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Fortunato A, Valentini I, Rumi F, Antonini D, Siviero L, Di Brino E, Basile M, Cicchetti A. A budget impact model and a cost-utility analysis of reducer device (Neovasc) in patients with refractory angina. Front Cardiovasc Med 2024; 11:1307534. [PMID: 38562187 PMCID: PMC10982321 DOI: 10.3389/fcvm.2024.1307534] [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: 10/04/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background Refractory angina (RA) is a chronic condition characterized by the presence of debilitating angina symptoms due to established reversible ischemia in the presence of obstructive coronary artery disease (CAD). Treatments for this condition have undergone major developments in recent decades; however, the treatment for RA remains a challenge for medicine. In this sense, the Coronary Sinus Reducer System (CSRS) stands as the last line of therapy for ineligible patients for revascularization with reversible ischemia. The purpose of this report is to evaluate the potential burden on the National Health Service (NHS) and measure the health effects in terms of both quantity (life years) and quality-of-life aspects related to the reducer. Methods Two different economic evaluation models were developed as part of the analysis. The budget impact was developed to estimate the potential burden on the NHS from incremental uptake of the use of the reducer in the target population. The utility cost analysis compares and evaluates the quality of life and health resource use and costs between the two alternatives, based on the research of Gallone et al. A deterministic and probabilistic sensitivity analysis was carried out to characterize the uncertainty around the parameters of the model. Results In the budget impact analysis (BIA), the reducer is shown to be more expensive in the first 2 years of the model, due to the gradual uptake in the market and the cost of the device. Starting from the third year, assuming maintenance of effectiveness, there are savings in terms of resource absorption in direct healthcare costs arising from hospitalizations, emergency department accesses, coronarography, and visits avoided. Conclusion The BIA and cost-effectiveness model show that the reducer device, despite an increase in resources absorbed in the first years of implementation and use, has the potential to result in increased quality of life in patients with RA. These costs are largely offset in the short term by the improved clinical outcomes achievable leading to savings from the third year onward in the BIA and a dominance ratio in the cost-utility analysis.
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Affiliation(s)
- Agostino Fortunato
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS) - Università Cattolica del Sacro Cuore, Roma, Italy
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Basile M, Valentini I, Attanasio R, Cozzi R, Persichetti A, Samperi I, Scoppola A, Auriemma RS, De Menis E, Esposito F, Ferrante E, Iatì G, Mazzatenta D, Poggi M, Rudà R, Tortora F, Cruciani F, Mitrova Z, Saulle R, Vecchi S, Cappabianca P, Paoletta A, Bozzao A, Caputo M, Doglietto F, Ferraù F, Lania AG, Laureti S, Lello S, Locatelli D, Maffei P, Minniti G, Peri A, Ruini C, Settanni F, Silvani A, Veronese N, Grimaldi F, Papini E, Cicchetti A. A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas. Glob Reg Health Technol Assess 2024; 11:1-16. [PMID: 38230389 PMCID: PMC10788683 DOI: 10.33393/grhta.2024.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024] Open
Abstract
Background Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results The average cost of the first year of treatment was €2,558.91 and €3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were €798.13 and €1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of €3,201.15 compared to bromocriptine, based on a willingness-to-pay of €40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of €44,846.64. Considering a willingness-to-pay of €40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.
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Affiliation(s)
- Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| | - Ilaria Valentini
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| | | | - Renato Cozzi
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
| | - Agnese Persichetti
- Ministry of Interior, Department of Firefighters, Public Rescue and Civil Defense, Rome
| | | | | | - Renata Simona Auriemma
- Department of Clinical Medicine and Surgery, Endocrinology Section, ‘Federico II’ University of Naples, Naples
| | - Ernesto De Menis
- Internal Medicine 2, Treviso Hospital, Treviso and Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto
| | - Felice Esposito
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome
| | - Roberta Rudà
- Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin
| | - Fabio Tortora
- Radiology Unit, Department of Advanced Biomedical Sciences, University “Federico II”, Naples
| | - Fabio Cruciani
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Paolo Cappabianca
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
| | | | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI)
| | | | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI)
| | | | - Stefano Lello
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese
| | - Pietro Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University, Padua
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena
| | - Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence
| | - Chiara Ruini
- Department of Psychology, University of Bologna, Bologna
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
| | - Nadia Veronese
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale (RM) - Italy
| | - Americo Cicchetti
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
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Rossi G, Spagnolo P, Wuyts WA, Ryerson CJ, Valli M, Valentini I, Grani G, Gennari A, Bizzarro T, Lazzari-Agli L. Pathologic comparison of conventional video-assisted thoracic surgical (VATS) biopsy versus non-intubated/“awake” biopsy in fibrosing interstitial lung diseases. Respir Med 2022; 195:106777. [DOI: 10.1016/j.rmed.2022.106777] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
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Potalivo A, Montomoli J, Facondini F, Sanson G, Lazzari Agli LA, Perin T, Cristini F, Cavagna E, De Giovanni R, Biagetti C, Panzini I, Ravaioli C, Bitondo MM, Guerra D, Giuliani G, Mosconi E, Guarino S, Marchionni E, Gangitano G, Valentini I, Giampaolo L, Muratore F, Nardi G. Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study. Clin Epidemiol 2020; 12:1421-1431. [PMID: 33408529 PMCID: PMC7779307 DOI: 10.2147/clep.s278709] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources. Patients and Methods All COVID-19 patients (26/02/2020–18/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab. Results We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001). Conclusion This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.
