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Giordano A, De Panfilis L, Veronese S, Bruzzone M, Cascioli M, Farinotti M, Giovannetti AM, Grasso MG, Kruger P, Lugaresi A, Manson L, Perin M, Pucci E, Solaro C, Ghirotto L, Solari A. User appraisal of a booklet for advance care planning in multiple sclerosis: a multicenter, qualitative Italian study. Neurol Sci 2024; 45:1145-1154. [PMID: 37816932 PMCID: PMC10858142 DOI: 10.1007/s10072-023-07087-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Implementation of advance care planning (ACP) in people with progressive multiple sclerosis (PwPMS) is limited. We aimed to involve users (PwPMS, significant others, and healthcare professionals involved in PwPMS care) in the evaluation and refinement of a booklet to be used during the ACP conversations. METHODS This qualitative study consisted of cognitive interviews with PwPMS and significant others and a focus group with healthcare professionals from three Italian centers. We analyzed the interviews using the framework method and the focus group using thematic analysis. RESULTS We interviewed 10 PwPMS (3 women; median age 54 years; median Expanded Disability Status Scale score 6.0) and three significant others (2 women; 2 spouses and one daughter). The analysis yielded three themes: booklet comprehensibility and clarity, content acceptability and emotional impact, and suggestions for improvement. Twelve healthcare professionals (7 neurologists, 3 psychologists, one nurse, and one physiotherapist) participated in the focus group, whose analysis identified two themes: booklet's content importance and clarity and challenges to ACP implementation. Based on analysis results, we revised the booklet (text, layout, and pictures) and held a second-round interviews with two PwPMS and one significant other. The interviewees agreed on the revisions but reaffirmed their difficulty in dealing with the topic and the need for a physician when using the booklet. CONCLUSIONS Appraisal of the booklet was instrumental in improving its acceptability and understandability before using it in the ConCure-SM feasibility trial. Furthermore, our data reveal a lack of familiarity with ACP practice in the Italian context.
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Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Ludovica De Panfilis
- Bioethics Unit - Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
| | | | | | - Marta Cascioli
- Hospice 'La Torre Sul Colle, Azienda USL Umbria 2, 06049, Spoleto, Italy
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | | | - Paola Kruger
- The European Patients' Academy (EUPATI), 00165, Rome, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40121, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40121, Bologna, Italy
| | - Leigh Manson
- Health Quality & Safety Commission New Zealand, 7045, Nelson, New Zealand
| | - Marta Perin
- Bioethics Unit - Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
- Doctoral Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100, Modena, Italy
| | - Eugenio Pucci
- UOC Neurologia AV4, ASUR Marche, 63900, Fermo, Italy
| | - Claudio Solaro
- Department of Rehabilitation, CRRF "Mons. L. Novarese", Loc. Trompone, 13040, Moncrivello, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, 42100, Reggio Emilia, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Moglia C, Palumbo F, Veronese S, Calvo A. Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey. Neurol Sci 2023; 44:4349-4357. [PMID: 37418099 PMCID: PMC10641048 DOI: 10.1007/s10072-023-06905-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Law 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient's right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV). OBJECTIVE To investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice. METHODS We conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology. RESULTS Out of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team. CONCLUSIONS Law 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved.
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Affiliation(s)
- Cristina Moglia
- "Rita Levi Montalcini", Department of Neuroscience, ALS Centre, University of Turin, Turin, Italy.
- Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza Di Torino, Turin, Italy.
| | - Francesca Palumbo
- "Rita Levi Montalcini", Department of Neuroscience, ALS Centre, University of Turin, Turin, Italy
| | | | - Andrea Calvo
- "Rita Levi Montalcini", Department of Neuroscience, ALS Centre, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città Della Salute e Della Scienza Di Torino, Turin, Italy
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Veronese S, Bertocchi E, Lissoni B, Rudà R, Silvani A, Simonetti G, Pisanello A, Ieraci S, Salmaggi A, Merli R, Verza M, De Panfilis L, Solari A, Pace A. Patient and carer involvement in the formulation of research questions: findings from the Italian guideline on palliative care in adults with glioma. Neurol Sci 2023:10.1007/s10072-023-06687-y. [PMID: 36809422 DOI: 10.1007/s10072-023-06687-y] [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: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND In 2017, the European Association for Neuro-Oncology (EANO) published the guideline for palliative care (PC) in adults with glioma. The Italian Society of Neurology (SIN), the Italian Association for Neuro-Oncology (AINO), and the Italian Society for Palliative Care (SICP) joined forces to update and adapt this guideline to the Italian context and aimed to involve patients and carers in the formulation of the clinical questions. METHODS During semi-structured interviews with glioma patients and focus group meetings (FGMs) with family carers of deceased patients, participants rated the importance of a set of pre-specified intervention topics, shared their experience, and suggested additional topics. Interviews and FGMs were audio-recorded, transcribed, coded, and analyzed (framework and content analysis). RESULTS We held 20 interviews and five FGMs (28 carers). Both parties considered the pre-specified topics as important, chiefly information/communication, psychological support, symptoms management, and rehabilitation. Patients aired the impact of focal neurological and cognitive deficits. Carers reported difficulties in dealing with patient's behavior and personality changes and appreciated the preservation of patient's functioning via rehabilitation. Both affirmed the importance of a dedicated healthcare path and patient's involvement in the decision-making process. Carers expressed the need to be educated and supported in their caregiving role. CONCLUSIONS Interviews and FGMs were well informative and emotionally challenging. Both parties confirmed the importance of the pre-specified topics, and carers suggested one additional topic: education/support to caregivers. Our findings strengthen the importance of a comprehensive care approach and of addressing the needs of both patients and their family carers.
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Affiliation(s)
- Simone Veronese
- Palliative Care and Research Department, Fondazione FARO, Turin, Italy
| | | | - Barbara Lissoni
- Hospice and Palliative Care Unit, Niguarda Hospital, Milan, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Dept of Neuroscience, City of Health and Science and University of Turin, Turin, Italy
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giorgia Simonetti
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Pisanello
- Unit of Neuro-Oncology, Azienda USL - IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Sonia Ieraci
- Psychology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Salmaggi
- Unit of Neurology, Presidio A. Manzoni, ASST Lecco, Lecco, Italy
| | - Rossella Merli
- Unit of Neurosurgery, ASST Papa Giovanni 23, Bergamo, Italy
| | | | | | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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Solari A, Veronese S, Verde GD, De Panfilis L, Bertocchi E, Lissoni B, Merli R, Salmaggi A, Silvani A, Rudà R, Pace A. Health professional involvement in the formulation of research questions: findings from the Italian guideline on palliative care in adults with glioma. Neurol Sci 2023; 44:1749-1754. [PMID: 36598619 DOI: 10.1007/s10072-022-06593-9] [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: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2017, the European Association of Neuro-Oncology (EANO) published the guideline for palliative care in adults with glioma. The Italian Society of Neurology (SIN), the Italian Society for Palliative Care (SICP), and the Italian Association for Neuro-Oncology (AINO) joined forces to update the guideline, and adapt it to the Italian context. AIM We involved patients, caregivers, and (herein presented) healthcare professionals (HPs) in the formulation of the guideline clinical questions. DESIGN AND PARTICIPANTS Online survey of Italian HPs experienced in the care of patients with glioma. Participants rated the importance of 14 pre-specified intervention topics on a 0/10 scale and gave their free comments. RESULTS Of 244 participants, 149 (61%) were palliative medicine (PM) HPs and 95 Neuro HPs. Their mean age was 48.9 years, 63% were women, and 48% had over 12 years of experience in the care of glioma patients. Physicians were 68%, followed by nurses (28%), psychologists (7%), therapists (3%), and social workers (2%). Most HPs rated the pre-specified topics as important (score ≥ 7) or critical (score ≥ 9), with some differences between PM and Neuro HP groups. There were 58 free comments: 46 (78%) on nine pre-specified topics, and 13 on four new topics, three of which were guideline-pertinent ("caregiver's support and education"; "family physician's training in neuro-oncology"; and "PM HPs' training in neuro-oncology"). CONCLUSIONS Participation in the survey was high and information-rich, between-group rating differences reflecting HP background. Participants endorsed the 14 intervention topics devised by the guideline panel and identified three additional topics.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Simone Veronese
- Palliative Care and Research Department, Fondazione FARO, Turin, Italy
| | | | | | | | - Barbara Lissoni
- Hospice and Palliative Care Unit, Niguarda Hospital, Milan, Italy
| | - Rossella Merli
- Unit of Neurosurgery, ASST Papa Giovanni 23, Bergamo, Italy
| | - Andrea Salmaggi
- Unit of Neurology, Presidio A. Manzoni, ASST Lecco, Lecco, Italy
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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De Panfilis L, Veronese S, Perin M, Cascioli M, Farinotti M, Kruger P, Zagarella RM, Curtis JR, Sudore RL, Nielsen EL, Engelberg RA, Giordano A, Solari A. Italian cross-cultural adaptation of the Quality of Communication questionnaire and the 4-item advance care planning engagement questionnaire. PLoS One 2023; 18:e0282960. [PMID: 36952509 PMCID: PMC10035811 DOI: 10.1371/journal.pone.0282960] [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] [Received: 11/05/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) is influenced by several factors (e.g., patient's readiness to engage, clinician's skills, and the cultural environment). Availability of reliable and valid self-reported measures of the ACP domains is crucial, including cross-cultural equivalence. AIM To culturally adapt into Italian the 19-item Quality of Communication (QOC) and the 4-item ACP Engagement (4-item ACP-E) questionnaires. METHODS We translated and culturally adapted the two questionnaires and produced a significant other (SO) version of the QOC (QOC-SO). Each questionnaire was field tested via cognitive interviews with users: nine patients (QOC, 4-item ACP-E) and three SOs (QOC-SO) enrolled at three palliative care services. RESULTS We made minor changes to 5/19 QOC items, to improve clarity and internal consistency; we changed the response option 'didn't do' into 'not applicable'. Finally, we slightly revised the QOC to adapt it to the paper/electronic format. QOC debriefing revealed that the section on end of life was emotionally challenging for both patients and SOs. We simplified the 4-item ACP-E layout, added a sentence in the introduction, and revised the wording of one item, to improve coherence with the Italian ACP legislation. ACP-E debriefing did not reveal any major issue. CONCLUSIONS Results were satisfactory in terms of semantic, conceptual and normative equivalence of both questionnaires. Acceptability was satisfactory for the 4-item ACP-E, while findings of the QOC cognitive debriefing informed a major amendment of a pilot trial protocol on ACP in multiple sclerosis (ConCure-SM): use of the interviewer version only, in an adaptive form. Psychometric testing of both questionnaires on a large, independent sample will follow.
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Affiliation(s)
| | | | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Cascioli
- Hospice 'La Torre sul Colle', Azienda USL Umbria 2, Spoleto, Italy
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paola Kruger
- EUPATI Fellow (European Patients Academy for Therapeutic Innovation) Italy, Rome, Italy
| | - Roberta M Zagarella
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- National Research Council (CNR), Interdepartmental Center for Research Ethics and Integrity (CID Ethics), Rome, Italy
| | - J R Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, Washington, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Rebecca L Sudore
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Health Care System, San Francisco, California, United States of America
| | - Elizabeth L Nielsen
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, Washington, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, Washington, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Oliver D, Baker I, Borasio GD, Cras P, Faull C, Hepgul N, Lorenzl S, Stockdale C, de Visser M, Vanopdenbosch L, Voltz R, Veronese S. The involvement of palliative care with neurology – a comparison of UK, Switzerland and Italy. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:256-262. [PMID: 36288469 DOI: 10.1080/21678421.2022.2136993] [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: 11/01/2022]
Abstract
OBJECTIVES To ascertain the involvement of palliative care with neurology services in the care of people with amyotrophic lateral sclerosis (ALS) in the United Kingdom, Italy and Switzerland, in particular the collaboration with and referral from neurology, the involvement in multidisciplinary team care and in the respiratory support of ALS patients. METHODS In 2019, two online surveys were undertaken of palliative care specialists, using specialist groups of the European Academy of Neurology, European Association of Palliative Care and the Association of Palliative Medicine for Great Britain and Ireland. RESULTS The respondents were specialist palliative care professionals, predominantly senior doctors, involved in the care of people with ALS. As the numbers of respondents from many countries were in single figures the analysis was restricted to the United Kingdom, Italy and Switzerland. The time of involvement varied, with early involvement commonest in the UK. Barriers to referral included neurologists not referring and financial issues, particularly in Switzerland. The reluctance of patients and families to see palliative care services was reported as less than 20% in all countries. Respondents were often involved in the care of people receiving noninvasive ventilation (NIV), in all countries. and with tracheostomy ventilation (TV), particularly in Italy. CONCLUSIONS Palliative care services are often involved in the care of people with ALS, but the extent and timing of involvement varies. The use of clinical guidelines and education on palliative care for neurology services may encourage collaboration, for the benefit of people with ALS and their families.
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Affiliation(s)
- David Oliver
- Tizard Centre, University of Kent, Canterbury, United Kingdom
| | - Idris Baker
- Morriston Hospital, Swansea, Wales, United Kingdom
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Cras
- Department of Neurology, Antwerp University, Antwerpen, Belgium
| | | | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College, London, United Kingdom
| | - Stefan Lorenzl
- Institute of Nursing Sciences and Practice, Paracelsus Medical University, Salzburg, Austria
| | | | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Raymond Voltz
- Department of Palliative Medicine, University Hospital, Cologne, Germany
| | - Simone Veronese
- Department of Research in Palliative Care, Fondazione FARO, Turin, Italy
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Lordi R, Veronese S, Beggi G, Grazzi N, Piccinini A, Sammali A, Tesini M, Cervellati D, Grazzi G, Capucci A, Pasanisi G. P369 BIOCIRCUIT®: A NEW SYSTEM FOR IMPROVING EXERCISE CAPACITY IN PATIENTS WITH CARDIOVASCULAR DISEASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.355] [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: 11/14/2022]
Abstract
Abstract
Introduction
Cardiovascular diseases is one of the most important public health problems; are among the main causes of morbidity, disability and mortality. Those who survive to an acute form become chronically ill with repercussions on the quality of life and on the economic and social costs. Secondary prevention through an intervention aimed to modify risk factors, in particular the sedentary lifestyle could be effective in the improvement of functional abilities. In this observational study carried out at the ABCardio company in Bologna (Italy), a personalized program of Physical Activity was performed through the innovative Biocircuit technology (Technogym®), on outpatients with a prevalent diagnosis of chronic ischemic heart disease.
Methods
We have analyzed 31 patients (M / F, 25/6) with a mean age of 61 years, and BMI of 26.4 kg / m2. Patients followed a two–month personalized physical activity program consisting in functional assessment at baseline (T0) and at the end of the program (T1) and of 2 weekly training sessions. Evaluation included: lower and upper limb isokinetic test to measure muscle strength, 500–meter moderate walking test to estimate maximum oxygen uptake (VO2max).
Results
The results obtained from the comparison between T0 and T1 in the 31 patients in study show significant improvements in the muscle strength of the lower limbs: Leg press +32.9 kg (p = 0.0003), Leg curl +11.8 kg (p < 0.0001), Leg extension +15.8 kg (p = 0.0002); as well as in upper limb muscle strength: Low Row +10.5 kg (p = 0.0005), Chest press +5.7 kg (p = 0.0007), Shoulder press +6.2 kg (p = 0, 0005). Estimated VO2max was also significantly improved from 26.2 mL / kg / min (T0) to 36.3 mL / kg / min (T1), with a mean increase of 10.1 mL / kg / min (p = 0, 0001). No adverse events occurred during supervised training sessions.
Conclusions
The program, safe and well tolerated by the patients in study, has proved to be effective in increasing exercise capacity in terms of both muscle strength and aerobic capacity. This secondary prevention intervention can be considered useful in reducing residual cardiovascular risk as it induced a significant increase in VO2max.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - G Beggi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - N Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - A Sammali
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - M Tesini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - D Cervellati
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - A Capucci
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, FERRARA, BOLOGNA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA, LAGOSANTO; DEPARTMENT OF SCIENTIFIC RESEARCH AND DEVELOPMENT, ABCARDIO BOLOGNA, BOLOGNA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRAR
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Lordi R, Veronese S, Piccinini A, Ferro A, Zerbini V, Piva T, Raisi A, Mandini S, Grazzi G, Sassone B, Pasanisi G. P370 INNOVATIVE TELEMONITORED MODEL OF PHYSICAL EXERCISE PRESCRIPTION IN SECONDARY PREVENTION DURING THE QUARANTINE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.356] [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: 11/14/2022]
Abstract
Abstract
Introduction
COVID–19 pandemic induced the emanation of extraordinary measures like quarantine, that can be considered a risk factor for both physical and mental health in the population. In particular, gym’s closure and the need to stay home didn’t allow people to perform physical activity easily, with a consequent worsening of cardiovascular risk factors. During quarantine some general recommendations have been disseminated, but little is known about specific guidelines for home–based exercise prescription in patients with cardiovascular disease. Therefore, the purpose of this study is to develop home–based physical exercise programs for cardiac patients referred to the Center for Exercise Science and Sports of University of Ferrara.
Methods
On the basis of exercise capacity obtained from the last functional evaluation, performed in presence before the closure, three structured workouts were realized following the guidelines. They are composed as follows: warm–up, strenght and balance exercises alternate to indoor walking, cool–down. Patients received an explicative iconographic via e–mail or smartphone. Some domiciliary sessions were supervised by an operator through video connection.
Results
All patients showed excellent compliance with the proposed program. Adherence has been verified through biweekly recalls. No adverse events occurred.
Conclusions
Telemonitored exercise prescription in cardiac outpatients was effective and safe, helping to prevent negative consequences of the abrupt cessation of physical activity due to COVID–19 pandemic. These evidence could be useful even after the end of pandemic, for all those patients that are less likely to participate in traditional cardiovascular rehabilitation programs because of difficulties in reaching facilities or leaving home.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - A Ferro
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - V Zerbini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - T Piva
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - A Raisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - S Mandini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - B Sassone
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
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Lordi R, Veronese S, Ferro A, Piccinini A, Piva T, Zerbini V, Raisi A, Mandini S, Grazzi G, Sassone B, Pasanisi G. P401 REMOTE COUNSELING ROLE DURING COVID–19 PANDEMIC IN SECONDARY PREVENTION AFTER ACUTE CORONARY SYNDROME. Eur Heart J Suppl 2022. [PMCID: PMC9384009 DOI: 10.1093/eurheartj/suac012.387] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Patients affected by acute coronary syndrome are usually referred to center–based secondary prevention programs where they are enrolled in physical activity programs and received indications about cardiovascular risk factors control. COVID–19 pandemic induced the emanation of restrictions in people’s mobility, ban on gathering and the obligation of social distancing. This made it difficult to maintain such group meetings in presence. Methods After hospitalization for acute coronary syndrome in Cardiology Unit of the AUSL of Ferrara, patients equipped with electronic devices were allowed to participate to remote counseling meetings on the digital platform LifesizeC. To improve participation, meetings were organized monthly (in order to gradually include new discharged patients) and involving caregivers (if patients weren’t able to access the web app). Information on regular physical activity benefits were provided. In particular, the F.I.T.T. principle (Frequency, Intensity, Type, Time) has been explained and Borg’s exertion scale was illustrated to be used in autonomy. Furthermore, there were provided recommendations about the need of a proper warm– up/cool–down, the possibility to wear a heart rate monitor and the early recognition of symptoms and warning signs. To complete health education, there were given information about correct nutrition, risk factors control and correct assumption of pharmacological therapy. Results All patients showed interest in the topics analyzed, asking various questions during the meetings. They also stated that they were strongly motivated to undertake regular physical activity having received convincing explanations on its usefulness and safety. Conclusions Remote counseling meetings obtained a high approval rating and the moments of discussion with the speakers were particularly well attended. The prescription of physical exercise in secondary prevention can follow innovative telemonitored approaches, which could be maintained even after COVID–19.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Ferro
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - T Piva
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - V Zerbini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Raisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Mandini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - B Sassone
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
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Lordi R, Veronese S, Mandini S, Raisi A, Piccinini A, Ferro A, Zerbini V, Piva T, Grazzi G, Biagio S, Pasanisi G. P422 EARLY EXERCISE PRESCRIPTION AFTER ACUTE CORONARY SINDROME. A NEW MODEL FROM BEDSIDE TO THE COMMUNITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.406] [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: 11/15/2022]
Abstract
Abstract
Purpose
Physical inactivity is a major risk factor and negative prognostic index of cardiovascular disease. It is necessary to define effective strategies to direct patients after an acute coronary syndrome (ACS) to physically active lifestyle. The aim of this study was to examin efficacy, feasibility and long term adherence of a new physical activity prescription, adapted to patients (pts) early after ACS.
