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What is known and objective The aim of this survey, conducted by the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), was to evaluate the involvement of pharmacists in the haematopoietic stem cell transplant (HSCT) program in Italian adult and paediatric centres. Methods A 63-item online questionnaire was developed and sent to the Italian Transplant Programs on behalf of GITMO. Results and discussion Overall, 54.7% of the Italian HSCT centres participated in the survey (88.5% adult, 7.7% paediatric, 3.8% mixed), of which 50% were in public hospitals and 50% affiliated with public universities. Just over 80% declared that a pharmacist is involved in the HSCT centre, and 86.5% reported the presence of a documentation system to signal of adverse events, accessible by physicians, nurses and pharmacists in 57.7%. Chemotherapy drugs were centralized in the pharmacy in 98.1% of HSCT centres, while parenteral nutrition was centralized in 55.8%. The use of off-label drugs was authorized by an internal committee and by the regional health authorities in 88.5% of the centres. On univariate analysis, few statistically significant differences were found on response frequencies between public hospitals and university centres or between HSCT centres performing only autologous stem cell transplantation versus other centres performing autologous and allogeneic stem cell transplantation. What is new and conclusion This survey suggests that there is good collaboration between pharmacists and physicians and nurses in Italian HSCT transplantation centres. The enhancement of pharmacists dedicated to HSCT programs could improve some problems, for example, the centralization of parenteral nutrition.

TBackground. Information regarding ominous prognoses, which may cause concern and distress, should be provided carefully and cautiously, using non-traumatizing terminology, accommodating the patient's fears, and not excluding elements of hope. Goal. To analyze the difficulties of health care providers in the process of communicating bad news. Materials and Methods. An observational, cross-sectional, multicenter study was conducted from March to August 2021 among Italian Physicians and Nurses. Results. The results of the study indicate a greater participation of Nurse practitioners than Physicians, a fact that may indicate how necessary it is, to overcome the belief that the communication of bad news is of exclusive medical relevance. Among the participants in the study, about half, equal to 46.7% stated that they had no specific training, while the remainder claimed to have attended master's or higher education courses in 8.5% of cases, 23% attended conferences, while 21.8% acquired their skills through work experience. Conclusions. The communication of bad news, needs to be recognized in the same way as those procedures that characterize care itself, and for which the highest possible quality is sought.

Background: Italy was one of the first European Countries to deal with the Coronavirus Disease 2019 (COVID-19) outbreak, since its appearance in China. The virus spread from northern regions to central and southern ones with different intensity. Drastic emergency restrictions were introduced including quarantine and self-isolation measures. Initially, these were limited to Northern Italy then extended nationwide. The Italian Health System is organized on a regional basis with different funding, resources, institutional pathways. Health Care Professionals (HCPs) working in clinically demanding areas such as Emergency Departments and Intensive Care Units are at high risk of developing physical/mental health outcomes related to Coronavirus pandemic, such as stress, anxiety, depression, sleep disorders and burn-out symptoms (Luo et al., 2020). Nurses in Hematopoietic Stem Cell Transplant (HSCT) Units are caring for "complex" immune-compromised patients, being hospitalized for long period without seeing relatives. However, it is not known if nurses working in HSCT settings experience similar problems during the pandemic. The aim of the study was to investigate physical and psychological issues among nurses working in Italian HSCT Units during COVID-19 spread. Methods: A cross-sectional study was conducted between June and August 2020 through an online questionnaire sent to nurses working in Italian HSCT centers registered with GITMO (Gruppo Italiano per il Trapianto Midollo Osseo). Data were collected immediately after the lockdown period (during phase 2, consisting of a progressive reduction of lockdown measures) in order to:-investigate the prevalence of sleep disorders and burnout symptoms with validated tools: Pittsburgh Sleep Quality Index (PSQI) and Maslach Burnout Inventory (MBI), respectively.-explore significant correlations with other variables such as geographical areas (Northern Italy-NIT vs Central Sothern Italy-CSIT) according with COVID-19 incidence, its spread. Statistical analysis was performed using the Matrix Laboratory (MATLAB) Statistical toolbox version 2008 (MathWorks, Natick, MA, USA). Results: Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey: 214 nurses from NIT and 94 nurses from CSIT. Nurses responding from CSIT were older (mean 47, p = 0.0001) and male (74.5%, p < 0.0001). More nurses from NIT did not have children compared to those from CIST (49.5% vs 30.9%, p = 0.0023). Symptoms like stress, anxiety and depression were more frequently reported by CSIT than NIT nurses (NIT 27.7% vs 12.6%, p = 0.0013). MBI results: NIT and CSIT nurses reported low level of emotional exhaustion (median score: 14.0 vs 12.0 respectively) and depersonalization (3.0 vs 4.0);medium level of personal accomplishment (36.0 vs 34.5) were reported without significant differences between groups. Worst sleep quality was detected on nurse working in CSIT centers than NIT (global PSQI score 7.6 vs 6.5;p = 0.008) with the main differences in sleep duration (p = 0.006), sleep disturbance (p = 0.03), need of medication (p < 0.001). Conclusions: Despite cited differences on disease incidence and spread of infection, COVID-19 pandemic did not appear to have an impact on nurses' sleep quality or symptoms of burnout. Greater sleep disorders of nurses working in CSIT centers suggests that other factors influencing this issue.

Oral mucositis is one of the worst effects of the conditioning regimens given to patients undergoing hematopoietic stem cell transplantation. It is characterized by dry mouth, erythema, mucosal soreness, ulcers, and pain, and it may impact patient outcomes. Bovine colostrum and Aloe vera contain a wide variety of biologically active compounds that promote mucosal healing. A non-randomized phase II study was designed to assess the safety and efficacy of a combined bovine colostrum and Aloe vera oral care protocol to prevent and to treat severe oral mucositis in transplant patients. Two commercially available products were given to patients in addition to the standard protocol: Remargin Colostrum OS® mouthwash and Remargin Colostrum Gastro-Gel® taken orally. Forty-six (78.0%) patients experienced oral mucositis, 40 (67.8%) developed mild–moderate forms, and 6 (10.2%) severe ones. Comparing the study group’s outcomes with those of a homogeneous historical control group, severe oral mucositis decreased significantly (10.2% vs. 28.4%; P P P P

In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the results on the rehabilitation treatment.

Background Oral mucositis (OM) is one of the most debilitating effects of toxicity due to hematopoietic stem cell transplantation (HSCT) conditioning regimens. The aim of this secondary analysis of the data of a phase II study designed to assess the efficacy of a novel oral care protocol containing bovine colostrum and aloe vera to prevent oral mucositis was to compare outcomes reported by patients with those collected by healthcare professionals (HCPs). Method Data on oral mucositis severity, duration, time of onset and related pain were collected from patients using the Oral Mucositis Daily Questionnaire (OMDQ). HCPs assessed the same outcomes using the World Health Organization oral mucositis scale and pain numerical rating scale. Quality of life was assessed with the 3-level EuroQol-5 dimensions. Results Fifty-nine autologous/allogeneic graft patients were recruited, 46 of whom (78.0%) experienced OM. Mean onset was 9.1 (SD ± 3.5) days after conditioning initiation, mean duration was 10.4 (SD ± 4.3) days, and the average maximum pain score was 3.7 (SD ± 2.7). Self-administration of the OMDQ detected oral symptoms at least 1 day sooner compared to objective assessments (p = 0.025). Significant differences were observed between the patient-reported and the HCP-assessment data on oral mucositis severity grading distribution (p p Conclusions Further studies are necessary to improve the understanding of these findings; a randomised controlled trial is being set up at our institution.

The progressive and constant aging of the global population together with the economy crises and the social variations within family contexts increasingly leads to the use of external resources (Home Care Workers, HCWs) for health care within one's own family of origin. Purpose of the study is to describe Italian Home Care Workers' (HCWs) living and working conditions and understand the interactions with outcomes of the patients and informal caregiver.Observational study with cross sectional design to evaluate the interaction of HCWs without specific training on patients and informal caregivers' outcomes.understand Italian HCWs' condition and interaction between these conditions and outcomes of patients and informal caregiver.understanding how HCWs' conditions can affect outcome about patient and informal caregivers, represents a fundamental step in order to increase QoL of these families.

