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Extant healthcare literature has demonstrated that providing oncological patients with detailed, continuous, and diversified information on their pathology positively affects patient empowerment and care continuum effectiveness. Medical information is traditionally conveyed by physicians and professional care givers. In the latest years, however, there has been a rapid rise in the use of web media as a source of health information. Improving cancer care continuum requires also the implementation of a reliable and high-quality oncological web communication system, as well as a deeper understanding of patients' requirements in this respect. To the best of our knowledge, however, no papers have investigated the importance and role of web communication, and of websites, in particular. This work aims to address these aspects explicitly, proposing the use of text mining as a tool for identifying oncological patient communication needs. For this purpose, we conducted an exploratory study on a sample of rare cancer patients. Text mining techniques were applied on transcriptions of semi-structured interviews on patients' information requirements, and the text content was synthetized. By means of correspondence analysis, the main concepts expressed by patients were identified, and the association between patients and concepts was represented in an appropriate metric space. Although our study is at an early stage, the findings highlighted by this preliminary text mining analysis could support the design of a patient-centered e-health communication system and be the basis for further analysis.

Textual analysis is a cutting-edge technique that is becoming prominent in customer satisfaction analysis. It has been widely developed in the field of web communication, but, in our opinion, it has a great potential in classic customer satisfaction applications. In our work, we propose performing a textual analysis in order to study the new image communication approach of pharmaceutical companies that want access to the Italian market. For the last few years, the pharmaceutical market in Italy has required stakeholder-oriented policies, aiming at communicating the value of products proposed to market. This innovative approach requires a new vision of market access activities, especially inside the company. In order to study the implementation of this strategy, we propose analyzing the perception of this change of direction amongst companies’ employee and management. We recorded the definition of market access given by the management and by a sample of Field Access Managers (FAM) of a big pharma company. Using textual analysis, we constructed perceptual maps of concepts used to define the market access policies of the company, and we positioned individuals on these maps in order to evaluate the differences in the perception of management and FAMs. Moreover, we provided a referral framework considering the definitions of market access given by literature. The first component provided by textual analysis discriminates between strategic and tactic orientation. The management positions are in the middle, with few overlapping, between the strategic-oriented position of literature and the tactic-oriented position of FAMs, who are too far from the concept of value transmission. The second component discriminates between the communicative and the normative attitude, showing a more dispersive positioning of both management and FAMs. Our findings show that a distance exists between managerial and operational perceptions of company image. Our future research will strengthen ou

The Fleiss’ kappa statistic is a well-known index for assessing the reliability of agreement between raters. It is used both in the psychological and in the psychiatric field. Unfortunately, the kappa statistic may behave inconsistently in case of strong agreement between raters, since this index assumes lower values than it would have been expected. The aim of this paper is to propose a new method to avoid this paradox through permutation techniques. Furthermore, we study the problem of kappa confidence intervals and, in particular, we suggest to use Bootstrap confidence intervals free of paradoxes.

In healthcare literature, several papers have demonstrated that providing patients with detailed, continuous, and diversified information on their pathology - in a broad sense - has a significantly positive effect on patient empowerment and on care continuum effectiveness. In this respect, besides healthcare professionals, indirect communication (printed material, website, etc.) plays an increasingly important role. Web communication, in particular, has stated to be crucial: it is expected to be accessible to everyone and cost-saving for healthcare systems, to facilitate two-way interaction, and to promote patient-doctor-advocacy groups collaboration. Web communication, however, seems to suffer from two main limitations: 1. it can be unreliable if unsupervised; 2. it can be used to diffuse only some kinds of information. This work aims to address the extent of these limitations, examining patient propensity toward using web communication and identifying the patient needs that it could contribute to satisfy. For this purpose, we run an exploratory empirical study on a sample of rare cancer patients treated in a highly specialized research center in Northern Italy. We conduct semi-structured interviews on patient propensity and needs and analyze their transcriptions by means of text mining techniques. We clean and normalize the texts with automatic techniques for lexical- grammatical analysis and, finally, we synthesize the text contents with correspondence analysis (shortly, CA). CA allows us to identify the main concepts expressed by patients and to represent geometrically, in a reduced factorial space, the patients and the concepts. This simultaneous graphic representation of concepts and individuals allows visual representation of the association between patients and their information needs.

Causality is a concept extremely important in science, but its definition is quite controversial and its detection is not exempt from problems. There are different approaches to deal with causality. Two of them are the Structural Equation Models (SEMs) and the Probabilistic Bayesian Networks (PBNs). SEMs are confirmative models. Given a causal structure, they test if it is coherent with data. In this context they are estimated using the Partial Least Squares Path Modeling technique in order to obtain the scores of latent variables. PBNs are inductive methods. Their attempt is to extract the causal scheme deriving from data, without presupposing any knowledge. Both models presents advantages and disadvantages regardless of the causality approach they refer to. SEMs are best suited for quantitative data and when there is a solid theoretical knowledge on the subject of analysis. PBNs are preferable for nonlinear analysis or uncertain causal scheme. In the thesis a possible integration of the two methods is proposed in the analysis of data deriving from a satisfaction and customer loyalty survey for “Customer American Satisfaction Index” (ACSI). Results suggest that the SEMs are more suitable than the PBNs and that the integration of the two statistical models is advantageous only in part. This is related to the kind of data, since the ACSI survey is structured for a PLS-PM analysis. Thus, it could be very interesting repeat the comparison for different types of data.

BACKGROUND: The safety and efficacy of sirolimus-eluting stenting have been demonstrated, but the outcome of patients treated with this novel technology beyond the first year remains unknown. We sought to evaluate the angiographic, intravascular ultrasound (IVUS), and clinical outcomes of patients treated with sirolimus-eluting stents 2 years after implantation. METHODS AND RESULTS: This study included 30 patients treated with sirolimus-eluting Bx Velocity stenting (slow release [SR], n=15, and fast release [FR], n=15) in Sao Paulo, Brazil. Twenty-eight patients underwent 2-year angiographic and IVUS follow-up. No deaths occurred during the study period. In-stent late loss was slightly greater in the FR group (0.28+/-0.4 mm) than in the SR group (-0.09+/-0.23 mm, P=0.007). No patient had in-stent restenosis. At 2-year follow-up, only 1 patient (FR group) had a 52% diameter stenosis within the lesion segment, which required repeat revascularization. The target-vessel revascularization rate for the entire cohort was 10% (3/30) at 2 years. All other patients had < or =35% diameter stenosis. Angiographic lumen loss at the stent edges was also minimal (in-lesion late loss was 0.33+/-0.42 mm [FR] and 0.13+/-0.29 mm [SR]). In-stent neointimal hyperplasia volume, as detected by IVUS, remained minimal after 2 years (FR= 9.90+/-9 mm3 and SR=10.35+/-9.3 mm3). CONCLUSIONS: This study demonstrates the safety and efficacy of sirolimus-eluting Bx Velocity stents 2 years after implantation in humans. In-stent lumen dimensions remained essentially unchanged at 2-year follow-up in the 2 groups, although angiographic lumen loss was slightly higher in the FR group. Restenosis "catch-up" was not found in our patient population.

BACKGROUND: We have previously reported the safety and effectiveness of sirolimus-eluting stents for the treatment of de novo coronary lesions. The present investigation explored the potential of this technology to treat in-stent restenosis. METHODS AND RESULTS: Twenty-five patients with in-stent restenosis were successfully treated with the implantation of 1 or 2 sirolimus-eluting Bx VELOCITY stents in Sao Paulo, Brazil. Nine patients received 2 stents (1.4 stents per lesion). Angiographic and volumetric intravascular ultrasound (IVUS) images were obtained after the procedure and at 4 and 12 months. All vessels were patent at the time of 12-month angiography. Angiographic late loss averaged 0.07+/-0.2 mm in-stent and -0.05+/-0.3 mm in-lesion at 4 months, and 0.36+/-0.46 mm in-stent and 0.16+/-0.42 mm in-lesion after 12 months. No patient had in-stent or stent margin restenosis at 4 months, and only one patient developed in-stent restenosis at 1-year follow-up. Intimal hyperplasia by 3-dimensional IVUS was 0.92+/-1.9 mm(3) at 4 months and 2.55+/-4.9 mm(3) after 1 year. Percent volume obstruction was 0.81+/-1.7% and 1.76+/-3.4% at the 4- and 12-month follow-up, respectively. There was no evidence of stent malapposition either acutely or in the follow-up IVUS images, and there were no deaths, stent thromboses, or repeat revascularizations. CONCLUSION: This study demonstrates the safety and the potential utility of sirolimus-eluting Bx VELOCITY stents for the treatment of in-stent restenosis.

