In total, 990 cases of uveitis were identified, who were mostly female (59%) with a median age at presentation of 44years (interquartile range=29-57). Anterior uveitis was most frequent (53.5%), followed by panuveitis (22.8%), posterior (16.2%), and intermediate uveitis (5.5%). Anterior herpetic uveitis (15.6%), Fuchs uveitis (9.7%), and HLA-B27 positive anterior uveitis (7.7%) were the most common specific diagnoses. Compared with the previous series, we observed an increased incidence of uveitis, and a different pattern of diagnoses. Rates of herpetic, HLA-B27 positive uveitis, and presumed ocular tuberculosis were higher, but Fuchs uveitis was less frequent.The pattern of uveitis appears to be changing, very likely due to population-level increases in infectious diseases, to the availability of new diagnostic tests and to the interdisciplinary approach used in patient diagnosis.
Lazzeroni M.,Italian National Cancer Institute |
Lazzeroni M.,University of Rome Tor Vergata |
Gandini S.,Italian National Cancer Institute |
Puntoni M.,Scientific Directorate |
And 3 more authors.
Breast | Year: 2011
Summary: This review highlights the role of vitamins and natural compounds in breast cancer prevention, with a particular focus on Vitamin D. In the last decades, both encouraging and discouraging results about the association between antioxidant supplementation and cancer have been reported to public and scientific community. Their safe and favorable toxicity profile makes them suitable to be investigated in a preventive setting. However, a recent large meta-analysis showed that treatment with beta carotene, vitamin A, and vitamin E may increase mortality, whereas the potential roles of vitamin C and selenium on mortality need further study. Likewise, folate levels were not associated with reduced breast cancer risk in a recent meta-analysis. Several studies have shown that a high proportion of women at-risk for breast cancer or affected by the disease have deficient vitamin D levels, i.e., 250H-D <20ng/ml or 50nmol/L. While the association between Vitamin D levels and breast cancer risk/prognosis is still controversial, the U-shaped relationship between 250H-D levels observed in different studies suggests the need to avoid both deficient and too high levels. Further trials using an optimal dose range are needed to assess the preventive and therapeutic effect of vitamin D. Finally, Fenretinide, a pro-apoptotic and pro-oxidant vitamin A derivative, has shown promise in several trials and its preventive potential is being assessed in young women at very high risk for breast cancer. © 2011 Elsevier Ltd.
Adherence to Selective Serotonin and Serotonin-Norepinephrine Reuptake Inhibitor Prescriptions Affects Overall Medication Adherence in Older Persons: Evidence From the Italian Nationwide OsMed Health-DB Database
PubMed | CliCon S.r.l. Health, Clinical and Molecular Epidemiology, Catholic University of the Sacred Heart, University of Florence and 4 more.
Type: Journal Article | Journal: The Journal of clinical psychiatry | Year: 2017
This study aimed to evaluate prevalence of prescription of and adherence to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and whether adherence to these classes of drugs affects overall medication adherence in older persons.In a cross-sectional analysis of administrative data comprehensive of all prescribed drugs reimbursed by the Italian national health care system, new prescriptions of SSRIs and SNRIs to persons aged 65 years or older were analyzed (n = 380,400 in 2011; 395,806 in 2012; 409,741 in 2013, from a total sample of 3,762,299 persons aged 65 years or older) as well as prescriptions of antihypertensives, statins, other psychiatric drugs, antidiabetics, antiplatelets, anticoagulants, drugs for chronic obstructive pulmonary disease, and antiosteoporotics. Adherence was estimated by calculating the proportion of days covered by drugs dispensed during a period of 365 days. Adherence was defined as a proportion of days covered of more than 80%.Prevalence of SSRI and SNRI prescriptions varied from 11.4% in 2011 to 12.1% in 2013. Adherence to SSRI and SNRI prescriptions ranged from 31.2% in persons aged 95 years in 2011 to 41.8% in persons aged 75-84 years in 2013. Persons adherent to SSRI and SNRI prescriptions were more likely to be adherent to the other medications, after adjustment for age, gender, and number of drugs prescribed. The highest association was found for adherence to psychiatric drugs (OR = 1.9; 95% CI, 1.8-2.0).Adherence to SSRI and SNRI prescriptions is poor in older persons. However, people adherent to these classes of antidepressants are more likely to be adherent to the other medications they are prescribed. Studies are needed to evaluate the reasons for and the potential benefits of increasing adherence to antidepressants on overall adherence.
