The Kinematic and Electromyographic Analysis of Roller Skating at Different Speeds on a Treadmill: A Case Study.

Elite athletes in speed roller skates perceive skating to be a more demanding exercise for the groin when compared to other cyclic disciplines, increasing their risk of injury. The objective of this study was to monitor the kinematic and electromyographic parameters of roller speed skaters, linearly, on a treadmill, and to compare different skating speeds, one at 20 km/h and one at 32 km/h, at a 1° inclination. The acquisition was carried out by placing an inertial sensor at the level of the first sacral vertebra, and eight surface electromyographic probes on both lower limbs. The kinematic and electromyographic analysis on the treadmill showed that a higher speed requires more muscle activation, in terms of maximum and average values and co-activation, as it not only increases the intrinsic muscle demand in the district, but also the athlete's ability to coordinate the skating technique. The present study allows us to indicate not only how individual muscle districts are activated during skating on a surface different from the road, but also how different speeds affect the overall district load distributions concerning effective force, which is essential for the physiotherapist and kinesiologist for preventive and conditional purposes, while also considering possible variations in the skating technique in linear advancement.

Physical Activity in Oncology: To Do, Not to Do, and How to Do It? An Announcement of an Educational Program.

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.

Doctor@Home: Through a Telemedicine Co-production and Co-learning Journey.

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.

New frontiers in e-health. Policies and the Doctor@Home case study. / La frontiera delle cure a distanza. Assetto normativo ed il caso Doctor@Home.

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.

[Covid-19 and front-line nurses' mental health: a literature review]. / Covid-19 e salute mentale del personale infermieristico in prima linea: una revisione della letteratura.

INTRODUCTION: The Coronavirus (Covid-19) pandemic caused a severe health crisis that has affected millions of people and quarantined half of the world's population. The health emergency from Covid-19 has seen health workers on the front line face all the difficulties related to the burden of care and the reorganization of procedures, roles, and tools at the hospital level. One of the most significant and probably underestimated aspects is the psychological stress of frontline nurses. The article aims to analyze the literature relating to the impact on the mental health of nurses engaged in the management and care of Covid-19 patients. METHODS: A systematic review of the published articles on the subject was conducted from January 2020 to November 2020. The search for papers was conducted on scientific databases like PubMed, Scopus and Embase. RESULTS: The results show the onset of anxiety, depression and stress and insomnia in healthcare workers. These aspects are closely related to numerous factors, including the fear of contracting the disease and infecting family members, stressful shifts and little rest, leading to a state of psychological and physical tension capable of activating pathological behaviours. The literature highlights the importance of support interventions for frontline personnel to avoid the onset of psycho-pathophysical severe problems. CONCLUSION: The review suggests that frontline nurses during the emergency phase of Covid- 19 may be prone to psychological disorders that can compromise mental health. Therefore, the surveillance and monitoring of symptoms, together with targeted support interventions, should be guaranteed daily to all professionals involved to prevent the onset of psychological disorders.

Post-breast cancer coaching: the synergy between health and fitness through co-production.

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.

Pulsed radiofrequency on peripheral nerve as a rehabilitation aid.

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.

Physical Activity in Cancer Rehabilitation and Technology Acceptance: Results From the "Oncology in Motion" Project.

Aims: The international literature underlines that physical activity has a role in preventing cancer and is beneficial for cancer recovery and rehabilitation. Therefore, patient education is essential to stimulate training. Telemedicine and e-health tools like apps and wearables can support patients' education and the monitoring of their health condition and progress. Methods: The article reports the results of the Oncology in Motion telemedicine program of the National Cancer Institute of Aviano, Italy, to provide breast cancer patients with a personalized fitness path and telemonitoring. Results: 144 women took part in the program. Low adherence was recorded, performing the customized training schedule and, for those women sticking to the plan, using the technological devices and submitting the training data to the Institute. Conclusion: Low technology acceptance and literacy, laziness, and lack of collaboration between cancer centers stood among the causes of low adherence, calling for more comprehensive and effective educational programs and support to stimulate physical activity and the use of new devices to get personalized counseling and contribute to the creation of knowledge.

Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation.

BACKGROUND: The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits. METHODS: An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile. RESULTS: 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care. DISCUSSION: The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.

Evaluation of muscle energy in isometric maintenance as an index of muscle fatigue in roller speed skating.

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.

Economic and Performance Evaluation of E-Health before and after the Pandemic Era: A Literature Review and Future Perspectives.

