61 research outputs found
EFFECTIVENESS AND COST-EFFECTIVENESS OF SUPPLEMENTAL GLUTAMINE DIPEPTIDE IN TOTAL PARENTERAL NUTRITION THERAPY FOR CRITICALLY ILL PATIENTS: A DISCRETE EVENT SIMULATION MODEL BASED ON ITALIAN DATA
No full textIntroduction: The supplementation of alanyl-glutamine dipeptide in critically ill patients necessitating total parenteral nutrition (TPN) improves clinical outcomes, reducing mortality, infection rate, a shortening intensive care unit (ICU) hospital lengths of stay (LOSs), as compared to standard TPN regimens. Methods: A Discrete Event Simulation model that incorporates outcomes rates from 200 Italian ICUs for over 60,000 patients, alanyl-glutamine dipeptide efficacy data synthesized by means of a Bayesian random effects meta-analysis, and national cost data has been developed to evaluate the alternatives from the cost perspective of the hospital. Simulated clinical outcomes are death and infection rates in ICU, death rate in general ward, and hospital LOSs. Sensitivity analyses are performed by varying all uncertain parameter values in a plausible range. Results: The internal validation process confirmed the accuracy of the model in replicating observed clinical data. Alanyl-glutamine dipeptide on average results more effective and less costly than standard TPN: reduced mortality rate (24.6% +/- 1.6% vs. 34.5% +/- 2.1%), infection rate (13.8% +/- 2.9% vs. 18.8% +/- 3.9%), and hospital LOS (24.9 +/- 0.3 vs. 26.0 +/- 0.3 days) come at lower total cost per patient (23,409 +/- 3,345 vs. 24,161 +/- 3,523 Euro). Treatment cost is completely offset by savings on ICU and antibiotic costs. Sensitivity analyses confirmed the robustness these results. Conclusions: Alanyl-glutamine dipeptide is expected to improve clinical outcomes and to do so with a concurrent saving for the Italian hospital
Le cri comme l'écriture... Blanchot, Adorno et une écriture de mémoire
No full textThe aim of this article is to develop a critical and theoretical enquiry into the possibility of philosophy after Auschwitz. Starting from the relationship between the screams of the victims and the necessity of writing, the paper addresses the problem of the unspeakable and claims for the creation of a collective memory. Following Adorno, the author argues in favor of a “philosophy of the testimony” that must then be conceived as extreme and perennial lucidity, always implying an act of resistance and non-resignation in face of the inexorable course of the events. A form of resistance sometimes silent and sometimes glaring and dazzling, but all the same a resistance which operates - and must operate - from the inside: from the inside of philosophy and its means, the concepts, from the inside of metaphysics and eventually from the inside of the writing itself
Dora Bruder una pietra d’inciampo per Dora Bruder. Distruzione e ricostruzione della sua memoria nella scrittura di Patrick Modiano
No full textIn this paper I focus on Patrick Modiano’s book Dora Bruder, because in some ways it is the summa of a literary expression of the dialectic between destruction and reconstruction of memory and, also, of the necessity to recover of what was deliberately hidden during the period of German Occupation in France.
In fact, on the basis of an historical research, conducted by the author in archives, and an “intimate” research too, along the Parisian boulevards and cobblestones of a personal or deferred memory of those who remained unknown, this book attempts to bring to light, out of nothingness and silence, the life and portrait of Dora Bruder – a girl of Jewish origin, who lived in Paris during World War II and of whom nothing is known except her final destination.
By means of literary writing, the author seeks to rescue the singular stories and proper names of the “drowned”, such as Dora, and to unravel or at least clear up the opacity of personal, national and universal history.
