The solitary pulmonary nodule in patients with previous cancer history: results of surgical treatment.

BACKGROUND: The present study was carried out to evaluate the characteristics of solitary pulmonary nodule (SPN) in patients with previous cancer(s) and to analyse the outcome of its surgical treatment. METHODS: We retrospectively analysed 131 patients with history of previous malignancy submitted to lung surgery for new identified SPN between January 2004 and December 2009. RESULTS: The diagnosis was metastasis in 65 patients, primary lung cancer in 57, benign lesion in 9. Primary lung cancers were significantly larger, had higher maxSUV at CT-PET scanning, occurred after a longer disease-free interval in patients older and with worse lung function when compared with metastatic lesions. Overall survival at 5-year was 67% for benign lesions, 62% for primary lung cancer, 48% for metastatic disease. Histological subtype, SPN diameter less than 2 cm and DFI >36 months were factors influencing long-term prognosis of metastatic patients. Histological subtype and pathological staging were factors influencing long-term outcome of primary lung cancer patients. DISCUSSION: Surgical resection of solitary pulmonary nodule is essential in patients with history of previous cancer to rule out benign lesions, to offer diagnostic confirmation and local control of the disease in metastatic tumours and to correctly stage and treat primary lung cancer.

Impact of vaccinating HCWs on the ward and possible influence of avian flu threat.

BACKGROUND: The aim of the study was to evaluate the impact of a 2-year vaccination program on the compliance of healthcare workers (HCWs) employed in an acute care university hospital to influenza vaccination. MATERIALS AND METHODS: The study was carried out in October/November from 2004 to 2006 in a 286-bed acute care university hospital located in northern Italy employing 523 HCWs. The study cohort consisted of 473 HCWs continuously present in the hospital from 2004 to 2006. In 2005 and 2006, a vaccination campaign was made available in the wards that supplemented a pre-existing (2004) employee health service program. A personalized informative letter was sent to all HCWs explaining the risks and benefits of influenza vaccination for both patients and HCWs and indicating the scheduling of the additional vaccination service. RESULTS: The additional 2005 and 2006 campaigns produced significantly higher vaccination rates among HCWs than those achieved in previous years, from 10.4% in 2004 to 36.6% in 2005 and 23.2% in 2006. The year 2005 was characterized by an avian flu threat, which likely accounted for the highest vaccination rate of the 3-year study period. Physicians had the highest vaccination rates in the 3-year period (20.8%), while nurses in 2005 had the highest single vaccination rate (42.5%). CONCLUSIONS: Providing easy access to vaccination in the wards is a useful approach for improving vaccination rates among HCWs, but further tailored interventions are needed because overall vaccination rates remain too low. Subgroups, such as nurses and ancillary staff, should be considered as specific targets of such vaccination programs.

Application of Hazard Analysis Critical Control Points to control surgical site infections in hip and knee arthroplasty.

This study examined critical points linked to the increase of surgical site infections in patients undergoing joint replacement. With this type of infection, it is not always possible to detect specific causes, and it often is necessary to perform a systematic review of assistance processes. Using Hazard Analysis Critical Control Points methodology, 4 stages of patients' pathway were identified: preoperative assessment, surgical procedure, postoperative assistance, and discharge. Surgical site infection risk factors were identified for each stage and categorized as patient conditions, staff and procedures, equipment, and environment.

Is an institution-wide programme able to reduce the in-patients' experiences of pain in a high specialization hospital?

The study examines the implication of an institution-wide programme on pain management in reducing the patients' perception of the pain carried out in a university hospital by comparing the results of two surveys conducted in 2002 (prior to the programme) and in 2003 (during the course of the programme). The study was conducted in November 2003 and it consisted in a priority survey on the patients' pain perception using a questionnaire which was distributed to all the patients admitted in a highly specialised hospital and interviewed by trained interviewers. Later on the data were compared to the results obtained with a similar survey carried out in November 2002 in the same hospital. In 2002 the percentage of patients reporting pain at the moment of the interview was 43.4% (82/145), in the year 2003 it was 35.3% (49/139) [OR = 2.4, CI (95%) = 1.4-4.0, p < 0.001]. With regards to the pain reported in the previous 24 hrs, there was a reduction in the percentage of patients experiencing pain from 69.0% in 2002 (100/145) to 42.4% in 2003 (59/139) [OR = 3.0, CI (95%) = 1.8-5.0, p < 0.001]. Our hospital wide program succeeded in reducing pain in patients, improving professional quality and creating customer satisfaction in a hospital.

