1
|
Rosa D, Villa G, Amigoni C, Rossetti AM, Guberti M, Ghirotto L, Manara DF. Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study. MethodsX 2024; 12:102590. [PMID: 38322133 PMCID: PMC10844854 DOI: 10.1016/j.mex.2024.102590] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.
Collapse
Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
2
|
De Mauro D, Balato G, Festa E, Di Cristo A, Marasco L, Loffredo G, Di Lauro P, Di Gennaro D, Maccauro G, Rosa D. Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:248. [PMID: 38561717 PMCID: PMC10983737 DOI: 10.1186/s12891-024-07288-2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI) rates in patients who underwent TKA after BS compared to obese patients without BS. METHODS Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using a meta-analytical approach. RESULTS The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p < 0.0001), with a lower risk in the BS group (z = -10.3114, p < 0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p = 0.4975). CONCLUSIONS The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.
Collapse
Affiliation(s)
- D De Mauro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy.
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy.
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - G Balato
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - E Festa
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy.
| | - A Di Cristo
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - L Marasco
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - G Loffredo
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - P Di Lauro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - D Di Gennaro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - G Maccauro
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Rosa
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| |
Collapse
|
3
|
Marcomini I, Pendoni R, Pauciulo V, Sansone V, Milani L, Terzoni S, Zibaldo A, Rosa D. Nurse-to-Nurse Collaboration: A Scoping Review. J Nurs Adm 2024; 54:184-189. [PMID: 38381574 DOI: 10.1097/nna.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To map predictors and outcome of collaboration between nurses, outcomes of a good collaboration, and the tools developed to evaluate nurse-nurse collaboration. BACKGROUND Collaboration between nurses is an intraprofessional relationship between coworkers that is expressed through shared objectives, authority, and a decisional process. Studies on collaboration between nurses are very limited. METHODS A scoping review was conducted through 4 databases. RESULTS Eighteen studies were included. Nurses with higher levels of collaboration are more satisfied with their work and report less of an intention to leave their job. Greater collaboration among nurses resulted in a decrease of patient falling, hospital-acquired pressure ulcers, and a better care. Three tools have been developed to evaluate nurse-nurse collaboration: the Nurse-Nurse Collaboration Scale, the Nurse-Nurse Collaboration Behavior Scale, and the Nurse-Nurse Collaboration Between Sector. CONCLUSIONS Further studies should be conducted to fully understand the issue of collaboration between nurses and the factors connected to it.
Collapse
Affiliation(s)
- Ilaria Marcomini
- Author Affiliations: Nurse Tutor (Dr Marcomini), University of Milan, Milan AND Research Fellow (Dr Marcomini), Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan; Nurse Tutor (Pendoni), Nursing Degree Course, Cremona Hospital, Cremona; Nurse (Pauciulo), Crema Hospital; Research Nurse (Dr Sansone), Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples; Degree Program Coordinator (Milani), Crema Bachelor School of Nursing, University of Milan; Adjunct Professor of Nursing (Dr Terzoni), San Paolo Bachelor School of Nursing, ASST Santi Paolo e Carlo, Milan; Pediatric Nurse (Zibaldo), Department of Oncology Hematology and Gene Therapy, Santobono Children's Hospital, Naples; and Assistant Professor in Nursing Science (Dr Rosa), Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Paneroni M, Scalvini S, Perger E, Zampogna E, Govetto S, Oliva FM, Matrone A, Bernocchi P, Rosa D, Vitacca M. Home-based exercise program for people with residual disability following hospitalization for COVID-19: Randomized control trial. Ann Phys Rehabil Med 2024; 67:101815. [PMID: 38479344 DOI: 10.1016/j.rehab.2023.101815] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND The best exercise program for individuals with effort intolerance or hypoxia at rest and/or during exercise post-COVID-19 treatment who have already had in-hospital rehabilitation remains unknown. OBJECTIVE We evaluated the efficacy of a home-based rehabilitation exercise program intervention that included teleconsultations with a specialist nurse. METHODS This was a multicenter randomized controlled trial for individuals who had been diagnosed with, and treated for, COVID-19. Despite inpatient rehabilitation they still had effort intolerance; this was defined as being a) only able to walk <70 % of the predicted distance during the six-minute walking test (6MWT) and/or b) oxygen desaturation all day long/during effort. The primary outcome was effort tolerance, as evaluated by the 6MWT. Secondary outcomes were dyspnea, fatigue, spirometry, respiratory muscle evaluations, and oxygenation. The Intervention group performed 4 weeks of a self-directed exercise program with bi-weekly physiotherapist video calls; the Control group participated in physical activity howsoever they wished. Exercises were divided into 4 intensity levels according to disability and oxygen desaturation. The program progressively increased from low (walking, free-body exercise, sit-to-stand, and balance exercises) to high (speed walking with a pedometer, cycle ergometer, and strengthening exercises). RESULTS We included 79 participants: 40 in the Intervention and 39 in the Control group. Mean (SD) age was 67.1 (10.3) years; 72 % (n = 57) were male. No intergroup differences in effort tolerance were found [Intervention 77.6 (75.4)m vs Control 49.5 (73.3)m (p = 0.109)]. Participants with 6MWT distance results < lower limit of normality values showed best improvements in mean (SD) effort tolerance: Intervention, 120.1 (75.8)m vs Control, 59.1 (75.6)m (p = 0.035). After 2 months, mean (SD) 6MWT distances in the 2 groups were similar: Intervention, 475.9 (82.4)m vs Control, 469.2 (118.9)m (p = 0.807). CONCLUSIONS In individuals with residual disability post-COVID-19 and after inpatient rehabilitation, a home-based exercise program with teleconsultation significantly improves effort tolerance but only for people who had severe effort intolerance at baseline. DATABASE REGISTRATION ClinicalTrials.gov number, NCT04821934.
Collapse
Affiliation(s)
- Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Cardio-Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy.
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation and Continuity of Care Units of Institute of Lumezzane, Brescia, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; University of Milano Bicocca, Department of Medicine and Surgery, Milan, Italy
| | - Elisabetta Zampogna
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Tradate, Varese, Italy
| | - Simone Govetto
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Federico Mattia Oliva
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Tradate, Varese, Italy
| | - Ambra Matrone
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation and Continuity of Care Units of Institute of Lumezzane, Brescia, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation and Continuity of Care Units of Institute of Lumezzane, Brescia, Italy
| | - Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| |
Collapse
|
5
|
Trapani S, Villa G, Poliani A, Gnecchi S, Rosa D, Manara DF. Non-Pharmacological Management of Urge Urinary Incontinence in Women between 40 and 65 Years Old: A Systematic Review. Nurs Rep 2024; 14:174-196. [PMID: 38251193 PMCID: PMC10801617 DOI: 10.3390/nursrep14010015] [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: 10/25/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40-65 years old. METHODS This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. RESULTS Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. CONCLUSION Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed.
Collapse
Affiliation(s)
- Sara Trapani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| | - Andrea Poliani
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| | - Silvia Gnecchi
- Department of Onco-Hematology, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| | - Duilio F. Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| |
Collapse
|
6
|
Poliani A, Gnecchi S, Villa G, Rosa D, Manara DF. Gamification as an Educational Approach for Oncological Patients: A Systematic Scoping Review. Healthcare (Basel) 2023; 11:3116. [PMID: 38132006 PMCID: PMC10742971 DOI: 10.3390/healthcare11243116] [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: 09/23/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Education plays a pivotal role in the care of oncological patients, reducing health costs, hospital readmission, and disease relapses. Education can be supportive in achieving multiple outcomes, improving symptom control and quality of life. A new approach is emerging in patient education: gamification. Gamification was defined as the "use of game elements in non-game contexts", including the application of games in serious contexts. The aim of this review is to explore the use of gamification in the oncology setting. METHODS A systematic scoping review was conducted in the MEDLINE, CINAHL, PsychINFO, Embase, Scopus, and Cochrane Library databases using the JBI guidelines. RESULTS The 13 included reports were critically appraised by two reviewers independently. It seems that gamification could be effective both in prevention and cancer treatments. Gamification also seems to improve chemotherapy-induced nausea and vomiting management, quality of life, and reduced anxiety levels in different cancer groups. Moreover, gamification seems effective in improving self-care in cancer patients, regardless of gender, age, and ethnicity. CONCLUSIONS Gamification improves patient engagement and biopsychosocial outcomes and could represent a valid approach to cancer patient education; however, it is not a substitute for healthcare professionals, who remain the leaders in the education process.
Collapse
Affiliation(s)
- Andrea Poliani
- Center for Nursing Research and Innovation, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| | - Silvia Gnecchi
- IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Giulia Villa
- Center for Nursing Research and Innovation, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| | - Debora Rosa
- Center for Nursing Research and Innovation, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| | - Duilio F. Manara
- Center for Nursing Research and Innovation, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.P.); (D.R.); (D.F.M.)
| |
Collapse
|
7
|
Rosa D, Pengo MF, Adorni R, Bilo G, Parati G, Steca P. Psychometric Properties of a Brief Version of the Perception of Risk of Heart Disease Scale in an Italian Sample. High Blood Press Cardiovasc Prev 2023; 30:475-484. [PMID: 37847486 PMCID: PMC10600277 DOI: 10.1007/s40292-023-00603-3] [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: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION The number of Italian citizens unaware of their risk of cardiovascular disease it is still very high. AIM This study aimed to translate and preliminarily validate a brief Italian version of the Perception of Risk of Heart Disease Scale (PRHDS). METHODS PRHDS was culturally adapted to the Italian context. Then, the scale was administered to 772 healthy adults. By randomly dividing the sample into two subsamples, we tested the scale dimensionality through Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA). Finally, we evaluated internal consistency. RESULTS Psychometric properties of the scale were appropriate. EFA and CFA evidenced a unidimensional structure of a brief version of the scale, composed of six items. Internal consistency was adequate. CONCLUSIONS Italian version of the brief PRHDS is a promising self-report questionnaire to measure cardiovascular risk perception among Italian adults.
Collapse
Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Martino Francesco Pengo
- Istituto Auxologico Italiano IRCCS, Milan, Italy.
- University of Milano-Bicocca, Faculty of Medicine, Milan, Italy.
| | - Roberta Adorni
- University of Milano-Bicocca, Department of Psychology, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- University of Milano-Bicocca, Faculty of Medicine, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- University of Milano-Bicocca, Faculty of Medicine, Milan, Italy
| | - Patrizia Steca
- University of Milano-Bicocca, Department of Psychology, Milan, Italy
| |
Collapse
|
8
|
Baldassarre D, Iacoviello L, Baetta R, Roncaglioni MC, Condorelli G, Remuzzi G, Gensini G, Frati L, Ricciardi W, Conaldi PG, Uccelli A, Blandini F, Bosari S, Scambia G, Fini M, Di Malta A, Amato M, Veglia F, Bonomi A, Klersy C, Colazzo F, Pengo M, Gorini F, Auteri L, Ferrante G, Baviera M, Ambrosio G, Catapano A, Gialluisi A, Malavazos AE, Castelvecchio S, Corsi-Romanelli MM, Cardani R, La Rovere MT, Agnese V, Pane B, Prati D, Spinardi L, Liuzzo G, Arbustini E, Volterrani M, Visconti M, Werba JP, Genovese S, Bilo G, Invitti C, Di Blasio A, Lombardi C, Faini A, Rosa D, Ojeda-Fernández L, Foresta A, De Curtis A, Di Castelnuovo A, Scalvini S, Pierobon A, Gorini A, Valenti L, Luzi L, Racca A, Bandi M, Tremoli E, Menicanti L, Parati G, Pompilio G. Rationale and design of the CV-PREVITAL study: an Italian multiple cohort randomised controlled trial investigating innovative digital strategies in primary cardiovascular prevention. BMJ Open 2023; 13:e072040. [PMID: 37451717 PMCID: PMC10351259 DOI: 10.1136/bmjopen-2023-072040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Prevention of cardiovascular disease (CVD) is of key importance in reducing morbidity, disability and mortality worldwide. Observational studies suggest that digital health interventions can be an effective strategy to reduce cardiovascular (CV) risk. However, evidence from large randomised clinical trials is lacking. METHODS AND ANALYSIS The CV-PREVITAL study is a multicentre, prospective, randomised, controlled, open-label interventional trial designed to compare the effectiveness of an educational and motivational mobile health (mHealth) intervention versus usual care in reducing CV risk. The intervention aims at improving diet, physical activity, sleep quality, psycho-behavioural aspects, as well as promoting smoking cessation and adherence to pharmacological treatment for CV risk factors. The trial aims to enrol approximately 80 000 subjects without overt CVDs referring to general practitioners' offices, community pharmacies or clinics of Scientific Institute for Research, Hospitalization and Health Care (Italian acronym IRCCS) affiliated with the Italian Cardiology Network. All participants are evaluated at baseline and after 12 months to assess the effectiveness of the intervention on short-term endpoints, namely improvement in CV risk score and reduction of major CV risk factors. Beyond the funded life of the study, a long-term (7 years) follow-up is also planned to assess the effectiveness of the intervention on the incidence of major adverse CV events. A series of ancillary studies designed to evaluate the effect of the mHealth intervention on additional risk biomarkers are also performed. ETHICS AND DISSEMINATION This study received ethics approval from the ethics committee of the coordinating centre (Monzino Cardiology Center; R1256/20-CCM 1319) and from all other relevant IRBs and ethics committees. Findings are disseminated through scientific meetings and peer-reviewed journals and via social media. Partners are informed about the study's course and findings through regular meetings. TRIAL REGISTRATION NUMBER NCT05339841.
Collapse
Affiliation(s)
- Damiano Baldassarre
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, Italy
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Luigi Frati
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Walter Ricciardi
- Istituti Clinici Scientifici Maugeri IRCCS Pavia, Pavia, Italy
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
| | - Pier Giulio Conaldi
- IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | | | - Fabio Blandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvano Bosari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Mauro Amato
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Veglia
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | | | - Catherine Klersy
- Unit of Clinical Epidemiology & Biostatistic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Martino Pengo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Alberico Catapano
- IRCCS Multimedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, Italy
| | - Alexis Elias Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Massimiliano Marco Corsi-Romanelli
- UOC SMEL-1, IRCCS POLICLINICO SAN DONATO, San Donato Milanese, Italy
- Department of Health and Biomedical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rosanna Cardani
- BioCor Biobank, UOC SMEL-1 of Clinical Pathology, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | | | - Valentina Agnese
- IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Bianca Pane
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Spinardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Liuzzo
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Eloisa Arbustini
- Centro Malattie Genetiche Cardiovascolari - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Volterrani
- Cardio Pulmonary Department, IRCCS San Raffaele, Rome, Italy
- Exercise Science and Medicine, San Raffaele Open University, Rome, Italy
| | - Marco Visconti
- Co.S. (Consorzio Sanità) Study Center, Italy, Soresina, Italy
| | | | | | - Grzegorz Bilo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Carolina Lombardi
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Andrea Faini
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Debora Rosa
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luisa Ojeda-Fernández
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andreana Foresta
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | | | | | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri IRCCS Montescano, Montescano, Italy
| | - Alessandra Gorini
- Istituti Clinici Scientifici Maugeri IRCCS Milano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Valenti
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Fisiopatologia e Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Livio Luzi
- IRCCS Multimedica, Milan, Italy
- Department of Health and Biomedical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Annarosa Racca
- Federfarma Lombardia & Fondazione Guido Muralti, Milan, Italy
| | - Manuela Bandi
- Federfarma Lombardia & Fondazione Guido Muralti, Milan, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
9
|
Villa G, Poliani A, Rosa D, Gnecchi S, Galli E, Manara DF. Gamification: A new approach to support nurses in patient empowerment education? Nurse Educ Pract 2023:103672. [PMID: 37321889 DOI: 10.1016/j.nepr.2023.103672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Poliani
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy.
| | - Silvia Gnecchi
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Galli
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
10
|
Rosa D, Negro A, Marcomini I, Pendoni R, Albabesi B, Pennino G, Terzoni S, Destrebecq A, Villa G. The Effects of Early Mobilization on Acquired Weakness in Intensive Care Units: A Literature Review. Dimens Crit Care Nurs 2023; 42:146-152. [PMID: 36996359 DOI: 10.1097/dcc.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness (ICUAW) is defined as a clinical syndrome of neuromuscular weakness, and a consequence of critical illness, unrelated to any other etiology. It is associated with difficult weaning from the ventilator, prolonged ICU stay, increased mortality, and other important long-term outcomes. Early mobilization is defined as any active exercise in which patients use their muscle strength actively or passively within the first 2 to 5 days of critical illness. Early mobilization can be safely initiated from the first day of admission to the ICU during mechanical ventilation. OBJECTIVES The purpose of this review is to describe the effects of early mobilization on complications from ICUAW. METHOD This was a literature review. Inclusion criteria were as follows: observational studies and randomized controlled trials conducted with adult patients (aged ≥18 years) admitted to the ICU were included. Studies selected were published in the last 11 years (2010-2021). RESULTS Ten articles were included. Early mobilization reduces muscle atrophy, ventilation, length of hospital stay, and ventilator-associated pneumonia and improves patients' responses to inflammation and hyperglycemia. DISCUSSION Early mobilization appears to have a significant impact on the prevention of ICUAW and appears to be safe and feasible. The results of this review could be useful for improving the provision of efficient and effective tailored care for ICU patients.
Collapse
|
11
|
Gandossi C, De Brasi EL, Rosa D, Maffioli S, Zappa S, Villa G, Manara DF. How Do Nursing Students Perceive Moral Distress? An Interpretative Phenomenological Study. Nursing Reports 2023; 13:539-548. [PMID: 36976701 PMCID: PMC10056563 DOI: 10.3390/nursrep13010049] [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: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Background: Research shows that the longer nurses care for terminally ill patients, the greater they experience moral distress. The same applies to nursing students. This study aims to analyze episodes of moral distress experienced by nursing students during end-of-life care of onco-hematologic patients in hospital settings. Methods: This study was conducted in the interpretative paradigm using a hermeneutic phenomenological approach and data were analyzed following the principles of the Interpretative Phenomenological Analysis. Results: Seventeen participants were included in the study. The research team identified eight themes: causes of moral distress; factors that worsen or influence the experience of moral distress; feelings and emotions in morally distressing events; morally distressing events and consultation; strategies to cope with moral distress; recovering from morally distressing events; end-of-life accompaniment; internship clinical training, and nursing curriculum. Conclusions: Moral distress is often related to poor communication or lack of communication between health care professionals and patients or relatives and to the inability to satisfy patients’ last needs and wants. Further studies are necessary to examine the quantitative dimension of moral distress in nursing students. Students frequently experience moral distress in the onco-hematological setting.
Collapse
Affiliation(s)
| | | | - Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence:
| | | | - Sara Zappa
- San Raffaele Institute (IRCCS), 20132 Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
12
|
Rosa D, Bonetti L, Villa G, Allieri S, Baldrighi R, Elisei RF, Ripa P, Giannetta N, Amigoni C, Manara DF. Moral Distress of Intensive Care Nurses: A Phenomenological Qualitative Study Two Years after the First Wave of the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:ijerph192215057. [PMID: 36429775 PMCID: PMC9690457 DOI: 10.3390/ijerph192215057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has imposed great pressure on healthcare facilities, exposing healthcare professionals to various challenges that may result in the onset of moral distress, a condition of psychological distress caused by the inability to act as it would be most morally appropriate. The purpose of this research was to investigate the experience lived by nurses who worked in an intensive care unit during the COVID-19 pandemic. METHODS This is a phenomenological study using interpretative phenomenological analysis. Sixteen nurses who worked in the COVID-19 Intensive Care Unit of Northern Italian Hospitals from January to April 2022 were selected through purposive sampling. Data on experiences, thoughts, and symptoms were collected through semi-structured interviews with in-person and remote modalities. RESULTS Five themes and fourteen subthemes emerged from the study. The themes are: (1) pride, isolation, and fear; (2) teamwork and organisation; (3) moral/ethical aspect; (4) true heroes; and (5) dignity. CONCLUSIONS This study highlights the impact of the COVID-19 pandemic on intensive care unit nurses. It has emerged that the risk of moral distress is high among healthcare workers in the front line of the fight against the virus. This condition should be avoided and managed through early psychological interventions, sharing of experiences, and a good organization that supports decision-making and professional well-being.
Collapse
Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano-IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Centre, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Sara Allieri
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Riccardo Baldrighi
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Rolando Francesco Elisei
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy
| | - Paola Ripa
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy
| | - Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano-IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
13
|
Rosa D, Perger E, Villa G, Bonetti L, Storti V, Cartabia E, Ledonne G, Lombardi C, Beatrice A, Amigoni C, Parati G. Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction. Healthcare (Basel) 2022; 10:1859. [PMID: 36292306 PMCID: PMC9601695 DOI: 10.3390/healthcare10101859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Obstructive Sleep Apnoea (OSA) is a common chronic sleep-related breathing disorder. Drug therapy is a recent approach to treating OSA, and no data is available regarding its effects on a couple's life. The aim of this study was to investigate the impact on couples' lives of a novel drug treatment for OSA. METHODS Participants of a trial on new drug therapy (reboxetine plus oxybutynin) for OSA were interviewed. The study was conducted using a descriptive phenomenological approach by Sundler et al. Results: Ten patients and six of their partners were recruited through a purposive sampling between February and April 2021. The results indicate that drug treatment of OSA had a favourable impact on the couples' lives. Pharmacotherapy improved self-reported sleep quality, as the absence of CPAP allows people to sleep closer to the bed partner and because the patient does not have to sleep in a forced position. Moreover, the couples developed teamwork from the beginning which appeared to be crucial during the trial, especially when some difficulties and adverse events occurred. CONCLUSIONS This study presents the presence of a positive closed loop that could be considered a predictor of adherence to drug therapy.
Collapse
Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Valeria Storti
- Department of Nursing, University of Milan, ASST Fatebenefratelli Sacco, Luigi Sacco Teaching Hospital, 20146 Milan, Italy
| | - Elisa Cartabia
- Neuromotor Rehabilitation Unit, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Giuseppina Ledonne
- Department of Nursing, University of Milan, ASST Fatebenefratelli Sacco, Luigi Sacco Teaching Hospital, 20146 Milan, Italy
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Albanesi Beatrice
- Department of Clinical and Molecular Medicine, University “La Sapienza”, 00185 Rome, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano, IRCCS, SITR Lombardia, 20149 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| |
Collapse
|
14
|
Giannetta N, Villa G, Bonetti L, Dionisi S, Pozza A, Rolandi S, Rosa D, Manara DF. Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review. Int J Environ Res Public Health 2022; 19:10640. [PMID: 36078353 PMCID: PMC9517876 DOI: 10.3390/ijerph191710640] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No systematic review in the literature has analyzed the intensity and frequency of moral distress among ICU nurses. No study seems to have mapped the leading personal and professional characteristics associated with high levels of moral distress. This systematic review aimed to describe the intensity and frequency of moral distress experienced by nurses in ICUs, as assessed by Corley's instruments on moral distress (the Moral Distress Scale and the Moral Distress Scale-Revised). Additionally, this systematic review aimed to summarize the correlates of moral distress. METHODS A systematic search and review were performed using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Library of Medicine (MEDLINE/PubMed), and Psychological Abstracts Information Services (PsycINFO). The review methodology followed PRISMA guidelines. The quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. RESULTS Findings showed a moderate level of moral distress among nurses working in ICUs. The findings of this systematic review confirm that there are a lot of triggers of moral distress related to patient-level factors, unit/team-level factors, or system-level causes. Beyond the triggers of moral distress, this systematic review showed some correlates of moral distress: those nurses working in ICUs with less work experience and those who are younger, female, and intend to leave their jobs have higher levels of moral distress. This systematic review's findings show a positive correlation between professional autonomy, empowerment, and moral distress scores. Additionally, nurses who feel supported by head nurses report lower moral distress scores. CONCLUSIONS This review could help better identify which professionals are at a higher risk of experiencing moral distress, allowing the early detection of those at risk of moral distress, and giving the organization some tools to implement preventive strategies.
Collapse
Affiliation(s)
- Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Loris Bonetti
- Department of Nursing, Nursing Research Centre, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
| | - Sara Dionisi
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Debora Rosa
- Department of Cardiovascular, Neural, and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
15
|
Villa G, Boarin M, Rosa D, Togni S, Manara DF, Bonetti L, Terzoni S. Phytotherapy in urological benign disease: A systematic review. Int J of Uro Nursing 2022. [DOI: 10.1111/ijun.12328] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Giulia Villa
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
| | - Mattia Boarin
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
| | - Debora Rosa
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences Milan Italy
| | - Serena Togni
- Foundation IRCCS National Cancer Institute Milan Italy
| | - Duilio F. Manara
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department Ente Ospedaliero Cantonale (EOC) Bellinzona Switzerland
- Department of Business Economics University of Applied Sciences and Arts of Southern Switzerland, Health and Social Care Manno Switzerland
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing San Paolo Teaching Hospital Milan Italy
| |
Collapse
|
16
|
Rosa D, Albanesi B, Bassola B, Dellafiore F, Di Simone E, Terzoni S, Villa G, Bonetti L. Nurse's bedside screening of dysphagia: an umbrella review. Recenti Prog Med 2022; 113:361-371. [PMID: 35758114 DOI: 10.1701/3827.38109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Dysphagia often results in serious, poor health outcomes. Nurses have an important role in assessing dysphagia. Therefore, they need reliable and effective screening tools to detect dysphagia. The purpose of this umbrella review is to locate the most valid, reliable, and usable bedside screening tools that allow nurses to identify dysphagia in institutionalized patients. METHODS Umbrella Review as suggested by the Joanna Briggs Institute. Inclusion criteria were: systematic reviews of randomized controlled trials or cross-sectional studies. We excluded: pediatric and psychiatric patients. We searched on PubMed, CINAHL, Scopus, Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the Joanna Briggs Institute Evidence-Based Practice Database. RESULTS Six reviews were included. Four tools were reported in all the reviews: 3 oz swallowing water test, Mann Assessment of Swallowing Ability, Toronto Bedside Swallowing Screening Test, Gugging Swallowing Screen. They have shown fair to good sensitivity and specificity. The reviews analysed did not allow for a comparative analysis between instruments, which may be hindering the selection of the optimal instrument for clinical practice. CONCLUSIONS Almost all reviews have considered stroke patients. The next steps will be to determine if there is a tool applicable in multiple settings with different patients and if this intervention is cost-effective.
Collapse
Affiliation(s)
- Debora Rosa
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | | | | | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Direction, IRCCS Istituti Fisioterapici Ospitalieri - IFO, Rome
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland - University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Manno, Switzerland
| |
Collapse
|
17
|
Rosa D, Amigoni C, Rimoldi E, Ripa P, Ligorio A, Fracchiolla M, Lombardi C, Parati G, Perger E. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let's Talk about Partners! Healthcare (Basel) 2022; 10:943. [PMID: 35628081 PMCID: PMC9141202 DOI: 10.3390/healthcare10050943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). The benefits of this therapy were studied and analyzed over time; patient adherence is often poor, as many factors negatively influence it. A topic that needs clarification is whether adherence to CPAP treatment in a patient with OSA is influenced by the behavior of a partner or spouse. METHODS A scoping review was conducted to evaluate the role of partner involvement in the CPAP treatment management in a patient with OSA. The research project was performed between August and September 2021 by consulting the main biomedical databases: CINHAL, Embase, PsycINFO, and PubMed. RESULTS Among 21 articles considered valid for our aim, 15 are qualitative studies, 5 are quantitative and 1 presents a mixed method. We identified several thematic areas and "key" elements, which are prevalent in the studies evaluated. CONCLUSIONS The presence of a partner promotes adherence to CPAP therapy in patients with OSA, resulting in ameliorating their overall quality of life. To increase CPAP adherence, a trained nurse could represent a reference figure to technically and emotionally support couples during the adaptation period and in the long term.
Collapse
Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano, IRCCS, SITR Lombardia, 20149 Milan, Italy;
| | - Elisa Rimoldi
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Paola Ripa
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Antonella Ligorio
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Miriam Fracchiolla
- Multimedica, IRCCS, Emergency Department, 20099 Sesto San Giovanni, Italy;
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| |
Collapse
|
18
|
Prestes J, Rosa D, Barrios C, Bines J, Werutsky G, Cronemberger E, Queiroz G, Simon S, Rebelatto T, de Jesus R, da Silva M, Marta G. PO-1230 Delay in postoperative radiation in pts with breast cancer in Brazil: a sub-analysis of AMAZONA III. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Abstract
OBJECTIVE To summarise the available clinical evidence on the efficacy and safety of osteopathic manipulative treatment (OMT) for different conditions. DESIGN Overview of systematic reviews (SRs) and meta-analyses (MAs). PROSPERO CRD42020170983. DATA SOURCES An electronic search was performed using seven databases: PubMed, EMBASE, CINAHL, Scopus, JBI, Prospero and Cochrane Library, from their inception until November 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES SRs and MAs of randomised controlled trials evaluating the efficacy and safety of OMT for any condition were included. DATA EXTRACTION AND SYNTHESIS The data were independently extracted by two authors. The AMSTAR-2 tool was used to assess the methodological quality of the SRs and MAs. The overview was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The literature search revealed nine SRs or MAs conducted between 2013 and 2020 with 55 primary trials involving 3740 participants. The SRs reported a wide range of conditions including acute and chronic non-specific low back pain (NSLBP, four SRs), chronic non-specific neck pain (CNSNP, one SR), chronic non-cancer pain (CNCP, one SR), paediatric (one SR), neurological (primary headache, one SR) and irritable bowel syndrome (IBS, one SR). Although with a different effect size and quality of evidence, MAs reported that OMT is more effective than comparators in reducing pain and improving functional status in acute/chronic NSLBP, CNSNP and CNCP. Due to small sample size, presence of conflicting results and high heterogeneity, questionable evidence existed on OMT efficacy for paediatric conditions, primary headache and IBS.No adverse events were reported in most SRs. According to AMSTAR-2, the methodological quality of the included SRs was rated low or critically low. CONCLUSION Based on the currently available SRs and MAs, promising evidence suggests the possible effectiveness of OMT for musculoskeletal disorders. Limited and inconclusive evidence occurs for paediatric conditions, primary headache and IBS. Further well-conducted SRs and MAs are needed to confirm and extend the efficacy and safety of OMT.
