Asymmetric gap balancing improves knee kinematic following primary total knee arthroplasty.

PURPOSE: The purpose of this study was to demonstrate closer-to-normal knee kinematics following primary total knee arthroplasty (TKA) performed establishing asymmetric gap balancing intraoperatively. MATERIAL AND METHOD: Two age-, sex-, BMI-matched groups of patients underwent medially stabilized TKA because of isolated knee disease. Group A (12 patients) underwent "unrestricted" kinematic alignment (uKA) according to Howell while group B (15 patients) received robot-assisted "simplified" KA (sKA) with an alignment goal (Hip-Knee-Ankle axis-HKA) ± 5° respect to the mechanical axis. Intraoperatively, in group B, the flexion gap at 90° was first set at an average of 1.5 mm (0-5 mm; SD 4.4 mm) tighter in the medial compartment with respect to the lateral; in the same way, the extension gap was then set at an average of 2.0 mm (0-4.5 mm; SD 3.1 mm) tighter in the medial compartment with respect to the lateral. All patients, including a non-arthritic cohort (group C: 5 controls) underwent gait analysis using an instrumented treadmill (WalkerView-WV) equipped with an instrumented belt armed with a 3D video camera. The WV software evaluated multiple spatiotemporal and kinematic parameters, including: (1) contact time (s); (2) knee ROM during gait cycle; (3) step length percentage with respect to total gait (%) and pure step length (cm). Statistical analyses included t-Test and ANOVA and were conducted by using SPSS. RESULTS: At the final FU, significant differences were noted during gait between the two TKA groups (uKA-sKA) and the controls. Both TKA groups showed superior mean contact time on the surgical knee (uKA 1 s; sKA 0.97 s) as compared to the controls (0.72 s) (P = 0.002) while no differences were found between them (P = 0.11). TKA groups showed a lower, maximum ROM in the surgical knee (mean uKA 36º; mean sKA 49º) relative to the controls (mean 57º) (P < 0.05) but a statistical difference was found between them (P = 0.003). Both TKA groups showed a higher step length percentage with respect to the total gait and a shorter step length on the surgical side (uKA: mean 8.28% and mean step length 35.5 cm; sKA: mean 8.38% and mean step length 34.6 cm) in comparison to the controls (mean 3.38%; mean step length 71.4 cm) (P < 0.05) while no statistical differences were found between them. CONCLUSION: To our knowledge, this was the first study to exhibit the kinematic advantages of a slightly asymmetric gap balancing during KA TKA. Combining a medially-stabilized implant design and a surgical technique aiming to obtain a tighter medial compartment represents a promising approach to improve outcomes after TKA.

Sleep-disordered breathing and pregnancy outcomes: The impact of maternal oxygen saturation.

OBJECTIVE: To investigate pathological associations between sleep-disordered breathing (SDB) and pregnancy outcomes. METHODS: From May 2016 to September 2019, obese women during their uncomplicated singleton pregnancies underwent screening sleep questionnaires, oxygen saturation monitoring, and, in proper cases, complete overnight polysomnography. Their medical records were also recorded. RESULTS: In all, 112 pregnant women were included in the study cohort; 44 showed an oxygen desaturation index ≥10, and their newborns had a significantly higher rate of congenital abnormalities and respiratory distress syndrome compared with the women with normal pulse oximetry. Stepwise multivariate regression analysis showed that basal oxygen saturation was independently associated with the occurrence of fetal growth restriction. CONCLUSION: Among obese pregnant women, the rate of congenital abnormalities is higher in the ones with altered pulse oximetry. Maternal basal oxygen saturation in the first trimester of pregnancy predicts fetal growth restriction independently of maternal age, ethnicity, body mass index, gravidity, and hypertensive disorders of pregnancy.

Safety of COVID-19 Vaccine in Patients with Cancer in a High-Volume Comprehensive Cancer Center.

BACKGROUND: Few data are available on the safety of COVID-19 vaccines in cancer patients undergoing active cancer-directed treatment. PATIENTS AND METHODS: This case series analyzes outcomes in terms of adverse events in 5297 patients undergoing anti-cancer treatment who were vaccinated with anti-SARS-CoV-2 Pfizer-BioNTech vaccine at a single cancer center from March 6, 2021 to May 9, 2021. Adverse events were retrieved from the national Italian pharmacovigilance platform (http://www.vigicovid.it). RESULTS: Of the 5297 patients treated for either solid tumors (87%) or onco-hematologic malignancies (13%) who were vaccinated, 8 adverse drug reactions (ADRs) were reported. One was a severe ADR and 7 were non-severe ADRs. Non-severe ADRs resolved within 48 hours. CONCLUSION: BNT162b2 Pfizer-BioNTech vaccine was safely administered in the largest cohort of cancer patients reported to date.

Fusarium Oxysporum f. sp. Cannabis Isolated from Cannabis Sativa L.: In Vitro and In Planta Biocontrol by a Plant Growth Promoting-Bacteria Consortium.

