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Background: Reliable venous access device(VAD) is essential in providing effective care for many cancer patients. VAD are placed by a specialized team using ultrasound guidance in a dedicated room of the hospital, however, during the pandemic COVID-19, many not autonomous or bedridden cancer patients were unable to reach the hospital for VAD insertion, due to unavailability of ambulance for the transport. For this reason the specialized team organized a modality of positioning VAD at patients' homes. Material (patients) and methods: In January 2012, a VADs-team was established by the health authority in the oncology-hematology department at the hospital of Piacenza, it initially served the care of cancer patients in the oncology and hematology department of the Piacenza hospital;subsequently, during the COVID-19 pandemic, the team was able to reach patients at home to positioning VAD for people unable to go to the hospital. The positioning of the VAD was performed under ultrasound guidance, according to the same modalities used in the hospital. In the present study we retrospectively analyzed data of patient who positioned a VAD. Result(s): Between March 2020 to December 2020 and January 2021 to December 2021, VADs were positioned in 28 and 31 cancer patients respectively, in both groups there were patients with advanced cancer. The VAD utilized was the Midline for each patients. The mean age of the patients was 88 years, the majority were female (>60%). VADs allowed the planned treatment in 94% of the patients. The complications were low: VAD dislocation (<1%), thrombosis (<2%). No infections were registered. Conclusion(s): During COVID-19 pandemic the VAD-team demonstrated the feasibility of VADs home positioning, in for cancer patients, subsequently, the VAD-team served also non-cancer patients who need home Vad positioning. The results of our study allowed this procedure to become routine practice for not autonomous or bedridden cancer patients with a need for VADs who are unable to reach the hospital for the insertion.
ABSTRACT
Background: Severe acute respiratory syndrome coronovirus- 2 (SARS-CoV-2) is the cause of the coronavirus disease 2019 (COVID-19) pandemic. Vaccination is considered the core approach to containing the pandemic, but differences in immunogenicity between mRNA SARSCoV- 2 vaccines have not been reported in patients with cancer. Material (patients) and methods: We conducted a retrospective monocentric study on oncological patients, treated at the Piacenza hospital, who received the BNT162b2 or mRNA-1273 SARS-CoV-2 vaccines. The aim was to investigate the humoral response determining IgG antibody levels against the SARS-CoV-2 receptor-binding domain developed according to the type of vaccine. To reduce the possibility of selection bias and make the baseline characteristics of the two groups more comparable we conducted propensity score matching (1:1 nearest-neighbor without replacement). Serum samples were evaluated for SARS-COV-2 antibodies prior vaccinations and 2-6 weeks after the administration of the second vaccine dose, data about age, gender, anticancer treatment, type and stage of cancer were collected. Result(s): Between 20 March 2021 and 12 June 2021, 293 consecutive patients with solid tumor underwent a program of COVID-19 vaccinations and 257 were evaluable;after propensity score matching 76 were included in each group. The IgG antibody levels were different among the two groups: median 319.5 AU/ml [IQR 76.15-401] mRNA- 1273 vs 53.55 AU/ml [IQR 5.83-152] BNT162b2, p<0.001. Conclusion(s): We found greater antibody response with the mRNA-1273 vaccine than the BNT162b2 vaccine in patients with cancer and the other factor that has the greatest impact on the intensity of the vaccine response, regardless of its type, was the active anticancer treatment. These two factors should be taken into consideration when choosing the type of vaccine and the timing of administration based on the oncologic-hematologic treatment.
ABSTRACT
Background: After Covid-19 emergency, operators always had to work with approved and safe Personal Protective Equipment (PPE) for patients and professionals, but which limited communication, the approach to assistance and the helping relationship. Those who practice professional health care practices as they are exposed to the suffering of others should be aware of the need for themselves to equip themselves adequately to face difficult situations through suitable narrative practices of selfcare. This study has a dual purpose: to investigate the experience of the health care personnel of the Piacenza's Oncology Department through narrative medicine following the use of PPE and to help operators become aware of it through creative writing. Material(s) and Method(s): We conducted a qualitative study, the data collection tool is creative writing, consisting of write unconditionally by first reading a preface consisting of sequential questions. The sample selection has been voluntary based subject to prior informed consent signature. 14 texts writed by nurses and oss were collected. The data analysis took place with analysis of the thematic content. Qualitative analysis involves the fragmentation of data into simpler units and the subsequent recomposition in new ways. Result(s): The results of creative writing were divided into four macrocodes: PPE Data Changes, Strategies, PPE Negative Side, PPE Positive Side, in turn divided into several microcodes. Emerge the difficulties of the health care personnel in using PPE in the care approach and the strategies that were introduced in the face of these difficulties. Conclusion(s): From the analysis emerged all the changes that the PPE have involved: the impossibility of approaching, seeing and touching each other, in particular not being able to show the face and to be recognized and to smile. Through examples of everyday life, the disadvantages of the use of PPE have been highlighted but at the same time it is evident that the use of protective devices has made it possible to re-elaborate the approach to the patient, reminding professionals of the need for empathy and listening, devising creative ways to deal with these difficulties such as the use of video calls, gazes. They noticed a greater humanization thanks to the use of PPE: less abrupt and frenetic ways have been introduced during the satisfaction of needs and a greater willingness to stay "here and now" in the care relationship to limit the shortcomings.
ABSTRACT
Background: Onco-haematological patients are considered a vulnerable group with early access to SARS-CoV-2 vaccination. The Onco-Hematological Department of Piacenza has activated a dedicated vaccination program, with appropriate timing. We selected patients on active injection therapy with extreme immune fragility or undergoing haematopoietic stem cell transplantation. The project has created a path for access to vaccination, with reservations on a dedicated agenda and departmental vaccination point, has allowed patients to be vaccinated before starting therapies, start a clinical study of immunological surveillance, feed a departmental database by recording the number of vaccinated patients and any adverse events, favor vaccination in a known, familiar, comfortable context. Materials and methods: The staff underwent training on the preparation, administration, registration of the vaccine, observation and management of any adverse events. On the basis of the identified criteria, the patients who had to carry out the vaccination were selected. The programming was carried out by the referring physician who delivered the informed consent and who checked the medical history. During the vaccination sessions, the patients were managed by the Department team who took care of all the planned vaccination phases. The data were recorded on a regional IT platform. Each vaccination session was coordinated by a nurse and a vaccinating doctor. Results: The vaccination sessions were organized from 20/03/2021 for a total of 13 vax days. 426 patients were vaccinated, 230 F (53.99%) and 196 M (46.01%), mean age 63.38 ± 11.35, range 20-86, of these 415 (97.42%) completed the two scheduled vaccination doses, 11 patients (2.58%) did not receive the second administration due to worsening of the clinical picture. To evaluate the perceived quality and make suggestions, 10 posts were published on the FB page, totaling 2217 likes, 93 comments and 97 shares. The comments were positive, in particular the family environment, the presence of the treating team and the adequate waiting times were appreciated. Conclusions: Experience has made it possible to vaccinate the category of vulnerable patients ensuring safety, appropriateness, effectiveness, efficiency, satisfaction and user loyalty, without delaying or interrumpting oncological treatment.
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Background: Cancer patients are presumed a frail group at high risk of contracting coronavirus disease (COVID- 19), and vaccination represents a cornerstone in addressing the COVID-19 pandemic. However, data on COVID-19 vaccination in cancer patients are fragmentary and poor. Material (patients) and methods: An observational study was conducted to evaluate the seropositivity rate and safety of a two-dose regimen of the BNT162b2 or mRNA-1273 vaccine in adult patients with solid cancer undergoing active anticancer treatment or whose treatment had been terminated within 6 months of the start of study. The control group was composed of healthy volunteers. Serum samples were evaluated for SARS-COV-2 antibodies prior vaccinations and 2-6 weeks after the administration of the second vaccine dose. Primary endpoint: seropositivity rate. Secondary endpoints: safety, factors influencing seroconversion, IgG titers of patients versus healthy volunteers, COVID-19 infection. Results: Between 20 March 2021 and 12 June 2021, 293 consecutive cancer patients with solid tumors underwent a program of COVID-19 vaccinations: of these, 2 patients refused vaccination, 13 did not receive the second dose of the vaccine due to cancer progression and 21 had COVID-19 antibodies at baseline and were excluded. The 257 evaluable patients had a median age of 65 years (range 28 - 86), 66.15% with metastatic disease. Primary endpoint: seropositivity rate in patients was 75.88%, versus 100% in the control group. Secondary endpoints: no grade 3 - 4 side effects, no COVID-19 infections were reported. Patients median IgG titer was significantly lower than in the control group, male sex and active anticancer therapy influenced negatively seroconversion. Conclusions: BNT162b2 or mRNA-1273 vaccines were immunogenic in cancer patients, showing good safety profile.
