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Antonio Greco-Daniele Sancarlo
Unità Operativa Complessa di Geriatria
IRCCS Casa Sollievo della Sofferenza, San Giovanni
R...
70% DI OVER 65 HA ALMENO 2 MALATTIE CRONICHE
Paradox
We are still practicing acute care medicine in
a world of chronic disease
19th
century models at the dawn of the 2...
5
Productive
Interactions
Informed,
Activated
Patient and
Caregiver
Prepared,
Proactive
Practice Team
Health System
Health...
L’anziano fragile: il problema della
definizione
Prevenzione
Gestione
VMD
Ahmed, AJM, 2007
Ferrucci, J Gerontol, 2006
Frie...
- Activities of Daily Living (ADL) 6 items
- Instrumental Activities of Daily Living (IADL) 8 items
- Short Portable Menta...
The Multidimensional Approach to the Older
Patient with Chronic Kidney Disease
Alberto Pilotto, Daniele Sancarlo, Marilisa...
Background
• The diabetes represents one of most serious
public health disease for the planet.
• The WHO estimated about 6...
Aim
The aim of the Metabolink project was to
develop a smart solution for elderly people
with diabetes and obesity, in ord...
Platform overview
Dispositivi integrati
14
Integrabilità nel SSN
Care giver
MMG/PLS
RMMG/Fascicolo Sanitario
Piano terapeutico
Rendicontazione
Paziente
Dir. Medico
M...
Methods
Each patient of the first cohort were
adequately informed and they was provided
by a kit comprising a glucose mete...
Pilot study
Two cohorts of 20 patients each were included:
1) Cohort treated with Metabolink support in addition to
the st...
Methods
Evaluated parameters
Forum participation
Glycemia
Weight
Blood pressure
Mobility
Compliance to
treatment
Complianc...
Patients at baseline
Parameters (mean) Metabolink Standard care
Age 70,5 69,2
ADL 5,2 5,5
IADL 7,1 7,4
MNA 27 28
CIRS 4,3 ...
Results
Parameters Δ percentage
from basal
Metabolink Standard Care
MPI 0,3% -
GSQ 3.9% -
Q-LES-Q 3.8% -
Results
After experimental period, from a subjective
point of view patients in cohort 1 have
appreciated the possibilities...
Conclusion
The system was accepted by all the patients and
they learned efficaciously in a few hours to use it.
Preliminar...
Grazie per l’attenzione
Metabolink  IRCCS Casa Sollievo della Sofferenza 14 settembre 2016
Metabolink  IRCCS Casa Sollievo della Sofferenza 14 settembre 2016
Metabolink  IRCCS Casa Sollievo della Sofferenza 14 settembre 2016
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Metabolink IRCCS Casa Sollievo della Sofferenza 14 settembre 2016

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Antonio Greco-Daniele Sancarlo Unità Operativa Complessa di Geriatria IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG)

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Metabolink IRCCS Casa Sollievo della Sofferenza 14 settembre 2016

