Articles de revues : « Niguarda »

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Colombo, Fabrizio, Lucia Taurino, Giulia Colombo, Massimo Amato, Salvatore Rizzo, Matteo Murolo, Rita Facchetti et Ruggero Ruggeri. « The Niguarda MEWS, a new and refined tool to determine criticality and instability in Internal Medicine Ward and Emergency Medicine Unit ». Italian Journal of Medicine 11, n^o 3 (11 septembre 2017) : 310. http://dx.doi.org/10.4081/itjm.2017.826.

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This study compares the effect of the modified early warning score (MEWS) versus 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.

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Sironi, V. A. « Niguarda Ca’ Granda Hospital : seventy years of history ». Journal of Medicine and the Person 8, n^o 1 (avril 2010) : 39–41. http://dx.doi.org/10.1007/s12682-010-0045-7.

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Maione, G., C. V. Sansalone, P. Aseni, A. De Roberto, S. Soldano, I. Mangoni, L. Perrino, E. Minetti et G. Civati. « Laparosopic Hand-Assisted Living Donor Nephrectomy : The Niguarda Experience ». Transplantation Proceedings 37, n^o 6 (juillet 2005) : 2445–48. http://dx.doi.org/10.1016/j.transproceed.2005.06.052.

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Maloberti, Alessandro, Davide Ceruti, Elena Gualini, Valentina Colombo, Valentina Giani, Martina Milani, Jinwei Sun, Marta Alloni et Cristina Giannattasio. « PRESCRIPTIVE APPROPRIATENESS IN PRIMARY CARDIOVASCULAR PREVENTION : DATA FROM NIGUARDA HOSPITAL ». Journal of Hypertension 40, Suppl 1 (juin 2022) : e131-e132. http://dx.doi.org/10.1097/01.hjh.0000836620.30726.93.

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Maloberti, A., D. Ceruti, E. Gualini, V. Colombo, V. Giani, M. Milani, J. Sun, M. Alloni et C. Giannattasio. « Prescriptive appropriateness in primary cardiovascular prevention : Data from Niguarda hospital ». Atherosclerosis 355 (août 2022) : 188. http://dx.doi.org/10.1016/j.atherosclerosis.2022.06.770.

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Ferla, F., A. Mariani, S. di Sandro, V. Buscemi, A. Lauterio, J. Mangoni, E. Covucci, A. Giacomoni et L. De Carlis. « Do Older Liver Grafts Have Worse Survival ? The Niguarda Experience ». Transplantation Proceedings 48, n^o 2 (mars 2016) : 362–65. http://dx.doi.org/10.1016/j.transproceed.2015.12.043.

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Garatti, A., T. Colombo, C. Russo, M. Lanfranconi, G. Bruschi, F. Milazzo, E. Catena et E. Vitali. « Impella recover 100 microaxial left ventricular assist device : the Niguarda experience ». Transplantation Proceedings 36, n^o 3 (avril 2004) : 623–26. http://dx.doi.org/10.1016/j.transproceed.2004.02.051.

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Mariani, A., F. Ferla, R. De Carlis, O. Rossetti, E. Covucci, M. Tripepi, G. Concone, A. Lauterio, I. Mangoni et L. De Carlis. « Dual Kidney Transplantation : Evaluation of Recipient Selection Criteria at Niguarda Hospital ». Transplantation Proceedings 48, n^o 2 (mars 2016) : 315–18. http://dx.doi.org/10.1016/j.transproceed.2015.12.041.

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Chiereghin, F. « Educating patients on carbohydrate counting : efficiency of distance support in type 1 diabetes ». Journal of AMD 23, n^o 4 (décembre 2020) : 275. http://dx.doi.org/10.36171/jamd20.23.4.5.

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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.

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Vitali, Ettore, Marco Lanfranconi, Giuseppe Bruschi, Claudio Russo, Tiziano Colombo et Elena Ribera. « Left Ventricular Assist Devices as Bridge to Heart Transplantation : The Niguarda Experience ». Journal of Cardiac Surgery 18, n^o 2 (mars 2003) : 107–13. http://dx.doi.org/10.1046/j.1540-8191.2003.02012.x.

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Giacomoni, A., A. Lauterio, A. Slim, I. Mangoni, P. Aseni, V. Pirotta, S. Boati et L. De Carlis. « L/I-9 Adult living donor liver transplants : Niguarda experience in Milan ». Clinical Transplantation 20, s16 (octobre 2006) : 30. http://dx.doi.org/10.1111/j.1399-0012.2006.00577_3_9.x.

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Bozza-Marrubini, Marialuisa. « Three Major Disasters in Italy. Experiences of Niguarda-Ca'Granda Staff of Milan ». Prehospital and Disaster Medicine 1, S1 (1985) : 414–19. http://dx.doi.org/10.1017/s1049023x00045325.

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The medical and nursing staff of the Niguarda-Ca' Granda Hospital of Milano has been involved in three major disasters that occurred in Italy in the years 1976 and 1980: (1) the earthquake of May 6, 1976 in a northeastern region (Friuli); (2) the ICMESA plant explosion of July 10, 1976 in Seveso (Milano) and (3) the earthquake of November 23, 1980 in the region of Irpinia (Southern Italy).Friuli Earthquake 1976On May 7, 1976, about 12 hours after the earthquake struck, the Udine Hospital, located at about 15 km from the border of the disaster area, contacted by phone the director of the Ca' Granda Hospital in Milano, requesting a relief staff of operating room and ICU nurses. The Udine Hospital was undamaged and was overburdened by work for the surgical, orthopedic and medical treatment of the rescue victims. The staff requested was needed to relieve the exhausted local nursing staff. Extra staff was needed also to accompany ambulances with patients that, after initial triage and treatment, were evacuated to other hospitals outside the seismic area.

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Biagi, L., M. A. Brovelli et L. Stucchi. « MAPPING THE ACCESSIBILITY IN OPENSTREETMAP : A COMPARISON OF DIFFERENT TECHNIQUES ». ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLIII-B4-2020 (24 août 2020) : 229–36. http://dx.doi.org/10.5194/isprs-archives-xliii-b4-2020-229-2020.

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Abstract. Architectural barriers are physical elements that limit the freedom of movement and use of services of a person. The lack of accessibility is one of the physical barriers that most limit people with motor disabilities, as recognised by the World Health Organization. The work aims to identify the optimal methodology to map accessible ways and critical barriers, in order to produce cartographic support for people with motor disabilities. It should also be a tool that allows citizens to report barriers to public authority. The work is part of the ViaLibera?! project, which aims to apply the methodology in the Municipality 9 of the city of Milan. The project is founded by Fondazione di Comunit`a Milano; Politecnico di Milano is the scientific partner, while the other partners are associations that represent people with disabilities: Spazio Vita Niguarda Onlus, Ledha Milano and AUS Niguarda Onlus. The mapping elements of interest for the project were identified in collaboration with the other partners, also studying the state of the art. In the framework of Open Street Map, a comparison between different existing mapping techniques was done to select the optimal compromise between rigour and simplicity. In addition, the different techniques must be suitable for the chosen tagging scheme to map accessibility elements. The techniques analysed involve the use of paper maps, Field Papers, and street-level images or applications for smartphones. They are compared to identify the best one.

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Sansalone, C. V., P. Aseni, M. L. Follini, A. O. Slim, O. Rossetti, G. Colella, F. Di Benedetto et al. « Enteric Versus Bladder Drainage in Pancreas Transplantation : Initial Experience at Niguarda Hospital, Milan ». Transplantation Proceedings 30, n^o 2 (mars 1998) : 251–52. http://dx.doi.org/10.1016/s0041-1345(97)01247-5.

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Gaspari, F., L. Stucchi, G. Bratic, D. Jovanovic, C. Ponti, L. G. A. Biagi et M. A. Brovelli. « INNOVATION IN TEACHING : THE POLIMAPPERS COLLABORATIVE AND HUMANITARIAN MAPPING COURSE AT POLITECNICO DI MILANO ». International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLVI-4/W2-2021 (19 août 2021) : 63–69. http://dx.doi.org/10.5194/isprs-archives-xlvi-4-w2-2021-63-2021.

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Abstract. Collaborative projects imply a wide variety of skills, ranging from technical abilities to teamwork and problem-solving attitudes. Innovative teaching programmes focused on the use and promotion of open-source geospatial tools represent a key element in developing such transversal abilities. OpenStreetMap (OSM) brings into play open and collaborative dynamics that build a critical ecosystem where single contributions are part of collective intelligence. This initiative led to the foundation of structured contributors groups such as PoliMappers, the first European YouthMappers chapter based in Politecnico di Milano (Italy). Pursuing the objective to build a responsible student-led community of Free and Open Source Software users, in 2021 PoliMappers organised the course entitled “Collaborative and Humanitarian Mapping”. The programme is structured into 7 meetings and aims to introduce university students to the OSM environment with a focus on the potential of open data and related geospatial tools, especially in the humanitarian field. It has seen the participation of the World Food Programme, Open Knowledge Foundation, TECHO Colombia, IMM Design Lab, Map for Future, UN Mappers, Spazio Vita Niguarda Onlus, Ledha Milano, AUS Niguarda Onlus and Humanitarian OpenStreetMap Team. Enrolled attendants’ contributions have been assessed with tools for quality review and statistics. Also, Q&As and suggestions to the attendants have been collected to detect common issues. The paper presents the course, from the design to the assessment of the students’ activities, and the lessons learned in this experience in such a way to provide some guidance to those who want to organize similar initiatives.

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Cioffi, Stefano Piero Bernardo, Osvaldo Chiara, Luca Del Prete, Alessandro Bonomi, Michele Altomare, Andrea Spota, Roberto Bini et Stefania Cimbanassi. « Failure to Rescue (FTR) and Pitfalls in the Management of Complex Enteric Fistulas (CEF) : From Rescue Surgery to Rescue Strategy ». Journal of Personalized Medicine 12, n^o 2 (16 février 2022) : 292. http://dx.doi.org/10.3390/jpm12020292.

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Purpose: Complex enteric fistulas (CEF) represent general surgeons’ nightmare. This paper aims to explore the impact on failure-to-rescue (FTR) rate of a standardised and integrated surgical and critical care step-up approach. Methods: This was a retrospective observational cohort study. Patients treated for CEF from 2009 to 2019 at Niguarda Hospital were included. Each patient was approached following a three-step approach: study phase, sepsis control and strategy definition phase, and surgical rescue phase. Results: Sixteen patients were treated for CEF. Seven fistulas were classified as complex entero-cutaneous (ECF) and nine as entero-atmospheric fistula (EAF). Median number of surgical procedures for fistula control before definitive surgical attempt was 11 (IQR 2–33.5). The median time from culprit surgery and the first access at Niguarda Hospital to definitive surgical attempt were 279 days (IQR 231–409) and 120 days (IQR 34–231), respectively. Median ICU LOS was 71 days (IQR 28–101), and effective hospital LOS was 117 days, (IQR 69.5–188.8). Three patients (18.75%) experienced spontaneous fistula closure after conversion to simple ECF, whereas 13 (81.25%) underwent definitive surgery for fistula takedown. Surgical rescue was possible in nine patients. Nine patients underwent multiple postoperative revision for surgical complications. Four patients failed to be rescued. Conclusion: An integrated step-up rescue strategy is crucial to standardise the approach to CEF and go beyond the basic surgical rescue procedure. The definition of FTR is dependent from the examined population. CEF patients are a unique cluster of emergency general surgery patients who may need a tailored definition of FTR considering the burden of postoperative events influencing their outcome.

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Sgoifo, A., P. Proserpio, U. Mazza et E. Agostoni. « Psychological treatment for insomnia. The experience of the Sleep Disorder centre of Niguarda hospital ». Journal of Psychosomatic Research 133 (juin 2020) : 110087. http://dx.doi.org/10.1016/j.jpsychores.2020.110087.

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Caruso, Raul, Filomena Asgresta et Emiliano Sironi. « Profilo economico delle donne nel disagio post-partum. Un'indagine empirica presso l'Ospedale Niguarda di Milano ». ECONOMIA PUBBLICA, n^o 2 (janvier 2016) : 159–80. http://dx.doi.org/10.3280/ep2015-002005.

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Altomare, Michele, Andrea Chierici, Francesco Virdis, Andrea Spota, Stefano Piero Bernardo Cioffi, Shir Sara Bekhor, Luca Del Prete et al. « Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy : Lesson Learned from COVID-19 Pandemic ». Journal of Clinical Medicine 11, n^o 13 (24 juin 2022) : 3658. http://dx.doi.org/10.3390/jcm11133658.

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Background: During the COVID-19 pandemic, the centralization of patients allowed trauma and transplants referral centers to continue their routine activity, ensuring the best access to health care. This study aims to analyze how the centralization of trauma is linked with liver allocation in Northern Italy. Methods: Cluster analysis was performed to generate patient phenotype according to trauma-related variables. Comparison between clusters was performed to evaluate differences in damage control strategy procedures (DCS) performed and the 30-day graft dysfunction. Results: During the pandemic period, the centralization of major trauma has deeply impaired the liver procurement and allocation between the transplant centers in the metropolitan area of Milan (Niguarda: 22 liver procurement; other transplant centers: 2 organ procurement). Two clusters were identified the in Niguarda’s series: cluster 1 is represented by 17 (27.4%) trauma donors, of which 13 (76.5%) were treated with DCS procedures, and 4 (23.5%) did not; cluster 2 is represented by 45 trauma donors (72.6%), of which 22 (48.8%) underwent DCS procedures. A significant difference was found in the number of DCS procedures performed between clusters (3.18 ± 2.255 vs. 1.11 ± 1.05, p = 0.0001). Comparative analysis did not significantly differ in the number of transplanted livers (cluster1/cluster2 94.1%/95.6% p = 0.84) and the 30-day graft dysfunction rate (cluster1/cluster2 0.0%/4.8% p = 0.34). Conclusions: The high level of care guaranteed by first-level trauma centers could reduce the loss of organs suitable for donation, maintaining the good outcomes of transplanted ones, even in case of multiple organ injuries. The pandemic period underlined that the centralization of major trauma impairs the liver allocation between transplant centers.

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Cassani, M., N. Da Re, L. Giuliani et F. Sesana. « Experience with hair testing in the clinical biochemistry laboratory of Ca' Granda Niguarda Hospital, Milan, Italy ». Forensic Science International 84, n^o 1-3 (janvier 1997) : 17–24. http://dx.doi.org/10.1016/s0379-0738(96)02044-0.

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Chiara, Osvaldo, Sara Andreani, Stefania Cimbanassi, Fabio Sansonna, Sergio Vesconi et Raffaele Pugliese. « Relevance of trauma team organization in the management of severe injuries : the Niguarda model in Milan ». Journal of Medicine and the Person 9, n^o 1 (16 octobre 2010) : 17–25. http://dx.doi.org/10.1007/s12682-010-0061-7.

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Nittari, Giulio, Getu Gamo Sagaro, Alessandro Feola, Mattia Scipioni, Giovanna Ricci et Ascanio Sirignano. « First Surveillance of Violence against Women during COVID-19 Lockdown : Experience from “Niguarda” Hospital in Milan, Italy ». International Journal of Environmental Research and Public Health 18, n^o 7 (6 avril 2021) : 3801. http://dx.doi.org/10.3390/ijerph18073801.

