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2. An Integrated Low-Cost Monitoring Platform to Assess Air Quality Over Large Areas

Author

Brilli, L., Carotenuto, F., Gioli, B., Berton, A., Profeti, S., Gualtieri, G., Andreini, B. P., Stefanelli, M., Martelli, F., Vagnoli, C., Zaldei, A., Kacprzyk, Janusz, Series Editor, Pal, Nikhil R., Advisory Editor, Bello Perez, Rafael, Advisory Editor, Corchado, Emilio S., Advisory Editor, Hagras, Hani, Advisory Editor, Kóczy, László T., Advisory Editor, Kreinovich, Vladik, Advisory Editor, Lin, Chin-Teng, Advisory Editor, Lu, Jie, Advisory Editor, Melin, Patricia, Advisory Editor, Nedjah, Nadia, Advisory Editor, Nguyen, Ngoc Thanh, Advisory Editor, Wang, Jun, Advisory Editor, Arai, Kohei, editor, Kapoor, Supriya, editor, and Bhatia, Rahul, editor

Published
2021
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8. Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Author

Cenzato, F, Milani, G, Amigoni, A, Sperotto, F, Bianchetti, M, Agostoni, C, Montini, G, Farello, G, Chiarelli, F, Greco, R, Di Lollo, F, Rocco Forte, F, Manieri, S, Carpino, L, Caloiero, M, Cirisano, A, Bragho, S, Della Casa, R, Nunziata, F, Pecoraro, C, Pacifico, R, Lanari, M, Ghizzi, C, Serra, L, Stella, M, Maggiore, G, Fiorini, R, Dodi, I, Morelli, A, Lughetti, L, Cella, A, Vergine, G, De Fanti, A, Dragovic, D, Santori, D, Cozzi, G, Cogo, P, Raponi, M, Lubrano, R, de Martinis, M, Gatto, A, Barbieri, M, Reale, A, Bracaglia, G, Piccotti, E, Borea, R, Gaiero, A, Martelli, L, Arrighini, A, Cianci, P, Cavalli, C, De Santis, L, Pietra, B, Biondi, A, Sala, M, Pogliani, L, Cherubini, S, Bellini, M, Bruni, P, Traina, G, Tommasi, P, Del Barba, P, Arrigoni, S, Salvini, F, Bernardo, L, Bertolozzi, G, Fasoli, S, Marseglia, G, Palumbo, E, Bosco, A, Mirri, G, Fabiani, E, Ruffini, E, Pieragostini, L, Fornaro, M, Ripanti, G, Pannoni, D, Enrico, F, Perona, A, Tappi, E, Nis Haitink, O, Rabbone, I, Capalbo, P, Urbino, A, Guala, A, Cosi, G, Barracchia, M, Martire, B, Cardinale, F, Moramarco, F, Perrone, C, Campanozzi, A, Cecinati, V, Canetto, A, Clemente, C, Cualbu, A, Narducci, F, Mula, G, Bulciolu, P, Antonucci, R, Gramaglia, G, Cavaleri, G, Salpietro, C, Corsello, G, Salvo, R, Palmeri, M, Vitale, M, Morgano, A, Falorni, S, Peroni, D, Masi, S, Bertini, A, Vaccaro, A, Vasarri, P, Reinstadler, P, Soffiati, M, Stefanelli, M, Verrotti di Pianella, A, Bertone, C, Marzini, S, Da Dalt, L, Rugolotto, S, Scozzola, F, Ecclesio Livio, L, Cinquetti, M, Silvagni, D, Bellettato, M, Cenzato F., Milani G. P., Amigoni A., Sperotto F., Bianchetti M. G., Agostoni C., Montini G., Farello G., Chiarelli F., Greco R., Di Lollo F., Rocco Forte F., Manieri S., Carpino L., Caloiero M., Cirisano A., Bragho S., Della Casa R., Nunziata F., Pecoraro C., Pacifico R., Lanari M., Ghizzi C., Serra L., Stella M., Maggiore G., Fiorini R., Dodi I., Morelli A., Lughetti L., Cella A., Vergine G., De Fanti A., Dragovic D., Santori D., Cozzi G., Cogo P., Raponi M., Lubrano R., de Martinis M., Gatto A., Barbieri M. A., Reale A., Bracaglia G., Piccotti E., Borea R., Gaiero A., Martelli L., Arrighini A., Cianci P., Cavalli C., De Santis L., Pietra B. C., Biondi A., Sala M., Pogliani L. M., Cherubini S., Bellini M., Bruni P., Traina G., Tommasi P., Del Barba P., Arrigoni S., Salvini F. M., Bernardo L., Bertolozzi G., Fasoli S., Marseglia G. L., Palumbo E., Bosco A., Mirri G., Fabiani E., Ruffini E., Pieragostini L., Fornaro M., Ripanti G., Pannoni D., Enrico F., Perona A., Tappi E., Nis Haitink O., Rabbone I., Capalbo P. T., Urbino A., Guala A., Cosi G., Barracchia M. G., Martire B., Cardinale F., Moramarco F., Perrone C., Campanozzi A., Cecinati V., Canetto A., Clemente C., Cualbu A., Narducci F., Mula G., Bulciolu P., Antonucci R., Gramaglia G., Cavaleri G., Salpietro C., Corsello G., Salvo R., Palmeri M., Vitale M. A., Morgano A., Falorni S., Peroni D., Masi S., Bertini A., Vaccaro A., Vasarri P., Reinstadler P., Soffiati M., Stefanelli M., Verrotti di Pianella A., Bertone C., Marzini S., Da Dalt L., Rugolotto S., Scozzola F., Ecclesio Livio L., Cinquetti M., Silvagni D., Bellettato M., Cenzato, F, Milani, G, Amigoni, A, Sperotto, F, Bianchetti, M, Agostoni, C, Montini, G, Farello, G, Chiarelli, F, Greco, R, Di Lollo, F, Rocco Forte, F, Manieri, S, Carpino, L, Caloiero, M, Cirisano, A, Bragho, S, Della Casa, R, Nunziata, F, Pecoraro, C, Pacifico, R, Lanari, M, Ghizzi, C, Serra, L, Stella, M, Maggiore, G, Fiorini, R, Dodi, I, Morelli, A, Lughetti, L, Cella, A, Vergine, G, De Fanti, A, Dragovic, D, Santori, D, Cozzi, G, Cogo, P, Raponi, M, Lubrano, R, de Martinis, M, Gatto, A, Barbieri, M, Reale, A, Bracaglia, G, Piccotti, E, Borea, R, Gaiero, A, Martelli, L, Arrighini, A, Cianci, P, Cavalli, C, De Santis, L, Pietra, B, Biondi, A, Sala, M, Pogliani, L, Cherubini, S, Bellini, M, Bruni, P, Traina, G, Tommasi, P, Del Barba, P, Arrigoni, S, Salvini, F, Bernardo, L, Bertolozzi, G, Fasoli, S, Marseglia, G, Palumbo, E, Bosco, A, Mirri, G, Fabiani, E, Ruffini, E, Pieragostini, L, Fornaro, M, Ripanti, G, Pannoni, D, Enrico, F, Perona, A, Tappi, E, Nis Haitink, O, Rabbone, I, Capalbo, P, Urbino, A, Guala, A, Cosi, G, Barracchia, M, Martire, B, Cardinale, F, Moramarco, F, Perrone, C, Campanozzi, A, Cecinati, V, Canetto, A, Clemente, C, Cualbu, A, Narducci, F, Mula, G, Bulciolu, P, Antonucci, R, Gramaglia, G, Cavaleri, G, Salpietro, C, Corsello, G, Salvo, R, Palmeri, M, Vitale, M, Morgano, A, Falorni, S, Peroni, D, Masi, S, Bertini, A, Vaccaro, A, Vasarri, P, Reinstadler, P, Soffiati, M, Stefanelli, M, Verrotti di Pianella, A, Bertone, C, Marzini, S, Da Dalt, L, Rugolotto, S, Scozzola, F, Ecclesio Livio, L, Cinquetti, M, Silvagni, D, Bellettato, M, Cenzato F., Milani G. P., Amigoni A., Sperotto F., Bianchetti M. G., Agostoni C., Montini G., Farello G., Chiarelli F., Greco R., Di Lollo F., Rocco Forte F., Manieri S., Carpino L., Caloiero M., Cirisano A., Bragho S., Della Casa R., Nunziata F., Pecoraro C., Pacifico R., Lanari M., Ghizzi C., Serra L., Stella M., Maggiore G., Fiorini R., Dodi I., Morelli A., Lughetti L., Cella A., Vergine G., De Fanti A., Dragovic D., Santori D., Cozzi G., Cogo P., Raponi M., Lubrano R., de Martinis M., Gatto A., Barbieri M. A., Reale A., Bracaglia G., Piccotti E., Borea R., Gaiero A., Martelli L., Arrighini A., Cianci P., Cavalli C., De Santis L., Pietra B. C., Biondi A., Sala M., Pogliani L. M., Cherubini S., Bellini M., Bruni P., Traina G., Tommasi P., Del Barba P., Arrigoni S., Salvini F. M., Bernardo L., Bertolozzi G., Fasoli S., Marseglia G. L., Palumbo E., Bosco A., Mirri G., Fabiani E., Ruffini E., Pieragostini L., Fornaro M., Ripanti G., Pannoni D., Enrico F., Perona A., Tappi E., Nis Haitink O., Rabbone I., Capalbo P. T., Urbino A., Guala A., Cosi G., Barracchia M. G., Martire B., Cardinale F., Moramarco F., Perrone C., Campanozzi A., Cecinati V., Canetto A., Clemente C., Cualbu A., Narducci F., Mula G., Bulciolu P., Antonucci R., Gramaglia G., Cavaleri G., Salpietro C., Corsello G., Salvo R., Palmeri M., Vitale M. A., Morgano A., Falorni S., Peroni D., Masi S., Bertini A., Vaccaro A., Vasarri P., Reinstadler P., Soffiati M., Stefanelli M., Verrotti di Pianella A., Bertone C., Marzini S., Da Dalt L., Rugolotto S., Scozzola F., Ecclesio Livio L., Cinquetti M., Silvagni D., and Bellettato M.

Abstract

Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques.What is Known:• Several guidelines are published on the management of children with suspected or confirmed urinary tract infection.• No data are available on the management of pediatric urinary tract infections in the emergency setting.What is New:• Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture.• Diagnostic

Published
2022

11. Smooth Integration of Decision Support into an Existing Electronic Patient Record

Author

Quaglini, S., Panzarasa, S., Cavallini, A., Micieli, G., Pernice, C., Stefanelli, M., Hutchison, David, editor, Kanade, Takeo, editor, Kittler, Josef, editor, Kleinberg, Jon M., editor, Mattern, Friedemann, editor, Mitchell, John C., editor, Naor, Moni, editor, Nierstrasz, Oscar, editor, Pandu Rangan, C., editor, Steffen, Bernhard, editor, Sudan, Madhu, editor, Terzopoulos, Demetri, editor, Tygar, Dough, editor, Vardi, Moshe Y., editor, Weikum, Gerhard, editor, Carbonell, Jaime G., editor, Siekmann, Jörg, editor, Miksch, Silvia, editor, Hunter, Jim, editor, and Keravnou, Elpida T., editor

Published
2005
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12. Navigating the “liberation procedure”: a qualitative study of motivating and hesitating factors among people with multiple sclerosis

Author

Ploughman M, Harris C, Hogan SH, Murray C, Murdoch M, Austin MW, and Stefanelli M

Subjects
Medicine (General), R5-920
Abstract

Michelle Ploughman,1 Chelsea Harris,1 Stephen H Hogan,1 Cynthia Murray,2 Michelle Murdoch,3 Mark W Austin,1 Mark Stefanelli4 1Recovery and Performance Laboratory, Faculty of Medicine, 2School of Nursing, Memorial University, 3Coalition of Persons with Disabilities, 4Department of Neurology, Faculty of Medicine, Memorial University, St John’s, NL, Canada Background: The debate within the multiple sclerosis (MS) community initiated by the chronic cerebrospinal venous insufficiency (CCSVI) hypothesis and the subsequent liberation procedure placed some people with MS at odds with health care professionals and researchers.Objective: This study explored decision making regarding the controversial liberation procedure among people with MS.Subjects and methods: Fifteen people with MS (procedure, n=7; no procedure, n=8) participated in audiotaped semistructured interviews exploring their thoughts and experiences related to the liberation procedure. Data were transcribed and analyzed using an iterative, consensus-based, thematic content-analysis approach.Results: Participants described an imbalance of motivating factors affirming the procedure compared to hesitating factors that provoked the participant to pause or reconsider when deciding to undergo the procedure. Collegial conversational relationships with trusted sources (eg, MS nurse, neurologist) and ability to critically analyze the CCSVI hypothesis were key hesitating factors. Fundraising, family enthusiasm, and the ease of navigation provided by medical tourism companies helped eliminate barriers to the procedure.Conclusion: Knowledge of factors that helped to popularize the liberation procedure in Canada may inform shared decision making concerning this and future controversies in MS. Keywords: alternative medicine, CCSVI, decision making, liberation, multiple sclerosis, qualitative

Published
2014

13. Guidelines-Based Workflow Systems

Author

Quaglini, S., Mossa, C., Fassino, C., Stefanelli, M., Cavallini, A., Micieli, G., Goos, G., editor, Hartmanis, J., editor, van Leeuwen, J., editor, Carbonell, J. G., editor, Siekmann, J., editor, Horn, Werner, editor, Shahar, Yuval, editor, Lindberg, Greger, editor, Andreassen, Steen, editor, and Wyatt, Jeremy, editor

Published
1999
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19. Process Engineering and Interfacial Defects Passivation of Large Area Perovskite Solar Modules

Author

Vesce, L., Stefanelli, M., Razza, S., Castriotta, L.A., Di Giacomo, F., and Di Carlo, A.

Subjects
Perovskites, Evolving and Emerging Technologies: Tandems, Thin Film absorbers, III-V, New Materials and Concepts, Advanced Modelling
Abstract

8th World Conference on Photovoltaic Energy Conversion; 252-254, The industrial and economical transition of the perovskite (PVSK) photovoltaic (PV) technology is feasible by scaling-up effective PVSK recipe and post-treatment from small area cells ( 1 cm2) to sub-modules (≥ 200 cm2). In this work, we reported on the ambient air fabrication of a low temperature planar n-i-p PVSK submodule (total area 320 cm2, aperture area 201 cm2, 93% GFF) exploiting the defect passivation strategy, the PVSK composition and a hybrid blade/slot-die coating technique assisted by air and green antisolvent quenching method. Finally, the sub-module record efficiency is 16.13% with 7% and 0% losses with respect to small area cell and minimodule, respectively. Further details, characterizations, life cycle assessment (LCA) and stability test are in the full paper submitted to Progress in Photovoltaics.

Published
2022
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20. The cortisol burden in elderly subjects with metabolic syndrome and its association with low-grade inflammation

Author

Martocchia A., Gallucci M., Noale M., Maggi S., Cassol M., Stefanelli M., Postacchini D., Proietti A., Barbagallo M., Dominguez Rodriguez LJ, Ferri C., Desideri G., Toussan L., Pastore F., Falaschi G. M., Paolisso G., Falaschi P., Eleuteri S., D'Urso R., Petricca L., Cardelli P., Oddo M. G., Giuli C., Macchiati I., Migale M., Sorvillo F., Brunelli R., Francavilla M., Santini S., Marini L., Santillo E., Fallavollita L., Rotunno S., Barbieri M., Angellotti E., Ludovici V., Cheli P., Del Pinto R., Dominguez L. J., Di Bella G., Culotta V., Martocchia A., Gallucci M., Noale M., Maggi S., Cassol M., Stefanelli M., Postacchini D., Proietti A., Barbagallo M., Dominguez Rodriguez LJ, Ferri C., Desideri G., Toussan L., Pastore F., Falaschi G.M., Paolisso G., Falaschi P., Eleuteri S., D'Urso R., Petricca L., Cardelli P., Oddo M.G., Giuli C., Macchiati I., Migale M., Sorvillo F., Brunelli R., Francavilla M., Santini S., Marini L., Santillo E., Fallavollita L., Rotunno S., Barbieri M., Angellotti E., Ludovici V., Cheli P., Del Pinto R., Dominguez L.J., Di Bella G., Culotta V., Martocchia, A., Gallucci, M., Noale, M., Maggi, S., Cassol, M., Stefanelli, M., Postacchini, D., Proietti, A., Barbagallo, M., Dominguez, L. J., Ferri, C., Desideri, G., Toussan, L., Pastore, F., Falaschi, G. M., Paolisso, G., Falaschi, P., Eleuteri, S., D'Urso, R., Petricca, L., Cardelli, P., Oddo, M. G., Giuli, C., Macchiati, I., Migale, M., Sorvillo, F., Brunelli, R., Francavilla, M., Santini, S., Marini, L., Santillo, E., Fallavollita, L., Rotunno, S., Barbieri, M., Angellotti, E., Ludovici, V., Cheli, P., Del Pinto, R., Di Bella, G., and Culotta, V.

Subjects
Male, Aging, medicine.medical_specialty, Settore MED/09 - Medicina Interna, Hydrocortisone, Urinary system, Neurological examination, Urine, Gastroenterology, Cortisol, aging, cortisol, Inflammation, metabolic syndrome, aged, 80 and over, echocardiography, female, humans, hydrocortisone, inflammation, male, Excretion, Metabolic syndrome, Aged, Aged, 80 and over, Echocardiography, Female, Humans, Metabolic Syndrome, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, 030212 general & internal medicine, Creatinine, medicine.diagnostic_test, business.industry, Carotid ultrasonography, medicine.disease, chemistry, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, Hormone
Abstract

Background: Elderly people are exposed to an increased load of stressful events and neuro-hormonal stimulation is a key finding in metabolic syndrome and its related disorders. Aims: To determine the role of cortisol in elderly subjects, with or without metabolic syndrome (MetS), by means of a national multicentre observational study, AGICO (AGIng and Cortisol). Methods: From 2012 to 2017, the AGICO study enrolled n.339 subjects (aged > 65), after obtaining their informed consent. The investigators assessed a cardio-metabolic panel (including electrocardiogram, carotid ultrasonography and echocardiography), the presence of MetS (on Adult Treatment Panel III criteria), a neurological examination (including brain imaging), and cortisol activity (using a consecutive collection of diurnal and nocturnal urine). Results: In the patients presenting with MetS, the standardized diurnal and nocturnal cortisol excretion rates were 210.7 ± 145.5 and 173.7 ± 118.1 (mean ± standard deviation) μg/g creatinine/12h; in those without MetS, the standardized diurnal and nocturnal cortisol excretion rates were 188.7 ± 92.7 and 144.1 ± 82.3μg/g creatinine/12h, respectively (nocturnal urinary cortisol in patients with MetS versus those without MetS p = 0.05, female patients with MetS vs female patients without MetS, p < 0.025). A significant positive correlation was found between the CRP levels and both the diurnal and nocturnal urinary cortisol levels with r = 0.187 (p < 0.025) and r = 0.411 (p < 0.00000001), respectively. Discussion: The elderly patients with MetS showed a trend towards increased standardized nocturnal cortisol excretions, with particular regard to the female subjects. Conclusion: The positive correlation between cortisol excretion and low-grade inflammation suggests a common mechanism driving both hormonal and inflammatory changes.

Published
2020

32. Potenziale uso di idrolati in forma 'GELYD' come prevenzione per biodeteriogeni in ambienti confinati

Author

Di Vito M., Bellardi M. G., Colaizzi P., Ruggiero D., Mazzuca C., Micheli M., Paolesse R., Stefanelli M., Capuano R., Mondello F., Mattarelli P., Sclocchi M. C., and Di Vito M., Bellardi M.G., Colaizzi P., Ruggiero D., Mazzuca C., Micheli M., Paolesse R., Stefanelli M., Capuano R., Mondello F., Mattarelli P., Sclocchi M.C.

Subjects
GELYD, Citrus aurantium, Monarda citriodora, Beni cuturali cartacei
Abstract

Gli oli essenziali, così come gli idrolati, sono considerati composti bioattivi di origine vegetale e quindi “naturali”. Questo spiega il sempre maggiore interesse verso le potenzialità in svariati ambiti compreso quello della conservazione del patrimonio culturale. Uno dei problemi più annosi da risolvere nel campo della conservazione dei documenti grafici è il trattamento preliminare al restauro per mettere in sicurezza l’opera dal punto di vista microbiologico. Questo problema è stato affrontato dal nostro gruppo di ricerca sviluppando uno studio volto a valutare l’efficacia degli idrolati quando integrati nel gel di gellano (GELYD) per conferirgli un’azione citocida verso i biodeteriogeni della carta. La fase successiva al nostro studio è stata quella di indagare l’azione del GELYD quando posto in ambienti confinati non a diretto contatto con l’opera al fine di valutarne l’azione preventiva vs l’attacco di biodeteriogeni al patrimonio cartaceo. Dati preliminari di laboratorio sono stati ottenuti utilizzando contenitori di diverso volume (piccoli, medi e grandi) sul fondo dei quali sono stati posti tasselli di carta Whatman assieme a piastre Petri contenenti 15 ml di solo gellano o di GELYD ottenuto con idrolati di Monarda citriodora o Citrus aurantium. Sono stati condotti due tipologie di esperimenti. Nel primo caso i tasselli di carta sono stati seminati con 50 l di una sospensione caratterizzata da ceppi fungini isolati da opere cartacee (Aspergillus sydowii, Penicillium chrysogenum e Cladosporium spherospermum) e, settimanalmente, è stato valutato il segnale dell’ATP presente sui tasselli trattati e di controllo. Nel secondo caso i campioni di carta Whatman sono stati lasciati a temperatura ambiente per 7-14 e 21 gg per poi essere analizzati al settimo e al quattordicesimo giorno mediante analisi dei composti volatili eseguita con gascromatografia abbinata a spettrometria di massa (GC-MS). Mentre tutti e tre i tempi sono stati analizzati per la qualità dell’aria negli ambienti confinati mediante campionamento dei composti volatili con tecnica di preconcentrazione denominata microestrazione in fase solida (Solid Phase Microextraction-SPME). I risultati delle analisi microbiologiche mostrano come il GELYD sia in grado di abbattere la carica fungina quando posto in ambienti confinati. Mentre, i dati ottenuti dall’analisi relativa alla qualità dell’aria e ai residui sulla carta, indicano che le componenti volatili terpeniche degli idrolati sono rilevabili sin dai primi giorni di esposizione del GELYD nell’ambiente confinato; le stesse componenti non sono rilevabili sulla carta sin tanto che, per deposizione, non raggiungono una concentrazione superiore alla soglia di sensibilità dello strumento che, nel nostro caso, è raggiunto solo dopo i primi 14 giorni di esposizione. I nostri dati preliminari individuano un nuovo potenziale uso del GELYD nella prevenzione della contaminazione da biodeteriogeni del patrimonio cartaceo posto in ambienti confinati, anche se ulteriori indagini volte a valutarne la sicurezza d’uso sull’opera sono necessarie e in fase di sviluppo.

Published
2018

46. Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: a qualitative study nested in a randomized controlled trial

Author

Borreani, C., Giovannetti, A. M., Bianchi, E., Giordano, A., Cilia, S., Cipollari, S., Rossi, I., Cavallaro, C., Clerici, V. Torri, Rossetti, E., Stefanelli, M. C., Totis, A., Pappalardo, A., Occhipinti, G., Confalonieri Paolo, Veronese, S., Grasso, M. G., Patti, F., Zaratin, P., Battaglia, M. A., and Solari, A.

Published
2018

47. Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: A qualitative study

Author

Giovannetti, A. M., Borreani, C., Bianchi, E., Giordano, A., Cilia, S., Cipollari, S., Rossi, I., Cavallaro, C., Clerici, V. T., Rossetti, E., Stefanelli, M. C., Totis, A., Pappalardo, A., Occhipinti, G., Confalonieri, P., Veronese, S., Grasso, M. G., Patti, F., Zaratin, P., Battaglia, M. A., Solari, A., Amadeo, R., Ponzio, M., Lugaresi, A., Martino, G., Palmisano, L., Pagano, E., Radice, D., Farinotti, M., Ferrari, G., Rosato, R., Oliver, D. J., Pucci, E., Tesio, L., Pietrolongo, E., Giuntoli, M., Fittipaldo, A., Cugno, C., Causarano, R., Morino, P., Campanella, A., Mantegazza, R., Tucci, L., Ippoliti, F., Morone, G., Fusco, A., Cascio, V., Cimino, V., Zagari, F., Lopes de Carvalho, M. L., Motta, R., Onofrj, M., Da Col, D., and Casale, G.

Subjects
Male, Genetics and Molecular Biology (all), Palliative care, Medical Doctors, Psychologists, Team Role Inventories, Health Care Providers, medicine.medical_treatment, Nurses, Social Sciences, lcsh:Medicine, Referring Physician, Severity of Illness Index, Biochemistry, law.invention, 0302 clinical medicine, Sociology, Randomized controlled trial, Biochemistry, Genetics and Molecular Biology (all), Agricultural and Biological Sciences (all), law, Medicine and Health Sciences, Medical Personnel, 030212 general & internal medicine, Human Families, lcsh:Science, Aged, 80 and over, Multidisciplinary, Rehabilitation, Palliative Care, Neurodegenerative Diseases, Qualitative Studies, Middle Aged, Home Care Services, Professions, Neurology, Research Design, Female, Psychology, Research Article, Adult, Multiple Sclerosis, Drug Research and Development, Patients, Immunology, Research and Analysis Methods, Autoimmune Diseases, 03 medical and health sciences, Nursing, Physicians, Intervention (counseling), medicine, Humans, Clinical Trials, Aged, Pharmacology, lcsh:R, Biology and Life Sciences, Demyelinating Disorders, Focus group, Randomized Controlled Trials, Health Care, People and Places, Population Groupings, Clinical Immunology, lcsh:Q, Clinical Medicine, 030217 neurology & neurosurgery, Qualitative research
Abstract

Background We performed a qualitative study to investigate the experiences of participants in a multicentre randomized controlled trial on a home-based palliative approach (HPA) for adults with severe multiple sclerosis (MS) and their caregivers. Our aim was to explore the strengths and challenges of the intervention, and circumstances that may have influenced its efficacy. Methods Participants to the qualitative study were the patients, their caregivers, patient referring physicians, and the teams who delivered the HPA intervention. We performed semi-structured one-on-one interviews with 12 patients and 15 informal caregivers chosen using a maximum variation strategy, two focus group meetings with patient referring physicians (4 participants each), and one with the HPA teams (9 participants). Results From data analysis (framework method) 38 sub-categories emerged, which were grouped into 10 categories and 3 themes: 'expectations,' 'met and unmet needs', and 'barriers’. Intervention benefits were improved control of symptoms and reduced sense of isolation of the patient-caregiver dyads. Limitations were: factors related to experimental design (difficulty of dyads in identifying examiner and team roles, additional burden for caregivers); team issues (insufficient team building /supervision, competing priorities); limitations of the intervention itself (insufficient length, lack of rehabilitation input); and external factors (resource limitations, under-responsive services/professionals). The referring physician focus groups provided little experiential data. Conclusions The HPA reduced patient symptoms and sense of isolation in patients and caregivers. The indirect role of the HPA teams, and insufficient length of the intervention were key limitations. The experimental design imposed additional burdens on the dyads. Key barriers were the paucity of available services, the demanding administrative procedures, and lack of networking facilities. These findings suggest that two major requirements are necessary for home palliative care to be effective in this patient population: HPA teams well-connected with MS rehabilitation services, and care delivered over the long-term, with variable intensity. Trial registration Current Controlled Trials ISRCTN73082124 (Registered 19/06/2014).

Published
2018

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