The process of developing the professional identity of the Nurse Case Care Manager: A Grounded Theory Study

Background and purpose.

The Nurse Case Care Manager (NCCM) is still an emerging figure in the Italian healthcare context. The knowledge of the dynamics inherent in the process of identity development shows how they can be decisive for the affirmation and recognition of this new role. The aim of the study was therefore to analyse the psychosocial processes of developing the identity of the NCCM for a better understanding of the variables that influence its development.

Methods.

A qualitative study with Grounded Theory method was conducted. From December 2018 to January 2019, 20 semi-structured interviews were given to the NCCM of the Emilia Romagna Region and the Lombardy Region. The analysis of the material has led to a structuring of the theoretical model on the processes of development of professional identity.

Results.

Two main conditions have been identified: that of the “LOST CASE CARE MANAGER” and that of the “CASE CARE MANAGER DIRECTOR”. This process requires time, perseverance, courage and personal skills. Two transversal background concepts have been identified, namely “available space” and “relationship with the family”.

Conclusion.

The process of developing the NCCM’s professional identity encounters several obstacles. Among these, in particular a lack of recognition by operators highlighting the need for greater organizational clarity in the context in which the professional operates, in order to facilitate the inclusion of the NCCM clarifying skills and effectiveness profile. (www.actabiomedica.it)

Use of traffic crash as a risk assessment scale in hospitalized seniors: a perspective observational study

Background and aim:

According to the World Health Organization (WHO), falls represent the second main cause of accidental and involuntary deaths worldwide, which led to define them as one of the “four giants of the geriatrician” that particularly affect the elderly aged ≥ 65 years. The study’s aim is to evaluate whether the Traffic Crash scale is valid in identifying patients at risk of falling by comparing it to the Conley scale currently used.

Methods:

Prospective observational study evaluating the fall risk using TC on a sample of patients aged ≥ 65 years, hospitalized in General Medicine Ward and Gastroenterology, after informed consent and favorable opinion of the AVEN Ethics Committee. The results are compared with those obtained from the Conley scale, and with those obtained from the indications of the Business Operating Instruction. The method of administration occurred concurrently and distinctly on the same patient by two researchers in order to demonstrate the scale inter-rater reliability.

Results:

The final sample was made up of 88 patients. Data shows that 46 out of 55 patients (84%) are medium / high risk for both scales. According to the indications of the Company Operating Instruction, the entire sample is at risk. The inter-rater reliability was confirmed with Cohen’s K which is equal to p = 1.

Conclusions:

The TC scale is comparable to Conley scale, for the fall risk identification but specifically the stratification is low-medium-high. Therefore, in future, this will make it possible to implement personalized prevention interventions in care planning. (www.actabiomedica.it)

Italian pilot version of DEMOQL-PROXY: Content and Face validity: a methodological bridge for a future Italian validation

BACKGROUND AND AIM OF THE WORK

The assessment of Quality of Life through validated tools allow to improve level of assistance for people suffering from Dementia. To our Knowledge in Italian language seem to be absent a tool to evaluate mild and moderate dementia, consequently underestimating and underrating needs of this specific target. We show an Italian pilot version of the DEMQOL-PROXY (specific for mild and moderate Dementia) testing some psychometric properties as: back-translation, content validity and face validity in Italian language.

METHOD

A back-translation by two bilingual authors was presented. Was enrolled an expert panel to test Content Validity composed by eight Medical Doctor and a panel of six participants was recruited to assess Face Validity (three professional caregivers and three family caregivers) related to patients with moderate Dementia (with 10 to 20 MMSE, mild and moderate Dementia).

RESULTS

Each item has a degree of agreement between experts of more than 70% and the Total CVI score is .90 (90% of agreement). So, in line with these results we can accept the version of items proposed. As regard Face Validity, the items of the instrument seem to be clear, without difficulty and there are no questions consiedered offensive or irritating.

CONCLUSION

The Italian version of the DEMQOL-PROXY showed good psychometric properties: its structure and the results it leads to are similar to the original version and to the other translations produced so far. For this reason, we consider this paper as a methodological bridge for a future complete Italian Validation.

The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma

Background and aim of the work.

To activate the participation of the person in his/her care path, the literature highlights the impact of the professional’s ability to show a genuine interest in the problems brought by the patient and to recognize him/her as ‘competent’. In this sense the narrative patient’s agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient’s narrative agenda during the assessment phase.

Method.

A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert’s problems.

Results.

The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to Understand difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported.

Discussion and conclusion.