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Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March–30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries.

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Viganò, Raffaella, Chiara Mazzarelli, Alberto Battista Alberti et Giovanni Perricone. « Change of liver transplantation list composition : Pre versus post direct-acting antivirals era. The Niguarda Hospital experience ». Digestive and Liver Disease 49, n^o 3 (mars 2017) : 317. http://dx.doi.org/10.1016/j.dld.2017.01.145.

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Cavazza, Marianna, Graziella Civenti et Roberto Ravasio. « Capitolo 4 : Servizi e pazienti reclutati ». Epidemiologia e psichiatria sociale. Monograph Supplement 11, S6 (décembre 2002) : 33–37. http://dx.doi.org/10.1017/s1827433100000216.

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Lo studio ha coinvolto 10 Unità Operative di Psichiatria (UOP) della regione Lombardia:– UOP 4 di Busto Arsizio (popolazione residente 172.419);– UOP 5 di Saranno (popolazione residente 134.029);– UOP 30 di Crema (popolazione residente 122.043);– UOP 35 di Vimercate (popolazione residente 154.877);– UOP 38 di Desio (popolazione residente 218.157);– UOP 39 di Sesto San Giovanni (popolazione residente 117.355);– UOP 43 di Legnano (popolazione residente 202.798);– UOP 47 “Niguarda 2” di Milano (popolazione residente 70.447);– UOP 51 “San Paolo 1” di Milano (popolazione residente 159.421);– UOP 53 “San Carlo 1” di Milano (popolazione residente 149.002).Il bacino di utenza complessivo risulta composto da circa un milione e mezzo di abitanti, pari al 16% della popolazione lombarda.Le 10 Unità Operative esprimono realtà territoriali e sociali differenziate: includono infatti servizi collocati in area metropolitana, quali quelli della città di Milano, e servizi di aree non urbane quali, per esempio, quelli di Crema, Legnano, Desio.

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De Carlis, L., A. Lauterio, A. Giacomoni, A. O. Slim, V. Pirotta, J. Mangoni et P. Mihaylov. « Adult Living Donor Liver Transplantation With Right Lobe Graft : The Venous Outflow Management in the Milan-Niguarda Experience ». Transplantation Proceedings 40, n^o 6 (juillet 2008) : 1944–46. http://dx.doi.org/10.1016/j.transproceed.2008.05.051.

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Cuppari, I., R. Crocchiolo, E. Boiani, A. Cafro, P. Bertazzoni, M. Soldarini, M. T. Pugliano, E. Volpato et S. Rossini. « PB2445 PRE-TRANSFUSION IMMUNOHEMATOLOGY TESTING INTERFERENCE WITH DARATUMUMAB : PRELIMINARY EXPERIENCE FROM THE FIRST PATIENTS TREATED AT ASST GOM NIGUARDA ». HemaSphere 3, S1 (juin 2019) : 1082. http://dx.doi.org/10.1097/01.hs9.0000568240.54656.1b.

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Ferrara, L., E. Listorti, A. Adinolfi, M. C. Gerardi, N. Ughi, O. M. Epis et V. Tozzi. « POS1553-HPR A VIRTUOUS IMPLEMENTATION OF TELEMEDICINE SERVICES IN RHEUMATOLOGY : DESCRIPTION OF CHANGE MANAGEMENT PRACTICES ADOPTED BY THE NIGUARDA HOSPITAL ». Annals of the Rheumatic Diseases 81, Suppl 1 (23 mai 2022) : 1121. http://dx.doi.org/10.1136/annrheumdis-2022-eular.5262.

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BackgroundOver the past few decades there have been an increasing debate around the use of telemedicine. Despite this, there is still a slow rate of adoption of telemedicine services. According to a recent scoping review this may be due to a piecemeal approach to the change process, and a lack of understanding of how to plan, manage and reinforce change when implementing telemedicine service1.A virtuous example of implementation of telemedicine services can be found within the rheumatology unit of Niguarda Hospital in Milan (Italy), where the whole staff has been involved in experimenting with new multichannel interactions to communicate with patients for more than a decade. Developed in 2011 with the introduction of the iAr Plus app for the collection of Patient Reported Outcomes (PROs), the project was first targeted to patients with Rheumatoid arthritis, Psoriatic arthritis and Spondylarthritis. In 2019 the project consolidated and added the home delivery of biological drugs for the stable patients. During spring 2020, this experience was further enhanced and extended to all patients treated with biological drugs to facilitate patient interaction during Covid-19 and was characterized by three elements: remote monitoring, triage through phone calls and home delivery of medication. What contextual factors and mechanisms adopted to plan, manage, and reinforce change where more successful?ObjectivesThis study aimed to highlight what were the distinctive and successful elements of this implementation experience, what we could learn from it, and which managerial implications we could derive for future implementations.MethodsWe adopted a realist evaluation approach2 to identify the underlying generative mechanisms that explain ‘how’ the outcomes were caused and the influence of context. Thus, we deepened how the change management process has been managed by conducting semi-structured interviews with the unit director, and the staff members involved in the phases of the project (i.e., clinicians, nurses, and administrative staff). The interviews were recorded and analyzed through an ad-hoc framework1 for the analysis of change management practices. This framework identifies 10 change steps divided into 13 strategic practices and 6 operational practices that are important during the preparatory phase of the change process, for managing the change, and to sustain and reinforce long-term change.ResultsOur study identified the most relevant actions put in place by the rheumatology unit during the three major steps of preparing for change (e.g., developed telemedicine App, assigned coordinating role, identified champions), managing change (e.g., developed and articulated a clear vision, provided training, developed ownership), and reinforcing change (e.g., continued to engage partners). The analysis highlighted four main lessons learned: first the characteristics of the context and a strong managerial structure were a prerequisite for success. The generative mechanisms that explain how these successful outcomes were caused are: a leadership role able to define a clear vision and a clear specialization of tasks and roles; the involvement of all team members; regular meetings and interactions. Second, patients should be involved as central actors in the definition of the care pathway. The final decision on the kind of services to be used was made by the patient. Third, the relevant stakeholders should be involved since the co-design of the app. Finally, change should be incremental. The Rheumatic unit introduced one change at a time, and this brought to constant improvements.ConclusionThe framework adopted can be used either to retrospectively analyze the experiences developed but may also act as a tool to guide future telemedicine service implementation and research. As well as the lessons learned can guide the implementation of future telemedicine experiencesReferences[1]Kho J., et al., 2020. BMC Health Services Research[2]Pawson R., et al., 1997. Realistic Evaluation. SageAcknowledgementsThis study would not have been possible without the support of the whole staff of the Rheumatology unit who participated to the interviewsDisclosure of InterestsLucia Ferrara: None declared, Elisabetta Listorti: None declared, Antonella Adinolfi Speakers bureau: JANSSEN, BMS, Maria Chiara Gerardi: None declared, Nicola Ughi Speakers bureau: ROCHE, PFIZER, ALFASIGMA, ABBVIE, JANSSEN, GALAPAGOS, BRISTOL MYERS SQUIBB, oscar massimiliano epis: None declared, Valeria Tozzi: None declared

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Pedotti, Rosetta, Laura Losappio, Mariangela Farinotti, Donatella Preziosi, Irene Tramacere, Chrysi Stafylaraki, Ambra Mascheri, Graziella Filippini et Elide A. Pastorello. « Accuracy of a questionnaire for identifying respiratory allergies in epidemiological studies ». Rhinology journal 53, n^o 1 (1 mars 2015) : 49–53. http://dx.doi.org/10.4193/rhino14.057.

