How people with chronic obstructive pulmonary disease perceive their illness: a qualitative study between mind and body.

BACKGROUND: Although many studies on people with Chronic Obstructive Pulmonary Disease (COPD) have examined the mutual impact of physical status and emotional experience, there is limited knowledge about the way COPD people first-hand perceive their condition. This study was designed to investigate the illness perceptions of the patients and, secondarily, to explore their beliefs about the mind-body relationship. METHODS: This qualitative study has exploited an ad-hoc semi-structured interview to collect personal perspectives of participants on their illness. Twenty-seven patients (15 males and 12 females), with a mild to severe COPD, were recruited within the Respiratory Rehabilitation Unit of Don Carlo Gnocchi Foundation, in Milan. The thematic analysis of the interviews' content was facilitated by NVivo (12th version, QSR International®). RESULTS: The thematic analysis of the corpus resulted in four master themes. Illness experience has been considered the primary one. Indeed, dealing with COPD every day allows these people to portray a specific representation of the mind-body relationship, to gain a certain degree of expertise and to develop a perspective on the future. CONCLUSIONS: Individual perceptions of the illness vary among people with COPD, but some common experiences characterize them. Many patients share a profound belief that their mental state and their physical symptoms are highly interrelated.

Informal Caregivers of Patients with Disorders of Consciousness: a Qualitative Study of Communication Experiences and Information Needs with Physicians.

Due to improvements in medicine, the figures of patients with disorders of consciousness (DoC) are increasing. Diagnostics of DoC and prognostication of rehabilitation outcome is challenging but necessary to evaluate recovery potential and to decide on treatment options. Such decisions should be made by doctors and patients' surrogates based on medico-ethical principles. Meeting information needs and communicating effectively with caregivers as the patients´ most common surrogate-decision makers is crucial, and challenging when novel tech-nologies are introduced. This qualitative study aims to explore information needs of informal DoC caregivers, how they manage the obtained information and their perceptions and experiences with caregiver-physician communication in facilities that implemented innovative neurodiagnostics studies. In 2021, we conducted semi-structured interviews with nine caregivers of clinically stable DoC patients in two rehabilitation centers in Italy and Germany. Participants were selected based on consecutive purposeful sampling. Caregivers were recruited at the facilities after written informed consent. All interviews were recorded, transcribed verbatim and translated. For analysis, we used reflexive thematic analysis according to Braun & Clarke (2006). Caregivers experienced the conversations emotionally, generally based on the value of the information provided. They reported to seek positive information, comfort and empathy with-in the communication of results of examinations. They needed detailed information to gain a deep understanding and a clear picture of their loved-one's condition. The results suggest a mismatch between the perspectives of caregivers and the perspectives of medical profession-als, and stress the need for more elaborate approaches to the communication of results of neu-rodiagnostics studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12152-022-09503-0.

Ageing as a mindset: a study protocol to rejuvenate older adults with a counterclockwise psychological intervention.

INTRODUCTION: Although ageing is generally perceived as a biologically determined process, the literature increasingly points to the importance of psychological factors in the ageing process, specifically age-related stereotypes or cognitive mindsets. Such stereotypes reflect self-perceptions and others' perceptions about the ageing process and can have a strong influence on health and life satisfaction, specifically through self-fulfilling prophecy mechanisms. This study aimed to investigate whether changes in mindsets can change the ageing process. METHODS AND ANALYSIS: This study replicates in large part the original 1979 'Counterclockwise' experiment by Ellen Langer and will involve a group of older adults (aged 75+) taking part of a 1-week retreat outside of Milan, Italy. Participants will be instructed and helped to relive their younger selves, acting as if they are living in the year 1989. The week-long residential programme is designed to prime this perception by incorporating a completely retrofitted physical environment, as well as providing opportunities to engage in social activities that would have been common in the late 1980s. This 'counterclockwise' intervention will be tested as a randomised control trial comprised of the experimental ('counterclockwise') group, an active control group (same activities, no time manipulation) and a no-treatment group. Ninety participants will be randomly allocated to one of these three conditions. Every participant will be assessed for medical, cognitive, psychological and age appearance at four time points: at the time of recruitment, after the intervention (ie, after a week for the no-treatment group) and again after 6 and 12 months. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Committees of the Department of Psychology of Università Cattolica del Sacro Cuore and Don Gnocchi Foundation. Results will be disseminated through peer-reviewed journals, scientific meetings and direct presentation to the general population. TRIAL REGISTRATION NUMBER: NCT03552042; Pre-results.

Psychological Support for Health Professionals: An Interpretative Phenomenological Analysis.

Background: The work of health care professionals (HCPs) exposes them to emotionally difficult situations, anxiety, suffering and death, so they are at risk of burnout. Objectives: To describe HCPs' experiences of a psychological support intervention and its influence on the daily work of a sample caring for patients with neuromuscular and chronic respiratory illnesses. Methods: This exploratory, descriptive, qualitative study was carried out at the Respiratory Rehabilitation Unit of IRCCS Santa Maria Nascente, in Milan, Italy. Semi-structured interviews with a purposive sample of 10 HCPs were subjected to interpretative phenomenological analysis (IPA). Results: Five related themes emerged: psychological support; repeating the experience; relationships; the role of homework; competences. HCPs perceived that the intervention influenced their daily life, giving them a secure base and a new perspective on their professional role. Conclusion: Psychological support interventions may not be appropriate for all HCPs, but they may help some HCPs to handle the demands of a stressful work life. Further studies are needed to determine its efficacy in reducing stress and prevent burnout.

Use of Noninvasive Ventilation During Feeding Tube Placement.

Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity < 30% of normal, 18 of whom were dependent on continuous NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18-25 cm H2O, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated.