Silvia arroyo perez

Many institutions and individuals are contributing to the Digital Indipetae Database. 

Archives

Each letter identifies its archival source. As letters from more archives are entered into the Digital Indipetae Database, the abbreviation for each will appear here. Archivists should contact the database’s board to learn how to collaborate on this project. The Digital Indipetae Database publishes scans of a letter with permission from the respective archive. Any requests regarding those images, including all requests for permission to republish, should be directed to those holding institutions.

• ARSI (Archivum Romanum Societatis Iesu)

ARSI is located on the grounds of the Jesuit General Curia in Rome. It oversees the archives of the central government for the Society of Jesus. ARSI also has a publishing division, Institutum Historicum Societatis Iesu (IHSI). Founded in , the IHSI has several book series and a biennial, peer-reviewed journal, the Archivum Historicum Societatis Iesu. ARSI, along with the Institute for Advanced Jesuit Studies, is a co-founding institution of the Digital Indipetae Database.

Visit ARSI at

• ASPEM (Archivio Storico della Provincia Euro-Mediterranea dei Gesuiti)

Located near the Residenza del Gesù in Rome, the archive for the Euro-Mediterranea Province of the Society of Jesus preserves the historical documentation of Jesuits and their works throughout Italy and its former provinces, as well as those in modern-day Albania, Malta, and Romania. In close proximity to the archive is the library of the former Roman province, with an extensive collection of texts written by or about the Society of Jesus and their works.

Please learn more about ASPEM at:

Scholars

A team of international scholars contributes to the Digital Indipetae Database. 

Transcribers

The following are all the transcribers (and how they are identified on the letters) contributing to the project:

• Alessio Cavazzini (AC)
• Adnen El Ghali (AEG)
• Ana Burrò (AB)
• Andreas Motsch (AM)
• Amélie Vantard (AV)
• Bruno Pomara (BP)
• Emanuele Colombo (EC)
• Elisa Frei (EF)
• Emilia Marrozzini (EM_fer)
• Eleonora Rai (ER)
• Filippo Bertolasi (FB_pv)
• George Yeryomin (GY)
• Isaure Vorstman (IV)
• Letizia Evangelisti (LE)
• Michele Bulgini (MB)
• Martina D'Amato (MD)
• Marina Massimi (MM)
• Monica Miazek-Męczyńska (MMM)
• Marco Rochini (MR)
• Miriam Turrini (MT)
• Rafael Benítez Sánchez-Blanco (RBSB)
• Sonia Isidori (SI)

In addition to the contributions of scholars, several projects with Italian high schoolshave involved almost five hundred high school students, who are working with their teachers to read, transcribe, and study the litterae indipetae in partnership with the Digital Indipetae Database. 

Students from Liceo Daniele Crespi, Busto Arsizio (VA):

• Alessia Ceriani (ACE_cr)
• Alessia Crespi (ALC_cr)
• Anita Di Luca (AD_cr)
• Alessia Crespi (ALC_cr)
• Alessia Mettifogo (AM_cr)
• Chiara Aiani (CA_cr)
• Chiara Corrieri (CC_cr)
• Chiara Pigni (CP_cr)
• Deborah Igbinedion (DI_cr)
• Estella Barbieri (EB_cr)
• Eleonora Bano (EBA_cr)
• Eleonora Bellea (EBE_cr)
• Ena Milos (EM_cr)
• Francesca Gallazzi (FG_cr)
• Federica Tibaldo (FT_cr)
• Giuditta Ferrazzi (GF_cr)
• Gloria Menoncini (GM_cr)
• Giulia Moroni (GIM_cr)
• Gaia Papaleo (GP_cr)
• Giulia Voltolini (GV_cr)
• Imane Boussouf (IB_cr)
• Jacopo Montorio (JM_cr)
• Luana Manuli (LM_cr)
• Letizia Panni (LP_cr)
• Lucrezia Putignano (LUP_cr)
• Maddalena Fagnani (MF_cr)
• Marta Gallazzi (MG_cr)
• Milena Loira (ML_cr)
• Matilde Manenti (MM_cr)
• Marta Pisani (MP_cr)
• Milena Susannetto (MS_cr)
• Mia Vaccaro (MV_cr)
• Nicholas Burchielli (NB_cr)
• Pietro Sanna (PS_cr)
• Rebecca Borriero (RB_cr)
• Ronny Zea (RZ_cr)
• Stefania Castelli (SC_cr)
• Sofia Musazzi (SM_cr)
• Sveva De Tomasi (ST_cr)
• Valeria Bertino (VB_cr)
• Valentina Rolfi (VR_cr)

Students from Liceo Don Gnocchi, Carate Brianza:

• Anna Ceppi (ACE_dg)
• Andrea Coletta (ACO_dg)
• Alessandro Marasco (AMR_dg)
• Anna Magnelli (AMG_dg)
• Anna Sarubbi (AS_dg)
• Alessio Vegna (AVE_dg)
• Andrea Vitani (AVI_dg)
• Caterina Amori (CA_dg)
• Chiara Fusar Poli (CFP_dg)
• Cristina Griner (CG_dg)
• Camilla Sportoletti (CS_dg)
• Diletta Redaelli (DR_dg)
• Eleonora Birondi (EB_dg)
• Eleonora Colombo (EC_dg)
• Elena Frigeni (EF_dg)
• Emma Miticocchio (EM_dg)
• Francesca Buzzi (FB_dg)
• Francesca Piolanti (FP_dg)
• Francesca Tantardini (FT_dg)
• Fabiola Viola (FV_dg)
• Federica Zaccone (FZ_dg)
• Giulia Cattaneo (GCA_dg)
• Giorgia Carzaniga (GCR_dg)
• Giacomo Del Grossi (GDG_dg)
• Giovanni Nassi (GN_dg)
• Gabriele Ottolini (GO_dg)
• Giorgia Ruina (GRU_dg)
• Giulia Ruzzene (GRZ_dg)
• Giacomo Vitali (GV_dg)
• Jacopo Roaro (JR_dg)
• Lucrezia Bussola (LBU_dg)
• Lorenzo Di Giovanni (LDG_dg)
• Luigi de Lorenzo (LDL_dg)
• Luca Ferrantino (LF_dg)
• Lorenzo Perrella (LP_dg)
• Marta Boffi (MB_dg)
• Martina Cesana (MCE_dg)
• Michele Costanzi (MCO_dg)
• Martina Dalla Rovere (MDR_dg)
• Marta Magni (MM_dg)
• Matteo Mauri (MMA_dg)
• Marianna Panzeri (MP_dg)
• Melissa Varenna (MV_dg)
• Pietro Lecchi (PL_dg)
• Prisca Manzoni (PM_dg)
• Rachele Boscolo (RB_dg)
• Riccardo Motta (RM_dg)
• Raffaele Redaelli (RR_dg)
• Rebecca Rusticelli (RRU_dg)
• Sofia Bertacco (SB_dg)
• Simone Jannacci (SJ_dg)
• Silvia Molteni (SM_dg)
• Tommaso Bon (TB_dg)
• Teresa Meroni (TM_dg)
• Vittoria Colombo (VC_dg)
• William Ardoni (WA_dg)

Students from Centro di Formazione Professionale Castel Fusano Alberghiero, Roma:

• Gianna Baltazar (GN_cfa)
• Sara Bruno (SB_cfa)

Students from Liceo classico e musicale "Bartolomeo Zucchi", Monza: 

• Anna Battaia (AB_zu)
• Alice Battagliere (ABAT_zu)
• Alessandro Bazzoli (ABAZ_zu)
• Andrea Cavenaghi (AC_zu)
• Aurora Deste (ADE_zu)
• Alice De Gresti (ADG_zu)
• Alessandro Fracasso (AF_zu)
• Alessandro Ferrara (AFE_zu)
• Elisabetta Galbusera (EG_zu)
• Alessandro Mettke (AM_zu)
• Asia Orlandi (AO_zu)
• Anna Pizzocri (AP_zu)
• Annalisa Quaggia (AQ_zu)
• Arianna Zappa (AZ_zu)
• Beatrice Ferrari (BF_zu)
• Benedetta Grasso (BG_zu)
• Bianca Mitrofan (BM_zu)
• Chiara Biffi (CB_zu)
• Camilla Cesana (CC_zu)
• Cecilia D'Amora (CDA_zu)
• Claudia Devda (CDE_zu)
• Chiara Galimberti (CG_zu)
• Camilla Giordano (CGI_zu)
• Clara Maria Maggiore (CMM_zu)
• Claudia Petrillo (CP_zu)
• Chiara Solari (CS_zu)
• Chiara Villa (CV_zu)
• Dario Parma (DP_zu)
• Davide Subranni (DS_zu)
• Elisabetta Bernardinello (EB_zu)
• Elena Cocchia (EC_zu)
• Elisa Del Corno (EDC_zu)
• Erika Giardina (EGI_zu)
• Ester Stucchi (EST_zu)
• Emma Sueri (ESU_zu)
• Edoardo Viganò (EV_zu)
• Federico Contini (FC_zu)
• Federico De Santis (FD_zu)
• Filippo Di Nunzio (FDN_zu) 
• Fabio Lucchese (FL_zu)
• Francesca Laggetta (FLA_zu)
• Francesca Masera (FM_zu)
• Francesca Poletti (FP_zu)
• Francesco Sanseverino (FS_zu)
• Federica Sala (FSA_zu)
• Gloria Fontana (GF_zu)
• Gaia Giacometti (GGI_zu)
• Gabriele Grimaldi (GGR_zu)
• Gregorio Gabriele Solaroli (GGS_zu)
• Giulia Leonetti (GLE_zu)
• Giulia Lidia Dolcini (GLD_zu)
• Gabriele Mazzoletti (GM_zu)
• Gaia Novi (GN_zu)
• Gaia Pesavento (GP_zu)
• Giulia Ponti (GPO_zu)
• Giada Settanta (GS_zu)
• Giorgia Uccelli (GU_zu)
• Irene Beretta (IB_zu)
• Iris Zulberti (IZ_zu)
• Jessica Ji Huang (JJH_zu)
• Luna Albanese (LA_zu)
• Laura Brambilla (LB_zu)
• Laura Ceddia (LC_zu)
• Lorenzo Cavallari (LCA_zu)
• Laura Crotolo (LCR_zu)
• Letizia Oluzzi (LO_zu)
• Lola Rossi (LR_zu)
• Lidia Zemignani (LZ_zu)
• Margherita Contardi (MC_zu)
• Martina Famiglietti (MFA_zu)
• Matilde Festa (MFE_zu)
• Martina Mediani (MM_zu)
• Margherita Rinaldi (MR_zu)
• Marta Serentha (MS_zu)
• Noemi D'Agostino (ND_zu)
• Noemi De Santis (NDS_zu)
• Pasquale Cirillo (PC_zu)
• Pietro Calzavara (PIC_zu)
• Pierluigi Loparco (PL_zu)
• Riccardo Argento (RA_zu)
• Rebecca Costantin (RC_zu)
• Riccardo Cappella (RCA_zu)
• Riccardo Galimberti (RG_zu)
• Sara Buccella (SB_zu)
• Sofia Crescenti (SC_zu)
• Silvia Taliento (ST_zu)
• Tommasso Bogani (TB_zu)
• Tommaso Cazzaniga (TC_zu)
• Valeria Elena Spanò (VES_zu)
• Viola Jacovino (VJ_zu)

Students from Istituto Tecnico Economico "Alberico Gentili", Macerata: 

• Adriano Severini (ADS_ag)
• Abel Luciani (AL_ag)
• Alessia Principi (ALP_ag)
• Agnese Piergentili (AP_ag)
• Azzurra Strazzante (AS_ag)
• Chiara Nogara (CN_ag)
• Federico Barelli (FB_ag)
• Francesco Pantanetti (FP_ag)
• Giorgia Incicco (GI_ag)
• Gianluca Spinali (GS_ag)
• Lorenzo Bravi (LB_ag)
• Lorenzo Cologni (LC_ag)
• Lorenzo Petritoli (LP_ag)
• Luca Pigliacampo (LUP_ag)
• Michele Biondi (MB_ag)
• Matteo Mandolesi (MM_ag)
• Maria Vittoria Fioretti (MVF_ag)
• Nicola Carboni (NC_ag)
• Piero Ruani (PR_ag)
• Riccardo Ciccarelli (RC_ag)
• Sadou Diallo Thierno (SDT_ag)
• Stella Naranjo Valladares (SNV_ag)
• Simone Pirro (SP_ag)

Students from Istituto di Istruzione Superiore "A. Berenini", Fidenza:

• Alfieri Alessandro (AA_be)
• Alessandro Bacchini (AB_be)
• Alessandro Battecca (ABA_be)
• Andrea Dagoni (AD_be)
• Alberto Morza (AM_be)
• Alessandro Spaggiari (AS_be)
• Beatrice Ianelli (BI_be)
• Celeste Luisetti (CL_be)
• Caterina Zanella (CZ_be)
• Davide De Santo (DDS_be)
• Dalila Etichetta (DM_be)
• Emanuele Bergamaschi (EB_be)
• Elisa Esposito Ferrara (EEF_be)
• Eddine El Ouelhani Farraj (EEOF_be)
• Enrico Giovenali (EG_be)
• Filippo Montanari (FM_be)
• Federico Moschini (FMO_be)
• Francesco Parolari (FP_be)
• Greta Sesenna (GS_be)
• Hanna Bereszynska (HB_be)
• Jasleen Kaur (JK_be)
• Kledi Koceku (KK_be)
• Klendi Meci (KM_be)
• Luca Rossetti (LR_be)
• Luca Trivelloni (LT_be)
• Lorenzo Varani (LV_be)
• Mattia Bonassera (MB_be)
• Matteo Furlotti (MF_be)
• Matthias Galvani (MG_be)
• Matteo Gandelli (MG_be)
• Majson Hotaj (MH_be)
• Matteo Massari (MM_be)
• Marta Montali (MMO_be)
• Sebastian Capasso (SC_be)
• Samantha Ferrari (SF_be)
• Sara Meschi (SM_be)
• Simone Pedretti (SP_be)
• Tommaso Caraffini (TC_be)
• Walid El Ati (WEA_be)

Students from Istituto Educazione Secondaria Superiore "Gandhi", Merano:

• Andrea Golinelli (AG_me)
• Chiara Peluso (CP_me)
• Diana Marina Caser (DMC_me)
• Elisa Muca (EM_me)
• Emily Vucemillo (EV_me)
• Giulia Maria Roat (GMR_me)
• Giulia Ricci (GR_me)
• Lea Sejfullaj (LS_me)
• Manuel Bertolini (MB_me)
  
• Mia De Gennaro (MDG_me)
• Michele Petrilli (MP_me)
• Sofia Fregoni Lenz (SFL_be)
• Valentina De Martin Toprarin (VDMT_me)

Students from Istituto di Istruzione Secondaria Eccellente "Paciolo - D'Annunzio", Fidenza:

• Arianna Azzali (AA_da)
• Alessia Cerri (AC_da)
• Adelina Ciumac (ACI_da)
• Anastasia Duric (AD_da)
• Anita Franzini (AF_da)
• Alice Granelli (AG_da)
• Anureet Kaur (AK_da)
• Alessandro Lucca (AL_da)
• Adriana Lazar (ALA_da)
• Alessio Marasi (AM_da)
• Anita Marani (AMA_da)
• Anika Marchesi (ANM_da)
• Antonella Passiatore (AP_da)
• Angela Raimo (AR_da)
• Alice Ronchini (ARO_da)
• Alice Santi (AS_da)
• Annalisa Tedaldi (AT_da)
• Anna Tosi (ATO_da)
• Alba Vogli (AV_da)
• Alberto Zerbini (AZ_da)
• Azzurra Ciliberti (AZC_da)
• Beatrice Catelli (BC_da)
• Benedetta Garbi (BG_da)
• Beatrice Sampaolo (BS_da)
• Cecilia Negri (CN_da)
• Chiara Marani (CM_da)
• Carlotta Molinari (CMO_da)
• Camilla Pioli (CP_da)
• Chiara Paraboschi (CPA_da)
• Caterina Ortega (CO_da)
• Chiara Rapetti (CR_da)
• Camilla Zoni (CZ_da)
• Daniela Cortesi (DC_da)
• Donata Decastri (DD_da)
• Dejana Krsic (DK_da)
• Dennis Paganuzzi (DP_da)
• Elisabeth Bussacchini (EB_da)
• Emanuele Cornini (EC_da)
• Eleonora Conti (ECO_da)
• Erik Giorgi (EG_da)
• Emma Magnani (EM_da)
• Erika Migliorati (EMI_da)
• Emma Pesci (EP_da)
• Eles Tonanti (ET_da)
• Elisabetta Trentini (ETR_da)
• Francesco Berti (FB_da)
• Federica Basile (FBA_da)
• Francesco Ciati (FC_da)
• Federico Castellani (FCA_da)
• Filippo Delledonne (FD_da)
• Francesca Groppi (FG_da)
• Federico Gualerzi (FGU_da)
• Fabrizio Monopoli (FM_da)
• Francesca Aristocratico (FN_da)
• Fabiola Tosini (FTO_da)
• Giulio Albini (GA_da)
• Gaia Barzieri (GAB_da)
• Giulia Brambilla (GB_da)
• Giulia Bedodi (GBE_da)
• Giorgia Cironi (GC_da)
• Giulia Di Martino (GDM_da)
• Gianmarco Gombi (GG_da)
• Giulia Iona Alexandroaei (GIA_da)
• Greta Macchia (GM_da)
• Gioele Madonna (GMA_da)
• Gian Maria Brandi (GMB_da)
• Gaia Moschini (GMO_da)
• Giuseppe Muraca (GMU_da)
• Giada Porteri (GP_da)
• Giada Spaggiari (GS_da)
• Giulia Tummarello (GT_da)
• Irene Di Lucchio (IDL_da)
• Ilaria Pezzetti (IP_da)
• Jacopo Boscarecci (JB_da)
• Karen Eliana Mosquera Pulgarin (KEMP_da)
• Lisa Anselmi (LA_da)
• Lisa Haregu Colongo (LHC_da)
• Luca Lovati (LL_da)
• Lara Teif (LT_da)
• Marcella Magnani (MAM_da)
• Martina Bassi (MB_da)
• Margherita Bellini (MBE_da)
• Michelle Comini (MC_da)
• Matteo Cattaneo (MCA_da)
• Maria Chiara Malavolta (MCM_da)
• Maria Chiara Valesi (MCV_da)
• Michele Dattolo (MD_da)
• Michele Delnevo (MDE_da)
• Maria Elena Porta (MEP_da)
• Marta Frati (MFR_da)
• Matilde Fabbriani Zoni (MFZ_da)
• Marta Granelli (MG_da)
• Matteo Giusti (MGI_da)
• Marcello Legatti (ML_da)
• Matilde Mariuccia Ajroldi (MMA_da)
• Matteo Poletti (MP_da)
• Marta Usberti (MU_da)
• Niccolò Ajolfi (NA_da)
• Nikolas Tanzi (NT_da)
• Noemi Tarallo (NTA_da)
• Oliver Cyril Eviston (OCE_da)
• Oliver Squeri (OS_da)
• Pietro Ajolfi (PA_da)
• Pietro De Pau (PDP_da) 
• Pietro Faverzani (PF_da)
• Pietro Marzoli (PM_da)
• Rebecca Asti (RA_da)
• Riccardo Bersani (RB_da)
• Ranim Bechir (RBE_da)
• Riccardo Boselli (RBO_da)
• Riccardo Forestelli (RF_da)
• Riccardo Lagori (RL_da)
• Riccardo Pedretti (RP_da)
• Sofia Amigoni (SA_da)
• Sara Amici (SAM_da)
• Serena Cacciali (SC_da)
• Sebastiano Ceri (SCE_da)
• Simone Deriu (SD_da)
• Sara Fogliati (SF_da)
• Samuele Giannì (SG_da)
• Sabrina Hamad (SH_da)
• Silvia Laurini (SL_da)
• Sophia Loreni (SLO_da)
• Samuele Porta (SP_da)
• Silvia Capo (ST_da)
• Sebastian Zilocchi (SZ_da)
• Tommaso Bonfanti (TB_da)
• Thierry Cassi (TC_da)
• Tommaso Finetti (TF_da)
• Valentina Comunale (VC_da)
• Virginia Mori (VM_da)

Students from University of Valencia, Valencia: 

