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Self-care performed by patients and the caregiver contribution to this self-care are essential for improving cardiovascular outcomes; however, so far, no studies have sufficiently investigated this field in Italy. This paper describes a research protocol of a multi-center longitudinal study designed to investigate the self-care of patients affected by coronary heart disease (CHD), the caregiver's contribution to this self-care, the predictors of patient and caregiver self-care, the mediating role of self-efficacy, and the self-care outcomes. Data collection will be performed across seven Italian inpatient settings at baseline and 3 and 6 months from enrollment. Multilevel modeling and actor partner interdependence models will be implemented on a sample of 330 patient-caregiver dyads to adjust for the interdependence of measurements. The study received approval from an ethics committee in Italy and was financed in January 2021 by a grant from the Solidal Foundation in Alessandria. This research will advance the knowledge about the self-care process in CHD. The results will guide research and clinical practice by identifying variables sensitive to educational interventions.

Objectives The early detection and stratification of asphyxiated infants at higher risk for impaired neurodevelopment is challenging. S100B protein is a well-established biomarker of brain damage, but lacks conclusive validation according to the “gold standard” methodology for hypoxic-ischemic encephalopathy (HIE) prognostication, i.e. brain MRI. The aim of the present study was to investigate the predictive role of urinary S100B concentrations, assessed in a cohort of HIE infants receiving therapeutic hypothermia (TH), compared to brain MRI. Methods Assessment of urine S100B concentrations was performed by immunoluminometric assay at first void and at 4, 8, 12, 16, 20, 24, 48, 72, 96, 108 and 120-h after birth. Neurologic evaluation, routine laboratory parameters, amplitude-integrated electroencephalography, and cerebral ultrasound were performed according to standard protocols. Brain MRI was performed at 7–10 days of life. Results Overall, 74 HIE neonates receiving TH were included in the study. S100B correlated, already at first void, with the MRI patterns with higher concentrations in infants with the most severe MRI lesions. Conclusions High S100B urine levels soon after birth constitute trustable predictors of brain injury as confirmed by MRI. Results support the reliability of S100B in clinical daily practice and open the way to its inclusion in the panel of parameters used for the selection of cases suitable for TH treatment.

The study aims to explore the experiences of nurses who have worked in Covid-19 wards providing care for Covid-19 patients.During the Covid-19 pandemic, personal protective equipment (PPE) was considered an effective and guaranteed protective measure.This is a descriptive qualitative study with thematically analysed interviews. Twelve nurses working (specify context) were interviewed.Three themes emerged from interviews: (1) confidence with PPE used during the Covid-19 crisis, (2) training in the use of PPE and (3) technical requirements for PPE.This study clarified the importance of PPE quality and choice in establishing comfort for nurses and providing better patient care. These results could suggest useful elements to improve the PPE products by making them more comfortable for health care workers.Our results are important to promote and suggest prevention measures that are as comfortable and suitable as possible for health workers involved in the Covid-19 emergency, and also for potential future similar crises.

The epigenetic role of microRNAs is established at both physiological and pathological levels. Dysregulated miRNAs and their targets appear to be a promising approach for innovative anticancer therapies. In our previous study, circulating miR-197-3p tested dysregulated in workers ex-exposed to asbestos (WEA). Herein, an epigenetic investigation on this circulating miRNA was carried out in sera from malignant pleural mesothelioma (MPM) patients. MiR-197-3p was quantified in MPM (n = 75) sera and comparatively analyzed to WEA (n = 75) and healthy subject (n = 75) sera, using ddPCR and RT-qPCR techniques. Clinicopathological characteristics, occupational, non-occupational information and overall survival (OS) were evaluated in correlation studies. MiR-197-3p levels, analyzed by ddPCR, were significantly higher in MPM than in WEA cohort, with a mean copies/µl of 981.7 and 525.01, respectively. Consistently, RT-qPCR showed higher miR-197-3p levels in sera from MPM with a mean copies/µl of 603.7, compared to WEA with 336.1 copies/µl. OS data were significantly associated with histologic subtype and pleurectomy. Circulating miR-197-3p is proposed as a new potential biomarker for an early diagnosis of the MPM onset. Indeed, miR-197-3p epigenetic investigations along with chest X-ray, computed tomography scan and spirometry could provide relevant information useful to reach an early and effective diagnosis for MPM.

Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL. Methods: This was a retrospective, multicentric, case–control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the guidelines and how these deviations affected mortality. Results: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin. Conclusions: Adherence to 2015 ESC guidelines was limited but it did not affect mortality.

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The SARS-CoV-2 pandemic significantly affected oncology practice across the globe. There is uncertainty as to the contribution of patients' demographics and oncologic features to severity and mortality from COVID-19 and little guidance as to the role of anticancer and anti–COVID-19 therapy in this population. In a multicenter study of 890 patients with cancer with confirmed COVID-19, we demonstrated a worsening gradient of mortality from breast cancer to hematologic malignancies and showed that male gender, older age, and number of comorbidities identify a subset of patients with significantly worse mortality rates from COVID-19. Provision of chemotherapy, targeted therapy, or immunotherapy did not worsen mortality. Exposure to antimalarials was associated with improved mortality rates independent of baseline prognostic factors. This study highlights the clinical utility of demographic factors for individualized risk stratification of patients and supports further research into emerging anti–COVID-19 therapeutics in SARS-CoV-2–infected patients with cancer.Significance:In this observational study of 890 patients with cancer diagnosed with SARS-CoV-2, mortality was 33.6% and predicted by male gender, age ≥65, and comorbidity burden. Delivery of cancer therapy was not detrimental to severity or mortality from COVID-19. These patients should be the focus of shielding efforts during the SARS-CoV-2 pandemic.This article is highlighted in the In This Issue feature, p. 1426

Background: the European Federation of Immunogenetics excellence accreditation awarded to the Transfusion Medicine Complex Structure of the “SS. Antonio and Biagio e Cesare Arrigo” Hospital in the year 2000, requires all laboratories working in the field of hematopoietic stem cell transplantation to meet specific standards for guaranteeing a good level of service quality. Objectives: to evaluate the performance of the new Applied Biosystems™ SeqStudio™ Genetic Analyzer by validating the PowerPlex® 16 HS System kit (Promega Italia Srl, Milan, Italy), at the Transfusion Medicine Laboratory of the “SS. Antonio e Biagio and Cesare Arrigo” Hospital of Alessandria. Materials and Methods: three different studies were conducted: sensitivity, mixture, reproducibility, using DNA from hematology patients undergoing allogeneic hematopoietic stem cell transplantation and DNA from blood donors. Results: the sensitivity studies using the AB SeqStudio genetic analyzer proved to be more sensitive than those used previously (AB 3130), while the values obtained in the mixture studies overlapped with the expected values and the results obtained in the reproducibility studies were replicable and the same correlation exists in the tests performed on both instruments. Conclusions: the AB SeqStudio genetic analyzer through the PowerPlex® 16 HS System kit demonstrates excellent performance in accuracy and reproducibility of results and is a better performing instrument in sensitivity than the previous analyzer.

Background: The most common post-operative symptoms are nausea and vomiting. Aromatherapy has been shown to reduce post-operative nausea and vomiting and thus could be used as a complementary therapy to antiemetic drugs; however, no studies have considered the exclusive use of Lavender in these patients. The study’s aim is to assess aromatherapy in reducing nausea and vomiting in post-operative patients. Materials and Methods: A 2-arm randomised controlled interventional study was carried out in the Neurosurgery, General Surgery, Vascular Surgery, and Gynaecology facilities of the SS Antonio e Biagio e Cesare Arrigo Hospital of Alessandria. Study inclusion criteria: patients over the age of 18, who sign an informed consent form, have had an anaesthesiologic examination, have had general anaesthesia, and are clinically stable with a nausea score of NRS>0. Multiple instruments will be used, including a numerical rating scale, a Likert rating scale, and a Likert rating scale to assess Vomiting and the degree of satisfaction. Conclusions: The use of complementary non-pharmacological methods such as aromatherapy may help patients feel more comfortable in the post-operative period.

The report written by the World Health Organization (WHO) in 2016 presents an extensive assessment to show how the improvement of the environment can promote health and well-being. The awareness of how many diseases could be avoided by focusing on environmental risk factors would give a boost to global efforts to promote preventive health. The results obtained by the quantitative analysis on the burden of diseases attributable to the environment, confirm that 24% of global deaths and 26% of deaths among children under 5 years are caused by modifiable environmental risk factors. For this reason, this report strongly supports the idea that the environment is a solid platform for good public, community and individual health. Furthermore, in 2021, WHO with the United Nations developed a Compendium, which provides strategies and key guidance for acting on environmental conditions as a key contributor to reducing many communicable and Non-Communicable Diseases (NCDs). In the following article we examined the environment-related diseases according to WHO paperwork.

Obiettivi: Lo scopo del presente lavoro è stato quello di esplorare l’impatto psicologico a lungo termine della pandemia da COVID-19 negli operatori sanitari e in altri professionisti che lavorano presso l’Azienza Ospedaliera “SS Antonio e Biagio, e Cesare Arrigo” di Alessandria. Materiali e Metodi: È stato condotto uno studio osservazionale prospettico monocentrico su 112 operatori dell’Azienda Ospedaliera attraverso la somministrazione di un questionario on-line. I dati sono stati raccolti a tra l’1 e il 30 aprile 2021. Il questionario comprendeva un’autovalutazione delle informazioni socio-demografiche, cliniche, lavorative e relative al COVID-19 e la percezione del rischio. Inoltre, includeva la versione on-line di questionari psicologici validati in lingua italiana: Scala dell’impatto dell’Evento-Rivista (IES-R), Scala di Depressione, Ansia e Stress (DASS-21), Insomnia Severity Index (ISI), Coping Orientation to the Problems Experienced - Nuova Versione Italiana (COPE-NVI- 25), e Scala della Qualità di Vita Professionale (ProQOL-5). Risultati: L’analisi dei dati mostra che i lavoratori dell’Azienda Ospedaliera partecipanti allo studio, presentano percentuali moderate di sintomatologia da stress post-traumatico (40,2%), depressiva (40.2%), ansiosa (28.6%), da stress (44.6%) e insonnia (16.1%). La categoria dei lavoratori in ambito amministrativo mostra maggiori sintomi ansiosi e di stress post-traumatico. Le strategie di coping maggiormente utilizzate nel nostro campione sono l’attitudine positiva, l’orientamento al problema e il sostegno sociale. Il sottogruppo di lavoratori a diretto contatto con i pazienti mostra livelli moderati di compassion-satisfaction e bassi livelli di stress traumatico secondario e burn-out. Conclusioni: Dai risultati del presente lavoro si è osservato che gli effetti negativi a livello psicologico si possono mantenere anche nel lungo termine dall’insorgenza della pandemia.

Perinatal sepsis constitutes a medical emergency and is still one of the major causes of mortality and morbidity. The possibility of an early diagnosis of sepsis is still debated and controversial. In particular, clinical symptoms can be hidden by the association of sepsis with other perinatal diseases and/or by therapeutic strategies performed. In this context, there is evidence that the accuracy of standard of care diagnostic parameters (i.e. blood culture, C-reactive protein, procalcitonin) can be biased by additional confounding factors (gestational age, birth-weight, acute-chronic hypoxia). Therefore, the inclusion in clinical daily practice of new biomarkers of sepsis is of utmost importance. Of a panel of biomarkers, Presepsin (P-SEP) plays an important role in the development and response of the immune system and as an early marker of sepsis both in adult and pediatric patients. Therefore, in the present review we aim to offer an overview of the role of P-SEP in the early detection of perinatal sepsis as a trustworthy marker according to actual statements of official international institutions. Future perspectives regard the possibility of a longitudinal non-invasive biological fluids P-SEP assessment thus limiting the sample stress in high risk newborns.

Objectives Standard of care sepsis biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) can be affected by several perinatal factors, among which perinatal asphyxia (PA) has a significant role. In this light, new early sepsis biomarkers such as presepsin (P-SEP) are needed to enact therapeutic strategies at a stage when clinical and laboratory patterns are still silent or unavailable. We aimed at investigating the potential effects of PA on longitudinal P-SEP urine levels. Methods We conducted an observational case-control study in 76 term infants, 38 with PA and 38 controls. Standard clinical, laboratory, radiological monitoring procedures and P-SEP urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Results Higher (p0.05, for all) at T0 were observed between groups. P-SEP urine levels were higher (p0.05) at 48 and 96 h were observed. No significant correlations were found (p>0.05) between P-SEP and urea (R=0.11) and creatinine (R=0.02) blood levels, respectively. Conclusions The present results, showed that PA effects on P-SEP were limited up to the first 24 h following birth in absence of any kidney function bias. Data open the way to further investigations aimed at validating P-SEP assessment in non-invasive biological fluids as a reliable tool for early EOS and LOS detection in high-risk infants.

Objectives: La Peyronie's disease tends to be underdiagnosed and undertreated. In Italy it affects about 7% of the population aged between 50 and 70 years old. The aim of this study is to evaluate the quality of life of patients undergoing iontophoretic therapy with verapamil and treatment outcomes at a two-year interval. Materials and methods: This study evaluated 128 patients subjected to treatment cycles over a period of two years. Questionnaires were administered to the patients at the beginning and end of each cycle of iontophoretic therapy in order to monitor the degree of presumed anxiety, depression, pain and the associated quality of life. Result: This prospective descriptive observational study included 128 patients aged between 42 and 74 years presenting pain during erection and/or coital intercourse, which ceased in 108 cases, diminished in 12 and remained present in 4. Concerning the penile deviation, which was present in all patients (128 cases), it disappeared in 6 cases, regressed in 90 cases, while it remained unchanged in 32 cases. As for the plaque consistency on palpation, in 42 patients the plaque was no longer present, in 50 cases the consistency diminished, while in 36 patients it remained unchanged. None of the cases evidenced an aggravation of the clinical condition. 57% of the evaluated patients had high levels of anxiety in the first cycle of iontophoretic sessions and low levels of depression. Anxiety decreased in 32% of cases. Depression was not related to pain but to sexual dysfunction. About 80 % of the patients assessed had an increase in quality of life at the end of the two-year follow-up. Conclusions: In conclusion, it can be claimed that iontophoresis combined with verapamil therapy can improve patients' quality of life and offer them psychophysical well-being and an acceptable sexual relationship, thus decreasing anxiety and depression levels.

Bolus and continuous nutrition are commonly used enteral nutrition (EN) administration methodologies. Currently, there is insufficient evidence to establish which is the most effective method for reducing gastrointestinal complications in adult patients. The aim of this review is to evaluate the impact of bolus/intermittent EN compared with continuous EN for the following outcomes: diarrhea, constipation, emesis/vomiting, gastric residual volume, aspiration, and glycemic control in adult patients receiving intragastric prepyloric EN in the hospital setting. Bibliographical research was performed on the following databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. The review included all randomized and nonrandomized controlled trials of patients aged ≥18 years with preserved gastrointestinal function. Meta-analysis was performed by Review Manager V.5.3. Seven studies including 551 patients were included in the meta-analysis. Five of these studies reported that the diarrhea rate was higher in the bolus feeding group (risk ratio [RR] = 2.50; 95% CI, 1.17-5.34; P = 0.02), and another five of these studies indicated that the aspiration rate was higher in the continuous feeding group (RR = 0.55; 95% CI, 0.35-0.87; P = 0.01). There were no significant differences for the other outcomes. In conclusion, intermittent EN appears to reduce the incidence of aspiration in the hospital setting; however, it may increase the risk of diarrhea. For future research, we hypothesize the joint use of continuous nutrition until the patient reaches tolerance and then passing to bolus nutrition, thus reducing the incidence of aspiration and enabling a physiological nutrition intake.

Recent advances in perioperative management of adult and pediatric patients requiring open heart surgery (OHS) and cardiopulmonary bypass (CPB) for cardiac and/or congenital heart diseases repair allowed a significant reduction in the mortality rate. Conversely morbidity rate pattern has a flat trend. Perioperative period is crucial since OHS and CPB are widely accepted as a deliberate hypoxic-ischemic reperfusion damage representing the cost to pay at a time when standard of care monitoring procedures can be silent or unavailable. In this respect, the measurement of neuro-biomarkers (NB), able to detect at early stage perioperative brain damage could be especially useful. In the last decade, among a series of NB, S100B protein has been investigated. After the first promising results, supporting the usefulness of the protein as predictor of short/long term adverse neurological outcome, the protein has been progressively abandoned due to a series of limitations. In the present review we offer an up-dated overview of the main S100B pros and cons in the peri-operative monitoring of adult and pediatric patients.

Objective: To examine caregivers' experiences and training needs after radical cystectomy with urinary diversion for the first three months following the patient's discharge. Methods: This study applied a phenomenological design approach through open-ended interviews and descriptive analysis. Phenomenology applied to empirical research requires researchers to explore the empirical facts narrated by partici-pants. This study followed the Consolidated Criteria for Reporting Qualitative Research guidelines, a 32 – item checklist for inter-views and focus groups. The study population included caregivers of bladder cancer patients, admitted to three Italian hospitals. Data were collected between March 2020 and March 2022. Results: Fifty-two caregivers of patients who underwent cystecto-my with urinary diversion from three Italian hospitals (41 males and 11 females) participated to the study. The data analysis con-verged in the identification of three themes – with sub-themes –that included various aspects of the caregiver’s lived experiences: 1) living with the burden of being indispensable, for the family member, 2) feeling abandoned by institutions, 3) tiredness and less willingness to look after the relative due to work burden. Conclusions: Our study demonstrates that the caregiver of a patient with bladder cancer and urostomy in the first three months of hospital discharge is very worried and stressed. Despite the training program received in hospital, the caregiver does not recognize the newly acquired skills and has difficulty applying them. Further study would be required.

This study aims to observe the clinical characteristics and outcomes of recovered patients from Coronavirus Disease (COVID-19) related to the vaccination status. We examined results of 205 COVID-19-recovered patients from 15 December 2021 to 1 March 2022 in two hospitals of Local Health Authority of Alessandria (Italy) during the fourth pandemic wave. 77% of patients were hospitalized for acute respiratory failure (ARF) with radiological pneumonia pattern (recovered for COVID), 23% for other causes with occasional positivity finding (recovered with COVID). 32% of patients were not vaccinated for Sars-COV-2, 37% had three doses, 25% two doses, 5% only one dose. All patients without vaccination were hospitalized for ARF and they had a 7 times higher risk of hospitalization than the vaccinated. 60% of all patients had >3 comorbidities, of these 50% was vaccinated with three doses. In the fourth pandemic wave compared to the other not all patients were hospitalized for ARF and pneumonia and the presence of comorbidities >3 is a risk factor for hospitalization regardless of vaccination status. This justifies the administration of the fourth dose to frail patients.

Background This study aimed to explore whether explainable Artificial Intelligence methods can be fruitfully used to improve the medical management of patients suffering from complex diseases, and in particular to predict the death risk in hospitalized patients with SARS-Cov-2 based on admission data. Methods This work is based on an observational ambispective study that comprised patients older than 18 years with a positive SARS-Cov-2 diagnosis that were admitted to the hospital Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy from February, 24 2020 to May, 31 2021, and that completed the disease treatment inside this structure. The patients’medical history, demographic, epidemiologic and clinical data were collected from the electronic medical records system and paper based medical records, entered and managed by the Clinical Study Coordinators using the REDCap electronic data capture tool patient chart. The dataset was used to train and to evaluate predictive ML models. Results We overall trained, analysed and evaluated 19 predictive models (both supervised and unsupervised) on data from 824 patients described by 43 features. We focused our attention on models that provide an explanation that is understandable and directly usable by domain experts, and compared the results against other classical machine learning approaches. Among the former, JRIP showed the best performance in 10-fold cross validation, and the best average performance in a further validation test using a different patient dataset from the beginning of the third COVID-19 wave. Moreover, JRIP showed comparable performances with other approaches that do not provide a clear and/or understandable explanation. Conclusions The ML supervised models showed to correctly discern between low-risk and high-risk patients, even when the medical disease context is complex and the list of features is limited to information available at admission time. Furthermore, the models demonstrated to reasonably perform on a dataset from the third COVID-19 wave that was not used in the training phase. Overall, these results are remarkable: (i) from a medical point of view, these models evaluate good predictions despite the possible differences entitled with different care protocols and the possible influence of other viral variants (i.e. delta variant); (ii) from the organizational point of view, they could be used to optimize the management of health-care path at the admission time.

Background: Post-COVID-19 syndrome has been found in patients admitted to a hospital with severe conditions of COVID-19 and in adults who initially presented a mild illness. The aim is to underline the available literature on post-COVID-19 follow-up until 12 months about symptoms reported by adults infected with Sars-Cov-2 from at least 12 weeks after disease onset. Methods: The bibliographic search was conducted on PubMed, Embase, CINHAL, Scopus and the Cochrane Central Register of Controlled Studies. Results: We found that 68% of patients had at least one symptom post-COVID-19 after 12 weeks and up to 24 weeks post-onset. The most frequent symptoms were fatigue and muscle weakness (26%), dizziness and mental clouding (15%) and taste disturbances (10%). Conclusions: Health policy needs to prepare for a long-term management plan to address COVID-19, as there are significant needs beyond recovery from the acute infection.

Urinary tract infections (UTIs) are a frequent disorder of childhood, mainly caused by Escherichia coli. The aim of this study was to evaluate the antimicrobial susceptibility trend in bacterial isolates in urine cultures in pediatric environment, analyzing data from our laboratory in a 6-year period.A retrospective study was performed in AO SS. Antonio e Biagio e Cesare Arrigo (Pediatric Hospital) of Alessandria in Piedmont, North Ital. From 2015 to 2020, in a 6-year period, 1299 urinocultures were collected. Data collection was focused on demographic characteristics (age and sex) and laboratory findings (positive urocultures, antibiogram).Positive urocultures were 577, in which Escherichia coli represented most isolates (428, 74.2%). We found a statistically significant trend toward amoxiclavulanate resistance in the E. coli positive urinoculture comparing the period 2015-2018 vs. 2019-2020.Actual guidelines mostly recommend for amoxicillin-clavulanate prescription as first-line option for pediatric UTI management, this indication might be partially reconsidered. Our data underline the importance to conduct surveillance studies to determine local prevalence of antibiotic resistance to optimize therapeutic management.

COVID-19; High-flow nasal cannula; Pneumonia COVID-19; Cánula nasal de alto flujo; Neumonía COVID-19; Cànula nasal d'alt flux; Pneumònia The use of non-invasive respiratory strategies (NIRS) is crucial to improve oxygenation in COVID-19 patients with hypoxemia refractory to conventional oxygen therapy. However, the absence of respiratory symptoms may delay the start of NIRS. The aim of this study was to determine whether a simple bedside test such as single-breath counting test (SBCT) can predict the need for NIRS in the 24 h following the access to Emergency Department (ED). We performed a prospective observational study on 120 patients with COVID-19 pneumonia. ROC curves were used to analyze factors which might predict NIRS requirement. We found that 36% of patients had normal respiratory rate and did not experience dyspnea at rest. 65% of study population required NIRS in the 24 h following the access to ED. NIRS-requiring group presented lower PaO2/FiO2 (235.09 vs. 299.02), SpO2/FiO2 ratio (357.83 vs. 431.07), PaCO2 (35.12 vs. 40.08), and SBCT (24.46 vs. 30.36) and showed higher incidence of dyspnea at rest (57.7% vs. 28.6%). Furthermore, SBCT predicted NIRS requirement even in the subgroup of patients without respiratory symptoms (AUC = 0.882, cut-off = 30). SBCT might be a valuable tool for bedside assessment of respiratory function in patients with COVID-19 pneumonia and might be considered as an early clinical sign of impending respiratory deterioration.

Spatial distribution heterogeneity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed in several countries. While previous studies have covered vast geographic areas, detailed analyses on smaller territories are not available to date. The aim of our study was to understand the spatial spread of SARS-CoV-2 in a province of Northern Italy through the analysis of positive nasopharyngeal (NP) swabs. The study was conducted on subjects who lived in the province of Alessandria with at least one positive NP swab between 2 March and 22 December 2020. To investigate if clustering occurred, the proportion of SARS-CoV-2 positive subjects over the total number of residents in each small administrative subregion was calculated and then mapped. A total of 17,260 subjects with at least one positive NP swab were included; the median age was 54 years (Interquartile range 38–72) and 54.9% (n = 9478) of our study population were female. Among the 192 towns scanned, 26 showed a prevalence between 5% and 7.5%, one between 7.5% and 10% and two with more than 10% positive swabs. The territories with a higher prevalence of positive subjects were located in areas with at least one nursing home and potential clusters were observed within these structures. The maps produced may be considered a useful and important monitoring system to identify areas with a significant and relevant diffusion of SARS-CoV-2.

Background: L’ambito delle terapie con CAR-T è un campo ancora nuovo e la gestione delle tossicità è nella sua fase iniziale; è necessaria, dunque, una ricerca mirata che affronti le questioni critiche relative agli outcomes dei pazienti. Scopo dello studio è quello di monitorare l’incidenza di complicanze da tossicità dovuta a CAR-T durante il periodo relativo al ricovero ospedaliero. Metodi: Studio osservazionale, prospettico, monocentrico. Il campione sarà composto da tutti i pazienti di età ≥18 anni candidati a trattamento con CAR-T da aprile 2022 ad aprile 2025. Al fine della raccolta dati verranno utilizzate le seguenti scale di valutazione: Numeric Rating Scale for Pain, Scheda Eventi Avversi, Immune Effector Cell-associated Encephalopathy Score, Grading WHO, EuroQol-5D-3L, Hospital Anxiety Scale, Scored Patient-Generated Subjective Global Assessment, Contentment with Life Assessment Scale. Conclusioni: L’immunoterapia e le CAR-T hanno mostrato risultati promettenti nel trattamento di alcune neoplasie maligne, ma possono essere associate a tossicità diverse e non completamente comprese che possono essere fatali se non identificate precocemente e trattate in modo appropriato. La comprensione delle complicanze potrebbero migliorare gli outcomes dei pazienti.

Background: Tra le numerose figure professionali che partecipano al complesso e articolato processo di prelievo e trapianto di organi e tessuti, è sempre più presente la figura infermieristica. Ogni anno la Regione Piemonte trasmette alle singole aziende ospedaliere gli obiettivi in merito a donazioni e trapianti. L’obiettivo è quello di creare una procedura operativa aziendale per la corretta gestione del processo di donazione di cornee. Metodi. A novembre 2020 l'Azienda Ospedaliera ha nominato l'Infermiere Esperto in Procurement; Tra le sue funzioni e attività spiccano la sensibilizzazione e la formazione del personale dei reparti di degenza in materia di donazione di cornee. Risultati: La formazione è stata avviata nei vari reparti tramite degli incontri di gruppo; inoltre, è stato divulgato un Documento a Validità Aziendale (DVA 109/21) con l'intento di scandire le modalità del processo uniformando e semplificando le procedure. Conclusioni: La figura infermieristica diventa sempre più presente nel processo di donazione e trapianti. L'Infermiere Esperto in Procurement, grazie all'esperienza e alle competenze acquisite, gestisce collaborando con il gruppo di coordinamento l'intero processo di procurement di organi e tessuti.

In this updated Self-Care of Coronary Heart Disease Inventory (SC-CHDI) v3.0, items were added to better reflect the theory of self-care of chronic illness and revised based on recent research. The expanded SC-CHDI now reflects the theoretical concepts of self-care maintenance, monitoring, and management.The aim of this study was to evaluate the psychometric properties of the SC-CHDI v3.0.In a sample of adults with coronary heart disease, we tested the SC-CHDI v3.0 validity with confirmatory factor analysis. Reliability was calculated using Cronbach α, factor score determinacy coefficient, and global reliability index for multidimensional scales, with values0.70 considered adequate.The sample (n = 205) was predominantly male (79%) with a mean age of 65.3 ± 11.1 years. The self-care maintenance scale encompassed 2 distinct behaviors, namely, "illness related behaviors" and "health promoting behaviors," which reflect consulting and autonomous dimensions, respectively. The goodness-of-fit indices were adequate: χ2(25, N = 205) =31.86, P = .16, comparative fit index = 0.97, Tucker-Lewis Index = 0.95, root mean square error of approximation = 0.04 (90% confidence interval, 0.00-0.07), P = .705, and standardized root mean square residual = 0.045. Analysis of the new self-care monitoring scale yielded a single factor; goodness-of-fit indices were excellent: χ2(12, N = 205) =11.56, P = .48, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation0.001 (90% confidence interval, 0.000-0.07), P = .86, and standardized root mean square residual = 0.02. The self-care management scale had 2 dimensions of autonomous and consulting behavior with strong goodness-of-fit indices: χ2(7, N = 205) =6.57, P = .47, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation ≤ 0.001 (90% confidence interval, 0.00-0.08), P = .76, and standardized root mean square residual = 0.02. Reliability estimates were ≥0.80 for all scales.Our testing suggests that the SC-CHDI v3.0 is a sound measure of the essential elements of self-care for adults with coronary heart disease.

Una biobanca, in termini generali, viene descritta come una struttura volta alla collezione, gestione, conservazione e distribuzione di biomateriali e dati ad essi correlati a fini di ricerca genetica. Il termine biobancaggio si riferisce dunque ad una serie di attività svolte dalle biobanche che differiscono per natura, obiettivi, business models, risultati e impatto sociale, politico e scientifico. Data l’interazione tra biomateriale e dati associati, le biobanche rappresentano un ponte tra l’evoluzione della medicina personalizzata e la preservazione e il miglioramento delle condizioni della salute pubblica, alla luce del ruolo che svolgono nel permettere, appunto, la conservazione di un significativo numero sia di biomateriali che di dati correlati, necessari per l’avanzamento della ricerca biomedica. Presso l’Infrastruttura Ricerca Formazione e Innovazione dell’Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo è inserito il “Centro Raccolta Materiale Biologico” (CRMB) che comprende la collezione del mesotelioma maligno (BB-MM), istituita fin dal 2005, la collezione del carcinoma mammario, istituita nel 2021, e il Biorepository, istituito già nel 2016 per garantire elevati livelli di qualità e sicurezza in ambito di stoccaggio e conservazione dei campioni biologici previsti da protocolli di studi clinici e/o destinati ad attività di ricerca. Si configura come un’unità di servizio finalizzata alla raccolta, conservazione e distribuzione dei campioni biologici a scopo di ricerca scientifica, garantendo i diritti dei soggetti coinvolti. Il presente studio si prefigge, in linea con l’evidenza fornita dalla letteratura scientifica di settore e il suo contributo, di descrivere la storia del biobanking e, parallelamente, l’evoluzione di Alessandria Biobank, tra istituzionalizzazione e risultati raggiunti, per incrementare la conoscenza della biobanca e del suo operato.