Methods
34 pts, mean age 67years, hospitalized for ACS, were enrolled consecutively and randomized 2:1 in treatment (TR) group (n = 23) or in control (CT) group. All pts were evaluated before discharge from hospital (T0) through Quality of Life (QoL) SF12 questionnaire, determination of physical activity during free time, six–minute walking test (6MWT). All pts were orally advised about the importance of changing life–style as recommended by current international guidelines. At T0, pts in the TR group performed a 500m moderate and perceptually–regulated (11–13 on the 6–20 Borg scale) treadmill walking test (500–m TWT) to estimate peak oxygen uptake (VO2peak). A home–based physical activity based on walking, was provided to pts in the TR group: it was recommended to maintain the level of perceived intensity of effort as indicated during 500m–TWT. These pts also received a reinforce phone–call at 2 and 4 weeks (T1 and T2), that allowed monitoring the adherence to the programme. All pts were finally evaluated 8 weeks after enrollment (T3) through the same tests performed at T0.
Results
Pts of the TR group at T3 reported significative improvement, compared to T0, in 6MWT (+79 m, p < 0.001), QoL (expressed in the items of SF12), usual physical activity during free time (+13MET/h/week, p < 0.001), VO2peak (+4 mL/kg/min, p < 0.001). Compliance to the programme resulted optimal since all TR group pts continued the planned physical activity for all the follow–up.
Conclusions
Results of this study on efficacy, feasibility and compliance of a new model of secondary prevention programme, suggest the importance of implementing programmes of tailored physical activity schedules, based on walking, that can be safetly started soon after clinical stabilization of ACS.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Mandini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Raisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Ferro
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - V Zerbini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - T Piva
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Biagio
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
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11
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Rukavina K, Oliver DJ, Guijarro C, Tudor KI, Veronese S, Vanopdenbosch L. Neuropalliative Care in Times of War. Eur J Neurol 2022; 29:3130-3131. [PMID: 35510741 DOI: 10.1111/ene.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Katarina Rukavina
- Institute of Psychiatry, Psychology & Neuroscience at King's College London and King's College Hospital NHS Foundation Trust, London, United Kingdom.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - David J Oliver
- Tizard Centre, University of Kent, Canterbury, United Kingdom
| | - Cristina Guijarro
- Department of Neurology, The HM Sanchinarro University Hospital, Madrid, Spain
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12
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Giordano A, De Panfilis L, Perin M, Servidio L, Cascioli M, Grasso MG, Lugaresi A, Pucci E, Veronese S, Solari A. Advance Care Planning in Neurodegenerative Disorders: A Scoping Review. Int J Environ Res Public Health 2022; 19:ijerph19020803. [PMID: 35055625 PMCID: PMC8775509 DOI: 10.3390/ijerph19020803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 01/27/2023]
Abstract
Advance care planning (ACP) is increasingly acknowledged as a key step to enable patients to define their goals/preferences for future medical care, together with their carers and health professionals. We aimed to map the evidence on ACP in neurodegenerative disorders. We conducted a scoping review by searching PubMed (inception-December 28, 2020) in addition to trial, review, and dissertation registers. From 9367 records, we included 53 studies, mostly conducted in Europe (45%) and US-Canada (41%), within the last five years. Twenty-six percent of studies were qualitative, followed by observational (21%), reviews (19%), randomized controlled trials (RCTs, 19%), quasi-experimental (11%), and mixed-methods (4%). Two-thirds of studies addressed dementia, followed by amyotrophic lateral sclerosis (13%), and brain tumors (9%). The RCT interventions (all in dementia) consisted of educational programs, facilitated discussions, or videos for patients and/or carers. In conclusion, more research is needed to investigate barriers and facilitators of ACP uptake, as well as to develop/test interventions in almost all the neurodegenerative disorders. A common set of outcome measures targeting each discrete ACP behavior, and validated across the different diseases and cultures is also needed.
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Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.G.); (L.S.)
| | - Ludovica De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (L.D.P.); (M.P.)
| | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (L.D.P.); (M.P.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Laura Servidio
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.G.); (L.S.)
| | - Marta Cascioli
- Hospice ‘La Torre sul Colle’, Azienda USL Umbria 2, 06049 Spoleto, Italy;
| | | | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40126 Bologna, Italy;
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Eugenio Pucci
- UOC Neurologia, ASUR Marche-AV4, 63900 Fermo, Italy;
| | | | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.G.); (L.S.)
- Correspondence: ; Tel.: +39-022344660
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Pace A, Solari A, De Panfilis L, Lissoni B, Pronello E, Rudà R, Silvani A, Salmaggi A, Merli R, De Paula U, Bertocchi E, Verza M, Veronese S. P14.72 Involving patients and caregivers in the production of guidelines for palliative care in primary brain tumours: identification of intervention priorities. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.179] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Involving patients and caregivers is an important component of clinical guideline development. The three main Italian scientific associations for neurology, neuro-oncology and palliative care (SIN-AINO-SICP) recently appointed a joint task force (TF) of clinicians and researchers to develop specific guidance on palliative care of people with primary brain tumours, following the GRADE approach. To identify clinical questions meaningful to the patients and caregivers, a qualitative approach was used.
MATERIAL AND METHODS
Based on the existing literature and on consensus, the TF identified nine intervention areas, whose relevance was apprised by patients (via personal semi-structured interviews) and bereaved caregivers (via focus groups, FGs) from five tertiary neuro-oncology centres. Participants were prompted to provide their personal disease-related experience, and were asked to elicit the areas that mostly impacted their own lives. Interviews and FGMs were audio-recorded, transcribed and analysed using thematic analysis.
RESULTS
Twenty interviews and five FGs (28 caregivers) were completed between late 2020 and early 2021. Preliminary findings show that all the pre-specified areas were defined as important by participants. Most discussed topics were communication, organization and service satisfaction, cognitive and psychological issues, and advance care planning (ACP). Caregivers focused their discussions on the need for patient psychological support, difficulties experienced with symptoms control (e.g. epileptic seizures, behavioural changes), communication and organizational issues.
CONCLUSION
Participation of Italian patients with brain tumours and family caregivers was high and information-rich. All of the nine guideline intervention areas were considered important, communication, care organization, symptom control and ACP being the most discussed.
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Affiliation(s)
- A Pace
- IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - L De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - B Lissoni
- Unit of Clinical Psychology, Niguarda Hospital, Milan, Italy
| | - E Pronello
- Department of Neuro-Oncology, City of Health and Science Hospital, Turin, Italy
| | - R Rudà
- Department of Neuro-Oncology, RomeCity of Health and Science University of Turin, Italy
| | - A Silvani
- Neuro-Oncologia Clinica, IRCC Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Salmaggi
- Neurology and Stroke Unit, ASST, Lecco, Italy
| | - R Merli
- Neurosurgery Unit, ASST PGXXIII, Bergamo, Italy
| | - U De Paula
- Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - E Bertocchi
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Verza
- IRENE BT Patients Association, Rome, Italy
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14
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De Panfilis L, Veronese S, Bruzzone M, Cascioli M, Gajofatto A, Grasso MG, Kruger P, Lugaresi A, Manson L, Montepietra S, Patti F, Pucci E, Solaro C, Giordano A, Solari A. Study protocol on advance care planning in multiple sclerosis (ConCure-SM): intervention construction and multicentre feasibility trial. BMJ Open 2021; 11:e052012. [PMID: 34389580 PMCID: PMC8365819 DOI: 10.1136/bmjopen-2021-052012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/02/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is the most common cause of progressive neurological disability in young adults. The use of advance care planning (ACP) for people with progressive MS (pwPMS) remains limited. The ConCure-SM project aims to assess the effectiveness of a structured ACP intervention for pwPMS. The intervention consists of a training programme on ACP for healthcare professionals caring for pwPMS, and a booklet to be used during the ACP conversation. Herein, we describe the first two project phases. METHODS In phase 1 we translated and adapted, to the Italian legislation and MS context, the ACP booklet of the National ACP Programme for New Zealand. Acceptability, comprehensibility and usefulness of the booklet were assessed via 13 personal cognitive interviews with pwPMS and significant others (SOs), and one health professional focus group. Based on these findings, we will revise the booklet. In phase 2 we will conduct a single-arm pilot/feasibility trial with nested qualitative study. Participants will be 40 pwPMS, their SOs, health professionals from six MS and rehabilitation centres in Italy. In the 6 months following the ACP conversation, we will assess completion of an advance care plan document (primary outcome), as well as safety of the intervention. Secondary outcomes will be a range of measures to capture the full process of ACP; patient-carer congruence in treatment preferences; quality of patient-clinician communication and caregiver burden. A qualitative process evaluation will help understand the factors likely to influence future implementation and scalability of the intervention. ETHICS AND DISSEMINATION The project is coleaded by a neurologist and a bioethicist. Phase 1 has received ethical approvals from each participating centre, while phase 2 will be submitted to the centres in May 2021. Findings from both phases will be disseminated widely through peer-reviewed publications, conferences and workshops. TRIAL REGISTRATION NUMBER ISRCTN48527663; Pre-results.