• Aarón Pardo Celaya (APC_va)
• Adrià Díez Gandia (ADG_va)
• Adrián Manzano Velasco (AMV_va)
• Aitor Aguilar Esteban (AAE_va)
• Alejandro Agustín Nogués (AAN_va)
• Aleks Svetlinov Atanasov (ASA_va)
• Ana González Durán (AGD_va)
• Ana Maria Montero Grafiá (AMMG_va)
• Ana Maria Vázquez Salvador (AMVS_va)
• Anca Peterfi (AP_va)
• Andrea Celda Gomez (ACG_va)
• Andrea Delgado Ros (ADR_va)
• Andrea Guijarro García (AGG_va)
• Andrés Borrás Benavente (ABB_va)
• Andrés Ernesto Autentica Ruiz (AEVR_va)
• Andrés Martínez García (AMG_va)
• Andreu Mahiques Catalá (AMC_va)
• Angel Terual Ortega (ATO_va)
• Angela Barrachina Serrano (ABS_va)
• Ángela Cervera Corberà (ACC_va)
• Anna Lena Kötteritzsch  (ALK_va)
• Bárbara Navarro Pardo  (BNP_va)
• Borja Gómez Granero (BGG_va)
• Carla Castaño Fraile (CCF_va)
• Carles Huerta Meseguer (CHM_va)
• Carles Moltó Mondéjar (CMM_va)
• Carles Sanz Olmos (CSO_va)
• Carles Tortosa Esteve (CTE_va)
• Carlos Bertomeu Martínez (CBM_va)
• Chema Vañó Galindo (CVG_va)
• Costanza Consales (CC_va)
• Cristian Peinado Lozano (CPL_va)
• Dani Andrés Escolástico (DAE_va)
• Daniel Ortega A mio parere l'alba segna un nuovo inizio (DOA_va)
• David González Vivó (DGV_va)
• Diego Barragan Nadal (DBN_va)
• Diego Mendaña Rodríguez (DMR_va)
• Edgar Hidalgo Ponce (EHP_va)
• Eduardo Granero Penalba (EGP_va)
• Eduardo Salvador Martínez Vivas (ESMV_va)
• Elena Baca Cervera (EBC_va)
• Elena Cardona Climent (ECC_va)
• Encarnación Bataller Alfaro (EBA_va)
• Enrique Martínez Barcia (EMB_va)
• Eric Hortelano Heredia  (EHH_va)
• Erica Trenta (ET_va)
• Eugenio Chaves Fuentes (ECF_va)
• Eva Martín Grimaldo (EMG_va)
• Ferran Álvarez Rodríguez (FAR_va)
• Ferran Ferreres Albiol (FFA_va)
• Ferran Rosell Arambul (FRA_va)
• Gabriela Soler Ends (GSE_va)
• Gemma Senchermés Castillo (GSM_va)
• Giada Murgia (GM_va)
• Giulia Incandela (GI_va)
• Guillem Madrigal Gallud (GMG_va)
• Hector Bachero Escrig (HBE_va)
• Hiba Bendada (HB_va)
• Ignacio Lino Olmedo (ILO_va)
• Iván Ramos Delgado (IRD_va)
• Jaume Devesa Alcaraz (JDA_va)
• Jaume Martinis Perona (JMP_va)
• Javier Solaz Serra (JSSE_va)
• Jesús Galán Martínez (JGM_va)
• Joan Moltó Cutanda (JMC_va)
• Joana García García (JGG_va)
• Jordi del Castillo Ferre (JCF_va)
• Jordi Llacer Izquierdo (JLI_va)
• José Ignacio Moreno Caballero (JIMC_va)
• Josep María Pérez Tornero (JMPT_va)
• Josué Simó Sacristán (JSS_va)
• Juan Arroyo (JA_va)
• Juan Manuel Yedra Quílez (JMYQ_va)
• Júlia Santamaria i Paredes (JSP_va)
• Krzysztof Bartosik (KB_va)
• Laura Monroy Rodríguez (LMR_va)
• Lluis Gaona i Roselló (LGR_va)
• Lucía Gandía García (LGG_va)
• Lucía Martínez Aranda (LMA_va)
• Malou Hugonnard (MH_va)
• Marc Aparisi Server (MAS_va)
• Marco Royo Muñoz (MRM_va)
• Marcos Coll Cañado (MCC_va)
• María Asensio Cobos (MAC_va)
• Maria Calpe Huesa (MCH_va)
• María de las Nieves Todo Cordero (MNTD_va)
• María Oltra Vercher (MOV_va)
• Mario González Pérez (MGP_va)
• Marta Safont Pérez (MSPE_va)
• Marta Signes Pedrós (MSP_va)
• Martin Loïc (ML_va)
• Martina Natalia (MN_va)
• Márton Zsolt, Mészáros (MMZ_va)
• Maura Curridori (MC_va)
• Miguel Angel Cuñat Batanero (MACB_va)
• Miguel Femenia Puig (MFP_va)
• Miguel Ruiz Andreu (MRA_va)
• Miquel Enguix Carrasco (MEC_va)
• Mireia Benavent Marín (MBM_va)
• Nayara González Soto (NGS_va)
• Nicolas Villasante Ospina (NOV_va)
• Olga Salvador Fernández (OSF_va)
• Óscar Salone Sanchis (OSS_va)
• Pablo Griñó Martín (PGM_va)
• Pablo Martinez Bautista (PMB_va)
• Pau Lemus Bonet (PLB_va)
• Paula Hernández Navarro (PHN_va)
• Paula Jimenez Valero (PJV_va)
• Ramón Cortés Fernández (RCF_va)
• Raquel Torres Ferrer (RTF_va)
• Raúl Villena Morillas (RVM_va)
• Renovell Hernández Blas (RHB_va)
• Roberto Arias Bascuñana (RAB_va)
• Rosalia Russo (RR_va)
• Roser Folguerà Gaspar (RFG_va)
• Roser Pastor Climent (RPC_va)
• Samuel Noguera Santandreu (SNS_va)
• Santiago Pérez López (SPL_va)
• Silvia Montaña Bellé (SMB_va)
• Slavina Ivanova Markilova (SIM_va)
• Sonia Antón Torres (SAT_va)
• Valeria Marín Magdalena (VMM_va)
• Vanessa Gallo (VG_va)
• Vera Joana García Mora (VJGM_va)
• Verónica Pérez Lara (VPL_va)
• Vicent Cerdà Alonso (VCA_va)
• Vicente Tamarit Lorca (VTL_va)
• Victor Conejero Martinez (VCM_va)
• Yakhub Babacar (YB_va)
• Yana Plamenova Nedkova (YPN_va)
• Zuriñe Terol Company (ZTC_va)

Abstract

Objective

Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs. The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI).

Materials and Methods

We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy.

Results

The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; % vs. n = 21; %; p = ). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (%) patients were also exposed to at least 1 potentially severe DDI at discharge.

Conclusion

Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.

Keywords: Elderly, End of life, Limited life expectancy, Polypharmacy, Symptomatic medications

Significance of the Study

• Pharmacotherapy in older patients with a limited life expectancy should avoid unnecessary polypharmacy and focus on symptom control. This study showed a small reduction in the use of commonly prescribed preventive medications. Medications could be reviewed to optimize polypharmacy.

Introduction

The end of life is the preterminal phase of a person's decline towards death and normally involves accumulating health problems over a period of weeks to months, with failing homeostasis that is irreversible and inexorably leads to death [1]. Older people approaching the end of life are at a high risk for adverse drug reactions resulting from polypharmacy, declining organ function, comorbidity, malnutrition, cachexia, and changes in body composition [2]. As a consequence, approaching the end of life should shift the therapeutic aims, triggering a reduction in the number of drugs, but this is not the usual practice [3–5].

The aim of pharmacotherapy in the rising numbers of end-of-life older people should be to avoid polypharmacy and focus on controlling symptoms rather than prolonging life [1, 2]. Although polypharmacy is very common among older end-of-life patients, with their need to relieve symptoms, disease-related problems, and quality of life [6–8], it may also be a major risk factor for inappropriate prescribing and potentially severe drug-drug interactions (DDI) [2, 9, 10]. In this circumstance, drugs for the prevention of secondary diseases are of no value if the time to therapeutic benefit exceeds the probable life expectancy and should be discouraged. However, the few studies that have examined drug therapy in patients at the end of life have found that about half of them continued to take ineffective and unnecessary medication for the prevention or treatment of chronic diseases [11], although the potential for harm can be expected to outweigh any benefit in view of the limited life expectancy [6, 12]. Statins, antihypertensives and bisphosphonates are frequently used in patients with a terminal disease and advanced disability, although the real benefits are unknown because their safety and efficacy have been demonstrated for a young general population but evidence supporting their utility at the end of life is limited [12, 13, 14].

No study has examined the prescription of internal and geriatric hospital specialists to patients with a limited life expectancy. The main aim of this study was to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe DDI.

