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Capone F, Molinari L, Noale M, Previato L, Giannini S, Vettore G, Fabris F, Saller A. Admission criteria for a cardiovascular short stay unit: a retrospective analysis on a pilot unit. Intern Emerg Med 2021; 16:2087-2095. [PMID: 33770369 PMCID: PMC8563614 DOI: 10.1007/s11739-021-02700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Rapid intensive observation (RIO) units have been created to guarantee high standards of care in a sustainable health-care system. Within short stay units (SSUs), which are a subgroup of RIOs, only rapidly manageable patients should be admitted. Physicians are unable to predict the length of stay (LOS) as objective criteria to make such a prediction are missing. A retrospective observational study was carried out to identify the objective criteria for admission within a cardiovascular care-oriented SSU. Over a period of 317 days, 340 patients (age 69.4 ± 14.7 years) were admitted to a pilot SSU within our internal medicine department. The most frequent diagnoses were chest pain (45.9%), syncope (12.9%), and supraventricular arrhythmias (11.2%). The median LOS was 4 days (quartile 1:3; quartile 3:7). Predictors of LOS ≤ 96 h were age < 80, hemoglobin > 115 g/L, estimated glomerular filtration rate > 45 mL/min/1.73 m2, Charlson Comorbidity Index < 3, Barthel Index > 40, diagnosis of chest pain, syncope, supraventricular arrhythmias, or acute heart failure. The HEART (history, ECG, age, risk factors, troponin) score was found to be excellent in risk stratification of patients admitted for chest pain. Blood tests and anamnestic variables can be used to predict the LOS and thus SSU admission. The HEART score may help in the classification of patients with chest pain admitted to an SSU.
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Affiliation(s)
- Federico Capone
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy.
| | - Leonardo Molinari
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Marianna Noale
- Neuroscience Institute, Aging Branch, National Research Council (CNR), Padua, Italy
| | - Lorenzo Previato
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Sandro Giannini
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Gianna Vettore
- Department of Urgent and Emergency Care, University of Padova, Padua, Italy
| | - Fabrizio Fabris
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Alois Saller
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
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2
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Zoleo M, Della Rocca F, Tedeschi F, Zucchetto M, Maddalena G, Vettore G. Violence against health workers: findings from three emergency departments in the teaching hospital of Padua, Italy. Intern Emerg Med 2020; 15:1067-1074. [PMID: 32072369 DOI: 10.1007/s11739-020-02290-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Emergency departments (EDs) are high-risk places for Workplace Violence (WPV). In Italy, this phenomenon is scarcely investigated. The aim of this study is to evaluate the incidence, experiencing and perception of WPV in the general ED (GED), paediatric ED (PED) and obstetric-gynaecological ED (OGED) of the teaching hospital Azienda Ospedaliera in Padua (AOP). We led a cross-sectional study among the GED, OGED and PED staffs, submitting an anonymous questionnaire, regarding personal information, verbal and physical aggression experiences, risk factors and proposals for corrective actions. Our sample consists of 73 people from GED, 45 from OGED and 53 from PED. Aggressions are common. Verbal aggressions are almost never recorded, even in the case of physical aggressions, 41% did not signal the event. Both in GED and in OGED, most of the staff (68.9% and 75.0%, respectively) underwent aggression by neither psychiatric nor substance abuser patients (PSAPs). Physical aggressions are more common in GED than in OGED and in PED; most of professionals were assaulted by PSAPs. In all EDs, verbal or physical assault has been lived through by anger, resignation or fear, rarely by indifference. Professionals think there are structural characteristics and risk factors that could be corrected. They do not know how to manage assaults and would deem it useful training meetings with experts. Our results regarding how staff perceive and experience violence in the ED concern a local situation, that nevertheless reflect current evidence about the topic of WPV which plagues EDs across the globe.
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Affiliation(s)
- Miranda Zoleo
- Aulss 4 Veneto Orientale Emergency Department Portogruaro, CAP 30026, Portogruaro, Venetia, Italy.
| | - Foscarina Della Rocca
- Pronto Soccorso Azienda Ospedaliera Di Padova, Via Giustiniani 2, 35122, Padua, Italy
| | - Federico Tedeschi
- Section of Psychiatry, Department Neurosciences Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Mirka Zucchetto
- Pronto Soccorso Di San Donà Di PiaveULSS 4 Veneto, Orientale Via Nazario Sauro, 25, 30027, San Donà di Piave, Venetia, Italy
| | - Giovanna Maddalena
- Pronto Soccorso VeneziaULSS 3 Veneto, Sestiere Castello, 6777, 30122, Venice, Italy
| | - Gianna Vettore
- Coordinamento Regionale Emergenza Urgenza Regione Veneto, Via Giustiniani 2, Padua, Italy
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3
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Della Rocca F, Zoleo M, Pignatiello F, De Lazzari F, Frigo AC, Vettore G, Favretto D, Snenghi R. Relationship between anatomical sites and severity of the lesions and use of alcohol and psychotropic substances in traumatized drivers admitted to the Emergency Department of Padua, Italy. Ann Ist Super Sanita 2018; 54:201-207. [PMID: 30284546 DOI: 10.4415/ann_18_03_06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Driving under the influence of alcohol and/or psychoactive substances increases the risk of road accidents, but it is controversial whether this affects site and severity of injuries. MATERIAL AND METHODS We search for alcohol, cannabinoids, cocaine, benzodiazepines, opioids, methadone, amphetamines and barbiturates in biological fluids of 1764 traumatized drivers admitted to the Emergency Department (ED) of Padua between 2010 and 2014. RESULTS We note correlation between alcohol and benzodiazepines and admission in ICU and between all the intoxications and the reserved prognosis. The sites of injuries were: head (37.13%), maxillofacial (8.33%), spinal column (44.67%), thoracic (15.31%), abdominal (5%), pelvic (2.55%) and limb traumas (23.58%). We observed a correlation between head trauma (p < 0.0001), maxillofacial trauma (p = 0.0418), thoracic trauma (p = 0.0215), pelvic trauma (p = 0.0008), spinal column trauma (p < 0.0001) and the totality of the intoxication and an association between benzodiazepines and thoracic and pelvic trauma. CONCLUSIONS Alcohol and benzodiazepines intoxication increases the risk of reserved prognosis and admission in ICU; benzodiazepines intoxication correlates with thoracic and pelvic trauma.
