Constitution of a malnutrition task force in an Italian University Hospital

Abstract Context.—Although there is evidence that endometriosis results from basal endometrium dislocation, the underlying biology is not fully understood. One protein that plays an important role in regulating epithelial proliferation and differentiation is the 63-kDa membrane protein (p63), which is also a marker of basal and reserve cells in the female genital tract. Objective.—To determine whether p63 is expressed differently in peritoneal endometriosis, endometriomas, and adenomyosis, as well as in deep endometriotic nodules of the rectovaginal septum and abdominal wall. Design.—This study includes a prospective series of consecutive patients (Canadian Task Force classification II-2) from a tertiary care university hospital. Specimens collected from 83 patients (15 peritoneal endometriosis specimens, 22 endometrioma specimens, 36 adenomyosis specimens, and 10 rectovaginal septum/abdominal wall specimens) were evaluated. Diagnostic and operative laparoscopies or laparotomies were performed, and tissue samples were obtained. Immunohistochemistry was used to evaluate p63 expression. Results.—Positivity for p63 was detected in 93.3% of the peritoneal endometriosis specimens, 81.8% of the endometrioma specimens, 36.1% of the adenomyosis specimens, and none of the rectovaginal/abdominal wall endometriosis specimens (P < .001). Distribution of p63 immunostaining in the positive specimens was homogeneous. Conclusions.—Endometriotic lesions express p63 differently, and some retain the basal/reserve cell immunophenotype. Nevertheless, it remains unclear whether the lack of p63 expression in some lesions is related to the extent of the disease, to its clinical behavior, or to exacerbation of the accompanying symptoms.

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Breast cancer screening guidelines: Is it time to revisit? A survey.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11089 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11089-e11089

Author(s):

Archana C. Rao ◽

Srivalli Gopaluni ◽

Sheila M. Lemke

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Health Care Providers ◽

Task Force ◽

University Hospital ◽

Care Providers ◽

Cancer Society ◽

Adherence To Guidelines ◽

Screening Guidelines ◽

Cancer Network

e11089 Background: Breast cancer is the most common non-skin cancer among women in US. In a 2012 report by CDCbreast cancer screening rates are falling short of government targets. At least 10 different societies have laid out screening guidelines, making it difficult to follow. We conducted a survey to better understand adherence to guidelines among health care providers. Methods: A questionnaire comprising of 15 questions was distributed to 120 providers within the Department of Medicine at a University Hospital. Results: 68% returned completed questionnaires: Residents (53%), Attendings/Fellows (36%) and Nurse Practioners/Medical students (11%). Despite 60% respondents claiming that screening guidelines were easy to comprehend and follow; the table suggests otherwise. 49% of the respondents follow United States Preventive Services Task Force guidelines (USPSTF) 28% of these commenced screening at age 40; against the recommendations to start at age 50 and to initiate discussions between the ages of 40-50. 16% of the respondents followed National Comprehensive Cancer Network (NCCN)/American Cancer Society guidelines. 46% of these commenced screening at age 50 or between ages 40-50 contrary to recommendations to begin screening at age 40. Similarly 42% of respondents chose to discontinue screening at the age of 75 in concordance to USPSTF guidelines. 5% chose to screen indefinitely and 1% said they would individualize. 52% did not conform to any guidelines. 69% advocated self breast examinations despite most societies not encouraging the same. Conclusions: While majority of providers follow USPSTF guidelines, there is a considerable discordance between guidelines respondents claim to follow and their practices. This could be attributed to the lack of uniformity in the guidelines across various societies making it harder to comprehend and recall. A unifying consensus would make it easier for providers to improve effective screening. [Table: see text]

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Surgical Support for Severe COVID-19 Patients: A Retrospective Cohort Study in a French High-Density COVID-19 Cluster

Surgical Innovation ◽

10.1177/1553350620954571 ◽

2020 ◽

pp. 155335062095457 ◽

Cited By ~ 1

Author(s):

Eric Noll ◽

Christophe Muccioli ◽

Pierre-Olivier Ludes ◽

Julien Pottecher ◽

Pierre Diemunsch ◽

...

Keyword(s):

Task Force ◽

High Density ◽

University Hospital ◽

Nontechnical Skills ◽

Phone Calls ◽

Single Center Study ◽

Surgical Teams ◽

Collaborative Efforts ◽

Primary Measure

Background. The COVID-19 epidemic has resulted in a massive surge in the need for intensive care unit (ICU) care. To avoid being overwhelmed, hospitals had to adapt and support the ICU teams in structured ICU care including involving surgical teams. This work aims at describing the collaborative efforts between the ICU care team and the Surgical Task Force (STF) during a surge of ICU activity in a University Hospital in a French high-density COVID-19 cluster. Study Design. This retrospective single center study analyzed the STF workflow and the ICU population. The study included 55 patients hospitalized in our ICU, ICU-converted step-down units, and post-anesthesia care units. The primary measure was the global daily STF activity. The secondary measure was the daily activity for each of the 5 tasks accomplished by the STF. Results. The STF attempted 415 phone calls for 55 patients’ families, 237 mobilizations of patients requiring prone positions, follow-up of 20 patients requiring medevac, and contribution to ethical discussion for 2 patients. The mean (SD) daily number of successful phones calls, ethical discussions, mobilizations of patients requiring prone positions and medevac follow-up were 18 (7), .1 (.4), 10 (7), and 2 (3), respectively. No actions for discharge summaries writing were required. The maximum number of daily mobilizations for patients requiring prone positions was 25. The maximum number of daily attempted phone calls and successful phone calls were 37 and 26, respectively. Conclusion. Surgeons’ technical and nontechnical skills represented an effective support for ICU teams during the COVID-19 pandemic.

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The pretreatment lymphocyte-to-monocyte ratio (LMR) to predict treatment efficacy and prognosis in metastatic colorectal cancer treated with the combination of TAS-102 and bevacizumab (TAS-CC3 Study).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.224 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 224-224

Author(s):

Akihisa Matsuda ◽

Yoichiro Yoshida ◽

Hirohiko Kamiyama ◽

Chihiro Kosugi ◽

Hiroshi Yoshida ◽

...

Keyword(s):

Colorectal Cancer ◽

Combination Therapy ◽

Metastatic Colorectal Cancer ◽

Phase Ii ◽

Medical Information ◽

Task Force ◽

University Hospital ◽

Current Phase ◽

Combination Regimen ◽

Line Therapy

224 Background: The combination regimen of TAS-102 and bevacizumab as salvage-line therapy for metastatic colorectal cancer (mCRC) was established based on its high clinical effectiveness (C-TASK FORCE). Recently, our current phase II TAS-CC3 study demonstrated comparable median progression-free survival (PFS: 4.5m) and overall survival (OS: 9.2m) with exclusive inclusion of 3rd line therapy patients. However, practical predictors for its efficacy are lacking. This study evaluated inflammation-based scores as potential predictors for this combination therapy. Methods: This is a post hoc analysis of investigator-initiated, open-label, single-arm, multicentered phase II study (TAS-CC3) in Japan with 32 mCRC patients treated with the combination therapy. We investigated the predictive and prognostic values of pretreatment blood inflammation-based scores, including neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-monocyte ratios (LMR), on disease-control (DC), PFS and OS. These were divided into two groups (high and low) using cut-off of each median values. This study was registered at the University Hospital Medical Information Network, as UMIN#000022438. Results: ROC curve analyses of 3 inflammation-based scores versus DC showed a best predictive performance in LMR, followed by NLR and PLR (AUC: 0.89, 0.85, and 0.68, respectively). The high LMR group had a significantly higher DC rate than the low group (87.5 vs. 43.8%, P= 0.023). Two patients showing partial responses were in the high group. The high LMR group showed significantly longer survivals compared with the low group (4.9 vs. 2.3m, respectively for median PFS, P= 0.014) (20.5 vs. 5.1m, respectively for median OS, P< 0.001). The values of LMR were significantly correlated with PFS and OS (r = 0.56: P< 0.001 and 0.62: P< 0.001, respectively). Conclusions: Pretreatment LMR is a valid predictive and prognostic biomarker for mCRC patients with TAS-102 and bevacizumab treatment and might be clinically useful for selecting patients of the responder. Clinical trial information: 000022438.

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Echocardiographic Probability of Pulmonary Hypertension in Myeloproliferative Neoplasms Patients in Chiang-Mai University

Blood ◽

10.1182/blood-2019-126599 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5390-5390

Author(s):

Yanika Jindamai ◽

Ekarat Rattarittamrong ◽

Arintaya Phrommintikul ◽

Lalita Yongsmith ◽

Thanawat Rattanathammethee ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Conflicts Of Interest ◽

Task Force ◽

Myeloproliferative Neoplasms ◽

White Blood Cells ◽

Philadelphia Chromosome ◽

University Hospital ◽

Chiang Mai ◽

European Respiratory Society ◽

Number Of Patients

Introduction: Pulmonary hypertension (PHT) is an emerging complication of myeloproliferative neoplasms (MPNs). The aim of this study was to determine the prevalence and risk factors of high echocardiographic probability of PHT according to 2015 The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Guideline. The echocardiographic probability of PHT was assessed by peak tricuspid regurgitation velocity (TRV max) and echocardiographic signs suggesting PHT. Methods: This was a cross-sectional study conducted in Chiang-Mai University Hospital during January 2019 and July 2019. Patients aged 18 years or older with Philadelphia chromosome negative MPNs including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF) were eligible after obtaining informed consents. Patients who were known to have a preexisting PHT from any causes were excluded. All enrolled patients had an echocardiography performed by a cardiologist for evaluating the probability of PHT according to 2015 ESC/ERS guideline. Primary outcome of the study was the prevalence of MPNs patients who had high echocardiographic probability of PHT. Secondary outcomes were risk factor of high echocardiographic probability of PHT. Results: A total of 23 patients with a median age of 64 years (range 45-87) were enrolled. There were 14 PV (60.9%), 8 ET (34.8%), 1 MF (4.3%) patients included. There were13 male patients (56.5%). The most common driver mutation was JAK2V617F mutation (19 patients, 82.6%). Common co-morbid diseases were hypertension (26.1%), combined hypertension and dyslipidemia (13%), and combined hypertension and diabetes (8.7%), respectively. The majority of patients (73.9%) did not have history of thrombosis. However, 57.2% and 62.5% of PV and ET patients were classified as high risk of thrombosis. Twenty two patients (95.6%) received both antiplatelets and cytoreductive agents with 9 patients (39.1%) also underwent phlebotomy. Hydroxyurea was only cytoreductive drug prescribed in this study. The median time from diagnosis to echocardiogram evaluation was 66 months (range 9-6,242 months). Median (range) hemoglobin was 11.7 g/dl (9.7-16.8), median white blood cells count was 7.5x109/L (4.0-24.1), and median platelet count was 374x109/L (171-931). No patient with high echocardiographic probability of PHT was detected. One patient (4.3%) patient had intermediate probability and 22 (95.7%) patients had low probability. The median value of TRV max was 2.42 m/s (range 1.93-2.90). Conclusions: No MPNs patients (0/23) with high echocardiographic probability of PHT detected in this study. Further study with higher number of patients is warrant for determine the prevalence of PHT in Thai MPN patients. Table Disclosures No relevant conflicts of interest to declare.

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COVID-19 pandemic management at the Emergency Department: the changing scenario at the University Hospital of Pisa

Emergency Care Journal ◽

10.4081/ecj.2020.9146 ◽

2020 ◽

Vol 16 (2) ◽

Author(s):

Greta Barbieri ◽

Stefano Spinelli ◽

Matteo Filippi ◽

Francesca Foltran ◽

Mauro Giraldi ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

Task Force ◽

Regional Distribution ◽

University Hospital ◽

Organizational Model ◽

Similar Reduction ◽

The University ◽

Italian Territory

Starting from 1st case in Italy, on February 20th, 2020, CO-rona VI-rus D-isease 2019 (COVID-19) pandemic spread to whole Italian territory, with different regional distribution. Tuscany has been classified as medium diffusion area (40-100 cases/100000 inhabitants). In this context, all healthcare structures reviewed their organization to meet new needs. Our study’s objectives were description of organizational model outlined to safely manage Emergency Department (ED) and analysis of patients’ flows within Hospital of Pisa during pandemic. The ED has been reorganized with dedicated areas for examination and waiting for tests results. A similar reduction (-62%) of ED accesses comparing to the same period of 2019 and the previous months of 2020 was observed. Hospital Task Force arranged for progressive activation of Units by modules, according to territorial needs. From the beginning of March to the end of April 2020, 315 COVID-19 patients were hospitalized. Overall, a 45% reduction in hospital admissions compared to the same period of 2019 was observed, with increased mortality (4% versus 2%). The University Hospital of Pisa efficiently managed COVID-19 emergency with a logistical reorganization of ED.

