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1. A qualitative study of specialist multidisciplinary clinician perspectives on barriers/facilitators to care for children with brain cancer and their families: 'We're a little bit different to our adult counterparts'.

Author

Luckett, T, DiGiacomo, M, Heneka, N, Disalvo, D, Garcia, M, Schaeffer, I, Attwood, R, Phillips, J, Luckett, T, DiGiacomo, M, Heneka, N, Disalvo, D, Garcia, M, Schaeffer, I, Attwood, R, and Phillips, J

Abstract

OBJECTIVES: Children with brain cancer and their families have complex care needs throughout diagnosis, active treatment, long-term survivorship, and the palliative phase of illness. This study aimed to explore the perspectives of Australian specialist clinicians on barriers and facilitators to health care for children with brain cancer and their families. METHODS: A qualitative approach was taken using semi-structured interviews. Eligible participants were clinicians of any discipline providing care to children with brain cancer and their families in Australia. Interviews were conducted by telephone and asked about perceived strengths and weaknesses in health care and available resources for this population. Qualitative content analysis used a directed approach with inductive refinement. RESULTS: Eleven clinicians participated, 5 of whom were medical, 3 nursing, and 3 allied health. The overarching theme was that the rarity and diversity of brain tumors in children confers challenges to care that lead to variation in practice. Participants reported having to adapt care from guidelines and patient/family resources designed for adults with brain cancer and children with other cancers, and rely on clinical and research networks. Specialist comprehensive cancer care was generally perceived to offer the best model for accommodating the unique needs of each child/family, but barriers to access were highlighted for children in remote Australia, and long-term follow-up was perceived to be inadequate regardless of where children lived. SIGNIFICANCE OF RESULTS: Until further brain cancer-specific paediatric guidelines become available, our findings highlight the need for communities of practice to share resources and reduce unwarranted variation. CONCLUSION: Future research should focus on developing and evaluating guidelines and other resources specific to children with brain cancer, as well as informing suitable models for long-term follow-up care for survivors.

Published
2024

3. The effect of comprehensive geriatric assessment on care received, treatment completion, toxicity, cancer-related and geriatric assessment outcomes, and quality of life for older adults receiving systemic anti-cancer treatment: A systematic review.

Author

Disalvo, D, Moth, E, Soo, WK, Garcia, MV, Blinman, P, Steer, C, Amgarth-Duff, I, Power, J, Phillips, J, Agar, M, Disalvo, D, Moth, E, Soo, WK, Garcia, MV, Blinman, P, Steer, C, Amgarth-Duff, I, Power, J, Phillips, J, and Agar, M

Abstract

INTRODUCTION: This systematic review aims to summarise the available literature on the effect of geriatric assessment (multidimensional health assessment across medical, social, and functional domains; "GA") or comprehensive geriatric assessment (geriatric assessment with intervention or management recommendations; "CGA") compared to usual care for older adults with cancer on care received, treatment completion, adverse treatment effects, survival and health-related quality of life. MATERIALS AND METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, and PubMed was conducted to identify randomised controlled trials or prospective cohort comparison studies on the effect of GA/CGA on care received, treatment, and cancer outcomes for older adults with cancer. RESULTS: Ten studies were included: seven randomised controlled trials (RCTs), two phase II randomised pilot studies, and one prospective cohort comparison study. All studies included older adults receiving systemic therapy, mostly chemotherapy, for mixed cancer types (eight studies), colorectal cancer (one study), and non-small cell lung cancer (one study). Integrating GA/CGA into oncological care increased treatment completion (three of nine studies), reduced grade 3+ chemotherapy toxicity (two of five studies), and improved quality of life scores (four of five studies). No studies found significant differences in survival between GA/CGA and usual care. GA/CGA incorporated into care decisions prompted less intensive treatment and greater non-oncological interventions, including supportive care strategies. DISCUSSION: GA/CGA integrated into the care of an older adult with cancer has the potential to optimise care decisions, which may lead to reduced treatment toxicity, increased treatment completion, and improved health-related quality of life scores.

Published
2023

4. Eating and drinking-related care for persons with advanced dementia in long-term care

Author

Luckett, T, Pond, D, Mitchell, G, Chenoweth, L, Amgarth-Duff, I, Disalvo, D, Phillips, JL, Beattie, E, Davidson, PM, Luscombe, G, Goodall, S, Agar, M, Luckett, T, Pond, D, Mitchell, G, Chenoweth, L, Amgarth-Duff, I, Disalvo, D, Phillips, JL, Beattie, E, Davidson, PM, Luscombe, G, Goodall, S, and Agar, M

Abstract

Background: Advanced dementia is a life-limiting illness that requires a palliative approach to care. Decline in eating/drinking represents a milestone in progression that warrants decision-making and planning of care. In long-term care (LTC), this is best conducted via family case conferences. Aim: To explore decision-making and planning regarding eating/drinking-related care in case conferences for persons with advanced dementia in LTC to inform future practice. Methods: A qualitative approach was taken, using observation of audio-recorded case conferences. Case conferences were conducted in 6 LTC facilities within the intervention arm of a cluster randomized controlled trial. Participants were LTC personnel, doctors, and families of persons with advanced dementia. Content was analysed for eating/drinking-related goals of care and the degree to which decision-making was shared. Findings: Thirty-two case conferences considered eating/drinking-related care. The goals included nutrition, hydration, weight gain and maintenance, food enjoyment, social interaction, and independence. Key considerations included secondary health issues impacting comfort, and tensions between food enjoyment versus nutrition and risk of aspiration. While families contributed essential information about eating/drinking history, sometimes decision-making was dominated by professionals and overlooked overall goals of care. Discussion: Shared decision-making regarding eating/drinking-related care for persons with advanced dementia in LTC should start with consensus on overall goals of care and include contributions to quality of life as well as risks. Family involvement should be supported beyond information-giving. Conclusion: Future studies are needed to identify the most sensitive and understandable ways for families of discussing eating/drinking-related decline in dementia.

Published
2023

5. Facilitated case conferences on end-of-life care for persons with advanced dementia-a qualitative study of interactions between long-term care clinicians and family members.

Author

Francisco, MC, Lane, H, Luckett, T, Disalvo, D, Pond, D, Mitchell, G, Chenoweth, L, Phillips, J, Beattie, E, Luscombe, G, Goodall, S, Agar, M, Francisco, MC, Lane, H, Luckett, T, Disalvo, D, Pond, D, Mitchell, G, Chenoweth, L, Phillips, J, Beattie, E, Luscombe, G, Goodall, S, and Agar, M

Abstract

BACKGROUND: Prognostic uncertainty and the need for proxy decision-making owing to cognitive impairment in advanced dementia, adds complexity to end-of-life care planning within the long-term care setting. Case conferences provide a structure to facilitate difficult conversations and an opportunity for family and clinicians to engage in prospective planning, and reach agreement on goals of end-of-life care. OBJECTIVE: To explore interactions between multidisciplinary healthcare clinicians and families during facilitated case conferences on end-of-life care for residents with advanced dementia. METHODS: A qualitative approach was used. Transcripts of audio-recorded case conferences facilitated by a trained registered nurse were coded by two independent researchers and analysed inductively. Transcripts were selected from an available pool until thematic saturation was reached. Emerging themes were confirmed with the wider research group. RESULTS: Thematic saturation was reached after 25 transcripts. An overarching theme concerned the ways in which clinicians and families bridged medical and person-centred perspectives. Subthemes included: details of day-to-day care versus establishing overall goals of care; expression of emotion versus retreat from emotion; and missed opportunities versus expressed cues. Successful facilitation served to 'bridge the gap' between family and clinicians. CONCLUSION: Facilitation of case conferences for residents with advanced dementia should focus on ensuring that: clinicians do not miss opportunities to discuss end-of-life care; discussions on the minutiae of care regularly return to the resident's broader goals of care; and information on dementia and treatments provided by clinicians is integrated with advice by family members regarding the resident's premorbid values and likely preferences.

Published
2022

6. Outcomes and measures of delirium interventional studies in palliative care to inform a core outcome set: A systematic review

Author

Agar, MR, Siddiqi, N, Hosie, A, Boland, JW, Johnson, MJ, Featherstone, I, Lawlor, PG, Bush, SH, Page, V, Amgarth-Duff, I, Garcia, M, Disalvo, D, Rose, L, and Del-COrS Group

Subjects
mental disorders, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences, behavioral disciplines and activities, Gerontology, nervous system diseases
Abstract

Background: Trials of interventions for delirium in various patient populations report disparate outcomes and measures but little is known about those used in palliative care trials. A core outcome set promotes consistency of outcome selection and measurement. Aim: To inform core outcome set development by examining outcomes, their definitions, measures and time-points in published palliative care studies of delirium prevention or treatment delirium interventions. Design: Prospectively registered systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources: We searched six electronic databases (1980–November 2020) for original studies, three for relevant reviews and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We included randomised, quasi-randomised and non-randomised intervention studies of pharmacological and non-pharmacological delirium prevention and/or treatment interventions. Results: From 13/3244 studies (2863 adult participants), we identified 9 delirium-specific and 13 non-delirium specific outcome domains within eight Core Outcome Measures in Effectiveness Trials (COMET) taxonomy categories. There were multiple and varied outcomes and time points in each domain. The commonest delirium specific outcome was delirium severity (n = 7), commonly using the Memorial Delirium Assessment Scale (6/8 studies, 75%). Four studies reported delirium incidence. Non-delirium specific outcomes included mortality, agitation, adverse events, other symptoms and quality of life. Conclusion: The review identified few delirium interventions with heterogeneity in outcomes, their definition and measurement, highlighting the need for a uniform approach. Findings will inform the next stage to develop consensus for a core outcome set to inform delirium interventional palliative care research.

Published
2021

7. Quality of online self-management resources for adults living with primary brain cancer, and their carers: a systematic environmental scan

Author

Schaefer, I., Heneka, N., Luckett, T., Agar, M.R., Chambers, S.K., Currow, D.C., Halkett, Georgia, Disalvo, D., Amgarth-Duff, I., Anderiesz, C., Phillips, J.L., Schaefer, I., Heneka, N., Luckett, T., Agar, M.R., Chambers, S.K., Currow, D.C., Halkett, Georgia, Disalvo, D., Amgarth-Duff, I., Anderiesz, C., and Phillips, J.L.

Abstract

Background: A primary brain cancer diagnosis is a distressing, life changing event. It adversely affects the quality of life for the person living with brain cancer and their families (‘carers’). Timely access to evidence-based information is critical to enabling people living with brain cancer, and their carers, to self-manage the devastating impacts of this disease. Method: A systematic environmental scan of web-based resources. A depersonalised search for online English-language resources published from 2009 to December 2019 and designed for adults (> 25 years of age), living with primary brain cancer, was undertaken using the Google search engine. The online information was classified according to: 1) the step on the cancer care continuum; 2) self-management domains (PRISMS taxonomy); 3) basic information disclosure (Silberg criteria); 4) independent quality verification (HonCode); 5) reliability of disease and treatment information (DISCERN Sections 1 and 2); and readability (Flesch-Kincaid reading grade). Results: A total of 119 online resources were identified, most originating in England (n = 49); Australia (n = 27); or the USA (n = 27). The majority of resources related to active treatment (n = 76), without addressing recurrence (n = 3), survivorship (n = 1) or palliative care needs (n = 13). Few online resources directly provided self-management advice for adults living with brain cancer or their carers. Just over a fifth (n = 26, 22%) were underpinned by verifiable evidence. Only one quarter of organisations producing resources were HonCode certified (n = 9, 24%). The median resource reliability as measured by Section 1, DISCERN tool, was 56%. A median of 8.8 years of education was required to understand these online resources. Conclusions: More targeted online information is needed to provide people affected by brain cancer with practical self-management advice. Resources need to better address patient and carer needs related to: rehabilitation, managing

Published
2021

8. Quality of online self-management resources for adults living with primary brain cancer, and their carers: a systematic environmental scan.

