Guido Bertolini

Guido Bertolini
Mario Negri Institute for Pharmacological Research | Mario Negri · Department of Public Health

MD

About

126
Publications
28,397
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6,870
Citations
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January 1990 - October 2016
Mario Negri Institute for Pharmacological Research
Position
  • Principal Investigator

Publications

Publications (126)
Article
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Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. Results: LST limitation was iden...
Article
The calibration belt is a graphical approach designed to evaluate the goodness of fit of binary outcome models such as logistic regression models. The calibration belt examines the relationship between estimated probabilities and observed outcome rates. Significant deviations from the perfect calibration can be spotted on the graph. The graphical a...
Article
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Riassunto. La professione medica opera contemporanea-mente in tre diversi ambiti: scientifico, etico ed economico. Ciascuno di essi è in continua evoluzione così come, di con-seguenza, lo sono le loro reciproche interrelazioni. Pertanto, se la professione medica vorrà mantenere il suo ruolo cen-trale nella società dovrà porre costante attenzione a...
Article
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Septic shock definitions are being revisited. We assess the feasibility, reliability, and validity characteristics of the current definitions and criteria of septic shock. Septic shock is conceptualised as cardiovascular dysfunction, tissue perfusion and cellular abnormalities caused by infection. Currently, for feasibility, septic shock is identif...
Article
A prognostic model is well calibrated when it accurately predicts event rates. This is first determined by testing for goodness of fit with the development dataset. All existing tests and graphic tools designed for the purpose suffer several drawbacks, related mainly to the subgrouping of observations or to heavy dependence on arbitrary parameters....
Article
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The prompt availability of reliable epidemiological information on emerging pandemics is crucial for public health policy-makers. Early in 2013, a possible new H1N1 epidemic notified by an intensive care unit (ICU) to GiViTI, the Italian ICU network, prompted the re-activation of the real-time monitoring system developed during the 2009-2010 pandem...
Article
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Objectives: To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study...
Article
Full-text available
Objectives: To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study...
Article
Calibration is one of the main properties that must be accomplished by any predictive model. Overcoming the limitations of many approaches developed so far, a study has recently proposed the calibration belt as a graphical tool to identify ranges of probability where a model based on dichotomous outcomes miscalibrates. In this new approach, the rel...
Article
Full-text available
Objectives: To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study...
Article
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The management of patients with end-stage chronic organ failure is an increasingly important topic, since the extraordinary medical and technological advances have significantly reduced mortality and improved quality of life with prolonged survival of end-stage diseases. What should be the plan of care for these patients? Who should bear the respon...
Article
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Coupled plasma filtration adsorption (CPFA, Bellco, Italy), to remove inflammatory mediators from blood, has been proposed as a novel treatment for septic shock. This multicenter, randomised, non-blinded trial compared CPFA with standard care in the treatment of critically ill patients with septic shock. Prospective, multicenter, randomised, open-l...
Article
PROWESS was a multicentre, double-blind, randomised placebo- controlled study that enrolled 1658 patients with severe sepsis and septic shock and showed a 6% absolute reduction in 28 day mortality with drotrecogin alfa (activated) treatment. However, two additional randomised controlled trials, ADDRESS and PROWESS-SHOCK, failed to show a benefit of...
Article
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More recent severity scores should be more reliable than older ones because they account for the improvement in medical care over time. To provide more insight into this issue, we compared the predictive ability of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 (originally developed from data collected in 1991-1992 and 2002, respectivel...
Article
Clin Microbiol InfectAbstractThe aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study i...
Article
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Interspinous spacers are implanted to treat symptomatic lumbar stenosis. Posterior vertebral element fractures can occur during or after interspinous spacer implants, especially in patients with osteopenia. The purpose of our study was to assess the biomechanical rationale, safety, feasibility, and effectiveness of posterior vertebral arch cement a...
Article
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Most cardiopulmonary diseases share at least one symptom with pulmonary embolism (PE). The aim of this study was to identify the most common acute causes of dyspnea, chest pain, fainting or palpitations, which diagnostic procedures were performed and whether clinicians investigate them appropriately. An Italian multicenter collaboration gathered 17...
Article
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Uncertainty about the severity of the A(H1N1) pandemia persists. Information about disease severity can be obtained by investigating intensive care unit (ICU) admissions, especially when historical comparisons can be made with cases of community-acquired pneumonia (CAP). This prospective observational study was conducted in 155 ICUs contributing to...
Article
