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1. Patient flow for the management of ostomy patients

Author

Maculotti D., Melis V., Roveron G., Spena P. R., Villa G., Amatucci E., Bergo C., Bernardo M. C., Bosio G., Broncolo F., Castiglione S., Cavina M., Ceroli C., Fazzari N., Femminella A., Ficoroni M., Gallocchio C., Grasso E., Grilli M., Leggio N., Marcarino T., Mariani F., Marin G., Merico F., Mevi C., Migliore G., Pertusini D., Pugliese F., Rumbolo N., Salesiani V., Santoro E., Sapone G., Scordia F., Sfondrini S., Siciliano C., Strino C., Tesei D., Zanetti S., Maculotti, D., Melis, V., Roveron, G., Spena, P. R., Villa, G., Amatucci, E., Bergo, C., Bernardo, M. C., Bosio, G., Broncolo, F., Castiglione, S., Cavina, M., Ceroli, C., Fazzari, N., Femminella, A., Ficoroni, M., Gallocchio, C., Grasso, E., Grilli, M., Leggio, N., Marcarino, T., Mariani, F., Marin, G., Merico, F., Mevi, C., Migliore, G., Pertusini, D., Pugliese, F., Rumbolo, N., Salesiani, V., Santoro, E., Sapone, G., Scordia, F., Sfondrini, S., Siciliano, C., Strino, C., Tesei, D., and Zanetti, S.

Subjects
Appreciative inquiry, Ostomy, MEDLINE, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, Quality of life (healthcare), Nursing, Surgical stomas, Perioperative Nursing, Health care, Humans, Medicine, Postoperative Care, Diagnostic Tests, Routine, business.industry, Communication, Stoma care, Charter, Timeline, Congresses as Topic, Continuity of Patient Care, Patient Discharge, Patient flow, Patient care management, Italy, 030220 oncology & carcinogenesis, Quality of Life, 030211 gastroenterology & hepatology, Surgery, business
Abstract

Subjects undergoing ostomy are increasing and share a reduced quality of life. The patient flow (PF) is the pathway of a patient from hospital admission to discharge and should provide care appropriateness to the patient himself. In the recent literature no paper exists regarding the PF of the patient undergoing (intestinal or urinary) ostomy, which is the objective of the present article. This paper stems from the work done during the Educational Camp entitled "The Patient Flow in Stoma Care," which took place on three separate days (27supth/supMay, 18supth/supSeptember, and 21supst/supNovember 2019) at B. Braun Milano S.p.A. and regarded 33 stomatherapy nurses from all over Italy supervised by the authors. The participants, divided into heterogeneous groups, developed the PF by means of three specific work methodologies: mental maps, timeline and appreciative inquiry. The elaborated PF was inspired to the International Charter of the Ostomates' Rights. The efficacious and empathic communication and the role of the patient and/or the caregiver as the main characters are transversal to every step and must be always pursued. The PF is developed in eight macro-areas: diagnosis; pre-admission; admission and preoperative phase; surgical operation; awakening; postoperative phase; discharge; follow-up. In agreement with the recent literature, this systematic approach will give benefits to the patients in terms of outcome and perception of taking charge before, during and after the ostomy. At the same time the performances, the therapeutic appropriateness, the optimization of technology and healthcare resources and the staff satisfaction will equally be guaranteed.

Published
2020

2. GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery: early analysis on 977 patients

Author

Montroni, I, Rostoft, S, Spinelli, A, Van Leeuwen, BL, Ercolani, G, Saur, NM, Jaklitsch, MT, Somasundar, PS, Carino, ND, Ghignone, F, Foca, F, Zingaretti, C, Audisio, RA, Ugolini, G, Garutti, A, Taffurelli, G, Zattoni, D, Tramelli, P, Sermonesi, G, Di Candido, F, Carvello, M, Sacchi, M, De Lucia, F, Foppa, C, Plas, M, Van der Wal-Huisman, H, Tauceri, F, Perenze, B, Di Pietrantonio, D, Mirarchi, M, Fejka, M, Bleier, JIS, Frain, L, Fox, SW, Cardin, K, De Leon, LE, Baltatzis, M, Chan, AKC, Siriwardena, AK, Vertogen, B, Nanni, O, Garulli, G, Alagna, V, Pirrera, B, Lucchi, A, Monari, F, Conti, L, Capelli, P, Romboli, A, Palmieri, G, Banchini, F, Marano, L, Spaziani, A, Castagnoli, G, Bartoli, A, Trompetto, M, Gallo, G, Luc, AR, Clerico, G, Sammarco, G, De Luca, R, Barile, G, Simone, M, Costanzi, A, Mari, G, Maggioni, D, Pellegrino, R, Riggio, V, Kenig, J, Szabat, K, Scabini, S, Pertile, D, Stratta, E, Massobrio, A, Soriero, D, Nesbakken, A, Lonn, M, Backe, IF, Ferrari, G, Mazzola, M, Alampi, BDA, Achilli, P, Sfondrini, S, Ioannidis, O, Loutzidou, L, Galanos-Demiris, K, Pellino, G, Balducci, G, Frezza, B, Lucarini, A, Santos, C, Cooper, L, Siam, B, Levy, Y, Brenner, B, Kashtan, H, Belgrano, V, De Cian, F, Palermo, B, Eggenhoffner, R, Albertelli, M, Sanchez-Guillen, L, Arroyo, A, Lopez-Rodriguez, F, Lario, S, Lillo, C, Wexner, SD, SIOG Surgical Task Force, and ESSO GOSAFE Study Grp

Subjects
MULTICENTER, CANCER
Abstract

Objective: Older patients with cancer value functional outcomes as much as survival, but surgical studies lack functional recovery (FR) data. The value of a standardized frailty assessment has been confirmed, yet it's infrequently utilized due to time restrictions into everyday practice. The multicenter GOSAFE study was designed to (1) evaluate the trajectory of patients' quality of life (QoL) after cancer surgery (2) assess baseline frailty indicators in unselected patients (3) clarify the most relevant tools in predicting FR and clinical outcomes. This is a report of the study design and baseline patient evaluations. Materials & Methods: GOSAFE prospectively collected a baseline multidimensional evaluation before major elective surgery in patients (70 years) from 26 international units. Short-/mid-/Iong-term surgical outcomes were recorded with QoL and FR data. Results: 1003 patients were enrolled in a 26-month span. Complete baseline data were available for 977(97.4%). Median age was 78 years (range 70-94); 52.8% males. 968(99%) lived at home, 51.6% without caregiver. 54.4% had 3 medications, 5.9% none. Patients were dependent (ADL < 5) in 7.9% of the cases. Frailty was either detected by G8 = 2(37.4%), TUG > 20 s (5.2%) or ASAIII-IV (48.8%). Major comorbidities (CACI > 6) were detected in 36%; 20.9% of patients had cognitive impairment according to Mini-Cog. Conclusion: The GOSAFE showed that frailty is frequent in older patients undergoing cancer surgery. QoL and FR, for the first time, are going to be primary outcomes of a real-life observational study. The crucial role of frailty assessment is going to be addressed in the ability to predict postoperative outcomes and to correlate with QoL and FR. (C) 2019 Elsevier Ltd. All rights reserved.

