La percezione degli infermieri della morte del paziente oncologico: uno studio qualitativo

Background: Il tema della morte è uno dei fondamentali problemi con cui gli infermieri si possono confrontare nell’agire professionale ed al quale difficilmente si è profondamente e sinceramente preparati. Le difficoltà nel gestire il carico emotivo possono indurlo a sviluppare sentimenti negativi nei confronti della vita e, nella pratica clinica tali da influenzare le capacità di caregiving e la qualità delle cure fornite.  OBIETTIVO: esplorare le percezioni dell’infermiere di fronte alla morte del paziente degente nei reparti di oncologia.  METODO: Studio qualitativo fenomenologico. Il campione di infermieri è stato reclutato presso un I.R.C.C.S. di Roma, un Hospice di Latina ed uno di Rieti. I dati sono stati raccolti mediante mediante focus group. Le interviste semi-strutturate caratterizzate da tre domande costruite ad hoc, audio-registrate, sono state poi trascritte ed analizzate utilizzando il framework analysis approach.  RISULTATI: sono stati condotti in totale 7 focus group con una partecipazione in totale di 39 infemieri. Dall’analisi qualitativa sono emersi quattro temi: “I diversi significati della morte”, “Lo strappo della morte”, “Le variabili percettive della morte”, “Le richieste di aiuto”.  CONCLUSIONI: Lo studio ha evidenziato la necessità di fornire al personale infermieristico un importante supporto psicologico ed emotivo, e di porre attenzione agli elementi organizzativi-ambientali per una migliore gestione dell’evento morte in oncologia.  PAROLE CHIAVE: Infermiere, fine vita, morte,paziente oncologico, studio qualitativo, cure palliative, psiconcologia BACKGROUND: Death is one of the basic theme with which nurses are faced, and for which it is hard for them to prepare deeply and sincerely.  The difficulties in handling the emotional burden can cause them to develop negative feelings towards life and clinical practice, so that it affects their caregiving capacity and the quality of care provided.  AIM: To explore nurses’ perceptions facing the death of a hospitalized oncology patient.  METHODS: Qualitative phenomenological study. The sample of nurses was recruited at IRCCS (Scientific Institute for Research and Healthcare) in Rome, a hospice in Latina and a hospice in Rieti. The data were collected by means of focus groups. The semi-structured interviews featuring three guiding questions constructed for this purpose, were audio-recorded, transcribed, and then analyzed using the analysis framework approach.  RESULTS: In total 7 focus groups were conducted with a total participation of 39 nurses. Four themes emerged from the qualitative analysis: “The different meanings of death”, “The rupture of death”, “The perceptual variables of death”, and “Requests for help”.  CONCLUSION: The study highlighted the need to provide nurses with substantial psychological and emotional support, and give consideration to organizational and environmental factors for better management of the event of death in oncology.  KEY WORDS: Nurse, end of life, nurses perception, death, oncology patient, qualitative study, palliative care, psycho-oncology&nbsp

Nurses' perception of the oncology patient's death: a qualitative study

Background: Death is one of the basic theme with which nurses are faced, and for which it is hard for them to prepare deeply and sincerely. The difficulties in handling the emotional burden can cause them to develop negative feelings towards life and clinical practice, so that it affects their caregiving capacity and the quality of care provided. Aim: To explore nurses' perceptions facing the death of a hospitalized oncology patient. Methods: Qualitative phenomenological study. The sample of nurses was recruited at IRCCS (Scientific Institute for Research and Healthcare) in Rome, a hospice in Latina and a hospice in Rieti. The data were collected by means of focus groups. The semi-structured interviews featuring three guiding questions constructed for this purpose, were audio-recorded, transcribed, and then analyzed using the analysis framework approach. Results: In total 7 focus groups were conducted with a total participation of 39 nurses. Four themes emerged from the qualitative analysis: "The different meanings of death", "The rupture of death", "The perceptual variables of death", and "Requests for help". Conclusion: The study highlighted the need to provide nurses with substantial psychological and emotional support, and give consideration to organizational and environmental factors for better management of the event of death in oncology

Role of specialized nutrition for wound healing: a narrative review

Background. Wound healing is a dynamic process that depends not only on the interaction between different cellular factors involved in the tissue repair process but can also be adjuvant by a daily nutritional support. Therefore it can be considered a kind of specialized nutrition of which several elements favour the repair and wound healing process. Objective: The aim of this study was to verify the effect of beta-hydroxy-beta-methylbutyrate (HMB). To investigate the effects of the combination of arginine, beta-hydroxy-beta-methylbutyrate and glutamine in order to favour collagen deposition on the wound bed. Materials and Methods: The research was conducted by analysing publications of recent years and also by setting “title and abstract” as a search criterion. Results: From the studies conducted, it was shown that by analysing the combined action of the amino acid mixture in relation to collagen deposition in humans, in just two weeks the integration with arginine, HMB and glutamine produced a significant increase in plasma levels of arginine and ornithine equal to 67%. Conclusions: HMB increases lean mass, improves muscle strength and exerts anti-catabolism. Glutamine is essential in the metabolism of lymphocytes, enterocytes and other cells with a rapid turnover. Collagen synthesis and scar formation are necessary for complete resolution of a wound

The association between personality trait and the development of postoperative complications in enterostomized patients. Systematic review of literature

AIM: To investigate the presence of association between the personality trait and the onset of postoperative complications in patients undergoing enterostomy packaging. MATERIALS AND METHODS: Systematic review of the literature. RESULTS: Type D personality traits and those with a low tendency to optimism and temperament (ex. anxiety-depressive syndrome) would seem to be associated with an increased risk of developing postoperative psychiatric morbidity and reduced levels of health-related quality of life (HRQoL) in enterostomized patients for colorectal cancer (CRC). Also, type-D personality, has been associated with greater risk of multiple comorbidities including an increased risk of heart failure unrelated to other sociodemographic causes 32-34-35. Personality with little tendency to optimism may represent a predictive factor on the development of psychological suffering one year after the diagnosis of CRC 3. Patients with personality traits associated with reduced levels of life satisfaction and / or reduced coping capacity require longer hospitalization time 26. DISCUSSION: Several studies highlight the presence of association between personality traits oriented to performance, persistence and extroversion and outcomes in various areas of surgery 14,2,-27,30. However, in almost all cases, the outcomes measured do not correspond to the early post-operative complications defined in the inclusion criteria but to mediumlong term psychological and rehabilitative outcomes. CONCLUSIONS: From the review study, no sources were found concerning the association between the personality trait and the onset of early postoperative complications in enterostomised patients, highlighting, furthermore, a lack of data on the subject involving the entire field of abdominal surgery

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50\ue2\u80\u9375 years with type 2 diabetes inadequately controlled with metformin monotherapy (2\ue2\u80\u933 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15\ue2\u80\u9345 mg) or a sulfonylurea (5\ue2\u80\u9315 mg glibenclamide, 2\ue2\u80\u936 mg glimepiride, or 30\ue2\u80\u93120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57\uc2\ub73 months. The primary outcome occurred in 105 patients (1\uc2\ub75 per 100 person-years) who were given pioglitazone and 108 (1\uc2\ub75 per 100 person-years) who were given sulfonylureas (hazard ratio 0\uc2\ub796, 95% CI 0\uc2\ub774\ue2\u80\u931\uc2\ub726, p=0\uc2\ub779). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0\uc2\ub70001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. Interpretation In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society