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Affiliation(s)
| | | | | | - Marta Cascioli
- Hospice "La Torre sul Colle", USL Umbria 2, Spoleto (PG), Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Unit of Neurology, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Paola Kruger
- EUPATI Fellow (European Patients Academy for Therapeutic Innovation) Italy, Roma, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Leigh Manson
- New Zealand Health Quality and Safety Commission, Nelson, New Zealand
| | - Sara Montepietra
- Multiple Sclerosis Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Claudio Solaro
- Department of Rehabilitation, M.L. Novarese Hospital, Moncrivello (VC), Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Rosato R, Pagano E, Giordano A, Farinotti M, Ponzio M, Veronese S, Confalonieri P, Grasso MG, Patti F, Solari A. Living with severe multiple sclerosis: Cost-effectiveness of a palliative care intervention and cost of illness study. Mult Scler Relat Disord 2021; 49:102756. [PMID: 33486403 DOI: 10.1016/j.msard.2021.102756] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/26/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the economic consequences of living with severe multiple sclerosis (SMS). AIMS To assess the cost-effectiveness of a home-based palliative approach (HPA) for people with SMS (pwSMS). To assess direct healthcare costs in this population. METHODS PwSMS from three Italian centers received (2:1 ratio) HPA or usual care over six months. Direct healthcare costs were collected on a monthly basis. Incremental cost-effectiveness was gauged from a national healthcare system (NHS) and a personal perspective, considering the Palliative Outcome Scale-Symptoms-MS (POS-S-MS) and the EuroQol five-dimension descriptive system quality-adjusted life years (EQ-5D-3L QALYs), both completed at baseline, after three and six months. RESULTS Of 78 randomized pwSMS, 76 (50 HPA, 26 usual care) were analyzed. Mean QALYs were close to zero, and the mean group difference was -0.006 (95% CI -0.057 to 0.044). The mean baseline-adjusted cost difference was € -394 (95% confidence interval, CI -3,532 to 2,743). POS-S-MS cost-effectiveness showed a slight mean reduction of symptom burden (-1.9; 95% CI -1.1 to 5.0) with unchanged costs. Mean direct costs due to MS were € 23,195/year, almost equally distributed between NHS (€ 13,108) and pwSMS (€ 10,087). Personal care, medications and home rehabilitation accounted for 80% of total expenditures. Most personal care costs were covered by pwSMS, and these costs were 3/4 of pwSMS out-of-pocket. CONCLUSIONS The slight reduction of symptom burden produced by the HPA was not associated with an increase in costs. NHS and pwSMS almost equally sustained these costs. TRIAL REGISTRATION Current Controlled Trials ISRCTN73082124.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy; Unit of Clinical Epidemiology, "Città della Salute e della Scienza" Hospital, Turin, Italy and CPO Piemonte, Turin, Italy.
| | - Eva Pagano
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza" Hospital, Turin, Italy and CPO Piemonte, Turin, Italy
| | - Andrea Giordano
- Department of Psychology, University of Turin, Turin, Italy; Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149 Genoa, Italy.
| | | | - Paolo Confalonieri
- Multiple Sclerosis Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Francesco Patti
- Multiple Sclerosis Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Via S. Sofia 78, 95123 Catania, Italy.
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
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16
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Zullo S, Ingravallo F, Crespi V, Cascioli M, D'Alessandro R, Gasperini M, Lalli C, Lugaresi A, Marogna M, Mori M, Pesci I, Pistoia F, Porteri C, Vedovello M, Veronese S, Pucci E, Solari A. The impact of the COVID-19 pandemic on people with neurological disorders: an urgent need to enhance the health care system's preparedness. Neurol Sci 2021; 42:799-804. [PMID: 33433758 PMCID: PMC7801877 DOI: 10.1007/s10072-020-04984-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Silvia Zullo
- Department of Legal Studies, University of Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Vittorio Crespi
- Ethics Committee "Brianza", S. Gerardo Hospital, Monza, Italy
| | - Marta Cascioli
- Hospice 'La Torre sul Colle', Azienda USL Umbria 2, Spoleto, Italy
| | - Roberto D'Alessandro
- Servizio di Epidemiologia e Biostatistica, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marcella Gasperini
- Rehabilitation Department, Marzana Hospital, AULSS 9 (VR), Marzana, Italy
| | | | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Maura Marogna
- SC Neurologia, Ospedale Villa Scassi ASL3, Genoa, Italy
| | - Maurizio Mori
- Dipartimento di filosofia e scienze dell'educazione, University of Turin, Turin, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, Ospedale di Vaio, Fidenza, PR, Italy
| | - Francesca Pistoia
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Corinna Porteri
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
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Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I, Aleksovska K, Battaglia MA, Bay J, Copetti M, Drulovic J, Kooij L, Mens J, Murillo ERM, Milanov I, Milo R, Pekmezovic T, Vosburgh J, Silber E, Veronese S, Patti F, Voltz R, Oliver DJ. EAN Guideline on Palliative Care of People with Severe, Progressive Multiple Sclerosis. J Palliat Med 2020; 23:1426-1443. [PMID: 32469284 PMCID: PMC7583337 DOI: 10.1089/jpm.2020.0220] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background and Purpose: Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. Methods: This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the Patients-Intervention-Comparator-Outcome format, involving patients, carers and healthcare professionals (HPs). No uniform definition of severe MS exists: in this guideline, constant bilateral support required to walk 20 m without resting (Expanded Disability Status Scale score >6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. Results: Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient's wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. Conclusions: The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efficacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain, Germany
| | - Sascha Köpke
- Institute of Clinical Nursing Science, University of Cologne, Cologne, Germany
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | | | - Jette Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Jelena Drulovic
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - John Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - Edwin R. Meza Murillo
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain, Germany
| | | | - Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Francesco Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - David J. Oliver
- The Tizard Centre, University of Kent, Canterbury, United Kingdom
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Veronese S, Bernardi P, Sbarbati A. How the use of surgical masks during COVID-19 pandemic can induce skin effects. J Eur Acad Dermatol Venereol 2020; 35:e7-e8. [PMID: 32869374 DOI: 10.1111/jdv.16905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- S Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - P Bernardi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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19
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Pace A, Koekkoek JAF, van den Bent MJ, Bulbeck HJ, Fleming J, Grant R, Golla H, Henriksson R, Kerrigan S, Marosi C, Oberg I, Oberndorfer S, Oliver K, Pasman HRW, Le Rhun E, Rooney AG, Rudà R, Veronese S, Walbert T, Weller M, Wick W, Taphoorn MJB, Dirven L. Determining medical decision-making capacity in brain tumor patients: why and how? Neurooncol Pract 2020; 7:599-612. [PMID: 33312674 DOI: 10.1093/nop/npaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/09/2023] Open
Abstract
Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient's "best interests" and wishes are guaranteed. Several methods are available that may help to enhance patients' consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients' consent capacity, and alternative procedures, including surrogate consent.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, The Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Jane Fleming
- Department of Palliative Medicine, University Hospital Waterford, Waterford, Ireland
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland, UK
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | | | - Christine Marosi
- Department of Internal Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Stefan Oberndorfer
- Department Neurology, University Clinic St Pölten, KLPU and KLI-Neurology and Neuropsychology, St Pölten, Austria
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland, UK
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Simone Veronese
- Department of Palliative Care, Fondazione FARO, Turin, Italy
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, US
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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20
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Oliver D, Borasio GD, Veronese S, Voltz R, Lorenzl S, Hepgul N. Current collaboration between palliative care and neurology: a survey of clinicians in Europe. BMJ Support Palliat Care 2020:bmjspcare-2020-002322. [PMID: 32651190 DOI: 10.1136/bmjspcare-2020-002322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/02/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The collaboration between palliative care and neurology has developed over the last 25 years and this study aimed to ascertain the collaboration between the specialties across Europe. METHODS This online survey aimed to look at collaboration across Europe, using the links of the European Association for Palliative Care and the European Academy of Neurology. RESULTS 298 people completed the survey-178 from palliative care and 120 from neurology from over 20 countries across Europe. They reported that there was good collaboration in the care for people with amyotrophic lateral sclerosis and cerebral tumours but less for other progressive neurological diseases. The collaboration included joint meetings and clinics and telephone contacts. All felt that the collaboration was helpful, particularly for maintaining quality of life, physical symptom management, psychological support and complex decision making, including ethical issues. DISCUSSION The study shows evidence for collaboration between palliative care and neurology, but with the need to develop this for all neurological illness, and there is a need for increased education of both areas.
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Affiliation(s)
- David Oliver
- Tizard Centre, University of Kent, Canterbury, Kent, UK
| | - Gian Domenico Borasio
- Service de soins palliatifs, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Stefan Lorenzl
- Institute of Nursing Sciences and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I, Aleksovska K, Battaglia MA, Bay J, Copetti M, Drulovic J, Kooij L, Mens J, Meza Murillo ER, Milanov I, Milo R, Pekmezovic T, Vosburgh J, Silber E, Veronese S, Patti F, Voltz R, Oliver D. EAN guideline on palliative care of people with severe, progressive multiple sclerosis. Eur J Neurol 2020; 27:1510-1529. [PMID: 32469447 DOI: 10.1111/ene.14248] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. METHODS This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the Patients-Intervention-Comparator-Outcome format, involving patients, carers and healthcare professionals (HPs). No uniform definition of severe MS exists: in this guideline, constant bilateral support required to walk 20 m without resting (Expanded Disability Status Scale score > 6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. RESULTS Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient's wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. CONCLUSIONS The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efficacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs.
