ABSTRACT
This period of pandemic has had important consequences on the flow and the entire organization of any hospital. In particular, the number of accesses to the emergency room has increased, with the consequent urgent need to reorgani ze it quickly. The model proposed in this paper allows to respond to these needs by freeing not only shifts of nursing staff but also surgical staff. This workforce can then be relocated in the emergency room or of the intensive care unit who are in fact at the forefront of emergency management. The aim of this study conducted by the authors is to analyze, inside the context of a midsize Italian hospital, the actual organization model, and then to approach it by Business Process Reengineering (BPR) methodology with the goal to propose a KPI management system that evaluates the efficiency of the whole surgical path. The second objective of the study is to verify if the Operating Rooms (ORs) are properly sized to cover the surgical workload or if it would be necessary to build new ORs (answer to this question is the project mandate by Surgical Wards Chiefs). The last objective is to implement a flexible to cope with emergency situations such as a pandemic. The main result is the approximate maintenance of surgical annual activity (8169 vs 7889). The fewer resources required can be reallocated to deal with emergencies such as the current COVID-19 pandemic. In fact, the surgical shifts decreased during the test case from 464 versus 365 (-15,32%). The rooms’ utilization coefficient rose from 41% to over 52%, whereas the surgeons’ utilization coefficient rose to 61% (with values over 68% for parallel shifts). The results achieved demonstrate that improving efficiency of surgical processes is feasible and a systematic approach allows to respond to new global health challenges. © 2022, AIDI - Italian Association of Industrial Operations Professors. All rights reserved.
ABSTRACT
Background: The prevalence of moderate or severe emotional distress in cancer patients ranges from 30 to 45%. There is evidence that distress and depression can impair the immune system's response to vaccines, and this effect may be greatest in vulnerable groups such as cancer patients. We have previously shown that chemotherapy, targeted therapy, hormone therapy, lymphocyte count < 1x109/L and increasing age predicted poor antibody response at 6 weeks (Buttiron Webber T. et al, Eur J Cancer. 2021). Here we assessed the effect of psychological distress on the antibody response at 6 months after two doses of vaccine. Material (patients) and methods: Before the first dose of vaccine, after 42 days and at six months the clinical research nurse administered the Distress Thermometer questionnaire to the participants. The main outcome measure was the antibody response at 6 months. Multivariable logistic and linear mixed-effects models for repeatedmeasures analysis were applied adjusting for possible confounding variables. Result(s): Between March and July 2021, 320 subjects were recruited, and 290 were assessable both for distress and antibody response at 6 months. Main patient characteristics were the following: median age 68.2, female 59%, stage IV 59%, no treatment 22%, chemo 39%, hormone 24%, target or immuno 15%. At baseline, high distress (5+) was present in 26% of subjects, with a higher rate in women vs men (34.4% vs 23.8%, p=0.08). Women with the highest educational level (degree) were significantly more distressed during time (p=0.04). Younger age predicted a higher risk of elevated distress in terms of personal relationships (p=0.004) and practical problems (p=0.01). The percentage of non-responders at 6 months was 10.1% in patients with low distress vs 20.6% in those with high distress (Odds Ratio [OR]=2.5;95% Confidence Interval [CI] 1.1-5.8, p=0.04). Also advanced stage and increasing age significantly predicted a poor seroconversion. High distress at baseline was also associated with lower CRP response, a marker of vaccine response (p=0.003). Depression was also associated with lower antibody response at 6 months (p=0.003). Conclusion(s): Distress and depression are important predictor of poor seroconversion to SARS-CoV-2 vaccine. These findings indicate the need for a multidisciplinary approach with the contribution of a psycho-oncologist to manage psychological disorders in cancer patients and further studies by the clinical research nurse.
ABSTRACT
Background: mRNA-based vaccines have shown 95% protection from SARS-COV-2 disease in healthy populations. Initial findings in cancer patients suggest a lower seroconversion and greater toxicity possibly related to myelo-immunosuppressive therapies. Material and methods: We conducted a prospective study to assess factors predicting poor seroconversion and adverse events following immunization (AEFI) to the BNT162b2 vaccine in cancer patients on active treatment. Blood samples were collected by the research nurse for serum IgG, C-Reactive Protein (CRP), blood cell count, D-dimer and cytokine panel measurement at baseline first dose (visit 1), second dose at 21 days (visit 2), after 42 days (visit 3) and after 6 months (visit 4). At visit 1, 3 and 4 all participants will receive questionnaires about their psychological status: Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer. The primary endpoint was poor seroconversion (IgG<25 AU/mL) after 21 days from second dose. Patients who ended treatment >6 months on active surveillance served as controls. Multivariable logistic model and mixed effect models for repeated measures investigated independent factors associated with poor seroconversion and AEFI, adjusting for confounders. Results: Between March 15 and July 21, 2021, 320 subjects were recruited and 291 were assessable for IgG response. The lack of seroconversion at 42 days was 1.6% (95% CI, 0.4-8.7) on active surveillance, 13.9% (8.2-21.6) on chemotherapy, 1.4% (5.1-21.3) on hormone therapy, 21.7% (7.5-43.7) on biological therapy and 4.8% (0.12- 23.8) on immunotherapy. Compared to controls, risk of no IgG response was greater for chemotherapy (P=0.023), biological therapy (0.009) and hormonotherapy (P=0.052). Older age and advanced stage also predicted poor seroconversion. Overall, 43 patients (14.8%) complained of AEFI, mostly of mild grade. Risk of AEFI was greater in females (P=0.001) and younger patients (P=0.009). There was a trend to a D-dimer increase in IgG responders (p=0.01). Conclusions: Except for immunotherapy, chemotherapy, biological therapy and hormone therapy as well as increasing age and advanced stage predict poor seroconversion after two doses of BNT162b2 in up to 20% of patients, indicating the need for a booster dose and long-term serological testing in vaccine non-responders. AEFI occur much more frequently in women and younger subjects who may benefit from preventive medications.
ABSTRACT
Background: Recent studies show that patients with cancer are more exposed to a greater risk of Covid-19 infection, developing more severe symptoms and higher risk of death. The fear and risks include a source of stress for patients who have to go to the hospital for treatment. To meet their needs, we designed the Home Se-Cure project which aims to guarantee patients the continuity of oral, intramuscular and subcutaneous cancer therapies, delivering treatment at home. Materials and methods: The project will include patients aged> 65 years, fragile patients with ECOG 2-3-4, living in the neighboring areas of the hospital. We hypothesized to perform about 8 intervention per day. The interventions will include blood sampling, oral, intramuscular and subcutaneous therapies. The activity will be carried out during working hours, from 7.30 to 11 for two days a week. Nurses and oncologists will select the patients who will be contacted by phone to schedule the appointment. The oncologist prescribes and documents the blood tests and / or home cancer therapy to be delivered to the patient. The nurse picks up the drugs at the hospital pharmacy and goes to the patient's home equipped with the required PPE. Therapy can only be taken after confirmation by telephone from the nurse and doctor based on the result of the blood tests. A customer satisfaction questionnaire will be administered to patients and will be compared with those who refuse this service or cannot access it because of geographical reasons. Results: We expect our results to bring: reduce patient travel, ensure continuity of therapy, avoid gatherings at the day hospital. Guarantee the safety of fragile patients by respecting the ministerial recommendations. Avoid the stress related to the dilemma to perform the therapies Vs risk of contagion. Reduce access to the Emergency Room through early recognition of toxicity and non-compliant blood values. Conclusions: By accomplishing these results we would should achieve a better organization of the work, a reduction of the clinical risk, an improvement of the quality of care and a greater working well-being of the staff.