Roberto Satolli - Academia.edu (original) (raw)

Papers by Roberto Satolli

PLoS ONE

Hormone therapy (HT) in the menopause is still a tricky question among healthcare providers, wome... more Hormone therapy (HT) in the menopause is still a tricky question among healthcare providers, women and mass media. Informing women about hormone replacement therapy was a Consensus Conference (CC) organized in 2008: the project Know the Menopause has been launched to shift out the results to women and healthcare providers and to assess the impact of the cc's statement. And Findings: The project, aimed at women aged 45-60 years, was developed in four Italian Regions: Lombardy, Tuscany, Lazio, Sicily, each with one Local Health Unit (LHU) as "intervention" and one as "control". Activities performed were: survey on the press; training courses for health professionals; educational materials for target populations; survey aimed at women, general practitioners (GPs), and gynaecologists; data analysis on HT drugs' prescription. Local activities were: training courses; public meetings; dissemination on mass media. About 3,700 health professionals were contacted a...

BMC Women's Health

The risks/benefits balance of hormone replacement therapy is controversial. Information can influ... more The risks/benefits balance of hormone replacement therapy is controversial. Information can influence consumers' knowledge and behavior; research findings about hormone replacement therapy are uncertain and the messages provided by the media are of poor quality and incomplete, preventing a fully informed decision making process. We therefore felt that an explicit, rigorous and structured assessment of the information needs on this issue was urgent and we opted for the organisation of a national consensus conference (CC) to assess the current status of the quality of information on hormone replacement therapy (HRT) and re-visit recent research findings on its risks/benefits. We chose a structured approach based on the traditional CC method combined with a structured preparatory work supervised by an organising committee (OC) and a scientific board (SB). The OC and SB chose the members of the CC's jury and appointed three multidisciplinary working groups (MWG) which were asked...

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[The debate about randomization]

Epidemiologia e prevenzione

Il corso per rappresentanti di associazioni di cittadini e pazienti organizzato ogni anno da Part... more Il corso per rappresentanti di associazioni di cittadini e pazienti organizzato ogni anno da Partecipasalute può contare ora su una dispensa che ne presenta i principali contenuti: dalla sperimentazione clinica all’informazione in medicina e sanità; dall’incertezza ai conflitti di interesse, ai comitati etici; da come funzio- nano le agenzie regolatorie dei farmaci al mondo dell’associazionismo in ambito sanitario. La dispensa è cresciuta di anno in anno insieme ai diversi protagonisti dei corsi: scritta per buona parte dai docenti stessi, in una prima versione è stata “speri- mentata” all’interno del corso del 2007 e quindi modificata in base alle indica- zioni e le esigenze emerse tra quei fruitori. Ogni capitolo, inoltre, è stato rivisto da almeno un rappresentante di associa- zione o componente laico di comitato etico. I contenuti della dispensa offrono un quadro generale dei vari temi che verran- no approfonditi durante il corso attraverso incontri con esperti, discussioni e la...

PLoS ONE, 2013

Background: Hormone therapy (HT) in the menopause is still a tricky question among healthcare pro... more Background: Hormone therapy (HT) in the menopause is still a tricky question among healthcare providers, women and mass media. Informing women about hormone replacement therapy was a Consensus Conference (CC) organized in 2008: the project Know the Menopause has been launched to shift out the results to women and healthcare providers and to assess the impact of the cc's statement.

Public Health Ethics, 2012

The objective of the article is to examine the extensions of a clinical measure of efficacy, the ... more The objective of the article is to examine the extensions of a clinical measure of efficacy, the Number Needed to Treat (NNT), in different settings including screening, scanning, genetic testing and primary prevention, and the associated ethical implications. We examine several situations in which the use of the NNT or NNS (Number Needed to Screen) has been suggested, such as Prostate-Specific Antigen for prostate cancer, Magnetic Resonance Imaging scans, genetic testing and banning of smoking. For each application, we explore the ethical implications of the relevant measure. We have found that the different measures have different ethical implications. For example, the Number Needed to Prevent is the only measure that can be lower than one, indicating with a numerical example that prevention is better than cure. Conversely, we raise questions about the acceptability of genetic screening. In a realistic example, we show that primary prevention of the effects of arsenic in drinking water, targeted to the most susceptible, would require to genetically screen a large number of subjects, whereas giving rise to ethical concerns. We warn against the abuse of testing, in particular genetic testing, we show that different measures are associated with different ethical issues and that prevention tends to be better than cure.

Maturitas, 2009

Objectives: Investigating women's knowledge, attitude and practice in relation to menopause and s... more Objectives: Investigating women's knowledge, attitude and practice in relation to menopause and systemic hormone therapy (HT) through a sample survey implemented within the preliminary works for the Consensus Conference "Informing women on hormone replacement therapy" that took place in Turin in May 2008 [Available at www.partecipasalute.it. Last access 7/8/2008]. Methods: The survey involved representative samples of women 45-60 years from five Italian regions. Twenty trained interviewers distributed the questionnaires reaching participants at their homes. A total of 969 women were selected from electoral rolls. 720 of them completed the interview (74.3% response rate). Results: Participants reported positive attitudes about menopause; more than 90% believed menopause is a normal phase in women's life and more than 40% stated it is a good experience for a woman. Nevertheless, more than half of the sample did not receive any information about menopause and possible therapies, and those who did, often rated it as poor and contrasting. Moreover, clinicians who prescribed HT reported advantages (94%) much more frequently than disadvantages (22%) and risks (39%) in relation to this treatment. Lack of knowledge was associated with women's low educational level and their no or scarce attitude to attend health services.

Intensive Care Medicine, 2010

Purpose: To appraise the end-of-life decision-making in several intensive care units (ICUs) and t... more Purpose: To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level. Design: Prospective, multicenter, observational study, lasting 12 months. Setting: Eighty-four Italian, adult ICUs. Patients: Consecutive patients (3,793) who died in ICU or were discharged in terminal condition, in 2005. Measurements: Data collection included patient description, treatment limitation and decisionmakers, involvement of patients and relatives in the decision, and organ donation. A logistic regression model was used to identify predictors of treatment limitation and develop a measure of the inclination to limit treatment for each ICU. This was compared with the standardized mortality ratio, an index of the overall performance of the unit. Results: Treatment limitation preceded 62% of deaths. In 25% of cases, nurses were involved in the decision. Half the limitations were do-notresuscitate orders, with the remaining half almost equally split between withholding and withdrawing treatment. Units less inclined to limit treatments (odds ratio \0.77) showed higher overall standardized mortality ratio (1.08; 95% confidence interval: 1.04-1.12). Limitations: The voluntary nature of participation, with selfselected ICUs from a self-selected independent network. Conclusions: Treatment limitation is common in ICU and still principally a physician's responsibility. Units with below-average inclination to limit treatments have worse performance in terms of overall mortality, showing Intensive Care Med (2010) 36:1495-1504

Implementation Science, 2008

In an effort to ensure that all physicians have access to valid and reliable evidence on drug eff... more In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of Clinical Evidence.

Health Research Policy and Systems, 2012

Background: When properly trained through training programs on epidemiology, clinical research an... more Background: When properly trained through training programs on epidemiology, clinical research and healthcare policy, members of patients'/consumers' organizations could be helpful for a patient-oriented healthcare system. Since 2006 the not for profit project PartecipaSalute has organized periodic editions of a training program for representatives of citizens'/patients' organizations. After five editions of this training program, a survey of the long-term satisfaction and the impact on activities has been carried out.

Health Expectations, 2007

BMC Women's Health, 2009

Are adaptive randomised trials or non-randomised studies the best way to address the Ebola outbreak in west Africa?

The Lancet. Infectious diseases, Jan 13, 2015

The Ebola outbreak that has devastated parts of west Africa represents an unprecedented challenge... more The Ebola outbreak that has devastated parts of west Africa represents an unprecedented challenge for research and ethics. Estimates from the past three decades emphasise that the present effort to contain the epidemic in the three most affected countries (Guinea, Liberia, and Sierra Leone) has been insufficient, with more than 24 900 cases and about 10 300 deaths, as of March 25, 2015. Faced with such an exceptional event and the urgent response it demands, the use of randomised controlled trials (RCT) for Ebola-related research might be both unethical and infeasible and that potential interventions should be assessed in non-randomised studies on the basis of compassionate use. However, non-randomised studies might not yield valid conclusions, leading to large residual uncertainty about how to interpret the results, and can also waste scarce intervention-related resources, making them profoundly unethical. Scientifically sound and rigorous study designs, such as adaptive RCTs, coul...