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Sarno G, Iacone B, Tedesco A, Gargiulo A, Ranieri A, Giordano A, Tramontano S, Bracale U. End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches. Hernia 2024:10.1007/s10029-024-03026-8. [PMID: 38625435 DOI: 10.1007/s10029-024-03026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Parastomal hernia (PSH) is the most common and challenging complication after stoma creation, with an estimated 50% incidence 2 years after the index surgery. Mesh repair is the treatment of choice. Laparoscopic and/or robotic approaches allow acceptable outcomes. MATERIALS AND METHODS A systematic literature review from January 2012 to November 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Embase, PubMed, and Scopus search were performed to select articles dealing with minimally invasive surgical treatment for PSH after end colostomy. RESULTS 603 studies were found, and 24 were chosen. When compared to open surgery, laparoscopy showed decreased postoperative complications and recurrence. The main laparoscopic approaches are the keyhole (KH), the Sugarbaker (SB), and the sandwich technique. Continuous improvement in surgery, mesh technology, and surgeons' expertise led to an amelioration of surgical outcome and recurrence rate after repair. Recent studies showed comparable outcomes for SB and KH techniques, while novel surgical approaches have been proposed in an attempt to further increase the operative and long-term results. Reports on PSH robotic repairs are scarce and describe small series results, suggesting a role of the initial learning curve as a risk factor for complications. CONCLUSION End-colostomy PSH surgical repair still represents a challenge for surgeons. Recent evidence has not shown a significant advantage in postoperative complications and recurrence with a specific repair among SB, KH, and sandwich technique. The paucity of data on robotic surgery does not allow to draw definitive conclusion. Further primary, multicentric, and larger cohort studies are needed.
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Affiliation(s)
- G Sarno
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy.
| | - B Iacone
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Tedesco
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Gargiulo
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Ranieri
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Giordano
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - S Tramontano
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - U Bracale
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
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MacNeil E, Lau J, Tedesco A, Babaei-Rad R, Hutton L. Managing opioids and mitigating opioid risks in patients with cancer: An environmental scan of the attitudes, confidence, and practices of ambulatory, community and hospital pharmacists practicing in Canada. J Oncol Pharm Pract 2023:10781552231200169. [PMID: 37743630 DOI: 10.1177/10781552231200169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Canada is in the midst of an overdose crisis. The use of prescription opioids in Canada has increased steadily over the past two decades, with stark increases in opioid-induced respiratory depression and related deaths. Opioids are the mainstay of treatment for cancer-related pain. Patients with cancer are not immune to the risks associated with opioid use but are underrepresented in available literature outlining risk mitigation strategies. Pharmacists are ideally placed to employ opioid risk mitigation practices to support safe and effective opioid use for patients with cancer-related pain. However, the current attitudes, confidence, and safety practices of pharmacists around how to best support these patients are not known. METHODS This study was a descriptive environmental scan of pharmacists who provide direct patient care in Canada. An electronic questionnaire was built using the web based Opinio software. It was distributed via email by several provincial and national pharmacy organizations and online platforms. The questionnaire consisted of Likert-scale and open-ended questions and was open to participants for a 6-week period from February 12th to March 23rd, 2020. Analysis was conducted using descriptive statistics and qualitative content analysis. RESULTS Eighty-one responses from pharmacists in nine provinces were included in the analysis. Respondents endorsed limited and varied practices when caring for patients receiving opioids for cancer-related pain. Further, they demonstrated wide ranging confidence and attitudes regarding opioid risk mitigation practices and beliefs. Less than 50% of pharmacists were aware of resources available for their patients with non-medical opioid use, and/or patients at high risk of opioid-induced respiratory depression. Education, resources, and communication were the most commonly reported perceived facilitators and barriers to resource use. CONCLUSIONS Pharmacists in Canada report employing opioid risk mitigation practices with low and varied frequency when caring for patients receiving opioids for cancer-related pain. They endorsed varied confidence and limited awareness of available provider and patient resources. These findings may help inform the development of new education models and evidence-based guidelines. New education models and evidence-based guidelines will support pharmacists in their pharmaceutical care of this vulnerable patient population, ultimately aiming to improve patient outcomes.
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Affiliation(s)
- Erin MacNeil
- Department of Pharmacy, Nova Scotia Health, Nova Scotia, Canada
| | - Jenny Lau
- Department of Supportive Care, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Alissa Tedesco
- Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Lauren Hutton
- Department of Pharmacy, Nova Scotia Health, Nova Scotia, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia
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Buchanan N, Dosani N, Bond A, Spaner D, Tedesco A, Persaud N, Morey T. Palliative Education and Care for the Homeless (PEACH): A Model of Outreach Palliative Care for Structurally Vulnerable Populations. Healthc Q 2023; 26:24-30. [PMID: 37144698 DOI: 10.12927/hcq.2023.27055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The Palliative Education and Care for the Homeless (PEACH) program comprises a community palliative care team serving some of the most complex clients in the healthcare system. Formal partnerships bring together physician, nursing, psychosocial and homecare, health and housing navigation supports. PEACH has served over 1,000 clients, leading field-defining research, medical education and public advocacy. The PEACH program demonstrates that innovation through deep interorganizational and intersectoral integration can drive value-based impact for the most complex clients, providing instructive lessons for public health system reform well beyond the margins faced by people who are unhoused. This paper describes how PEACH's unique model, critical community partnerships and research have been necessary for it to become a leader in community-based palliative care for structurally vulnerable people.
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Affiliation(s)
- Nicole Buchanan
- Is a palliative care fellow at the University of Toronto, based in Toronto, ON. She is interested in improving the accessibility of palliative care for structurally vulnerable populations. Nicole can be reached by e-mail at
| | - Naheed Dosani
- Is a palliative care physician at the Department of Family and Community Medicine of St Michael's Hospital at Unity Health Toronto and an assistant professor at the University of Toronto, based in Toronto, ON. A health justice activist, Naheed is the founder and lead physician of the PEACH program at ICHA
| | - Andrew Bond
- Is a medical director and community justice physician at ICHA and a lecturer at the Department of Family and Community Medicine, University of Toronto, based in Toronto, ON. He is the founder and co-chair of the Canadian Network for the Health and Housing of People Experiencing Homelessness. As a physician executive, he is dedicated to radically rethinking the design and delivery of healthcare systems bringing together health, home and community for population health equity
| | - Donna Spaner
- Is a clinical director at the Palliative Care Program - Toronto Grace Health Centre and a PEACH physician at ICHA, based in Toronto, ON. She has an interest in working with structurally vulnerable clients and has been with the PEACH program since 2016
| | - Alissa Tedesco
- Is a palliative care physician at the Temmy Latner Centre for Palliative Care, Sinai Health System, and a PEACH physician at ICHA, based in Toronto, ON. She is also a lecturer at the University of Toronto who works to improve equitable access to high-quality care to structurally vulnerable populations through her work
| | - Nadine Persaud
- Is the executive director at Kensington Hospice and the senior director of Client Services at Kensington Health, based in Toronto, ON. She has been working in the palliative care field for the past 16 years. Through her multiple leadership positions and her clinical practice, Nadine works to ensure that palliative care is equitable and accessible with the overall goal of supporting individuals to live well
| | - Trevor Morey
- Is a palliative care physician at PEACH, ICHA, based in Toronto, ON. He has a passion for ensuring equitable access to palliative care
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Robinson L, Trevors Babici L, Tedesco A, Spaner D, Morey T, Dosani N. Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation. Palliat Med 2022; 37:646-651. [PMID: 36576315 PMCID: PMC10074742 DOI: 10.1177/02692163221146812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health navigators are healthcare professionals who specialize in care coordination, case management, navigating transitions, and reducing barriers to care. There is limited literature on the impact of health navigators on community-based palliative care for people experiencing homelessness. AIM We devised key performance indicators in nine categories with the aim to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness. DESIGN Data were collected prospectively for all patient encounters involving a health navigator from July 2020 to 2021 and reviewed to determine the distribution of the health navigator's role and the ways in which patient care was impacted. SETTING AND PARTICIPANTS This study was conducted in Toronto, Ontario with the Palliative Education and Care for the Homeless (PEACH) Program. At any one time, the PEACH health navigator served a total of 50 patients. RESULTS We identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones. The health navigator role was split evenly between activities pertaining to palliative care for structurally vulnerable populations and community-based palliative care for the general population. To achieve high impact outcomes, a considerable investment of time and energy was required of the health navigator, speaking to the importance of adequate and sustainable funding. CONCLUSIONS These findings underscore the potential for health navigators to add value to community-based palliative care teams, especially those caring for structurally vulnerable populations.
