Burden of an educational program on end of life management in a Internal Medicine ward: a real life report.

BACKGROUND AND AIM: Appropriate end of life (EOL) management in Internal Medicine wards is challanging. The aim of this study was to analyze the burden of an educational program on EOL management in a Internal Medicine ward. Materials and methods: We retrospectively analysed characteristics and management of patients consecutively died in an italian Internal Medicine ward along one year. We compared demographic, co-morbidity, pharmacological treatment in the last 48-hours of life and procedures during hospital stay in patients died six months before and after an educational program on palliative cares and EOL management addressed to a team of physicians and nurses. RESULTS: Study population was composed by 354 patients (190 females), with mean age ± DS 83.5 ± 10.6 years, one half admitted after the educational program. Eighty-four percent of deaths was exepected in the last 48 hours before exitus. Demographic characteristics and causes of hospitalization were not different before and after educational program. After the educational program the sharing of palliative care program with patient, relatives and/or caregivers (97.7% vs 85.8%, p=0.0001) and written order to withdrawal vital parameters relevation (39.5% vs 22%, p=0.0005) significantly increased, while difference in pharmacological classes prescribed in the last 48 hours of life was not find. Blood (54.8% vs 67.2%, p=0.0219) and arterial gas analysis (28.8% vs 39.5%, p=0.0435) samples in the last 48 hours of life were significantly reduced. Radiological and/or endoscopic examinations, red cells or platelets transfusion were reduced and palliative therapy was increased, despite difference between the two periods was not statistically significant. CONCLUSION: Educational program in Internal Medicine wards aimed to improve skills could contribute to make EOL management more appropriate and patient-oriented and it should be strongly encour-aged.

Mean-field annealing for phase unwrapping.

Use of mean-field annealing theory is proposed for solving the phase-unwrapping (PU) problem. PU is formulated as a constrained optimization problem for the field of integer corrections to be added to the wrapped gradient field. A deterministic algorithm is described to provide an approximation of the average of the correction field over the global minima of the cost function. The proposed algorithm can be applied for any choice of the cost function. Using a cost function based on second-order differences, we obtain results close to those from simulated annealing and spend less computational time.

Fibrosarcoma of the thigh. Case report and literature review.

Sarcomas of the soft tissue constitute a fairly rare group of neoplasms localized mainly at the level of the extremities. Apart from clinical and semeiotic investigations, diagnosis is based on imaging techniques. Among these (ultrasound, CT, NMR and angiography), all of which are helpful in diagnosis, NMR seems to provide the most complete data and sensitivity and specificity. In fact, it has greater specificity than ultrasound or CT as regards identification of any infiltration of the muscle or deep interstitial tissues and can also contribute information on the nature of the sarcoma, as it provides high definition of the structural composition of the tissues. Angiography remains important as a preoperative guide to the surgical approach. Surgery is the treatment of choice, although in recent years it has been integrated with radio or chemotherapy. Thanks to the progress in treatment constituted by combination treatments there has been a dramatic reduction in the need for amputations, compartmental excision and disinsertion of muscle groups. We report the case of a patient with fibrosarcoma of the thigh and discuss the various imaging techniques and different approaches to the treatment of these neoplasms.

[Short-term perioperative antibacterial prophylaxis using imipenem-cilastatin versus acylureide penicillins in pacemaker implantation. A 30-month follow-up]. / Short-term profilassi antibatterica perioperatoria con imipenem-cilastatina versus acilureido-penicilline negli impianti di pace-makers. Follow-up a 30 mesi.

The authors have evaluated the efficacy of short term treatment with an imipenem-cilastatin combination in a selected group of 72 patients undergoing implant or substitution of a pacemaker and with associated pathology potentially increasing the risk of infection. After 30 months' follow-up, the authors underline the efficacy and advantages of this treatment.

[The Italian experience in permanent pacing. A casuistry for more of 10 years: a policentric study (author's transl)]. / L'esperienza italiana con l'elettrostimolazione permanente a lungo termine. Casistica in trattamento da oltre 10 anni: studio policentrico.

According to a recent national survey, 387 patients were treated by permanent pacing in 10 Italian centers, between 1961 and 1966. Of these patients 205 have died; 131 (77 males and 54 females) are still alive and no informations could be obtained for the remaining 51 (13%). The overall survival of patients treated during this period of time is therefore not less than 34% which is comparable to that of general population of the same age group. The 131 patients still alive have totaled 1,486 years of pacing and have used up to 784 pacers. Comparing the incidence of the most common causes for replacement during the periods 1961-66 and 1973-77, electrode failures dropped from 21 to 0.9%; circuitry malfunctions occurred in 10.5 and 7.8%; battery depletion rose from 36.8 to 69% of the cases. According to their clinical conditions, the 131 patients on long-term follow-up can be grouped as follows: 62% are in class 1 or 2 of NYHA; 26.7% are in class 3, and 3.8% in class 4. Moreover, 53.4% of patients are living an active life, having some sort of occupation and 29% are holding a driving license.