Search

Radiographic evaluation of the implant configuration after reverse shoulder arthroplasty (RSA) is time-consuming and subject to interobserver disagreement. The final configuration is a combination of implant features and surgical execution. Artificial intelligence (AI) algorithms have been shown to perform accurate and efficient analysis of images. The purpose of this study was to develop an AI algorithm to automatically measure glenosphere inclination, humeral component inclination, and the lateralization and distalization shoulder angles (DSAs) on postoperative anteroposterior radiographs after RSA. The Digital Imaging and Communications in Medicine files corresponding to postoperative anteroposterior radiographs obtained after implantation of 143 RSAs were retrieved and used in this study. Four angles were analyzed: (1) glenoid inclination angle (GIA, between the central fixation feature of the glenoid and the floor of the supraspinatus fossa), (2) humeral alignment angle (HAA, between the long axis of the humeral shaft and a perpendicular to the metallic bearing of the prosthesis), (3) DSA, and (4) lateralization shoulder angle (LSA). A UNet segmentation model was trained to segment bony and implant elements using manually segmented training (n = 89) and validation (n = 22) images. Then, an image-processing–based pipeline was developed to measure all 4 angles using AI-segmented images. Measures performed by 3 physician observers and the AI algorithm were then completed in 32 additional images. The agreements among human observers and between observers and the AI algorithm were evaluated using intraclass correlation coefficients (ICCs) and absolute differences in degree. The ICCs (95% confidence interval) for manual measurements of LSA, DSA, GIA, and HAA were 0.79 (0.55, 0.90), 0.90 (0.80, 0.95), 0.96 (0.93, 0.98), and 0.99 (0.97, 0.99), respectively. The AI algorithm measured the 32 images in the test set in less than 2 minutes. The agreement between observers and the AI algorithm was lowest when measuring the LSA for observer 2, with an ICC of 0.77 (0.52, 0.89), and an absolute difference in degrees (median [interquartile range]) of 5 (4). Better agreements were found between the AI measurements and the average manual measurements: absolute differences in degree for LSA, DSA, GIA, and HAA were 3 (5), 2 (3), 2 (2), and 2 (1), respectively; ICCs for LSA, DSA, GIA, and HAA were 0.89 (0.79, 0.95), 0.96 (0.93, 0.98), 0.85 (0.68, 0.93), and 0.98 (0.95, 0.99), respectively. The AI algorithm developed in this study can automatically measure the GIA, HAA, LSA, and DSA on postoperative anteroposterior radiographs obtained after implantation on RSA. [ABSTRACT FROM AUTHOR]

Shoulder arthroplasty in the setting of severe proximal humerus bone loss can be challenging. The purpose of this study was to evaluate the outcomes of a modular segmental megaprosthesis when implanted in a reverse configuration for complex primary arthroplasty, reconstruction at the time of oncologic resection, and revision shoulder arthroplasty. A Joint Registry Database was queried to identify all shoulder arthroplasties performed at a single institution using the Comprehensive Segmental Revision System reverse shoulder arthroplasty (SRS-RSA; Zimmer Biomet). A retrospective review of electronic medical records and radiographs was performed to record demographic data, indication, outcomes, complications, and revision surgery. Between February 2012 and October 2022, a total of 76 consecutive SRS-RSAs were implanted. An analysis of patients with minimum 12-month follow-up yielded 53 patients with a mean follow-up of 4.1 ± 2.43 years. Surgical complication rate in this cohort was observed in 41.5% (22 of 53) of cases. Overall, the revision rate at final follow-up was 26.4% (14 of 53), with a significant difference between the primary and revision cohorts. The number of prior surgeries was a significant risk factor for revision surgery, with a hazard ratio of 1.789 (95% confidence interval 1.314-2.436, P <.001). When analyzing aseptic humeral loosening rates across study cohorts, a significant difference was found between the primary arthroplasty (0%, n = 0) and the revision arthroplasty cohorts (22.2%, n = 6) (P =.04). Reverse shoulder arthroplasty using a modular segmental megaprosthesis remains a reasonable salvage option for shoulder reconstruction in the setting of proximal humeral bone loss. Because of the substantial bone loss and soft tissue deficiencies typically present in these cases, surgeons should educate patients on the relatively high complication rate, particularly when used in the setting of a previous failed arthroplasty. [ABSTRACT FROM AUTHOR]

This study aims to analyze the mid-to long-term results of the latissimus dorsi tendon for the treatment of massive posterosuperior irreparable rotator cuff tears as reported in high-quality publications and to determine its efficacy and safety. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and EMBASE databases were searched until December 2022 to identify studies with a minimum 4 year follow-up. Clinical and radiographic outcomes, complications, and revision surgery data were collected. The publications included were analyzed quantitatively using the DerSimonian Laird random-effects model to estimate the change in outcomes from the preoperative to the postoperative condition. The proportion of complications and revisions were pooled using the Freeman-Tukey double arcsine transformation. Of the 618 publications identified through database search, 11 articles were considered eligible. A total of 421 patients (432 shoulders) were included in this analysis. Their mean age was 59.5 ± 4 years. Of these, 277 patients had mid-term follow-up (4-9 years), and 144 had long-term follow-up (more than 9 years). Postoperative improvements were considered significant for the following outcome parameters: Constant-Murley Score (0-100 scale), with a mean difference (MD) = 28 points (95% confidence interval [CI] 21, 36; I 2 = 89%; P <.001); visual analog scale, with a standardized MD = 2.5 (95% CI 1.7, 3.3; P <.001; I 2 = 89%; P <.001); forward flexion, with a MD = 43° (95% CI 21°, 65°; I 2 = 95% P <.001); abduction, with a MD = 38° (95% CI 20°, 56°; I 2 = 85%; P <.01), and external rotation, with a MD = 8° (95% CI 1°, 16°; I 2 = 87%; P =.005). The overall reported mean complication rate was 13% (95% CI 9%, 19%; I 2 = 0%), while the reported mean revision rate was 6% (95% CI: 3%, 9%; I 2 = 0%). Our pooled estimated results seem to indicate that latissimus dorsi tendon transfer significantly improves patient-reported outcomes, pain relief, range of motion, and strength, with modest rates of complications and revision surgery at mid-to long-term follow-up. In well-selected patients, latissimus dorsi tendon transfer may provide favorable outcomes for irreparable posterosuperior cuff tears. [ABSTRACT FROM AUTHOR]

Joint arthroplasty registries usually lack information on medical imaging owing to the laborious process of observing and recording, as well as the lack of standard methods to transfer the imaging information to the registries, which can limit the investigation of various research questions. Artificial intelligence (AI) algorithms can automate imaging-feature identification with high accuracy and efficiency. With the purpose of enriching shoulder arthroplasty registries with organized imaging information, it was hypothesized that an automated AI algorithm could be developed to classify and organize preoperative and postoperative radiographs from shoulder arthroplasty patients according to laterality, radiographic projection, and implant type. This study used a cohort of 2303 shoulder radiographs from 1724 shoulder arthroplasty patients. Two observers manually labeled all radiographs according to (1) laterality (left or right), (2) projection (anteroposterior, axillary, or lateral), and (3) whether the radiograph was a preoperative radiograph or showed an anatomic total shoulder arthroplasty or a reverse shoulder arthroplasty. All these labeled radiographs were randomly split into developmental and testing sets at the patient level and based on stratification. By use of 10-fold cross-validation, a 3-task deep-learning algorithm was trained on the developmental set to classify the 3 aforementioned characteristics. The trained algorithm was then evaluated on the testing set using quantitative metrics and visual evaluation techniques. The trained algorithm perfectly classified laterality (F1 scores [harmonic mean values of precision and sensitivity] of 100% on the testing set). When classifying the imaging projection, the algorithm achieved F1 scores of 99.2%, 100%, and 100% on anteroposterior, axillary, and lateral views, respectively. When classifying the implant type, the model achieved F1 scores of 100%, 95.2%, and 100% on preoperative radiographs, anatomic total shoulder arthroplasty radiographs, and reverse shoulder arthroplasty radiographs, respectively. Visual evaluation using integrated maps showed that the algorithm focused on the relevant patient body and prosthesis parts for classification. It took the algorithm 20.3 seconds to analyze 502 images. We developed an efficient, accurate, and reliable AI algorithm to automatically identify key imaging features of laterality, imaging view, and implant type in shoulder radiographs. This algorithm represents the first step to automatically classify and organize shoulder radiographs on a large scale in very little time, which will profoundly enrich shoulder arthroplasty registries. [ABSTRACT FROM AUTHOR]

To analyze the clinical outcomes of lower trapezius transfer (LTT) for patients with functionally irreparable rotator cuff tears (FIRCT) and summarize the available literature regarding complications and reoperations. After registration in the International prospective register of systematic reviews (PROSPERO [CRD42022359277]), a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Inclusion criteria were English, full-length, peer-reviewed publications with a level of evidence IV or higher reporting on clinical outcomes of LTT for FIRCT. Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus via Elsevier databases were searched. Clinical data, complications and revisions were systematically recorded. Seven studies with 159 patients were identified. The mean age range was 52 to 63 years, 70.4% of the patients included were male, and the mean follow-up time ranged between 14 and 47 months. At final follow-up, LTT lead to improvements in range of motion, with reported forward elevation (FE) and external rotation (ER) mean gains of 10° to 66° and 11° to 63°, respectively. ER lag was present before surgery in 78 patients and was reversed after LTT in all shoulders. Patient-reported outcomes were improved at final follow-up, including the American Shoulder and Elbow Society score, Shoulder Subjective Value and Visual Analogue Scale. The overall complication rate was 17.6%, and the most reported complication was posterior harvest site seroma/hematoma (6.3%). The most common reoperation was conversion to reverse shoulder arthroplasty (5%) with an overall reoperation rate of 7.5%. Lower trapezius transfer improves clinical outcomes in patients with irreparable rotator cuff tears with a rate of complications and reoperations comparable to other surgical alternatives in this group of patients. Increases in forward flexion and ER are to be expected, as well as a reversal of ER lag sign when present before surgery. Level IV, systematic review of Level III-IV studies. [ABSTRACT FROM AUTHOR]

Previous study showed that elevated circulating hepatokine follistatin (FST) associates with an increased risk of type 2 diabetes by inducing adipose tissue insulin resistance. Here we explore further the relationships between plasma FST levels with mortality and health outcomes. The population-based Malmö Diet Cancer cardiovascular cohort (n = 4733, age 45–68 years) was used to study plasma FST in relation to incidence of health outcomes, by linkage with national patient registers. Cox regression analysis was used to assess the associations of plasma FST and outcomes, with adjustments for multiple potential confounding factors. During the mean follow-up time of 22.64 ± 5.84 years in 4,733 individuals, 526 had incident stroke, 432 had ischemic stroke, 530 had incident coronary events (CE), 339 had incident heart failure (HF), 320 had incident chronic kidney disease (CKD) and 1,843 individuals died. Hazard ratio (HR) per standard deviation increase in FST levels adjusted for multiple risk factors was 1.05 (95%CI: 1.00–1.11, p = 0.036) for mortality; 1.10 (95%CI: 1.00–1.20, p = 0.042) for stroke; 1.13 (95%CI: 1.03–1.25, p = 0.014) for ischemic stroke; 1.16 (95%CI: 1.03–1.30, p = 0.015) for HF; and 1.38 (95%CI: 1.12–1.70, p = 0.003) for a diagnosis of CKD. In MDC-CC individuals without prevalent or incident diabetes, the association between FST and stroke, CE and CKD remained significant; but not with mortality or HF. Elevated circulating FST associates with an increased risk of mortality and HF, which partly may be mediated by diabetes. FST also associated with stroke, ischemic stroke, CE and CKD, independently of established risk factors including diabetes. • Elevated circulating follistatin associates with an increased risk of mortality and heart failure. • The association between follistatin and increased risk of mortality and heart failure is partly mediated by diabetes. • Follistatin associates with stroke, incident coronary events and chronic kidney disease, independently of diabetes. [ABSTRACT FROM AUTHOR]

Microorganisms play a crucial role in various physiological processes, including metabolism, immune defense, nutrition absorption, defense against cancer, and protection against pathogen colonization. Changes in microbial communities serve as potential biomarkers for diseases, offering significant insights into disease treatment and diagnosis. However, the association between microorganisms and diseases is still unclear, and more computational methods are needed to predict potential associations. In this paper, we introduce a novel computational model, the Graph Convolutional Network to Predict Microbe-Disease Associations (GCNPMDA), which employs layer attention mechanisms (see Figure 1). GCNPMDA integrates known microbe-disease associations, microbe–microbe similarities, and disease–disease similarities into a heterogeneous network. The model utilizes a Graph Convolutional Network (GCN) to learn embeddings for diseases and microbes. To enhance attribute information, microbe–microbe similarities are computed using Cosine similarity, Jaccard similarity, Gaussian kernel, and functional information, while disease–disease similarities are computed using Cosine similarity, Jaccard similarity, Gaussian kernel, and symptom information. Additionally, attention mechanisms are applied to combine embeddings from multiple graph convolution layers. The model's predictive effectiveness is evaluated on Human Microbe-Disease Association Database (HMDAD). Leave-one-out cross-validation (LOOCV) was conducted. The Area Under ROC Curve (AUC) of LOOCV is 0.98. The 5-fold cross-validation (5-fold CV) on HMDAD yields average AUC of 0.98 ± 0.009. Furthermore, we carried out a case study of type 2 diabetes (T2D), inflammatory bowel disease (IBD), and rheumatoid arthritis. Based on existing literature evidence, it was confirmed that 6, 7, and 7 of the top-10 inferred microbes have established associations with T2D, IBD, and rheumatoid arthritis, respectively. GCNPMDA demonstrates potential efficacy in identifying disease-related microbes, offering a promising tool to uncover the intricate relationship between microorganisms and their human hosts. [Display omitted] • We propose a novel model named GCNPMDA to forecast microbe-disease associations. • GCNPMDA uses multilayer graph convolution to capture diverse features from microbes and diseases. • We use an attention mechanism to combine embeddings from different convolution layers for microbes and diseases. [ABSTRACT FROM AUTHOR]

This study aimed to describe patients' perspectives on their experience in osteopathic treatment, to contribute toward developing interpretative models on effectiveness. A descriptive phenomenological approach was used. The data were collected through a semistructured interview. To capture the variability of the phenomenon, a purposive sample of 12 participants with previous experience of osteopathic care was selected. The data analysis was carried out in an inductive way, and it was parallel to the recruitment to continuously monitor the data saturation. Data saturation was reached with 12 participants (female = 9; male = 3). Participants' age ranged from 27 to 82 years old (mean: 55.25 ± 17.15; median: 59; kurtosis: -0.82). Participants had different reasons for consultation. The analysis showed 1 overarching theme, "Osteopathy is a path of awareness," 3 themes, and 12 categories. Themes were: (1) "The experience of pain produces awareness of the need for care," (2) "Osteopathy is a journey to be shared over time," and (3) "The effectiveness of the osteopathic treatment is the discovery of the person's unity by experience." Participants affirm that osteopathy is a path of awareness that starts from an experience of pain; leads them to contact an osteopath; and ends with their experience of the unity of body, mind, and spirit. [ABSTRACT FROM AUTHOR]

• Compliance with standard precautions (SPs) is still suboptimal among clinical nurses. • This issue has a negative impact on HAIs, and corrective interventions are needed. • Implementing link nurses and systematic audits and feedback was an effective strategy. • Nurses in the intervention group reported a significant increased SPs compliance. • This study could inform initiatives to improve compliance with SPs and safety in nursing care. To prevent health care-associated infections, health organizations recommend that health care workers stringently observe standard precautions (SPs). Nevertheless, compliance with SPs is still suboptimal, emphasizing the need for improvement interventions. A cluster randomized controlled trial with a pretest-post-test design was conducted with 121 clinical nurses who worked in different wards of a university hospital. The intervention group (n = 61) had 3 infection control link nurses nominated and attended systematic audits and feedback. The control group (n = 60) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of SPs compliance was performed via the World Health Organization observational hand hygiene form and Compliance with Standard Precaution Scale Italian version. At the post-test, nurses in the intervention group reported significantly increased compliance with hand hygiene, whereas no significant improvement was found in the control group. Nurses in both groups reported significantly increased Compliance with Standard Precaution Scale Italian version scores; however, a higher increase and practical significance was observed in the intervention group. Participants who improved their scores were also compared between groups, showing a significantly greater increase of individual scores in intervention group compared to the control group. The findings of this study provide significant practical implications for hospitals seeking to improve compliance with SPs among nurses, showing the effectiveness of using infection control link nurses combined with systematic audits and feedback. [ABSTRACT FROM AUTHOR]

Stakeholder engagement is the basis of an emerging and innovative educational model called competency-based education. However, although several studies have analysed the stakeholders' perspective in nursing, few studies have analysed the stakeholders' perspective in competence-based curriculum design. Thus, the aim of this study was to analyse the opinions and perspectives of stakeholders about the development of a competency-based baccalaureate nursing curriculum with stakeholder engagement. A phenomenological study was conducted. This method combines descriptive features (Husserlian) and interpretive phenomenology (Gadamerian). The interviews were ended when data saturation was achieved, specifically the redundancy of themes. The content analysis identified three main categories: (1) a "bridge" that merges education and the work context, (2) stakeholder engagement – a contentious issue; and (3) stakeholder engagement – structuring a methodology. Through the stakeholder engagement, university could have a constant interaction between the didactics and professional practice and could improve professional identity and job satisfaction among nurses. • Stakeholder engagement is crucial in the development of a competence-based curriculum • Stakeholders' engagement may be implemented in the area of nursing education • Stakeholders engagement in nursing education favours a more effective correspondence between acquired and expected competencies. [ABSTRACT FROM AUTHOR]

Aim To explore factors that influence intensive care nurses' experiences of being compliant with standard precautions (SP) during emergencies. Intensive care nurses can be exposed to a greater risk of biohazardous exposure during an emergency. The primary strategy to address the complex variety of biological hazards in clinical practice is represented by the implementation of SP guidelines. Previous research has indicated that nurses' compliance rates with SPs are suboptimal, but no study has focused on the factors influencing compliance during an emergency. A descriptive qualitative study was conducted in an Italian university hospital with 19 intensive care nurses who had at least two years of work experience in critical care. The nurses were interviewed in four focus groups and were asked about their experiences of being compliant with SPs during an emergency. Data were analyzed using conventional content analysis. Three themes emerged: conflict, competencies, and context. Conflict was reported regarding the need to save the patient and the need for self-protection through the use of SPs. In particular, nurses had to manage the pressure of limited time. Competencies were identified by nurses' knowledge, attitude, skills, training, and experience. Context was related to the work and organizational conditions during the emergency, including overcrowding. To support intensive care nurses' compliance with SPs during emergencies, conflict, competencies, and context should be audited regularly in clinical practice. The findings of this study could inform infection control programs and training that targets intensive care nurses. • ICU nurses' compliance with SP can reduce exposure to biohazards during an emergency. • Conflict, competencies, and context, can affect compliance for ICU nurses. • Conflict was noted when deciding to save the patient or prioritize the nurse's self-protection. • Infection control programs and training for ICU nurses should address these aspects. [ABSTRACT FROM AUTHOR]

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p =.02; and 55.2% vs. 45.9%, p <.001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively). [ABSTRACT FROM AUTHOR]

Highlights • Xanthogranulomas of the sellar location is exceedingly rare. • It is difficult to diagnose a sellar xanthogranuloma with radiological features. • Endocrine impairment is a common finding and it is often worsened by surgery. • We performed a clinical-radiological comparison among sellar-parasellar pathologies. • The paper provides elements to identify and manage sellar Xanthogranulomas. Abstract Xanthogranulomas are rare intracranial lesions with controversial etiology. The sellar location is exceedingly rare. Here we report a clinical case and a review of the English-language literature of histologically confirmed xanthogranulomas in order to furnish useful tools in diagnosis and management of this unusual disease. We performed an English-language literature MEDLINE search for the last 18 years and analyzed the reports of the published series and the present case. The clinical, radiological, pathological features and outcome of the published cases of Xanthogranuloma have also been compared with the traits of Craniopharyngioma and Rathke Cleft Cyst. The data collection has been hindered by the lack of important details in the published series. The available clinical and radiological data have been reported in Table 1 (28 papers for a total of 59 patients reported). A clinical-radiological comparison among common pathologies of the sellar-parasellar region has been performed in Table 2. Endocrine impairment was a common finding in the clinical presentation and it was often worsened by surgery. Natural history of Xanthogranuloma is similar to other benign pathologies of the sellar area, but some typical features might help in distinguishing it before the pathological exam. [ABSTRACT FROM AUTHOR]

• Immune checkpoint inhibitors (ICIs) have limited benefit in EGFR -mutant NSCLC. • A systematic review on ICI-based regimens in this setting was performed. • The available evidence do not support the use of ICIs in pts with EGFR-mutant NSCLC. • Combinations of ICIs, chemo, and antiangiogenic drugs may have role in this setting. • Novel combinations acting on TME are explored to refine potential role of ICIs. Since their first introduction in clinical practice, immune checkpoint inhibitors showed limited benefit in patients with NSCLC harboring EGFR mutations. With the rationale of increasing immune activation, combinatorial ICI strategies have been evaluated also in this subgroup of patients. We performed a systematic review on efficacy of ICI-based strategies in EGFR -mutant NSCLC according to most updated evidence. Overall, ICI monotherapy and ICI plus chemotherapy confirm to be ineffective in EGFR -mutant NSCLC, whereas the combination of ICI with antiangiogenic and chemotherapy showed promising results. Limited data are available with alternative ICI combination strategies, driven by strong biological rationale of modulating the tumor immune microenvironment. To date, the available evidence do not support the use of ICI in patients with NSCLC harboring EGFR mutations. Clinical trials are ongoing to define which is the best timing and exploring novel combinations with ICI in this specific disease. [ABSTRACT FROM AUTHOR]

Trihalomethanes (TTHMs) are water disinfection by-products whose consumption via drinking water may eventually be harmful for human health, as they could have carcinogenic effects, also for the exposure to them via non-ingestion routes [1] . In the present work the possibility to reduce the vulnerability of the population exposed to TTHMs by the optimal operational interventions in water distribution systems is explored. The proposed approach is formulated as a multi-objective optimization problem with two objective functions, the number of the operations and the maximum TTHMs concentration that occurs at each node in the network during time, both to minimize. The feasible operational actions concern opening/closing valves and hydrants and turning pumping stations for a fixed time. The AMGA 2 optimizer [2] is used herein for solving the problem, coupled with a module coded in C++, where the implementation of the EPANET Programmers Toolkit functions allows to run the hydraulic and water quality simulations and to calculate the objective functions. [ABSTRACT FROM AUTHOR]

This study aims to assess the effects of immersive Virtual Reality in people with cancer undergoing antiblastic therapy, on anxiety, fatigue and pain. This is a randomized controlled three-arm trial. Seventy-four cancer patients were recruited from a regional hospital in Italy, and randomly allocated into three groups: a Virtual Reality group (n=25), a narrative medicine group (n=25) and a standard care group (n=24). The primary outcome was anxiety. Secondary outcomes included fatigue and pain. The outcomes were evaluated immediately before and after the interventions. The findings showed that anxiety decreased more in the Virtual Reality group (Δpre-post = 6.24, 95% CI 2.578 to 9.902, p =.001, d = 0.63) than in the narrative medicine group, whereas it did not change for those in the standard care group. Fatigue decreased in the Virtual Reality group (Δpre-post = 0.576, 95% CI 0.246 to 0.907, p =.001, d = 0.23), while remaining stable in the narrative medicine group, and increasing in the standard care group. Average levels of pain did not change before and after the intervention [F(1,71) = 1.06, p =.307, ηp2 =.015]. Findings show that virtual reality is effective to reduce anxiety and fatigue in people with cancer undergoing antiblastic therapy. Virtual Reality can be recommended as an complementary intervention to manage anxiety and fatigue in people with cancer during antiblastic therapy. ClinicalTrials.gov NCT05629507. [ABSTRACT FROM AUTHOR]

Copyright of Nurse Education Today is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This Systematic review and meta-analysis aimed to assess the effectiveness of Virtual Reality on anxiety, fatigue and pain in patients with cancer during chemotherapy and provide evidence for decision-making in clinical practice. A systematic literature search was performed in the databases PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature and the Cochrane Library. Risk of Bias was used to assess the quality of individual studies, and Grading of Recommendations Assessment, Development and Evaluation was used to assess confidence for each individual outcome. A random-effects model was used to examine the overall effect. Four randomized controlled trials and four crossover studies were included, with an overall sample of 459 patients. Results showed that Virtual Reality compared with standard care had a significant reduction of anxiety only (MD = −6.57, 95% CI: −11.59 to −1.54, p = 0.01) but with considerable heterogeneity (I2 = 92%), while Virtual Reality was not significantly different from integrative interventions. The trials included showed small sample sizes, lack of statistical power, low methodological quality, high heterogeneity, and different Virtual Reality technology types, lengths and frequencies. The quality of evidence is very low and the strength of recommendation is weak. Further research has large potential for reducing uncertainty about the effects of Virtual Reality in patients with cancer receiving chemotherapy. This study was registered with PROSPERO as CRD42020223375. • There is a lack of recommendations regarding the use of Virtual Reality. • Virtual Reality was compared with both standard care and integrative interventions. • Virtual Reality showed a significant reduction of anxiety than standard care only. • The quality of evidence was very low and the strength of recommendation weak. [ABSTRACT FROM AUTHOR]

Purpose Patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) usually receive hospital care in protective isolation until full neutrophil recovery. Although the aim of protective isolation is to benefit patients' health by preventing risks of infection, it could have severe psychological implications. The aim of this study was to explore the lived experiences of protective isolation in adult patients who had been treated with allogeneic HSCT. Method A descriptive phenomenological inquiry based on Giorgi's approach was conducted in a university hospital in Italy. Ten patients (7 female and 3 male, age range 28–66), who had undergone allogeneic HSCT to treat a haematological malignancy, were interviewed about their hospital stay in protective isolation. Results A general meaning structure was identified as being isolated to achieve transformation. The revelatory themes were as follows: (1) the special place for transformation, (2) the experience of embodied transformation, and (3) light and shade from inside and outside. Participants experienced a transformation of themselves, of their relationships with loved ones, and of the environment. Conclusions Since patients may live the experience of being treated with allogeneic HSCT in protective isolation as a transformation process, health-care providers should monitor the psychosocial implications of the isolation practice. [ABSTRACT FROM AUTHOR]

The use of valid and reliable instruments for assessing self-care is crucial for the evaluation of chronic obstructive pulmonary disease (COPD) management programs. The aim of this review is to evaluate the measurement properties and theoretical foundations of instruments for assessing self-care and related concepts in people with COPD. A systematic review was conducted of articles describing the development and validation of self-care instruments. The methodological quality of the measurement properties was assessed using the COSMIN checklist. Ten studies were included evaluating five instruments: three for assessing self-care and self-management and two for assessing self-efficacy. The COPD Self-Efficacy Scale was the most studied instrument, but due to poor study methodological quality, evidence about its measurement properties is inconclusive. Evidence from the COPD Self-Management Scale is more promising, but only one study tested its properties. Due to inconclusive evidence of their measurement properties, no instrument can be recommended for clinical use. [ABSTRACT FROM AUTHOR]

Patients with stage IIIA-ipsilateral mediastinal lymph node involvement (N2) non-small cell lung cancer (NSCLC) represent a heterogeneous group with different clinical presentation. The aim of this study was to analyze a series of patients with "potentially resectable" stage IIIA-pathologically proven N2 (pN2) NSCLC undergoing induction chemotherapy followed by surgery to evaluate their long-term outcomes and to identify prognostic factors. Out of 287 patients who underwent induction chemotherapy for NSCLC with ipsilateral mediastinal lymph node involvement pathologically proven, we retrospectively evaluated 141 (49%) patients with no clinical evidence of progression after induction chemotherapy and candidates for surgery. Most of them (73%) underwent at least 3 cycles of cisplatin-based chemotherapy. We used the Kaplan-Meier method to plot survival and the log-rank test to assess the survival difference between groups. Multivariable analysis was performed using Cox proportional hazards regression. A total of 15 (10.6%) patients underwent explorative thoracotomy; 126 patients underwent surgical anatomical resection after a median 27 days (range: 21-30) from the last cycle of chemotherapy. A total of 113 (89.7%) patients had a radical resection. A total of 22 (17.5%) patients had a complete pathologic lymph node downstaging (pN0), and 8 (6.3%) patients had a complete pathological response (pT0N0). The median overall survival was 24 months, with a 5-year overall survival of 30%. At multivariable analysis, downstaging and number of cycles of chemotherapy were independent prognostic factors (P = 0.006); downstaging benefit was mostly because of complete pathological response (hazards ratio = 0.23, 95% CI: 0.07-0.76). In conclusion, more than 3 cycles of chemotherapy and pathological downstaging could significantly improve 5-year survival in selected patients with "potentially resectable" pathologically proven N2 disease. [ABSTRACT FROM AUTHOR]

