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Aim: Increasing immigration in Italy poses challenges in providing cross-cultural palliative care (PC) and end-of-life (EOL) care. In this retrospective study we report the difficulties encountered by hospice operators caring for immigrant patients admitted to 16 hospices in Emilia Romagna from 2001 to 2011. Materials and methods: 327 immigrants were admitted in the study period (1.6% of total admissions). 379 hospice operators were surveyed regarding their experiences in cross-cultural encounters through a questionnaire. Answers were evaluated by the Mann-Whitney U test and chi-square test. 252 operators responded to the questionnaire (67% of total). Results: Relational aspects were the most frequent difficulties experienced by nurses during patient admission and hospitalization and by physicians during EOL. Language difficulties were reported by 75% of responders, regardless of their profession. Difficulties directly correlated with years of experience in a hospice (p=0.002). Conclusions: The results of this study suggest that hospice operators should learn how to deliver quality cross-cultural care. The problems encountered by both Italian doctors and nurses were most likely due to lack of teaching and training in cross-cultural communication and cultural competence. Immigrant patients admitted to Italian hospices are still few, but their number is expected to increase. Appropriate cross-cultural education should become mandatory for medical and nursing students as well as oncology and PC operators.

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Background: Using the ‘surprise’ question ‘Would you be surprised if this patient died in the next year?’ may improve physicians’ prognostic accuracy and identify people appropriate for palliative care. Aim: Determine the prognostic accuracy of general practitioners asking the ‘surprise’ question about their patients with advanced (stage IV) cancer. Design: Prospective cohort study. Setting/participants: Between December 2011 and February 2012, 42 of 50 randomly selected general practitioners (Bologna area, Italy) prospectively classified 231 patients diagnosed with advanced cancer according to the ‘surprise’ question and supplied the status of each patient 1 year later. Results: Of the 231 patients, general practitioners responded ‘No’ to the ‘surprise’ question for 126 (54.5%) and ‘Yes’ for 105 (45.5%). After 12 months, 104 (45.0%) patients had died; 87 (83.7%) were in the ‘No’ group. The sensitivity of the ‘surprise’ question was 69.3%; the specificity was 83.6%. Positive predictive value was 83.8%; negative predictive value was 69.0%. The answer to the ‘surprise’ question was significantly correlated with survival at 1 year. Patients in the ‘No’ group had an odds ratio of 11.55 (95% confidence interval: 5.83–23.28) and a hazard ratio of 6.99 (95% confidence interval: 3.75–13.03) of being dead in the next year compared to patients in the ‘Yes’ group ( p = 0.000 for both odds ratio and hazard ratio). Conclusion: When general practitioners used the ‘surprise’ question for their patients with advanced cancer, the accuracy of survival prognosis was very high. This has clinical potential as a method to identify patients who might benefit from palliative care.

This booklet describes the existing programmes on specialisation in palliative medicine within the WHO European region.

In an effort to determine the functional activity of anti-HIV-1 human mAb and to define the epitopes against which they are directed, supernatants from 10 EBV-transformed lymphoblastoid cell lines producing mAb to HIV were tested. Five clones producing mAb to gp41 and five producing mAb to p24 were identified. The anti-HIV-1 human mAb were tested in neutralization and cell fusion assays in the form of cell culture supernatants at concentrations ranging from 1.7 to 22.0 micrograms/ml. None of the human mAb were found either to inhibit HIV-1-(IIIB or RF) associated cell fusion or to neutralize HIV-1 (IIIB) infection of AA5 cells. All human mAb were additionally tested in 6 h 51Cr release assays for their ability to direct HIV-1 specific antibody-dependent cellular cytotoxicity (ADCC). For ADCC assays, PBMC were isolated from healthy seronegative donors and used as effector cells. HIV-1 infected (IIIB, RF, and MN) CEM.NKR cells as well as CEM.NKR cells with purified gp120 adsorbed onto their surface served as targets. None of the anti-p24 mAb mediated ADCC. In contrast, three of the anti-gp41 mAb were able to direct a significant level of ADCC against each of the infected targets, but as expected, failed to lyse gp120 adsorbed cells. To define the specific epitopes against which the anti-gp41 mAb were directed, seven small peptides homologous to regions within the extracellular domain of gp41 were synthesized. Using RIA, two of the mAb could be mapped. The most effective ADCC-directing human mAb bound to a peptide comprising amino acids 644-663, whereas the least effective ADCC directing anti-gp41 human mAb bound to a region within the immunodominant portion of gp41 outlined by amino acids 579-604. Together, these results for the first time assign a functional activity to human mAb directed at specific regions within gp41 by demonstrating that areas within this molecule can serve as targets for ADCC.