Materials and Methods

Data Collection

The Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI) is a collaborative, independent initiative of the Italian Society of Internal Medicine (SIMI), the Istituto di Ricerche Farmacologiche Mario Negri IRCCS, and the IRCCS Ca' Granda Superiore Policlinico Hospital Foundation. The registry was set up in by a network of internal medicine and geriatric wards in order to collect information on elderly hospital in-patients with multimorbidities receiving multiple drugs. The first run of data collection was between January and December , and the second, third, and fourth runs as well as ongoing runs took place between January and December , , , and , respectively. To ensure an unselected population of elderly patients admitted to internal medicine and geriatric wards, the first 5 patients admitted to the wards participating in this study during 4-week periods 3 months apart were consecutively recruited if they were 65 years old or older. Participation was voluntary and all patients gave signed informed consent. Giorno collection complied fully with Italian law on personal giorno protection and this study was approved by the ethics committees of each ward participating in REPOSI.

The attending physicians completed a standardized web-based case report form, recording sociodemographic details and the diagnosis and drug treatment at admission, during the hospital stay, and at discharge. From the second REPOSI runs we collected the following additional information for a short-term follow-up in order to improve the quality of the data: main laboratory parameters, comorbidity according to the Cumulative Illness Rating Scale (CIRS), basic activities of daily living, cognitive impairment, depression, and clinical events during the hospital stay. Patients were followed for 3 months after discharge via a telephone interview in order to collect information on new diagnoses, hospital readmissions, drug regimens, adverse events, basic activities of daily living, and mortality.

To describe the drug therapy of patients discharged with a limited life expectancy, we considered eligible for analysis all patients discharged in “critical condition,” defined as a high risk of short-term mortality (at 3 months) on the basis of the clinical evaluation. Analysis of each patient's drug therapy at admission reflects drugs prescribed by general practitioners for patients who lived at home, or physicians in nursing homes for those in an institution; drug therapy at discharge referred to prescriptions by hospital internists or geriatricians. Patients transferred to palliative care wards, though potentially terminally ill, were excluded because the drug therapy at discharge was not collected.

Classification of Drug Therapies

The drugs prescribed at admission and discharge were divided into the following 3 main classes according to their preventive or symptomatic effects: (1) potentially avoidable preventive medications, i.e., drugs that usually have no place in the end-of-life patient because the time to benefit is clearly shorter than the life expectancy; (b) medications of uncertain appropriateness, i.e., drugs that need a case-by-case evaluation because they could have a role in end-of-life patients but their real effectiveness is questionable on account of the short life expectancy; and (c) potentially appropriate treatments, i.e., drugs that provide symptomatic relief or that should be tapered slowly over several weeks or months in order to avoid withdrawal symptoms, such as psychotropic drugs or proton pump inhibitors[15]. A geriatrician and a clinical pharmacologist separately analyzed drug prescriptions and resolved any discordances with a final round.

Statistical Analysis

The patients' sociodemographic characteristics were compared using univariate analysis by χ² tests for categorical variables and t tests or matched pair t tests for continuous variables. The McNemar test was used to compare drug treatments at admission and discharge. p < were considered statistically significant. Analyses were done using JMP Pro 12 (SAS Institute Inc., Cary, USA).

Results

The sample comprised 55 end-of-life patients recruited among the patients discharged by the internal medicine and geriatric wards of REPOSI. Follow-up data were available for 30 of those discharged in critical conditions; 27 (90%) died between discharge and the 3-month follow-up, confirming their limited life expectancy. The main sociodemographic characteristics and diagnoses are reported in Table 1. Patients had high rates of comorbidity and most of them suffered from cardiovascular diseases. About 72% had a caregiver and most had cognitive impairment consistent with a diagnosis of dementia. Half of the patients had been admitted in the previous 6 months and were bedridden at discharge with pressure sores.

Table 1.

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The mean number of drugs remained the same from admission to discharge (mean ± SD: ± and ± ; p = ). Table 2 lists the drugs that we considered as potentially avoidable preventive medications in end-of-life patients, those of uncertain appropriateness, and those that were potentially appropriate. There were significantly fewer patients with at least 1 preventive medication that could be considered for deprescription at the end of life from admission to discharge (p = ). Angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable cardiovascular medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Drugs for peptic ulcer and gastroesophageal reflux disease, analgesics, psychotropic drugs, and systemic corticosteroids were the potentially appropriate symptomatic medications maintained at discharge.

Table 2.

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Patients exposed to at least 1 potentially severe DDI slightly increased between admission (31; %) and discharge (37; %; p = ); drugs that concomitantly increased the risk of QT prolongation and torsades de pointes, followed by those that increased the risk of bleeding, were the most frequent potentially severe DDI (Table 3).

Table 3.

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Discussion

Identification of the end of life should bring about a significant reduction in the number of daily drugs, but this was not observed in the present study. Hospital discharge was associated with only a small, though significant, reduction in the use of preventive medications that are commonly prescribed. However, these results could be further improved since in fact about 40% of patients were discharged with avoidable medications. Cardiovascular drugs were the potentially avoidable preventive medications most frequently prescribed at admission that were partially reduced at discharge. Most cardiovascular drugs usually have no place in end-of-life patients because the time to benefit is clearly shorter than the life expectancy [2]; when prescribed to prevent diabetic nephropathy or reduce mortality from heart failure angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers (excluding diltiazem or verapamil) are of little value when a patient's life expectancy is severely curtailed as a result of other irreversible disorders. Similarly, lipid-lowering drugs are almost always inappropriate at the end of life. There were definite reductions in the prescription of oral antidiabetics and xanthine oxidase inhibitors at discharge. Stopping these drugs is generally appropriate because the goals for managing diabetes change at the end of life since it is no longer important to prevent the long-term effects of hyperglycemia. Similarly, treating asymptomatic hyperuricemia to prevent gout is clearly inappropriate [16] in the end-of-life patient.

Among the preventive medications of uncertain appropriateness, the use of low-molecular-weight heparin increased at discharge while the proportion of patients treated with antiplatelet drugs decreased; these drugs could be useful in preventing thrombotic events, although they increase the risk of bleeding in older and frailer patients who often fall. It is hard to assess the appropriateness of these medications and a case-by-case evaluation is needed, although anticoagulants and antiplatelets were frequently involved in potentially severe DDI at discharge, increasing the risk of adverse drug events. Because deprescribing must consider not only the risks of individual drugs but also the cumulative risk of DDI [17], the higher percentage of patients exposed to potentially severe DDI emphasizes the need for closer evaluation of drugs prescribed to end-of-life patients.

Our findings suggest that the review of drug medications, optimizing polypharmacy and deprescribing could be further improved in older adults discharged with a very limited life expectancy (e.g., less than 3 months). A consensus framework, or shared criteria with deprescribing guidelines for potentially inappropriate medication, could be useful in rationalizing drug therapy. Careful consideration of a patient's life expectancy, the time to benefit of treatments, goals of care, and treatment targets for each drug (including those used for a long time before the end-of-life period) is important for recommending any rational framework for decision making [2, 5, 18].

There may be several reasons for physicians not considering the discontinuation of futile medications in patients with a limited life expectancy. Scant awareness, as well the reactions of patients or their relatives, seems to be an important factor [19]. Unexpectedly, patients may be more willing to stop unnecessary medications than their physicians believe, as observed in a study of older patients with multiple chronic morbidities who were favorable to discontinue medication in 90% of cases [20]. Emphasizing the positive aspects of stopping medicines, such as reducing the burden of taking pills, rather than insisting on the uselessness of continuation, may be a helpful approach [21] that physicians could emphasize in conversations with patients and relatives.