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Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - J Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Köpke
- Institute of Clinical Nursing Science, University of Cologne, Cologne, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - J Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - M Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - J Drulovic
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - L Kooij
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E R Meza Murillo
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Milanov
- Medical University of Sofia, Sofia, Bulgaria
| | - R Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - T Pekmezovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Vosburgh
- Israel Multiple Sclerosis Society, Tel-Aviv, Israel
| | - E Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - F Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - R Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - D Oliver
- The Tizard Centre, University of Kent, Canterbury, UK
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Abstract
Patients, and their families, with Parkinson's disease (PD) and related disorders face many issues, including physical, psychological, social and spiritual. Palliative care is an essential part of care from the time of diagnosis, and should be provided by all services involved with the patient and family. Specialist palliative care is able to support the overall care particularly for complex issues-whether symptoms or psychosocial and spiritual problems, ethical and decisions making issues, and at the end of life. This should be in collaboration with other teams, working together to improve the quality of life (QOL) of patients and families, supporting the professional teams and enabling patients to be as fully involved in the decisions about their care and at the end of life.
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Affiliation(s)
- David Oliver
- Tizard Centre, Cornwallis North East, University of Kent, Canterbury, UK.
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Veronese S, Rabitti E, Costantini M, Valle A, Higginson I. Translation and cognitive testing of the Italian Integrated Palliative Outcome Scale (IPOS) among patients and healthcare professionals. PLoS One 2019; 14:e0208536. [PMID: 30601810 PMCID: PMC6314603 DOI: 10.1371/journal.pone.0208536] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Outcome measurement is fundamental to assess needs and priority of care in palliative care settings. The Integrated Palliative care Outcome Scale (IPOS) was developed from earlier versions of this tool. Its use is encouraged to ameliorate the assessment of individual outcomes in palliative care settings. This study aimed to translate and culturally adapt IPOS into Italian, and explore its face and content validity. Methods After forward-backward translation, a qualitative study explored the views of and cognitive processes used by respondents. We conducted individual semi structured interviews with 21 patients admitted to two palliative care services, from hospitals, hospices and the community, and focus groups with 12 professionals working in multidisciplinary palliative care teams and used thematic analysis. The results were integrated in a final audit, including the project team and the original POS developers, to refine the final format of the tool. Results We conducted 21 face to face cognitive interviews with patients, and 2 focus groups with 14 professionals. Patients and professionals felt content and format of IPOS appropriate and feasible, and not burdensome. Some layout problems were raised leading to adaptation. Main issues regarded: clarifying the meaning of choices and some cultural interpretation of some questions and response options and interpretation of some instructions. We proposed using some new terms as more appropriate and comprehensive in our context, such as replacing the term “family” with “dear ones”. The items that appeared unchanged from the previously validated Italian POS were left unmodified to maintain coherence. Conclusions The Italian IPOS, in its four versions directed to patients or staff and with a recall period of 3 or 7 days, has face and content validity for use in clinical settings and is ready for further psychometric and clinimetric validation.
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Affiliation(s)
| | - Elisa Rabitti
- Psycho-Oncology Unit, Azienda USL di Reggio Emilia–IRCCS, Reggio Emilia, Italy
| | - Massimo Costantini
- Scientific Directorate, Azienda USL di Reggio Emilia–IRCCS, Reggio Emilia, Italy
| | | | - Irene Higginson
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
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De Panfilis L, Cattaneo D, Cola L, Gasparini M, Porteri C, Tarquini D, Tiezzi A, Veronese S, Zullo S, Pucci E. [Conscience clause in end-of-life care.]. Recenti Prog Med 2018. [PMID: 28643812 DOI: 10.1701/2695.27558] [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: 11/05/2022]
Abstract
The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento". In particular, the conscience clause has been discussed in the light of advance care planning (ACP), which represents the instrument to guarantee the shared planning of care and the shared-decision making. In this context, recourse to the clause of conscience brings out critical ethical and deontological issues that the article discusses, using the position paper SIAARTI and the text of law currently being debated, both built on the assumptions of a shared care relationship, where patient has a key-role in medical decisions.
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Affiliation(s)
- Ludovica De Panfilis
- Direzione Scientifica, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia - Centro Interdipartimentale di Ricerca in Storia del Diritto, Filosofia e Sociologia del Diritto e Informatica Giuridica (CIRSFID), Università di Bologna
| | | | | | | | - Corinna Porteri
- Unità di Bioetica - IRCCS, Centro S. Giovanni di Dio Fatebenefratelli, Brescia
| | | | | | | | - Silvia Zullo
- Centro Interdipartimentale di Ricerca in Storia del Diritto, Filosofia e Sociologia del Diritto e Informatica Giuridica (CIRSFID), Università di Bologna
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25
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Köpke S, Giordano A, Veronese S, Christin Rahn A, Kleiter I, Basedow-Rajwich B, Fornari A, Battaglia MA, Drulovic J, Kooij L, Koops J, Mens J, Meza Murillo ER, Milanov I, Milo R, Patti F, Pekmezovic T, Sastre-Garriga J, Vosburgh J, Voltz R, Bay J, Oliver DJ, Solari A. Patient and caregiver involvement in the formulation of guideline questions: findings from the European Academy of Neurology guideline on palliative care of people with severe multiple sclerosis. Eur J Neurol 2018; 26:41-50. [PMID: 30035845 DOI: 10.1111/ene.13760] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 02/26/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Patient and public involvement in clinical practice guideline development is recommended to increase guideline trustworthiness and relevance. The aim was to engage multiple sclerosis (MS) patients and caregivers in the definition of the key questions to be answered in the European Academy of Neurology guideline on palliative care of people with severe MS. METHODS A mixed methods approach was used: an international online survey launched by the national MS societies of eight countries, after pilot testing/debriefing on 20 MS patients and 18 caregivers, focus group meetings of Italian and German MS patients and caregivers. RESULTS Of 1199 participants, 951 (79%) completed the whole online survey and 934 from seven countries were analysed: 751 (80%) were MS patients (74% women, mean age 46.1) and 183 (20%) were caregivers (36% spouses/partners, 72% women, mean age 47.4). Participants agreed/strongly agreed on inclusion of the nine pre-specified topics (from 89% for 'advance care planning' to 98% for 'multidisciplinary rehabilitation'), and <5% replied 'I prefer not to answer' to any topic. There were 569 free comments: 182 (32%) on the pre-specified topics, 227 (40%) on additional topics (16 guideline-pertinent) and 160 (28%) on outcomes. Five focus group meetings (three of MS patients, two of caregivers, and overall 35 participants) corroborated the survey findings. In addition, they allowed an explanation of the guideline production process and the exploration of patient-important outcomes and of taxing issues. CONCLUSIONS Multiple sclerosis patient and caregiver involvement was resource and time intensive, but rewarding. It was the key for the formulation of the 10 guideline questions and for the identification of patient-important outcomes.
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Affiliation(s)
- S Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - A Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - A Christin Rahn
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - I Kleiter
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | - B Basedow-Rajwich
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | - A Fornari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - J Drulovic
- Clinic of Neurology, CSS, Faculty of Medicine, University Hospital of Belgrade, Belgrade, Serbia
| | - L Kooij
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Koops
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E R Meza Murillo
- MS Centre of Catalonia (Cemcat), University Hospital Vall d'Hebron, Barcelona, Spain
| | - I Milanov
- Neurology Clinic, Medical University of Sofia, Sofia, Bulgaria
| | - R Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - F Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - T Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Sastre-Garriga
- MS Centre of Catalonia (Cemcat), University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Vosburgh
- Israel Multiple Sclerosis Society, Tel-Aviv, Israel
| | - R Voltz
- Department of Palliative Medicine, University Hospital Cologne, Cologne, Germany
| | - J Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - D J Oliver
- The Tizard Centre, University of Kent, Canterbury, UK
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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26
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Giovannetti AM, Borreani C, Bianchi E, Giordano A, Cilia S, Cipollari S, Rossi I, Cavallaro C, Torri Clerici V, Rossetti E, Stefanelli MC, Totis A, Pappalardo A, Occhipinti G, Confalonieri P, Veronese S, Grasso MG, Patti F, Zaratin P, Battaglia MA, Solari A. Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: A qualitative study. PLoS One 2018; 13:e0200532. [PMID: 30001423 PMCID: PMC6042757 DOI: 10.1371/journal.pone.0200532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background We performed a qualitative study to investigate the experiences of participants in a multicentre randomized controlled trial on a home-based palliative approach (HPA) for adults with severe multiple sclerosis (MS) and their caregivers. Our aim was to explore the strengths and challenges of the intervention, and circumstances that may have influenced its efficacy. Methods Participants to the qualitative study were the patients, their caregivers, patient referring physicians, and the teams who delivered the HPA intervention. We performed semi-structured one-on-one interviews with 12 patients and 15 informal caregivers chosen using a maximum variation strategy, two focus group meetings with patient referring physicians (4 participants each), and one with the HPA teams (9 participants). Results From data analysis (framework method) 38 sub-categories emerged, which were grouped into 10 categories and 3 themes: 'expectations,' 'met and unmet needs', and 'barriers’. Intervention benefits were improved control of symptoms and reduced sense of isolation of the patient-caregiver dyads. Limitations were: factors related to experimental design (difficulty of dyads in identifying examiner and team roles, additional burden for caregivers); team issues (insufficient team building /supervision, competing priorities); limitations of the intervention itself (insufficient length, lack of rehabilitation input); and external factors (resource limitations, under-responsive services/professionals). The referring physician focus groups provided little experiential data. Conclusions The HPA reduced patient symptoms and sense of isolation in patients and caregivers. The indirect role of the HPA teams, and insufficient length of the intervention were key limitations. The experimental design imposed additional burdens on the dyads. Key barriers were the paucity of available services, the demanding administrative procedures, and lack of networking facilities. These findings suggest that two major requirements are necessary for home palliative care to be effective in this patient population: HPA teams well-connected with MS rehabilitation services, and care delivered over the long-term, with variable intensity. Trial registration Current Controlled Trials ISRCTN73082124 (Registered 19/06/2014).
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Affiliation(s)
- Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Elisabetta Bianchi
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Sabina Cilia
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Ilaria Rossi
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia, Rome, Italy
| | - Claudia Cavallaro
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Valentina Torri Clerici
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Edoardo Rossetti
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | | | - Amadio Totis
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Angelo Pappalardo
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Gina Occhipinti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Paolo Confalonieri
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | | | | | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
- * E-mail:
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27
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Abstract
Cellular proliferative activity was evaluated by the determination of 3H-thymidine labeling index (LI) in 20 specimens of human urologic malignancies (13 renal cell carcinomas and 7 transitional cell bladder carcinomas). Very low LI values were found in renal cell carcinomas, with a median value of 0.28%. Slightly higher proliferative activities were observed in bladder carcinomas, with a median LI value of 1.96%. No significant correlations were found between proliferative activity and pathologic stage or histologic grading in renal cell carcinomas. Although the number of bladder carcinomas evaluated does not allow any definite conclusion, an increase in LI values was found from in situ to invasive carcinoma and from tumors at stage I to tumors at stage III.
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29
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Paradiso A, Marubini E, Verderio P, Cortese M, Pizzamiglio S, De Paola F, Silvestrini R, Simone G, Sarotto I, Carcangiu M, Menard S, Tagliabue E, Mottolese M, Benevolo M, Bisceglia M, Giardina E, Maiorano E, Napoli A, Querzoli P, Nenci I, Pedriali M, Rinaldi R, Bianchi S, Vezzosi V, Collecchi P, Bevilacqua G, Colombari R, Caneva A, Gasparin P, Rucca V, Morigi F, De Paola F, Dubini A, Gaudio M, Medri L, Padovani F, Saragoni L, Volpi A, Granato A, Marinaro E, Folicaldi S, Ghidoni D, Cortecchia S, Veronese S, Galli C, Gambacorta M, Stella M, Rizzo A, Nizzoli R, Bozzetti C, Guazzi A, Naldi N, Sidoni A, Bucciarelli E, Ludovini V, Pistola L, Bernardi L, Ghisolfi G, Pecchioni C, Sapino A, Bussolati G, Barbareschi M, Dalla Palma P, Leonardi E. Interobserver Reproducibility of Immunohistochemical Her-2/Neu Assessment in Human Breast Cancer: An Update from INQAT round III. Int J Biol Markers 2018. [DOI: 10.1177/172460080502000307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical interest in HER-2/neu is related to trastuzumab, a drug used to treat patients with invasive breast carcinoma overexpressing the HER-2/neu protein. It is very important to correctly identify those patients who may benefit from trastuzumab by accurate assessment of the HER-2/neu status. Of the various methods available, the Dako Herceptest for immunohistochemical assay is considered the most reliable to reach this goal. The aim of this study was to investigate within a group of Italian laboratories the reproducibility of the results of HER-2/neu assessment by means of the Dako scoring system on slides stained with the Herceptest kit. This study was also conceived as the continuation of one of our previous studies, which was similar in its aims but different in the classification criteria adopted. Our results show that, whereas the intra-observer reproducibility was generally satisfactory, the interobserver reproducibility was not. Moreover, our findings confirm that the two extreme classes (0 and 3+) are more easy to identify than the other two and that the Herceptest does not allow to discriminate optimally between scoring classes 2+ and 3+. These findings are relevant in clinical practice where the treatment choice is based on categories defined by this assay, suggesting the need of adopting educational programs and/or new reference materials to improve the assay performance.
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Affiliation(s)
| | | | | | - P. Verderio
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - M.E. Cortese
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - S. Pizzamiglio
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | | | - R. Silvestrini
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | | | | | - M.L. Carcangiu
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - S. Menard
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - E. Tagliabue
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - M. Mottolese
- Istituto Regina Elena per lo Studio e la Cura dei Tumori, Rome
| | - M. Benevolo
- Istituto Regina Elena per lo Studio e la Cura dei Tumori, Rome
| | - M. Bisceglia
- IRCCS - Ospedale Casa Sollievo della Sof-ferenza, San Giovanni Rotondo
| | - E. Giardina
- Azienda Os-pedaliera e Università degli Studi di Bari, Bari
| | - E. Maiorano
- Azienda Os-pedaliera e Università degli Studi di Bari, Bari
| | - A. Napoli
- Azienda Os-pedaliera e Università degli Studi di Bari, Bari
| | | | - I. Nenci
- Università degli Studi di Ferrara, Ferrara
| | | | - R. Rinaldi
- Università degli Studi di Ferrara, Ferrara
| | - S. Bianchi
- Azienda Ospedaliera Careggi e Università degli Studi di Firenze, Florence
| | - V. Vezzosi
- Azienda Ospedaliera Careggi e Università degli Studi di Firenze, Florence
| | | | | | | | | | | | - V. Rucca
- Os-pedale Cazzavillan, Arzignano
| | | | - F. De Paola
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - A. Dubini
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - M. Gaudio
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - L. Medri
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - F. Padovani
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - L. Saragoni
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - A. Volpi
- U.O. Oncologia Medica, Os-pedale Morgagni-Pierantoni, Forlì
| | - A.M. Granato
- U.O. Oncologia Medica, Os-pedale Morgagni-Pierantoni, Forlì
| | | | | | | | | | | | - C. Galli
- Azienda Os-pedaliera Niguarda, Milan
| | | | | | | | | | | | | | | | - A. Sidoni
- Anatomia Patologica, Azienda Ospedaliera Policlinico Monteluce, Perugia
| | - E. Bucciarelli
- Anatomia Patologica, Azienda Ospedaliera Policlinico Monteluce, Perugia
| | - V. Ludovini
- Oncologia Medica, Azienda Os-pedaliera Policlinico Monteluce, Perugia
| | - L. Pistola
- Oncologia Medica, Azienda Os-pedaliera Policlinico Monteluce, Perugia
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Mauri G, Valtorta E, Sartore-Bianchi A, Cerea G, Amatu A, Schirru M, Marrapese G, Fiorillo V, Recchimuzzo P, Stella I, Veronese S, Tosi F, Maiolani M, Truini M, Siena S. TRKA expression and NTRK1 gene copy number across solid tumors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx391.015] [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: 11/12/2022] Open
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Solari A, Giordano A, Patti F, Grasso MG, Confalonieri P, Palmisano L, Ponzio M, Borreani C, Rosato R, Veronese S, Zaratin P, Battaglia MA. Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis. Mult Scler 2017; 24:663-674. [PMID: 28381133 PMCID: PMC5946675 DOI: 10.1177/1352458517704078] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence on the efficacy of palliative care in persons with severe multiple sclerosis (MS) is scarce. OBJECTIVE To assess the efficacy of a home-based palliative approach (HPA) for adults with severe MS and their carers. METHODS Adults with severe MS-carer dyads were assigned (2:1 ratio) to either HPA or usual care (UC). At each center, a multi-professional team delivered the 6-month intervention. A blind examiner assessed dyads at baseline, 3 months, and 6 months. Primary outcome measures were Palliative care Outcome Scale-Symptoms-MS (POS-S-MS) and Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW, not assessed in severely cognitively compromised patients). RESULTS Of 78 dyads randomized, 76 (50 HPA, 26 UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC ( p = 0.047). Effect size was 0.20 at 3 months and 0.32 at 6 months, and statistical significance was borderline in per-protocol analysis ( p = 0.062). Changes in SEIQoL-DW index did not differ in the two groups, as changes in secondary patient and carer outcomes. CONCLUSION HPA slightly reduced symptoms burden. We found no evidence of HPA efficacy on patient quality of life and on secondary outcomes.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Paolo Confalonieri
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Lucia Palmisano
- National Center for Drug Evaluation and Research, Istituto Superiore di Sanità, Rome, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
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Ammirati E, Veronese G, Moioli M, Baldan R, Orcese C, De Rezende G, Veronese S, Perna E, Masciocco G, Travi G, Puoti M, Mondino M, Cipriani M, Cirillo D, Frigerio M. First Outbreak of Pneumocystis jirovecii Pneumonia in Heart Transplantation Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.222] [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: 12/01/2022] Open
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Siena S, Sartore-Bianchi A, Trusolino L, Martino C, Bencardino K, Lonardi S, Zagonel V, Leone F, Martinelli E, Ciardiello F, Racca P, Amatu A, Palmeri L, Valtorta E, Cassingena A, Vanzulli A, Regge D, Veronese S, Bardelli A, Marsoni S. Final Results of the HERACLES trial in HER2 amplified colorectal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Giordano A, Cimino V, Campanella A, Morone G, Fusco A, Farinotti M, Palmisano L, Confalonieri P, Lugaresi A, Grasso MG, Ponzio M, Veronese S, Patti F, Solari A. Low quality of life and psychological wellbeing contrast with moderate perceived burden in carers of people with severe multiple sclerosis. J Neurol Sci 2016; 366:139-145. [PMID: 27288793 DOI: 10.1016/j.jns.2016.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Vincenzo Cimino
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, via S. Sofia, 78, 95123 Catania, Italy.
| | - Angela Campanella
- Scientific Direction, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Giovanni Morone
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Augusto Fusco
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Lucia Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Paolo Confalonieri
- Unit of Neuroimmunology, and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Michela Ponzio
- Department of Research, Fondazione Italiana Sclerosi Multipla (FISM), Via Operai 40, 16149 Genoa, Italy.
| | - Simone Veronese
- FARO Charitable Foundation, Via Oddino Morgari 12, 10125 Turin, Italy.
| | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, via S. Sofia, 78, 95123 Catania, Italy.
| | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
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Solari A, Giordano A, Grasso MG, Confalonieri P, Patti F, Lugaresi A, Palmisano L, Amadeo R, Martino G, Ponzio M, Casale G, Borreani C, Causarano R, Veronese S, Zaratin P, Battaglia MA. Erratum to: 'Home-based palliative approach for people with severe multiple sclerosis and their carers: study protocol for a randomized controlled trial'. Trials 2016; 17:89. [PMID: 26883617 PMCID: PMC4756392 DOI: 10.1186/s13063-016-1228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy.
