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The National Cancer Institute of Aviano, Italy, recently launched a new program to educate the cancer population, bringing patients as close as possible to the world of physical activity during the cancer rehabilitation phase. A personalized assessment of the patient using the latest technologies allows to create a personalized electronic record of the state of physical performance to be shared among the patient, the staff at the institute (including the medical doctors and physiotherapists in charge), and the fitness instructors, who deal with of the recovery tasks. The outcome of the program can allow the development of a personalized rehabilitation path that includes physical fitness to be monitored remotely.
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Exercício Físico , Neoplasias , Humanos , Aptidão Física , Neoplasias/prevenção & controle , Oncologia , ItáliaRESUMO
Telemedicine and remote visits are becoming more and more popular in several medical disciplines, including oncology. The Covid-19 pandemic has enhanced the need to continue to meet patients' ambulatory care necessities ensuring social distancing and limiting the access to clinical facilities. The National Cancer Institute of Aviano, Italy, has recently launched a program called "Doctor @ Home" (D@H). The pillars of the program are the co-production of the oncological care and the co-learning approach, which sees the clinical staff "hand in hand" with patients to maximize the outcome of the care, trying to take advantage of the new tools offered by modern technologies.
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COVID-19 , Telemedicina , COVID-19/epidemiologia , Humanos , Oncologia , Pandemias , SARS-CoV-2RESUMO
INTRODUCTION: In recent years, and even more following the need for social distancing generated by the global COVID-19 pandemic, e-health has become an increasingly widespread reality in clinical practice, especially for those clinicians operating in the front-line, like nurses. Its growing importance has been followed by increasing attention both by the literature as well as in the generation of specific rules aimed at regulating the phenomenon. METHODS: A regulatory review of the literature aims to outline the current regulatory framework relating to telemedicine. Telemedicine, especially in a pandemic context, calls for regulation that runs parallel to the rapid evolution of the phenomenon itself. The paper traces the European, Italian, and Regional legislation, focusing then on a practical experience of telemedicine, called Doctor @ Home, active at the IRCCS National Cancer Center in Aviano (Italy). DISCUSSION: First, the need for regulatory harmonization emerges. Secondly, the potential of co-production and co-learning processes for healthcare professionals and patients arises to adapt to the outpatient needs of patients in a post-pandemic "new normal," exploiting the new technological tools made available by the National Health Service.
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COVID-19 , Telemedicina , Humanos , Pandemias , Medicina Estatal , PolíticasRESUMO
The American College of Sports Medicine states that 150 minutes per week of moderate aerobic activity improves quality of life, also in patients treated for cancer. Physical activity before, during, and after oncological treatments increases rates of survival, interval free from sickness, and side effects of treatment. The importance of physical exercise is often underestimated in Oncology, above all because of the need for an individualized approach and for a lack of recommendations that are valid for everyone. The literature now states that rehabilitation and exercise are as important as medical care. The National Cancer Institute in Aviano (Italy) has started a rehabilitation program for patients treated for breast cancer, followed by an assisted path to encourage physical activity. Thanks to various co-production processes, this program allows women to benefit from a personalised plan and it will be possible to assist patients and encourage physical activity through use of a mobile app. A synergy between the health and fitness worlds has been created, through co-production, accustoming patients to exercise during and following treatments.
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Neoplasias da Mama , Exercício Físico , Tutoria , Qualidade de Vida , Neoplasias da Mama/psicologia , Exercício Físico/fisiologia , Exercício Físico/psicologia , Terapia por Exercício , Feminino , Humanos , ItáliaRESUMO
OBJECTIVE: The study compare two tests for evaluating the driving abilities of patients undergoing opioid therapy for chronic pain: the Vienna Test System (VTS), a software developed for this purpose, and a new free APP for smartphones (SafeDrive) measuring visual and auditory reaction times. METHODS: One hundred and five patients undergoing long term opioid therapy for chronic pain were enrolled. The driving abilities of study patients were evaluated using two tests, namely the Vienna test System (VTS) and the SafeDrive APP. The concordance between the two tests was evaluated through Cohen's test. In addition we evaluated the correlation between the results of both VTS and SafeDrive tests and prescribed Morphine Equivalent Doses (MEDs), sex, age and the specific drugs taken, by multivariate linear regression analysis. RESULTS: A statistically significant concordance (Cohen's K coefficient=0.476) was found between the SafeDrive APP and the VTS; multivariate linear regression analysis found no significant influences of dosage and type of opioid prescribed on test performances, but significant influences of sex and age. CONCLUSIONS: The Authors found a significant correlation between VTS with SafeDrive test results. The SafeDrive APP is cheaper, easier to use and faster than VTS, and is portable and "usable on the road". Complex behavioral tasks such as driving may be severely impaired by psychoactive drugs, and consequently SafeDrive could be considered a useful portable screening tool to identify drivers with drug associated psychomotor impairment.
