Riding a roller coaster: narrative typologies of patients with neuroendocrine tumors.

BACKGROUND AND OBJECTIVE: Illness stories have attracted growing attention in health care research in the context of learning from looking at the world through the patients' eyes. No narrative studies were found about the patients with neuroendocrine tumors (NETs); a rare illness including tumors usually starting in hormone-producing cells. The aim of this article was to develop an extended understanding of these patients' experiences and struggles, as well as their solutions to a common problem. METHODS: The data source was 21 letters written by the patients with NETs treated at an ambulatory treatment center at a large urban hospital in Italy. The letters were analyzed using the Arthur Frank's narrative method. We paid particular attention to statements of self-experience, which is crucial to get the character of the story. RESULTS: We identified four different typologies: "Not illness stories", "Living in imbalance", "Living a new life in balance", and "Living a normal life". The main characteristics of these four groups could be linked to Frank's typologies. However, the patients with this periodically changing disease were continuously in the process of attaining balance in life, and they might move between these various typologies. CONCLUSION: The NETs are incurable illnesses that challenged the peoples to attaining a new balance in life. We will highlight stories focusing on the patients' imbalance and chaos because they illuminated the patients' concrete suffering, which might provide clinicians with specific information about the patients' emotional, physical, and spiritual state. Through learning from the stories of the patients attaining new balance, it seems possible to move forward to acceptance and to develop a model for a new way of living. However, we are skeptical about labeling these stories as a model for clinical practice because they might contribute to individualistic and heroic prescriptions for life that are impossible for others to achieve.

Management of suspected acute inflammatory pancreatopathies in a "real-world" setting: a single-centre observational study.

CONTEXT: Acute pancreatitis is defined as an acute inflammatory process in the pancreas with variable involvement of other regional tissues or remote organ systems. In Italy, the incidence ranges from 20 to 40 x100,000 inhabitants/year and the mortality rate ranges from 5 to 10%. OBJECTIVE: To assess the management of patients with suspected acute inflammatory pancreatopathy and to evaluate the impact of this management on clinical outcomes, including morbidity and mortality. METHODS: A "real-world" observational study based on the analysis of consecutive (one year) records from the Hospital Data Processing Centre: 112 cases with final diagnosis of "acute pancreatitis". RESULTS AND CONCLUSIONS: Sixty-nine men and 43 women were analyzed; 91 (81.3%) patients were older than 40 years and 53 (47.3%) were older than 60 years. Two patients died. One-hundred and five patients (93.8%) had abdominal pain on admission. White blood cell count was greater than 15.0 x10³/dL in 26 patients (23.2%). Hematocrit levels were greater than 40% in 30 patients (26.8%). Triglycerides were elevated in 21 patients (18.8%). In 3 of them (14.3%) levels were higher than 1,000 mg/dL. Creatinine was altered in 22 (19.6%) patients. CRP values were increased in all patients. In the majority of cases (58 patients; 51.8%) pancreatitis was of biliary origin, while alcohol accounted for 16 (14.3%) cases. Four tumors were found (3.6%). Forty patients (35.7%) were discharged in the first week, 41 (36.6%) in the second week, 19 (17.0%) in the third week, and 12 (10.7%) after 21 days. After 72 hours, acute pancreatitis was classified as mild in 80 patients (71.4%) and as severe in 32 patients (28.6%).

Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy.

Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct (IPMN-B) could be the the biliary counterpart of IPMN of the pancreas (IPMN-P) since they share several clinical-pathological features. These include prominent intraductal papillary proliferation pattern, a gastrointestinal phenotype, frequent mucin hyper-secretion and progression to mucinous carcinoma. To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically. We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky fluid lesion obstructing the bile duct lumen, diagnosed as a malignant IPMN-B, and synchronous multiple pancreatic cystic lesions (10-13 mm) communicating with an irregular Wirsung, diagnosed as branch duct IPMN-P. Since surgery was ruled-out because of the patient's age and preferences, she underwent a conservative management regimen comprising both chemotherapy and radiotherapy. This was effective in decreasing the mass size and in resolving subsequent jaundice. This is also the first reported case of IPMN-B successfully treated with chemoradiotherapy. Clinicians should consider medical treatment as an option in this clinical scenario, in patients who may be unfit for surgery.

[A picture of the Italian nursing scientific literature as a result of nursing journal analysis. First part: 1978-1997]. / Una fotografia delle aree di produzione scientifica infermieristica italiana attraverso un'analisi di cosa pubblicano gli infermieri. Prima parte: anni 1978-1997.

This is the result of a revision of what Italian nurses have written from 1978 to 1997 in Nursing Journals. Four well known Nursing Journals have been selected and taken into consideration: two are the only nursing refereed journals in the Country (one is a nursing Association official journal), one is the official journal of the National nursing Statutory Body and one is a specialty nursing Group journal. Articles has been divided into seven categories and results show that Italian nurses lack in the continuity of writing. Research and theory are the sectors where nurses write less.

