Elderly patients with multimorbidity in the home setting: umbrella review on therapeutic non-adherence causes

Objective: The elderly population is the most at risk regarding adherence, especially in the coexistence of multiple diseases. This study aims to detect factors contributing to therapeutic non-adherence in elderly patients in home settings. Materials and methods: A review protocol was developed to conduct the umbrella review using the methodological framework of the Richardson et al study. The search strategy was developed in December 2022 to conduct a systematic search and to perform an Umbrella Review of systematic reviews, meta-analyses and integrative reviews published from 2012 to 2022 in English. Results: A total of 26,038 articles were identified and screened. 18 relevant articles were included in the study. Conclusions: Therapeutic adherence in elderly patients with comorbidities in polypharmacotherapy at home is a significant problem in public health and health care. Several factors of non-adherence have been identified in the studies reviewed, confirming that the problem is multifactorial. Reducing the number of medications prescribed would appear optimal, although often not possible, as this has been seen to have an immediate positive impact. A multidisciplinary approach makes it possible not to fragment care, ensuring positive feedback on therapeutic adherence

Improving sleep quality in cancer patients. a literature review on non-pharmacologic interventions

Objective: Disrupted sleep-in cancer patients is due to several factors. Pre-existing sleep disorders, mental status in cancer, or side effects of cancer treatment are all potential predictors of sleep disturbances in this vulnerable population. This review aims to evaluate and synthesise non-pharmaco-logic interventions for improving sleep quality and the associated benefits in cancer patients. Materials and Methods: A literature review was performed according to PRISMA guidelines. PubMed, Google Scholar, MEDLINE, CINAHL, and Embase databases were interrogated, selected the article with cancer, neoplasm, oncology, sleep-wake disorders, sleep disturbance, sleep problem, strategies, treat-ment, and intervention such as keywords. No time and geographic restrictions but paediatrics, children, and interventions unrelated to sleep improvement in cancer were excluded. Results: Overall, twenty-nine articles were included in the review after selection. The included studies analysed different types of cancer, like breast, lung, and prostate cancer and acute leukaemia. Most of the data gathered from the relevant research suggest that nonpharmacologic interventions significantly improved cancer patients’ sleep quality. Conclusions: Cancer survival rates are increasing; researchers and healthcare professionals should aim not just at survival but also to allow cancer patients just comfortably to live, considering the best quality of life possible. Nurses have a crucial role in the care of this patient population. Nursing implies an intimate relationship with patients and educating the patient to improve their mental and physical condition through non-pharmacological approaches, which should be considered a specific competence

Cancer patients and telenursing interventions in Italy. a systematic review

Objective: The use of digital technologies could improve patients’ quality of care, satisfaction, and health-related outcomes in cancer patients. This paper aims to explore the use of digital technologies in nursing management of cancer patients in Italy. Patients and Methods: A systematic literature review was performed. PubMed, Excerpta Medica dataBASE (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library databases were consulted from September 1, 2021, to January 31, 2022. Key terms for Telenurs-ing/Telemedicine and cancer in Italy were used. The quality of each study was assessed through the Grading of Recommendations, Assessment, Development, and Evaluations method. Results: 131 articles were found and 5 were included: two randomized-clinical-trial protocols aimed to explore the impact of medication management apps on patients’ quality of life; one validation trial suggested good reliability in the therapeutic adherence of patients on chemotherapy but limited sensitivity in detecting related adverse events; two observational studies described the validation of telephone triage prehospitalization programs performed by nurses during the pandemic. Conclusions: The use of digital technologies in nursing management of cancer patients is in-frequent in Italy, however, increased during the pandemic. Further studies are needed to evaluate the impact and effectiveness of the use of digital technologies in nursing management in cancer patients

How to improve educational behaviors for caregivers and patients having Central Venous Access Device (CVAD). a scoping review

Objective: Central venous access devices (CVADs) are essential to the modern management of patients with hematological malignancies and solid tumors. Educational programs play a crucial role in promoting appropriate patient actions to support patient safety during hospitalization and homecare. This review aimed to identify literature concerning educational interventions to promote patients’ actions to overcome CVAD-related problems and improve self-monitoring and self-management. Materials and Methods: Documentary evaluation of international databases, such as PubMed, CINAHL, Scopus and Cochrane. Searching for data on population, context and concept regarding CVAD self-management. The extracted data was subject to thematic analysis. The following scoping reviews were developed using the five-stage framework outlined by Arksey and O’Malley, and advanced by Levac and colleagues. Results: Of the 2802 articles identified, 19 research articles were selected in this review. Educational programs have been shown to improve CVAD self management, to decrease stress and anxiety related to their use, and to reduce the onset of complications. In addition, nurses have proven to be the professional reference figure for educational interventions. Conclusions: The results of the study lead to the conclusion that programs aimed at improving selfcare and reducing the onset of complications in patients living with chronic and debilitating diseases should be made available to a larger portion of individuals. Both generic and specific programs are needed, in the different contexts of home and hospital, for the short and long term, in order to ameliorate participants’ abilities. The results of this study should, therefore, encourage health professionals to plan, carry out, and evaluate the establishment of educational programs with patient participation

Cancer patients and telenursing interventions in Italy: a systematic review

OBJECTIVE: The use of digital technologies could improve patients’ quality of care, satisfaction, and health-related outcomes in cancer patients. This paper aims to explore the use of digital technologies in nursing management of cancer patients in Italy. PATIENTS AND METHODS: A systematic literature review was performed. PubMed, Excerpta Medica dataBASE (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library databases were consulted from September 1, 2021, to January 31, 2022. Key terms for Telenursing/Telemedicine and cancer in Italy were used. The quality of each study was assessed through the Grading of Recommendations, Assessment, Development, and Evaluations method. RESULTS: 131 articles were found and 5 were included: two randomized-clinical-trial protocols aimed to explore the impact of medication management apps on patients' quality of life; one validation trial suggested good reliability in the therapeutic adherence of patients on chemotherapy but limited sensitivity in detecting related adverse events; two observational studies described the validation of telephone triage prehospitalization programs performed by nurses during the pandemic. CONCLUSIONS: The use of digital technologies in nursing management of cancer patients is infrequent, however, increased during the pandemic. Further studies are needed to evaluate the impact and effectiveness of the use of digital technologies in nursing management in cancer patients

Improving sleep quality in cancer patients: a literature review on non-pharmacologic interventions

Objective: Disrupted sleep-in cancer patients is due to several factors. Pre-existing sleep disorders, mental status in cancer, or side effects of cancer treatment are all potential predictors of sleep disturbances in this vulnerable population. This review aims to evaluate and synthesise non-pharmacologic interventions for improving sleep quality and the associated benefits in cancer patients. Materials and Methods: A literature review was performed according to PRISMA guidelines. PubMed, Google Scholar, MEDLINE, CINAHL, and Embase databases were interrogated, selected the article with cancer, neoplasm, oncology, sleep-wake disorders, sleep disturbance, sleep problem, strategies, treatment, and intervention such as keywords. No time and geographic restrictions but paediatrics, children, and interventions unrelated to sleep improvement in cancer were excluded. Results: Overall, twenty-nine articles were included in the review after selection. The included studies analysed different types of cancer, like breast, lung, and prostate cancer and acute leukaemia. Most of the data gathered from the relevant research suggest that nonpharmacologic interventions significantly improved cancer patients' sleep quality. Conclusions: Cancer survival rates are increasing; researchers and healthcare professionals should aim not just at survival but also to allow cancer patients just comfortably to live, considering the best quality of life possible. Nurses have a crucial role in the care of this patient population. Nursing implies an intimate relationship with patients and educating the patient to improve their mental and physical condition through non-pharmacological approaches, which should be considered a specific competence

High disease impact of myotonic dystrophy type 2 on physical and mental functioning

The aim of the study was to investigate health status in patients with myotonic dystrophy type 2 (DM2) and determine its relationship to pain and fatigue. Data on health status (SF-36), pain (MPQ) and fatigue (CIS-fatigue) were collected for the Dutch DM2 population (n = 32). Results were compared with those of sex- and age-matched adult-onset myotonic dystrophy type 1 (DM1) patients. In addition, we compared the obtained scores on health status of the DM2 group with normative data of the Dutch general population (n = 1742). Compared to DM1, the SF-36 score for bodily pain was significantly (p = 0.04) lower in DM2, indicating more body pain in DM2. DM2 did not differ from DM1 on any other SF-36 scales. In comparison to the Dutch population, DM2 patients reported lower scores (indicating worse clinical condition) on the physical functioning, role functioning-physical, bodily pain, general health, vitality, social functioning, and role functioning-emotional scales (p < 0.01 on all scales). The difference was most profound for the physical functioning scale. In the DM2 group the severity of pain was significantly correlated with SF-36 scores for bodily pain (p = 0.003). Fatigue was significantly correlated with the SF-36 scores for role functioning-physical (p = 0.001), general health (p = 0.02), and vitality (p = 0.02). The impact of DM2 on a patients’ physical, psychological and social functioning is significant and as high as in adult-onset DM1 patients. From the perspective of health-related quality of life, DM2 should not be considered a benign disease. Management of DM2 patients should include screening for pain and fatigue. Symptomatic treatment of pain and fatigue may decrease disease impact and help improve health status in DM2, even if the disease itself cannot be treated

The graph rewriting calculus: confluence and expressiveness

Introduced at the end of the nineties, the Rewriting Calculus (rho-calculus, for short) is a simple calculus that uniformly integrates term-rewriting and lambda-calculus. The Rhog has been recently introduced as an extension of the rho-calculus, handling structures with cycles and sharing. The calculus over terms is naturally generalized by using unification constraints in addition to the standard rho-calculus matching constraints. This leads to a term-graph representation in an equational style where terms consist of unordered lists of equations. In this paper we show that the (linear) Rhog is confluent. The proof of this result is quite elaborated, due to the non-termination of the system and to the fact that we work on equivalence classes of terms. We also show that the Rhog can be seen as a generalization of first-order term-graph rewriting, in the sense that for any term-graph rewrite step a corresponding sequence of rewritings can be found in the Rhog

A Mouse Model of Heritable Cerebrovascular Disease

The study of animal models of heritable cerebrovascular diseases can improve our understanding of disease mechanisms, identify candidate genes for related human disorders, and provide experimental models for preclinical trials. Here we describe a spontaneous mouse mutation that results in reproducible, adult-onset, progressive, focal ischemia in the brain. The pathology is not the result of hemorrhage, embolism, or an anatomical abnormality in the cerebral vasculature. The mutation maps as a single site recessive locus to mouse Chromosome 9 at 105 Mb, a region of shared synteny with human chromosome 3q22. The genetic interval, defined by recombination mapping, contains seven protein-coding genes and one processed transcript, none of which are changed in their expression level, splicing, or sequence in affected mice. Targeted resequencing of the entire interval did not reveal any provocative changes; thus, the causative molecular lesion has not been identified

Micro-CT imaging reveals<i> Mekk3 </i>heterozygosity prevents cerebral cavernous malformations in <i>Ccm2</i>-deficient mice

Mutations in CCM1 (aka KRIT1), CCM2, or CCM3 (aka PDCD10) gene cause cerebral cavernous malformation in humans. Mouse models of CCM disease have been established by deleting Ccm genes in postnatal animals. These mouse models provide invaluable tools to investigate molecular mechanism and therapeutic approaches for CCM disease. However, the full value of these animal models is limited by the lack of an accurate and quantitative method to assess lesion burden and progression. In the present study we have established a refined and detailed contrast enhanced X-ray micro-CT method to measure CCM lesion burden in mouse brains. As this study utilized a voxel dimension of 9.5μm (leading to a minimum feature size of approximately 25μm), it is therefore sufficient to measure CCM lesion volume and number globally and accurately, and provide high-resolution 3-D mapping of CCM lesions in mouse brains. Using this method, we found loss of Ccm1 or Ccm2 in neonatal endothelium confers CCM lesions in the mouse hindbrain with similar total volume and number. This quantitative approach also demonstrated a rescue of CCM lesions with simultaneous deletion of one allele of Mekk3. This method would enhance the value of the established mouse models to study the molecular basis and potential therapies for CCM and other cerebrovascular diseases