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Mortality is high among patients with hematologic malignancies admitted to intensive care units for acute respiratory failure. Early noninvasive mechanical ventilation seems to improve outcomes. To characterize noninvasive mechanical ventilation use in Italian intensive care units for acute respiratory failure patients with hematologic malignancies...
Article
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Chorea and other movement disorders are rarely described as paraneoplastic. The aim of this study was to describe 13 patients with paraneoplastic chorea and dystonia collected by the members of the paraneoplastic neurological syndrome (PNS) EuroNetwork and to review 29 cases from the literature. We analyzed neurological symptoms, severity of the ne...
Data
Computation of the confidence band. In this Appendix, we compute the confidence band for the calibration curve. By generalizing the procedure given in [10] to the case in which , we demonstrate the results reported in Eqs. (9) and (10). (PDF)
Article
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Prognostic models applied in medicine must be validated on independent samples, before their use can be recommended. The assessment of calibration, i.e., the model's ability to provide reliable predictions, is crucial in external validation studies. Besides having several shortcomings, statistical techniques such as the computation of the standardi...
Article
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Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Two hundred twenty patients admit...
Article
To define the frequency and clinical and immunologic characteristics of patients affected by paraneoplastic neurologic syndromes (PNS) and lymphoma. Patients fulfilling the criteria for PNS associated with lymphoma collected from the European Commission-funded PNS Euronetwork group database were analyzed. Fifty-three patients with Hodgkin lymphoma...
Article
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To assess patterns of intensive care reimbursement practices. A detailed questionnaire about basic intensive care unit (ICU) characteristics and ICU reimbursement practices was created, and then members of the European Society of Intensive Care (ESICM) were asked by e-mail to participate in the survey and complete the web-based questionnaire. There...
Article
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Centralisation of critically ill children to paediatric intensive care units is supported by a strong rationale, but evidence is not overwhelming. To compare the outcome of children admitted to adult intensive care units (ICUs) in Italy between 2003 and 2007 with that of children admitted to paediatric intensive care units (PICUs) in Italy between...
Article
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The author considers the ten years experience of the Italian Program for Continuing Medical Education.The favorable shift in medical education is due to higher interest in this area and to the rising numbers of people involved in the debate.Today, the challenge is getting the emphasis on the"educational"approach rather than on didactics.The approac...
Article
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To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level. Prospective, multicenter, observational study, lasting 12 months. Eighty-four Italian, adult ICUs. Consecutive patients (3,793) who died in ICU or we...
Article
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Background: Paraneoplastic neurologic syndrome (PNS) represents the remote effects of cancer on the nervous system. Diagnostic criteria for the syndrome were pub- lished by the PNS Euronetwork and form the basis of a database to collect standardized clinical data from pa- tients with PNS. Objectives: To analyze various types of PNS, frequent tumor...
Article
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The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in bacteraemic critically ill patients has led to a wide variety of strategies and major issues with drug resistance. We therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in intensive care units (ICUs); and the impact of timin...
Article
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Physicians are trained within a cultural framework in which the main emphasis is toward the correctness and precision of what is known. The areas of uncertainty are seldom made clear and medical error is more or less implicitly considered unacceptable. Nevertheless, errors are always possible and even unavoidable. Hence, the ability to learn from e...
Article
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A continuous infection surveillance program was conducted by GiViTI throughout 2006 in Intensive Care Units (ICUs). This was a prospective epidemiological study carried out in 125 Italian intensive care units. All patients have been included in the study. Aside from the detailed clinical information collected for all patients, in cases of infection...
Article
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To evaluate the SAPS 3 score predictive ability of hospital mortality in a large external validation cohort. Prospective observational study. A total of 28,357 patients from 147 Italian ICUs joining the Project Margherita national database of the Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva (GiViTI). None. Evaluation of...
Article
Graphical monitoring tools are needed for real-time quality evaluation in intensive care unit. The variable life-adjusted display (VLAD) provides a directly interpretable assessment indicating whether the overall performance is better or worse than expected on the basis of the predicted risk of failure. The aim of this study is to quantify the abil...
Article
Paraneoplastic neurological syndromes (PNS) probably result from an immune reaction against antigens shared by the nervous system and tumour cells. To characterise CSF alterations in these syndromes, we studied a large series of paraneoplastic patients. Using the PNS European database which includes patients diagnosed with PNS in Europe, we reviewe...
Article
