THE VALUE-BASED HEALTH CARE: A PSYCHOLOGICAL PERSPECTIVE IN CANCER CARE

This project has been developed in the breakthrough framework of the Value Based Health Care (VBHC), which aims at improving health outcomes at lower cost in different medical conditions. The VBHC paradigm has been applied in cancer care to improve the management of the disease, considering epidemiological, medical, psychological and economic outcomes. Two studies have been designed and implemented to better investigate the psychological perspective of lung and prostate cancer patients, in the light of the VBHC paradigm. The project identifies the trend of clinical and psychological status over time and predict this change with sociodemographic or medical variables. Several categories of patients characterized by different trends were identified, elucidating the psychological dimension of cancer patients. A person-oriented approach was used to analyze patients\u2019 recovery. One-year Quality of Life (QoL) trends in early stage of lung and prostate cancer patients undergoing surgery were identified. Patients\u2019 recovery after surgery was characterized by both an overall decrease of symptoms and an increase of health and functioning over time. Prostate cancer patients showed different longitudinal trajectories of urinary incontinence and sexual dysfunction. In lung cancer patients, pre-surgery QoL, type of surgery, perioperative complications, and age, affected the post-surgery QoL as well as the linear and quadratic trends over time. Through the implementation of this holistic approach, the predictive model of patients\u2019 recovery will be developed, thus improving medical decision-making, the choice of treatment, and patients\u2019 awareness about their care process. Potential harms, QoL, and expected outcomes will be more predictable and better manageable. Participants will be more empowered, being more aware of their post-surgical care

Value as the key concept in the health care system : how it has influenced medical practice and clinical decision-making processes

In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of \u201cvalue\u201d is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on \u201cvalue\u201d and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care

Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients

Background: This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery. Methods: A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted). Results: The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery. Conclusion: These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery

Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients

Background: This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery. Methods: A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted). Results: The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery. Conclusion: These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery

Lactobacillus rhamnosus GG and Saccharomyces cerevisiae boulardii exert synergistic antipathogenic activity in vitro against enterotoxigenic Escherichia coli

Short-term colonic in vitro batch incubations were performed to elucidate the possible synergistic effects of Lactobacillus rhamnosus GG (CNCM-I-4798) and Saccharomyces cerevisiae boulardii (CNCM-1-1079) (associated in Smebiocta/Smectaflora Protect (R)) on the colonic microbial fermentation process, as well as their antipathogenic activity against enterotoxigenic Escherichia coli (LMG2092) (ETEC). These incubations adequately simulate the native microbiota and environmental conditions of the proximal colon of both adult and toddler donors, including the colonic mucosal layer. Results indicated that both strains were capable of growing together without showing antagonistic effects. Co-cultivation of both strains resulted in increased butyrate (stimulated by L. rhamnosus GG), propionate (stimulated by S. boulardii), and ethanol (produced by S. boulardii) production compared to the control incubations, revealing the additive effect of both strains. After inoculation of ETEC under simulated dysbiotic conditions, a 40 and 46% reduction in the concentration of ETEC was observed upon addition of both strains during the experiments with the adult and toddler donor, respectively. Furthermore, ETEC toxin levels decreased upon S. boulardii inoculation, probably due to proteolytic activity of this strain, with a synergistic effect being observed upon co-cultivation of L. rhamnosus GG and S. boulardii resulting in a reduction of 57 and 46% for the adult and toddler donor, respectively. Altogether, the results suggest that both probiotics together may help microbiota functionality, in both adults and toddlers and under healthy or impaired conditions, which could be of great interest when the colonic microbiota is dysbiotic and therefore sensitive to pathogenic invasion such as during antibiotic treatment

Study of the Interaction Between a High-Pressure Jet and Horizontal Tanks using CFD

Accidental high-pressure flammable gas releases are among the most relevant hazards in the process safety, and consequences could be severe. In the recent decades, there have been numerous efforts to study high-pressure jets in open field (i.e., free jets). Easy-to-use mathematical models have been developed, to rapidly assess the main physical variables involved in safety evaluations. However, in a realistic scenario, the accidental leak may involve either the ground or a piece of equipment. As demonstrated by recent works, when a jet interacts with an obstacle, its behavior can significantly change. Therefore, the mathematical models extrapolated for the free jet scenario could be a source of incorrect predictions. Focusing on the scenario of an accidental high-pressure unignited flammable jet, this work shows how the presence of one or two obstacles, placed at a different distance from the source of the leak, can influence the lower flammability limit cloud extent of methane. Varying the height of the source term, the effect of the interaction among the jet, both the obstacles, and the ground was systematically studied through a Computational Fluid Dynamics analysis

Site effects “on the rock”: the case of Castelvecchio Subequo (L’Aquila, central Italy)

The April 6, 2009 L’Aquila earthquake was responsible for an “anomalous”, relatively high degree of damage (i.e. Is 7 MCS scale) at Castelvecchio Subequo (CS). Indeed, the village is located at source-to-site distance of about 40 km, and it is surrounded by other inhabited centres to which considerably lower intensities, i.e. Is 5-6, have been attributed. Moreover, the damage was irregularly distributed within CS, being mainly concentrated in the uppermost portion of the old village. Geophysical investigations (ambient seismic noise and weak ground motions analyses) revealed that site effects occurred at CS. Amplifications of the ground motion, mainly striking NE-SW, have been detected at the uppermost portion of the carbonate ridge on which the village is built. Geological/structural and geomechanical field surveys defined that the CS ridge is affected by sets of fractures, joints and shear planes – mainly roughly NW-SE and N-S trending – that are related to the deformation zone of the Subequana valley fault system and to transfer faults linking northward the mentioned tectonic feature with the Middle Aterno Valley fault system. In particular, our investigations highlight that seismic amplifications occur where joints set NW-SE trending are open. On the other hand, no amplification is seen in portions of the ridge where the bedrock is densely fractured but no open joints occur. The fracture opening seems related to the toppling tendency of the bedrock slabs, owing to the local geomorphic setting. These investigations suggest that the detected amplification of the ground motion is probably related to the polarization of the seismic waves along the Castelvecchio Subequo ridge, with the consequent oscillation of the rock slabs perpendicularly to the fractures azimuth

A meta-analysis on heart rate variability biofeedback and depressive symptoms

Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies. Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analysed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI = − 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, QT = 23.49, p = 0.03, I2 = 45%, which suggested a moderate variance among the included studies. The year of publication (χ2(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ2(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being

Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer

Background: This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite - Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients. Methods: Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45 days (T1) and 3 months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations. Results: At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach's alphas could be classified as acceptable (i.e., above.65) except for low Cronbach's alpha for hormonal dysfunction at T1 (i.e.,.638) and urinary irritation at both waves. (i.e., respectively.585 and.518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above.500) to good test-retest reliability (i.e. ICC for urinary incontinence =.764). Conclusions: Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients

Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer

Background: This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite - Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients. Methods: Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45 days (T1) and 3 months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations. Results: At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach's alphas could be classified as acceptable (i.e., above.65) except for low Cronbach's alpha for hormonal dysfunction at T1 (i.e.,.638) and urinary irritation at both waves. (i.e., respectively.585 and.518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above.500) to good test-retest reliability (i.e. ICC for urinary incontinence =.764). Conclusions: Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients