Laparoscopic surgery does not reduce the need for red blood cell transfusion after resection for colorectal tumour: a propensity score match study on 728 patients

Background: Patients with colorectal tumour often present with anaemia, and up to 60% will receive red blood cells (RBC) transfusion. Some evidence suggests a correlation between RBC transfusion and worse outcomes. Since laparoscopy minimizes intraoperative blood loss, we retrospectively investigated its role in reducing haemoglobin (Hb) drop and requirements for postoperative RBC transfusions. Methods: Patients were identified from consecutive cases undergone elective surgery for non-metastatic colorectal tumour between 2005 and 2019. Laparoscopic cases were matched 1:1 with open controls through propensity score matching (PSM). The main outcome measures were postoperative Hb drop and requirement for RBC. The secondary aim was evaluation of risk factors for postoperative RBC transfusions. Results: After application of PSM, 364 patients treated by laparoscopy were matched with 364 patients undergone open surgery. The two groups presented similar clinical and pathological characteristics, as well as comparable postoperative outcomes. 56 patients in the open group and 47 in the laparoscopic group required postoperative RBC (P = 0.395). No difference was observed in terms of mean number of RBC units (P = 0.608) or Hb drop (P = 0.129). Logistic regression analysis identified preoperative anaemia and occurrence of postoperative complications as relevant risk factors for postoperative RBC transfusion, while surgical approach did not prove statistically significant. Conclusion: Laparoscopy did not influence postoperative requirements for RBC transfusions after elective colorectal surgery. Preoperative anaemia and occurrence of postoperative complications represent the major determinants for postoperative transfusions after open as well as laparoscopic surgery

Nursing students' interprofessional educational experiences in the clinical context: findings from an Italian cross-sectional study

To explore nursing students' interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences

Nursing students' involvement in shift-to-shift handovers: Findings from a national study

Background Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers. Objective To explore nursing students' handover involvement during their clinical rotations and associated factors. Method This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement. Results Handover involvement was reported as \u2018only a little\u2019, \u2018to some extent\u2019, and \u2018always\u2019 by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (\u3b2\u202f=\u202f0.115, p\u202f<\u202f0.001); having children (\u3b2\u202f=\u202f0.107, p\u202f=\u202f0.011); being a 3rd-year student (\u3b2\u202f=\u202f0.142, p\u202f<\u202f0.001) and being a 2nd-year student as compared to a 1st-year student (\u3b2\u202f=\u202f0.050, p\u202f=\u202f0.036); and having a longer clinical rotation (\u3b2\u202f=\u202f0.015, p\u202f<\u202f0.001) in units with high \u2018quality of the learning environment\u2019 (\u3b2\u202f=\u202f0.279, p\u202f<\u202f0.001). Moreover, students who were supervised by the nurse teacher (\u3b2\u202f=\u202f 120.279, p\u202f<\u202f0.001), or by a nurse on a daily basis (\u3b2\u202f=\u202f 120.253, p\u202f=\u202f0.004), or by the staff (\u3b2\u202f=\u202f 120.190, p\u202f<\u202f0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience. Conclusions Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students

Nursing students' interprofessional educational experiences in the clinical context: findings from an Italian cross-sectional study

To explore nursing students' interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences

Thrombocytopenias: a clinical point of view

The finding of thrombocytopenia may sometimes be a warning sign of high-risk situations requiring swift therapeutic decisions. The diagnosis must start with the patient\u2019s history and data, with a careful evaluation of all blood counts and confirmation of the thrombocytopenia, followed by a morphological evaluation of the peripheral blood smear which, together with objective clinical findings, such as bleeding, lymphadenopathy and splenomegaly, will indicate the need for immediate therapy or appropriate further diagnostic investigations. Thrombocytopenia occurring in surgical patients can basically be attributed to DIC or HIT: the differential diagnosis is made on the basis of the correct laboratory investigations. In our opinion, the possibility of an ongoing pregnancy should always be evaluated in thrombocytopenic women of childbearing age, since a confirmed pregnancy implies that clinical forms of strictly obstetric pertinence are also possible. In conclusion, the overall picture of thrombocytopenias is extremely variegated, leading to numerous diagnostic and therapeutic problems whose solutions require close collaboration between clinicians and laboratory specialists

Nursing students' experience of the mental health setting as a clinical learning environment: Findings from a national study

To explore nursing students' perceptions of their clinical learning experiences in the mental health (MH) setting

The Lived Experience of Nursing Students with Culturally and Linguistically Diverse (CALD) Backgrounds in Italy: A Descriptive Phenomenological Study

Introduction: In recent decades, Italy has been exposed to significant migrant flows resulting from political and economic instability in neighbouring countries. As a result, there has been an increased amount of cultural and linguistic diversity (CALD) among nursing students. The aim of this study was to explore the experience of CALD nursing students as lived in the Italian nursing programmes. Method: A descriptive phenomenological method was used in 2017 with the involvement of a purposeful sample of 21 CALD nursing students in five Italian Bachelor of Nursing Science campuses. Data were collected using semistructured interviews; the subsequent content analysis was conducted by two independent researchers. Results: CALD nursing students reported having lived a transformative experience based on seven themes, from "living in the middle, between belonging and detachment" to "acquiring cultural awareness and cultural sensitivity." Discussion: Dealing with linguistic and cultural differences can affected CALD students' academic success, but also encourages them to develop awareness and cultural sensitivity by influencing their peers and the environment of the nursing programme. Therefore, having CALD students is a great value for nursing programmes. Nursing programmes should embody the values of cultural sensitivity and acceptance, including them as a nursing care value and as a concrete strategy to support CALD students. They should also develop strategies to promote the knowledge and responsibilities of nurses among CALD students and increase cultural sensitivity among faculty members at different levels

Effect of peri-operative blood transfusions on long-term prognosis of patients with colorectal cancer

Background: Patients with colorectal cancer often present with anaemia and require red blood cell transfusions (RBCT) during their peri-operative course. Evidence suggests a significant association between RBCT and poor long-term outcomes in surgical patients, but the findings in colorectal cancer are contradictory. Material and methods: The aim of this retrospective, single-centre, cohort study was to investigate the prognostic role of peri-operative RBCT in a large cohort of patients with stage I-III colorectal cancer submitted to curative surgery between 2005 and 2017. The propensity score matching technique was applied to adjust for potential confounding factors. Results: Among 1,414 patients operated within the study period, 895 fulfilled the inclusion criteria: 29.6% (n=265) received peri-operative RBCT. The group that received peri-operative RBCT was significantly older (p&lt;0.001), had more comorbidities (p&lt;0.001), more advanced tumours (p&lt;0.001) and more colon tumours (p=0.002) and stayed in hospital longer (p&lt;0.001). Post-operative mortality was 7-fold higher (2.3 vs 0.3%, p=0.01) in this group. Survival outcomes were significantly worse in the group receiving RBCT than in the group not receiving RBCT for both overall (64.5 vs 80.1%, p&lt;0.001) and cancer-specific survival (74.3 vs 85.1%, p&lt;0.001). On multivariable analysis, peri-operative RBCT was significantly associated with poorer overall survival (hazard ratio 1.51, p=0.009). When transfused and non-transfused cases were paired through the propensity score matching technique considering main clinico-pathological features, no differences in overall and cancer-specific survival were found. Discussion: Our data suggest that, after adjustment for potential confounding factors, no significant association exists between RBCT and prognosis in colorectal cancer

Biomarker Landscape in Neuroendocrine Tumors With High-Grade Features: Current Knowledge and Future Perspective

19noNeuroendocrine tumors (NETs) are classified based on morphology and are graded based on their proliferation rate as either well-differentiated low-grade (G1) to intermediate (G2-G3) or poorly differentiated high-grade neuroendocrine carcinomas (NEC G3). Recently, in gastroenteropancreatic (GEP) NETs, a new subgroup of well-differentiated high-grade tumors (NET G3) has been divided from NEC by WHO due to its different clinical-pathologic features. Although several mutational analyses have been performed, a molecular classification of NET is an unmet need in particular for G3, which tends to be more aggressive and have less benefit to the available therapies. Specifically, new possible prognostic and, above all, predictive factors are highly awaited, giving the basis for new treatments. Alteration of KRAS, TP53, and RB1 is mainly reported, but also druggable alterations, including BRAF and high microsatellite instability (MSI-H), have been documented in subsets of patients. In addition, PD-L1 demonstrated to be highly expressed in G3 NETs, probably becoming a new biomarker for G3 neuroendocrine neoplasm (NEN) discrimination and a predictive one for immunotherapy response. In this review, we describe the current knowledge available on a high-grade NET molecular landscape with a specific focus on those harboring potentially therapeutic targets in the advanced setting.openopenMichele Prisciandaro, Maria Antista, Alessandra Raimondi, Francesca Corti, Federica Morano, Giovanni Centonze, Giovanna Sabella, Alessandro Mangogna, Giovanni Randon, Filippo Pagani, Natalie Prinzi, Monica Niger, Salvatore Corallo, Erica Castiglioni di Caronno, Marco Massafra, Maria Di Bartolomeo, Filippo de Braud, Massimo Milione, Sara PuscedduPrisciandaro, Michele; Antista, Maria; Raimondi, Alessandra; Corti, Francesca; Morano, Federica; Centonze, Giovanni; Sabella, Giovanna; Mangogna, Alessandro; Randon, Giovanni; Pagani, Filippo; Prinzi, Natalie; Niger, Monica; Corallo, Salvatore; Castiglioni di Caronno, Erica; Massafra, Marco; Di Bartolomeo, Maria; de Braud, Filippo; Milione, Massimo; Pusceddu, Sar

A Nationwide Italian Cross-sectional Study on Nursing Students' Perceived Workplace Safety During Clinical Practice

Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession