Conflicting results come from epidemiological studies on the correlations between gender and pain in hospitalized patients. No specific data are reported in patients admitted to Internal Medicine ...Units (IMUs). Post-hoc analysis of the FADOI-DOMINO study, performed in 26 IMUs in Italy, with two cross-sectional surveys interspersed with an educational program. The 5200 medical charts of the FADOI-DOMINO study were re-analyzed. The following sex differences were highlighted: i) a greater pain prevalence was evidenced in women in the Pre-phase; ii) among patients with chronic pain, anxiety and depression were significantly more present in women compared with men; iii) oncologic pain was more prevalent in men; in a specular way, nononcologic pain showed a greater prevalence in women in both phases; iv) strong opioids therapy was higher for men. Some sex differences in pain seem to exist in IMUs, although less evident if compared with those previously reported in other settings. A more careful assessment of coexisting conditions such as anxiety, depression or cognitive impairment can result in a better management of these problems.
We present here the results from dynamical and thermal models that describe a channeled lava flow as it cools by radiation. In particular, the effects of power-law rheology and of the presence of ...bends in the flow are considered, as well as the formation of surface crust and lava tubes. On the basis of the thermal models, we analyze the assumptions implicit in the currently used formulae for evaluation of lava flow rates from satellite thermal imagery. Assuming a steady flow down an inclined rectangular channel, we solve numerically the equation of motion by the finite-volume method and a classical iterative solution. Our results show that the use of power-law rheology results in relevant differences in the average velocity and volume flow rate with respect to Newtonian rheology. Crust formation is strongly influenced by power-law rheology; in particular, the growth rate and the velocity profile inside the channel are strongly modified. In addition, channel curvature affects the flow dynamics and surface morphology. The size and shape of surface solid plates are controlled by competition between the shear stress and the crust yield strength: the degree of crust cover of the channel is studied as a function of the curvature. Simple formulae are currently used to relate the lava flow rate to the energy radiated by the lava flow as inferred from satellite thermal imagery. Such formulae are based on a specific model, and consequently, their validity is subject to the model assumptions. An analysis of these assumptions reveals that the current use of such formulae is not consistent with the model.
Summary
Hospitalised medical patients are at increased risk of venous thromboembolism (VTE), but the incidence of hospitalisation-related VTE in unselected medical inpatients has not been extensively ...studied, and uncertainties remain about the optimal use of thromboprophylaxis in this setting. Aims of our prospective, observational study were to assess the prevalence of VTE and the incidence of symptomatic, hospitalisation-related events in a cohort of consecutive patients admitted to 27 Internal Medicine Departments, and to evaluate clinical factors associated with the use of thromboprophylaxis. Between March and September 2006, a total of 4,846 patients were included in the study. Symptomatic VTE with onset of symptoms later than 48 hours after admission (”hospital-acquired” events, primary study end-point) occurred in 26 patients (0.55٪), while the overall prevalence of VTE (including diagnosis prior to or at admission) was 3.65٪. During hospital stay antithrombotic prophylaxis was administered in 41.6٪ of patients, and in 58.7% of those for whom prophylaxis was recommended according to the 2004 Guidelines of the American College of Chest Physicians. The choice of administering thromboprophylaxis or not appeared qualitatively adherent to indications from randomised clinical trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Data from our real-world study confirm that VTE is a relevant complication in patients admitted to Internal Medicine Departments, and recommended tromboprophylaxis is still under-used, in particular in some patients groups. Further efforts are needed to better define risk profile and to optimise prophylaxis in the heterogeneous setting of medical inpatients.
Chronic obstructive pulmonary disease (COPD) is one of the most frequent pathologies among patients hospitalized in Internal Medicine (IM) Departments. COPD is frequently associated with concomitant ...diseases, which represent major causes of death, and affect disease management. Objectives of our study are to assess the prevalence of COPD patients in IM, to evaluate their comorbidity status, and to describe their complexity, by means of the validated multidimensional prognostic index (MPI) score. COMPLEXICO is an observational, prospective, multicenter study, enrolling consecutive patients hospitalized for any cause in IM, with diagnosis of COPD documented by spirometry. A total of 1002 patients in 43 IM Units in Italy were enrolled. The prevalence of COPD in IM was found to be 18.1%, and 72.8% of patients had at least three chronic diseases other than COPD. The mean MPI was 0.43±0.15, and according to a stratification algorithm 31.8% of patients were classified as having low-risk, 58.9% moderate-risk and 9.3% severe-risk of adverse outcome. More than two-thirds of COPD patients in our study present moderate to severe risk of poor outcome according to the MPI stratification.