Industrial hemp (Cannabis sativa L.) is a multipurpose plant used in several fields. Several phytopathogens attack hemp crops. Fusarium oxysporum is a common fungal pathogen that causes wilt disease in nurseries and in field cultivation and causes high losses. In the present study, a pathogenic strain belonging to F. oxysporum f. sp. cannabis was isolated from a plant showing Fusarium wilt. After isolation, identification was conducted based on morphological and molecular characterizations and pathogenicity tests. Selected plant growth-promoting bacteria with interesting biocontrol properties-Azospirillum brasilense, Gluconacetobacter diazotrophicus, Herbaspirillum seropedicae and Burkholderia ambifaria-were tested against this pathogen. In vitro antagonistic activity was determined by the dual culture method. Effective strains (in vitro inhibition > of 50%) G. diazotrophicus, H. seropedicae and B. ambifaria were combined in a consortium and screened for in planta antagonistic activity in pre-emergence (before germination) and post-emergence (after germination). The consortium counteracted Fusarium infection both in pre-emergence and post-emergence. Our preliminary results show that the selected consortium could be further investigated as an effective biocontrol agent for the management of this pathogen.

The role of the clinical trial nurse in Italy.

PURPOSE: To assess the role of the Clinical Trials Nurse (CTN) and to evaluate the quality of the job performed by Clinical Trials Nurses (CTNs) in Italy. METHODS: The study design was descriptive. The sample included 30 CTNs in Italy who were involved in conducting clinical trials in the last years. Respondents completed the Italian Clinical Trials Nursing Questionnaire (CTNQ) developed to measure frequency and importance of clinical trials nursing activities. Data analyses included descriptive statistics, Student's t-test and Chi-Square test. RESULTS: Thirty out of 34 CTNs consented to participate. Respondents were more involved in the experimental drug management, in the protocol implementation and, partially, in the informed consent process. CTNs have a marginal position with respect to the protocol assessment and planning, subject recruitment, data management. CTNs reported high rates for the importance evaluation. Number of years in the nursing role was significantly associated with data management related activities (p = 0.016). Items with minor response rate differences between frequency and importance were not statistically significant (p values ranging from 0.087 to 0.911). The CTNs reported to be autonomous and competent; however, they lack and/or do not perform some nursing-related responsibilities and/or activities. CONCLUSIONS: Although CTNs are not involved in all of the activities listed on the CTNQ, most of them are fully aware to be a key member of research teams. Overall, the Italian CTN role is mostly practical task-oriented and focuses little on data management and organizational activities.

Validating a measure to delineate the clinical trials nursing role in Italy.

In Italy, the role of a nurse in cancer research is beginning to develop, but instruments developed to delineate the dimensions of the Italian clinical trials nursing role are lacking. This study aimed to translate into Italian the Clinical Trials Nursing Questionnaire (CTNQ) and assess its content validity, internal consistency, and stability reliability. Forward-backward translation and review by experts were performed to assess linguistic and content validation. Internal consistency reliability was computed using Cronbach alpha and by administering the translated CTNQ to a sample of 30 research nurses coming from different Italian districts. To determine the test-retest reliability, a copy of the questionnaire was given again to a subgroup of 10 research nurses. The pretest and posttest scores were compared using kappa coefficient. The comparison of the target language version with the original version allowed us to consider the translation of CTNQ as acceptable. The analyses revealed a Cronbach alpha coefficient of .98 for the frequency scale and .96 for the importance scale. The overall kappa coefficient was 0.98 for the frequency scale and 0.99 for the importance scale. The CTNQ is a valid and reliable instrument for the assessment of the research nurse's role in Italy.

Knowledge and attitudes about cancer pain management: a national survey of Italian hospice nurses.

To obtain information about the knowledge and attitudes of Italian hospice nurses concerning cancer pain management and to determine the predictor of nurses' pain management knowledge. Nationwide descriptive study. Hospice nurses in Italy from 9 hospice units distributed in the north, center, and south of Italy. Sixty-six nurses completed the questionnaire, indicating a 66.6% response rate. The Nurses' Knowledge and Attitudes Survey (Italian version) and a background information form were used to collect the data. Knowledge and attitudes regarding cancer pain. Among the 39 pain knowledge questions assessed, the mean number of correctly answered question was 24.4 (SD = 4.2), with a range of 15 to 35 items correctly answered. The correct answer rate for the entire scale, on average, was 62.7% (SD = 28%). Further analysis of items showed that more than 30% of hospice nurses underestimated the patients' pain and they did not treat the pain in the correct way; they had an incorrect self-evaluation about their pain management knowledge. Results from stepwise regression showed that nurses with higher mean correct answer scores had attended more courses on pain education. From these results, we conclude that there are still significant knowledge deficits and erroneous beliefs that may hamper treatment of hospice patients in pain. The results of this study could be useful to institutions involved in the education and application of patient pain management.

Knowledge and attitudes about cancer pain management: a national survey of Italian oncology nurses.