E-Health represents one of the pillars of the modern healthcare system and a strategy involving the use of digital and telemedicine tools to provide assistance to an increasing number of patients, reducing, at the same time, healthcare costs. Measuring and understanding the economic value and performance of e-Health tools is, therefore, essential to understanding the outcome and best uses of such technologies. The aim of this paper is to determine the most frequently used methods for measuring the economic value and the performance of services in the framework of e-Health, considering different pathologies. An in-depth analysis of 20 recent articles, rigorously selected from more than 5000 contributions, underlines a great interest from the clinical community in economic and performance-related topics. Several diseases are the object of detailed clinical trials and protocols, leading to various economic outcomes, especially in the COVID-19 post-pandemic era. Many e-Health tools are mentioned in the studies, especially those that appear more frequently in people's lives outside of the clinical setting, such as apps and web portals, which allow for clinicians to keep in contact with their patients. While such e-Health tools and programs are increasingly studied from practical perspectives, such as in the case of Virtual Hospital frameworks, there is a lack of consensus regarding the recommended models to map and report their economic outcomes and performance. More investigations and guidelines by scientific societies are advised to understand the potential and path of such an evolving and promising phenomenon.

Surface electromyographic wheel speed skate protocol and its potential in athletes' performance analysis and injury prevention.

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.

Case report: Movement analysis in oncological rehabilitation: proposal of a kinematic and surface electromyographic protocol in breast oncology.

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.

Roller Speed Skating Kinematics and Electromyographic Analysis: A Methodological Approach.

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.

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies.

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.

Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training.

INTRODUCTION: The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT. MATERIALS AND METHODS: Search keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women. RESULTS: Regarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect. CONCLUSIONS: Gynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management.

What People Search for When Browsing "Doctor Google." An Analysis of Search Trends in Italy after the Law on Pain.

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.

[Patient engagement in rehabilitation path after breast cancer surgery: costs impact. State-of-the-art and new perspectives.] / Coinvolgimento del paziente nel percorso riabilitativo dopo l'intervento per cancro al seno: costi, stato dell'arte e prospettive.

INTRODUCTION: The Italian Association of Medical Oncology (AIOM) and the Italian Association of Cancer Registers (AIRTUM) highlight that one out of three women experiences cancer in the course of her life. In 2018, excluding skin cancers, breast cancer accounted for 14.1% of total cancers, confirming it as the most diagnosed cancer among women (29.3%). In the postoperative stage, patients suffer side effects. They need immediate and active rehabilitation to encourage their return to work as well as the psychological recovery. The effectiveness and speed of this recovery, therefore, have significant impact in the short and long term, also for the society. The rehabilitative oncology path increases its positive effects if carried out through co-productive pathways. The economic impact of this process is unclear. MATERIALS AND METHODS: An exhaustive literature search was performed to shed light on state of the art about the patients' engagement during the rehabilitation path after breast cancer surgery, focusing on the literature analyzing the impact that co-productive processes can have on costs. Eligibility criteria: papers and reviews published in English and Italian were searched in Scopus and PubMed/Medline, among other datasets. INCLUSION CRITERIA: dealing with economic effects resulting from patient engagement or following post-breast cancer oncology rehabilitation. RESULTS: 24 papers have been selected. The review of the literature has revealed a lack of contributions on the economic impact of the patient engagement in the oncological rehabilitation path, taking into account the impact on costs, but not developing a more detailed study. The back-to-work issue and psychological effects are widely investigated. No studies have been conducted in Italy. DISCUSSION: The analyzed literature did not identify the economic impact that patients' engagement may have during rehabilitation, opening up new research questions. Co-production processes are starting to develop.

[Knowledge Translation in the medical field among different stakeholders. A case study in oncology.] / La traduzione della conoscenza in ambito medico tra diversi stakeholder. Un caso di studio in oncologia.

INTRODUCTION: Knowledge Translation (KT) is defined as the synthesis, exchange and application of knowledge to foster the benefits of global and local innovation. In healthcare and medicine, KT is an increasingly relevant topic, as recognized by the growing number of publications. While the traditional definition of KT recalls the need to translate scientific research into clinical practice, other types of KT emerge. More in details, they concern the interaction of actors with different skills and feelings, who find themselves working together to achieve a common outcome. The paper aims to understand the dynamics and tools of KT by analyzing the case of an Italian Breast Unit. MATERIALS AND METHODS: The paper uses a methodology based on a case study relating to the IRCCS CRO - National Care Institute Center for Oncological Reference of Aviano. Multiple information sources are used to collect, triangulate, and verify data. RESULTS: The analysis allows to divide the stakeholders into two groups: a first professional or internal group, characterized by a common healthcare background, and a second non-professional or external group, which gathers actors with various skills, needs, and feelings. The two groups use profoundly different tools and methodologies to translate knowledge effectively. DISCUSSION: While the first group translates knowledge internally using more explicit tooles, and benefits from the team's durability, the second group needs more creative methodologies, many of which are based on language and interpersonal skills. The temporary nature of relations with the BU of this latter group requires the use of always different and innovative tools.