[The COVID-19 emergency management in Nephrology: a cross-sectional survey on the procedures management to deal with the pandemic].

From mid-March 2020, the pandemic caused by COVID 19 has placed health facilities in front of the need to implement a rapid and profound reorganization. However, many hospitals have not had time to organize a rapid and effective response, both for the speed of spread of the virus, and for the lack of previous experience with a pandemic of this magnitude. With the aim of assessing the knowledge and adoption of the procedures and recommendations disseminated by hospitals during the COVID-19 pandemic, in the dialysis and hemodialysis services of Italian centers, a cross-sectional survey was designed by the Society of Nurses in Nephrology (SIAN). The online survey was conducted among nurses who work in the Italian services of dialysis and hemodialysis during the first and second waves. The online survey was completed by 150 nurses. Although hospitals have set up protocols and procedures for patient management during the COVID-19 pandemic, among participants not all were aware of it. With regard to the training of personnel in the use of personal protective equipment, 18.6% declared that they have not received it. The majority implemented specific precautions for patient management, awareness and information.

Describing nurses' awareness of biological risk in delivering care for renal-dialysis patients: an Italian pilot survey.

BACKGROUND AND AIM OF WORK: Despite national descriptions of awareness, knowledge, and perceptions about the exposure to the biological risk among nurses employed in renal-dialysis care are pivotal to increase work safety, there is a paucity of data on these descriptions in the Italian context. This study aimed at describing Italian nurses' awareness and knowledge about biological risk in delivering care for renal-dialysis patients, and their experiences of biological accidents. METHODS: A pilot survey using cross-sectional data collection and convenience sampling procedure. 124 nurses were enrolled receiving a 7-item questionnaire: Questions 1, 2, and 7 were referred to the awareness about educational learning needs, questions 3 and 4 explored nurses' knowledge about biological risk, questions 5 and 6 collected accident-related information. RESULTS: Overall, nurses' awareness and knowledge about biological risk appeared almost limited. Surprisingly, 52% of the enrolled nurses experienced a biological accident, and 29.5% reported to know colleagues who developed work-related disease after a biological accident. We found positive significant associations between awareness and knowledge. CONCLUSIONS: This pilot study highlighted the need to further describe Italian nurses' awareness and knowledge about biological risk in delivering care for renal-dialysis patients, as well as the need of up-to-date epidemiological description about biological accidents. Accordingly, future studies are highly recommended to provide robust evidence aimed at supporting policy makers, educators, clinicians, regulators, and managers.

[SARS-CoV-2: recommendations on nursing care for dialyzed and transplanted patient].

Coronavirus disease 2019 is an infectious respiratory syndrome caused by the virus called SARS-CoV-2, belonging to the family of coronaviruses. The first ever cases were detected during the 2019-2020 pandemic. Coronaviruses can cause a common cold or more serious diseases such as Middle Eastern Respiratory Syndromes (MERS) and Severe Acute Respiratory Syndrome (SARS). They can cause respiratory, lung and gastrointestinal infections with a mild to severe course, sometimes causing the death of the infected person. This new strain has no previous identifiers and its epidemic potential is strongly associated with the absence of immune response/reactivity and immunological memory in the world population, which has never been in contact with this strain before. Most at risk are the elderly, people with pre-existing diseases and/or immunodepressed, dialyzed and transplanted patients, pregnant women, people with debilitating chronic diseases. They are advised to avoid contacts with other people, unless strictly necessary, and to stay away from crowded places, also observing scrupulously the recommendations of the Istituto Superiore di Sanità. In this article we detail the recommendations that must be followed by the nursing care staff when dealing with chronic kidney disease patients in dialysis or with kidney transplant patients. We delve into the procedures that are absolutely essential in this context: social distancing of at least one meter, use of PPI, proper dressing and undressing procedures, frequent hand washing and use of gloves, and finally the increase of dedicated and appropriately trained health personnel on ward.

Effectiveness of selective neck dissection in head and neck cancer: the experience of two Italian centers.

OBJECTIVE: The aim of this study was to evaluate the oncologic outcomes after a selective neck dissection (SND), both in elective and therapeutic settings, with particular regard to regional recurrence rate. METHODS: Retrospective analysis of 827 patients with head and neck primary tumors submitted to SND from 1999 to 2011 in two large hospital centers of northern Italy. RESULTS: A total of 40 neck recurrences were found in the whole series, with the same incidence after primary or salvage surgery (4.4% and 5.2%, respectively), but only 22 neck recurrences occurred in the same side of the dissected neck (3.0%). Factors predicting an increase of ipsilateral neck relapse were pathologically positive nodes, number of positive nodes, and nodal ratio (ratio between positive nodes and total nodal removed), but the risk of regional relapse did not exceed 5.0% in any subgroups. A total of 320 patients (39%) had postoperative radiotherapy (52.0% and 22.0% after primary and salvage surgery, respectively). Considering the primary surgery group alone, postoperative radiotherapy produced only a light reduction of homolateral neck recurrence rate in patients with pathological positive nodes (2.4% vs. 5.0%), but it impacted significantly disease-specific survival, both in pathological classification of nodes (pN)1 and pN2-3 patients. CONCLUSION: The SND can be considered a safe and sound procedure both in primary surgery and in salvage setting. Postoperative radiotherapy adds minor advantage to regional control only in node-positive patients but may impact survival. LEVEL OF EVIDENCE: 4.

Gamma probe accuracy in detecting the sentinel lymph node in clinically N0 squamous cell carcinoma of the head and neck.

The sentinel node, which is not always located at the first-echelon nodal area close to the primary tumor, is the initial recipient of possible metastasis. In order to verify the usefulness of the sentinel lymph node technique in the staging of head and neck cancers, we studied 31 untreated patients with squamous cell carcinoma of the upper airways by injecting them around the primary tumor with technetium 99m albumin microcolloid (99mTc) and submitting them to selective neck dissection with en bloc tumor removal. The nodes were examined after gamma-probe identification of the sentinel node(s). No patients were found to have microscopic tumor spread outside the level(s) containing the gamma-probe-identified sentinel node(s). In only 1 case was the metastatic node not the gamma-probe-positive one, but an adjacent one. Lymphoscintigraphy with 99mTc seems reliable in identifying the sentinel node(s) and might contribute to the reduction of surgical morbidity by reserving therapeutic neck dissection for cases with histologically confirmed nodal metastasis.

Extra-capsular dissection in benign parotid tumors.

UNLABELLED: The type of surgery for benign parotid tumors is still lacking of general consensus: this retrospective study, from 1964 to 2004 with a minimum follow-up of 7 years, is carried out with the aim to evaluate the results of parotidectomy and extracapsular dissection (ECD). PATIENTS AND METHODS: Three hundred forty-nine pts were operated for pleomorphic adenoma (219) or cystadenolymphoma (165). ECD was performed in 332 pts and parotidectomy in 52. Pts retrospectively provided health-related informations. The local recurrences and the complications were the main outcome measures. RESULTS: The total recurrence rate was 3.15%:2.3% after ECD and 12% after parotidectomy (p=0001). The rate of post-operative complications was lower in the ECD group with 1.3% of permanent facial paralysis, 0.3% of salivary fistula and 1.3% of Frey's syndrome compared to 4%, 6% and 44% respectively in the parotidectomy group. CONCLUSION: ECD may be an effective alternative to parotidectomy for the treatment of benign parotid tumors and generally results in a low rate of recurrences and complications.