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- Zazzara, Maria B., et al.
(författare)
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Frailty and chronic disease
- 2019
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Ingår i: Panminerva Medica (Testo stampato). - 0031-0808 .- 1827-1898. ; 61:4, s. 486-492
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Forskningsöversikt (refereegranskat)abstract
- Chronic diseases and frailty represent the clinical expressions of the accumulations of biological deficits that occur with aging. However, when addressing chronic diseases, the evaluation of frailty is yet far to be part of routine clinical practice. Frailty and chronic diseases are often treated as different identities. However, the two concepts are related and present a certain amount of overlap and the presence of chronic diseases contributes to the onset of frailty. By taking into considerations not only the physical domain and function, but also psychological, socioeconomical and spiritual factors, frailty is a good descriptor of complexity found in older age. Strategies to identify, manage. and prevent frailty at any age in individuals with multimorbidity or chronic conditions are advised. Benefits and harms of pharmacological treatments should be weighted in older people considering the underlying frailty status. In fact, frailty acts as a modifier of the risks and benefits of chronic diseases treatments. Moreover, some treatments could lead to frailty itself (i.e. proton pump inhibitors, diuretics, hypoglycemic drugs, antihypertensive treatments). underlining the need of an individualized and flexible prescribing decision-making in this population. For these reasons, a different pathway of care for older patients with frailty and chronic diseases seems necessary. An assessment of frailty should be simple and not time consuming in order to address patient's needs and expectations, evaluating the social background, lifestyle and priorities. Empowering the patient implies a personalized evaluation and the development of individualized management plans which would ultimately lead to a reorganization of the health care provision and eventually increase quality of life in the elderly multimorbid frail patient.
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| 2. |
- Karacagil, Sadettin, et al.
(författare)
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Influence of twist on vein and PTFE graft hemodynamics : an ex vivo experimental study
- 1997
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Ingår i: Panminerva Medica (Testo stampato). - 0031-0808 .- 1827-1898. ; 39:2, s. 95-99
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In an ex vivo infusion model, the effect of different factors affecting the critical level of twist in vein and PTFE grafts was analysed. SETTING: University Hospital, Department of Surgery. EXPERIMENTAL DESIGN: Saline perfusion of grafts with various diameter and length under constant high (90 ml/min) and low (50 ml/min) flow rates against various peripheral resistance was performed. MEASURES: The pressure changes in the grafts were measured at increasing increments of twisting. RESULTS: The critical level of twist appears to be dependent on the diameter, length, stretching, status of peripheral resistance, amount of volume flow and the type of graft material, varying between 90 to more than 360 degrees. In vein grafts critical twisting appeared earlier with a decrease in diameter, shortening in length, high peripheral resistance, high flow rate and stretching. PTFE grafts especially with external spiral support were resistant to twist. CONCLUSIONS: These data suggest that the critical level of graft twist is dependent upon multiple factors and moderate or even high grade twist with especially externally supported PTFE grafts regardless of length and long mobilized vein grafts do not lead to hemodynamic changes. On the other hand total cessation of flow occurs at lower degrees of twist in stretched, short vein grafts.
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| 3. |
- Ludvigsson, Johnny
(författare)
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Novel therapies in the management of type I diabetes mellitus
- 2012
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Ingår i: Panminerva Medica (Testo stampato). - : Edizioni Minerva Medica. - 0031-0808 .- 1827-1898. ; 54:4, s. 257-270
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Tidskriftsartikel (refereegranskat)abstract
- Development of insulin pumps and glucose sensors together with sophisticated algoritms and connections leading to closed loop systems will probably soon improve and facilitate treatment for many patients with Type 1 diabetes (T1D). However, the burden for patients will not disappear completely, and such therapy will still require both competence and motivation of patients. Therefore the final goal should be either to cure the disease via replacement therapy (transplantions) or stop the destructive process, preserve residual insulin secretion or even improve via beta cell regeneration. This will give a milder disease, a more stable metabolism, simpler treatment and perhaps even cure. It is neither necessary nor even plausible that Type 1 diabetes has one single cause or pathogenesis. Infections may be one causal factor, and vaccinations will then turn the increasing incidence downwards. We will also soon know whether it is possible to prevent some cases of T1D by avoiding cows milk in the early nutrition. It is possible that probiotics can influence the gut flora so that the gut permeability is normlized and maturation of the immune system is improved which may also contribute to less incidence of Type 1 diabetes. However, for those who already have got the disease we need interventions to preserve exisiting beta cell function and facilitate regeneration of beta-cells. Broader immunosuppressive therapies have been disappointing. Phase III studies using monocloncal antiCD3 antibodies have recently failed, but one dose regimen showed promising effect in patients aged 8-20 years. Therefore furthers studies are needed. Autoantigen treatment is a promising concept, and has the great advantage of being easy, practical with no adverse events. Diapep277 has shown some positive results in adults with good C-peptide, and glutamic acid decarboxylase (GAD)-alum has given quite impressive results in children aged 10-20 years, even though the results from studies differ. It is time to start combination therapies where auto-antigen/s, alone or in combination, are used together with other agents such as Vitamin D and anti-inflammatory drugs. We need to learn how to treat subgroups of patients. Gradually a more individualized treatment may become successful.