Through a method of investigation and writing that is a skilful hybrid of historical research, topographical exploration (enlivened by the evocative power of the name), and trace retrieval, Modiano thus – and myself as her interpreter – sheds light on this underlying and restorative dialectic, creating not only a literary masterpiece with a strongly philosophical approach, but also a true and real stumbling block for Dora Bruder
Le metafore spaziali della congiunzione "e" ne La Stella della redenzione
No full textSpatial Metaphors of the Conjunction «And» in the Star of Redemption · In this paper I will
attempt to illustrate how the conjunction ‘and’ also appears in spatial ‘forms’ in Rosenzweig’s principal work : the and is implicit and at times made explicit through certain used figures, indebted to geometrical or mathematical semantics yet not confined by the rigidities of abstraction. These figures aim paradoxically toward a close link with the tangible dimension of experience – in other words, life. Indeed, the structure of the book reveals three passage sections which may be interpreted as structural conjunctions of The Star of Redemption’s architectural composition, but equally as metaphorical conjunctions leading « toward life ». Between Part One and Part Two we find the section entitled Transition (Übergang) ; between Parts Two and Three there is a Threshold (Schwelle) ;
and between Part Three and its outlet – “life”, according to the last word of the book and of its author – we find Gate (Tor). Corresponding to these three titles which indicate places of topological transition, are then three sections, or rather inter-sections, that give a rhythm to the contents page and to the author’s inspiration as structural conjunctions and metaphorical conjunctions of the thematic discourse. For in their contents as well as their form and titles, these parts refer to other spatial metaphors, still considered as conjunctions but this time between elements (God, man, the world),
between the three movements (Creation, Revelation, Redemption) and between all of them, invariably referring to space – whether geometrical space (flat or solid), Cartesian space, cosmic space, etc. There is, for example, the orbit, the circle, the hyperbola, the ‘figure’, i.e. the six-pointed star formed by two inverted and crossed equilateral triangles, figures that will be specifically studied here. However – and paradoxically –, Rosenzweig employs these metaphors (at the head of these parts/inter-sections or within them) to explain his philosophical system and thinking while in some way attempting to de-mathematise the same figures that are used, since his sights are always set on the dimension of becoming, of experience – that is, the dimension of time
Impiego di tramadolo nelle diverse patologie dolorose
No full textPain represents a major health problem that afflicts a significant number of patients, resulting in personal suffering, reduced productivity and substantial health care costs, specially in chronic conditions. Chronic pain, such as low back pain, osteoarthritis, neuropathic and oncologic pain, requires a global management based on clinical evaluation, defining of the adequate therapeutic strategy and assiduous cares. Generally, patients with chronic pain need two different analgesic formulation: one at fixed doses and prolonged duration of action for control of baseline pain and one fast-release drug for treatment of breakthrough pain. Main guidelines recommend use of the same active principle for both these formulations. Tramadol, a dual action analgesic agent, used for controlling moderate to severe pain control in acute and chronic diseases, is available in several different oral formulations. This is important because, apart from efficacy and tolerability, that are the most important criteria to evaluate a therapy, the choice of a formulation with an uncomplicated dosing regimen can increase compliance and, consequently, clinical results, and ameliorate patient quality of life. For the treatment of chronic pain, the appropriate analgesic dosage can be achieved through a gradual titration: this permits to minimize adverse effects and cost of therapy.With tramadol this action can be realized with 50 mg extended-release capsules, that represent the minimal effective dose. When adequate pain relief is obtained, it’s possible to reduce frequency and complexity of dosing regimen using a new once-daily tablet of tramadol. Fast-release orodispersible tramadol tablet, with its practical advantage (rapid disintegration in the mouth without need of water), can be used for the control of breakthrough and acute pain. The cost of treatment with tramadol results relatively low, also when two daily episodes of breakthrough pain are considered
Forme galeniche e qualità di vita: il caso di tramadolo
No full textTramadol is a weak opioid analgesic used for moderate to severe pain control in acute and chronic diseases. Two new formulations of tramadol are recently admitted for marketing: once-daily (OD) controlled-release and fast-release orodispersible tablets. OD tramadol with its special lipophilic matrix permits to prolong drug effect up to 24 hours with a steady-state bioavailability comparable to that of immediate-release formulations. The efficacy and safety of this formulation of tramadol was evaluated in several trials on patients with moderate to severe chronic pain from osteoarthritis. These studies show similar effect of OD tramadol compared to standard formulation in pain control, quality of sleep, physical and mental functions, dropouts due to insufficient therapeutic effect and adverse events. Specially in the elderly and in chronic pain patients, frequency and complexity of dosing regimen remarkably affects quality of life. Furthermore, several studies show that a high number of daily administrations is one of the main factors that reduce patient compliance. For these reasons, OD tablets of tramadol seem to improve quality of life and acceptability of the therapy. Tramadol orodispersible tablets are useful for acute pain control, in the titration phase and for breakthrough pain control in chronic diseases. The manifacturing process of this formulation allows for rapid disintegration (20-30 seconds), once placed into the mouth, secondary to contact with salivary enzymes. This property facilitates its administration (in every place, without need of water), primarily for people with difficulty in swallowing tablets. Furthermore, respect to drops, it decreases the risk of misdosage. A open, randomized crossover study shows that, even although the galenics of tramadol in orodispersible and conventional fast-release capsules are different, they are bioequivalent and have similar pharmacokinetic parameters
Clinical and pharmacoeconomic profile of esomeprazole in acid-related diseases
No full textProtonic pump inhibitors (PPIs) are the most prescribed drugs for acute and maintenance therapy of gastroesophageal reflux disease, H. pylori-eradication (in association with antibacterial therapy), for ulcers prevention and cure and, recently, for prevention of NSAIDs-induced gastropathy. The high prevalence of these acid-related disorders induces a large consumption of PPIs; actually, they are the first drug class in terms of National Health Service pharmaceutical expenditure. This widespread and gradually increasing use enforces the need of a rational assessment of their impact on health care resources. This paper provides an updated profile of esomeprazole, the first PPI developed as a pure isomer, which property involves an advantageous metabolism, resulting in enhanced delivery to the proton pump compared with racemic omeprazole. Several studies showed that the success rate for healing reflux esophagitis is greater for esomeprazole than for omeprazole and some other PPIs. According to an Italian pharmacoeconomic model, esomeprazole therapy for erosive esophagitis is associated with higher benefits and lower costs as compared to omeprazole and pantoprazole. For long-term management of non-erosive gastroesophageal reflux disease, on-demand approach with esomeprazole shows clinical outcomes similar to daily treatment regimens, with substantial cost-saving. Furthermore, esomeprazole is the only PPI approved for 1-week triple therapy for both the eradication and the healing of H. pylori-associated duodenal ulcer, while the other PPIs registered the indication for H. pylori-eradication and, separately, a dosing scheme for ulcer healing (independently from etiology)
Pharmacoeconomic profile of vitamin D3: in the prevention of osteoporosis
No full textHypovitaminosis D is one of the principal risk factors for osteoporosis. Some studies estimated that more of 40% of Italian women over sixty are osteoporotic. Osteoporotic fracture is a significant cause of morbidity and cost. In Italy, in 2002, the global burden for hip fractures in over 65-years old patients has been estimated in more than one billion euro. Administration of vitamin D to prevent pathological fractures has a low cost-efficacy ratio, which reaches dominance compared to non-treatment in women over 70, i.e. avoided management costs of fractures exceed cost of therapy. In primary prevention, use of vitamin D3 involves some advantages with respect to partially or totally activated forms: higher safety and tolerability, lower costs and less frequent administrations. In order to prevent hypovitaminosis D, Regional Health Service of Toscana started to dispense free cholecalciferol to every person with more than 65 years (two 300.000 UI vials). The impact on the National Health Service budget, supposing all Italians over 65 would take cholecalciferol, has been estimated; annual savings resulted in more than 100.000.000 euro, only for hospitalization costs due to avoided fractures
Dabigatran in the prevention of venous thromboembolism after major orthopedic surgery
No full textVenous thromboembolism (VTE) is a very frequent surgical complication, especially in major orthopedic procedures. Prophylaxis with pharmacological agents, including warfarin and subcutaneous injection of either low-molecular weight heparin (LMWH) or low-dose unfractionated heparin, and/or with mechanical methods has been shown to be effective and safe. Despite recommendations on the routine implementation of these prophylaxis methods, some surveys demonstrate that many patients currently don’t receive any prophylaxis. The recent introduction of dabigatran etexilate, a novel oral direct thrombin inhibitor approved for VTE prophylaxis in total knee and hip substitution, represents a major advance in the provision of efficient anticoagulation therapy. Two pivotal randomized controlled multicenter trials assessed non-inferiority of dabigatran 150/220 mg/day versus enoxaparin 40 mg/day in the prevention of VTE after hip and knee replacement. From an economical point of view, an English modeling study on dabigatran cost/effectiveness showed it to be associated with lower cost and slightly higher gain in Quality Adjusted Life Years, thus dominating enoxaparin. Other analyses obtained results consistent with these, estimating inferior costs related to the use of dabigatran with respect to low weight heparin; this difference was mainly due to health personnel work for heparins subcutaneous administration. In Italy, acquisition costs for a 28-35 days therapeutic cycle of main antithrombotic drugs vary between 70 and 170 €, according to different distribution policy. Dabigatran, with a cost of 117 €, holds a medial position. Cost savings related to oral administration may partially offset the price difference between dabigatran and the less expensive options among LMWHs or, compared with the more expensive ones, add to pharmaceutical cost savings. In order to increase the effectiveness of VTE prophylaxis, the improvement of patient adherence to the prescribed strategy is needed. On this plane, dabigatran may be associated to some advantages, like the lack of drug and food interactions, the need for less frequent coagulation monitoring compared to vitamin K antagonists, and obviation of daily injections of parenteral agents. In conclusion, these considerations suggest that dabigatran may prove an interesting alternative in VTE prevention in orthopedic surgery
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