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Affiliation(s)
- Lilian Robinson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Leeann Trevors Babici
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada.,Second Mile Club, Kensington Health, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Donna Spaner
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Trevor Morey
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Naheed Dosani
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
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Buchman DZ, Lo S, Ding P, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies, and programs and guidelines. Palliat Med 2022; 37:426-443. [PMID: 36522840 PMCID: PMC9760505 DOI: 10.1177/02692163221143153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. AIM To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. DESIGN Scoping review. DATA SOURCES We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. RESULTS Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. CONCLUSIONS Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics.
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Affiliation(s)
- Daniel Z Buchman
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philip Ding
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Naheed Dosani
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
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Buchman DZ, Ding P, Lo S, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use substances during communicable disease epidemics and pandemics: a scoping review protocol. BMJ Open 2021; 11:e053124. [PMID: 34706961 PMCID: PMC8551744 DOI: 10.1136/bmjopen-2021-053124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Communicable disease epidemics and pandemics magnify the health inequities experienced by marginalised populations. People who use substances suffer from high rates of morbidity and mortality and should be a priority to receive palliative care, yet they encounter many barriers to palliative care access. Given the pre-existing inequities to palliative care access for people with life-limiting illnesses who use substances, it is important to understand the impact of communicable disease epidemics and pandemics such as COVID-19 on this population. METHODS AND ANALYSIS We will conduct a scoping review and report according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. We conducted a comprehensive literature search in seven bibliographical databases from the inception of each database to August 2020. We also performed a grey literature search to identify the publications not indexed in the bibliographical databases. All the searches will be rerun in April 2021 to retrieve recently published information because the COVID-19 pandemic is ongoing at the time of this writing. We will extract the quantitative data using a standardised data extraction form and summarise it using descriptive statistics. Additionally, we will conduct thematic qualitative analyses and present our findings as narrative summaries. ETHICS AND DISSEMINATION Ethics approval is not required for a scoping review. We will disseminate our findings to healthcare providers and policymakers through professional networks, digital communications through social media platforms, conference presentations and publication in a scientific journal.
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Affiliation(s)
- Daniel Z Buchman
- Bioethics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Philip Ding
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Samantha Lo
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Naheed Dosani
- Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, University Health Network, Toronto, Ontario, Canada
| | - Sarina R Isenberg
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheryl Spithoff
- Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alissa Tedesco
- Inner City Health Associates, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
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Lau J, Mazzotta P, Fazelzad R, Ryan S, Tedesco A, Smith AJ, Sud A, Furlan AD, Zimmermann C. Assessment tools for problematic opioid use in palliative care: A scoping review. Palliat Med 2021; 35:1295-1322. [PMID: 34000897 PMCID: PMC8267087 DOI: 10.1177/02692163211015567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Screening for problematic opioid use is increasingly recommended in patients receiving palliative care. AIM To identify tools used to assess for the presence or risk of problematic opioid use in palliative care. DESIGN Scoping review. DATA SOURCES Bibliographic databases (inception to January 31, 2020), reference lists, and grey literature were searched to find primary studies reporting on adults receiving palliative care and prescription opioids to manage symptoms from advanced cancer, neurodegenerative diseases, or end-stage organ diseases; and included tools to assess for problematic opioid use. There were no restrictions based on study design, location, or language. RESULTS We identified 42 observational studies (total 14,431 participants) published between 2009 and 2020 that used questionnaires (n = 32) and urine drug tests (n = 21) to assess for problematic opioid use in palliative care, primarily in US (n = 38) and outpatient palliative care settings (n = 36). The questionnaires were Cut down, Annoyed, Guilty, and Eye-opener (CAGE, n = 8), CAGE-Adapted to Include Drugs (CAGE-AID, n = 6), Opioid Risk Tool (n = 9), Screener and Opioid Assessment for Patients with Pain (SOAPP; n = 3), SOAPP-Revised (n = 2), and SOAPP-Short Form (n = 5). Only two studies' primary objectives were to evaluate a questionnaire's psychometric properties in patients receiving palliative care. There was wide variation in how urine drug tests were incorporated into palliative care; frequency of abnormal urine drug test results ranged from 8.6% to 70%. CONCLUSION Given the dearth of studies using tools developed or validated specifically for patients receiving palliative care, further research is needed to inform clinical practice and policy regarding problematic opioid use in palliative care.
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Affiliation(s)
- Jenny Lau
- Division of Palliative Care, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Paolo Mazzotta
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Rouhi Fazelzad
- UHN Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Suzanne Ryan
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada
| | - Alissa Tedesco
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Andrew J Smith
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Medical Psychiatry Alliance, Toronto, ON, Canada
| | - Andrea D Furlan
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute for Work and Health, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology, University of Toronto, Toronto, ON, Canada
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Tedesco A, Shanks L, Dosani N. The Good Wishes Project: An End-of-Life Intervention for Individuals Experiencing Homelessness. Palliat Med Rep 2020; 1:264-269. [PMID: 34223486 PMCID: PMC8241317 DOI: 10.1089/pmr.2020.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Individuals experiencing homelessness face marginalization, dehumanization, and barriers to accessing quality palliative care. Inspired by the 3 Wishes Project, the Good Wishes Project (GWP) facilitates granting wishes to individuals experiencing homelessness and receiving palliative care with a goal of enhancing comfort and personalizing the end-of-life experience. Objective: The main objective of this study was to elicit provider perspectives on the utility of the GWP in the delivery of end-of-life care to a population of homeless and vulnerably housed individuals. Design: For this qualitative study, GWP client information and wish data were collected anonymously and analyzed quantitatively and descriptively. Semistructured interviews were conducted with health and social service professionals who cared for GWP clients. Interviews were recorded, transcribed, and analyzed through qualitative content analysis. Results: At the time of evaluation, there were a total of 27 clients in the GWP. At 14 months after the project's launch, 40 wishes had been made, 24 of which had been granted. Wishes were classified into five categories: basic necessities, end-of-life preparations, personal connections, paying-it-forward, and leisure. From the provider perspective (n = 7), the project was found to have utility in three main domains: establishing and enhancing connection, satisfying basic needs, and promoting person-centered care. Conclusions: The GWP is a promising psychosocial intervention in providing quality palliative care to individuals experiencing homelessness, whose lives have largely been burdened with hardship and marginalization.
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Affiliation(s)
| | - Leslie Shanks
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates, Toronto, Ontario, Canada
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Chun-Leung Chau D, Wang D, Tedesco A, McGuffin M, Di Prospero L, Fitch M, Cao X, Feldman-Stewart D, Ellis J, Szumacher E. Prostate Cancer Patients' Preferences for Intermittent vs. Continuous Androgen Deprivation-A Pilot Institutional Study. J Med Imaging Radiat Sci 2016; 47:108-112.e2. [PMID: 31047156 DOI: 10.1016/j.jmir.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With locally advanced, recurrent, and metastatic prostate cancer patients, patient preference between intermittent (IAD) and continuous (CAD) androgen deprivation therapy has not been investigated. The goal of the study was to determine patients' preference for IAD vs. CAD therapy. The secondary aim was to elucidate demographic or treatment variables that may affect a patient's preference for one type of hormonal treatment. MATERIALS AND METHODS Using a tradeoff model that demonstrates the difference in outcome between IAD and CAD, a survey questionnaire was developed and administered to prostate cancer patients at the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. Only patients who had (1) locally advanced prostate cancer, (2) been previously treated for prostate cancer with relapsing prostate-specific antigen, or (3) slow metastatic disease were asked to participate. Data related to patients' demographic information and their decisional preference factors were collected. RESULTS AND CONCLUSIONS Overall, 36 of 53 (68%) patients completed the survey. Most patients favoured IAD (n = 32) over CAD (n = 4). Patients currently on radical treatment (adjuvant hormone therapy and radiation therapy) preferred CAD compared with patients who were not on radical treatment (P = .044). Patients with high (>20 ng/L) pretreatment prostate-specific antigen showed preference for CAD; however, this was not statistically significant (P = 0.07). Patients from both groups viewed quality of life as the strongest influence on their treatment preference, but had diverging opinions on side effects and general well being. The results of this pilot study could serve as a guide for future studies; a larger study combined with qualitative methodology may better address patients' needs and minimize any regret over their hormonal treatment.
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Affiliation(s)
| | - David Wang
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Alissa Tedesco
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Merrylee McGuffin
- Department of Radiation Therapy, Sunnybrook Odette Cancer Centre, Toronto, Ontario
| | - Lisa Di Prospero
- Department of Research and Education, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario; Department of Radiation Oncology, University of Toronto, Toronto, Ontario
| | - Margaret Fitch
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Xingshan Cao
- Department of Evaluative Clinical Science, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | | | - Janet Ellis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Ewa Szumacher
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario.
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10
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Schena FP, De Cesaris R, Tedesco A, La Raia E, Bonomo L. Urinary excretion of beta-2-microglobulin and albumin during antibiotic therapy in urinary tract infections. Contrib Nephrol 2015; 26:42-9. [PMID: 6169487 DOI: 10.1159/000396103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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11
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Croisile B, Tedesco A, Bernard E, Gavant S, Minssieux-Catrix G, Mollion H. [Diagnostic profile of young-onset dementia before 65 years. Experience of a French Memory Referral Center]. Rev Neurol (Paris) 2011; 168:161-9. [PMID: 22104064 DOI: 10.1016/j.neurol.2011.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/01/2011] [Accepted: 09/14/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to compare the profiles of patients with young (age≤65 years) and late (age>65 years) onset of dementia in a memory clinic of a Memory Referral Center in Lyons (France), for the year 2008. METHODS A total of 746 demented patients were evaluated using clinical, neuropsychological and imaging information. For each patient, diagnoses of the dementing disorder used clinical criteria at the first visit. We examined the distribution of patients diagnosis and differences in sex and education between the young-onset dementia (YOD) and the late-onset dementia (LOD) groups. RESULTS From a total of 746 registered demented patients (300 men, 446 women), there were 91 patients (12.2%) with YOD (from 36.5 to 65 years) and 655 patients with LOD (from 66 to 92 years). Among the 91 YOD patients, the most frequent causes were Mild Cognitive Impairment (MCI) (18.7%), then Alzheimer's disease (AD), frontotemporal dementia and posterior cortical atrophy (14.3% each), followed by progressive aphasia (11.0%), dementia with Lewy bodies (DLD) (9.9%), semantic dementia (8.8%), other causes (3.3%), vascular dementia (2.2%), undetermined dementia (2.2%), AD+cerebrovascular disease (1.1%). Among the 655 LOD patients, AD was the most frequent cause of dementia (57.4%). Referred cases by a specialist doctor were 50.5% in the YOD group and 12.7% in the LOD group (P<0.0001). In the ACP group, 68.4% patients began before 65 years. CONCLUSION The number of YOD in our memory clinic was four-fold the number of expected patients in France. The characteristics of the Referral Center explain the high frequency of rare dementia such as progressive aphasia (5.2% of overall number), semantic dementia (3.6%) and posterior cortical atrophy (2.5%).
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Affiliation(s)
- B Croisile
- Service de neuropsychologie, centre mémoire de ressources et de recherche de Lyon, hôpital neurologique, 59, boulevard Pinel, 69677 Bron cedex, France.
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12
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Durante-Mangoni E, Ravasio V, Tripodi MF, Stellini R, Barzaghi N, Del Bono V, Chinello P, Delle Foglie P, Di Caprio D, Tedesco A, Rizzi M, Suter F, Utili R. 078 HEART FAILURE IN INFECTIVE ENDOCARDITIS: A REPORT FROM THE MULTICENTER, PROSPECTIVE, OBSERVATIONAL STUDY ON ENDOCARDITIS IN ITALY (SEI). Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Tedesco A, D'Agostino D, Soriente I, Amato P, Piccoli R, Sabatini P. A new strategy for the early diagnosis of rheumatoid arthritis: A combined approach. Autoimmun Rev 2009; 8:233-7. [DOI: 10.1016/j.autrev.2008.07.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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De Lorenzo C, Tedesco A, Terrazzano G, Cozzolino R, Laccetti P, Piccoli R, D'Alessio G. A human, compact, fully functional anti-ErbB2 antibody as a novel antitumour agent. Br J Cancer 2004; 91:1200-4. [PMID: 15305184 PMCID: PMC2747711 DOI: 10.1038/sj.bjc.6602110] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A new human, compact antibody was engineered by fusion of a human, antitumour ErbB2-directed scFv with a human IgG1 Fc domain. Overexpression of the ErbB2 receptor is related to tumour aggressiveness and poor prognosis. This new immunoagent meets all criteria for a potential anticancer drug: it is human, hence poorly or not immunogenic; it binds selectively and with high affinity to target cells, on which it exerts an effective and selective antiproliferative action, including both antibody-dependent and complement-dependent cytotoxicity; it effectively inhibits tumour growth in vivo. Its compact molecular size should provide for an efficient tissue penetration, yet suitable to a prolonged serum half-life.
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MESH Headings
- Animals
- Antibodies/pharmacology
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/pharmacology
- Base Sequence
- CHO Cells
- Cell Division/drug effects
- Cell Line, Tumor
- Cricetinae
- DNA Primers
- Female
- Humans
- Mice
- Mice, Inbred BALB C
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/pathology
- Polymerase Chain Reaction
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/immunology
- Recombinant Fusion Proteins/pharmacology
- Trastuzumab
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Affiliation(s)
- C De Lorenzo
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy
| | - A Tedesco
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy
| | - G Terrazzano
- Department of Cellular and Molecular Biology and Pathology ‘L Califano’, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
| | - R Cozzolino
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy
| | - P Laccetti
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy
| | - R Piccoli
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy
| | - G D'Alessio
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy
- Department of Biological Chemistry, University of Naples Federico II, Via Mezzocannone 16, 80134 Naples, Italy. E-mail:
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15
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Acocella A, Nardi P, Tedesco A, Beninati F, Giannini D. [Anterior iliac bone grafts: techniques and sequelae. Report on 107 cases and review of the literature]. Minerva Stomatol 2003; 52:441-53. [PMID: 14608250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The anterior iliac crest is the harvest site preferred by many authors because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. The purpose of the present paper is to present a review of anterior iliac crest harvesting techniques and to illustrate the most serious sequelae reported in the literature. A clinical series is also presented in order to evaluate what is, in our experience, the degree of morbility connected with this donor site. We have controlled 107 patients who underwent bone harvesting from the anterior iliac crest between 1980 and 2000, investigating minor complications such as walking deficiency (immediate and long-term) the formation of seromas, haematomas, adynamic ileus and more serious complications such as retroperitoneal haemorrhages, abdominal hernias, ileus fractures, nervous lesions (immediate and long-term). From our survey it emerged that, among the major complications, incidentally rarely reported in the international literature, we found only a small percentage of cases involving damage to nervous structures. Minor complications were also limited and the only problem remains difficulty in walking after the operation which resolves fully in almost all cases. We can therefore state that the anterior iliac crest remains, to date, an excellent site for harvesting and there is no significant morbility and the surgeon has numerous techniques available for reducing the incidence of complications to the minimum.
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Affiliation(s)
- A Acocella
- Scuola di Specializzazione in Chirurgia Odontostomatologica, Dipartimento di Odontostomatologia, Università degli Studi di Firenze, U.O. di Chirurgia Maxillo-Facciale, CTO, Firenze, Italy.
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16
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Nardi P, Acocella A, Tedesco A, Rispoli A, Giacomelli E. Psychological aspects in orthognathic surgery. Body image and quality of life in postsurgical assessment. Body image and quality of life in postsurgical assessment. Minerva Stomatol 2003; 52:145-52, 152-55. [PMID: 12874522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
AIM The aim of this study is to evaluate the psychological assessment of 20 patients after orthognathic surgery. Body image, anxiety levels, depression, somatic symptoms, aggressiveness and quality of life have been evaluated using 3 different questionnaires (BDDE, SQ, Q-LES-Q) during the postsurgical period. Analysis of the questionnaire has shown that the patients undergo orthognathic surgery mainly for esthetical reasons and, even if they could be considered normal, psychological evaluation followed by a proper support is a must. The present study has mainly developed and outlined this aspect. METHODS BDDE has been utilised to evaluate body image, self-estimation and social relationship. It was evident that the psychological impact after surgery represents a "revolution" for the patient. The "new face" may generate psychological problems for the patients. The SQ test has been used to evaluate the emotional profile. We also considered it essential for our study to evaluate several aspects of the quality of life of our sample group. The body image, particularly when others find it pleasing or displeasing may affect everyday life behaviour. RESULTS The study reports positive results in the psycho-emotional profiles and in several aspects of the quality of life, while the results of the self-perception of the body image could be considered average. CONCLUSION Reported data show that the corrections following orthognathic surgery have a positive impact on the assessment of the patients and on the personal and social attitude and behaviour, however suggesting, a long term psychological support to assure a satisfactory postoperative recovery.
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Affiliation(s)
- P Nardi
- Unit of Maxillo-Facial Surgery, CTO of Florence, School of Odontostomatologic, Surgery Specialization, Department of Odontostomatology, University of Florence, Florence, Italy
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17
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Beciani M, Tedesco A, Azzarito M, Violante A. [Cardiac troponin I in chronic hemodialysis. Comparison of methods and results after 3 months]. Recenti Prog Med 2001; 92:660-2. [PMID: 11765657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The laboratory and instrumental markers today in use for the determination of myocardial damage present limitations in dialysis patients due to interference patterns that tend to reduce prognostic evaluation. The aim of this study is to evaluate whether troponin I (cTnI), a recently established marker of myocardial damage, can help to identify, in asymptomatic patients too, minor ischemic lesions that could screen this patient population for future acute cardiac events. In our study of 103 patients undergoing chronic dialysis, instrumental measurements and serum dosages of cTnI were carried out at the onset and after three months, using first and second generation methods. Among the patients who tested positive using the above tests, 4 acute cardiac events were observed. A follow-up of the present study is due in one year's time.
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Affiliation(s)
- M Beciani
- Laboratorio Analisi, Aurelia Hospital Roma
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18
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Michelotti A, Farella M, Tedesco A, Cimino R, Martina R. Changes in pressure-pain thresholds of the jaw muscles during a natural stressful condition in a group of symptom-free subjects. J Orofac Pain 2001; 14:279-85. [PMID: 11203761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
AIMS To investigate the effects of a natural emotional stressor on pressure-pain thresholds (PPTs) of the masticatory muscles of symptom-free subjects. METHODS Sixteen healthy dental students were selected before they undertook an academic examination. Sixteen gender-matched students who were not exposed to an examination served as controls. The 2 groups of students were monitored in parallel on 5 separate days over a 1-month period: 2 days before the examination (T1), on the day of the examination (T2), 2 days after (T3), 1 month after (T4), and again after another 2 days (T5). On the day of the examination (T2), the control students were only required to complete a brief, non-demanding questionnaire. On each day, the following parameters were assessed: PPTs of the masseter, the anterior temporalis, and the Achilles tendon; state anxiety; and present stress (measured on a visual analog scale [VAS]). Furthermore, in the students undergoing the examination, venous blood samples for assessment of beta-endorphin levels were obtained at T2 and T5. RESULTS In the stressed students, the PPTs of the masticatory muscles and the Achilles tendon were significantly lower (analysis of variance [ANOVA], P < or = 0.02) on the day of the examination (T2) and on the days nearest the exam (T1, T3), and state anxiety and present stress were significantly higher (ANOVA, P < or = 0.003). No significant change was found in beta-endorphin plasma levels (P > 0.05). In the control group, PPTs, state anxiety, and present stress did not change significantly (ANOVA, P > 0.05). CONCLUSION The results support a relationship between psychologic stress and pressure-pain sensitivity of the masticatory muscles.
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Affiliation(s)
- A Michelotti
- School of Dentistry, Department of Orthodontics, University of Naples Federico II, Via Pansini, 5, I-80131 Naples, Italy.
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19
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Palumbo N, Tedesco A, Faggioli GL. [Treatment of aneurysm of the inferior pancreaticoduodenal artery associated with celiac axis occlusion]. MINERVA CHIR 2000; 55:623-8. [PMID: 11155477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A case of the inferior pancreaticoduodenal artery aneurysm, associated with occlusion of the celiac axis is reported. The aneurysm seemed to be related to a high-flow state secondary to the associated occlusion of the celiac axis. The occlusion was typical of the atheromatous disease. The aneurysm was atherosclerotic in origin and was treated with resection and PTFE patching. Eighty months later an angiogram was performed, demonstrating a normal patency of the pancreaticoduodenal arcades. The treatment of these aneurysms is discussed, and the literature on this uncommon disease is reviewed.
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Affiliation(s)
- N Palumbo
- Dipartimento di Scienze Chirurgiche e Anestesiologiche, Università degli Studi, Bologna
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20
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Landau RN, Blacklock TJ, Girgis MJ, Tedesco A. The role of chemical engineering in pharmaceutical chemical process development. Curr Opin Drug Discov Devel 1998; 1:257-263. [PMID: 19649800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The task of chemical process development in the pharmaceutical industry has grown into a multidisciplinary endeavor requiring years to complete. Increased competition in the pharmaceutical Additionally, the ever-tightening regulatory environment further compromises the business objective (ultimately, profits). This has required careful analysis of the activities within development. This work discusses the results of this analysis, which shows how a balance between minimal resource utilization and phased development achievements can be reached. The cycle of development, from inception to completion, is examined. Special emphasis is placed upon the role of chemical engineering and its appropriate deployment. Simple examples of the synergies that are possible between chemistry and chemical engineering are also given.
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Affiliation(s)
- R N Landau
- Novartis Pharmaceuticals Corporation, Technical Research & Development, East Hanover, NJ 07936, USA.
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21
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Biagini MR, Milani S, Fedi P, Calabro A, Tedesco A, Surrenti C. Duodenal ulcer and Sjogren's syndrome in patients with primary biliary cirrhosis: a casual association? Am J Gastroenterol 1991; 86:1190-3. [PMID: 1882799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Peptic ulcer has been reported in patients with primary biliary cirrhosis (PBC), but its frequency and pathogenesis are still poorly defined. We have analyzed the occurrence of duodenal ulcer in 37 female patients affected by PBC and in 35 with chronic liver disease of various etiologies. An active ulcer was found in seven patients with PBC and in one with chronic autoimmune hepatitis. The presence of an exocrine gland defect, as indicated by clinical signs of Sjogren's syndrome (SS), was found in six patients with PBC and duodenal ulcer (85%), but in only eight (26.6%) of those without ulcer (p less than 0.02). Therefore, in our patients, duodenal ulcer occurs more often in PBC than in other types of chronic liver disease. The association of SS with PBC, significantly higher in patients with than without ulcer, supports the hypothesis that the underlying exocrine gland defect is involved in the development of duodenal ulcer.
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Affiliation(s)
- M R Biagini
- Department of Clinical Pathophysiology, University of Florence, Italy
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22
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Residori C, Tedesco A, Tegani GP, Frattini P, Sestili F. [Gastric leiomyoblastoma. Description of a clinical case]. MINERVA CHIR 1990; 45:107-9. [PMID: 2336151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The paper describes a case of gastric myoblastoma, a rare tumour of the smooth musculature most commonly found in the stomach but also encountered outside the digestive tract. The tumour is potentially malignant and the occasional malignant forms feature histologically a large number of clearly atypical mitoses and clinically an aggressive pattern often involving even widespread metastasis. The case presented is that of a 73 year old woman given a Billroth I gastric resection who was in perfect health 7 months later despite the findings of a myoblastoma with some signs of enhanced mitosis.
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Affiliation(s)
- C Residori
- Divisione di Chirurgia Generale, Regione Veneto, U.S.L. n. 28, Presidio Ospedaliero, Sede di Nogara
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23
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Tedesco A, Sestili F, Frattini P, Tegani GP, Residori C. [Adenocarcinoma of the cecal appendix. Presentation of 2 cases and a review of the literature]. MINERVA CHIR 1989; 44:1757-60. [PMID: 2682367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two cases of adenocarcinoma of the vermiform appendix are described. The literature on these rare cancers which are almost always diagnosed at routine histology and whose prognosis is related to Duke grading and staging, is reviewed. The stable cure observed in one patient after 13 years after straightforward caecal resection for cancer of the appendix extending beyond the base of the implant (which today would be handled with hemicolectomy) and then treated for multiple polyps, two of them in a stage of malignant degeneration, suggests a difference of biological behaviour compared to tumours of the other colon districts. In the second case, stress is laid on the unusual extension of the tumour-related inflammation to the skin of the gluteal region.
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24
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Marini R, Tedesco A, Abaldo C. [Organization of sterilization in the dental office. The ergonomic considerations]. Minerva Stomatol 1986; 35:1065-70. [PMID: 3468331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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25
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Miracco A, Iodice G, Peluso C, Quarentelli A, Selce P, Tedesco A, Pastore P. Arginine thiazolidinecarboxylate in the treatment of chronic active hepatitis: double-blind comparison with placebo. J Int Med Res 1984; 12:35-9. [PMID: 6363155 DOI: 10.1177/030006058401200106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Forty-four patients with chronic active hepatitis were given arginine thiazolidinecarboxylate (800 mg/day per os for 40 days) or placebo in a randomized, double-blind trial. The most important liver function parameters were measured in each patient at the beginning of the trial, after 20 days, and at the end of the trial. The active drug lessened the parameters of necrosis and cholestasis while protein synthesis improved in liver cells. The differences between ATCA and placebo groups were highly significant. No treatment-related side-effects were reported.
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