A holistic approach to cancer management should be followed. Patient's treatment is the major medical concern, but health system and professionals should be involved in the mental and physical support of caregivers as well. Tailored interventions that focus on the support of the dyad patient-caregiver should be developed.

Introduction. Overutilization of Proton Pump Inhibitors (PPIs) both in ambulatory care and in the inpatient setting possesses economic implications and increases the risk for adverse drug reactions. This study was undertaken to identify factors associated with inappropriate PPI use among consecutively unplanned admissions of elderly patients at the time of admission. Materials and Methods. In 758 patients (54.2% women), mean age 80.3±8.0 (M±1SD), demographic characteristics, and medical and medication history were recorded. Parametric tests and multiple logistic regression analysis were applied to identify the predictors of inappropriate PPI use. Results. 232 patients (30.6%) were receiving PPIs. 37 (4.9%) were receiving PPIs appropriately and 195 (25.7%) were receiving PPIs without a proper indication. Consequently, PPIs prescribing was inappropriate in 195/232 (84%). Moreover, 512 patients (67.5%) were not receiving PPIs appropriately and 14 patients (1.8%) were not receiving PPIs but they had a proper indication. When we compared patients receiving PPIs without a proper indication with those who were not receiving PPIs, a statistical difference was found according to Charlson Comorbidity Index (p≤0.001, U=37922.00), number of diseases (p≤0.001, U=33269.00) and medications (p≤0.001, U=31218.50), Katz Index score (p=0.01, U=45328.00), and the use of blood thinners (p≤0.001, χ2=21.15). In multivariate analysis the only independent predictor of inappropriate PPI use was the number of medications (p=0.001, OR=1.16, 95%CI 1.06-1.27). Conclusions. The main predictor of inappropriate PPI use was the number of received medications. Εfforts needed to apply the predefined criteria for PPI prescription and to deprescribe PPIs received inappropriately.

Introduction. Cancer is a major disorder physically and psychologically affecting both patients and their caregivers. In this study, health-related quality of life (HRQoL) of patient-caregiver dyads during the period of chemotherapy was assessed. Material and Methods. Two hundred twenty-two cancer patient-caregiver dyads were enrolled in the study, which was conducted from October 2008 to March 2009. HRQoL was evaluated with EQ-5D. Results. The mean age of the sample was 57.4 and 48.9 for patients and caregivers, respectively. The EQ-5D descriptive system indicates that female patients more frequently experience anxiety and depression than male patients. Male and higher-education caregivers had higher VAS scores, while demographic factors did not seem to influence patients' HRQoL. Anxiety and depression of caregivers were correlated with patients' problems in self-care and usual activities. Conclusions. Quality of life is highly influenced during the period of chemotherapy for both patients and caregivers and is often under reported. Interventions that can improve HRQoL, especially in the domain of mental health for both cancer patients and their caregivers, need to be implemented.

Introduction Polypharmacy in several cases is deemed necessary and elderly patients are prone to this phenomenon. The objective of this study was to identify the prevalence and the predictors of polypharmacy among consecutively unplanned admissions of patients aged ≥65 years. Patients and Methods In 310 patients (51% women), mean age 80.24 years (95% CI 79.35–81.10), demographic characteristics, medical history, medications, and cause of admission were recorded. Parametric tests and multiple logistic regression analysis were applied to identify the factors that have significant association with polypharmacy. Results 53.5% of patients belonged to polypharmacy group. In multivariate analysis the independent predictors of polypharmacy were arterial hypertension (p = 0.003, OR = 2.708, and 95% CI 1.400–5.238), coronary artery disease (p = 0.001, OR = 8.274, and 95% CI 3.161–21.656), heart failure (p = 0.030, OR = 4.042, and 95% CI 1.145–14.270), atrial fibrillation (p = 0.031, OR = 2.477, and 95% CI 1.086–5.648), diabetes mellitus (p = 0.010, OR = 2.390, and 95% CI 1.232–4.636), dementia (p = 0.001, OR = 4.637, and 95% CI 1.876–11.464), and COPD (p = 0.022, OR = 3.626, and 95% CI 1.208–10.891). Conclusions Polypharmacy mainly was linked to cardiovascular diseases. If deprescribing is not feasible, physicians must oversee those patients in order to recognise early, possible drug reactions.

Infective endocarditis is defined as an infection of a native or prosthetic heart valve, the endocardial surface of the heart, or an indwelling cardiac device. Among the miscellaneous emerging opportunistic bacteria that can cause infective endocarditis is Gemella sanguinis that has been reported as a cause of infective endocarditis in nine cases in the past. All of the survivors received antimicrobial therapy and underwent prosthetic valve replacement surgery while, in general, a proportion of 40–50% of the patients with infective endocarditis underwent valve surgery. Our case illustrates that valve surgery, in combination with the administration of antibiotics, is not the only therapeutic option for infective endocarditis due to Gemella sanguinis and that a conservative management with prolonged administration of parenteral antibiotics under close supervision of the patient can be an option.