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lung perfusion (EVLP) is a technique for graft preservation, evaluation and treatment, that could expand donor pool for transplantation. Nevertheless, the wide spectrum of available platforms has generated disparities in use, outcome, and costs. This study is an attempt to create a national consensus on EVLP use by a group of experts from the Italian Society of Organ Transplantation. The 9-member promoting committee was divided into 3 groups to propose statements. Using the DELPHI method 27 experts (three from each of the 9 lung transplant centres) voted agreement to each statement in 3 rounds. The cutoff for acceptance was set at 80% agreement. In the first vote, 52 statements were proposed, and an agreement was reached for 20 of them (38%). After revision, the second round resulted in a quorum for 36 out of 40 statements proposed (90%). At the third vote, agreement was confirmed for 36 statements (8 indications for use, 19 modalities for use, 13 evaluation parameters). The statements outlined in this document do not represent absolute guidelines, but rather recommendations. The statements selected and presented are therefore aimed to assist Italian clinicians in the use of an normothermic perfusion platform in the right context.

Abstract   Family caregivers sustain the palliative trajectory of people with advanced cancer, yet little is known about how service configuration shapes their quality of life (QoL). To compare the multidimensional QoL of caregivers assisting patients in outpatient versus home palliative-oncology programmes and to assess the influence of patient performance status. A cross-sectional survey enrolled 62 caregiver-patient dyads (37 outpatient; 25 home care) from a Northern Italian palliative network. Caregiver demographics, relationship, cohabitation and weekly care hours were collected, together with patient age, sex, diagnosis and functional status (Karnofsky Performance Status [KPS] and Eastern Cooperative Oncology Group [ECOG]). QoL was measured using the Adult Carer QoL questionnaire (seven subscales plus total index). Group differences were examined with Mann-Whitney and t-tests. Home-care caregivers demonstrated higher total QoL (mean ± SD = 89.2 ± 10.8) than outpatient peers (79.5 ± 14.3; p < 0.01). Pronounced advantages for the home group were observed in “support for caring” (12.3 vs 8.5; p < 0.0001), “caring choice” (10.7 vs 8.9; p < 0.01) and “money matters” (10.7 vs 8.9; p < 0.001). No setting differences emerged for caring stress, personal growth, sense of value, ability to care or satisfaction. Caregiver QoL did not vary across patient KPS or ECOG categories (p > 0.34). Delivery setting, rather than patient functional decline, is the principal determinant of caregiver QoL. Outpatient caregivers report poorer support, restricted autonomy and heavier financial strain, signalling the need for respite, counselling and flexible scheduling within ambulatory oncology. Integrating caregiver-centred indicators into routine evaluation could strengthen family resilience and advance the European Public Health agenda for equitable, person-centred palliative care. Key messages • Caregiver QoL rises with home-based palliative care; outpatient carers suffer reduced support, autonomy and greater financial strain. • Respite, financial counselling and flexible schedules in ambulatory oncology can close the QoL gap and fortify family resilience.

Abstract   In Italy, there is a need to strengthen home care and to adjust the allocated resources in response to increased service utilisation. No tools have been identified to better allocate care resources according to the real needs of the population. Among the studies that have examined resource utilisation in home care, time of visits has emerged as the most used parameter to estimate the cost of this service. The aims of this study were to identify the variables that characterise the work of home care nurses and influence the time spent caring for patients, to better allocate nursing resources, and to assess the feasibility of a larger data collection. A mixed-methods approach was used. A descriptive qualitative approach was used to identify the variables that characterise the work of home care nurses through literature review, interviews, focus groups, and the Delphi method, leading to the selection of a core set of variables. A prospective longitudinal study was then conducted to measure travel, times, and the core variables at each home visit. Data were analysed using a gamma model regression and presented using the Local Interpretable Model-Agnostic Explanations (LIME) technique; sample size estimation was also performed. The analysis included 368 observations of 231 patients. Most of them lived with their families, had chronic disorders, and had informal caregivers, often present during service delivery and collaborating with the nurse. Variables significantly associated with overall home care time (travel time & service time) are the distance travelled (Average Marginal Effect -AME- 1.434), the number of services provided (AME 7.058), and the number of patients’ skin lesions (AME 2.142). This study provides a detailed description of home care nursing. A larger study, in different contexts (e.g. rural and urban), would allow an improved prediction of nursing time and, consequently, a better allocation of nursing resources. Key messages • A core set of variables influencing home care nursing resources consumption has been described. • This study provide information for a better time planning of home care nurses.

Introduction The sudden and unexpected nature, which often characterizes death in intensive care, complicates the processing of the loss by relatives and caregivers increasing the risk of complicated grief (CG). Due to the high social impact and long-term consequences on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. This review aims to identify nursing interventions for the management of the bereavement of relatives and caregivers and to assess their effectiveness, relatives' and caregivers' satisfaction and prevention of CG. Methods Research was performed in CINAHL, PubMed, Psycinfo and Scopus databases with no limits on study design and publication timespan. The population included relatives or caregivers of patients died in intensive care unit. Results 14 studies met inclusion criteria. Two studies show that the communication of the bad news through dialogue between the team and relatives/caregivers can reduce, in the latter, the levels of anxiety and depression and the incidence of post-traumatic stress disorder. The quality study by Kentish-Barnes et al. (2017) shows that subjects perceived support in receiving a letter of condolence, but the RCT of the same author concludes that those who received the letter were more exposed to the risk of CG. Four studies claim that follow-up meetings facilitate the process of adaptation to loss by providing relatives/caregivers the opportunity to clarify the circumstances of death. Finally, two studies report that the events of commemoration arouse positive emotions in family members. Conclusions The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines. Further research is needed and it should consist of RCTs of high methodological quality. Key messages Due to the long-term consequences of the sudden death on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines.

Background Home care and hospices are gaining higher importance in providing end-of-life care. The main aim of this study is to investigate clinical decisions of healthcare professionals in north-eastern home-care services and hospices caring for patients in their end-of-life. Moreover, the study aims to study nurses' and physicians' opinions on palliative care. Methods A questionnaire was administered to healthcare personnel in 5 homecare services and 2 hospices in a regional health service trust in north-eastern Italy. The questionnaire is made of three parts: the first deals with clinical decisions for the last patient who died, the second investigates opinions on terminal care, while the last collect data on participants. Results 42 subjects have been enrolled, most of them are nurses, 64,1% without bioethics training and 53,8% without palliative care training. All the End- of-Life Decisions (DEL) were “non-treatment” decisions. None of the participants discussed the potential life-shortening effect with the patient. The involvement of patients' relatives in terminal care was meaningful for 86% of the professionals. The participants reported they usually discuss terminal issues only when patients or relatives ask for them, but palliative care seems to be the most discussed care-related topic. Conclusions Comparison with previous studies can't be performed because of the small number of participants. DEL were exclusively “non-treatment”. We found relevant data about options of shortening life, which was not discussed at all. Mainly only the professionals who give great importance to patient's religious beliefs discussed spiritual themes with them. Finally, the professionals trained in palliative care were more comfortable starting to talk to patients about the possibility of receiving palliative care. Key messages This study investigates clinical decisions taken by professionals in home-care and hospices in terminal ill patients care and professionals ‘opinions on palliative care. Communication on palliative care (PC) has been widely investigated: professionals trained in PC were more comfortable starting to talk to patients about the possibility of receiving PC.

Ulcerative colitis (UC) is a chronic, idiopathic, inflammatory bowel disease, characterized by alternating stages of clinically active and inactive disease. UC exhibits several inflammatory characteristics, including immune activation, leukocyte infiltration, and altered vascular density. In UC, many of the upregulated inflammatory cytokines are proangiogenic and are released by diverse cell populations, such as infiltrating immune cells and endothelial cells (EC). Increasing evidences suggest that neovascularisation may involve also endothelial progenitor cells (EPCs). In this study we evaluated EPCs recruitment and homing, assessed by CXCR4 expression, in both acute and remitting phase of UC. We report an overall decrease of EPCs in UC patients (controls = 97,94 ± 37,34 cells/mL; acute = 31,10 ± 25,38 cells/mL; remitting = 30,33 ± 19,02 cells/mL; P < 0.001 for both UC groups versus controls). Moreover CXCR4+-EPCs, committed to home in inflammatory conditions, were found to be reduced in acute UC patients compared to both remitting patients and controls (acute = 3,13 ± 4,61 cells/mL; controls = 20,12 ± 14,0; remitting = 19,47 ± 12,83; P < 0,001 ). Interestingly, we found that administration of anti-inflammatory drugs in acute UC is associated with an increase in circulating EPCs, suggesting that this therapy may exert a strong influence on the progenitor cells response to inflammatory processes.

Assessing the clinical course of inflammatory bowel disease (IBD) patients consists of periodical clinical evaluations and laboratory tests. We aimed to assess the role of calprotectin tests in predicting clinical relapse in IBD patients. Ninety-seven patients with ulcerative colitis (UC) and 65 with Crohn's disease (CD) in clinical remission were prospectively included in the study. A 10-g stool sample was collected for calprotectin assay. The cutoff level was set at 130 mg/kg of feces. Patients were followed up for 1 yr after the test or until relapse. The cumulative proportion of relapses was estimated by the Kaplan-Meier analysis. Statistics for equality of survival distribution were tested using the log-rank test. The calprotectin test was positive in 44 UC patients and 26 of them relapsed within a year, while 11 of 53 UC patients with a negative calprotectin test relapsed within the same time frame. Thirty CD patients had a positive calprotectin test and 13 of them relapsed within a year, as did 7 of the 35 with a negative test result. A significant correlation emerged between a positive calprotectin test and the probability of relapse in UC patients (P= 0.000). In CD patients, only cases of colonic CD showed a significant correlation between a positive calprotectin test and the probability of relapse, i.e., 6 colonic CD patients were positive for the calprotectin test and 4 relapsed (P= 0.02). Measuring calprotectin may help to identify UC and colonic CD patients at higher risk of clinical relapse.

In Intensive Care Units (ICUs) patients can experience severe organ failures. In several cases, failures can be incurable, making many of the treatments inappropriate, according to ethical principles. Based on the current legislation, in ICUs, clinicians proceed to limit life support care in most of the cases described. Despite this, some studies report that in many cases the care provided is inappropriate for the prognosis. The study aims at investigating the type and frequency of healthcare personnel's End of Life Decisions (DEL) and the point of view of patients' family, contributing to the debate. A non-interventional cross-sectional pilot study was conducted in 3 ICUs in North-Eastern Italy. Two questionnaires were administered: the first investigates DEL and the perception of nurses and physicians regarding the inadequacy of care provided to patients (from the ELDY study), the second focuses on the family's opinions. Data are expressed by frequencies, percentages, means and standard deviations. In line with most of previous studies, cases identified as DEL are all related to non-treatment decisions (n = 20, 74%), 44% of these are related to having stopped or not started treatments already knowing the possibility of anticipating the end of life of the patient, while 27% had the precise intention of shortening life. The situation has been discussed with patient's relatives only in two cases. The cause of increased inappropriateness (87%) was the perception that other patients would benefit more from intensive care than the patient in charge, and 40% of the healthcare personnel reported that similar situations occur very frequently. The restriction of treatment has been confirmed as the most frequent DEL, and interruption being more frequent than non-implementation. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients' family.