Potentially inappropriate prescriptions for poly-treated patients in long-term care facilities: retrospective pharmacoutilization analysis.

BACKGROUND This study aimed to investigate, among elderly patients in long-term care (LTC) facilities, potentially inappropriate drug prescriptions, potentially interactions and verify whether they can be traced back to hospitalisations or accesses to the Emergency Department (ED). The study data were acquired by means of a case report form investigating the medication management process in LTCs. MATERIAL AND METHODS Analysis of pharmacutilisation in LTCFs patients aged ≥65 years on polypharmacy or excessive polypharmacy, January-July 2023. Data was extracted from a database (DB) containing the monthly prescriptions of medicines supplied by direct distribution (DD) to LTCs. The prevalence of PIMs was evaluated by applying the Beers and STOPP criteria to the medication profile of each patient. RESULTS The overall prevalence of polypharmacy and hyperpolypharmacy was 83% and 17%, respectively. PIMs were defined using Beers and STOPP criteria. The most frequent PIMs were proton pump inhibitors (19% e 15%), antiplatelets agent (17% e 13%) and non-associated sulfonamides (14% e 12%). Of the 1,921 PIMs, 121 were contraindicated or very serious (6%) and 1,800 were major (94%).The most common medicaments involved in drug-drug interaction are furosemide (21%), sertraline (19%), pantoprazole (16%) e trazodone (15%). LTCs participating in the study (56%) excluded polypharmacy as a cause of access to the ED and ADRs. Therefore no case was ever reported (100%). CONCLUSIONS Polypharmacy or excessive polypharmacy among elderly patients may increase PIMs and ADRs. A constant review of the therapeutic regimens and deprescribing decrease inappropriate use of medications and interactions, ADRs, and accesses to the ED with consequent reduction of pharmaceutical spending.

Correlations between Sleep Features and Iron Status in Children with Neurodevelopmental Disorders: A Cross-Sectional Study.

A high prevalence of sleep disturbances has been reported in children with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability (ID). The etiology of sleep disorders in these children is heterogeneous and, recently, iron deficiency has received increasing attention. This study aims to investigate sleep features in children with NDDs and to explore a possible correlation between serum iron status biomarkers and qualitative features of sleep. We included 4- to 12-year-old children with a diagnosis of ASD, ADHD, or ID and assessed their sleep features through the children's sleep habits questionnaire (CSHQ). Venous blood samples were collected to investigate ferritin, transferrin, and iron levels. The mean CSHQ total score exceeds the cut-off in all groups of children. In the ASD group, the Parasomnias subscale negatively correlated with serum ferritin levels (Rho = 0.354; p = 0.029). Our findings may suggest the existence of an association between iron status, sleep quality, and neurodevelopmental processes. In clinical practice, sleep assessment should be included in the routine assessment for patients with NDDs. Furthermore, a routine assessment of iron status biomarkers should be recommended for children with NDDs who have sleep disturbances.

Monitoring of the territorial consumption of antibiotics in local health authority of Vercelli as a measure to contrast AMR.

In 2022 the Italian Ministry of Health published the National Antibiotic Resistance Plan (PNCAR) 2022 - 2025 which provides the strategic guidelines and operational indications for dealing with the emergency of antimicrobial resistance (AMR). ESAC recorded, in the year 2021, an average consumption of 16.4 DDD/1000 inhab. res. die, with a statistically significant decrease in the period 2012 -2021 for class J01, on total territorial and hospital consumption. Italy is one of the countries with the highest consumption of antibiotics, it ranks 9th with a total hospital and territorial consumption of 17.53 DDD/1000 inhab. res. die. The present study aims to monitor the territorial consumption of antibiotics in ASL VC through the analysis of synthetic indicators and ESAC indicators, comparing them with regional and national values. Through the IQVIA database, a retrospective descriptive study was conducted on the consumption of antibiotics (ATC J01), for the period 2020 - 2022, measuring the synthetic indicators of consumption (DDD1,000 inhab. res. die) and costs (value1,000 inhab. res. die). Subsequently, a second analysis was carried out by measuring the ESAC indicators for the year 2022, comparing them with the previous year or period. With regard to consumption, while a reduction (average -7%) was observed for contracted pharmaceuticals (CONV) in 2021 compared to 2020, followed by an increase in 2022 (average +31%); for private purchase (PRIV), consumption remained constant in 2021 and then increased in 2022 (average +40%). The same trend was observed for the costs of the J01 class. The ESAC indicators show a mild improvement for ASL VC (variable for regional and national level), except for the use of 3rd and 4th generation cephalosporins which recorded an increase in 2022. The reduction in the consumption of antibiotics in 2021, followed by an increase in 2022 can be partly explained by the pandemic period that has just ended which led to the return to the community with the resumption of infectious agents in circulation. It therefore becomes essential to pay particular attention to antibiotic stewardship activities, both in the hospital and on the territory. (community).

Effects of care pathways on the in-hospital treatment of heart failure: a systematic review.

BACKGROUND: Care pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care. METHODS: Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case-control studies, cohort studies and time interrupted series. RESULTS: Seven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials. CONCLUSION: By combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.

[Prevalence of infections in nursing homes in the Vercelli area (Piemonte, Italy)]. / Le infezioni nelle residenze sanitarie assistenziali dell'Asl VC: studio di prevalenza.

UNLABELLED: The frequency of infections in nursing homes is similar to that found in acute care hospitals: infectious complications are reported in 5-10% of hospitalized patients and 5-16% of nursing home residents. In Italy, the prevalence of infections in nursing homes ranges from 2.7% to 32.7%.The main objective of this study was to estimate the prevalence of acquired infections in nursing homes located in the territory of the Vercelli (VC) local health unit in northern Italy. We also aimed to assess which were the most frequently prescribed antibiotics among the nursing home guests, the reasons for antibiotics prescriptions, whether their use is supported by appropriate microbiological tests, the most common types of microorganisms isolated and the prevalence of antimicrobial resistance. METHODS: the survey was conducted from 1 July to 31 August 2010 in 14 publicly-funded nursing homes in the VC local health unit. Data for each nursing home were collected in a single day. A modified version of the "Healthcare-Associated Infections in European Long-Term care Facilities" questionnaire was used. Only subjects living in the nursing homes for more than 24 hours, who had signs or symptoms of infection or who were being treated with an antibiotic and who gave informed consent, were included in the study. Multiple linear regression models were used to assess the effects of independent variables on the risk of infection. RESULTS: the study population consisted of 450 subjects, 46% of whom aged over 85 years, 24% male and 88% living in a nursing home since more than one year. The overall prevalence of infection on the day of the study was 25.5%. Acquired infections were more prevalent among bedridden and wheelchair-bound guests, those who had undergone invasive procedures and those affected by decubitus ulcers. Thirty-two percent of subjects were using antibiotics. Fluoroquinolones were the most frequently used antibiotics and the most frequent reason for antibiotic use was respiratory tract infection followed by urinary tract infection. In 21% of cases no indication for antibiotic use was identified. 12.5% of E coli strains isolated by urine culture were resistant as were 100% of Klebsiella pneumoniae. CONCLUSIONS: the data highlight a high prevalence of infections in nursing homes in Vercelli as well as worryingly elevated frequencies of antibiotic prescriptions and resistance.

A cluster randomized trial to assess the impact of clinical pathways for patients with stroke: rationale and design of the Clinical Pathways for Effective and Appropriate Care Study [NCT00673491].

BACKGROUND: Patients with stroke should have access to a continuum of care from organized stroke units in the acute phase, to appropriate rehabilitation and secondary prevention measures. Moreover to improve the outcomes for acute stroke patients from an organizational perspective, the use of multidisciplinary teams and the delivery of continuous stroke education both to the professionals and to the public, and the implementation of evidence-based stroke care are recommended. Clinical pathways are complex interventions that can be used for this purpose. However in stroke care the use of clinical pathways remains questionable because little prospective controlled data has demonstrated their effectiveness. The purpose of this study is to determine whether clinical pathways could improve the quality of the care provided to the patients affected by stroke in hospital and through the continuum of the care. METHODS: Two-arm, cluster-randomized trial with hospitals and rehabilitation long-term care facilities as randomization units. 14 units will be randomized either to arm 1 (clinical pathway) or to arm 2 (no intervention, usual care). The sample will include 238 in each group, this gives a power of 80%, at 5% significance level. The primary outcome measure is 30-days mortality. The impact of the clinical pathways along the continuum of care will also be analyzed by comparing the length of hospital stay, the hospital re-admissions rates, the institutionalization rates after hospital discharge, the patients' dependency levels, and complication rates. The quality of the care provided to the patients will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and rehabilitation, and by the use of key quality indicators at discharge. The implementation of organized care will be also evaluated. CONCLUSION: The management of patients affected by stroke involves the expertise of several professionals, which can result in poor coordination or inefficiencies in patient treatment, and clinical pathways can significantly improve the outcomes of these patients. It is proposed that this study will test a new hypothesis and provide evidence of how clinical pathways can work. TRIAL REGISTRATION: ClinicalTrials.gov ID [NCT00673491].