Skin is usually the first and most affected organ involved in graft-versus-host disease (GvHD), and treatment is still a clinical challenge. Although the need for skin-directed treatments such as physical treatments and topical medications are generally agreed on, what the gold standard treatment strategy should be remains open to debate. The aim of this scoping review was to synthesize the current knowledge on the topical and physical treatments of cutaneous GvHD in haematopoietic stem cell transplantation patients and to highlight the best evidence available so as to reduce the gap between 'what is known' and 'what is done' in the clinical practice. Twenty-eight studies were included in this qualitative synthesis. Photo-biomodulation with psoralen was not included in this review. Phototherapy (ultraviolet A or B or narrowband B) was the physical treatment most described in the literature in both acute GvHD and chronic GvHD. Topical calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream as well as corticosteroid creams such as clobetasol and triamcinolone are mainly used in case of chronic GvHD. In all of the studies included in the review, topical treatments were always associated with systemic therapy. None of the topical interventions identified in our review provided strong evidence supporting its use, and the topical approaches seemed to have an adjuvant role in the treatment of cutaneous GvHD.
Background and objective: Northern Italy was one of the first European territories to deal with the Coronavirus Disease 2019 (COVID-19) outbreak. Drastic emergency restrictions were introduced across the country to contain the spread and limit pressure on healthcare facilities. Nurses were at high risk of developing physical, mental and working issues due to professional exposure. The aim of this cross-sectional study was to investigate these issues among nurses working in Italian hematopoietic stem cell transplant (HSCT) programmes during the COVID-19 pandemic.
Methods: Data were collected online immediately after the first "lockdown" period in order to investigate the prevalence of physical issues, sleep disorders and burnout symptoms and explore correlations with COVID-19 territorial incidence in Northern Italian regions versus Central and Southern Italian regions.
Results: Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey. Depression, cough and fever were more frequently reported by nurses working in geographical areas less affected by the pandemic (p=0.0013, p<0.0001 and p=0.0005 respectively) as well as worst sleep quality (p=0.008). Moderate levels of emotional exhaustion (mean±SD - 17.4±13.0), depersonalization (5.3±6.1) and personal accomplishment (33.2±10.7) were reported without significant differences between territories.
Conclusions: different COVID-19 incidence among territories did not influenced nurses’ burden of symptoms in HSCT setting. However, burnout and insomnia levels should be considered by health care facilities in order to improve preventive strategies.
Background: L’ambito delle terapie con CAR-T è un campo ancora nuovo e la gestione delle tossicità è nella sua fase iniziale; è necessaria, dunque, una ricerca mirata che affronti le questioni critiche relative agli outcomes dei pazienti. Scopo dello studio è quello di monitorare l’incidenza di complicanze da tossicità dovuta a CAR-T durante il periodo relativo al ricovero ospedaliero. Metodi: Studio osservazionale, prospettico, monocentrico. Il campione sarà composto da tutti i pazienti di età ≥18 anni candidati a trattamento con CAR-T da aprile 2022 ad aprile 2025. Al fine della raccolta dati verranno utilizzate le seguenti scale di valutazione: Numeric Rating Scale for Pain, Scheda Eventi Avversi, Immune Effector Cell-associated Encephalopathy Score, Grading WHO, EuroQol-5D-3L, Hospital Anxiety Scale, Scored Patient-Generated Subjective Global Assessment, Contentment with Life Assessment Scale. Conclusioni: L’immunoterapia e le CAR-T hanno mostrato risultati promettenti nel trattamento di alcune neoplasie maligne, ma possono essere associate a tossicità diverse e non completamente comprese che possono essere fatali se non identificate precocemente e trattate in modo appropriato. La comprensione delle complicanze potrebbero migliorare gli outcomes dei pazienti.
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