Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

School combo-desk comfort assessment: A method for weighing postural factors that affect the overall perceived comfort

BACKGROUND:In recent years, a growing interest in ergonomics and comfort perception in secondary schools and universities can be detected, to go beyond the UNI-EN regulations and understanding how practically improve students’ perceived comfort during lessons. OBJECTIVE:This study aimed to analyse the (dis)comfort perceived by students while sitting in a combo-desk during lessons; it proposed a method for understanding and weighing the influence of postural factors on overall (dis)comfort. METHODS:Twenty healthy students performed a random combination of three different tasks in two sessions - listening, reading on a tablet and writing. Subjective perceptions were investigated through questionnaires, in which the expected and the overall comfort were evaluated; postural angles were gathered by processing photos through Kinovea® software and were used for the virtual-postural analysis, using a DHM (Digital Human Modelling) software; statistical analysis was used to investigate the influence of subjective comfort of each body part on the overall perceived comfort. RESULTS:The statistical correlations were used to perform an optimization problem in order to create a general law to formulate the overall comfort function, for each task, as a weighted sum of the comfort perceived in each body part. The test procedure, additionally, evaluated the influence on comfort over time. The results showed how the upper back and the task-related upper limb are the most influencing factors in the overall comfort perception. CONCLUSIONS:The paper revealed a precise and straightforward analysis method that can be easily repeated for other design applications. Obtained results can suggest to designers easy solution to re-design the combo-desk

School combo-desk comfort assessment: a method for weighing postural factors that affect the overall perceived comfort while performing different activities

t In recent years, a growing interest in ergonomics and comfort perception in secondary schools and universities can be detected, with the aim of going beyond the UNI-EN regulations and understanding how practically improve students’ perceived comfort during lessons. The aim of this study was to analyse the discomfort perceived by students while sitting on combo-desk during lessons. A statistical sample of 20 healthy students performed a combination of three different tasks in two sessions - listening, reading on a tablet and writing - in a mixed sequence. Subjective perceptions were investigated through questionnaires, in which the expected comfort and the overall one were rated on a 10-point comfort scale and the perceived comfort on a 5-point Likert scale. Subject’s postures were acquired non-invasively using cameras; Kinovea® software was used to detect postural angles directly on pictures; the acquired angles were used for the virtual-postural analysis, using a DHM (Digital Human Modelling) software; CaMAN® software was used to obtain an objective measure of the postural comfort. Once correlations between subjective and objective data were calculated, the results of the analysis were used to define the influence of each body part comfort on the overall perceived comfort and to quantify the weight of each factor influencing the overall perception. Finally, some guidelines to modify the combodesk design, in order to increase the level of perceived comfort, were developed

Impact of Chronic Care Model determinants in multimorbid patients health plans: a systematic review

The co-occurrence of two or more chronic conditions within one person is continuously growing. Currently, healthcare is mostly characterized by fragmented interventions frequently addressing single chronic diseases. Chronic Care Model (CCM) is the forefather of disease management programs (DMPs) developed to deliver to chronic patients coordinated healthcare among several health services. A systematic review was carried out in order to evaluate the impact of Chronic Care Model determinants addressing patients with multiple chronic conditions. Methods The search was conducted by querying electronic databases and hand searching. Only studies concerning interventions belonging to structured health plan and addressing adults patients with long-term multiple chronic conditions were selected. Studies were divided in two groups depending on the inclusion of depression as comorbidity and in further subgroups according to the CCM dimensions interested. To describe the impact of CCM dimensions and to grade the strength of recommendations, the outcomes of the studies were grouped in macro-categories according to thematic topics. Results 12 studies (8 trials and 4 observational) out of 7807 were included. The total sample regarded 57713 subjects. Years of publication were comprised from 2002 to 2012. 8 studies were set in USA and 4 in Germany, The Netherlands, Finland and Canada. Interventions attributable to Delivery System Design (DSD) and Self Management Support (SMS) as CCM dimensions were represented in all the selected studies. A positive impact on outcomes was observed in the subgroup including DSD, SMS and Clinical Information System (CIS) addressing depression and in the subgroup not addressing depression but including all the six CCM dimensions. Conclusions Delivering coordinated interventions attributable to minimum three CCM dimensions (DSD, SMS, CIS) seem to have a positive impact on healthcare addressing multimorbid patients. Key messages Our research contributes to the debate on which healthcare interventions address multimorbid patients Health plans addressing multi-chronic patients include interventions attributable to Delivery System Design and Self Management Support as Chronic Care Model (CCM) dimension

SensApp:A FET-Open project for developing a supersensor able to detect Alzheimer's disease biomarkers in blood

The goal of the SensApp FET-Open project is to develop an innovative super-sensor that will be able to detect Alzheimer’s disease (AD) biomarkers (β-amyloid, Tau and pTAU) in peripheral blood. Considering that nowadays an accurate diagnosis of AD requires the highly invasive withdrawal and analysis of cerebrospinal fluid, SensApp will represent a breakthrough in the field of AD diagnosis thanks to the ability to detect the early stage of the disease by a simple blood collection. We call Droplet-Split-and-Stack (DSS) the new technology that will emerge from SensApp. The achievement of SensApp goal is enabled by the interdisciplinary cooperation between different research institutions and one company involved in the key fields of the project, Vrije Universiteit Brussels, VTT Technical Research Centre of Finland, University of Linz, Ginolis Ltd, IRCCS Centre “Bonino Pulejo”, under the coordination of CNR-Institute of Applied Sciences and Intelligent Systems. This communication will illustrate the progress of the activities

Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding