Stress in nursing staff: a comparative analysis between intensive care units and general medicine units

It's a current belief that stress is an outstanding feature of intensive care units, in particular within nursing staff. The aim of this study was to compare some variables belonging to stress (i.e. anxiety, depression and `Burnout' syndrome) between nurses working in intensive care units (ICUs) and general medicine units (GMUs). Materials and methods We studied a population of 883 nurses working in ICUs, distributed in 79 Italian hospitals (70.1 % female) and 509 nurses working in GMUs, distributed in 35 Italian hospitals (80.2 % female). We asked them to fill in a form including: 1) general data and his/her work environment; 2) different evaluation standardized scales - the Hospital Anxiety and Depression Scale, divided into anxiety (HAD A) and depression (HAD D) status 0-7 `non cases', 8-10 `doubtful cases', 11-21 `cases'; the S.T.A.I. scale, divided into acute anxiety (Y-1) and chronic anxiety (Y-2) status; the Maslach Burnout Inventory-Human Services Survey (MBI.) divided into Emotional Exhaustion (EE), 64 18 `low', 19-26 `average', 65 27 `high', Depersonalization (DP) and Personal Accomplishment (PA). We also evaluated the different reasons of anxiety through individual questions (higher value, more anxiety): A1, a critically ill patient; A2, a young patient; A3, an old patient; A4, a suicidal patient; A5, a terminal patient; A6, presence of mechanical supports; A7, relationship with patients' relatives. The comparison between the two groups was performed by the Mann-Whitney Rank Sum test and z-test; statistical significance was accepted as P<0.05. Results The results, expressed as median value, with 25th and 75th percentile in brackets, are shown in Tables 1 and 2. Table 1 also shows the proportions of nurses that had a highest value of HAD A and M.B.I. EE. Conclusions Pathologic anxiety and emotional exhaustion are more prevalent in nurses working in GMUs. Thus, contrary to a common belief, `stress' is a more distinctive peculiarity of general medicine units than intensive care units

Mast cells and acute coronary syndromes : Relationship between serum tryptase, clinical outcome and severity of coronary artery disease

Objective: To assess the relationship between serum tryptase and the occurrence of major cardiovascular and cerebrovascular events (MACCE) at 2-year followup in patients admitted with acute coronary syndrome (ACS). To compare serum tryptase to other validated prognostic markers (maximum high-sensitivity troponin (hs-Tn), C reactive protein (CRP) levels at admission, Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score). Methods: We measured serum tryptase at admission in 140 consecutive patients with ACS and in 50 healthy controls. The patients' follow-up was maintained for 2 years after discharge. The predictive accuracy of serum tryptase for 2-year MACCE was assessed and compared with hs-Tn, CRP and SYNTAX score. Results: Serum tryptase levels at admission were significantly higher in patients with ACS compared with the control group (p=0.0351). 2 years after discharge, 28/140 patients (20%) experienced MACCE. Serum tryptase levels, maximum hs-Tn measurements and SYNTAX score were higher in patients who experienced MACCE compared with those without (p<0.0001). Conversely, we found no significant association between MACCE and CRP. The predictive accuracy of serum tryptase for MACCE was set at the cut-off point of 6.7 ng/mL (sensitivity 46%, specificity 84%). Conclusions: In patients with ACS, serum tryptase measured during index admission is significantly correlated to the development of MACCE up to 2 years, demonstrating a possible long-term prognostic role of this biomarker

5-grass pollen tablets achieve disease control in patients with seasonal allergic rhinitis unresponsive to drugs : a real-life study

BACKGROUND: An important subpopulation in allergic rhinitis is represented by patients with severe form of disease that is not responsive to drug treatment. It has been reported that grass pollen subcutaneous immunotherapy is effective in drug-resistant patients. In a real-life study, we evaluated the efficacy of 5-grass pollen tablets in patients with grass pollen-induced allergic rhinitis not responsive to drug therapy. METHODS: We carried out this multicenter observational study in adults and adolescents with grass-induced allergic rhinitis not responsive to drug therapy who were treated for a year with 5-grass pollen tablets. Clinical data collected before and after sublingual immunotherapy (SLIT) included Allergic Rhinitis and its Impact on Asthma (ARIA) classification of allergic rhinitis, response to therapy, and patient satisfaction. RESULTS: Forty-seven patients entered the study. By ARIA classification, three patients had moderate to severe intermittent allergic rhinitis, ten had mild persistent allergic rhinitis, and 34 had moderate to severe persistent allergic rhinitis. There were no cases of mild intermittent allergic rhinitis before SLIT. After SLIT, 33 patients had mild intermittent allergic rhinitis, none had moderate to severe intermittent allergic rhinitis, seven had mild persistent allergic rhinitis, and seven had moderate to severe persistent allergic rhinitis. The mean medication score decreased from 4.2\ub11.3 before to 2.4\ub12.0 after SLIT (P<0.01), representing a reduction of 42%. The response to treatment before SLIT was judged as poor by 70% of patients and very poor by 30%. Patient satisfaction was significantly increased after SLIT (P<0.01). CONCLUSION: In real life, most patients with grass pollen-induced allergic rhinitis not responsive to drug treatment can achieve control of the condition with one season of treatment using 5-grass pollen tablets. KEYWORDS: allergen immunotherapy, drug resistance, effectiveness, grass pollen, patient satisfaction, rhiniti

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden. Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18\u201345 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment. Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR. . Conclusions: These fndings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed

BURNOUT SYNDROME IN ICU NURSING STAFF

INTRODUCTION. Burnout syndrome was defined as a whole of emotional exhaustion, depersonalization and reduced personal accomplishment, that may occur among individuals who work in direct touch with people, and that may lead to a decreased working yield. Aim of the study was to analyze burnout syndrome within nursing staff working in Intensive Care Units (ICUs), and to compare nurses with an high and a low level of burnout. METHODS. We studied a population of 883 nurses working in ICUs, distributed in 79 Italian hospitals. We asked them to fill in a form including: 1) general data and his/her work environment, 2) different evaluation standardized scales: the Hospital Anxiety and Depression Scale, divided in anxiety (HAD A) and depression (HAD D) status \u2013 0-10 \u201cnon pathologic\u201d, 11-21 \u201cpathologic\u201d \u2013; the State-Trait Anxiety Inventory (S.T.A.I.), divided in acute anxiety (Y-1) and chronic anxiety (Y-2) status; the Maslach Burnout Inventory \u2013 (M.B.I.) divided in Emotional Exhaustion (EE), Depersonalization (DP) and Personal Accomplishment (PA). High level of burnout was defined as a value of EE \uf0b327, DP \uf0b310 and PA \uf0a333, while low level was defined as a value of EE \uf0a318, DP \uf0a35 and PA \uf0b340. The comparison between the two groups was performed by t-test and z-test; statistical significance was accepted as p < 0.05. Results are expressed as percentage or as mean \uf0b1 SD. RESULTS. Among our population, 12.5% of nurses resulted to have a low level of burnout, and 10% to have an high level of burnout, while 77.5% of nurses presented at least one variables of burnout above low level. In nursing staff with high level of burnout, compared with nurses with low level of burnout, we found: an higher percentage of nurses working in ICU for more than 2 years (89% vs 68%), an higher mean of intubated patients (5.7 \ub12.9 vs 3.8 \ub12.8), an higher percentage of pathologic anxiety (42% vs 3%) and pathologic depression (14% vs 0%), and an higher mean of S.T.A.I. Y-1 (45.4 \ub111.7 vs 30.4 \ub15.4) and S.T.A.I. Y-2 (46.7 \ub19.1 vs 31.4 \ub17.0). Moreover, in nurses with high level of burnout EE was correlated with S.T.A.I. Y-1 (r = 0.54, p < 0.001) and with HAD A (r = 0.51, p < 0.001), and HAD A was correlated with HAD D (r = 0.63, p < 0.001). CONCLUSION. 1) Burnout syndrome may be an important phenomenon within ICU nursing staff. 2) Some features of working environment, general and psychological personal data may be associated with the degree of burnout