  1. 1. Antonio Greco-Daniele Sancarlo Unità Operativa Complessa di Geriatria IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG) Implementation of a solution for the remote monitoring of subjects affected of metabolic diseases: the Metabolink project.
  2. 2. 70% DI OVER 65 HA ALMENO 2 MALATTIE CRONICHE
  3. 3. Paradox We are still practicing acute care medicine in a world of chronic disease 19th century models at the dawn of the 21st century
  4. 4. 5 Productive Interactions Informed, Activated Patient and Caregiver Prepared, Proactive Practice Team Health System Health Care Organization Self- Management Support Delivery System Design Decision Support Clinical Information Systems Community Resources and Policies Improved Outcomes Wagner, 1996
  5. 5. L’anziano fragile: il problema della definizione Prevenzione Gestione VMD Ahmed, AJM, 2007 Ferrucci, J Gerontol, 2006 Fried, Hazzard Book, 2005 Kulminski, Rej Res, 2007 Rockwood, CMAJ,2007 Senin, EdiSES, 2006 Specifico fenotipo almeno 3/5 caratteristiche Fisiopatologia specifica? Fried Progressivo accumulo di deficit biologici, funzionali, sociali: Indice di Fragilità Rockwood
  6. 6. - Activities of Daily Living (ADL) 6 items - Instrumental Activities of Daily Living (IADL) 8 items - Short Portable Mental Status Questionnaire (SPMSQ) 10 items - Mini-Nutritional Assessment (MNA) 18 items - Exton-Smith Scale 5 items - Cumulative Illness Rating Scale_comorbility (CIRS) 14 items - Number of drugs 1 - Social index 1 TOTAL 63 items Development and Validation of a CGA-based Multidimensional Prognostic Index (MPI) Mild Moderate Severe SCORE 0.180.09 0.480.09 0.770.08 RANGE 0.00-0.33 0.34-0.66 0.67-1.0 M. P. I. Pilotto & Ferrucci, Rejuvenation Res 2008; 11: 151-61
  7. 7. The Multidimensional Approach to the Older Patient with Chronic Kidney Disease Alberto Pilotto, Daniele Sancarlo, Marilisa Franceschi, Massimiliano Copetti, Piero D’Ambrosio, Carlo Scarcelli, Luigi Ferrucci Multidimensional Prognostic Index Based on a Comprehensive Geriatric Assessment Predicts Short-Term Mortality in Older Patients With Heart Failure Alberto Pilotto, Filomena Addante, Marilisa Franceschi, Gioacchino Leandro, Giuseppe Rengo, Piero D’Ambrosio, Maria Grazia Longo, Franco Rengo, Fabio Pellegrini, Bruno Dallapiccola and Luigi Ferrucci Circ Heart Fail 2010; 3: 14-20 A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short- and long-term all-cause mortality in older hospitalized patients with transient ischemic attack Daniele Sancarlo • Andrea Pilotto • Francesco Panza • Massimiliano Copetti • Maria Grazia Longo • Piero D’Ambrosio • Grazia D’Onofrio • Luigi Ferrucci • Alberto Pilotto J Neurol 2012; 259 (4): 670-678
  8. 8. Background • The diabetes represents one of most serious public health disease for the planet. • The WHO estimated about 60 million of subjects are affected in Europe. In Italy the rough prevalence is 5.8%. • The prevalence of disease in the next years will grow both as a result of the aging of the population and to the increase of the risk factors such as overweight and obesity, sedentary lifestyle and lack of proper nutrition education.
  9. 9. Aim The aim of the Metabolink project was to develop a smart solution for elderly people with diabetes and obesity, in order to promote a healthier style of life, improve diabetic control (glicaemic control, blood pressure, adherence to a specific diet and treatment) trying to reduce overall cost for the community.
  10. 10. Platform overview
  11. 11. Dispositivi integrati 14
  12. 12. Integrabilità nel SSN Care giver MMG/PLS RMMG/Fascicolo Sanitario Piano terapeutico Rendicontazione Paziente Dir. Medico Monitor e controllo Sistemi informativi dipartimentali/Regionali Sistemi informativi Ospedalieri Import/export METABOLINK 15
  13. 13. Methods Each patient of the first cohort were adequately informed and they was provided by a kit comprising a glucose meter, a scale, a blood pressure monitor, a count steps and a mobile-phone all with NFC interface. Every patient received at the beginning and at the end of the study a complete clinical assessment including a standardized comprehensive geriatric assessment (CGA)
  14. 14. Pilot study Two cohorts of 20 patients each were included: 1) Cohort treated with Metabolink support in addition to the standard care. 2) Cohort treated with standard care. The follow-up lasted 2 months. Inclusion criteria 1) age ≥ 60 years, 2) diagnosis of diabetes 3) ability to provide informed consent.
  15. 15. Methods Evaluated parameters Forum participation Glycemia Weight Blood pressure Mobility Compliance to treatment Compliance to diet Heart rate Test CGA QLES-Q GSQ Open questionnaire
  16. 16. Patients at baseline Parameters (mean) Metabolink Standard care Age 70,5 69,2 ADL 5,2 5,5 IADL 7,1 7,4 MNA 27 28 CIRS 4,3 4,1 MPI 0,3 0,2 Education Level 5 4,6
  17. 17. Results Parameters Δ percentage from basal Metabolink Standard Care MPI 0,3% - GSQ 3.9% - Q-LES-Q 3.8% -
  18. 18. Results After experimental period, from a subjective point of view patients in cohort 1 have appreciated the possibilities offered by the system and felt them more secure. Metabolink cohort showed an increase in resiliency, self perceived well-being status and quality of life.
  19. 19. Conclusion The system was accepted by all the patients and they learned efficaciously in a few hours to use it. Preliminary data suggest a positive impact of Metabolink in the diabetes disease management for the elderly people. More work however has to be done to produce a solution that could be more suitable to the elderly population and validated by a larger sample size.
  20. 20. Grazie per l’attenzione

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