Published
2020

3. GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery: early analysis on 977 patients

Author

Barbara Frezza, Giampaolo Castagnoli, Genoveffa Balducci, Valentina Riggio, G. Ugolini, Antonio Arroyo, Gianluca Garulli, Caterina Foppa, Kristin Cardin, Matthijs Plas, Gaetano Gallo, Francesca De Lucia, Francisco López-Rodríguez, Sandra Lario, Franco De Cian, Flavia Foca, Alberto Realis Luc, Paola Tramelli, Roberta Pellegrino, Giacomo Sermonesi, Stefano Sfondrini, Federico Ghignone, Orestis Ioannidis, Nicole M. Saur, Michael David Fejka, Basilio Pirrera, Bruno Alampi, Siri Rostoft, Sam Fox, Chiara Zingaretti, Ingeborg Flåten Backe, Alessandro Spaziani, Barbara Perenze, Minas Baltatzis, Riccardo A. Audisio, Claudia Santos, Luigi Marano, Mariann Lønn, Stefano Scabini, Andrea Massobrio, Patrizio Capelli, Isacco Montroni, Luis E. De León, Cristina Lillo, Alessio Lucarini, Valerio Belgrano, Antonino Spinelli, Daniela Di Pietrantonio, Nicola de Liguori Carino, Davide Pertile, Luigi Conti, Andrea Romboli, Giuseppe Sammarco, Hanoch Kashtan, Baha Siam, Michael T. Jaklitsch, Arild Nesbakken, Michele De Simone, Oriana Nanni, Filippo Banchini, Ajith K. Siriwardena, Giorgio Ercolani, Pietro Achilli, Davide Zattoni, Bernadette Vertogen, Steven D. Wexner, Laura Frain, Konstantinos Galanos-Demiris, Dario Maggioni, Baruch Brenner, Gerardo Palmieri, Giovanni Taffurelli, Barbara L. van Leeuwen, Manuela Albertelli, Gianluca Pellino, Anthony Chan, Alberto Bartoli, Emanuela Stratta, Mario Trompetto, Anna Garutti, Francesca Tauceri, Michele Mazzola, Beatrice Palermo, G. Clerico, Jakub Kenig, Yochai Levy, Graziana Barile, Vincenzo Alagna, Giulio Mari, Roberto Eggenhöffner, Joshua I. S. Bleier, Giovanni Ferrari, Andrea Costanzi, Michele Carvello, Francesca Di Candido, Francesco Monari, Ponnandai Somasundar, Kinga Szabat, Matteo Sacchi, Luis Sánchez-Guillén, Lydia Loutzidou, Lisa Cooper, Hanneke van der Wal-Huisman, Mariateresa Mirarchi, Domenico Soriero, Raffaele De Luca, Andrea Lucchi, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Clinical Cognitive Neuropsychiatry Research Program (CCNP), Montroni I., Rostoft S., Spinelli A., Van Leeuwen B.L., Ercolani G., Saur N.M., Jacklitsh M.T., Somasundar P.S., de Liguori Carino N., Ghignone F., Foca F., Zingaretti C., Audisio R.A., Ugolini G., Garutti A., Taffurelli G., Zattoni D., Tramelli P., Sermonesi G., Di Candido F., Carvello M., Sacchi M., De Lucia F., Foppa C., Plas M., Van der Wal-Huisman H., Tauceri F., Perenze B., Di Pietrantonio D., Mirarchi M., Fejka M., Bleier J.I.S., Frain L., Fox S.W., Cardin K., De Leon L.E., Baltatzis M., Chan A.K.C., Siriwardena A.K., Vertogen B., Nanni O., Garulli G., Alagna V., Pirrera B., Lucchi A., Monari F., Conti L., Capelli P., Romboli A., Palmieri G., Banchini F., Marano L., Spaziani A., Castagnoli G., Bartoli A., Trompetto M., Gallo G., Luc A.R., Clerico G., Sammarco G., De Luca R., Barile G., Simone M., Costanzi A., Mari G., Maggioni M., Pellegrino R., Riggio V., Kenig J., Szabat K., Scabini S., Pertile D., Stratta E., Massobrio A., Soriero D., Nesbakken A., Lonn M., Backe I.F., Ferrari G., Mazzola M., Alampi B.D.A., Achilli P., Sfondrini S., Ioannidis O., Loutzidou L., Galanos-Demiris K., Pellino G., Balducci G., Frezza B., Lucarini A., Santos C., Cooper L., Siam B., Levy Y., Brenner B., Kashtan H., Belgrano V., De Cian F., Palermo B., Eggenhoffner R., Albertelli M., Sanchez-Guillen L., Arroyo A., Lopez-Rodriguez F., Lario S., Lillo C., Wexner S.D., Montroni, I., Rostoft, S., Spinelli, A., Van Leeuwen, B. L., Ercolani, G., Saur, N. M., Jacklitsh, M. T., Somasundar, P. S., de Liguori Carino, N., Ghignone, F., Foca, F., Zingaretti, C., Audisio, R. A., Ugolini, G., Garutti, A., Taffurelli, G., Zattoni, D., Tramelli, P., Sermonesi, G., Di Candido, F., Carvello, M., Sacchi, M., De Lucia, F., Foppa, C., Plas, M., Van der Wal-Huisman, H., Tauceri, F., Perenze, B., Di Pietrantonio, D., Mirarchi, M., Fejka, M., Bleier, J. I. S., Frain, L., Fox, S. W., Cardin, K., De Leon, L. E., Baltatzis, M., Chan, A. K. C., Siriwardena, A. K., Vertogen, B., Nanni, O., Garulli, G., Alagna, V., Pirrera, B., Lucchi, A., Monari, F., Conti, L., Capelli, P., Romboli, A., Palmieri, G., Banchini, F., Marano, L., Spaziani, A., Castagnoli, G., Bartoli, A., Trompetto, M., Gallo, G., Luc, A. R., Clerico, G., Sammarco, G., De Luca, R., Barile, G., Simone, M., Costanzi, A., Mari, G., Maggioni, M., Pellegrino, R., Riggio, V., Kenig, J., Szabat, K., Scabini, S., Pertile, D., Stratta, E., Massobrio, A., Soriero, D., Nesbakken, A., Lonn, M., Backe, I. F., Ferrari, G., Mazzola, M., Alampi, B. D. A., Achilli, P., Sfondrini, S., Ioannidis, O., Loutzidou, L., Galanos-Demiris, K., Pellino, G., Balducci, G., Frezza, B., Lucarini, A., Santos, C., Cooper, L., Siam, B., Levy, Y., Brenner, B., Kashtan, H., Belgrano, V., De Cian, F., Palermo, B., Eggenhoffner, R., Albertelli, M., Sanchez-Guillen, L., Arroyo, A., Lopez-Rodriguez, F., Lario, S., Lillo, C., and Wexner, S. D.

Subjects
Geriatric Oncology, Surgical Assessment, Functional Recovery, Pre&postoperative testing, Surgery morbidity, Surgery mortality, Male, medicine.medical_specialty, Surgery morbidity, MEDLINE, MULTICENTER, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Pre&postoperative testing, Quality of life, aged, aged, 80 and over, female, geriatric assessment, humans, male, neoplasms, postoperative complications, prospective studies, quality of life, Functional Recovery, Internal medicine, Neoplasms, medicine, 80 and over, Humans, 030212 general & internal medicine, Prospective Studies, Elective surgery, Geriatric Assessment, cancer, geriatric, outcome, Aged, Aged, 80 and over, business.industry, Surgical Assessment, Cancer, Functional recovery, medicine.disease, CANCER, Geriatric Oncology, Surgery mortality, Oncology, Geriatric oncology, 030220 oncology & carcinogenesis, Quality of Life, Observational study, Female, Geriatrics and Gerontology, business, Early analysis
Abstract

Objective: Older patients with cancer value functional outcomes as much as survival, but surgical studies lack functional recovery (FR) data. The value of a standardized frailty assessment has been confirmed, yet it's infrequently utilized due to time restrictions into everyday practice. The multicenter GOSAFE study was designed to (1) evaluate the trajectory of patients' quality of life (QoL) after cancer surgery (2) assess baseline frailty indicators in unselected patients (3) clarify the most relevant tools in predicting FR and clinical outcomes. This is a report of the study design and baseline patient evaluations. Materials & Methods: GOSAFE prospectively collected a baseline multidimensional evaluation before major elective surgery in patients (≥70 years) from 26 international units. Short−/mid−/long-term surgical outcomes were recorded with QoL and FR data. Results: 1003 patients were enrolled in a 26-month span. Complete baseline data were available for 977(97.4%). Median age was 78 years (range 70–94); 52.8% males. 968(99%) lived at home, 51.6% without caregiver. 54.4% had ≥ 3 medications, 5.9% none. Patients were dependent (ADL < 5) in 7.9% of the cases. Frailty was either detected by G8 ≤ 14(68.4%), fTRST ≥ 2(37.4%), TUG > 20 s (5.2%) or ASAIII-IV (48.8%). Major comorbidities (CACI > 6) were detected in 36%; 20.9% of patients had cognitive impairment according to Mini-Cog. Conclusion: The GOSAFE showed that frailty is frequent in older patients undergoing cancer surgery. QoL and FR, for the first time, are going to be primary outcomes of a real-life observational study. The crucial role of frailty assessment is going to be addressed in the ability to predict postoperative outcomes and to correlate with QoL and FR.

