An Italian Model for the Management of Cancer patients during COVID-19 pandemic: the Oncological Orientation region Center (COrO) of Taranto (ROP)

Objective: The recent outbreak of COVID-19 caused a limitation of the resources of the National Health System and the necessity to formulate novel practice recommendation for oncological care. To date there are not available any management guidelines for cancer patients in case of pandemic. Each center has tried to manage its own needs and requests independently, often reducing access to treatment and diagnostic exams to patients. Here we have described the management of cancer patients during COVID-19 infection with suggestions of some practical approaches applied by our Regional Center for Oncological Orientation (COrO) in S.G. Moscati Hospital (Taranto-Italy). Subjects and Methods: Our strategies were the minimization of interruption of cancer treatment through the extension of Taranto's Health Regional (CorO). The extension of oncological network, assisted by the General Management of Taranto ASL through agreements with private structures in Taranto 's area allowed cancer patients to receive up to 11 different types of services, according to their needs(first investigation or follow up)and representing an exclusive organization on the entire Italian territory. Results: Thanks to the organization of the COrO in 2020, 1406 first oncological visits and 566 preparatory treatments were carried out, 372 of exemption for oncological pathology (free health care) were activated, 1742 instrumental investigations and 7 cases of civil invalidity were performed(certificate of disability). Conclusions: We have overcome the barriers to care of oncology patients that has led to a total reduction of waiting lists representing a practical application model that can be extended in to other healthcare settings.

Should we use a patient’s port as the preferred intravenous route rather than inserting an additional venous access?

Early in 2021, the Infusion Nursing Society has released the latest version of the Infusion Therapy Standards of Practice. In the last two decades, these Standards have been representing one of the most important evidence-based documents available in the world of venous access. Nevertheless, we were quite concerned reading a recommendation included in chapter 26 (Vascular Access Device Planning: practice recommendation I, C): “Use a patient’s port, unless contraindicated (e.g. existing complication) as the preferred IV route in preference to insertion of an additional VAD.” Such recommendation is offered not on the basis of evidence, but as experts’ opinion (“Committee Consensus”). This Editorial deals with the opinion of GAVeCeLT (The Italian Study Group for Long Term Central Venous Access) that strongly discourage the use of ports for intravenous treatment different from chemotherapy (or from the therapy that specifically required that long term, infrequent access). The rationale for this choice is based on the consideration that the patient’s port—if used in a non-specialty ward—would be at high risk of complications, some of them potentially leading to the loss of the device, and that such complications might be particularly difficult to manage in this setting. The continuous or frequent use of a port transforms it into an external device, thus cancelling the main advantage of a totally subcutaneous location, while adding a significant disadvantage (need for repeated percutaneous punctures and risk of extravasation/infiltration due to improper insertion or dislocation of the non-coring needle). One exception is the possible use of port for radio-diagnostic purposes (as long as the port is power injectable). This strategy may be associated with advantages for the patient, and imaging quality improvement, but requires the adoption of specific protocols for prevention of infective and mechanical complications.

Reducing Fall Among Acute Rehabilitation Patients Through Implementation of a Video Monitoring System

Practice Problem: Falls are a significant healthcare issue that leads to substantial patient suffering and exorbitant health care expense. The Centers for Medicare and Medicaid Services (CMS) identify falls as preventable and not eligible for reimbursement. PICOT: The PICOT question that guided this project was: for acute rehabilitation inpatients (P), will the continuous use of video monitoring (VM) (I) compared to using bed alarms (C), decrease the fall rate by 10% (O) within six weeks of implementation (T)? Evidence: The practice recommendation for using a VM system as a primary intervention or part of a multifactorial comprehensive fall prevention strategy was recommended in the literature to improve patient safety and outcomes. Intervention: VM surveillance was used to decrease the prevalence of falls in moderate to high fall risk traumatic brain injury (TBI) patients on a rehabilitation unit. VM technicians verbally refocused patients and quickly alerted staff to potential falls. Outcome: The intervention achieved a 49% reduction in the hospital fall rate per 1,000 patient days, 65% in the rehabilitation fall rate per 1,000 patient days, 100% reduction in the TBI fall rate per 1,000 patient days, and a 30% reduction in cost for 1:1 sitter. Conclusion: This clinical project demonstrated support for the use of live VM surveillance to decrease fall rates on a TBI unit. As a result, this evidence-based project (EBP) project was recognized as improving the organization's clinical care.

Modern Approach in Radiological Diagnosis of Prostate Cancer (Systematic Review of International Clinical Guidelines and Clinical Studies Over 2014–2020)

An increase in the level of prostate-specific antigen requires additional examination of the patient in order not to subject him to unnecessary treatment in case of clinically insignificant prostate cancer and, conversely, to carry out the necessary volume of measures in case of clinically significant prostate cancer. The paper presents the modern solutions for effective usage of diagnostic methods in visualization of clinically significant prostate cancer. To assess the advantages and disadvantages of various methods for diagnosing prostate cancer a search of publications for 2014–2020 period was conducted based on the Scopus, Web of Science, PubMed databases. The request included keywords: prostate cancer, multiparametric MRI, multiparametric ultrasound, PSMA PET/CT. We selected 27 articles. The review includes guidelines from the European Association of Urology, the American Urological Society, the American College of Radiology, and one practice recommendation.

The Use of Nonspeech Oral Motor Exercises in the Treatment of Children With Cleft Palate: A Re-Examination of Available Evidence

Purpose The purpose of this tutorial is to re-examine the current literature on nonspeech oral motor exercise (NSOME) in general and its use in the treatment of children with cleft palate specifically and provide a best practice recommendation. Method The Population Intervention Comparison Outcome process was used to investigate the clinical question. This systematic framework identifies the clinical population, evaluates the intervention(s) applied to the population, assesses the results of interventions, and delineates the outcome. A literature search, which examined developmental research, applied clinical research, and systematic treatment reviews, was conducted for this purpose. Results The literature reviewed herein suggests that, on a number of different levels, the implementation of NSOME s does not result in positive communication outcomes for children with cleft palate who present with velopharyngeal dysfunction or compensatory speech errors. Conclusion Based on the current review, there is no empirical support for the use of NSOME as a direct or adjunct treatment for velopharyngeal dysfunction or compensatory speech errors. Appropriate treatments for these communication disorders include surgical, dental, and speech-based interventions.