Pain, symptoms and therapy satisfaction in adult oncologic patients at admission to palliative care: An Italian prospective, multicenter, observational study.

BACKGROUND: Pain in cancer patients is a complex clinical problem. Pain is systematically assessed and treated during palliative care, but little is known about how it is addressed before starting palliative care. AIM: This study primarily analyzed pain, symptoms, ongoing therapy at patients' admittance to the palliative care unit, and the relationships between pain and tumor, comorbidities, performance status and quality of life (QoL). Notably, patient satisfaction with the received antalgic therapy was assessed. METHODS: A multicentric, prospective, observational study was conducted in seven Italian palliative centers. The population consisted of adult cancer patients admitted to specialist palliative care units in hospice and home care. RESULTS: The sample consisted of 476 patients. Ninety-three patients reported moderate pain of 4.0 and worst pain of 5.9 at the initial medical examination. The pain was high, and QoL was lower in breakthrough pain. The pain was lower in older subjects when it was discontinuous and when it was also treated with corticosteroids. A total of 61% of the patients were unsatisfied with the prescribed pain therapy. CONCLUSIONS: Before the beginning of palliative care, physicians do not manage pain adequately. We support the idea that palliative care is not only intended for the last days of life but must be started early and simultaneously with oncological treatments. All that, in our opinion, is often ignored, and we hope that our study could have a positive influence and that the study results stimulate further research in this area with in-depth studies.

Adherence to hormone therapy in patients with mCRPC: psychometric validation of the A-HT questionnaire.

Abstract: The incidence rate of prostate cancer (PCa) in many Western countries is high, contributing greatly to the cancer disease bur-den. In most cases, patients progress to metastatic disease defined as castration-resistant prostate cancer after androgen deprivation (mCRPC) following primary treatment where the majority of patients receive first-line new-generation oral hormonal therapies (HT) such as Abiraterone Acetate (AA) and Enzalutamide (ENZ). Despite the importance of correct intake of these drugs, adherence in patients with mCRPC is still poorly investigated and managed with measures not specific to this population. A self-report questionnaire was developed and validated with women with breast cancer treated with oral HT (A-BET). Therefore, this study aims to test the psychometric properties of this instrument on patients with mCRPC treated with AA or ENZ. A prospective observational validation study. The questionnaire was completed by all participants and again after 7/10 days by a randomized subsample to assess stability. Sixty-six patients completed the study (mean age of 72.8 years) and 31 completed the re-test (mean age of 72.7 years). Content validity reported excellent results. Cronbach's alpha of each item showed a strong correlation. Validation of an instrument to measure adherence to HT in patients with mCRPC can be a valuable tool for health professionals involved in patient care. In addition, having a population-specific validated instrument allows to make comparisons between results from different observations.

Adherence to endocrine therapy in women with breast cancer: development and preliminary validation of the A-BET questionnaire.

Purpose: To develop an Italian tool that measures the therapy adherence of women with breast cancer undergoing treatment with oral endocrine therapy. Methods: A two-phase study was conducted, which followed the guidelines of the European Statistical System for the development and validation of a questionnaire. In the first phase, the questionnaire was developed; in the second phase, a preliminary validation was carried out on patients with breast cancer undergoing treatment with oral hormonal therapies. Results: In its final version, the questionnaire presents 6 main items which aim to investigate the level of adherence, the degree of awareness of the nature of the drug taken and the reasons that may influence non-adherence. 82 patients were recruited in the validation study, with an average age of 56.4 years, while for the re-test 40 were selected with an average age of 57.3 years. Content validity reported excellent results. Cronbach's alpha of each item showed a strong degree of correlation. Conclusions: The creation of a tool for measuring adherence to endocrine therapy in breast cancer patients can be a valuable support for healthcare professionals involved in their care. Future studies should be aimed at using A-BET (Adherence - Breast Endocrine Therapy) on larger cohorts of patients in order to verify its validity / reliability more accurately and to be able to generalize the results.

Italian version of Nursing Students' Perception of Instructor Caring (I-NSPIC): assessment of reliability and validity.

BACKGROUND: Clinical experience is an essential component of nursing education since it provides students with the opportunity to construct and develop clinical competencies. Instructor caring is a pivotal facilitator at the forefront of clinical education, playing a key and complex educating role in clinical sectors. For these reasons the aims of this study was to assess the validity and reliability of the Italian version of NSPIC (I-NSPIC). METHODS: A validation multicentre study was conducted in three different Italian universities. A total of 333 nursing students were enrolled in the 2014/2015 academic year. Exploratory factor analysis (EFA) with oblique rotation was performed to test the construct validity of I-NSPIC. The Cronbach's alpha coefficient and test retest via Intraclass Correlation Coefficient (ICC) analyses were done to assess the internal consistency and stability of the scale. A Spearman's correlation with another scale (CLES-T) was used to examine the concurrent validities. RESULTS: Four factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA. The Cronbach's alpha value showed that I-NSPIC was a reliable instrument (α = 0.94) and the ICC coefficient was satisfactory. CONCLUSION: The I-NSPIC is a valid instrument for assessing the perception of instructor caring in Italian nursing students. It may also prove helpful in promoting the caring ability of nursing students and in increasing the caring interactions in the relationship between instructor and nursing students. The knowledge emerged from this study provide important insight in developing effective training strategies in the clinical training of undergraduate nursing students.

Propolis in the prevention of oral mucositis in breast cancer patients receiving adjuvant chemotherapy: A pilot randomised controlled trial.

Chemo-induced oral mucositis (OM) is associated with significant symptoms, treatment delays and increased costs. This pilot randomised controlled trial aimed at evaluating the safety, tolerability and compliance with propolis in breast cancer patients receiving doxorubicin and cyclophosphamide, testing preliminary clinical efficacy of propolis in the prevention of OM, and prospectively evaluating the incidence of OM. Sixty patients were randomised to receive either a dry extract of propolis with 8%-12% of galangin plus mouth rinsing with sodium bicarbonate (experimental arm), or mouth rinsing with sodium bicarbonate (control arm). OM was evaluated with the NCI-CTCAE v4.0 after 5, 10, 15 and 21 days of treatment. Compliance with, tolerability of propolis and adverse events were recorded. The incidence of OM was also prospectively evaluated for 6 months. Two patients (6.7%) manifested a suspected skin reaction to propolis. No patient in the experimental arm developed OM > G1, while in the control arm OM > G1 was 16.7% (p = .02). The incidence of OM ≥ G1 at the end of cycles 2-8 was higher at the second (25%) and fifth cycles (45.8%). Propolis plus bicarbonate was safe, well tolerated and promisingly effective in the prevention of OM in patients with breast cancer.

The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis.

Protective isolation is aimed at preventing infection in neutropenic patients, but it is implemented inconsistently across centres and is supported by recommendations with poor evidence. This review and metasynthesis explored the experiences and the psychological implications of protective isolation in patients with haematological malignancies undergoing bone marrow (BMT) or haematopoietic stem cell transplantation (HSCT). A systematic search of multiple databases for qualitative studies exploring BMT or HSCT patients' experiences of protective isolation was completed. The metasynthesis followed the meta-aggregative method from the Joanna Briggs Institute, with four procedural steps: (1) comprehensive search, (2) quality appraisal, (3) extraction of relevant findings and (4) synthesis of the identified findings. Twenty-six findings were extracted from 11 articles included in the review. The synthesising process yielded seven categories, aggregated into three synthesised findings: (1) isolation is a source of suffering, (2) isolation can lead to relating with oneself and (3) the person does not close the door to the outside world. This metasynthesis sheds light on patients' suffering from being isolated, and the possibility of overcoming this suffering thanks to relationships that patients have with themselves and with the external world. Healthcare providers should reconsider this practise in order to avoid unnecessary patient suffering.

Latent Growth Modeling of nursing care dependency of acute neurological inpatients.

Longitudinal three-time point study, addressing how neurological adult patient care dependency varies from the admission time to the 3rd day of acute hospitalization. Nursing care dependency was measured with the Care Dependency Scale (CDS) and a Latent Growth Modeling approach was used to analyse the CDS trend in 124 neurosurgical and stroke inpatients. Care dependence followed a decreasing linear trend. Results can help nurse-managers planning an appropriate amount of nursing care for acute neurological patients during their initial stage of hospitalization. Further studies are needed aimed at investigating the determinants of nursing care dependence during the entire in-hospital stay.

Stakeholders in nursing education: their role and involvement.

INTRODUCTION: In literature, there is evidence that all stakeholders need to be involved in the curricula building process to make sure that health professionals are "educated" to meet the stakeholders' "demands". In Italy, the involvement of stakeholders in the definition of university curricula is ratified by various regulations. AIMS: To describe the major experiences of stakeholder involvement in nursing education, identify the main stakeholders for nursing education, and the processes in which they are involved. METHODS: The search strategy included an electronic exploration of the relevant databases. The search terms were: Stakeholders, Curriculum, Nursing Education combined with Boolean operators. The references of the retrieved articles were hand searched for additional related studies. RESULTS: Most of the studies identified were from the United Kingdom, Australia, and the USA. In Italy, no relevant studies were found. The most frequently identified stakeholders were: students, clinicians, educators, nurse managers. They were mainly involved during profound changes in the curricula and the implementation of new educational approaches. DISCUSSION AND CONCLUSIONS: Stakeholders are mostly involved in countries with a private funding system for universities. Such funding systems have probably developed in the academia a greater propensity to involve stakeholders, to provide recognition of success when starting new programs, and are perceived more as marketing research. This seems contrary to the spirit of the Italian and European regulatory interventions, which instead, provide a structured commitment to consolidating and expanding the collaboration among universities, users, and the world of labor. This latter collaboration should facilitate internship activities, lifelong learning, and employability of the newly-graduated professionals.

The licensure exam in nursing degree courses: a survey in the four universities of the Lazio Region.

BACKGROUND: In recent years, the nursing licensure exam is at the centre of a national and international wide debate. This debate regards the planning of the nursing licensure exam in many Universities and the competences that this exam must certify to ensure quality, effectiveness, and ethics of nursing care from newly-graduated nurses to general public. The aim of this study was to describe the practical tests used for the licensure exam in the four Universities of the Lazio Region. The researchers analyzed the type of practical tests used and the field of competences assessed according to the degrees of performance defined by the Dublin Descriptors. METHODS: The data were collected through semi-structured interviews to Presidents, Directors and Lecturers of nursing degree courses and through direct retrieval of the written texts of the licensure exam. Two researchers analyzed the practical tests. A special lecture-grid divided into three different sections to interpret the data was created. Statistical analysis was carried out by means of Epi-info 3.5.1/2008. RESULTS: Analysis of data showed that the most used tests were Discussion of theoretical and practical aspects in context (33.6%), followed by the Test with open and/or closed questions (23,9%). Psychomotor and relational skills tests were little used. The most valued field of competence was the cognitive one (85,5%) that assessed, above all, the storage of the concept. The ability to interpret data and solve problems was less valued. CONCLUSIONS: The study showed the high discrepancy in the types of tests used in the four Universities of the Lazio Region. Universities found it difficult to assess psychomotor and relational skills of the students. Most of the cognitive tests utilized omitted the evaluation of mastery of complex competences. Therefore, there is the necessity of a new planning of the nursing licensure exam to overcome these critical issues.

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

BACKGROUND: Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. METHODS: A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. RESULTS: CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). CONCLUSIONS: In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

[Online information supplied by Italian Hospitals and Local Healthcare Units: a descriptive research on their compliance with the guidelines issued by the Italian Ministry of Health]. / L'informazione online fornita dai siti delle Aziende Sanitarie Ospedaliere Italiane: indagine descrittiva sull'aderenza alle linee guida del Ministero della Salute.

