Risultati per: Nota 55

New England Journal of Medicine, Volume 388, Issue 3, Page 214-227, January 2023.

New England Journal of Medicine, Volume 387, Issue 23, Page 2172-2183, December 2022.

Circulation, Volume 146, Issue Suppl_1, Page A14425-A14425, November 8, 2022. Introduction:It is unclear what the rates of carcinoid heart disease (CHD) diagnosis, disparities, and inpatient outcomes are.Methods:We performed the first nationally representative longitudinal analysis of the above using Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) and the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset. The propensity score was modified for the likelihood of developing malignant carcinoid tumor (MCT).Results:From 2016-2018 among 101,521,656 hospitalizations, 55,910 (0.05%) had a malignant carcinoid tumor (MCT), of whom 4,030 (7.20%) had CHD. The rate of CHD diagnosis remained largely stable from 2016 (18,900 [0.06%]) to 2017 (19,025 [0.05%]) to 2018 (17,985 [0.05%]). Patients with versus without CHD had significantly higher unadjusted mortality in 2016 (4.05% versus 2.19%), 2017 (3.75% versus 1.95%), and 2018 (3.75% versus 1.95%). Of patients with CHD, 0.15% had acute carcinoid syndrome. Compared to the racial distribution throughout the population, the diagnosis of CHD was under-represented in Hispanics (12.83% versus 7.95%), Asians (3.13% versus 2.84%), lowest income quartile (29.47% versus 28.07%), second lowest income quartile (26.90% versus 25.41%), metros of 250,000-999,999 residents (20.79% versus 19.73%) and metros of 50,000-249,999 (9.30% versus 8.56%) (all p

Circulation, Volume 146, Issue Suppl_1, Page A334-A334, November 8, 2022. Background:Heart transplant (HTX) candidates often develop cardiogenic shock (CS) and require mechanical circulatory support (MCS). UNOS criteria prioritize temporary MCS over durable left ventricular assist devices (LVADs). Extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump are associated with poor outcome. In early 2020, we transitioned to using axillary Impella 5.5 in CS patients with both isolated LV or biventricular failure as bridge to HTX. This reports our two-year experience.Methods:We performed a retrospective single center chart review. 19 patients treated with Impella 5.5 as bridge to HTX were identified. UNOS criteria were used to classify CS. If inotropes and diuresis failed to resolve CS, Impella 5.5 was placed via a 10 mm graft sewn to the axillary artery. Key endpoints were survival to transplant without disabling stroke, 30-day and 1-year post-HTX survival.Results:Mean age 55 yrs, 89% male, mean Impella support 19 days (2 – 71, total 369). 58% biventricular failure with at least moderate right ventricular dysfunction (RVD). RVD was managed medically, no RV assist device or ECMO was needed. Transient elevation ( >40 mg/dl) of free plasma hemoglobin occurred in 42% but resolved with device repositioning and/or fluids. No renal replacement therapy was required. No serious infectious, vascular or bleeding complication occurred. There was no device malfunction, one pump was replaced due to an exposed wire after 22 days of support. 100% of patients were able to ambulate prior to HTX. Overall survival was 100%. 89% patients were successfully bridged to HTX without major morbidity. Two cases received durable LVAD. One developed non-disabling ischemic stroke on day 16 of Impella support. One elected LVAD as destination therapy after 71 days of support. Stroke free survival during Impella support was 95%. There were no disabling strokes. Post-transplant 30-day survival was 100% (n=17). 1-year post-HTX survival data was 100% (n=10).Conclusion:Impella 5.5 successfully restores hemodynamics in CS in HTX eligible patients with both isolated LV and biventricular failure. RVD in this situation can be managed medically. With this strategy, patients are able to ambulate prior to HTX and survival after HTX exceeds national average.

L’introduzione della Nota 100 da parte dell’Agenzia italiana del farmaco ha riconfigurato le modalità di prescrizione di alcune classi di farmaci per il trattamento del diabete mellito di tipo 2, che possono essere prescritti anche dal medico di famiglia

Stroke, Volume 53, Issue Suppl_1, Page A55-A55, February 1, 2022. Data collection and analysis is essential for stroke center certification, registries and as a public responsibility. When large amounts of data need to be extracted, manual data collection is extremely time consuming. The existing challenge for stroke centers is leveraging technology for efficient data collection and analysis. The purpose of this project was to improve efficiency, analysis and reporting of stroke data by automating manual data extraction with stroke specific data fields built in the electronic health record. The data collected would create individual patient summaries, data reports and a stroke dashboard. The method chosen to accomplish this was by using data moved through an EPIC Clarity Database, our Enterprise Data Warehouse Suite of products, Subject Area Mart (SAM) and Instant Data Entry Application (IDEA app) and 5 SSRS Reports. Use of the innovative IDEA app allows for updating data behind the scenes. This 8-month collaborative project included IT support from a project manager, quality analyst, Power BI developer and SAM/data layer developer. This project resulted in over 250 discrete data points and 25 separate dashboard tabs, including volume, demographics, stroke metrics and outcomes. System-wide stroke data over a 10-month period included an overall volume of 2,814 patients, with 280 receiving tPA or thrombectomy. The option to run individual patient summaries and 5 different auditing reports was included. Estimated staff time savings is over 50 hours per month. In conclusion we have demonstrated it is possible to pull discrete data points from the electronic health record to be used in a dashboard, patient summaries and stroke data reports. The biggest challenge was dividing the large scope of work into manageable stages. A next step is to pull in EMS data through health data exchange. Streamlining data collection and analysis efficiency is essential for the future of a stroke center of excellence.

Risultati positivi dalla Nota che amplia agli mmg la prescrizione di anticoagulanti orali diretti per i soli pazienti con fibrillazione atriale non valvolare. Un percorso che coinvolge sempre di più il territorio e la medicina generale nella presa in carico di pazienti cronici.

La novità della Nota Aifa 99: aspetti positivi e criticità. Le considerazioni del coordinatore Simg area pneumologia Franco Lombardo, del presidente Simg Claudio Cricelli, del responsabile area politica del farmaco Fimmg Roberto Venesia e del pneumologo dell’ospedale Sacco Pierachille Santus.