Assistenza Infermieristica E Ricerca最新文献

. A model of continuity of care for not residents through medical-nursing teleconsultation in a Hub & Spoke network.

Introduction: The Seasonal Continuity of Care (CAS) is a service of the Bergamo Health Protection Agency that provides medical and healthcare services, guaranteeing outpatient or home care to Italian and foreign tourists and seasonal workers during the months of July and August. The Covid-19 pandemic and the shortage of doctors made it impossible to provide the service in 2021 as in previous summer seasons.

Aims: To activate a CAS service with the involvement of nurses.

Methods: A "Hub-Spoke" network model was activated; nurses in the Spoke sites, with the patient in attendance, through teleconsultation by video call, made remote contact with a doctor in the Hub.

Results: In the 3 Spoke CASs, from 2 to 22 August 2021, 274 services (of which 14.3% were teleconsultations between the nurse at the Spoke CAS site and the doctor at the Hub site) and 162 repeat prescription requests were made. Teleconsultation was mainly performed for patients with acute pathology (71.8%), mainly for arthralgia and fever. In the majority of cases, it was sufficient to answer to the needs of the patient (87.2%); a small number of cases were referred to a doctor's appointment (10.3%) or to Emergency Department (2.6%).

Conclusions: Nurse triage reduced the time of medical visits, allowing more patients to be taken care of. The need for digital infrastructure, training and integration with district services emerged.

. Indications for CAR-T cell therapy and management of the complications: an update.

Introduction: The engineering of T lymphocytes with the chimeric antigen receptor (CAR-T) opened a new pattern for the treatment of malignant neoplasms and it was pivotal for the treatment of some haematological malignancies.

Aim: To describe the therapy with CAR-T, the mechanism, the management process, the role of the multidisciplinary team and highlight the main complications and management, follow-up, the impact on quality of life and the role of nurse.

Method: A literature review was conducted. Secondary studies published between 1 January and 17 October 2022, in English and Italian language, on adult population undergoing CAR-T, were included. Of the 335 articles, 64 were, finally, included.

Results: New CAR-T products have been tested for the treatment of acute myeloid leukaemia, multiple myeloma and some kind of solid tumours. The two main toxicities are the cytokine release syndrome and the neurotoxicity. Alternative drugs have been tested for minor adverse effects. The multidisciplinary team and the nurse are fundamental, both in the clinical care and in the organization; an emphasis was put on the correct patients' information. Quality of life after CAR-T treatment is still poorly investigated.

Conclusions: The knowledge on CAR-T is in continuous and rapid growth and several questions are still without answer, requiring a continuous update of the transplant centres.

. Open ICU in pandemic phase Sars-CoV-2: the partial reopening of family visits in an ICU in Northern Italy.

Introduction: During the Covid-19 pandemic, policies restricting family visits to health care facilities were commonly adopted, negatively impacting on patients, families and on the care team.

Aim: To describe the reorganisation of a 23-bed Intensive Care Unit in Northern Italy for partial reopening to visits during the pandemic.

Methods: The reorganisation involved several phases: I) feasibility analysis, II) thawing out resistances; III) identifying behavioural, IV) organisational and structural indications for family access in the Covid area; V) fostering communication to guarantee information and emotional support for family members and VI) assessing, through an anonymous questionnaire, the degree of agreement on the impact of the presence of family members on health care team, patient and perception of safety.

Results: The majority of the relatives felt that the visit at the patient's bedside had a beneficial effect and reduced their anxiety. Almost all family members felt protected from the Covid-19 infectious risk. Healthcare staff also felt that the presence of family members contributed positively to the relationship with the patient. No family members contracted the Covid-19 infection during the evaluation period.

Conclusions: Reopening access to family members during the Covid-19 period is possible, sustainable and beneficial. The use of flexible and motivational management principles by the coordinator were crucial in ensuring a family-centred approach during the pandemic.

. Measuring strategies and instruments at the uncertain frontiers of quality and quantity. As a development of previous contributions in this section on methodology, and with a specific reference to the ongoing discussion in the literature on the reliability and relevance of quantitative measures of qualitative dimensions such as satisfaction, the present comment underlines the need of a 'cultural' approach to the problems which are a mix/crossroad of quality and quantity. Two most recent very brief, didactical, provocative publications, by a woman mathematician and a famous world-renowned economist respectively, are suggested as model examples of the need and potential contribution of a broader, multidisciplinary, culturally contextualized research strategies and instruments.