Abstract Background Osteoporotic vertebral fractures (VFs) are often misdiagnosed because asymptomatic and occurring in the absence of specific trauma. Further, diagnostic assessment of VFs may be ...suboptimal. Aim of the study To assess the misdiagnosis of vertebral fractures on local radiographic readings in the cohort of patients enrolled in the POINT study. Methods We enrolled hospitalised patients, admitted for any cause to the Internal Medicine Units of 37 hospitals participating to the cross-sectional previously published POINT study. The assessment of VFs was performed both by local radiologists and by two expert skeletal radiologists, by using semiquantitative method (SQ). To better evaluate mild vertebral deformities, the two central radiologists also used the algorithm-based qualitative assessment (ABQ). Results The radiographs of 661 patients (401 females; mean age 75.8 ± 8.0) were evaluated. The inter-reader percent agreement between two central expert radiologists per-vertebra assessment was excellent (99.78%; k = 0.984; 95% CI, 0.977–0.991 ). Central reading identified 318/661 (48.1%) patients with at least one VF. Local and central readings agreed in 502/661 (75.9%) patients, resulting in a fair reproducibility (k = 0.52; 95% confidence interval 0.44–0.59 ). Diagnostic performance parameters of local readings were: sensitivity 76.1%; specificity 75.8%; PPV 74.46%; NPV 77.38%). By examining 9254 vertebrae, central and local readers diagnosed 665 (7.2%) and 562 (6.1%) VFs respectively. Misdiagnosis (102 false positives and 205 false negatives) mainly occurred for mild VFs. Local readings identified correctly 460 out 665 VFs diagnosed by central readings, resulting in sensitivity of 69.2% and PPV of 81.8%. Conclusions Following a standardized protocol of acquisition techniques and of interpretation criteria, an excellent agreement between local and central readings for moderate and severe vertebral fractures resulted. However a significant amount of mild vertebral fractures, that are the most of VFs, were misdiagnosed by local radiologists. In order to improve VFs assessment, the radiologists should be trained and sensitized in relation to the relevant clinical significance of osteoporotic VFs identification.
Abstract
Background and Aim
Post-discharge prophylaxis for venous thromboembolism (VTE) is a challenging issue in patients hospitalised in Internal Medicine Units (IMUs). The aim of this study was ...to evaluate the frequency and the factors associated with post-discharge prophylaxis for VTE in IMUs.
Methods
Multi-centre, retrospective study including consecutive patients who were admitted for any cause and discharged from an IMU.
Results
Overall, 3,740 patients (mean age 74.1 ± 15.7 years) were included in the study at 38 IMUs in Italy. At discharge, the percentage of patients receiving pharmacological thromboprophylaxis was 16.0% (20.1% after excluding patients treated with anticoagulants for indications other than VTE prophylaxis). At multivariable analysis, history of ischaemic stroke, hypomobility ≥ 7 days, central venous catheter, ≥ 10 versus ≤ 5 days of hospital stay, use of corticosteroids, cancer, history of falls, availability of a caregiver, infections and age were significantly associated with thromboprophylaxis, while an inverse correlation was observed with concomitant anti-platelet drugs and platelet count < 70,000/mm
3
. Patients with a Padua Prediction Score ≥ 4 versus < 4 and with an IMPROVE bleeding score ≥ 7 versus < 7 more frequently received prophylaxis at discharge (31.2% vs. 10.6%,
p
< 0.0001, and 25.7% vs. 19.6%,
p
= 0.028, respectively).
Conclusion
In this study, one in five patients discharged from an Italian IMU received prophylaxis for VTE. The perceived thrombotic risk is significantly related to the use of prophylaxis.
Background: Nursing home-acquired pneumonia (NHAP) was described in 1978, but only in 2005 it has been proposed as part of a new category (health care-associated pneumonia) distinct from community- ...or hospital-acquired infections. However, limited clinical data exist to validate this proposal. Aim of the study: To compare characteristics and outcome of patients hospitalised for pneumonia and coming from private residence or nursing home. Methods: Post-hoc analysis of the prospective phase of the FASTCAP study, performed to evaluate the impact of the Recommendations issued by the Italian Federation of Internal Medicine (FADOI) in 2002 on the management of hospitalised community-acquired pneumonia (CAP). Results: The study examined 1,219 patients coming from private residence, and 179 with NHAP. Failures of therapy were significantly more frequent in patients with NHAP (35.8% vs 24.9%; Odds Ratio 1.48; 95% confidence interval 1.05-2.09). Mortality was higher in patients coming from nursing home (24.0% vs 9.8%; OR 2.59; 95% CI 1.72-3.90). Antibiotic treatment was more frequently performed as monotherapy in case of NHAP. Conclusions: At the time of FASTCAP, NHAP was included in the category of CAP, and coherently, treatment of NHAP was not more aggressive if compared to community-acquired infections. However, our results confirm that NHAP is at increased risk for worst outcome, and probably worth considering for specific therapeutic strategies. Future studies are needed to better assess the microbiology of NHAP, and to evaluate if specific treatments, as those recommended by recent guidelines, may improve the outcome for these high-risk patients.
Introduction: Several studies show that physical activity can reduce the risk of cardiovascular disease, but the vast majority of these focus on the short- to intermediate-term benefits or refer to ...very specific populations. This observational study was conducted to determine whether physical activity performed during the third or fourth decade of life influences the occurrence of cardiovascular events in patients aged 65-75 years. Materials and methods: We studied a cohort of 2191 unselected patients admitted to Internal Medicine Departments. Data were collected on the patients’ medical history and their physical activity level when they were 20 to 40 years old. For the latter purpose, we used a specific questionnaire to assess the levels of physical activity related to the patients’ job, daily life, leisure time, and sports. Results: Almost half (44.2%) of the patients we evaluated reported moderate-intense physical activity when they were 20-40 years old. Around one third (35.8%) of the patients had experienced at least one major cardiovascular event, and there was a slight trend towards fewer cardiovascular events in patients with histories of physical activity (mean risk reduction: 4%, multivariate analysis). More evident benefits were observed in the subgroup of patients with diabetes, where cardiovascular outcomes were much better in patients who had been physically active than in those with sedentary life-styles (mean risk reduction: 24%). Conclusions: Given its design, our study may have underestimated the cardiovascular benefits of physical activity. Nonetheless, our results suggest that moderate-intense exercise during young adulthood may have limited beneficial effects on cardiovascular disease in old age, except in specific high-risk populations (diabetic patients). More evident benefits are probably associated with regular physical activity throughout life.
Background: Wireless vital parameter continuous monitoring (WVPCM) after discharge is compared to regular monitoring to provide data on the clinical-economic impact of complex patients (CPs) ...discharged from Internal Medicine Units of Ospedale dei Castelli, Lazio. Primary outcome: Major complications (MC) reduction. Secondary outcomes: Patients who reached discharge criteria within the 7th day from admission; difference in MC incidence at the conclusion of the standard telemonitoring/clinical monitoring phase, 5 and 30 days after discharge; and conditions predisposing to MC occurrence. Methods: Open label randomized controlled trial with wearable wireless system that creates alerts on portable devices. Continuous glycemic monitoring is performed for patients with diabetes mellitus. Results: There were 110 patients enrolled (mean age: 76.2 years). Comorbidity: Cumulative Illness Rating Scale CIRS-CI (comorbidities index): 3.93, CIRS SI (severity index): 1.93. About 19% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. Globally, 48% of patients in the control group had major complications (27 out of 56 patients), in contrast to 22% in the intervention group (12 out of 54 patients). Conclusions: Since WVPCM detects early complications during the post-discharge CPs monitoring, it increases safety and reduces inappropriate access to the Emergency Room, preventing avoidable re-hospitalizations.
SUMMARY
Bends in lava channels are often observed in volcanic fields. The curvature of a channel affects flow dynamics and surface morphology and may be a trigger for the formation of lava tube. We ...propose a model to describe the effects of curvature on velocity, shear stress and the formation of crust at the flow surface. Lava is described as a Newtonian, homogeneous, isotropic and incompressible fluid. The steady‐state solution of the Navier‐Stokes equation is found for a unidirectional flow, in cylindrical coordinates. The flow levees are described as arcs of concentric circumferences, with their centres in the origin of the coordinate system. Under the assumption that the gravity force has no radial component, in the bend the fluid moves parallel to the levees. The velocity is assumed to depend on the radial coordinate only. As an effect of curvature, velocity and shear stress are asymmetric with respect to the centre of the channel. The maximum of surface velocity is shifted toward the internal levee, and the shear stress has larger values close to the internal levee. This effect is greater for wider channels. Heat radiation and convection into the atmosphere are considered as the main cooling mechanisms and the temperature distribution along the channel is calculated. Crust formation at the flow surface is considered under the assumption that solid lava is a plastic body. The amount of crust coverage is mainly controlled by the channel width: narrow channels have a greater coverage than wide channels for a given radius of curvature. The effect of a bend is to favour the crust growth toward the internal levee, while the crust coverage toward the external levee decreases. The presence of a bend in a lava channel may favour the formation of a lava tube. The analytical solution will serve as a benchmark for numerical models. Understanding the mechanism of formation of lava tubes is crucial to the simulation of actual lava flows and to evaluation of the associated hazard.
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