Publications by authors named "Giuseppe D Testa"

Article Synopsis
  • Frailty is a significant geriatric syndrome affecting older adults, particularly influencing their surgical and oncological care, especially in cases of renal masses or renal cell carcinoma (RCC).
  • A review of literature highlighted that frailty is a negative prognostic factor that can impact treatment outcomes; screening tools like the G8 and Mini-COG are essential for assessing older patients and guiding comprehensive evaluations by geriatricians.
  • Integrating geriatricians into multidisciplinary tumor boards and creating specific care pathways for frailty assessment can enhance individualized treatment strategies and improve clinical outcomes for older patients with RCC.
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Introduction: Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022.

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Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients.

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Background And Aims: Few studies have evaluated frailty in older hypertensive individuals and the most appropriate tools to identify frailty in this population have yet to be identified. This study compared the performance of six frailty instruments in the prediction of 1-year functional decline in older hypertensive outpatients.

Methods: The HYPERtension and FRAILty in Older Adults (HYPER-FRAIL) longitudinal pilot study involved hypertensive participants ≥75 years from two geriatric outpatient clinics at Careggi Hospital, Florence, Italy, undergoing identification of frailty with four frailty scales (Fried Frailty Phenotype, Frailty Index [FI], Clinical Frailty Scale [CFS], Frailty Postal Score) and two physical performance tests (Short Physical Performance Battery [SPPB] and gait speed).

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The integration of digital health technologies in geriatric oncology has the potential to enhance patient care and self-management. This review article discusses the applications of these technologies, including teleassessment, telemonitoring, and teleintervention, within geriatric oncology, and evaluates their potential to improve cancer care and patient outcomes. We also review challenges to the implementation of digital health technologies among populations of older patients with cancer.

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Background: There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition.

Methods: The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane.

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Introduction: Despite high prevalence of hypertension, few studies have analysed the adverse effects (AEs) of antihypertensive medications, especially in older patients.

Aim: To investigate the prevalence and associated factors of antihypertensive-related AEs, focusing on the influence of age on treatment tolerability.

Methods: We retrospectively investigated antihypertensive-related AEs in patients evaluated at the Hypertension Clinic of Careggi Hospital, Florence, Italy, between January 2017 and July 2020.

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Article Synopsis
  • The scoping review aimed to systematically map the various outcomes and assessment tools used in surgical prehabilitation trials, highlighting the heterogeneity of reported results.
  • A total of 76 trials, mostly involving abdominal or orthopedic surgeries, identified 50 different outcomes assessed through 184 tools, with a strong reliance on observer, clinician, and patient-reported metrics.
  • The study concludes that standardizing outcome reporting and assessment tools is essential for improving the clarity and reliability of evidence in prehabilitation research.
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Immune checkpoint inhibitors (ICIs) became a treatment option in most tumor types and improved survival in patients with cancer in the last decade. Older patients with cancer are underrepresented in the pivotal clinical trials with ICIs. Older patients with cancer often have significant comorbidities and geriatric syndromes like frailty, which can complicate cancer care and treatment decisions.

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Article Synopsis
  • * Patients with frailty and HF had a significantly higher risk of polypharmacy (odds ratio: 1.87) and were prescribed more medications than those without frailty, but the results for the number of medications became non-significant when considering other health conditions.
  • * The findings suggest that HF patients with frailty may face a higher need for polypharmacy, which could lead to the use of potentially inappropriate medications; further research on this issue could aid in better clinical management.
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Objectives: To date, few studies have investigated frailty in hypertensive individuals. This study aimed at identifying the prevalence of frailty in a sample of hypertensive older outpatients using six different identification tools. Clinical correlates of frailty and agreement between different frailty definitions were also investigated.

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Background: Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists.

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Introduction: Liver transplantation is an efficacious treatment option for those with liver cirrhosis. However, the prognostic role of sarcopenia in these patients is unknown. Given this background, we conducted a systematic review and meta-analysis of the impact of sarcopenia on mortality in patients listed, evaluated and undergoing liver transplantation.

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Article Synopsis
  • A study evaluated the RootiRx® multisensory patch monitor's ability to detect sweat-induced reflex syncope compared to traditional blood pressure methods during tilt table tests (TTT) on 32 patients.
  • While there was no significant decrease in systolic blood pressure with RootiRx® during TTT, its readings of heart rate variability (RRI) and LF/HF power ratio were consistent with conventional methods.
  • The study concluded that RootiRx® cannot effectively identify rapid blood pressure drops associated with reflex syncope but can reliably measure heart rate parameters.
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Hypertension management forms a cornerstone of cardiovascular prevention. Strong evidence is available supporting the benefits of blood pressure (BP) lowering in older adults, and recent studies indicate that intensive BP control may provide additional advantages concerning cardiovascular and mortality risk, also at older ages. Yet, in older adults, the cardiovascular benefit of intensive treatment may come at the expense of an increase in adverse events.

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Background We assessed the reliability and feasibility of blood pressure (BP) measurements by means of a new wearable watch-type BP monitor (HeartGuide) in detecting episodes of hypotensive (pre)syncope induced by tilt table test. Methods and Results An intrapatient comparison between systolic BP (SBP) measured by means of the HeartGuide device and noninvasive finger beat-to-beat BP monitoring was undertaken both at baseline in supine position and repeatedly during tilt table test in patients evaluated for reflex syncope. Intrapatient fall of systolic BP from baseline was measured.

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Aims: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM.

Methods And Results: ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared.

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Falls are a geriatric syndrome affecting mortality, morbidity, and institutionalization. Falls are also the leading cause of unintentional injury and a common emergency department presentation. Physical and psychological issues may develop after falling, leading to increase in dependency and disability and their relative costs.

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Background And Purpose: In patients with acute ischemic stroke treated with reperfusion therapy we aimed to evaluate whether pretreatment blood-brain barrier (BBB) leakage is associated with subsequent hemorrhagic transformation (HT).

Methods: We prospectively screened patients with acute ischemic stroke treated with intravenous thrombolysis and/or endovascular treatment. Before treatment, each patient received computed tomography (CT), CT angiography, and CT perfusion.

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Background: Pre-existing small vessel disease (SVD) has been associated with poor functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis; however, there are scarce data in patients treated with endovascular therapy. We aimed to investigate the associations between SVD and clinical outcomes in patients treated with endovascular therapy.

Methods: We retrospectivel y evaluated patients with acute ischemic stroke in the anterior circulation receiving endovascular treatment.

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