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Aim The primary aim of the study was to describe the perioperative care ensured on a daily basis to prevent surgical site infection in Italian neurosurgeries; the secondary aim was to explore surgical site infections 30 days after the surgical procedures. Methods Patients cared for in 16 neurosurgical units who (a) were ≥18 years of age, (b) underwent neurosurgical procedures, and (c) were willing to participate in the study were taken into account. Results A total of 383 patients were included. A preoperative shower was performed in 332 cases (86.7%), shaving in 318 (83%) cases, and antibiotic prophylaxis was administered in 293 (76.5%) cases. Surgical site disinfection was performed mainly with povidone–iodine (344; 89.8%). A surgical site dressing was applied in 376 (98.2%) cases and was changed on average after 37.8h for shaved and 39h for non-shaved patients. Postoperative shampooing was performed only in 74 (19.3%) cases. Surgical site infection at 30 days occurred in three (0.8%) patients. Discussion and conclusions: Perioperative care aimed at preventing surgical site infections is variable across Italian neurosurgical units. More studies aimed at developing evidence capable of supporting decision-making processes in neurosurgery care are strongly recommended.

Purpose To explore the emotional concerns and coping strategies of patients with Low Grade Glioma (LGG) and whether or not their caregivers are reliable in reporting these concerns as surrogate informants. Methods An explorative cross-sectional study. Patients who had undergone a neurosurgical procedure at least one year before this study for LGG and who were capable of participating in a face-to-face interview were included. Each patient nominated a reference caregiver. Both the patient and the caregiver were interviewed independently, using the Beck Depression Inventory Scale, the State – Trait Anxiety Inventory, and the Jalowiec Coping Scale. Main results Forty-six patients and 46 caregivers were included. The average scores of the Beck scale were homogeneous between patients and caregivers (7.76 [CI 95% 5.76–9.75] vs. 6.23 [CI 95% 4.57–7.90]; p = 0.102). Patients reported significantly greater state and trait anxiety (44.26 [CI 95% 40.21–48.31] and 37.95 [CI 95% 34.97–40.94]), respectively compared to their caregivers (40.28 [CI 95% 36.64–43.91] and 35.17 [CI 95% 32.16–38.18]). The coping strategies enacted were homogeneous between patients and caregivers (82.78 [CI 95% 77.21–88.35] vs (80.93 [CI 95% 76.32–85.55]; p = 0.102) while the kind of strategies adopted were significantly diverse. Conclusions Patients suffer from depression and greater state anxiety as compared to trait anxiety; moreover, they enact less than half of the available coping strategies. Caregivers may be involved as surrogate informants when necessary for health-care professionals to detect depression while more caution is advised for what concerns anxiety and the coping strategies enacted by patients.

Background Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning. Objectives The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts. Design An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015. Setting Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved. Participants First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed. Methods First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis. Results Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p = 0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a “time potentially capable of generating clinical learning”: learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff. Conclusions Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks.

Purpose Although the profile of the problems and risks associated with cancer patients has expanded over the past few years, and so has our available knowledge on the concordance between patients and nurses, there is a lack of evidence concerning neurosurgical patients. In comparison with patients who have neoplasm located in other lobes, those with frontal lobe cancer can suffer from personality changes, disinhibition, apathy, and higher-order attentional difficulties. Such behavior may give rise to a stigma, and consequently, pose a risk to have their problems misunderstood by caregivers, and be at greater risk than they are perceived to be. Objective To explore the risk of nurses underestimating the problems of patients who were operated on for frontal neoplasm, compared to patients suffering from neoplasms located in other cerebral lobes. Methods A prospective study was undertaken in 2008 in Italy. Patients admitted to the hospital with brain neoplasm were eligible for the study. For each patient with a frontal lobe neoplasm, a corresponding patient with a cerebral neoplasm located in either the temporal, parietal or occipital lobes was also included. Nurses working in the units involved and providing care to these patients were also included. On the afternoon of the 2nd postoperative day, the researcher interviewed both the patients, and the registered nurses (RNs) responsible for the patients' care, in regards to pain intensity, dependence in activities of daily living, anxiety and depression, and fear of falling, as each was perceived by patients and nurses. The level of concordance between the patients' and nurses' responses was calculated. Results Forty-six patients were considered (mean age 53.5 years); 23 had surgery for a frontal brain neoplasm and 23 for brain neoplasms located in either the temporal, parietal, or occipital areas. Overall, patients operated on for frontal lobe neoplasms had much of the same risks of underestimation of their problems, as patients with other cerebral neoplasms. Conclusions Patients with frontal lobe neoplasms seemed, overall, to run the same risk of their problems being underestimated as patients with cerebral neoplasms located at other sites. Neurosurgical nurses tended to overestimate patients' problems, particularly in cases with neoplasms not located in the frontal lobe. This unexpected finding needs to be addressed with further research, and might warrant a different approach to caring for patients with frontal lobe neoplasms, whose problems are overestimated less, so that they might receive less supportive care.

