Rehabilitation in children and adolescents undergoing stem cell transplantation: A pilot study focused on motor performance.

OBJECTIVES: The aim of this pilot trial is evaluating the preliminary effectiveness of two in-hospital interventions in the maintenance of motor performance in children/adolescents undergoing hematopoietic stem cell transplantation (HSCT). Secondary objectives investigated the interventions' feasibility, impact on fatigue and to what degree the subjects' maintained their ankle dorsiflexion range of movement (ROM), functional mobility, muscle strength and flexibility. METHODS: This trial included 5- to 18-year-old participants, affected by oncological and non-oncological diseases during hospitalisation for autologous/allogenic HSCT. The subjects were assigned to an exercise group (EG), or a counselling group based on a cluster model based on inpatient timeframe. The EG subjects performed strengthening, stretching and aerobic exercises for 30 min/5 days a week. Both groups followed rehabilitation counselling indications (RCI), 7 days a week. RESULTS: Forty-nine participants were enrolled (median age = 12.9 years) (EG n = 36). In both groups the participants maintained their baseline motor performance and ankle ROM, and the children/adolescents and parents reduced their levels of fatigue. However, the interventions were not effective in maintaining strength. CONCLUSION: In maintaining the subjects' motor performance, the RCI results are significant because they pave the way for the application in clinical practice contexts where there are poor rehabilitation resources. Clinical Trials registration NCT03842735.

Facial Pressure Ulcers in a COVID-19 50-year-old Female Intubated Patient.

In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus disease 2019 (COVID-19) affected patients, the invasive ventilation in prone position can improve the prognosis, albeit with an increased risk of facial pressure ulcers. In this report, we will relate a case of facial pressure ulcers in a SARS-CoV-2 positive 50 year-old woman with the aim to describe the high-complexity management of COVID 19 in which healthcare professionals across the world are still involved.

Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients.

INTRODUCTION: Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding. VPI is clinically characterised by hypernasal speech and nasal regurgitation. In cases of severe VPI, pharyngoplasty is recommended. Cases of mild-to-moderate VPI can be treated with fat grafting of the posterior pharyngeal wall in addition to speech therapy. The lipofilling can also be useful after pharyngoplasty to improve the outcomes. MATERIALS AND METHODS: Twenty-one patients (14 males and 7 females), ages 4-23 affected by mild-to-moderate VPI and treated with lipofilling were included in this retrospective study. The mean injected fat volume was 7.95 cc (median 6 cc, min 4 cc, max 20 cc and range 16 cc). The follow-up ranged from 6 to 60 months. The pre- and post-operative Borel-Maisonny scores were compared using Wilcoxon test. Moreover, we performed a telephone survey with the aim to assess the parental perception on child's speech and quality of life after the surgical treatment. RESULTS: Despite the small sample size, in this case series, we observed a statistically significant Borel-Maisonny score improvement and a parental satisfaction rate of about 85%. CONCLUSIONS: The augmentation of the posterior pharyngeal wall in addition to speech therapy improved the Borel-Maisonny score and the intelligibility of this case series of patients affected by mild-to-moderate VPI. In these patients, evaluated in a multidisciplinary approach, this technique allowed us to avoid major surgical procedures that would modify the anatomy of the velopharyngeal port. However, prospective comparative studies or randomised controlled trials could be useful to compare fat grafting with velopharyngoplasty techniques, with the aim to clarify indications and to define a specific treatment protocol.

[Burnout and risk of burnout in the teams of bone marrow transplant:a multicentre Italian survey]. / Il burnout e il rischio di burnout nelle equipe di trapianto di midollo osseo: uno studio multicentrico italiano.

UNLABELLED: . Burnout and risk of burnout in the Italian teams of bone marrow transplant: a multicentre survey. INTRODUCTION: The term burnout is used to describe a state of work-related psychological distress in healthcare employees characterized by three related, but independent, components: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). AIM: The aim of this study was to evaluate the prevalence of burnout and stress symptoms in physicians, nurses, and other healthcare professionals in Italian Bone Marrow Transplantation Units. METHODS: All personnel of a multidisciplinary group of the Italian Group of Bone Marrow Transplantation were asked to answer two different validated questionnaires: the Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) for the assessment of general wellbeing. Logistic regression was used to investigate possible risk factors for burnout. RESULTS: This study showed a relatively low burnout prevalence (3.7%), however about 43.5% of health workers were at risk for developing a burnout syndrome. No personal or center characteristics seemed related to burnout risk, but there was a strong correlation between higher scores from the general health questionnaire and burnout risk. CONCLUSIONS: Results from our survey suggest that burnout is a relevant problem in transplant teams and as such strategies should be implemented to prevent it.