INTRODUCTION: In most countries where Internet is widely used the number of people surfing the web for healthcare information equals (and in some countries is more than) the number of people looking for healthcare assistance. More and more often, all over the world, Internet is integrated by advanced healthcare systems as a cornerstone of their e-health infrastructure, to meet citizens' needs for health information. Therefore, information plays a key role in the relationship between healthcare providers and citizenship. In 2010 the Italian Ministry of Health has worked out a set of guidelines to improve online communication, within the framework of health promotion. OBJECTIVE: To analyze if the web sites of the Italian public hospitals (PH) and the local healthcare units (LHU) comply with the guidelines of the Italian Ministry of Health (IMH) on the improvement of online communication within the framework of healthcare promotion. MATERIALS AND METHODS: All Italian PH and LHU web sites have been analyzed using the self evaluation tool of the IMH. RESULTS: The total number of web sites analyzed was 245. Their compliance with the IMH guidelines was low. Web sites linking to other professional sites, such as the College of Physicians, the College of Pharmacists, or the College of Nurses, were 32 (13%). One hundred and forty-two (58%) were the sites that did not offer any kind of health information, such as pathophysiology of diseases, the most relevant pathologic conditions, risky behaviors, primary and secondary prevention's interventions. A web navigation menu organized according to the most relevant life events or according to categories of users (I am ... /dedicated to...) was available only in 53 web sites (22%). CONCLUSIONS: The IMH's guidelines on online communication -- with reference to the aspects here analyzed -- have been in some ways disregarded and the criteria suggested by them have not been fully adopted by PHs and LHUs. Overall, communication is globally meant (and directed) "towards" citizenship and not "together with" the citizens. To reach this type of communication, experts suggest to redirect resources and efforts towards a different context, different tools and different models of communication, such as social networking. Further studies will be needed to fully understand information needs and expectations of users and the way to use social networking on behalf of healthcare providers.

A brief history of the Quality of Life: its use in medicine and in philosophy.

The term Quality of Life (QoL) has been increasingly used in medical and philosophical literatures for the past four decades. The purpose of this article is to analyze how QoL is being used in medicine and in philosophy to understand its current status. In the 1960s and 1970s new technologies raised new questions for clinicians, so they used QoL as a parameter for making decisions in health issues. Consequently, researchers focused their interest on the construction and testing of instruments designed to measure health and QoL. However, all these instruments showed some conceptual and methodological problems that made the use of QoL in medicine difficult. While some researchers considered QoL an "idiosyncratic mystery", others believed that QoL was useful in implementing the patient's point of view into clinical practice and they suggested improving QoL's definition and methodology. In the 1980s, some consequentialist philosophers used QoL to formulate moral judgment, in particular they justified infanticide for some severely handicapped infants, and both euthanasia and suspension of life-sustaining treatment using QoL. In the 1990s, welfarist philosophers opened a new debate about QoL and they associated it with health and happiness. These philosophers developed QoL and those other concepts as subjectivist notions; consequently their definition and their measurements pose challenges. Afterwards researchers' interest in theoretical issues regarding QoL has fallen; nevertheless, physicians have continued to use QoL in clinical practice.

Pressure ulcers in cancer palliative care patients.

Terminally ill cancer patients are considered at high risk for pressure ulcers because of their clinical condition. However, in Italy, data about pressure ulcers and their prevalence are insufficient. This paper reports a study on pressure ulcers incidence and prevalence in a population of oncology patients cared for in an Italian palliative care service. A retrospective analysis of 414 clinical records of patients admitted over 6 months showed a prevalence of pressure ulcers of 22.9% and an incidence of 6.7%. Karnofsky Performance Scale Index scores, age and length of the stay were significantly related to the pressure sore development. These results support the need to focus attention on pressure ulcers prevention and treatment in terminally ill cancer patients, and to further define specific guidelines aimed at warranting patients' comfort and quality of life.

Observations on EEG patterns in neurally-mediated syncope: an inspective and quantitative study.

