How to improve care in outpatients with cirrhosis and ascites: a new model of care coordination by consultant hepatologists.

BACKGROUND & AIMS: The development of ascites in patients with cirrhosis is associated with a high rate of health care utilization. New models of specialized caregiving support are necessary to optimize its management. The aim of the study was to evaluate the efficacy and financial sustainability of the "Care management check-up" as a new model of specialized caregiving support based on a series of diagnostic facilities performed in real time and on the integrated activity of consultant hepatologists at the hospital unit for outpatients, dedicated nurses, physicians in training and primary physicians, compared to standard care in outpatients with cirrhosis and ascites. METHODS: 100 cirrhotic patients admitted to our hospital were allocated, after discharge, to the "Care management check-up" group (group 1), or to the "Standard outpatient care" group (group 2), and followed prospectively as outpatients up to death or for at least 12 months. Patients of the two groups could also access to a "Day hospital" when an invasive procedure was required. In group 1, the "Care management check-up" and the "Day hospital" taken together defined the "Care management program". RESULTS: Twelve-month mortality was higher in group 2 than in group 1 (45.7% vs. 23.1%, p<0.025). The rate of 30-day readmission was also higher in group 2 (42.4% vs. 15.4%, p<0.01). The global cost attributable to the management per patient-month of life was lower (1479.19 ± 2184.43 €) in group 1 than (2816.13 ± 3893.03 €) in group 2 (p<0.05). CONCLUSIONS: The study suggests that this new model of specialized caregiving reduces 12-month mortality in patients with cirrhosis and ascites as well as the global health care costs for their management.

[Klebsiella pneumoniae resistente ai carbapenemici: prevalenza delle infezione ematiche prima e dopo la pandemia da SARS-CoV-2 in un ospedale di livello terziario del Nord-Est italiano.] / Klebsiella pneumoniae resistant to carbapenems: bloodstream infection prevalence before and during the SARS-CoV-2 pandemic in a tertiary level, North-Eastern Italian Hospital.

Riassunto. La pandemia da covid-19 ha comportato un incremento dell'uso degli antibiotici e dell'antibiotico-resistenza negli ospedali, sia negli Stati Uniti che in Europa, causando un aumento della morbilità e della mortalità nei pazienti ospedalizzati per la covid-19. Come in altri ospedali anche noi abbiamo documentato un incremento delle colonizzazioni e infezioni da germi multiresistenti. In questo studio siamo andati a valutare, nel nostro ospedale, come è cambiata la prevalenza delle infezioni ematiche da Klebsiella pneumoniae resistente ai carbapenemici nel periodo 2019-primo quadrimestre del 2021 (prima e durante la diffusione della pandemia covid-19). I nostri dati documentano un incremento significativo delle infezioni ematiche da Klebsiella pneumoniae resistente ai carbapenemici e un incremento dell'uso e dei costi per ceftazidime/avibactam.

Depressive symptoms and development of coronary heart disease events: the Italian longitudinal study on aging.

BACKGROUND: Studies on the association between depressive symptomatology (DS) and cardiovascular events and mortality in elderly persons have yielded contradictory findings. To address this issue, the authors assessed DS and an extensive array of sociodemographic, behavioral, and biological variables in the largest population-based sample of older Italians ever studied and analyzed their association with coronary heart disease (CHD) morbidity and total number of deaths. METHODS: This prospective, community-based cohort study included a sample of 5632 Italians, 65 years and older, who were recruited from the demographic registries of eight municipalities in Italy. Depressive symptomatology was assessed using the Geriatric Depression Scale, and a score > or =10 was used to indicate the presence of DS. All traditional cardiovascular disease risk factors were assessed at baseline, through questionnaires, blood tests, and physical examinations. The outcomes were CHD fatal and nonfatal events and total number of deaths. The association of the predictive variables with the outcomes was assessed using different Cox models. RESULTS: Baseline DS was associated with a higher incidence of fatal and nonfatal CHD events (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.06-2.60) and with cardiovascular mortality in men (HR, 2.49; 95% CI, 1.60-3.87) and with total mortality in men (HR, 2.02; 95% CI, 1.58-2.58) and women (HR, 1.43; 95% CI, 1.04-1.95) at the 4-year follow-up assessment. This association was observed after adjusting for a vast array of potential confounding variables, including major chronic conditions. CONCLUSIONS: Depressive symptomatology confers an increased risk for CHD in men and for total mortality in men and women but is not explained by health behaviors, social isolation, or biological or clinical determinants.

