ABSTRACT
OBJECTIVE: This research was focused on expert professionals in epilepsy care to understand their points of view on the care pathway and their living relationships with patients. METHODS: Researchers prepared a semi-structured parallel chart and distributed it online among 21 Italian centres of care. Each health professional was prompted to write five narratives on cases of patients with epilepsy, subsequently analysed through narrative medicine methods. Next, a consensus meeting was held, to individualise an action plan based on the narratives. RESULTS: Ninety-one parallel charts were collected from 25 epileptologists, who had a mean age of 50 years; their narratives concerned patients with a mean age of 37 years, with different types of epilepsy (53 % drug-resistant; 31 % unemployed). The limitations in the daily life of people with epilepsy (57 %), employment (42 %), caregiver burden (51 %), and the universal prevalence of fear were the primary topics that emerged. Attentive and reassuring care relationships were found to be the main element of coping (21 %). A new multi-factorial classification of epilepsies, integrating clinical with social and legal risk factors, was the main agreed action to face the issues identified. CONCLUSIONS: The narrative medicine approach supplied a broader scenario of living with epilepsy, including the family and social impact and possible effects on the choices for care pathways. The epileptologists showed a strong motivation to care for patients with epilepsy and deep involvement in the care relationships; the use of parallel chart demonstrated to be an effective tool to preserve their wellbeing.
Subject(s)
Epilepsy , Adult , Employment , Epilepsy/therapy , Humans , Italy , Middle Aged , Patient CareABSTRACT
BACKGROUND: The problem of unexpected neoplastic residual at the bronchial stump after surgery is discussed. Even if the prognostic impact of a macroscopic neoplastic residual at the bronchial stump is well known, the microscopic residual is still uncertain as well as the better therapeutic strategy to face this problem. METHODS: 43 out of 2350 patients operated on for lung cancer in our Institute from 1976 to 1998 had a neoplastic residual bronchial stump; 16 patients underwent a second surgery and are no more included in this study. 27 patients with a mean follow-up of three years were treated without another operation. Radiotherapy was proposed to all these patients and performed only in 20, while 4 patients were treated with polychemotherapy alone. Postoperative stage was IIIa in 17 patients, IIb in 8 and IIa in 2. RESULTS: The three year survival rate is 29% (8 patients still alive, 7 of which disease free); 7 received radiotherapy (35% of the whole patients treated with radiotherapy), only 5 complicated by radiation pneumonia without stopping the treatment, and one only chemotherapy. The survival rate after therapy is the same of patients operated on in the same stage without neoplastic bronchial residual. CONCLUSIONS: The authors are favorable to perform a second look surgery to enlarge bronchial resection in the initial stages and to perform in all cases adjuvant therapy. Attention is given to the meaning of mucosal or extramucosal involvement, to the effectiveness of frozen section examination and the authors' therapeutic suggestions in relationship to stage and histotype are discussed.
