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Biomedical subjects

A Tampieri

Publications and source records attributed to A Tampieri.

At least 37 records · Page 2Linked to original sources
PubMed2000

Routine use of external cephalic version in three hospitals.

BACKGROUND: External cephalic version has been advocated as a safe alternative to vaginal breech delivery or cesarean birth. The purpose of this study was to determine the efficacy of routine use of external cephalic version at 36 weeks or more of gestation in three different levels of hospitals. METHODS: External cephalic version was performed on 923 women with a single breech fetus at three hospitals in Italy. The procedure was attempted with a tocolytic agent for uterine relaxation and with no maternal analgesia. The version technique adopted was the "forward roll." RESULTS: Version was successfully performed on 579 fetuses (62.7%); each hospital had a similar success rate, and 56.9 percent of the women delivered vaginally. The procedure was more successful in multiparas and in women with an incomplete type of breech, polyhydramnios, and posterior localization of the placenta. Vaginal bleeding was experienced by 14 women; eight cesarean sections were performed for suspected abruptio placentae, confirmed in four cases. Two cephalic-turned fetuses experienced an episode of persistent bradycardia and were turned again to breech; in five cases a nonstress test recorded after the version showed repeated variable decelerations and in one case a cesarean section was performed. Neonatal outcomes were good in 922 infants. A fracture of the femur attributable to the version was observed in one newborn. CONCLUSIONS: External cephalic version is effective in reducing the number of cesarean deliveries in term breech infants in different obstetric settings, with no major neonatal adverse outcomes.

Adult↗
PubMed2000

Incidence and causes of non-invasive mechanical ventilation failure after initial success.

BACKGROUND: The rate of failure of non-invasive mechanical ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD) with acute respiratory insufficiency ranges from 5% to 40%. Most of the studies report an incidence of "late failure" (after >48 hours of NIMV) of about 10-20%. The recognition of this subset of patients is critical because prolonged application of NIMV may unduly delay the time of intubation. METHODS: In this multicentre study the primary aims were to assess the rate of "late NIMV failure" and possible associated predictive factors; secondary aims of the study were evaluation of the best ventilatory strategy in this subset of patients and their outcomes in and out of hospital. The study was performed in two respiratory intensive care units (ICUs) on patients with COPD admitted with an episode of hypercapnic respiratory failure (mean (SD) pH 7.23 (0.07), PaCO(2) 85.3 (15.8) mm Hg). RESULTS: One hundred and thirty seven patients initially responded to NIMV in terms of objective (arterial blood gas tensions) and subjective improvement. After 8.4 (2.8) days of NIMV 31 patients (23%; 95% confidence interval (CI) 18 to 33) experienced a new episode of acute respiratory failure while still ventilated. The occurrence of "late NIMV failure" was significantly associated with functional limitations (ADL scale) before admission to the respiratory ICU, the presence of medical complications (particularly hyperglycaemia), and a lower pH on admission. Depending on their willingness or not to be intubated, the patients received invasive ventilation (n=19) or "more aggressive" (more hours/day) NIMV (n=12). Eleven (92%) of those in this latter subgroup died while in the respiratory ICU compared with 10 (53%) of the patients receiving invasive ventilation. The overall 90 day mortality was 21% and, after discharge from hospital, was similar in the "late NIMV failure" group and in patients who did not experience a second episode of acute respiratory failure. CONCLUSIONS: The chance of COPD patients with acute respiratory failure having a second episode of acute respiratory failure after an initial (first 48 hours) successful response to NIMV is about 20%. This event is more likely to occur in patients with more severe functional and clinical disease who have more complications at the time of admission to the ICU. These patients have a very poor in-hospital prognosis, especially if NIMV is continued rather than prompt initiation of invasive ventilation.

Aged↗
PubMed1999

A European version of the Appropriateness Evaluation Protocol. Goals and presentation. The BIOMED I Group on Appropriateness of Hospital Use.