The aim of this study is to explore the lived experience of women who gave birth during the COVID-19 pandemic.Experiencing pregnancy during the Covid-19 pandemic exacerbates the risk of the onset of psychological problems.This is a descriptive, single-centre, qualitative study.The enrolment for data collection included childbearing mothers aged 18 years and over between November 2021 and April 2022. The researchers invited them to write about their personal experiences during the isolation period of the first pandemic wave. The descriptive phenomenological analysis of the data was carried out using the method described by Mortari.A total of 50 mothers were recruited, of whom 28 were primiparous (56.0%) and 22 multiparous (44.0%). From the analysis of the interviews, five main themes emerged that enclose the experience of both primiparous and multiparous mothers: 'The negative feeling: between loneliness, sadness and fear'; 'The comfort of being cared for: between humanity and competence'; 'Family proximity: between comfort and stress'; 'Symbiotic intimacy: bonding; Managing physical pain and consciousness of being resilient women'.The study showed that the discomfort associated with the absence of family support in the phase of labour and childbirth was compensated by the professionalism of the health staff and allowed new mothers to experience moments of great intimacy with the child.Such data could help create recommendations based on the assisted person's experiences to ensure that care is increasingly attentive and tailored to the needs of mothers and, thus, of children.

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Background: L’inattività fisica è un problema di particolare rilevanza nei pazienti con insufficienza renale cronica, una categoria di pazienti in cui il peggioramento sostanziale della forma fisica e della fragilità è fortemente associato a prognosi avversa e ridotta qualità della vita. Lo scopo di questo studio pilota è quello di implementare un programma di attività fisica all’interno del percorso terapeutico di pazienti adulti in trattamento sostitutivo renale (peritoneale e emodialitico) e trapiantati, al fine di incrementare la performance fisica e migliorare la qualità di vita. Metodi: Studio pilota, interventistico non farmacologico, a singolo braccio, monocentrico, no-profit, su un campione di convenienza di almeno 10 individui affetti da nefropatia reclutati da novembre 2021 a gennaio 2022. I pazienti saranno sottoposti a un programma di camminata terapeutica costituito da 22 sedute. Verranno misurati l’indice di recupero immediato, la composizione di massa corporea, i parametri ematochimici e la qualità di vita. Conclusioni: L’applicazione di questo studio su piccola scala, ha lo scopo di verificarne la fattibilità e l’adeguatezza per ricavare informazioni che permettano di progettare studi futuri.

In this randomized controlled study, we aimed to assess the effects of US-guided injections of the subacromial bursa followed by a personalized rehabilitation program for breast cancer (BC) survivors. We assessed patients with subacromial pain syndrome without tendon lesions and with a history of post-surgical non-metastatic BC. Thirty-seven patients were enrolled and randomly assigned 1:1 to receive US-guided corticosteroid injections combined with a personalized rehabilitation program (Group A; n: 19) or US-guided corticosteroid injections alone (Group B; n: 18). The primary outcome was pain relief, assessed using a numerical pain rating scale (NPRS). The secondary outcomes were muscle strength, shoulder function, and quality of life. No major or minor late effects were reported after the multidisciplinary intervention. Statistically significant within-group differences were found in terms of NPRS (p ≤ 0.05) in both groups. No significant between-group differences were reported after one week. However, the between-group analysis showed significant differences (p ≤ 0.05) after three months of follow-up in terms of pain intensity, muscle strength, shoulder function, and quality of life. Our findings suggested positive effects of a multidisciplinary approach including US-guided corticosteroid injections combined with a personalized rehabilitation program in improving pain intensity and quality of life of BC survivors with subacromial pain syndrome.

Objectives The early detection of preterm infants (PI) at risk for intraventricular hemorrhage (IVH) and neurological sequelae still constitutes an unsolved issue. We aimed at validating the role of S100B protein in the early diagnosis and prognosis of IVH in PI by means of cerebral ultrasound (CUS) and magnetic resonance imaging (MRI) today considered standard of care procedures. Methods We conducted an observational case-control study in 216 PI of whom 36 with IVH and 180 controls. Standard clinical, laboratory, radiological monitoring procedures and S100B urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Cerebral MRI was performed at 40–42 weeks of corrected gestational age. Results Elevated (p Conclusions The present results showing a correlation among S100B and CUS and MRI offer additional support to the inclusion of the protein in clinical daily management of cases at risk for IVH and adverse neurological outcome. The findings open the way to further investigations in PI aimed at validating new neurobiomarkers by means of S100B.

Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the ‘Scale for the Assessment of Narrative Review Articles’ (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses.

Trauma is a major cause of mortality throughout the world. Traumatic pain—acute, sudden, or chronic—is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Patients’ perceptions of pain assessment and management have become an important criterion and relevant outcome measure for healthcare institutions. Several studies show that 60–70% of ER patients experience pain, and more than half of them express a feeling of sorrow, which can be moderate or severe, at triage. The few studies that have analyzed how pain is assessed and managed in these departments agree that approximately 70% of patients receive no analgesia or receive it with remarkable delay. Specifically, less than half of the patients receive treatment for pain during admission and 60% of discharged patients have higher intensity pain than at admission. Trauma patients are also the ones who most commonly report low satisfaction with pain management. Associated with this lack of satisfaction, we can describe the poor use of tools for measuring and recording pain, poor communication among caregivers, inadequate training in pain assessment and management, and widespread misconceptions among nurses about the reliability of patients’ estimation of pain. The aim of this article is to review the scientific literature to explore the methodologies of pain management in trauma patients attending the emergency room and analyzing their weaknesses as a starting point to improve the approach to this, unfortunately too often, underestimated issue. A literature search was performed using the major databases to identify relevant studies in indexed scientific journals. The literature showed that the multimodal approach in trauma patients is the best approach to pain management. It is becoming increasingly crucial to manage the patient on multiple fronts. Drugs acting on different pathways can be administered together at lower doses, minimizing risks. Every emergency department must have staff trained in the assessment and immediate management of pain symptoms as this allows the reduction of mortality and morbidity and shortens hospital stays, contributing to early mobilization, reduced hospital costs, and enhanced patient satisfaction and quality of life.

Contesto: Internet è un mondo di comunicazione in gran parte libera e di condivisione reciproca, ma rappresenta anche un rischio per la tutela della privacy e della riservatezza. È importante che gli operatori sanitari forniscano istruzione sull'uso corretto della tecnologia, creino programmi di supporto e stabiliscano la correlazione tra uso della tecnologia e dipendenza. L'obiettivo del progetto di educazione sanitaria è educare i bambini delle scuole secondarie all'uso responsabile delle tecnologie digitali. Materiali e metodi: La formazione segue un programma di apprendimento misto, che combina diversi strumenti: e-learning; attività in aula con il docente di classe e il formatore del progetto; l'utilizzo di scenari, sia online che offline; e discussioni sui forum online. Risultati: Lo sviluppo di un programma di formazione di sei moduli della durata di un anno scolastico. Conclusioni: Un metodo di insegnamento innovativo che utilizza le tecnologie digitali può garantire un apprendimento personalizzato, autonomo e collaborativo: ogni allievo diventa il principale contributore della propria formazione.

