PubMed Health⌕ Search

Biomedical subjects

L Grassi

Publications and source records attributed to L Grassi.

At least 19 recordsLinked to original sources
PubMed2005

Emotional and interpersonal factors are most important for patient satisfaction with anaesthesia.

BACKGROUND: Questionnaires to evaluate patient satisfaction with anaesthesia mainly consider physiological aspects. This study was performed to identify the items of value for patients having anaesthesia (pilot phase) and to validate the questionnaire built on these findings in a new group of inpatients. METHODS: In the pilot phase, 100 surgical patients were interviewed and asked whether each of the 23 items selected by a panel of providers was relevant (score 1) and to rank these from 1 (additional score 6) to 5 (additional score 2). The resulting 10-item final instrument was administered to 219 consecutive inpatients by interview, after recent anaesthesia, asking them how much of each item they received (item received) and the level of satisfaction with the same item, using Numerical Rating Scales (range 0-10). RESULTS: In the pilot phase, gender, age, education and surgery did not influence the score enough to change the first 10 rank-ordered items. The 219 patients subsequently studied did not differ from those missing the questionnaire administration. The patients aged less than 55 years showed lower satisfaction scores than those aged 55 years or more (P = 0.019). In all items, except 'feeling anxious/frightened', the item received was significantly associated with the satisfaction reported. 'Kindness/regard of caregivers' together with 'information given by anaesthetist' and 'feeling safe' predicted 47% of the variance in total patient satisfaction. CONCLUSIONS: Inpatients value highly those elements of care that pertain to emotional and interpersonal relationships.

Adult↗
PubMed2005

Post-traumatic stress disorder-related symptoms after intensive care.

AIM: To determine the incidence of Post Traumatic Stress Disorder (PTSD) related symptoms in a population of intensive care unit (ICU) admitted patients and the relationship between PTSD-related symptoms and memories of ICU. METHODS: Adults consecutively admitted to an ICU of a University hospital during 1 year, who stayed in the ICU at least 3 days, were prospectively studied. A questionnaire (ICU memory tool) was administered to 84 patients 1 week after ICU discharge and to 63 of them after 3 months. Past medical history and clinical variables present during ICU stay were collected. RESULTS: At the 1st interview, 5 patients (5.9%) did not remember to have been in ICU. Of the remaining 79 patients (males 59.5%, median age 69 years, SAPS II 34, APACHE II 14 and ICU stay 5 days), 4 reported intrusive memories and none panic attacks. The Impact of Events Scale (IES), available in 3 of them, scored in medium/high levels. Only the median number of factual memories reported by the patients with and without intrusive memories was significantly different (4 interquartile range 2-5 vs 8 interquartile range 6-10; p=0.002). The patients with intrusive memories at the 1st interview did not report them at the 2nd interview. Two patients not having panic or intrusive memories at the 1st interview reported PTSD-related symptoms after 3 months. CONCLUSIONS: In a general ICU population, few patients (5%) have PTSD-related symptoms and those who present those symptoms report less factual memories of ICU stay.

Aged↗
PubMed2001

Suicide probability and psychological morbidity secondary to HIV infection: a control study of HIV-seropositive, hepatitis C virus (HCV)-seropositive and HIV/HCV-seronegative injecting drug users.

BACKGROUND: Suicide ideation and psychological morbidity among HIV-positive patients has been the object of intense research. No study has investigated this area among injecting drug users (IDUs) infected with HIV and those infected with the hepatitis C virus (HCV), which has the same patterns of transmission of the HIV and may favour HIV replication and, possibly, HIV disease progression. METHODS: In order to examine the prevalence and characteristics of suicide ideation and psychological morbidity associated with HIV and HCV infection in IDUs, a sample of HIV+ (n=81), HIV-/HCV+ (n=62) and HIV-/HCV- (n=152) subjects completed the Suicide Probability Scale (SPS), The Brief Symptom Inventory (BSI) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: No difference was found between the groups as far as the mean scores on SPS and the risk of suicide (no-low risk category: 70.7% HIV+, 56.09% HCV+, 65.6% HIV-/HCV-). Estimated psychological morbidity (BSI) (26.9% HIV+, 27.1% HCV+, 25.4% of HIV-/HCV-) and BSI and HADS scores were comparable across the groups. CONCLUSIONS: Suicide ideation, psychological morbidity and anxiety and depression symptoms seemed not to be directly influenced by HIV-serostatus. Careful assessment of psychological symptoms and suicide ideas among IDUs, as a vulnerable segment of population at risk of HIV and HCV infections, needs to be routinely carried out in clinical settings.

