The “Psychology” of organ donation: two exploratory studies considering Italian “Health professionals” and “Citizens”

Background: Transplantation extends and improves lives, but the shortage of organs is one of the main factors limiting the number of transplants in Italy. Objectives: The aim of this research was to understand the psychological and socio demographic determinants that can be related to the manifestation of the willingness to donate in a sample of citizens and professionals. Methods: In the study conducted on two samples (health professionals and citizens), two self-administered questionnaires were created ad hoc and administered to the participants recruited by means of a snowballing not-randoming procedure. Results: 386 citizens and 122 health professionals completed the questionnaire. Results frequently supported the literature. Specifically, with reference to the sample of citizens, (a) women are more likely to express a willingness to donate than men; furthermore, (b) having a realistic knowledge of the topic has a relationship with this manifestation. In both samples, (c) having previously discussed the topic of donation is relevant to expressing willingness to donate. With reference to the sample of professionals only, (d) having received training on organ donation has a relationship with practitioners' willingness to donate. Conclusion: There are several factors that influence the manifestation of willingness to donate in both samples. Efforts should be stepped up to provide comprehensive and appropriate education, knowledge and training on the subject to increase willingness to donate

Effects of prolonged flushing interval in totally implantable venous access devices (TIVADs)

Totally implantable venous access device (TIVAD) lumen occlusion is a long-term complication of central venous catheters, associated with risks of infection, therapy interruptions and increased healthcare costs. The role of flushing and locking in maintaining TIVAD patency is paramount. Most flushing protocols are based on manufacturers' recommendations, which indicate that 4 weeks is the safest interval between two consecutive flushing procedures during periods when TIVADs are not in use. Conversely, results of several studies suggest that extended flushing intervals (FIs) do not increase the rate of obstructive or infective complications. The study aimed to describe the effects of prolonged FIs in a cohort of 317 patients with cancer. The authors found no significant difference in terms of TIVAD problems between long (>45 days) and short ( 6445 days) FI groups, which raises questions over the validity of current practice

GLIM Criteria for Malnutrition in Surgical IBD Patients: A Pilot Study

Background: A gold standard method for malnutrition diagnosis is still lacking in Inflammatory Bowel Disease (IBD). Objective: The aims of this study are to determine the prevalence of malnutrition in IBD patients according with recently published Global Leadership Initiative on Malnutrition (GLIM) criteria, to detect the factors contributing to the onset of malnutrition, and to evaluate the most accurate predictor of malnutrition risk within the available nutritional screening tools. Methods: Fifty-three consecutive adult IBD patients [38 Crohn’s disease (CD) and 15 ulcerative colitis (UC)] had been assessed preoperatively by a multidisciplinary IBD team before undergoing elective surgery. Several malnutrition risk tools were tested, such as NRS-2002, MUST, MST, MIRT, and SaskIBD-NR. The statistical association of independent GLIM variables with baseline characteristics of patients was explored as well as the concordance with the European Society for Clinical Nutrition and Metabolism (ESPEN 2015) and the screening tools. Results: Twenty-two IBD patients (42%) were malnourished according to GLIM criteria, of which 13 were CD (34%) and 9 UC (60%). The etiological criteria of inflammation and reduction of food intake were present in 51% and 19% of our patients, respectively. The prevalence of GLIM phenotypic criteria was 28%, 28% and 34% for BMI, Free Fat Mass Index (FFMI) and unintended weight loss (UWL), respectively. The presence of ileostomy was statistically associated with a higher prevalence of BMI (p = 0.030), FFMI (p = 0.030) and UWL (p = 0.002) values lower than the GLIM criteria cut-offs, while secondary surgery is associated with a decrease in FFMI (p = 0.017) and UWL (p = 0.041). The sensitivity of the tested nutritional screening tools, compared with the GLIM prevalence of malnutrition, was not satisfactory (between 50 and 82%). Conclusions: GLIM has a higher rate of malnutrition detection than ESPEN 2015, as malnutrition in IBD seems linked to inflammation and secondary malabsorption even without a reduction of food intake. The sensitivity of the screening tools is lower than the specificity when compared with GLIM criteria for malnutrition diagnosis

Preliminary Validation of the Digital Ulcer Clinical Assessment Score in Systemic Sclerosis

To date, "healed/non-healed" and clinical judgment are the only available assessment tools for digital ulcers (DU) in patients with systemic sclerosis (SSc). The aim of our study is to examine a preliminary composite DU clinical assessment score (DUCAS) for SSc for face, content, and construct validity