Assistenza Infermieristica E Ricerca最新文献

. Early warning scores for clinical deterioration in pediatric patients: a literature review.

Introduction: An early recognition of clinical worsening (the manifestation of signs and symptoms resulting in physiological instability) in pediatric inpatients may prevent the evolution towards cardiorespiratory arrest. In recent decades, several tools known as PEWS (Pediatric Early Warning Scores), have been developed, aiming to reduce in-hospital morbidity and mortality.

Objective: To describe efficacy, sensitivity and specificity of the available tools for early detection of clinical worsening in children, based on literature review.

Methods: Systematic review through the consultation of PubMed and Google Scholar, cross-combining Mesh terms and free text words.

Results: Out of 266 analysed papers, 34 were included in this review: 23 retrospective observational studies, 8 reviews, 1 reliability study, and 2 pilot studies. Overall, 23 main PEWS with sufficient evidence of efficacy were described (11 track and trigger and 12 aggregate). Ranges of sensibility and specificity were available only for 18 PEWS. It is not possible to recognize a gold standard, however, some PEWS are better in terms of validity and efficacy in different clinical settings. Internationally, the BPEWS (Brighton Pediatric Early Warning Score) is the most commonly adopted tool, able to identify clinical worsening of in-hospital children almost 11 hours before cardiac arrest.

Conclusions: Although with limited evidence, validated PEWS have shown good ability to prevent the risk of clinical worsening by reducing adverse events. Further studies and greater standardization according to the clinical context are still needed.

. Tracheal rupture treated with robotic surgery: the importance of evidence-based practice in nursing management. A case report. Tracheal rupture is a very rare condition with high morbidity and mortality. While it has a multifactorial etiology, however it occurs most frequently after orotracheal intubation. The case of a 76-year-old woman who underwent out-of-hospital orotracheal intubation for severe respiratory failure due to a state of coma is described. The patient suddenly developed a subcutaneous emphysema extending from the chest to the skull due to tracheal laceration. The management of the case is described with special focus on nursing goals to prevent ventilator associated pneumonia and mediastinitis, avoid the endotracheal tube dislocation and further tracheal injuries. The case presented underlines the importance of a systematic recourse to evidence-based practice (EBP), which allowed to effectively manage a complex situation.

. Patient and public involvement in research. Patient and public involvement (PPI) entails research being carried out 'with' members of the public, rather than 'to', 'about' or 'for' them. The word public can refer to patients, potential patients, carers and people who use health and social care services, people from organisations that represent people who use services as well as members of the public. People with lived experience of a particular service or health condition may add value to the research and even influence the research question. The involvement may occurr in any stage of the research process, but preferably since the very start, when the study is designed. To obtain a real involvement and participation some practical tips are suggested. In this paper advantages but also difficulties related to PPI are presented, based both on the literature but also from the authors' experience.

. Septic shock in patient undergoing hemopoietic stem cell transplantation. A case-report. This case on septic shock is the last contribution proposed on oncology emergencies. It is the case of a 66-year-old man who undergoes an autologous hemopoietic stem-cell transplantation for a multiple myeloma. The case follows the update on hemopoietic stem cell transplantation published in issue 1, 2023. The readers are invited to read the update for a useful guide to answering learning questions.

. The management of structured interviews from lay personnel of the European non-emergency call number 116117.

Introduction: The 116117 telephone number is the European harmonised number (NEA) for access to non-emergency medical care and other low-intensity/priority community health services.

Aim: To describe the model used for handling calls from citizens of the Lombardy Region to the NEA central unit and to compare it with other NEA central unit organisational models.

Methods: The calls received at the centre in 2021 were analysed according to the indicators proposed by a governamental agency (AGENAS).

Results: In 2021, 1,415,590 calls were received (approximately 1 in every 10 inhabitants of the Lombardy Region): 2% were transferred to the 118 emergency service; 92% to the Continuity of Care service and 6% were calls requesting information. The response time to the citizen was on average less than 3 minutes, with 90% of calls being handled within 6 minutes. Most of the NEA centres in Italy are managed by lay people and a structured interview model is adopted in all of them.

Conclusions: The model adopted in Lombardy appears to be safe. The calls were handled without incidents. It would be useful to compare the costs and outcomes of centres organised with other models and to make a comparison of the interview patterns adopted.

