Development and preliminary evaluation of a communication skills training programme for hospital physicians by a specialized palliative care service: the 'Teach to Talk' programme.

BACKGROUND: There is widespread agreement about the importance of communication skills training (CST) for healthcare professionals caring for cancer patients. Communication can be effectively learned and improved through specific CST. Existing CSTs have some limitations with regard to transferring the learning to the workplace. The aim of the study is developing, piloting, and preliminarily assessing a CST programme for hospital physicians caring for advanced cancer patients to improve communication competences. METHODS: This is a Phase 0-I study that follows the Medical Research Council framework; this paper describes the following sections: a literature review on CST, the development of the Teach to Talk training programme (TtT), the development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and the pilot programme. The study was performed at a 900-bed public hospital. The programme was implemented by the Specialized Palliative Care Service. The programme was proposed to 19 physicians from 2 departments. RESULTS: The different components of the training course were identified, and a set of quality indicators was developed. The TtT programme was implemented; all the physicians attended the lesson, videos, and role-playing sessions. Only 25% of the physicians participated in the bedside training. It was more challenging to involve Haematology physicians in the programme. CONCLUSIONS: The programme was completed as established for one of the two departments in which it was piloted. Thus, in spite of the good feedback from the trainees, a re-piloting of a different training program will be developed, considering in particular the bed side component. The program should be tailored on specific communication attitude and believes, probably different between different specialties.

[Clinical effectiveness of N-oleyl-phosphatidyl-ethanolamine (NOPE) in obesity: our experience]. / Efficacia clinica della n-oleil-fosfatidil-etanolamina (NOPE) nella terapia dell'obesita: nostra esperienza.

Adjustment and maintenance of body weight are the result of many process combination, that affect both the gastrointestinal system and other mechanisms in the central nervous system. Often a diet modification alone is not sufficient to guarantee significant changes in body weight. For this reason, it sometimes necessary to make other interventions, in order to help an individual to adhere to the diet as much as possible and to achieve the objectives established. The N-oleyl-phosphatidyl-ethanolamine (NOPE) is a phospholipid. It can be endogenous or exogenous, and it is present in cell membranes and in much of the food. Food intake increases its production; in fact, because of certain stimuli, it is sometimes produced by the epithelial intestine cells too. Another substance whose activity is comparable to NOPE is the epigallocatechin gallate (EGCG), an abundant catechin present in the green tea, which allows a lipid lowering and antioxidant action, and acts on energy consumption as well. The aim of our study was to evaluate the effectiveness of NOPE and EGCG pharmaceutical formulation in a population of obese women, administering the supplement twice daily before meals, for a period of 60 days. The comparison between the effectiveness of the results in a homogeneous group of patients treated with diet and placebo, allows to confirm the data reported in the literature regarding the effectiveness of the pharmaceutical formulation and the absence of side effects.

[Psychic aspects of the premenstrual dysphoric disorders. New therapeutic strategies: our experience with Vitex agnus castus]. / Aspetti psichici del disturbo disforico della fase luteale: nuove prospettive terapeutiche, il vitex agnus castus. Nostra esperienza.

AIM: The premenstrual dysphoric disorder (PMDD) is one of the main problems of the premenstrual phase. It consists of symptoms that sometimes invalidate the scope of employment, social and psycho-affective of patients, requiring thus a diagnostic and therapeutic approach as detailed and accurate as possible. The therapeutic strategies available for this disease are many, but recently the emphasis has been on Vitex agnus castus (VAC), considered by many as evidence drug of choice for both PMS and for the PMDD, being with satisfactory therapeutic properties and small side effects. METHODS AND RESULTS: Our study evaluated a group of patients suffering from PMDD and the clinical efficacy of treatment with VAC (and compared the effectiveness of the results of a more homogeneous group of patients treated with fluoxetine). CONCLUSION: This study confirms the data reported in the literature regarding the effectiveness of VAC therapy with no side effects.

[Controversies on the staging of microinvasive cervix carcinoma]. / Controversie sulla stadiazione del carcinoma microinvasivo della cervice.

Controversies regarding the nosographical classification and staging of microinvasive cervical cancer are still the subject of debate largely based on two schools of thought: one privileges the morphovolumetric criterion, while the other, in an attempt to overcome one of the general aims of FIGO staging, pragmatically assigns a therapeutic orientation to it and proposes staging criteria that the opposing school finds arbitrary and not satisfactory for prognostic purposes. The key point that generates most of the dissension is the correctness of the biopsy procedures and the histological process used to examine material. The general rules for FIGO staging are rightly based on the limitation that clinical staging cannot be modified, even when subsequent histological or surgical findings show a different extension of the disease. But this is true of "clinical" carcinomas for which the diagnostic and staging criteria are still mainly clinical using procedures that have been classified by FIGO itself. However, in those cases where the diagnosis of staging is exclusively microscopic, as in IA, clear indications should be given regarding the procedures and failure to observe them should preclude staging.