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Analgésicos Opioides/uso terapêutico , Condução de Veículo , Dor Crônica/tratamento farmacológico , Destreza Motora/efeitos dos fármacos , Humanos , SmartphoneRESUMO
General practitioners often request specialist consultations to manage their patients affected by chronic pain, but in Italy wait times for the consultations are usually very long. For this reason, The Friuli Venezia Giulia region is the first Italian region to start using priority criteria for access to consultation with a pain specialist (brief within 10 days, delayed within 30 days, scheduled within 180 days).
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Manejo da Dor/normas , Medição da Dor/normas , Dor Crônica/terapia , Emergências , Medicina Geral , Prioridades em Saúde , Humanos , Itália , Clínicas de Dor/estatística & dados numéricos , Clínicas de Dor/provisão & distribuição , Medição da Dor/métodos , Encaminhamento e Consulta/normas , Listas de EsperaRESUMO
OBJECTIVES: Objectives. To explore the perceived self-competence level of palliative care nurses in the province of Belluno (Italy), compared to Core Curriculum in Palliative Care Nursing (CCICP) competencies and to identify own strengths and weaknesses. METHODS: The authors performed a descriptive study using an anonymous questionnaire. The study population included 25 Palliative Care and Hospice nurses and ward managers of a local health unit in the city of Belluno and one in Feltre (Italy), of whom 24 agreed to participate in the study and compiled the questionnaire correctly. Participants were asked to evaluate their own competencies as compared to those defined by the CCICP, by assigning to themselves a score from 0 (no competence) to 10 (total competence). Three competency levels were identified: score 0-5 "low" level, score 6-7 "medium" level, score 8-10 "high" level. RESULTS: Overall, 33,33% reports feeling highly competent, 62,5% feels average, 4,17% considers insufficiently competent. Nurses feel most competent in "Appropriate use of interventions, activities and nursing skills, aimed to provide optimal care in Palliative Care" while they feel least competent in "leadership competencies and management of group dynamics in Palliative Care". More specifically, the "ability to personalize assistance to improve the quality of life of the assisted person and his family, relieving physical, psychosocial and spiritual suffering in the team and in all the services of the Network" is the area in which they feel especially confident; on the contrary, the "ability to promote fundraising activities to finance Palliative Care and recruit volunteer resources" is reported to be the most critical. CONCLUSIONS: Results show that nurses have a medium to high level of self-perceived skills. The study has laid down the foundations for a wider staff evaluation process which would be useful in improving nursing satisfaction and, indirectly, the quality of the service.
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Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Competência Clínica , Autoavaliação Diagnóstica , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Humanos , Itália , Cuidados Paliativos/normas , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
The work described below explores the field of the effects of pulsed radiofrequency for pain relief purposes. While the effects of this technique on pain modulation (A-delta and C fibers) are relatively well-known, little has been written yet about the potential of pulsed radiofrequency interactions with other fibers. The proposed algorithm, specifically elaborated, investigates the effect of this technique on neuromuscular fatigue, through a surface electromyographic study of the femoral nerve of a patient with residual pain after knee arthroplasty surgery, before and after the treatment. This work yields a preliminary result that is encouraging for subsequent large-scale studies.
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Roller speed skating is a discipline in which muscle fatigue plays an important role in athletes; in this work, we wanted to evaluate whether a methodological approach based on the energy required to maintain an isometric muscle contraction for one minute, indexed on the MVIC (maximum voluntary isometric contraction), i.e. % RMS/MVIC can give results similar to the frequency decay analysis/time in terms of usability for athlete training and injury prevention. Right and left gluteus maximus and vastus lateralis muscles (involved in the propulsive phase of skating ) were examined separately by surface electromyography in three competitive athletes in short-track speed skating on asphalt. The results showed an asymmetry between the right (less resistant) and left (more resistant) lower limb, in all three athletes, from the point of view of fatigue, in both investigated muscles. Furthermore, a trend in terms of fatigue resistance was found that was directly proportional to skill in both muscles studied. This can be of help in better planning the training of street speed skaters (which although similar to the discipline on ice is not completely superimposable) with the dual purpose of improving their performance and preventing injuries, often linked to the degree of right-left muscle asymmetry.
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BACKGROUND: Speed skating is a discipline that involves cyclical and repetitive movements that make athletes susceptible to injuries, especially in the groin. In professional athletes, during a season, it was found that about 20% had overuse injuries with significant consequences during the competitive season due to long recovery times. Currently, new technological tools allow the measurement of multiple parameters and, through a panel of data deriving from various measurements, provide a valuable aid for training and rehabilitative purposes. This study aimed to probe the potential of the new analysis algorithm, or its ability to detect differences in electromyographic and acceleration patterns between newcomers to the discipline and professional athletes. METHODS: We proceeded through measurements using a system based on an inertial sensor and four probes for surface electromyography. RESULTS: The analysis highlights important differences both from the point of view of accelerations (with marked oscillations on the three axes of the neophyte concerning greater stability of the professional's trunk) and a different pattern of muscle activation during joint movement a greater coactivation of the neophyte compared to the professional, which could lead to a greater risk of injury due to less training. CONCLUSIONS: This new protocol, when validated on a statistically significant sample of elite athletes leading to specific benchmarks, can be used to improve athletes' performances and maybe to prevent athletes' injuries.
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Traumatismos em Atletas , Transtornos Traumáticos Cumulativos , Humanos , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/diagnóstico , Eletromiografia , AtletasRESUMO
Introduction: Breast cancer disease often affects the ipsilateral shoulder joint, with pain and joint limitation. Proper pain management, which can be obtained using, for example, pulsed radiofrequency of the suprascapular nerve, can help the physiotherapist mitigate patient pain. The modern technologies of kinematic analysis and surface electromyography of movement analysis can give further support in building a personalized rehabilitation program, based on the quantitative study of movement, in this case of the upper limb. Methods: A brief case report was conceived to develop and test the evolution of a shoulder joint analysis protocol based on an inertial accelerometer and non-invasive surface electromyography. Results: An analysis algorithm was defined to adapt to the needs of patients operated on at the breast based on a kinematic component (ROM - range of movement - and Jerk index) and an electromyographic one (study of muscle behavior in groups of four). The coactivations were also evaluated, both as an average value and in graphical form, to offer the physiotherapist a complete overview of the movement of the upper limb. Discussion: The promising protocol results underline its strengths, including the simplicity of use, combined with the reduced time required for processing the reports and the portability of the PC-sensors complex, making these analyses potentially valuable for patient care.
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Roller speed skating is a discipline similar to hockey and ice skating from a biomechanical point of view, but there are no specific functional protocols for rehabilitation and performance improvement for these athletes. The aim of the study is to create a dedicated functional, kinematic and electromyographic protocol to be used as a tool for future studies on the subject. The protocol was created, starting from a correct and repeatable movement as a case study, on a world speed skating champion, using an inertial sensor positioned at the level of the first sacral vertebra, eight electromyographic probes positioned on one or the other lower limb, and a high-definition camera at 50 Hz. The results show the electromyographic activity of the muscles investigated, the degree of absolute muscle activation and compared to their maximum voluntary isometric contraction (MVIC), the level of co-activation of the agonist/antagonist muscles, and the accelerations of the body on the three axes of space. The results will represent the basis for physiotherapy and specific training use. Future developments will include the analysis of a sample of elite athletes to be able to build a normal range on the parameters investigated, and the possibility of treating in the most appropriate way possible muscle injuries (which mostly occur in the groin in such athletes) once they have occurred, even with oriented MVIC or co-activation oriented exercises.
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OBJECTIVES: Despite guidelines, a large percentage of cancer patients continue to suffer from ineffectively treated pain. The authors undertook this survey to assess the strengths and weaknesses of cancer pain management in Italy. DESIGN: This was a prospectively administered survey. PARTICIPANTS: The participants were anesthesiologists of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). INTERVENTION: A 58-item questionnaire covered the demographics and features of cancer pain management in the Italian context. RESULTS: The authors received responses from 611 pain therapists of 279 centers. Only 22% of physicians are exclusively pain therapists. Seventy-five percent are specialists in anesthesiology, intensive care, and pain medicine. Most pain centers are hospital or university facilities (78%). The strengths of cancer pain management in Italy are the careful opioid prescriptions, the use of strategies for the treatment of neuropathic pain, patient/healthcare provider partnerships, and breakthrough cancer pain management. Weaknesses to be addressed include poor adherence to guidelines, inadequate attention toward the patient's quality of life, insufficient use of minimally invasive techniques, lack of teamwork approaches, inappropriate timing of pain specialist engagement, and poor telemedicine use. CONCLUSIONS: Despite several strengths, further efforts are needed to improve the care of patients suffering from cancer pain in Italy.
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In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse.
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Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides/efeitos adversos , Overdose de Drogas/epidemiologia , Humanos , Transtornos Relacionados ao Uso de Opioides/etiologia , Estados Unidos/epidemiologiaRESUMO
Telemedicine represents a major opportunity to facilitate continued assistance for patients with chronic pain and improve their access to care. Preliminary data show that an improvement can be expected of the monitoring, treatment adherence, assessment of treatment effect including the emotional distress associated with pain. Moreover, this approach seems to be convenient and cost-effective, and particularly suitable for personalized treatment. Nevertheless, several open issues must be highlighted such as identification of assessment tools, implementation of monitoring instruments, and ability to evaluate personal needs and expectations. Open questions exist, such as how to evaluate the need for medical intervention and interventional procedures, and how to define when a clinical examination is required for certain conditions. In this context, it is necessary to establish dynamic protocols that provide the right balance between face-to-face visits and telemedicine. Useful tips are provided to start an efficient experience. More data are needed to develop precise operating procedures. In the meantime, the first experiences from such settings can pave the way to initiate effective care pathways in chronic pain.
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Dor Crônica , Telemedicina , Dor Crônica/terapia , HumanosRESUMO
Due to a lack of published evidence on the topic, a modified Delphi approach was used to develop recommendations useful for chronic pain management during and after the COVID-19 pandemic. Focusing on the available literature and personal clinical expertise, an Italian board of nine professionals from different disciplines identified four main topics: prevention of chronic pain, treatment of chronic pain, consequences of inadequate treatment, and perspectives. They elaborated a semi-structured questionnaire. A multidisciplinary panel of experts in the field of pain management was requested to comment on the statements. Based on the answers provided, a structured questionnaire was prepared (Round 1). It included 21 statements divided into three categories (organizational issues; diagnosis and therapies; telemedicine and future perspectives). A five-point Likert scale was adopted. The threshold for consensus was set at a minimum of 70% of the number of respondents (level of agreement ≥ 4, Agree or Strongly Agree). A final questionnaire with rephrasing of the statements that did not reach the consensus threshold was elaborated (Round 2). A total of 29 clinicians were included in the panel. Twenty clinicians (69%) responded in both the first and second round. After two rounds, consensus (≥70%) was achieved in 20 out of 21 statements. The lack of consensus was recorded for the statement regarding the management of post-COVID pain (55%; Median 4; IQR 2.3). Another statement on telemedicine reached the threshold in the first round (70%), but the value was not confirmed in Round 2 (65%; Median 4; IQR 2). Most of the proposed items reached consensus, suggesting the need to make organizational changes, the structuring of careful diagnostic and therapeutic pathways, and the application of new technologies in pain medicine. Long-COVID-19 care is an issue that needs further research. Remote assistance for chronic pain must be regulated.
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COVID-19 , Dor Crônica , Manejo da Dor , COVID-19/complicações , Dor Crônica/diagnóstico , Dor Crônica/terapia , Consenso , Técnica Delphi , Humanos , Pandemias , Síndrome de COVID-19 Pós-AgudaRESUMO
Italy adopted a law on chronic pain in March 2010, which focused on detection and management of this symptom, that affects approximately 25% of the population. The aim of this study is to analyze the interest of the Italian population in palliative care and chronic pain and to understand whether the Law 38/2010 made an impact on the internet search on chronic pain. Five research parameters were included using Google Trends (chronic pain, anti-inflammatory drugs, opioids, fibromyalgia, medical cannabis) from 2004 to 2019 using "joint point regression analysis." Comparisons of annual relative search volume (ARSV), average annual percentage change (AAPC), and temporal patterns were analyzed to assess loss or gain of interest in research of all the terms after adopting Law 38/2010; collected data were analyzed using Kruskall-Wallis test. The research trend of almost every word increased in time (AAPC > 0) with significant inflexion points after issuing law on chronic pain management in March 2010. Our results suggest the relevance of internet search engines, like "Doctor Google," to translate and share knowledge about specific conditions, diseases, and treatment alternatives, with a call to a raise in authoritative scientific voices on the topic, especially when it comes to widespread conditions like chronic pains.