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| 4. |
- Archer, Trevor, 1949, et al.
(författare)
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Factors governing personal health and development: stress (distress) and empowerment : I fattori che regolano la salute personale e lo sviluppo: Stress (distress) e potenziamento
- 2014
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Ingår i: Panminerva Medica. - 0031-0808. ; 56:1 suppl. 1, s. 101-107
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Tidskriftsartikel (refereegranskat)abstract
- Individuals express personal attributes that render them vulnerable to stress to greater or lesser extent. According to how we deal with all the events, incidents and interactions upon our daily lives, whether Monday to Friday working days or the weekends with expected rest, the progression of our life cycles develop, in some cases towards relative life satisfaction, psychological well-being and health but sadly in others towards dissatisfaction, a lack of psychological well-being and ill-health. Stress and distress may exert adaptive or maladaptive influences. Psychosocial stress, physiological stress, stress-inducing immunosenescence, or oxidative forms of stress are generally associated with detrimental effects upon personal health and development. Nevertheless, the adaptive aspect of stress ought not to be neglected since the capacity and ability to cope with stress, develop one’s own personal resources to accommodate coping strategies, hardiness and resilience all provide stages to elevate an individual’s developmental trajectory. Education, self-learning and an optimal life-style based upon healthy attachment to self all endower us with personal empowerment which is further reinforced when we facilitate the empowerment of others as evidence of our attachment to them. The related, yet distinctive, qualities, dignitas and auctoritas, capture the requirement of empowerment in self-fulfilling personal profiles. An individual with dignitas has acquired accomplishments, personal habits and a special ‘aura’ that invariably commands respect whether this person is a gardener or a general whereas auctoritas is conferred, rather than acquired, in the hope that this person will empower both others and himself/herself. One measure of success, perhaps the most important, is offered by the degree to which we empower our own personal health and development, and the extent to which we facilitate that of others.
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| 7. |
- Rapp-Ricciardi, Max, 1964
(författare)
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Group efficiency and medical leadership. Creating leverage : Through group development, presenting the IMGD model : Efficienza del gruppo e leadership medica. Creazione di leverage : Attraverso lo sviluppo del gruppo: Il modello IMGD
- 2014
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Ingår i: Panminerva Medica. - : Edizioni Minerva Medica. - 0031-0808. ; 56:1, s. 117-126
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Tidskriftsartikel (refereegranskat)abstract
- The public health sector in Sweden has during the past decade been undergoing a number of organizational improvements in order to become more professional. The professionalization does not primarily regard the qualities of the scientific skills of the medical doctors or the specialized kills of the health care staff, but rather their qualifications as leaders, organizers and empowered co-workers with a sense of responsibility and beholders of true organizational citizenship.1 It has been recognized that the quality of leadership and management in health-care defines the difference between excellence and mediocrity and success.2 Swedish health care has been meeting many challenges due to the lack of availability of professional doctors. This has led to a situation where the medical teams are very heterogeneous as regards the nationality of the medical doctors, and their medical training. There are also a great difference in the perception of the role and the status of the medical doctor and on how work should be organized and lead. For that reason some hospitals, medical research centres, clinics invests in forming cohesive teams, through different sessions of group development activities such as communication/feed-back training, goal clarification, role definition etc. Group development is essential, not only in order to create a positive working atmosphere, but also in order to decrease the number of casualties in health care. Wheelan, Burchill and Tilin3 showed that investment in team development could pay off since more cohesive and mature groups and the emergency rooms lead to more surviving patients.
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| 10. |
- Fouard, Céline, et al.
(författare)
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Weighted distance transforms generalized to modules and their computation on point lattices
- 2007
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Ingår i: Pattern Recognition. - : Elsevier BV. - 0031-3203 .- 1873-5142. ; 40:9, s. 2453-2474
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents the generalization of weighted distances to modules and their computation through the chamfer algorithm on general point lattices. The first part is dedicated to formalization of definitions and properties (distance, metric, norm) of weighted distances on modules. It resumes tools found in literature to express the weighted distance of any point of a module and to compute optimal weights in the general case to get rotation invariant distances. The second part of this paper proves that, for any point lattice, the sequential two-scan chamfer algorithm produces correct distance maps. Finally, the definitions and computation of weighted distances are applied to the face-centered cubic (FCC) and body-centered cubic (BCC) grids.
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