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Background: Previous studies during SARS and Ebola pandemics have shown that quarantine is associated with several negative psychological effects, such as post-traumatic stress symptoms, confusion, and anger. These conditions may affect the course of many diseases, including migraine. Although it is possible that the quarantine measures for the current COVID-19 pandemic affect migraine burden, no information is currently available on this issue. Aim: In this study, we aimed to: (1) explore the possible changes in migraine frequency, severity, and days with acute medication intake during quarantine period; (2) evaluate possible differences in migraine outcomes in consideration of lifestyle changes, emotions, pandemic diffusion, and COVID-19 infection. Methods: We interviewed patients who were included in the observational Italian Headache Registry (Registro Italiano Cefalee, RICE), retrospectively collecting information on main headache features, lifestyle factors, emotions, individual infection status, and perception of COVID-19 for 2 months before (pre-quarantine) and after the beginning of the quarantine (quarantine). Inclusion criteria were: age > 18, diagnosis of migraine without aura, migraine with aura and chronic migraine, last in-person visit more than 3 months preceding the beginning of quarantine. Results: A total of 433 migraine subjects agreed to be interviewed. We found an overall reduction in headache frequency (9.42 ± 0.43 days with headache vs. 8.28 ± 0.41) and intensity (6.57 ± 0.19 vs. 6.59 ± 0.21) during the quarantine, compared to pre-quarantine. There was a correlation between improvement and number of days of stay-at-home. When results were stratified for geographic area, we found a tendency toward worsening of headache frequency in northern Italy. Disgust regarding viral infection corresponded to a minor improvement in migraine. Conclusions: Migraine patients showed a mild improvement of migraine features, probably attributable to resilient behavior toward pandemic distress. Disgust regarding the contagion whereas potentially favoring defensive behavior, could potentially worsen migraine. The spontaneous limitation of migraine burden during quarantine could favor patient follow-up via the use of telemedicine visits, reliable diaries, and frequent remote contacts.

High-Fidelity Simulation (HFS) is a tool used to expand nursing students’ opportunities to care for critically ill patients while also overcoming limitations often faced during clinical placements. HFS provides students with opportunity to interact within a realistic clinical environment with a patient simulator able to reproduce a wide range of clinical conditions. Professional growth and improved learning outcomes are associated with the level of fidelity in simulation; however, heterogeneity of the adopted HFS definitions and studies reporting lead to a heterogeneity of research results. The aims of this scoping review, that analyzed 69 studies, were to clarify HFS concept, document its related main features, and provide an unambiguous definition of HFS. Thematic analysis of definitions and conceptual frameworks reported in the considered studies allowed for the identification of three main themes that represent the concept of HFS in nursing education: innovative educational strategy, realistic learning experience for skills improvement, and safe experience. Debriefing and pre-briefing were respectively the most common reported features related to HFS. The definition derived from thematic analysis considers HFS as a ‘technology-based educational approach performed in a realistic and safe environment, that uses an interactive patient simulator able to reproduce life-like clinical conditions, allowing students to improve their technical and non-technical skills’.

BackgroundMost patients treated with erenumab in clinical practice have chronic migraine (CM). We assessed the rate and possible predictors of conversion from CM to episodic migraine (EM) in a real-life study.Main bodyWe performed a subgroup analysis of patients treated with erenumab from January 2019 to February 2020 in the Abruzzo region, central Italy. Treatment was provided according to current clinical practice. For the purpose of the present study, we included patients fulfilling the definition of CM for the three months preceding erenumab treatment and with at least 6 months of follow-up after treatment. We assessed the rate of conversion to EM from baseline to Months 4–6 of treatment and during each month of treatment. To test the clinical validity of conversion to EM, we also assessed the decrease in monthly headache days (MHDs), acute medication days, and median headache intensity on a Numerical Rating Scale (NRS). We included in our study 91 patients with CM. At Months 4–6, 62 patients (68.1%) converted from CM to EM; the proportion of converters increased from Month 1 to Month 5. In the overall group of patients, median MHDs decreased from 26.5 (IQR 20–30) to 7.5 (IQR 5–16;P P P ConclusionsIn our study, two thirds of patients with CM converted to EM during 6 months of treatment with erenumab. MHDs, acute medication use, and headache intensity decreased regardless of conversion from CM to EM.

BACKGROUND Previous studies during the SARS and Ebola pandemics have shown that quarantine is associated with several negative psychological effects. Although it is possible that quarantine for the current COVID-19 pandemic affects migraine burden, no information is currently available on this i AIM: In this study, we aimed: a) to explore the effect of quarantine on migraine frequency, severity and days with acute medication intake, and b) to evaluate whether migraine, changes in lifestyle, and emotions. were affected in a different manner in three geographic Italian areas with diverse COVID-19 diffusion, METHODS We interviewed patients included in the observational Italian registry of headache (Registro Italiano Cefalee, RICe), retrospectively collecting information on main headache features, lifestyles factors, emotions, individual infection status, and perception for COVID-19 for the two months before quarantine and during quarantine. Inclusion criteria were: age > 18; diagnosis of migraine without aura, migraine with aura, and chronic migraine; last in-person visit in the 3 months before the beginning of the quarantine. RESULTS A total of 433 migraine subjects agreed to be interviewed. We found an overall reduction in headache frequency and days with acute medication intake during the quarantine as compared to pre-quarantine. Reduction in headache frequency prevailed in patients reported more days of effective staying at home. Improvement was not evident in northern Italy. Disgust against viral infection corresponded to a reduced improvement in migraine parameters. CONCLUSIONS. Migraine patients showed a resilient behavior toward the pandemic distress. Disgust against the contagious disease, could increase migraine frequency. ssue.

Migraine, and especially migraine with aura, is associated with an increased risk of stroke and vascular events; however, the reasons for this association are unclear. Several studies evaluated cerebral autoregulation and vasomotor reactivity in patients with migraine compared with non-migraineurs, with conflicting results. Our narrative review aimed at summarizing their results to find the most reliable evidence in the field. Studies which used visual stimuli to evoke vascular responses consistently showed an increased vascular reactivity in migraineurs compared with non-migraineurs, while studies which used systemic stimuli such as hyper- or hypocapnia showed inconsistent results. Therefore, central neural mechanisms might be more important than peripheral vascular mechanisms in determining the cerebral vascular responses of patients with migraine. However, a large body of evidence supports the existence of peripheral vascular dysfunction in patients with migraine. Further studies are needed to explain the complex interactions between central neural and peripheral vascular mechanisms in determining migraine and its vascular risk. Migraine preventive treatments, and especially the most recent ones with a peripheral action, might provide important insights in this field.

Background and aim of the work: Structured nursing care planning, patients’ satisfaction with care, nurses’ job satisfaction, and the characteristics of the work environment may influence each other and impact on the quality of hospital care. This study aimed at investigating the differences in nurses’ perception of the work environment and patients’ satisfaction with care, between two groups of hospital wards that used NANDA-I, NIC, and NOC taxonomies or not in the daily practice. Methods: A pilot cross-sectional study was conducted involving nurses employed in eight wards of a teaching hospital in central Italy and patients hospitalized in these wards. The ‘Nursing Work Index Revised’ and the ‘Patient Satisfaction Scale’ were used to investigate nurses’ perception of the work environment and patients’ satisfaction with care, respectively. Results: Significant better perceptions of both the constructs were highlighted in those wards that used nursing taxonomies. Conclusions: The application of a healthcare model based on the nursing process methodology should be empowered in the hospital settings, since it can influence the quality of the environment and patients’ satisfaction with care. (www.actabiomedica.it)

The treatment of cluster headache (CH) is challenging in view of the few evidence-based treatments. The authors aim to summarize the evidence of efficacy and safety of greater occipital nerve blocks (GONBs) in CH.The authors included papers indexed in PubMed and Web of Science from the beginning of indexing to 5 May 2020. They included both observational and randomized studies referring to patients with episodic and/or chronic CH. The authors identified 12 studies on 365 patients. Five studies (two randomized controlled trials) could be included in the meta-analyses. The pooled proportion of pain-free subjects at 1 month was 50% (95% CI 24-76%) with considerable heterogeneity (IDespite several limitations and considerable heterogeneity, the available data support the efficacy and safety of GONBs for the treatment of CH. Further large randomized trials are needed to confirm efficacy and establish optimal treatment protocols.

High-Fidelity Simulation (HFS) founded on critical care scenarios requires nursing students to perform clinical interventions to effectively face life-threatening conditions. Since little evidence is available on the effectiveness of HFS on knowledge, self-confidence, self-efficacy, performance, and satisfaction of postgraduate nursing students attending an intensive care course, a before-and-after study was conducted on 28 students to document any change of learning outcomes in a respiratory failure scenario. After the HFS session, a significant improvement for self-confidence was revealed. Beyond the statistical significance, the HFS demonstrated to be a valuable complement to traditional education for many students, determining an improvement of their knowledge and self-efficacy. High level in performance and satisfaction during and after HFS session were also documented, confirming HFS as a valid teaching method in the achievement of learning goals, especially when associated with the traditional work placement models, in nursing students attending a postgraduate academic course on intensive and emergency care.

The study aims were to define the psychometric properties of the Albanian Jefferson Scale of Empathy–Health Professional Students’ version, compare empathy levels among Albanian Health Professional students, and explore any relationship among students’ characteristics and their empathy levels. To achieve these aims, a comparative cross-sectional study was conducted. A preliminary exploratory factor analysis was conducted to determine the factor structure of the scale, while group comparisons of empathy scores were examined using t-test and ANOVA F-test. A total of 1,240 students were enrolled in the study. Psychometric properties of the scale were confirmed. Midwifery, physiotherapy, and female students showed higher levels of empathy than other groups. Similarly, third-year students showed higher empathy than first- and second-year students. Monitoring empathy levels is fundamental to the adoption of useful educational strategies by faculties to improve empathy skills in Health Professional students and guarantee better care of patients, especially those in need of psychological support.

High-Fidelity Patient Simulation (HFPS) allows the nursing students’ immersion in a learning environment marked by complexity, dynamism, reality, and safety, connecting theory to practice. The increased use of the HFPS was also sustained by the beneficial impact that HFPS seems to produce on nursing students’ learning outcomes. However, available research is still conflicting, and several methodological issues do not allow achieving best-quality evidence. To analyse the impact of the HFPS on nursing students’ learning outcomes in critical care area, a methodological overview of the studies included in a systematic review was conducted. Heterogeneity about the geographic area, methods, simulation techniques, and control approaches was pointed out. However, studies based on cardiocirculatory scenarios showed the highest standardization of methods and assessment tools. The development and application of shared guidelines derived from adequately-sampled randomized controlled trials are expected to demonstrate the high-fidelity simulation to be a valuable adjunct to the traditional training program.

Objectives: The study aims to assess the impact of the second COVID-19 pandemic wave on migraine characteristics. Methods: This is an observational cross-sectional study conducted on migraine patients previously interviewed during the first Italian pandemic outbreak. A second structured telephone interview was conducted between 20 November 2020 and 18 January 2021. We compared migraine characteristics among T0 (before pandemic), T1 (during the first pandemic phase), and T2 (during the second pandemic phase). Results: Among the 433 patients interviewed during the first pandemic phase, 304 cases were finally considered. One hundred forty-eight patients had a control visit between March 2020 and December 2020, 120 had an in-person visit, 14 by phone, the remainder used telemedicine software provided by the hospital. Frequency of headache, number of symptomatic drugs and headache intensity worsened during T2, compared to T0 and T1, especially in episodic migraine. Headache intensity increased relating to the negative emotional impact of the pandemic. Migraine management during the pandemic did not influence the clinical outcome. Conclusion: The prolongation of the pandemic seems to have a negative impact on migraine evolution. The arousal and negative psychological behavior toward the COVID-19 outbreak seem to worsen migraine.

