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Pizzoli SFM, Marzorati C, Gatti D, Monzani D, Mazzocco K, Pravettoni G. A meta-analysis on heart rate variability biofeedback and depressive symptoms. Sci Rep 2021; 11:6650. [PMID: 33758260 PMCID: PMC7988005 DOI: 10.1038/s41598-021-86149-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies. Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analysed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI = - 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, QT = 23.49, p = 0.03, I2 = 45%, which suggested a moderate variance among the included studies. The year of publication (χ2(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ2(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being.
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Affiliation(s)
- Silvia F M Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy.
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
| | - Daniele Gatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IEO, IRCCS, Milan, Italy
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2
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Russo S, Monzani D, Pinto CA, Vergani L, Marton G, Falahee M, Simons G, Whichello C, Kihlbom U, Pravettoni G. Taking into Account Patient Preferences: A Consensus Study on the Assessment of Psychological Dimensions Within Patient Preference Studies. Patient Prefer Adherence 2021; 15:1331-1345. [PMID: 34177261 PMCID: PMC8219660 DOI: 10.2147/ppa.s261615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
Patient preferences are gaining recognition among key stakeholders involved in benefit-risk decision-making along the medical product lifecycle. However, one of the main challenges of integrating patient preferences in benefit-risk decision-making is understanding differences in patient preference, which may be attributable to clinical characteristics (eg age, medical history) or psychosocial factors. Measuring the latter may provide valuable information to decision-makers but there is limited guidance regarding which psychological dimensions may influence patient preferences and which psychological instruments should be considered for inclusion in patient preference studies. This paper aims to provide such guidance by advancing evidence and consensus-based recommendations and considerations. Findings of a recent systematic review on psychological constructs having an impact on patients' preferences and health-related decisions were expanded with input from an expert group (n = 11). These data were then used as the basis for final recommendations developed through two rounds of formal evaluation via an online Delphi consensus process involving international experts in the field of psychology, medical decision-making, and risk communication (n = 27). Three classes of recommendations emerged. Eleven psychological constructs reached consensus to be recommended for inclusion with the strongest consensus existing for health literacy, numeracy, illness perception and treatment-related beliefs. We also proposed a set of descriptive and checklist criteria to appraise available psychological measures to assist researchers and other stakeholders in including psychological assessment when planning patient preference studies. These recommendations can guide researchers and other stakeholders when designing and interpreting patient preference studies with a potential high impact in clinical practice and medical product benefit-risk decision-making processes.
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Affiliation(s)
- Selena Russo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Discipline of Paediatrics, School of Women’s and Children’s Health, The University of New South Wales, Kensington, NSW, Australia
- Correspondence: Selena Russo Department of Medicine and Surgery, University of Milano, Bicocca, via Cadore 48, Monza (MB), 20052, Italy Email
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Cathy Anne Pinto
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Birmingham, UK
| | - Chiara Whichello
- Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ulrik Kihlbom
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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3
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Corso G, Montagna G, Figueiredo J, La Vecchia C, Fumagalli Romario U, Fernandes MS, Seixas S, Roviello F, Trovato C, Guerini-Rocco E, Fusco N, Pravettoni G, Petrocchi S, Rotili A, Massari G, Magnoni F, De Lorenzi F, Bottoni M, Galimberti V, Sanches JM, Calvello M, Seruca R, Bonanni B. Hereditary Gastric and Breast Cancer Syndromes Related to CDH1 Germline Mutation: A Multidisciplinary Clinical Review. Cancers (Basel) 2020; 12:E1598. [PMID: 32560361 PMCID: PMC7352390 DOI: 10.3390/cancers12061598] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
E-cadherin (CDH1 gene) germline mutations are associated with the development of diffuse gastric cancer in the context of the so-called hereditary diffuse gastric syndrome, and with an inherited predisposition of lobular breast carcinoma. In 2019, the international gastric cancer linkage consortium revised the clinical criteria and established guidelines for the genetic screening of CDH1 germline syndromes. Nevertheless, the introduction of multigene panel testing in clinical practice has led to an increased identification of E-cadherin mutations in individuals without a positive family history of gastric or breast cancers. This observation motivated us to review and present a novel multidisciplinary clinical approach (nutritional, surgical, and image screening) for single subjects who present germline CDH1 mutations but do not fulfil the classic clinical criteria, namely those identified as-(1) incidental finding and (2) individuals with lobular breast cancer without family history of gastric cancer (GC).
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
| | - Giacomo Montagna
- Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Joana Figueiredo
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy;
| | - Uberto Fumagalli Romario
- Department of Digestive Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Maria Sofia Fernandes
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
| | - Susana Seixas
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
| | - Franco Roviello
- Departments of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Cristina Trovato
- Division of Endoscopy, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
- Division of Pathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
- Division of Pathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (E.G.-R.); (N.F.); (G.P.)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Serena Petrocchi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Anna Rotili
- Division of Breast Imaging, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Giulia Massari
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
| | - Francesca De Lorenzi
- Division of Plastic Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (F.D.L.); (M.B.)
| | - Manuela Bottoni
- Division of Plastic Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (F.D.L.); (M.B.)
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (G.M.); (F.M.); (V.G.)
| | - João Miguel Sanches
- Institute for Systems and Robotics, Instituto Superior Técnico, 1049-001 Lisboa, Portugal;
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (M.C.); (B.B.)
| | - Raquel Seruca
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal; (J.F.); (M.S.F.); (S.S.); (R.S.)
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), 4200-135 Porto, Portugal
- Medical Faculty, University of Porto, 4099-002 Porto, Portugal
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy; (M.C.); (B.B.)
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Abstract
Providing useful resources to patients is essential in achieving the vision of participatory medicine. However, the problem of identifying pertinent content for a group of patients is even more difficult than identifying information for just one. Nevertheless, studies suggest that the group dynamics-based principles of behavior change have a positive effect on the patients’ welfare. Along these lines, in this paper, we present a multidimensional recommendation model in the health domain using collaborative filtering. We propose a novel semantic similarity function between users, going beyond patient medical problems, considering additional dimensions such as the education level, the health literacy, and the psycho-emotional status of the patients. Exploiting those dimensions, we are interested in providing recommendations that are both high relevant and fair to groups of patients. Consequently, we introduce the notion of fairness and we present a new aggregation method, accumulating preference scores. We experimentally show that our approach can perform better recommendations to small group of patients for useful information documents.
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Monzani D, Vergani L, Pizzoli SFM, Marton G, Mazzocco K, Bailo L, Messori C, Pancani L, Cattelan M, Pravettoni G. Sexism Interacts with Patient-Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design. Appl Psychol Health Well Being 2020; 12:471-492. [PMID: 31985173 PMCID: PMC7384069 DOI: 10.1111/aphw.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients' individual differences, contextual and situational qualities, and their complex interaction in explaining this variability. METHODS We assessed the role of the interaction of patient's sociodemographic and psychological factors with a physician's gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor. RESULTS Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences. CONCLUSIONS In conclusion, patients' attitudes toward the physicians' gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship.
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Affiliation(s)
- Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Messori
- Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Manuela Cattelan
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
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Badran I, Bruynseels A, Khan S, Sii F, Shah P. Barriers to adoption of a personal health record in an ophthalmic setting: lessons from implementation of a Glaucoma Patient Passport. Clin Ophthalmol 2019; 13:1369-1375. [PMID: 31440025 PMCID: PMC6664246 DOI: 10.2147/opth.s208377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/03/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Self-care in chronic disease is increasingly important. In glaucoma services, there is an unmet need for a self-care tool such as a patient passport. This study aims to evaluate adoption of a new self-care tool, the Glaucoma Patient Passport (GPP) within a tertiary hospital glaucoma service. Patients and methods The GPP was designed following consultation exercises between patients and clinicians at the first and second UK National Glaucoma Think Tanks. A patient questionnaire, comprising a mixed methods quantitative and qualitative research approach was used to explore the utility of GPP, patient attitude to GPP and barriers to adoption, 6 months after GPP receipt. Results GPP feedback was received from 62 patients. On-going utilization of the GPP after receipt was high, at 84%, with patients most commonly using the GPP at home, to “look for information.” Seventy-three percent reported improved knowledge of glaucoma care since using the GPP, with two-thirds (63%) reporting that the GPP had improved their glaucoma care. Three main themes were identified in exploring barriers to GPP adoption; clinician involvement in GPP use, GPP size, and GPP use in visual impairment. Conclusion Implementation and adoption of the world’s first GPP were a success. GPP utility was high and patient attitudes were predominantly positive, with improved self-care. However, several areas were identified for future GPP improvement. The GPP has the potential to improve patient self-care in glaucoma, bridging the care gap created by the increased workload in glaucoma services.
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Affiliation(s)
- Imad Badran
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Department for Therapies and Public Health, Birmingham City University, Birmingham, UK
| | - Alice Bruynseels
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Birmingham Institute for Glaucoma Research, Institute for Translational Medicine, Birmingham, UK
| | - Salim Khan
- Department for Therapies and Public Health, Birmingham City University, Birmingham, UK
| | - Freda Sii
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Birmingham Institute for Glaucoma Research, Institute for Translational Medicine, Birmingham, UK
| | - Peter Shah
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Birmingham Institute for Glaucoma Research, Institute for Translational Medicine, Birmingham, UK.,Institute of Ophthalmology, University College London, London, UK.,Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
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Marzorati C, Monzani D, Mazzocco K, Pavan F, Cozzi G, De Cobelli O, Monturano M, Pravettoni G. Predicting trajectories of recovery in prostate cancer patients undergone Robot-Assisted Radical Prostatectomy (RARP). PLoS One 2019; 14:e0214682. [PMID: 30946773 PMCID: PMC6448842 DOI: 10.1371/journal.pone.0214682] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify trends of patients' urinary and sexual dysfunctions from a clinical and psychological perspective and understand whether sociodemographic and medical predictors could differentiate among patients following different one-year longitudinal trajectories. METHODS An Italian sample of 478 prostate cancer patients undergone Robot-Assisted Radical Prostatectomy completed the EPIC-26 survey between July 2015 and July 2016 at the pre-hospitalization (T0), 45 days (T1) and 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after surgery. Sociodemographic and clinical characteristics (age, BMI, diabetes, nerve-sparing procedure) were also collected. Latent Class Growth Analysis was conducted separately for sexual dysfunction and urinary incontinence EPIC-26 subscales. The association between membership in the two longitudinal trajectories of urinary and sexual dysfunctions was assessed by considering Chi-square test and its related contingency table. RESULTS People who have a high level of urinary incontinence at T1 are likely to have a worse recovery. Age, BMI and pre-surgical continence may affect the level of incontinence at T1 and the recovery trajectories. Patients with low and moderate sexual problems at T1 can face a moderate linear recovery, while people with high level of impotence immediately after surgery may take a longer period to solve sexual dysfunctions. Age and the pre-surgical sexual condition may impact the recovery. Finally, a great proportion of patients reported both steady problems in sexual function and constant high levels of urinary incontinence over time. CONCLUSIONS This study highlights different categories of patients at risk who may be important to know in order to develop personalized medical pathways and predictive models in a value-based healthcare.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Pavan
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Monturano
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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8
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Bailo L, Guiddi P, Vergani L, Marton G, Pravettoni G. The patient perspective: investigating patient empowerment enablers and barriers within the oncological care process. Ecancermedicalscience 2019; 13:912. [PMID: 31123495 PMCID: PMC6467453 DOI: 10.3332/ecancer.2019.912] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
Patient empowerment is a multi-factorial concept and its relevance has led to a growing body of literature; despite this attention, there is still no agreement regarding the elements that define its expression. While several studies have already investigated the positive effect of empowerment interventions on the care process outcome, the aim of this study is to investigate which factors can foster an empowered management of the cancer condition from the patient's perspective. To examine patients' perception of empowerment enablers, we asked for participants' input on the role of three factors frequently cited as positively affected by empowerment: care quality, perception of direct control and relationships within the care context, during the care process. Three focus groups were conducted with 34 cancer patients. The results highlight the perception of direct control on their treatment as the least valued element (2.87, SD 0.566) when compared with care quality (3.75, SD 0.649) and relational support in the care context (3.91, SD 0.274). Unlike traditional approaches to empowerment, patient's expression of empowerment does not mainly reside in the direct control of their condition as much as in an active role within the relationship with caretakers, such as the ability to choose the doctor, the care team or the health organisation in charge of their healthcare. Emerging aspects from this analysis of patient's perspective are central in order to adequately consider empowerment in the care process and to provide more effective care strategies.
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Affiliation(s)
- Luca Bailo
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
| | - Paolo Guiddi
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
| | - Laura Vergani
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giulia Marton
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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9
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Vergani L, Marton G, Pizzoli SFM, Monzani D, Mazzocco K, Pravettoni G. Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10855. [PMID: 30888326 PMCID: PMC6444278 DOI: 10.2196/10855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022] Open
Abstract
Background Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient’s home. Objective This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients.
