Elderly patients with multimorbidity in the home setting: umbrella review on therapeutic non-adherence causes.

OBJECTIVE: The elderly population is the most at risk regarding adherence, especially in the coexistence of multiple diseases. This study aims to detect factors contributing to therapeutic non-adherence in elderly patients in home settings. MATERIALS AND METHODS: A review protocol was developed to conduct the umbrella review using the methodological framework of the Richardson et al study. The search strategy was developed in December 2022 to conduct a systematic search and to perform an Umbrella Review of systematic reviews, meta-analyses and integrative reviews published from 2012 to 2022 in English. RESULTS: A total of 26,038 articles were identified and screened. 18 relevant articles were included in the study. CONCLUSIONS: Therapeutic adherence in elderly patients with comorbidities in polypharmacotherapy at home is a significant problem in public health and health care. Several factors of non-adherence have been identified in the studies reviewed, confirming that the problem is multifactorial. Reducing the number of medications prescribed would appear optimal, although often not possible, as this has been seen to have an immediate positive impact. A multidisciplinary approach makes it possible not to fragment care, ensuring positive feedback on therapeutic adherence.

Assessing validity and reliability of a new tool: the ECSQ (Endoscopy Customer Satisfaction Question-naire) in Italian for customer satisfaction in digestive endoscopy.

BACKGROUND: The European Society of Gastrointestinal Endoscopy and the American Society for Gastroin-testinal Endoscopy recommend the identification of quality indicators for endoscopy services, including patient satisfaction. Patients happy with the treatment received will be more willing to participate in screening programs and more adherent to the indications received from the doctor. The aim of this study is to validate the Endoscopy Customer Satisfaction Questionnaire in Italian, in order to have a valid and reliable tool that can allow each patient to fully describe their experience in digestive endoscopy services. METHODS: The validation of the questionnaire was carried out through a a monocentric cross-sectional study, in the endoscopy service of the Campus Bio-Medico University Hospital in Rome between August and September 2020. RESULTS: A total of 155 patients underwent an endoscopy. The mean age of the sample was 56.21 years (SD ± 14.136) with 46.5% male and 53.5% female. The analysis of the validity and reliability of the question-naire was ensured through the finding of an average value of 0.944 for Cronbach's α. CONCLUSION: From the analysis of the results, we can therefore believe that the Italian version of the En-doscopy Customer Satisfaction Questionnaire is to be considered valid and reliable for measuring patient satisfaction, allowing them to express their point of view.

Underprescription of medications in older adults: causes, consequences and solutions-a narrative review.

PURPOSE: Under-prescription is defined as the omission of a medication that is indicated for the treatment of a condition or a disease, without any valid reason for not prescribing it. The aim of this review is to provide an updated overview of under-prescription, summarizing the available evidence concerning its prevalence, causes, consequences and potential interventions to reduce it. METHODS: A PubMed search was performed, using the following keywords: under-prescription; under-treatment; prescribing omission; older adults; polypharmacy; cardiovascular drugs; osteoporosis; anticoagulant. The list of articles was evaluated by two authors who selected the most relevant of them. The reference lists of retrieved articles were screened for additional pertinent studies. RESULTS: Although several pharmacological therapies are safe and effective in older patients, under-prescription remains widespread in the older population, with a prevalence ranging from 22 to 70%. Several drugs are underused, including cardiovascular, oral anticoagulant and anti-osteoporotic drugs. Many factors are associated with under-prescription, e.g. multi-morbidity, polypharmacy, dementia, frailty, risk of adverse drug events, absence of specific clinical trials in older patients and economic factors. Under-prescription is associated with negative consequences, such as higher risk of cardiovascular events, worsening disability, hospitalization and death. The implementation of explicit criteria for under-prescription, the use of the comprehensive geriatric assessment by geriatricians, and the involvement of a clinical pharmacist seem to be promising options to reduce under-prescription. CONCLUSION: Under-prescription remains widespread in the older population. Further studies should be performed, to provide a better comprehension of this phenomenon and to confirm the efficacy of corrective interventions.

The Occupational Health Nurse and his/here role in the prevention of work-related diseases: results of an observational study.

BACKGROUND: In Italy, health in the workplace is still considered a field for physicians only. In contrast to Europe, the figure of the occupational health nurse is not yet present, due to the absences of contractual and university fields. The present study aimed to carry out a survey for understanding the usefulness of the introduction of the occupational health nurse in the field of prevention and protection of health at work. MATERIAL AND METHODS: The questionnaire was administered via an online survey to health professionals including Students (undergraduate and post-graduate levels) of Nursing Sciences and Midwives, Nurses, Physicians specialized in Hygiene and Preventive Medicine, in Occupational Medicine and Legal Medicine. The questionnaire included 26 questions. The statistical analysis, conducted with SPSS software (release 25.0), has been articulated through the use of frequency tables and contingency tables. Differences in participants' responses were analyzed with the chi-square and Fisher's exact tests, where applicable, considering gender, marital status, presence of sons in families, age, macro-region, and professional activities as potential explanatory variables. RESULTS: After two general reminders, 232 individuals entered the survey, with an overall response rate of 65%. 42.2% of the participants were nurses, aged between 20 and 64 years. Around 70% were females. A low percentage (9.9%) is associated with respondents from northern Italy 53.0% from Center and 37.1% from southern Italy. The questionnaire included four major fields of occupational health nursing. The nursing role for companies (items 8, 12, 13, 14, and 17): the responders approve the introduction of the occupational health nurse in the companies for his/her competences on health promotion and work-related diseases prevention. Utility for companies (items 18, 19, 20 and 21): the usefulness brought by the occupational health nurse to companies is fully shared by the responders. Occupational Health Nurse's action field (items 16, 22, 23 and 24): the answer "yes" has the highest prevalence among the responders, followed by "I don't know". Education (items 25 and 26): Nurses, Physicians and Nursing Students think that the occupational health nurse must have an appropriate university training program, in particular, a master's first degree. Concerning the main focus of the study (opinion on which was the most suitable course of study for the occupational health nurse), 85 (36,6 %) participants answered, "First level Master degree", and 60 (25,9 %) "Advanced training course". CONCLUSIONS: This study wanted to highlight the opinion of professionals on the usefulness of this new nursing figure, projected into the world of occupational medicine. The OHN supports the Physician with his/her professionalism and autonomy in prevention and treatment of work-related diseases, as demonstrated and valued in the rest of Europe. The implementation of advanced courses on occupational nursing, and in particular specific post-graduate degrees, is needed.

Role and skills of the oncology nurse: an observational study.

PURPOSE: The importance of nursing competence arises from its central role in influencing and determining care outcomes. The employment of adequately educated staff, able to base clinical decisions on the best scientific evidence, is one of the components required for delivering high quality nursing care in the oncological field. The aim of this study is to analyze - through the Nurse Competence Scale - the level of competence of nurses working in oncological settings. METHOD: A descriptive study was performed between March and September 2017. The participants were recruited among the nursing staff working in the Day Hospital and the Units of the IRCCS -Regina Elena National Cancer Institute in Rome. The confidentiality and the anonymity of the subjects involved in the study were guaranteed by submitting a socio-cultural data sheet -specifically designed to collect demographic and education data - and the Nurse Competence Scale. RESULTS: The sample included 65 nurses (93%) and 5 head nurses (7%), with a mean age of 41.8 years, predominantly female (80%), who had been working in oncology units for a mean of 17.2 years. The Nurse Competence Scale showed a high level of competence in all dimensions. Moreover, the Chi-Square test allowed to identify the presence of significant associations between the different dimensions of the Nurse Competence Scale and the work experience >15 years and the age > 40 years. CONCLUSIONS: The results of our study show that, even if lacking specific oncology competence, nurses working in oncology care settings have developed a good level of clinical competences. Highlighting the importance of nursing care in the oncology area will increase the demand of both patients and organizations of high quality nursing care, consequently enhancing the nursing profession.

Perioperative nutritional support or perioperative fasting? A narrative review.

Traditionally, overnight fasting before elective surgery has been Romathe routine in medical practice for risk reduction of pulmonary aspiration of gastric contents. Several original study and international societies recommend a 2h preoperative fast for clear fluids and a 6h fast for solids in most elective patients. We conducted a narrative review of the literature, searching electronic databases (Medline and CINAHL). We used PICO approach. The results of our review suggest that nutrition support in the perioperative period is very important to reduce length of hospital stay and reduced postoperative complication.

Health self-perception in patient with Crohn's disease: a web survey.

BACKGROUND: Crohn's Disease (CD) has an incidence on the physical and psychological autonomy of the patient, such as to alter their daily life. The impact of the disease on the daily life of the patients is related to the symptoms and complications of the disease. Patient autonomy and participation in social and work life are the goals that nurses must reach for patients with CD to improve their quality of life. AIM: To measure the perception of the health of people with a diagnosis of CD. METHOD: Review of the literature on PubMed, and internet sites. Administration on the web of the standardised questionnaire Short Form Health Survey (SF-12). RESULTS: A total of 228 patients with CD completed valid questionnaires and were enrolled. The SF-12 questionnaire scores make it possible to build a physical health index (PCS) with a median value of 36,10 (min 33,8; max 42,4) and mental health index (MCS) with a median value of 36,04 (min 28.5; max 38,4). There were statistically significant data related to the achievement of the degree with median 41.9 (min 35,1; max 48,4) compared to non-graduates with a p<0.001 and in relation to the employment level (median 37.9 min/max 34,7/46,7) compared to unemployed and inactive with a p = 0.03. CONCLUSION: Despite the inevitable complications of the disease (intestinal and extra-intestinal symptoms), most of our sample did not exhibit significant physical limitations (surgical intervention, stomach packaging which generally causes a decrease in libido in both male and female patients ). The nurse cares for a patient with CD must have not only technical skills and specialist skills, but a holistic vision of the patient. Despite some findings in this study, this research orientation deserves more attention.

Flutamide-induced hepatotoxicity: ethical and scientific issues.

OBJECTIVE: Flutamide (FLU) is a non-steroidal antiandrogen drug approved for the treatment of advanced prostate cancer. While this indication limits the use to male patients, FLU is widely prescribed to women, off-label, for the treatment of polycystic ovary syndrome (POCS) related hirsutism and acne. According to the literature, its assumption is associated with a higher incidence of adverse events in women than in male patients. MATERIALS AND METHODS: A literature search was conducted in main databases targeting unwilling FLU effects in hepatic and reproductive function. References in the selected paper were also considered as an additional source of data. Human- and animal-based studies were separately considered. RESULTS: Twenty-three human-based studies were evaluated: ten were case reports, six were retrospective studies, four were prospective, two were surveillance studies, while the last was an observational study. Nine animal-based studies were also evaluated. CONCLUSIONS: Scientific contributions highlight that FLU is responsible for specific hepatotoxic profiles in the female gender. From the ethical point of view, off-label prescribing of FLU in women is not only substantially unlawful, but also, without major safeguards being granted, a potential source of liability for prescribers.

The role of hysteroscopy in unexplained infertility.

PURPOSE OF INVESTIGATION: To evaluate pregnancy rate after diagnostic and operative hysteroscopy in nulliparous patients with inter- tility of unknown cause. MATERIALS AND METHODS: The authors conducted this study on 92 nulliparous patients with unexplained infer- tility that underwent diagnostic hysteroscopy which showed an uterine lesion (submucous fibroids, uterine septa, polyps, synechias) and underwent operative hysteroscopy to remove the lesion between 2007 and 2011. Patients' data were retrospectively extrapolated from patient's charts, then the patients were called to ask if they had pregnancies after hysteroscopic surgery. RESULTS: The present study showed a significant increase in pregnancy rate after hysteroscopic surgery (85% during the two years after the surgery). The most common endocavitary lesions were endometrial polyps (21%), uterine septa (25%), and submucous myomas (18%). CONCLUSIONS: Ac- cording to the present data, hysteroscopic evaluation of nulliparous women with unexplained infertility could be useful to detect lesions not diagnosed with other tests, and the treatment of these endocavitary lesions plays an important role in the diagnostic and therapeutic iter. The results show-a pregnancy rate of 85% in the patients treated for endocavitary lesions, but 15% of the patients, despite a normal uterine cavity, continue to have unexplained infertility and are classified as idiopathic infertility.

Prognostic significance of presence and reduplication of basal lamina in malignant pleural mesothelioma.

The prognosis of patients with malignant pleural mesothelioma (MM) is dependent more on tumor extension and differentiation than on therapeutic effects. Reduplication of the basal lamina (RBL) is an ultrastructural feature of some benign and malignant tumors that has been inversely correlated with aggressiveness and was recently described in MM. To investigate whether RBL is important for predicting the survival of patients with MM, transmission electron microscopy was used to identify the presence of basal lamina or RBL in biopsy specimens obtained by thoracoscopy from 35 patients. Cox's regression analysis was used to study the relation of these ultrastructural features to survival. Better outcomes were found for patients whose tumors expressed either basal lamina (HR 0.48; 95% CI, 0.09-2.47) or RBL (HR 0.38; 95% CI 0.12-1.22) compared with the reference category, where basal lamina or RBL was not found. The expression of basal lamina and RBL is an important novel prognostic factors in MM. HUM PATHOL 31:1341-1345.

Modulation of integrin expression on mesotheliomas: the role of different histotypes in invasiveness.

The in vitro and in vivo integrin expression in human pleural malignant mesothelioma (MM) of three different histotypes was studied. Cell lines from MM of epithelioid (E1), fibrous (F1), byphasic histotype (B1) and normal mesothelial cells (NM) were analysed for the surface expression of alpha2, alpha3, alpha4, alpha5, alpha6, alphav, beta1, beta3, beta4 subunits and alphavbeta5 integrins. We found that alpha6, beta4 subunits and alphavbeta5, weakly detectable on NM cells, were expressed on MM cells. The beta3 subunit, well expressed on NM cells, was absent on MM cells. Differential expression among histotypes was observed, the MM-E1 was the least and the MM-B1 the most positive. Specimens for each MM histotype, were analysed by immunohistochemistry. The alpha6 and alphav subunits were more evident on the epithelioid histotype. Intense staining for beta3 and beta4 subunits, was found in all MM, particularly in invading cells, while the alpha5, and alphavbeta5 integrins were variously expressed. The different histotypes can affect the in vitro integrin expression and may indicate a preferential involvement of some subunits in vivo during MM tumor progression.

[Effect of A1 adenosine receptor blockade on postischemic damage to the coronary microcirculation]. / Effetti del blocco dei recettori A1 dell'adenosina sul danno postischemico della microcircolazione coronarica.

Recent studies suggest that A1 adenosine receptor antagonists may prevent reperfusion injury in the lung and heart. The pathophysiology of this protective effect is unclear; a possible inhibition of superoxide anion release from neutrophils, or leukocyte activation and platelet aggregation are reported. We tested the hypothesis of a blood-independent cardioprotection following A1 adenosine receptor antagonism with 1,3 dipropyl,8-cyclopentylxanthine (DPCPX). Isolated working rat hearts were submitted to 10 and 20 min global ischemia in order to assess functional alterations, necrosis enzyme and purine release in coronary effluent, arrhythmias, heart weight, ultrastructural morphometry and microvascular permeability by FITC-albumin diffusion technique. DPCPX (100 nM) was administered to the perfusion buffer before ischemia. In untreated hearts we detected a significant impairment of function, associated with a significant enzyme and purine release, myocardial edema and ultrastructural damage. In DPCPX-treated hearts functional and histological damage was significantly reduced compared to controls. Moreover, a significant reduction in postischemic endothelial permeability (FITC-albumin diffusion, p < 0.02) and ultrastructural damage was observed. Our data suggest that A1 adenosine receptor antagonism with DPCPX significantly reduces ischemia-reperfusion damage in isolated, crystalloid perfused rat heart by a direct reduction of endothelium damage, fluid diffusion within the interstitium and improvement of coronary microcirculation.

Basal lamina reduplication in malignant epithelioid pleural mesothelioma.

Malignant mesothelioma of the pleura is divided in three morphological variants: epithelioid, sarcomatous, and biphasic. Histological similarities between epithelioid malignant mesothelioma (EMM) and lung adenocarcinoma are responsible for the difficult differential diagnosis. Monoclonal antibodies are useful for distinguishing the two neoplasms through immunohistochemical phenotyping, although many cases require ultrastructural characterization for definitive diagnosis. In this study, transmission electron microscopic observations of EMM were compared with those of peripheral adenocarcinoma of the lung (PAL). More specifically, the morphology of the basal lamina is described in 23 cases of EMM and 12 cases of PAL. Reduplication of the basal lamina (RBL) was found in 11 cases (48%) of EMM and in none of the PAL cases. The same cases were immunostained for type IV collagen and the localization of this basement membrane component corresponded to the areas where basal lamina was observed. Since RBL has been associated with neoplastic differentiation in other tumors, this novel feature in EMM needs to be evaluated in future prognostic studies in malignant mesothelioma of the pleura. Moreover, RBL expression in EMM may be an additional ultrastructural parameter used in the differential diagnosis between EMM and adenocarcinoma.

Neuramide inhibits Epstein-Barr virus-induced transformation activity and proliferation of transformed B lymphocytes.

