Remdesivir is widely used for treatment of SARS-CoV-2 pneumonia. The aim of this study was to evaluate the characteristics of patients with moderate-to-severe COVID-19 treated with remdesivir, and ...their outcomes during hospitalization.
This retrospective observational multicenter study included consecutive patients, hospitalized for moderate-to-severe COVID-19 (September 2020-September 2021), who were treated with remdesivir.
One thousand four patients were enrolled, all with onset of symptoms occurring less than 10 days before starting remdesivir; 17% of patients had 4 or more concomitant diseases. Remdesivir was well tolerated, adverse drug reactions (ADRs) being reported in 2.3% of patients. In-hospital death occurred in 80 patients (8.0%). The median timing of the first remdesivir dose was 5 days after symptom onset. The following endpoints did not differ according to the time span from the onset of symptoms to the first dose: length of hospitalization, in-hospital death, composite outcome (in-hospital death and/or endotracheal intubation). Advanced age, number of comorbidities ≥ 4, and severity of respiratory failure at admission were associated with poor in-hospital outcomes.
In a real-world setting, remdesivir proved to be a safe and well-tolerated treatment for moderate-to-severe COVID-19. In patients receiving remdesivir less than 3 or 5 days from the onset of SARS-CoV-2 symptoms, mortality and the need for mechanical ventilation did not differ from the rest of the sample.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Acute pyelonephritis (aPN) is defined as a severe form of urinary tract infection. Despite its severity and the high incidence in the community setting, there is no consensus on the optimal duration ...of treatment. The aim was to compare effectiveness and tolerability of short- versus long-course treatment with the same antibiotic agent in patients with aPN. We searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2016 for randomized controlled trials (RCTs). Three pairs of authors independently extracted data and appraised risk of bias. We included 4 RCTs (439 participants). Short antibiotic treatment lasted from 4 to 14 days and long treatment from 7 to 42 days but was at least 2 days longer than the corresponding short-course. At the end of treatment, we did not find any significant differences in clinical success risk ratio (RR) 1.01; 95% confidence interval (CI), 0.96-1.07, moderate quality evidence as well as in microbiological success (RR 0.99; 95% CI, 0.92-1.07, very low-quality evidence). At 4-6 weeks after the end of treatment there were no significant differences in clinical relapses (RR 1.20, 95% CI 0.43-3.30, very low-quality evidence) and re-infection of other germs (RR 2.40; 95% CI, 0.68-8.49, very low-quality evidence), even if short-term therapy seemed to have more risk of recurrences (RR 2.39, 95% CI 1.19-4.83, very low quality of evidence). The incidence of any adverse effect seemed to be lower with the short-term therapy, though the results are not statistically significant (RR 0.63, 95% CI 0.39-1.02, low quality evidence). Short-term treatment for aPN seems to be equivalent to long-term treatment in terms of clinical and microbiological success at the end of treatment or tolerability. The only relevant difference is the frequency of recurrence of the same biological germ up to 4-6 weeks after the end of treatment, which is significantly higher with the short-term therapy.