Sexual dysfunction after allogeneic hematopoietic cell transplantation (allo-HCT) is a common long-term complication. We conducted a European multicenter cross-sectional study of adult allo-HCT recipients who had survived >2 years and their partners to investigate sexual functioning after HCT and to evaluate whether discussion about sexual functioning between the transplant team and the survivor and partner was perceived to have taken place. In total, 136 survivors (77 males, 59 females) and 81 partners (34 males, 47 females) participated. Median age was 56 and 54 years in male and female survivors, respectively. Forty-seven percent of male and 65% of female survivors and 57% of male and 59% of female partners reported clinically relevant sexual problems. Sixty-two percent of survivors and 79% of partners reported that sexual functioning had not been discussed with them during transplant. Standardized sexual functioning scores were correlated with self-reported health status in survivors (rho = 0.24, p = 0.009). The high prevalence of sexual dysfunction warrants additional studies focusing on the impact of changes in sexuality for patients as well as their partners. Future studies should also investigate which methods that are effective in preventing or treating sexual problems after allo-HCT.

Although the effects of malnutrition on morbidity and mortality in adult patients undergoing allogeneic hematopoietic stem cell transplantation are clear, the relationship with quality of life (QOL) is less clear. The purpose of this study was to assess the relationship between malnutrition and QOL. A prospective observational study was conducted in 36 adult patients undergoing allogeneic hematopoietic stem cell transplantation. Adapted criteria of the Global Leadership Initiative on malnutrition have been used for the diagnosis of malnutrition in clinical settings. A cancer linear analog scale was used to assess QOL. Overall QOL at 14 days after allogeneic hematopoietic stem cell transplantation was 37.1 (95% CI 2.9–45.39) in patients without severe malnutrition, versus 16.0 (95% CI − 6.6 to 38.6) in patients with severe malnutrition (p = 0.05). At discharge, it was 48.0 (95% CI 38.4–57.6) versus 34.0 (95% CI 4.1–63.9) (p = 0.27). The results of our study suggest that patients with severe malnutrition at discharge tend to have worse QOL. A larger cohort of patients is required to confirm this hypothesis.

In allogeneic hematopoietic stem cell transplantation (AHSCT), falls can lead to immediate and late consequences and in some cases to death. We analyzed risks and causes of falls with root cause analysis (RCA) based on which improvement interventions were implemented.A retrospective observational study was conducted to analyze with RCA data of incidence reports and medical records of patients admitted; an expert panel identified actions to prevent falls, which were collected in a checklist.Between December 2017 and November 2019, 214 patients were admitted to ordinary hospital stays for AHSCT or AHSCTrelated complications. In this period, 15 falls, involving 11 patients, occurred resulting in a 2.32 d/patient incidence. In 66.67% of cases minor head trauma occurred. Diuretic drugs (93.33%), induced hyper-diuresis in nonbladder catheter patients (93.33%) and antihypertensive drugs (93.33%) were reported as most common cause in our incident reports. The most frequent fall time slot was between 10 PM and 7 AM (60%). We determined with RCA diuretics and consequent induced hyper-diuresis (80%), self-insufficiency (40%), antihypertensive (33.3%) and noncompliance (33.3%) as the most common cause of falls. Finally, 16 actions, collected in a "safe comfort" checklist, were identified to prevent falls.Diuretic drugs inducing hyper-diuresis, self-insufficiency, poor patient compliance, orthostatic hypotension, fever, night-time and obstacles within inpatient units are the most common contributing factors. Therefore, administration of diuretic and antihypertensive drugs should be rescheduled and a multidimensional risk assessment scale integrated with a preventive action plan, such as the safe comfort checklist, should be implemented to reduce falls.

Background and aim of the work. Safety in hospitals is a structural variable on which depends not only on health, but also on physical safety of patients and employees, whom are increasingly exposed to risks as a result of which they may suffer from occupational diseases and/or develop important psycho-physical consequences. The study aimed to evaluate the association between work environment and perceived burnout levels in two hospitals of Southern Italy. Method. From March to August 2019 an observational study was carried out through a survey consisting of four sections: sociodemographic data; the Post Occupancy Evaluation (POE) questionnaire; the perception of the environment and possible causes of stress; the burnout levels perceived through the Maslach Burnout Inventory (MBI). A convenience sample of 169 healthcare workers participated in the study. All nurses (including nursing coordinators), clinicians, support staff of the “Vito Fazzi” Hospital of Lecce (Le) and “San Giuseppe da Copertino” Hospital of Copertino (Le) with at least one year of work experience and who signed the informed consent were recruited. Results. The healthcare workers involved in the survey declared limits in handling and usability of the equipment, both for the patient n=77 (45.6%) and for the healthcare worker n=75 (44.4%), a lack of visual privacy n=89 (52.6%) and acoustic n=128 (75.7%). The analysis also shows higher scores on the ‘depersonalization’ scale among the health care workers of San Giuseppe da Copertino” Hospital (LE) (M= 9.36; DS= 9.439) and higher levels on the ‘emotional exhaustion’ scale in the surgical areas (M= 22.0; DS= 11.86) and in the female gender (M= 23.10; DS=. 12.01). Conclusions. The study reveals a poor condition of environmental comfort and safety, which generate high levels of stress and burnout in healthcare workers. Such a study can encourage further multicenter studies.

Background: Cancer is the leading cause of death worldwide. Of the various therapeutic approaches, chemotherapy is the most widely used treatment. Among the various side effects associated with this treatment, taste alterations (TAs) have received little attention, even though they have a serious impact on the nutritional aspect and quality of life (QoL) of patients. TAs concern 75% of the patients receiving chemotherapy, and this figure is still considered to be underestimatedbeacuse could be due both to inadequate attention and to the absence of specific subjective tools able to fully evaluate TAs in patients undergoing chemotherapy. Methods: A review by querying CINAHL, PubMed, Scopus and Google Scholar databases about the current status of use of the CiTAS self-evaluation scale, was performed. Results: From critical reading of the selected reports, it can be said that until now CiTAS has not been used to a large extent for evaluating taste, even at a late stage in patients undergoing chemotherapy. However, the results and the selected reports seem to indicate hope for its wider use. Conclusions: In literature, CITAS scale has been used on very heterogeneous populations and not adequately studied in specific care settings, its use within controlled trials could implement its spread. Correct and subjective evaluation of TAs would allow the planning of specific and personalized interventions aimed at providing adequate nutrition to support the maintenance and/or achievement of a correct body mass index. All this could contribute significantly to a better perception of QoL in patients undergoing chemotherapy. (www.actabiomedica.it)

Objectives Malnutrition in patients undergoing hematopoietic stem cell transplant (HSCT) can develop rapidly without appropriate nutritional support and affect morbidity and mortality. Guidance to monitor and manage nutrition status is described within the literature; however, whether this is applied in clinical practice is unclear. Methods This paper describes a cross-sectional survey to explore current practice approaches in nutrition support management and adherence to international guidelines. Results A total of 108 nurses from 108 centers across 16 countries replied to the questionnaire. A significant variation was observed regarding the availability of documents supporting the monitoring and management of nutrition status, application of recommendations, and nutritional practices. Discussion The findings revealed that country was the most important factor influencing the differences in practice; however, significant differences were also observed based on patient age group (pediatrics vs. adults), department composition (hematology + HSCT unit vs. HSCT unit alone), and availability of nutrition health care professionals. Behavioral differences regarding nutritional practice approaches could be indicative of differences in knowledge or subject awareness, as well as a reflection of diversity across health care system policies. Conclusions Guideline dissemination and raising awareness through educational campaigns are suggested approaches to improve health care professionals’ knowledge and sensitivity to this important topic.

Because of increasing survival rates in pediatric oncology, attention is focusing on cancer and its treatment-related side effects. Rehabilitation may reduce their impact. However, the literature does not provide strong evidence regarding rehabilitation pathways. Therefore, the Italian Association of Pediatric Hematology and Oncology organized a consensus conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system, and bone tumors to define recommendations for daily practice. The grading of recommendation assessment, developing and evaluation (GRADE) method was used in order to formulate questions, select outcomes, evaluate evidence, and create recommendations. This paper includes the results on the rehabilitation assessment.

Haematopoietic stem cell transplantation (HSCT) has become the standard of care for many haematological diseases unresponsive to traditional treatments; pretransplant therapy still causes high mortality and morbidity today. Due to the high risk, patient care requires careful assessment and often complex, intensive and non-risk free interventions; the NANDA-I classification provides a way to classify and standardise areas of nursing interest. In 2011, Speksnijder, using the Delphi technique, identified 68 diagnoses relevant to identify health problems in the field of oncohaematology.Based on Speksnijder's contribution, the study tries to identify which of these diagnoses were relevant in identifying health problems in HSCT patients.A quantitative-descriptive study was carried out; a structured questionnaire on a 4-point Likert scale was used to build consensus, involving 57 expert nurses enrolled in the Italian GITMO Centres.Of the 68 NANDA-I diagnoses defined as relevant by Speksnijder in the oncohaematological field, this study identified 37 as relevant in detecting health problems in patients undergoing HSCT (34 in Round 1, 3 in Round 2) and also defined 12 as important diagnoses having obtained an absolute consensus.Using the NANDA-I diagnoses to identify, from a panel of experts, the most important and relevant health problems associated with the toxicity of pre-TCSE treatment, allows to focus attention on expected and known outcomes in order to be able to intervene with performances aimed at reducing specific risks and complications.Il Trapianto di Cellule Staminali Ematopoietiche (TCSE) è diventato lo standard di cura per molte malattie ematologiche che non rispondono ai trattamenti tradizionali; la terapia pre-trapianto causa ancora oggi una elevata mortalità e morbilità. Per l’elevato rischio, l’assistenza ai pazienti necessita di attenta valutazione e di interventi spesso complessi, intensivi e non privi di rischi; la classificazione NANDA-I fornisce un modo per classificare e standardizzare le aree di interesse infermieristico. Nel 2011 Speksnijder, con tecnica Delphi, ha identificato 68 diagnosi rilevanti nell’identificare i problemi di salute in ambito onco-ematologico.Partendo dal contributo di Speksnijder, lo studio ha cercato di identificare quali di queste diagnosi fossero rilevanti nell’identificare i problemi di salute nei pazienti sottoposti a TCSE.E’ stato condotto uno studio quantitativo-descrittivo; per la costruzione del consenso è stato utilizzato un questionario strutturato su scala Likert a 4 punti coinvolgendo 57 infermieri esperti arruolati nei Centri GITMO italiani.Delle 68 diagnosi NANDA-I definite rilevanti da Speksnijder in ambito onco-ematologico, il presente studio ne ha identificate 37 rilevanti nell’individuare i problemi di salute nei pazienti sottoposti a TCSE (34 nel 1° round, 3 nel 2° Round); inoltre ha definito importanti 12 diagnosi avendo ottenuto un consenso assoluto.Utilizzare le diagnosi NANDA-I per conoscere, da un panel di esperti, i problemi di salute più importanti e rilevanti associati alla tossicità del trattamento pre-TCSE, consente di concentrare l’attenzione sugli esiti attesi e noti, così da poter intervenire con prestazioni finalizzate a ridurne i rischi e le complicanze specifiche.

Bone marrow aspiration (BMA) or biopsy is a necessary and frequent procedure for diagnosis and monitoring of hematological diseases. Pharmacological pain management approaches exist; however, previous experience and psychological preparation for BMA may impact pain perception.This study aimed to explore current practices in procedural pain management for BMA or biopsy.A cross-sectional internet-based survey was performed by the Nurses Group of the Italian Transplant Group (GITMO). Participants were nurses working in bone marrow transplant centers regularly performing BMA/biopsies.Sixty out of 94 centers receiving the survey responded (63.8%), 47 adult and 13 pediatric centers. The majority of them (75%) provided only verbal information for patient preparation before BMA. . Injected local anesthetics were used in 55.4% of centers, and combined with topical anesthetics in 33.9% of centers. Use of oral anesthetics was rare; however, anxiolytics and benzodiazepines were occasionally used (18.3%, 18.3% respectively). All pediatric centers used deep sedation for the procedure (p .001), but drug choice depended on anesthetist preference. Ice packs (35.0%) and oral analgesia as required (40.0%) were used for postprocedural pain. Nurses perceived their patients' pain scores as relatively low (3.5 on scale 0-10), but recognized that it was a painful procedure provoking anxiety, and that pain management could be improved.Results revealed the lack of a standardized approach to procedural pain management for BMA in this study sample. Assessing a patient's pain experience is a key component to identifying effective pain management for BMA.

Variation in clinical practice affects veno-occlusive disease management, mainly in patients who undergo allogeneic hematopoietic stem cell transplantation. Disputes about diagnostic criteria, treatment, and prophylaxis, due to the lack of high-quality data, are at the base of this variability. With the aim of limiting inconsistency in clinical care, thus improving both patient outcomes and data collection reliability, the Italian Society of Stem cell transplant (Gruppo Italiano Trapianto Midollo Osseo e Terapia Cellulare) launched a collaborative effort to formulate recommendations based on integration of available evidence and expert's consensus. A systematic method, according to US National Institute of Health guidelines and Italian National System for Guidelines, was used. Twenty-nine recommendations were approved with a strong (20) or weak (9) level of agreement, while 26 were rejected. In particular, the panel pointed out the need to achieve an early diagnosis, encouraging the adoption of European Society for Blood and Marrow Transplantation criteria and the prompt use of ultrasonography. Moreover, our experts strongly recommended in favor of prophylactic use of ursodeoxycholic acid. As soon as a veno-occlusive disease diagnosis is established, treatment with defibrotide should be started for at least 21 days. A number of areas of uncertainty, particularly concerning risk stratification and use of diagnostic tools such as elastography has been identified and discussed.

Sinusoidal obstruction syndrome (SOS) is one of the most serious complications post haematopoietic stem cell transplantation (HSCT). The diagnosis of SOS is clinical, but nurses should be involved in the pre-transplant risk assessment period and play a crucial role in the early detection of signs and symptoms during and after hospitalization. The aim of this work is to achieve a consensus on nurses’ behaviour in caring for SOS. On behalf of the Italian Group for Bone and Marrow Transplantation (GITMO), a promoter committee was established to put in place a consensus conference approach. A multidisciplinary group of GITMO together with four nurses, three haematology physicians and one patient representative acted as jury, who reviewed the reports and wrote recommendations and suggestions. Recommendations gaining 100% of consensus were considered ‘Golden Points of Care’; if a consensus was achieved by ≥ 75% of the jury’s members, those recommendations were defined as ‘Good Practices’. Eighteen papers written by nurses as first authors have been identified. Golden Points of Care and Good Practices were worked out for the following topics: nurses’ role in general, nurses’ role in pre-transplant assessment, pre-transplant risk assessment and risk stratification, baseline monitoring, suspected mild or moderate SOS, suspected severe or very severe SOS and late-onset cases. SOS is relatively rare; therefore, a holistic approach to the patients’ needs considering nursing role as essential may result in better care outcomes.

Haematopoietic Stem Cell Transplantation ( HSCT) has become the standard of care for some haematological diseases that do not respond to traditional treatments: pre-transplant therapy still causes high mortality and morbidity today. Due to the high risk, patient care requires careful evalua- tion and often complex, intensive and non-risk free interventions; the NANDA-I classification provides a way to classify and standardise areas of nursing interest. A previous consensus among experts had iden- tified 61 diagnoses, according to the classification NANDA-I 2018-2020, relevant in onco-haematolo- gical field.The aim of the study was to identify which of the 61 diagnoses were relevant for patients undergoing HSCT.A Delphi study was conducted in two rounds; a structured questionnaire on a 4 point Likert scale was used to build consensus, involving 57 experienced nurse enrolled in Italian GITMO Centres.The present study has identified 34 relevant NANDA-I diagnoses in patients undergoing HSCT; it also defined 11 as important diagnoses having obtained absolute consensus.Use the NANDA-I diagnoses to know, from a panel of experts, the most important and relevant health problems associated with the toxicity of pre- HCSE treatment, it can direct assistance and resources towards expercied and known outcomes so as to be able to intervene effectively with performances aimed at reducing risks and specific complications.Il Trapianto di Cellule Staminali Ematopoietiche (TCSE) è diventato lo standard di cura per alcune malattie ematologiche che non rispondono ai trattamenti tradizionali; la terapia pre- trapianto causa ancora oggi una elevata mortalità e morbilità. Per l’elevato rischio, l’assistenza ai pazienti necessita di attenta valutazione e di interventi spesso complessi, intensivi e non privi di rischi. La classi- ficazione NANDA-I fornisce un modo per classificare e standardizzare le aree di interesse infermieri- stico. Un precedente consensus tra esperti aveva identificato 61 diagnosi, secondo la classificazione NANDA-I 2018-2020, rilevanti in ambito onco-ematologico.Lo scopo dello studio è stato quello di identificare quali delle 61 diagnosi fossero rilevanti per i pazienti sottoposti a TCSE. Metodo. E’ stato condotto uno studio Delphi in 2 round; per la costruzione del consenso è stato utilizzato un questionario strutturato su scala Likert a 4 punti coinvolgendo 57 infermieri esperti arruolati nei Centri GITMO italiani.Il presente studio ha identificato 34 diagnosi NANDA-I rilevanti nei pazienti sottoposti a TCSE; inoltre ha definito fondamentali 11 diagnosi, avendo queste ottenuto un consenso assoluto.Utilizzare le diagnosi NANDA-I per conoscere, attraverso un panel di esperti, i problemi di salute più importanti e rilevanti associati alla tossicità del trattamento pre-TCSE, può orientare l’as- sistenza e le risorse sugli esiti attesi e noti, così da poter intervenire efficacemente con prestazioni fina- lizzate a ridurne i rischi e le complicanze specifiche.

Background Haemorrhagic cystitis (HC) is a severe complication occurring after haematopoietic stem cell transplantation (HSCT) in 13-40% of patients, caused by infectious and/or non-infectious factors that increase the in-hospital length of stay and the risk of mortality of transplanted recipients. Although different management interventions have been suggested in the literature, available knowledge on interventions performed by Italian nurses in their daily practices has not been documented to date. Aim of the study The aim of this study is to describe HC preventive and treatment interventions in patients undergoing HSCT as performed by Italian nurses in their daily practice. Material and methods A multicentre survey was conducted in 2018 by inviting all 110 Italian HSCT centres belonging to the Italian Group for Bone Marrow Transplantation (GITMO). Data collection was performed with an online questionnaire submitted to GITMO reference nurses working in each HSCT centre. Descriptive statistics were performed. Results A total of 38 Italian centres participated. The preventive intervention most applied in daily care was the mesna administration (n=37; 97.4%), followed by intravenous hyperhydration (n=33; 86.8%) and forced diuresis with furosemide (n=24; 63.1%). Preventive continuous bladder irrigation (CBI) was performed in 13 centres (34.2%). Transfusions of blood products (n=32; 84.2%), CBI (n=31; 81.6%) and intravenous hydration (n=28; 73.7%) were the most applied treatments, beyond the administration of analgesics (n=38; 100.0%) and antispasmodics (n=26; 68.4%). Conclusion A great variability both in the HC prevention and treatment interventions applied in daily practice across centres have emerged suggesting that no strong recommendations in the field are available to date. Therefore, there is a need to increase the evidence available in the field by providing methodological studies of higher quality, multicentre and prospective.

Colostrum is the first secretion of mammalian glands during the early period after birth giving. Its components are biologically active and have beneficial effects on new-born growth and well-being. Bovine colostrum has the highest concentration of these substances and its supplementation or application may provide health benefits. This systematic review was conducted to update current knowledge on bovine colostrum effects including all administration routes on healthy and sick subjects. Full texts or abstracts of twenty-eight papers as reports of systematic reviews, randomized controlled trials, observational studies and case series were included after searches in Medline, Embase, Cochrane Library and Cinahl databases. The full texts of selected studies were assessed for quality using validated tools and their results were summarized in different categories. Studies were highly heterogeneous as regards to population, intervention, outcome and risk of bias. Bovine colostrum topical application was shown effective on vaginal dryness related symptoms limitation. Its use as food supplement showed interesting effects preventing upper respiratory illness in sportsmen, modulating immune system response and reducing intestinal permeability in healthy and sick subjects. Conflicting results were provided in pediatric population and little evidence is available on its use with older adults. Further studies are mandatory to better understand all factors influencing its activity.

Recommendations on screening and nutritional support for patients undergoing hematopoietic stem cell transplantation (HSCT) have been presented by international nutritional societies, but nutritional practices remain poorly standardized. Following the general policy of the European Society for Blood and Marrow Transplantation (EBMT) to standardize transplantation procedures, the Complications and Quality of Life Working Party and Nursing Research Group carried out a survey among all EBMT centers about their current nutritional practices. The aim of this study was to better understand current practices, differences from available guidelines, and possible barriers for recommended nutritional therapy. Responses from 90 centers (19%) from 23 countries were received. We observed a marked variability in nutritional care between EBMT centers and a substantial lack of standardized operating procedures in screening patients for malnutrition and management of gastrointestinal GVHD. Furthermore, our study confirmed neutropenic diet as standard of care in most centers as well a preference for parenteral nutritional support over enteral. On the basis of these findings, future EBMT efforts will focus on better implementation of international nutritional guidelines into clinical practice.