The strength of this study is that this it analyzes how the hospital transition can be associated with changes in preventive and symptomatic medications by internal medicine and geriatric specialists for patients with a limited life expectancy.

This study has some limitations. First, REPOSI was not specifically designed to collect information about patients with a limited life expectancy and only those able to give written informed consent were enrolled, thus excluding those who were too frail to give consent. The sample of patients is very small, because we focused on patients in ‘critical conditions’, so we could assess the use of preventive or symptomatic drugs in patients with a limited life expectancy according to the clinical evaluation.

Conclusion

Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with a limited life expectancy could help improve drug prescription.

Disclosure Statement

The authors declare no conflict of interests.

Spanish Hospitals

Nieves Ramirez Duque (Hospital Universitario Virgen del Rocio, Sevilla); Alberto Muela Molinero (Hospital de Leon); Pedro Abad Requejo, Vanessa Lopez Pelaez, and Lara Tamargo (Hospital del Oriente de Asturias, Arriondas); Xavier Corbella Viros and Francesc Formiga (Hospital Universitario de Bellvitge); Jesus Diez Manglano, Esperanza Bejarano Tello, Esther Del Corral Behamonte, and Maria Sevil Puras (Hospital Royo Villanova, Zaragoza); Manuel Romero (Hospital Infanta Elena Huelva); Blanca Pinilla Llorente, Cristina Lopez Gonzalez-Cobos, and M.

Acknowledgement

REPOSI is a network of Italian internal medicine hospital wards which, voluntarily and with no financial support, agreed to participate in the collection of giorno for this study over the 4 index weeks (see the Appendix for a list of investigators and coauthors of the REPOSI Study Group). The authors are grateful to J.D. Baggott for editorial assistance.

Appendix

The investigators and coauthors of the REPOSI Study Group are as follows:

Steering committee: Pier Mannuccio Mannucci (Chair, Fondazione IRCCS Cà Granda Clinica Maggiore Policlinico, Milan, Italy); Alessandro Nobili (Cochair, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy); Mauro Tettamanti, Luca Pasina, and Carlotta Franchi (IRCCS-Istituto di Ricerche Farmacologiche Mario Negri); Salvatore Corrao (ARNAS Civico, Di Cristina, Benfratelli, DiBiMIS, Università di Palermo, Palermo, Italy); Alessandra Marengoni (Spedali Civili di Brescia, Brescia, Italy); Francesco Salerno (IRCCS Policlinico San Donato Milanese, Milan, Italy), Matteo Cesari (UO Geriatria, Università degli Studi di Milano), Francesco Perticone (President, SIMI), Giuseppe Licata (Medicina Interna e Cardioangiologia, Secondo me l'azienda ha una visione chiara Ospedaliera Universitaria Policlinico P. Giaccone di Palermo, Palermo, Italy); Francesco Violi (Prima Clinica Medica, Policlinico Umberto I, Rome, Italy); and Gino Roberto Corazza, (Clinica Medica I, Sezione 11, IRCCS Policlinico San Matteo di Pavia, Pavia, Italy).

Clincal data monitoring and revision: Carlotta Franchi and Laura Cortesi (IRCCS-Istituto di Ricerche Farmacologiche Mario Negri).

Database management and statistics: Mauro Tettamanti, Laura Cortesi, and Ilaria Ardoino (IRCCS-Istituto di Ricerche Farmacologiche Mario Negri).