Adolescent↗
PubMed2001

Assessing delirium in cancer patients: the Italian versions of the Delirium Rating Scale and the Memorial Delirium Assessment Scale.

To validate the Italian versions of the Delirium Rating Scale (DRS) and the Memorial Delirium Assessment Scale (MDAS), 105 cancer patients consecutively referred for neurological or psychiatric consultation for mental status change were evaluated using the Confusion Assessment Method (CAM), the DRS, the MDAS, and the Mini-Mental State Examination (MMSE). According to the CAM criteria and clinical examination, 66 patients were delirious, and 39 received diagnoses other than delirium. The DRS and the MDAS scores significantly distinguished delirious from non-delirious patients. The MDAS and the DRS were mutually correlated. When using the proposed cut-off scores for the two scales, the MDAS had higher specificity (94%) but lower sensitivity (68%) than the DRS (sensitivity = 95%, specificity = 61% for DRS cut-off 10; sensitivity = 80%, specificity = 76%, DRS cut-off 12). The MMSE showed high sensitivity (96%) and very low specificity (38%). Exploratory factor analysis of the DRS and the MDAS suggested a three-factor and two-factor structure, respectively. Both instruments in their Italian version proved to be useful for the assessment of delirium among cancer patients. Further research is needed to examine the use of the DRS and the MDAS in other clinical contexts.

Aged↗
PubMed2001

Characteristics of violent behaviour in acute psychiatric in-patients: a 5-year Italian study.

OBJECTIVE: In order to examine prospectively the characteristics of violence among psychiatric patients, a 5-year study was carried out in an acute psychiatric unit. METHOD: All assaultive behaviour occurred in the ward during the study period were assessed routinely using the Staff Observation Aggression scale (SOAS). RESULTS: Of 1534 patients admitted to the unit during the study period, 116 were responsible for 329 aggressive episodes (prevalence of violence=7.5%, 2.8 incidents/patient). Most violent patients had an ICD-9 diagnosis of schizophrenia and/or delusional syndromes (55.1%), a history of violence (80.7%) and previous psychiatric admissions (92%). Approximately half of the incidents had no specific cause, occurred during daytime and the first week of admission and, in most cases, were directed towards individuals (77.8%). CONCLUSION: Although confirming the low rate of violence among Italian psychiatric in-patients, the study indicates the need for more attention to the problem of aggression in general hospital psychiatric units.

Adult↗
PubMed2001

Analgesia, sedation, and memory of intensive care.

PURPOSE: The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care. PATIENTS AND METHODS: One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives. RESULTS: The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P <.05), and had a shorter ICU stay (P <.01). Group C patients were more seriously ill according to SAPS II, duration of mechanical ventilation, and length of stay in ICU and in hospital (P <.001). The incidence of factual, sensation, and emotional memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59). CONCLUSIONS: The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males.

Adult↗
PubMed2001

Day-night variation in aggressive behavior among psychiatric inpatients.

Self-directed aggressive behaviors of human beings show a 24h pattern. The aim of this study was to evaluate if violence of psychiatric inpatients against one another and hospital staff varies over the 24h. The clock time occurrence of 334 episodes of assault behaviors by 119 psychiatric inpatients (78 males and 41 females, mean age 34.8+/-11.3 years) committed during a 5-year span in the psychiatric unit of the university-based hospital of Ferrara, Italy, was evaluated. The clock time of each event was categorized by hour during the 24h and into one of four 6h intervals for analysis of temporal variation by cosinor and chi2 tests, respectively. A significant 24h variation, characterized by an early afternoon peak, was detected irrespective of gender and number (single vs. repeated) of episodes committed. Changes during the 24h in ward activity, patient contact, and endogenous circadian rhythms are likely to contribute to the observed 24h pattern, although further study is needed to confirm our findings and to define causal factors.

Adult↗
PubMed2001

Knowledge about HIV transmission and prevention among Italian patients with psychiatric disorders.

For a study designed to examine the accuracy of information about HIV transmission, risk behavior, and preventive measures among individuals with psychiatric disorders in Italy, 214 psychiatric patients-114 outpatients and 100 inpatients-and 88 nonpsychiatric patients completed the AIDS Risk Behavior Knowledge Test. Levels of knowledge were lower among psychiatric patients than among control subjects. Patients with chronic illness and a diagnosis of schizophrenia were found to have less knowledge than other patients about HIV transmission. These findings confirm the need for HIV-related educational and behavior-modification programs for patients with chronic and severe mental illness in the community in Italy.

Adolescent↗
PubMed2001

Short report: Schistosoma mansoni miracidia are killed by the defense system of an Argentine strain of Biomphalaria straminea.

Biomphalaria straminea snails from Argentina fail to shed cercariae even if exposed to high doses of Schistosoma mansoni EC miracidia. Alternative explanations for this failure are that miracidia are unable to penetrate the snail's epithelium or that the miracidia are killed by the snail's defense system. To discriminate between these 2 possibilities, B. straminea snails were individually exposed to increasing doses of miracidia. Susceptible B. glabrata were used as controls. Exposed snails were fixed 12 hr after exposure, and histological sections of the whole specimens were examined. Miracidia were seen to penetrate the epithelium of B. straminea and B. glabrata at similar rates (14.7%), independent of the exposure level. Regardless of the miracidial dose, 94% of the penetrating miracidia appeared encapsulated by the B. straminea defense system, whereas in B. glabrata, only 42% of the miracidia underwent encapsulation. These results show that resistance of B. straminea to S. mansoni EC strain is due to an efficient defense system that destroys miracidia once they have penetrated.

Animals↗
PubMed2000

Physicians' attitudes to and problems with truth-telling to cancer patients.

Disclosure of a diagnosis of cancer to patients is a major problem among physicians in Italy. The aim of the study was to assess physicians' attitudes to and opinions about disclosure. A convenience sample of 675 physicians in Udine (North Italy) completed a ten-item questionnaire. About 45% indicated that, in principle, patients should always be informed of the diagnosis, but only 25% reported that they always disclosed the diagnosis in practice. Physicians with a surgical specialization employed in general hospitals endorsed disclosure of the diagnosis more frequently than GPs and older physicians. One third of the responding physicians persist in the belief that the patients never want to know the truth. Hospital doctors considered the hospital, rather than the patient's home, was the most appropriate place to inform the patients. The opposite result was found among GPs. Almost all the physicians endorsed the involvement of family members when disclosing the diagnosis, but, at the same time they also indicated that families usually prefer their ill relative not to be informed. Ninety-five per cent of physicians believed that the GP should always be involved in the processes of diagnosis and communication, and 48% indicated that the GP should communicate the diagnosis to the patient (as opposed to the physician who made the diagnosis). Having guidelines for breaking bad news to patients was indicated as an important need by 86% of the responding physicians. Despite changes in medical education, improvement of communication skills in dealing with cancer patients and their families represents an important need in healthcare settings.

Adult↗
PubMed2000

Psychosocial problems secondary to cancer: an Italian multicentre survey of consultation-liaison psychiatry in oncology. Italian Consultation-Liaison Group.

Data relative to consultation-liaison psychiatry (C-L) in oncology are lacking. In order to examine this area, a multicentre investigation was conducted in 17 general hospitals in Italy. All psychiatric consultation requests for cancer patients referred to C-L during a 1-year period were evaluated. Only 5% (n=217 referred patients: 114 men and 103 women) of all C-L activity were for cancer patients. Most were 'routine' consultations (72%) for current psychiatric symptoms (69%) or coping/compliance problems (12%). Previous psychological or psychiatric disorders were shown in 32% of cases. Approximately 40% of patients were not informed of their referral to C-L. The most frequent ICD-10 psychiatric diagnoses were adjustment disorders (27%) and major affective disorders (23%). Transfer to psychiatric units was low (1%). These findings indicate the need for improvement of referral criteria to C-L and closer attention to continuity of psychosocial care of cancer patients during hospitalisation and post-discharge.

