Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial

Background Early palliative care (EPC) in oncology has been shown to have a positive impact on clinical outcome, quality-of-care outcomes, and costs. However, the optimal way for activating EPC has yet to be defined. Methods This prospective, multicentre, randomised study was conducted on 207 outpatients with metastatic or locally advanced inoperable pancreatic cancer. Patients were randomised to receive ‘standard cancer care plus on-demand EPC’ (n = 100) or ‘standard cancer care plus systematic EPC’ (n = 107). Primary outcome was change in quality of life (QoL) evaluated through the Functional Assessment of Cancer Therapy – Hepatobiliary questionnaire between baseline (T0) and after 12 weeks (T1), in particular the integration of physical, functional, and Hepatic Cancer Subscale (HCS) combined in the Trial Outcome Index (TOI). Patient mood, survival, relatives' satisfaction with care, and indicators of aggressiveness of care were also evaluated. Findings The mean changes in TOI score and HCS score between T0 and T1 were −4.47 and −0.63, with a difference between groups of 3.83 (95% confidence interval [CI] 0.10–7.57) (p = 0.041), and −2.23 and 0.28 (difference between groups of 2.51, 95% CI 0.40–4.61, p = 0.013), in favour of interventional group. QoL scores at T1 of TOI scale and HCS were 84.4 versus 78.1 (p = 0.022) and 52.0 versus 48.2 (p = 0.008), respectively, for interventional and standard arm. Until February 2016, 143 (76.9%) of the 186 evaluable patients had died. There was no difference in overall survival between treatment arms. Interpretations Systematic EPC in advanced pancreatic cancer patients significantly improved QoL with respect to on-demand EPC

Prodotti dell'alveare: la propoli e le sue proprietà benefiche

La propoli è una sostanza naturale prodotta dalle api operaie in seguito alla raccolta di resine ed estratti vegetali; è impiegata nell’alveare come materiale di costruzione con funzione cementante e protettiva. Essendo un prodotto di origine naturale, la sua composizione è estremamente complessa ed allo stesso tempo peculiare: molteplici sono le sostanze chimiche che ne fanno parte, la loro presenza e concentrazione dipende dal luogo d’origine, dall’ape, dalla stagione, dalla specie vegetale bottinata e da numerose altre variabili. È importante considerare la variabilità compositiva della propoli per poterne valutare le caratteristiche qualitative, che ancora oggi non sono ufficialmente definite a livello Europeo, ma che fanno riferimento principalmente all’intensità con cui essa è in grado di determinare effetti benefici nell’uomo. Dalla peculiarità delle molecole che la compongono emergono le sue potenzialità come sostanza antimicrobica, antiossidante, antiinfiammatoria ed antitumorale, caratteristiche che la rendono sempre più spesso oggetto di studi e ricerche scientifiche. In questo studio vengono messi a confronto i risultati ed i metodi analitici degli studi effettuati su tale matrice: ne deriva una forte difformità, data dall’origine dei campioni e dalla impossibilità, ad oggi, di ottenere un prodotto standardizzato

Personality Disorders in Addiction Outpatients: Prevalence and Effects on Psychosocial Functioning

AIM: To evaluate the prevalence of personality disorders (PDs) in the outpatients attending an addiction service, with particular attention to the effects of PDs on social and occupational functioning and on the intensity of treatment required. DESIGN: A cross-sectional epidemiological study with the assessment of 320 outpatients, through SCID-II (Structured Clinical Interview for DSM-IV Axis II PDs), SOGS (South Oaks Gambling Screen), and questionnaire extracted from EuropASI. RESULTS: The percentage prevalence of PDs was 62.2% (confidence interval at 95% (95% CI): 57-68). PDs were positively associated with placement in an addiction treatment community (odds ratio (OR) = 2.98, CI = 1.77-5.03), having received lifetime treatment at the mental health center (MHC) (OR = 3.67, CI = 1.67-8.07) or having attempted suicide (OR = 2.30, CI = 1.05-5.02). Furthermore, PDs were related to a reduced probability of keeping a job (OR = 0.54, CI = 0.31-0.95) or starting a family (OR = 0.51, CI = 0.30-0.87). CONCLUSION: Axis II comorbidity occurs in 62% of addiction outpatients and has substantial effects on social and occupational functioning as well as on treatment programs

Personality Disorders in Addiction Outpatients: Prevalence and Effects on Psychosocial Functioning

Aim To evaluate the prevalence of personality disorders (PDs) in the outpatients attending an addiction service, with particular attention to the effects of PDs on social and occupational functioning and on the intensity of treatment required. Design A cross-sectional epidemiological study with the assessment of 320 outpatients, through SCID-II (Structured Clinical Interview for DSM-IV Axis II PDs), SOGS (South Oaks Gambling Screen), and questionnaire extracted from EuropASI. Results The percentage prevalence of PDs was 62.2% (confidence interval at 95% (95% CI): 57–68). PDs were positively associated with placement in an addiction treatment community (odds ratio (OR) = 2.98, CI = 1.77–5.03), having received lifetime treatment at the mental health center (MHC) (OR = 3.67, CI = 1.67–8.07) or having attempted suicide (OR = 2.30, CI = 1.05–5.02). Furthermore, PDs were related to a reduced probability of keeping a job (OR = 0.54, CI = 0.31–0.95) or starting a family (OR = 0.51, CI = 0.30–0.87). Conclusion Axis II comorbidity occurs in 62% of addiction outpatients and has substantial effects on social and occupational functioning as well as on treatment programs