Efficacia di un intervento educativo rivolto ai pazienti portatori di un catetere venoso centrale ad inserzione periferica: studio pilota

Introduzione: Il Peripherally Inserted Central Catheter (PICC) è un catetere venoso centrale adatto per pazienti in regime di Day Hospital. Il suo utilizzo è considerato vantaggioso ma comporta degli oneri di gestione a carico della persona. E' bene formare il paziente ad una corretta gestione domiciliare del presidio attraverso un'educazione strutturata.Obiettivo: In un gruppo di pazienti portatori di PICC, valutare l'efficacia di un intervento educativo mirato attraverso la comparazione di: colloquio informativo, opuscolo cartaceo, video informativo. Metodo: Studio clinico randomizzato e controllato monocentrico, schema comparativo semplice a tre bracci. Popolazione: tutti i pazienti sottoposti all'impianto di PICC nel periodo di osservazione tra Ottobre 2013 e Febbraio 2014 presso l'Unití  Operativa Day Hospital Oncologico e Breast Unit, presidio Molinette di Torino. L'intervento educativo standard è erogato attraverso un colloquio con l'infermiere che esegue l'impianto. Il team di impiantatori è costituito da due infermieri con comprovata esperienza in ambito oncologico ed in possesso di Master di I Livello "Gestione degli accessi venosi".I pazienti eleggibili, dopo randomizzazione, sono stati divisi in tre gruppi: gruppo A colloquio informativo; gruppo B opuscolo; gruppo C video. I pazienti dei gruppi B e C hanno ricevuto informazioni standard inte- grate con informazioni audiovisive oppure cartacee, in base al braccio al quale erano stati destinati; il grado di conoscenza raggiunto è stato indagato attraverso la somministrazione di questionari costruiti ad hoc, non vali- dati in quanto non presenti in letteratura.Risultati: Adesione allo studio di 40 pazienti, campione di convenienza costituito da persone di etí  compresa tra 18 e 75 anni, consenzienti e risiedenti al proprio domicilio. L'analisi delle conoscenze apprese in seguito all'intervento educativo mostra una differenza statisticamente significativa in diversi ambiti necessari per la corretta gestione del PICC: quando eseguire la medicazione (p=0.001), quando indicato il lavaggio (p=0), segni/sintomi di infezione (p =0,001), comportamenti a rischio (p=0.005), controllo sito inserzione (p=0). Intervallo di confidenza (IC): 95%; significativití  fissata allo 0.05%. Conclusioni: L'utilizzo di uno strumento educativo multimediale risulta essere più efficace rispetto al solo colloquio nell'ampliare le competenze personali. Il video risulta avere un efficacia maggiore rispetto all'opu- scolo. I risultati ottenuti tengono conto dei limiti imposti dalla ridotta numerosití  del campione e del breve periodo di follow up, con una bassa generalizzabilití  delle conclusioni.Parole Chiave: Catetere periferico, formazione infermieristica, infermieristica oncologica, self managementEfficacy of educational intervention for patients wearing peripherall inserted central catheter. A pilot studyBackground: Peripherally Inserted Central Catheter (PICC) is a central venous catheter suitable for patients who receive chemotherapy in Day Hospital regimen. The patient must be educated to a proper home management of the PICC through targeted education. Aim: To evaluate the effectiveness of a targeted educational intervention through the comparison of: indi- vidual interview, brochure paper, informative video.Method: Single-centre randomized controlled clinical trial with a simple three-arm comparative scheme. The study population is represented by all patients undergoing the insertion of PICC at the Oncological Day Hospital and Breast Unit in the observation period between October 2013 and February 2014. The Standard educational session is performed by the nurse positioning the PICC. PICC team consists of two nurses in possession of the first level master in venous access management.Following randomization eligible patients were divided in three groups: group A received Standard educa- tional session; group B received the standard information and the brochure; group C received the stan- dard information and the informative video. The level of the achieved knowledge was investigated by administering targeted questionnairesResults: A total of 40 patients joined the study: a convenience sample represented by people between the ages of 18 and 75 years, in outpatient care. Statistically significant difference in key areas necessary for the proper management of PICC: when to change the dressing (p=0.001), when to wash the catheter (p=0), how to recognize signs and symptoms of infection (p=0.001), identify at-risk behaviors (p=0.005), when carrying out the inspection of the cathe- ter's insertion site (p=0).Confidence interval (CI): 95%; statistical significance: 0.05%.Conclusions: The administration of a multimedial educational tool was found to be superior in efficacy compared to the only Standard educational session to increase patient's knowledges. The video appears to be more effective than the brochure. The obtained results are influenced by the small sample size and by the shortness of the follow up timing; this leads to a low generalizability of the conclusions.Keywords: Peripheral Catheterization, Educational Nursing, Oncological Nursing, Self Management