Purpose Increasing burden of cancer in Europe and socio-demographic trends imply that more cancer patients will face high levels of dependency. Care dependency is often perceived as a distressing experience by cancer patients who are concerned about becoming a burden to others. The experience of care dependence has been scarcely investigated in advanced cancer patients, especially in the hospital setting. This study aimed at describing advanced cancer patients' experiences of care dependence in hospital and of the factors perceived by them as contributing to decrease or increase this dependence. Methods The study used a descriptive phenomenological approach based on Husserl's (1913) life world perspective. Data collection and analysis followed Giorgi's (1997) five basic methodological steps. Data were gathered by semi-structured interviews with thirteen advanced cancer adult inpatients of a teaching hospital. The interviews were audio-recorded and the recordings transcribed word for word. Results Three themes emerged: ‘dependency discovers new meanings of life’, ‘active coping with dependency’ and ‘the care cures the dependent person’. The essential meaning of care dependency was the possibility to become aware of being a person as both an object and subject of care. Conclusion Dependence appears as an experience with strong relational connotations, which enable patients to see differently their life, themselves, the world and others. Dependency is revealed as a natural experience, only partly in accordance with previous studies. Deeper insight into the meaning patients attach to care dependency can enable nurses to better meet the patient's needs, e.g. by improving caring relationships with patients. [ABSTRACT FROM AUTHOR]

The first high pressure stage of a modern gas turbine operates at very high temperatures that require complex blade-cooling systems to guarantee high performance and efficiency of the gas turbine while maintaining a very low level of energy losses, though using compressed air for cooling. An accurate and efficient conjugate heat transfer (CHT) solver is thus necessary to compute the flow and temperature fields of the air within the cooling channels and of the gas around the blades-by means of the Navier-Stokes and energy equations-as well as the blade temperature field, by means of the heat conduction equation. Due to the very high geometrical complexity of the cooling channels within the blades, generating a body fitted mesh for the three domains-air, gas and blade-is extremely difficult and time consuming. Nevertheless, many turbine blade-cooling simulations have been performed with success, though at large computational cost, see, e.g., [1]. A promising alternative approach is provided by the Immersed Boundary (IB) method, which discretizes both the solid and fluid fields by means of a single Cartesian grid, thus reducing the grid generation process to a relatively simple and quick task-an interesting review of the IB method and its application is provided in [2]. The CFD group at the Department of Mechanics, Mathematics and Management of the Polytechnic of Bari has chosen such an approach, by first developing and improving an accurate and efficient IB method for the compressible Navier-Stokes equations [3, 4], and later extending it with success to solve CHT problems [5]. At present, these works are limited to two-dimensional serial calculations. The aim of this work is to extend the two-dimensional IB solver to three-dimensions, using a new IB least-squares reconstruction, an advanced data structure and a parallel solver, so as to obtain a computational tool capable of computing very complex CHT problems within reasonable computational times. [ABSTRACT FROM AUTHOR]

The first high pressure stage of a modern gas turbine operates at very high temperatures that require complex blade-cooling systems to guarantee high performance and efficiency of the gas turbine while maintaining a very low level of energy losses, though using compressed air for cooling. An accurate and efficient conjugate heat transfer (CHT) solver is thus necessary to compute the flow and temperature fields of the air within the cooling channels and of the gas around the blades—by means of the Navier—Stokes and energy equations—as well as the blade temperature field, by means of the heat conduction equation. Due to the very high geometrical complexity of the cooling channels within the blades, generating a body fitted mesh for the three domains—air, gas and blade—is extremely difficult and time consuming. Nevertheless, many turbine blade-cooling simulations have been performed with success, though at large computational cost, see, e.g., [1] . A promising alternative approach is provided by the Immersed Boundary (IB) method, which discretizes both the solid and fluid fields by means of a single Cartesian grid, thus reducing the grid generation process to a relatively simple and quick task—an interesting review of the IB method and its application is provided in [2] . The CFD group at the Department of Mechanics, Mathematics and Management of the Polytechnic of Bari has chosen such an approach, by first developing and improving an accurate and efficient IB method for the compressible Navier—Stokes equations [3,4] , and later extending it with success to solve CHT problems [5] . At present, these works are limited to two-dimensional serial calculations. The aim of this work is to extend the two-dimensional IB solver to three-dimensions, using a new IB least-squares reconstruction, an advanced data structure and a parallel solver, so as to obtain a computational tool capable of computing very complex CHT problems within reasonable computational times. [ABSTRACT FROM AUTHOR]

The objective of present paper is to propose a criterion for performing a vulnerability analysis in a water distribution system, which involves the estimation of the consumers’ exposure to pathogenic risk and to elevated trihalomethanes concentration, deriving from the reaction of natural organic matter with sodium hypochlorite, widely used for the drinking water disinfection. The analysis is carried out by introducing some index parameters, linked to a trihalomethanes fixed threshold, which has not to be exceeded. The results of the methodology show that the considered factors identify different vulnerable nodes respect to the different kind of exposure they refer to. [ABSTRACT FROM AUTHOR]

Pain is multidimensional, and, as such, the chief reason patients seek urgent healthcare services. If inadequately assessed and untreated, pain may negatively impact on the quality of life of the patient. Treating pain is an important step in regaining control over quality of life. The objective of the present study is to examine the level of knowledge and types of approach among Italian nurses who deal with pain assessment and management. The Ferrell and McCaffery's Knowledge and Attitudes Survey Regarding Pain (KASRP) was distributed to 286 nurses employed in one of the biggest specialized hospitals in Rome, Italy. The interviewed staff work at three different settings, according to the healthcare assistance they are required to provide: intensive care unit (ICU), subintensive care unit (SICU), and ordinary ward (OW). Descriptive statistics, including frequencies and means, as well as analysis of chi-square ( p < .05), were used to compare differences in scores by demographic characteristics of the participants and different settings. A logistic regression model was performed to evaluate the factors that may influence the attitude to pain and the level of knowledge of care providers. Results have shown that the odds of developing positive attitudes towards pain management were 1.62 times higher (95% CI: .92 to 2.85) in nurses employed in SICUs than in those working in OWs, while the odds of possessing a satisfactory level of knowledge was 1.76 times higher (95% CI: .93 to 3.31) among nurses in ICUs than those in OWs. A “good assessment” was better for SICU (OR = 2.17, p < .05) and ICU (OR = 3.20, p < .05) nurses. Our survey has highlighted an overall limited level of knowledge in the assessment and management of pain among the nursing staff. It is therefore a priority to implement specific training to healthcare providers from different fields, who may respond differently to patients with pain. On the other hand, further investigations are required on a greater sample of Italian nurses to better understand how to overcome the most problematic barriers to achieving good pain assessment and control. [ABSTRACT FROM AUTHOR]

Delivering bad news is a difficult task that involves all healthcare professionals, including midwives. The hypothesis is that, in order to learn how to disclose and to discuss bad news, students need a phase of personal reflection, of awareness of their own emotional processes. The use of films in healthcare education can foster this process evoking different emotions concerning suffering and disease, in a “safety zone”. This study examines the effects that a course, which uses reflection as a method of learning and the cinema as a teaching tool, produces on a little group of Italian third-year Midwifery students. From the content analysis (supported by Atlas-Ti® software) of the texts produced by the students after the vision of two entire films, it appears that they correctly identified many elements related to good and poor communication of bad news and that they were able to describe the emotions felt while watching the film, but still revealed a certain difficulty to interpret them. The course helped students to recognize the value of reflection on their emotions to better understand others, to empathize with people who suffer, but also to recognize their difficulties and compete with their own limits. [ABSTRACT FROM AUTHOR]

Background: Hypofractionated proton beam radiotherapy (PBT) is gaining attention in early-stage non-small cell lung cancer (ES-NSCLC). However, there is a large unmet need to define indications, prescription doses and potential adverse events of protons in this clinical scenario. Hence, the present work aims to provide a critical literature revision, and to investigate associations between fractionation schedules/ biological effective doses (BEDs), oncological outcomes and toxicities.Materials and Methods: This systematic review and meta-analysis complied with the PRISMA recommendations. Inclusion criteria were: 1) curative-intent hypofractionated PBT for ES-NSCLC (≥3 Gy(RBE)/fraction), 2) report of the clinical outcomes of interest, 3) availability of full-text written in English. The bibliographic search was performed on the NCBI Pubmed, Embase and Scopus in September 2021; no other limitations were applied. The BED was calculated for each included study (α/β = 10 Gy); the median BED for all studies was used as a threshold for stratifying selected evidence into "high" and "low"-dose subgroups. Heterogeneity was tested using chi-square statistics; inconsistency was measured with the I2 index. Pooled estimate was obtained by fitting both the fixed-effect and the DerSimonian and Laird random-effect model.Results: Eight studies and 401 patients were available for the meta-analysis; median follow-up was 32.8 months. The median delivered BED was 105.6 Gy(RBE). A BED ≥ 105.6 Gy(RBE) consistently provided superior OS, CSS, DFS and LC rates (i.e.: 4-year OS: 0.56 [0.34-0.76] for BED < 105.6 Gy(RBE) and 0.78 [0.64-0.88] for BED ≥ 105.6 Gy(RBE)). The meta-analysis of proportions showed a comparable probability of developing acute grade ≥ 2 toxicity between the two groups, while the probability of any late grade ≥ 2 event was almost three-times greater for BED ≥ 105.6 Gy(RBE), with rib fractures being more common in the high dose group.Conclusion: Hypofractionated PBT is a safe and effective treatment option for ES-NSCLC; the delivery of BED ≥ 105.6 Gy(RBE) with advanced techniques for uncertainty management has been associated with improved oncological outcomes across all considered time points. [ABSTRACT FROM AUTHOR]

In WDS characterized by significant variation in elevation, the necessity of pumping water to higher levels is conflicted by a requirement to reduce excess pressure. A multi-objective optimization methodology is presented to minimize leakage and to minimize the difference between operational pumping costs and income generated through energy recovery by strategically locating in the network Pumps operating As Turbines (PATs), which can act in an analogous fashion to conventional PRVs. The approach is demonstrated on a case study resulting in a clear economic benefit from installing PATs for energy recovery in conjunction with a combined pump-scheduling and pressure management regime. [ABSTRACT FROM AUTHOR]

Abstract: The economic crisis of recent years has refocused interest in minimizing energy consumption in WDS management. An integrated methodology is presented which seeks to fulfill three broad energy-conservation aims: conventional pump- scheduling is considered to minimize direct electricity consumption; concurrently, the optimization considers the production of energy by strategically locating in the network Pumps operating As Turbines (PATs) which can act in an analogous fashion to conventional Pressure Reducing Valves, whilst additionally recovering electricity. Results, obtained on a real WDS, demonstrate a clear economic benefit to installing PATs for energy recovery in conjunction with a pump-scheduling and pressure management regime. [Copyright &y& Elsevier]

Abstract: The present work compares the performances of first and second order kinetic models for predicting trihalomethanes (THMs) formation in a real case-study. The kinetic parameters are evaluated through an automatic calibration procedure, in which a least-squared objective function relating measured and computed residual chlorine and THMs concentrations is adopted. The effect of measurements uncertainty on the calibrated parameters and on THMs concentrations predictions are quantified in terms of confidence limits using the First Order Second Moment approach. The study reveals that the performances of the two models are quite similar, but the second order one results less influenced by uncertainty. [Copyright &y& Elsevier]

Summary: To evaluate all the variables that affect nursing education is important for nursing educators to have valid and reliable instruments that can measure the perceived quality of the Bachelor Degree in Nursing. This study testing the Scale for Quality Evaluation of the Bachelor Degree in Nursing instrument and its psychometric properties with a descriptive design. Participant were first, second and third year students of the Bachelor Degree in Nursing Science from three Italian universities. The Scale for Quality Evaluation of Bachelor Degree in Nursing consists of 65 items that use a 4 point Likert scale ranging from “strongly disagree” to “strongly agree”. The instrument comes from a prior version with 41 items that were modified and integrated with 24 items to improve reliability. Six hundred and fifty questionnaires were completed and considered for the present study. The mean age of the students was 24.63years, 65.5% were females. Reliability of the scale resulted in a very high Cronbach's alpha (0.96). The construct validity was tested with factor analysis that showed 7 factors. The Scale for Quality Evaluation of the Bachelor Degree in Nursing, although requiring further studies, represents a useful instrument to measure the quality of the Bachelor Nursing Degree. [ABSTRACT FROM AUTHOR]

Summary: To evaluate all the variables that affect nursing education is important for nursing educators to have valid and reliable instruments that can measure the perceived quality of the Bachelor Degree in Nursing. This study testing the Scale for Quality Evaluation of the Bachelor Degree in Nursing instrument and its psychometric properties with a descriptive design. Participant were first, second and third year students of the Bachelor Degree in Nursing Science from three Italian universities. The Scale for Quality Evaluation of Bachelor Degree in Nursing consists of 65 items that use a 4 point Likert scale ranging from “strongly disagree” to “strongly agree”. The instrument comes from a prior version with 41 items that were modified and integrated with 24 items to improve reliability. Six hundred and fifty questionnaires were completed and considered for the present study. The mean age of the students was 24.63years, 65.5% were females. Reliability of the scale resulted in a very high Cronbach's alpha (0.96). The construct validity was tested with factor analysis that showed 7 factors. The Scale for Quality Evaluation of the Bachelor Degree in Nursing, although requiring further studies, represents a useful instrument to measure the quality of the Bachelor Nursing Degree. [Copyright &y& Elsevier]

Background: Preoperative determination of Ki-67 expression, an important prognostic factor for grading nonfunctioning pancreatic endocrine tumors (NF-PETs), remains an important clinical challenge. Objective: To prospectively evaluate the feasibility, yield, and clinical impact of EUS-guided fine-needle tissue acquisition (EUS-FNTA) with a large-gauge needle to obtain tissue samples for histologic diagnosis and Ki-67 analysis in patients with suspected NF-PETs. Design: Prospective cohort study. Setting: Tertiary-care academic medical center. Patients: Consecutive patients with a single pancreatic lesion suspicious for NF-PET on imaging. Intervention: EUS-FNTA with a 19-gauge needle. Main Outcome Measurements: Feasibility and yield of EUS-FNTA for diagnosis and Ki-67 expression determination. Results: Thirty patients (mean [± SD] age 55.7 ± 14.9 years), with a mean (± SD) lesion size of 16.9 ± 6.1 mm were enrolled. EUS-FNTA was successfully performed without complications in all patients, with a mean (± SD) of 2.7 ± 0.5 passes per patient. Adequate samples for histologic examination were obtained in 28 of the 30 patients (93.3%). Ki-67 determination could be performed in 26 of these 28 patients (92.9%, 86.6% overall), 12 of whom underwent surgical resection. Preoperative and postoperative Ki-67 proliferation indexes were concordant in 10 patients (83.3%), whereas 2 patients were upstaged from G1 to G2 or downstaged from G2 to G1, respectively. Limitations: Single center study with a single operator. Conclusion: In patients with suspected nonfunctioning low-grade to intermediate-grade pancreatic neuroendocrine tumors (p-NETs), retrieval of tissue specimens with EUS-FNTA by using a 19-gauge needle is safe, feasible, and highly accurate for both diagnosis and Ki-67 determination. A Ki-67 proliferative index acquired through this technique might be of great help for further therapeutic decisions. [Copyright &y& Elsevier]

Summary: Glucagon secretion is inhibited by glucagon-like peptide-1 (GLP-1) and stimulated by adrenaline. These opposing effects on glucagon secretion are mimicked by low (1–10 nM) and high (10 μM) concentrations of forskolin, respectively. The expression of GLP-1 receptors in α cells is <0.2% of that in β cells. The GLP-1-induced suppression of glucagon secretion is PKA dependent, is glucose independent, and does not involve paracrine effects mediated by insulin or somatostatin. GLP-1 is without much effect on α cell electrical activity but selectively inhibits N-type Ca2+ channels and exocytosis. Adrenaline stimulates α cell electrical activity, increases [Ca2+]i, enhances L-type Ca2+ channel activity, and accelerates exocytosis. The stimulatory effect is partially PKA independent and reduced in Epac2-deficient islets. We propose that GLP-1 inhibits glucagon secretion by PKA-dependent inhibition of the N-type Ca2+ channels via a small increase in intracellular cAMP ([cAMP]i). Adrenaline stimulates L-type Ca2+ channel-dependent exocytosis by activation of the low-affinity cAMP sensor Epac2 via a large increase in [cAMP]i. [Copyright &y& Elsevier]

Abstract: Biliopancreatic diversion (BPD) is a surgical procedure performed in patients with untreatable obesity and insulin resistance. The demonstrated metabolic and hormonal results of this procedure include the reversal of insulin resistance; an increase in diet-induced thermogenesis; and modifications of gut hormones, such as gastrin, enteroglucagon, neurotensin, and cholecystokinin. On the other hand, obesity is a condition of increased oxidative stress; however, few studies have investigated antioxidant systems in obese persons with BPD. To evaluate the metabolic status and antioxidant systems in such patients, we studied a group of 11 morbidly obese patients, aged 28 to 62years, with a mean body mass index (BMI) of 54.71 ± 2.52 kg/m2, before and after successful BPD (mean post-BPD BMI, 44.68 ± 1.51 kg/m2). A control group composed of 10 slightly overweight women, with a mean BMI of 28.5 ± 0.72 kg/m2, was also studied. Coenzyme Q10 (CoQ10) levels (also normalized for cholesterol levels) and total antioxidant capacity in blood plasma were assessed in these populations. The most striking datum was the extremely low level of CoQ10 in postoperative period (0.34 ± 0.16 vs 0.66 ± 0.09 μg/mL, P = .04); also, the data corrected for cholesterol levels presented the same pattern, with a more marked significance (152.46 ± 11.13 vs 186.4 ± 17.98 nmol/mmol, P = .001).This could be due to lipid malabsorption after surgery. In fact, the pre-BPD data present all the metabolic and hormonal characteristics of severe obesity; and after BPD, there was a net improvement in the metabolic parameters. The first pathophysiologic phenomenon seems to be lipid malabsorption that has been argued to be the cause of insulin resistance reversion. This metabolic interpretation is also confirmed by the absence of significant variations of total antioxidant capacity (57.5 ± 5.3 vs 66 ± 5.3). The mechanisms of these phenomena remain to be established. These data suggest the importance of correcting postsurgical metabolic complications, in these clinical populations, with CoQ10 supplementation. [Copyright &y& Elsevier]

Copyright of European Journal of Oncology Nursing is the property of Churchill Livingstone, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: In healthy subjects, parathyroid hormone (PTH) is secreted in a dual fashion, with low-amplitude and high-frequency pulses superimposed on tonic secretion. These 2 components of PTH secretion seem to have different effects on target organs. The aim of our study was to evaluate whether growth hormone excess in acromegaly may modify the spontaneous pulsatility of PTH. Five male patients with newly diagnosed active acromegaly and 8 healthy subjects were evaluated by 3-minute blood sampling for 6 hours. Plasma PTH concentrations were evaluated by multiparameter deconvolution analysis. Plasma PTH release profiles were also subjected to an approximate entropy (ApEn) estimate, which provides an ensemble measure of the serial regularity or orderliness of the release process. In acromegalic patients, baseline serum PTH values were not significantly different from those measured in the healthy subjects, as well as tonic PTH secretion rate, number of bursts, fractional pulsatile PTH secretion, and ApEn ratio. Conversely, PTH pulse half-duration was significantly longer in acromegalic patients vs healthy subjects (11.8 ± 0.95 vs 6.9 ± 1.6 minutes; P = .05), whereas PTH pulse mass showed a tendency (P = .06) to be significantly greater in acromegalic patients. These preliminary data suggest that growth hormone excess may affect PTH secretory dynamics in patients with acromegaly. Potentially negative bone effects of the modifications of PTH secretory pattern in acromegaly should be investigated. [Copyright &y& Elsevier]

Inpatients with cancer are likely to experience care dependency and would benefit from nurses' evaluation of such dependency. The Care Dependency Scale (CDS) is a 15-item instrument widely used to assess patients' dependency in different populations and settings. This study aimed to test the psychometric properties of the proxy Italian version of the CDS in inpatients with cancer. A multicentre cross-sectional cross-validation study was conducted between February 2016 and October 2017 in a convenience sample of 517 adult patients with cancer admitted to four hospitals in Italy. The sample was randomly divided into two subsamples. The factor structure of the CDS based on previous studies was tested on a subsample through confirmatory factor analyses (CFAs). The best fitting model was cross-validated through CFA on the second subsample and on the total sample. The sample mean age was 65.68 years, 51.5% were male. The CFAs performed on the first subsample (n = 258), on the second subsample (n = 259) and on the total sample yielded acceptable fit indexes. The factors Physical care dependency and Psychosocial care dependency with a second-order factor were confirmed. Reliability in terms of internal consistency and inter-rater reliability were satisfactory. The Care Dependency Scale is a tool able to assess the level of care dependency in patients with cancer with adequate validity and reliability. The Care Dependency Scale can help to distinguish between physical and psychosocial needs and to create a base for personalized patient care. What is already known about the topic? • The Care Dependency Scale (CDS) is a specific measure of nursing care dependence. • Oncology nurses need an instrument to measure the patients' degree of care dependency. What this paper adds • The CDS is valid and reliable and can be used by oncology nurses helping them to distinguish physical and psychosocial care dependence. • The CDS helps nurses to identify the patient' needs and plan individualized care. [ABSTRACT FROM AUTHOR]

International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory. To explore Italian nursing students' attitudes towards caring for dying patients. A multicenter cross-sectional study was conducted. The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region. The sample included 1193 students. Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t -test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression. The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care. Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering. • Italian nursing students have more positive attitudes than those of other countries. • For Italian nursing students, the experience with dying patients is formative. • Education and experience can model and transform students' attitudes. • Students do not feel adequately prepared to deal with end-of-life care. • Palliative care education is needed to prepare students to empathize with patients. [ABSTRACT FROM AUTHOR]

Understanding students' experiences with regard to older adults is important for educators in developing specific educational strategies to encourage future healthcare professionals to consider the geriatric field as a career choice. The study explored Italian university healthcare students' experiences with older people and their perceptions of them at the beginning of their course. A qualitative descriptive design. A Faculty of Medicine in Italy. A sample of 15 students enrolled in healthcare courses was included. Semistructured interviews were conducted. The data were analyzed using inductive content analysis. Six categories were identified. The young Italian students' first experiences with older adults were with their grandparents, representing their first models of aging. Grandparents were sources of emotional support. Older adults were seen as custodians of collective memory and as a guide for younger generations. The intergenerational relationship was characterized by respect and reciprocity. Young adults recognize the frailty and vulnerability of older adults and view intergenerational solidarity as a way to protect them. They imagined their own old age as characterized by strong family relationships and by active aging, due to their personal experience with their grandparents. This study revealed mainly positive experiences and attitudes of healthcare students toward older adults. The students' relationships with their grandparents contributed greatly to this outcome. • For Italian young adults the grandparents are the first significant models of aging. • Older people are custodians of collective memory and guides for younger generations. • The intergenerational relationship is characterized by respect and reciprocity. • The intergenerational solidarity can protect frail and vulnerable older people. • Italian young people imagine their old age similar to that of their grandparents. [ABSTRACT FROM AUTHOR]

To investigate the degree of concordance on fatigue assessment between children and adolescents with cancer and their parents, and its changes over time. Multicentre longitudinal study. Data from 134 dyads were analysed. The mean age of patients was 11.7 years; caregivers had a mean age of 44.1 years. Almost 90% of patients already reported mild or moderate fatigue at the time of diagnosis, decreasing to 69.7% after one year. Concordance on the total fatigue improved over time for the total sample, moving from moderate at the time of diagnosis to good concordance after one year. This was the first study with a longitudinal design investigating concordance between paediatric self-reports and parent proxy reports on fatigue. It showed how concordance between proxies and patients changed over time reaching a good level after one year from the cancer diagnosis. • Fatigue is a prevalent problem for children and adolescents diagnosed with cancer. • The prevalence and intensity of fatigue decrease over time. • Concordance between proxy and patient on fatigue level is higher one year after diagnosis. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) represent one of the main steps forward for the treatment of advanced or metastatic non-small-cell lung cancer (NSCLC), without oncogenic driver alterations. Despite this recent progress, only a minority of patients achieve a broad and durable benefit and another proportion report poor survival and sometimes fast disease progression, confirming the need to optimise the patient's selection. To date, several issues are unsolved about how to personalise the immunotherapy treatment for individual patients. In this review, analysing data from pivotal randomised clinical trials (RCTs), we discuss patient baseline clinical and demographic features, including sex, age, ECOG performance status, smoking habit and specific site of metastases (liver, bone and brain) that may influence the efficacy outcomes in patients treated with ICIs. The high performance of the ICIs blurred the vision on different efficacy-limiting factors, which require extensive evaluation to improve the understanding ofthe tumour-specificimmune response, in which clinical drivers could be useful for better patient stratification. [ABSTRACT FROM AUTHOR]

The Care Dependency Scale is a theory-based, comprehensive tool widely used in low-intensity care settings to evaluate patients' dependency. This study aimed to test the psychometric properties of the Care Dependency Scale in intensive care units. A multicentre cross-sectional validation study was conducted. Exploratory factor analysis and confirmatory factor analysis were performed using a Maximum Likelihood robust estimator with Geomin oblique rotation. Adult patients admitted to intensive care units of four Italian hospitals. The sample included 453 patients (mean age = 68 years, 62% male). The exploratory factor analysis, conducted on a subsample of 227 patients, revealed a two-factor structure (Physical care dependency and Psychosocial care dependency) with good fit indexes. The confirmatory factor analysis was conducted on another subsample of 226 patients and a second-order factor was specified. The model tested yielded adequate fit indexes. Concurrent and known-groups validity, and reliability, were also adequate. The Care Dependency Scale is a multidimensional, valid and reliable tool able to assess the care dependency of critically ill patients. It can help to distinguish between physical and psychosocial needs and to create a base for patient-customised and holistic care. [ABSTRACT FROM AUTHOR]

Worldwide, nursing students have reported a preference for working in intensive care, paediatrics, and operating theatres after graduation, disregarding psychiatry and geriatrics. Many factors can influence student choices. Educators need to know students' preferences and influencing factors in order to plan appropriate interventions to orient future nurses towards the clinical areas that are most in need of trained and motivated nurses. To identify career preferences and student-related factors that influence the career intentions of students attending Italian nursing schools. A cross sectional design. The study was conducted in 14 Italian nursing schools. Students enrolled on a three-year undergraduate nursing program were invited to participate. A questionnaire was used to collect sociodemographic data and clinical area preferences. A multivariate binary logistic regression was performed to identify the student characteristics influencing career choices. 1534 students were enrolled in the study. Students preferred working in paediatrics, emergency departments and operating theatres, and these preferences were consistent in all of the three years. Psychiatry and geriatrics were the clinical areas least preferred in all the three years. Age, gender, nationality, and university attended were the factors that predicted students' preferences for specific clinical areas. In line with international literature, students attending Italian nursing schools expressed preferences for working in some clinical areas and to disregard others. Nursing curricula and internships need to be reviewed in terms of declared and hidden curriculum in order to enable students to view all areas of practice as equally valuable. [ABSTRACT FROM AUTHOR]

Summary Type 2 diabetes (T2D) develops after years of prediabetes during which high glucose (glucotoxicity) impairs insulin secretion. We report that the ATP-conducting mitochondrial outer membrane voltage-dependent anion channel-1 (VDAC1) is upregulated in islets from T2D and non-diabetic organ donors under glucotoxic conditions. This is caused by a glucotoxicity-induced transcriptional program, triggered during years of prediabetes with suboptimal blood glucose control. Metformin counteracts VDAC1 induction. VDAC1 overexpression causes its mistargeting to the plasma membrane of the insulin-secreting β cells with loss of the crucial metabolic coupling factor ATP. VDAC1 antibodies and inhibitors prevent ATP loss. Through direct inhibition of VDAC1 conductance, metformin, like specific VDAC1 inhibitors and antibodies, restores the impaired generation of ATP and glucose-stimulated insulin secretion in T2D islets. Treatment of db/db mice with VDAC1 inhibitor prevents hyperglycemia, and maintains normal glucose tolerance and physiological regulation of insulin secretion. Thus, β cell function is preserved by targeting the novel diabetes executer protein VDAC1. Graphical Abstract Highlights • Hyperglycemia increases VDAC1 expression and its mistargeting to the β cell surface • VDAC1 surface expression causes ATP loss and β cell dysfunction in T2D islets • VDAC1 inhibition restores β cell function and prevents hyperglycemia in db/db mice • Metformin preserves β cell function by directly inhibiting VDAC1 conductance Zhang et al. report on the role of the ATP-conducting mitochondrial outer membrane voltage-dependent anion channel-1 (VDAC1) in β cell glucotoxicity preceding diabetes. VDAC1 upregulation leads to ATP depletion and impaired insulin secretion. VDAC1 inhibitors, including metformin, restore insulin secretion in T2D islet donors and prevent hyperglycemia in diabetic mice. [ABSTRACT FROM AUTHOR]