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Affiliation(s)
- Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Francesca Facondini
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luigi Arcangelo Lazzari Agli
- Department of Pneumology, Infermi Hospital, Rimini, Italy.,Ceccarini Hospital, AUSL della Romagna, Riccione, Italy
| | - Tiziana Perin
- Department of Emergency Medicine, Infermi Hospital, AUSL Della Romagna, Rimini, Italy
| | - Francesco Cristini
- Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Enrico Cavagna
- Department of Radiology, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Raffaella De Giovanni
- Department of Internal Medicine, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy
| | - Carlo Biagetti
- Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Ilaria Panzini
- Department of Clinical Research, AUSL della Romagna, Ravenna, Italy
| | - Cinzia Ravaioli
- Ausl della Romagna Health Care Service Direction, Ravenna, Italy
| | - Maria Maddalena Bitondo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Daniela Guerra
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Giovanni Giuliani
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Elena Mosconi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Sonia Guarino
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Elisa Marchionni
- Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gianfilippo Gangitano
- Department of Emergency Medicine, Infermi Hospital, AUSL Della Romagna, Rimini, Italy
| | - Ilaria Valentini
- Department of Pneumology, Infermi Hospital, Rimini, Italy.,Ceccarini Hospital, AUSL della Romagna, Riccione, Italy
| | - Luca Giampaolo
- Department of Internal Medicine, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy
| | - Francesco Muratore
- Department of Radiology, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Giuseppe Nardi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
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Stolfi P, Valentini I, Palumbo MC, Tieri P, Grignolio A, Castiglione F. Potential predictors of type-2 diabetes risk: machine learning, synthetic data and wearable health devices. BMC Bioinformatics 2020; 21:508. [PMID: 33308172 PMCID: PMC7733701 DOI: 10.1186/s12859-020-03763-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of a recent research project was the investigation of the mechanisms involved in the onset of type 2 diabetes in the absence of familiarity. This has led to the development of a computational model that recapitulates the aetiology of the disease and simulates the immunological and metabolic alterations linked to type-2 diabetes subjected to clinical, physiological, and behavioural features of prototypical human individuals. RESULTS We analysed the time course of 46,170 virtual subjects, experiencing different lifestyle conditions. We then set up a statistical model able to recapitulate the simulated outcomes. CONCLUSIONS The resulting machine learning model adequately predicts the synthetic dataset and can, therefore, be used as a computationally-cheaper version of the detailed mathematical model, ready to be implemented on mobile devices to allow self-assessment by informed and aware individuals. The computational model used to generate the dataset of this work is available as a web-service at the following address: http://kraken.iac.rm.cnr.it/T2DM .
