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Un approccio multidisciplinare integrato bio-psico-sociale nella programmazione dell’attività riabilitativa nelle Residenze Sanitarie Assistenziali (RSA)
No full textObjectives, social role and organization of
Italian nursing homes (RSA) are characterized by a pronounced
regional differentiation that causes situations which are difficult
to compare about expected outcomes. The definition of a
functional outcome is particularly difficult in institutionalized
patients and this is due to the failure of a conclusive moment
of the rehabilitative treatment. Furthermore we often take care
of patients who have already been admitted to intensive and/or
extensive rehabilitation units time after time, without further
functional profit margin. The inconstant presence of professional
figures of rehabilitation in nursing homes’ staff makes difficult
the drafting of an adequate rehabilitative project, especially for
the multiple needs of frail old people. Starting with these
assumptions, authors hypothesize and adopt a model of sanitary
organization to consent a correct allocation of available
resources, according to the patient’s needs. They stratified all
nursing home patients, using the Multidimensional Prognostic
Index (MPI) and “Scheda di osservazione intermedia assistenza”
(SOSIA), and measured the residual function. They concluded
that a multidimensional evaluation of patients allows to identify
wellness (of the sick person and of caregivers) as the main
objective; nursing home organization could be think as a
“complex supportive prosthesis for old people”, made by
the interaction among structure, operators and activities.
In Italia gli obiettivi, il ruolo sociale e
l’organizzazione delle Residenze Sanitarie Assistenziali (RSA)
sono caratterizzati da una marcata differenziazione regionale
che crea situazioni di difficile confronto sugli outcome attesi.
In particolare nel paziente istituzionalizzato è molto difficoltosa
soprattutto la definizione di un outcome funzionale, mancando
un momento conclusivo del trattamento riabilitativo e
trovandoci spesso di fronte a pazienti che hanno già avuto più
ricoveri in regime di riabilitazione intensiva e/o estensiva e
quindi senza più ulteriori margini di guadagno funzionale.
L’incostante presenza di figure professionali della riabilitazione
nell’organico delle RSA, rende difficoltosa la redazione di un
Progetto riabilitativo adeguato alle molteplici esigenze
dell’anziano fragile. Gli autori partendo da questi presupposti
ipotizzano ed applicano un modello di organizzazione sanitaria
per consentire una corretta allocazione delle risorse disponibili,
coerentemente con i bisogni dell’ospite. Dopo aver stratificato
tutti i pazienti residenti in RSA con il Multidimensional
Prognostic Index (MPI) e (Scheda di osservazione intermedia
assistenza) SOSIA e misurato la funzione residua concludono
che la valutazione multidimensionale dell’ospite consente di
identificare nel benessere (del malato e dei caregivers) l’obiettivo
principale da conseguire, ripensando l’organizzazione della
RSA come una “protesi complessa di sostegno all’anziano”,
composta dall’interazione tra struttura, operatori e attivita
Pharmacogenetic Tests in Reducing Accesses to Emergency Services and Days of Hospitalization in Bipolar Disorder: A 2-Year Mirror Analysis
Full text linkDespite the enormous costs associated to mood disorders’, few studies evaluate potential cost saving from the use of pharmacogenetic tests (PGT). This study compares 12 months before the execution of the PGT versus 12 months after, in terms of number and days of hospitalization and accesses to emergency services, in a sample of 30 patients affected by bipolar disorder. Secondarily, the study gives an economic value to the data based on the diagnosis-related group (DRG). Patients included in the study were required to be aged ≥18 years, sign an informed consent, have a score of Clinical Global Impression item Severity (CGIs) ≥3, and have a discordant therapy compared to the PGT in the 12 months preceding it and a therapy consistent with it for the following 12 months. Cost saving has been evaluated by paired t-tests in a mirror analysis. Statistically significant differences in all the comparisons (p < 0.0001) emerged. Important cost saving emerged after the use of PGT (€148,920 the first year versus €39,048 the following year). Despite the small sample size and lack of a control group in this study, the potential role of PGT in cost saving for the treatment of bipolar disorder treatment emerged. To confirm this result, larger and clinical trials are needed
Four clinical cases of recurrent surgery addiction (polyopérés): diagnostic classification in the DSM-IV-TR vs DSM-5
Full text linkThe article presents four clinical cases of patients with the common history of recurrent
surgery. These conditions are interesting first of all for general medicine and surgery, apart
from psychiatry. Indeed, patients with these characteristics are almost invariably subjected to
psychiatric evaluation by internal doctors and surgeons and this is evident in our case reports,
despite the rarity of the phenomenon in latest decades aside from plastic surgery. The first
aim of the study is to compare diagnostic classifications between DSM-IV-TR and DSM-5 in