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Background: The assessment of allergic asthma (AA) and allergic rhinitis (AR) in epidemiological studies is often challenging. We performed a cross-sectional study to test the accuracy of a Questionnaire aimed at Identifying subjects with Respiratory Allergy (QIRA) in a simple and fast way. Methods: One hundred-thirty subjects, 18-76 years of age, admitted consecutively at the Allergy Center of the Niguarda Ca` Granda Hospital of Milan were included. The questionnaire (index test) investigated the presence of AA and AR with seven questions enquiring history of symptoms, diagnosis made by a doctor, allergy tests performed, and treatments. After completing the questionnaire, all subjects were subsequently diagnosed by an allergist (reference standard). Results: The accuracy of the questionnaire for the diagnosis of AA and AR was high (sensitivity 94.7% [95% confidence interval CI: 74.0-99.9] and specificity 99.1% [95% CI 95.1-100.0] for AA; sensitivity 82.8% [95% CI 71.3-91.1] and specificity 98.5% [95% CI 91.8-100.0] for AR). Conclusion: The questionnaire significantly distinguished subjects with respiratory allergy from those without. The QIRA represents a valid and accurate tool for classifying subjects as having or not AA and/or AR in epidemiological studies.

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Canzi, Gabriele, Valeria Morganti, Giorgio Novelli, Alberto Bozzetti et Davide Sozzi. « Posttraumatic Delayed Enophthalmos : Analogies with Silent Sinus Syndrome ? Case Report and Literature Review ». Craniomaxillofacial Trauma & ; Reconstruction 8, n^o 3 (septembre 2015) : 251–56. http://dx.doi.org/10.1055/s-0034-1399799.

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Acute posttraumatic enophthalmos is a well-known symptom occurring in orbital blowout fractures. Its late onset in the absence of radiologic evidence of displaced fractures is rare and traditionally attributed to ischemic liponecrosis or fibrotic scarring of endo-orbital soft tissues. In this article, we describe a case of facial trauma, diagnosed and treated at the Maxillo-Facial Surgical Department of Hospital Ca’ Granda Niguarda of Milan, in which delayed monolateral enophthalmos is associated with CT evidence of remodeling of orbital walls attributed to atelectasis of the maxillary sinus, as occurs spontaneously in patients suffering from silent sinus syndrome (SSS). Despite that classic criteria exclude traumatic etiology of SSS, recent literature suggests the possibility to include it. Our case is the first reported in literature supported by complete clinical and radiological documentation obtained before and after the condition established itself. The analogy with cases of spontaneous obstacle of aeration allows us to choose “two-step” surgical treatment with endoscopic uncinectomy and antrostomy and a delayed surgical correction of orbital volume to improve aesthetic results. The case described in this article and the review of the literature may focus physicians’ attention on evaluating the possible traumatic changes in the physiologic sinus drainage system.

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Sgoifo, Annalisa, Maria Raffaella Marazzi, Emanuela Laura Susani, Lorenzo Saraceno, Maria Grazia Esposito, Concetta Campagna, Elio Agostoni et Alessandra Protti. « Fragiles but Resilient. The Key Strategies to Cope with Pandemic in Persons with Multiple Sclerosis. A Controlled Web Survey ». Journal of Neurological Research and Therapy 3, n^o 4 (1 juin 2022) : 31–49. http://dx.doi.org/10.14302/issn.2470-5020.jnrt-22-4106.

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Background SARS-CoV-2 pandemic represented an unexpected psychological stress, being a major threat to health and limiting daily’s life, especially for the fragile population. How could the people with (pw) Multiple Sclerosis (MS) cope with this emergency? Objective To observe the pwMS’s psychological reaction in comparison with non affected persons and to evaluate the impact of lifestyle changes on psychological symptoms, due to the pandemic. Methods The study was observational, retrospective, controlled, focused on good clinical practice and conducted at Niguarda Hospital. PwMS and controls filled a web survey containing anamnestic data, habits, depression and anxiety self-questionnaires. The primary outcome was the pwMS’s psychological anxiety and depression score compared with controls. Results On April, 10 2020, 88/165 pwMS and 187 controls joined the study. Unexpectedly, no significant differences between groups were observed for depression mean score: 6.6(5.2) in pwMS and 6.2(4.8) in controls and for anxiety: 5.9(4.8) and 5.0(4.2). PwMS focused on health concern more often than controls, but they respected the restrictions more easily and benefited from practical activities more than controls. Conclusion PwMS showed a proper psychological resilience in comparison with controls. These findings might guide the clinical interviews and suggest both the areas to be supported and the strengths to be promoted in pwMS.

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Vettorello, Marco, Michele Altomare, Andrea Spota, Stefano Piero Bernardo Cioffi, Marta Rossmann, Andrea Mingoli, Osvaldo Chiara et Stefania Cimbanassi. « Early Hypocalcemia in Severe Trauma : An Independent Risk Factor for Coagulopathy and Massive Transfusion ». Journal of Personalized Medicine 13, n^o 1 (28 décembre 2022) : 63. http://dx.doi.org/10.3390/jpm13010063.

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The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify risk factors associated with massive transfusion requirements and hypocalcemia. All major trauma (ISS > 16) presented directly from the scene to the Niguarda hospital between 1 January 2015 and 31 December 2021 were analyzed. A total of 798 patients were eligible out of 1586 screened. Demographic data showed no significant difference between hypocalcemic (HC) and normocalcemic (NC) patients except for the presence of crush trauma, alcohol intake (27% vs. 15%, p < 0.01), and injury severity score (odds ratio 1.03, p = 0.03). ISS was higher in the HC group and was an independent, even if weak, predictor of hypocalcemia (odds ratio 1.03, p = 0.03). Prehospital data showed a lower mean systolic arterial pressure (SAP) and a higher heart rate (HR) in the HC group (105 vs. 127, p < 0.01; 100 vs. 92, p < 0.001, respectively), resulting in a higher shock index (SI) (1.1 vs. 0.8, p < 0.001). Only retrospective studies such as ours are available, and while hypocalcemia seems to be an independent predictor of mortality and massive transfusion, there is not enough evidence to support causation. Therefore, randomized prospective studies are suggested.

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Meliante, Maria, Chiara Rossi, Lara Malvini, Clara Niccoli, Osmano Oasi, Simona Barbera et Mauro Percudani. « The Relationship between PID-5 Personality Traits and Mental States. A Study on a Group of Young Adults at Risk of Psychotic Onset ». Medicina 57, n^o 1 (1 janvier 2021) : 33. http://dx.doi.org/10.3390/medicina57010033.

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Background and Objectives: The diagnosis of psychosis is a challenge for the scientific community, both in terms of its definition and treatment. Some recent studies have investigated the relationship between personality and psychosis onset to prevent or intervene early. Materials and Methods: Sixty young adults were recruited during their first access in 2019 near the Community Mental Health Service of Niguarda Hospital, Milan, Italy. The assessment included the Social and Occupational Functioning Assessment Scale (SOFAS), the Global Assessment of Functioning (GAF) (clinician scales), the 16-item Version of the Prodromal Questionnaire (PQ-16), the Personality Inventory for DSM-5 (PID-5) (self-report), and a clinical session. Statistical analysis was performed by SPSS. Results: The results show a negative correlation between the Detachment domain and the GAF scores. Correlational analysis also highlights that all PID-5 domains, except for Antagonism, have positive correlations with high scores in the PQ-16. The multivariate analysis of variance showed that patients diagnosed with versus without a psychotic disorder significantly differed on Detachment, Antagonism and Psychoticism PID-5 domains. Conclusions: The involvement of the personality construct in psychopathological development is displayed. In particular, higher levels of Detachment and Psychoticism can distinguish people who are more vulnerable to psychosis or who already have overt psychosis from those who do not have a psychotic predisposition. The study highlights the fundamental role of personality traits, emerging from PID-5, to distinguish young adults at risk of onset.