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Affiliation(s)
- Paola Stolfi
- Institute for Applied Mathematics, National Research Council of Italy, Rome, Italy
| | | | | | - Paolo Tieri
- Institute for Applied Mathematics, National Research Council of Italy, Rome, Italy
| | - Andrea Grignolio
- Research Ethics and Integrity Interdepartmental Center, National Research Council of Italy, Rome, Italy
- Medical Humanities - International MD Program, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Castiglione
- Institute for Applied Mathematics, National Research Council of Italy, Rome, Italy
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Valentini I, Lazzari Agli L, Michieletto L, Innocenti M, Savoia F, Del Prato B, Mancino L, Maddau C, Romano A, Puorto A, Corbetta L, Fois A. Competence in flexible bronchoscopy and basic biopsy technique. Panminerva Med 2018; 61:232-248. [PMID: 30394711 DOI: 10.23736/s0031-0808.18.03563-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diagnostic bronchoscopy and tissue sampling techniques using forceps (endobronchial biopsy [EBB] and transbronchial biopsies [TBB]) or needle aspiration (transbronchial needle aspiration-TBNA), all performed with a flexible bronchoscope, are the basic elements of any interventional procedure. The flexible fibrobronchoscopy allows the visualization of the airways and is used both for diagnostic and therapeutic purposes. The working channel of both fibrobronchoscopes with optical fibers and videobronchoscopes, even if of relatively small diameter, allows the insertion of various diagnostic and therapeutic accessories. Fiber optic systems have been widely replaced by video cameras using a miniaturized charge-coupled device camera positioned at the end of the scope that provides electronic transmission of images to a monitor. The indications for both diagnostic and therapeutic fibrobronchoscopy derive from a correct evaluation of symptoms and objective signs of the patient and from the correct interpretation of imaging methods. Although bronchoscopy techniques keep evolving at a rapid pace, basic procedures such as bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration still play a key role in pulmonary disease diagnostics, and therefore, these methods must still be part of the training of interventional pulmonologists. Trainees will acquire a thorough knowledge of thoracic anatomy and become skilled in the interpretation of thoracic imaging, after which they will be given a theoretical and practical training course on virtual reality simulators, on animal or cadaver models, the effectiveness of which has been fully demonstrated by scientific studies. Specific DOPS tests have been developed for a qualitative evaluation of procedures on simulators, on animal models and on the patient.
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Affiliation(s)
| | | | | | | | - Francesca Savoia
- Unit of Pneumology, ULSS 2 Marca Trevigiana, Treviso Hospital, Treviso, Italy
| | - Bruno Del Prato
- Department of Bronchial Endoscopy and Emergency Pneumology, Cardarelli Hospital, Naples, Italy
| | - Laura Mancino
- Institute for Oncological Study, Prevention, and Networking (ISPRO), Florence, Italy
| | - Cristina Maddau
- Unit of Pneumology, San Giuseppe Moscati Hospital, Avellino, Italy
| | | | - Antonella Puorto
- Clinic of Pneumology, Sassari University Hospital, Sassari, Italy
| | - Lorenzo Corbetta
- Unit of Interventional Pneumology, Careggi University Hospital, Florence, Italy
| | - Alessandro Fois
- Clinic of Pneumology, Sassari University Hospital, Sassari, Italy
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Trisolini R, Valentini I, Tinelli C, Ferrari M, Guiducci GM, Parri SNF, Dalpiaz G, Cancellieri A. DIPNECH: Association Between Histopathology and Clinical Presentation. Lung 2016; 194:243-7. [PMID: 26880164 DOI: 10.1007/s00408-016-9854-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/14/2015] [Accepted: 02/05/2016] [Indexed: 02/01/2023]
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder which can be an incidental finding in imaging tests performed during the investigation of another condition, or is the final diagnosis in patients evaluated for chronic obstructive complaints. To explore the possible association between specific histopathology features and the mode of clinical presentation, we retrieved the clinical, functional, radiological, and pathological data of all 13 patients diagnosed with DIPNECH at our Institution over a 14-year period (2000-2014). As compared to patients with incidental disease (6/13, 46 %), patients with symptomatic disease were younger [mean (SD): 57.7 vs. 68.7 years, p = 0.046], were more likely to have mosaic attenuation (100 vs. 0 %, p = 0.001) and small multiple nodules (100 vs. 17 %, p = 0.005) at CT, and showed a significantly higher number of foci of linear neuroendocrine proliferation [median (IQR): 28 (13-37) vs. 6 (5-13), p = 0.018] and of tumorlets [median (IQR): 10 (8-20) vs. 1 (1-1), p = 0.002] at histology. Incidental disease was found in association with pulmonary adenocarcinoma in five out of six patients (83.3 %). The results of our study provide preliminary evidence that symptomatic patients with DIPNECH represent a specific subset characterized by younger age and a higher burden of foci of neuroendocrine proliferation.
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Affiliation(s)
- Rocco Trisolini
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi, via Albertoni 15, 40138, Bologna, Italy.