reference to the case reports of recurrent surgery in order to observe the changes occurring in
the diagnostic criteria and classification and the different attitude of the two manuals towards
these disorders. The second endpoint is to describe the common features and the differences
between the cases that could motivate a different prognostic evolution to raise a hypothesis
that could be a starting point for further research. According to previous classification of
mental disorders in the DSM IV-TR, patients addicted to recurrent surgery are included in the
diagnostic category of “Factitious Disorder with Predominantly Physical Signs and Symptoms”. In
the DSM-5 typical clinical manifestations of recurrent surgery are excluded from diagnostic
criterions of “Factitious Disorder”. The new manual moves away from the classic nosography
tradition and highlights a bigger importance of an objective clinical observation of patients in
comparison with the sole clinical history: the most suitable diagnosis is the “Somatic Symptom
Disorder”
Resilience in older adults: influence of the admission in nursing home and psychopathology
Full text linkObjective: The resilience is the ability to face and overcome the adversities of life. The first aim of the study is to explore this construct referring to ageing. The characteristics of resilience were assessed in older adults, the additional endpoint is to focus on the role of institutionalization in nursing home and on the influence of chronic psychiatric illness. Method: 197 patients (aged 65 and over) have been enrolled in the observational cross-sectional study. The sample was composed by 91 subjects who lived at home (Community-dwelling, group I), 56 subjects who lived in a nursing home (Nursing-home, group II) and 50 subjects who lived in a nursing home, suffering from psychiatric disorders (Psychogeriatric division, group III). The resilience was evaluated through the Resilience Scale (RS) and the Connor-Davidson Resilience Scale (CD-RISC). Results: The mean total score of RS decreased from the group I to the group III (55.4, 49.8 and 46.6, respectively). Moreover, using pairwise comparison among groups, significant differences between the group I and the group II (5.6, p<0.0001) and between the group I and the group III (8.8, p<0.0001) were found. In the CD-RISC total score, significant differences among the three groups (p<0.0001) were observed, with a decrease of the mean values from the group I to the group III (66.2, 62.4 and 56.4, respectively). The pairwise comparison showed significant differences between the group III and the group I (p<0.0001) and between the group III and the group II (p=0.03). Conclusion: The first aim of the study to explore the construct of resilience in reference to ageing both as a dispositional resource and as an environment adjusted strategy of adaptation has been reached: the characteristics of resilience were assessed in older adults. Moreover, the second endpoint has been achieved too as the data showed that resilience skills of older adults are compromised both by institutionalization and by concurrent diagnosis of psychiatric disorder
Medically unexplained physical symptoms in hospitalized patients: A 9-year retrospective observational study
Full text linkIntroduction: “Medically Unexplained Physical Symptoms” (MUPS) defines a subgroup of patients presenting physical symptoms of unclear origin. The study aims to profile clinical and socio-demographic characteristics of patients with MUPS. Materials and Methods: This 9-years observational retrospective study assesses all patients admitted between 2008 and 2016 in the divisions of neurology and gastroenterology. Socio-demographic and clinical variables were evaluated: gender, age, diagnosis or diagnostic hypothesis, presence of psychiatric comorbidities, psychiatric evaluation, pharmacological treatment, number of admissions/visits. Results: Among 2,479 neurological patients 10.1% presented MUPS. Patients were more frequently women (63.5%), with a mean age of about 50 years. Reported symptoms were headache (22.6%), seizures (8.7%), vertigo (5.9%), fibromyalgia (5.5%), paresthesia (5.1%), visual disturbances (5.1%), amnesia (3.9%). The diagnosis was somatoform disorder in 6.3% of cases, conversion disorder in 2.7%, and somatic symptom disorder in 1.5% only. 2,560 outpatients were evaluated in gastroenterology division. 9.6% (n = 248) of patients had MUPS; 62.1% of them were women. The most affected age group ranged between 15 and 45 years. The most frequent diagnoses were functional abdominal pain (50%), dysmotility-like dyspepsia (26.6%), irritable bowel syndrome (10.4%), meteorism of unknown cause (2.4%), hiccup (1.6%), burning mouth syndrome (1.2%). No patients received a diagnosis of somatic symptom disorder. Discussion: Patients with MUPS are more often women, of middle age, with self-referred specific symptomatology. While neurological patients received a diagnostic-therapeutic approach in line with the literature, gastroenterological patients mainly received antipsychotics. A more comprehensive assessment and a development of psychoeducational interventions are needed to improve patients' quality and quantity of life
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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