ABSTRACT
Background: Complication and complexity are two aspects that the cancer patient carries with him during the time he spends in cancer treatment. The tumor is to be considered a disease that is part of the biological complications that affect one or more organs of our body, which refer to a very specific treatment, to surgical interventions of a certain type, to any pain therapy, etc. Complexity, on the other hand, represents a term that refers to the description of the ensemble that make up the individuality of the cancer patient. Therefore, within the treatment, various elements that are part of the patient's world and that can represent a strength in the oncological path must be taken into consideration. Material(s) and Method(s): 80 patients from the oncology ward participated in the research, recruited in 2019 (n = 40) and in 2020-2021 (N = 40). The semi-structured clinical psychological interview, lasting one hour, was used as a data collection tool, which examined the evaluation of the patient's depression, anxiety and altered emotional states regarding the presence or fewer family affections during hospitalization, visits from friends, knowledge of one's status as a cancer patient. Result(s): From the analysis of the data it emerges that the oncological patients who suffered from depression, anxiety or elements attributable to altered emotional states in 2019 are 32.50% of the sample examined while in 2020 and 2021 the recorded incidence includes about 90.00% of the sample. This higher incidence derives mainly from the consequence of the closure to visits by family members in the medical oncology ward for the sars-cov-2 pandemic, rather than from the other factors taken into consideration, leading, in the most serious cases, to requests for early discharge by of the patient himself. Conclusion(s): Understanding the worlds within the cancer patient should not be seen as an obstacle to treatment but as a resource to be used to improve patient compliance. Placing the complexity of the individual at the center of the analysis determines a decrease in anxiety, depression and altered emotional states with an increase in the doctorpatient relationship, effectiveness of treatments, circulation of information and trust in care.
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Background: Enteral tubes, including nasogastric (NG) tubes, are an important tool in managing multiple medical conditions in which oral feeding cannot be successfully accomplished due to feeding ability or safety, and these devices are commonly employed at children's hospitals worldwide. While these devices are life-saving, they can develop are a significant burden on families and the healthcare system. There is relatively little published data on the practices of pediatric enteral tube outpatient management, including whether primary outpatient management is undertaken by pediatric gastroenterologists or other medical practitioners (e.g. primary care providers and other pediatric subspecialists), and if a primary management team would affect overall clinical outcomes. In the late fall of 2019, at the American Family Children's Hospital (AFCH), a tertiary care children's hospital, pediatric outpatient enteral tube management, with the exception of tubes in patients under the primary care of Pediatric Hematology/Oncology (PHO), was fully assumed by the Pediatric Gastroenterology (PGI) division, with previous management divided or shared among the PGI division, primary care providers, and other pediatric subspecialists. Due to the division having subspecialty nurses, nurse practitioners, and physicians who had expertise managing enteral tubes on an inpatient and outpatient basis, we hypothesized that primary outpatient management by Pediatric GI would reduce ED utilization for nasogastric tube evaluation. Method(s): We performed a retrospective chart review of all patients discharged from AFCH with a nasogastric tube in place from March 1 2018 to October 31 2019 and June 1 2020 to January 31 2022. The study was reviewed by the University of Wisconsin-Madison Minimal Risk Research Institutional Review Board and met criteria for exempt human subjects. We left a 7-month temporal gap to allow for complete implementation of the policy of pediatric GI management to be uniformly practiced within the hospital, and to account for the beginning of the COVID-19 pandemic, when outpatient clinics were closed and ED evaluation was required for all hands-on non-inpatient medical care at our institution. Patients were grouped and analyzed according to being pre-intervention or post-intervention, and they were followed until either their NG tube was permanently removed, or until their NG tube was replaced with a gastrostomy tube. Patients were excluded if they were primarily managed by PHO, lost to followup, still had NG tube in place at time of data analysis, died during the study period, or had their tube converted to a postpyloric tube. Our primary outcome was the incidence rate of ED visits for nasogastric tube evaluation per patient-weeks between the pre- and post-intervention groups. Patient demographics and diagnoses were also recorded and analyzed. Statistical analysis was conducted. Result(s): There were 130 patients identified after applying inclusion and exclusion criteria, with 56 in the pre-intervention group and 74 in the post-intervention group. The median chronological age of patients in the pre-intervention group was 5 months, and it was 6 months for the post-intervention group. The mean time from initial hospital discharge to either NG tube removal or conversion to gastrostomy tube was 6.2 weeks in the pre-intervention group and 8.8 weeks in the post-intervention group. In the pre-intervention group, the incidence rate of ED visits for NG tube evaluation was 15.6 visits per 100 patient-weeks (95% Confidence Intervals (CI): 11.7-20.3), and in the post-intervention group, the rate was 9.7 visits per 100 patient-weeks (95% CI: 7.4-12.4). Discussion(s): This study demonstrated that at our institution, there appeared to be a decrease in ED utilization for nasogastric tube evaluation after outpatient tube management was assumed by the PGI division, but this decrease was not quite enough to reach statistical significance. This study is limited by multiple factors including the retrospective nature of the study, modest sample size limiting statistical power, and, potentially, lingering effects of the COVID-19 pandemic affecting patient care decisions. Identifying balancing measures from this intervention, as well as identifying alternative changes that could further decrease ED evaluation rates, can be explored in future quality improvement initiatives.
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Social media fuels fake news’ spread across the world. English news has dominated existing fake news research, and how fake news in different languages compares remains severely under studied. To address this scarcity of literature, this research examines the content and linguistic behaviors of fake news in relation to COVID-19. The comparisons reveal both differences and similarities between English and Spanish fake news. The findings have implications for global collaboration in combating fake news. © 2022, Springer Nature Switzerland AG.
ABSTRACT
AIGkit is an easy-to-use mobile application, created with the aim of allowing a telematic interaction between adult patient with Pompe disease and clinicians that can be downloaded for free on smartphone. After a first phase, whose results were presented as oral communication at AIM congress in 2018 and 2019, and published as original article in Neuromuscolar Disorders, the second operational phase of the project has been activated for its use in real life and clinical practice. The pre-established goal has been therefore to create an informatic platform for the collection of clinical data where each patient can access through the personal app on their smartphone, in order to allow the registration of their data and facilitate interaction with their clinicians. The design activity and procedures, despite the difficulties encountered in the various phases also caused by the Sars-COVID-19 emergency, were carried out to meet the requirements of the privacy guarantor, in order to activate the use of the platform and the real-time sharing of the data collected remotely on the app of each patients. We are now planning the dissemination of the initiative at national level and the implementation of this project in collaboration with other clinical centers that will be able to use the servers of the Azienda Ospedaliera Universitaria Pisana (AOUP) as coordinating center, thus improving value and utility for users, both patients and clinicians.
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Background: Since March 2020, Sars-Cov-2 lead to an immediate reprogramming of all aspects of private and professional life. The fear of contagion and the new rules to follow also imply in cancer patients the progressive birth of irrational beliefs, such as not being treated, dysfunctional emotions, namely anxiety, depression, anger, guilt and a marked psychological illness. At the same time, in the health workers of the Oncology Department this translates into stress, a heavy working climate, a slowdown in activities. We developed a project for the management of the emotions of the patients group and of healthcare professionals through the Cognitive Behavioral Approach (CBT). Material and Methods: The intervention with patients was carried out by telephone, while two interviews of 15 minutes each in the working shift were carried out for health workers. Some CBT techniques postulate that individuals try to achieve their goals in a reference environment where they are subjected to activating events (including emotions, memories, reality perceptions) that tend to favor or not the achievement of the goals themselves. The emotional and behavioral consequences are the reactions to the contents of thought. In both groups we worked on rational or irrational thoughts (everything we think about the world and ourselves): for cancer patients we used the logical and empirical questioning based on inductive reasoning, teaching, analogies, while for health professionals we used the logical and empirical discussion often integrated by the self-reinforcing humor. Results: Globally, 25 cancer patients and 15 health workers at the Medical Oncology Unit of the University Hospital of Cagliari were included in our project. 90% of the patient group reported an improvement on psychological malaise, on the reduction of irrational thoughts and on the change of dysfunctional emotions towards more functional ones, reducing the sense of abandonment. The whole group of health workers obtained a significant improvement in stress and the perceived organizational climate resulting from the easing of tension and a review of the situations that occurred. Conclusions: The new keys of interpretation and alternative analysis of one's thinking create a substantial improvement in one's internal perception and external perception of events and one's behavior by reflecting on relationships. Humor becomes an effective coping strategy for reducing emotional impact.
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Background: A year ago we conducted a survey using self-administered questionnaires that showed a relevant picture regarding insomnia and stress for most of the sample and depression for some categories more exposed to close contact, such as nurses and social health workers. It showed the symptoms of a sudden, destructuring and emergency emotional impact. We performed the same survey one year later, with the aim to reveal how the coping strategies inherent in human nature have worked in the emotional management of the SARS-CoV-2 pandemic. Material and Methods: Dass-21 and the Insomnia Index questionnaires were administered. The interviewed heterogeneous sample (health personnel, nurses, social health workers, administrators), proved to be collaborative, open and available. The questionnaires were delivered, completed and returned independently to ensure privacy and the free expression of the real situation experienced. A code was assigned in order to guarantee anonymity. The list of names with the corresponding codes were archived separately from the questionnaires. Results: Overall, in the subjects attending the Medical Oncology Unit of the University Hospital of Cagliari who were included in the research, the questionnaires showed improvement data on all four dimensions in a heterogeneous way: normal values were obtained from 64.29% about stress, 78.57% about anxiety, 78.57% about depression and 35.71% about insomnia. Those who achieved high anxiety, stress and insomnia scores in May 2020 reported normal levels of stress, anxiety and insomnia in 2021. Depression data also improved, with a reassessment of the issues and emotional burden that the SARS-CoV-2 pandemic has brought, allowing for a reassessment of priorities and what is actually important and what is not. Conclusions: It is believed that the medical staff of our Medical Oncology Unit is basically trained to manage emergencies. It has excellent coping strategies and good global functioning, thanks also to an organization on shifts for both nurses, social health workers, doctors and trainees, and for the structuring of the procedures to be followed, a timely vaccination campaign and the possibility of dialoguing with psychologists present in the department. It would be interesting to administer it once in May 2022 to detect if and how the post-emergency situation of the pandemic will have changed.
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Objective: To assess and trend fears surrounding elective surgeries and office procedures with a standardized questionnaire in benign gynecologic and urogynecologic patients during the Coronavirus-19 (COVID) pandemic.We hypothesized that COVID-related fear was greater in surgical patients over procedural patients, that surgical fearwould be greater than historic data, and that fear levels would increase with the course of the pandemic. Methods: This is a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020 until March 23, 2021. Females 18 years or older presenting for elective, benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed with the Surgical Fear Questionnaire (SFQ), a validated 8-item survey that evaluates short term (questions 1-4) and long term (questions 5-8) fears related to surgery. We modified the SFQ to include 2-4 additional questions about the COVID-19 pandemic (mSFQ) and to apply to procedures (10 questions) and surgeries (14 questions) (Table 1). Questions were scored on a scale of 0-10 with 0 being 'not at all afraid' and 10 being 'very afraid'. Total SFQ scores and short and long term fear scores were compared between procedures and surgeries and to historic data (Theunissen et al, 2016). Results: 209 subjects undergoing 107 procedures or 102 surgeries completed the questionnaire. Demographics are shown in Table 1. The prevalence of chronic pain, depression, and anxiety was similar to national statistics. The most common procedure was urodynamics (n = 59, 55%). Themost common elective surgery was hysterectomy (n = 59, 57.8%). 72.5% surgeries were for urogynecologic indications. Fear assessed by the SFQ (12.21 ± 16.21) was overall low and not different in subjects undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). Similarly, fear was not different between procedures vs surgery for short term (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) and long term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). The mSFQ, which captured COVID-specific fears, demonstrated higher fear scores for both procedures and surgeries compared to SFQ (mSFQ 20.57 ± 20.55 for procedures, 28.78 ± 28.51 for surgeries versus 12.21 ± 16.21 for SFQ). These included fear of hospitalization, overworked doctors, concern for family, etc (Table 1). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events (Figure 1). We compared our data to the largest study of surgical fear in 428 women undergoing benign hysterectomy outside of a pandemic by Theunissen et al 2016 and found a significantly lower fear in our population in both the short (6.5 ± 8.39 vs 16 ± 9.9, P < 0.001) and long term(5.71 ± 8.56 vs 9.3 ± 8.6, p < 0.001) scores. This lower level of surgical fear persisted solely comparing our hysterectomy subjects to the aforementioned data in both short term (7.37 ± 8.62 vs 16 ± 9.9, p < 0.001) and long term (5.12 ± 7.14 vs 9.3 ± 8.6, P < 0.001) scores. Conclusions: Fear of surgeries and office procedures was overall low and consistent throughout the COVID-19 pandemic. Compared to historic data, our patients had lower levels of surgical fear. Fear scores increased with the addition of COVID-specific questions, indicating some fear surrounding having a procedure or surgery during the pandemic. Interpretation of our results is limited by the fact that the patients surveyed had already decided to continue in-person care.