BACKGROUND: The need for repeated treatment of restenosis of a treated vessel remains the main limitation of percutaneous coronary revascularization. Because sirolimus (rapamycin) inhibits the proliferation of lymphocytes and smooth-muscle cells, we compared a sirolimus-eluting stent with a standard uncoated stent in patients with angina pectoris. METHODS: We performed a randomized, double-blind trial to compare the two types of stents for revascularization of single, primary lesions in native coronary arteries. The trial included 238 patients at 19 medical centers. The primary end point was in-stent late luminal loss (the difference between the minimal luminal diameter immediately after the procedure and the diameter at six months). Secondary end points included the percentage of in-stent stenosis of the luminal diameter and the rate of restenosis (luminal narrowing of 50 percent or more). We also analyzed a composite clinical end point consisting of death, myocardial infarction, and percutaneous or surgical revascularization at 1, 6, and 12 months. RESULTS: At six months, the degree of neointimal proliferation, manifested as the mean (+/-SD) late luminal loss, was significantly lower in the sirolimus-stent group (-0.01+/-0.33 mm) than in the standard-stent group (0.80+/-0.53 mm, P<0.001). None of the patients in the sirolimus-stent group, as compared with 26.6 percent of those in the standard-stent group, had restenosis of 50 percent or more of the luminal diameter (P<0.001). There were no episodes of stent thrombosis. During a follow-up period of up to one year, the overall rate of major cardiac events was 5.8 percent in the sirolimus-stent group and 28.8 percent in the standard-stent group (P<0.001). The difference was due entirely to a higher rate of revascularization of the target vessel in the standard-stent group. CONCLUSIONS: As compared with a standard coronary stent, a sirolimus-eluting stent shows considerable promise for the prevention of neointimal pro

BACKGROUND: Restenosis remains an important limitation of interventional cardiology. Therefore, we aimed to determine the safety and efficacy of sirolimus (a cell-cycle inhibitor)-coated BX Velocity stents. METHODS AND RESULTS: Thirty patients with angina pectoris were electively treated with 2 different formulations of sirolimus-coated stents (slow release [SR], n=15, and fast release [FR], n=15). All stents were successfully delivered, and patients were discharged without clinical complications. Independent core laboratories analyzed angiographic and 3D volumetric intravascular ultrasound data (immediately after procedure and at 4-month follow-up). Eight-month clinical follow-up was obtained for all patients. There was minimal neointimal hyperplasia in both groups (11.0+/-3.0% in the SR group and 10.4+/-3.0% in the FR group, P:=NS) by ultrasound and quantitative coronary angiography (in-stent late loss, 0.09+/-0.3 mm [SR] and -0.02+/-0.3 mm [FR]; in-lesion late loss, 0.16+/-0.3 mm [SR] and -0.1+/-0.3 mm [FR]). No in-stent or edge restenosis (diameter stenosis >or=50%) was observed. No major clinical events (stent thrombosis, repeat revascularization, myocardial infarction, or death) had occurred by 8 months. CONCLUSIONS: The implantation of sirolimus-coated BX Velocity stents is feasible and safe and elicits minimal neointimal proliferation. Additional placebo-controlled trials are required to confirm these promising results.

BACKGROUND: We have previously reported a virtual absence of neointimal hyperplasia 4 months after implantation of sirolimus-eluting stents. The aim of the present investigation was to determine whether these results are sustained over a period of 1 year. METHODS AND RESULTS: Forty-five patients with de novo coronary disease were successfully treated with the implantation of a single sirolimus-eluting Bx VELOCITY stent in Sao Paulo, Brazil (n=30, 15 fast release [group I, GI] and 15 slow release [GII]) and Rotterdam, The Netherlands (15 slow release, GIII). Angiographic and volumetric intravascular ultrasound (IVUS) follow-up was obtained at 4 and 12 months (GI and GII) and 6 months (GIII). In-stent minimal lumen diameter and percent diameter stenosis remained essentially unchanged in all groups (at 12 months, GI and GII; at 6 months, GIII). Follow-up in-lesion minimal lumen diameter was 2.28 mm (GIII), 2.32 mm (GI), and 2.48 mm (GII). No patient approached the >/=50% diameter stenosis at 1 year by angiography or IVUS assessment, and no edge restenosis was observed. Neointimal hyperplasia, as detected by IVUS, was virtually absent at 6 months (2+/-5% obstruction volume, GIII) and at 12 months (GI=2+/-5% and GII=2+/-3%). CONCLUSIONS: This study demonstrates a sustained suppression of neointimal proliferation by sirolimus-eluting Bx VELOCITY stents 1 year after implantation.