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Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

BioMed Research International ◽

10.1155/2017/1827913 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Feng-Hsiang Tang ◽

Eing-Mei Tsai

Keyword(s):

Learning Curve ◽

Task Force ◽

Laparoscopic Hysterectomy ◽

Learning Curves ◽

University Hospital ◽

Uterine Weight ◽

Robotic Assisted ◽

Rapid Learning ◽

Control Rules ◽

Medical University

Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44±5.31 years, 23.97±4.75 kg/m2, and 435.48±250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve.

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SAT0093 CDAI AND DAS28 IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS IN CLINICAL PRACTICE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1377 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 980.1-980

Author(s):

S. Takanashi ◽

Y. Kaneko ◽

T. Takeuchi

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Disease Activity ◽

Medical Information ◽

Task Force ◽

University Hospital ◽

Expert Committee ◽

Chugai Pharmaceutical ◽

Patient Reported ◽

Remission Criteria

Background:The primary therapeutic target for rheumatoid arthritis (RA) is remission, assessed using validated composited measures. Currently, index-based remission frequently used in clinical practice are disease activity (CDAI) and disease activity score for 28 joints (DAS28). Generally, CDAI is believed more stringent than DAS28 in assessing clinical remission, however, this confirmation was mainly derived from trial results.Objectives:To investigate the real-world performance of CDAI and DAS28 -erythrocyte sedimentation rate (ESR) in RA.Methods:We reviewed consecutive RA patients who are receiving any disease modifying anti-rheumatic drug (DMARDs) in Keio University Hospital between 2016 and 2017 and collected medical information. We focused on the patients in CDAI remission and/or DAS28-ESR remission at the time of last visit, and analyzed their clinical characteristics.Results:A total of 1585 patients with RA were reviewed. Their characteristics were mean age of 64 years old, female of 84% and mean disease duration of 12.0 years. Current treatments were conventional synthetic (cs) DMARDs alone, TNF inhibitors (TNFi), IL-6 receptor inhibitors (IL-6i), CTLA-4Ig, and JAK inhibitors (JAKi) in 39.2%, 29.0%, 22.8%, 7.1%, and 1.8% patients, respectively. Of them, 62.7% were in CDAI remission and 64% were in DAS28-ESR remission. Among patients in CDAI remission, the proportion of DAS28-ESR non-remission was 19.4% in those treated with csDMARDs, 18.2% treated with TNFi, 4.2% treated with IL-6i, 27.6% treated with CTLA-4Ig, and 33.3% treated with JAKi (Figure). In contrast, among patients in DAS28 remission, the proportion of CDAI non-remission was 11.7% in those treated with csDMARDs, 15.4% treated with TNFi, 29.5% treated with IL-6i, 16.0% treated with CTLA-4Ig, and 14.3% treated with JAKi. Venn diagrams of CDAI remission and DAS28-ESR remission demonstrated that more patients satisfied the CDAI remission criteria without satisfying the DAS28-ESR remission criteria than vice versa, except for those treated with IL-6i (Figure). Patients in CDAI remission and DAS28-ESR non-remission had higher C-reactive protein, ESR and comorbidity rates (0.37 vs 0.07 mg/dL, p<0.001; 45.7 vs 8.0 mm/h, p<0.001; 26.4 vs 18.0%, p=0.07, respectively), and those in CDAI non-remission and DAS28-ESR remission had worse patient-reported outcomes including patient global assessment and health assessment questionnaire-disability index (31.1 vs 9.5 mm, p<0.001; 0.82 vs 0.41, p<0.001, respectively). Patients in both CDAI and DAS28-ESR remission were apparently in better disease activity than those who met either criteria.Conclusion:Assessing patients with two composite measures simultaneously is important to evaluate patients’ condition from view points of RA itself and comorbidities and adjust treatment appropriately.References:[1] Smolen JS et al. T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631-7.Disclosure of Interests:Satoshi Takanashi: None declared, Yuko Kaneko Speakers bureau: Dr. Kaneko reports personal fees from AbbVie, personal fees from Astellas, personal fees from Ayumi, personal fees from Bristol-Myers Squibb, personal fees from Chugai, personal fees from Eisai, personal fees from Eli Lilly, personal fees from Hisamitsu, personal fees from Jansen, personal fees from Kissei, personal fees from Pfizer, personal fees from Sanofi, personal fees from Takeda, personal fees from Tanabe-Mitsubishi, personal fees from UCB, Tsutomu Takeuchi Grant/research support from: Eisai Co., Ltd, Astellas Pharma Inc., AbbVie GK, Asahi Kasei Pharma Corporation, Nippon Kayaku Co., Ltd, Takeda Pharmaceutical Company Ltd, UCB Pharma, Shionogi & Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co. Ltd., Consultant of: Chugai Pharmaceutical Co Ltd, Astellas Pharma Inc., Eli Lilly Japan KK, Speakers bureau: AbbVie GK, Eisai Co., Ltd, Mitsubishi-Tanabe Pharma Corporation, Chugai Pharmaceutical Co Ltd, Bristol-Myers Squibb Company, AYUMI Pharmaceutical Corp., Eisai Co., Ltd, Daiichi Sankyo Co., Ltd., Gilead Sciences, Inc., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., Dainippon Sumitomo Co., Ltd.

