Minerva medica
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Atrial fibrillation (AF) is the most common cardiac sustained arrhythmia, whose incidence and prevalence increase with age, representing a significant burden for health services in western countries. Older people contribute to most patients affected from AF. Although oral anticoagulant therapy represents the cornerstone for the prevention of ischemic stroke and its disabling consequences, several other interventions - including left atrial appendage occlusion (LAAO), catheter ablation (CA) of AF, and rhythm control strategy (RCS) - have proved to be potentially effective in reducing the incidence of AF-associated clinical complications. ⋯ Practical treatment of older AF patients is presented, including approach and management of patients with geriatric syndromes, selection of the most appropriate individualized drug treatment, clinical indications, and potential clinical benefit of LAAO and CA in selected older AF patients. Older people carry the greatest burden of AF in real world practice. Within a shared decision-making process, the patient centered approach needs to be put in the context of a comprehensive assessment, in order to gain maximal net clinical benefit and avoid futility or harm.
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Arthrosis is now intended as a multifactorial pathology that involves various joints and is caused by different biological functional alterations at the basis of the joints damage. Considering this new evidence, the prevention and the conservative treatment of arthrosis acquire an important role with respect to a surgical approach. The "Osteo-Experience" project was designed to collect, describe and compare the personal experiences of osteoarticular specialists in the field of the conservative treatment of the various forms of arthrosis. In addition, some useful insights for a correct management of conservative therapy in respect to the various forms of arthrosis were provided. ⋯ Observations collected within the "Osteo-Experience" project show that a more conscious use of the conservative therapy should be pursued for arthrosis. The present study denotes how it is necessary to better define some therapeutic schemes based on the different clinical characteristics of the patient, to improve the clinical outcome.