Ranucci M.,IRCCS Policlinico San Donato Intensive Care |
Baryshnikova E.,IRCCS Policlinico San Donato Intensive Care |
Crapelli G.B.,IRCCS Policlinico San Donato Intensive Care |
Woodward M.K.,Grifols |
And 2 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2013
Objectives: Purified antithrombin supplementation in cardiac surgery has been suggested for the treatment of heparin resistance and the prevention of thromboembolic complications. This study is a randomized controlled trial of preoperative purified antithrombin supplementation, with the primary end point of avoiding low (<58%) postoperative antithrombin activity levels and secondary end points including avoidance of heparin resistance, clinical outcome, and safety end points. Methods: Two hundred patients were randomly allocated to the antithrombin group and the control group. Patients in the antithrombin group received a dose of purified antithrombin to reach an antithrombin activity value of 120%, whereas patients in the control group did not receive antithrombin. Results: The antithrombin activity values were significantly higher in the antithrombin group at all postoperative determinations until discharge. Antithrombin activity levels <58% at admission to the intensive care unit were found in 26.6% of patients in the control group versus none in the antithrombin group (P = .001). Heparin resistance rate was significantly (P = .001) higher in the control group (38.2%) versus the antithrombin group (17%). Patients in the antithrombin group had a significant but clinically irrelevant (8 mL/hour) higher postoperative bleeding, with no differences in transfusion rates. No differences were found for clinical outcomes, and no safety issues were identified. Conclusions: Preoperative antithrombin supplementation prevents heparin resistance and avoids excessive postoperative decrease of antithrombin activity. Copyright © 2013 by The American Association for Thoracic Surgery.
Ranucci M.,Intensive Care Unit |
Conti D.,Intensive Care Unit |
Castelvecchio S.,Intensive Care Unit |
Menicanti L.,IRCCS Policlinico S. Donato |
And 3 more authors.
Annals of Thoracic Surgery | Year: 2010
Background: Preoperative anemia and the lowest registered hematocrit value on cardiopulmonary bypass are recognized risk factors for morbidity and mortality after coronary operations. A low hematocrit often results in blood transfusions with all of the associated possible complications. The relative contribution of these three factors to long-term outcome is still not well established. This study aimed to identify the role of preoperative anemia and hemodilution during cardiopulmonary bypass as determinants of morbidity and mortality after coronary operations. Methods: A consecutive series of 3,003 patients was analyzed. They had all undergone isolated coronary operations without receiving blood transfusions during their hospital stay. The preoperative hematocrit and the lowest hematocrit on cardiopulmonary bypass were analyzed in a multivariable model as predictors of major morbidity and operative mortality. Results: After adjustment for the other explanatory variables, both the preoperative hematocrit and the lowest hematocrit on cardiopulmonary bypass were found to be independent risk factors for major morbidity, but not for operative mortality. However, low values of preoperative hematocrit were not associated with an increased morbidity, provided that the lowest hematocrit on cardiopulmonary bypass was maintained above 28%. Median values of the lowest hematocrit on cardiopulmonary bypass below 25% were associated with an increased major morbidity rate. Conclusions: Excessive hemodilution during cardiopulmonary bypass is a risk factor for major morbidity even in the absence of blood transfusions. Techniques that aim to reduce the fall in hematocrit during cardiopulmonary bypass, including blood cardioplegia, may be useful, especially in patients with a low preoperative hematocrit. © 2010 The Society of Thoracic Surgeons.
Invernizzi A.,University of Milan |
Cigada M.,University of Milan |
Savoldi L.,Scientific Directorate |
Cavuto S.,Scientific Directorate |
And 2 more authors.
British Journal of Ophthalmology | Year: 2014
Purpose: To assess the effectiveness of spectral domain optical coherence tomography (SD-OCT) in providing in vivo measurements of iris thickness in healthy and pathological subjects. Methods: 14 healthy volunteers and 14 patients with unilateral Fuchs' uveitis were enrolled in the study. The two groups were comparable for age, gender and race. Each subject underwent complete clinical examination and anterior segment SD-OCT imaging in both eyes. SD-OCT scans of the iris were performed following a cross-sectional pattern. Iris thickness values were obtained using a purposely developed software-based analysis of OCT images. Measurements were carried out twice by two trained independent operators to assess intraobserver and interobserver repeatability. Analysis of iris thickness was conducted in four main quadrants: superior, inferior, nasal and temporal. Iris thickness values from normal subjects were compared with the ones measured in the affected and fellow eyes of patients with Fuchs' uveitis. Results: Iris thickness measurements showed good intraobserver and interobserver repeatability (intraclass correlation coeffi cient >0.971). Superior and temporal iris sectors showed respectively thickest and thinnest values in all groups. In healthy eyes, iris thickness ranged from 327.92±37.29 μm temporally to 405.25 ±48.49 μm superiorly. Iris thickness measurements in the affected eyes of Fuchs' uveitis patients ranged from 285.48±56.02 μm temporally to 376.12±60.97 μm superiorly. Multiple comparison analysis showed iris thickness values to be signi ficantly lower in eyes affected by Fuchs' uveitis than both in fellow eyes (p<0.001) of the same patients and in healthy eyes (p=0.0074). Conclusions: SD-OCT is a suitable technique for iris thickness assessment. Thickness analysis must be carried out using a sectorial approach, taking into consideration anatomical variations existing between different iris regions. SD-OCT is a potentially useful tool for detecting iris thickness variations induced by pathological conditions such as Fuchs' uveitis.
