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Pubblicazioni - Marzorati Dott.ssa Chiara
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Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer.
Health Qual Life Outcomes2019 Aug;17(1):147. doi: 10.1186/s12955-019-1214-x.
Marzorati Chiara, Monzani Dario, Mazzocco Ketti, Masiero Marianna, Pavan Francesca, Monturano Massimo, Pravettoni Gabriella
Abstract
BACKGROUND:
This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite - Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients.
METHODS:
Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45?days (T1) and 3?months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations.
RESULTS:
At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach's alphas could be classified as acceptable (i.e., above .65) except for low Cronbach's alpha for hormonal dysfunction at T1 (i.e., .638) and urinary irritation at both waves. (i.e., respectively .585 and .518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above .500) to good test-retest reliability (i.e. ICC for urinary incontinence?=?.764).
CONCLUSIONS:
Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients.
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Predicting trajectories of recovery in prostate cancer patients undergone Robot-Assisted Radical Prostatectomy (RARP).
PLoS One2019 ;14(4):e0214682. doi: 10.1371/journal.pone.0214682.
Marzorati Chiara, Monzani Dario, Mazzocco Ketti, Pavan Francesca, Cozzi Gabriele, De Cobelli Ottavio, Monturano Massimo, Pravettoni Gabriella
Abstract
OBJECTIVE:
To identify trends of patients' urinary and sexual dysfunctions from a clinical and psychological perspective and understand whether sociodemographic and medical predictors could differentiate among patients following different one-year longitudinal trajectories.
METHODS:
An Italian sample of 478 prostate cancer patients undergone Robot-Assisted Radical Prostatectomy completed the EPIC-26 survey between July 2015 and July 2016 at the pre-hospitalization (T0), 45 days (T1) and 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after surgery. Sociodemographic and clinical characteristics (age, BMI, diabetes, nerve-sparing procedure) were also collected. Latent Class Growth Analysis was conducted separately for sexual dysfunction and urinary incontinence EPIC-26 subscales. The association between membership in the two longitudinal trajectories of urinary and sexual dysfunctions was assessed by considering Chi-square test and its related contingency table.
RESULTS:
People who have a high level of urinary incontinence at T1 are likely to have a worse recovery. Age, BMI and pre-surgical continence may affect the level of incontinence at T1 and the recovery trajectories. Patients with low and moderate sexual problems at T1 can face a moderate linear recovery, while people with high level of impotence immediately after surgery may take a longer period to solve sexual dysfunctions. Age and the pre-surgical sexual condition may impact the recovery. Finally, a great proportion of patients reported both steady problems in sexual function and constant high levels of urinary incontinence over time.
CONCLUSIONS:
This study highlights different categories of patients at risk who may be important to know in order to develop personalized medical pathways and predictive models in a value-based healthcare.
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Empowerment from patient's and caregiver's perspective in cancer care.
Health Psychol Open;5(2):2055102918815318. doi: 10.1177/2055102918815318.
Marzorati Chiara, Bailo Luca, Mazzocco Ketti, Pravettoni Gabriella
Abstract
The caregivers' perceptions of the patients' health condition may be biased and induce them to perceive higher needs than patients actually disclose. Our aim was to assess if the level of knowledge and awareness about cancer disease and treatment, and patient participation and assistance differs between caregivers and patients. A descriptive, cross-sectional study was conducted across five countries (Italy, United Kingdom, Spain, France and Germany) on a total of 510 participants who directly (patient) or indirectly (caregiver) faced a cancer diagnosis. Investigating this divergence could help to identify possible difficulties in patient-caregiver relationship, eventually improving patient empowerment.
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A Modified Translaryngeal Tracheostomy Technique in the Neurointensive Care Unit. Rationale and Single-center Experience on 199 Acute Brain-damaged Patients.
J Neurosurg Anesthesiol2019 Jul;31(3):330-336. doi: 10.1097/ANA.0000000000000535.
Spina Stefano, Scaravilli Vittorio, Cavenaghi Giovanni, Manzolini Dario, Marzorati Chiara, Colombo Enrico, Savo Davide, Vargiolu Alessia, Citerio Giuseppe
Abstract
BACKGROUND:
Brain-injured patients frequently require tracheostomy, but no technique has been shown to be the gold standard for these patients. We developed and introduced into standard clinical practice an innovative bedside translaryngeal tracheostomy (TLT) technique aided by suspension laryngoscopy (modified TLT). During this procedure, the endotracheal tube is left in place until the airway is secured with the new tracheostomy. This study assessed the clinical impact of this technique in brain-injured patients.
MATERIALS AND METHODS:
This is a retrospective analysis of prospectively collected data from adult brain-injured patients who had undergone modified TLT during the period spanning from January 2010 to December 2016 at the Neurointensive care unit, San Gerardo Hospital (Monza, Italy). The incidence of intraprocedural complications, including episodes of intracranial hypertension (intracranial pressure [ICP] >20?mm?Hg), was documented. Neurological, ventilatory, and hemodynamic parameters were retrieved before, during, and after the procedure. Risk factors for complications and intracranial hypertension were assessed by univariate logistic analysis. Data are presented as n (%) and median (interquartile range) for categorical and continuous variables, respectively.
RESULTS:
A total of 199 consecutive brain-injured patients receiving modified TLT were included. An overall 52% male individuals who were 66 (54 to 74) years old and who had an admission Glasgow Coma Scale of 7 (6 to 10) were included in the cohort. Intracerebral hemorrhage (30%) was the most frequent diagnosis. Neurointensivists performed 130 (65%) of the procedures. Patients underwent tracheostomy 10 (7 to 13) days after intensive care unit admission. Short (ie, <2?min) and clinically uneventful increases in ICP>20?mm?Hg were observed in 11 cases. Overall, the procedure was associated with an increase in ICP from 7 (4 to 10) to 12 (7 to 18)?mm?Hg (P<0.001). Compared with baseline, cerebral perfusion pressure (CPP), respiratory variables, and hemodynamics were unchanged during the procedure (P-value, not significant). Higher baseline ICP and core temperature were associated with an increased risk of complications and intracranial hypertension. Complication rates were low: 1 procedure had to be converted to a surgical tracheostomy, and 1 (0.5%) episode of minor bleeding and 5 (2.5%) of minor non-neurological complications were recorded. Procedures performed by intensivists did not have a higher risk of complications compared with those performed by ear, nose, and throat specialists.
CONCLUSIONS:
A modified TLT (by means of suspension laryngoscopy) performed by neurointensivists is feasible in brain-injured patients and does not adversely impact ICP and CPP.
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Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review.
J Med Internet Res2018 06;20(6):e223. doi: 10.2196/jmir.9812.
Marzorati Chiara, Renzi Chiara, Russell-Edu Samuel William, Pravettoni Gabriella
Abstract
BACKGROUND:
The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined.
OBJECTIVE:
We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers.
METHODS:
We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework.
RESULTS:
We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions.
CONCLUSIONS:
Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results.
©Chiara Marzorati, Chiara Renzi, Samuel William Russell-Edu, Gabriella Pravettoni. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.06.2018.
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Intracerebral hemorrhage in Intensive Care Unit: early prognostication fallacies. A single center retrospective study.
Minerva Anestesiol2018 05;84(5):572-581. doi: 10.23736/S0375-9393.17.12225-X.
Spina Stefano, Marzorati Chiara, Vargiolu Alessia, Magni Federico, Riva Matteo, Rota Matteo, Giussani Carlo, Sganzerla Erik P, Citerio Giuseppe
Abstract
BACKGROUND:
Intracerebral hemorrhage (ICH) admitted to Intensive Care is deem of poor prognosis. The aim of this study was to compare observed and predicted 30-day mortality and to evaluate long term functional outcome in a consecutive ICH cohort.
METHODS:
Retrospective analysis of prospectively collected data of ICH patients managed in a Neuro-ICU from 2012 to 2015.
RESULTS:
Out of 136 consecutive patients, 34 (25%) had "withholding of life-sustaining treatment" (WLST) order and 102 (75%) received a "full treatment" (FT). WLST cohort: median (IQR): 72 (70-77) years old, Glasgow Coma Scale (GCS) 4 (3-4) at admission, ICH volume 114 cm3 (68-152); all patients died during neuro-ICU recovery, 28 (82%) patients had brain death diagnosis and 15 (54%) of these were organ donors. FT cohort: 67 (51-73) years old, GCS 9 (6-12) at admission, ICH volume 46 (24-90) cm3, neurosurgery for clot removal in 65 (64%) (P<0.05 vs. WLST cohort for each of previously listed variables); 13 (13%) patients died during neuro-ICU recovery, of these 11 (85%) patients had brain death diagnosis and 4 (36%) of them were organ donors. Overall 30-day observed mortality for FT group was 18% (95% CI: 11-26%). Patients with ICH Score 1, 2, 3, 4+ had 0%, 10%, 16% and 26% 30-day mortality, respectively (P<0.01 vs. ICH Score). Full treatment group 180-day mortality was 32% (95% CI: 24-42%). Modified Rankin Scale (mRS) after one year was ?3 in 35 (35%), i.e. good recovery, and >3 in 64 (65%). Neurosurgery for clot removal was associated with a lower 30 and 180-day mortality (P=0.01 and P=0.03, respectively) and along with GCS at admission it was an independent significant prognostic factor.
CONCLUSIONS:
Mortality and functional outcome is less severe than predicted in patients with ICH receiving a full medical and/or surgical treatment.
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Professor Umberto Veronesi: a physician, a researcher, a brilliant man.
Ecancermedicalscience2017 ;11():742. doi: 10.3332/ecancer.2017.742.
Mazzocco Ketti, Marzorati Chiara, Pravettoni Gabriella
Abstract
Many of those who work in oncology or deal with cancer patients know of Prof. Umberto Veronesi and none of them could deny the importance of his battle against cancer. He devoted his life to improving cancer treatment and quality of life for patients. He was a physician, and a politician, but above all he was a researcher. He embodied the true spirit of research, i.e., to believe in something and investigate every aspect of it until all the questions about it have been satisfactorily answered. He never gave up when faced with challenges, and he never stopped being curious. He believed in science, because he wanted to believe in the future. He mixed scientific knowledge with human warmth and was the pioneer of many breast cancer innovations. From the beginning of Prof. Veronesi's career, his mission was clear: ''.
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Neurological failure in ICU patients with hematological malignancies: A prospective cohort study.
PLoS One2017 ;12(6):e0178824. doi: 10.1371/journal.pone.0178824.
Marzorati Chiara, Mokart Djamel, Pène Frederic, Lemiale Virginie, Kouatchet Achille, Mayaux Julien, Vincent François, Nyunga Martine, Bruneel Fabrice, Rabbat Antoine, Lebert Christine, Perez Pierre, Benoit Dominique, Citerio Giuseppe, Azoulay Elie, Legriel Stephane,
Abstract
BACKGROUND:
Epidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure.
METHODS:
Post hoc analysis of a prospective study of adults with hematological malignancies admitted for any reason to one of 17 university or university-affiliated participating ICUs in France and Belgium (2010-2012). The primary outcome was vital status at hospital discharge.
RESULTS:
Of the 1011 patients enrolled initially, 226 (22.4%) had neurological failure. Presenting manifestations were dominated by drowsiness or stupor (65%), coma (32%), weakness (26%), and seizures (19%). Neuroimaging, lumbar puncture, and electroencephalography were performed in 113 (50%), 73 (32%), and 63 (28%) patients, respectively. A neurosurgical biopsy was done in 1 patient. Hospital mortality was 50%. By multivariate analysis, factors independently associated with higher hospital mortality were poor performance status (odds ratio [OR], 3.99; 95%CI, 1.82-9.39; P = 0.0009), non-Hodgkin's lymphoma (OR, 2.60; 95%CI, 1.35-5.15; P = 0.005), shock (OR, 1.95; 95%CI, 1.04-3.72; P = 0.04), and respiratory failure (OR, 2.18; 95%CI, 1.14-4.25; P = 0.02); and factors independently associated with lower hospital mortality were GCS score on day 1 (OR, 0.88/point; 95%CI, 0.81-0.95; P = 0.0009) and autologous stem cell transplantation (OR, 0.25; 95%CI, 0.07-0.75; P = 0.02).
CONCLUSIONS:
In ICU patients with hematological malignancies, neurological failure is common and often fatal. Independent predictors of higher hospital mortality were type of underlying hematological malignancy, poor performance status, hemodynamic and respiratory failures, and severity of consciousness impairment. Knowledge of these risk factors might help to optimize management strategies.
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Rumination in breast and lung cancer patients: Preliminary data within an Italian sample.
Psychooncology2018 02;27(2):703-705. doi: 10.1002/pon.4468.
Gorini Alessandra, Riva Silvia, Marzorati Chiara, Cropley Mark, Pravettoni Gabriella
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Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes.
J Multidiscip Healthc2017 ;10():101-106. doi: 10.2147/JMDH.S122383.
Marzorati Chiara, Pravettoni Gabriella
Abstract
In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of "value" is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on "value" and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care.
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Who Is a Cancer Survivor? A Systematic Review of Published Definitions.
J Cancer Educ2017 Jun;32(2):228-237. doi: 10.1007/s13187-016-0997-2.
Marzorati Chiara, Riva Silvia, Pravettoni Gabriella
Abstract
The term "cancer survivor" is commonly used by different persons, clinical institutions, academic bodies, and political organizations although it lacks of a unanimous and detailed definition. The objective of the study is to make a systematic review of published and proposed definitions of "cancer survivor." Utilizing a systematic search strategy with different strings of "cancer survivor," we searched the following databases: Medline (June 1975-June 2015), Scopus (all the years), Web of Science (all the years), Google Scholar (all the years), ERIC (all the years). This review suggests that there is not a unique definition of who is a "cancer survivor" and what is "cancer survivorship." However, the most widely used definition sees cancer survivorship as a process that begins at the moment of diagnosis and continues through the balance of life. This definition highlights psychological and legal patient's needs-as well as medical ones-to receive care and assistance from the beginning and, at the same time, it establishes valid criteria for making scientific and statistical sampling research. The extensive use of the term "cancer survivor" indicates that it is a significant term. This review has been written to outline the state of the art and it invites to reflect on a shared definition that could satisfy both clinical and research aspects. Implication for cancer survivors: this compendium of proposed definitions may improve communication among the many patients and patient organizations that use and work with this term.
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A neurofeedback-based intervention to reduce post-operative pain in lung cancer patients: study protocol for a randomized controlled trial.
JMIR Res Protoc2015 May;4(2):e52. doi: 10.2196/resprot.4251.
Gorini Alessandra, Marzorati Chiara, Casiraghi Monica, Spaggiari Lorenzo, Pravettoni Gabriella
Abstract
BACKGROUND:
Thoracic surgery appears to be the treatment of choice for many lung cancers. Nevertheless, depending on the type of surgery, the chest area may be painful for several weeks to months after surgery. This painful state has multiple physical and psychological implications, including respiratory failure, inability to clear secretions by coughing, and even anxiety and depression that have negative effects on recovery.
OBJECTIVE:
The aim of this study is to evaluate the effect of a neurofeedback-based intervention on controlling acute post-surgery pain and improving long-term recovery in patients who undergo thoracotomy for lung resection for non-small cell lung cancer (NSCLC) at an academic oncologic hospital.
METHODS:
This study will be based on a 2-parallel group randomized controlled trial design, intervention versus usual care, with multiple in-hospital assessments and 2 clinical, radiological, and quality of life follow-ups. Participants will be randomized to either the intervention group receiving a neurofeedback-based relaxation training and usual care, or to a control group receiving only usual care. Pain intensity is the primary outcome and will be assessed using the Numeric Pain Rating Scale (NRS) in the days following the operation. Secondary outcomes will include the effect of the intervention on hospital utilization for pain crisis, daily opioid consumption, anxiety, patient engagement, blood test and chest x-ray results, and long-term clinical, radiological, and quality of life evaluations. Outcome measures will be repeatedly taken during hospitalization, while follow-up assessments will coincide with the follow-up visits. Pain intensity will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations.
RESULTS:
We expect to have results for this study before the end of 2016.
CONCLUSIONS:
The proposed innovative, neurofeedback- and relaxation-based approach to support post-surgery pain management could lead to significant improvements in patient short and long-term outcomes.
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Emergence delirium, pain or both? A challenge for clinicians.
Paediatr Anaesth2015 May;25(5):524-9. doi: 10.1111/pan.12580.
Somaini Marta, Sahillio?lu Emre, Marzorati Chiara, Lovisari Federica, Engelhardt Thomas, Ingelmo Pablo M
Abstract
BACKGROUND:
Children commonly display early postoperative negative behavior (e-PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e-PONB.
OBJECTIVE:
This prospective observational study evaluates the possibility to distinguish between ED and pain in young children using validated pediatric observational scales in the early postoperative phase.
METHODS:
Following institutional approval and written consent, children undergoing elective adenoidectomy and/or tonsillectomy were enrolled. Following standardized anesthesia, two trained observers simultaneously evaluated children's behavior with the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and with the Face, Legs, Activity, Cry, Consolability scale (FLACC) at extubation, and at 5, 10, and 15 min.
RESULTS:
Of 150 children that completed the study, 32 (21%) had ED, 7 (5%) had pain, and 98 (65%) had simultaneously both ED and pain. The association of 'No eye contact', 'No purposeful action' and 'No awareness of surroundings' (ED1) had a sensitivity of 0.96 and a specificity of 0.80 (PPV 0.97, NPV 0.78) to identify ED. 'Inconsolability' and 'Restlessness' (ED2) had a sensitivity of 0.69 and a specificity of 0.88 (PPV 0.83 and NPV 0.78) to identify pain.
CONCLUSION:
It is difficult to differentiate between ED and pain using FLACC and PAED scores. 'No eye contact', 'No purposeful action', and 'No awareness of surroundings' significantly correlated with ED. 'Inconsolability' and 'Restlessness' are not reliable enough to identify pain or ED in the first 15 min after awakening.
© 2015 John Wiley & Sons Ltd.
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