Giuseppina Majani

Quality of life and patients' satisfaction in chronic urticaria and respiratory allergy

Background:  Few articles are available about chronic urticaria (CU) impact on patients’ quality of life (QoL). The aim of our study was to evaluate QoL in CU patients both focusing on health status and subjective satisfaction. We adopted two generic tools: SF‐36 (an health status questionnaire) and SAT‐P (a satisfaction profile).

Physical and emotional symptom burden of patients with end-stage heart failure: What to measure, how and why

Objective Much of our understanding about symptom burden near the end of life is based on studies of cancer patients. The aim of this study was to explore physical and emotional symptom experience among end-stage chronic heart failure patients, looking for those symptoms mostly related to their global health status. Methods Forty-six patients with end-stage heart failure compiled the following: Edmonton Symptom Assessment Scale (ESAS) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Results End-stage heart failure patients have many complaints and poor global health status. The most distressing symptoms reported were general discomfort and tiredness followed by anorexia and dyspnea. The KCCQ summary scores were highly correlated with ESAS (r = −0.78; P = 0.0001). Among the domains explored by the KCCQ, social functioning and self-efficacy showed the lowest correlation coefficients with ESAS (r = −0.50; P = 0.001 and r = −0.31; P = 0.003, respectively); concerning the physical limitation domain, the symptom score and the quality-of-life domain, the correlation coefficients were as follows: r = −0.71 (P = 0.0001), r = −0.75 (P = 0.0001) and r = −0.74 (P = 0.0001), respectively. In the multiple regression analysis of ESAS and KCCQ scores, general discomfort, depression and anxiety were the symptoms that mostly related with the results in the domains explored by the KCCQ. No independent predictor was found among symptoms and quality of life. Conclusion General discomfort together with depression and anxiety were the symptoms that were mostly related with the physical limitation domain of global health status, but did not influence the social functioning and the self-efficacy domains. When ESAS is used together with KCCQ, comprehensive and quantitative information on a patients physical, emotional and social distress is provided.

Satisfaction profile (SAT-P) in 732 patients: Focus on subjectivity in hrqol assessment

Abstract A 32-item questionnaire aimed at assessing patients satisfaction about every day life is presented. In the Satisfaction Profile (SAT-P) patients are asked to evaluate their own satisfaction level on 32 daily life aspects concerning the last month. 732 participants were enrolled into the study: 490 in-patients suffering from different types of chronic diseases (e.g., chronic heart failure, severe respiratory failure, coronary heart disease) and 242 healthy persons of working age. SAT-P validity was confirmed by comparing its scores with the NHP, EPQ and STAI-X2 scores. The factor analysis extracted 5 factors which corresponded to the hypothesised areas (54% of variance explained). Test-retest reliability and internal consistency were confirmed: Pearsons coefficients were ranging from 0.45 to 0.93 and Cronbachs alpha coefficient was 0.92. SAT-P responsiveness, evaluated by comparing baseline and 6 months follow up scores from 45 chronic heart failure patients, resulted to be satisfatory, although further studies are needed. These results, together with the “user-friendly” structure, the brief administration and scoring time, the simple graphic representation, suggest to consider the SAT-P a useful complementary tool in HRQoL assessment. The Italian, English and French versions are available.

Disexecutive functions and depression in patients with Parkinson disease: the impact on rehabilitation outcome.

BackgroundStudies relating to patients with Parkinson disease that assess neuropsychologic, psychologic, and clinical aspects are very uncommon. ObjectiveThe aim of this study was to analyze the impact of executive functioning (impaired vs. not impaired) or depression (depressed vs. nondepressed) on the outcome of rehabilitation treatment in patients with Parkinson disease without dementia at the medium stage of disease. MethodsForty consecutive inpatients affected by Parkinson disease were psychologically and neuropsychologically assessed by means of standardized tests during the first week of admission and at discharge after undergoing an intensive rehabilitation training. ResultsAt baseline, the patients (mean [SD] age, 70.1 [8.0]; Mini–Mental State Examination [MMSE], ≥24) showed impairment in the following executive functions: frontal functions (32.5%), selective and divided attention (55.0% and 41.9%, respectively), and word fluency (17.5%). Depressive symptoms reported using the Geriatric Depression Scale were distributed as follows: mild (n = 13), 32.5%; moderate (n = 4), 10.0%; and severe (n = 5), 12.5%. As for the outcome of the intensive rehabilitation treatment, a general improvement in the Unified Parkinson’s Disease Rating Scale, the Berg’s scale, the 6-min walking test, and the Timed Up and Go test was observed (P < 0.0001). The improvement was homogeneous for all groupings of the patients for all of the considered variables, indicating that the changes in performance as a result of treatment were unaffected by the presence of executive function deficits or moderate-to-severe depression. ConclusionsThe patients’ executive function impairment or moderate-to-severe depressive symptoms did not seem to interfere with the outcome of the intensive physical and occupational rehabilitation. Therefore, these aspects in patients without dementia should not be considered a contraindication to an intensive rehabilitation program. Furthermore, despite the presence of impaired executive functions and/or of depressive symptoms, the 4-wk multidisciplinary rehabilitation program resulted to be highly effective.

Prevalence of job-related distress and satisfaction in a nationwide cardiology setting: The IANUS - itAliaN cardiologists' Undetected distress Study.

Introduction and objectives Cardiologists’ work distress has been seldom studied. The ItAliaN cardiologists’ Undetected distress Study survey was designed to assess prevalence of work distress and satisfaction, and to gain insight into associations among these constructs and socio-demographics and job description. Methods We invited members of our national cardiological society (Associazione Nazionale Medici Cardiologi Ospedalieri) to participate in an anonymous, self-report, exclusively web-based survey, posted on the Associazione Nazionale Medici Cardiologi Ospedalieri website. ItAliaN cardiologists’ Undetected distress Study included socio-demographics, job description and a 15-item questionnaire on job-related distress and work satisfaction. Results Of 7393 invited cardiologists, 1064 completed the survey. Organizational problems and worries about medico-legal controversies were reported by 71% and 49% of participants, respectively; over one-third reported loss of enthusiasm, helplessness, work-life imbalance and lack of control over work. Conversely, 86% felt competent at work, 67% rewarded by the moral/human meaning of their work and 52% satisfied with their professional fulfilment. Factor analysis revealed a meaningful underlying structure including four factors: job strain, positive meaning, emotional fatigue and relational difficulties. Relational difficulties were more frequent in cardiologists working in primary-level than in secondary and tertiary care hospitals (P = 0.017 and P = 0.013, respectively). Interventional cardiologists reported higher positive meaning than those in the clinical inpatients area and outpatient diagnostic settings (P = 0.007 and P = 0.025, respectively) and lower emotional fatigue than subjects in the clinical inpatients area (P = 0.0005). Conclusion Cardiologists’ work distress should be interpreted integrating job-related negative aspects with a reappraisal of protective personal and relational resources, which should be fostered to promote physicians’ wellbeing at the individual, collective and organizational levels.

Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure

Background: Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data. Methods: One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value. Results: Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only Physical functioning (PF) was significantly reduced in the patients who died (p = 0.003). Using the best subset selection procedure, Resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75–0.98, p = 0.02). Conclusions: Patients’ dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.