Ranucci M.,IRCCS Policlinico S. Donato |
Castelvecchio S.,IRCCS Policlinico S. Donato |
Menicanti L.,IRCCS Policlinico S. Donato |
Frigiola A.,IRCCS Policlinico S. Donato |
Pelissero G.,Scientific Directorate
European Journal of Cardio-thoracic Surgery | Year: 2010
Background: The European system for cardiac operative risk evaluation (EuroSCORE) is currently used in many institutions and is considered a reference tool in many countries. We hypothesised that too many variables were included in the EuroSCORE using limited patient series. We tested different models using a limited number of variables. Methods: A total of 11 150 adult patients undergoing cardiac operations at our institution (2001-2007) were retrospectively analysed. The 17 risk factors composing the EuroSCORE were separately analysed and ranked for accuracy of prediction of hospital mortality. Seventeen models were created by progressively including one factor at a time. The models were compared for accuracy with a receiver operating characteristics (ROC) analysis and area under the curve (AUC) evaluation. Calibration was tested with Hosmer-Lemeshow statistics. Clinical performance was assessed by comparing the predicted with the observed mortality rates. Results: The best accuracy (AUC 0.76) was obtained using a model including only age, left ventricular ejection fraction, serum creatinine, emergency operation and non-isolated coronary operation. The EuroSCORE AUC (0.75) was not significantly different. Calibration and clinical performance were better in the five-factor model than in the EuroSCORE. Only in high-risk patients were 12 factors needed to achieve a good performance. Conclusions: Including many factors in multivariable logistic models increases the risk for overfitting, multicollinearity and human error. A five-factor model offers the same level of accuracy but demonstrated better calibration and clinical performance. Models with a limited number of factors may work better than complex models when applied to a limited number of patients. © 2009 European Association for Cardio-Thoracic Surgery.
Ranucci M.,IRCCS Policlinico San Donato |
Di Dedda U.,IRCCS Policlinico San Donato |
Castelvecchio S.,IRCCS Policlinico San Donato |
Menicanti L.,IRCCS Policlinico San Donato |
And 2 more authors.
Annals of Thoracic Surgery | Year: 2012
Background: Preoperative anemia is not considered an operative mortality risk factor by the majority of the risk stratification tools used in cardiac surgery. However, retrospective studies have found associations between preoperative anemia and morbidity and mortality in cardiac operations. The present study compares the postoperative outcome of a group of moderate-to-severe anemic patients with a propensity-matched group of nonanemic patients undergoing cardiac operations. Methods: This is a retrospective study based on 17,056 consecutive patients included in our Institutional Database. A total of 13,843 adult patients with preoperative hematocrit value available were selected for this study; 401 patients had a severe anemia (hematocrit < 30%). From the remaining patients, a control group of 401 non-severely anemic patients was selected with a propensity-based matching. Postoperative morbidity and mortality were compared between the 2 groups. Results: The 2 groups were comparable for preoperative comorbidities and operative details. Anemic patients had a significantly (p = 0.045) higher rate of stroke (1% vs 0%), major morbidity (27.4% vs 17.5%, p = 0.001), and a significantly higher (0.014) operative mortality rate (12.7% vs 7.5%). An additional analysis, inclusive of patients with moderate preoperative anemia, confirmed these results. Conclusions: Moderate-to-severe preoperative anemia is a risk factor for major morbidity and operative mortality in adult cardiac operations. This finding is confirmative of the role of preoperative anemia in determining adverse events in major noncardiac operations. The exclusion of preoperative anemia from the existing risk scores is probably a statistical consequence of the associated comorbid conditions that confound the specific role of anemia as a risk factor. © 2012 The Society of Thoracic Surgeons.
Ranucci M.,Vascular Anesthesia and Intensive Care |
Baryshnikova E.,Vascular Anesthesia and Intensive Care |
Castelvecchio S.,Vascular Anesthesia and Intensive Care |
Pelissero G.,Scientific Directorate
Annals of Thoracic Surgery | Year: 2013
Background: Postoperative bleeding is common after cardiac surgery. Major bleeding (MB) is a determinant of red blood cell (RBC) transfusion, especially in patients with preoperative anemia. Preoperative anemia and RBC transfusions are recognized risk factors for operative mortality. The present study investigates the role of MB as an independent determinant of operative mortality in cardiac surgery. Methods: A single-center retrospective study based on the institutional database of cardiac surgery in the period 2000-2012 was conducted. Sixteen thousand one hundred fifty-four (16,154) consecutive adult patients undergoing cardiac surgery were analyzed. The impact of postoperative bleeding and MB on operative (30 days) mortality was analyzed univariately and after correction for preoperative anemia, RBC transfusions, and other confounders. Results: Postoperative bleeding was significantly (p < 0.001) associated with operative mortality, both in univariate and multivariable models. The main complications associated with MB were thromboembolic complications, infections, and surgical reexploration. In a multivariable model, MB remained an independent predictor of operative mortality (odds ratio, 3.45; 95% confidence interval, 2.78 to 4.28). Preoperative anemia and RBC transfusions coexist in the model, acting with a multiplying effect when associated with MB. Conclusions: Major bleeding is per se a risk factor for operative mortality. However, its deleterious effects are strongly enhanced by RBC transfusions and, to a lesser extent, preoperative anemia. Major bleeding is a partially modifiable risk factor, and adequate preemptive and treatment strategies should be applied to limit this event. © 2013 The Society of Thoracic Surgeons.