Can Digital Technologies Be Useful for Weight Loss in Individuals with Overweight or Obesity? A Systematic Review.

Digital technologies have greatly developed and impacted several aspects of life, including health and lifestyle. Activity tracking, mobile applications, and devices may also provide messages and goals to motivate adopting healthy behaviors, namely physical activity and dietary changes. This review aimed to assess the effectiveness of digital resources in supporting behavior changes, and thus influencing weight loss, in people with overweight or obesity. A systematic review was conducted according to the PRISMA guidelines. The protocol was registered in PROSPERO (CRD42023403364). Randomized Controlled Trials published from the database's inception to 8 November 2023 and focused on digital-based technologies aimed at increasing physical activity for the purpose of weight loss, with or without changes in diet, were considered eligible. In total, 1762 studies were retrieved and 31 met the inclusion criteria. Although they differed in the type of technology used and in their design, two-thirds of the studies reported significantly greater weight loss among electronic device users than controls. Many of these studies reported tailored or specialist-guided interventions. The use of digital technologies may be useful to support weight-loss interventions for people with overweight or obesity. Personalized feedback can increase the effectiveness of new technologies in motivating behavior changes.

Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors.

Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78-9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit.

The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

Healthcare Management, avoidable mortality, telemedicine to improve health of the diabetic population.

BACKGROUND: Worldwide the International Diabetes Federation (IDF) estimated that in 2021 9.2% of adults (536.6 million, between 20 and 79 years of age) are diabetic and 32.6% under 60 years (6.7 million) die because of diabetes. This disease is set to become the leading cause of disability and mortality by 2030. In Italy, the prevalence of Diabetes is about 5%; in the pre-pandemic period, from 2010 to 2019, diabetes was responsible for 3% of deaths recorded, while during the pandemic in 2020, these deaths increased to about 4%. The present work aimed to measure the outcomes obtained from the ICPs (integrated care pathways) implemented by a Health Local Authority according to the model of the Lazio region and its impact on avoidable mortality, i.e., those deaths potentially avoidable with primary prevention interventions, early diagnosis and targeted therapies, adequate hygienic conditions and proper health care. MATERIALS AND METHODS: Data from 1675 patients enrolled in the diagnostic treatment pathway were analyzed, 471 with type 1 diabetes and the remainder with type 2 (mean age 17.5 and 69, respectively). 987 patients with type 2 diabetes also had comorbidities: in 43% obesity, 56% dyslipidemia, 61% hypertension, 29% COPD. In 54% they had at least 2 comorbidities. All patients enrolled in the ICPs were equipped with a glucometer and an app capable of recording results on capillary blood, 269 with type 1 diabetes were equipped with continuous and 198 insulin pump measurement devices. All enrolled patients recorded at least one daily blood glucose reading, one weekly weight reading, and recorded steps taken daily. They also underwent glycated hemoglobin monitoring, periodic visits and scheduled instrumental checks. A total of 5500 parameters were measured for patients with type 2 diabetes and 2345 for patients with type 1 diabetes. RESULTS: Analysis of medical records revealed that 93% of patients with type 1 diabetes were found to be adherent to the treatment pathway, adherence of patients with type 2 diabetes was recorded in 87% of enrolled cases. The analysis of accesses to the Emergency Department for decompensated diabetes saw only 21% of patients enrolled in the ICPs, but recording poor compliance. The mortality in enrolled patients was 1.9% compared with 4.3 percent in patients not enrolled in ICPs, and patients amputated for diabetic foot resulted in 82% of patients not enrolled in ICPs. Finally, it is noted that patients also enrolled in the telerehabilitation pathway or home care rehabilitation (28%), with the same conditions of severity of neuropathic and vasculopathic picture presented a reduction of 18% in leg or lower limb amputation compared to patients not enrolled or not adhering to ICPs, a reduction of 27% in metatarsal amputation and 34% in toes amputation. CONCLUSIONS: Telemonitoring of diabetic patients allows for greater patient empowerment with increased adherence, as well as a reduction in Emergency Department and inpatient admissions, thus resulting in ICPs being a tool for both standardization of quality of care and standardization of the average cost of the chronic patient with diabetic disease. Likewise, telerehabilitation can reduce the incidence of amputations from diabetic foot disease if associated with adherence to the proposed pathway with ICPs.

Healthcare Quality Management and Integrated Care Pathways (ICPs).

