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Background To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. Methods Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013–2017 were analyzed. Results The sample comprised 2262 children and adolescents aged 5–17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66–375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. Conclusions To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.

Objective: We aimed to define the sociodemographic, clinical, and prescription profiles of the participants enrolled in the Italian Lombardy ADHD Register. Method: Data on patients evaluated by the 18 regional ADHD reference centers in the 2012 to 2013 period were analyzed. Results: Seven hundred fifty-three of 1,150 (65%) suspected patients received a diagnosis of ADHD. In 24% of cases, there was a family history of ADHD. Four hundred eighty-three (64%) patients had at least one psychopathological disorder, the more common of which were learning disorders (35%). Eighty-four percent of patients received a prescription for psychoeducational interventions, 2% received only pharmacological treatment, and 14% a combination of both. Compared with patients treated with psychoeducational intervention alone, patients with drug prescriptions more commonly presented values of Clinical Global Impressions - Severity scale (CGI-S) of 5 or higher ( p < .0001). Conclusion: A continuous and systematic monitoring of patterns of care is essential in promoting significant improvements in clinical practice and ensuring an efficient and homogeneous quality of care.

Obiettivo. Definire la prevalenza e descrivere i percorsi diagnostico-terapeutici dei pazienti ADHD in Regione Lombardia. Metodi. I dati relativi ai nuovi pazienti valutati dai 18 Centri di Riferimento Lombardi nel periodo 2012-2013 sono stati estrapolati dal database del Registro regionale ADHD e analizzati, per descrivere le caratteristiche clinico-diagnostiche e prescrittive del campione. Risultati. 753 dei 1150 casi sospetti (65%) hanno ricevuto una diagnosi di ADHD (M:F=6:1; età mediana: 9aa; range: 5-17aa), nel 24% dei casi era presente familiarità per ADHD. 483 (65%) pazienti presentavano almeno un altro disturbo psicopatologico, più frequentemente disturbi dell’apprendimento (35%), disturbi del sonno (14%) e disturbo oppositivo-provocatorio (13%); mentre 69 (9%) avevano in associazione altra condizione medica cronica, per lo più di tipo neurologico (n=28). L’85% dei pazienti ha ricevuto una prescrizione di tipo psicologico, più comunemente parent training (n=428, 82%), seguito da child training (n=308, 59%) e teacher training (n=173, 33%); il 2% solo farmacologica, il 13% entrambe. Dei 115 pazienti con terapia farmacologica, 95 (83%) sono stati trattati con metilfenidato (5-40 mg/die), 5 dei quali in associazione con un altro psicofarmaco, il 7% (n=8) con atomoxetina (10-75 mg/die) e il restante 10% (n=12) con un altro farmaco, in particolare risperidone. Rispetto ai soggetti cui è stato prescritto solo l’intervento psicologico, i pazienti con prescrizione farmacologica presentavano più frequentemente valori di CGI-S di 5 o superiore (P

Obiettivo. Lo scopo di questo studio era valutare il profilo delle comorbidità psichiatriche in bambini e adolescenti afferenti ai 18 centri di riferimento della Regione Lombardia per sospetto Disturbo da deficit dell'attenzione con iperattività/impulsività (ADHD). Metodi. Sono stati analizzati i dati clinico-anamnestici presenti nel database del Registro Lombardo dell’ADHD di tutti i nuovi pazienti valutati nel periodo Giugno 2011-Novembre 2014. Risultati. 1108 di 1703 pazienti con sospetta ADHD (65%) hanno ricevuto una diagnosi di ADHD: 952 (86%) maschi e 156 (14%) femmine (età mediana: 9aa; range: 5-17aa), di questi 402 (36%) hanno ricevuto esclusivamente una diagnosi di ADHD, mentre 706 (64%) presentavano almeno un altro disturbo psichiatrico (disturbi dell’apprendimento: 35%, disturbo oppositivo/provocatorio: 13%, disturbi del sonno: 13%, disturbi d’ansia: 8%). 254 di 1703 casi sospetti (15%) non hanno ricevuto alcuna diagnosi. La diagnosi di ADHD di tipo combinato (OR: 1,37, 95% IC: 1,07-1,76), un punteggio CGI-S ≥ 5 (OR:1,93, 95% IC: 1,44-2,60) e la prescrizione di trattamento farmacologico (OR: 3,07, 95% IC: 2,05-4,60) erano associate ad una maggiore probabilità di presentare disturbi psichiatrici in comorbidità. Conclusioni. Nei pazienti con ADHD è importante valutare e monitorare sistematicamente l’intero spettro delle possibili comorbilità psicopatologiche associate, anche tenendo conto della loro evoluzione, comparsa e associazione con particolari tappe cronologiche e psicologiche dello sviluppo Objective. The main aim of this study was to evaluate psychiatric comorbidity of children and adolescent accessing the 18 Reference Centers of the Lombardy Region for a suspected Attention Deficit Hyperactivity Disorder (ADHD). Methods. Data in the ADHD Lombardy Registry database of all new patients evaluated on June 2011-November 2014 period were analyzed. Results. 1108 of 1703 patients with a suspected ADHD (65%) met the DSMIV-TR criteria for ADHD: 952 (86%) males and 156 (14%) females (median age: 9yrs; range: 5-17yrs), of those 402 (36%) received only a diagnosis of ADHD, while 706 (64%) had at least a psychiatric disorder associated (learning disorders: 35%, oppositional defiant disorder: 13%, sleep disorders: 13%, anxiety disorders: 8%). 254 of 1703 (15%) did not receive any diagnosis. A diagnosis of ADHD-C (OR 1:37 CI 1,07 to 1,76), a CGI-S score ≥ 5 (OR 1,93 CI 1,44 to 2,60) and a prescription of drug treatment (OR 3:07 CI 2,05 to 4,60) were associated with an higher risk to present comorbid psychiatric disorders. Conclusions. It is important to fully assess and systematically monitor the entire spectrum of psychopathological disorders in patients with ADHD, also taking into account their evolution, lifespan presentation and association with psychological development.

Results: In all, 753 of 1150 (65%) suspected patients received a diagnosis of ADHD (M:F=6:1; median age 9yr; range: 5-17yr). In 24% of cases there was a family history of ADHD. A total of 483 (65%) patients had at least one psychopathological disorder, the most frequent of which were learning disorders (35%), sleep disturbances (14%), and oppositional defiant disorder (13%), while 69 (9%) had other chronic medical conditions, most of which were neurological diseases (n=28). In all, 85% of patients received a prescription for a psychological type of intervention, involving mostly parent training (428 patients, 82%), child training (308, 59%), and teacher training (173, 33%), while 2% received prescriptions for drugs alone, and 13% a combination of both. Of the 115 patients receiving drug therapy, 95 (83%) were treated with meihylphenidate (5-40 mg/day), 5 of whom in combination with other psychotropic drugs, 7% (n=8) with atomoxetine (10-75 mg/day), and the remaining 10% (n=12) with another drug especially risperidone. Compared to subjects treated with psychological interventions alone, patients with drug prescriptions more commonly presented values of CGI-S of 5 or higher (p

OBJECTIVE: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. METHODS: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. RESULTS: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. DISCUSSION: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.