Investigators

Italian Hospitals

Giaccone di Palermo); Marco Zoli, Ilaria Lazzari, and Mattia Brunori (Unità Operativa di A mio avviso la medicina salva vite ogni giorno Interna, Azienda Ospedaliera Universitaria Policlinico Sant'Orsola-Malpighi); Franco Laghi Pasini and Pier Leopoldo Capecchi (Unità Operativa Complessa Medicina 2, Azienda Ospedaliera Università Senese); Giuseppe Palasciano, Maria Ester Modeo, and Carla Di Gennaro (Medicina Interna Ospedaliera L. D'Agostino, Medicina Interna Universitaria A. Annunziata, Chieti); Gerardo Mancuso, Daniela Calipari, and Mosè Bartone (Unità Operativa Complessa Medicina Interna, Ospedale Giovanni Paolo II Lamezia Terme, Catanzaro); Giuseppe Delitala and Maria Berria (Clinica Medica, Secondo me l'azienda ha una visione chiara Ospedaliera-Universitaria di Sassari); Maurizio Muscaritoli, Alessio Molfino, and Enrico Petrillo (Medicina Interna e Nutrizione Clinica, Policlinico Umberto I, Sapienza Università di Roma); Giuseppe Zuccalà and Gabriella D'Aurizio (Unità Operativa Complessa Medicina d'Urgenza e Pronto Soccorso, Policlinico Universitario A. Gemelli, Rome); Giuseppe Romanelli, Alessandra Marengoni, and Alberto Zucchelli (Geriatria, Spedali Civili di Brescia); Antonio Picardi, Umberto Vespasiani Gentilucci, Paolo Gallo, and Chiara Dell'Unto (Medi­cina Clinica-Epatologia, Università Campus Biomedico, Rome); Giorgio Annoni, Maurizio Corsi, Giuseppe Bellelli, Sara Zazzetta, Paolo Mazzola, Hajnalka Szabo, and Alessandra Bonfanti (Unità Operativa di Geriatria, Università degli studi di Milano-Bicocca Clinica S. Frugoni, Secondo me l'azienda ha una visione chiara Ospedaliero-Universitaria Consorziale Policlinico di Bari); Luigi Fenoglio, Christian Bracco, and Alessia Valentina Giraudo (S.C. Indirizzo d'Urgenza, Dipartimento di Scienze Mediche, Università di Torino, Città della Scienza e della Salute, Torino); Raffaella Salmi and Piergiorgio Gaudenzi (Unità Operativa di A mio avviso la medicina salva vite ogni giorno Ospedaliera II, Secondo me l'azienda ha una visione chiara Ospedaliera-Universitaria Sant'Anna); Francesco Violi and Ludo­vica Perri (Prima Clinica Medica, Policlinico Umberto I); Raffaele Landolfi, Massimo Montalto, and Antonio Mirijello (Clinica Medica, Policlinico Universitario A. Gemelli); Luigina Guasti, Luana Castiglioni, Andrea Maresca, Alessandro Squizzato, Marta Molaro, and Alessandra Grossi (Medicina Interna I, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese); Marco Bertolotti, Chiara Mussi, Maria Vittoria Libbra, Giulia Dondi, Elisa Pellegrini, and Lucia Carulli (Unità Operativa di Geriatria e U.O. di A mio avviso la medicina salva vite ogni giorno a indirizzo Metabolico Nutrizionistico, Nuovo Clinica Civile, Università di Modena e Reggio Emi­lia, AUSL di Modena, Modena,); Francesco Perticone, Lidia Colangelo, and Tania Falbo (Unità Operativa Malattie Cardiovascolari Geriatriche, Università Magna Grecia, Policlinico Mater Domini); Vincenzo Stanghellini, Roberto De Giorgio, Eugenio Ruggeri and Sara del Vecchio (Dipartimento di Scienze Mediche e Chirurgiche, Unità Operativa di Medicina Interna, Università degli Studi di Bologna/Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi); Andrea Salvi, Roberto Leonardi, and Giampaolo Damiani (U.O. 3a Medicina Globale, Spedali Civili di Brescia); Armando Gabrielli, William Capeci, Massimo Mattioli, Giuseppe Pio Martino, Lorenzo Biondi, and Pietro Pettinari (Clinica Medica, Secondo me l'azienda ha una visione chiara Ospedaliera Universitaria − Ospedali Riuniti di Ancona); Riccardo Ghio and Anna Dal Col (Medicina III, Azienda Ospedaliera Università San Martino); Salvatore Minisola and Luciano Colangelo (Medicina Interna F e Malattie Metaboliche dell'osso, Policlinico Umberto I); Antonella Afeltra, Benedetta Marigliano, and Maria Elena Pipita (Medicina Clinica, Policlinico Campus Biomedico Roma, Rome); Pietro Castellino, Julien Blanco, Luca Zanoli, and Samuele Pignataro (Dipartimento di Medicina, Secondo me l'azienda ha una visione chiara Ospedaliera Universitaria Policlinico − V. Giovanni Battista Molinette, Torino); Giorgio Galanti, Gabriele Mascherini, Cristian Petri, and Laura Stefani (Agenzia di Credo che la medicina moderna abbia fatto miracoli dello Sport, AOUC Careggi, Florence); Margherita Girino and Valeria Piccinelli (Medicina Interna, Ospedale S. Anima Casale Monferrato, Alessandria); Francesco Nasso, Vincenza Gioffrè, and Maria Pasquale (Struttura Operativa Complessa di A mio avviso la medicina salva vite ogni giorno Interna, Ospedale Santa Maria degli Ungheresi, Reggio Calabria); Giuseppe Scattolin, Sergio Martinelli, and Mauro Turrin (Medicina Interna, Clinica di Monselice, Pa­dua); Leonardo Sechi, Cristina Catena, and Gianluca Colussi (Clinica Medica, Azienda Ospedaliera Universitaria, Udine); Nicola Passariello, Luca Rinaldi (Medicina Interna, Presidio Dottore di Marcianise, Naples); Franco Berti, Giuseppe Famularo, and Tarsitani Patrizia (Medicina Interna II, Azienda Ospedaliera San Camillo Forlanini); Roberto Castello and Michela Pasino (Medicina Generale e Sezione di Decisione Clinica, Ospedale Civile Superiore Borgo Trento, Verona); Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta Morganti, and Andrea Artoni (U.O.C Clinica Geriatrica, Secondo me l'azienda ha una visione chiara Ospedaliero Universitaria di Parma); Stefano Del Giacco, Davide Firinu, Francesca Losa, and Giovanni Paoletti (Medicina Interna, Allergologia ed Immunologia Clinica, Policlinico Universitario Dulio Casula, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari); Giuseppe Montalto, Anna Licata, and Valentina Malerba (U.O.S Prevenzione Malattie Epatobiliari, Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo); Lasco Antonino, Giorgio Basile, and Catalano Antonino (Unità Operativa di Geriatria, Secondo me l'azienda ha una visione chiara Ospedaliera Universitaria Policlinico G. Martino, Messina); Lorenzo Malatino, Benedetta Stancanelli, Va­lentina Terranova, and Salvatore Di Marca (Azienda Ospedaliera per l'Emergenza Cannizzaro andClinica Medica Università di Ca­tania, Catania); Patrizia Mecocci, Carmelinda Ruggiero, and Virginia Boccardi (Struttura Complessa di Geriatria, Università degli Studi di Perugia-Azienda Ospedaliera Santa Maria della Misericordia); Tiziana Meschi, Fulvio Lauretani, and Andrea Ticinesi (U.O. A mio avviso la medicina salva vite ogni giorno Interna e Lungodegenza Critica, Azienda Ospedaliera Universitaria di Parma); Pietro Minuz and Luigi Fondrieschi (Medicina Generale per lo Studio ed il Trattamento dell'Ipertensione Arteriosa, Azienda Ospedaliera Universitaria Verona, Policlinico GB Rossi, Verona); Mario Pirisi, Gian Paolo Fra, and Daniele Sola (Medicina Interna 1, Azienda Ospedaliera Universitaria Maggiore della Carità); Massimo Ingresso and Piero Penso che la riva sia un luogo di riflessione (Medicina Interna 1U, Azienda Ospedaliera Universitaria Città della Benessere e della Secondo me la scienza risponde alle grandi domande di Torino); Roberto Quadri (S.C. A mio avviso la medicina salva vite ogni giorno Interna, Ospedale di Ciriè, ASL TO4, Torino); Giorgio Scanzi, Caterina Mengoli, A mio parere la stella polare guida i naviganti Provini, and Laura Ricevuti (Medicina, ASST Lodi, Presidio di Codogno, Milan); Emilio Simeone, Rosa Scurti, and Fabio Tolloso (Geriatria, Ospedale Anima Santo di Pescara); Roberto Tarquini, Alice Valoriani, Silvia Dolenti, and Giulia Vannini (Medicina Interna I, Ospedale San Giuseppe, Empoli, USL Toscana Centro, Florence); Alberto Tedeschi and Lucia Trotta (Medicina Interna a indirizzo Pneumologico, ASST Fatebenefratelli − Sacco, Milan); Riccardo Volpi, Pietro Bocchi, and Alessandro Vignali (Clinica e Mi sembra che la terapia giusta cambi la vita Medica, Azienda Ospedaliera Universitaria di Parma); and Sergio Harari, Chiara Lonati, and Mara Cattaneo (U.O. Medicina Generale, Mi sembra che l'ospedale sia un luogo di speranza San Giuseppe Multimedica Spa)

