INvolvement of breast CAncer patients during oncological consultations: a multicentre randomised controlled trial--the INCA study protocol.

INTRODUCTION: Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, the patients who participate in the decision-making process show greater treatment adherence and have better health outcomes. Different methods to encourage the active participation during oncological consultation have been described; however, similar studies in Italy are lacking. The aims of the present study are to (1) assess the effects of a preconsultation intervention to increase the involvement of breast cancer patients during the consultation, and (2) explore the role of the attending companions in the information exchange during consultation. METHODS AND ANALYSIS: All female patients with breast cancer who attend the Oncology Out-patient Services for the first time will provide an informed consent to participate in the study. They are randomly assigned to the intervention or to the control group. The intervention consists of the presentation of a list of relevant illness-related questions, called a question prompt sheet. The primary outcome measure of the efficacy of the intervention is the number of questions asked by patients during the consultation. Secondary outcomes are the involvement of the patient by the oncologist; the patient's perceived achievement of her information needs; the patient's satisfaction and ability to cope; the quality of the doctor-patient relationship in terms of patient-centeredness; and the number of questions asked by the patient's companions and their involvement during the consultation. All outcome measures are supposed to significantly increase in the intervention group. ETHICS AND DISSEMINATION: The study was approved by the local Ethics Committee of the Hospital Trust of Verona. Study findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01510964

Antidepressants, benzodiazepines and azapirones for panic disorder in adults:a network meta-analysis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To compare individual active drugs (antidepressants, benzodiazepines and azapirones) and placebo in terms of efficacy and acceptability in the acute treatment of panic disorder, with or without agoraphobia. To rank treatments for panic disorder (antidepressants, benzodiazepines, azapirones and placebo) according to their effectiveness and acceptability

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis

Internal funding from the University of Veron

Composition and variability of the essential oils of the leaves and berries from Juniperus navicularis

The compositions of the essential oils isolated from leaves and berries of Juniperus navicularis Gand., an endemic species from Portugal, were investigated by GC and GC-MS. Oils from representative samples of populations as well as from individual samples were studied. The oils consisted mainly of monoterpene hydrocarbons (67.1-88.0% and 61.7% for leaf and berry oils, respectively). [alpha]-Pinene (6.3-38.0%), limonene (7.0-34.6%), [alpha]-phellandrene (2.2-13.1%) and p-cymene (4.8-10.3%) were the major constituents of the oils from leaves and [beta]-myrcene (25.8%) and [alpha]-pinene (24.4%) the major ones of the oil from berries. No meaningful differences were observed comparing the composition of leaf oils from populations collected at distinct seasons but, within the same season, the range of variation of the major components suggests variability. Hierarchical clustering and principal component analysis (PCA) of the compositional data of the oils from individual samples confirms the variability allowing to establish two groups of essential oils differentiated by the content of the major constituents ([alpha]-pinene, limonene, [alpha]-phellandrene and E-nerolidol) and the ratios [alpha]-pinene/limonene.http://www.sciencedirect.com/science/article/B6T4R-45X2M9D-3/1/3ae1513be21a40e0e9ba345d27eaa81

Psychosocial treatments for relapse prevention in schizophrenia: study protocol for a systematic review and network meta-analysis of randomised evidence.

INTRODUCTION There is evidence that different psychosocial interventions could reduce the risk of relapse in schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychosocial treatments for relapse prevention in schizophrenia according to their efficacy, acceptability and tolerability. METHODS AND ANALYSIS We will include all RCTs comparing a psychosocial treatment aimed at preventing relapse in patients with schizophrenia with another psychosocial intervention or with a no treatment condition (waiting list, treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, acutely ill patients). Primary outcome will be the number of patients experiencing a relapse. Secondary outcomes will be acceptability (dropout), change in overall, positive, negative and depressive symptoms, quality of life, adherence, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using Confidence in Network Meta-Analysis (CINeMA). Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION No ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42019147884

Extractives of cork (querkus suber L.): Chemical composition of dichloromethane and supercritical CO2 extracts

The polymeric matrix of the cork is mainly composed of suberin, lignin and polysaccharides and contains also extractives. Typical components of the extracted mixtures are triterpenes belonging to friedelane, lupane and steroid families and long chain alkanes and alkanols. Two extractive methods have been used, the conventional extraction with a solvent (SE) using dichloromethane (DCM) and the innovative method which uses as solvent supercritical CO2 (SFE) at moderate pressures (200–250 bar). Identification and quantitation of the individual triterpenoids and steroids present in the extracts have been carried out by means of the computer aided 13C NMR analysis without previous separation. Friedelin was found as the main component of the extracts. The main difference between the two extracts concerned the contents of sitost-4-en-3-one which represented 15% of the CO2 extract against 3% in the DCM extract. Similarly, #1;-sitosterol was found in CO2 extract (3%) but not in DCM extract