Neurosurgical site infections are an important issue. Among the acknowledged preventive tactics, the non-shaving technique is well established in the neurosurgical setting. However, given that patient's hair around the surgical site may retain biologic material that emerges during the surgical procedure or that may simply become dirty, which may increase the risk of surgical site infections, if and when shampooing should be offered remains under debate.A pilot experimental study was undertaken from 2011 to 2012. A series of neurosurgical patients not affected by conditions that would increase the risk of post-operative infection were assigned randomly to the exposed group (receiving shampoo 72 h after surgical procedure) or control group (receiving standard dressing surveillance without shampooing). Comfort, surgical site contamination (measured as the number of colony-forming units [CFU]), and SSIs at 30 d after surgery were the main study outcomes.A total of 53 patients were included: 25 (47.2%) received a shampoo after 72 h whereas 28 (52.8%) received standard care. Patients who received a shampoo reported a similar level of comfort (average=8.04; standard deviation [SD] 1.05) compared with those receiving standard care (average 7.3; SD 3.2) although this was not statistically significant (p=0.345). No statistically significant difference emerged in the occurrence of surgical site contamination between the groups, and no SSIs were detected within 30 d.In our pilot study, the results of which are not generalizable because of the limited sample of patients involved, a gentle shampoo offered 72 h after the surgical procedure did not increase the SSIs occurrence or the contamination of the surgical site, although it may increase the perception of comfort by patients. Further studies are strongly recommended involving a larger sample size and designed to include more diversified neurosurgical patients undergoing surgical procedures in different centers.

Objective The aim of this work is to provide an in-depth investigation of the impact of low-grade gliomas (LGG) and their surgery on patients' cognitive and emotional functioning and well-being, carried out via a comprehensive and multiple-measure psychological and neuropsychological assessment. Patients and Methods Fifty surgically treated patients with LGG were evaluated 40 months after surgery on their functioning over 6 different cognitive domains, 3 core affective/emotional aspects, and 3 different psychological well-being measures to obtain a clearer picture of the long-term impact of illness and surgery on their psychological and relational world. Close relatives were also involved to obtain an independent measure of the psychological dimensions investigated. Results Cognitive status was satisfactory, with only mild short-term memory difficulties. The affective and well-being profile was characterized by mild signs of depression, good satisfaction with life and psychological well-being, and good personality development, with patients perceiving themselves as stronger and better persons after illness. However, patients showed higher emotional reactivity, and psychological well-being measures were negatively affected by epileptic burden. Well-being was related to positive affective/emotional functioning and unrelated to cognitive functioning. Good agreement between patients and relatives was found. Conclusions In the long-term, patients operated on for LGG showed good cognitive functioning, with no significant long-term cognitive sequelae for the extensive surgical approach. Psychologically, patients appear to experience a deep psychological change and maturation, closely resembling that of so-called posttraumatic growth, which, to our knowledge, is for the first time described and quantified in patients with LGG.

The main aims of this study were to evaluate the intensity of stress, anxiety and depression as well as the effectiveness of coping strategies adopted pre-operatively in brain neoplasm patients. A descriptive-explorative study design was undertaken. During 2008, patients admitted to a large Italian hospital neurosurgical unit with their first (n = 21) or recurrent (n = 15) brain neoplasm, on the day before their surgical procedure, were consecutively recruited into the study. The Perceived Stress Scale, the Hospital Anxiety and Depression Scale and the Jalowiec Coping Scale were administered via face-to-face interview. Patients with their first occurrence of neoplasm perceived the same stress intensity as those with recurrent neoplasm (mean ± standard deviation: 14.9 ± 6.7 versus 17.2 ± 8.8, p = 0.36). They also reported the same likelihood of anxiety at a borderline level (odds ratio (OR) 4.88, 95%CI 0.42 to 40.97, p = 0.06) and at a clinically relevant level (OR 0.32, 95%CI 0.01 to 5.37, p = 0.35) as well as the same likelihood of depression at a borderline level (OR 1.25, 95%CI 0.20 to 8.40, p = 0.78). Only one case of clinically relevant depression emerged among patients at their first diagnosis. Patients at their first occurrence, as well as those at recurrence, reported that they adopted optimistic coping strategies (mean 2.20, 95%CI 2.01 to 2.38 versus mean 1.96, 95%CI 1.71 to 2.20) and sought support (mean 1.81, 95%CI 1.58 to 2.05 versus mean 1.89, 95%CI 1.63 to 2.15). According to the findings of this exploratory study, on the pre-operative day, brain neoplasm patients at their first diagnosis and at recurrence wish to confront the situation: they adopt optimistic coping strategies, they seek support and they wish to take a constructive problem-solving approach. Knowledge of the intensity of stress, anxiety and depression as well as the coping strategies adopted by the patients is important for clinicians in their efforts to tailor care to patients' individual needs.