Adolescent↗
PubMed2000

[Genetics of type 1 neurofibromatosis].

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by cafè au lait spots, multiple neurofibromas and Lisch nodules of the iris, with marked variability of expression. The NF1 gene is located at 17q11.2, spans 350 kb genomic DNA and comprises 60 exons encoding a 11-13 kb transcript (Viskochil et al.). Four alternatively spliced NF1 transcripts have been identified and they show differential expression in various tissues. NF1 gene is a member of the tumor suppressor gene family. The protein encoded by NF1, neurofibromin, has a domain homologous to the GTPase activating protein (GAP) family, and downregulates ras activity. Neurofibromin is involved in the control of cellular growth and differentiation and germline mutation analysis has shown that around 82% of all the fully characterised NF1 specific mutations so far predict severe truncation of neurofibromin. The current demand for molecular diagnosis of NF1 is low. Many couples would probably request a prenatal diagnosis if it could predict disease severity. Molecular prediction of disease severity and prognosis may either be very complicated or even impossible. Presymptomatic DNA diagnosis is probably not going to be in huge demand because the clinical diagnosis of NF1 is usually straightforward, even in early childhood. Further knowledge of the gene function may also lead to the development of new therapy for the disease.

Child↗
PubMed1999

Attitudes toward euthanasia and physician-assisted suicide among Italian primary care physicians.

The public debate about euthanasia and assisted suicide is less pronounced in Italy than in other countries, and data about this topic are lacking. The aim of this study was to investigate primary care physicians' experience in requests for and opinions about euthanasia and/or assisted suicide for terminally ill patients and the relationship between attitudes and professional variables. Three-hundred thirty-six general practitioners completed the Euthanasia Questionnaire to assess attitudes toward euthanasia and/or assisted suicide and the Maslach Burnout Inventory to examine burnout symptoms. The rate of requests for euthanasia or assisted suicide was low (11% and 4.5%, respectively). Only a minority of the physicians endorsed euthanasia and/or assisted suicide. Agreement with the practice of euthanasia/assisted suicide was correlated with non-Catholic religious affiliation, inexperience in treating terminally ill patients, and the burnout dimension of depersonalization. The fact that professional as well as individual factors (e.g., inexperience, non-Catholic affiliation, burnout) were associated with favorable attitudes toward euthanasia and/or assisted suicide underscores the need to examine the problem as a complex phenomenon involving the dyadic patient-doctor relationship.

Attitude of Health Personnel↗
PubMed1999

Use of medical resources and quality of life of patients with chronic heart failure: a prospective survey in a large Italian community hospital.

AIMS: To assess the prevalence, clinical characteristics, use of medical resources and quality of life in consecutive patients with chronic heart failure (CHF) hospitalized in a large community hospital during 3 months. METHODS AND RESULTS: The study group included 354 patients with CHF, admitted in the Departments of Internal Medicine (97%) and Cardiology. Median age was 78 years [72;85], 45% were males. CHF was the main diagnosis in 72%; 28% were in NYHA class III and 49% in class IV; 42% had atrial fibrillation. The median hospital stay was 8 days [5;14], in-hospital mortality 9% in those admitted for CHF and 19% in those admitted primarily for other diseases. Patients with CHF occupied 15% of the beds; 1330 ECGs, 389 chest X-rays, 112 echocardiograms and 10 coronary angiograms were performed. A quality of life questionnaire revealed that 82% had problems with mobility, 54% with self-care and 88% with everyday activity. Thirty-nine percent of patients had at least one hospitalization during the previous year. CONCLUSIONS: Ninety-seven percent of hospitalized patients with CHF are admitted in the Internal Medicine wards and occupy 15% of beds. The majority of the patients are 72 years or older, with severe heart failure. The frequency of rehospitalization(s) and mortality rate in this population remains high. Echocardiography is performed only in 27% of patients.

Aged↗