Psychological and symptom distress in terminal cancer patients with met and unmet needs.

This study identified the needs of terminal cancer patients, investigated the factors associated with unmet needs, and assessed psychological and symptom distress associated with unsolved needs. Ninety-four patients were randomly selected from 324 patients admitted for palliative care in 13 Italian centers. Two self-administered questionnaires (the Symptom Distress Scale and the Psychological Distress Inventory) were administered to all the patients. Patients needs were identified using a semi-structured interview, aimed at exploring five areas: physiological needs, safety needs, love and belonging needs, self-esteem needs, self-fulfillment needs. A content analysis of the answers defined 11 needs, and identified patients with unmet needs. The most frequent unmet needs were symptom control (62.8%), occupational functioning (62.1%), and emotional support (51.7%). The less frequently reported needs were those related to personal care (14.6%), financial support (14.1%), and emotional closeness (13.8%). Low functional state was significantly associated with a high proportion of patients with unmet needs of personal care, information, communication, occupational functioning, and emotional closeness. Patients with unmet needs showed significantly higher psychological and symptom distress for most needs. This study provides some suggestions about the concerns that should be carefully considered during the late stage of cancer.

Attitude of potential users in Sicily towards preimplantation genetic diagnosis for beta-thalassaemia and aneuploidies.

This study aims to report the willingness of different populations of high-risk couples to undergo preimplantation genetic diagnosis (PGD) for beta-thalassaemia as an alternative to prenatal genetic diagnosis (PND), and the willingness of infertile couples to undergo PGD for aneuploidies. An information sheet and questionnaire presenting PGD and PND procedures were distributed to four population types: 54 high-risk couples for beta-thalassaemia coming for their first PND (population A); 51 similar couples coming for their second or further PND without previous experience of therapeutic abortion (population B-na); 50 similar couples coming for their second or further PND with previous experience of therapeutic abortion for beta-thalassaemia-affected fetus (population B-ab); and 74 infertile couples undergoing routine in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) (population C). Favourable first impressions towards PGD compared with PND were observed in all four populations in the following proportions: 79.6% population A; 76.5% population B-na; 92.0% population B-ab; and 96.0% population C. Willingness to undergo PGD for beta-thalassaemia was as follows: 44.4% population A; 47.1% population B-na; and 72.0% population B-ab. We conclude that previous experience of PND for beta-thalassaemia is a crucial point in the willingness to accept the PGD procedure, and that couples belonging to population B-ab are the most suitable to undergo PGD for beta-thalassaemia. Some 96.0% of infertile couples in population C were ready to undergo PGD for aneuploidies.

Angiogenesis as a prognostic factor in cervical carcinoma.

Angiogenesis and other prognostic factors have been studied among 32 recurrences and 28 deaths of 420 patients with cervical carcinoma operated in the 1st Department of Obstetrics & Gynecology of Catania University. Prognostic factors were studied in comparison with a group of patients still alive and NED was followed for more than 60 months independently of stage and node involvement. Angiogenesis, nuclear grading 3, and lymphovascular invasion were factors common to all patients with negative prognosis. It seems that in the presence of these negative prognostic factors, we should adopt a more aggressive attitude in both our surgical strategies and adjuvant therapies, particularly preferring chemotherapy where angiogenesis is more significant.

[Carcinoma of the uterine cervical canal. Staging and biometric assessment with magnetic resonance]. / Il carcinoma del canale cervicale dell'utero. Stadiazione e valutazione biometrica con risonanza magnetica.

In uterine cervical canal carcinoma, the current clinical FIGO criteria often fail not only to differentiate stage IA2 from stage IB but also to demonstrate possible parametrial involvement. Moreover, the analysis of tumor volume and of the depth of neoplastic stromal invasion is not very reliable. The authors investigated MR accuracy in the definition of such variables: to this purpose, 24 patients with histologically confirmed endocervical adenocarcinoma were submitted to MRI, which was performed with an 0.5-T superconductive magnet. Sagittal and oblique transverse or sometimes coronal SE images, oriented so as to be perpendicular to longitudinal cervical major axis were obtained with T2 weighting (TR 1800 ms, TE 25-90 ms). MR data were correlated with pathologic findings. MR accuracy in demonstrating parametrial involvement was 92%, its sensitivity was 86% and specificity 97%. Volumetric MR data showed a high correlation (r = 0.970) with those derived from pathologic findings. In 92% of cases stromal invasion exceeded 5 mm. MRI, thanks to its high accuracy, should be included in diagnostic pretreatment protocols, even though FIGO criteria do not require it yet, especially in the presence of an endocervical adenocarcinoma. Moreover, the accurate definition of tumor volume can allow less extensive surgery with the same survival rates and fewer complications, which are frequently observed after radical hysterectomy.

[Gynecologic oncology: a daily confrontation for the gynecologist]. / Oncologia ginecologica: confronto quotidiano per il ginecologo.

In the last decades a new discipline of "gynaecologic oncology" has spontaneously developed in the field of obstetrics and gynaecology. In this article the authors point out the necessity of an oncologic education for the gynecologist. The gynaecologist oncologist must have a solid cultural background in general and medical oncology, radio and immunotherapy. He also must have acquired surgical experience and clinical maturity. The authors underline the important role of the "general" gynecologist who must recognize risk cases, formulate a correct pre-surgical staging in order to plan a rational therapy and take part in the follow-up. His participation is important in the care of end-stage patients.

The role of follow-up after treatment for gynecologic cancer.

The quality of life of the genital cancer patient may be considered in its many different aspects and principally from a medical, sexual and psychological point of view. In order to verify whether a substantial modification of the variable "anxiety" and of the bipolar axis male-female exists, we are conducting a research on our patients undergoing oncologic follow-up (806 patients, treated from 1975 to 1990). The result shows that the state "anxiety" decreases after follow-up examination; on the contrary to trait "anxiety" increases before and after follow-up examination. More complete information could perhaps be obtained having knowledge of the patient's personality, attitudes, feelings etc.

Nimesulide in the treatment of pelvic inflammatory diseases. A multicentre clinical trial conducted in Campania and Sicily.

400 patients aged 18 to 71 years took part in a multicentre noncomparative study designed to assess the clinical efficacy and tolerability of nimesulide in gynaecological inflammatory disease: adnexitis (72 patients), cervicitis (78 patients), endometritis (18 patients), myometritis (22 patients), and combined disorders (210 patients). All patients were treated with nimesulide 100mg twice daily in granular form for an average of 19.5 days. The treatment produced good results in all types of diseases considered, with a significant decrease in severity of symptoms being observed. The drug was well tolerated.

[A Sicilian multicenter study of the clinical effectiveness and tolerability of nimesulide in gynecologic inflammatory diseases]. / Studio policentrico siciliano sull'efficacia clinica e la tollerabilità della nimesulide nelle affezioni flogistiche ginecologiche.

Hundred-eighty patients, aged between 18 and 58 years, participated in a multicenter study, in order to assay the efficacy and tolerability of nimesulide in gynaecological inflammatory diseases. Thirty patients were affected by adnexitis, 41 patients by cervicitis, 6 by endometritis, 13 by myometritis and 90 patients presented more pathologies associated. Al the patients were treated with nimesulide 100 mg granular (sachets) bid for a mean period of 19 days. Treatment with nimesulide produced good results in all pathologies, significantly reducing the intensity of symptomatology. The tolerability of the drug was always good.

Endometrial cancer: our experience.

The Authors have referred to their experience based on 293 endometrial cancer patients operated at the II University Gynecological Clinic in Catania, between 1975 and 1989. Many prognostic indicators such as stage, histologic grade, myometrial invasion depth, lymph-node metastasis, non-neoplastic endometrium histology, tumor size and histology were studied; the Authors affirm the validity of two risk factors such as tumor size and the histology of the non-neoplastic endometrium, readily observable by hysteroscopy during the preoperative assessment and which are well correlated with the depth of myometrial invasion and lymph node methastasis.

[Socio-psychological aspects of voluntary abortion at the Obstetrical and Gynecological Clinic of Catania]. / Aspetti socio-psicologici dell'aborto volontario nella Clinica Ostetrica e Ginecologica di Catania.

PIP: At the Obstetrical and Gynecologic Clinic of the University of Catania, Italy, a questionnaire was prepared to be completed by patients seeking abortion. The purpose was to gather some knowledge of the psychosocial factors and attitudes leading to voluntary abortion. The questionnaire, which is included in the document, contains questions about medical history, sexual life, motivation for abortion, psychological reaction, and contraceptive knowledge and usage. Of 595 abortions performed between March and September 1979 only 151 (25.37%) questionnaires were completed. 47.01% of women were between 25-35, 84.10% were married, 70% came from the city of Catania or the neighboring suburbs, 52.31% of women had elementary school education, 45.01% had 1-2 children and 27.14% 2-4 children, 68.62% of women requesting abortion were in the age group 18-25 with 1-2 children, and 68.21% were housewives. Motivation for interruption of pregnancy was high parity (19.20%), too close pregnancies (17.21%), and psychological reasons (9.27%). While most women knew about modern contraceptive methods, only 47.01% used hormonal contraception, 78.14% relied on coitus interruptus, 37.08% on the condom, and 34.43% on periodic abstinence. Last conception was due to contraceptive failure in 53.98% of cases. In 1979 there were a total of 960 legal abortions; only 97 women requested contraception after the abortion, and 13 came back for a repeat intervention. These data clearly demonstrate the lack of correct information on contraception on the part of most women.^ieng