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Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti, Luca Pasina, Carlotta Franchi, Salvatore Corrao, Alessandra Marengoni, Francesco Salerno, Matteo Cesari, Francesco Perticone, Giuseppe Licata, Francesco Violi, Gino Roberto Corazza, Carlotta Franchi, Laura Cortesi, Mauro Tettamanti, Laura Cortesi, Ilaria Ardoino, Domenico Prisco, Elena Silvestri, Caterina Cenci, Giacomo Emmi, Gianni Biolo, Michela Zanetti, Martina Guadagni, Michele Zaccari, Massimo Vanoli, Giulia Grignani, Edoardo Alessandro Pulixi, Mauro Bernardi, Silvia Li Bassi, Luca Santi, Giacomo Zaccherini, Elmo Mannarino, Graziana Lupattelli, Vanessa Bianconi, Francesco Paciullo, Ranuccio Nuti, Roberto Valenti, Martina Ruvio, Silvia Cappelli, Alberto Palazzuoli, Oliviero Olivieri, Domenico Girelli, Thomas Matteazzi, Mario Barbagallo, Ligia Dominguez, Floriana Cocita, Vincenza Beneduce, Lidia Plances, Marco Zoli, Ilaria Lazzari, Mattia Brunori, Franco Laghi Pasini, Pier Leopoldo Capecchi, Giuseppe Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Diletta Maira, Valeria Di Stefano, Giovanna Fabio, Sonia Seghezzi, Marta Mancarella, Matteo Cesari, Paolo Dionigi Rossi, Sarah Damanti, Marta Clerici, Federica Conti, Gino Roberto Corazza, Emanuela Miceli, Marco Vincenzo Lenti, Martina Pisati, Costanza Ricerca Dominioni, Giovanni Murialdo, Alessio Marra, Federico Cattaneo, Maria Beatrice Secchi, Davide Ghelfi, Luigi Anastasio, Lucia Sofia, Maria Carbone, Francesco Cipollone, Maria Teresa Guagnano, Ermanno Angelucci, Emanuele Valeriani, Gerardo Mancuso, Daniela Calipari, Mosè Bartone, Giuseppe Delitala, Maria Berria, Maurizio Muscaritoli, Alessio Molfino, Enrico Petrillo, Giuseppe Zuccalà, Gabriella D'Aurizio, Giuseppe Romanelli, Alessandra Marengoni, Alberto Zucchelli, Antonio Picardi, Umberto Vespasiani Gentilucci, Paolo Gallo, Chiara Dell'Unto, Giorgio Annoni, Maurizio Corsi, Giuseppe Bellelli, Sara Zazzetta, Paolo Mazzola, Hajnalka Szabo, Alessandra Bonfanti, Franco Arturi, Elena Succurro, Mariangela Rubino, Maria Grazia Serra, Maria Antonietta Bleve, Laura Gasbarrone, Maria Rosaria Sajeva, Antonio Brucato, Silvia Ghidoni, Fabrizio Fabris, Irene Bertozzi, Giulia Bogoni, Maria Victoria Rabuini, Elisabetta Cosi, Roberto Manfredini, Fabio Fabbian, Benedetta Boari, Alfredo De Giorgi, Ruana Tiseo, Giuseppe Paolisso, Maria Rosaria Rizzo, Claudio Borghi, Enrico Strocchi, Valeria De Sando, Ilenia Pareo, Carlo Sabbà, Francesco Saverio Vella, Patrizia Suppressa, Pasquale Agosti, Andrea Schilardi, Francesca Loparco, Luigi Fenoglio, Christian Bracco, Alessia Valentina Giraudo, Silvia Fargion, Giulia Periti, Marianna Porzio, Slivia Tiraboschi, Flora Peyvandi, Raffaella Rossio, Barbara Ferrari, Giulia Colombo, Valter Monzani, Valeria Savojardo, Christian Folli, Giuliana Ceriani, Francesco Salerno, Giada Pallini, Franco Dallegri, Luciano Ottonello, Luca Liberale, Lara Caserza, Kassem Salam, Nicola Lucio Liberato, Tiziana Tognin, Giovanni Battista Bianchi, Sabrina Giaquinto, Francesco Purrello, Antonino Di Pino, Salvatore Piro, Renzo Rozzini, Lina Falanga, Elena Spazzini, Camillo Ferrandina, Giuseppe Montrucchio, Paolo Petitti, Raffaella Salmi, Piergiorgio Gaudenzi, Francesco Violi, Ludovica Perri, Raffaele Landolfi, Massimo Montalto, Antonio Mirijello, Luigina Guasti, Luana Castiglioni, Andrea Maresca, Alessandro Squizzato, Marta Molaro, Alessandra Grossi, Marco Bertolotti, Chiara Mussi, Maria Vittoria Libbra, Giulia Dondi, Elisa Pellegrini, Lucia Carulli, Francesco Perticone, Lidia Colangelo, Tania Falbo, Vincenzo Stanghellini, Roberto De Giorgio, Eugenio Ruggeri, Sara Del Vecchio, Andrea Salvi, Roberto Leonardi, Giampaolo Damiani, Armando Gabrielli, William Capeci, Massimo Mattioli, Giuseppe Pio Martino, Lorenzo Biondi, Pietro Pettinari, Riccardo Ghio, Anna Dal Col, Salvatore Minisola, Luciano Colangelo, Antonella Afeltra, Benedetta Marigliano, Maria Elena Pipita, Pietro Castellino, Julien Blanco, Luca Zanoli, Samuele Pignataro, Valter Saracco, Marisa Fogliati, Carlo Bussolino, Francesca Mete, Miriam Gino, Antonio Cittadini, Carlo Vigorito, Michele Arcopinto, Andrea Salzano, Emanuele Bobbio, Alberto Maria Marra, Domenico Sirico, Guido Moreo, Francesca Gasparini, Silvia Prolo, Gloria Pina, Alberto Ballestrero, Fabio Ferrando, Sergio Berra, Simonetta Dassi, Maria Cristina Nava, Bruno Graziella, Stefano Baldassarre, Salvatore Fragapani, Gabriella Gruden, Giorgio Galanti, Gabriele Mascherini, Cristian Petri, Laura Stefani, Margherita Girino, Valeria Piccinelli, Francesco Nasso, Vincenza Gioffrè, Maria Pasquale, Giuseppe Scattolin, Sergio Martinelli, Mauro Turrin, Leonardo Sechi, Cristina Catena, Gianluca Colussi, Nicola Passariello, Luca Rinaldi, Franco Berti, Giuseppe Famularo, Tarsitani Patrizia, Roberto Castello, Michela Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta Morganti, Andrea Artoni, Stefano Del Giacco, Davide Firinu, Francesca Losa, Giovanni Paoletti, Giuseppe Montalto, Anna Licata, Valentina Malerba, Lasco Antonino, Giorgio Basile, Catalano Antonino, Lorenzo Malatino, Benedetta Stancanelli, Valentina Terranova, Salvatore Di Marca, Patrizia Mecocci, Carmelinda Ruggiero, Virginia Boccardi, Tiziana Meschi, Fulvio Lauretani, Andrea Ticinesi, Pietro Minuz, Luigi Fondrieschi, Mario Pirisi, Gian Paolo Fra, Daniele Sola, Massimo Porta, Piero Riva, Roberto Quadri, Giorgio Scanzi, Caterina Mengoli, Stella Provini, Laura Ricevuti, Emilio Simeone, Rosa Scurti, Fabio Tolloso, Roberto Tarquini, Alice Valoriani, Silvia Dolenti, Giulia Vannini, Alberto Tedeschi, Lucia Trotta, Riccardo Volpi, Pietro Bocchi, Alessandro Vignali, Sergio Harari, Chiara Lonati, Mara Cattaneo, Ramirez Duque Nieves, Muela Molinero Alberto, Abad Requejo Pedro, Lopez Pelaez Vanessa, Tamargo Lara, Corbella Viros Xavier, Formiga Francesc, Diez Manglano Jesus, Bejarano Tello Esperanza, Del Corral Behamonte Esther, Sevil Puras Maria, Manuel Romero, Pinilla Llorente Blanca, Lopez Gonzalez-Cobos Cristina, Villalba Garcia M Victoria, Lopez Saez, Juan Bosco, Sanz Baena Susana, Arroyo Gallego Marta, Gonzalez Becerra Concepcion, Fernandez Moyano Antonio, Mercedes Gomez Hernandez, Manuel Poyato Borrego, Pacheco Cuadros Raquel, Perez Rojas Florencia, Garcia Olid Beatriz, Carrascosa Garcia Sara, Gonzalez-Cruz Cervellera Alfonso, Peinado Martinez Marta, Sara Carrascosa Garcia, Ruiz Cantero Alberto, Albarracín Arraigosa Antonio, Godoy Guerrero Montserrat, Barón Ramos Miguel Ángel, Machin Jose Manuel, Novo Veleiro Ignacio, Alvela Suarez Lucía, Lopez Alfonso, Rubal Bran David, Iñiguez Vazquez Iria, Rios Prego Monica