The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient’s problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person’s history, lending itself to the re-exploration of its functional areas over time.

Italian Validation of the Chiba Interprofessional Competency Scale (CICS29)

BACKGROUND AND AIM OF THE WORK

The Chiba Inter-professional Competency Scale (CICS29) validated in several languages, it is a self-report instrument that investigates the degree of interprofessional collaboration in six areas: attitudes and beliefs of the professional; ability to manage a work group; actions to achieve goals; providing assistance that respects the patient; attitudes and behaviours that improve the cohesion of the working group; fulfilling or performing the own professional role. In addition to being recent, the scale investigates collaboration among all health professionals, and is not limited to specific professionals. The aim of the study was to validate the Italian version of CICS29.

METHOD

A questionnaire-based study was conducted with an Italian sample consisting of 530 health professionals (419 women¸ mean age = 40 years, SD = 10.7; range 23- 58 years). The internal validity was measured using factor analysis. To verify the convergent validity, the Italian Version of Interprofessional Collaborative Competency Attainment Survey (ICCAS) was correlated with the CICS29; Results: The reliability and the internal validity of the CICS29 revealed 6 factors corresponding to the original subscales. The analysis presents an excellent sample adequacy measure (KMO = .933) with the scores ranging from 0.62 to 0.78 for the interclass correlation coefficients of the 6 domains. A significant level of correlation was found between the subscales of the CICS29 and the ICCAS.

CONCLUSIONS

In conclusion, the Italian version of CICS29 has a satisfactory level of reliability and validity and it is recommended for measuring interprofessional collaboration of the health professionals. (www.actabiomedica.it).

Myanmar health professionals' educational needs: a pilot study

Background and aim of the work:

The main factor hindering the development of the Myanmar health system lies in the scarcity of financial and human resources attributed to the health system. This paper presents the preliminary results of a pilot study on the educational needs of Myanmar health professionals, addressing the empowerment of human resources as a strategic pillar for delivering the essential packages of health services.

Methods:

An explorative study following a qualitative approach has been conducted through semi-structured interviews to a convenience sample of 15 persons, selected as authoritative key-informants.

Results:

In addition to the lack of infrastructures, medicines, ambulances and health instruments, and the health disparities between the urban and rural areas, some widespread problems are reported as requiring health professionals’ training empowerment: traumas due to road accidents, management of childbirth, non-communicable diseases’ management and poor health education of the population.

Discussion:

Some areas can be evidenced for an improvement of professionals, training: maternal, neonatal and child health; communication between professionals and laypeople; Myanmar population’s health education; inter-professional training between doctors and nurses, but also between health personnel and non-health personnel.

Conclusions:

The educational needs of Myanmar health professionals emerge as closely related to the social and health needs of the Myanmar population, to the available resources and missing resources of the country’s health system and to the role of professionals within professionals/patients’ relationship. (www.actabiomedica.it)

A meta-synthesis study of the key elements involved in childhood vaccine hesitancy

OBJECTIVES

Immunization is one of the most successful and cost-effective interventions to improve health outcomes. However, internationally, the phenomenon of parental vaccine hesitancy is increasing and presents a growing challenge for health professionals. This article summarizes the evidence surrounding childhood vaccine hesitancy from the perspective of parents.

STUDY DESIGN

We conducted a systematic review and meta-synthesis of qualitative studies.

METHODS

We searched for qualitative research articles in electronic databases from inception to March 2018. In addition, a manual search of the retrieved articles and their references was conducted to identify other potential articles. We used the Critical Appraisal Skills Programme to examine study validity, adequacy and potential applicability of the results. No articles were excluded for reasons of quality. By performing a meta-synthesis, we identified descriptive themes and, subsequently, the conceptual elements of vaccine hesitancy.

RESULTS

The review included 27 studies involving a total of 1557 parents who were hesitant about vaccinating their child. Five overarching categories were identified: (1) risk conceptualization; (2) mistrust towards vaccine-related institutions, pharmaceutical companies, researchers, health professionals and the information from media; (3) parental alternative health beliefs about childhood immunity, vaccine scheduling and the perceived toxicity of vaccinations; (4) philosophical views on parental responsibility; and (5) parents' information levels about vaccination.

CONCLUSIONS

Healthcare providers need to approach this difficult situation considering that parents desire to do what they feel right for the child. Understanding the core elements of hesitancy will allow health professionals to adopt effective communication and behavioural strategies.

Infectious risk in ostomy patient: the role of nursing competence

Background and aim of the work: The risk of peristomal infections in ostomy patients is well documented in the literature. The nurse and the stoma therapist play a fundamental role in the management and prevention of ostomy-related infections. The present research aims to investigate, across the different phases of the nursing process, the level and characteristics of nursing expertise and highlight their impact on reducing infectious risk in ostomy patients. Methods: 40 nurses (31 women; mean age = 47.7; SD= 7.68) working with ostomy patients were interviewed, in three Italian Local Healthcare Company (LHC) of Northern Italy, Central Italy, and Southern Italy. Nurses compiled a semi-structured ad-hoc interview concerning the level of skills, training, and experience with ostomy patients. The declared expertise has been compared to the retrospective archive data related to the peristomal skin infections of the three LHC. Results: Several differences have emerged in terms of nurses’ expertise and care settings: for instance, ostomy complications in Southern Italy being managed with specific checklists, whereas in the Northern Italy complications being managed by stoma therapists and in Central Italy by hospital ward general nurses. Moreover, the level of professional training was very important for all respondents. The incidence rates of infections after training are lower than a pre-training period. Conclusions: The expertise resulting from specific training for nurses and stoma therapists are crucial for the management of the ostomy and the prevention of complications, in particular of infections. If the training reduces the peristomal complications, therefore, it is necessary to provide and preserve nurses’ expertise, to guarantee patients an optimal treatment path. (www.actabiomedica.it)

Interprofessionalism and interprofessional research: a challenge still to be won in Italy

Public health and pedagogical institutions have long been calling for collaborative models of assistance and training that provide inter-professional synergy and there is a broad international consensus on the importance of inter-professionalism in the field of assessment and healthcare provision (1-10). [...].

The Case/Care Manager in Eating Disorders: the nurse's role and responsibilities

BACKGROUND AND AIM OF THE WORK

Despite its incidence, the Eating Disorder (ED) is underdiagnosed and, for its complexity, it requires multidisciplinary interventions. The Nurse and Case/Care Manager (CCM) have a central role in taking care of the patients with ED, even if the research concerning their role are lacking. Thus, the aim of the study was to investigate roles, activities and expectations of the nurse and the CCM in taking care of patients with ED.

METHOD

25 Italian different professionals were interviewed (16 women, average age 43.4; SD = 9.23). The semi-structured interview has investigated: nurses' roles and activities; perceptions of nurses' evaluation; expectations on nurses' and CCM's roles; the interprofessional collaboration.

RESULTS

The nurses analyse patients' care needs and coordinate the multi-professional care with empathic attitude. Their "professionalism, skills, sensitivity, ability to relate to the patient-family unit" are expectations shared by various professionals. About the interprofessional collaboration, the action of professionals is not always well coordinated, the decisions are often not shared and hospital-territory connection is not always realised. The CCM would be the reference in this process for all interviewees.

CONCLUSIONS

In the three examined contexts the figure of the CCM was not present, but his/her importance was acknowledged in the management of the patient's care path and as a point of reference for health professionals. It seems important that CCM is institutionally recognized, because the CCM would ensure an efficient management of the clinical pathway and would guarantee the continuity and appropriateness of care.

Opening the horizons of clinical reasoning to qualitative research

Clinical Reasoning (CR) is an important aspect of health professional education and effective practice. It is a complex series of factors and cognitive functions, involving higher-level thinking to define problems, examine the evidence and then making decisions and choices to improve the patient's physiological and psycho-social state.CR consists of 3 interconnected and interdependent sub-processes: clinical experience and clinical context and Evidence-Based Practice. This essay focuses on the opportunities that Qualitative Research offers during the CR process when the doctor finds the evidence to address a patient's health problem. Clinicians are often faced with questions that randomized clinical trials or systematic reviews of efficacy studies cannot answer. For this reason, we considered it necessary to offer an expanded view of the process of interpretation of the scientific literature used in daily clinical practice through the complex process of Clinical Reasoning, through the use of studies conducted with qualitative methods, which are able to respond to a different range of clinical questions, and to support studies based on the effectiveness of treatments.

Health-Care-Associated Infections Management, sow the seed of good habits: a grounded theory study

BACKGROUND AND AIM OF THE WORK

The reasons that condition and motivate adherence to good practices have a multifactorial nature. From the literature review, emerged different elements that interact within the operating context and represent a part of the variables that condition the "Best Practice". The aim of this research was to investigate the variables that influence adherence to operators' good practices.

METHODS

A qualitative study with Grounded Theory (GT) methodology was carried out, which leads to the establishment of a theory about basic social processes. This theory is based on the observation and perception of the social scene and evolves during data collection. Data collection took place through interviews with the participants, through an ad hoc semi-structured interview grid. The initial sampling consisted of 12 health workers, while the theoretical sample was made up of 6 health workers.

RESULTS

The analysis organization through the creation of schemes and diagrams has allowed to formulate different concepts including: false beliefs, knowledge and emotions experienced, that connect with the initial condition of Unconsciousness unaware; awareness of the consequences, team, welcome the new, which are connected to the intermediate phase of Revolution of the professional oneself; awareness of the limits, culture, responsibility, context, rigor and control that connects to the final state of Attentive Habit.

CONCLUSIONS

The theoretical model develops through a path of growth and revolution that starts from the roots of an Unconsciousness unaware and brings with it the seed of a model.

The use of blended learning to improve health professionals' communication skills: a literature review

Background and aim of the work:

In recent years, health professionals’ education has moved towards the increasing use of blended learning. One of the most widespread blended formulas is the mix of face-to-face and online learning, which combines the advantages of distance learning, both in training provision and in training fruition, with the maintenance of socialization goals and application to practice activities. This literature review aims to find out whether blended-learning is employed for improving health professionals’ communication skills and which are its outcomes.

Methods:

Literature review of publications released from January 2000 to January 2019 was conducted across the academic databases Cinahl (EBSCO), Cochrane and Pubmed using relevant keywords.

Results:

Research has shown that blended learning is used in the education of different health professionals (students, nurses, physicians, etc.) at various stages of the educational path. The enhancement of communication skills appears to be a secondary learning objective in many studies, but it is shown to be nevertheless central to the proper acquisition and application of more clinical skills addressed by the blended courses. The blended modules here examined achieved their goals. However, the evaluation of the learning outcomes is still based on self-assessment, and thus needs to be implemented.

Conclusions:

Blended learning providers would need to pay more attention in the design and implementation phases of blended modules, assessing participants’ needs and offering more tailored and targeted programs, and should provide a more rigorous evaluation of learning outcomes. (www.actabiomedica.it)

Inter-Professionalism in Health Care Post-graduate specialization: an innovative Laboratory

BACKGROUND AND AIM

Inter- professional Collaboration (IPC) is an important component of a well-functioning healthcare system. It is linked to improvements in patient safety and case management, optimal use of the skills of each healthcare team member and provision of better health services. Inter- professional Education (IPE), is one key factor in the development of positive behaviors useful for IPC: the basic and post-basic training are key moments to raise awareness, train and help implement the IPC. Aim of this paper is to present and evaluate the use of an innovative laboratory of Consensus Conference implemented in the Nursing Post-graduate specialization at the University of Parma to train students to IPC.

METHODS

An Innovative Laboratory inspired by of the Consensus Conference (CC) methodology on the "Integrated Narrative Nursing Assessment" was designed. Three Post-graduate specialization courses were involved and assigned to different tasks in the CC, according to the characteristics of the specializations.

RESULTS

Strengths and weaknesses of the methodology were analyzed. Strengths: students' engagement in their competencies building, and the acquisition inter-professional collaboration skills. Weaknesses: the lack of time to develop the whole process, and the need of a deeper guidance in the scientific production.

CONCLUSIONS

Although the methodology have to be continuously improved through practice, this experimental Laboratory reached the aim of offering a real experience of IPC to the students. They really collaborated with different professionals to reach a common goal and being already considered an expert.

Application of palliative care in demented patients: the caregivers' point of view

Background: The 38/2010 law has widened the supply of palliative care for patients with chronic and degenerative illness. Dementia is a chronic and debilitating illness and it requires specific, complex and constant assistance, involving the health professionals’ community and family, and should also benefit from palliative care. But what do the caregivers of these patients think about it? Aim: To explore the point of view of caregivers accompanying dementia patients regarding palliative care and the accompaniment of the medical team. Method: A qualitative method with phenomenological approach: 29 semi-structured interviews have been submitted to caregivers of patients suffering from dementia. The interviews were submitted to analysis of thematic content. Result: In the majority of cases the caregiver is a member of the family and holds this position because of the affective relationship he/she shares with the patient. They too live the illness of the relative as if it were theirs. The caregiver doesn’t know about palliative care or has only heard of it, but is resistant to the application of this care, especially when its correct meaning and use are explained. At the same time, the health professionals’’ role is important when it comes to taking decisions: caregivers rely completely on the team’s competence and on their judgement. Conclusion: A correct sharing of knowledge is fundamental. The healthcare professionals must be trained in palliative care in order to correctly inform caregivers and to avoid false beliefs about or resistance to the application of these useful pathways.