The purpose of this study was to obtain information about the knowledge and attitudes of Italian oncology nurses concerning cancer pain management and to determine the predictors of nurses' pain management knowledge. The study was a nationwide descriptive survey and included 287 nurses in Italy from 21 oncology wards in the north, center and south of Italy. The Nurses' Knowledge and Attitudes Survey (Italian version) and a background information form were used to collect the data. Knowledge and attitudes regarding cancer pain were the main research variables. Among the 39 pain knowledge questions assessed, the mean number of correctly answered question was 21.4 (SD=5.5), with a range of 6-35. The correct answer rate for the entire scale, on average, was 55% (SD=25.9). Further analysis of items showed that more than 50% of oncology nurses underestimated the patients' pain and they did not treat it in the correct way; they also had an incorrect self-evaluation about their pain management knowledge. Results from stepwise regression showed that nurses with higher mean correct answer scores had attended more courses about pain education. There are still significant knowledge deficits and erroneous beliefs that may hamper treatment of oncology patients in pain. The results of this study could be useful to institutions involved in patient care and teaching of pain management.

[Testing an instrument measuring Italian nurses' knowledge and attitudes regarding pain]. / Validazione di uno strumento che misura le conoscenze e gli atteggiamenti degli infermieri italiani sulla gestione del dolore.

AIM: To test the construct validity, test-retest reliability, and internal consistency of the Nurses' Knowledge and Attitudes Survey Regarding Pain translated from English to Italian. DESIGN: Validation study. SETTING: Oncology, long term care wards and hospice of 5 different italian regions. SAMPLE: 157 nurses divided in four groups according to the setting: students (29), general medical wards (35), oncology (43) and hospice (50). METHODS: The instrument was translated and adapted from English to Italian by a group of experts in pain and by pilot-testing. It was completed by 90% of the sample and the percentage of correct answers and alpha Cronbach were calculated. The test-retest reliability was measured having the questionnaire completed after a 14 days time interval, by the nurses of medical wards. RESULTS: The instrument discriminated between levels of expertise. Overall, the average percentage of correct answers was 52.7%: 40.7% for student nurses, 46% for general medicine nurses, 56.3% for oncology nurses and 62% for hospice nurses (P<0.001). Test-retest reliability was r = 0.97 and Cronbach's alfa was 0.69. CONCLUSION: These results contribute to the validity and reliability of the Italian version of the Nurses' Knowledge and Attitudes Survey Regarding Pain, show a limited knowledge in the four groups of nurses and provide the basis for other studies in oncology and palliative settings.

[The world of nursing burnout. A literature review]. / Il mondo del burnout infermieristico. Una revisione della letteratura.

The aim of this paper is to photograph, through a literature review, the burnout and all its related aspects in the world of nursing. We have selected 40 papers with a specific valence which frame and study the nursing burnout in an appropriate way. This topic has been studied in all of the continents, apart from South America. The burnout has been subject of analysis in all the departments, whom oncology and psychiatry result the ones with the highest frequency of studies. In this paper all the studies have been divided into three categories according to their objective: studies on aspects related to the burnout (57,5%), comparative studies (25%), studies on the burnout level (17,5%). From the studies concerning the related aspects comes out that the burnout is strongly related to the coping strategies, the stress index and the personal accomplishment and these factors are highly predictive. Beside that, the data show some disagreements concerning the relation between burnout and sex and burnout and age. The comparative studies show that nurses are, between health care staff, the ones which run the highest risk of burnout, especially the oncologic nurses and nurses working with AIDS patients. This literature review, summing up which steps the research has done and which are still to do, reflects the strong importance of the problem called burnout and the aspects related to it inside the world of nursing. This review underlines the importance of an insertion of support group inside the clinical practice to avoid the risk to have sick persons who take care of other patients.

[The antibiotic-lock therapy in oncoematology pediatric unit]. / L'uso dell'antibiotic-lock therapy in un reparto di oncoematologia pediatrica.

BACKGROUND: Central venous catheter (CVC) is the mandatory device for the administration of chemotherapy and support therapy to patients, particularly to children affected by malignancies. One of the major draw-backs of the extended use of CVC is the occurrence of CVC-related infections (CVC-RI) which represent an important cause of morbidity and mortality. In order to reduce the incidence of the removal of CVCs due to the persistent CVC -related infection, a new treatment based on a highly concentrated antibiotic lock solution instilled into the catheter lumen was proposed. AIMS: To describe the experience and results of the implementation of the lock therapy (associated to the use of connector CLC 2000) in a sample of patients of the oncoematology paediatric ward of Padova Hospital. MATERIAL AND METHODS: Sample. 11 patients (4-21 years of age), affected by CVCRI. 10 patients had a 2 way tunneled catheter and one an implanted Port. A connector CLC 2000 was inserted to 9 patients with CVC. TREATMENT: An antibiotic lock therapy was administered for an average duration of 6.3 days: to the 9 patients with CLC 2000 no heparin was added. Success was defined in terms of absence of feverfor at least 7 days in patients febrile at baseline; negativization of previously positive CVC blood culture without removal of CVC within 30 days starting from lock therapy. RESULTS: Only in one out of 11 patients a negative outcome led to CVC removal. Problems with a malfunctioning device had to be solved also in one patient. CONCLUSION: The antibiotic lock therapy is a promising method to treat the CVCRI although the experience on oncohematological patients is limited. The use of connector CLC 2000 may improve the technique and reduce the problems.