Background and aims: The use of Tirosine Kinase Ihnibitors (TKIs) for the treatment of Chronic Myeloid Leukemia (CML) has definitely represented a turning point in the treatment of the onco-hematological diseases. Over the years, the interest of physicians, nurses, patients and caregivers has increasingly focused on the aspects of the humanization of care, the management of side effects and on the full and constant therapeutic adherence.The aim of the project was to define patient-oriented care processes, based on a proactive approach that can fully respond to the new health needs of CML patients.Methods: A nursing expert Working Group (WG) was established. WG reviewed literature about CML patients assistance and then it was conducted a survey on organizational models for the treatment of CML patients, adopted by Italian haematologic and transplant centers. Finally, the main issues regarding CML patients care were identified and discussed on a multiprofessional basis.Results: Euriclea Project for care of CML patients with the description of a new and expanded nurse role was defined. The Nurse Case Manager or Nursing Clinical Experts were identified as key people for the management of the side effects of treatment, the promotion of the therapeutic adherence and the evaluation of efficacy and effectiveness of the process through the identification of specific indicators for structure, process and outcome. Discussion: The focal areas of the care process were identified so as to define a different approach to the CML patient, through a holistic view of care and the multidisciplinary interventions.

In the last years we have seen an ever increasing number of patients with haematologic disorders who need hematopoietic stem cell transplantation (HSCT). The whole sector of HSCT results, infact to be in a continous scientific and technological clinical progress, offering a very advanced care. Despite this, some aspects are underconsidered, some of which could be fundamental to determine the success of the care pathway, such as the experience of the illness by the patient. Using a Narrative Based Medicine approach we wanted to investigate clinical, psychosocial and organizational aspects of the patient's journey whilst undergoing HSCT.Various narrative interviews were conducted using non-structured approach. Results were analysed by thematic contents.Psycological dimension is the most compromised: above all emerged sentiments of oppression linked to the isolation period in the Low Bacterial Load (LBL) room. To note are also the different dynamics with which the patients perceive the organisation and hospital structures, and how much these factors can influence their care experience.Results suggest the need in clinical practice of an integration between qualitative and clinical approach, so as to permit the psychosocial and relational necessities to emerge, often unexpressed by patients undergoing HSCT.

Veno-occlusive disease (VOD) is a complication arising from the toxicity of conditioning regimens that have a significant impact on the survival of patients who undergo stem cell transplantation. There are several known risk factors for developing VOD and their assessment before the start of conditioning regimens could improve the quality of care. Equally important are early identification of signs and symptoms ascribable to VOD, rapid diagnosis, and timely adjustment of support therapy and treatment. Nurses have a fundamental role at the stages of assessment and monitoring for signs and symptoms; therefore, they should have documented skills and training. The literature defines nurses' areas of competence in managing VOD, but in the actual clinical practice, this is not so clear. Moreover, there is an intrinsic difficulty in managing VOD due to its rapid and often dramatic evolution, together with a lack of care tools to guide nurses. Through a complex evidence-based process, the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), cellule staminali emopoietiche e terapia cellulare nursing board has developed an operational flowchart and a dynamic monitoring tool applicable to haematopoietic stem cell transplantation patients, whether they develop this complication or not.

A survey within Italian haematopoietic stem cell transplant (HSCT) programmes was performed, in order to obtain a snapshot of nutritional support (NS) in patients undergoing HSCT. The primary objective was to verify whether an evidence-based practice (EBP) approach to NS was implemented in HSCT centres. A multicentre survey was performed by questionnaire, covering the main areas of NS (screening, treatment planning, monitoring, nutritional counselling, and methods of nutritional support). The results indicated a significant variation between clinical practice and evidence-based guidelines in terms of clinical pathways, decision-making, and care provision regarding NS. Further research is required to identify reasons for the limited application of EBP and measures that may be undertaken to address such issues. Development of a multidisciplinary educational programme in order to raise awareness of the issue should be undertaken.

The increasing incidence of infections by carbapenem-resistant enterobacteria (CRE), in particular carbapenem-resistant Klebsiella pneumoniae (CRKp), is a significant public health challenge worldwide.[1][1] The interim results of the last European survey on CRE (EuSCAPE project 2013) indicate that