PubMed Health⌕ Search

Biomedical subjects

G Gambassi

Publications and source records attributed to G Gambassi.

156 records · Page 9Linked to original sources
PubMedDate not supplied

Pain management in frail, community-living elderly patients.

BACKGROUND: Pain is a common problem among older people living in different community settings. As indicated by the World Health Organization (WHO), pain can be relieved using pharmacologic agents. However, pain continues to be addressed inadequately. OBJECTIVES: To describe the prevalence of pain in frail elderly people living in the community and to evaluate the adequacy of pain management. METHODS: We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home health care programs. Twelve home health care agencies participated in the project evaluating the implementation of the Minimum Data Set for Home Care instrument. We enrolled 3046 patients, 65 years and older, in the present study. The main outcome measures were the prevalence of daily pain and analgesic treatment. RESULTS: A total of 1341 individuals (39%, 49%, and 41% of those aged 65-74, 75-84, and > or = 85 years, respectively) reported daily pain. Of patients with daily pain, 25% received a WHO level 1 drug; 6%, a WHO level 2 drug; and 3%, a WHO level 3 drug (eg, morphine sulfate). Patients 85 years or older were less likely to receive analgesics compared with the younger patients (univariate odds ratio, 0.73; 95% confidence interval [CI], 0.60-0.89). Another independent predictor of failing to receive any analgesic was low cognitive performance (adjusted odds ratio, 0.80; 95% CI, 0.69-0.93). CONCLUSIONS: Daily pain is prevalent among frail elderly patients living in the community and is often untreated, particularly among older and demented patients.

Aged↗
PubMedDate not supplied

Comorbidity and drug use in cognitively impaired elderly living in long-term care.

Cognitive impairment is associated with an increased mortality in older people. The prevalence and impact of comorbidity on functional status and mortality of demented patients has not been fully elucidated. Using a population-based data set, we describe the prevalence of cognitive impairment, functional status, principal comorbid conditions and 1-year survival for over 300,000 patients admitted to the nursing homes in five US states. Sixty-one percent of patients have some level of cognitive impairment, and this correlates with the degree of physical frailty. Severer cognitive impairment is associated with a higher mortality rate. Yet, patients with cognitive impairment appear to have fewer comorbid conditions and are less likely to receive medications and special treatments than residents with normal cognitive status. Additional studies are needed to understand whether demented patients may paradoxically be considered healthier or, instead, are only neglected.

Aged↗
PubMedDate not supplied

Impact of the type and severity of dementia on hospitalization and survival of the elderly. The SAGE Study Group.

We conducted a retrospective cohort study to examine whether patients with Alzheimer's disease (AD) or vascular dementia (VaD) differed in the number and type of associated comorbid conditions. In addition, we evaluated the impact of the severity of cognitive impairment on hospitalization and mortality of patients in each group. We studied 161,106 patients over age 65, with any degree of cognitive impairment, residing in any of 1,573 Medicare/Medicaid-certified nursing homes of 5 states of the USA between 1992 and 1995. Patients were assessed with the federally mandated Minimum Data Set (MDS). The MDS has been cross-linked to Medicare eligibility files and to the Medicare Provider Analysis and Review database. AD patients were younger, and more likely to be female and Caucasian than VaD patients. For comparable levels of cognitive impairment, AD patients appeared to have fewer comorbid conditions, including those that were not risk factors for VaD. In addition, patients with AD had decreased morbidity and mortality relative to patients with VaD. These findings support the hypothesis that AD patients are a healthier group of demented patients.

Age Factors↗
PubMedDate not supplied

[Analysis of growth, phenotype and cytotoxic activity of tumor infiltrating lymphocytes expanded in vitro with interleukin-2 and interleukin-4: preliminary results].

Tumor infiltrating lymphocytes (TIL) play an important role in the host immune response to cancer. When these cells are reinfused into cancer patients after in vitro expansion with lymphokines such as interleukin 2 (rIL-2), they often induce regression of tumor metastases. We obtained TIL of enzymatic digestion of 7 human solid tumors and then cultured them with rIL-2 and interleukin 4 (IL-4) at different concentrations for about 36 days. Immunophenotypic analysis was performed at the end of the second and fourth week; cytotoxic activity against autologous and heterologous targets was assessed on the 30th day of culture. The best lymphocytic growth was observed when we used rIL-2 and IL-4 for the first two weeks of culturing and then continued with rIL-2 alone. CD3 and CD56 cells formed the majority of TIL in all cultures. In 4 cases CD4 cells predominated at the initial stage of culturing, with CD8 cells gradually increasing and finally inverting the CD4/CD8 ratio. Autologous cytotoxicity (3/4 cases) appeared to be better in those patients in whom the CD4/CD8 ratio was inverted. These data enable identification of the combination of lymphokines that will will best provide expansion of live TIL active against tumoral cells. This procedure must be followed before in vivo reinfusion of expanded lymphocytes is carried out.

Adenocarcinoma↗
PubMedDate not supplied

Increased prevalence of intestinal metaplasia in the gastric mucosa of the elderly: clinical implications.

Evidence which suggests a close relationship between intestinal-type gastric carcinoma (IGC) and intestinal metaplasia (IM) associated with chronic atrophic gastritis (CAG) has accumulated in the literature. The aim of this study has been to analyze retrospectively the prevalence of IM in patients with bioptically-proven chronic gastritis, as well as its age-specific distribution. A series of 230 patients, comprising 162 cases of CAG with IM (70.5%) and 68 cases of gastritis without IM (29.5%-57 superficial type, 11 CAG) was reviewed. All patients underwent upper gastrointestinal endoscopy one or more times, during which multiple biopsies were taken from the gastric mucosa. Moreover, patients were divided into two age-groups: over and under 65 years old. Three features were also investigated: location, endoscopic appearance and clinical manifestations. In agreement with other Authors, our findings showed: 1) predominance of the antral location (B-type gastritis); 2) a close relationship between prevalence of IM and increasing age, with an upward age-related trend. A statistically significant difference was noted between patients with IM and those without the lesion, emerging in the VII decade, with a further rise in the succeeding decade. In line with the literature, these findings emphasize the importance of endoscopic-bioptic follow-up, which takes on even greater significance in elderly patients, in whom an increased incidence of IGC has been reported.

Adenocarcinoma↗
PubMedDate not supplied

[Essential mixed cryoglobulinemia with liver involvement: a still open problem].

Essential mixed cryoglobulinemia (EMC) is a syndrome characterized by cryoglobulinemia and clinical features including purpura, arthralgia, asthenia (Meltzer-Franklin syndrome) without evidence of any systemic disease Liver involvement in the course of EMC is described in 50-84% of patients. It consists of mild silent hepatosplenomegaly and slightly rise of serum amino transferase. Eleven patients with clinical and laboratory findings suggestive for EMC (five type II and six type III) underwent percutaneous liver biopsy to evaluate the degree of liver involvement. Two liver cirrhosis, two chronic active hepatitis, one chronic persistent hepatitis and a case of hepatic steatosis were found. A type III cryoglobulinemia was present in four of the six patients with liver involvement. All the patients were Hbs Ag negative but three of them were Hbs Ab positive. The pathogenesis of liver involvement in the course of EMC is still now uncertain. The authors believe that a previous HBV infection plays no role in the pathogenesis of EMC syndrome. This syndrome must be considered different from mixed cryoglobulinemia secondary to chronic liver disease. They suggest that liver biopsy is mandatory during the course of EMC even when clinical and laboratory data are silent.

Aged↗