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Background: In Piacenza it all started on 21 February 2020.The local hospital that the gravity of the situation was perceived more clearly, and the actions that were needed to reorganise happened quickly. Among the various interventions that were rapidly approved, was the creation of a team capable of bringing care home to home. Case managers work to meet patient needs through assessment, coordination, and planning, and by evaluating the available. The nursing directors wanted the presence of a case manager within the team made up of the nursing coordinator and the medical manager. Materials and methods: The need to give quick answers to a tragic situation has highlighted how telephone contact can be used to integrate take-up interventions aimed at preventing hospitalizations and early treatment. The telephone is an important communication tool and can be used to provide information to the patient, to control it remotely, to prevent it from going to the clinic. In the period between 12 March and 30 April, 240 phone calls were made by the case manager in patients suffering from symptoms attributable to the covid who requested, leaving a message to a dedicated number, a service. Each visit was preceded by a phone call in which the case manager monitored with the aid of a specially designed card the comorbid symptoms, the presence of symptoms, the therapy taken. The telephone interview lasted an average 5 minutes. The completed forms were evaluated by the team that established the priority of access to the home based on the data collected. The evaluation was carried out by the team daily and determined the choice of patients to visit on the following day Home visits were 220 while 20 patients were managed with only telephone contact. It was 20 people who reported a temperature not exceeding 37.5 degrees and no other symptoms. These 20 patients were indicated the drug therapy to be taken by the team's medical contact and given as an indication if there was a worsening recall. For these 20 patients it was decided to make a follow-up call after 10 days. Results: 20 patients followed by telephone, 15 reported an improvement in symptoms, 5 had the need to be visited. Everyone reported feeling taken care of and reducing anxiety. Conclusions: The choice of the presence of the case manager allowed, through the intervention of the phone call, to reduce access to the emergency room and the visits n charge. No less important is the reduction of anxiety.
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Background: Italy has been one of the countries most affected by Covid-19 emergency, in particular Piacenza has reached the record for the number of victims caused by the virus and is still facing a copious number of infections. The healthcare staff of Piacenza Hospital faced this emergency demonstrating a strong spirit of adaptation, alleviating suffering, loneliness and leading many patients infected with the virus towards healing. Moral distress is a common reaction in morally difficult situations, and includes feelings of frustration and lack of power when healthcare professionals are prevented from acting in accordance with their values and ideals (Gustavsson et al, 2019). Morally demanding choices add a greater burden to working in an already stressful environment. The Covid-19 emergency as a pandemic can be considered a real catastrophe, characterized by health needs that exceed existing capacities and so often health professionals have had to make difficult decisions, quickly choose who to treat and how to use optimal limited resources available. The study aims to investigate the Moral Distress of oncologic operators of Piacenza Oncology during Covid-19 emergency period. Material and methods: We conducted an observational qualitative study, the data collection tool is a semi-structured interview, consisting of sequential and standardized questions. 26 operators were interviewed (8 doctors, 13 nurses and 5 OSS) who worked in the Medical Oncology Unit of Piacenza hospital during the emergency period. The data analysis took place with analysis of the thematic content. Qualitative analysis involves the fragmentation of data into simpler units and the subsequent recomposition in new ways. Results: The results of the interviews were divided into four macrocodes: Sensations associated with Moral Distress, Negative episodes, Changes, Positive episodes, in turn divided into several microcodes. The Moral Distress therefore emerges that this pandemic has evoked in operators despite their professionalism and preparation for end of life. Conclusions: Moral Distress is a usual condition for Oncology operators who are used to being in contact with suffering and death, caused by the high psychological and physical contact that is established with the sick person, but the results of our work highlighted how the pandemic has changed the care and perception of operators, intensifying this feeling of psychological imbalance.
ABSTRACT
Background: The U.O. of Oncology DH / DSA of the Piacenza Hospital provides life-saving and indifferent services that could not be postponed or suspended even during the maximum spread of Coronavirus infection in the city of Piacenza. In order to ensure continuity of care and containment of the transmission of infected cases between patients, visitors and health professionals, the organization of the service was planned and changed. Materials and methods: All patients were invited to wash their hands with hydroalcoholic gel, to wear the surgical mask and their temperature was detected. All patients were accepted after triage performed by a nurse who, through the use of a questionnaire, ascertained the health conditions, the geographical origin and epidemiological criteria at risk. Patients who tested positive for screening were isolated and managed in a specific area identified within the service and assisted by dedicated staff. Access was allowed only to the person who was to receive the service;the presence of Caregiver was allowed for people who are not independent, if linguisticcultural mediation was required or in specific cases agreed with the staff and the oncologist. The patient paths inside the structure ware redesigned in order to guarantee the safety distance required by current legislation and the ventilation of the locations. Patient appointments were spaced apart to avoid gatherings in common areas. The patients were instructed to contact their oncologist on the day before the appointment if they had symptoms such as dyspnea temperature, gastrointestinal symptoms, dysgeusia. The use of telephone conversation as a tool for active patient surveillance was implemented. All the processes for sanitizing environments, disinfecting surfaces, equipment and care devices ware revised. Specific procedures ware written for the wearing of operators and the use of DPI based on the risk of exposure to Covid19. Results: In the period from 21/02/2020 to 30/04/2020 there were 2935 DSA accesses with an average value of 60 daily accesses in five daily opening days of the service. During this period, 2 patients, during the first cancer visit were found positive post-nasopharyngeal swab, while no new infections were found in the patients already in charge. Conclusions: The reorganization of the service has made it possible to provide safe and secure care to cancer patients.