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Biomedical subjects

A Liberati

Publications and source records attributed to A Liberati.

117 records · Page 7Linked to original sources
PubMedDate not supplied

Quality of life among mastectomy patients using external breast prostheses.

BACKGROUND: Most women who undergo mastectomy for breast cancer use external breast prostheses. Yet, little is known about patterns of use, satisfaction levels, and quality of life associated with their use as compared to other options. PATIENTS AND METHODS: We report longitudinal, self-report questionnaire data regarding prosthetic use from 592 Italian mastectomy patients. Women who report satisfaction with their prostheses are compared on medical, demographic, and quality of life variables to a matched sample of women who report dissatisfaction. We also compare matched samples of women who do not use prostheses and women who had reconstruction to prosthetic users. RESULTS: Most women used and were satisfied with their prostheses. However, there was a small group of women who were dissatisfied. These women reported greater disruption to their sense of feminility and worse quality of life in some areas. We found few differences between prosthetic users and women who used either of the other two options available following mastectomy-taking no action to restore the appearance of the amputated breast or having reconstructive surgery. CONCLUSIONS: No one technique for restoring the appearance of the mastectomized breast is necessary to optimize quality of life for all women. Physicians should describe the options to women, along with the average satisfaction rates for women choosing those options, and help women to make the best personal decisions.

Body Image↗
PubMedDate not supplied

Evidence-based medicine and practice: what's new for the physicians?

This paper introduces the readers to the concepts of Evidence-Based Medicine (EBM) and Evidence-Based Health Care (EBHC). After taking the view that EBM and EBHC are essentially a new way of thinking about the theory and practice of medicine, the paper discusses their potential, limitation and ambiguities. Besides summarising the roles of EBM and EBHC in providing information relevant for patient care, medical education, health policy-making, information-seeking and eventually, guideline production, the paper closes discussing some of the potentials as well as dangers of this new scientific and cultural movement.

Conflict of Interest↗
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[Quality control of spirometric tests used in health surveillance for occupational exposure risk, in the province of Viterbo].

A quality control survey on spirometry assessments carried out in a number of factories in the province of Viterbo (Lazio Region) was made by the Local Health Unit in Viterbo, as required by law 626/94 on the promotion of workers health. The survey concerned 734 measurements concerning the same number of employees from 29 different factories. Each spirometry assessment was repeated in this study according to the quality standards defined in the literature and our own results were compared with the values which had been obtained over one year during the health surveillance program (ASP). A few main functional parameters were considered according to the following criteria: percentage of agreement (tolerance +/- 5%) between the two FVC, FEV1 and FEF25-75 measures or degree of discrepancy; for FEV1/FVC ratio, the occurrence of < 70 (suggestive of an obstructive lesion) and > 90 values (reflecting poor reliability in the measurement of the lung volumes) in the two sets of data. Further criteria concerned the comparison of the height of the individuals (tolerance range +/- 1 cm), and the comparison of the overall spirometry rating expressed as the number of tests rated normal or abnormal (during the first assessment as compared to the second). The results show poor agreement (11.4%) for FVC with as many as 85.8% underestimated values; 30.1% agreement and 64.2% underestimate for FEV1; 17% agreement and 53.5% overestimate for FEF25-75. There were 6.5% fewer < 70 FEV1/FVC ratios, and 18.3% more > 90 ratios in the tests carried out in the factories as compared to our own. There was 32.9% agreement on the height, with overestimation in 63.7% of the cases. There were 12.3% "false abnormal" and 2.6% "false normal" results in the overall rating of the spirometry (as carried out by the factories compared to our own). In conclusion, the survey revealed a trend in the measurements carried out by the factories to underestimate the volumes, overestimate the flows, improperly select the theoretical reference values because of a mistake in measuring the height, to overestimate restrictive abnormalities, and underestimate the obstructive ones.

Adult↗
PubMedDate not supplied

[Geographic variability in the appropriateness of surgical treatment of breast carcinoma].

To assess appropriateness of surgical care delivered to breast cancer patients in Italy and quantify the use of unnecessary radical procedures, a retrospective charts review of patients treated in 1988-1989 was conducted. Information about hospital characteristics was collected directly from administrative departments as a part of a national survey. A series of 1724 consecutive patients (median age 61 years; range 17-89) treated in 63 hospitals selected from within 8 regions, with newly diagnosed operable breast carcinoma was evaluated. Overall, 541 (38%) patients had inappropriate surgery with more than two thirds of it being accounted for by the use of unnecessary mutilating Halsted mastectomy. About one-fourth of patients with stage I-II disease undergone mastectomy according Halsted technique and conservative surgery in patients with small tumors (i.e. tumor size < = 2 cm) was under utilized. Substantial geographic variations emerged in the overall rates of inappropriateness (range 12-48%) which were not substantially affected by allowance for imbalances in patient- and hospital-related variables. Despite the important contribution given by Italian clinical researchers to the demonstration that less radical surgery can be as good as more radical procedures, still a substantial proportion of breast cancer patients are treated too aggressively. Besides pointing to the urgent need of interventions aimed at promoting more appropriate surgical care these results suggest that efforts to increase patients' participation into treatment decision and awareness about alternative treatment options are warranted.

Adolescent↗