Linguagem oral e escrita em adolescentes infratores institucionalizados / Oral and written language in institutionalized juvenile offenders

OBJETIVO: mapear e caracterizar a ocorrência de distúrbios de comunicação oral e/ou escrita em um grupo de jovens infratores institucionalizados, verificando possíveis impactos das dificuldades de linguagem e comunicação na vida social desses sujeitos. MÉTODO: estudo exploratório e descritivo, com 40 internos da Fundação Casa, entre 15 e 18 anos, da unidade UI 25 - Rio Negro, do complexo da cidade de Franco da Rocha - SP. Para a coleta de dados, foram aplicados o Teste do Mini-Exame do estado mental, com o objetivo de detectar eventuais alterações cognitivas; o Teste Montreal, que analisou habilidades simples de linguagem oral e escrita; e uma entrevista semi-estruturada, cujo roteiro versou sobre Saúde Geral, Trajetória Escolar, Trajetória Profissional e percepções sobre o comportamento infracional. RESULTADOS: verificou-se que a maior parte da população era alfabetizada e que não houve ocorrência de déficits cognitivos. Houve índice alto de abandono escolar, oriundo de dificuldades em acompanhar conteúdos escolares e se adaptar às regras e dinâmica escolar, o que indica impactos das dificuldades de linguagem, especialmente da linguagem escrita, em condição que, associadas a outros fatores, favoreceram os comportamentos infracionais. CONCLUSÃO: os jovens infratores apresentaram problemas para se desenvolver e se engajar a valores e normas sócio-culturais, como também escolares, o que impõe limites ao acesso e circulação discursiva desses sujeitos, restringindo os usos da linguagem, na condição de prática social ao desenvolvimento pessoal e da cidadania. Tais achados dão indícios, entre outros fatores, do impacto social que a precária escolarização e socialização dos jovens pode ajudar a acarretar. O estudo demonstra que a linguagem deve ser concebida como prática social, sobretudo, nas formas de expressão e de comunicação desses sujeitos.

PURPOSE: to map and characterize the occurrence of oral and / or written language disturbances in a group of institutionalized juvenile offenders, checking how possible language and communication difficulties impact on these subjects' social life. METHOD: exploratory and descriptive study, with 40 interns of Fundação Casa / IU 25 unit - Rio Negro/ Franco da Rocha city complex - SP, between 15 and 18 year old. For collecting the data we applied the Mini-Mental State Examination - MMSE test, to detect individuals who may have cognitive impairment; the Montreal test, to examine simple oral and written language abilities and a semi-structured an interview, whose script was related to General Health, School Path, Vocational Path and perceptions of criminal behavior. RESULTS: the results showed that the majority of the population was literate and there was no occurrence of cognitive impairment. There was a high rate of school dropouts due from difficulties in following school curriculum and adapting to school rules and dynamics, indicating the impacts referring to language difficulties, especially written language, on condition that, in combination with other factors favored the conduct infractions. CONCLUSION: the young offenders had problems to develop and to engage in socio-cultural patterns and values, including school rules, which impose limits on their discursive access and movement, by restricting the uses of language, as a path to the development of personal social practice and citizenship. The findings provide evidence, among other factors, on the social impact that poor schooling and socialization of young people may come to cause. The study demonstrates that language should be designed as a social practice, mostly in the expression and communication forms of these subjects.

Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features.

UNLABELLED: The aim of the study was to investigate the prevalence and clinical course of renal failure that was induced by the various types of bacterial infections in patients with cirrhosis and ascites. Three hundred and nine patients, who were consecutively admitted to the 3 major hospitals of Padova, Italy, during the first 6 months of 2005, were studied prospectively. Of these, 233 patients (75.4%) had evidence of ascites. In 104 patients with cirrhosis and ascites (44.6%) a bacterial infection was diagnosed. A bacterial infection-induced renal failure was observed in 35 of 104 patients (33.6%). The prevalence of renal failure was higher in biliary or gastrointestinal tract infections and in spontaneous bacterial peritonitis (SBP) and in than in other types of infections. In addition, the progressive form of renal failure was only precipitated by biliary or gastrointestinal tract infections, SBP, and urinary tract infections (UTI). In a multivariate analysis only MELD score (P = 0.001), the peak count of neutrophil leukocyte in blood (P = 0.04), and the lack of resolution of infection (P = 0.03) had an independent predictive value on the occurrence of renal failure. CONCLUSION: The results of the study show that the development of bacterial-induced renal failure in patients with cirrhosis and ascites is related to the MELD score, and to both the severity and the lack of resolution of the infection. A progressive form of renal failure occurs only as a consequence of biliary or gastrointestinal tract infections, SBP, and UTI.