Littérature scientifique sur le sujet « Niguarda »

This study compares the effect of the modified early warning score (MEWS) <em>versus</em> a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca’ Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care.

Due to the current historical moment, implementing technological systems has become a imperative. Niguarda Hospital in Milan dedicated an area of its official web site to a new educational course about carbohydrate counting. The project is mainly addressed to individuals with diabetes mellitus. The aim is to deliver a systematic support and a accurate educating intervention, permanently and gratuitously available. The project started in July 2020. Clinicians and healthcare professionals from Niguarda Hospital Diabetes Division recorded a number of 14 educational videos, that will be extended. The educational videos are focused on scientific subjects that are essential in daily life of people with diabetes and their caregivers, and discuss various different topics: from adequate nutrition concepts to general principles of insulin therapy, from carbohydrates classification to insulin sensitivity factor and insulin/carbohydrate ratio explanation. Outcomes related to tele-education effectiveness will be evaluated through two dietary-knowledge questionnaires and one satisfaction questionnaire, available on the same web page. Remote education allows to break down physical, economic and organizational barriers. It strengthens and supports each individual’s path, encouraging them to enhance self-management skills, and therefore their disease progression. Digital health is increasingly becoming part of our everyday life, allowing us to achieve a shared purpose of all those who deal with diabetes: improving their quality of life. KEY WORDS diabetes mellitus; CHO counting; telemedicine; remote education; nutrition.

Background: l’acido urico (AU) nei pazienti che si presentano con SCA è stato riconosciuto come fattore determinante la mortalità intra-ospedaliera. Inoltre esso è anche correlato con le complicanze intraospedaliere in termini di recidiva precoce di altri eventi cardiovascolari non fatali e altri outcome intermedi interpretabili come segni di decorso intra-ospedaliero complicato (l’utilizzo di contropulsatore aortico o di ventilazione non invasiva, un maggior tempo di degenza ed una maggior frequenza di sanguinamenti ma anche la presentazione con un quadro di scompenso cardiaco acuto o con FA all’ingresso in unità coronarica). Scopo dello studio: scopo principale del nostro studio è quello di valutare il ruolo dell’AU misurato in acuto come possibile determinante di mortalità intraospedaliera (outcome primario) e di complicanze durante la degenza (outcomes secondari). Scopo secondario è stato anche quello di individuare il miglior cut-off per tale associazione. Oltre all’individuazione di uno specifico cut-off è stata anche valutata la performance diagnostica, in termini di sensibilità e specificità, del cut-off classico oggi utilizzato per definire l’iperuricemia (> 6 mg/dL nelle femmine e 7 mg/dL nei maschi) e di un cut-off più basso individuato dalla letteratura più recente (5.26 mg/dL per le femmine e 5.49 mg/dL per i maschi). Metodi: Per fare questo sono stati analizzati i dati di 563 pazienti ricoverati presso l’Unità di Cure Intensive Cardiologiche (UCIC) dell’ospedale Niguarda Ca’ Granda. Gli outcome considerati sono la mortalità intraospedaliera per tutte le cause, il re-infarto, la trombosi intrastent, la nuova rivascolarizzazione non programmata, i sanguinamenti, gli stroke, la presentazione con scompenso cardiaco, la presentazione con FA, l’utilizzo di inotropi, contropulsatore aortico e ventilazione non invasiva, l’evidenza di coronaropatia trivasale alla coronarografia e la FE in ingresso ed in dimissione dall’UCIC. Risultati: i pazienti presentavano un’età media di 66.5 ± 12.3 anni, nel 79.2% dei casi erano maschi e nel 49.9% dei casi accedevano per STEMI. Con entrambi i cut-off i soggetti iperuricemici erano più anziani e presentavano più frequentemente FRCV e pregresso infarto miocardico. Essi morivano più frequentemente durante la degenza, giungevano al ricovero in FA o con scompenso cardiaco, presentavano con maggior frequenza coronaropatia trivasale ed utilizzavano più frequentemente contropulsatore aortico e NIV. Infine i valori di FE sia all’ingresso che in dimissione dall’UCIC erano più bassi rispetto al gruppo dei non iperuricemici. All’analisi multivariata l’AU resisteva come determinante significativo di tutti gli outcomes (esclusa la coronaropatia trivasale) in un modello contenente età, genere, precedente infarto miocardico, anamnesi positiva per ipertensione arteriosa, Charlson Comorbidity Index e creatinina. Entrambi i cut-off erano in grado di discriminare in modo statisticamente significativo l’incrementata mortalità dei pazienti iperuricemici anche se in entrambi i casi la performance in termini di Sensibilità (Sn) e Specificità (Sp) presentava alcuni problemi. Abbiamo infine provato ad individuare un cut-off ideale per questa specifica popolazione che è stato di 6.35 mg/dL con un’area sotto la curva complessiva di 0.772 e con una Sn ed una Sp di 70.3% ed 81.8%. Conclusioni: in conclusione AU risulta determinante indipendente della mortalità intraospedaliera per tutte le cause e di variabili indicative di peggior presentazione al momento dei ricovero (scompenso cardiaco, FA ed FE all'ingresso), di complicanze intra-ricovero (utilizzo di contropulsatore aortico e NIV) e di un peggior risultato sulla ripresa della funzione ventricolare sinistra (FE in dimissione). Ulteriori studi con valutazione longitudinale dell'andamento dell'AU sono necessari per chiarire definitivamente la direzionalità delle relazioni individuate.
Background: Uric acid (UA) has been related to in-hospital mortality in ACS patients. Furthermore, it has been related to early relapse of non-fatal cardiovascular events and to intermediate outcome such as use of intra-aortic balloon pump, noninvasive ventilation, longer inward stay, bleeding but also clinical presentation with AF or heart failure. Aim of the study: principal aim of our study was to evaluate the role of UA as a possible determinants of in-hospital mortality (primary outcome) and in hospital complications (secondary outcomes). Secondary aim was to identify the best cut-off and to evaluate diagnostic performance of already used cut-off (the classic one of > 6 mg/dL in female and 7 mg/dL in males, and a recently described one with 5.26 mg/dL in females and 5.49 mg/dL in males). Methods: we analyze data of 563 patients admitted for ACS at the Cardiological Intensive Care Unit of the Niguarda Ca’ Granda Hospital. We consider as outcome in-hospital mortality, inward myocardial infarction, instent thrombosys, bleeding, stroke, clinical presentation with heart failure of AF, inotropes, intra-aortic balloon pump and non-invasive ventilation uses during hospital stay, three vessels coronaric involvement at the coronary angiogram and EF both at admission and at discharge. Results: mean age was 66.5 ± 12.3 years, 79.2% of the patients were males and 49.9% of the ACS were STEMI. With both cut-off hyperuricemic subjects were older, with more prominent cardiovascular risk factor and previous myocardial infarction. Furthermore, they more frequently died during hospital stay, they present more frequently heart failure and AF as clinical presentation, have more commonly three vessels disease and use more frequently intra-aortic balloon pump and non-invasive ventilation. Finally, also EF at admission and discharge were lower in hyperuricemic patients. At multivariate analysis UA was a significant determinants of primary and secondary outcomes (except for three vessels coronaric disease) in a model with age, gender, previous myocardial infarction, arterial hypertension, Charlson Comorbidity Index and creatinine as covariates. Both cut-off can significantly discriminate in-hospital mortality but with only fair results in term of Sensibility (Sn) and Specificity (Sp). Finally, we identify 6.35 mg/dL as the best cut-off for this specific population with an area under the curve of 0.772, Sn 70.3% and Sp 81.8%. Conclusions: in conclusion UA was an independent determinants of in-hospital mortality and of variables suggestive of worst clinical presentation (heart failure, AF and admission EF), in-hospital complications (intra-aortic balloon pump and non-invasive ventilation uses) and worst recovery (discharge EF). Further study with longitudinal evaluation of UA during ACS are needed in order to better clarify directionality of detected relationship.

La tesi propone un originale modello per lo studio della qualità di vita urbana riferendosi alla Capability Approach (CA) di Amartya Sen (1992, 1999, 2004, 2009) con l’inclusione di aspetti partecipativi. Il concetto di qualità di vita si lega al benessere inteso in termini di sviluppo umano. L’approccio pone la centralità dei cittadini nell’individuazione di quelle dimensioni di benessere che essi stessi hanno motivo di valore come importanti per il raggiungimento degli obiettivi di sviluppo della proprio vita. Il modello propone una definizione partecipativa di benessere e qualità di vita urbana e viene combinata con l'indagine dei modi di vita dei cittadini. La tesi prende in esame quei tratti di vita urbana composti da funzionamenti, capacità, libertà, scelte e valori messi in gioco dai cittadini quotidianamente per migliorare la propria qualità di vita. Un test empirico di questo modello è stato implementato in un’analisi comparativa sulle famiglie con i bambini in due quartieri di Milano e Amsterdam. I dati sono stati raccolti attraverso focus group e interviste e sono stati analizzati secondo le categorie del CA declinato all’ambito urbano. Risultati positivi delineano una nuova direzione negli studi sulla qualità di vita urbana basata su un approccio centrata sulle persone e sugli abitanti della città.
The thesis proposes an original model to define quality of urban life referring to the Capability Approach (CA) of Amartya Sen (1992, 1999, 2004, 2009) with a participative enforcement. Opening the concept of quality of life to well-being as human development we refer to citizens' centrality in identifying own dimensions of well-being according to what they have reason to value and to what they aim to achievement. The model proposes a participative definition of well-being and quality of urban life to be combined with the investigation of citizens' agency as the sum of valued actions chosen to develop their life. Urban traits of citizens' functionings, capabilities, freedom, choices and values emerge with relevant indications on how people like to improve their personal and social well-being. An empirical test of this model has been implemented in a comparative analysis on families with children in neighborhood in Milan and Amsterdam. Data has been collected trough focus groups and interviews and analyzed trough the CA categories with urban sociological and geographical declination. Positive results have emerged and further improvement on this model could bring new direction on quality of urban life based on a more people-centered approach.