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Affiliation(s)
- Laura Vergani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Giulia Marton
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
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10
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Marzorati C, Bailo L, Mazzocco K, Pravettoni G. Empowerment from patient's and caregiver's perspective in cancer care. Health Psychol Open 2018; 5:2055102918815318. [PMID: 30619617 PMCID: PMC6299910 DOI: 10.1177/2055102918815318] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The caregivers’ perceptions of the patients’ health condition may be biased and induce them to perceive higher needs than patients actually disclose. Our aim was to assess if the level of knowledge and awareness about cancer disease and treatment, and patient participation and assistance differs between caregivers and patients. A descriptive, cross-sectional study was conducted across five countries (Italy, United Kingdom, Spain, France and Germany) on a total of 510 participants who directly (patient) or indirectly (caregiver) faced a cancer diagnosis. Investigating this divergence could help to identify possible difficulties in patient–caregiver relationship, eventually improving patient empowerment.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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11
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Vegter MW. Towards precision medicine; a new biomedical cosmology. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:443-456. [PMID: 29429062 PMCID: PMC6267256 DOI: 10.1007/s11019-018-9828-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new 'medical cosmology' in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the conceptualisation of disease. Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive 'right' to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego.
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Affiliation(s)
- M W Vegter
- Faculty of Science, Institute for Science in Society, Radboud University Nijmegen, P.O. Box 9010, 6500 GL, Nijmegen, The Netherlands.
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12
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Gorini A, Mazzocco K, Triberti S, Sebri V, Savioni L, Pravettoni G. A P5 Approach to m-Health: Design Suggestions for Advanced Mobile Health Technology. Front Psychol 2018; 9:2066. [PMID: 30429810 PMCID: PMC6220651 DOI: 10.3389/fpsyg.2018.02066] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
In recent years, technology has been developed as an important resource for health care management, especially in regard to chronic conditions. In the broad field of eHealth, mobile technology (mHealth) is increasingly used to empower patients not only in disease management but also in the achievement of positive experiences and experiential growth. mHealth tools are considered powerful because, unlike more traditional Internet-based tools, they allow patients to be continuously monitored and followed by their own mobile devices and to have continual access to resources (e.g., mobile apps or functions) supporting health care management activities. However, the literature has shown that, in many cases, such technology not accepted and/or adopted in the long term by its users. To address this issue, this article reviews the main factors influencing mHealth technology acceptance/adoption in health care. Finally, based on the main aspects emerging from the review, we propose an innovative approach to mHealth design and implementation, namely P5 mHealth. Relying on the P5 approach to medicine and health care, this approach provides design suggestions to address mHealth adoption issues already at the initial stages of development of the technologies.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Stefano Triberti
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Valeria Sebri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Lucrezia Savioni
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan, Italy
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13
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Callus E, Bertoldo EG, Beretta M, Boveri S, Cardani R, Fossati B, Brigonzi E, Meola G. Neuropsychological and Psychological Functioning Aspects in Myotonic Dystrophy Type 1 Patients in Italy. Front Neurol 2018; 9:751. [PMID: 30298045 PMCID: PMC6160752 DOI: 10.3389/fneur.2018.00751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Myotonic Dystrophy Type 1 (DM1) is an autosomal dominant genetic illness, characterized by a progressive loss of strength. Important deficits in cognitive functioning and a significant prevalence of psychiatric disorders have been previously reported. Methods:A neuropsychological and psychological assessment was carried out in 31 DM1 patients (61% males) in order to measure the cognitive functioning and explore their personality profiles. The MMSE Mini-Mental State Examination, Frontal Assessment Battery (FAB), ENB-2 Battery assessing memory (short term, long term and working memory), integration capacities, visual-spatial ability, attention (selective, divided, shifting/switching) executive functions, praxis, discrimination and logic capabilities and psychopathology Symptom Check List 90-R (SCL-90-R) were administered. The neuropsychological and psychological evaluation of DM1 patients was carried out taking into consideration the clinical parameters (CTG repeat, age at onset, disease duration, Muscular Impairment Rate Scale (MIRS), Medical Research Council Scale (MRC) and the Epworth Sleepiness Scales (EPS)). Results: Regarding psychopathology 19.4% of patients scored a moderate or high level of symptoms intensity index (GSI), 12.9% reported a high number of symptoms (PST) and 16.1% reported a high intensity level of the perceived symptoms (PSDI). Fatigue and daytime sleepiness resulted as being associated with higher levels of psychoticism (PSY). Only 1 patient reported a severe impairment in the spatial and temporal orientation, memory, language, praxis, attention and calculation. Longer disease duration was also associated with cognitive impairment evaluated through ENB-2 (p < 0.05). Discussions and Conclusions:There are indications of the utility of neuropsychological and psychological screening and support for these patients and their families due to the link between disease duration and cognitive performances. A proposal of a clinical protocol, with an illustration of a clinical case report of a family is presented.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Enrico G Bertoldo
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maria Beretta
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosanna Cardani
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Barbara Fossati
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elisa Brigonzi
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Meola
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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14
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Cost-Effective eHealth System Based on a Multi-Sensor System-on-Chip Platform and Data Fusion in Cloud for Sport Activity Monitoring. ELECTRONICS 2018. [DOI: 10.3390/electronics7090183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
eHealth systems provide medical support to users and contribute to the development of mobile and quality health care. They also provide results on the prevention and follow-up of diseases by monitoring health-status indicators and methodical data gathering in patients. Telematic management of health services by means of the Internet of Things provides immediate support and it is cheaper than conventional physical presence methods. Currently, wireless communications and sensor networks allow a person or group to be monitored remotely. The aim of this paper is to develop and assess a system for monitoring physiological parameters to be applied in different scenarios, such as health or sports. This system is based on a distributed architecture, where physiological data of a person are collected by several sensors; next, a Raspberry Pi joins the information and makes a standardization process; then, these data are sent to the Cloud to be processed. Our Cloud system stores the received data and makes a data fusion process in order to indicate the athlete’s fatigue status at every moment. This system has been tested in collaboration with a small group of voluntary tri-athletes. A network simulation has been performed to plan a monitoring network for a bigger group of athletes. Finally, we have found that this system is useful for medium-term monitoring of the sports activities.
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15
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Iatraki G, Kondylakis H, Koumakis L, Chatzimina M, Kazantzaki E, Marias K, Tsiknakis M. Personal Health Information Recommender: implementing a tool for the empowerment of cancer patients. Ecancermedicalscience 2018; 12:851. [PMID: 30079113 PMCID: PMC6057655 DOI: 10.3332/ecancer.2018.851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Indexed: 11/25/2022] Open
Abstract
Nowadays, patients have a wealth of information available on the Internet. Despite the potential benefits of Internet health information seeking, several concerns have been raised about the quality of information and about the patient’s capability to evaluate medical information and to relate it to their own disease and treatment. As such, novel tools are required to effectively guide patients and provide high-quality medical information in an intelligent and personalised manner. With this aim, this paper presents the Personal Health Information Recommender (PHIR), a system to empower patients by enabling them to search in a high-quality document repository selected by experts, avoiding the information overload of the Internet. In addition, the information provided to the patients is personalised, based on individual preferences, medical conditions and other profiling information. Despite the generality of our approach, we apply the PHIR to a personal health record system constructed for cancer patients and we report on the design, the implementation and a preliminary validation of the platform. To the best of our knowledge, our platform is the only one combining natural language processing, ontologies and personal information to offer a unique user experience.
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Affiliation(s)
- Galatia Iatraki
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion GR70013, Greece
| | | | - Lefteris Koumakis
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion GR70013, Greece
| | - Maria Chatzimina
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion GR70013, Greece
| | - Eleni Kazantzaki
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion GR70013, Greece
| | - Kostas Marias
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion GR70013, Greece.,Department of Informatics Engineering, Technological Educational Institute of Crete, Heraklion GR71004, Greece
| | - Manolis Tsiknakis
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion GR70013, Greece.,Department of Informatics Engineering, Technological Educational Institute of Crete, Heraklion GR71004, Greece
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16
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Crico C, Renzi C, Graf N, Buyx A, Kondylakis H, Koumakis L, Pravettoni G. mHealth and telemedicine apps: in search of a common regulation. Ecancermedicalscience 2018; 12:853. [PMID: 30079115 PMCID: PMC6057658 DOI: 10.3332/ecancer.2018.853] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 12/13/2022] Open
Abstract
Developments in information and communication technology have changed the way healthcare processes are experienced by both patients and healthcare professionals: more and more services are now available through computers and mobile devices. Smartphones are becoming useful tools for managing one’s health, and today, there are many available apps meant to increase self-management, empowerment and quality of life. However, there are concerns about the implications of using mHealth and apps: data protection issues, concerns about sharing information online, and the patients’ capacity for discerning effective and valid apps from useless ones. The new General Data Protection Regulation has been introduced in order to give uniformity to data protection regulations among European countries but shared guidelines for mHealth are yet to develop. A unified perspective across Europe would increase the control over mHealth exploitation, making it possible to think of mHealth as effective and standard tools for future medical practice.
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Affiliation(s)
- Chiara Crico
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan 20141, Italy
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan 20141, Italy
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg/Saar, Germany
| | - Alena Buyx
- Department of Biomedical Ethics, Institute of Experimental Medicine, University of Kiel, Germany
| | | | | | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan 20141, Italy
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17
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Corso G, Figueiredo J, La Vecchia C, Veronesi P, Pravettoni G, Macis D, Karam R, Lo Gullo R, Provenzano E, Toesca A, Mazzocco K, Carneiro F, Seruca R, Melo S, Schmitt F, Roviello F, De Scalzi AM, Intra M, Feroce I, De Camilli E, Villardita MG, Trentin C, De Lorenzi F, Bonanni B, Galimberti V. Hereditary lobular breast cancer with an emphasis on E-cadherin genetic defect. J Med Genet 2018; 55:431-441. [PMID: 29929997 DOI: 10.1136/jmedgenet-2018-105337] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 12/22/2022]
Abstract
Recent studies have reported germline CDH1 mutations in cases of lobular breast cancer (LBC) not associated with the classical hereditary diffuse gastric cancer syndrome. A multidisciplinary workgroup discussed genetic susceptibility, pathophysiology and clinical management of hereditary LBC (HLBC). The team has established the clinical criteria for CDH1 screening and results' interpretation, and created consensus guidelines regarding genetic counselling, breast surveillance and imaging techniques, clinicopathological findings, psychological and decisional support, as well as prophylactic surgery and plastic reconstruction. Based on a review of current evidence for the identification of HLBC cases/families, CDH1 genetic testing is recommended in patients fulfilling the following criteria: (A) bilateral LBC with or without family history of LBC, with age at onset <50 years, and (B) unilateral LBC with family history of LBC, with age at onset <45 years. In CDH1 asymptomatic mutant carriers, breast surveillance with clinical examination, yearly mammography, contrast-enhanced breast MRI and breast ultrasonography (US) with 6-month interval between the US and the MRI should be implemented as a first approach. In selected cases with personal history, family history of LBC and CDH1 mutations, prophylactic mastectomy could be discussed with an integrative group of clinical experts. Psychodecisional support also plays a pivotal role in the management of individuals with or without CDH1 germline alterations. Ultimately, the definition of a specific protocol for CDH1 genetic screening and ongoing coordinated management of patients with HLBC is crucial for the effective surveillance and early detection of LBC.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
| | - Joana Figueiredo
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy.,Oncology and Hematology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Oncology and Hematology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Debora Macis
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | | | - Roberto Lo Gullo
- Division of Breast Imaging, European Institute of Oncology, Milan, Italy
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK.,Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
| | - Ketti Mazzocco
- Oncology and Hematology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Fátima Carneiro
- Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Division of Pathology, Hospital São Joao, Porto, Portugal
| | - Raquel Seruca
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Medical Faculty of the University of Porto, Porto, Portugal
| | - Soraia Melo
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Medical Faculty of the University of Porto, Porto, Portugal
| | - Fernando Schmitt
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Medical Faculty of the University of Porto, Porto, Portugal
| | - Franco Roviello
- Departments of Surgery and Pathology, Le Scotte Hospital, University of Siena, Siena, Italy
| | | | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | | | - Chiara Trentin
- Division of Breast Imaging, European Institute of Oncology, Milan, Italy
| | | | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
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18
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Marzorati C, Renzi C, Russell-Edu SW, Pravettoni G. Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review. J Med Internet Res 2018; 20:e223. [PMID: 29914858 PMCID: PMC6028768 DOI: 10.2196/jmir.9812] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. OBJECTIVE We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. METHODS We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. RESULTS We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. CONCLUSIONS Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results.
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Affiliation(s)
- Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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19
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Dekkers T, Melles M, Mathijssen NMC, Vehmeijer SBW, Ridder HD. Tailoring the orthopaedic consultation: How perceived patient characteristics influence surgeons' communication. PATIENT EDUCATION AND COUNSELING 2018; 101:428-438. [PMID: 28911881 DOI: 10.1016/j.pec.2017.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether and how orthopaedic surgeons tailor communication during medical consultations based on perceived patient characteristics. METHODS Seven orthopaedic surgeons were repeatedly interviewed following an approach based on ecological momentary assessment. Qualitative content analysis was used to analyse the eighty short interviews. The association between patient characteristics and tailoring approaches was explored in a correspondence analysis of the counted codes. RESULTS Surgeons estimate patients' competence (illness management and communication abilities), autonomy, and interpersonal behaviour. They report tailoring communication in two-thirds of the consultations. The surgeons' perception was associated with the employment of specific approaches to communication: (1) high patient competence with extensive information provision or no changes in communication, (2) less autonomy and less competence with reassurance and direction, (3) high autonomy with discussions about pace and expectations, and (4) high sociability with communication about personal circumstances and wishes. CONCLUSION The surgeon's perception of a patient influences communication during consultations. Future research should address whether these intuitively employed approaches are appropriate, effective, and generalizable to other medical specialists. PRACTICE IMPLICATIONS Tailoring physician-patient communication can improve its quality. The novel approaches identified in this study can be used to formulate and test formal guidelines for tailored communication.
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Affiliation(s)
- Tessa Dekkers
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Huib de Ridder
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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Koumakis L, Kondylakis H, Katehakis DG, Iatraki G, Argyropaidas P, Hatzimina M, Marias K. A Content-Aware Analytics Framework for Open Health Data. PRECISION MEDICINE POWERED BY PHEALTH AND CONNECTED HEALTH 2018. [DOI: 10.1007/978-981-10-7419-6_10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Renzi C, Fioretti C, Oliveri S, Mazzocco K, Zerini D, Alessandro O, Rojas DP, Jereczek-Fossa BA, Pravettoni G. A Qualitative Investigation on Patient Empowerment in Prostate Cancer. Front Psychol 2017; 8:1215. [PMID: 28798701 PMCID: PMC5526923 DOI: 10.3389/fpsyg.2017.01215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose: Men with prostate cancer often describe low levels of empowerment. eHealth interventions may represent useful tools to deliver care and education and to meet patients' needs within an empowerment framework. In order to design a platform for cancer patients' empowerment within the H2020 iManageCancer project, the perspective of the target population for the platform was assessed. The present study aims to assess the qualitative experience of prostate cancer patients during treatment in order to provide insights for clinical practice with a particular focus on the design of a web platform to promote cancer patients' empowerment. Methods: Ten patients undergoing radiation therapy treatment took part in a semi-structured interview to explore different aspects of patient empowerment. Four main thematic areas were addressed: patient-healthcare providers' communication, decision-making, needs, and resources. A qualitative approach using thematic analysis was followed. Results: Half of the patients reported little to no possibility to share information and questions with healthcare providers. With regards to decision-making, the role of healthcare providers was perceived as directive/informative, but half of the patients perceived to assume an active role in at least one interaction. Difficulties and needs included the choice of the specialist or of the structure after diagnosis, clinicians' support in self-management, surgical consequences, and side effects, preparation for radiation therapy. Resources included family and social support both from a practical and from an emotional perspective, coping style, and work schedule management. Conclusions: These results suggest that relations with healthcare providers should be supported, especially immediately after diagnosis and after surgery. Support to self-management after surgery and at the beginning of radiation therapy treatment also constitutes a priority. The adoption of a personalized approach from the beginning of prostate cancer care flow may promote patient empowerment, overcoming the aforementioned needs and mobilizing resources. The social network represents an important resource that could be integrated in interventions. These considerations will be taken into account in the design of a cancer self-management platform aiming to increase patients' empowerment.
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Affiliation(s)
- Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Serena Oliveri
- Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy
| | - Ombretta Alessandro
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Damaris P Rojas
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
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22
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Masiero M, Riva S, Oliveri S, Fioretti C, Pravettoni G. Optimistic bias in young adults for cancer, cardiovascular and respiratory diseases: A pilot study on smokers and drinkers. J Health Psychol 2016; 23:645-656. [PMID: 27624614 DOI: 10.1177/1359105316667796] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Optimistic bias defines the tendency for human beings to underrate risk when it pertains to themselves compared with their view of risk pertaining to other people in the same conditions. The aim of this work is to investigate the optimistic bias in risk perception and health-related behaviours for three specific conditions in a young adult sample: cancer, respiratory disorders and cardiovascular diseases. Young adults showed an optimistic bias related to cancer, and to cardiovascular diseases. Our findings suggest that optimistic bias is linked to specific behavioural patterns, largely widespread in young adults, such as tobacco cigarette smoking and alcohol consumption.
