Communicating Bad News to Older Patients from the Physician's Point of View: Focus on the Influence of Gender and Length of Work Experience.

BACKGROUND: Communicating bad news is of great interest in the geriatric field, but few works have considered the physician's point of view in this regard. OBJECTIVES: The aim of this study was to explore possible differences related to physicians' gender and work experience in how a terminal diagnosis is disclosed to older patients. METHODS: Study participants were 420 Italian physicians (277 M, 143 F) working in clinical medicine (58.2%), surgery (33.3%), or other medical departments (8.5%). They completed an anonymous multiple-choice questionnaire that investigated various issues associated with communicating bad news to terminally ill older patients. RESULTS: Men had more work experience than women (55.6% vs. 44.8% had worked for ≥23 years) and were more likely to work in surgery departments, while more women worked in clinical medicine. Most physicians declared that terminally ill older patients, if mentally competent, should always (14.4%) or generally (64.3%) be directly and openly informed of their condition. With no difference in gender, length of work experience, or specialty area, 36.9% of physicians thought that this was a human right and 18% that it would improve the patient's quality of life. Where older patients were alone, male physicians were more likely than female (30.2% vs. 8.9%) to always communicate bad news directly to them. More than 70% of physicians, especially those with longer work experience, declared that they always or often took enough time to inform the patient. Female physicians and those working in clinical medicine were more likely to need psychological help when deciding to break bad news, but only a smaller proportion declared to have received it. CONCLUSIONS: Gender and work experience may influence how physicians communicate with patients and how often they seek psychological support.

The first familial cluster of the B.1.1.7 variant of SARS-CoV-2 in the northeast of Italy.

PURPOSE: We report on the first identified cluster of the B.1.1.7 variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the northeast of Italy. METHODS: The cluster was recognized in January 2021 with an epidemiological started from the hospitalization of a 68-year-old man suffering from coronavirus disease 2019 (COVID-19) related pneumonia and we surprisingly found three families involved in the same cluster. RESULTS: We retrospectively rebuilt the pathway of infection and performed a virological analysis. CONCLUSION: This allow us to make clear the very high attack rate and the great infective capacity of this B.1.1.7 variant of SARS-CoV-2.

The use of Biochip immunofluorescence microscopy for the serological diagnosis of epidermolysis bullosa acquisita.

Epidermolysis bullosa acquisita is a rare autoimmune bullous disease characterized by the presence of circulating antibodies directed against the collagen type VII. Diagnosis is generally based on clinical history, clinical features, histology, direct and indirect immunofluorescence, immunoblotting and ELISA. Our study aims to determine the validity of the Biochip immunofluorescence microscopy for the serological diagnosis of epidermolysis bullosa acquisita. Six patients with epidermolysis bullosa acquisita and presence of antibodies against type VII collagen confirmed by ELISA were included in the study. Subsequently, all sera of patients were analyzed using Biochip. Antibodies anti-collagen type VII were detected in all sera by means of the Biochip technology. Thus, Biochip shows a good correlation with ELISA and seems to be an appropriate method for the diagnosis of epidermolysis bullosa acquisita. It is an easy, fast and standardized method which could facilitate the diagnosis of this autoimmune bullous disease. We suggest that it could be used as an initial screening test to identify patients with epidermolysis bullosa acquisita.