Collapse
Affiliation(s)
| | - Debora Rosa
- Department of Cardiovascular Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Francesca Borrelli
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| |
Collapse
|
20
|
Rosa D, Villa G, Giannetta N, Dionisi S, Togni S, Bonetti L, Terzoni S, Di Muzio M, Di Simone E. Tackling the Italian emergency 2019-nCoV: nurses' knowledge, attitudes and behaviors. Acta Biomed 2022; 93:e2022010. [PMID: 35315389 PMCID: PMC8972885 DOI: 10.23750/abm.v93i1.12316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/03/2022]
Abstract
Background and aim: The aim was to understand the knowledge, attitudes, and behaviors of Health Care workers regarding the Novel Coronavirus 2019 cases at the start of the diffusion of the disease in Italy. Methods: Cross-sectional survey of nurses working in Italian hospitals. Results: Most of the sample showed good knowledge and behaviors about the new virus and good attitudes. Logistic regression analysis demonstrated that predictive variables of knowledge, attitude, and behavior were: educational background, work experience years and age of nurses. Conclusions: This study is the first one in a time of a full health emergency. It would be appropriate to develop further studies to better analyze the skills implemented to tackle Novel Coronavirus 2019 disease. Novel Coronavirus 2019 pandemic has put on health personnel a considerable workload. Despite this, the Italian nursing staff has been showing excellent knowledge, attitude, and good behavior in the management of this pandemic. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | | | - Noemi Giannetta
- a:1:{s:5:"en_US";s:35:"PhDc Tor Vergata University of Rome";}.
| | | | | | | | | | | | | |
Collapse
|
21
|
Marcomini I, Pendoni R, Rosa D, Locatelli G, Milani L, Terzoni S, Celik Durmus S. The cross-cultural adaptation and validation of the Nurse-Nurse Collaboration Scale in Italy. Acta Biomed 2022; 93:e2022148. [PMID: 35545990 PMCID: PMC9534207 DOI: 10.23750/abm.v93is2.12353] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Collaboration between colleagues is an essential element of clinical nursing care because it helps to ensure patient safety. This study aimed to evaluate the psychometric properties of the XXX version of the Nurse-Nurse Collaboration Scale (NNCS). The secondary goal of this study was to assess the degree of collaboration between nurses in Italy. METHODS First, the cultural adaptation of the NNCS tool was performed. The face and content validity of the tool were assessed through the involvement of nursing experts. To test construct validity, a descriptive cross-sectional study was conducted on a sample of 362 nurses. RESULTS The Italian version of the NNCS was composed of 23 items distributed across five domains. The five-dimensional model showed an adequate model goodness of fit (RMSEA=0.075, CFI=0.883, SRMR=0.072). The NNCS dimension with the highest average score was Professionalism (M=3.10 ± 0.45), while Conflict Management (M=2.14 ± 0.47) exhibited the lowest score. CONCLUSIONS The Italian version of the NNCS is a valid and reliable tool. More effort should be made to ensure the proper management of conflicts in healthcare environments.
Collapse
Affiliation(s)
- Ilaria Marcomini
- Nursing Degree Course, University of Milan, Crema Hospital, Crema, Italy
| | | | - Debora Rosa
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Laura Milani
- Nursing Degree Course, University of Milan, Crema Hospital, Crema, Italy
| | - Stefano Terzoni
- Nursing Degree Course, University of Milan, San Paolo Teaching Hospital, Milan, Italy
| | | |
Collapse
|
22
|
Perger E, Taranto Montemurro L, Rosa D, Vicini S, Marconi M, Zanotti L, Meriggi P, Azarbarzin A, Sands SA, Wellman A, Lombardi C, Parati G. Reboxetine Plus Oxybutynin for OSA Treatment: A 1-Week, Randomized, Placebo-Controlled, Double-Blind Crossover Trial. Chest 2022; 161:237-247. [PMID: 34543665 PMCID: PMC10835052 DOI: 10.1016/j.chest.2021.08.080] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 03/19/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The recent discovery that a combination of noradrenergic and antimuscarinic drugs improved upper airway muscle function during sleep and reduced OSA severity has revitalized interest in pharmacologic therapies for OSA. RESEARCH QUESTION Would 1 week of reboxetine plus oxybutynin (Reb-Oxy) be effective on OSA severity? STUDY DESIGN AND METHODS A randomized, placebo-controlled, double-blind, crossover trial was performed comparing 4 mg reboxetine plus 5 mg oxybutynin (Reb-Oxy) vs placebo in patients with OSA. After a baseline in-laboratory polysomnogram (PSG), patients underwent PSGs after 7 nights of Reb-Oxy and 7 nights of placebo to compare apnea-hypopnea index (AHI), which was the primary outcome. Response rate was based on the percentage of subjects with a ≥ 50% reduction in AHI from baseline. Secondary outcomes included Epworth Sleepiness Scale (ESS) score and psychomotor vigilance test (PVT) values. Home oximetry evaluated overnight oxygen desaturation index (ODI) throughout treatment. RESULTS Sixteen subjects aged 57 [51-61] years (median [interquartile range]) with a BMI of 30 [26-36] kg/m2 completed the study. Reb-Oxy lowered AHI from 49 [35-57] events per hour at baseline to 18 [13-21] events per hour (59% median reduction) compared with 39 [29-48] events per hour (6% median reduction) with placebo (P < .001). Response rate for Reb-Oxy was 81% vs 13% for placebo (P < .001). Although ESS scores were not significantly lowered, PVT median reaction time decreased from 250 [239-312] ms at baseline to 223 [172-244] ms on Reb-Oxy vs 264 [217-284] ms on placebo (P < .001). Home oximetry illustrated acute and sustained improvement in the oxygen desaturation index on Reb-Oxy vs placebo. INTERPRETATION The administration of Reb-Oxy greatly decreased OSA severity and increased vigilance. These results highlight potential possibilities for pharmacologic treatment of OSA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT04449133; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Luigi Taranto Montemurro
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Stefano Vicini
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mariapaola Marconi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Lucia Zanotti
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | | | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
23
|
Rosa D, Villa G, Bonetti L, Togni S, Destrebecq A, Montanari E, Terzoni S. The relationship between overactive bladder, metabolic syndrome and shift work: A literature review. Int J Urol Nurs 2021. [DOI: 10.1111/ijun.12303] [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: 12/21/2022]
Affiliation(s)
- Debora Rosa
- Department of Cardiovascular, Neural and Metabolic Sciences IRCCS Istituto Auxologico Italiano, San Luca Hospital Milan Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
| | - Loris Bonetti
- Nursing research competence centre, department of Nursing Ente Ospedaliero Cantonale Bellinzona Switzerland
- Department of Business Economics, Health and Social Care University of Applied Sciences and Arts of Southern Switzerland (SUPSI) Manno Switzerland
| | - Serena Togni
- Health Care Profession Department Foundation IRCCS National Cancer Institute Milan Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health University of Milan Milan Italy
| | - Emanuele Montanari
- Department of Biomedical Sciences for Health University of Milan Milan Italy
- Department of Urology Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing San Paolo Teaching Hospital Milan Italy
| |
Collapse
|
24
|
Rosa D, Amigoni C, Villa G, Albanesi B, Bonetti L, Lombardi C, Perger E, Parati G. The influence of drug therapy for obstructive sleep apnoea on couple life. Qualitative study grounded theory. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnoea (OSA) is characterised by the collapse of the upper airway during sleep, which determine intermittent hypoxia and sleep fragmentation leading to snoring, impaired cognitive function, excessive daytime sleepiness, and cardiovascular impairments. These disorders have a significant impact on the quality of life and health of both patient and partner, determining stress and frustration also to the couple relationship, and to the workplace. Although the gold standard of treatment for OSA is the use of continuous positive airway pressure (CPAP), many patients find it uncomfortable both for them and for their partners (difficulty in partner intimacy, fear of disturbing their partner's sleep) with consequent low adherence to treatment in about 50% of OSA patients.
For these reasons, efforts to develop drug therapies for the treatment of OSA have been ongoing for at least 20 years. Recently, we conducted a randomized controlled trial (RCT) in Italy to test the combination of reboxetine (a noradrenergic agent) and oxybutynin (an antimuscarinic) for OSA treatment with promising results. The aim of this study is to understand how OSA drug therapy has influenced couples' life.
Methods
The study was conducted from February to March 2020 by the research nurse who participated during the trial. We interviewed 11 patients participating in the pharmacological RCT and 7 partners. The data analysis was conducted in order to collect the subjects' answers in categories, and to identify a core category as the central element for the explanation of the process.
Results
Interviews permitted to extrapolate 6 main categories and the relative subcategories for patients: 1) OSA: unconscious danger; 2) OSA and couple life (subcategories: sleepiness and nervousness, lack of sleep); 3) transitory situations; 4) drug therapy and couple (subcategories:change in intimacy and sleep quality); 5) motivation to help others (subcategories: therapy recommended for everyone; intention to continue); 6) partner awareness helps in adherence to therapy (subcategories: partner as caregiver, presence and proximity, partner support). While for partners, 7 main categories and the relative subcategories emerged: 1) apprehension and concern for the partner; 2) repercussions on daily life (subcategorie: discomfort); 3) OSA and the couple's lives; 4) drug therapy and couple; 5) support during therapy (subcategorie: before therapy, during therapy); 6) changes during drug therapy; 7) recommended therapy (subcategories: helping others, partner support). “The OSA is our problem” was the core category of the study that linked the categories together.