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Fanelli, Simone, Gianluca Lanza et Antonello Zangrandi. « Competences management for improving performance in health organizations ». International Journal of Health Care Quality Assurance 31, n^o 4 (14 mai 2018) : 337–49. http://dx.doi.org/10.1108/ijhcqa-02-2017-0035.

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PurposeThe purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital.Design/methodology/approachThe paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome.FindingsResults reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities.Originality/valueLiterature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools.

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Gatelli, Italo Francesco, Ottavio Vitelli, Gaia Chiesa, Francesca De Rienzo et Stefano Martinelli. « Noninvasive Cardiac Output Monitoring in Newborn with Hypoplastic Left Heart Syndrome ». American Journal of Perinatology 37, S 02 (septembre 2020) : S54—S56. http://dx.doi.org/10.1055/s-0040-1713603.

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Objective This study aimed to describe the first two cases of electrical cardiometry applied to newborn with hypoplastic left heart syndrome for hemodynamical assessment in the first days of life before surgical correction and see if this can help decision making process in these patients. Study Design We describe two case series of two full-term newborn with hypoplastic left heart syndrome in the Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, between December 2019 and January 2020. Results Case 1 was persistently hemodynamically stable with prostaglandin E1 infusion at 0.01 mcg/kg/min, showing good capillary refill time, good diuresis, no difference between pre- and postductal values of oxygen saturation or blood pressure. Electrical cardiometry monitoring constantly showed cardiac output values higher than 300 mL/kg/min. Case 2 showed poor clinical condition needing prostaglandin E1 infusion up to 0.05 mcg/kg/min, intubation and septostomy associated with low cardiac output around 190 mL/kg/min. Once cardiac output has begun to rise and reached values constantly over 300 mL/kg/min, clinical condition improved with amelioration in oxygen saturation, diuresis, blood pressure, and blood gas analysis values. She was then extubated and finally clinically stable until surgery with minimal infusion of prostaglandin E1 at 0.01 mcg/kg/min. Conclusion This case highlights how hemodynamic information provided by electrical cardiometry can be used to supplement the combined data from all monitors and the clinical situation to guide therapy in these newborns waiting surgery. Key Points

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Sartore-Bianchi, A., A. Amatu, S. Stabile, F. Tosi, E. Bonazzina, M. Maiolani, F. Rusconi et al. « Pooled analysis of clinical outcome of patients with chemorefractory metastatic colorectal cancer treated within clinical studies based on individual molecular alterations at Niguarda Cancer Center ». Annals of Oncology 26 (octobre 2015) : vi39. http://dx.doi.org/10.1093/annonc/mdv340.11.

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Bini, Roberto, Caterina Accardo, Stefano Granieri, Fabrizio Sammartano, Stefania Cimbanassi, Federica Renzi, Francesca Bindi, Laura Briani et Osvaldo Chiara. « Independent Predictors of Mortality in Torso Trauma Injuries ». Journal of Clinical Medicine 9, n^o 10 (3 octobre 2020) : 3202. http://dx.doi.org/10.3390/jcm9103202.

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Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

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Cancarini, Giovanni C., Dirk Faict, Catherine De Vos, Robert Guiberteau, Anders Tranæus, Luigi Minetti et Rosario Maiorca. « Clinical Evaluation of a Peritoneal Dialysis Solution with 33 mmol/L Bicarbonate ». Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis 18, n^o 6 (novembre 1998) : 576–82. http://dx.doi.org/10.1177/089686089801800604.

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Objective To evaluate the efficacy and safety of a new peritoneal dialysis solution with 33 mmol/L bicarbonate. Design In an acute, prospective, randomized crossover study, 8 patients were randomized in two groups of 4. On the first study day, the first group performed two consecutive 4-hour exchanges with a dialysis solution containing 35 mmol/L lactate: the first exchange with 13.6 g/L and the second with 38.6 g/L dextrose. On the second study day, the same type of exchanges were performed with bicarbonate. The second group underwent the same treatment, but used bicarbonate solutions on the first day and control solutions on the second study day. Thirty-three patients participated in a 2-month prospective and randomized study. After a 4-week baseline period using solutions containing 40 mmol/L lactate, the patients were dialyzed with either 33 mmol/L bicarbonate solutions or 40 mmol/L lactate solutions. Setting Peritoneal dialysis units at the University Hospital of Brescia and the Niguarda Hospital of Milan, Italy. Results Acute study: Control and bicarbonate solutions had similar effects on blood chemistries and peritoneal transport. Chronic study: Mean venous bicarbonate concentrations remained unchanged in the control group (26.6 -27.2 mmol/L), but decreased significantly in the bicarbonate group from 28.8 mmol/L at the start of the study to 23.0 mmol/L after 2 months of bicarbonate administration. Other biochemical parameters remained unchanged. Conclusion A peritoneal dialysis solution with a bicarbonate level of 33 mmol/L does not adequately correct uremic acidosis.

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Meneghelli, A. « Assertive Interventions for First Episode Psychoses : The Italian Experience ». European Psychiatry 41, S1 (avril 2017) : S4. http://dx.doi.org/10.1016/j.eurpsy.2017.01.022.

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In Italy, despite the favourable conditions created by the 1978 reform law and the community psychiatry, at the end of the past century there were no culture or initiatives oriented to innovative and evidence-based founded interventions in early psychosis. The watershed was the setting up in the MHD of Niguarda (Milan) of Programma 2000, addressed to FEP and HR mostly inspired by the knowledge of existing studies and experiences and with the recommended characteristics of specificity, multicomponentiality, assertiveness and doctrinal orientation. From the very start, one fundamental aim was to disseminate information, training, supervision, and to raise consensus and initiatives throughout Italy, as well as to improve international links. In many ways, the consequences have been extremely positive. In 2005, Angelo Cocchi and Programma 2000 team founded the AIPP (Italian Association for Early Intervention in Psychosis), now named Italian Association for Prevention and Early Intervention in Mental Health. Over the years, the Association has organized conferences, scientific days, working network, two national surveys on EIS and produced a document to favour their development. The results of the second survey are the more updated and articulated about the number of early interventions services, their characteristics and distribution in the different Italian regions. The survey conclusion is that EI Services implementation in Italy has been proceeding, albeit slowly. Nevertheless, there is still a great variability of therapeutic strategies and further efforts are then necessary to stimulate resources allocation as well as to assess and address adherence and fidelity to guidelines recommendations.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Caccianiga, Paolo, Lorenzo Giovanni Mantovani, Marco Baldoni et Gianluigi Caccianiga. « Distribution of Malocclusion Traits in the Pediatric Population of Milan : An Observational Study ». International Journal of Environmental Research and Public Health 19, n^o 21 (30 octobre 2022) : 14199. http://dx.doi.org/10.3390/ijerph192114199.

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Background: Epidemiological investigations define the prevalence and distribution of the various types of malocclusions, and can help to identify etiological factors and set the most correct orthodontic therapy. Aim: The goal of this study was to verify the prevalence and distribution of various types of malocclusions in the pediatric population. Methods: The study was performed on a sample of 350 patients (ages 5–9) being treated at the ASST Grande Ospedale Metropolitano Niguarda in Milan. A comparison was presented with one similar epidemiological investigation conducted 22 years earlier by the same researchers. The values of the malocclusion indices were reported from the cephalometric analyzes of the patients and were differentiated on the basis of gender and ethnicity. Results: The predominant traits of malocclusion in the general population of the analyzed sample were: skeletal class II (47.43%), hyper-divergence (40.86%), maxillary retrusion (46%), mandibular retrusion (66%), maxillary hypoplasia (50%), mandibular hypoplasia (49.14%), Wits index > 2 mm (22.57%); overjet > 4 mm (31.1%) and overbite > 4 mm (24.86%). Substantial differences were found between Italian patients and patients belonging to different ethnic groups in almost all parameters, and between the male and female genders in some of them. Patients in the 2000 study had a higher prevalence of Class II and hyper-divergence. Conclusions: This epidemiological investigation can suggest different approaches in setting the orthodontic treatment plan based on the ethnic group of the patient taken in charge and encourage more specific and large-scale analytical studies on the subject.

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Mattia, Cristina De, Federica Rottoli, Marina Sutto, Paola Enrica Colombo, Andrea Pola et Alberto Torresin. « [OA138] Organ dose estimate in CT exams : Inter-comparison of four commercial software and characterization of the main CT procedures used in asst Niguarda (Milan, Italy) ». Physica Medica 52 (août 2018) : 53. http://dx.doi.org/10.1016/j.ejmp.2018.06.210.

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Altomare, Michele, Stefano Granieri, Stefano Piero Bernardo Cioffi, Andrea Spota, Silvia Azisa Basilicò, Osvaldo Chiara et Stefania Cimbanassi. « High-Grade Limbs Open Fractures : Time to Find Milestones in the Emergency Setting ». Life 11, n^o 11 (12 novembre 2021) : 1226. http://dx.doi.org/10.3390/life11111226.

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(1) Background: The Gustilo–Anderson (G/A) grading system is a universally accepted tool used to classify high-grade limb open fractures. The purpose of this study is to find early independent predictors of amputation in emergency settings. (2) Methods: A retrospective analysis involving patients treated at our center between 2010 and 2016 was conducted. Patients with at least one G/A grade III fracture or post-traumatic amputation were included. Three groups were identified: G/A IIIA (A group), G/A IIIB-C (BC group), and Amputation group (AMP group). Each group was further divided into two subgroups considering timing of coverage (early vs. delayed). Univariate and multivariate logistic regression models were developed to identify independent predictors of the limb’s outcome. (3) Results: One-hundred-six patients with G/A III A-B-C fractures or amputation of the affected limb were selected from the Niguarda Hospital Trauma Registry. The patients were divided into the A group (26), BC group (66), and AMP group (14). The rate of infectious complications following early or delayed coverage was evaluated: A group, 9.1% vs. 66.7% (p > 0.05); BC group, 32% vs. 63.6% (p = 0.03); and AMP group, 22% vs. 18.5% (p > 0.05). After further recategorization, the BC subgroups were analyzed: multivariate logistic regression model identified systolic blood pressure (SBP) <90 mmHg (p = 0.03) and Mangled Extremity Severity Score MESS ≥ 7 (p = 0.001) were determined to be independent predictors of limb amputation. (4) Conclusion: MESS and SBP serve as predictors of amputation. Based on the results, we propose a new management algorithm for mangled extremities. Early coverage is related to lower rates of infectious complications. Referral to high-volume centers with specific expertise is mandatory to guarantee the best results.

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Maina, Cecilia, Stefano Piero Bernardo Cioffi, Michele Altomare, Andrea Spota, Francesco Virdis, Roberto Bini, Roberta Ragozzino et al. « Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients : A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic ». Journal of Personalized Medicine 13, n^o 1 (9 janvier 2023) : 128. http://dx.doi.org/10.3390/jpm13010128.

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Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. During the COVID-19 pandemic (COVID-19), different trends for pediatric trauma (PT) were described. This study aims to explore the trend over time of PT in our center, also considering the effects of COVID-19, focusing on trauma mechanisms, violence-related trauma (VRT) and intentionality, especially suicide attempts (SAs). Methods: All PT patients accepted at Niguarda Trauma Center (NTC) in Milan from January 2015 to December 2020 were retrospectively analyzed. We considered demographics and clinical variables and performed descriptive and year comparison analyses. Results: There were 684 cases of PT accepted at NTC: 84 in 2015, 98 in 2016, 125 in 2017, 119 in 2018, 114 in 2019 and 144 in 2020 (p < 0.001), 66.2% male, mean age 9.88 (±5.17). We observed a higher number of traffic-related, fall-related injuries and an increasing trend for VRT and SAs, peaking in 2020. We report an increasing trend over time for head trauma (p = 0.002). The Injury Severity Score did not significantly change. During COVID-19 we recorded a higher number of self-presenting patients with low priority codes. Conclusions: NTC is the adult level I referral trauma center for the Milan urban area with pediatric commitment. During COVID-19, every traumatic emergency was centralized to NCT. In 2020, we observed an increasing trend in SAs and VRT among PT patients. The psychological impact of the COVID-19 restriction could explain this evidence. The long-term effects of COVID-19 on the mental health of the pediatric population should not be underestimated. Focused interventions on psychological support and prevention of SAs and VRT should be implemented, especially during socio-demographic storms such as the last pandemic.

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Listorti, E., L. Ferrara, A. Adinolfi, M. C. Gerardi, N. Ughi, V. Tozzi et O. M. Epis. « POS1543-HPR Joining Telemedicine Services in Rheumatology : the Role Played by Personalized Experience From Patients’ Perspective ». Annals of the Rheumatic Diseases 81, Suppl 1 (23 mai 2022) : 1116. http://dx.doi.org/10.1136/annrheumdis-2022-eular.5206.

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BackgroundWith the beginning of the Covid-19 pandemic, many hospital departments worldwide, including rheumatology ones, were forced to implement telemedicine strategies. Telemedicine revealed to be an umbrella term, with various practical implementations and different degrees of preparedness1. Some practitioners were already familiar with telemedicine, as in the case of the Rheumatology Unit of ASST Niguarda Hospital in Milan (Italy), where telemedicine projects have been implemented for more than a decade with structured design and organized processes. Moreover, patients in Niguarda have experimented telemedicine with personalized mixes of channels, including e-mails and phone calls, Patient Reported Outcomes questionnaires, and home delivery of drugs. This represents a paradigmatic case study that enables us to deepen essential questions on the success of telemedicine.ObjectivesGiven that the last decision on joining telemedicine rests with patients2, we decided to adopt their perspective. We deepened three main aspects: i) the benefits perceived, ii) the willingness to enrol in future projects, iii) the preference on the service-mix, i.e., on-distance contacts rather than in-person visits. Most importantly, we investigated differences in the three areas among all patients based on the type of personalized experience had.MethodsWe conducted a survey from November 2021 to January 2022, enrolling randomly outpatients who attended the rheumatology unit for any reason. The survey originated from well-known surveys, such as the TeleHealth Usability Questionnaire3 and the Intention to use telehealth services4. However, we decided to overcome the usual separation that makes surveys addressed either to users or no users of telemedicine. Our survey comprised an introductory set of questions related to personal, social, clinical and ICT skills information, followed by the central part on telemedicine, which explored the three areas mentioned: benefits, adherence, preferences on service-mix. For this part, questions were the same for all patients apart from the tense used, being conditional tense for no-users and past tense for users. All the answers were analysed with descriptive statistics and regression models.ResultsA complete response was given by 400 patients: 71% were female, 59% were 40-64 years old, 53% of them declared to work, and the diseases most represented were Rheumatoid Arthritis (36%) and Osteoporosis/arthrosis (21%).The descriptive statistics revealed interesting differences between users and no users, e.g., the desire to participate in future projects was stated by 95% of users, 81% of no users. These results were confirmed by multivariate logistic regression models that controlled for the influencing patients’ characteristics (such as being old or a frequent hospital attender).It emerged that no-users imagined wide-ranging benefits. As for the willingness to participate to future telehealth projects, even if personal characteristics showed an impact (e.g., being a worker increased the probability to adhere), other things being equal, having had a more intense experience of telemedicine increased the odds of accepting by 3.1 times (95% C.I. 1.04-9.25), compared to no users. Furthermore, the more telemedicine was experienced, the higher the willingness to substitute in-person with online contacts.ConclusionOur study contributes to enlighten the crucial role played by the telemedicine experience in determining patients’ preferences. On one side, users appeared more aware of the realistic benefits to be expected from telemedicine. On the other side, it seemed that the more telemedicine was experienced, the higher the willingness to adhere to future projects and to increase on-distance contacts.References[1]Hashiguchi T.C.O. 2020. Bringing health care to the patient: An overview of the use of telemedicine in OECD countries.[2]Eze ND et al. 2020 PloS one[3]ParmantoB, et al. 2016 International journal of telerehabilitation[4]Ghaddar S et al. 2020 Journal of Medical Internet ResearchAcknowledgementsThis study would not have been possible without the support of the whole staff of the Rheumatology unit who contributed to the distribution of the surveyDisclosure of InterestsElisabetta Listorti: None declared, Lucia Ferrara: None declared, Antonella Adinolfi Speakers bureau: Janssen, BMS, Maria Chiara Gerardi: None declared, Nicola Ughi Speakers bureau: ROCHE, PFIZER, ALFASIGMA, ABBVIE, JANSSEN, GALAPAGOS, BRISTOL MYERS SQUIBB, Valeria Tozzi: None declared, oscar massimiliano epis: None declared

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Maloberti, Alessandro, Francesco Fribbi, Elena Motto, Paola Vallerio, Lucia Occhi, Matteo Palazzini, Alessio Peretti et al. « Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients ». Gerontology 67, n^o 6 (2021) : 674–80. http://dx.doi.org/10.1159/000514450.

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Introduction: Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients. Methods: This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period. Results: The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (β = 0.231, p = 0.013 and β = 0.314, p = 0.001, respectively). Conclusions: The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.

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Mauri, Gianluca, Alessio Amatu, Federica Tosi, Katia Bencardino, Erica Bonazzina, Viviana Gori, Lorenzo Ruggieri et al. « Efficacy of retreatment with oxaliplatin-based regimens in metastatic colorectal cancer patients : The RETROX-CRC retrospective study. » Journal of Clinical Oncology 40, n^o 4_suppl (1 février 2022) : 127. http://dx.doi.org/10.1200/jco.2022.40.4_suppl.127.

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127 Background: Oxaliplatin in association with fluoropyrimidines is universally considered one of the most effective drugs for colorectal cancer and the mainstay of front-line treatment of metastatic patients. In contrast the efficacy and safety profile of oxaliplatin based regimens in the late-care treatment space have been poorly and conflictingly reported. Methods: We identified a real-world cohort of metastatic colorectal cancer (mCRC) patients undergoing repeated oxaliplatin treatments in a single institution and retrospectively analysed their clinicopathological features to identify potential efficacy-predictive determinants of oxaliplatin response at retreatment (RETROX-CRC Study). Results: Out of 2,606 consecutive mCRC patients referred to Niguarda Cancer Center, 119 fulfilled the eligibility criteria of the study. The response rate (RR) and the disease control rate (DCR) after oxaliplatin retreatments were respectively 21.6% (95% CI 14.4-31.0%), and 57.8% (95% CI 47.7-67.4). A trend towards better RR and DCR was observed among patients who were exposed to oxaliplatin in the adjuvant setting, while a significantly poorer outcome was observed when two or more intervening treatments were delivered in between oxaliplatin exposures. Median progression-free survival (PFS) was 5.1 months (95% CI 4.3-6.1), significantly lower if oxaliplatin was re-administered beyond the third line (HR 2.02; 1.25-3.25; p=0.004). Safety data were reliably retrieved in 65 patients (54,6%). Of these 18.5% (12/65) and 7.7% (5/65) of them had G3-4 toxicities. Overall, toxicity was the cause of treatment discontinuation in almost a third of cases (28.6%; 34/119), with hypersensitivity reactions as the most prevalent reason for stopping treatment (58.8%; 20/34). Conclusions: In this large real-world series of 2,606 mCRC patients, less than 5% were re-treated with oxaliplatin. A late-disease control was achieved in almost 60% of patients, with a clinically acceptable sustained PFS and safety. Given the low performance of current standard drugs in late care of mCRC, retreatment with oxaliplatin might be considered a viable alternative especially if hopefully biology-based predictive markers for improving patient selection could be found.

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Attanasio, Roberto, Renato Cozzi, Giuseppe Oppizzi, Daniela Dallabonzana, Iacopo Chiodini, Zaira Benini, Paola Orlandi, Antonio Liuzzi et Pier Giorgio Chiodini. « Persistence of somatostatinergic tone in acromegaly ». European Journal of Endocrinology 132, n^o 1 (janvier 1995) : 27–31. http://dx.doi.org/10.1530/eje.0.1320027.

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Attanasio R, Cozzi R, Oppizzi G, Dallabonzana D, Chiodini I, Benini Z, Orlandi P, Liuzzi A, Chiodini PG. Persistence of somatostatinergic tone in acromegaly. Eur J Endocrinol 1995;132:27–31. ISSN 0804–4643 It is a matter of debate whether hypothalamic somatostatin (SRIH) secretion in acromegaly is preserved and still regulated by the physiological feedback mechanisms of growth hormone (GH) and insulin-like growth factor I. To gather further information on this, the reproducibility of plasma GH changes induced by growth hormone-releasing hormone (GHRH) administration was evaluated in 15 acromegalic patients. There was a highly significant correlation between the peak/basal ratio (P/B) GH response in the 15 patients administered GHRH on two separate occasions (r = 0.99, p <0.001). The test was performed also before and after the administration of drugs able to inhibit or stimulate hypothalamic SRIH release, by activating (pyridostigmine) or inhibiting (pirenzepine) cholinergic pathways, respectively. The GHRH-induced GH response (P/B = 2, range 1.1–26.1) was increased significantly by pyridostigmine pretreatment in 30 patients (P/B = 2.6, range 1.3–34.8; p = 0.0045). In nine out of 30 patients an increase of greater than 2sd of within-subject GHRH variability was observed in response to GHRH plus pyridostigmine when compared to GHRH alone. An inverse correlation (r = −0.37, p <0.05) was observed between GH response to GHRH alone and after pyridostigmine pretreatment. On the contrary, no change of GHRH-induced GH response was observed in 12 patients after pirenzepine pretreatment (P/B =1.9, range 1.1–5 and P/B = 2, range 1.3–6 without and after pirenzepine pretreatment, respectively). These data suggest that in acromegaly the somatostatinergic tone does not seem to fluctuate, and that it can be inhibited often by cholinergic pathway activation but not increased further by cholinergic suppression. Roberto Attanasio, Divisione di Endocrinologia, Ospedale Niguarda, Piazza Ospedale Maggiore 3, 1-20162 Milano, Italy

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Graham, Neil Samuel Nyholm, Karl A. Zimmerman, Guido Bertolini, Sandra Magnoni, Mauro Oddo, Henrik Zetterberg, Federico Moro et al. « Multicentre longitudinal study of fluid and neuroimaging BIOmarkers of AXonal injury after traumatic brain injury : the BIO-AX-TBI study protocol ». BMJ Open 10, n^o 11 (novembre 2020) : e042093. http://dx.doi.org/10.1136/bmjopen-2020-042093.

