[The telephone follow-up by a nurse case manager in major surgery. A prospective observational study]. / Il follow-up infermieristico telefonico nell'ambito del case management in chirurgia maggiore. Uno studio osservazionale prospettico.

. The telephone follow-up by a nurse case manager in major surgery. A prospective observational study. INTRODUCTION: One of the methods used in case management is a structured telephone follow-up, helpful in improving patient satisfaction, supporting autonomy, and addressing information needs post-discharge. OBJECTIVE: To describe the experience of nursing case management and post-hospital telephone follow-up in patients undergoing major abdominal surgery. METHOD: Single-centre prospective observational study. All consecutive patients undergoing major abdominal surgery from April 2021 to May 2022 were included. Symptoms and nursing care needs during the post-discharge period, along with case management interventions, were described. RESULTS: Of the 205 patients included in the study, 89.8% underwent elective surgery and 135 (65.9%) did not develop postoperative complications, with a median hospital stay of 8 days. 182 (88.8%) patients reported at least one postoperative symptom, with fatigue, altered bowel movements, pain, and lack of appetite being the most common. Interventions provided by the case manager decreased progressively over time, from 149 at the first telephone contact (72%) to 44 at the third (25%). A total of 22 patients (10.7%) were readmitted to the hospital, 12 of whom on the recommendation of the case manager. CONCLUSIONS: After discharge, patients experience numerous issues: although the symptoms encountered are common during the post-operative period, they often require support beyond the patient's capacity. The intervention of the case manager with information and support for self-management of symptoms enabled the early identification of risk situations.

Experiences of people with spinal cord injuries readmitted for continence-related complications: a qualitative descriptive study.

STUDY DESIGN: Qualitative descriptive. OBJECTIVES: To describe the experiences of people with Spinal Cord Injury (SCI) re-admitted to the hospital due to continence-related complications. SETTING: Inpatient service of a large spinal unit in North-West of Italy. METHODS: Semi-structured interviews were conducted on a purposive sample of people with SCI (n = 11; age range 22-66 years, n = 5 females, n = 6 with cervical injuries), audio-recorded, and transcribed verbatim (duration range 38-52 min). Data were analysed inductively using the thematic analysis approach as described by Braun and Clarke. RESULTS: Three main themes were identified: (i) managing the frustration of continence-related complications; (ii) finding your way to deal with continence-related complications; (iii) identifying precise needs to deal with continence-related complications. Obtained findings highlighted the perceived emotional and physical burden suffered by people with SCI and their caregivers regarding the constant look for solutions and renounces to social participation, the different strategies implemented to address continence-related complications, and the unmet or partially met needs of people with SCI regarding support in transition to the community, infrastructure, and reliable information or education. CONCLUSIONS: Continence-related complications have a significant impact on the lives of people with SCI and their families. Interventions using technological tools and peer participation could reduce the burden associated with continence-related complications. Specific instruments are needed to facilitate evaluation, goal setting, and promote discussion of continence to allow HCPs to support people with SCI. Structured follow-up for SCI survivors should also focus on their needs to improve knowledge, facilitate decision making, and promote preventive behaviours.

Association between sleep quality and participation in people with spinal cord injury: A preliminary study.

Objective: To explore the association between perceived sleep quality and participation in people with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Spinal unit at the Città della Salute e della Scienza University Hospital of Turin, Italy.Participants: From May to July 2019, 55 consecutive outpatients were recruited.Outcome measures: A set of structured questionnaires was administered. It included sociodemographic data, the Pittsburgh Sleep Quality Index, the Utrecht Scale for Evaluation of Rehabilitation-Participation, the Spinal Cord Independence Measure Self-Report, the Short Form version 12.2, and the Hospital Anxiety and Depression Scale. T-tests were used to highlight differences between participation and participant characteristics. Bivariate analyses and linear regressions were performed to identify associations between sleep quality and participation.Results: Differences in participation occurred mainly in individuals with a higher level of injury, caregiver dependency, and lower functional level. Participants reporting better sleep quality had more frequent (r = -0.36, P < 0.01), less restricted (r = -0.32, P < 0.05), and more satisfactory participation (r = -0.33, P < 0.01). Linear regression analyses showed that poor sleep quality was significantly associated with reduced participation frequency (ß = -0.30, P = 0.03) and less satisfaction with participation (ß = -0.49, P < 0.001). Moreover, age, number of hours slept at night, and time since injury were associated with satisfaction with participation.Conclusions: An association was found between sleep quality and participation in people with SCI. Given the high prevalence of sleep problems and their association with all dimensions of participation, the promotion of sleep quality should be encouraged because it may positively affect participation.

Characteristics of Breakthrough Pain and Its Impact on Quality of Life in Terminally Ill Cancer Patients.

Purpose. This study aimed to characterize breakthrough pain (BTP) and investigate its impact on quality-of-life (QoL) in terminally-ill cancer patients. Similarities and differences between high and low predictable BTP were also tested. Methods. Secondary analysis of a multicenter longitudinal observational study included 92 patients at their end-of-life. BTP was assessed with a short form of the Italian version of the Alberta Breakthrough Pain Assessment Tool. QoL was assessed with the Palliative Outcome Scale (0-40). Patients were stratified by self-reported BTP predictability into unpredictable BTP (never or rarely able to predict BTP) and predictable BTP (sometimes to always able to predict BTP). Results. In all, 665 BTP episodes were recorded (median 0.86 episodes/day). A median duration of 30 minutes and a median peak intensity score of 7 out of 10 were reported. Time to peak was <10 minutes, 10 to 30 minutes, and ≥30 minutes in 267 (41.1%), 259 (39.9%), and 30 (4.6%) of the episodes, respectively. Onset of relief occurred after a median of 30 minutes. Time to peak (P < .001) and duration (P = .046) of BTP was shorter in patients with predictable pain (n = 31), who usually were younger than those with unpredictable pain (P = .03). The mean (SD) QoL score was 14.6 (4.6). No difference in QoL between patients with predictable and unpredictable BTP was found (P = .49). Conclusions. In terminally-ill cancer patients, BTP is a severe problem with a negative impact on QoL and has different characteristics according to its predictability.

The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients.

Opioid therapy must be adjusted to the rhythm of a cancer patient's pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study was aimed at verifying the existence of a circadian rhythm of BTP episodes in terminally-ill cancer patients. Consecutive adult cancer patients at their EOL treated with long-acting major opioids to control background pain (Numeric Rating Scale ≤ 3/10) were recruited from two Italian palliative care services. Using a personal diary, patients recorded the frequency and onset of BTP episodes and the analgesic rescue therapy taken for each episode over a 7-day period. Rhythms identified in BTP episodes were validated by Cosinor analysis. Overall, 101 patients were enrolled; nine died during the study period. A total of 665 BTP episodes were recorded (average of 7.2 episodes, mean square error 0.8) per patient, with 80.6% of episodes recorded between 8:00 a.m. and 12:00 a.m. At Cosinor analysis, a circadian rhythm of BTP episodes was observed, with a Midline Estimating Statistics of the Rhythm (MESOR) of 1.5, a double amplitude of 1.8, and an acrophase at 12:30 p.m. (p < 0.001). Oral morphine was the most frequent analgesic rescue therapy employed. In terminally-ill cancer patients, BTP episodes follow a circadian rhythm; thus, tailoring the timing of opioid administration to this rhythm may prevent such episodes. This circadian rhythm of BTP episodes in terminally-ill cancer patients should be confirmed in larger samples.

Prevalence, Severity, and Self-Reported Characteristics of Taste Alterations in Patients Receiving Chemotherapy.

OBJECTIVES: To describe the prevalence, severity, and self-reported characteristics of taste alterations (TAs) induced by chemotherapy and to investigate TAs across chemotherapy regimens. SAMPLE & SETTING: 243 adult patients from five outpatient practices in Northern Italy. METHODS & VARIABLES: Correlation, univariate, and multivariate linear regression analyses. Variables include TAs, symptoms reported by patients, and the effect of TAs on quality of life. RESULTS: A majority of the study sample reported TAs. Difficulty in tasting saltiness was most common, followed by difficulty in tasting umami and sweetness. The severity and characteristics of TAs changed across chemotherapy regimens. TAs correlated with quality of life and were significantly associated with patient's age and a 21-day chemotherapy schedule. IMPLICATIONS FOR NURSING: TAs are a frequent side effect of chemotherapy, with varying characteristics that have a negative effect on quality of life. Healthcare professionals should routinely assess for TAs and provide patients with specific management strategies depending on the nature of TAs.

Clinical practices to promote sleep in the ICU: A multinational survey.

PURPOSE: To describe sleep assessment and strategies to promote sleep in adult ICUs in ten countries. METHODS: Multicenter, self-administered survey sent to nurse managers. RESULTS: Response rate was 66% with 522 ICUs providing data. 'Lying quietly with closed eyes' was the characteristic most frequently perceived as indicative of sleep by >60% of responding ICUs in all countries except Italy. Few ICUs (9%) had a protocol for sleep management or used sleep questionnaires (1%). Compared to ICUs in Northern Europe, those in central Europe were more likely to have a sleep promoting protocol (p < 0.001), and to want to implement a protocol (p < 0.001). In >80% of responding ICUs, the most common non-pharmacological sleep-promoting interventions were reducing ICU staff noise, light, and nurse interventions at night; only 18% used earplugs frequently. Approximately 50% of ICUs reported sleep medication selection and assessment of effect were performed by physicians and nurses collaboratively. A multivariable model identified perceived nursing influence on sleep decision-making was associated with asking patients or family about sleep preferences (p = 0.004). CONCLUSIONS: We found variation in sleep promotion interventions across European regions with few ICUs using sleep assessment questionnaires or sleep promoting protocols. However, many ICUs perceive implementation of sleep protocols important, particularly those in central Europe.

[Italian validation of the Chemotherapy Induced Taste Alteration Scale]. / Validazione italiana della Chemotherapy induced Taste Alteration Scale (CiTAS).

UNLABELLED: . Italian validation of the Chemotherapy Induced Taste Alteration Scale. Introdution. Taste alterations (TAs) are an underestimated side effect despite affecting 75% of chemo-radiotherapy patients. TAs may cause discomfort and food aversions up to loss of appetite and anorexia. The available instruments do not discriminate the different types of TAs. AIM: The aim of the study is to validate the Italian version of CiTAS, a 18-items scale that assesses specific TAs, symptoms of discomfort and their impact on patient nutrition. METHODS: A convenience sample of 243 patients with chemotherapy-induced taste alterations were enrolled. Data were analyzed for item consistency using Cronbach alpha and construct validity using factor analysis. RESULTS: The factor analysis identified four dimensions that explained a total variance of 67%: decline in basic taste, discomfort, phantogeusia and parageusia, and general taste alterations. The scale showed good validity (Cronbach's alpha = 0.82). CONCLUSIONS: The CiTAS enabled the valid and reliable measurement of specific symptoms of chemotherapy-induced TAs. It can be used both as a clinical tool and in future studies to evaluate the effectiveness of specific TAs treatments.

Decisional responsibility for mechanical ventilation and weaning: an international survey.

INTRODUCTION: Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement. METHODS: A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making. RESULTS: Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs. CONCLUSIONS: Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.