Conclusions
Drug therapy is well embraced by both patients and partners as it allows the couple to recover intimacy during sleep and in daily life. The results of this study provide useful information on the need to involve the partner in order to promote adherence to therapy.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Rosa
- Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - C Amigoni
- Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milan, Italy
| | - G Villa
- University Vita-Salute San Raffaele, Center of Nursing Research and Innovation, Milan, Italy
| | - B Albanesi
- Sapienza University of Rome, Department of Medicine and Psychology, Rome, Italy
| | - L Bonetti
- Oncology Institute of Southern Switzerland (IOSI), Nursing Development and Research Unit, Bellinzona, Switzerland
| | - C Lombardi
- Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - E Perger
- Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| |
Collapse
|
25
|
Rosa D, Villa G, Bonetti L, Togni S, Montanari E, Destrebecq A, Terzoni S. The use of mobile applications in urology. A systematic review. Int J Urol Nurs 2021. [DOI: 10.1111/ijun.12282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Debora Rosa
- IRCCS Istituto Auxologico Italiano, San Luca Hospital Department of Cardiovascular, Neural and Metabolic Sciences Milan Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation Vita‐Salute San Raffaele University Milan Italy
| | - Loris Bonetti
- Nursing Development and Research Unit Oncology Institute of Southern Switzerland (IOSI) Bellinzona Switzerland
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI) Department of Business Economics, Health and Social Care Manno Switzerland
| | - Serena Togni
- Health Care Profession Department Foundation I.R.C.C.S. National Cancer Institute Milan Italy
| | - Emanuele Montanari
- Department of Urology Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Biomedical Sciences for Health University of Milan Milan Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health University of Milan Milan Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing San Paolo Teaching Hospital Milan Italy
| |
Collapse
|
26
|
Negro A, Villa G, Zangrillo A, Rosa D, Manara DF. Diaries in intensive care units: An Italian qualitative study. Nurs Crit Care 2021; 27:36-44. [PMID: 34053148 DOI: 10.1111/nicc.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/10/2020] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The literature emphasizes the importance of the intensive care unit (ICU) diary to fill the gaps and recover the delusional memories of patients admitted to ICU in order to build the history of their illness. The ICU diary is a measure originally intended to support the severely ill patient, but it would also seem to be useful for family members and carers. According to our analysis of the literature, this study is the first description of the contents of ICU diaries in the Italian context. AIM The aim of the study was to describe the contents of ICU patients' diaries filled in by their caregivers, in order to explore the experience and significance attributed to the diaries. DESIGN A qualitative longitudinal narrative investigation was conducted at an ICU during the period from April 2016 to April 2017 with a sample composed of 32 families. METHODS The participants were caregivers selected through purposive sampling. An ICU nurse explained the study to caregivers and offered the opportunity to participate. RESULTS The sample included 32 diaries. Through the analysis we identified seven themes: future plans and memories; the people who care for the patient and the context; the love surrounding the patient; the clinical progression of the patient and the passage of time; what happens outside the patient's life; references to the usefulness/non-usefulness of the diary; communication/reflection on the likely death of the patient. CONCLUSIONS Some themes emerged that have never explored in the literature, and it would be necessary to understand whether the themes that emerged depend on cultural issues. RELEVANCE TO CLINICAL PRACTICE The diaries could be adapted to the Italian context and this could make the diary a common practice in Italy as well.
Collapse
Affiliation(s)
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- IRCCS San Raffaele Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Debora Rosa
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Duilio F Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
27
|
Dellafiore F, Rosa D, Udugampolage NS, Villa G, Albanesi B. Professional values and nursing self-efficacy in the Italian context. Correlational descriptive study. Scand J Caring Sci 2021; 36:142-149. [PMID: 33751624 DOI: 10.1111/scs.12971] [Citation(s) in RCA: 12] [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: 08/17/2020] [Revised: 12/23/2020] [Accepted: 01/31/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nurses' professional values (NPVs) and self-efficacy (SE) are two fundamental elements in nursing care that influence its professional identity, competences, resulting in changing the behaviour of professionals and their response to the patient's health needs. The various studies produced so far have not investigated a possible relationship between these two areas. Therefore, the objective of the following study is to identify and deepen the relationship between NPV and SE, in order to improve the knowledge of these issues. MATERIALS AND METHODS An observational, correlational and multicentric study has been carried out through a questionnaire based survey. The sampling was conventional. The data collection took place through Nursing Professional Values Scale, version 3 (NPVS-3), which investigates professional values; and Nursing Professional Self-Efficacy Scale (NPSES), which investigates self-efficacy and a socio-demographic questionnaire. RESULTS The total sample was 532 nurses and 65.6% was female, with a median age of 42 years and a median of 15 working years. Positive statistically significant correlations between the various domains of the NPVS-3 and NPSES scales were found. These relationships also emerged in the analyses between geographical areas. Overall, the relationships between self-efficacy and values were similar in all the analyses. DISCUSSION As the professional values of nurses increase in their response to the patient's health needs, self-efficacy perceived by them increases and vice versa, significantly effecting the clinic and care outcomes of the patients and improving nursing outcomes. The stratification of the sample by geographical area regarding the relationship between age, years of work and professional values indicated that these variables strongly influence the NPV and SE of nurses. Therefore, in some contexts, more support in maintaining a stable value structure may be needed; moreover, it is necessary to incentivise nurses with more effective interventions, as an example and a basis of motivation for future generations.
Collapse
Affiliation(s)
- Federica Dellafiore
- Area of Research and Development of Health Professions, IRCCS Policlinico San Donato, Milan, Italy
| | - Debora Rosa
- S. Luca Hospital, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Giulia Villa
- Health Professions Research and Development Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Albanesi
- Department of Medicine and Psychology, Università la Sapienza, Rome, Italy
| |
Collapse
|
28
|
Albanesi B, Nania T, Barello S, Villa G, Rosa D, Caruso R, Udugampolage NS, Casole L, Dellafiore F. Lived experience of patients in
ICU
after cardiac surgery: A phenomenological study. Nurs Crit Care 2020; 27:204-213. [DOI: 10.1111/nicc.12562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Beatrice Albanesi
- Department of Medicine and Psychology Sapienza University Rome Italy
| | - Tiziana Nania
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Research Center Università Cattolica del Sacro Cuore Milan Italy
| | | | - Debora Rosa
- IRCCS Istituto Auxologico Italiano Milan Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | | | - Lorenzo Casole
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| |
Collapse
|
29
|
Barello S, Falcó-Pegueroles A, Rosa D, Tolotti A, Graffigna G, Bonetti L. The psychosocial impact of flu influenza pandemics on healthcare workers and lessons learnt for the COVID-19 emergency: a rapid review. Int J Public Health 2020; 65:1205-1216. [PMID: 32888048 PMCID: PMC7472941 DOI: 10.1007/s00038-020-01463-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES During a pandemic, healthcare workers (HCWs) are essential to the health system response. Based on our knowledge, little information is available regarding the psychosocial impact on HCWs or interventions for supporting them during pandemics. Therefore, the study aimed to assess available literature on perceived stress and psychological responses to influenza pandemics in HCWs and identify implications for healthcare practice and future research. METHODS This is a rapid review of the literature. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. RESULTS Across all the studies-both qualitative and quantitative-HCWs working during the epidemic reported frequent concerns regarding their own health and the fear of infecting their families, friends and colleagues. Moreover, social isolation, uncertainty, fears of stigmatization and reluctance to work or considering absenteeism were frequently reported. Moreover, many studies highlighted a high prevalence of high levels of stress, anxiety and depression symptoms, which could have long-term psychological implications in HCWs. CONCLUSIONS This rapid review offers an overview of the major concerns regarding HCWs' psychosocial well-being and possible preventive strategies, which could be useful for the current COVID-19 outbreak and similar future pandemics. Studies suggested to invest on preventive psychological, social, family and physical support and to guaranteeing reasonable work conditions and others in order to protect HCWs from the long-lasting psychological effect of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Serena Barello
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, L.go Gemelli 1, 20123 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Anna Falcó-Pegueroles
- Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Consolidated Research Group SGR 269 Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | | | - Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 1, 6500 Bellinzona, Switzerland
| | - Guendalina Graffigna
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, L.go Gemelli 1, 20123 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Loris Bonetti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland (IOSI), EOC, Via Ospedale, 1, 6500 Bellinzona, Switzerland
- Department of Business Economic Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| |
Collapse
|
30
|
Rosa D, Villa G, Togni S, Bonetti L, Destrebecq A, Terzoni S. How to Protect Older Adults With Comorbidities During Phase 2 of the COVID-19 Pandemic: Nurses' Contributions. J Gerontol Nurs 2020; 46:7-8. [PMID: 32845342 DOI: 10.3928/00989134-20200811-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
31
|
Ascione T, Balato G, Mariconda M, Rosa D, Rizzo M, Pagliano P. Post-arthroscopic septic arthritis of the knee. Analysis of the outcome after treatment in a case series and systematic literature review. Eur Rev Med Pharmacol Sci 2020; 23:76-85. [PMID: 30977874 DOI: 10.26355/eurrev_201904_17477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to review the characteristics of patients with septic arthritis after ACL reconstruction comparing our results with those deriving from the literature review. PATIENTS AND METHODS Patients with suspected post arthroscopic septic arthritis of the knee occurring within 6 months after surgery were evaluated to be included in the investigation. Septic arthritis was defined by i) clinical evidence; ii) laboratory investigations; iii) synovial fluid leukocyte count of more than 2,5 x 104/μL or positive cultures obtained by synovial fluid aspirate. RESULTS Thirty-nine patients (median age 25 years, range 17-42) with septic arthritis following ACL reconstruction were enrolled. Staphylococci were the main bacteria identified. Resolution within 4 weeks of local signs was observed more frequently in those receiving arthroscopic debridement and synovectomy coupled with antibiotic therapy (18/21 vs. 9/18, p<0.05). Fever was present in 33 (85%) cases. Fever disappearance and CRP normalization within 4 weeks were reported more frequently in patients receiving intravenous antibiotics (17/20 vs. 9/19, p<0.05). Similar findings were retrieved by literature analysis. CONCLUSIONS An intravenous antibiotic therapy with surgical debridement is the first-line treatment for septic arthritis. Staphylococci are the main causative agents, justifying an empiric therapeutic approach with an anti-MRSA agent and cephalosporin.
Collapse
Affiliation(s)
- T Ascione
- Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.
| | | | | | | | | | | |
Collapse
|
32
|
Iacono V, De Franco C, Auletta N, Zarra A, D'addona A, Rosa D, Zorzi C. New plates with polyaxial locking system and PSI technique in medial open wedge high tibial osteotomy: preliminary results. J BIOL REG HOMEOS AG 2020; 34:111-113. ADVANCES IN MUSCULOSKELETAL DISEASES AND INFECTIONS-SOTIMI 2019. [PMID: 32856449] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Medial open-wedge (MOW) high tibial osteotomy (HTO) is proven treatment option, indicated in medial unicompartimental knee osteoarthritis (OA) and in varus OA. New devices and techniques were developed in last years, such as Activemotion plates with polyaxial locking system (Dualtec System®, NewClip-Technics) and PSI technique. We describe outcomes and rate of complications in patients treated with Activemotion plates and PSI technique. From January 2019 to August 2019 a sample of 77 cases (72 NCT plates, 5 PSI technique) was observed, evaluating the rate of complications and the return to activity. The rate of complications is 2.6% and the mean time to return to activity is 10 weeks. MOW HTO with Activemotion plate has showed good results with a low rate of complications. About PSI technique, the preliminary results are excellent, but we need to increase the sample.
Collapse
Affiliation(s)
- V Iacono
- Orthopaedic Department, Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - C De Franco
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - N Auletta
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - A Zarra
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - A D'addona
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - D Rosa
- Orthopaedic Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - C Zorzi
- Orthopaedic Department, Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| |
Collapse
|
33
|
Rosa D, Villa G, Montanari E, Destrebecq A, Terzoni S. The relationship between urolithiasis, metabolic syndrome and nurse shift work. A literature review. Int J Urol Nurs 2020. [DOI: 10.1111/ijun.12233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Debora Rosa
- Department of Biomedicine and PreventionUniversity of Rome Tor Vergata Roma Italy
| | - Giulia Villa
- Department of UrologyIRCCS San Raffaele Institute Milan Italy
| | - Emanuele Montanari
- Department of UrologyFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Anne Destrebecq
- Department of Biomedical Sciences for HealthUniversity of Milan Milan Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital Milan Italy
| |
Collapse
|
34
|
Abstract
BACKGROUND Nursing is characterized by a working articulation in shifts to ensure continuity of care throughout the 24 h. However, shift work and the resulting desynchronization of circadian rhythms may have adverse effects on nurses' health. AIMS To describe the effects of shift work and desynchronization of circadian rhythms on nurse's health. METHODS Databases: PubMed, Cinahl, Scopus, Embase and Ilisi. Search terms (free terms, MeSH): 'nurses', 'shiftwork', 'nightwork', 'sleep disorder, circadian rhythm', 'work schedule tolerance', 'breast neoplasm', 'metabolic syndrome X', 'metabolic cardiovascular syndrome', 'Cardiovascular disease', 'stress', 'diabetes'. We included all randomized controlled trials, observational studies, reviews and papers studying nurses' shift work. Quality assessment of the retrieved papers was verified according to Dixon-Woods checklist. RESULTS Twenty-four articles were analyzed. Literature review has shown that shift work involves an alteration in psychophysical homeostasis, with a decrease in performance. It is an obstacle for social and family relationships, as well as a risk factor for stress, sleep disorders, metabolic disorders, diabetes, cardiovascular disorders and breast cancer. CONCLUSIONS An organized ergonomic turnaround can be less detrimental to the health of nurses and more beneficial for the healthcare providers. Therefore, we suggest organizing studies to assess whether improving nurses' health would lead to a reduction in miscarriages, absenteeism and work-related stress.
Collapse
Affiliation(s)
- D Rosa
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - S Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | - F Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - A Destrebecq
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
35
|
Perea Gabriel GP, Corneli M, Daquarti G, Meretta A, Rosa D, Masoli O. 436 Prognostic value of calcium scoring in changes of echogenicity in carotid plaques. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atherosclerosis is a dynamic process, in which the characteristics of the plaques evaluated by imaging methods could represent the degree of inflamatory activity of the disease.
Purpose
Assess the value of the coronary calcium score in the changes of echogenicity of carotid plaques in a population with low-intermediate cardiovascular risk.
Methods
Patients with no cardiovascular history and low and intermediate Framingham risk score were evaluated. Patients attended at our institute for a preventive cardiovascular control between January 2012 and April 2013, and then a subsequent follow-up was made until January 2019.
They were screened for coronary calcium scoring (CCS) and carotid plaque by ultrasound at first visit. Then the changes of carotid atherosclerotic disease were evaluated through new carotid ultrasound exam at follow up.
A carotid artery plaque was defined as a localized protrusion of the vessel wall, which 1) extended into the lumen ≥ 1.5 mm, or 2) had a thickness exceeding the intima-media thickness (IMT) of the adjacent portion of the vessel wall by >50%. Plaque morphology was defined in terms of its echogenicity.
Results
121 patients that have carotid atherosclerotic disease at first carotid ultrasound exam were included. The mean age was 61 ± 9 years, 72 (59%) male patients. Cardiovascular risk factors: hypertension: 68 (56%), dyslipidemia: 46 (38%), sedentary lifestyle: 24 (20%), overweight: 17 (14%), smoking: 29 (24%) and diabetes: 15 (12%).
Median distribution of CCS was 192 (percentile distribution 25-75%: 8 – 224) Agatston units. Medium follow-up: 5 ± 1 year. At first ultrasonography study, 47 patients (39%) presented hypoechoic plaques, 61 patients (50%) isoechoic plaques and hyperechoic plaques in 13 patients (11%).
After the follow-up, the distribution of the plates according to their sonographic characteristics was: hypoechoic plaques in 23 patients (19%), isoechoic plaques in 55 patients (45%) and hyperechoic plaques in 42 patients (36%).
The incidence of the progression of sonographic changes of the carotid plaques varies according to CCS: 0-100:29%, 101-400: 54%, >401:53% (p < 0,001) Figure 1.
The value of CCS was associated with the progression of carotid atherosclerotic plaque regardless of the use of statins and angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers (Cox model p <0.001).
Conclusions
This study shows that there is an association between coronary calcium score and progression of carotid disease. Even in populations with low and intermediate cardiovascular risk, the higher the severity of the calcium score, the greater changes in the structure of the carotid plaque manifested in our work as changes in the echogenicity; regardless of the use of statins. These findings could be useful to assess the progression of atherosclerotic disease at a median follow up.
Abstract 436 Figure. folow up
Collapse
Affiliation(s)
- G P Perea Gabriel
- Cardiovascular Institute of Buenos Aires (ICBA), Cardiovascular Imaging Department, Buenos Aires, Argentina
| | - M Corneli
- Cardiovascular Institute of Buenos Aires (ICBA), Cardiovascular Imaging Department, Buenos Aires, Argentina
| | - G Daquarti
- Cardiovascular Institute of Buenos Aires (ICBA), Cardiovascular Imaging Department, Buenos Aires, Argentina
| | - A Meretta
- Cardiovascular Institute of Buenos Aires (ICBA), Cardiovascular Imaging Department, Buenos Aires, Argentina
| | - D Rosa
- Cardiovascular Institute of Buenos Aires (ICBA), Cardiovascular Imaging Department, Buenos Aires, Argentina
| | - O Masoli
- Cardiovascular Institute of Buenos Aires (ICBA), Cardiovascular Imaging Department, Buenos Aires, Argentina
| |
Collapse
|
36
|
Toscani F, Finetti S, Giunco F, Basso I, Rosa D, Pettenati F, Bussotti A, Villani D, Gentile S, Boncinelli L, Monti M, Spinsanti S, Piazza M, Charrier L, Di Giulio P. The last week of life of nursing home residents with advanced dementia: a retrospective study. BMC Palliat Care 2019; 18:117. [PMID: 31882007 PMCID: PMC6935223 DOI: 10.1186/s12904-019-0510-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/19/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. METHODS This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. RESULTS Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. CONCLUSIONS Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.
Collapse
Affiliation(s)
- Franco Toscani
- Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100 Cremona, Italy
| | - Silvia Finetti
- Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100 Cremona, Italy
| | - Fabrizio Giunco
- Department of Health and Social Services Polo Lombardia 2, Don Carlo Gnocchi Foundation ONLUS, Via Palazzolo, 21, 20149 Milan, Italy
| | - Ines Basso
- Intensive Care Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Via Venezia, 16, 15121 Alessandria, Italy
| | - Debora Rosa
- University of Milan, section of Don Carlo Gnocchi Foundation, Via A. Capecelatro, 66, 20148 Milan, Italy
| | - Francesca Pettenati
- Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100 Cremona, Italy
| | - Alessandro Bussotti
- Agenzia Continuità Ospedale Territorio, Azienda Ospedaliero- Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Villani
- Neuro-Rehabilitation and Alzheimer Disease Evaluation Unit, Figlie di San Camillo Hospital, Via F. Filzi , 56, 26100 Cremona, Italy
| | - Simona Gentile
- Rehabilitation and Alzheimer Disease Evaluation Unit, Ancelle della Carità Hospital, Via G. Aselli, 14 Cremona, Italy
| | - Lorenzo Boncinelli
- Intensive Care Unit Geriatric, AOU Careggi-Largo Brambilla,3, 50134 Florence, Italy
| | - Massimo Monti
- Geriatric Institute Pio Albergo Trivulzio, via Trivulzio, 15, 20146 Milan, Italy
| | - Sandro Spinsanti
- Istituto Giano, Via Stazzo Quadro 7, 00060 Riano (Rm), Milan, Italy
| | - Massimo Piazza
- Italian Foundation of Leniterapia (FILE), Via San Niccolò, 1, 50125 Florence, Italy
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
- SUPSI, Manno, Switzerland
| |
Collapse
|
37
|
Dellafiore F, Arrigoni C, Grugnetti AM, Zaffino G, Calorenne V, Pitella F, Rosa D, Caruso R. Bedside nursing handover and organisational will to achieve personalisation within an Italian Cardiac SurgeryUnit: the nurses' viewpoint through a qualitative study. Prof Inferm 2019; 72:51-59. [PMID: 31162044 DOI: 10.7429/pi.2019.721051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Bedside nursing handover may be an efficient way to achieve quality nursing outcomes, supporting the personalization of care. Recent literature attests to how bedside nursing handover is perceived by cardiac patents, but the experience of nurses participating in these handovers is largely unknown. The aim of this study is to explore nurses' experiences after the implementation of bedside nursing handover in an Italian cardiac surgical ward. METHOD A qualitative descriptive research approach was used to respond to the study aim, and the data was collected using two focus groups. RESULTS The main themes that were identified revolved around improving nursing care, greater professionalism, effective relationships, consequences for the patient, and obstacles to change. Moreover, we found that nurses perceive bedside nursing handover to be effective in promoting patient-centred care. The nurses in our study also felt that any difficulties with the implementation of a bedside nursing handover protocol (e.g. confidentiality) should be addressed through continued nursing education. CONCLUSIONS This study provides a valuable insight into nurses' perceptions of bedside nursing handover in a single cardiac surgery setting in Italy and is the first qualitative investigation from this perspective. Further research may help to elucidate the impact of bedside nursing handover on clinical and organisational outcomes.
Collapse
Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Italy
| | - Anna Maria Grugnetti
- IRCCS Policlinico San Matteo and Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Italy
| | - Giovanni Zaffino
- PhD, RN, Head of Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Veronica Calorenne
- PhD, RN, Head of Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Pitella
- Head of Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Debora Rosa
- Nursing Degree Course, University of Milan, section of Don Carlo Gnocchi Foundation, Milan, Italy
| | - Rosario Caruso
- PhD, RN, Head of Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| |
Collapse
|
38
|
Daquarti G, Sanabria H, Rosa D, Cornelli M, Gobbo M, Rapallo C, Vera M, Aguirre E, Coronel D, Blanco N, Perez Balino N, Masoli O, Meretta A. P389Microvascular dysfunction in type 2 diabetic patients with normal rest-stress myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez149.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Daquarti
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - H Sanabria
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - D Rosa
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - M Cornelli
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - M Gobbo
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - C Rapallo
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - M Vera
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - E Aguirre
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - D Coronel
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - N Blanco
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - N Perez Balino
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - O Masoli
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - A Meretta
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| |
Collapse
|
39
|
Franzoi MA, Rosa D, Barrios C, Bines J, Cronemberger E, Queiroz G, Cordeiro de Lima VC, Junior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Evyl B, Neron Y, Dybal V, Lazaretti N, Costamilan R, de Andrade D, Mathias C, Zerwes Vacaro G, Borges G, Silva K, Werutsky G, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S, Liedke PE. Abstract P1-08-27: Advanced stage at diagnosis and worse clinicopathologic features in young woman with breast cancer. A sub-analysis of Brazilian population through the AMAZONA III study (GBECAM 0115). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-08-27] [Citation(s) in RCA: 1] [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] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer (BC) in young women is uncommon and often more aggressive. There are disparities in terms of screening coverage, diagnostic features and access to optimal treatment among young BC patients worldwide. To better understand this scenario through real world data we performed a sub-analysis of AMAZONA III study. METHODS: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2950 women newly diagnosed with invasive BC in Brazil during the period of January 2016 to March 2018 within 22 sites. Of them, 2888 patients had valid data regarding age at diagnosis and complete baseline information. For the purpose of comparisons of epidemiologic and clinicopathologic features at the time of diagnosis of BC, patients were divided in two groups: women aged ≤40 years (Group 1) and >40 years (Group 2). Quantitative variables were expressed with mean, while categorical variables were described as their count and percentage and compared using the chi-square test. RESULTS: Of 2888 women, 486 (17%) were ≤40 years of age. No differences were found between ethnicity, performance status, body mass index, personal income, health insurance and family history of cancer between the two groups. Young women had higher educational level (p<0.001), were more involved into a labor activity (p<0.001) and were more frequently married (p<0.001). There were also significant differences regarding nulliparity (p<0.001) and previous use of oral contraceptives (p<0.001). Mode of detection of BC was symptomatic in 73.4% of young group versus 64.5% in older group and screen-detected was only 26.6% vs. 35.5% respectively (p<0.001). Table 1 describes clinicopathological characteristics of the two groups. Young women presented more frequently with stage III,T3/T4, Grade 3 tumors and HER-2 positive, Luminal B and triple negative subtypes. Women older than 40 years had more stage I, Luminal A and Grade 1/2 tumors. CONCLUSION: Brazilian women under the age of 40 have unfavorable clinicopathological features of BC at diagnosis with more aggressive subtypes and advanced stage compared with older women. No differences in socioeconomic and ethnical aspects were found but a higher percentage of young women had symptomatic detection of BC which could explain the later stage of disease at diagnosis. Young women were economically active and the majority married which highlights the socioeconomic impact of this disease in Brazil.
Breast cancer features by age groups at diagnosis in Brazilian women.InformationGroup 1 (≤40 years)Group 2 (> 40 years)p-valueN: 2888486 (16.83%)2402 (83.17%) Stage at diagnosis p< 0.001I76 (19.2%)541 (27.8%) II156 (39.4%)816 (41.9%) III146 (36.8%)489 (25.1%) IV19 (4.6%)101 (5.2%) Tumor size p< 0.001T1114 (27.1%)749 (36.9%) T2141 (33.6%)764 (37.6%) T3101 (24.1%)282 (13.9%) T464 (15.2%)235 (11.6%) Tumor grade p < 0.001Grade 146 (10.7%)381 (17.9%) Grade 2198 (46.2%)1150 (52.0%) Grade 3185 (43.1%)641 (30.1%) Molecular Subtype p < 0.001Luminal A106 (30.6%)957 (51.3%) Luminal B - HER 2 negative55 (15.8%)212 (11.4%) Luminal B- HER 2 positive79 (22.8%)298 (16.0%) HER 2 positive27 (7.8%)135 (7.2%) Triple negative80 (23.0%)264 (14.1%)
Citation Format: Franzoi MA, Rosa D, Barrios C, Bines J, Cronemberger E, Queiroz G, Cordeiro de Lima VC, Junior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Evyl B, Neron Y, Dybal V, Lazaretti N, Costamilan RdC, de Andrade D, Mathias C, Zerwes Vacaro G, Borges G, Silva K, Werutsky G, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S, Liedke PE. Advanced stage at diagnosis and worse clinicopathologic features in young woman with breast cancer. A sub-analysis of Brazilian population through the AMAZONA III study (GBECAM 0115) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-27.
Collapse
Affiliation(s)
- MA Franzoi
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - D Rosa
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - C Barrios
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - J Bines
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - E Cronemberger
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - G Queiroz
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - VC Cordeiro de Lima
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - R Junior
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - J Couto
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - K Emerenciano
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - H Resende
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - S Crocamo
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - T Reinert
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - B Van Evyl
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - Y Neron
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - V Dybal
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - N Lazaretti
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - RdC Costamilan
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - D de Andrade
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - C Mathias
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - G Zerwes Vacaro
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - G Borges
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - K Silva
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - G Werutsky
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - A Morelle
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - CA Sampaio Filho
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - M Mano
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - F Zaffaroni
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - S Simon
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| | - PE Liedke
- Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil; Centro de Pesquisa em Oncologia (CPO), Porto Alegre, Brazil; Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil; Hospital Araujo Jorge, Goiás, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiás, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte Riograndense, Natal, Brazil; Hospital Jardim Amalia, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisas em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica - CITO, Pass
| |
Collapse
|
40
|
Rosa D, Barrios C, Bines J, Werustky G, Cronemberger E, Queiroz GS, Lima VC, Freitas-Júnior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyil B, Néron Y, Dybal V, Lazaretti N, Costamilan RC, Andrade DA, Mathias C, Vacaro GZ, Borges G, Torres KL, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S. Abstract P1-08-29: Current status of clinical and pathological characteristics of breast cancer patients in Brazil: Results of the AMAZONA III study (GBECAM 0115). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-08-29] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND
Breast cancer (BC) is the most common tumor in women in Brazil with about 60 thousand new cases estimated per year. In low and middle-income countries, patients with BC are diagnosed with more advanced stages as compared with high-income countries. In Brazil, disparities in access to new therapies are recognized; previous data suggests worse survival of BC patients treated in the public system. The aim of AMAZONA III study (GBECAM 0115) is to describe the current status of BC care in Brazil. Here we report patients data at baseline.
METHODS
The AMAZONA III is a prospective BC registry that included women 18 years or older with newly diagnosed stage I to IV BC from 22 sites in Brazil in the period of January 2016 to March 2018. All patients provided written informed consent; data was collected from interview and medical charts, comprising clinical-demographic variables, initial treatment and a planned follow-up for 5 years. BC subtypes were defined by hormone receptor (HR) expression, HER2 status and grade according to von Minckwitz G. et al 2012. Here we present a descriptive analysis of the patients' baseline characteristics. Continuous variables are shown as mean (standard-deviation) and categorical variables by its absolute and relative frequencies. The study is registered in clinicaltrials.gov NCT02663973.
RESULTS
A total of 2950 patients were included in the study. Median age at diagnosis was 53 years old (8.4% <= 35 years, 34.8% 36-50 years, 56.8% > 50 years), 58.6% were white, 34.4% had brown skin-color, 83% had children before BC diagnosis (median of 1 child/patient) and 63.1% had public health insurance. In terms of method of detection 34% were screen-detected whereas 66% were symptomatic, the last was even higher (70%) in patients in younger than 50 years. The distribution of BC stage at diagnosis was I (26.4%), II (41.6%), III (27%) and IV (5%). The most common histologies were ductal (80.9%) and lobular carcinoma (6.9%). The pathological characteristics were HR positive in 78.0%, HER-2 positive in 23.4% and grade 2 in 51%. BC subtypes were as follows: Luminal A 48%, Luminal B 12%, Luminal HER2 positive 17%, Non-luminal HER2 positive 7.3% and Triple negative 15.5%.
DISCUSSION
Breast cancer is diagnosed at an earlier age among Brazilian patients. The majority of patients were detected through symptomatic BC and therefore a significant proportion is still diagnosed in stages III and IV. Among other factors, these findings could have a significant impact in treatment outcomes. Further analysis of this large cohort of patients will help to identify other important elements and direct future strategies for breast cancer control.
TRIAL REGISTRY: NCT02663973
KEYWORDS: Breast Cancer; Epidemiology; Treatment; Brazil
Citation Format: Rosa D, Barrios C, Bines J, Werustky G, Cronemberger E, Queiroz GS, Lima VC, Freitas-Júnior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyil B, Néron Y, Dybal V, Lazaretti N, Costamilan RC, Andrade DA, Mathias C, Vacaro GZ, Borges G, Torres KL, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S. Current status of clinical and pathological characteristics of breast cancer patients in Brazil: Results of the AMAZONA III study (GBECAM 0115) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-29.