Author

Schaefer, I, Heneka, N, Luckett, T, Agar, MR, Chambers, SK, Currow, DC, Halkett, G, Disalvo, D, Amgarth-Duff, I, Anderiesz, C, Phillips, JL, Schaefer, I, Heneka, N, Luckett, T, Agar, MR, Chambers, SK, Currow, DC, Halkett, G, Disalvo, D, Amgarth-Duff, I, Anderiesz, C, and Phillips, JL

Abstract

Background

A primary brain cancer diagnosis is a distressing, life changing event. It adversely affects the quality of life for the person living with brain cancer and their families ('carers'). Timely access to evidence-based information is critical to enabling people living with brain cancer, and their carers, to self-manage the devastating impacts of this disease.

Method

A systematic environmental scan of web-based resources. A depersonalised search for online English-language resources published from 2009 to December 2019 and designed for adults (> 25 years of age), living with primary brain cancer, was undertaken using the Google search engine. The online information was classified according to: 1) the step on the cancer care continuum; 2) self-management domains (PRISMS taxonomy); 3) basic information disclosure (Silberg criteria); 4) independent quality verification (HonCode); 5) reliability of disease and treatment information (DISCERN Sections 1 and 2); and readability (Flesch-Kincaid reading grade).

Results

A total of 119 online resources were identified, most originating in England (n = 49); Australia (n = 27); or the USA (n = 27). The majority of resources related to active treatment (n = 76), without addressing recurrence (n = 3), survivorship (n = 1) or palliative care needs (n = 13). Few online resources directly provided self-management advice for adults living with brain cancer or their carers. Just over a fifth (n = 26, 22%) were underpinned by verifiable evidence. Only one quarter of organisations producing resources were HonCode certified (n = 9, 24%). The median resource reliability as measured by Section 1, DISCERN tool, was 56%. A median of 8.8 years of education was required to understand these online resources.

Conclusions

More targeted online information is needed to provide people affected by brain cancer with practical self-management advice. Resources need to better address patient and carer needs related to

Published
2021

9. Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis.

Author

Disalvo, D, Agar, M, Caplan, G, Murtagh, FE, Luckett, T, Heneka, N, Hickman, L, Kinchin, I, Trethewie, S, Sheehan, C, Urban, K, Cohen, J, Harlum, J, Long, B, Parker, T, Schaefer, I, Phillips, J, Disalvo, D, Agar, M, Caplan, G, Murtagh, FE, Luckett, T, Heneka, N, Hickman, L, Kinchin, I, Trethewie, S, Sheehan, C, Urban, K, Cohen, J, Harlum, J, Long, B, Parker, T, Schaefer, I, and Phillips, J

Abstract

Background: Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for ‘accessible and flexible’ models of care that are ‘responsive’ to peoples’ changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. Aim: To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each. Design: A systematic review of systematic reviews (‘meta-review’). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results. Data sources:Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020. Results: The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care. Conclusions: There are opportunities to test new models of virtual care, beyond telehealth and/or video conferencing, such as 24-h command centres, and rapid response teams.

Published
2021

10. Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis

Author

Disalvo, D, Luckett, T, Bennett, A, Davidson, PM, and Agar, M

Subjects
Pharmacology & Pharmacy, 1115 Pharmacology and Pharmaceutical Sciences
Abstract

PURPOSE:This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. METHODS:Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. RESULTS:Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. CONCLUSION:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.

Published
2019

11. Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis.

Author

Disalvo, D, Luckett, T, Bennett, A, Davidson, PM, Agar, M, Disalvo, D, Luckett, T, Bennett, A, Davidson, PM, and Agar, M

Abstract

PURPOSE:This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. METHODS:Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. RESULTS:Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. CONCLUSION:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.

Published
2020

12. Glomerular filtration rate: A prognostic marker in atrial fibrillation—A subanalysis of the AntiThrombotic Agents Atrial Fibrillation

Author

Proietti, Riccardo, Gonzini, Lucio, Pizzimenti, Giovanni, Ledda, Antonietta, Sanna, Pietro, Alturki, Ahmed, Russo, Vincenzo, Lencioni, Mauro, Siciliano, R., Boffa, M., Bazzanini, F., Di Nucci, G., Fonti, S., De Franceschi, T., Davio, P., Alagna, G., Cipollini, F., Arma, P., Gunnellini, M. G., Dottori, M., Paulillo, D., Giudice, M., Sicuro, M., Lenti, S., Iannelli, G., Notarstefano, P., Galiotto, M., Apolloni, Enzo, Molini, G., Massarelli, L., Di Iorio, P., Scandurra, F., Candelmo, F., Iodice, P., Laureano, R., Perlangeli, S., Praticò, A., Lucchesi, Q., Conese, V., Scalera, G., Palma, F., De Antoni, M. E., Beltramello, G., Carbonella, M., Capone, A., Bianchi, V., Zerella, F., Masina, M., Boggian, G., Pancaldi, L. G., Brucato, A. L., Scialfa, S., Ferrari, P., Gavazzi, A., Santoro, E., Bertinieri, G., Caragnano, V., Zaccaroni, S., Marchetti, G., Urbinati, S., Belmonte, G., Giannoni, C., Panuccio, D., Pedone, V., Colletta, M., Di Pasquale, G., Cemin, R., Paffoni, P. R. C., Pezzotti, Chiara, Capretti, M., Lamari, A. L., Maugeri, S., Moretti, R., Ganga, R., Mascia, P., Caddori, A., Cusumano, S., Alletto, M., DE VINCENZO, Ciro, Musacchio, E., Stendardo, A., Cantarella, SALVATORE ALFREDO, Ferrari, V., Bassano, F., PERRONE CAPANO, Carla, Piccinni, G. C., Catanzaro, M., Vinciguerra, A., Lusiani, L., De Caro, G., Scarcia, M., Scarcia, Aurora, Losi, E., Gaddi, O., Lo Sciuto, A., Cascio Ingurgio, N., Vignai, E., Romano, M., Borzì, V., Bellanuova, I. A., Felis, S., Gulizia, M. M., Francese, G. M., Artale, S., Mazzuca, S., Perticone, F., Tirotta, D., Talini, E., Ventrella, F., Iosa, G., Cuccurullo, O., Bertello, P. D., Benemio, G., Garognoli, O., Arcelli, G., Prosciutti, L., De Matthaeis, G., Quattrini, C., Calcagno, S., Canestrini, S., Franco, A., Pastorelli, R., Acquati, F., Botto, G. L., Sitta, N., Migliacci, R., Cosmi, F., Tarquini, B., Chiappetta, P., Sprovieri, M. F., Macrì, G., Bertolazzi, S., Spotti, Alessia, Pirelli, S., Marasco, M. F., Elia, Martina, Gambino, G. M., Fenoglio, L., Gelmini, G. P., Ziacchi, V., Rigon, N., Petix, N. R., Zipoli, A., Caiolo, A., Marino, E., Scattolin, G., Gerini, S., Parisi, G., Tavernese, G., Conti, Alessandro, Ferrante, Federico, Morettini, A., Alterini, B., Rocchi, Federico, Nozzoli, C., Goedecke, L., Seravalle, C., Cuomo, A., Panettieri, I., Pellegrino, P., Di Biase, M., Savarese, G., Patriarchi, F., Bondì, Giuseppina, Rossini, Elena, Nello, S., Ranieri, A. T., Gelonesi, F. N., Costantini, M., Dugnani, M., Ria, L., Mussardo, V., Zanini, G., Morgante, O., Fazio, G., Lo, G., Castello, C., Moroni, L. A., Costa, S., Domenicucci, S., Venzano, C., Loiacono, L., Ortuso, R., Esposito, L., Cuzzucrea, D. G., Fiammengo, F., Selva, E., Gestra, R., Alessandri, M., Nuzzi, G., Porrino, L., Parise, P., Capponi, E. A., Mandorla, S., Politi, Caterina, Olivieri, Claudia, Gurioli, L., Agostinelli, P., Striuli, R., Petrarca, Massimo, Corsini, Francesca, Orlandini, F., Badolati, S., Colarusso, D., Vertullo, V., Pelaggi, P., Campagna, G., Haupt, E., Parente, F., Milanese, G., Magliari, F., Morando, G., Guarise, P., Mazzone, A., Palumbo, G., Lambelet, P., Camaiti, A., Pasquinelli, P., Frediani, L., Vituliano, A., Brunelleschi, G., Lisi, C., La Torre, P. P. A., Villella, A., Rimoldi, A., Russo, V., Di Summa, F., Reggiani, A., Raimondo, F. C., Disalvo, D., Borrello, V. M., Magnante, A., Stellitano, E., Procopio, L., Franculli, F., Serafini, Filippo, Tondo, C., Fiorentini, C., Manfredini, R., Robbiolo, L., Pizzimenti, G., VASQUEZ LOPEZ, LUIDER FERNEY, Piangiamore, A., Tosi, P., Donà, G., Bacchiega, E., Malavasi, V., Modena, M. G., Divella, C., Marengo, C., Montanari, P., Manicardi, V., Abate, L., Cuccuini, A., Magni, S., Vincenti, A., Spinelli, M., Mortara, A., Specchia, G., Silvestri, N., Silvestri, Oriana, Piscopo, G., Muscherà, R., Gallucci, F., Cannavale, A., Bresciani, A., Perrone Filardi, P., Fontanella, Andrea, Iannuzzo, D., Lucà, S., Zuccoli, A., Rinaldi, P., Ferri, G., Barbieri, E., Grasselli, S., Rossi, A., Agosti, S., Sanna, GIAN PAOLO, Casu, G., Orecchioni, G., Da Silva Carvalho, P. C., POZZI MUCELLI, Roberto, Salvati, Fabio, Bendini, M. G., Giordano, G., Pellegrini, F., Pighini, G., Tremolada, F., Zanin, L., Ledda, A., Floresta, A. M., Enia, F., Nicolosi, G., Ingrillì, F., D'Angelo, A., Musacchio, D., Savastano, Silvia, Magnani, Leonardo, Capitelli, M., Cioni, Giovanni, Aloisi, B., De Finis, A., Vacri, A., Costantini, V., Guercini, F., Zingarini, G., Nardoni, M. C., Teghini, L., Panigada, G., Di Marco, S., Vergoni, W., Paonessa, K., Artom, A., Bigliardi, M., Riccardi, R., Riva, L., Marandino, A., Barsotti, L., Ginocchio, G., Marchese, Dario, Tintori, G., Annese, M., Breschi, R., Manini, M., Scopelliti, Giulia, Pastore, A., Spirito, G., Amato, A., Del Bianco, F., Ongari, M., Fiorencis, R., Querci, F., Martone, V. D., Molero, U., Fiusti, R., Giovannini, T., D'Arienzo, E., Cellamare, G., Placci, A., Gulli, G., Ruggeri, A., Pulitanò, G., Iori, I., Ingianni, N., Saporito, D., Marconi, GIAN MARIA, Grossi, Alice, Grosseto, D., Ciamei, M., Mete, F., Russo, F., Bianchi, C., Costantino, S., Manfellotto, D., Risa, M. P., Azzolini, P., Conversano, L., Santini, M., Macchiusi, A., Francia, P., Pietrantonio, F., Biscione, F., Magliano, G., Fedele, Francesca, Salituri, S., Salituri, F., Zamboni, S., Rossetti, C., Roncon, Leonora, Delucchi, M., De Benedictis, M., Vitolo, A., Anselmi, Michela, Celino, T., Moretti, V., Cuccurullo, M., Castelli, G., Martino, G., Pierandrei, G., Carella, A. M., Tonizzo, M., Nassi, R., Tarducci, R., Fronticelli Baldelli, M., Commisso, B., Lazzarini, D., Matarazzo, M. M., Novati, P., Petacchi, R., Maninchedda, P., Melandri, F., Bellesi, P., Sacchetti, C., Grandi, M., Cattana, A., Tassara, R., Menardo, G., Aykut, V., Chesi, G., Reverzani, A., Galgano, Angela, Bartone, B., Stornello, M., Muscio, G., Gemmiti, M. P., Alfonsi, F., Fontana, D., Astarita, C., Gaspardo, G., La Brocca, A., Rillo, M., Pascente, T., Pirozzi, M. R., Addis, L., De Siati, P., Beato, E., Iannaccone, V., Barabani, M., Castronuovo, M., Battaia, L., Biscottini, B., Boccali, A., Marengo, S., Dallerba, R., Diana, A., Coser, Alessandra, Pauletto, P., Calzolari, V., Olivari, Z., De Masi De Luca, G., Accogli, M., Gerloni, R., Cattin, Laura, Vitali Serdoz, L., Sinagra, G., Bulfoni, A., DE BIASIO, Melissa, Proclemer, A., Miserocchi, F., Marazzi, R., SALERNO URIARTE, JORGE ANTONIO, Levantesi, G., Olivetti, P., Capuano, A., Bertoncelli, M. C., Molinaro, N., Anastasio, L., Teti, G., Vescovo, G. A., Muriago, M., Incao, F., Lettica, G. V., Nieswandt, V., Osti, R., Tafi, A., Proietti, Riccardo, Gonzini, Lucio, Pizzimenti, Giovanni, Ledda, Antonietta, Sanna, Pietro, Alturki, Ahmed, Russo, Vincenzo, Lencioni, Mauro, Siciliano, R., Boffa, M., Bazzanini, F., Di Nucci, G., Fonti, S., De Franceschi, T., Davio, P., Alagna, G., Cipollini, F., Arma, P., Gunnellini, M. G., Dottori, M., Paulillo, D., Giudice, M., Sicuro, M., Lenti, S., Iannelli, G., Notarstefano, P., Galiotto, M., Apolloni, E., Molini, G., Massarelli, L., Di Iorio, P., Scandurra, F., Candelmo, F., Iodice, P., Laureano, R., Perlangeli, S., Praticò, A., Lucchesi, Q., Conese, V., Scalera, G., Palma, F., De Antoni, M. E., Beltramello, G., Carbonella, M., Capone, A., Bianchi, V., Zerella, F., Masina, M., Boggian, G., Pancaldi, L. G., Brucato, A. L., Scialfa, S., Ferrari, P., Gavazzi, A., Santoro, E., Bertinieri, G., Caragnano, V., Zaccaroni, S., Marchetti, G., Urbinati, S., Belmonte, G., Giannoni, C., Panuccio, D., Pedone, V., Colletta, M., Di Pasquale, G., Cemin, R., Paffoni, P. R. C., Pezzotti, C., Capretti, M., Lamari, A. L., Maugeri, S., Moretti, R., Ganga, R., Mascia, P., Caddori, A., Cusumano, S., Alletto, M., De Vincenzo, C., Musacchio, E., Stendardo, A., Cantarella, S. A., Ferrari, V., Bassano, F., Perrone, C., Piccinni, G. C., Catanzaro, M., Vinciguerra, A., Lusiani, L., De Caro, G., Scarcia, M., Scarcia, A., Losi, E., Gaddi, O., Lo Sciuto, A., Cascio Ingurgio, N., Vignai, E., Romano, M., Borzì, V., Bellanuova, I. A., Felis, S., Gulizia, M. M., Francese, G. M., Artale, S., Mazzuca, S., Perticone, F., Tirotta, D., Talini, E., Ventrella, F., Iosa, G., Cuccurullo, O., Bertello, P. D., Benemio, G., Garognoli, O., Arcelli, G., Prosciutti, L., De Matthaeis, G., Quattrini, C., Calcagno, S., Canestrini, S., Franco, A., Pastorelli, R., Acquati, F., Botto, G. L., Sitta, N., Migliacci, R., Cosmi, F., Tarquini, B., Chiappetta, P., Sprovieri, M. F., Macrì, G., Bertolazzi, S., Spotti, A., Pirelli, S., Marasco, M. F., Elia, M., Gambino, G. M., Fenoglio, L., Gelmini, G. P., Ziacchi, V., Rigon, N., Petix, N. R., Zipoli, A., Caiolo, A., Marino, E., Scattolin, G., Gerini, S., Parisi, G., Tavernese, G., Conti, A., Ferrante, F., Morettini, A., Alterini, B., Rocchi, F., Nozzoli, C., Goedecke, L., Seravalle, C., Cuomo, A., Panettieri, I., Pellegrino, P., Di Biase, M., Savarese, G., Patriarchi, F., Bondi, G., Rossini, E., Nello, S., Ranieri, A. T., Gelonesi, F. N., Costantini, M., Dugnani, M., Ria, L., Mussardo, V., Zanini, G., Morgante, O., Fazio, G., Lo, G., Castello, C., Moroni, L. A., Costa, S., Domenicucci, S., Venzano, C., Loiacono, L., Ortuso, R., Esposito, L., Cuzzucrea, D. G., Fiammengo, F., Selva, E., Gestra, R., Alessandri, M., Nuzzi, G., Porrino, L., Parise, P., Capponi, E. A., Mandorla, S., Politi, C., Olivieri, C., Gurioli, L., Agostinelli, P., Striuli, R., Petrarca, M., Corsini, F., Orlandini, F., Badolati, S., Colarusso, D., Vertullo, V., Pelaggi, P., Campagna, G., Haupt, E., Parente, F., Milanese, G., Magliari, F., Morando, G., Guarise, P., Mazzone, A., Palumbo, G., Lambelet, P., Camaiti, A., Pasquinelli, P., Frediani, L., Vituliano, A., Brunelleschi, G., Lisi, C., La Torre, P. P. A., Villella, A., Rimoldi, A., Russo, V., Di Summa, F., Reggiani, A., Raimondo, F. C., Disalvo, D., Borrello, V. M., Magnante, A., Stellitano, E., Procopio, L., Franculli, F., Serafini, F., Tondo, C., Fiorentini, C., Manfredini, R., Robbiolo, L., Pizzimenti, G., Vasquez, L., Piangiamore, A., Tosi, P., Donà, G., Bacchiega, E., Malavasi, V., Modena, M. G., Divella, C., Marengo, C., Montanari, P., Manicardi, V., Abate, L., Cuccuini, A., Magni, S., Vincenti, A., Spinelli, M., Mortara, A., Specchia, G., Silvestri, N., Silvestri, O., Piscopo, G., Muscherà, R., Gallucci, F., Cannavale, A., Bresciani, A., Perrone Filardi, P., Fontanella, A., Iannuzzo, D., Lucà, S., Zuccoli, A., Rinaldi, P., Ferri, G., Barbieri, E., Grasselli, S., Rossi, A., Agosti, S., Sanna, P., Casu, G., Orecchioni, G., Da Silva Carvalho, P. C., Pozzi, R., Salvati, F., Bendini, M. G., Giordano, G., Pellegrini, F., Pighini, G., Tremolada, F., Zanin, L., Ledda, A., Floresta, A. M., Enia, F., Nicolosi, G., Ingrillì, F., D'Angelo, A., Musacchio, D., Savastano, S., Magnani, L., Capitelli, M., Cioni, G., Aloisi, B., De Finis, A., Vacri, A., Costantini, V., Guercini, F., Zingarini, G., Nardoni, M. C., Teghini, L., Panigada, G., Di Marco, S., Vergoni, W., Paonessa, K., Artom, A., Bigliardi, M., Riccardi, R., Riva, L., Marandino, A., Barsotti, L., Ginocchio, G., Marchese, D., Tintori, G., Annese, M., Breschi, R., Manini, M., Scopelliti, G., Pastore, A., Spirito, G., Amato, A., Del Bianco, F., Ongari, M., Fiorencis, R., Querci, F., Martone, V. D., Molero, U., Fiusti, R., Giovannini, T., D'Arienzo, E., Cellamare, G., Placci, A., Gulli, G., Ruggeri, A., Pulitanò, G., Iori, I., Ingianni, N., Saporito, D., Marconi, M., Grossi, A., Grosseto, D., Ciamei, M., Mete, F., Russo, F., Bianchi, C., Costantino, S., Manfellotto, D., Risa, M. P., Azzolini, P., Conversano, L., Santini, M., Macchiusi, A., Francia, P., Pietrantonio, F., Biscione, F., Magliano, G., Fedele, F., Salituri, S., Salituri, F., Zamboni, S., Rossetti, C., Roncon, L., Delucchi, M., De Benedictis, M., Vitolo, A., Anselmi, M., Celino, T., Moretti, V., Cuccurullo, M., Castelli, G., Martino, G., Pierandrei, G., Carella, A. M., Tonizzo, M., Nassi, R., Tarducci, R., Fronticelli Baldelli, M., Commisso, B., Lazzarini, D., Matarazzo, M. M., Novati, P., Petacchi, R., Maninchedda, P., Melandri, F., Bellesi, P., Sacchetti, C., Grandi, M., Cattana, A., Tassara, R., Menardo, G., Aykut, V., Chesi, G., Reverzani, A., Galgano, A., Bartone, B., Stornello, M., Muscio, G., Gemmiti, M. P., Alfonsi, F., Fontana, D., Astarita, C., Gaspardo, G., La Brocca, A., Rillo, M., Pascente, T., Pirozzi, M. R., Addis, L., De Siati, P., Beato, E., Iannaccone, V., Barabani, M., Castronuovo, M., Battaia, L., Biscottini, B., Boccali, A., Marengo, S., Dallerba, R., Diana, A., Coser, A., Pauletto, P., Calzolari, V., Olivari, Z., De Masi De Luca, G., Accogli, M., Gerloni, R., Cattin, L., Vitali Serdoz, L., Sinagra, G., Bulfoni, A., De Biasio, M., Proclemer, A., Miserocchi, F., Marazzi, R., Salerno Uriarte, J. A., Levantesi, G., Olivetti, P., Capuano, A., Bertoncelli, M. C., Molinaro, N., Anastasio, L., Teti, G., Vescovo, G. A., Muriago, M., Incao, F., Lettica, G. V., Nieswandt, V., Osti, R., and Tafi, A.

Subjects
Male, medicine.medical_specialty, Time Factors, Clinical Investigations, Renal function, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, atrial fibrillation, glomerular filtration rate, mortality, Cardiology and Cardiovascular Medicine, Internal medicine, Antithrombotic, medicine, Humans, In patient, 030212 general & internal medicine, Renal Insufficiency, Cardiovascular mortality, Aged, Retrospective Studies, business.industry, Incidence, Atrial fibrillation, General Medicine, medicine.disease, Prognosis, Survival Rate, Italy, Hospital admission, Atrial Fibrillation, Female, Follow-Up Studies, Glomerular Filtration Rate, Morbidity, Cardiology, business
Abstract

OBJECTIVE: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA‐AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. METHODS AND RESULTS: The ATA‐AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post‐hoc analysis included 1097 AF patients with eGFR data available and 1‐year clinical follow‐up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow‐up. Patients were also divided in two groups according to the eGFR (

Published
2018

13. Pharmacists’ perspectives on medication reviews for long-term care residents with advanced dementia: a qualitative study

Author

Disalvo, D, Luckett, T, Bennett, A, Davidson, P, and Agar, M

Subjects
Patient Care Team, Attitude of Health Personnel, Medication Therapy Management, education, Australia, Humans, Dementia, Pharmacology & Pharmacy, Pharmacists, Long-Term Care, Intersectoral Collaboration, health care economics and organizations, Qualitative Research
Abstract

© 2019, Springer Nature Switzerland AG. Background Medication reviews by pharmacists have been shown to identify and reduce drug-related problems in long-term care residents. Objective To explore pharmacist perspectives of the Australian Government funded pharmacist-conducted residential medication management review and its role improving the quality and safety of prescribing in long-term care, in particular for those living with advanced dementia. Setting Australian Long-term care pharmacists. Method A qualitative research methodology approach using semi-structured interviews was used, with participants pharmacists with Residential Medication Management Review experience. Interviews were recorded, transcribed and coded utilising a meta-model of Physician-Community Pharmacy Collaboration in medication review. Main outcome measure Pharmacists’ perspectives on the Residential Medication Management Review and how to improve the quality of reviews for residents with advanced dementia. Results Fifteen accredited pharmacists participated. The majority believed that the Residential Medication Management Review had the potential to improve the quality and safety of medicines but highlighted systemic issues that worked against collaborative practice. Participants emphasised the importance of three-way collaboration between general practitioners, pharmacists and nursing staff and highlighted key strategies for its optimisation. Conclusion Incorporating avenues for greater communication between team members can improve collaboration between health professionals and ultimately the quality of medication reviews.

Published
2019

14. Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia: A Substudy of the IDEAL Study

Author

Disalvo, D, Luckett, T, Luscombe, G, Bennett, A, Davidson, P, Chenoweth, L, Mitchell, G, Pond, D, Phillips, J, Beattie, E, Goodall, S, and Agar, M

Subjects
Gerontology
Abstract

© 2018, Mary Ann Liebert, Inc. Background: Prescribing medications for nursing home residents with advanced dementia should focus on optimizing function and comfort, reducing unnecessary harms and aligning care goals with a palliative approach. Objective: The aim of the study was to estimate the proportion of Australian nursing home residents with advanced dementia receiving potentially inappropriate medications, and identify those most commonly prescribed and factors associated with their use. Design: Data were collected through retrospective audit of medication charts. Setting/Subjects: Two hundred eighteen nursing home residents with advanced dementia from 20 nursing homes participated in a cluster-randomized controlled trial of case conferencing (the IDEAL Study) from June 2013 to December 2014. Measurements: Inappropriate drug use was defined as medications classified as "never appropriate" by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria. Generalized linear mixed models were used to identify variables predicting use of "never" appropriate medications. Results: Over a quarter (n = 65, 30%) of residents received at least one medication classed as "never" appropriate, the most common being lipid-lowering agents (n = 38, 17.4%), antiplatelet agents (n = 18, 8.3%), and acetylcholinesterase inhibitors (n = 16, 7.3%). Residents who had been at the nursing home for ≤10 months (odds ratio [OR] 5.60, 95% confidence interval [CI] 1.74-18.06) and 11-21 months (OR 5.41, 95% CI 1.67-17.75) had significantly greater odds of receiving a never appropriate medication compared with residents who had been at the nursing home for >5 years. Conclusions: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required.

Published
2018

18. Systems to identify potentially inappropriate prescribing in people with advanced dementia: A systematic review

Author

Disalvo, D, Luckett, T, Agar, M, Bennett, A, Davidson, PM, Disalvo, D, Luckett, T, Agar, M, Bennett, A, and Davidson, PM

Abstract

© 2016 The Author(s). Background: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. Methods: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 - August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually. Results: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals' opinions on appropriateness of specific medications in different clinical scenarios. Conclusions: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications.

Published
2016

19. The Correlation between Placental Pathology and Intraventricular Hemorrhage in the Preterm Infant

Author

DiSalvo D

Subjects
Fetus, medicine.medical_specialty, Univariate analysis, business.industry, Obstetrics, Confounding, Gestational age, Amniotic sac, medicine.disease, Low birth weight, Intraventricular hemorrhage, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, Medicine, medicine.symptom, business, Prospective cohort study
Abstract

The aim of this study is to better understand the relationship between placental pathology and risk of intraventricular hemorrhage (IVH). We address two specific hypotheses. 1) Morphologic correlates of pregnancy-induced hypertension (PIH) are associated with a decreased risk of IVH. 2) Morphologic correlates of amniotic sac inflammation (ASI) are associated with an increased risk of IVH. Maternal, neonatal, and placental data were analyzed by univariate and multivariate methods in this prospective cohort study of 1095 very low birth weight infants. A cluster analysis model was used to categorize the placental pathologic features into clusters, the two main ones being PIH and ASI. Deliveries were subdivided by the interval between membrane rupture and delivery as an index of preexisting infection ( or =1 h). Univariate analysis supports both hypotheses. However, in multivariate models that adjusted for such potential confounders as gestational age, labor, and route of delivery, the only associations that persisted were the increased risk of IVH associated with the presence of chorionic or umbilical vasculitis in infants born within 1 h of membrane rupture. Placental correlates of PIH do not provide additional information about IVH risk independent of the presence of other components of the PIH and ASI clusters, and confounders such as gestational age, labor, and route of delivery. Placental correlates of ASI, specifically the fetal responses of chorionic and umbilical vasculitis to preexisting infection, are associated with an increased risk of IVH independent of confounders. Cytokines may provide the link between placental inflammation and fetal/neonatal brain hemorrhage.

Published
1998
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22. Elementi in traccia ed abuso cronico di etanolo

Author

Loguercio C., De Girolamo V., Disalvo D., Cuomo A., Feng S. L., Cataldi V., Gialanella G., Del Vecchio Blanco C., FEDERICO, Alessandro, Loguercio, C., De Girolamo, V., Disalvo, D., Cuomo, A., Federico, Alessandro, Feng, S. L., Cataldi, V., Gialanella, G., and Del Vecchio Blanco, C.

Published
1997

24. AMOUNT AND DURATION OF ALCOHOL INTAKE IN PATIENTS WITH CHRONIC LIVER-DISEASE - AN ITALIAN MULTICENTER STUDY

Author

ARICO S., GALATOLA G., TABONE M., CORRAO G., TRINGALI M., CERRATO G., MARENCO G., PONASSI I., RIZZO A., BREZZA E., DALESSANDRO A., SALVAGNINI M., BURRA P., NACCARATO R., FORNACIARI G., BELTRAMI M., PLANCHER A. C., STEFANINI G. F., ADDOLORATO G., GASBARRIN G., LOGUERCIO C., DELVECCHIO BLANCO C., COLTORTI M., DISALVO D., BUDILLON G., CUOMO, ROSARIO, ASCIONE A., DELUCA M., DICOSTANZO G. G., IAQUINTO G., DEVITA A., BRUNO A., AMBROSONE L., MANGHISI O. G., PETRUZZI J., PLANTONE F., LEANDRO G., ALTOMARE E., VENDEMIALE G., MANNO G., BELMONTE A., MOLLICA A., SABATINO A., AJELLO A., FRENI M. A., SPADARO A., FERRAU O., LONGO G., RAIMONDO G., RODINO G., RUSSO F., SCIFO G., RISICATO R., GIUDICI C. A., NARDONE, GERARDO ANTONIO PIO, Arico, S., Galatola, G., Tabone, M., Corrao, G., Tringali, M., Cerrato, G., Marenco, G., Ponassi, I., Rizzo, A., Brezza, E., Dalessandro, A., Salvagnini, M., Burra, P., Naccarato, R., Fornaciari, G., Beltrami, M., Plancher, A. C., Stefanini, G. F., Addolorato, G., Gasbarrin, G., Loguercio, C., DELVECCHIO BLANCO, C., Coltorti, M., Disalvo, D., Budillon, G., Nardone, GERARDO ANTONIO PIO, Cuomo, Rosario, Ascione, A., Deluca, M., Dicostanzo, G. G., Iaquinto, G., Devita, A., Bruno, A., Ambrosone, L., Manghisi, O. G., Petruzzi, J., Plantone, F., Leandro, G., Altomare, E., Vendemiale, G., Manno, G., Belmonte, A., Mollica, A., Sabatino, A., Ajello, A., Freni, M. A., Spadaro, A., Ferrau, O., Longo, G., Raimondo, G., Rodino, G., Russo, F., Scifo, G., Risicato, R., and Giudici, C. A.

Abstract

We report the results of an Italian multicenter study aimed at measuring retrospectively the lifetime amount and duration of alcohol consumption in non-selected consecutive patients with chronic liver disease. We used a standardized, reproducible questionnaire for measuring the lifetime daily alcohol intake (globally and separately for wine, beer and spirits), total alcohol intake and duration of alcohol consumption in 1,258 patients recruited from 17 medical centers. Wine intake contributed to the total alcohol intake in a proportion ranging from 44% to 85% throughout the centers. Spirits and beer intake contributed in smaller proportions (15% to 56%; and 3% to 27%, respectively). Males showed higher alcohol intake: those from northern-central Italy showed significantly higher intake than their southern-insular counterparts; of these, younger patients also showed a higher alcohol intake, due to a higher beer and spirit intake. Older patients showed higher intakes in southern-insular Italy, whereas the opposite was found in northern-central Italy. In this area, a longer duration of alcohol consumption was found, reflecting an earlier start in the use of alcohol. In conclusion, we believe that measuring alcohol intake on a wide series of patients in a multicenter study is feasible. This should stimulate gastroenterologists to approach the relationship between alcohol and liver disease using standardized and epidemiologically correct methods, and form the basis for well-designed case-control studies on a large scale, aimed at clarifying the risk of both hepatic and extrahepatic diseases associated with alcohol intake.

Published
1994

38. List of Contributors

Author

Levin, Martin A., DiSalvo, Daniel, and Shapiro, Martin M.

Published
2012

45. Index

Author

Levin, Martin A., DiSalvo, Daniel, and Shapiro, Martin M.

Published
2012

49. Acknowledgments

Author

Levin, Martin A., DiSalvo, Daniel, and Shapiro, Martin M.

Published
2012

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