. Visiting hospitalized loved ones: a right of family members and patients. In hospitals and nursing homes, regulations apply different limitations to family visits: from a total ban even for critical and/or terminal patients, or in the delivery room (new mothers give birth alone), to limiting the number of visitors (one at a time) or the type (immediate family members only), to the time for the visit (a maximum of 10 to 45 minutes); other facilities allow access for critical and/or end-of-life patients. It is time to return to pre-covid normality. The patient has the right to be accompanied, by the people who matter to her/him; the presence of family members next to the patient is not a concession but a concrete expression of the respect and attention due to the patient and his/her dignity as a human being. To continue the debate on family visits to hospitalised loved ones, we publish two letters/appeals. One, from the relatives of nursing home residents, hospitalised and dead during the pandemics, without any contact with their relatives (edited by Anchise Comitato Nazionale Famiglie RSA RSD Sanità), which in sometimes very harsh, but hardly contestable tones, at the end of August 22 launched an appeal (which is still little heeded) to the future government, to reopen the doors of hospitals and nursing homes. The other, a press release of December 2022, from the Nursing College of Trento, reaffirms the importance of family visits as a right and responsibility to guarantee the care and caring of the person being cared for, recalling the attention and responsibility of nurses, who should consider a fundamental care to be able to care for patients with the closeness of the family.

. The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area.

Introduction: The demographic and epidemiological changes of Western societies lead to the implementation of new organizational models based on prevention and health promotion interventions mainly oriented to chronic patients. This approach promotes people's living places as the privileged place of care.

Aim: To guarantee, in a rural area, the care of patients without a general practitioner, through the activation of the Primary Care District Clinic.

Methods: After having mapped the main chronic health problems of the catchment area, an outpatient care service based on an integrated medical-nursing approach was implemented. The Family and Community Nurse was responsible for the stratification of subgroups of patient according to their health problem, ensuring an integrated care of patients with chronic diseases or frail conditions, by education and symptoms monitoring. A convenience sample of 100 patients was selected, to analyze the degree of satisfaction with the care offered, by administering a questionnaire.

Results: Six months after its implementation, 4,000 patients accessed to the District Clinic. Those who answered the questionnaire declared high levels of satisfaction for the care received. The main needs were requests for repeated prescriptions and prescriptions for specialist examinations or visits for acute symptoms.

Conclusions: The implemented model is promising, the patients were satisfied with the care received but would prefer to have contacts with the same nurse over time.

This is the third contribution of a series of updates on oncological emergencies. The updates are published in the form of a case, with multiple-choice questions to assess knowledge, a brief discussion of the answer, and reference literature, to further explore. This case, which involves the management of a B-cell non-Hodgkin lymphoma, is accompanied by a more extensive update on CAR-T cell treatment.

Mental health in Gaza. The article that follows - which is the gift of one of the most competent and responsible doctors in the field of international cooperation - is not only one of the very few reports on one of the most serious and least known aspects of the repression of the population of Gaza: it would like to be a cultural and methodological reminder of how great is the invisibility of the rights denied to all the populations that permanently live in a state of war in the world. The situation described here for such a fragile part of the Palestinian population is the most explicit and tragic case in which the chronicle of wars does not accept the blackmail of telling of winners and losers, of victims and destruction, but wants to play the role of restoring visibility, dignity, windows of future to concrete people, to their unmet needs, to the demand for profound attention, which is the main way to recognise and make violated rights possible again. The mental health of the paediatric and adolescent age is a very strong indicator (also for Italy - Save the Children's annual reports describe a worrying situation) of how much society and health care leave 'orphans' precisely those who have the most difficulty in resisting-overcoming the insecurity-fragility-non-autonomy created by all types of war: their request is first of all for an adoption that needs less doctors and medicine, and much more accompaniment made up of time, acceptance, and hope for the future. The most widespread war that affects society and health today is the one which excludes the right to personalised and lasting visibility-recognition. May Gaza become a permanent school of looking and listening.