Regulatory agencies take responsibility for the safety and efficacy of the drugs they license. Over the past few years, however, several serious failings in the approval procedure have raised widespread concern that the present process of drug regulation is inadequate to guarantee the defence of public health. We discuss the approval process of dro...
Article
Originally, aetiology of liver disease has been incorporated into the computation of the Model of End-stage Liver Disease (MELD) score. Clinical observations prompted us to hypothesize that patients with viral and alcoholic cirrhosis may differ in predicted survival rates. Until now, no large representative studies evaluated the impact of aetiology...
Article
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Critical illness myopathy (CIM) and polyneuropathy (CIP), alone or in combination (CIP/CIM), are frequent complications in patients in the intensive care unit (ICU). There is no evidence that differentiating between CIP and CIM has any impact on patient prognosis. 1-year prospective cohort study of patients developing CIP, CIM or combined CIP and C...
Article
To describe the epidemiology of infections in intensive care units (ICUs), whether present at admission or acquired during the stay. Prospective data collection lasting 6 months in 71 Italian adult ICUs. Patients were screened for infections and risk factors at ICU admission and daily during their stay. Out of 9,493 consecutive patients admitted to...
Article
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The aim of this study was to verify the capability of the Italian Group for the Evaluation of Intervention in Intensive Care Medicine (Gruppo Italiano Valutazione Interventi in Terapia Intensiva, GiViTI) Intensive Care Units (ICUs) in providing high level care (HLC) and to develop a flexible organiziational model, allowing for different levels of c...
Article
The Model for End-Stage Liver Disease (MELD) is widely used to predict the short-term mortality in patients with cirrhosis, but potential limitations of this score have been reported. The aim of this study was to improve the score's prognostic accuracy by assessing new objective variables. Data of 310 consecutive patients with cirrhosis who underwe...
Article
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The diagnosis of pulmonary embolism demands flexible decision models, both for the presence of clinical confounders and for the variability of local diagnostic resources. As Bayesian networks fully meet this requirement, Bayes Pulmonary embolism Assisted Diagnosis (BayPAD), a probabilistic expert systems focused on pulmonary embolism, was developed...
Article
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To monitor the use of drotrecogin alfa activated (DrotAA) in Italy and its effects on patients' health. Prospective pharmaco-surveillance program with a parallel non-randomized control group. The Ministry of Health required all intensive care units (ICUs) using DrotAA to participate in the pharmaco-surveillance program. Our control group was formed...
Article
Two different ways of thinking pervaded the history of science: rationalism and empiricism. In theory, these two paradigms are not necessarily in conflict. In practice, there has always been tension between them. The coming of evidence-based medicine put empiricism in a privileged position, but empiricism without a rationalistic guide could even be...
Article
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Critical illness myopathy and/or neuropathy (CRIMYNE) is frequent in intensive care unit (ICU) patients. Although complete electrophysiological tests of peripheral nerves and muscles are essential to diagnose it, they are time-consuming, precluding extensive use in daily ICU practice. We evaluated whether a simplified electrophysiological investiga...
Data
A table showing the normal mean value and lower limit of normality of motor and sensory nerve conduction studies in the nine participating centres.
Chapter
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Sepsis is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide [1]. The mortality rate in sepsis ranges from 20% to 70%, depending on the severity of the disease, the time treatment is started, the number of affected organs and the study design [2]. It has recently been described as the tenth most frequent cause of deat...
Article
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We compared early parenteral nutrition (PN) and early enteral immunonutrition (iEN) in critically ill patients, distinguishing those with and without severe sepsis or septic shock (SS) on admission to intensive care units (ICUs). Multicenter, randomized, unblinded clinical trial in 33 Italian general ICUs. The study included 326 patients, 287 of wh...
Article
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The assessment of the quality of intensive care medicine is mandatory in the modern healthcare system. In Italy, the GiViTI (Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva) network is working in this field since 1991 and it now involves 295 out of the about 450 Italian intensive care units (ICU). In 2002 GiViTI launched a...
Conference Paper
Full-text available
Aim The assessment of the quality of intensive care medicine is mandatory in the modern healthcare system. In Italy, the GiViTI (Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva) network is working in this field since 1991 and it now involves 295 out of the about 450 Italian intensive care units (ICU). In 2002 GiViTI launche...
Article
To analyze the costs of treating critically ill patients. Multicenter, observational, prospective, cohort, bottom-up study on variable costs in 51 ICUs. A total of 1,034 patients aged over 14 years who either spent less than 48 h in the ICU or had multiple trauma, major abdominal surgery, ischemic stroke, chronic obstructive pulmonary disease, card...
Article
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Extracorporeal lung assist, an extreme resource in patients with acute respiratory failure (ARF), is expanding its indications since knowledge about ventilator-induced lung injury has increased and protective ventilation has become the standard in ARF. A prospective study on seven adult sheep was conducted to quantify carbon dioxide (CO2) removal a...