The "Lazio ADVICE" telemedicine platform: First results of general practitioners' usage, facilitators and barriers in the Local Health Authority Roma 1.

Background: Telemedical approaches represent a valuable tool for the management of coronavirus disease 2019 patients, allowing daily clinical assessment, monitoring of vital parameters, remote visits, and prescription of treatment or hospitalization in case of clinical worsening. This cross-sectional study aims to evaluate the use, barriers and facilitators of the "Lazio ADVICE" telemedical platform, a regional system for remote assistance for coronavirus disease 2019 patients at home, according to General Practitioners and Family Pediatricians of the Local Health Authority Roma 1, during the coronavirus disease 2019 pandemic. Methods: An interview-based survey was performed between December 2020 and January 2021. The survey investigated the demographic information of General Practitioner and Family Pediatricians, the knowledge of the platform, frequency of utilization, usefulness, strengths and weaknesses, and hypothesis of future implementation proposed. Results: We interviewed 214 physicians and 89 (41.6%) were classified as users and 125 (58.4%) as non-users. Older age and working in District 1, 14 and 15 (vs. District 13) significantly reduced the probability of using the platform physician. Among the 89 users, 19 (21.3%) used the platform every day or even several times a day, 40 (44.9%) several times a week but less than one access per day, 30 (33.7%) used the platform several times a month up to one entry per week. Most of them (92.3%) consider the platform useful. Barriers were poor integration with software and work routine (76.4%), and usability issues (53.9%). Among the 125 non-users, 14 (11.2%) didn't know the existence of the platform, 60 (48.0%) never tried it and 51 (40.8%) tried to use it. Reported reasons for the interruption of use were not very user-friendly (45.1%), perceived useless (37.3%), non-optimal functioning (23.5%), and lack of time (19.6%). Conclusion: The pandemic accelerated the implementation of telemedicine services around Lazio Region, starting a positive and continuous exchange of experiences, activities and best practices among physicians.

[Health and disability in the elderly: old paradigms and future prospects]. / Salute e disabilità nell'anziano, tra vecchi paradigmi ed un nuovo sorprendente futuro.

The projections regarding the ageing of the Italian population are cause for great concern; however, the ageing scenario may actually be interpreted in a more optimistic way. Theories formulated in the 80s envisaging a decline of mortality, morbidity and disability in the elderly are now confirmed and prefigure an unexpected decrease in disability rates in the elderly population. The aim of this review is to attempt to explain the reasons for this by analyzing the role played by the various determinants of health, in particular social isolation, which are likely to play an important role in the future as well.

The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: a prospective observational study.

BACKGROUND: The Mini-Mental State Examination (MMSE) has contributed to detecting cognitive impairment, yet few studies have evaluated its accuracy when used by general practitioners (GP) in an actual public-health setting. OBJECTIVES: We evaluated the accuracy of MMSE scores obtained by GPs by comparing them to scores obtained by Alzheimer's Evaluation Units (UVA). METHODS: The study was observational in design and involved 59 voluntary GPs who, after having undergone training, administered the MMSE to patients with symptoms of cognitive disturbances. Individuals who scored < or = 24 (adjusted by age and educational level) were referred to Alzheimer's Evaluation Units (UVA) for diagnosis (including the MMSE). UVAs were unblinded to the MMSE score of the GP. To measure interrater agreement, the weighted Kappa statistic was calculated. To evaluate factors associated with the magnitude of the difference between paired scores, a linear regression model was applied. To quantify the accuracy in discriminating no cognitive impairment from any cognitive impairment and from Alzheimer's disease (AD), the ROC curves (AUC) were calculated. RESULTS: For the 317 patients, the mean score obtained by GPs was significantly lower (15.8 vs. 17.4 for the UVAs; p < 0.01). However, overall concordance was good (Kappa = 0.86). Only the diagnosis made by the UVA was associated with the difference between paired scores: the adjusted mean difference was 3.1 for no cognitive impairment and 3.8 for mild cognitive impairment. The AUC of the scores for GPs was 0.80 (95%CI: 0.75-0.86) for discriminating between no impairment and any impairment and 0.89 (95%CI: 0.84-0.94) for distinguishing patients with AD, though the UVA scores discriminated better. CONCLUSION: In a public-health setting involving patients with symptoms of cognitive disturbances, the MMSE used by the GPs was sufficiently accurate to detect patients with cognitive impairment, particularly those with dementia.