Neuramide, in Italy, is a prescription drug and contains various polypeptides, with molecular weights ranging between 10,000 and 1,000. It is commonly used in Italy for the clinical therapy of varicella-zoster and other viral herpetic diseases. In the present study, we investigated its effect on the in vitro transformation activity and transformed status of the Epstein-Barr virus (EBV), ab herpesvirus closely associated with infectious mononucleosis (IM), nasopharyngeal carcinoma (NPC) and Burkitt's lymphoma (BL). Antiviral effects of neuramide were evaluated on viral-induced immortalization, transformed status and DNA synthesis. Our results show that simultaneous and/or post-treatment of EBV-infected lymphocytes with neuramide, at a concentration of 2 inhibiting units (IU)/ml, blocks EBV-mediated transformation and related events, whereas pretreatment does not show any inhibiting activity against EBV. Neuramide was also found to be a potent inhibitor of the proliferation of EBV-transformed B lymphocytes in vitro. These results suggest that the molecular mechanisms of action of the drug should be investigated more closely and also support the necessity to further purify the active polypeptides, in order to improve its possible in vivo efficacy in EBV-associated diseases, such as infectious mononucleosis and other lymphoproliferative diseases.

[Anatomical and functional characteristics of the myocardial interstitial space]. / Caratteristiche anatomiche e funzionali dello spazio interstiziale miocardico.

The extracellular matrix plays an important role in biological processes, for example cellular adhesion, proliferation, migration and differentiation. Many of the cell-cell and cell-matrix interactions are mediated by extracellular matrix components and by their respective membrane receptors. Important pathophysiological processes occur through these interactions of which ontogenesis tissue differentiation and reconstruction, many inflammatory and immunological events and metastatic processes and invasion. The myocardium is made of muscular, vascular and connective components that exist in a state of equilibrium based on their relative proportions, integral structures, and on their physical and chemical characteristics. The Authors have described molecular events that lead to the organization of the cardiac tissue in physiological conditions and to its reorganization in pathological situation. Furthermore they have evaluated the role of fibronectin, a glycoprotein of the extracellular matrix in the initial phase of cardiac ischemia.

Simian virus 40-like DNA sequences in human pleural mesothelioma.

Mesotheliomas are pleural, pericardial, or peritoneal neoplasms frequently associated with asbestos exposure, and it is estimated that over the next twenty years up to 80,000 new cases are expected in the USA alone. We found simian virus 40-like DNA sequences in 29 of 48 mesotheliomas studied (60%) and demonstrated simian virus large-T antigen expression in 13 of 16 specimens. The matching lung samples did not contain simian virus 40-like sequences; however, they contained asbestos. These findings are to our knowledge the first demonstration of a physical link between DNA virus-like sequences and human mesothelioma. We suggest that a simian virus 40-like virus may act independently or as a co-carcinogen with asbestos. Moreover, the selective large T antigen expression by mesothelioma and not by the surrounding pulmonary parenchyma may have both diagnostic and therapeutic implications.

[A case of surgical ligature of the sacro-iliac joint from Renaissance Central Italy]. / Un caso di legatura chirurgica sacro-iliaca di epoca rinascimentale dall'Italia Centrale.

The paper reports a case of interbone ligature between the sacrum and right ileum using copper wire in an adult woman whose skeleton, dating from approximately 1600-1700 A.D., was exhumed from the Church of Sant'Egidio in Borrello (Chieti). Having described the ligature and the techniques used, the Authors discuss the reasons for the operation. In conclusion, it is suggested that the most plausible hypothesis is that it represent an interbone ligature during the course of autopsy to allow the recomposition of a corpse with a sacro-ileal dislocation. The absence of signs of sacro-ileal dislocation caused by mechanical levers during the course of autopsy leads the Authors to suppose the sacro-ileal rupture occurred while the subject was still alive. The Authors therefore hypothesise that the woman died while giving birth following the laceration of the pubic symphysis and rupture of the right sacro-ileal joint. The hypothesis of a corpse restoration is also suggested.

[The congenital absence of the permanent upper lateral incisors with the persistence of the deciduous canines in a subject of the Iron Age from the Sulmona (AQ) necropolis]. / Assenza congenita degli incisivi laterali superiori permanenti con persistenza dei canini decidui in un soggetto dell'età del Ferro della necropoli di Sulmona (AQ).

The paper reports a case of bilateral agenesia of the permanent upper lateral incisors associated with the persistence of the deciduous eye teeth placed between the first premolars and the permanent canine teeth which, in turn, had emerged in place of the agenetic lateral incisors (situs dentis inversus) in a adult male from the Iron Age whose skeletal remains were exhumed from tomb no. 58 of the Sulmona necropolis (AQ). The authors place the case in the context of agenesia as found both in today's population and in ancient times.