[Physicians working at the NHS Prevention Department: a national survey in Italy]. / Profilo ed aspettative del medico operante presso il Dipartimento di Prevenzione in Italia.

In Italy NHS Prevention Departments (PDs) are central in Public Health (PH) management. Objective was to describe profile of Medical Doctors (MDs) working at Italian PDs. The study, part of another survey, was conducted in 2003, using a phone questionnaire to administer to a sample of Italian MDs in PH. Response rate was 72.3% (603/833). Physicians of PDs were 255, 42.3% of whole sample. Job satisfaction mean (scale: 0-100) was 66.6 (SD = 19.3). 81.6% (208/225) of MDs said that Regions must monitor health status to identify collective risks and problems, while 77.3% (197/255) of them answered that function of State is to develop politics and planes to pursue individual and collective health. The study gives a positive frame of MDs at PDs. They were satisfied and persuaded of importance of State and Regions in PH management.

Lung donors selection criteria: a review.

Lung transplantation has had increasing success worldwide and it became an acceptable treatment modality in end-stage pulmonary diseases. The insufficient supply of donor lungs, resulting in prolonged waiting time, and the significant rise of patients on the waiting list, have forced the most experienced transplantation centers to redefine the acceptable lung donor criteria including marginal allografts. Existing standard lung donor criteria have been established in the first period of lung transplantation activity, based mainly on opinions and individual experiences rather than on existing evidences: the paucity of donors may be also explained by the rigid application of these criteria. The quality of donor organs has a significant impact on early and long-term recipient outcome. Recent studies have demonstrated that the use of marginal donors did not affect early and late recipient outcome, and significantly increased the number of transplants performed. The aim of this paper is to review how the main lung donor selection criteria have been changed and how they influence the recipient outcome.

Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes.

AIM: To examine the effectiveness of reflexology foot massage in hospitalized cancer patients undergoing second or third chemotherapy cycles. BACKGROUND: Since the late-1970s, studies have been conducted to assess the efficacy of behavioural and relaxation approaches in controlling nausea/vomiting, anxiety and other side-effects associated with chemotherapy. METHODS: The study consisted of 30 patients being admitted to the oncology unit at a Scientific Research Hospital in Italy. Only 15 of the 30 participants received therapeutic massage. The subjects' self-reports of anxiety (measured by the Spielberger State-Trait Anxiety Inventory) were recorded before, after and 24 hours after the intervention. RESULTS: There was an average decrease of 7.9 points on the state-anxiety scale in the treatment group and of 0.8 points in the control group (P < 0.0001). CONCLUSIONS: Reflexology foot massage can be considered a support treatment used in combination with traditional medical treatments and executed by an expert, qualified person to help cancer patients receiving chemotherapy feel better and also cope better with their disease.

[Chronic inflammation and airway remodeling in asthma. Importance of an early treatment]. / Flogosi cronica e rimodellamento delle vie aeree nell'asma. Importanza dell'intervento precoce.

Chronic inflammation in asthma stimulates complex repair mechanisms which ultimately lead to deep structural changes in the bronchial tree, defined as airway remodeling, consisting principally in the thickening of the bronchial wall. These processes contribute to progressive airway narrowing with incomplete responsiveness to bronchodilating agents: clinical conditions of patients are irreversibly impaired. There is evidence that remodeling is a process that begins in early childhood and continues into adult life. These observations provide the rationale for early intervention with antiinflammatory drugs like inhaled corticosteroids, which effectively reduce airway inflammation and possibly prevent the progression to lung damage. Several clinical and pharmacological studies have demonstrated that these drugs inhibit cellular processes involved remodeling.