144 research outputs found
Strategie di riduzione del rischio di sviluppare linfedema dell'arto superiore in pazienti affette da carcinoma mammario trattate con dissezione ascellare
No full textIl progetto di ricerca si è svolto nell'Unità di Chirurgia Oncologica Senologica e Unità di Chirurgia Plastica dell'AOU Policlinico di Modena.
Le donne con diagnosi di carcinoma mammario non metastatico vengono sottoposte a intervento chirurgico. L'indicazione a eseguire un intervento conservativo o demolitivo viene presa in base all'estensione di malattia. Contemporaneamente è indicato eseguire una stadiazione dei linfonodi ascellari, per escludere un coinvolgimento linfonodale. Se vengono riscontrate metastasi ai linfonodi ascellari, l'indicazione terapeutica è di eseguire una dissezione ascellare completa (ALND); in caso contrario le pazienti vengono sottoposte a biopsia del linfonodo sentinella (SLNB). Il 15-20% delle pazienti che vengono sottoposte a ALND sviluppa un linfedema dell'arto superiore, mentre ciò avviene solo nel 2-3% di quelle trattate con biopsia del linfonodo sentinella. Nella maggior parte dei casi la sintomatologia può essere mitigata con dei trattamenti riabilitativi ma quando l'approccio conservativo fallisce, le pazienti sperimentano un deficit funzionale e un importante peggioramento della qualità di vita. In letteratura sono stati pubblicati studi clinici fondamentali, con lo scopo di identificare gruppi di pazienti per cui è possibile non eseguire l'ALND, poiché queste sono state definite a basso rischio di presentare metastasi nei linfonodi non sentinella. Nonostante i risultati di questi studi, nella pratica clinica solo una minoranza di pazienti non vengono trattate con la dissezione ascellare nel momento in cui si riscontra una metastasi nel linfonodo sentinella, poiché le linee guida internazionali sono ancora poco chiare sulla corretta linea di trattamento.
Lo scopo di questo progetto è di analizzare tutte le pazienti sottoposte a dissezione ascellare nella Breast Unit di Modena durante il periodo di ricerca del PhD per confrontare l'indicazione di trattamento data, con i risultati emersi dagli studi randomizzati che identificavano profili di pazienti a basso rischio (ACOSOG Z0011 e SINODAR ONE), in modo da chiarire se per alcune pazienti sarebbe stato possibile omettere la dissezione ascellare. Tutte le pazienti che sarebbero rientrate nei criteri di omissione dell'ALND secondo gli studi citati saranno richiamate per eseguire un rivalutazione clinica al fine di verificare se si sia effettivamente sviluppato un linfedema dell'arto superiore.
In caso di diagnosi di linfedema, le pazienti verranno indirizzate al "Programma Linfedema" che è stato creato in collaborazione con il reparto di Chirurgia Plastica. Le pazienti verranno inizialmente indirizzate a un programma riabilitativo dedicato e successivamente, in caso di mancato beneficio clinico, a una valutazione chirurgica per definire l'appropriato trattamento microchirurgico.
Insieme alle precedenti ricerche condotte durante il progetto di PhD, abbiamo perseguito lo scopo di definire le migliori strategie di riduzione del rischio di sviluppare un linfedema dell'arto superiore in pazienti in trattamento per un carcinoma mammario e, in particolare, il focus è stato quello di ridurre il rischio attraverso un corretto processo di selezione e un trattamento chirurgico personalizzato.The research project is taking place in the Breast Surgical Oncology and Plastic and Reconstructive Surgery Units of the University Hospital of Modena. Women who are diagnosed with non-metastatic breast cancer, are treated with surgical excision. A conservative choice or a demolitive one is done depending on the local extension of the disease. Simultaneously a surgical staging of the axillary lymph nodes must be performed, to rule out loco-regional lymphatic spread. When metastatic lymphatic involvement is found, the surgical choice is complete axillary dissection (ALND); otherwise, patients undergo sentinel lymph node biopsy (SLNB). 15-20% of women develop upper limb lymphedema after ALND while 2-3% after SLNB. In most cases, it can be mitigated with rehabilitation but when conservative treatment fails, women experience functional discomfort and a dramatic worsening in quality of life. Major studies were published in literature to identify patients for whom ALND can be spared, since low-risk of non-sentinel node metastasis was assessed. Despite these results, in clinical practice, very few patients do not undergo ALND if a metastatic sentinel node is found, since many international guidelines are not clear on the correct management yet.
The aim of this thesis project is to analyze all the patients that underwent ALND in the Breast Unit of Modena during the PhD research period, to compare their indications with international randomized studies that identify low risk patients (ACOSOG Z0011 and SINODAR ONE) to clarify if for some patients ALND could be avoided. All the patients that fit the criteria for ALND omission in the cited studies will be recalled for clinical evaluation in order to assess if they developed upper limb lymphedema.
If upper limb lymphedema is diagnosed, patients are referred to “Lymphedema Program” that has been created in collaboration with Plastic Surgery Unit. They will be first addressed to a tailored rehabilitation program and then, if no clinical benefit will be reached, to surgical evaluation for the appropriate microsurgical treatment.
Together with the previous research that was conducted during the PhD project, we aim at defining the best strategies to reduce the risk of developing upper-limb lymphedema and in particular, we are focusing on reducing the risk through a correct selection of patients and tailored surgical treatment
A Logical Formalization of Time-Critical Processes with Resources
No full textChecking time-critical properties of concurrent process instances having a finite amount of allocated resources is a challenging task. Modelling and understanding at design time the interactions of concurrent activities along the time line can become quite cumbersome, even for expert designers. In this paper, we consider processes that are composed of activities having a constrained duration and a bounded number of allocated resources, and we rely on a well-studied first order formalism, called, FO2(∼ <, -) to model and verify the interdependencies among multiple and concurrent process instances. Then, we show the expressiveness of our approach by describing the temporal properties that may be expressed through it. Throughout all the paper, we refer to a real clinical scenario to motivate our approach and showcase its expressiveness
Modeling and handling duration constraints in BPMN 2.0
No full textWhen dealing with business processes, modeling and managing temporal aspects, either properties or constraints, is crucial. In this paper, we propose a set of structured BPMN process diagrams for specifying duration constraints at different levels of abstraction, starting from BPMN atomic tasks and up to consider the duration of selected process sub-regions. Moreover, we suggest suitable techniques for addressing their violation at process run-time
Driving time-dependent paths in clinical BPMN processes
No full textThe modeling of temporal aspects in BPMN processes is poorly addressed to date, despite the crucial role played by time during process design and execution. In the clinical domain, temporal conditions often constrain medical decisions that drive healthcare process execution and organizational outcomes. However, both temporal constraints and their effects on process decisions are often hidden within process models. In this paper, we deal with modeling a set of selected time constraints that "decide" how process execution paths are taken and we address their enforcement in BPMN process diagrams. A formal semantics based on timed automata clarifies the behavior of the proposed processes
A modular approach to the specification and management of time duration constraints in BPMN
No full textThe modeling and management of business processes deals with temporal aspects both in the inherent representation of activity coordination and in the specification of activity properties and constraints. In this paper, we address the modeling and specification of constraints related to the duration of process activities. In detail, we consider the Business Process Model and Notation (BPMN) standard and propose an approach to define re-usable duration-aware process models that make use of existing BPMN elements for representing different nuances of activity duration at design time. Moreover, we show how advanced event-handling techniques may be exploited for detecting the violation of duration constraints during the process run-time. The set of process models specified in this paper suitably captures duration constraints at different levels of abstraction, by allowing designers to specify the duration of atomic tasks and of selected process regions in a way that is conceptually and semantically BPMN-compliant. Without loss of generality, we refer to real-world clinical working environments to exemplify our approach, as their intrinsic complexity makes them a particularly challenging and rewarding application environment
Integrated Exploration of Data-Intensive Business Processes
No full textModeling and reasoning over business processes require enterprises to manage and integrate large amounts of information. Despite process designers and engineers may benefit from a unified view of process and data models, integrating these two perspectives is challenging, especially when considering conceptual models. In this paper, we provide a uniform formal representation of a process model, the schema of a related database, and the data operations connecting them. Then, we show how we can use such a formal representation to identify interesting information during the integrated conceptual modeling and analysis of processes and related databases, from a process (re-)design and improvement perspective. Finally, we discuss the evaluation of the proposed approach through a controlled experiment and a proof-of-concept implementation that considers both relational and XML database technologies
Conceptual modeling of inter-dependencies between processes and data
No full textThe connection between business processes and data has drawn the attention of many research efforts within the community of business process management. In traditional activity-centric process models, representing how process activities access the information organized in a data model is a challenging task. Accordingly, a conceptual model that combines process and data aspects is still missing. In this paper, we propose an approach for supporting the integrated conceptual modeling of business processes and related data. We devise the concept of activity view to capture relevant aspects of data operations performed by process activities. Then, we show how such new representation allows the evaluation of consistency between different data operations, with the goal of detecting possible data modeling flaws at design time
Combi-TED: a new trial testing Tedopi R with docetaxel or nivolumab in metastatic non-small-cell lung cancer progressing after first line study protocol
No full textCombi-TED: a new trial testing Tedopi R with docetaxel or nivolumab in metastatic non-small-cell lung cancer progressing after first line study protocol </p
A Methodological Framework for the Integrated Design of Decision-Intensive Care Pathways—an Application to the Management of COPD Patients
No full textHealthcare processes are by nature complex, mostly due to their multi-disciplinary character that requires continuous coordination between care providers. They encompass both organizational and clinical tasks, the latter ones driven by med- ical knowledge, which is inherently incomplete and distributed among people having different expertise and roles. Care pathways refer to planning and coordination of care processes related to specific groups of patients in a given setting. The goal in defining and following care pathways is to improve the quality of care in terms of patient satisfaction, costs reduction, and medical outcome. Thus, care pathways are a promising methodological tool for standardizing care and decision-making. Business process management techniques can successfully be used for representing organiza- tional aspects of care pathways in a standard, readable, and accessible way, while supporting process development, analysis, and re-engineering. In this paper, we intro- duce a methodological framework that fosters the integrated design, implementation, and enactment of care processes and related decisions, while considering proper rep- resentation and management of organizational and clinical information. We focus here and discuss in detail the design phase, which encompasses the simulation of care pathways. We show how business process model and notation (BPMN) and decision model and notation (DMN) can be combined for supporting intertwined aspects of decision-intensive care pathways. As a proof-of-concept, the proposed methodology has been applied to design care pathways related to chronic obstructive pulmonary disease (COPD) in the region of Veneto, in Italy
Seamless Design of Decision-Intensive Care Pathways
No full textHealthcare processes are intrinsically complex and multidisciplinary. In order to maintain acceptable levels of assistance quality, reduce costs and limit the variability of medical practice outcomes, care provision plans must rely on structured and standard procedures. Business process modeling suitably responds to the need for a clear, iterative and comprehensible design approach for care assistance paths, as it fosters work- load organization, coordination among participants and resource sharing. Moreover, the integrated modeling of process-related decisions enhances flexible information management, improving re-engineering and adaptability of healthcare delivery plans. In this paper, we propose an integrated approach to deal with healthcare processes and related decision-making design, in order to support the development and re-engineering of diagnostic-therapeutic care pathways and to enhance the (re)-use of clinical information. Such approach is based on BPMN 2.0 and the new DMN 1.0 formalism, developed under the OMG umbrella. Moreover, we apply the proposed methodology to the management of patients affected by Chronic Obstructive Pulmonary Disease in the region of Veneto, in north-eastern Italy
- …