Background: We aimed to assess the differences between menstrual and non-menstrual headache in women with chronic migraine treated with erenumab. Methods: We included fertile women from a single center. Patients were defined as responders to erenumab if reporting a ≥50% decrease in monthly headache days, as compared to pre-treatment for more than half of the treatment period. Premenstrual days were defined as the two days preceding menstruation, while menstrual days were defined as the first three days of menstruation. Results: We included 18 women (11 erenumab responders and 7 erenumab non-responders) contributing to a total of 103 menstrual cycles and 2926 days. The proportion of headache days was higher in menstrual than in premenstrual and non-menstrual days in erenumab responders (34.4% vs. 14.8% vs. 16.3%, respectively, p &lt, 0.001) and in erenumab non-responders (71.4% vs. 53.6% vs. 48.3%, respectively, 0.001). Headache days with ≥2 acute medications were higher in menstrual than in premenstrual or non-menstrual headache days in erenumab non-responders (p = 0.002) but not in erenumab responders (p = 0.620). Conclusions: Our data suggest that migraine is more frequent during than outside menstrual days even in women treated with erenumab.

Background Low academic success rates lead to fewer than the required number of nurses entering the national health systems, impacting on the supply of nurses and with negative consequences for global health care since low nurse-to-patient ratios are associated with an increase of patients' adverse outcomes. Objectives This study was mainly aimed at documenting any of the academic outcomes' potential predictors among Nursing Degree Program (NDP) students' characteristics. Design A retrospective multi-cohort study was conducted. Participants and Setting Ten cohorts of nursing students enrolled in a central Italy university were involved. Methods Qualitative and quantitative data on entry characteristics and academic outcomes were retrieved, observing retrospectively 10 cohorts of Italian nursing students for 13 academic years (2004–2017). Multiple regression analyses were conducted to assess if potential predictors reporting a p-value Results A total of 2278 students were enrolled in this study. Multivariate analyses showed that ‘female gender’, ‘having attended classical or scientific upper-secondary school’, and ‘having higher upper-secondary diploma grade’ were associated both with the qualitative outcomes (graduation within the legal duration of NDP) and the quantitative ones (final degree exam grade). The weight of the ‘admission-test score’ in explaining the variance of academic performances was very low (β = 0.03, 95% CI = 0.01 to 0.05) compared to the ‘upper-secondary diploma grade’ (β = 0.14, 95% CI = 0.12 to 0.16). Conclusions This evidence should lead to a reflection on the entry-selection methods for NDP, especially in those countries such as Italy, where these methods are essentially based on the entry-test, which in this study was shown to have a very low predictive power for academic outcomes.

Chronic diseases are mostly managed by family caregivers that often face the “caregiver burden”. This study aimed to understand whether a multidisciplinary theoretical-practical training course could influence the burden, health literacy and needs of caregivers. Seventy-six familial caregivers were asked to complete the Caregiver Burden Inventory-CBI, Caregiver Needs Assessment-CNA, and Health Literacy Questionnaire-HLQ, before and after the course. A significant decrease in CBI and an increase of CNA were observed. However, a significantly higher rate of CBI decrease and a lower increase of CNA were detected in the neurological compared to the oncological group (p = 0.001). Moreover, the ability of the participants to look for and find health information significantly improved. The course contrasted caregivers' burden, increased their search for health information, and revealed their requiring of training and emotional and social support. Caregiver education plays a pivotal role in the management of chronic patients, enhancing the quality of life of both patients and caregivers.

“Simulation,” in terms of its application in nursing education, is the imitation and replication of some of, or nearly all, the fundamental aspects of a clinical situation to strengthen comprehension and teach best practices.

ObjectiveThe purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students’ learning outcomes.DesignA systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.Data sourcesPubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references.Study selectionTo be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis.Review methodThree independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria.Synthesis methodFor each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen’s d with a 95% CI.ResultsThirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected.ConclusionsCompared with other teaching methods, HFPS revealed higher effects sizes on nursing students’ knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students’ competence and patient outcomes.