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - M G Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Rome, Italy
| | - P Confalonieri
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania; MS Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - A Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - R Amadeo
- Associazione Italiana Sclerosi Multipla, Genoa, Italy
| | - G Martino
- Associazione Italiana Sclerosi Multipla, Genoa, Italy
| | - M Ponzio
- Fondazione Italiana Sclerosi Multipla, Genoa, Italy
| | - G Casale
- Antea Charitable Association, Rome, Italy
| | - C Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - R Causarano
- Unit of Palliative Care-Hospice, Niguarda Ca' Granda Hospital, Milan, Italy
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - P Zaratin
- Fondazione Italiana Sclerosi Multipla, Genoa, Italy
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Sartore-Bianchi A, Amatu A, Stabile S, Tosi F, Bonazzina E, Maiolani M, Rusconi F, Galbiati D, Orlando V, Pietrogiovanna L, Gambaro A, Ghezzi S, Mastroianni D, Marrapese G, Lauricella C, Valtorta E, Veronese S, Truini M, Siena S. Pooled analysis of clinical outcome of patients with chemorefractory metastatic colorectal cancer treated within clinical studies based on individual molecular alterations at Niguarda Cancer Center. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.11] [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: 11/13/2022] Open
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Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2015; 23:30-8. [PMID: 26423203 DOI: 10.1111/ene.12889] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [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: 02/11/2014] [Revised: 07/10/2014] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The European Association of Palliative Care Taskforce, in collaboration with the Scientific Panel on Palliative Care in Neurology of the European Federation of Neurological Societies (now the European Academy of Neurology), aimed to undertake a review of the literature to establish an evidence-based consensus for palliative and end of life care for patients with progressive neurological disease, and their families. METHODS A search of the literature yielded 942 articles on this area. These were reviewed by two investigators to determine the main areas and the subsections. A draft list of papers supporting the evidence for each area was circulated to the other authors in an iterative process leading to the agreed recommendations. RESULTS Overall there is limited evidence to support the recommendations but there is increasing evidence that palliative care and a multidisciplinary approach to care do lead to improved symptoms (Level B) and quality of life of patients and their families (Level C). The main areas in which consensus was found and recommendations could be made are in the early integration of palliative care (Level C), involvement of the wider multidisciplinary team (Level B), communication with patients and families including advance care planning (Level C), symptom management (Level B), end of life care (Level C), carer support and training (Level C), and education for all professionals involved in the care of these patients and families (Good Practice Point). CONCLUSIONS The care of patients with progressive neurological disease and their families continues to improve and develop. There is a pressing need for increased collaboration between neurology and palliative care.
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Affiliation(s)
- D J Oliver
- Palliative Medicine, Wisdom Hospice, Rochester, UK.,University of Kent, Kent, UK
| | - G D Borasio
- Service de soins palliatifs, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy.,European Palliative Care Research Center NTNU, Trondheim, Norway
| | - M de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria
| | - S Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Veronese
- Fondazione Assistenza e Ricerca in Oncologia, Turin, Italy
| | - R Voltz
- Department of Palliative Medicine, University Hospital, Cologne, Germany.,EAN Subspeciality Scientific Panel on Palliative Care, Vienna, Austria
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Onorati M, Uboldi P, Bianchi CL, Nicola M, Corradini GM, Veronese S, Fascì AI, Di Nuovo F. Solitary thyroid metastasis from colon cancer: fine-needle aspiration cytology and molecular biology approach. Pathologica 2015; 107:192-196. [PMID: 26946875] [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: 06/05/2023] Open
Abstract
Thyroid gland is one of the most vascularized organs of the body, nevertheless clinical and surgical series report an incidence of secondary malignancies in this gland of only 3%. Colorectal carcinoma metastatic to the thyroid gland is not as uncommon as previously believed, infact the number of cases seems to be increased in recent years due to the more frequent use of fine-needle aspiration cytology (FNAC) guided by ultrasonography. Although kidney, breast and lung metastases to the thyroid are frequent, metastasis from colon cancer is clinically rare with 52 cases reported in the literature in the last 5 decades and three cases described as solitary thyroid metastasis from the colon cancer without any other visceral metastases. To the best of our knowledge, we report the fourth case of solitary, asymptomatic thyroid metastasis from colon cancer without involvement of other organs. We discuss the importance of FNAC to detect metastatazing process as a compulsory step of the diagnostic and therapeutic management algorithm, combined with a molecular biology approach. A review of the last 5 decades literature, to update the number of cases described to date, is also included.
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Rulli E, Marabese M, Torri V, Farina G, Veronese S, Bettini A, Longo F, Moscetti L, Ganzinelli M, Lauricella C, Copreni E, Labianca R, Martelli O, Marsoni S, Broggini M, Garassino MC. Value of KRAS as prognostic or predictive marker in NSCLC: results from the TAILOR trial. Ann Oncol 2015. [PMID: 26209642 DOI: 10.1093/annonc/mdv318] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 12/22/2022] Open
Abstract
BACKGROUND The prognostic and predictive role of KRAS mutations in advanced nonsmall-cell lung cancer (NSCLC) is still unclear. TAILOR prospectively assessed the prognostic and predictive value of KRAS mutations in NSCLC patients treated with erlotinib or docetaxel in second line. PATIENTS AND METHODS NSCLC patients from 52 Italian hospitals were genotyped for KRAS and EGFR mutational status in two independent laboratories. Wild-type EGFR patients (N = 218) received first-line platinum-based chemotherapy and were randomly allocated at progression to erlotinib or docetaxel. Overall survival (OS) according to KRAS mutational status was the primary end point. RESULTS KRAS mutations were present in 23% of TAILOR randomized cases. The presence of a KRAS mutation did not adversely affect progression-free (PFS) or overall (OS) survival [hazard ratio (HR) PFS = 1.01, 95% confidence interval (CI) 0.71-1.41, P = 0.977; OS = 1.24, 95% CI 0.87-1.77, P = 0.233], nor influenced treatment outcome (test for interaction: OS P = 0.965; PFS P = 0.417). Patients randomized to docetaxel treatment experienced longer survival independently from the KRAS mutational status of their tumors (HR: mutated KRAS 0.81, 95% CI 0.45-1.47; wild-type KRAS 0.79, 95% CI 0.57-1.10). CONCLUSION In TAILOR, KRAS was neither prognostic nor predictive of benefit for either docetaxel or erlotinib. Docetaxel remains superior independently from KRAS status for second-line treatment in EGFR wild-type advanced NSCLC patients. CLINICAL TRIAL REGISTRATION NCT00637910.
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Affiliation(s)
- E Rulli
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - M Marabese
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - G Farina
- Department of Medical Oncology, Fatebenefratelli e Oftalmico Hospital, Milan
| | - S Veronese
- Department of Pathology, Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milan
| | - A Bettini
- Department of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo
| | - F Longo
- Department of Medical Oncology, Università La Sapienza, Policlinico Umberto I, Rome
| | - L Moscetti
- Department of Medical Oncology, Ospedale Belcolle, Viterbo
| | - M Ganzinelli
- Thoracic Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - C Lauricella
- Department of Pathology, Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milan
| | - E Copreni
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - R Labianca
- Department of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo
| | - O Martelli
- Department of Medical Oncology, Ospedale San Giovanni e Addolorata, Rome
| | - S Marsoni
- Clinical Trials Coordination Unit, Istituto di Candiolo-FPO, IRCCS, Candiolo, Italy
| | - M Broggini
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - M C Garassino
- Thoracic Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Cavalla P, Zibetti M, Rivoiro C, Oliver DJ. Specialist palliative care improves the quality of life in advanced neurodegenerative disorders: NE-PAL, a pilot randomised controlled study. BMJ Support Palliat Care 2015; 7:164-172. [DOI: 10.1136/bmjspcare-2014-000788] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 12/25/2022]
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Rivoiro C, Oliver DJ. The palliative care needs of people severely affected by neurodegenerative disorders: A qualitative study. Progress in Palliative Care 2015. [DOI: 10.1179/1743291x15y.0000000007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Solari A, Giordano A, Grasso MG, Confalonieri P, Patti F, Lugaresi A, Palmisano L, Amadeo R, Martino G, Ponzio M, Casale G, Borreani C, Causarano R, Veronese S, Zaratin P, Battaglia MA. Home-based palliative approach for people with severe multiple sclerosis and their carers: study protocol for a randomized controlled trial. Trials 2015; 16:184. [PMID: 25899519 PMCID: PMC4409986 DOI: 10.1186/s13063-015-0695-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background Preliminary evidence suggests that palliative care may be useful for people with severe multiple sclerosis (MS). The aim of this study is to determine the effectiveness of a home-based palliative approach (HPA) for people with severe MS and their carers. Methods/design This is a single-blind randomized controlled trial with a nested qualitative study. Seventy-five severe MS-carer dyads are being randomized (at three centers, one in each area of Italy) to HPA or usual care (UC) in a 2:1 ratio. Each center has a specially trained team consisting of four professionals (physician, nurse, psychologist, social worker). The team makes a comprehensive assessment of the needs of the dyads. HPA content is then agreed on, discussed with the patient’s caring physician, and delivered over six months. The intervention is not intended to replace existing services. At later visits, the team checks the HPA delivery and reviews/modifies it as necessary. HPA and UC dyads are assessed at home by a blind examiner at baseline, and three and six months later; they also receive monthly telephone interviews. Dyads assigned to UC receive the examiner’s visits and telephone interviews, but not the team visits. Primary outcome measures are changes in symptoms (Palliative care Outcome Scale-Symptoms-MS, POS-S-MS), and quality of life (the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), not assessed in patients with severe cognitive compromise) at three and six months. Other outcomes are changes in patient functional status and mood; changes in carer quality of life, mood and caregiving burden; costs; incorporation with standard care; unplanned hospital admissions; referrals to hospice; and deaths. The experience of participants will be evaluated qualitatively by individual semi-structured interviews (HPA patients and carers) and focus group meetings (HPA patients’ caring physicians). Discussion The results of our study will show whether the HPA is feasible and beneficial to people with severe MS and their carers living in the three Italian geographic areas. The nested qualitative study will add to the understanding of the strengths and limitations of the intervention. Trial registration The trial was registered with Current Controlled Trials (identifier: ISRCTN73082124) on 19 June 2014.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Via Ardeatina 306, 00179, Rome, Italy.
| | - Paolo Confalonieri
- Unit of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania; MS Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Lucia Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Roberta Amadeo
- Associazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Giovanni Martino
- Associazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Michela Ponzio
- Fondazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Giuseppe Casale
- Antea Charitable Association, Piazza Santa Maria della Pietà 5, 00135, Rome, Italy.
