Screening for distress in cancer patients: a multicenter, nationwide study in Italy.

BACKGROUND: Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures. METHODS: In total, 1108 outpatients with cancer were recruited from 38 representative oncology centers in Italy. Each participant completed the DT and a list of 34 possible cancer-related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18-item Brief Symptom Inventory (BSI-18), and a short visual analog scale to determine the understandability of the tools. RESULTS: Receiver operating characteristic analysis revealed that DT cutoff scores ≥ 4 and ≥ 5 had optimal sensitivity and specificity relative to both HADS and BSI-18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores ≥ 4 (cases) were more likely to be women; to have had psychological problems in the past; to report more stressful events in the last year; and to currently have more family, emotional, and physical problems related to cancer or cancer treatment. Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI-18. CONCLUSIONS: The DT was identified as a simple and effective screening instrument for detecting distress in Italian cancer patients as a first step toward more properly referring those in need to psychosocial intervention.

COVID-19 pandemic distress among a sample of Italian psycho-oncologists: risk of isolation and loneliness.

PURPOSE: To measure the prevalence and characteristics of distress and hope for the future among psycho-oncologists, who faced the coronavirus disease 2019 (COVID-19) emergency along with other healthcare workers. METHODS: A web-based study was conducted among members of the Italian Society of Psycho-Oncology between May 29 and June 5, 2020. RESULTS: A total of 237 members, aged 28-72 years, completed the COVID-19 Peritraumatic Distress Index (CPDI), Impact of Event Scale-Revised (IES-R), and HOPE questionnaires; 86.92% were female, 58.65% worked in hospitals, 21.10% were exposed to COVID-19, 11.39% experienced peritraumatic distress, and 3.38% had posttraumatic stress disorder symptoms. Peritraumatic distress was associated with living alone (adjusted odds ratio [AOR] 3.05; 95% confidence interval [CI] 1.41-8.13), using sleep remedies (AOR 3.79; 95% CI 1.41-10.21), and the perception of being avoided by family or friends because of work (AOR 2.69; 95% CI 1.02-7.11); high HOPE-Agency scores were associated with the absence of peritraumatic stress (AOR 0.40; 95% CI 0.16-0.96) after adjustment for age and sex. CONCLUSIONS: Psycho-oncologists showed greater resilience than other healthcare workers as they are trained to help others, but also to review their own values and behavior in light of stressful events. Of interest is the association between peritraumatic distress and social isolation, real or perceived. Healthcare institutions should pay attention to the mental well-being of their employees by promoting distress screening using simple tools such as the CPDI and implementing support interventions. Psycho-oncology associations should introduce policies aimed at developing a sense of social connectedness by providing an interactive system of orientation and scientific reference.

Emergency department shift change is associated with pneumonia in patients with acute ischemic stroke.

BACKGROUND AND PURPOSE: Emergency department (ED) nurses play a pivotal role in early acute ischemic stroke patient management. We hypothesized that patients exposed to ED nursing shift changes (SC) may develop pneumonia (PNA) more frequently and have worse early outcomes than do patients who have continuity of care until stroke unit admission. METHODS: Consecutive acute ischemic stroke patients presenting to our ED were studied using chart review and prospectively collected registry data. We evaluated the association of patient presence during an ED SC (ie, 07:00-08:00, 19:00-20:00) with length of stay in the ED, PNA rates, and early outcome measures (discharge disposition, modified Rankin Scale score, and death). RESULTS: Three hundred sixty-six consecutive acute ischemic stroke patients met the criteria. Of those, 54.9% were present during an SC. After adjusting for baseline National Institutes of Health Stroke Scale, admission glucose, and intravenous tissue-type plasminogen activator, patients present during SC were half as likely to be discharged home or to inpatient rehab (OR, 0.50; 95% CI, 0.26-0.96; P=0.04) and were 2.5 times more likely to develop PNA (OR, 2.54; 95% CI, 1.02-6.30; P=0.045). After additional adjustment for time in the ED, the difference in favorable discharge disposition was no longer significant, but SC was associated with 5 times the odds of PNA (OR, 5.35; 95% CI, 1.34-21.39; P=0.018) compared with patients with continuity of care. CONCLUSIONS: In our center, acute ischemic stroke patients present during an ED nursing SC experienced higher rates of PNA and had decreased rates of favorable discharge disposition compared with patients with continuity of care. Strategies to prevent PNA and improve hand-off communication during SC may reduce this risk.

Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard.

Drug abuse robs individuals of their jobs, their families, and their free will as they succumb to addiction; but may cost even more: a life of disability or even life lost due to stroke. Many illicit drugs have been linked to major cardiovascular events and other comorbidities, including cocaine, amphetamines, ecstasy, heroin, phencyclidine, lysergic acid diethylamide, and marijuana. This review focuses on available epidemiological data, mechanisms of action, particularly those leading to cerebrovascular events, and it is based on papers published in English in PubMed during 1950 through February 2011. Each drug's unique interactions with the brain and vasculature predispose even young, healthy people to ischemic or hemorrhagic stroke. Cocaine and amphetamines have the strongest association with stroke. However, the level of evidence firmly linking other drugs to stroke pathogenesis is weak. Large epidemiological studies and systematic evaluation of each drug's action on the brain and cardiovascular system are needed to reveal the full impact of drug use on the population.

Psychological aspects in day-case surgery.

Many reasons have helped to achieve the expansion of day surgery in health care system. First, surgical and pharmacological advances have dramatically reduced length of hospitalizazion needed for recovery from anaesthesia and operation. Second, day surgery has the potential to be more cost-effective than inpatient surgery. Third, patients generally are satisfied with day surgery because they have no or minimal side effects, are discharged the same day they have surgery and there is a minimal disruption in their everyday life. In this new era of safe, efficient, convenient, economical and speedy surgical interventions and minimal hospital stay, considerable attention must be given to some psychological issues, as anxiety and its management and information provision. Several studies have highlighted causes and degree of anxiety experienced by patients admitted in day surgery and a lack of an adequate and documented support. A combination of consistent strategies and interpersonal skills may have the potential to become the base of a formal psychoeducational plan implemented to manage anxiety. An essential component of anxiety management is information provision. Since lack or inadequacy of information is one of the main complaints with day surgery and the most common cause of patients' dissatisfaction, a formal and structured programme of information delivery is required. The timely and appropriate provision of different levels of information tailored to patient's coping styles and preferences has been strongly recommended. The information provided must cover the whole range of procedural, behavioural and sensory information and include pre-operative, operative and post-operative phases.

Breast cancer surgery in an ambulatory setting.

AIM: To evaluate the feasibility and efficacy of outpatient surgery for early breast cancer in an Italian ambulatory setting and to assess its benefits. PATIENTS AND METHODS: A review of 88 women treated for breast cancer from an outpatient facility was undertaken from July 2003 to December 2006. The patients were selected for ambulatory surgery according to specific social, environmental, physical and oncological criteria. RESULTS: Eighty-eight women underwent a total of 107 surgical interventions in an ambulatory setting. Sixty out of the eighty-eight patients (68%) received a one-day conclusive surgical treatment, and the remaining 28 patients were promptly treated in two phases. Among this latter group, 18 patients (68%) were treated only in an outpatient facility, whereas the other 10 patients require reintervention with hospitalization. There were no intraoperative complications. In the postoperative period, 14 complications were observed: 6 wound infections, 3 hematomas, 1 axillary seroma and 4 readmissions. The patients' readmissions were due to nausea and emesis in one case, disphnoea in another case, and only two readmissions were due to surgical complications (hematoma in both cases). Patients that were interviewed exhibited a high level of satisfaction from the treatments they received. DISCUSSION: This study confirms the feasibility, efficacy and safety of the outpatient setting regime, which is highly appreciated by women and is more cost effective than surgery in a hospital setting.

Cancer of the esophagus: the value of preoperative patient assessment.

In the past few years, major improvements and new technologies have been proposed and applied in esophageal surgery. Its evolution depended not only on a thorough knowledge of surgical anatomy and technique, but also on important developments in pre- and postoperative care. Esophageal resection for cancer is still associated with high morbidity and mortality. Postoperative complications may be either patient or surgeon related. Patient-related factors include age, malnutrition, immunodepression and associated diseases. The surgeon-related factors are surgical experience, hospital volume and multidisciplinary approach. Preoperative evaluation is defined as the process of clinical assessment that precedes the delivery of anesthesia. The principle is to gain information concerning patients that leads to modification of their management, and improves the outcome from surgery.