Development and Validation of a New Tool in Predicting In-Hospital Mortality for Hip-Fractured Patients: The PRIMOF Score.

Background and Objectives: The improved life expectancy was associated to the increased in the incidence of hip fractures among elderly people. Subjects suffering hip fractures frequently show concomitant conditions causing prolonged lengths of stay and higher in-hospital mortality. The knowledge of factors associated to in-hospital mortality or adverse events can help healthcare providers improve patients' outcomes and management. The aim of this study was to develop a score to predict in-hospital mortality among hip fractured patients. Materials and Methods: Cases were selected from hospital admissions that occurred during the period 2006-2015 in Abruzzo region, Italy. The study population was split into two random samples in order to evaluate the accuracy of prediction models. A multivariate logistic regression was performed in order to identify factors associated to in-hospital mortality. All diagnoses significantly associated to in-hospital mortality were included in the final model. Results: The PRIMOF ranged between 0 and 27 and was divided into four risk categories to allow the score interpretation. An increase in odds ratio values with the increase in PRIMOF score was reported in both study groups. Conclusions: This study showed that a simple score based on the patient' clinical comorbidities was able to stratify the risk of hip-fractured patients in terms of in-hospital mortality.

The Impact of COPD on Hospitalized Patients with Diabetes: A Propensity Score Matched Analysis on Discharge Records.

(1) Background: Type 2 diabetes is a common comorbidity of chronic obstructive pulmonary disease. Despite the lack of knowledge of the pathophysiological link between diabetes and chronic obstructive pulmonary disease, the presence of diabetes among those with chronic obstructive pulmonary disease is associated with worse outcomes, such as mortality and hospitalization. The aim of this study was to evaluate the impact of chronic obstructive pulmonary disease on in-hospital mortality and prolonged length of stay (PLOS) among patients with diabetes. (2) Methods: The study considered all hospital admissions of patients with diabetes aged over 65 years performed from 2006 to 2015 in Abruzzo, Italy. To compare outcomes between patients with and without chronic obstructive pulmonary disease, a propensity score matching procedure was performed. (3) Results: During the study period, 140,556 admissions of patients with diabetes were performed. After matching, 18,379 patients with chronic obstructive pulmonary disease and 18,379 controls were included in the analyses. Logistic regression analyses showed as chronic obstructive pulmonary disease was associated with in-hospital mortality (OR: 1.10; p = 0.036) and PLOS (OR: 1.18; p = 0.002). (4) Conclusions: In a cohort of Italian patients, diabetic patients with chronic obstructive pulmonary disease were associated with in-hospital mortality and PLOS. The definition of the causes of these differences aims to implement public health surveillance and policies.

The Burden of Diabetes-Related Preventable Hospitalization: 11-Year Trend and Associated Factors in a Region of Southern Italy.

(1) Introduction: Diabetes care is complex and delivered by different care providers in different settings across the healthcare system. Better coordination through all levels of care can lead to better outcomes and fewer hospitalizations. Prevention quality indicators (PQIs) for diabetes allow us to monitor diabetes-related avoidable admissions. The aim of this research is to assess the trend of diabetes-related preventable hospitalizations and associated risk factors in a southern Italian region. (2) Methods: The study considered all hospital admissions performed from 2008 to 2018 in the Abruzzo region, Southern Italy. Data were collected from hospital discharge records. Four different indicators were evaluated as follows: short-term complications (PQI-01), long-term complications (PQI-03), uncontrolled diabetes (PQI-14) and lower-extremity amputations (PQI-16). Joinpoint models were used to evaluate the time trends of standardized rates and the average annual percent change (AAPC). (3) Results: During study period, 8660 DRPH were performed: 1298 among PQI-01, 3217 among PQI-03, 1975 among PQI-14 and 2170 among PQI-16. During the study period, PQI-01and PQI-04 showed decreasing trends. An increasing trend was showed by PQI-16. (4) Conclusions: During an 11-year period, admissions for short-term diabetes complications and for uncontrolled diabetes significantly decreased. The use of standardized tools as PQIs can help the evaluation of healthcare providers in developing preventive strategy.

Hospitalization for Short-Term Diabetes-Related Complications: Focus on Patients Aged over 85 Years.

(1) Background: The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As far as short-term complications among the elderly are concerned, hypoglycemia and hyperglycemic crises prove to be frequent. The aim of this study was to investigate the difference in hospitalization for short-term diabetes complications in patients below and over 85 years of age. (2) Methods: Data were collected from hospital discharge records (HDRs) of all hospital admissions that occurred in Abruzzo Region, Italy, from 2006 to 2015. Only diabetic patients aged over 65 years were included. Outcomes included were diabetic ketoacidosis, hyperosmolar coma, hypoglycemic shock, iatrogenic hypoglycemic coma, and other diabetic comas. (3) Results: During the study period, 144,376 admissions were collected, 116,305 (80.56%) of which referred to patients below 85 years. Those aged over 85 years were significantly associated to all short-term diabetes-related complications with the exception of ketoacidosis. (4) Conclusions: In older diabetic patients, the avoidance of short-term diabetes complications are a greater concern than in younger patients. Diabetes management among very elderly patients should be tailored accordingly to patient characteristics.

The impact of gender on diabetes-related lower extremity amputations: An Italian regional analysis on trends and predictors.

BACKGROUND: Diabetes-related lower extremity amputations (LEAs) are a major public health issue. The aim of the study was to evaluate trends by gender and predictors of LEAs in an Italian region. METHODS: Data were collected from hospital discharge records between 2006 and 2015. Gender- and age-adjusted standardised hospitalisation rates for major and minor amputations were calculated. Poisson regression model was performed to estimate trends in LEAs. RESULTS: Hospitalisation rates decreased for minor amputations both among males (-30.0%) and females (-5.3%), while the major amputation rates decreased only for males (-44.7%). Males were at higher risk of undergoing major (IRR 1.41, 95%CI 1.19-1.67) and minor (IRR 1.62, 95%CI 1.45-1.82) amputations. Peripheral vascular disease was the leading predictor of major and minor amputations. CONCLUSION: A significant reduction of LEAs was observed only for males. Identifying their predictable factors may help caregivers to provide higher standards of diabetes care.

Knowledge and Attitude towards Vaccination among Healthcare Workers: A Multicenter Cross-Sectional Study in a Southern Italian Region.

Background: In Italy, the loss of confidence towards vaccination resulted in low vaccine coverage, also among healthcare workers (HCWs). Indeed, low vaccination coverage among HCWs can lead to dangerous outbreaks of disease, reduce productivity, and increase absenteeism. The aim of this study was to investigate the vaccine coverage and attitudes toward vaccination among HCWs. Methods: A multicenter cross-sectional study was conducted among HCWs referred to all hospitals of the Local Health Authority 02 of Abruzzo Region, Italy. The survey was based on the questionnaire proposed by the H-ProImmune Project. Results: A total of 347 HCWs were enrolled in the study. Of these, 57.3% reported missing diphtheritis-tetanus-pertussis (DTP) vaccination, 50.1% reported missing measles-mumps-rubella (MMR) vaccination, and 62.5% reported missing flu vaccination. Regarding attitudes, other healthcare professionals reported to believe more in natural immunization compared to vaccination (26.5%; p < 0.001), and they were worried about long-term effects of vaccination (10.2%; p = 0.044). Conclusions: This survey showed all vaccination coverage considered resulted below the 95% threshold. Training on vaccination and mandatory measures may be needed in order to achieve better coverage.

Arsenic Exposure and Risk of Urothelial Cancer: Systematic Review and Meta-Analysis.

Background: Arsenic is a toxic metalloid element widely distributed throughout the environment. Arsenic contaminated water has become an ongoing public health issue affecting hundred million people worldwide. The aim of this paper was to summarize the evidence in the association between arsenic metabolites and urinary tract cancer risk. Methods: A systematic review was conducted searching for observational studies that evaluated the association of arsenic metabolites and urinary tract cancer. Risk estimates from individual studies were pooled by using random effects models. Results: All the metabolites considered in this study resulted to be significantly associated to urothelial cancer, respectively: IA% 3.51 (1.21-5.82) (p = 0.003), MMA with WMD = 2.77 (1.67-3.87) (p < 0.001) and DMA with WMD = -4.56 (-7.91-1.22) (p = 0.008). Conclusions: Arsenic metabolites are significantly associated to urothelial cancer. Future studies will help to verify the independent association(s) between arsenic metabolites and urothelial cancer.

Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients.

BACKGROUND: Cut-out is the most common mechanical complication of the osteosynthesis of pertrochanteric fractures. This complication determines a significant increase in morbidity in elderly patient. Cut-out is defined as the varus collapse of the femoral head-neck fragment with the extrusion of the cephalic screw. Surgical treatment of cut-out might lead to further complications, longer rehabilitation, increased social burden and healthcare system costs. The aim of the study is to identify the predictors of cut-out to prevent its occurrence. MATERIALS AND METHODS: Study population included all patients affected by extracapsular fracture of the proximal femur who were admitted and treated with short cephalomedullary nailing at the Cattinara Hospital-ASUITS of Trieste between 2009 and 2014. A retrospective analysis of clinical and radiographic data was carried out and cut-out cases recorded. The data collected on the study population were analyzed to find an eventual correlation with the occurrence of cut-out. The independent variables were age, gender, side of the fracture, ASA class, Evans classification, nailing system, quality of reduction, TAD, CalTAD, and Parker ratio. RESULTS: The study population counted 813 cases, with an F:M ratio of 4:1 and a mean age of 84.7 years. The cut-out was recorded in 18 cases (2.2%). There was no statistically significant association between cut-out and age, sex, side of fracture, ASA class, and nailing system. The Evans classification, the quality of reduction, the TAD, the CalTAD, and the Parker's ratio demonstrated a significant correlation at univariate analysis with cut-out. The results of multivariate analysis confirmed that TAD, Parker AP, and quality of reduction were independently significantly correlated to cut-out. CONCLUSION: The results of the present study demonstrate that good quality of reduction and correct position of the lag screw are likely to decrease the risk of cut-out complication. A nomogram for cut-out prediction is proposed for clinical validation.