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Renzo Causarano
- Unit of Palliative Care-Hospice, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Simone Veronese
- FARO Charitable Foundation, Via Morgari 12, 10125, Turin, Italy.
| | - Paola Zaratin
- Fondazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
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De Braud F, Pilla L, Niger M, Damian S, Bardazza B, Martinetti A, Pelosi G, Marrapese G, Palmeri L, Cerea G, Valtorta E, Veronese S, Sartore-Bianchi A, Ardini E, Martignoni M, Isacchi A, Pearson P, Luo D, Freddo J, Siena S. Rxdx-101, an Oral Pan-Trk, Ros1, and Alk Inhibitor, in Patients with Advanced Solid Tumors with Relevant Molecular Alterations. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Veronese S, Valle A, Chiò A, Calvo A, Oliver D. The last months of life of people with amyotrophic lateral sclerosis in mechanical invasive ventilation: A qualitative study. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:499-504. [DOI: 10.3109/21678421.2014.913637] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Adriano Chiò
- Department of Neuroscience, University of Turin, Italy
| | - Andrea Calvo
- Department of Neuroscience, University of Turin, Italy
| | - David Oliver
- Wisdom Hospice,
Rochester
- University of Kent, Centre for Professional Practice,
Chatham, UK
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Azimi A, Kuznecovs S, Kuznecovs J, Blazejczyk A, Switalska M, Chlopicki S, Marcinek A, Gebicki J, Wietrzyk J, Egyhazi S, Azimi A, Ghasghgaei S, Frostvik Stolt M, Hertzman Johansson C, Hansson J, Delage JD, Li H, Lu H, Cazin LH, Vannier JP, Drouet L, Dupuy E, Soria J, Varin R, Soria C, Castle J, Kreiter S, Diekmann J, Lower M, van der Roemer N, de Graaf J, Selmi S, Diken M, Boegel S, Paret C, Koslowski M, Kuhn AN, Britten CM, Huber C, Tureci O, Sahin U, Procopio G, Verzoni E, Testa I, de Braud F, Misale S, Yaeger R, Hobor S, Scala E, Janakiraman M, Liska D, Valtorta E, Schiavo R, Buscarino M, Siravergna G, Bencardino K, Cercek A, Chen C, Veronese S, Zanon C, Sartore-Bianchi A, Gambacorta M, Gallicchio M, Vakiani E, Boscaro V, Medico E, Weiser M, Siena S, di Nicolantonio F, Solit D, Bardelli A, Burbridge MF, Dovat SP, Song C, Payne KJ, Yang L, Cree A, Glaysher M, Bolton L, Johnson P, Atkey N, Torrance C, Bogush TA, Dudko EA, Shaturova AS, Tikhomirov MV, Bogush EA, Polotsky BE, Tjulandin SA, Davydov MI, Hertzman Johansson C, Azimi A, Pernemalm M, Pawitan Y, Frostvik Stolt M, Lazar V, Lundeberg J, Lehtio J, Egyhazi S, Hansson J, Rasul A, Ma T, Dyshlovoy SA, Naeth I, Venz S, Fedorov SN, Shubina LK, Stonik VA, Balabanov S, Honecker F, Kongpracha P, Tohtong R, Demidkina V, Kudryavtsev VA, Kabakov AE, Golan T, Atias D, Barshack I, Avivi C, Goldstein RS, Berger R, Ben-Arieh S, Urban D, Maimon N, Leibowitz-Amit R, Keizman D, Biran H, Mishaeli M, Onn A, Gottfried M, Saraswati S, Agrawal SS, Raval P, Patel M, Ganure L, Hanen JH, Sonia BHK, Aya M, Zohra H, Touhami M, Cheng X, Shi TY, Yang L, Yang G, Tu XY, Wu XH, Wei QY, Benboubker H, Zheng BQ, Shi YQ, He XH, Liang LH, Saied GM. Therapeutics. Ann Oncol 2012. [DOI: 10.1093/annonc/mds162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Garassino M, de Braud F, Broggini M, Marabese M, Veronese S, Ganzinelli M, Martelli O. P1.25 Prospective Evaluation of the Role of Kras in Patients Treated with a Platinum Based Doublet. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31316-8] [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: 11/17/2022] Open
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Einert TR, Schmidt G, Binnig G, Balacescu O, Balacescu L, Rus M, Buiga R, Tudoran O, Todor N, Nagy V, Irimie A, Neagoe I, Yacobi R, Ustaev E, Berger RR, Barshack I, Kaur K, Henderson S, Cutts A, Domingo E, Woods J, Motley C, Dougherty B, Middleton M, Hassan B, Wang Y, Beasley E, Naley M, Schuh A, Tomlinson I, Taylor J, Planchard D, Lueza B, Rahal A, Lacroix L, Ngocamus M, Auger N, Saulnier P, Dorfmuller P, Le Chevalier T, Celebic A, Pignon JP, Soria JC, Besse B, Sun YH, Wang R, Li CG, Pan YJ, Chen HQ, Chouchane L, Shan J, Kizhakayil D, Aigha I, Dsouza S, Noureddine B, Gabbouj S, Mathew R, Hassen E, Chouchane L, Shan S, al-Rumaihi K, al-Bozom I, al-Said S, Rabah D, Farhat K, Kizhakayil D, Aigha I, Jakobsen Falk IA, Green KHZ, Lotfi K, Fyrberg A, Pejovic T, Li H, Mhawech-Fauceglia P, Hoatlin M, Guo MG, Huang M, Ge Y, Hess K, Wei C, Zhang W, Bogush TA, Dudko EA, Nureev MV, Kamensky AA, Polotsky BE, Tjulandin SA, Davydov MI, Caballero M, Hasmats J, Green H, Quanz M, Buhler C, Sun JS, Dutreix M, Cebotaru CL, Buiga R, Placintar AN, Ghilezan N, Balogh ZB, Reiniger L, Rajnai H, Csomor J, Szepesi A, Balogh A, Deak L, Gagyi E, Bodor C, Matolcsy A, Bozhenko VK, Rozhkova NI, Kudinova EA, Bliznyukov OP, Vaskevich EN, Trotsenko ID, Bozhenko VK, Rozhkova NI, Kharchenko NV, Kudinova EA, Bliznyukov OP, Kiandarian IV, Trotsenko ID, Pulito C, Terrenato I, Sacconi A, Biagioni F, Mottolese M, Blandino G, Muti P, Falvo E, Strano S, Mori F, Sacconi A, Ganci F, Covello R, Zoccali C, Biagini R, Blandino G, Strano S, Palmer GA, Wegdam W, Meijer D, Kramer G, Langridge J, Moerland PD, de Jong SM, Vissers JP, Kenter GG, Buist MR, Aerts JMFG, Milione M, de Braud F, Buzzoni R, Pusceddu S, Mazzaferro V, Damato A, Pelosi G, Garassino M, de Braud F, Broggini M, Marabese M, Veronese S, Ganzinelli M, Martelli O, Ganci F, Bossel N, Sacconi A, Fontemaggi G, Manciocco V, Sperduti I, Falvo E, Strigari L, Covello R, Muti P, Strano S, Spriano G, Domany E, Blandino G, Donzelli S, Sacconi A, Bellissimo T, Alessandrini G, Strano S, Carosi MA, Pescarmona E, Facciolo F, Telera S, Pompili A, Blandino G, de Vriendt V, de Roock W, di Narzo AF, Tian S, Biesmans B, Jacobs B, de Schutter J, Budzinska E, Sagaert X, Delorenzi M, Simon I, Tejpar S, Zhu Y, Wang HK, Ye DW, Denisov E, Tsyganov M, Tashireva L, Zavyalova M, Perelmuter V, Cherdyntseva N, Kim YC, Jang T, Oh IJ, Kim KS, Ban H, Na KJ, Ahn SJ, Kang H, Kim WJ, Park C, Abousamra NK, El-Din MS, Azmy EA. Diagnostics. Ann Oncol 2012. [DOI: 10.1093/annonc/mds161] [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: 11/12/2022] Open
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Marbello L, Riva M, Veronese S, Nosari AM, Ravano E, Colosimo A, Paris L, Morra E. T-cell receptor gene rearrangement in Epstein-Barr virus infectious mononucleosis. Med Oncol 2011; 29:2300-2. [PMID: 21607769 DOI: 10.1007/s12032-011-9987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/13/2011] [Indexed: 11/29/2022]
Abstract
This report describes the case of a previously healthy young man who presented with fever, pharyngitis, cervical lymphadenopathy, lymphocytosis, and severe thrombocytopenia. Serological tests for Epstein-Barr virus were diagnostic of a primary Epstein-Barr virus infectious mononucleosis but severe thrombocytopenia aroused the suspicion of a lymphoproliferative disease. T-cell receptor gene analysis performed on peripheral and bone marrow blood revealed a T-cell receptor γ-chain rearrangement without the evidence of malignancy using standard histologic and immunophenotype studies. Signs and symptoms of the infectious disease, blood count, and T-cell receptor gene rearrangement resolved with observation without the evidence of emergence of a lymphoproliferative disease. In the contest of a suspected lymphoproliferative disease, molecular results should be integrated with all available data for an appropriate diagnosis.
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Affiliation(s)
- L Marbello
- Department of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Sartore-Bianchi A, Fieuws S, Veronese S, Moroni M, Personeni N, Frattini M, Torri V, Cappuzzo F, Vander Borght S, Martin V, Skokan M, Santoro A, Gambacorta M, Tejpar S, Varella-Garcia M, Siena S. Standardization of EGFR FISH in colorectal cancer: Results of an international, interlaboratory reproducibility ring study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3597] [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: 11/20/2022] Open
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