This paper describes the development and testing of a European version of the Appropriateness Evaluation Protocol (AEP). It stemmed from the original U.S. version and the multiple adaptations and modifications made previously and separately by researchers in European countries. The group was particularly concerned with developing a common list of reasons for inappropriate admissions and days of stay, since the principal goal was to enable an understanding of inappropriate hospital use and potential solutions within local health and social care systems. Developing a common EU-AEP included several steps. First, each national instrument was translated from the national language to English. These back translations were compared with each other and with the US-AEP. A working group analyzed the content of the lists of reasons published in the literature and proposed a novel conceptual approach. On the basis of workshop discussions, a draft of a common European version was circulated to each participant for agreement. In the EU-AEP, the clinical criteria for the appropriateness of admission include 10 related to patient condition and five to clinical services. The criteria for the appropriateness of days of care include 10 covering medical services, six for life support/nursing services, and eight related to patient condition. The proposed core list of reasons of inappropriateness distinguish clearly between two concepts: a) the level of care required by the patient; and b) the reason why this level of care was not used. The first list would thus refer to the nature of resources and facilities required, while the second would focus more on the efficient organization of those resources. A validated European tool to assess inappropriate hospital admissions and hospital days of stay and their causes might be used to assess the need for resources for inpatient care as well as for outpatient care. Assessing the reasons for inadequacies might lead also to the examination of organizational questions. Finally, a common tool allows comparisons between countries concerning the frequency of inappropriate admissions and days of stay and their reasons in relation to the different organizations of health care across Europe.

Clinical Protocols↗
PubMed1999

Changes in cesarean delivery in an Italian university hospital, 1982-1996: a comparison with the national trend.

BACKGROUND: The cesarean delivery rate in Italy rose dramatically from the mid-1970s to 1996, accounting for 22.4 percent of all deliveries in the last national survey. The aim of this study was to analyze the results of the clinical practice of a new staff in the Department of Obstetrics and Gynecology of a university hospital, with particular focus on the application of common protocols. The rates of cesarean sections and perinatal mortality were chosen as parameters for good clinical practice and were compared with national data. METHODS: A new staff assumed the obstetric management at the hospital in 1982. Standardized protocols were implemented for all major indications for cesarean delivery (repeat cesarean section, dystocia, breech presentation, fetal distress). RESULTS: The rate of cesarean deliveries decreased from 26.4 to 12 percent and remained stable during the past decade. Other operative modalities were used for approximately 1.5 percent of deliveries. The perinatal mortality decreased to 0.5 percent in 1994. To confirm whether or not staff followed common protocols, a review of three years (1994-1996) showed a fairly stable frequency of cesarean sections on different days and nights during the week, confirming the homogeneity of obstetric management. CONCLUSIONS: Our data showed that, irrespective of the local situation and of the risks of litigation, a significant reduction of cesarean sections can be achieved in a tertiary care center without detrimental effects on newborns, especially in a teaching hospital where residents are trained. Despite national trends suggesting the contrary, some women may choose to deliver in an obstetrics department with better care and fewer operative procedures than in hospitals with higher cesarean delivery rates.

Cesarean Section↗
PubMed1999

Reliability study of the European appropriateness evaluation protocol.

OBJECTIVE: To help to co-ordinate and harmonize research on utilization review in Europe, the US Appropriateness Evaluation Protocol (f¿EP) was adapted for use in the European setting. The aim of this paper is to assess the reliability of the European version of the AEP (EU-AEP). DESIGN: Nineteen English-language medical records were reviewed by a physician reviewer from each of six participating countries: Austria, France, Italy, Spain, Switzerland and the UK. Each of the six reviewers was asked to assess the appropriateness of the 19 admissions and 31 hospitalization days (19 admission days and 12 randomly selected days of hospital stay, excluding days of discharge) using the revised review instrument. To evaluate inter-rater reliability, the kappa statistic was used to measure overall and pair-wise agreement for the assessment of appropriateness of admission and of day of care, respectively. RESULTS: For admission, the overall kappa statistic among the six reviewers was 0.64, with kappa values for each pair of reviewers in the range 0.46-0.86. For day of care, the kappa was 0.59, with pair-wise kappa coefficients in the range 0.25-0.95. CONCLUSION: The observed agreement could be considered substantial, especially if the fact that medical records were hand-written in a language native to only one of the reviewers is considered. Besides all the study limitations, this finding provides at least preliminary support for the application of the EU-AEP as a reliable instrument in the European setting, including application in comparative studies involving two or more countries.

Europe↗
PubMed1997

Sintering and characterization of HA and TCP bioceramics with control of their strength and phase purity.

HA and beta-TCP-based ceramics were prepared using commercial powders. Powder characteristics were defined and the processing parameters studied, aimed at the production of samples with improved microstructural and mechanical properties. The behaviour of HA powder subjected to various thermal treatments was investigated in order to control the formation of secondary phases (alpha- and beta-TCP) during sintering. The optimal thermal treatment required to prepare pure beta-TCP powder from the precursors (HA and DCP) was determined and the sintering method required to prepare fully dense beta-TCP completely free from alpha-form, was identified. Translucent hot-pressed beta-TCP ceramics with potential applications in aesthetic restorative prostheses were prepared and characterized. The interval of existence of alpha-TCP and alpha-TCP as secondary products was also defined. Crystallographic analysis was carried out on the imperfectly known low-temperature alpha-TCP phase, and a proper monoclinic unit cell determined.

Journal Article↗
PubMed1995

Quantitation of HIV-1 p24 antibody expressed as relative binding capacity p24 antigen (p24 RBC) in infants born to HIV-1 seropositive mothers: correlation of this serological marker with the HIV-1 maternal antibody course and p24 antigenemia detection.

The antibody content to HIV-1 p24 Ag expressed as relative binding capacity to the target antigen (p24 RBC) was retrospectively quantified in serum samples from 20 HIV-1-uninfected infants born to HIV-1 seropositive mothers. p24 RBC values quantified at birth were included either in a low (0-20%) or high (80-100%) range of values, classified as group A (11 infants) and group B (9 infants), respectively. The course of maternal antibodies to HIV-1 antigens p17, p24, p31, gp41, p51, p66, gp120, and gp160 was studied in each group. A substantial difference in the amount and subsequently in the decline of maternal antibodies to gag proteins p17, p24, and p55 and to pol proteins p51 and p66 was observed in the two infant groups in contrast with a similar content and decline of the remaining antibodies. In 7 HIV-1-infected infants of whom 4 resembled infant group A and 3 infant group B for p24 RBC values, a relationship appeared between p24 antibody decline and p24 antigenemia detection.

Biomarkers↗
PubMed1995

Appropriateness of hospital use: an overview of Italian studies.

This paper reports on the general features and findings of 11 studies conducted in Italy on appropriateness of hospital admission and days of stay using the Appropriateness Evaluation Protocol (AEP). Studies have been grouped for presentation in two categories. The first comprises six heterogeneous studies illustrating different ways of targeting the use of the AEP: two used it to assess appropriateness of admission in an emergency room setting, two measured appropriateness of days of stay in patients with AIDS and nosocomial infections and finally two others evaluated hospital days in a group of elderly patients and "before and after" the institution of a domiciliary nursing service, respectively. The second group comprises five more homogeneous utilization review studies aimed at assessing inappropriateness of admissions and days of stay in medical/surgical departments of large hospitals in northern Italy. Besides detecting a substantial amount of inappropriateness in admission (range = 25-38%) and days of stay (range = 28-49%) this latter group of studies suggests that delays in execution and reporting of laboratory investigations, unavailability of operating rooms and delays due to difficulties in transferring patients to long-term care facilities are the most common causes of inappropriate days of stay. Despite the differences in their objectives, design and methods of sampling, these studies indicate that an explicit, diagnosis-independent and standardized instrument such as the AEP can help to uncover a substantial amount of the potentially avoidable use of hospital resources in the Italian context.

Health Services Research↗
PubMed1994

Prevalence rates of gallstone disease in Italy. The Chianciano population study.

The prevalence of gallstone disease and associated factors in the entire population of subjects aged 15-65 years born and resident in Chianciano Terme (Siena - Tuscany) was examined in the years 1985 and 1986. The investigation included gallbladder ultrasonography, administration of a questionnaire on personal and family history, physical examination and blood chemistry. A total of 1809 subjects (attendance rate 87.7%) participated in the study. Personal history and physical examination showed that Chianciano inhabitants have a low prevalence of obesity (4.3%) and only 4.4% of the female population had more than two pregnancies. Overall prevalence of gallstone disease (cholecystectomy+cholelithiasis) was 5.9% (3.7% for males and 8.4% for females). Age standardized relative risk of gallstone disease for females was 2.25 (95% confidence limits = 1.68-2.68). Prevalence of cholelithiasis was 3.5% (2.7% for males and 4.2% for females). Prevalence of gallstone disease increased with increasing age in both sexes, being extremely low in the age interval of 15-29 years (0.25%). The overall gallstones/cholecystectomy ratio was found to be lower (1:1) in females than in males (2.7:1). Although subjects with gallstones reported more frequently biliary colics and non-specific dyspeptic symptoms, the diagnostic power of all symptoms in identifying cholelithiasis was very poor due to low sensitivity. Only one third of subjects with gallstones was aware of having the disease. Age, obesity and number of pregnancies were positively associated with gallstone disease in univariate analyses. The association with obesity and parity disappeared in multivariate analysis. Blood lipids and glucose were not associated with the disease both in univariate and multivariate analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Identification of homogeneous geographical areas of mortality for tumours from cluster analysis.

This paper attempts to demonstrate the utility of cluster analysis as a descriptive method of studying mortality in epidemiology. In order to verify which algorithms of clustering best fit the data structure, the method of cophenetic correlation was implemented. Furthermore the probabilistic algorithm proposed by Beale was used to assess the partition. The results show the presence of some striking clusters between Local Sanitary Units of the Emilia Romagna Region for four types of tumour in men.