Self-Completion Questionnaire on Sleep Evaluation in Patients Undergoing Oxaliplatin Therapy: An Observational Study

Sleep is a fundamental human need; sleep disruption, in fact, causes an increase in the activity of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and pro-inflammatory responses. The scientific literature is finally starting to pay attention to the central role of sleep alterations in patients health. Oxaliplatin is extensively used for the treatment of gastrointestinal cancer and other malignancies, with an increased frequency of use in recent years. This study aims to understand the effects of sleep complaints on health and quality of life in cancer patients treated with oxaliplatin. A study has been conducted through the creation and distribution of questionnaires to patients to investigate their complaints about sleep quality. We observed significant differences between males and females in evaluating sleep hygiene scores, the Pittsburgh Sleep Quality Index, and previous difficulty sleeping. Moreover, in females, stress, worries, and anxiety seem to play a negative role in the sleep hygiene score. The obtained results could improve the interest of healthcare personnel and caregivers in sleep quality in patients undergoing chemotherapy

GENDER-SPECIFIC SIDE EFFECTS OF CHEMOTHERAPY IN PANCREATIC CANCER PATIENTS

Pancreatic carcinoma incidence showed a significant increase in men over the last few years and the prognosis remains poor. Patients are treated with different pharmacological plans with no evidence about gender-specific adverse effects. We aimed to investigate differences in the incidence of chemotherapy side effects in the treatment of pancreatic cancer, in order to provide insights toward a personalized assistance based in individual needs. The sample population is composed of 207 patients. Regression model highlighted the predictive role of female gender for alopecia, constipation, hand-foot syndrome and epigastric pain. Also considering single therapeutic schemes, gender differences have been reported. Moreover, evaluating the effect of age, a general reduced risk of toxicity has been reported in younger patients. In order to personalize chemotherapy and increase patients survival rate and life quality during the therapy, gender medicine and pharmacology studies are recommended.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Colorectal cancer chemotherapy: can sex-specific disparities impact on drug toxicities?

PURPOSE: Given the biological differences between females and males, sex-specific evaluations should be carried out to obtain better cancer prevention, diagnosis, and treatment strategies. To this purpose, our aim was to evaluate sex differences for toxicity in a cohort of colorectal cancer (CRC) patients undergoing chemotherapy. METHODS: We performed a retrospective study in 329 CRC patients. Differences between males and females were tested performing the Mann-Whitney U test or the Fisher exact test. Multivariate logistic regression models were computed to evaluate the association between sex and risk of chemotherapy agent-related toxicity. RESULTS: According association sex toxicity, significant differences were observed in the median number of episodes of nausea (p = 0.044), vomit (p = 0.007), heartburn (p = 0.022), thrombocytopenia (p = 0.005), mucositis (p = 0.024). Moreover, statistically significant differences between males and females were observed in the distribution of the highest toxicity grades of nausea (p = 0.024), heartburn (p = 0.016), and thrombocytopenia (p = 0.034). Females have an increased risk of vomit (p = 0.002), alopecia (p = 0.035), heartburn (p = 0.005), mucositis (p = 0.003), and lower risk for thrombocytopenia (p = 0.005). CONCLUSION: According to the association of sex chemotherapy agent-related toxicities, females resulted on average at a significant increased risk of more common adverse events (constipation, dysgeusia, alopecia, heartburn, vomit, asthenia, nausea, pain events, and mucositis). Sex-tailored CRC chemotherapy treatment is necessary to obtain efficacy avoiding toxicity, based on patients’ biological and genetic characteristics, a vision that would change CRC setting, a stable disease but still orphan of a real tailored approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00228-022-03298-y

Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

Purpose Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CTalone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. Methods 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whoms-PET/CTcould be performed. Histopathology or follow-up data were used as a reference. Results In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary