Providing a nurse-led complex nursing INtervention FOcused on quality of life assessment on advanced cancer patients: The INFO-QoL pilot trial.

PURPOSE Unmet needs for advanced-disease cancer patients are fatigue, pain, and emotional support. Little information is available about the feasibility of interventions focused on patient-reported outcome measurement developed according to the Medical Research Council (MRC) Framework in advanced-disease cancer patients. We aimed to pilot a nurse-led complex intervention focused on QoL assessment in advanced-disease cancer patients. METHODS The INFO-QoL study was based on an exploratory, nonequivalent comparison group, pre-test-post-test design. Study sites received either the INFO-QoL intervention or usual care. Adult advanced-disease cancer patients admitted to hospice inpatient units that gave their informed consent were included in the study. Subjects were 187 patients and their families and 19 healthcare professionals. We evaluated feasibility, acceptability, and patients' outcomes using the Integrated Palliative Care Outcome Scale. RESULTS Nineteen healthcare professionals were included. The mean competence score increased significantly over time (p < 0.001) and the mean usefulness score was high 8.63 (±1.36). In the post-test phase, 54 patients were allocated to the experimental unit and 36 in the comparison unit. Compared to the comparison unit, in the experimental unit anxiety (R2 = 0.07; 95% CI = -0.06; 0.19), family anxiety (R2 = 0.22; 95% CI = -0.03; 0.41), depression (R2 = 0.31; 95% CI = -0.05; 0.56) and sharing feelings (R2 = 0.09; 95% CI = -0.05; 0.23), were improved between pre-test and post-test phase. CONCLUSIONS The INFO-QoL was feasible and potentially improved psychological outcomes. Despite the high attrition rate, the INFO-QoL improved the quality and safety culture for patients in palliative care settings

Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study

107noNonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolve into hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. The aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC) and to compare them to those of hepatitis C virus (HCV)-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in secondary care Italian centers. Survival was modeled according to clinical parameters, lead-time bias, and propensity analysis. Compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern, and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC patients, in contrast to the near totality of HCV-HCC. Regardless of tumor stage, survival was significantly shorter (P = 0.017) in patients with NAFLD-HCC, 25.5 months (95% confidence interval 21.9-29.1), than in those with HCV-HCC, 33.7 months (95% confidence interval 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively, 38.6 versus 41.0 months, P = nonsignificant) Conclusions: NAFLD-HCC is more often detected at a later tumor stage and could arise also in the absence of cirrhosis, but after patient matching, it has a similar survival rate compared to HCV infection; a future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. (Hepatology 2016;63:827-838)openopenPiscaglia F.; Svegliati-Baroni G.; Barchetti A.; Pecorelli A.; Marinelli S.; Tiribelli C.; Bellentani S.; Bernardi M.; Biselli M.; Caraceni P.; Domenicali M.; Garuti F.; Gramenzi A.; Lenzi B.; Magalotti D.; Cescon M.; Ravaioli M.; Del Poggio P.; Olmi S.; Rapaccini G.L.; Balsamo C.; Di Nolfo M.A.; Vavassori E.; Alberti A.; Benvegnau L.; Gatta A.; Giacomin A.; Vanin V.; Pozzan C.; Maddalo G.; Giampalma E.; Cappelli A.; Golfieri R.; Mosconi C.; Renzulli M.; Roselli P.; Dell'isola S.; Ialungo A.M.; Risso D.; Marenco S.; Sammito G.; Bruzzone L.; Bosco G.; Grieco A.; Pompili M.; Rinninella E.; Siciliano M.; Chiaramonte M.; Guarino M.; Camma C.; Maida M.; Costantino A.; Barcellona M.R.; Schiada L.; Gemini S.; Lanzi A.; Stefanini G.F.; Dall'aglio A.C.; Cappa F.M.; Suzzi A.; Mussetto A.; Treossi O.; Missale G.; Porro E.; Mismas V.; Vivaldi C.; Bolondi L.; Zoli M.; Granito A.; Malagotti D.; Tovoli F.; Trevisani F.; Venerandi L.; Brandi G.; Cucchetti A.; Bugianesi E.; Vanni E.; Mezzabotta L.; Cabibbo G.; Petta S.; Fracanzani A.; Fargion S.; Marra F.; Fani B.; Biasini E.; Sacco R.; Morisco F.; Caporaso N.; Colombo M.; D'ambrosio R.; Croce L.S.; Patti R.; Giannini E.G.; Loria P.; Lonardo A.; Baldelli E.; Miele L.; Farinati F.; Borzio M.; Dionigi E.; Soardo G.; Caturelli E.; Ciccarese F.; Virdone R.; Affronti A.; Foschi F.G.; Borzio F.Piscaglia, F.; Svegliati-Baroni, G.; Barchetti, A.; Pecorelli, A.; Marinelli, S.; Tiribelli, C.; Bellentani, S.; Bernardi, M.; Biselli, M.; Caraceni, P.; Domenicali, M.; Garuti, F.; Gramenzi, A.; Lenzi, B.; Magalotti, D.; Cescon, M.; Ravaioli, M.; Del Poggio, P.; Olmi, S.; Rapaccini, G. L.; Balsamo, C.; Di Nolfo, M. A.; Vavassori, E.; Alberti, A.; Benvegnau, L.; Gatta, A.; Giacomin, A.; Vanin, V.; Pozzan, C.; Maddalo, G.; Giampalma, E.; Cappelli, A.; Golfieri, R.; Mosconi, C.; Renzulli, M.; Roselli, P.; Dell'Isola, S.; Ialungo, A. M.; Risso, D.; Marenco, S.; Sammito, G.; Bruzzone, L.; Bosco, G.; Grieco, A.; Pompili, M.; Rinninella, E.; Siciliano, M.; Chiaramonte, M.; Guarino, M.; Camma, C.; Maida, M.; Costantino, A.; Barcellona, M. R.; Schiada, L.; Gemini, S.; Lanzi, A.; Stefanini, G. F.; Dall'Aglio, A. C.; Cappa, F. M.; Suzzi, A.; Mussetto, A.; Treossi, O.; Missale, G.; Porro, E.; Mismas, V.; Vivaldi, C.; Bolondi, L.; Zoli, M.; Granito, A.; Malagotti, D.; Tovoli, F.; Trevisani, F.; Venerandi, L.; Brandi, G.; Cucchetti, A.; Bugianesi, E.; Vanni, E.; Mezzabotta, L.; Cabibbo, G.; Petta, S.; Fracanzani, A.; Fargion, S.; Marra, F.; Fani, B.; Biasini, E.; Sacco, R.; Morisco, F.; Caporaso, N.; Colombo, M.; D'Ambrosio, R.; Croce, L. S.; Patti, R.; Giannini, E. G.; Loria, P.; Lonardo, A.; Baldelli, E.; Miele, L.; Farinati, F.; Borzio, M.; Dionigi, E.; Soardo, G.; Caturelli, E.; Ciccarese, F.; Virdone, R.; Affronti, A.; Foschi, F. G.; Borzio, F

Energy retrofitting of buildings and hygrothermal performance of building components: Application of the assessment methodology to a case study of social housing

Any intervention on the envelope/HVAC system of existing buildings should start from the evaluation of the building\u2019s envelope energy-saving options. Typical buildings critical from the energy standpoint are represented by social housings: in this case the energy-saving is not possible without the building\u2019s envelope renovation. Their energy retrofit towards NZEB should be the next challenge: it is analysed in the present paper by proposing an evaluation procedure that takes into account different constraints and limits imposed by national laws, following the indications of the European Directives. To illustrate the calculation methodology a case study is examined, by comparing the U-values of the existing walls with the NZEB limits and with the limits considered for the energy refurbishment of the buildings. The insulation improvement of the reference walls depends on both the thermo-physical properties and the thickness of the materials used. The choice of the most suitable combination of material and thickness is related not only to the energy-saving, but also to the risk of vapor condensation that depends on the position of the insulating materials within the wall\u2019s structure. Therefore, the outlined procedure takes into account both these aspects. Moreover, as the renovation design process involves a multiplicity of elements and parameters, the proposed procedure could be generalized to consider a wide list of characteristics and constraints that allow to guarantee the most suitable solution with acceptable costs

A procedure to evaluate the most suitable integrated solutions for increasing energy performance of the building\u2019s envelope, avoiding moisture problems

General guides to support the refurbishment design indicate separately the solutions to common problems such as thermal loss, interstitial condensation, sound transmission, fire safety etc. This paper deals with combined solutions that take into account simultaneously two of these aspects, aiming both at reducing thermal losses and at avoiding or limiting problems related to moisture transfer and condensation, jointly with an indispensable cost analysis. Improving the energy performance of buildings should start from the evaluation of the building\u2019s envelope energy-saving options. The subject of the research is oriented to typical buildings, often critical from the energy standpoint, which are represented by social housings. The refurbishment target should be the NZEB model, even if it is very difficult to find suitable general solutions. As the renovation design process depends also on the sustainability of costs, an evaluation procedure, previously proposed, is widened to take into account this aspect, by considering characteristics and constraints, and assuring reasonable costs for the most suitable solutions. The methodology has been applied to a case study represented by a common building unit. The insulation improvement is made through a choice of the most suitable combination of material and thickness, with the aim not only of the energy saving, but also of the reduction of the risk of vapour condensation that depends, among other things, on the position of the insulating materials within the wall\u2019s structure. Some combined refurbishment solutions for the building envelope are examined and the corresponding costs are evaluated. Moreover, to show the importance of the problem in mild and continental climates, a comparison of the results in different climatic conditions is presented

Malattie bollose autoimmuni: casisitica clinica e approccio terapeutico

Le malattie bollose costituiscono un gruppo eterogeneo di rare patologie che colpiscono la cute e le mucose, con caratteristiche cliniche e prognostiche e quadri isto- e immunopatologici vari, ma accomunate sul piano patogenetico dalla presenza di anticorpi diretti contro molecole d\u2019adesione intercellulare o componenti della membrana basale. Obiettivi della terapia sono la soppressione del sistema immunitario, il controllo dei processi infiammatori e la rapida riepitelizzazione delle lesioni. Cardine del trattamento sono i glucocorticoidi sistemici, con eventuale associazione di altri agenti immunosoppressori, anche se pi\uf9 recentemente sono state prese in considerazione modalit\ue0 alternative, quali l\u2019infusione di immunoglobuline, l\u2019utilizzo di anticorpi monoclonali o la fotochemioterapia extracorporea. Scopo di questo lavoro \ue8 valutare su una casistica di pazienti affetti da malattie bollose autoimmuni, sottoposti a diverse linee di trattamento, l\u2019entit\ue0 e i tempi di risposta, l\u2019incidenza degli eventuali effetti collaterali e gli schemi terapeutici in grado di garantire un migliore controllo della patologia. Sono stati presi in considerazione complessivamente 66 pazienti (30 maschi e 36 femmine), affetti da pemfigo (29 casi) o pemfigoide (37 casi), con diversa estensione di malattia, diagnosticati e seguiti presso il nostro centro negli ultimi 15 anni. L\u2019et\ue0 media era 59 anni per i pazienti affetti da pemfigo e 74 anni per quelli affetti da pemfigoide. In 23 pazienti (34.8%) \ue8 stata sufficiente un\u2019unica linea di trattamento (solo prednisone in 15 pazienti, prednisone in associazione con altri immunosoppressori e/o sulfoni in 8 pazienti) per ottenere la remissione clinica e il controllo della malattia per tutta la durata del follow up. Tale obiettivo \ue8 stato raggiunto con la seconda linea terapeutica in 20 casi, con la terza in 16, mentre in altri 9 pazienti sono state necessarie almeno 4 diverse linee di trattamento prima di ottenere un adeguato controllo della malattia. Nei pazienti non responsivi o plurirecidivati dopo i trattamenti convenzionali, sono state prese in considerazione modalit\ue0 di terapia differenti. L\u2019anticorpo monoclonale anti-CD20 (Rituximab), utilizzato in 5 casi ha permesso di ottenere 4 remissioni complete (RC) e 1 remissione parziale (RP), con un tempo mediano di mantenimento della risposta di 25 mesi (range 8-30). In 3 pazienti trattati con infusione di immunoglobuline il tempo mediano di mantenimento della risposta era di 5 mesi, mentre solo uno dei 2 pazienti trattati con fotoferesi ha ottenuto il controllo della malattia, che persiste tuttora ad un follow-up di 48 mesi. Dall\u2019analisi dei nostri dati non sono emersi parametri istopatologici o clinici (et\ue0 alla diagnosi, sesso, estensione della malattia) con funzione predittiva della risposta al trattamento. Durante il follow-up (mediana 51.45 mesi per i pazienti affetti da pemfigo, 42.46 mesi per quelli affetti da pemfigoide) non si \ue8 verificato il decesso di alcun paziente, n\ue9 a causa della patologia bollosa n\ue9 per complicanze relative al trattamento. La modalit\ue0 di trattamento maggiormente gravata da effetti collaterali era rappresentata dagli steroidi sistemici; nel trattamento a breve termine tali effetti erano prevalentemente rappresentati da aumento dei valori di glicemia e pressione arteriosa, sempre ben controllati dalla terapia di supporto. Nel trattamento a lungo termine l\u2019effetto di maggiore rilievo era rappresentato dall\u2019osteopenia che ha reso necessaria l\u2019interruzione o la modificazione del trattamento in 12 pazienti