A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients

Background and aim of the work: Numerous negative outcomes of inadequate pain management among children have been cited in the literature. Inadequate pain management may be particularly detrimental to children and adolescents facing life-threatening injury or illness on a Paediatric Intensive Care Unit (PICU). It is therefore absolutely necessary that professionals utilize effective and efficient tools in order to evaluate a person’s sensations of pain in the most objective way possible. The COMFORT-B scale is recognised as the gold standard in such patients. However, the use of this instrument in the clinical PICU setting is disputed. It requires long periods of observation to ensure an adequate utilization. Boerlage et al. noted that nurses are often impatient and do not always observe the patient for the recommended 2 minutes period. The Behavioral Pain Scale (BPS), instead, is considered to be the gold standard for pain assessment in deeply sedated, mechanically ventilated adult patients. This observational pain scale requires shorter observation time compared to the COMFORT-B. Moreover, BPS three subscales are included in other observational pain scales for paediatric patients. Therefore, the objective of this study was to assess the applicability of the BPS for use with paediatric patients. Methods: Firstly, a questionnaire was administered to physicians and nursing staff that work in the units where the study was conducted in order to investigate the actual use of observational pain scales in their units. A second questionnaire was administered to a group of experts regarding the BPS, to assess both face validity and content validity, and to gain opinions on the relative appropriateness of each item. A descriptive, comparative design was used. A convenience sample of non-verbal, sedated and mechanically ventilated critical care paediatric patients was included. 39 observations were collected from 9 patients, all in their first year of age. Patient pain was assessed concurrently with the three observational scales, before, during and after routine procedures that are considered painful and non-painful. Results: The data collected through questionnaires for professionals gave a useful insight into pain assessment in the investigated units: only 46% of respondents stated that they assessed patients’ pain levels, with an average of 2.8 times per shift; 60% of respondents declared to be unhappy with the observational scales that they utilise. Regarding the observations, internal consistency was α = .865. Correlations between BPS and the other instruments were high, demonstrating a good concurrent validity of the test. T test and ROC curves demonstrated a good discriminant validity as well. Conclusions: Although the current study is based on a small sample of participants, these first results encourage us to continue working in the validation of the BPS in paediatric patients.

Expressive writing. A tool to help health workers of palliative care

Background and aims: From a previous study (1) was highlighted that Expressive writing is an important strategy for preventing and managing the effects of compassion fatigue (2). It helps educate caregivers in recognising these feelings and providing them with a “space” and a time for their reflection. This, in turn, results in significant positive repercussions on the quality of service, reducing burnout risk, implementing coping strategies, and increasing perceived work satisfaction. Reflecting occasionally in writing about ambiguous and emotionally charged situations helps in many ways: it facilitates clarification and problem-solving, and makes one more spontaneous and present in social situations, more in tune with others and available to interact. People begin to interact differently with others and see themselves in a new light after writing about an emotional subject. The objective of thi study is ascertain and confirm the results of the previous study using a reduced methodological approach. Infact, the difference from the previous research is the use of only two expressive writing sessions. Methods: A comparison was made between the expressive writing and neutral writing of two randomized groups of health care professionals of palliative care. They were evaluated pre- and post-intervention using several scales and an ad hoc questionnaire. Results: After analyzing the texts, this study confirm previous results, using only two sessions.

Delayed, diffuse acute peritonitis secondary to misplacement of a cystogastrostomic "pigtail" drain in an outpatient after discharge

Background and aim of the work: Pancreatic pseudocyst endoscopic drainage by pancreatogastrostomy “pigtail” drain placement is spreading worldwide, with high success-rate and low morbidity, and is increasingly performed as outpatient procedure. The paper reports an unusual very early complication of this procedure and discusses the peculiar aspects of this event in an outpatient setting. Methods: The first case of a 56-year-old outpatient developing a postoperative diffused acute peritonitis by gastric juice spilling caused by the misplacement of the distal end of two transgastric drains not reaching the pseudocyst is reported. As the case was programmed as outpatient and acute peritonitis symptoms occurred eight hours postoperatively, the patient was discharged and rehospitalized. A review of the literature of rare perforative complications of pancreatogastrostomy is performed. Results: CT scan allowed the prompt diagnosis, as it showed massive pneumoperitoneum, free fluid collection, and pigtail drain misplacement. Emergency laparoscopy allowed the removal of the two misplaced drains and gastric reparation. The procedure lasted 65 minutes, mostly needed for lavage. The patient was discharged 5 days later and outcomes are unremarkable 7 months after the procedure. Conclusion: The indication to endoscopic pancreatogastrostomy and its outpatient management should be carefully pondered. Pancreogastrostomy drain misplacement may cause a life-threatening acute peritonitis associated with early aspecific symptoms, resulting in a challenging situation, especially in an outpatient setting. CT-scan may allow prompt diagnosis and effective management by minimally invasive surgery. (www.actabiomedica.it)

The palliative care in dementia context: health professionals point of view about advantages and resistances

Background and aim: The 38/2010 law has expanded the provision of palliative care to patients with chronic-degenerative diseases. The ISTAT data show that 60% of the dying population is suffering from these diseases and could, according to the literature review, benefit particularly from such treatments. This study investigates the point of view of healthcare professionals, working in the context of dementia, regarding the knowledge and application of palliative care in the field of dementia. The focus is on the analysis of the resistance that may prevent the spread of palliative care, slowing the application of such care in different settings of terminality. Methods: The method is a qualitative phenomenological approach. A grid of semi-structured interviews was created and was proposed to 33 health workers (18 women) who work in Health Centres or in the Alzheimer Nucleus of Northern Italy. Results: Most operators think they understand palliative care, they believe it to be useful and necessary, but often only connect it with terminal illness. Others have a broader vision based on a more abstract and theoretical level than on real practical knowledge. A majority of respondents think that the spread of palliative care is slow and difficult because of the prevalence of the biomedical model that holistically and prejudicially hinders the introduction of new models. Conclusion: Appropriate training is the fundamental key to overcoming resistance. The professionals interviewed showed that they were aware of their lack of knowledge and declared that they had little competence in managing the complexity of long-term pathologies.

DNA content in human colon cancer and non-neoplastic adjacent mucosa

DNA content was determined by flow cytometry in a series of 51 paired fresh tissue samples of primary colorectal carcinomas and the respective non-neoplastic adjacent mucosa in order to assess the relationship between DNA ploidy and the most commonly used prognostic factors. Aneuploidy was observed in 70.6% of the tumors and more than one aneuploid peak was present in 3.9%. Aneuploid tumor frequency was higher in left (93.3%) and right colon (64.7%) cancers than in rectal carcinomas (60.0%), and multiple aneuploid clones were detected more frequently in men than in women and in patients with advanced disease (Dukes stage D). Non-neoplastic mucosa adjacent to aneuploid tumors showed aneuploidy in 4 out of 51 samples (7.8%). The mucosa adjacent to diploid cancers had only diploid characteristics. Polidy did not correlate with histological abnormalities.

These findings suggest that DNA content as determined by flow cytometry needs further study with adequate follow-up to evaluate possible correlations with relapse-free and overall survival. Furthermore the aneuploidy of non-neoplastic mucosa provides evidence for a field defect in mucosa adjacent to colorectal cancer and supports the concept that this alteration may be of influence on carcinogenesis.

Evaluation of fatigue in patients with pancreatic cancer receiving chemotherapy treatment: a cross-sectional observational study

BACKGROUND AND AIM OF THE WORK

Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs) and negatively affects quality of life. Although CRF is frequently experienced, it is often underreported, underdiagnosed and undertreated. The objectives of this study were to evaluate the level of fatigue in patients with pancreatic cancer undergoing chemotherapy and to analyse its correlation with patients' demographic and clinical variables.

METHODS

A cross-sectional observational study was implemented in the Oncology Day Hospital of a Northern Italian hospital. A sample of 48 patients receiving chemotherapy were evaluated through the Brief Fatigue Inventory Italian version (BFI-I) between 1 May and 12 October 2016. Data were statistically analysed.

RESULTS

Most of our patients (94%) experienced fatigue. Women as well as patients with an age ≥65 years reported more fatigue. Anemia, pain and a weight loss of over 16 kg in the last 6 months were significantly related to the perception of fatigue. Regarding life habits, smoking was related to high global score of BFI-I.

CONCLUSIONS

In accordance with literature, our study suggests that fatigue is a frequent symptom influenced by many constitutional, clinical and environmental factors. Our results highlight the need for an early and regular evaluation of fatigue among cancer patients, in order to implement all those pharmacological and non-pharmacological interventions with proven efficacy in attenuating this symptom.

Foreword

Foreword.