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Biomedical subjects

A Pacitti

Publications and source records attributed to A Pacitti.

At least 55 records · Page 3Linked to original sources
PubMed1979

[Basic aspects and current trends in iatrogenic kidney diseases. Correlations between their physiopathological mechanisms and clinical findings for the general practitioner].

Iatrogenic origins may be assigned to any form of kidney disease. Of the pathogenetic mechanisms involved, increasing importance is now attached to immunological responses and intravascular coagulopathies, though other processes long known to medicine have not ceased to play their part. Moreover, recent advances in the improvement of drugs and the standardisation of their use have given a better idea of the potential damage to the kidneys from many substances. A re-examination is made of the main findings in this field with a view to offering a simple summary of the underlying physiopathogenetic mechanisms, and drawing the diagnostic and clinical conclusions therefrom, so as to aid the general practitioner rather than the specialist. An account of the various medical interventions that may lead to kidney lesions, and the circumstances in which such interventions are most likely to be harmful, is followed by an analysis of recent opinions on the correct way of administering drugs in patients with kidney disease, so as to limit their potentially harmful effects as far as possible.

Biological Products↗
PubMed1976

[Initial results in the treatment with short-term dialysis].

Results observed during short-period dialysis management lasting 8 months in 80 patients are presented. There was no significant change in blood chemistry and clinical pictures, through intra- and interdialytic well-being improved. Six, out of 33 patients and to be transferred from 12 hr per week to more prolonged treatment periods due to the rapid onset of sub-dialysis symptoms. No patients receiving 15 hr per week required such a change. The reasons for failure in these six subjects are discussed, together with the indications for a choice of 12 or 15 hr periods.

Calcium↗
PubMed1975

[Use of coil negative pressure in the kidney].

A sealed compartment recycling system has been created for use with Extracorporeal commercial filters in order to exploit the negative pressure of the dialysate for purposes of ultrafiltration. The results of in vivo and in vitro tests regarding ultrafiltration and dialysates of urea, creatinine, Hipaque I125 and vit. B12 Co57 are reported. The tests highlighted improved dehydration characteristics in the system compared with the traditional coil technique, while the dialysates of small and medium molecules showed no decrease. The system can profitably be used as an alternative to the open compartment coil system and is particularly interesting because it can be combined with monitors which provide exclusively for the use of closed circuit dialysate instruments.

Creatinine↗
PubMedDate not supplied

Three-year follow-up after withdrawal of iron therapy in uremic patients on regular dialytic treatment.

Iron supplementation is commonly recommended in uremic patients undergoing regular dialytic treatment in order to correct a presumed iron deficiency due to impaired absorption and dialytic losses. Serum ferritin levels show an iron overload in 83% of 136 patients on 1.25 g/year i.v. iron therapy. After the withdrawal of iron therapy, directly correlated ferritin levels and percentage transferrin saturation decreased slowly, except in carriers of HLA-A3 antigens and in polytransfused patients. In these latter patients, desferrioxamine reduced but did not normalize the iron balance. The 16 patients who never received iron therapy showed a normal iron balance over a 3-year follow-up. Despite iron-ferritin therapy, 11 patients with baseline ferritin values at the lower normal limits showed a tendency toward further depletion. Orally administered bivalent iron seems to be more promising in normalizing iron-deficient patients without potentially harmful overloading.

Adolescent↗
PubMedDate not supplied

[Quality of data or quality of care? Comparison of diverse standarization methods by clinical severity, based on the discharge form, in the analysis of hospital mortality].

Using discharge abstract data, we analysed hospital mortality comparing four different methods of risk adjustment. All patients discharged from the S. Giovanni Battista (Molinette) hospital in Turin (Italy) between January 1996 and June 1999 (n = 169,746) were classified with All Patient Refined--Diagnosis Related Groups (APR-DRG). A first analysis evaluated the time trend of hospital mortality by semester. A second analysis compared hospital mortality during the last 12 months among eight units of internal medicine (n = 5592). All comparisons were made through logistic regression models. As the quality of discharge abstracts increased during time and showed variation among units with similar patients, all comparisons were repeated using four models, characterised by increasing predictivity and sensitivity to quality of data. In addition to crude comparisons (A), the other models included as risk factors: B) age and emergency admission; C) same as 'B' plus expected mortality by APR-DRG; D) same as 'B' plus expected mortality by APR-DRG and risk of death subclass. If no risk factors were considered (A), hospital mortality showed an increasing trend, with an odds ratio (OR) of 1.02 by semester, with a 95% confidence interval (CI) between 1.01 and 1.03. The association was weakened when age and mode of admission were taken into account (B) and disappeared when the APR-DRG expected mortality was also considered (C) (OR = 1.00; CI = 0.98-1.01). Finally, if the comparisons were adjusted also for the expected mortality by APR-DRG and risk of death subclass (D) a reversed trend appeared (OR = 0.95; CI = 0.94-0.97). The comparison among the units of internal medicine gave discordant results according to the method used to adjust for confounders. The most striking variations were detected for those units with the best and the worst clinical data. The unit with the poorer clinical data (average number of diagnoses per patient = 2.9) showed a crude OR of 1.38 (CI = 0.99-1.93) and an adjusted OR (D) of 1.71 (CI = 1.10-2.66); the unit with the best quality of data (average number of diagnoses per patient = 4.4) changed the OR from 1.55 (CI = 1.06-2.26) (A) to 0.66 (CI = 0.37-1.17) (D). In conclusion, these results confirm the high sensitivity of the APR-DRG classification to the quality of data and, more in general, suggest to be prudent when using powerful instruments like this to assess quality of care, especially if the quality of data among the units compared is less than optimal or not homogeneous.

Hospital Mortality↗
PubMedDate not supplied

Modelling the "ideal" self care--limited care dialysis center.

Limited care dialysis is an interesting option, which has gained attention in several settings because of the aging of the uremic cohort. The aim of this study was to assess its potential in the Piedmont region in northern Italy, evaluating patients' and care-givers' preferences and testing them in a mathematical model of organisation. The study was conducted in the satellite unit of a university hospital (200-210 dialysis patients), following 35 patients (15 at home, 20 in the center, 10 on daily dialysis). Opinions were collected with a questionnaire and features identified were empirically tested through a simulation model. Most patients (34/35) preferred a small unit, with a stable caring team. Further options were flexibility of dialysis schedule, multiple treatment options, integrated center/home care. These needs could be met by a flexible organization including conventional dialysis (3/week) and daily dialysis (6/week). We employed a simulation model (ARENA software) to calculate the nurses required for each shift and the opening hours and best schedule for the unit. Addition of daily dialysis (2-3 hours) to two conventional 4-5 hour sessions to increased the number of patients followed or "spared" beds, ensuring flexibility. According to patients' best choice (7 dialysis stations), and to the recorded calls, the needs are for two nurses per shift, two shifts per day and six nurses for up to 30 patients in limited care. In conclusion, small centers with flexible schedules can tailor dialysis to patients' needs. A managerial approach is valuable for testing cost/benefit ratios in specific contexts.

Adult↗
PubMedDate not supplied

[Costs of dialysis in hospitalised patients with acute or chronic renal failure, according to area of treatment].

BACKGROUND: In Italy, dialysis reimbursement is regulated by the "Tariffario delle prestazioni ambulatoriali" (G.U. N 216, 14/9/1996), which does not take into account separately the dialysis sessions performed in hospitalised patients. In these cases the dialysis activity is considered within the final DRG (Diagnosis Related Group). Aim of the study was an analysis of production costs of dialysis performed in hospitalised patients, according to the setting in which dialysis is performed (Intensive Care Units (ICUs), other Units, hospital dialysis ward). METHODS: The direct production costs were assessed by the "bottom-up" technique logic (cost definition from the single elements needed for producing the treatment) referring to specific Cost Centres. The main items considered were health-care staff, dialysis supplies and hardware, blood tests, dialysis data recording and transmission. RESULTS: During the year 2000, there were 4,450 treatments performed in 490 patients. They included 924 haemodialyses in ICUs; 2,531 in the nephrology hospital dialysis ward; 602 peritoneal dialysis treatments in ICUs-other wards, 393 in the nephrology ward. Direct cost per haemodialysis treatment ranged from 276.05 E (UF) to 413.46 E (HF) in ICU, from 170.47 E (Bicarbonate Haemodialysis) to 275.36 E (Slow Haemofiltration) in hospital dialysis ward; for peritoneal dialysis between 128.95 E (CAPD in dialysis ward) and 282.10 E (CAPD in ICU/other Units). During the year 2000, the global cost of production was 1,038,346.65 E. CONCLUSIONS: The cost of dialysis in hospitalised patients is high. A dedicated budget is needed to avoid deficits, particularly in highly specialised Units of large referral hospitals.

Acute Disease↗
PubMedDate not supplied

[Long-term results of high-tolerance extracorporeal methods in the light of the new high-efficiency treatments].

While the efficiency of treatment has been recently related to long-term clinical outcome, the relevance of tolerance on this subject, even on critically ill patients, has seldom been evaluated, for the limited size of single pools on high tolerance dialytic treatments (HTT) and the flux of pts. among treatments. Since 1981, on 2243 pts on files of the Dialytic Piedmont Regional Registry, 1399 treatments on acetate-hemodialysis (HD), 1153 on bicarbonate dialysis (BC) and 249 hemofiltration (HF) were compared by survival analysis (Mantel test) and yearly hospitalization rate (YH), according to age, factors of clinical high risk (HR) and presence of diabetes. BC and HF showed on HR pts. LTS comparable to HD (at 1 yr. 82, 78.3 vs 76.77%) despite the higher age, and the lower proportion of first choice (38.9%, 25% vs. 83.5%) testifying successful treatment of more critical cases. On non HR pts. HF, a less efficient treatment vs BD and AD, showed slightly reduced LTS (95.2% at 1 yr. vs. 98.1 and 97.9%). HY results higher on HF vs. BD on non HR pts. (10.4 vs. 5.3 and 2.1%) but improves on HR pts. (10.7 vs. 12.5%) and is lower than BC on diabetics (8.3 vs. 14.5%) (p less than 0.01).

Adult↗