[A picture of the Italian nursing scientific literature as a result of nursing journals analysis. (part 2) 1998-2003]. / La produzione infermieristica scientifica italiana attraverso una analisi di cosa pubblicano gli infermieri. (2 parte) anni 1998-2003.

This article analyzes the Italian scientific Nursing production published on five National Nursing Journals from 1978 to 2003 it is the second part of the article in the antecedents pages. Results are showing that the Nursing literature production as it appears from dedicated Journals, is following a constant development. Of course each Journal has its own characteristics and specificity but in general more articles than in the past (1978-1998) are presenting research methodology discussions and reports of research conducted in the Nursing field. Few articles, considering the total, discuss conceptualization or theorization of Nursing but anyway, there is a visible movement in advance compared with the past considered period (1978-1998).

[The role of voluntary associations in healthcare politics]. / Il ruolo del volontariato nelle politiche socioassistenziali.

In the recent years an increasing interest has been observed on volunteering; among social scientist, politicians, and economists. A different approach to the management of volunteering has been observed both in the political and social set. Furthermore a remarkable development of the phenomenon is present worldwide as within Italy. The contribute to social development, universally attributed to the volunteer action has been acknowledged by the General Assembly of United Nations that declared the 2001 The International Years of Volunteering. Different aims was attributed to this event: the promotion of volunteer action, as expression of cohesiveness and democratic participation of civic society progress; stimulate the improvement of the volunteering status and role; increasing facilities to the activities realization; facilitate the communication opportunities among volunteers, associations and governments. Nevertheless, the phenomenon relevance has to be viewed in social, cultural, political and economical changes taking place in the last years and still in action in the country that on the one hand have produced new needs and an increasing socio-assistance demand and the other hand the needs of changing the responding traditional style and way from Institutions. The major aims of this paper consist in the analysis of motivation and relevance of socio-sanitary role of volunteer in contemporary society.

[Nurses presence in the sterilisation service according UNI EN directives]. / La presenza infermieristica nel servizio centralizzato di sterilizzazione alla luce della normativa UNI EN.

The aim of the sterilisation process is to inactivates the microbiological contamination, changing the status of contaminated product in sterile one. The exposition time at the correctly sterilisation is not the only factor which allow the process succeed: we need to pay attention at the microbiological charge that is present on the primary material, (bioburden), the place where the process occur, the assemblage, the pack and stockage. In the health services for a good successful of this passage, we need to identify an professional figure of reference as supervisors of the sterilisation process and as an expert adviser (consultant). This article represent an reflection of the nursing role.

[Self-esteem in adolescents. A study]. / L'autostima negli adolescenti. Uno studio.

In the present article the adolescents, self esteem is considered. An investigation has been effected in two schools of the Capital. Results show a strong relationship between Nursing and the problems related to the adolescence. Nursing answer and activities have to be expounded in the considered reality in order to have a nurses taking care of adolescents not only inside the hospital but also in the community. It is the case to develop a new model of nursing, an educational model related to health and wellness.

[Anxiety, stress and preoperative surgical nursing]. / Ansia, stress ed assistenza chirurgica preoperatoria.

The hospitalisation represents a stressful event, particularly for subjects facing surgical procedures. Assuming this situation is traumatic event in which anxiety and stress are lived experiences, we have analysed their influences and implications of the psychological aspects on surgical nursing care process. Patient affected of a various disease, waiting for surgery have been submitted a two different questionnaire (Cognitive, S.T.A.I.). The finding showed that different specific and complex aspects of hospital life are stressful conditions. The surgical procedures in general cause an increase of the level of anxiety in all subjects examinaed. This phenomenon was greater in those subjects in which the anxious personality was already present and in those with more serious disease. The surgical procedures is a stressful condition that require a positive adaptation for the patient and his relatives. The therapeutical-educative relationships represent the instrument to interact positively with the person and his need to be cured.

[Bifocal model in the management of respiratory problems. Application in a critical care unit]. / Il modello bifocale nella gestione dei problemi respiratori. Un'applicazione in area critica.

The peculiar situations involved in critical care need a complex and efficient team work. This induces very often an overlapping of different specific roles, due to the complexity of clinical situations. G. Buchechek and J. Mc Closkey define nursing interventions as every care treatment by nursing staff, including: nurse treatment initiated by nurse diagnosis, physician-initiated treatment, and daily tasks, defined as performances, for the patient that it is not autosufficient (Nursing interventions: Treatments for potential nursing diagnoses 1989). Thus, nursing initiative cannot be considered autonomous. The following manuscript represents a survey on nursing activities in respiratory care in a large hospital of the city of Rome, Italy, which follows the bifocal method of nursing care by Lynda J. Carpenito (1983).