AbstractIntroduction: Dural arteriovenous fistulas (dAVFs) account for 10–15% of all intracranial arteriovenous lesions. Different classification strategies have been proposed in the course of the years. None of them seems to guide the treatment strategy. Objective: We expose the experience of the vascular group at Niguarda Hospital and we propose a very practical classification method based on the location of the shunt. We divide dAVF in sinus and non-sinus in order to simplify our daily practice, as this classification method is simply based on the involvement of the sinuses. Material and Methods: 477 intracranial dural arteriovenous fistulas have been treated. 376 underwent endovascular treatment and 101 underwent surgical treatment. Cavernous sinus DAVFs and Galen ampulla malformations have been excluded from this series as they represent a different pathology per se. 376 dAVFs treated by endovascular approach: 180 were sinus and 179 were non-sinus. 101 dAVFs treated with surgical approach: 15 were sinus and 86 were non-sinus. Discussion: Of the 477 intracranial dAVF the recorded mortality and severe disability was 3% and morbidity less than 4%. All patients underwent a postoperative DSA with nearly 100% of complete occlusion of the fistula. At a mean follow-up of 5 years in one case there was a non-sinus fistula recurrence, due to the presence of a partial clipping of “piè” of the vein. Conclusions: The sinus and non-sinus concept has guided our institution for years and has led to good clinical results. This paper intends to share this practical classification with the neurosurgical community.

AbstractThe European-Japanese Cerebrovascular Congress originally started as a Swiss-Japanese joint conference on cerebral aneurysm. The Congress was held in Zürich, Switzerland, from 5–7 May 2001 with Prof. Y. Yonekawa of Zürich and Prof. Y. Sakurai of Sendai as the presidents.Three years later, in July of 2004, the second meeting was held at Zürich again with wide-ranging conference topics on cerebral stroke surgery.The third meeting at Zürich in 2006 was the key congress for future development. The conference was expanded to the European-Japanese Joint Conference for Stroke Surgery.As the year of 2006 was the 70th Anniversary of the Department of Neurosurgery, University Hospital Zürich, Prof. Krayenbühl, Prof. Yasargil, and Prof. Yonekawa introduced the impressive history of the Department of Neurosurgery at the conference.At the fourth European-Japanese Joint Conference on Stroke Surgery we moved from Zürich to the Nordic city of Helsinki, with Prof. Juha Hernesniemi as the conference president.The fifth joint conference was held at Düsseldolf am Rein with Prof. Hans-Jakob Steiger as the Conference president.The sixth conference, named “The European-Japanese Stroke Surgery Conference” (EJSSC), was held in Utrecht, The Netherlands. Professor Luca Regli and Prof. Gabriel Rinkel were the conference presidents.The seventh European-Japanese Stroke Surgery Conference (EJSSC) was held in Verona, Italy with the presidents Prof. Alberto Pasqualin and Prof. Giampietro Pinna.The eighth European-Japanese Cerebrovascular Congress (EJCVC) came back to Zürich in the year 2016 with Prof. Luca Regli as the president.The ninth European-Japanese Cerebrovascular Congress (EJCVC) was held in the historical room of Grande Ospedale Metropolitano Niguarda Milan, Italy, with Prof. Marco Cenzato as the president.The tenth European-Japanese Cerebrovascular Congress (EJCVC) will be held in Kyoto. It will be the first meeting of the EJCVC in Japan.Publication of the proceeding books of the conference as supplements of ACTA Neurochirurgica is one of the main reasons that we have been able to continue this conference for almost 20 years. We sincerely thank Prof. Steiger for his continuous and generous cooperation as the series Editor of ACTA Neurochirurgica.

Increasing evidence has demonstrated that patients' involvement promotes better health care outcomes and cost-effectiveness of services. However, limited literature is available about the experience of living donor kidney transplantation and best practices to promote patients and donors' engagement. Aim of the present chapter is to review the literature about patient engagement in the context of chronic kidney disease, and to introduce an innovative protocol developed to promote potential donors and recipients' participation and adherence to care at the Niguarda Ca' Granda Hospital in Milan (Italy). Results are critical to reflect on the identification of best practices for patients' engagement in the context of chronic kidney disease. Through a better understanding of the emotional and affective dynamics and the relational implications that may influence the elaboration of the information given by health care providers, it will be possible to develop evidence-informed interventions.