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Affiliation(s)
| | - Miranda Zoleo
- Pronto Soccorso, Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesca Pignatiello
- Scuola di Specializzazione Medicina Emergenza Urgenza, Università degli Studi di Padova, Padua, Italy
| | - Fabia De Lazzari
- Scuola di Specializzazione Medicina Emergenza Urgenza, Università degli Studi di Padova, Padua, Italy
| | - Anna Chiara Frigo
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi di Padova, Padua, Italy
| | - Gianna Vettore
- Pronto Soccorso, Azienda Ospedaliera di Padova, Padua, Italy
| | - Donata Favretto
- SC Medicina Legale e Tossicologia-Azienda Ospedaliera, Università degli Studi di Padova, Padua, Italy
| | - Rossella Snenghi
- SC Medicina Legale e Tossicologia-Azienda Ospedaliera, Università degli Studi di Padova, Padua, Italy
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Ferrazzi E, Romualdi C, Ocello M, Frighetto G, Turco M, Vigolo S, Fabris F, Angeli P, Vettore G, Costa R, Montagnese S. Changes in Accident & Emergency Visits and Return Visits in Relation to the Enforcement of Daylight Saving Time and Photoperiod. J Biol Rhythms 2018; 33:555-564. [PMID: 30056770 DOI: 10.1177/0748730418791097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Daylight saving time (DST) is a source of circadian disruption impinging on millions of people every year. Our aim was to assess modifications, if any, in the number, type, and outcome of Accident & Emergency (A&E) visits/return visits over the DST months. The study included 366,527 visits and 84,380 return visits to the A&E of Padova hospital (Northern Italy) over 3 periods between the years 2007 and 2016: period 1 (2 weeks prior to DST to 19 weeks after), period 2 (2 weeks prior to the return to "winter time" to 4 weeks after), and period 3 (5 consecutive non-DST weeks). For each A&E visit/return visit, information was obtained on triage severity code, main medical complaint, and outcome. Data were aggregated by day, cumulated over the years, and analyzed by generalized Poisson models. Generalized additive models for Poisson data were then used to include photoperiod as an additional covariate. An increase in A&E visits and return visits (mostly white codes, resulting in discharges) was observed a few weeks after the enforcement of DST and was significant over most weeks of period 1 (increase of ≈30 [2.8%] visits and ≈25 [10%] return visits per week per year). After the return to winter time, a decrease in absolute number of return visits was observed (mostly white codes, resulting in discharges), which was significant at weeks 3 and 4 of period 2 (decrease of ≅25 [10%] return visits per week per year). When photoperiod was taken into account, changes in A&E visits (and related white codes/discharges) were no longer significant, while changes in return visits (and related white codes/discharges) were still significant. In conclusion, changes in A&E visits/return visits were observed in relation to both DST and photoperiod, which are worthy of further study and could lead to modifications in A&E organization/staffing.
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Affiliation(s)
- Elena Ferrazzi
- 1. Emergency Department, Mestre Dell'Angelo Hospital, ULSS3 Serenissima, Mestre, Italy.,Department of Medicine, University of Padova, Padova, Italy.,Emergency Department, Padova University Hospital, Padova, Italy
| | | | - Michele Ocello
- Department of Medicine, University of Padova, Padova, Italy
| | - Giovanni Frighetto
- 2. Department of General Psychology, University of Padova, Padova, Italy.,Department of Medicine, University of Padova, Padova, Italy
| | - Matteo Turco
- Department of Medicine, University of Padova, Padova, Italy
| | - Stefania Vigolo
- Department of Medicine, University of Padova, Padova, Italy.,Emergency Department, Padova University Hospital, Padova, Italy
| | | | - Paolo Angeli
- Department of Medicine, University of Padova, Padova, Italy
| | - Gianna Vettore
- Emergency Department, Padova University Hospital, Padova, Italy
| | - Rodolfo Costa
- Department of Medicine, University of Padova, Padova, Italy
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Barbieri S, Omizzolo L, Tredese A, Vettore G, Calaon A, Behr AU, Snenghi R, Montisci M, Gaudio RM, Paoli A, Pietrantonio V, Santi J, Donato D, Carretta G, Dolcet A, Feltracco P. The Rise of New Alcoholic Games Among Adolescents and the Consequences in the Emergency Department: Observational Retrospective Study. JMIR Pediatr Parent 2018; 1:e4. [PMID: 31518328 PMCID: PMC6715062 DOI: 10.2196/pediatrics.6578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/06/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The links between the internet and teenager behavior are difficult situations to control and may lead to the development of new and excessive methods of drinking alcohol during alcoholic games. Findings indicate that reported cases are very useful sources for better understanding of alcoholic games, yielding successful measures promoting health among adolescents. Admittance of adolescents to hospital emergency departments (EDs) after consumption of excessive amounts of alcohol has become the norm in developed countries. The harmful effects of acute alcohol abuse are reported in this paper. OBJECTIVE The aim of this work was to investigate the close connections between new drinking behaviors among adolescents and study the increase in new alcoholic games, together with the challenges that cause acute alcohol intoxication, the influence of the internet and social networks, and their consequences for public health services. METHODS Data came from prehospital and intrahospital admissions attributable to alcohol consumption. From 2013 to 2015, 3742 patients were admitted to EDs due to acute alcohol intoxication: 830 of them were aged 15 to 30 years, and 225 were adolescents and young adults between 15 and 20 years who had been playing alcoholic games. Retrospectively, diagnostic data associated with extrahospital anamneses were selected by one of the hospital management information systems, Qlik. As a result of our previous experience, questionnaires and face-to-face interviews were performed at a later stage, when a clinical audit for intoxicated adolescent patients was described, with the overall goal of establishing a potential methodological workflow and adding important information to research carried out so far. RESULTS Between 2013 and 2015, 830 young patients aged 15 to 30 years were admitted to EDs for acute alcohol intoxication. About 20% (166/830) of the sample confirmed that they had drunk more than 5 alcoholic units within 2 hours twice during the past 30 days as a result of binge drinking. Referring to new alcoholic games, 41% of the sample stated that they knew what neknomination is and also that at least one of their friends had accepted this challenge, describing symptoms such as vomiting, headache, altered behavior, increased talkativeness, and sociability. The median value of the weighted average cost of the diagnosis-related group relating to interventions provided by hospitals was the same for both genders, €46,091 (US $56,497; minimum €17,349 and maximum €46,091). CONCLUSIONS Drinking games encourage young people to consume large quantities of alcohol within a short period of time putting them at risk of alcohol poisoning, which can potentially lead to accidental injuries, unsafe sex, suicide, sexual assault, and traffic accidents. The spread of these games through the internet and social networks is becoming a serious health problem facing physicians and medical professionals every day, especially in the ED; for this reason, it is necessary to be aware of the risks represented by such behaviors in order to recognize and identify preliminary symptoms and develop useful prevention programs. The strategic role of emergency services is to monitor and define the problem right from the start in order to control the epidemic, support planning, coordinate the delivery of assistance in the emergency phase, and provide medical education. Hospital-based interdisciplinary health care researchers collected specific data on hazardous drinking practices linked to evaluation of increased alcohol-related consequences and cases admitted to the ED.
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Affiliation(s)
- Stefania Barbieri
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy.,Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy.,Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
| | - Luca Omizzolo
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Alberto Tredese
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Gianna Vettore
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Alberto Calaon
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Astrid Ursula Behr
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Rossella Snenghi
- Department of Legal Medicine, University of Padova, Padova, Italy
| | - Massimo Montisci
- Department of Legal Medicine, University of Padova, Padova, Italy
| | - Rosa Maria Gaudio
- Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
| | - Andrea Paoli
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | | | - Jacopo Santi
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Daniele Donato
- Department of Directional Hospital Management, Padova General Hospital, Padova, Italy
| | - Giovanni Carretta
- Department of Directional Hospital Management, Padova General Hospital, Padova, Italy
| | - Annalisa Dolcet
- Surgery Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Paolo Feltracco
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
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6
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Schiavon L, Casarotti A, Mion MM, Vigolo S, Vettore G, Zaninotto M, Plebani M. Copeptin as a diagnostic and prognostic biomarker in patients admitted to Emergency Department with syncope, presyncope and vertiginous syndrome. Clin Chem Lab Med 2018; 56:e72-e74. [PMID: 28981440 DOI: 10.1515/cclm-2017-0750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Luca Schiavon
- University-Hospital of Padova, Department of Laboratory Medicine, via N. Giustiniani 2, 35128 Padova, Italy, Phone: +39 3400510080
| | | | - Monica M Mion
- University-Hospital of Padova, Department of Laboratory Medicine, Padova, Italy
| | - Stefania Vigolo
- University-Hospital of Padova, Emergency Department, Padova, Italy
| | - Gianna Vettore
- University-Hospital of Padova, Emergency Department, Padova, Italy
| | - Martina Zaninotto
- University-Hospital of Padova, Department of Laboratory Medicine, Padova, Italy
| | - Mario Plebani
- University-Hospital of Padova, Department of Laboratory Medicine, Padova, Italy
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7
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Barbieri S, Feltracco P, Lucchetta V, Gaudio RM, Tredese A, Bergamini M, Vettore G, Pietrantonio V, Avato FM, Donato D, Boemo DG, Nesoti MV, Snenghi R. A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments. Interact J Med Res 2018; 7:e2. [PMID: 29386170 PMCID: PMC5812984 DOI: 10.2196/ijmr.6573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/24/2017] [Accepted: 11/19/2017] [Indexed: 11/21/2022] Open
Abstract
Background NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes.
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Affiliation(s)
- Stefania Barbieri
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy.,Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy.,Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Paolo Feltracco
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Vittorio Lucchetta
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Rosa Maria Gaudio
- Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
| | - Alberto Tredese
- Forensic Medicine and Toxicology, University of Padova, Padova, Italy
| | - Mauro Bergamini
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Gianna Vettore
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | | | | | - Daniele Donato
- Department of Directional Hospital Management, Padova Hospital, Padova, Italy
| | - Deris Gianni Boemo
- Department of Directional Hospital Management, Padova Hospital, Padova, Italy
| | | | - Rossella Snenghi
- Forensic Medicine and Toxicology, University of Padova, Padova, Italy
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Barbieri S, Vettore G, Pietrantonio V, Snenghi R, Tredese A, Bergamini M, Previato S, Stefanati A, Gaudio RM, Feltracco P. Pedestrian Inattention Blindness While Playing Pokémon Go as an Emerging Health-Risk Behavior: A Case Report. J Med Internet Res 2017; 19:e86. [PMID: 28365563 PMCID: PMC5392382 DOI: 10.2196/jmir.6596] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cases of trauma resulting from the use of mobile phones while driving motor vehicles have become quite common in recent years. Road injuries incurred by people playing video games on mobile phones (or other media devices) while walking have also become a cause for concern. Pokémon Go has been the world's most popular game since it was launched in July 2016, with more than 15 million players trying to catch all Pokémon available in the game; however, the case detailed here is the first reported accident in the medical literature caused by a pedestrian distracted by the game while crossing a street. OBJECTIVE We aim to provide additional information on the innovative nature of distractions that generate risks in road-users, and to explore the underreporting of pedestrian-motor vehicle collisions due to mobile device usage. METHODS We included in this case report a 25-year-old male who suddenly crossed a road while playing Pokémon Go and was hit by a van, reporting several injuries and being assisted by the Emergency Medical Service of our hospital (Padova, Italy). The patient's history, the circumstances in which the collision happened, imaging data, and clinical course information were recorded per our hospital's privacy policy. RESULTS The patient hit by the van was playing Pokémon Go on his mobile phone while crossing a street, despite red traffic lights, which he did not notice due to of the distraction induced by the game. CONCLUSIONS Mobile videogames that imply movement (ie, walking, running, cycling) to play are an effective way to improve physical activity practice, especially in adolescents and young adults. Nevertheless, cases like the one presented here point out that these games could pose a significant risk to users who play while walking, cycling, or driving in unsafe areas such as city streets, because players become distracted and may ignore surrounding hazards. Comprehensive, multilevel interventions are needed to reduce accidents caused by distraction, and to stress findings on the positive and negative effects of video games, which are becoming a source of public health concern. Health care providers should be aware of their chief role in these possible prevention strategies, based on their direct interactions with road incident victims.
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Affiliation(s)
- Stefania Barbieri
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy.,Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy.,Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
| | - Gianna Vettore
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | | | - Rossella Snenghi
- Department of Legal Medicine, University of Padova, Padova, Italy
| | - Alberto Tredese
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Mauro Bergamini
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Sara Previato
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Rosa Maria Gaudio
- Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
| | - Paolo Feltracco
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
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9
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Mion MM, Bragato G, Casarotti A, Cosma C, Vigolo S, Vettore G, Tosato F, Zaninotto M, Plebani M. Clinical performance of cardiac Troponin I: A comparison between the POCT AQT90 FLEX and the Dimension Vista analyzer in an emergency setting. Clin Biochem 2017; 50:763-767. [PMID: 28377153 DOI: 10.1016/j.clinbiochem.2017.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiac troponin [cTn (I or T)] is the preferred biomarker for the diagnosis of myocardial infarction (MI). AIM We studied the analytical performance of the POCT AQT90 FLEX cTnI assay and its diagnostic accuracy, in comparison to the Dimension Vista cTnI method, in patients presenting to the Emergency Department (ED) with suspect of acute coronary syndrome (ACS). METHODS 786 consecutive patients were enrolled. cTnI was measured at admission to the ED and about 3 and 6 hours later. The imprecision study was carried out using different lots of quality controls (QCs). ROC curve analysis was conducted using discharge diagnoses in order to verify the global diagnostic accuracy. RESULTS The concentrations measured in the QCs ranging from 0.033 to 1.26μg/L show CVs% ranging from 2.81 to 7.56%, comparable to those declared by the manufacturer. Passing-Bablok and linear regression analysis show a high significant correlation (R2=0.90, p<0.0001); Bland-Altman test describes a statistically significant negative bias (Bias=-0.2336; 95%CI=-0.4217/-0.0456, p=0.0150). ROC curves obtained using Dimension Vista and AQT90 FLEX cTnI assays displayed similar clinical performance being not statistically significant the difference of the corresponding AUC. Comparing sensitivity and specificity of cTnI concentrations obtained from the ROC curve analysis using AQT90 FLEX, we found a "best cut-off" (0.014μg/L) lower than that declared from the manufacturer (0.023μg/L). CONCLUSIONS The comparison of two different assays of cTnI against a diagnosis of acute MI (AMI) shows that both assays behave equally well with a high degree of sensitivity and specificity. The resulting "best cut-off" suggests that this AQT90 FLEX cTnI concentration could be evaluated as the potentially new "clinically usable" cut-off for AMI/myocardial necrosis diagnoses.
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Affiliation(s)
- Monica Maria Mion
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy.
| | - Giada Bragato
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Alessandra Casarotti
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Stefania Vigolo
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Gianna Vettore
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Franco Tosato
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy; Emergency Department, University-Hospital of Padova, Padova, Italy
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Barbieri S, Feltracco P, Omizzolo L, Snenghi R, El Mazloum R, Vettore G, Bergamini M, Stefanati A, Donato D, Ferronato C, Avato FM, Tredese A, Gaudio RM. Planking or the "Lying-Down Game:" Two Case Reports. Interact J Med Res 2017; 6:e4. [PMID: 28336507 PMCID: PMC5383804 DOI: 10.2196/ijmr.6568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/18/2016] [Accepted: 01/05/2017] [Indexed: 11/22/2022] Open
Abstract
Background The monitoring and management of risks regarding children and young people admitted to the emergency department as a result of dangerous behaviors distributed via the Internet should be based on clinical reasoning and knowledge about these social media–related phenomena. Here we examine 2 cases of teenagers who reported severe injuries while performing the “planking” craze, a challenge that consists in lying face-down stiffly like a board on any kind of surface. Objective Our objective is to examine and describe the Internet craze called planking, also known as the “lying-down game,“ through 2 case reports from our experience, enriching this study with information gained through discussions with secondary school teenagers. Methods Details of the 2 case reports were taken from electronic medical records giving information on care support processes, care management, and the costs of traumatic episodes. Demographic data, hemoglobin and serum lactate values, and Injury Severity Scores were evaluated. The study took place in secondary schools of our city from 2013 to 2014 during medical education courses, with the aim of analyzing the influence of social media on teenagers' activities and behaviors. Results Both patients suffered multiple trauma injuries and needed high-level health assistance. The first patient underwent a splenectomy and the second one a nephrectomy; both of them required a long hospital stay (14 and 20 days, respectively), and the costs for their management have been estimated at US $27,000 and US $37,000, respectively. Their decision to perform the planking in dangerous locations was due to their ambition to gain peers' acclaim through shared videos and pictures. Conclusions Reporting and understanding these cases may potentially help prevent future events occurring in similar circumstances: the scientific community cannot leave this problem unaddressed. There is also a role of education resources for health care professionals; for this, we must identify and follow up strange or misleading information found on websites. A key element of this research study was to report physicians’ misperceptions concerning planking and, with these cases used for teaching purposes, improve knowledge of the clinical and forensic aspects of this emerging problem.
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Affiliation(s)
- Stefania Barbieri
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy.,Department of Urgent and Emergency Care, University of Padova, Padova, Italy.,Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
| | - Paolo Feltracco
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Luca Omizzolo
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Rossella Snenghi
- Department of Legal Medicine, University of Padova, Padova, Italy
| | - Rafi El Mazloum
- Department of Legal Medicine, University of Padova, Padova, Italy
| | - Gianna Vettore
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Mauro Bergamini
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | - Daniele Donato
- Department of Directional Hospital Management Padova, University of Padova, Padova, Italy
| | - Cecilia Ferronato
- Preventive Medicine and Risk Assessment, University of Ferrara, Ferrara, Italy
| | | | - Alberto Tredese
- Department of Urgent and Emergency Care, University of Padova, Padova, Italy
| | - Rosa Maria Gaudio
- Forensic Medicine and Toxicology, University of Ferrara, Ferrara, Italy
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Barbieri S, Feltracco P, Snenghi R, Vettore G, Ravaioli C, Franchi M, Previato S, Bergamini M, Stefanati A, Donato D, Carretta G, Rubini S, Frisoni P, Omizzolo L, Gori F, El Mazloum R, Gaudio RM. Drinking games: real-life hazardous challenges which probably increase ‘personal branding’. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Pietrantonio V, Omizzolo L, Snenghi R, Spagna A, Mazloum RE, Vettore G, Vigolo S, Gaudio RM, Feltracco P, Barbieri S. 921 Falling TVS: is it a resolved problem? Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Barbieri S, Omizzolo L, Mazloum RE, Previato S, Ravaioli C, Vettore G, Bergamini M, Snenghi R, Feltracco P. 919 New crazy game “Russian Biker Roulette”. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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El Mazloum R, Snenghi R, Barbieri S, Feltracco P, Omizzolo L, Vettore G, Gaudio RM, Bergamini M. ‘Butt-chugging' a new way of alcohol assumption in young people. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Boni S, Barbieri S, Frisoni P, Benedetti S, Snenghi R, Bergamini M, Vettore G, Omizzolo L, Avato FM, Feltracco P, Gaudio RM. The influence of social networks on unusual sexual practices and the related health impact. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Barbieri S, Feltracco P, Vettore G, Omizzolo L, Gaudio RM, Snenghi R, El Mazloum R, Vigolo S, Franchi M, Previato S, Ravaioli C, Marcolongo A, Guidi E, Stefanati A, Bergamini M. Evolution and revolution of dangerous drinking games among adolescents and young people. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Vetrone F, Santarelli S, Russo V, Lalle I, De Berardinis B, Magrini L, Di Stasio E, Salerno G, Cardelli P, Piccoli A, Codognotto M, Mion MM, Plebani M, Vettore G, Castello LM, Avanzi GC, Di Somma S. Copeptin decrease from admission to discharge has favorable prognostic value for 90-day events in patients admitted with dyspnea. Clin Chem Lab Med 2015; 52:1457-64. [PMID: 24803610 DOI: 10.1515/cclm-2014-0207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/14/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND With patients referred to emergency departments (EDs) for acute dyspnea, emergency physicians should consider all possible diagnoses and assess patients' risk stratification. Copeptin has been shown to have prognostic power for subsequent events, such as death and rehospitalization in patients admitted for dyspnea. The aim of this study was to investigate prognostic role of copeptin variations during hospitalization in patients admitted for dyspnea. METHODS We conducted a prospective, multicentric, observational study in acute dyspneic patients in three ED centers in Italy. Clinical data and copeptin assessments were performed at admission, and at discharge. A 90-day follow-up was performed. RESULTS A total of 336 patients were enrolled, and on the basis of final diagnosis distinguished into two groups: acute heart failure and no acute heart failure. Compared to a control group, in all studied population copeptin values at admission resulted in a significantly (p<0.001) higher median (maximum-minimum): 31 (0-905) versus 8 (0-13) pmol/L. Median copeptin value at admission was 42 (0-905) pmol/L in acute heart failure patients and 20 (0-887) pmol/L in no acute heart failure, respectively (p<0.001). In all studied patients and in each group copeptin at admission and discharge showed significant predictive value for 90-day events (p<0.001). Furthermore, in all patients population and in both groups Δ copeptin values from admission to discharge also showed significant predictive value for 90-day events (p<0.001). CONCLUSIONS In patients admitted for acute dyspnea, admission, discharge and Δ copeptin variations have significant prognostic value from subsequent 90-day death and rehospitalization.
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Mion MM, Bragato G, Zaninotto M, Vettore G, Tosato F, Babuin L, Iliceto S, Plebani M. Effect of a last generation cardiac troponin assay on patients' management: A real world emergency department experience. Clin Chim Acta 2013; 418:77-8. [DOI: 10.1016/j.cca.2013.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/01/2013] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
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19
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Stella F, Pistollato E, Della Rocca F, Vettore G, Tosato F. An ischemic stroke effectively treated with systemic thrombolytic therapy in an underage patient: clinic and ethics. Emerg Care J 2012. [DOI: 10.4081/ecj.2012.2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Piccoli A, Codognotto M, Cianci V, Vettore G, Zaninotto M, Plebani M, Maisel A, Peacock WF. Differentiation of Cardiac and Noncardiac Dyspnea Using Bioelectrical Impedance Vector Analysis (BIVA). J Card Fail 2012; 18:226-32. [DOI: 10.1016/j.cardfail.2011.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 10/28/2011] [Accepted: 11/09/2011] [Indexed: 12/31/2022]
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Realdi G, Giannini S, Fioretto P, Fabris F, Vettore G, Tosato F. Diagnostic pathways of the complex patients: rapid intensive observation in an Acute Medical Unit. Intern Emerg Med 2011; 6 Suppl 1:85-92. [PMID: 22009617 DOI: 10.1007/s11739-011-0681-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The present-day patients have complex diseases that are responsible for the great increase of medical interventions, overcrowding in emergency departments and access to the wards, increased waiting times and length of stay, difficult discharge, increased readmission rate and finally increased mortality. By breaking the steps of the patients pathways it allows us to simplify the problems and to face the individual aspects of the complexity related to the management of patients in the hospital. One solution that has been growing in popularity is the rapid intensive observation of the patients in acute hospital setting within Internal Medicine wards. This model has been otherwise defined with different terminology, but the most widely used name is Acute Medical Unit (AMU). We describe the model of an AMU within an Internal Medicine department as proposed and adopted in Anglo-Saxon countries, the methods of clinical approach and the practical organisation of the units in close collaboration with the ED ward. Finally we report our experience at an Internal Medicine department in Padova and the initial results obtained during the first 4 months of the project. Our approach of intensive rapid observation of intermediate risk patients admitted from the ED led to a significant reduction in the duration of hospitalization, without increasing readmission rate after discharge and fatality rate. Factors significantly associated to a short hospital stay were a preserved function and a lower number of previous admissions to the hospital. Several gray zones in the realisation and management of the project were identified and the possible solutions are still matter of discussion and debate.
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Affiliation(s)
- Giuseppe Realdi
- Clinica Medica 1, Department of Medical and Surgical Sciences of University of Padova, Policlinico Universitario, Via Giustiniani 2, Padua, Italy.
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Cancian M, Vettore G, Realdi G. An uncommon cause of acute pancreatitis. Hereditary angioedema-induced acute pancreatitis. Gastroenterology 2011; 140:33, 370. [PMID: 21110969 DOI: 10.1053/j.gastro.2010.02.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Revised: 02/04/2010] [Accepted: 02/18/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Mauro Cancian
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
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Gaudio RM, Barbieri S, Feltracco P, Spaziani F, Alberti M, Delantone M, Trevisiol P, Righini F, Talarico A, Sanchioni R, Spagna A, Pietrantonio V, Zilio G, Dalla Valle R, Vettore G, Montisci M, Bortoluzzi A, Sacco A, Ramacciato G, Pasetti A, Mognato E, Ferronato C, Costola A, Ori C, Avato FM. Impact of alcohol consumption on winter sports-related injuries. Med Sci Law 2010; 50:122-125. [PMID: 21133261 DOI: 10.1258/msl.2010.010007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This study was carried out to evaluate data about trauma-related winter sports, including risk factors such as high speed, gender, age, alcohol consumption, details about the accident and snow conditions. METHODS A retrospective review was conducted to determine the injury patterns and crash circumstances in holiday skiers and snowboarders. The data recorded were obtained from the database of the Pre-Hospital Emergency Registry of six skiing areas in the Dolomite mountains during the winter seasons November 2004-May 2009, injury data for major traumas from Ski Patrol Injury reports (helicopter, ambulance or ski slopes' patrol reports), and intrahospital Emergency Department data. Alcohol concentration in blood was detected in 200 individuals suffering from major trauma. RESULTS A total of 4550 injured patients, predominantly male (69%), mean age 22 years (range 16-72), were included in the observational analysis. Knee, wrist and shoulder injuries were frequently associated with major thoracic, abdominal or head traumas (64% of cases). Suboptimal technical level, high speed, low concentration, snow or weather conditions, faulty equipment and protective devices were among the various causes of accidents. The analysis revealed that high alcohol blood concentration was present in 43% of 200 patients. CONCLUSIONS Even though the major causes of accidents were excessive speed, excessive fatigue, technical errors and bad weather conditions, alcohol abuse was often discovered. Random sampling and a non-systematic detection of alcohol blood levels likely led to an underestimation of alcohol consumption-related injuries. It is recommended that investigations into alcoholic intoxication in injured skiers should be carried out on a large scale.