. Assessing the impact of bladder ultrasound on catheter-associated urinary tract infections and health-care costs: an observational pre-post study.

Introduction: The placement of a urinary catheter is a standard procedure, but it can cause discomfort, increase the risk of infections and costs. Pelvic ultrasound is a non-invasive assessment of the bladder and bladder catheter placement that can be performed by nurses.

Aim: To assess the appropriateness of urinary catheter placement using bladder ultrasound, to monitor urinary catheter-associated urinary tract infections and costs associated with catheter use.

Methods: A single-centre pre-post observational study was conducted from September 2021 to August 2022 in patients aged >18 years requiring urinary monitoring; the first 6 months patients were assessed without the use of bladder ultrasound (control group), while the last 6 months with bladder ultrasound.

Results: 189 patients were included in the pre-ultrasound group and 175 patients in the post-ultrasound group; the demographic and clinical characteristics of the two groups were comparable. The rate of inappropriate catheterisation was 22.6% in the pre-group, whereas no inappropriate catheterisation was performed in the post-group. There was a 2.2% of absolute reduction in the rate of urinary tract infections (from 8.5% to 6.3%). Costs associated with the use of urinary catheters were reduced by 74.2% (from 173 to 44.8 euros).

Conclusions: Bladder ultrasound in clinical practice is feasible and reduced the inappropriate use of bladder catheters, reducing patient risks and healthcare costs.

. Staffing standards in residential facilities: a regional regulatory survey.

Introduction: Residential facilities are present in all Regions and several data useful to better understand the activities performed are available through the residential care information flow. To date, some information useful for analysing staffing standards is difficult to capture and very likely in the Italian Regions heterogeneous care modalities and staffing levels are present.

Aim: To investigate the staffing standards of residential facilities in Italian Regions.

Methods: A review of regional regulations was carried out, between January and March 2022, on the website Leggi d'Italia, searching for documents on staffing standards in residential facilities.

Results: 45 documents were analysed and 16 from 13 regions were included. There are important inhomogeneities between regions. For example, Sicily sets unique staffing standards irrespective of the severity/complexity of the residents; the number minutes of nursing care per patient, for residents in intensive residential care may vary from 90 to 148 minutes/day. Standards have been set for nurses but not always for health care assistants, physiotherapists and social workers.

Conclusions: Only a few regions have defined standards for all the main professions in the community health system. The variability described should be interpreted accounting for the socio-organisational contexts of the region, the organisational models adopted, and the staffing skill-mix.

. The resignations among nurses in the Veneto healthcare institutions. A retrospective study.

Introduction: The phenomenon of large-scale resignations is complex, heterogeneous and cannot be attributed solely to the pandemic crisis, during which many people reconsidered the role of work in their lives. The health system was particularly exposed to the shocks caused by the pandemic.

Aims: To describe the turnover and analyse the resignations of nurses in the NHS hospitals and districts of the Veneto Region.

Methods: The hospitals were categorised into 4 types: Hub and Spoke of level 1 and 2. The positions of nurses with permanent contracts between 1 January 2016 and 31 December 2022 were analysed, considering active, nurses on duty for at least one day. The data were extracted from the human resource management database of the Region. Unexpected resignations were considered those occurring before the retirement date (59 years for women and 60 for men). Negative and overall turnover rates were calculated.

Results: The risk of unexpected resignations was increased for nurses not resident in Veneto, of male gender and employed at a Hub hospital.

Conclusions: The flight from the NHS is in addition to the physiological flow of retirements, due to increase in the coming years. It is necessary to: act on the retention capacity and attractiveness of the profession; implement organisational models based on task sharing and shifting; implement digital tools; favour flexibility and mobility to improve the balance between work and personal life; efficiently integrate professionals quali-fied abroad.

. The use of health information systems for planning community care. The health information system (HIS) integrates data collection, processing, reporting, and use of the information useful to measure and assess health and social care for improving their management. HIS has great potential to reduce healthcare costs and improve outcomes. Information may be used to plan community-based care interventions by identifying populations at risk, especially by community healthcare professionals (e.g., family/community nurses). In Italy, HIS collects health and social information of individuals cared by the National Health Service. This paper has two main objectives: (i) to provide an overview of the main existing health and social HIS Italian databases; (ii) to describe the experiences of use of the information of HIS databases in the Piedmont Region.