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy.
| | | | - Carmine Tinelli
- Clinical Epidemiology & Biometry Service, IRCCS Policlinico San Matteo, Pavia, Italy
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Trisolini R, Cancellieri A, Tinelli C, de Biase D, Valentini I, Casadei G, Paioli D, Ferrari F, Gordini G, Patelli M, Tallini G. Randomized Trial of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration With and Without Rapid On-site Evaluation for Lung Cancer Genotyping. Chest 2015; 148:1430-1437. [PMID: 26158441 DOI: 10.1378/chest.15-0583] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [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: 02/05/2023] Open
Abstract
BACKGROUND Experts and scientific society guidelines recommend that rapid on-site evaluation (ROSE) be used with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to optimize lung cancer genotyping, but no comparative trial has been carried out to confirm and quantify its usefulness. METHODS To assess the influence of ROSE on the yield of EBUS-TBNA for a multigene molecular analysis of lung cancer samples, consecutive patients with suspected or known advanced lung cancer were randomized to undergo EBUS-TBNA without ROSE (EBUS arm) or with ROSE (ROSE arm). The primary end point was the rate of the successful accomplishment of the institution's clinical protocol for molecular profiling of nonsquamous non-small cell lung cancer (EGFR and KRAS testing, followed by ALK testing for tumors with EGFR and KRAS wild-type status). RESULTS Complete genotyping was achieved in 108 of 126 patients (85.7%) (90.8% in the ROSE arm vs 80.3% in the EBUS arm, P = .09). The patients in the ROSE arm were less likely to have samples that could be used only for pathologic diagnosis because of minimal tumor burden (0 vs 6, P = .05), and were more likely to have the bronchoscopy terminated after a single biopsy site (58.9% vs 44.1%, P = .01). CONCLUSIONS ROSE prevents the need for a repeat invasive diagnostic procedure aimed at molecular profiling in at least one out of 10 patients with advanced lung cancer and significantly reduces the risk of retrieving samples that can be used only for pathologic subtyping because of minimal tumor burden. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01799382; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Rocco Trisolini
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna; Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi, Bologna.
| | - Alessandra Cancellieri
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
| | - Carmine Tinelli
- Clinical Epidemiology and Biometry Service, IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Ilaria Valentini
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
| | - Gianpiero Casadei
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
| | - Daniela Paioli
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
| | - Franco Ferrari
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
| | - Giovanni Gordini
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
| | - Marco Patelli
- Thoracic Endoscopy and Pulmonology Unit, the Pathology Unit, and the Intensive Care Unit/118 EMS, Maggiore Hospital, Bologna
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Valentini I, Pacilli AMG, Carbonara P, Fasano L, Vitale R, Zenesini C, Melotti RM, Faenza S, Nava S. Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One? Respir Care 2013; 58:2053-60. [DOI: 10.4187/respcare.02225] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Valentini I, Tonveronachi E, Gregoretti C, Mega C, Fasano L, Pisani L, Nava S. Different tracheotomy tube diameters influence diaphragmatic effort and indices of weanability in difficult to wean patients. Respir Care 2013; 57:2012-8. [PMID: 22612986 DOI: 10.4187/respcare.01747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the effects of different tracheotomy tube sizes on diaphragm effort and weanability indices. METHODS Ten tracheotomized and difficult to wean subjects were randomized to 2 T-piece trials, with different tracheotomy tube diameters: inner diameters 8 mm and 6.5 mm. Diaphragm pressure-time product per min. (PTP(di/min)), lung compliance and resistance (C(L) and R(L)), breathing pattern, tension-time index of the diaphragm (TT(di)), and the ratio of breathing frequency to tidal volume (f/V(T)) were recorded. In an in vitro model, the flow-pressure relationship was measured using the 2 tracheotomy tubes and 2 endotracheal tubes of the same diameter. RESULTS The use of a smaller diameter resulted in an increase of PTP(di) (337.63 ± 194.35 cm H(2)O · s/min vs 263.28 ± 156.23 cm H(2)O · s/min for 6.5 mm and 8 mm, respectively, P = .004) and R(L) (16.74 ± 8.10 cm H(2)O · s/min vs 11.72 ± 7.88 cm H(2)O · s/min, respectively, P = .008). Both weanability indices were also significantly higher using the smaller tube: f/V(T) 93.32 ± 20.91 vs 77.06 ± 19.26 for 6.5 mm and 8 mm, respectively, P < .02; TT(di) 0.09 ± 0.052 vs 0.08 ± 0.04, respectively, P < .02. In vitro measurements confirmed that the resistances were higher with the smaller diameter and similar between the tracheotomy tubes and the endotracheal tubes of the same diameters. CONCLUSIONS In tracheotomized difficult to wean subjects the decrease of the tracheotomy tube size was associated with an increased PTP(di), f/V(T), and TT(di), that were otherwise normal, using a higher diameter. The in vitro study showed that the resistances increased similarly for tracheotomy tube and endotracheal tube, decreasing the diameter and increasing the flows.
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Affiliation(s)
- Ilaria Valentini
- Azienda Opedaliera Universitaria Sant Orsola-Malpighi, Bologna, Italy
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Martinelli M, Scapoli L, Carbonara P, Valentini I, Girardi A, Farinella F, Mattei G, Pacilli AMG, Fasano L, Nava S, Solmi R. Idiopathic pulmonary fibrosis and polymorphisms of the folate pathway genes. Clin Biochem 2013; 46:85-8. [DOI: 10.1016/j.clinbiochem.2012.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/26/2012] [Accepted: 10/09/2012] [Indexed: 02/06/2023]
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Nicolini A, Tonveronachi E, Navalesi P, Antonelli M, Valentini I, Melotti RM, Pigna A, Carrassi A, Righini P, Ferrari Bravo M, Pelosi P, Nicoli F, Cosentini R, Vaschetto R, Faenza S, Nava S. Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study. Minerva Anestesiol 2012; 78:1333-1340. [PMID: 23032930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. METHODS In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2<300 were eligible for study; 38/98 required immediate ETI, while the others received NIV as a first line therapy; 13/60 patients failed NIV and were intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV. RESULTS Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P<0.001). ETI was associated with higher number of infectious complications, mainly sepsis and septic shock. The OR of having one of these events in the NIV failure group vs. NIV success was 16.7, P<0.001. According to logistic regression model, a SAPS II>29 and a PaO(2)/FIO(2)≤127 at admission and PaO2/FIO(2)≤149 after 1 hr of NIV were independently associated with the need for ETI. CONCLUSION The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.
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Affiliation(s)
- A Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
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Donati A, Coltrinari R, Loggi S, Pallotto R, Ruzzi M, Scarcella M, Valentini I, Pelaia P. Crit Care 2004; 8:P320. [DOI: 10.1186/cc2787] [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: 11/10/2022] Open
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Donati A, Gabbanelli V, Pantanetti S, Scala C, Carbini C, Valentini I, Antognini M, Pelaia P, Pietropaoli P. To verify four 5-year-old mathematical models to predict the outcome of ICU patients. Minerva Anestesiol 2003; 69:897-905. [PMID: 14743121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
AIM The aim of this study is to verify calibration and discrimination after 5 years in the case mix of patients admitted to the Intensive Care Unit (ICU) during the year 2000. In this way we want to perform a quality control of our ICU in order to justify the increased amount of money spent for intensive care. METHODS A prospective study has been made on the 357 patients admitted to the ICU during the year 2000. The Apache II score was calculated within the first 24 hours and, depending on the length of stay in the ICU, on the 5(th), 10(th) and 15(th) day after ICU admission. On the basis of the 4 mathematical models death risk has been calculated for each of the 4 times. The Hosmer-Lemeshow test was performed for calibration and ROC curves for discrimination, always for each of the 4 mathematical models. RESULTS The 1(st) model, at 24 hours from ICU admission, showed a bad calibration (p=0.000088), while the ROC curve was 0.744+/-0.32. Also the 2(nd) model, at the 5(th) day from admission, showed a bad calibration (p=0.000588), with ROC curve of 0.827+/-0.04. The 3(rd) model (10(th) day), was well calibrated (p=0.112247) and discriminating (ROC=0.888 +/-0.04). Finally the models at 15 days showed again a bad calibration (p=0.001422) but a very good discrimination (area=0.906+/-0.06). CONCLUSION Developing mathematical models to predict mortality within ICUs can be useful to assess quality of care, even if these models should not be the only ICU quality controls, but must be accompanied by other indicators, looking at quality of life of the patients after ICU discharge.
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Affiliation(s)
- A Donati
- Institute of Medical and Surgical Emergencies Marche, Polytechnic University, Ancona, Italy.
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Donati A, Gabbanelli V, Scala C, Carbini C, Valentini I, Antognini M, Pelaia P, Pietropaoli P. Crit Care 2002; 6:P240. [DOI: 10.1186/cc1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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