The process of truth disclosure: an assessment of the results of information during the diagnostic phase in patients with cancer.

BACKGROUND: Surveys carried out in Mediterranean countries demonstrated very low rates of awareness of both diagnosis and prognosis among cancer patients. In our institution, a long-term training program aimed at improving communication skills among all physicians interacting with cancer patients was conducted. We report here the results of an extensive assessment of patients' awareness conducted after the first training period. PATIENTS AND METHODS: In a 2-year period, after every first visit of patients with a histological diagnosis of cancer, oncologists elicited perception of the patients and completed a structured questionnaire focusing on the understanding of the diagnosis and prognosis. Our data are thus a photograph of the results of the informative process conducted during the diagnostic phase. RESULTS: Among the enrolled 649 patients, 79.3% were aware of their diagnosis; factors significantly associated with higher levels of awareness were age younger than 70 and referral from surgery (versus internal medicine). Knowledge about the palliative or curative aims of future treatments (a surrogate sign of prognostic consciousness) was evident in 55.2%. CONCLUSIONS: Compared with historical data, our results show a high level of comprehension of the diagnosis of malignancy, probably due to the extensive training effort together with the method chosen for assessment.

Echotomography in arteriovenous fistulae.

We employed Echotomography (by 2.25-5MHz probes) as a quick procedure to measure the vessel diameter at definite points to detect aneurysms and their evolution, to evaluate the arteriovenous fistula (AVF) characteristics, to detect haematoma, thrombi, and collateral vessels. Echotomography is a non-invasive technique which may be performed repetitively even immediately after AVF surgery. It was most valuable in the examination of proximal AVF and internal shunts (autologous venous and bovine carotid grafts). Echotomography has proved to be accurate in studying the initial morphological and functional evaluation and follow-up of AVF.

["Clinical clearance" and "weekly clearance" of urea in periodical hemodialytic treatment]. / "Clearance clinica" e "clearance settimanale" dell'urea nel trattamento emodialitico periodico.

Starting from the hypothesis that small molecules are freely diffusible, a simple formula is proposed for the determination of real ureic clearance during dialysis. This automatically allows for all variables (blood flow and flow of the dialysing solution, temperature, physical and/or chemical state of the membrane, level of solute concentration, transmembrane pressure, etc.). On the basis of this formula, a calculation system is also proposed for assessing weekly ureic clearance levels and hence the real efficiency of treatment. This system may also be applied to peritoneal dialysis and permits optimisation of substitutive treatment. It is thus easier to select the best filter and rhythms for each patient.

[Kinetics of anticoagulation in hemodialysis. Sequential study of single, intermittent and continuous heparinization]. / Cinetica dell'anticoagulazione in emodialisi. Studio sequenziale sull'eparinizzazione unica, intermittente e continua.

A sequential real-time study was run to monitor plasma heparin values following three standard dose protocols during 4-hr dialysis, using an enzymatic method. One group of patients was given a single dose of 7000 IU at the commencement of dialysis, a second group 5000 IU at the start and 2500 IU at the end of the third hour, and a third group 2500 IU at the start and 1500 UI/hr for four hours. Plasma levels were checked every hour and ranged from 0.702 IU/ml (+/- 0.069) (start) to 0.290 IU/ml (+/- 0.079) (end) in the first group, 0.552 (+/- 0.116) to 0.312 (+/- 0.09) in the second, and 0.456 (+/- 0.113) to 0.314 (+/- 0.063) in the third. Correlation of heparin levels with coagulation time led to the establishment of an optimal range of 0.2 to 0.6 IU/ml.