[Femur fractures among elderly in Lazio and Tuscany regions from 1999 to 2003]. / Le fratture di femore tra gli anziani del Lazio e della Toscana: analisi del fenomeno nel periodo 1999-2003.

OBJECTIVES: to compare the assistance delivered to elderly persons (age 65 +) hospitalized in 1999-2003 after femur fracture between two Italian regions (Lazio and Tuscany). Indicators derived from current databases have been used. MAIN OUTCOMES: 1) age-standardized proportion of patients treated surgically; 2) age-standardized proportion of patients with surgery within 2 days from admission among all the patients with surgery; 3) age-standardized proportion of deaths within 30 days from admission. METHODS: incident cases and patients undergoing surgery were retrieved from abstract discharge records, while deaths were traced through record linkage with mortality registers. RESULTS: in the period covered by the study, 32019 incident cases occurred in Lazio region and 30406 in Tuscany. The analysis shows better results for Tuscany for each indicator. In 2003, the age-standardized proportions of patients treated surgically were 83.0% in Lazio and 86.2% in Tuscany. The age-standardized proportion of patients undergoing surgery within 2 days from admission were respectively 14.7%, and 29.8%. The age-standardized proportions of deaths occurring within 30 days from admission were 5.0% and 2.8%. Lazio shows higher proportions of deaths both for patients with and without surgery. CONCLUSIONS: the use of the same procedure based on purely administrative data (available at national level) provides confidence on the reliability of the comparison between the two regions. Similar low-budget studies may easily be extended to other geographical areas.

[Incidence and risk factors for accidental falls among general practice elderly patients in Latina, Central Italy]. / Incidenza e fattori di rischio delle cadute accidentali in un campione di anziani assistiti da MMG nella provincia di Latina.

BACKGROUND: falls incidence in home resident elderly people varies from 30% to 40%. Falls induce loss of self-sufficiency and increase mortality and morbidity. OBJECTIVES: to evaluate falls incidence and risk factors in a group of general practice elderly patients. DESIGN: prospective cohort study with 1 year follow-up. METHODS: 18 practitioners visited their elderly patients (>75 years) for a baseline assessment. Information on current pathologies and previous falls in the last six months was collected. Functional status was evaluated using: Short Portable Mental State Questionnaire, Geriatric Depression Scale, Activities of Daily Living, Instrumental Activities of Daily Living. Total mobility Tinetti score was measured in a subgroup of elderly. Falls were monitored through 2 phone-interviews at 6 and 12 months. Data were analyzed through logistic regression. RESULTS: 1168 elderly were visited and 800 were enrolled in the study. Twenty-eight percent of the elderly fell in the whole period. Sixty percent of falls were not reported to the practitioner. Independent predictors for falls were ADL score (ADL<5: OR 1.90; 95% CI 1.05-3.45), falls occurred in the 6 months previous to the follow-up period (OR 1.62; 95% CI 1.03-2.54) and the interaction term among this factor and the follow-up period (OR 2.39; 95% CI 1.22-4.72). Tinetti score was significantly associated to falls only in univariate analysis. CONCLUSIONS: Practitioners can play a key-role in identifying at-risk subjects and managing prevention interventions. Falls monitoring and a continuous practice of comprehensive geriatric assessment should be encouraged.

Angiostrongylus vasorum in wolves in Italy: prevalence and pathological findings.

BACKGROUND: Angiostrongylus vasorum is a nematode residing in the heart and pulmonary vessels of dogs and wild carnivores. In Europe the red fox is its reservoir, while only three records from wolves have been published. Angiostrongylus vasorum has a worldwide distribution, and many pieces of evidence demonstrate that it is spreading from endemic areas to new ones. In Italy, A. vasorum was reported with increasing frequency in dogs and foxes in the last decades, and now it is considered endemic throughout the country. Angiostrongylus vasorum can be asymptomatic or cause respiratory and circulatory disorders, at times causing severe disseminated infections. METHODS: Between February 2012 and December 2016, 25 wolves found dead in central Italy were submitted to the Istituto Zooprofilattico del Lazio e della Toscana for post-mortem examination. Samples of lungs, heart, liver, spleen, kidneys, mediastinic lymph nodes and brain were collected from each animal for histological examination. When adult and larval nematodes were microscopically seen in lungs, the other organs were processed, and five histological sections for each organ were examined. To confirm parasite identification, lung samples were submitted to a PCR-sequencing protocol targeting the ITS2 region of A. vasorum. RESULTS: Seven wolves (28.0%) harboured nematode larvae in lung sections. In two of the positive wolves, adult nematodes were visible in pulmonary arteries, in four animals larvae were also detected in other organs. DNA sequencing reactions confirmed parasite identification as A. vasorum in all the cases. CONCLUSIONS: As a result of the high prevalence of A. vasorum reported in wolves in the present study, a focus of high circulation could be hypothesised in central Italy. Nevertheless, the similarly high prevalence in foxes originating from the same areas were reported in previous papers. Histopathological evidence highlights the pathogenic potential of A. vasorum in the wolf, especially in juvenile animals.

Ethylene glycol toxicity: a retrospective pathological study in cats.

Ethylene glycol (EG) is a well known toxic compound, the assumption of which can be fatal to pet animals as well as to humans. Limited information is available on the pathological features of EG poisoning in pet animals, with special emphasis on cats. Twenty-five cats with histologically confirmed EG intoxication were retrospectively investigated, in order to define more precisely the gross pathological findings and improve the diagnostic process. Furthermore, a brief comparison with the lesions reported in EG-poisoned human patients and dogs was also made.

Quality of care and rehospitalization rate in the last stage of disease in brain tumor patients assisted at home: a cost effectiveness study.

UNLABELLED: Despite aggressive multimodality treatment the prognosis of patients with primary brain tumors (BT) remains poor. At present, there are no data about the role of palliative home-care services and their impact on quality of care. We report the results of a pilot project of palliative home care for BT patients started in 2000 in the National Cancer Institute Regina Elena of Rome. We report also the result of a cost/effectiveness analysis utilizing administrative data on re-hospitalization rate in the last two months of life. METHODS: Since October 2000 until December 2009, 572 patients have been followed by our home care staff. Among 394 patients who died, 276 (70%) were followed at home until death. A cost/effectiveness analysis was carried out evaluating the rehospitalization rate in the last 2 months of life in a subgroup of patients (group 1 assisted at home, 72 patients; group 2 not assisted at home, 71). The number of hospital readmission in the last 2 months of life, and length and cost of hospitalization were retrospectively analyzed from hospital discharge records. RESULTS: Hospitalization rate of group 1 (16.7%) was lower than group 2 (38%) (95% CI: 0.18-0.65, p = 0.001). Costs of hospitalization also differed substantially: 517 Euros (95% CI: 512-522) in group 1 vs 24, 076 Euros (95%: 24,040-24,112 Euros) in group 2. CONCLUSION: Home-care may represent an alternative to in-hospital care for the management of brain tumor patients and may improve the end-of-life quality of care.

Pressure ulcer risk in long-term units: prevalence and associated factors.

AIM: This paper is a report of a study to assess pressure ulcer prevalence in a group of long-term units and to describe the main factors associated both with risk for and presence of a pressure ulcer. BACKGROUND: Despite being potentially preventable, pressure ulcers are highly frequent among institutionalized patients and are associated with increased morbidity and mortality. METHOD: A cross-sectional study was carried out, involving 571 patients from 10 long-term units in Rome, Italy. Healthcare staff in each unit evaluated pressure ulcer risk and collected clinical data while a single Registered Nurse assessed all patients to identify pressure ulcers. Univariate and multivariate analyses were performed for the two outcomes: condition at risk for pressure ulcers (Braden score < or = 16) and pressure ulcer presence. The data were collected in February-March 2005. FINDINGS: The overall prevalence of pressure ulcers was 27%. Multivariate analysis showed a statistically significant positive association between high-risk condition of pressure ulcer and previous stroke (OR = 1.96; 95% CI 1.30-2.96), previous trauma (OR = 1.83; 95% CI 1.12-2.99) and cognitive decline (OR associated with a 1 point Short Portable Mental State Questionnaire increase = 1.26; 95% CI 1.05-1.50). The model for pressure ulcer presence confirmed a statistically significant excess in patients with cardiovascular diseases (OR = 1.79; 95% CI 1.13-2.85), with high Activity of Daily Living scores (OR associated with a 1 point increase 1.38; 95% CI 1.03-1.84) and low Braden Scale scores (OR associated with a 1 point increase = 0.80; 95% CI 0.70-0.87). The risk of pressure ulcers according to number of full-time nurses and auxiliary staff per 10 beds lower than five was marginally statistically significant (OR = 1.60; 95% CI 0.98-2.61). CONCLUSION: Further research is needed to validate our findings and further prospective research is needed to identify ways of preventing pressure ulcers. Our data on staffing suggest that organizational factors should be taken into account when exploring determinants of pressure ulcers.