We performed an observational EEG study in 43 patients with neurally-mediated syncope in basal condition and during hyperventilation (HV), and compared it with 32 healthy controls. On blind analysis at rest, EEG was classified as normal in 47% of patients (vs. 94% of controls, P < 0.001). More abundant and pronounced delta-theta activities and alpha slowing were found in patients than in control subjects on both visual inspection and quantitative spectral analysis. During prolonged HV, the EEG remained normal in 21% of patients only. Slow activities became more evident in patients than in control subjects, and intermittent rhythmic delta activity appeared in 40% of syncopal patients. These "pseudoparoxysmal" EEG changes differed from the common slowings induced by HV in adult subjects and were not observed in our control subjects. Moreover, these distinctive EEG changes, a common finding in syncopal patients, could not be confused with epileptiform activity of any kind. Further studies will clarify the pathophysiology of these EEG modifications.

Video color perimetry: impairment in glaucoma suspects.

PURPOSE: To detect mild visual field impairment in asymptomatic glaucoma suspect patients. METHODS: Color perception within the visual field was tested with customized color video perimetry. The key features of the system were stimuli color desaturation, low-level luminance and equiluminant gray background. Twenty patients with asymptomatic glaucoma were tested and compared with a group of age-matched control subjects. RESULTS: Automated perimetry test findings differed significantly in the two groups, particularly for short-wavelength sensitivity (blue). The severity of color impairment correlated directly with intraocular pressure. CONCLUSION: Desaturated low-luminance video perimetry will reliably detect and quantify asymptomatic visual field defects. A previous work on multiple sclerosis has detected a mild long-wavelength (red) impairment in asymptomatic patients after an episode of optic neuritis, even in clinically unaffected fellow eyes. Our findings in glaucoma suspect patients indicate that a mild blue impairment could be the initial sign of this disease.

Sympathetic skin response and cardiovascular autonomic function tests in Parkinson's disease and multiple system atrophy with autonomic failure.

The relationship between sympathetic skin response (SSR) and cardiovascular autonomic function tests (CVTs) was investigated in 15 patients with idiopathic Parkinson's disease (PD), 15 patients with clinical evidence of multiple system atrophy (MSA) with autonomic failure, and in 15 healthy control subjects. SSR was elicited by electrical stimulation of the right and left median nerves and simultaneously recorded on the palms of both hands. CVTs included the following sympathetic and parasympathetic tests: orthostatism, head-up tilt, cold pressor test, deep breathing, Valsalva maneuver, and hyperventilation. The SSR was normal in all patients with PD and control subjects but was abnormal or absent in all patients with MSA. For patients with MSA, SSR latency was significantly longer and amplitude was significantly smaller than that of patients with PD and control subjects. For patients with PD, SSR did not differ from that of control subjects. In these patients, SSR latency was significantly longer and SSR amplitude was smaller when the side with more marked motor symptoms was stimulated, both ipsilaterally and contralaterally to the side of stimulation. A statistically significant difference in SSR latencies and amplitudes was found between patients with PD and control subjects only when motor asymmetries were considered. CVTs showed severe sympathetic and parasympathetic hypofunction in patients with MSA, but not in patients with PD or control subjects. No correlation was found between SSR and CVTs that assess sympathetic function in patients and control subjects. SSR is indicated as an additional test for the evaluation of sympathetic degeneration in patients with MSA.

Migraine and ocular pain in "glaucoma suspect".

A relationship between glaucoma and migraine has been hypothesized by some authors, but not confirmed by others. We studied the prevalence and features of migraine and ocular pain in 460 "glaucoma suspect" patients (with ocular hypertension, but without optic disc and visual field abnormalities) and 460 controls. A higher prevalence of migraine was found in patients (13%), particularly in women (17%), than in controls (7%). At the time of the interview, migraine was still active in 68% of the patients and had decreased in the remaining 32% (prevalently those not being treated for ocular hypertension), whereas it had ceased in 52% of controls. Attacks of "ocular pain" of mild and moderate intensity were found to occur in 51% of the patients with both "glaucoma suspect" and migraine, in almost all who were not taking treatment for ocular hypertension. "Ocular pain" was time-related to the history of glaucoma. Changes in intraocular pressure may play a role in the interaction between "glaucoma suspect", migraine, and ocular pain.