Objectives. Definition of a hospital-based technology governance model (hospital-based Health Technology Assessment (HTA)), involving health professionals at different organizational levels; applying HTA as a rational support tool at corporate organizational level for decisions concerning acquisitions, disposal, monitoring of technologies; implementation of the HTA methodology to create an organizational context favorable to the transfer of scientific evidence in clinical practice and managerial decision-making processes. Methods. At the end of 2014, the AO Hospital of Alessandria established a Technology Assessment Unit to analyze the requests for the supply of medical and non-medical equipment, involved in healthcare pathway processes. A training course has started, aimed at creating specific skills, to support the clinician requesting the adoption of a new technology. Results. Over the last 5 years, testing the form deployment has concerned: 56 requests examined by NVT; 226 cases concerning gathering information using the forms; 24 IT instances managed by ICT; 62 requests examined through facilitator support. Conclusions: To implement at micro level, the HTA methodology within the clinical-organizational structure governance, including decisions concerning clinical practice protocols, auditing and quality monitoring of healthcare performance.

Background. In Italy, to date, there are six Nursing and Allied Health Professions Research Centres; in Piedmont, the Nursing and Allied Health Professions Research Unit is located at the Public Hospital SS. Antonio e Biagio e Cesare Arrigo of Alessandria, within the Department of Integrated Activities, Research and Innovation. Aim. To build and establish a network of nurse and allied health professional research, within Departments and facilities, to increase scientific production, to promote partnerships with scientific communities for improving the quality of clinical healthcare activities. Materials and methods. Specific result indicators were defined, on the basis of which to estimate the trend of annual activities. A corporate network of Departments and Facilities has been established, as well as a collaboration with the Local Health Authority of Alessandria, the University of Eastern Piedmont and the other areas of the Integrated Activities, Research and Innovation Department. Results. The selection of 11 Departments and 67 Facilities referents. The activation of 13 collaborations with national organizations and 5 international institutions. Sixteen clinical studies activated, 10 articles published in impacted/indexed journals, 10 publications in grey literature and the participation in 3 funded calls. Conclusions. The organizational model established has achieved its objectives and can be reproduced in other national and international settings.

Background. Obesity is an emerging issue with serious health consequences. It is preventable in pediatric settings through prevention projects and education about healthy lifestyles. The aim of the study is to analyze the problem and the methods of intervention, through the involvement of physiotherapists throughout Italy, and to explore the interest and sensitivity of Italian physiotherapists to the issue. Study design. A cross-sectional survey of physiotherapists was conducted using a self-completed online questionnaire, from January to March 2020. Materials and Methods. Literature analysis searching for national and international prevention strategies. Administration of a cognitive questionnaire to the pediatric GIS group. Results. Ninety-five point seven percent of the interviewees had never taken part in projects dedicated to pediatric obesity. Three experiences emerged, but only two respondents made themselves available for interview. Ninety-four point four percent of the operators considered the contribution to the health problem useful and 82.2% of them expressed a real interest in the topic. Conclusions. Physiotherapists should play an active role in planning interventions aimed at promoting and supporting healthy lifestyles from early childhood to early adulthood, starting even earlier during the prenatal and perinatal periods.

Germline mutations in the tumor suppressor gene BRCA1-associated protein-1 (

Aim: Promote and enhance the path created to establish an organizational model of the Research Unit of the Healthcare Professions that is effective for increasing scientific production. Methods: The benchmarking techniques used make it possible to create a standard of excellence by comparing the performance achieved at the various decision-making levels of the system, evaluating the correct use of resources and, if necessary, undertaking changes in health policies. Results: Benchmarking activities were carried out in the organizational, training and research areas between the Research Units of the Health Professions present in Italy and adapted to the business context. Training and insertion paths for URPS personnel, activation phases of the company network, insertion of the students of the nursing degree course in clinical studies, collaborations with other bodies, dissemination of engagement and fundraising techniques have been defined. Conclusions: The defined paths have allowed the establishment of an organizational model of the Research Unit of the Healthcare Professions with the vision of becoming an attractive reference center for nursing research and all Healthcare Professions.

Background: Quality of life issues is a crucial burden in breast cancer (BC) survivors with relevant implications in terms of survivorship and health-care costs. The increasing long-term survival of these patients provides new challenges, with translational research now focusing on innovative and tailored approaches to improve their complex management. In this scenario, several emerging biomarkers have the potential to improve the clinical rehabilitative management of patients with BC. However, to date, guidelines supporting biomarker implementation in this area are still lacking. Therefore, the aim of this systematic review was to summarize the currently available biomarkers that might be potentially integrated into rehabilitation practice to promote a precision medicine approach to BC survivorship issues.Methods: On 9th March 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for randomized controlled trials (RCTs) assessing rehabilitation interventions in BC patients. Molecular biomarker modifications induced by physical exercise have been assessed through the review of the study protocols and published results. The Jadad scale was used to assess the quality of the studies included.Results: Out of 2,224 records, 22 studies were included in the present systematic review. Exercise therapy showed significant results in 15 RCTs, in terms of metabolic biomarkers, including glycemic and insulin profile, and lipid profile (p ≤ 0.05). Similarly, 12 studies underlined significant effects in inflammation and immune response biomarkers, including TNF-α, IL-6, IL-10, C-reactive protein, leptin, and adiponectin (p ≤ 0.05). On the other hand, cardiac biomarkers were assessed in three studies without reporting significant differences after exercise therapy (p = NS). The quality assessment identified 19 RCTs as high-quality studies and three RCTs of low quality.Conclusion: Our findings reveal significant biochemical perturbations in key molecules induced by physical exercise in patients with BC, suggesting room for the implementation of actionable biomarkers. Future research might clarify the role of biomarkers on treatment effectiveness monitoring, to optimize rehabilitative strategies tailored to patient’s needs.

The case study refers to the Clinical Trial Center (CTC) of the Public Hospital "SS. Antonio e Biagio and Cesare Arrigo" (AO AL) and the Local Health Authority of Alessandria (ASL AL), to which Clinical Research Coordinators (CRCs) and Clinical Research Nurses (CRNs) belong, unique in the regional panorama and a rarity into a public health organization not recognized as Scientific Institute for Research, Hospitalization and Healthcare (IRCCS).

Although SARS-CoV-2 vaccines immunogenicity in patients with cancer has been investigated, whether they can significantly improve the severity of COVID-19 in this specific population is undefined.Capitalizing on OnCovid (NCT04393974) registry data we reported COVID-19 mortality and proxies of COVID-19 morbidity, including post-COVID-19 outcomes, according to the vaccination status of the included patients.2090 eligible patients diagnosed with COVID-19 between 02/2020 and 11/2021 were included, of whom 1930 (92.3%) unvaccinated, 91 (4.4%) fully vaccinated and 69 (3.3%) partially vaccinated. With the exception of a higher prevalence of patients from the UK (p = 0.0003) and receiving systemic anticancer therapy at COVID-19 diagnosis (p = 0.0082) among fully vaccinated patients, no demographics/oncological features were associated with vaccination status. The 14-days case fatality rate (CFR) (5.5% vs 20.7%, p = 0.0004) and the 28-days CFR (13.2% vs 27.4%, p = 0.0028) demonstrated a significant improvement for fully vaccinated patients in comparison with unvaccinated patients. The receipt of prior full vaccination was also associated with reduced symptomatic COVID-19 (79.1% vs 88.5%, p = 0.0070), need of COVID-19 oriented therapy (34.9% vs 63.2%, p 0.0001), complications from COVID-19 (28.6% vs 39.4%, p = 0.0379), hospitalizations due to COVID-19 (42.2% vs 52.5%, p = 0.0007) and oxygen therapy requirement (35.7% vs 52%, p = 0.0036). Following Inverse Probability Treatment Weighting (IPTW) procedure no statistically significant difference according to the vaccination status was confirmed; however, all COVID-19 related outcomes were concordantly in favour of full vaccination. Among the 1228 (58.8%) patients who underwent a formal reassessment at participating centres after COVID-19 resolution, fully vaccinated patients experienced less sequelae than unvaccinated patients (6.7% vs 17.2%, p = 0.0320).This analysis provides initial evidence in support of the beneficial effect of SARS-CoV-2 vaccines against morbidity and mortality from COVID-19 in patients with cancer.

Il presente documento riporta la comparazione degli ultimi quattro anni solari e non dell’ultimo quinquennio in quanto, nel corso dell’anno 2012, è stato modificato il supporto informatico per l’archiviazione degli eventi infortunistici. Conseguentemente è stato possibile archiviare nel nuovo supporto solamente gli infortuni occorsi negli anni 2011, 2012, 2013 e 2014.

The omicron (B.1.1.529) variant of SARS-CoV-2 is highly transmissible and escapes vaccine-induced immunity. We aimed to describe outcomes due to COVID-19 during the omicron outbreak compared with the prevaccination period and alpha (B.1.1.7) and delta (B.1.617.2) waves in patients with cancer in Europe.In this retrospective analysis of the multicentre OnCovid Registry study, we recruited patients aged 18 years or older with laboratory-confirmed diagnosis of SARS-CoV-2, who had a history of solid or haematological malignancy that was either active or in remission. Patient were recruited from 37 oncology centres from UK, Italy, Spain, France, Belgium, and Germany. Participants were followed up from COVID-19 diagnosis until death or loss to follow-up, while being treated as per standard of care. For this analysis, we excluded data from centres that did not actively enter new data after March 1, 2021 (in France, Germany, and Belgium). We compared measures of COVID-19 morbidity, which were complications from COVID-19, hospitalisation due to COVID-19, and requirement of supplemental oxygen and COVID-19-specific therapies, and COVID-19 mortality across three time periods designated as the prevaccination (Feb 27 to Nov 30, 2020), alpha-delta (Dec 1, 2020, to Dec 14, 2021), and omicron (Dec 15, 2021, to Jan 31, 2022) phases. We assessed all-cause case-fatality rates at 14 days and 28 days after diagnosis of COVID-19 overall and in unvaccinated and fully vaccinated patients and in those who received a booster dose, after adjusting for country of origin, sex, age, comorbidities, tumour type, stage, and status, and receipt of systemic anti-cancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974, and is ongoing.As of Feb 4, 2022 (database lock), the registry included 3820 patients who had been diagnosed with COVID-19 between Feb 27, 2020, and Jan 31, 2022. 3473 patients were eligible for inclusion (1640 [47·4%] were women and 1822 [52·6%] were men, with a median age of 68 years [IQR 57-77]). 2033 (58·5%) of 3473 were diagnosed during the prevaccination phase, 1075 (31·0%) during the alpha-delta phase, and 365 (10·5%) during the omicron phase. Among patients diagnosed during the omicron phase, 113 (33·3%) of 339 were fully vaccinated and 165 (48·7%) were boosted, whereas among those diagnosed during the alpha-delta phase, 152 (16·6%) of 915 were fully vaccinated and 21 (2·3%) were boosted. Compared with patients diagnosed during the prevaccination period, those who were diagnosed during the omicron phase had lower case-fatality rates at 14 days (adjusted odds ratio [OR] 0·32 [95% CI 0·19-0·61) and 28 days (0·34 [0·16-0·79]), complications due to COVID-19 (0·26 [0·17-0·46]), and hospitalisation due to COVID-19 (0·17 [0·09-0·32]), and had less requirements for COVID-19-specific therapy (0·22 [0·15-0·34]) and oxygen therapy (0·24 [0·14-0·43]) than did those diagnosed during the alpha-delta phase. Unvaccinated patients diagnosed during the omicron phase had similar crude case-fatality rates at 14 days (ten [25%] of 40 patients vs 114 [17%] of 656) and at 28 days (11 [27%] of 40 vs 184 [28%] of 656) and similar rates of hospitalisation due to COVID-19 (18 [43%] of 42 vs 266 [41%] of 652) and complications from COVID-19 (13 [31%] of 42 vs 237 [36%] of 659) as those diagnosed during the alpha-delta phase.Despite time-dependent improvements in outcomes reported in the omicron phase compared with the earlier phases of the pandemic, patients with cancer remain highly susceptible to SARS-CoV-2 if they are not vaccinated against SARS-CoV-2. Our findings support universal vaccination of patients with cancer as a protective measure against morbidity and mortality from COVID-19.National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.