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is one of the largest causes of morbidity and chronic mortality and a public health problem of high importance. In Italy, COPD afflicts 5.6% of adult (3.5 million people) and is responsible for 55% of all deaths related to respiratory diseases. Smokers have a higher risk, in fact up to 40% develop the disease. From the Covid-19 pandemic, the most affected population is the elderly (mean age 80 years old), with previous chronic diseases, in 18% with chronic respiratory. The aim of the present work was to validate and measure the outcomes produced by the recruitment and care of COPD patients enrolled by an Healthcare Local Authority in the corresponding Integrated Care Pathways (ICPs) in order to measure how a multidisciplinary, systemic and e-health monitored care impacts upon mortality and morbidity. MATERIALS AND METHODS: Enrolled patients were stratified through the GOLD guidelines classification, a unified method to discriminate the various degrees of severity of COPD, using specific spirometric cut-points and providing homogeneous classes of patients. Monitoring examinations include simple spirometry, global spirometry, diffusing capacity measurement, pulse oximetry, EGA, 6-minute walk test. Chest Rx, chest CT, ECG may also be required. The severity of COPD identifies the timing of monitoring, which involves a fixed annual re-assessment for mild offset clinical forms, biannually in case of exacerbation, a quarterly cadence in moderate forms that becomes bimonthly in severe forms. RESULTS: In 2344 enrolled patients (46% women and 54% men, mean age 78 yo) 18% had GOLD severity 1, 35% GOLD 2, 27% GOLD 3 and 20% GOLD 4. In addition, 73% of patients had at least one other chronic comorbidity, mainly diabetes or hypertension, and in 48% both. The data analysis showed that the population followed in e-health presented a 49% reduction in improper hospital admissions and a 68% reduction in clinical exacerbations compared to the population enrolled in the ICPs but not followed also in e-health. Smoking habits present at the time of patient enrollment in the ICPs remained in 49% of the total population enrolled and in 37% of the population enrolled in e-health. The patients enrolled in GOLD 1 and 2 obtained the same benefits both if treated in e- health and if treated in the clinic. However, GOLD 3 and 4 patients instead presented better compliance if treated in e-health and continuous monitoring allowed punctual and early interventions such as to reduce complications and hospitalization. CONCLUSION: The e-health approach made possible to ensure proximity medicine and personalization of care. Indeed, the implemented diagnostic treatment protocols, if properly followed and monitored, are able to control complications and impact the mortality and disability of chronic disease. The advent of e-health and ICT tools are demonstrating a great support capacity for care taking that also allows greater adherence to patient care pathways, even more than the protocols up to now identified, characterized by a monitoring programmed over time, enhancing a patients and their families quality of life improvement.

Management of an Integrated Care Pathways (ICPs): an Italian Study.

BACKGROUND: The World Health Organization defines chronic disease as long duration and generally slow progression disease, with a continuous treatment over decades. The management of such diseases is complex, as the aim of treatment is not cure, but maintenance of a good quality of life and prevention of possible complications. Cardiovascular diseases are the leading cause of death worldwide (18 million deaths per year) and hypertension remains the largest preventable cause of cardiovascular disease globally. In Italy, the prevalence of hypertension was of 31.1%. The goal of antihypertensive therapy should be to reduce blood pressure back to physiological levels or to a range of values identified as targets. The National Chronicity Plan identifies an Integrated Care Pathways (ICPs) for several acute or chronic conditions, at different stages of disease and care levels, in order to optimize the healthcare processes. The aim of the present work was to perform a cost-utility analysis of management models of Hypertension ICPs to assist frail patients with hypertension following the National Health Service (NHS) guidelines in order to reduce morbidity and mortality rates. In addition, the paper emphasizes the importance of e-Health technologies for the implementation of chronic care management models based on the Chronic Care Model (CCM). MATERIALS AND METHODS: The management of the health needs of frail patients in a Healthcare Local Authority finds an effective tool in the Chronic Care Model, involving the analysis of the epidemiological context. Hypertension Integrated Care Pathways (ICPs) includes a series of first-level laboratory and instrumental tests necessary at the beginning of the intake, for accurate pathology assessment, and annually for adequate surveillance of the hypertensive patient. For the cost-utility analysis were investigated the flows of pharmaceutical expenditure for cardiovascular drugs and the measurement of the outcomes of the patients assisted by the Hypertension ICPs. RESULTS: The average cost of a patient included in the ICPs for hypertension is 1636.21 euros/year, reduced to 1345 euros/year using telemedicine follow-up. The data collected by Rome Healthcare Local Authority on 2143 enrolled patients allow us to measure both the effectiveness of prevention and the monitoring of adherence to therapy and thus the maintenance of hematochemical and instrumental tests in a range of compensation such that it is possible to impact on the outcomes, resulting in the 21% reduction in the expected mortality and the 45 % reduction in avoidable mortality due to cerebrovascular accidents, with related impact on potential disability. It was also estimated that patients included in ICPs and followed by telemedicine compared to outpatient care, obtained a 25% reduction in morbidity, with greater adherence to therapy and better empowerment results. The patients enrolled in the ICPs who accessed the Emergency Department (ED) or hospitalization presented adherence to therapy in 85% of cases and a change in lifestyle habits in 68%, compared to the population not enrolled in the ICPs, which presented a 56% adherence to therapy and a change in lifestyle habits of 38%. CONCLUSIONS: The performed data analysis allows to standardize an average cost and to evaluate the impact of primary and secondary prevention on the costs of hospitalizations associated with a lack of effective treatment management, and e-Health tools lead to a positive impact on adherence to therapy.