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Affiliation(s)
- Marianna Masiero
- 1 University of Milan, Italy.,2 European Institute of Oncology (IEO), Italy
| | - Silvia Riva
- 1 University of Milan, Italy.,2 European Institute of Oncology (IEO), Italy
| | - Serena Oliveri
- 1 University of Milan, Italy.,2 European Institute of Oncology (IEO), Italy
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Anaya JM, Duarte-Rey C, Sarmiento-Monroy JC, Bardey D, Castiblanco J, Rojas-Villarraga A. Personalized medicine. Closing the gap between knowledge and clinical practice. Autoimmun Rev 2016; 15:833-42. [DOI: 10.1016/j.autrev.2016.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 12/22/2022]
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Gorini A, Mazzocco K, Kondylakis H, McVie G, Pravettoni G. A web-based interactive tool to improve breast cancer patient centredness. Ecancermedicalscience 2016; 10:659. [PMID: 27563354 PMCID: PMC4970622 DOI: 10.3332/ecancer.2016.659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Indexed: 11/06/2022] Open
Abstract
The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient’s unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient–physician communication, improving the patient’s understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient–physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient’s profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient’s physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient’s answers in real time and send them, together with specific recommendations to the physician’s computer immediately before physician’s first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient’s profile). The proposed approach is supposed to improve the patient–physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment and personalisation of care.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Haemato-Oncology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy; European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Haemato-Oncology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy; European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
| | - Haridimos Kondylakis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, N. Plastira 100, Vassilika Vouton, GR-700 13 Heraklion, Crete, GR-700 13, Greece
| | - Gordon McVie
- European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Haemato-Oncology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy; European Institute of Oncology, Via G. Ripamonti 435, 20100 Milan, Italy
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Cesuroglu T, Syurina E, Feron F, Krumeich A. Other side of the coin for personalised medicine and healthcare: content analysis of 'personalised' practices in the literature. BMJ Open 2016; 6:e010243. [PMID: 27412099 PMCID: PMC4947721 DOI: 10.1136/bmjopen-2015-010243] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Various terms and definitions are used to describe personalised approaches to medicine and healthcare, but in ambiguous and inconsistent ways. They mostly have been defined in a top-down manner. However, actual practices might take different paths. Here, we aimed to provide a 'practice-based' perspective on the debate by analysing the content of 'personalised' practices published in the literature. METHODS The search in PubMed and EMBASE (April 2014) using the terms frequently used for personalised approaches resulted in 5333 records. 2 independent researchers used different strategies for screening, resulting in 157 articles describing 88 'personalised' practices that were implemented/presented on at least 1 individual/patient case. The content analysis was grounded on these data and did not have a priori analytical frameworks. RESULTS 'Personalised medicine/healthcare' can be a commodity in the healthcare market, a way how health services are provided, or a keyword for emerging applications. It can help individuals/patients to gain control of their health, health professionals to provide better services, healthcare organisations to increase effectiveness and efficiency, or national health systems to increase performance. Country examples indicated that for integration of practices into health services, attitude towards innovations and health system and policy context is important. Categorisation based on the terms or the technologies used, if any, was not possible. CONCLUSIONS This study is the first to provide a comprehensive content analysis of the 'personalised' practices in the literature. Unlike the top-down definitions, our findings highlighted not the technologies but real-life issues faced by the practices. 'Personalised medicine' and 'personalised healthcare' can be differentiated by using the former for specific tools available and the latter for health services with a holistic approach, implemented in certain contexts. To realise integration of 'personalised medicine/healthcare' into real life, science, technology, health policy and practice, and society domains must work together.
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Affiliation(s)
- Tomris Cesuroglu
- Faculty of Health, Medicine and Life Sciences, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Elena Syurina
- Faculty of Health, Medicine and Life Sciences, Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Frans Feron
- Faculty of Health, Medicine and Life Sciences, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anja Krumeich
- Faculty of Health, Medicine and Life Sciences, Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
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Abstract
OBJECTIVES This paper aims to present an overview of the medical informatics landscape in Greece, to describe the Greek ehealth background and to highlight the main education and research axes in medical informatics, along with activities, achievements and pitfalls. METHODS With respect to research and education, formal and informal sources were investigated and information was collected and presented in a qualitative manner, including also quantitative indicators when possible. RESULTS Greece has adopted and applied medical informatics education in various ways, including undergraduate courses in health sciences schools as well as multidisciplinary postgraduate courses. There is a continuous research effort, and large participation in EU-wide initiatives, in all the spectrum of medical informatics research, with notable scientific contributions, although technology maturation is not without barriers. Wide-scale deployment of eHealth is anticipated in the healthcare system in the near future. While ePrescription deployment has been an important step, ICT for integrated care and telehealth have a lot of room for further deployment. CONCLUSIONS Greece is a valuable contributor in the European medical informatics arena, and has the potential to offer more as long as the barriers of research and innovation fragmentation are addressed and alleviated.
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Affiliation(s)
| | - N Maglaveras
- Prof. Nicos Maglaveras, Lab of Medical Informatics, P.O. Box 323, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece, E-mail:
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Irizarry T, DeVito Dabbs A, Curran CR. Patient Portals and Patient Engagement: A State of the Science Review. J Med Internet Res 2015; 17:e148. [PMID: 26104044 PMCID: PMC4526960 DOI: 10.2196/jmir.4255] [Citation(s) in RCA: 418] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 12/30/2022] Open
Abstract
Background Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients’ and providers’ information needs and functionality.
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Affiliation(s)
- Taya Irizarry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.
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