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Affiliation(s)
- R M Gaudio
- Dip. Scienze Biomediche e Terapie Avanzate, Sezione di Medicina Legale, Università degli Studi di Ferrara, Ferrara, Italy
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Cancian M, Andres AL, Bendo R, Maggioni L, Ossi E, Vettore G, Realdi G. Hereditary angioedema-induced acute pancreatitis: Clinical picture and effects of C1-esterase inhibitor replacement. Mol Immunol 2008. [DOI: 10.1016/j.molimm.2008.08.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Bilora F, Manfredini R, Petrobelli F, Vettore G, Boccioletti V, Pomerri F. Chronobiology of non fatal pulmonary thromboembolism. Panminerva Med 2001; 43:7-10. [PMID: 11319511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND It as been demonstrated that acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary embolism show an increased onset rate during certain periods of the day, week, or year. According to some authors, the highest risk appears to occur in the morning, on weekends and during winter. This paper, therefore, intends to examine whether a circadian, weekly, or annual rhythm in the incidence rate of deep vein thrombosis (DVT) and non-fatal pulmonary embolism (PE) in ageing patients does exists. METHODS A survey was conducted into 212 patients affected by DVT and PE, admitted to the Second Medicine Institute of Padua, Italy, over a period of two solar years. Thromboses were diagnosed via echo-Doppler examination of the legs and pulmonary embolism via perfusive and ventilatory scintiphotographs. RESULTS In the overall sample, a circadian variation was found, both for deep vein thrombosis (peak at 12:26 hrs, p=0.001), and pulmonary embolism (peak at 10:26 hrs, p=0.001). A weekly, rhythmic recurrence was also found for the two complaints, with a peak on Saturdays, while no significant annual rhythmic recurrence was found. There was, however, a tendency towards an increase during the winter and summer months. CONCLUSIONS The results may have important clinical applications, both in prevention and in the timing of drug dosage.
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Affiliation(s)
- F Bilora
- Institute of Medicine II, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
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26
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Bilora F, Vettore G, Barbata A, Pastorello M, Petrobelli F, San Lorenzo I. Electrocardiographic findings in obese subjects. MINERVA GASTROENTERO 1999; 45:193-7. [PMID: 16498330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Obesity is often associated with cardiovascular pathology. Cardiac arrhythmias and sudden death are reported for obese subjects during severe caloric restriction and weight loss. Also obese patients without dieting are at increased risk of arrhythmias and sudden death in the absence of cardiac dysfunction. This is probably due to a delayed cardiac repolarization and prolongation of heart rate corrected electrocardiographic QT interval (QTc). METHODS This paper examined the electro-cardiographic findings of a group of obese young males compared with normal patients and whether QTc interval duration was associated with relative body mass index. All patients were free of cardiovascular diseases and came to the First Aid Department for other pathology than cardiac. We studied 109 subjects (50 obese males and 59 normal males; aged 43.4+/-14.8 and 42.8+/-9.8 years respectively). RESULTS Obese patients presented a shorter PQ, a prevalence of left cardiac axis, a higher heart rate, a longer QT, but not QTc compared with normal males. There was no correlation between QTc and obesity. CONCLUSIONS This study noticed that obese patients present some differences in electrocardiographic findings compared with normal subjects and that these alterations are not ascribed to cardiac repolarization. This is probably due to the young age of the studied groups.
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Affiliation(s)
- F Bilora
- Department of Medical and Surgical Sciences, Medical Clinic II, Padua Hospital, Padua
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27
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Bilora F, Vettore G, Saccaro G, Barbata A, Dei Rossi C, Petrobelli F. [Epidemiologic evaluation of cardiac decompensation and its impact on health costs]. Minerva Cardioangiol 1998; 46:235-9. [PMID: 9973786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Heart failure is a frequent pathology that requires a high degree of hospitalization. These characteristics have a high assistance cost. The purpose of this study was to evaluate the prevalence, acuteness, predisposing factors and therapy carried out in patients of a northeastern Italian town, and to evaluate their impact on health costs. METHODS We have examined patient under observation of the Department of Emergency at the Padua Hospital for 12 months. They had been hospitalized for heart failure symptoms. They all underwent individual and pharmacological anamnesis, objective exam, ECG, thorax X-rays and echocardiogram. The health expenses were calculated in relation to hospital stay, the cost of daily assistance, exams and medical treatments used. RESULTS 630 patients of both sexes (422 males and 208 females) aged 74.6 +/- 6.1 were studied. Among significantly interrelated factors were: hypertension in 51.4% of the patients; diabetes mellitus in 9% of the patients; hypercholesterolemia in 31.3% of the patients; hypertriglyceridemia in 7.2% of the patients; cigarettes smoking in 19.3% of the patients, whereas obesity was present in 19.7% of all the subjects. Heart diseases directly correlated with heart failure were respectively: myocardial ischemia (65.6%); hypertensive cardiopathy (14.7%); idiopathic dilatative (15%); and valvular cardiopathy (4.7%). In 9.5% of cases, patients presented episodes of TIA, ictus, or they were carriers of neurologic focal deficiencies. As far as NYHA functional class was concerned, the third was most prevalent with a different distribution (p < 0.05) between males and females. ACE inhibitors, digitalis and calcium antagonists are to be indicated among the most widely used drugs. The health cost for patients in this survey was deduced on the basis of: average; hospitalization stay (9.8 days); estimated daily expenses for patient and for further controls (L. 282,000); the area of users (85% of residents). Therefore the full hospital assistance of patients with heart failure is approximately L. 2.1 thousand millions. CONCLUSIONS Given the high preponderance of heart failure, the frequent relation with vascular risk factors and with ischemic cardiopathy, further investigation is necessary to curb these high rates. On the other hand, the NYHA advanced state of patients is not likely to allow lower costs in relation to hospital admission or the reduction of hospital stay. Nevertheless, the individualization of standardized therapeutic protocols and an adequate home care surveillance follow-up may reduce the number of hospitalizations and consequently the connected health expenses.
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Affiliation(s)
- F Bilora
- Università degli Studi, Padova II Clinica Medica
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Bilora F, Vettore G, Maifredini C, Rocco S, Pastorello M, Petrobelli F. [Chronobiology of acute pulmonary edema in an emergency service]. Cardiologia 1998; 43:303-7. [PMID: 9611859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Some diseases like acute myocardial infarction, sudden death and stroke have been reported to disclose daily, weekly or annual incidence fluctuations. We analyzed the rhythm of pulmonary edema occurrence. We considered 105 consecutive subjects (mean age 73.7 +/- 9.7 years) who came to an Emergency Department because of acute pulmonary edema during a solar year. Chronobiologic analysis was performed using Halberg single cosinor test. Pulmonary edema incidence was higher during the night with an acrophase at 2:14 a.m. (p < 0.001). No significant weekly or circannual rhythms were detected. We discuss the possible relations with diminished heart output, increase in sympathetic tone or partial baroceptor desensitization, occurring at night.
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Affiliation(s)
- F Bilora
- Istituto di Patologia Medica 2, Università degli Studi, Padova
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Bilora F, Vigna G, Manfredini R, Vettore G, Trivellato M, Scioldo C, San Lorenzo I. Chronobiology of Symptomatic Supraventricular Paroxysmal Tachycardia. BIOL RHYTHM RES 1998. [DOI: 10.1076/brhm.29.3.293.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bilora F, Vigna GB, Saccaro G, Pastorello MP, Polato G, Maifredini C, Chiesa M, Barbata A, Vettore G, San Lorenzo L. [Short term changes in risk factors of cerebrovascular diseases. A failure of preventive measures?]. Minerva Med 1996; 87:439-48. [PMID: 8992405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is the third main cause of death in western countries. To evaluate its ever-changing characteristics and the impact of recent public campaigns on cardiovascular risk factors (CRFs) in stroke morbidity and mortality, we carried out a retrospective investigation on subjects with cerebrovascular disease in different periods. METHODS All clinical data of patients with acute cerebrovascular disease (TIA or stroke) admitted to a regional hospital (Padua, Italy) during two distinct years (1985 and 1992) were examined (381 in 1985 and 440 in 1992). In every case the characteristics of the episode, clinical course, concomitant CRFs and relevant biochemical and instrumental examinations were recorded. RESULTS Altogether Transient Ischemic Attack (TIA) represented almost half the records; remaining cases could be classified as ischemic stroke (66% vs 55%), Intracerebral Haemorrhage (17% vs 26%) and subarachnoideal haemorrhage (17% vs 19%) (1985 vs 1992, respectively). The mean hospitalization period was longer in the most recent year, particularly in haemorrhagic patients (H-P, subarachnoid + intracerebral haemorrhage); the in-hospital case fatality rate was reduced in HP while it was significantly increased in those with Cerebral Ischemia (CI-P, TIA + ischemic stroke). The prevalence of blood hypertension, atrial fibrillation and dyslipidaemias rose significantly in 1992 compared to 1985. High plasma lipids were more frequently present in CI-P than in H-P; their 7-year increase was particularly related to combined forms, rather then isolated hypercholesterolemia or hypertriglyceridemia. CONCLUSIONS These results do not agree with an hypothetical improvement in the prognosis of stroke in the period we considered. Besides the efforts aiming at reducing CRFs in the short term have not shown to be successful.
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Affiliation(s)
- F Bilora
- Dipartimento di Emergenza, Università degli Studi-Padova
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Bilora F, Genovese R, Presotto F, Saccaro G, Vettore G, San Lorenzo I, Dazzi A. [Herpes zoster and post-herpetic neuralgia. Comparison between elderly patients and young adults treated with acyclovir]. Minerva Med 1994; 85:333-7. [PMID: 8084437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Herpes zoster (HZ) is a common skin disease due to a virus identical to that responsible for chickenpox. In a variable number of cases neuritic pain persist after cutaneous healing. Aim of this investigation was to analyze zoster clinical evolution in 102 immunocompetent patients, subdivided by age (< 60 years and > or = 60 years) and sex, after treatment with acyclovir (4 g/die x 10 days). Signs and symptoms of the disease were evaluated, with particular attention to pain and the duration of post-herpetic neuralgia. Vescicular eruption was most frequently found in the thoraco-abdominal region and in the trigeminal one, with no significant differences among the subgroups. Two thirds of the subjects complained of pain and it was prevalent in female sex (84% of cases vs 53%, p < 0.01) but not in any age-class. After 1 months from the episode (and its pharmacological treatment), post-herpetic neuralgia was still present in about 20% of the patients, above all in those > or = 60 years; this last difference reached statistical significance after 6 months (9.7% vs 1.4% for subjects > or = 60 years and < 60 years respectively, p < 0.05). No patient showed any adverse pharmacological effect after treatment. We conclude that acyclovir is well accepted both in young and elderly immune-competent subjects suffering from HZ, but it necessitates further efficacy investigations in sight of its broader utilization.
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Affiliation(s)
- F Bilora
- Dipartimento di Emergenza, Complesso Ospedale-Università degli Studi di Padova
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Bilora F, Vettore G, Manfredini R, Matterazzo G, Vigna GB, Dazzi A. [Chronobiological approach to renal colic]. Arch Ital Urol Nefrol Androl 1992; 64:319-23. [PMID: 1462155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The concentration of lithogenic and antilithogenic substances in urine shows circadian fluctuations. With this investigation we intended to verify the presence of a chronobiologic rhythm of colic pain in urinary tract calculosis. Four hundred and forty seven consecutive patients with a clinical symptomatology related to urinary tract colic pain were studied. They were subdivided according to sex and age (297 M, 150 F; > or = 65 ys 29, < 65 ys 428). Urinary and blood chemical analysis and instrumental examinations permitted to confirm the clinical diagnosis. To evaluate the circadian and circannual variability, acute events were grouped into one calendar year by the month and into a ideal day by the hour of occurrence respectively. Chronobiologic analysis was performed utilising Halberg single cosinor test. The results pointed out that the symptomatology related to urinary tract colic pain presents a circadian rhythmicity either in patients as a whole or in single subgroups (males, females, younger or older than 65 ys). Besides no seasonal variability was demonstrated, perhaps because of the mild climate present in the geographic area in which the study was carried on.
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Affiliation(s)
- F Bilora
- Ospedale Civile, Università di Padova
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