Algorithms↗
PubMed1991

Effects of B-HT 920 in the tail-suspension test.

The effect of B-HT 920 on mice subjected to the tail-suspension test (TST), a behavioural tool for gauging depression, was studied. During the test, all the animals had bouts of agitation interspersed with periods of immobility but B-HT 920-treated animals exhibited a differentiated behavioural pattern according to the dose employed: at doses selective for dopaminergic (DA) autoreceptor stimulation (50 and 100 micrograms/kg), the periods of immobility were unaffected, while at higher doses (0.5, 1, 2 and 3 mg/kg), which are also considered to be active on alpha 2-adrenoceptors, they were much shorter, as they are when known antidepressants are administered. Both clonidine (75 and 150 micrograms/kg) and yohimbine (1 and 5 mg/kg), alpha 2-adrenoceptor agonist and antagonist, respectively, increased immobility time, while N-n-propylnorapomorphine, a DA-agonist, at a dose (10 micrograms/kg) specific for DA autoreceptors, was completely ineffective. Since the behavioural effects of B-HT 920 vary according to the dosage employed, discussion centres on what receptors might conceivably underly these effects and on their preclinical relevance.

Adrenergic alpha-Agonists↗
PubMed1989

Relationship between lead exposure indicators and neuropsychological performance in children.

This study surveyed 237 schoolchildren in a lead-polluted industrial area in northern Italy to assess the relationship between various biological indicators (lead in blood, hair and teeth, and delta-aminolevulinic dehydratase [ALA-D] activity) and some neuropsychological functions, assessed by a battery of five psychometric tests. The geometric means of lead measured in blood, hair and teeth were 10.99 micrograms/dl, 6.79 micrograms/g and 6.05 micrograms/g, respectively. Mean ALA-D activity was 51 mU/ml RBC. By analysis of covariance, after regressing out the variance accountable to confounding variables (age, sex, occupation/education of parents), Total and Verbal WISC-R IQ and Toulouse Pieron test results were significantly affected by the levels of lead in teeth. ALA-D values also appeared to be related to WISC-R IQ results (Total, Verbal and Performance).

Child↗
PubMed1988

Imidazole and yohimbine antagonize hypomotility, penile erection, stretching and yawning induced in rats by BHT 920, a selective dopamine autoreceptor agonist.

When the azepine derivative BHT 920, a putative agonist at dopamine autoreceptors, was injected i.p. into adult male rats at 100 micrograms/kg, it induced numerous penile erections, stretching and yawning and sedation, all considered typical signs of central DA autoreceptor stimulation, but did not elicit stereotyped behaviour. Imidazole (37.5-150 mg/kg i.p.) and the alpha 2 antagonist yohimbine (0.5-1 mg/kg i.p.) both antagonized the behavioural effects of BHT 920. In the light of the proposed selective action of the drugs used, the possible involvement of specific receptors for the modulation of these forms of behaviour, as well the possible relevance of the data presented, are briefly discussed.

Adrenergic alpha-Agonists↗
PubMed1987

Imidazole modification of aggressive behaviour in rats and mice.

Imidazole (IMID) strongly affected aggressive behaviour in rodents, the type of influence varying according to the experimental model considered. In morphine-dependent rats, during naloxone-induced abstinence syndrome, signs of irritability and mild aggressiveness were observed after treatment with IMID. Moreover, IMID enhanced aggressive posturing elicited by the dopaminergic (DA) agonist lisuride, whether rats were affected by morphine-withdrawal symptoms or not. In isolation test in mice, on the other hand, IMID inhibited aggression. Imidazoleacetic acid, one of the metabolites of histamine, comparatively investigated in the same behavioural tests, never potentiated lisuride-induced aggressiveness in rats; moreover, it was more effective than IMID in inhibiting aggression in isolated mice.

Aggression↗
PubMed1983

[Evaluation of the immunoenzymatic method for the study of anti-Toxoplasma gondii type IgG antibodies in relation to the indirect immunofluorescence method].

The indirect immunofluorescence assay for detecting anti-Toxoplasma gondii serum IgG is compared with the enzyme immunoassay employing a commercial kit for IgG. Enzyme immunoassay test shows a high degree of sensitivity, but it is less specific in comparison with indirect immunofluorescence test. There is evidence of direct relation between values expressed in Optical Density and reciprocal dilutions of sera; moreover a direct relation appears between Optical Density values and International Units/cm3. The authors claim that is advisable to give enzyme immunoassay test results, not only as Optical Density values, but also as antibody dilutions and International Units/cm3.

Evaluation Studies as Topic↗