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Introduction and aimsTraumatic brain injury (TBI) often results in persistent disability, due particularly to cognitive impairments. Outcomes remain difficult to predict but appear to relate to axonal injury. Several new approaches involving fluid and neuroimaging biomarkers show promise to sensitively quantify axonal injury. By assessing these longitudinally in a large cohort, we aim both to improve our understanding of the pathophysiology of TBI, and provide better tools to predict clinical outcome.Methods and analysisBIOmarkers of AXonal injury after TBI is a prospective longitudinal study of fluid and neuroimaging biomarkers of axonal injury after moderate-to-severe TBI, currently being conducted across multiple European centres. We will provide a detailed characterisation of axonal injury after TBI, using fluid (such as plasma/microdialysate neurofilament light) and neuroimaging biomarkers (including diffusion tensor MRI), which will then be related to detailed clinical, cognitive and functional outcome measures. We aim to recruit at least 250 patients, including 40 with cerebral microdialysis performed, with serial assessments performed twice in the first 10 days after injury, subacutely at 10 days to 6 weeks, at 6 and 12 months after injury.Ethics and disseminationThe relevant ethical approvals have been granted by the following ethics committees: in London, by the Camberwell St Giles Research Ethics Committee; in Policlinico (Milan), by the Comitato Etico Milano Area 2; in Niguarda (Milan), by the Comitato Etico Milano Area 3; in Careggi (Florence), by the Comitato Etico Regionale per la Sperimentazione Clinica della Regione Toscana, Sezione area vasta centro; in Trento, by the Trento Comitato Etico per le Sperimentazioni Cliniche, Azienda Provinciale per i Servizi Sanitari della Provincia autonoma di Trento; in Lausanne, by the Commission cantonale d’éthique de la recherche sur l’être humain; in Ljubljana, by the National Medical Ethics Committee at the Ministry of Health of the Republic of Slovenia. The study findings will be disseminated to patients, healthcare professionals, academics and policy-makers including through presentation at conferences and peer-reviewed publications. Data will be shared with approved researchers to provide further insights for patient benefit.Trial registration numberNCT03534154.

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Vignati, Federico, Maria E. Berselli et Paola Loli. « Early postoperative evaluation in patients with Cushing's disease : usefulness of ovine corticotropin-releasing hormone test in the prediction of recurrence of disease ». European Journal of Endocrinology 130, n^o 3 (mars 1994) : 235–41. http://dx.doi.org/10.1530/eje.0.1300235.

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Vignati F, Berselli ME, Loli P. Early postoperative evaluation in patients with Cushing's disease: usefulness of ovine corticotropin-releasing hormone test in the prediction of recurrence of disease. Eur J Endocrinol 1994;130:235–41. ISSN 0804–4643 In the attempt to identify parameters that might predict the risk of recurrence of Cushing's disease at an early stage after successful pituitary microsurgery, we evaluated retrospectively the usefulness of an early postoperative determination of morning plasma and urinary cortisol levels and of adrenocorticotropin (ACTH) and cortisol responses to ovine corticotropin-releasing hormone (oCRH) stimulation in 30 patients with pituitary-driven Cushing's disease followed up for 9 months to 10 years after pituitary surgery. At an early postoperative evaluation, while off substitutive therapy, 30 patients, out of 36 treated by pituitary microsurgery for Cushing's disease, were considered in remission on the basis of subnormal (21 patients), low–normal (eight patients) or normal (one patient) morning plasma and urinary cortisol levels, whereas six patients with supranormal urinary cortisol excretion were considered as surgical failures. The plasma ACTH response to oCRH was subnormal (17 patients) or normal (four patients) in 21 patients (Group 1) and supranormal in nine patients (Group 2). All of the six patients with persistence of Cushing's disease had supranormal ACTH response to oCRH. Basal and oCRH-stimulated cortisol levels were subnormal in 25 out of 30 patients considered in remission. During long-term evaluation, six patients had recurrence of Cushing's disease 9 months to 5 years after surgery; their early postoperative mean basal morning plasma and mean urinary cortisol were higher than those recorded in patients who did not relapse, although a wide overlap between subjects was evident. In five out of these six patients urinary cortisol excretion had decreased to almost undetectable values during low-dose dexamethasone. One patient was among the 21 of Group 1 and five among those of Group 2. The different rate of recurrence between the two groups was significant. We conclude that the finding of ACTH hyperresponsiveness to an early postoperative CRH test seems to be a valuable criterion for identifying patients with higher risk of recurrence of Cushing's disease. Paola Loli, Divisione di Endocrinologia, Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italia

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Ciapanna, Denis, Annamaria Nosari, Livio Gargantini, Giovanni Mostarda, Michele Nichelatti, Mauro Turrini et Enrica Morra. « Portal Vein Thrombosis Following Splenectomy for Hematologic Diseases : Prevalence and Risk Factors. » Blood 108, n^o 11 (16 novembre 2006) : 1498. http://dx.doi.org/10.1182/blood.v108.11.1498.1498.

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Abstract Portal vein thrombosis (PVT) is a potentially fatal complication of splenectomy; the prevalence of PVT remains up till now controversial, such as the related-risk factors. The hematologic patients who underwent splenectomy in Niguarda Hospital, Milan, Italy, between January 1995 and November 2004 were retrospectively reviewed to identify the prevalence of post-splenectomy PVT and risk factors associated with its development. Splenectomy was performed because of malignant (n = 41) or non-malignant (n = 44) hematologic diseases. Indications for splenectomy in the groups with and without PVT were compared with Fisher’s exact test. We tested the reliability of platelet count as a marker of PVT, analysing the receiver operator characteristic (ROC) curve. Cut-off level was chosen for best prediction in term of sensitivity and specificity. Among 85 patients who underwent splenectomy, the associated non-malignant diseases were immune thrombocytopenic purpura (n = 40), hemolytic anemia (n = 2), Evan’s syndrome (n = 1), cryoglobulinemia (n = 1); malignant diseases were lymphoproliferative (n = 39) and myeloproliferative disorders (n = 2). Four cases of PVT (4,71%) were diagnosed. One of 2 patients with a myeloproliferative disorder had PVT. PVT was also present in 3/39 (7.69%) patients with lymphoproliferative malignancies, all with splenic marginal zone B-cell variety non-Hodgkin’s lymphoma (3/16) . The median splenic weight in patients who developed PVT was 1800 g (range 1500–1980 ) and the median post-surgery platelet count was 661 x 109/liter (range 211–1250). No patient with non-malignant diseases had portal vein thrombosis. The incidence of the event was of 0.0000523 new cases for day-patient, with a 0.005% new incidental case probability. Splenic weight, with a cut-off value of 500 grams for the risk analysis (p=0.029), was significantly correlated to thrombosis. PVT was also significantly correlated to the entity of the post-surgery thrombocytosis (p=0.024), setting the threshold value of thrombosis risk at 850.000/uL (Sensibility 0.50 - Specificity 0.95). Patients with myeloproliferative and lymphoproliferative disorders seem at higher risk for the development of PVT than those with non-malignant diseases. A splenic weight over 500 grams and a post-surgery thrombocytosis over 850.000/uL are significantly associated with the occurrence of PVT. The presence of these two risk factors should require the prophylactic use of adequate doses of low molecolar weight heparin.

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Murphy, Lynne M. « Protein-sparing therapy after major abdominal surgery : Lack of clinical effects GB DOGLIETTO, L GALLITELLI, F PACELLI, ET AL Instituto di Clinica Chirurgica, UCSC, Roma, Italy ; Instituto di Clinica Medica, UCSC, Roma, Italy ; Divisione Pizzamiglio I, Ospendale Niguarda, Milano, Italy ; Protein-Sparing Therapy Study Group ». Nutrition in Clinical Practice 11, n^o 6 (décembre 1996) : 274–75. http://dx.doi.org/10.1177/088453369601100606.

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