An integrative review of adult cancer patients' experiences of nursing telephone and virtual triage systems for symptom management.

PURPOSE: Telephone and virtual triage services are becoming increasingly common in ambulatory oncology settings. Few studies have evaluated their implementation from the perspective of service users. This study aims to evaluate the experiences of engaging with nurse-delivered telephone and virtual triage systems for symptom management among people undergoing cancer treatment. METHODS: An integrative review was undertaken. MEDLINE, CINAHL, PsycInfo, Academic Search Complete and Scopus were systematically searched. Twelve publications met the inclusion criteria, and data related to cancer patients' perceptions of the triage process were extracted and analysed. RESULTS: Telephone-based (n=7), app-based (n=5) and video-based teleconferencing (n=2) triage systems were evaluated positively overall, enhancing ease of health system navigation, avoidance of emergency department for consultation, and the information, reassurance and support provided to support self-management of symptoms. However, several factors influenced the users' engagement with triage services, including confidence to articulate symptoms, limited opening hours, waiting times for initial triage or follow-up and digital literacy. Collectively, these factors contributed to delayed reporting or under-reporting of symptoms, undermining the potential impact of services. Studies included variable reporting of intervention characteristics, including the qualification of nurses delivering and leading services. CONCLUSIONS: Future evaluations of triage services must give greater consideration to the characterisation of interventions to ensure transferability, including nursing roles and qualifications. To ensure effective intervention and optimal supportive care for symptom management, patients must be prepared to engage triage services early. Future evaluations must ensure the impact of digital literacy on engagement with, and experience of, virtual triage is investigated.

Body and milk production traits as indicators of energy requirements and efficiency of purebred Holstein and 3-breed rotational crossbred cows from Viking Red, Montbéliarde, and Holstein sires.

This study aimed to compare rotational 3-breed crossbred cows of Viking Red, Montbéliarde, and Holstein breeds with purebred Holstein cows for a range of body measurements, as well as different metrics of the cows' productivity and production efficiency. The study involved 791 cows (440 crossbreds and 351 purebreds), that were managed across 2 herds. Within each herd, crossbreds and purebreds were reared and milked together, fed the same diets, and managed as one group. The heart girth, height at withers, and body length were measured, and body condition score (BCS) was determined on all the cows on a single test day. The body weight (BW) of 225 cows were used to develop an equation to predict BW from body size traits, parity, and days in milk, which was then used to estimate the BW of all the cows. Equations from the literature were used to estimate body protein and lipid contents using the predicted BW and BCS. Evidence suggests that maintenance energy requirements may be closely related to body protein mass, and Holstein and crossbred cows may be different in body composition. Therefore, we computed the requirements of net energy for maintenance (NEM) on the basis either of the metabolic weight (NEM-MW: 0.418 MJ/kg of metabolic BW) or of the estimated body protein mass according to a coefficient (NEM-PM: 0.631 MJ/kg body protein mass) computed on the subset comprising the purebred Holstein. On the same day when body measurements were collected, individual test-day milk yield and fat and protein contents were retrieved once from the official Italian milk recording system, and milk was sampled to determine fresh cheese yield. Measures of NEM were used to scale the production traits. Statistical analyses of all variables included the fixed effects of herd, days in milk, parity, and genetic group (purebred Holstein and crossbred), and the herd × genetic group interaction. External validation of the equation predicting BW yielded a correlation coefficient of 0.94 and an average bias of -4.95 ± 36.81 kg. The crossbreds had similar predicted BW and NEM-MW compared with the Holsteins. However, NEM-PM of crossbreds was 3.8% lower than that of the Holsteins, due to their 11% greater BCS and different estimated body composition. The crossbred cows yielded 4.8% less milk and 3.4% less milk energy than the purebred Holsteins. However, the differences between genetic groups were no longer significant when the production traits were scaled on NEM-PM, suggesting that the crossbreds and purebreds have the same productive ability and efficiency per unit of body protein mass. In conclusion, measures of productivity and efficiency that combine the cows' production capability with traits related to body composition and the energy cost of production seem to be more effective criteria for comparing crossbred and purebred Holstein cows than just milk, fat, and protein yields.

Two-months quality of life of COVID-19 invasively ventilated survivors; an Italian single-center study.

BACKGROUND: COVID-19 disease can lead to severe functional impairments after discharge. We assessed the quality of life of invasively ventilated COVID-19 ARDS survivors. METHODS: We carried out a prospective follow-up study of the patients admitted to the Intensive Care Units (ICUs) of a teaching hospital. Patients affected by COVID-19 ARDS who required invasive ventilation and were successfully discharged home were assessed through the telephone administration of validated tests. We explored survival, functional outcomes, return to work, quality of life, cognitive and psychological sequelae. The main variables of interest were the following: demographics, severity scores, laboratory values, comorbidities, schooling, working status, treatments received during ICU stay, complications, and psychological, cognitive, functional outcomes. RESULTS: Out of 116 consecutive invasively ventilated patients, overall survival was 65/116 (56%) with no death occurring after hospital discharge. Forty-two patients were already discharged home with a median follow-up time of 61 (51-71) days after ICU discharge and 39 of them accepted to be interviewed. Only one patient (1/39) experienced cognitive decline. The vast majority of patients reported no difficulty in walking (32/35:82%), self-care (33/39:85%), and usual activities (30/39:78%). All patients were either malnourished (15/39:38%) or at risk for malnutrition (24/39:62%). Exertional dyspnea was present in 20/39 (51%) patients. 19/39 (49%) reported alterations in senses of smell and/or taste either before or after hospitalization. CONCLUSIONS: Invasively ventilated COVID-19 ARDS survivors have an overall good recovery at a 2-months follow-up which is better than what was previously reported in non-COVID-19 ARDS patients.

Nations with high smoking rate have low SARS-CoV-2 infection and low COVID-19 mortality rate.

Background and aim of the work The effect of tobacco smoking on COVID-19 disease is debated with common sense and experts suggesting a deleterious effect and manuscripts worldwide reporting a low prevalence of active tobacco smokers among intensive care unit patients. Methods We categorized countries worldwide into three groups with <25%; 25-45%; >45% of active male smokers with data expressed as median and interquartile range [IQR] and extracted data on SARS-CoV-2 infections and COVID-19 deaths per million inhabitants. We also applied multivariate regression techniques to adjust for several epidemiological factors. Results COVID-19 mortality was 13 (5-24) per million inhabitants in countries with male smokers >45% and 33 (4-133) in countries where male smokers were <25%. SARS-CoV-2 infection rates were 436 (217-954) and 1139 (302-4084) with data confirmed when dividing data for each continent and when controlling for confounding factors. Conclusions We found a counterintuitive low COVID-19 mortality and SARS-CoV-2 infection in countries with high prevalence of male smokers at the global level and within each continent, suggesting that active smoking habit is protective. Further research should urgently investigate which is the possible mechanism of action.

Lymph node ratio and liver metachronous metastases in colorectal cancer.

AIM: The authors seek to assess whether the lymph node ratio (the ratio of positive nodes divided by the total number of retrieved nodes) could predict the risk of metachronous liver metastases. MATERIAL AND METHODS: A homogeneous group of 280 patients, followed-up for at least 5 years, was evaluated. In order to highlight the groups with the highest risk of metachronous liver metastases, patients were divided into four quartiles groups in relation to the LNR. RESULTS: The number of lymph nodes sampled in group "stage I" was significantly lower. Even if statistical significance between the global LNR and the development of liver metastases has not been reached, the subdivision into quartiles has made it possible to highlight that in the more advanced ratio groups, a higher incidence of metachronous liver metastases (p <0.028) was registered and was a different distribution of patients with or without liver metastasis in function of quartiles (P =0.01). DISCUSSION: The LNR has enabled us to prognosticate patients who are at greater risk of developing metachronous liver metastases. The lower lymph node sampling in the patients with less advanced staging (I) and in patients with nodenegative cancer (I+II) who developed liver metastases, leads us to believe that some patients have been understaged. CONCLUSION: We believe that the LNR, especially in cases of adequate lymph node sampling, is a useful gauge to better sub-stratify "node-positive" patients. KEY WORDS: Colorectal cancer, Liver metastases, Lymph node ratio.