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van Hout L, Harker MJR, Vriens PWHE, Bökkerink WJV. Identifying postoperative complications after inguinal hernia repair with a smartphone application: a comparative cohort study. Hernia 2024:10.1007/s10029-024-03019-7. [PMID: 38506944 DOI: 10.1007/s10029-024-03019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The Q1.6 Inguinal Hernia application continuously measures patient-reported outcomes (PROs) by sampling experiences through brief, digital and condition-specific questions, utilising micro-moments. This can overcome the limitations of current paper questionnaires and give real-time insight into patient recovery. This exploratory study compares data from the application with retrospective data from electronic medical records (EMRs) to provide information on its accuracy in detecting postoperative complications after inguinal hernia repair. METHODS Patients were asked to use the application in addition to their usual care. The application employs twitch crowdsourcing to gather PROs. Questions from validated and frequently used questionnaires were integrated. A retrospective assessment of EMRs was combined with an additional telephone interview. The primary endpoints were the sensitivity and specificity of the application in detecting chronic postoperative inguinal pain, recurrence and surgical-site infection (SSI). RESULTS A total of 215 patients were analysed. The sensitivity and specificity for detecting chronic postoperative inguinal pain were 100% (95% CI [47.8%, 100%]) and 93.7% (95% CI [88.3%, 97.1%]), respectively. For recurrence, the sensitivity was 77.8% (95% CI [40.0%, 97.2%]), and the specificity was 81.3% (95% CI [75.0%, 86.5%]). For SSI, the sensitivity and specificity were 75.0% (95% CI [19.4%, 99.4%]) and 89.8% (95% CI [84.8%, 93.6%]), respectively. CONCLUSION This study demonstrates satisfactory measurement capabilities of the Q1.6 Inguinal Hernia application for identifying postoperative complications following inguinal hernia repair. However, certain aspects require further improvement, such as addressing error-prone questions, enhancing long-term compliance, and validating (pain) measurements through prospective control data. TRAIL REGISTRATION NUMBER NL7813 (Dutch Trial Registry), 19 May 2019.
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Affiliation(s)
- L van Hout
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
| | - M J R Harker
- Department of Surgery, Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - P W H E Vriens
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
| | - W J V Bökkerink
- Department of Surgery, Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
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Meng S, Meng M, Wang S, Zheng W. Analysis of surgical site infection and tumour-specific survival rate in patients with renal cell carcinoma after laparoscopic radical nephrectomy. Int Wound J 2024; 21:e14711. [PMID: 38387886 PMCID: PMC10834101 DOI: 10.1111/iwj.14711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
Surgical site infections (SSIs) may pose a significant risk to patients undergoing surgery. This study aims to explore the risk factors for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma and the impact of infection on tumour-specific survival (CSS) after nephrectomy for renal cell carcinoma. To explore the risk factors for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma and the impact of infection on tumour-specific survival (CSS) after nephrectomy for renal cell carcinoma. A retrospective analysis was conducted on 400 patients in our hospital from June 2021 to June 2023. This study divided patients into two groups: those with SSI and those without SSI. Collect general data and information related to the operating room. Clearly defined inclusion and exclusion criteria. Select surgical time, laminar mobile operating room use, and intraoperative hypothermia as observation indicators. Perform statistical analysis using SPSS 25.0 software, including univariate, multivariate, and survival analyses of wound-infected and uninfected patients. Out of 400 patients, 328 had no SSIs, 166 died during follow-up, 72 had SSIs, and 30 died during follow-up. There was no statistically significant difference (p > 0.05) in comparing primary data between individuals without SSIs and those with SSIs. There were statistically significant differences (p < 0.05) in surgical time, nonlaminar flow operating room use, and intraoperative hypothermia. The postoperative survival time of SSI patients with a tumour diameter of 7.0-9.9 cm was significantly longer than that of SSI patients, and the difference was statistically significant (p < 0.05). The occurrence of severe infection in patients with other tumour diameters did not affect postoperative survival, and the difference was not statistically significant (p > 0.05). After multiple factor analysis, it was found that severe infection can prolong the postoperative survival of patients with tumour diameter exceeding 7 cm (HR = 0.749, p < 0.05). This study identified nonlaminar flow operating rooms, prolonged surgical time, and intraoperative hypothermia as significant risk factors for SSIs. After nephrectomy for renal cell carcinoma patients with a tumour diameter of 7-9.9 μ m, perioperative infection can prolong their survival. However, it has no significant effect on patients with other tumour diameters.
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Affiliation(s)
- Shuai Meng
- Department of UrologyFirst Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouChina
| | - Meng Meng
- Department of PharmacyJinan Zhangqiu District Hospital of TCMJinanChina
| | - Shouwu Wang
- Department of PharmacyJinan Zhangqiu District Hospital of TCMJinanChina
| | - Wei Zheng
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
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Shen J, Xie X, Meng Y, Mu Y. Predictive value of preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio combined with operating room factors for surgical site infection after laparoscopic radical nephrectomy in renal cell carcinoma patients. Int Wound J 2024; 21:e14400. [PMID: 37718121 PMCID: PMC10788578 DOI: 10.1111/iwj.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) can pose significant risks to patients undergoing surgical procedures. This study aimed to investigate the risk factors and diagnostic value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma. METHODS A retrospective analysis of 866 patients at our hospital was conducted between June 2016 and June 2022. The study divided patients into two groups: those with SSIs and those without. General data and operative room-related information were collected. Inclusion and exclusion criteria were clearly defined. Peripheral blood indicators were analysed, and observation indicators were meticulously selected, including surgery time, usage of a laminar flow operating room and intraoperative hypothermia. Statistical analysis was performed using SPSS 25.0 software, including univariate, multivariate analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Thirty-six out of 866 patients developed SSIs. Statistically significant differences were found for surgery time, usage of non-laminar flow operating rooms and intraoperative hypothermia (p < 0.05). ROC curve analysis showed an AUC of 0.765 (95% CI: 0.636-0.868) for serum NLR and PLR, with optimal cut-off values at NLR 4.8 and PLR 196, indicating moderate to strong discriminative ability for SSIs. CONCLUSIONS The study identified non-laminar flow operating rooms, extended surgery time, and intraoperative hypothermia as significant risk factors for SSIs. Serum NLR and PLR were found valuable as biomarkers for SSIs diagnosis, holding potential for preoperative risk assessment and improved patient safety in renal cell carcinoma care.
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Affiliation(s)
- Jun Shen
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Xun Xie
- Department of NephrologyThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Yonghui Meng
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Youyou Mu
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
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Liu JKC, Kang R, Bilenkin A, Prorok R, Whiting J, Patel KB, Beer-Furlan A, Naso C, Rogers A, Castro XB, Peguero E, Mokhtari S, Tran N, Etame A, Pina Y, Spiess PE, Forsyth P, Vogelbaum MA. Patient satisfaction and cost savings analysis of the telemedicine program within a neuro-oncology department. J Neurooncol 2022; 160:517-525. [PMID: 36367630 PMCID: PMC9651094 DOI: 10.1007/s11060-022-04173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
Purpose Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person visits within a Neuro-Oncology Program to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine. Methods 1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) by surgical and medical neuro-oncology patients between 04/01/2020 and 06/30/2021 were reviewed. Survey results were divided into 4 categories (Access, Provider, Technology (telemedicine only), and Overall Satisfaction). Results were analyzed for the impact of telemedicine versus in-person visits, and gender, age, insurance, and specialty. Cost savings were calculated based on potential travel distance and lost productivity. Results Survey results from telemedicine visits demonstrated that patients with private insurance returned higher scores in the Provider (p = 0.0089), Technology (p = 0.00187), and Overall (p = 0.00382) categories. Surgical patients returned higher scores for Access (p = 0.0015), Technology (p = 0.0002), and Overall (p = 0.0019). When comparing telemedicine to in-person scores, in-person scored higher in Provider (p = 0.0092) for all patients, while in-person scored higher in Access (p = 0.0252) amongst surgical patients. Cost analysis revealed that telemedicine allowed patients to save an average of 4.1 to 5.6 h per visit time and a potential cost savings of up to $223.3 ± 171.4. Conclusion Telemedicine yields equivalent patient satisfaction when employed in surgical as compared to medical Neuro-Oncology patients with the potential to lessen the financial and time burden on neuro-oncology patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-022-04173-7
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Affiliation(s)
- James K C Liu
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA.
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Richard Kang
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Arkady Bilenkin
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rachel Prorok
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Junmin Whiting
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Krupal B Patel
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andre Beer-Furlan
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Cristina Naso
- Virtual Health Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Rogers
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Xavier Baez Castro
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Edwin Peguero
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Sepideh Mokhtari
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Nam Tran
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Arnold Etame
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Yolanda Pina
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Philippe E Spiess
- Department of GU Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter Forsyth
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Michael A Vogelbaum
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
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Kateera F, Riviello R, Goodman A, Nkurunziza T, Cherian T, Bikorimana L, Nkurunziza J, Nahimana E, Habiyakare C, Ntakiyiruta G, Matousek A, Gaju E, Gruendl M, Powell B, Sonderman K, Koch R, Hedt-Gauthier B. The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e35155. [PMID: 35675108 PMCID: PMC9218905 DOI: 10.2196/35155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings. Objective This trial assesses whether CHW’s use of a mobile health (mHealth)–facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district. Methods A total of 1025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7%), (2) phone call intervention (n=334, 32.6%), and (3) standard of care (n=356, 34.7%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care. Results The majority of women in Arm 1 (n=295, 88.1%) and Arm 2 (n=226, 67.7%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7%, Arm 2: 98.4%, and Arm 3: 99.7%, respectively). Conclusions Home-based post–c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy. Trial Registration ClinicalTrials.gov NCT03311399; https://clinicaltrials.gov/ct2/show/NCT03311399
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Affiliation(s)
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
| | - Andrea Goodman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Theoneste Nkurunziza
- Partners in Health, Kigali, Rwanda
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Teena Cherian
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | - Alexi Matousek
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Erick Gaju
- Rwanda Ministry of Health, Kigali, Rwanda
| | - Magdalena Gruendl
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Brittany Powell
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Kristin Sonderman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Rachel Koch
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bethany Hedt-Gauthier
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Telemedicine for Surgical Site Infection Diagnosis in Rural Rwanda: Concordance and Accuracy of Image Reviews. World J Surg 2022; 46:2094-2101. [PMID: 35665833 DOI: 10.1007/s00268-022-06597-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND In rural Africa where access to medical personnel is limited, telemedicine can be leveraged to empower community health workers (CHWs) to support effective postpartum home-based care after cesarean section (c-section). As a first step toward telemedicine, we assessed the sensitivity, specificity, and interrater reliability of image-based diagnosis of surgical site infections (SSIs) among women delivering via c-section at a rural Rwandan Hospital. METHODS Women ≥18 years who underwent c-section from March to October 2017 at Kirehe District Hospital (KDH) were enrolled. On postoperative day 10 at KDH, participants underwent a physical examination by a general practitioner, who provided a diagnosis of SSI or no SSI. Trained CHWs photographed patients' incisions and the collected images were shown to six physicians, who upon review, assigned one of the following diagnoses to each image: definite SSI, suspected SSI, suspected no SSI, and definite no SSI, which were compared with the diagnoses based on physical exam. We report the sensitivity and specificity and assessed reviewer agreement using Gwet's AC1. RESULTS 569 images were included, with 61 women (10.7%) diagnosed with an SSI. Of the 3414 image-reviews, 49 (1.4%) could not be assigned diagnoses due to image quality. The median sensitivity and specificity were 0.83 and 0.69, respectively. The Gwet's AC1 estimate for binary classification was 0.46. CONCLUSIONS We demonstrate decent accuracy but only moderate consistency for photograph-based SSI diagnosis. Strategies to improve overall agreement include providing clinical information to accompany photographs, providing a baseline photograph for comparison, and implementing photograph-taking processes aimed at improving image quality.
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Dionisi S, Giannetta N, Di Simone E, Ricciardi F, Liquori G, De Leo A, Moretti L, Napoli C, Di Muzio M, Orsi GB. The Use of mHealth in Orthopedic Surgery: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12549. [PMID: 34886274 PMCID: PMC8657184 DOI: 10.3390/ijerph182312549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 01/25/2023]
Abstract
(1) Background: It is well known that the success of surgical procedures is related to optimal postoperative management and follow-up. In this regard, mHealth technologies could potentially improve perioperative care. Based on these considerations, the objective of this scoping review is to evaluate the current status and use of mHealth interventions designed to provide perioperative care in orthopedic surgery. (2) Methods: This scoping review was conducted in accordance with the PRISMA statement (Extension for Scoping Review) and follows the framework of Arskey and O'Malley. (3) Results: The use of mHealth in the surgical setting is mainly oriented towards the development of applications for monitoring post-operative pain and optimizing communication between the various health professionals involved in patient care. (4) Conclusions: The mHealth systems can have a positive impact both on patient participation in the therapeutic process and on the communication between health professionals, increasing the quality of care.
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Affiliation(s)
- Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (S.D.); (G.L.); (A.D.L.)
| | - Noemi Giannetta
- Faculty of Philosophy, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Department, IRCCS Istituti Fisioterapici Ospitalieri—IFO, 00144 Rome, Italy;
| | - Francesco Ricciardi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (F.R.); (M.D.M.)
| | - Gloria Liquori
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (S.D.); (G.L.); (A.D.L.)
| | - Aurora De Leo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (S.D.); (G.L.); (A.D.L.)
| | - Lorenzo Moretti
- Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Christian Napoli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (F.R.); (M.D.M.)
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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