Published
2019

4. Exploring the Impact of a Structured Educational Approach on Peristomal Skin Complications: An Interim Analysis.

Author

Denti FC, Guerra E, Caroppo F, Abruzzese P, Alessi F, Barone F, Bernardino P, Bergamini M, Bernardo C, Bosio G, Carp P, Cecconello M, Cerchier A, Croci F, Detti R, Di Pasquale C, D'Ippolito MR, Ditta S, Ducci E, Belloni Fortina A, Frascarelli S, Galante M, Guarino R, Leggio N, Livio E, Marchetti A, Marelli F, Mastropaolo R, Melis V, Palmiero N, Panarelli A, Pascali AL, Pizzarelli F, Precisi L, Rastello C, Regaglia S, Rinaldi RE, Rumbolo N, Sansone C, Santelli A, Sarritzu G, Sfondrini S, Stanzani S, Stella M, Walterova M, and Caruso R

Abstract

This study, employing an interim analysis, investigates the effects of the Dermamecum protocol, a structured educational and tailored approach that stratifies ostomy patients into risk paths (green, yellow, red) based on pre-operative and post-operative characteristics. The green path indicates a low risk of peristomal skin complications (PSCs), focusing on sustaining healthy behaviours and basic stoma care. The yellow path represents a moderate risk, emphasizing the need for patients to self-monitor and recognize early signs of complications. The red path corresponds to high risk, requiring stringent monitoring and immediate access to healthcare support. The study aims to reduce PSCs and improve patient outcomes. Methods include the stratification of 226 patients, with significant differences in gender distribution, BMI categories, and stoma types across the paths. Results show an occurrence rate of PSCs of 5.9% in all risk paths (5.7% green path, 4.7% yellow path, and 7.9% red path, p = 0.685), significantly lower than the median rate of 35% reported in the literature. Multiple correspondence analysis validated the stratification, with distinct clusters for each path. Poisson regression models in the exploratory framework of an interim analysis identified male gender as the only significant predictor of PSCs, indicating the need for gender-specific interventions. The findings suggest that the Dermamecum protocol effectively reduces early PSCs, providing a foundation for further research.

Published
2024
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5. Postoperative risk of pancreatic fistula after distal pancreatectomy with or without spleen preservation.

Author

Mazzola M, Crippa J, Bertoglio CL, Andreani S, Morini L, Sfondrini S, and Ferrari G

Subjects
Adult, Aged, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Organ Sparing Treatments adverse effects, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Pancreatectomy adverse effects, Pancreatic Fistula etiology, Pancreatic Neoplasms complications, Postoperative Complications etiology, Retrospective Studies, Splenectomy adverse effects, Organ Sparing Treatments methods, Pancreatectomy methods, Pancreatic Fistula diagnosis, Pancreatic Neoplasms surgery, Postoperative Complications diagnosis, Splenectomy methods
Abstract

Introduction: Outcomes after distal pancreatectomy with or without splenectomy are controversial. The present study aims to investigate differences in short-term and long-term outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS)., Methods: In this retrospective review of consecutive patients undergoing distal pancreatectomy with or without splenectomy from January 2011 until December 2017 for benign disease, the primary endpoint was to compare postoperative pancreatic fistula (POPF). The secondary endpoint was to compare duration of surgery, intraoperative blood loss, postoperative complications, length of hospital stay, and long-term outcomes., Results: Patients undergoing SPDP had a lower rate of POPF (13.6% vs 46.1%; p = 0.02). Patients undergoing SPDP (n = 22) were discharged earlier than patients undergoing DPS (n = 26) (8 [4-29] vs 12 [6.48] days; p = 0.003). No differences in other intraoperative and postoperative outcomes were found between groups., Conclusion: Patients undergoing SPDP developed fewer POPF and were discharged earlier compared to patients undergoing DPS.

Published
2021
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