Collapse
Affiliation(s)
- D Rosa
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - C Barrios
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - J Bines
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - G Werustky
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - E Cronemberger
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - GS Queiroz
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - VC Lima
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - R Freitas-Júnior
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - J Couto
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - K Emerenciano
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - H Resende
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - S Crocamo
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - T Reinert
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - B Van Eyil
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - Y Néron
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - V Dybal
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - N Lazaretti
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - RC Costamilan
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - DA Andrade
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - C Mathias
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - GZ Vacaro
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - G Borges
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - KL Torres
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - A Morelle
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - CA Sampaio Filho
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - M Mano
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - F Zaffaroni
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| | - S Simon
- Hospital Moinhos de Vento, Porto Alegre, Brazil; Centro de Pesquisa em Oncologia (CPORS), Porto Alegre, Brazil; Instituto Nacional do Câncer, Rio de Janeiro, Brazil; Centro Regional Integrado de Oncologia, Fortaleza, Brazil; Hospital Araújo Jorge, Goiânia, Brazil; AC Camargo Cancer Center, São Paulo, Brazil; Universidade Federal de Goiás, Goiânia, Brazil; Hospital de Clínicas de Londrina, Londrina, Brazil; Liga Norte-riograndense Contra o Câncer, Natal, Brazil; Hospital Jardim Amália, Volta Redonda, Brazil; Oncoclínica RJ, Rio de Janeiro, Brazil; Centro de Pesquisa e Educação da Serra Gaúcha, Caxias do Sul, Brazil; Instituto do Câncer Dr Arnaldo, São Paulo, Brazil; Centro de Pesquisa em Oncologia, Florianópolis, Brazil; Clínica AMO, Salvador, Brazil; Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil; Universidade de Caxias do Sul, Caxias do Sul, Brazil; Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil; Núcleo Oncológico da Bahia, Salvador, Brazil; Hospital São Vicente de Paulo,
| |
Collapse
|
41
|
Rosa D, Terzoni S, Lembo R, Destrebecq A. [Relation between work-related stress and metabolic syndrome among Italian nurses.]. Recenti Prog Med 2019; 109:137-138. [PMID: 29493641 DOI: 10.1701/2865.28910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To investigate the prevalence of metabolic syndrome (MS) among nurses, as well as the organizational impact of work-related stress as a consequence of MS among nurses in Italy. To study the organizational models, turnover rates, and job satisfaction among nurses, in a sample of Italian healthcare facilities. BACKGROUND MS is considered an important metabolic disorder in the modern world, responsible for diseases with economic effects on hospitals. Shift work (SW) seems to be a risk factor for MS, while the Mediterranean diet appears to be protective. Work-related stress causes loss of working days, and generates high costs for hospitals. DESIGN Prospective observational study. METHODS The first step will be to create and validate a questionnaire to investigate the prevalence of MS among Italian nurses. The second step will be to estimate the risk of work-related stress. Data regarding absenteeism and turnover will be collected, as indicators of impact on organization. DISCUSSION This study is the first to investigate the previously describe SW's factors and their impact on organizing nursing work. This study is relevant for the organizations because it helps to define organizational strategies that permit nurses to remain healthy, to be work efficient and therefore to be able to provide high level care.
Collapse
Affiliation(s)
- Debora Rosa
- Dipartimento di Biomedicina e Prevenzione, Università di Roma Tor Vergata
| | | | | | - Anne Destrebecq
- Dipartimento di Scienze Biomediche per la Salute, Università di Milano
| |
Collapse
|
42
|
Di Vico G, Di Donato S, Balato G, Correra G, D’Addona A, Maffulli N, Rosa D. Correlation between time from injury to surgery and the prevalence of ramp and hidden lesions during anterior cruciate ligament reconstruction. A new diagnostic algorithm. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2017.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- G. Di Vico
- Orthopaedic Unit, S. Michele Clinic, Caserta, Italy
| | - S.L. Di Donato
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico Il, Naples, Italy
| | - G. Balato
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico Il, Naples, Italy
| | - G. Correra
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico Il, Naples, Italy
| | - A. D’Addona
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico Il, Naples, Italy
| | - N. Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, London, UK
| | - D. Rosa
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico Il, Naples, Italy
| |
Collapse
|
43
|
Di Giulio P, Finetti S, Giunco F, Basso I, Rosa D, Pettenati F, Bussotti A, Villani D, Gentile S, Boncinelli L, Monti M, Spinsanti S, Piazza M, Charrier L, Toscani F. The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study. J Pain Symptom Manage 2019; 57:93-99. [PMID: 30315916 DOI: 10.1016/j.jpainsymman.2018.10.268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT End-of-life care in nursing homes (NHs) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy). OBJECTIVES The objective of this study was to compare end-of-life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care. METHODS The intervention consisted of a seven-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff. This multicenter, comparative, observational study included up to 20 residents with advanced dementia from each NH: the last 10 who died before the intervention (preintervention group, 245 residents) and the first 10 who died at least three months after the intervention (postintervention group, 237 residents). Data for these residents were collected from records for 60 days and seven days before death. RESULTS The use of "comfort hydration" (<1000 mL/day subcutaneously) tended to increase from 16.9% to 26.8% in the postintervention group. The number of residents receiving a palliative approach for nutrition and hydration increased, though not significantly, from 24% preintervention to 31.5% postintervention. On the other hand, the proportion of tube-fed residents and residents receiving intravenous hydration decreased from 15.5% to 10.5%, and from 52% to 42%, respectively. Cardiopulmonary resuscitations decreased also from 52/245 (21%) to 18/237 (7.6%) cases (P = 0.002). CONCLUSION The short educational intervention modified some practices relevant to the quality of end-of-life care of advanced dementia patients in NHs, possibly raising and reinforcing beliefs and attitudes already largely present.
Collapse
Affiliation(s)
- Paola Di Giulio
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy; SUPSI, Manno, Switzerland
| | - Silvia Finetti
- Lino Maestroni Foundation, Palliative Medicine Research Institute, Cremona, Italy
| | - Fabrizio Giunco
- Department of Health and Social Services Polo Lombardia 2, Don Carlo Gnocchi Foundation ONLUS, Milano, Italy
| | - Ines Basso
- Intensive Care Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Debora Rosa
- Nursing Degree Course, Section of Don Carlo Gnocchi Foundation, University of Milan, Milan, Italy
| | - Francesca Pettenati
- Lino Maestroni Foundation, Palliative Medicine Research Institute, Cremona, Italy
| | - Alessandro Bussotti
- Agenzia Continuità Ospedale Territorio, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Daniele Villani
- Neuro-Rehabilitation and Alzheimer Disease Evaluation Unit, "Figlie di San Camillo" Hospital, Cremona, Italy
| | - Simona Gentile
- Rehabilitation and Alzheimer Disease Evaluation Unit, Ancelle della Carità Hospital, Cremona, Italy
| | | | - Massimo Monti
- Geriatric Institute "Pio Albergo Trivulzio", Milano, Italy
| | | | - Massimo Piazza
- Italian Foundation of Leniterapia (FILE), Firenze, Italy
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Franco Toscani
- Lino Maestroni Foundation, Palliative Medicine Research Institute, Cremona, Italy
| |
Collapse
|
44
|
Rosa D, Di Donato S, Balato G, D’Addona D, Schonauer F. Supinated forearm is correlated with the onset of medial epicondylitis in professional slalom waterskiers. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2016.17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- D. Rosa
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - S.L. Di Donato
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - G. Balato
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - D. D’Addona
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - F. Schonauer
- Department of Public Health, Federico II University of Naples, Naples, Italy
| |
Collapse
|
45
|
Cabral AD, Murcar-Evans BI, Toutah K, Bancerz M, Rosa D, Yuen K, Radu TB, Ali M, Penkul A, Kraskouskaya D, Gunning PT. Structure-activity relationship study of ProxyPhos chemosensors for the detection of proximal phosphorylation and other phosphate species. Analyst 2018; 142:3922-3933. [PMID: 28930308 DOI: 10.1039/c7an00722a] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chemosensors for the detection of phosphate-containing biological species are in high need. Detection of proximally phosphorylated sites of PPi and those found in peptides and proteins has been demonstrated using chemosensors containing pyrene, as a fluorescent reporter, and a Zn2+-chelate, as a phosphate-binding group. Using these sensors, detection of proximal phosphate groups is afforded by binding of at least two of the sensor molecules to the adjacent phosphates, via the Zn2+ centres, leading to excimer formation between the pyrene groups and the corresponding shift in emission from 376 to 476 nm. Although several reports of this chemosensor class have been made, no detailed studies of selectivity of these sensors among major phosphate targets have been reported. In this study, a library of this class of chemosensors, termed ProxyPhos, which contained various linkers and Zn2+-chelating groups (i.e. DPA, cyclen and cyclam), was prepared and the effects of structural variation on the sensing efficiency and selectivity were evaluated among proximally phosphorylated peptides, proteins, nucleotides, Pi and PPi. As a result of this study, we have identified ProxyPhos library members that are most suitable for the detection of proximally phosphorylated peptides, PPi, UTP, and a DpYD peptide motif, and have generally provided a foundation for the selection of ProxyPhos chemosensors for further development of specific biologically relevant assays. The broad utility of ProxyPhos is further supported by the demonstrated lack of these sensors' cytotoxicity, ability to rapidly permeate into live and fixed cells and compatibility with gel staining methods.
Collapse
Affiliation(s)
- A D Cabral
- Department of Chemistry and Department of Chemical and Physical Sciences, University of Toronto, Mississauga, 3359 Mississauga Road North, Mississauga, Ontario, CanadaL5L1C6.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Corneli MC, Perea GO, Daquarti G, Meretta AH, Rosa D, Belcastro F, Rapallo C, Gobbo M, Aguirre ME, Perez Balino N, Masoli OH. P728Coronary calcium score and carotid disease: is there an association with the development and progression of the plaque? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p728] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M C Corneli
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - G O Perea
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - G Daquarti
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - A H Meretta
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - D Rosa
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - F Belcastro
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - C Rapallo
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - M Gobbo
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - M E Aguirre
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - N Perez Balino
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - O H Masoli
- Instituto Cardiovascular de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| |
Collapse
|
47
|
Marot LP, Rosa D, Crispim CA. 0659 Effects of BMI and Fragmentation of The Activity Rhythm Across The Sleep-Wake Cycle on The Work Performance. Sleep 2018. [DOI: 10.1093/sleep/zsy061.658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L P Marot
- Faculty of Medicine, University 0f Uberlandia, Uberlândia, Brazil
| | - D Rosa
- Faculty of Medicine, University 0f Uberlandia, Uberlândia, Brazil
| | | |
Collapse
|
48
|
Daniele A, Rosa D, Lapadula V, Abbate I, Galetta D, Montagna E, Catino A. 14P MMP-2 1306 C/T promoter polymorphism and smoking: A possible role as risk factors in lung cancer. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30294-6] [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]
|
49
|
Laura S, Rosa D. Narrative review of quality of life in survivors of colorectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx438.018] [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
|
50
|
Rizzo E, Casiraghi L, Rosa D. Cancer related fatigue in adults, adolescents and children. Literature review. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx438.020] [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
|