Assistenza Infermieristica E Ricerca最新文献

. Non pharmacologic interventions for pain associated to venipuncture in children: a literature review.

Introduction: Venipuncture is one of the most common painful procedures performed on children. Pain prevention and control are essential in childhood, because the earlier is the nociceptive experience, the more it affects the response to subsequent painful events.

Objective: To analyse the literature on non-pharmacological methods of pain management in children undergoing venipuncture.

Method: The review was carried out between May and July 2019 by consulting the PubMed and Cochrane Database, combining Mesh terms and free text. The references reported in the articles found in the first part of the research were also analyzed, to identify further relevant studies.

Results: A total of 20 articles were included in this review (8 randomized clinical trials, 10 systematic reviews, 1 meta-analysis and 1 pilot study), on a total population of almost 20,086 children aged 1-18 years. The settings considered by the studies were pediatric wards, pediatric outpatient, and Emergency Department. Non-pharmacological interventions can be classified in 4 categories: supportive or environmental therapies; physical therapies; cognitive-behavioral therapies; and non-nutritive suction for newborns and infants. The strength of evidence ranged from high to low or extremely low.

Discussion: Most non-pharmacological methods are simple, cheap, easily acquired, and do not need excessive application time. They allow pain control and support the comfort and cooperation of children undergoing venipuncture, alone or combined to pharmacological treatment.

. We were told "everything will be all right", but we were afraid.

Introduction: During the pandemic, the elderly were an at-risk group.

Objective: To explore how older people >65 years lived through the pandemic.

Methods: Questionnaire available online for all members of the Italian Pensioners' Union of the CGL Lombardy, which explored the state of health, activities carried out, contacts with the doctor, psychological conditions.

Results: 1480 people responded, in good health and with a good level of schooling. Half did not change their habits during the pandemic. For 2/3 the psychological well-being did not change, with a substantially positive vision of the future, even if 64% reported having had stress symptoms. The aspect that was missing the most, as expected, was not being able to see their families. A very common feeling (60% of respondents) was a sense of isolation and abandonment.

Conclusions: As shown in other papers, older people do not seem particularly at risk of psychological problems during the pandemic.

. Disphagia: a guide to the assessment. Dysphagia is a frequent symptom in clinical and care practice; taking care of the person with dysphagia requires multidisciplinary approaches, however it involves nurses' responsibility in their daily relationship with the patients and frequent updates on the evolution of assessment, diagnostic and treatment tools. This contribution proposes an update on the different levels of assessment: from screening procedures to the clinical evaluation of dysphagia and presents the main tools used in clinical practice.

. Why quantitative estimates must and can be dependent variables of clear assumptions and objectives of care. The pandemic has highlighted the many fragilities of a national health system that for years gave priority in balancing the budget and not in providing a service to the entire population, including fragile and marginalized groups. The attention focused with specific intensity during the pandemia on the critical and broader role of the nursing for the caring component of a National Health Service, is highly suggestive of the need of conceiving the post-pandemia as a period of a reform, which must coincide and translate into a truly research effort. Concrete conceptual and operational protocols should be targeted with priority to areas which have emerged as indicators of unmet care, even more than of clinical needs: from the elderly non-autonomous populations, to the chronicity of the complexities looking to integrated hospital and district care, to the also epidemiologically orphan diverse and care-needing populations for whom no evidence based interventions are accessible/available. Based on the discussion of these premises, the contribution outlines the path leading to real-life protocols, whose fundamental starting point should be the epidemiological and qualified visibility of the populations of interest: their contextualized lives -beyond and above their diagnoses and interventions transformed in economic costs - must and are indicated how to be the baseline starting as well as the outcome end points.

. Care path for non-deferred elective hospitalizations in cardiology in the Covid-19 period.

Introduction: The novel coronavirus-19 (Covid-19) has rapidly resulted in a global pandemic. Our hospital had to postpone all elective admissions to increase capacity for COVID-19 patients. Therefore, a rearrangement of the elective admissions was necessary to guarantee a restart of ordinary procedures.

Aim: To describe the organizational model adopted for elective procedures during the Covid-19 pandemic, to guarantee maximum safety for patients and healthcare workers.

Methods: Patients on waiting list for cardiac procedures were rearranged based on risks prioritization. Procedure of coronary angiography and cardiac devices (PM and ICD) implants or replacement took priority upon other cardiac procedures. Each patient underwent a telephone nurse triage to assess for any covid-19 symptoms. The hospital admissions were organized in accordance with health and safety measures declared by the National Institute of Health, with different paths according to the swab results.

Results: A total of 66 patients were contacted and 40 accepted the hospital admission (26 refused it, for fear of infection or covid-19 related family problems). No patient resulted positive to the nasal swab.

Conclusions: In view of the impact on the health care system of this new pandemic, the choice of an appropriate pathway which can preserve patients' safety is essential, while guaranteeing the treatment of problems, such as cardiovascular diseases, with a high mortality rate.

. The reorganization of the strategies of a surgical department and the nosocomial diffusion of Covid-19.

Introduction: During the SARS-CoV2 pandemic, preventive measures and patients' selection were adopted to allow the treatment of non-deferrable oncological and trauma cases and to contain hospital diffusion of the virus. The reorganization of the ward management associated to the training of healthcare providers are the first available interventions.

Aim: To describe the interventions implemented to limit the spread of virus during the peak of pandemic in a high daily turn-over 25 beds surgical ward (9 patient admitted per day/mean duration of hospital stay 2.3 days).

Method: Description of the interventions implemented and of the admissions from March 9 to May 18 2020, and the swab results.

Results: 392 patients were treated in the period considered (342 were scheduled cases - 50 urgent cases; 364 were adults and 28 children). All scheduled patients underwent a screening survey, 5% of those contacted showed a risk factor at the interview and were rescheduled; 190 patients underwent a preoperative screening swab, all with negative results. None of healthcare providers was positive to swabs.

Conclusions: The prompt application of preventive measures and patients screening (preoperative interview and screening swab) possibly allowed to control the spread of SARS-CoV2 in our hospital. Sharing our experience would allow to find consensus to guarantee the safety for patients and healthcare workers.

. The use of facial masks: updated information after Covid-19. Preventive spread of infections to and from healthcare workers and patients relies on effective use of personal protective equipment. During the Covid-19 epidemic, different, often conflicting indications were given, based on evolving knowledge on the spread mechanism of the virus. In this contribution the most up to date indications on the use of facial masks by health care workers and general population, for the prevention of contagion are discussed and confronted.