La Maddalena

To assess the psycho-existential distress of patients and their caregivers in a specific setting, like hospice. Patients consecutively admitted to two hospices for a period of 8 months were enrolled. At admission (T0), patients were assessed by a routine data recording: age; gender; Edmonton Symptom Assessment Scale (ESAS); Memorial Delirium Assessment Scale (MDAS); Cut down, Annoy, Guilt, Eye-opener (CAGE); Karnofsky level; primary diagnosis; education; religiosity and comorbidities. Psycho-existential distress was assessed at T0 by the Psycho-existential Symptom Assessment Scale (PeSAS). The measurements were repeated 1 week after comprehensive palliative care treatment. 159 patients and 87 caregivers were considered. The majority of patients had a cancer diagnosis (88.7%). Non-cancer patients were older (p<0.0005), had a lower Karnofsky (p<0.0005) and higher cognitive decline (MDAS, p<0.0005). After 1 week of comprehensive palliative care treatment, significant changes were observed for most ESAS items and total ESAS in both patients and caregivers. PeSAS items were mild-moderate. All symptoms of PeSAS, except for depression, significantly decreased after 1 week of comprehensive palliative care with a significant decrease in total PeSAS. Caregivers showed similar psycho-existential distress, but total PeSAS did not significantly change. There was a positive correlation between patients and caregivers in the changes from T0 to T7 (Δ) for PeSAS (p=0<004) and total ESAS (p=0.005). Admission to hospice improved both physical symptoms and psycho-existential distress in patients significantly and non-significantly in caregivers.

Therapeutic prone positioning is widely used to improve oxygenation in patients with acute respiratory distress syndrome but is associated with an increased risk of pressure injuries, particularly affecting facial and anterior body regions. This systematic review was conducted according to PRISMA 2020 and Joanna Briggs Institute guidelines and was prospectively registered in PROSPERO (CRD42023442604). PubMed, CINAHL, Web of Science, Scopus, and the Cochrane Library were searched from inception to June 2025, including grey literature. Primary studies involving adult, mechanically ventilated patients undergoing therapeutic prone positioning and evaluating pressure injury prevention strategies were included. Methodological quality was assessed using JBI critical appraisal tools. Owing to clinical and methodological heterogeneity, findings were synthesized using a Synthesis Without Meta-analysis (SWiM) approach. Eight studies with heterogeneous designs were included. Preventive interventions mainly comprised prophylactic dressings, repositioning and support devices, and comprehensive care bundles. Most strategies were associated with a reduction in pressure injury incidence, particularly in facial and anterior anatomical areas. Greater effectiveness was observed when interventions were implemented within structured protocols supported by staff training and multidisciplinary coordination. Preventive strategies appear effective in reducing pressure injuries associated with prone positioning in critically ill patients. The implementation of standardized, bundled prevention protocols may improve patient safety in intensive care settings.

Chimeric antigen receptor (CAR)-T cell therapy has revolutionized outcomes in relapsed/refractory lymphomas, yet nonrelapse mortality (NRM) has emerged as a notable concern, with older age and infections identified as major determinants of NRM in real-life studies. The aim of the present study was to describe the rate and causes of NRM after CAR-T cells and identify risk factors. Within the framework of the prospective, multicenter, observational CART‑SIE study, we analyzed causes and determinants of NRM in a large real-world cohort of lymphoma patients receiving CAR‑T cells from 2019 to 2025. Associations between NRM and clinical or biological factors were assessed using Fine and Gray subdistribution hazard models. From 2019 to 2025, 1132 patients were enrolled in the CART-SIE Study; among those, 932 were evaluable for outcomes, with a median follow-up of 17.8 months (IQR 6.3-25.4). In this cohort, 305 deaths were observed, mainly occurring after disease progression (n = 258); overall, 47 deaths were solely attributable to NRM (5%), either early (≤28 days, 40.4%), late (29-90 days, 23.4%) or very late (>90 days, 36.2%). The 1- and 2-year cumulative incidence of NRM were 5.5% and 8.8%. Infections were the leading cause (51%), followed by CAR-T acute toxicities (CRS, ICANS, and HLH/MAS; 30%), and secondary malignancies (11%). In univariable analysis, age > 60 gt; 60 years, diabetes, atrial fibrillation, high CAR-HEMATOTOX score, elevated ferritin, baseline cytopenias, CRS grade ≥3, any-grade or grade ≥3 ICANS and infectious events were risk factors for NRM. Multivariable models revealed that, among pre-infusion factors, only high ferritin levels (HR 3.23, 95% CI: 1.37-7.62, P = .007) and diabetes (HR 3.93, 95% CI: 1.28-12.1, P = .017) independently predicted NRM, while only severe CRS, ICANS, and infections remained strong post-infusion predictors. These findings emphasize the role of host-related factors and inflammation in shaping CAR-T outcomes. Optimized patient selection, rigorous management of acute toxicities, tailored infectious prophylaxis and long-term oncologic surveillance are essential components of long-term survivorship care, aiming to mitigate NRM and sustain long-term benefits of CAR-T cells. Clinical trial registration ClinicalTrials.gov ID: NCT06339255.

Evidence-based practice (EBP) is widely endorsed as a cornerstone for high-quality, patient-centered care. However, its integration into daily clinical routines remains inconsistent, particularly in settings where cultural, educational, and organizational challenges persist. Reliable, contextually adapted tools are essential to measure EBP implementation and guide improvement efforts. This study aimed to validate the Italian versions of the EBP Implementation Scale and its short-form (3-item) version. A cross-sectional survey design was adopted. Both versions of the EBP Implementation Scale were translated and culturally adapted in accordance with internationally recognized guidelines. Data were gathered from a national sample of 405 nurses through a combination of convenience and snowball sampling. Psychometric assessment encompassed confirmatory and Bayesian factor analyses, evaluation of internal consistency and test-retest reliability, and measurement invariance testing. All analyses were performed in R Studio. Confirmatory factor analyses confirmed that both versions (long and short) of the scale measure a single underlying construct. The instruments demonstrated high reliability (ω = 0.96 and 0.87 respectively). Measurement invariance across educational groups was partially established, as the partial scalar invariance model demonstrated acceptable fit (CFI = 0.991, RMSEA = 0.045), suggesting consistent interpretation of the scale across different levels of EBP training. Latent profile analysis revealed distinct subgroups of EBP implementers, with notable differences in latent means (p < 0.001) associated with previous education in evidence-based practice. The Italian EBP Implementation Scales are valid and reliable tools for assessing EBP implementation behaviors. They can support education planning, monitor practice changes over time, and inform interventions aimed at enhancing evidence-based care.

Objectives: This systematic review aimed to evaluate the effectiveness of currently available methods for the diagnosis and monitoring of skeletal, dental, and soft tissue changes, as well as the adequacy of follow-up protocols, in adolescents and adults treated with miniscrew-assisted rapid palatal expansion (MARPE). Materials and Methods: This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive electronic literature search was performed across five databases (PubMed, Scopus, Embase, Cochrane, and Web of Science) to identify prospective and retrospective clinical studies evaluating dental, periodontal, and alveolar bone outcomes associated with MARPE in late adolescent and adult patients. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies and the RoB 2 tool for randomized studies. The certainty of the evidence was evaluated using the GRADE approach. Owing to substantial methodological heterogeneity and limited follow-up duration, a structured qualitative (narrative) synthesis of the results was performed. Results: A total of 20 studies were included in the systematic review. The reported adverse events primarily involved hard and soft tissues and were identified using cone-beam computed tomography (CBCT), clinical and periodontal examination, panoramic and cephalometric radiography, and digital dental casts. Dental effects, including dental tipping, were frequently reported across the included studies. Alveolar bone loss was reported in 11 studies, buccal alveolar bone dehiscence in 3 studies, and failure of palatal suture opening in 6 studies. In most of the included studies, follow-up was either not reported or limited. Conclusions: The MARPE technique appears to be potentially effective in achieving transverse maxillary expansion in late adolescent and adult patients. However, the included studies report possible adverse events affecting periodontal and alveolar bone tissues, such as alveolar bone thinning and gingival hypertrophy, the assessment of which requires an integrated diagnostic approach combining CBCT imaging with clinical and periodontal examination. Overall, the certainty of the available evidence was low to very low, mainly due to a high risk of bias, methodological heterogeneity, and limited or absent follow-up in most studies. Therefore, the results should be interpreted with caution. Well-designed prospective controlled studies with standardized protocols and long-term follow-up are needed to conclusively evaluate the safety and long-term clinical stability of the MARPE technique.

Background and Objectives: Telemedicine has become an essential component of chronic Inflammatory Bowel Disease (IBD) care, yet the factors that shape patient satisfaction with remote consultations remain only partially understood. This study aimed to assess satisfaction with institutional telemedicine services among Italian patients with ulcerative colitis (UC) and Crohn’s disease (CD), and to identify sociodemographic, clinical and organisational predictors to inform more person-centred telehealth models. Materials and Methods: We conducted a prospective, multi-centre, cross-sectional study in three IBD units in northern, central and southern Italy between June and October 2024. Consecutive adult patients who had completed a scheduled, non-emergency telemedicine visit were invited within 24–48 h to complete an online questionnaire including the Italian Telemedicine Satisfaction Questionnaire (I-TSQ), sociodemographic items, IBD-related variables, and telemedicine process indicators (accessibility, technology usability, technical support, time saved). Data were analysed descriptively and with multivariable linear regression to determine independent predictors of satisfaction, adjusting for recruiting centre. Results: A total of 705 patients participated (54.9% UC; 55.3% disease duration > 10 years). Overall, telemedicine satisfaction was high (mean I-TSQ total 57.5 ± 4.9; range 35–70), and all respondents reported reduced indirect costs compared with in-person visits. Greater ease of technology use, more frequent contact with the care team, male sex, older age, and employment were independently associated with higher satisfaction scores. Conversely, first-ever teleconsultations, CD, subcutaneous therapies, more difficult platform access, and the need for technical support were linked to lower satisfaction. Model fit was modest (R2 up to 0.20), suggesting the presence of additional unmeasured relational and contextual factors. Conclusions: Telemedicine for IBD is widely accepted in Italy, but satisfaction is strongly conditioned by digital usability, previous experience, and clinical complexity. Tailored telehealth pathways that incorporate user-friendly platforms, proactive technical support, and attention to vulnerable subgroups are needed to translate high satisfaction into sustained, equitable remote care.

<title>Abstract</title> Background Standard loop ileostomy protects low colorectal anastomoses but causes substantial stoma-related morbidity. ALPITube is a novel percutaneous diversion device designed to provide anastomotic protection while avoiding traditional stoma complications. Objective To evaluate the feasibility, safety, and preliminary efficacy of ALPITube compared with published loop ileostomy benchmarks. Methods Multicentre retrospective cohort study of consecutive patients undergoing elective colorectal surgery with low anastomosis and ALPITube diversion at two European centres (May 2023-June 2025). Primary outcome was 30-day complication rate. Secondary outcomes included device-specific complications, conversion to standard ileostomy, and mortality. Results Forty-three patients were analyzed (mean age 69.7 ± 9.0 years; 88.4% with comorbidities; 76.7% received neoadjuvant therapy). Device implantation was technically successful in all cases (mean implantation time 38 ± 14 minutes). Early complications occurred in 21 patients (48.8%), predominantly low-grade (Clavien-Dindo I-II: 32.6%). Five patients (11.6%) required conversion to loop ileostomy. No anastomotic leaks occurred. Compared with literature benchmarks, ALPITube showed significantly lower rates of high-output stoma (0% vs 16%), peristomal skin complications (18.6% vs 43%), postoperative ileus (4.7% vs 33%), and parastomal hernia (0% vs 8%) (all p &lt; 0.05). Conclusion ALPITube demonstrates technical feasibility with encouraging safety signals and potential reduction in stoma-specific complications. These proof-of-concept findings support progression to randomized controlled trials.