L’interprofessionalità tra evidenze scientifiche e best practiceT.M. Attardo, L. Tesei, A. Montagnani L’impatto della collaborazione interprofessionale nell’organizzazione e nella qualità di curaF. ...Dentali, G. Catania La nutrizione nei pazienti terminali: quali migliori approcciP. Gnerre, G. Riggi, G. Filannino L’iperglicemia e l’ipoglicemia: come prevenirle, come gestirleT.M. Attardo, A. Morselli La sindrome ipocinetica: cosa non ha funzionato? La collaborazione interprofessionale può fare la differenza?M. Frualdo, S. Brovarone, M. Piasentin, S. Lenti L’impatto dell’interprofessionalità sull’incidenza delle infezioni correlate all’assistenzaI. Lo Burgio, A. Toccaceli, D. Dalla Gasperina La cirrosi epatica: quali strategie clinico-assistenziali per migliorare la qualità di vita dei pazientiP. Piccolo, N. Cosentino L’interprofessionalità come strumento per un corretto management del deliriumP. Gnerre, R. Rocchi, D. Clemente Il giro visita congiunto come strumento per una migliore cogestione dei pazientiF. Dentali, A. Vitiello La dimissione dall’ospedale: percorso di condivisione del teamO. Para, R. Rapetti, S. Di Bernardino Quando l’interprofessionalità coinvolge anche il paziente: come fare buona sanità oltre la curaL. Tesei, D. Manfellotto Pillole di interprofessionalità: decalogo FADOI/ANIMO: punti comuni e rilevanti per creare collaborazioni tra professionistiT.M. Attardo, L. Tesei
Amplification in health expectations, increase in new technologies, decrease in economic resources and the breakdown of traditional control systems have led to the development of clinical governance ...(CG). The aim of the present pilot study was to investigate the application of CG tools in significant sample of Italian internal medicine wards (IMW). A 37-item questionnaire was developed and administered to 39 physicians, within 33 IMWs throughout Italy. Thanks to the data analysis, the perceived usefulness, the utilization rate of CG tools, the correlations between CG use, wards characteristics, and/or localization were studied. We identified at what organizational level the CG tools were applied and used. fifty-two percent of the studied tools were being used in the investigated hospitals. The average utility and utilization rate was different depending on the region of provenance. This research showed that CG is a methodology often used by Italian hospitals physicians, especially for inpatient care. The encouraging results of this pilot study could suggest opportunities to extend the survey at national level, to generalize the results.
The aim of the present study was to address it by conducting a clinical audit, one that focused on the quality evaluation of the assistance given to patients with diabetes at the moment of their ...discharge from hospital. The clinical audit was structured in 5 phases: i) preparation; ii) definition of criteria, indicators and standards; iii) retrospective data collection; iv) data analysis, identification of main deviations from standards; v) implementation of corrective measures. Twenty Departments of Internal Medicine from 10 Italian regions retrospectively reviewed medical reports obtaining a data collection from 1332 discharged patients with diabetes. Patients receiving instructions for home glycemic control/discharged patients, showed a mean performance =41.6% (range: 5.0-89.9); patients receiving instructions for hypoglycemic treatment/discharged patients, =32.4% (range: 0.0-92.1); patients receiving instructions for subcutaneous insulin administration/discharged patients, =60.4% (range: 56.5-100.0); patients receiving nutritional scheme or advice/discharged patients, =24.8 (range: 25.4-76.6); patients addressed to ambulatory control/discharged patients, =60.7% (range: 65.6-100.0); and finally patients with HbA1c reported in discharge report/discharged patients, =40.6% (range: 1.75-98.0). Results confirmed that all the levels are well below 70%, the acceptable level of quality. The clinical audit provided data that allows for better identification of deficient clinical behaviors and the addressing of them with specific ameliorative actions; a continuing process of check, re-check and feedback in order to further enhance the quality of assistance given to patients with diabetes discharged from hospital.
Celiac disease (CD) is a complex polygenic disorder, which involves genetic factors human leukocyte complex (HLA) and non-HLA genes, environmental factors, innate and adoptive immunity, and a robust ...chronic T-mediated autoimmune component. The main goal of the present monograph is to define a methodological approach for the disease, characterized by frequent late diagnosis, in order for the physician to become aware of the disease management, the diversity of the clinical presentation itself and in different patients. A unique attention is payed to the specific diagnostic tests to define a correct and accurate application of them, and in addition, to disease follow-up and possible complications. Moreover, a dedicated space is assigned to refractory CD, to potential CD and non-celiac gluten sensitivity. Legislative aspects of the celiac disease in Italy are addressed, too. The celiac disease guidelines and their evaluation by means of Appraisal of Guidelines, Research and Evaluation II instrument allow us to classify the different recommendations and to apply them according to the stakeholders’ involvement, pertinence, methodological accuracy, clarity and publishing independence. Finally, the most current scientific evidence is taken into account to create a complete updated monograph.
Syncope is defined as a transient loss of consciousness (T-LOC) due to temporary global cerebral hypoperfusion. It is characterized by rapid onset, short duration, loss of postural tone possibly ...causing patient fall, and spontaneous full recovery. Syncope has a high prevalence and incidence within the general population with a relevant impact on both quality of life and health care costs. The diagnosis of syncope is often inaccurate and subject to delay, and management is greatly variable. The main objective of this monograph is to discuss a methodological diagnostic approach to signs and symptoms suggestive of syncope, aiming for a management optimization. The present work is based on a systematic review of recent international guidelines.
L’interprofessionalità tra evidenze scientifiche e best practice T.M. Attardo, L. Tesei, A. Montagnani L’impatto della collaborazione interprofessionale nell’organizzazione e nella qualità di cura F. ...Dentali, G. Catania La nutrizione nei pazienti terminali: quali migliori approcci P. Gnerre, G. Riggi, G. Filannino L’iperglicemia e l’ipoglicemia: come prevenirle, come gestirle T.M. Attardo, A. Morselli La sindrome ipocinetica: cosa non ha funzionato? La collaborazione interprofessionale può fare la differenza? M. Frualdo, S. Brovarone, M. Piasentin, S. Lenti L’impatto dell’interprofessionalità sull’incidenza delle infezioni correlate all’assistenza I. Lo Burgio, A. Toccaceli, D. Dalla Gasperina La cirrosi epatica: quali strategie clinico-assistenziali per migliorare la qualità di vita dei pazienti P. Piccolo, N. Cosentino L’interprofessionalità come strumento per un corretto management del delirium P. Gnerre, R. Rocchi, D. Clemente Il giro visita congiunto come strumento per una migliore cogestione dei pazienti F. Dentali, A. Vitiello La dimissione dall’ospedale: percorso di condivisione del team O. Para, R. Rapetti, S. Di Bernardino Quando l’interprofessionalità coinvolge anche il paziente: come fare buona sanità oltre la cura L. Tesei, D. Manfellotto Pillole di interprofessionalità: decalogo FADOI/ANIMO: punti comuni e rilevanti per creare collaborazioni tra professionisti T.M. Attardo, L. Tesei
The presence of anaemia in patients with chronic kidney disease (CKD) is associated with decreased quality of life, along with increased morbidity, mortality, and hospitalization rates. This, in ...turn, affects healthcare costs and the utilization of medical resources. The mechanisms involved in anaemia of CKD are diverse and complex. They include reduced production of endogenous erythropoietin (EPO), absolute and/or functional iron deficiency (due to inflammation leading to elevated levels of hepcidin), the diminished response of the bone marrow to EPO due to uraemic toxins, the shortened lifespan of red blood cells (RBC), and deficiencies in vitamin B12 or folic acid. ...
Audit is a clinical instrument of government characterized by a whole process of evaluation inter pares to improve medical behaviors in the clinical practice. Different endocrinopathies are ...underestimated in the clinical and diagnostics practice but they can be a real problem in patients admitted in the departments of Internal Medicine. The adrenal incidentaloma is an accidental discovery with an incidence equal to 4% in radiologic studies but it's rarely considereted in the internal disorders. In the departments of Internal Medicine are hospitalized each year approximately 1450,000 patients and 58,000 about them show a surrenalic lesion identified with CT or MRI as Adrenal Incidentaloma.
Through a search in the radiological archives, were reviewed all abdominal CT performed in the year 2012 in 8 departments of Internal Medicine of 8 Italian public hospitals. They also examined all medical records of these patients to value clinical management of the adrenal masses and the real incidence of the adrenal incidentaloma.
Distribution of pathological results show an important incidence about adrenal incidentaloma in Italian patients although this pathology is represented as a rare disease and its clinical and economic burden are significant. Many questions remain unanswered as the association between duration and severity of the disease, morbidity and how the dimensions affecting it. These results need to be supported by important studies with long follow-up to realize an easy diagnosis.
The results of this audit confirm the real incidence of this pathology in the internistic patients and the final target is to implement changes about therapeutic diagnostic pathway of the hospital patients in the internal medicine departments.
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