Search

Background: Pain is a prevalent symptom in patients with advanced cancer. Recognition of prognostic factors associated with pain intensity, could help provide better assessment, leading to better pain management. Aim: identifying prognostic factors which could guide improvements on cancer pain classification. Design: a prospective observational study on chronic cancer pain, exploring the association between average mean pain intensity during a 28 days study follow-up and patients’ clinical and pain-related characteristics, including pain syndromes. To evaluate these associations, a mixed model was built. Setting/participants: Patients attending a Palliative Care and Pain Outpatient Clinic from May 2015 to June 2019 were screened. Patients with moderate to severe cancer pain who were already receiving or needed treatment with third step WHO ladder opioids were enrolled in the study. Data from 342 patients with at least one follow-up visit were analyzed. Results: Pain intensity decreased significantly for all patients during time ( p Conclusions: The recognition of specific pain syndromes may help to better classify cancer pain.

The ecological risk attached to the filling of Quito’s ravines, together with the subsequent loss of a memory about their existence, are the focus of this paper which aims to provide a base for both comprehension and action. Ravines are part of the geomorphology of the city’s basin and play a vital role in the hydrogeological system of Quito’s water cycle. They have been filled over time, disappearing from urban maps. This disrupts ravines’ original course and natural drainage system generating risks. An integral multi-scale perspective that considers geomorphological and hydrogeological modifications is missing. Three problematics can be observed. Technical-infrastructural, Urban-spatial and Architectural-cultural. The conjugation of all the phenomena described above, constitutes a call to consciously establish the risk level to which this territory is exposed. The damage goes beyond material or human loss. It affects history, living memory, identity, and knowledge. All these aspects have contributed to the consideration of HCQ (Historical Centre of Quito) as World Heritage Site. These are valuable legacies that need to be preserved. Therefore, it is necessary to undertake a detailed inventory of: i) the technical constructive state of patrimonial buildings made using raw earth; ii) the modifications and current state of DMQ’s (Metropolitan District of Quito) ravines; iii) the existing interstitial spaces associated to the ravines’ path within the HCQ. The paradigm under consideration for the future is not conservation but integral protection. Rescuing Memory in relation to HCQ’s ravines as an active operator for transformative provisions associated to social, environmental, urban and architectonic dimensions becomes fundamental for future development.

ObjectivesDuring the COVID-19 pandemic, telemedicine (TM) emerged as an important mean to reduce risks of transmission, yet delivering the necessary care to patients. Our aim was to evaluate feasibility, characteristics and satisfaction for a TM service based on phone/video consultations for patients with cancer attending an outpatient palliative care clinic during COVID-19 pandemics.MethodsA longitudinal observational study was conducted from April to December 2020. Consecutive patients were screened for video consultations feasibility. Either patients or their caregivers received video/phone consultations registering reason and intervention performed. Those contacted at least twice were eligible for experience of care assessment.ResultsVideo consultations were feasible in 282 of 572 screened patients (49%, 95% CI 45% to 52%); 112 patients among the 572 had at least two phone/video consultations and 12 of them had one or more video consultations. Consultations were carried out with patients (56%), caregivers (30%) or both (14%). 63% of the consultations were requested by the patients/caregivers. Reasons for consultation included uncontrolled (66%) or new symptom onset (20%), therapy clarifications (37%) and updates on diagnostic tests (28%). Most interventions were therapy modifications (70%) and appointments’ rescheduling (51%). 49 patients and 19 caregivers were interviewed, reporting good care experience (average of 1–5 satisfaction score of 3.9 and 4.2, respectively). The majority (83% and 84%) declared they would use TM after the pandemics.ConclusionsAlthough feasibility is still limited for some patients, TM can be a satisfactory alternative to in-person visits for palliative care patients in need of limiting access to the hospital.

The comparison of 3 approaches with neuropathic cancer pain diagnosis demands that careful etiological assessment and standardized clinical criteria be applied to this clinical condition., Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.

Objectives Recent evidences show that early integration of palliative care (PC) with oncology has a positive impact on patients' quality of life, quality of care and costs. However, there is no consensus on outpatient referral criteria. Based on real world data, the aim of this study was to identify timing and factors associated to PC referral in patients with thoracic malignancies, and to describe their clinical care pathway. Material and Methods This observational retrospective study included consecutive patients with thoracic cancer, seen for the first time at the Thoracic Medical Oncology outpatient Clinic (TMOC) of our institution, between Jan.01-Dec.31 2014. Patients were followed-up till death or Dec.31 2015. Clinical and demographic data were collected from the electronic patient records. Cox regression models were used to evaluate the association between time to Palliative care Outpatient Clinic (POC) referral and performance status (PS), disease stage and symptoms at inclusion. Results 229 patients were eligible. 98 of them (43%; 95%IC 36%–49%) were referred to the POC within a median of 30 days (IQR 4–188). 80/98 patients received simultaneous anticancer therapy and PC. Univariable analysis showed that the hazard ratio (HR) of being referred to POC was significantly higher for patients with worse PS (HR = 4.5), more advanced disease stage (HR = 3.1), pain (HR = 4.9), dyspnea (HR = 2.5) and cough (HR = 2.2). The multivariable model confirmed independent prognostic value for PS, disease stage and pain. On Dec.31, 2015, 25/98 patients were still alive, 8 were lost at follow up and 65 had died. Among the latter, 61% died with hospice or home care, and, in the last 30 days of life, 16% received chemotherapy and 29% were admitted to hospital. Conclusions Our results suggest considering symptom burden, PS and disease stage as screening criteria for referral to PC in patients with thoracic malignancies.

299 Background: Bone is one of the most common site of metastasis occurring in 30% of metastatic renal cell carcinoma (mRCC) patients (pts)3,4. Skeletal metastases from mRCC are usually osteolytic and associated to high rate of morbidity and complication through skeletal related events (SRE). Bone-targeted therapies (BTT) such as zolendronic acid (ZOL AC) and denosumab (Dmab), shown to decrease the time-to-first and subsequent SREs12. Osteonecrosis of the jaw (ONJ) is a rare but potentially serious adverse event associated with BTT. It occurs in 1-2% of pts treated with BTT and in 10-17% of mRCC pts treated with ZOL AC or Dmab. Vascular endothelial growth factor-Tyrosine kinase inhibitors (VEGF-TKI) represent the backbone treatment for mRCC. Nevertheless, it is unclear whether the association of DMAB and ZOL AC to VEGF-TKITTagents could be associated to higher incidence of ONJ. Methods: We retrospectively collected data, from 2 Italian referring centers for mRCC, about 74 pts with bone metastases from mRCC who received, concurrently or sequentially to VEGF-TKI or immune-oncology (IO), AC ZOL and DMAB from January 2013 to January 2020. All pts provided informed consent for inclusion in the study. Results: All pts received VEGF-TKI as first line treatment. 17 pts received AC ZOL whereas 57 received DMAB. All pts received odontological consultation and orthopantomography before start BTT. The median time of Dmab and AC ZOL exposure was 11.6 months. ONJ occurred in 10/74 pts (7.4%): 6/10 pts were on first line treatment and 4/10 on second line. Treatments administered at the time of ONJ diagnosis were nivolumab (1/10), cabozantinib (2/10), sorafenib (1/10), sorafenib (1/10), sunitinib (4/10) and one pts was off therapy. Conclusions: In this real-life Italian population, treatment with BTT in mRCC pts treated with VEGF-TKI inhibitors and IO is associated to higher incidence of ONJ compared to previous report of pts treated with BTT for bone metastasis and lower compared to previous reports in mRCC. Despite the retrospective collection, we provided one of the largest sample of pts treated concurrently with VEGF-TKI or IO and BTT. Physicians should be careful in the use of BTT combined with other treatments in mRCC pts.

Too big, fragmented, rundown and inaccessible. These and others are the reasons which the City of Rome used to justify the demolition of Tor Bella Monaca. A few questions should be asked here. Is it possible to turn the problems into potential for regenerating the neighbourhood? Is it possible to use a new description of Tor Bella Monaca to demonstrate that the project proposed by the City administration will not solve the problems identified? Strategic objectives for the regeneration project were formulated on the basis of the problems. These were permeability, connection and relationship. The map of the areas which can be changed is used as the key factor in the process. On the one hand it identifies the areas and spatial categories in which the strategic objectives are concretely addressed and on the other hand - thanks to a process of interpretation and abstraction - it is open to the determination of regenerative strategies.

Č ancora possibile parlare di spazio pubblico oggi? Se per spazio pubblico si fa riferimento ai modelli tradizionali di piazza, strada e parco, coincidenti allo spazio aperto, allora č possibile affermare che lo spazio pubblico č ormai obsoleto, cristallizzato in un immagine non piů rispondente alle necessitŕ contemporanee. La staticitŕ presupposta dalle figure archetipe oggi non č piů valida, tempo e spostamento sono fattori a cui il progetto deve far riferimento. Č necessaria un'innovazione tipologica dello spazio pubblico, in grado di interpretare complessitŕ, dinamicitŕ e stratificazione della cittŕ contemporanea. Tale innovazione passa indubbiamente attraverso l'ibridazione dei tipi tradizionali: un'evoluzione trasversale tra le tipologie dello spazio pubblico, tra tipologie dello spazio pubblico e spazio abitato e tra tipologie ibride ed usi urbani.

Context Oxycodone and morphine are recommended as first-choice opioids for moderate/severe cancer pain, but evidence about their relative tolerability has significant methodological limitations. Objectives This study was mainly aimed at comparing the risk of developing adverse events (AEs) with controlled-release oral morphine vs. oxycodone; secondary aims were comparing their analgesic efficacy and testing heterogeneity in tolerability across different age and renal function subgroups. Methods An open-label multicenter RCT (EudraCT number: 2006-003151-21) was carried out in patients with moderate/severe cancer pain. At baseline, 7 and 14 days, patients scored on 0–10 rating scales (0–10 numerical rating scale) the intensity of pain and of a list of common opioid side effects. The primary end point was the percentage of patients reporting an AE (a worsening ≥ 2 points on any of the listed side effects); tolerability by subgroups and average follow-up pain intensity were compared through regression models. Results One hundred eighty-seven patients were enrolled (47% of originally planned). Intention to treat (ITT) analysis (N = 185, morphine 94, oxycodone 91) did not show any difference in the risk of developing AEs (risk difference −0.6%, 95% CI −11.0% to 9.9%) nor in analgesia (0–10 numerical rating scale pain intensity difference −0.28, 95% CI −0.83 to 0.27). No evidence of heterogeneity of tolerability across age and renal function patient subgroups emerged. Conclusion This trial failed to show any difference in tolerability and analgesic efficacy of morphine and oxycodone as first-line treatment for moderate/severe cancer pain but results interpretation is difficult due to lack of power, potential bias from open-label design, and concerns about assay sensitivity. These data, however, can significantly contribute to future meta-analyses comparing WHO Step-III opioids and are relevant in designing future randomized studies.

Increased security risk in international travel has resulted in the creation of new programs to determine the admissibility of foreign travelers at official ports of entry within a country. Primary program goals are improving border security and, at the same time, facilitating the flow of legitimate travelers. Major program requirements include the adoption of machine readable travel documents (i.e., passports, visas, etc.), the use of biometric identifiers, and the interoperability among multiple information systems for travelers? identity verification and background checks. Performance analysis of a border inspection system early in its development life-cycle is essential to predict its ability to meet established performance goals, to identify key performance drivers and potential bottlenecks and to suggest possible design improvements. This paper presents our experience with performance evaluation of a hypothetical inspection system. We adopt an analytical modeling technique based on Layered Queuing Networks. Compared with similar studies which use extensive simulations, we observe that our methodology achieves comparably accurate results while being simpler and less costly.

An increasing number of applications operate in heterogeneous computing environments, often with mobile components. Methodologies that help developers assess the ability of such applications to meet their performance requirements throughout the software life-cycle are needed. In particular, early in the design phases, analysis techniques are critical for ensuring the future system's behavior, evaluating and comparing design alternatives. A performability evaluation is the most appropriate means to assess the expected system's ability to perform, including the effects of component failures and repairs. This paper focuses on model-based analysis of performability of mobile software systems. We propose a general methodology that starts from design artifacts expressed in a UML-based notation. Inferred performability models are based on the stochastic activity networks notation. The viability of the proposed approach is demonstrated through its application in a case study.

New Next Nature takes root in precise places and flourishes by exploiting the conditions of the “suspended” and “waiting” areas. OC OPEN CITY International Summer School has always had, since its first edition in 2010, a recognizable identity: to develop projects with global themes, experimenting and testing them locally, in the complementary landscapes that the particular urban and territorial condition of Piacenza gives us. The preparatory phase for OC2017 has further strengthened this double register by developing a rich and integrated background where the dense and stable parts of city is continuously compared with large areas (highlighted in yellow and black in the diagram alongside) available for transformation. The will of the OC direction and coordination is precise to the condition that no categories are proposed: empty areas and abandoned areas, internal areas and external areas, private areas and public areas, areas with precise functional destination and areas without definition.

The essay “The urban project as a project of modification” focuses on three different aspects: the architecture as a disciplinary corpus of spatial composition of the space, the city as Carlo Cattaneo describes it, as: "the principle of all histories" and finally the definition following the concept of creativity, as modification of the existing (Vittorio Gregotti). This triad of key words - that has connoted the title of the Summer School, edition 2014 - reflects on the relationship that has been developed in the twentieth century between architectural design and urban planning, but above all concentrating on a possible new relationship in response to the growing needs of the cities and searching the answers that are appropriate with the need for transformation.

The book, aimed to give a point of view, collects both the answer given by the students and the theoretical thoughts of scientific directors, professors and tutors who have guided the students during the fifth edition of the OC Open City International Summer School of Piacenza: "Architecture for the Creative City".