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P274 CONSTITUTION OF A MALNUTRITION TASK FORCE IN AN ITALIAN UNIVERSITY HOSPITAL: A 3-YEAR EXPERIENCE

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(08)70336-3 ◽

2008 ◽

Vol 3 ◽

pp. 146

Author(s):

R. Caccialanza ◽

M. Marinelli ◽

C. Bonardi ◽

B. Cameletti ◽

E. Carrai ◽

...

Keyword(s):

Task Force ◽

University Hospital

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Epidemiology of cardiomyopathies in children and adolescents: a retrospective study over the last 10 years

Cardiology in the Young ◽

10.1017/s1047951102000550 ◽

2002 ◽

Vol 12 (3) ◽

pp. 253-259 ◽

Cited By ~ 12

Author(s):

Ivan Malčić ◽

Marija Jelušić ◽

Hrvoje Kniewald ◽

Nina Barišić ◽

Dražen Jelašić ◽

...

Keyword(s):

Retrospective Study ◽

Hypertrophic Cardiomyopathy ◽

Dilated Cardiomyopathy ◽

Children And Adolescents ◽

Task Force ◽

Neuromuscular Disorders ◽

Restrictive Cardiomyopathy ◽

University Hospital ◽

World Health ◽

Paediatric Cardiology

We conducted a retrospective study at the Department of Paediatric Cardiology of the University Hospital Centre Rebro, Zagreb, over the period from 1988 to 1998, so as to assess the epidemiology of childhood cardiomyopathies. The patients were categorized according to the guidelines of the Task Force on Cardiomyopathies of the World Health Organization and the International Society and Federation of Cardiology. We identified 121 infants, children and adolescents as having cardiomyopathy, giving an average occurrence for all cardiomyopathies of 38.81 for each 10,000 patients examined in our outpatient clinics for paediatric cardiology. Of the patients, 50 were female (41.3%) and 71 were male (58.7%). The cardiomyopathy was of the dilated variant in 52 patients (42.9%), with 43 patients (35.5%) having hypertrophic cardiomyopathy, and 6 patients (4.8%) identified with restrictive cardiomyopathy. We encountered no patients with arrhythmogenic right ventricular cardiomyopathy. In nine patients (7.4%), it proved impossible to classify the cardiomyopathy. We placed 11 patients (9.0%) in the group of specific cardiomyopathies. Most of those with dilated cardiomyopathy had been diagnosed prior to the age of 3 years (RR 1.9, 95% CI 1.4–2.47). There were no statistically significant differences in the incidences of dilated as compared to hypertrophic cardiomyopathy (Z 0.923, p = 0.1779), but we encountered a significantly lower occurrence of restrictive cardiomyopathy (Z 6.044, p < 0.001). Of those with hypertrophic cardiomyopathy, 15 patients (34.8%) had the asymmetric variant, while 28 patients (65.2%) exhibited the concentric form. During the period of follow-up, 10 patients died, 4 with dilated cardiomyopathy, 4 with hypertrophic cardiomyopathy, 1 with restrictive cardiomyopathy, and 1 with a specific cardiomyopathy. We encountered 12 (9.9%) patients who, besides cardiomyopathies, also suffered from neuromuscular disorders. Most of these had dilated cardiomyopathy. Mitochondrial disorders, in contrast, were more frequently found in patients with hypertrophic cardiomyopathy.

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