Doctor@Home: Through a Telemedicine Co-production and Co-learning Journey

Telemedicine and remote visits are becoming more and more popular in several medical disciplines, including oncology. The Covid-19 pandemic has enhanced the need to continue to meet patients’ ambulatory care necessities ensuring social distancing and limiting the access to clinical facilities. The National Cancer Institute of Aviano, Italy, has recently launched a program called “Doctor @ Home” (D@H). The pillars of the program are the co-production of the oncological care and the co-learning approach, which sees the clinical staff “hand in hand” with patients to maximize the outcome of the care, trying to take advantage of the new tools offered by modern technologies

Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training

Introduction: The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT. Materials and Methods: Search keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women. Results: Regarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect. Conclusions: Gynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management

Cancer Rehabilitation and Physical Activity: the “Oncology in Motion” Project

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Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with se-vere risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strat-egies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescrip-tion practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated question-naires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background: Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods: The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results: Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions: Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence: Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

Knowledge translation in the medical field among different stakeholders. A case study in oncology

Introduction. Knowledge Translation (KT) is defined as the synthesis, exchange and application of knowledge to foster the benefits of global and local innovation. In healthcare and medicine, KT is an increasingly relevant topic, as recognized by the growing number of publications. While the traditional definition of KT recalls the need to translate scientific research into clinical practice, other types of KT emerge. More in details, they concern the interaction of actors with different skills and feelings, who find themselves working together to achieve a common outcome. The paper aims to understand the dynamics and tools of KT by analyzing the case of an Italian Breast Unit. Materials and methods. The paper uses a methodology based on a case study relating to the IRCCS CRO - National Care Institute Center for Oncological Reference of Aviano. Multiple information sources are used to collect, triangulate, and verify data. Results. The analysis allows to divide the stakeholders into two groups: a first professional or internal group, characterized by a common healthcare background, and a second non-professional or external group, which gathers actors with various skills, needs, and feelings. The two groups use profoundly different tools and methodologies to translate knowledge effectively. Discussion. While the first group translates knowledge internally using more explicit tooles, and benefits from the team’s durability, the second group needs more creative methodologies, many of which are based on language and interpersonal skills. The temporary nature of relations with the BU of this latter group requires the use of always different and innovative tools

Patient engagement in rehabilitation path after breast cancer surgery: Costs impact. State-of-the-art and new perspectives

Introduction. The Italian Association of Medical Oncology (AIOM) and the Italian Association of Cancer Registers (AIRTUM) highlight that one out of three women experiences cancer in the course of her life. In 2018, excluding skin cancers, breast cancer accounted for 14.1% of total cancers, confirming it as the most diagnosed cancer among women (29.3%). In the postoperative stage, patients suffer side effects. They need immediate and active rehabilitation to encourage their return to work as well as the psychological recovery. The effectiveness and speed of this recovery, therefore, have significant impact in the short and long term, also for the society. The rehabilitative oncology path increases its positive effects if carried out through co-productive pathways. The economic impact of this process is unclear. Materials and methods. An exhaustive literature search was performed to shed light on state of the art about the patients’ engagement during the rehabilitation path after breast cancer surgery, focusing on the literature analyzing the impact that co-productive processes can have on costs. Eligibility criteria: papers and reviews published in English and Italian were searched in Scopus and PubMed/Medline, among other datasets. Inclusion criteria: dealing with economic effects resulting from patient engagement or following post-breast cancer oncology rehabilitation. Results. 24 papers have been selected. The review of the literature has revealed a lack of contributions on the economic impact of the patient engagement in the oncological rehabilitation path, taking into account the impact on costs, but not developing a more detailed study. The back-to-work issue and psychological effects are widely investigated. No studies have been conducted in Italy. Discussion. The analyzed literature did not identify the economic impact that patients’ engagement may have during rehabilitation, opening up new research questions. Co-production processes are starting to develop

Covid-19 and front-line nurses' mental health: a literature review

OBIETTIVO: La pandemia da Coronavirus (Covid-19) ha causato una grave crisi sanitaria che ha coinvolto milioni di persone e messo in quarantena metà della popolazione mondiale. L'emergenza sanitaria da Covid-19 ha visto gli operatori sanitari in prima linea affrontare tutte le difficoltà legate all'onere della cura e alla riorganizzazione delle procedure, ruoli, e strumenti a livello ospedaliero. Uno degli aspetti più significativi e probabilmente sottovalutati è lo stress psicologico del personale infermieristico in prima linea. L'obiettivo dell’articolo è quello di analizzare la letteratura relativa all’impatto sulla salute mentale del personale infermieristico impegnato nella gestione e cura di pazienti affetti da Covid-19. METODI: È stata condotta una revisione sistematica degli articoli pubblicati sull'argomento da gennaio 2020 a novembre 2020. La ricerca degli articoli è stata condotta sui database scientifici Pub Med, Scopus e Embase. RISULTATI: I risultati mostrano l’insorgenza nel personale sanitario di ansia, depressione e stress e insonnia. Tali aspetti risultano strettamente correlati a numerosi fattori, tra cui la paura di contrarre la malattia e di trasmetterla alle famiglie, turni stressanti e poco riposo, portando ad uno stato di tensione psicologica e fisica in grado di attivare comportamenti patologici. La letteratura evidenzia l’importanza di interventi di sostegno al personale in prima linea al fine di evitare l'insorgere di gravi problemi di natura psico-patofisica. CONCLUSIONE: La revisione condotta suggerisce come gli infermieri in prima linea durante la fase di emergenza di Covid-19 possano essere soggetti a disturbi psicologici in grado di compromettere la salute mentale. Pertanto, la sorveglianza e il monitoraggio dei sintomi, congiuntamente a mirati interventi di sostegno, dovrebbero essere garantiti quotidianamente a tutti i professionisti coinvolti ai fine di prevenire l'insorgenza di disturbi psicologici.INTRODUCTION: The Coronavirus (Covid-19) pandemic caused a severe health crisis that has affected millions of people and quarantined half of the world's population. The health emergency from Covid-19 has seen health workers on the front line face all the difficulties related to the burden of care and the reorganization of procedures, roles, and tools at the hospital level. One of the most significant and probably underestimated aspects is the psychological stress of frontline nurses. The article aims to analyze the literature relating to the impact on the mental health of nurses engaged in the management and care of Covid-19 patients. METHODS: A systematic review of the published articles on the subject was conducted from January 2020 to November 2020. The search for papers was conducted on scientific databases like PubMed, Scopus and Embase. RESULTS: The results show the onset of anxiety, depression and stress and insomnia in healthcare workers. These aspects are closely related to numerous factors, including the fear of contracting the disease and infecting family members, stressful shifts and little rest, leading to a state of psychological and physical tension capable of activating pathological behaviours. The literature highlights the importance of support interventions for frontline personnel to avoid the onset of psycho-pathophysical severe problems. CONCLUSION: The review suggests that frontline nurses during the emergency phase of Covid- 19 may be prone to psychological disorders that can compromise mental health. Therefore, the surveillance and monitoring of symptoms, together with targeted support interventions, should be guaranteed daily to all professionals involved to prevent the onset of psychological disorders