3,664 research outputs found
COPD EXACERBATIONS IN THE EMERGENCY DEPARTMENT: EPIDEMIOLOGY, RELATED COSTS, AND VALIDATION OF THE RISK ASSESSMENT MODEL BAP-65.
No full textSintesi in lingua italiana – Parte prima Nei pazienti con BPCO, le riacutizzazioni sono una frequente causa di accesso in pronto soccorso e possono condizionarne negativamente la prognosi. Obiettivi dello studio erano: 1) descrivere le caratteristiche socio-demografiche e cliniche, nonché la gestione in pronto soccorso dei pazienti con riacutizzazione di bronco-pneumopatia ostruttiva cronica (BPCO); 2) stimarne i costi. Abbiamo condotto uno studio di coorte retrospettivo in Italia, raccogliendo dati su 4,396 pazienti da 34 centri. I pazienti avevano un’età media (deviazione standard [DS]) di 77 (11) anni, ed erano femmine nel 39% dei casi. Oltre il 70% dei pazienti presentava un indice di comorbidità moderato o severo, e nel 26% dei casi era presenta anche una diagnosi di scompenso cardiaco. Il 65% dei pazienti è stato ospedalizzato, per una durata media (DS) di 11 (10) giorni. Il costo stimato per paziente è 2.617 €. In conclusione, I pazienti che afferiscono in pronto soccorso con una riacutizzazione di BPCO sono anziani e gravate da importanti comorbidità. Il tasso di ricovero in questi pazienti è alto, e i costi onerosi. Sintesi in lingua italiana – Parte seconda Le riacutizzazioni di BPCO esitano frequentemente in ospedalizzazione, possono richiedere il trattamento con ventilazione invasiva e sono associate a elevata mortalità intraospedaliera. Il BAP-65 è modello di predizione del rischio di eventi avversi per pazienti con riacutizzazione di BPCO. Il BAP-65 è semplice da utilizzare e, se la sua accuratezza prognostica fosse confermata, potrebbe essere utilizzato per guidare la gestione dei pazienti. Abbiamo condotto uno studio retrospettivo, multicentrico in pazienti che afferivano in pronto soccorso per una riacutizzazione di BPCO durante il 2014. Lo scopo dello studio era validare il modello BAP-65 per la predizione dell’outcome combinato mortalità intraospedaliera e ricorso alla ventilazione invasiva. Abbiamo arruolato 2.908 pazienti da 20 centri Italiani. L’età media (DS) era 76 (11) anni, e il 38% dei pazienti era femmina. L’outcome combinato si è verificato nel 5% dei pazienti. L’area sotto la curva (AUROC) stimata per l’outcome combinato è risultata pari a 0,64 (95%CI 0,59-0,68). Un punteggio BAP-65 ≥ 4 ha mostrato una sensibilità pari a 44% (95% CI 34%-55%) nel predire la mortalità intraospedaliera, con specificità 84% (95% CI 82%-85%), valore predittivo positivo 9% (95% CI 6%-12%) e valore predittivo negativo 98% (95% CI 97%-98%). In conclusione, il modello BAP-65 non ha dimostrato accuratezza sufficiente per un’efficacie stratificazione del rischio di prognosi infausta nella popolazione studiata. DOI del primo articolo: https://doi.org/10.1016/j.ejim.2018.01.010 DOI del secondo articolo: https://doi.org/10.1016/j.ejim.2018.10.018.Abstract part 1 Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) frequently cause patients with COPD to access the emergency department and have a negative impact on the course of the disease. The objectives of our study were: 1) describing the socio-demographic and clinical characteristics, and the clinical management, of patients with AECOPD, when they present to the emergency department; and 2) estimating the costs related to the management of these patients. We conducted a retrospective cohort study in Italy, collecting data on 4,396 patients, from 34 centres. Patients had a mean (SD) age of 76,6 (10.6) years, and 61.2 % of them where males. More than 70 % of the patients had a moderate to very high comorbidity burden, and heart failure was present in 26.4 % of the cohort. The 64.6 % of patients were admitted to hospital wards, with a mean (SD) length of stay of 10.8 (9.8) days. The estimated cost per patient was 2617 €. Conclusions: Patients attending the ED for an AECOPD are old and present important comorbidities. The rate of admission is high, and costs are remarkable. Abstract part 2 Exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently require hospitalizations, may necessitate of invasive mechanical ventilation (IMV), and are associated with a remarkable in-hospital mortality. The BAP-65 score is a risk assessment model (RAM) based on simple variables, that has been proposed for the prediction of these adverse outcomes in patients with AECOPD. If showed to be accurate, the BAP-65 RAM might be used to guide the patients management, in terms of destination and treatment. We conducted a retrospective, multicentre, chart-review study, on patients attending the ED for an AECOPD during 2014. The aim of the study was the validation of the BAP-65 RAM for the prediction of in-hospital death or use of IMV (composite primary outcome). We assessed the discrimination and the prognostic performance of the BAP-65 RAM. We enrolled 2908 patients from 20 centres across Italy. The mean (standard deviation) age was 76 (11) years, and 38% of patients were female. The composite outcome occurred in 5.3% of patients. The AUROC of BAP-65 for the composite outcome was 0.64 (95%CI 0.59-0.68). The sensitivity of BAP-65 score ≥ 4 to predict in-hospital mortality was 44% (95% CI 34%-55%), the specificity was 84% (95% CI 82%-85%), the positive predictive value was 9% (95% CI 6%-12%), and the negative predictive value was 98% (95% CI 97%-98%). Conclusions: In patients attending Italian EDs with an AECOPD, we found that the BAP-65 score did not have sufficient accuracy to stratify patients upon their risk of severe in-hospital outcomes. DOI of published article # 1: https://doi.org/10.1016/j.ejim.2018.01.010 DOI of published article # 2: https://doi.org/10.1016/j.ejim.2018.10.018
Computed tomography to assess risk of death in acute pulmonary embolism : a meta-analysis
No full textThe aim of this study was to evaluate whether right ventricle dilation at computed tomography (CT) angiography can be used to assess the risk of death in patients with acute pulmonary embolism. Medline and EMBASE were searched up to April 30, 2013. Studies reporting on the association between right ventricle dilation (right-to-left ventricle diameter) or dysfunction (inter-ventricular septal bowing) at CT angiography and death at 30 days, as well as at 3 months in patients with acute pulmonary embolism, were included in a systematic review and meta-analysis. CT-detected right ventricle dilation was associated with an increased 30 day-mortality in all-comers with pulmonary embolism (OR 2.08 (95% CI 1.63-2.66); p0.00001) and in haemodynamically stable patients (OR 1.64 (95% CI 1.06-2.52); p=0.03), as well as with death due to pulmonary embolism (OR 7.35 (95% CI 3.59-15.09); p0.00001). An association between right ventricle dilation and 3-month mortality was also observed (OR 4.65 (95% CI 1.79-12.07); p=0.002). Right-to-left ventricle dilation as assessed by CT angiography can be used to evaluate risk of death in all-comers with pulmonary embolism and in haemodynamically stable patients
Milano consolato nell' elettione a questo arciuescouado, e promotione alla sagra porpora dell' eminentissimo Federico Visconti : colla sua solennissima entrata seguita a' 11. genaro 1682 e fontioni antecedenti /
No full textFrontispiece coat of arms of Milan, engraved by Federico Agnelli.Signatures: pi⁴ A-G⁴ H⁴(-H4).Mode of access: Internet.Binding: limp vellum. Author & title written on spine
Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism : systematic review and meta-analysis
No full textSummary: Background: In patients with acute pulmonary embolism (PE), risk stratification is indicated for tailoring of both diagnostic strategies and acute treatment. Whether embolic burden assessed at computed tomography (CT) angiography has a role in risk stratification in these patients is debated. Objective: To systematically review and perform a meta-analysis to evaluate the role of CT-assessed burden associated with embolic obstruction and embolic localization in the prognostic stratification of patients with acute PE. Methods: We performed a systematic search in EMBASE and MEDLINE up until 30 June 2013. Studies reporting on the 30-day outcome of patients with confirmed PE and CT-assessed embolic burden were included. The study outcome was death. Results: Thirty studies reporting on the prognostic value of CT-assessed embolic burden met the inclusion criteria for this systematic review; of these, 19 were included in the meta-analysis. Five studies (2215 patients) were included in the analysis of localization: an association between embolus localization in the central arteries and 30-day mortality was found after heterogeneity was resolved (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.29-3.89, I2 = 0%). No correlation was observed between obstruction index (according to the Qanadli scoring system) and 30-day mortality after heterogeneity was reduced (16 studies, 3884 patients, OR 1.22, 95% CI 0.99-1.51, I2 = 27%). Conclusion: Localization of emboli assessed at CT angiography can be used for risk stratification in patients with acute PE. Moreover, no correlation was observed between obstruction index and prognosis
»It contained harbours that pleased me like sonnets«. Kleine Poetik der diegetischen Karte
No full textIn this article, Federico Italiano explores the relationship between literature and cartography. Beginning with Stevenson’s Treasure Island, the author frames the topic through a general theoretical lens on the spatial dimension of literary texts. He then focuses on a specific phenomenon of literary "carticity"—the diegetic presence of the map, that is, the map as an integral element of the narrative structure. Among others, Italiano examines the works of Houellebecq and Cormac McCarthy
Portrait of the Author in (Him/Her)self
No full textA fragment of a philosophical essay by Jean-Luc Nancy and Federico Ferrari titled Iconographie dell’auteur (Paris, 2005), published for the first time in Polish, that addresses the problem of a relationship between the image of the author and his/her work
Aneddoti e ricette a corte di Federico II nel XXI secolo : il buon cibo e il buon bere nel più antico Ateneo pubblico al mondo
No full text[Italiano]: Questo volume rappresenta la finalizzazione di una iniziativa nata, condivisa ed interamente realizzata all'interno del gruppo social dei "Prof in cucina e in Cantina", che ha inteso raccogliere ricette e descrizioni aneddotiche di singoli Autori, appartenenti ai ruoli del personale docente e tecnico-amministrativo-bibliotecario dell'Ateneo federiciano, il più antico Ateneo pubblico al mondo. Aneddoti e ricette forniscono spaccati di vita quotidiana e ricostruzioni di eventi che hanno accompagnato gli Autori nei diversi percorsi formativi, sociali e lavorativi, e che non escludono riferimenti al recente periodo emergenziale della pandemia COVID-19. Ad introdurre il Volume è un menù federiciano, con una proposta di 3 pietanze che attualizzano ricette ed abitubini alimentari dell'epoca, e che hanno come riferimento il Liber de coquina, edito a corte di Federico II. Gli 8 Capitoli del volume raggruppano ricette e aneddoti per categorie, e ciascuno di essi è poi preceduto da un breve inserto con ulteriori riferimenti storici all'alimentazione a Corte di Federico II. Così, atmosfere vecchie e nuove, accompagnate dal sentore di aromi e da suggestioni ispirate al vissuto di ciascun Autore, si fondono per offrire a Lettrici e Lettori frammenti di quotidianità vissuti oggi a corte di Federico II, nel XXI secolo./[English]: The Volume represents the endpoint of a recent initiative, which was conceived, shared and fully realized within the social group of the "Prof in Cucina e in Cantina". Here, the several Authors, represented by the teaching and the technical/administrative/librarian staff of the Federico II University in Naples, the oldest public University in the world, propose recipes and anecdotal descriptions of their educational, social and work-related paths, including some episodes from the recent COVID-19 pandemic. A menu inspired to Frederick II introduces the book, with 3 recipes inspired to the Liber de coquina, a cooking manual compiled at the Emperor's court. Each of the following 8 thematic chapters of the book is also anticipated by a brief insert reporting historical reconstructions of the alimentary habits at the court of Frederick II. Thus, old and new atmospheres, accompanied by the scent of aromas and suggestions inspired by the experience of each Author, come together to offer Readers fragments of everyday life at the court of Frederick II, in the 21st century
Federico De Roberto, «L’imperio»
No full textIl breve saggio analizza l'incipit dell'Imperio di Federico De Roberto mettendo a fuoco come l'Autore riesca a dare una rappresentazione teatrale del parlamento e, con ciò, a desacralizzarne la funzione politica e a ridicolizzarne i principali attori: i parlamentari. Questo incipit è ovviamente funzionale alla successiva narrazione della progressiva delusione politica di Ranaldi.The short essay examines the incipit of "L'imperio" by Federico De Roberto focusing on how the author manages to give a theatrical performance of the parliament and, thereby, to desecration and ridiculing the political function of the main actors: the parliamentarians. This incipit is obviously functional to the narration of the progressive political disappointment of Ranaldi
Federico De Roberto, «L’imperio»
No full textIl breve saggio analizza l'incipit dell'Imperio di Federico De Roberto mettendo a fuoco come l'Autore riesca a dare una rappresentazione teatrale del parlamento e, con ciò, a desacralizzarne la funzione politica e a ridicolizzarne i principali attori: i parlamentari. Questo incipit è ovviamente funzionale alla successiva narrazione della progressiva delusione politica di Ranaldi.The short essay examines the incipit of "L'imperio" by Federico De Roberto focusing on how the author manages to give a theatrical performance of the parliament and, thereby, to desecration and ridiculing the political function of the main actors: the parliamentarians. This incipit is obviously functional to the narration of the progressive political disappointment of Ranaldi
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