95 research outputs found
Author Correction: Midbrain circuit regulation of individual alcohol drinking behaviors in mice
No full textThe original version of this Article contained an error in the spelling of the author Scott Edwards, which was incorrectly given as Scott Edward. This has now been corrected in both the PDF and HTML versions of the Article.</jats:p
Place conditioning for cocaine in male and female mice
No full textCocaine use and addiction are common and problematic. Within the past year, 1.3M people had a cocaine use disorder and 20,000 people died of cocaine overdose (NSDUH 2020). The present study had three goals. First, the same behavioral test can produce different results in different laboratories (Crabbe et al., 1999). We hoped to establish conditioned place preference (CPP) for cocaine in our laboratory mice, that was consistent with CPP reported by other laboratories. Second, response to many drugs, such as cocaine, can differ based on biological sex (Becker & Chartoff 2019). We wanted to identify sex differences in cocaine-induced locomotion and cocaine CPP. Third, females’ hormonal status can affect cocaine CPP and cocaine self-administration (Calipari et al., 2017, Johnson et al., 2019). We wanted to evaluate whether females’ estrus stage correlated with the strength of cocaine CPP. The CPP apparatus was composed of two chambers, one with white walls and grid flooring and the other with black walls and bar flooring. During the pre-conditioning session, mice passed freely between the chambers, to identify pre-existing chamber biases; the difference in time spent in each chamber was very small in both males and females. For the conditioning phase, mice were pseudorandomly assigned to receive cocaine (10mg/kg) or saline in each chamber, in an unbiased design (Cunningham et al., 2006). During each conditioning session, mice were injected with cocaine or saline before being placed in that chamber for 30min. Conditioned preference for the cocaine- and saline-paired chamber was then assessed. Both females and males showed an overall preference for the cocaine-paired chamber. The strength of this preference was consistent with existing literature. Control mice conditioned with saline in both chambers did not show an overall preference for either chamber, as expected. Cocaine also elevated locomotor activity during cocaine conditioning sessions; there were no sex differences in this cocaine-induced response. Estrus samples are currently being analyzed. Together, our findings revealed conditioned place preference for cocaine in both sexes, that is consistent with existing literature.Katharine Cammac
Conditioned Place Preference for a Possible Cocaine Antagonist
No full textCocaine use and addiction are common and problematic. Within the past year, 1.3M people had a cocaine use disorder and 20,000 people died of cocaine overdose (NSDUH 2020). The present study had three goals. First, the same behavioral test can produce different results in different laboratories (Crabbe et al., 1999). We hoped to establish conditioned place preference (CPP) for cocaine in our laboratory mice, that was consistent with CPP reported by other laboratories. Second, response to many drugs, such as cocaine, can differ based on biological sex (Becker & Chartoff 2019). We wanted to identify sex differences in cocaine-induced locomotion and cocaine CPP. Third, females’ hormonal status can affect cocaine CPP and cocaine self-administration (Calipari et al., 2017, Johnson et al., 2019). We wanted to evaluate whether females’ estrus stage correlated with the strength of cocaine CPP. The CPP apparatus was composed of two chambers, one with white walls and grid flooring and the other with black walls and bar flooring. During the pre-conditioning session, mice passed freely between the chambers, to identify pre-existing chamber biases; the difference in time spent in each chamber was very small in both males and females. For the conditioning phase, mice were pseudorandomly assigned to receive cocaine (10mg/kg) or saline in each chamber, in an unbiased design (Cunningham et al., 2006). During each conditioning session, mice were injected with cocaine or saline before being placed in that chamber for 30min. Conditioned preference for the cocaine- and saline-paired chamber was then assessed. Both females and males showed an overall preference for the cocaine-paired chamber. The strength of this preference was consistent with existing literature. Control mice conditioned with saline in both chambers did not show an overall preference for either chamber, as expected. Cocaine also elevated locomotor activity during cocaine conditioning sessions; there were no sex differences in this cocaine-induced response. Estrus samples are currently being analyzed. Together, our findings revealed conditioned place preference for cocaine in both sexes, that is consistent with existing literatureKatharine Cammac
Defining Aging Phenotypes and Related Outcomes: Clues to Recognize Frailty in Hospitalized Older Patients
No full textBackground: Because frailty is a complex phenomenon associated with poor outcomes, the identification of patient profiles with different care needs might be of greater practical help than to look for a unifying definition. This study aimed at identifying aging phenotypes and their related outcomes in order to recognize frailty in hospitalized older patients. Methods: Patients aged 65 or older enrolled in internal medicine and geriatric wards participating in the REPOSI registry. Relationships among variables associated to sociodemographic, physical, cognitive, functional, and medical status were explored using a multiple correspondence analysis. The hierarchical cluster analysis was then performed to identify possible patient profiles. Multivariable logistic regression was used to verify the association between clusters and outcomes (in-hospital mortality and 3-month postdischarge mortality and rehospitalization). Results: 2,841 patients were included in the statistical analyses. Four clusters were identified: the healthiest (I); those with multimorbidity (II); the functionally independent women with osteoporosis and arthritis (III); and the functionally dependent oldest old patients with cognitive impairment (IV). There was a significantly higher in-hospital mortality in Cluster II (odds ratio [OR] = 2.27, 95% confidence interval [CI] = 1.15-4.46) and Cluster IV (OR = 5.15, 95% CI = 2.58-10.26) and a higher 3-month mortality in Cluster II (OR = 1.66, 95% CI = 1.13-2.44) and Cluster IV (OR = 1.86, 95% CI = 1.15-3.00) than in Cluster I. Conclusions: Using alternative analytical techniques among hospitalized older patients, we could distinguish different frailty phenotypes, differently associated with adverse events. The identification of different patient profiles can help defining the best care strategy according to specific patient needs. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved
Sex-Differences in the Pattern of Comorbidities, Functional Independence, and Mortality in Elderly Inpatients: Evidence from the RePoSI Register
No full textBackground: The RePoSi study has provided data on comorbidities, polypharmacy, and sex dimorphism in hospitalised elderly patients. Methods: We retrospectively analysed data collected from the 2010, 2012, 2014, and 2016 data sets of the RePoSi register. The aim of this study was to explore the sex-differences and to validate the multivariate model in the entire dataset with an expanded follow-up at 1 year. Results: Among 4714 patients, 51% were women and 49% were men. The disease distribution showed that diabetes, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, and malignancy were more frequent in men but that hypertension, anaemia, osteoarthritis, depression, and diverticulitis disease were more common in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment, mood disorders, and disability in daily life measured by the Barthel Index (BI) were worse in women. In the multivariate analysis, BI, CIRS, and malignancy significantly increased the risk of death in men at the 1-year follow-up, while age was independently associated with mortality in women. Conclusions: Our study highlighted the relevance and the validity of our previous predictive model in the identification of sex dimorphism in hospitalised elderly patients underscoring the need of sex-personalised health-care
Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards
No full textBackground: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic.Objective: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards.Methods: Taking advantage of the "REgistro POliterapie Societa Italiana Medicina Interna" (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain.Results: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p<.0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p<.0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p=.172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p<.0001).Conclusions: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge
Patterns of infections in older patients acutely admitted to medical wards: data from the REPOSI register
No full textDisability, and not diabetes, is a strong predictor of mortality in oldest old patients hospitalized with pneumonia
No full textBackground: Pneumonia causes more deaths than any other infectious disease, especially in older patients with multiple chronic diseases. Recent studies identified a low functional status as prognostic factor for mortality in elderly patients with pneumonia while contrasting data are available about the role of diabetes. The aim of this study was to evaluate the in-hospital, 3-month and 1-year mortality in elderly subjects affected by pneumonia enrolled in the RePoSi register.Methods: We retrospectively analyzed the data collected on hospitalized elderly patients in the frame of the REPOSI project. We analyzed the socio-demographic, laboratory and clinical characteristics of subjects with pneumonia. Multivariate logistic analysis was used to explore the relationship between variables and mortality.Results: Among 4714 patients 284 had pneumonia. 52.8% were males and the mean age was 80 years old. 19.8% of these patients had a Barthel Index <= 40 (p < 0.0001), as well as 43.2% had a short blessed test >= 10 (p < 0.0117). In these subjects a significant CIRS for the evaluation of severity and comorbidity indexes (p < 0.0001) were present. Although a higher fasting glucose level was identified in people with pneumonia, in the multivariate logistic analysis diabetes was not independently associated with in-hospital, 3-month and 1-year mortality, whereas patients with lower Barthel Index had a higher mortality risk (odds ratio being 9.45, 6.84, 19.55 in hospital, at 3 and 12 months).Conclusion: Elderly hospitalized patients affected by pneumonia with a clinically significant disability had a higher mortality risk while diabetes does not represent an important determinant of short and long-term outcome
Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI
No full textThe dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient
Therapeutic Duplicates in a Cohort of Hospitalized Elderly Patients: Results from the REPOSI Study
No full textBACKGROUND:
Explicit criteria for potentially inappropriate prescriptions in the elderly are recommended to avoid prescriptions of duplicate drug classes and to optimize monotherapy within a single drug class before a new agent is considered. Duplicate drug class prescription (or therapeutic duplicates) puts the patient at increased risk of adverse drug reactions with no additional therapeutic benefits. To our knowledge, the prevalence of elderly inpatients receiving therapeutic duplicates has never been studied.
OBJECTIVES:
Our objective was to assess the prevalence of therapeutic duplicates at admission, discharge, and 3-month follow-up of hospitalized elderly patients.
METHODS:
This cross-sectional prospective study was conducted in 97 Italian internal medicine and geriatric wards. Therapeutic duplicates were defined as at least two drugs of the same therapeutic class prescribed simultaneously to a patient. A patient's drug therapy at admission relates to prescriptions from general practitioners, whereas prescriptions at discharge are those from hospital internists or geriatricians.
RESULTS:
The study sample comprised 5821 admitted and 4983 discharged patients. In all, 143 therapeutic duplicates were found at admission and 170 at discharge. The prevalence of patients exposed to at least one therapeutic duplicate rose significantly from hospital admission (2.5 %) to discharge (3.4 %; p = 0.0032). Psychotropic drugs and drugs for peptic ulcer or gastroesophageal reflux disease were the most frequently involved. A total of 86.8 % of patients discharged with at least one therapeutic duplicate were still receiving them at 3-month follow-up.
CONCLUSIONS:
Hospitalization and drugs prescribed by internists and geriatricians are both factors associated with a small but definite increase in overall therapeutic duplicates in elderly patients admitted to internal medicine and geriatric wards. More attention should be paid to the indications for each drug prescribed, because therapeutic duplicates are not supported by evidence and increase both the risk of adverse drug reactions and costs. Identification of unnecessary therapeutic duplicates is essential for the optimization of polypharmacy
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