Evaluating the effects of polices on nursing care as promoted by the Veneto region: the research protocol and its implications for public health.

Study design: Multi-centre mixed-method study design organised into several phases. Background: The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points. Methods: The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included. Conclusions: Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.

Thirst distress and interdialytic weight gain: a study on a sample of haemodialysis patients.

Severe thirst distress is frequent in haemodialysis (HD) patients, and some studies have noted a positive relationship between thirst and an increased interdialytic weight gain (IDWG). The goal of this explorative study was to describe the perception of thirst and correlated symptoms in HD patients, and verify the correlation between thirst intensity and the IDWG. The study was performed on an opportunistic sample of patients treated in the dialysis unit of a city hospital in the North-East of Italy. Data were collected using a questionnaire containing a demographic and a clinical part, the Thirst Distress Scale, and a Visual Analogue Scale (VAS) 0-10 about thirst intensity. The sample of 107 patients was composed of 71 males (66%). The average age was 68 years (SD 12, median 70 years). Fluid restriction causes severe physical discomfort and xerostomy. 66% of the respondents declared a thirst level of more than 7 on the VAS scale. The average IDWG was 2.47 kg. The chi2 test did not show a significant difference when correlated with thirst intensity (p = 0.88).

[Endoscopic approach to biliary stones: experience acquired in a general surgery unit. Comparison of 2 periods]. / L'approccio endoscopico alla calcolosi della via biliare: acquisizione e sviluppo dell'esperienza in una unità operativa di chirurgia generale. Due periodi a confronto.

The outcome of the laparoscopic technique, that in the first years needed to be applied in non complicated situations, imposed a more frequent use of ERCP preoperatively; this procedure was originally confined to a handful of European and American centers, but later spread to almost all large hospitals. Improvements in the techniques and materials have gone side by side with more specific indications and the assessment of complications. The purpose of the present study was to analyze the experience of a General Surgery Unit in terms of acquiring and developing skills in treating biliary stones by ERCP.

Synthesis of 4-O- and 6-O-monoacryloyl derivatives of sucrose by selective hydrolysis of 4,6-O-(1-ethoxy-2-propenylidene) sucrose. Polymerization and copolymerization with styrene.

The synthesis of an ethylenic orthoester of sucrose by transorthoesterification of an acrylic reagent with sucrose is described. Mild hydrolysis of this orthoester gave sucrose selectively monosubstituted by an acryloyl group at either the 4-O- or the 6-O-position. These acrylates were homopolymerized and copolymerized with styrene, and the corresponding polymers were characterized.

Carbofilm-covered prostheses in plastic surgery: preliminary observations.

The optimal interface between an implant and the host organism is that which minimizes uncontrolled and irregular growth of fibrous tissue around the foreign material. One way to achieve this goal is to coat the outer surface of the implant with a biocompatible material. A thin film of turbostratic carbon (Carbofilm, Sorin Biomedica, Saluggia, Italy) can be applied as a thin coating on tissue expanders and breast implants made of silicone elastomers. The success of biologic trials with such implants in rats and cytologic studies with murine and human fibroblasts encouraged us to employ the Carbofilm technology in clinical situations. Preliminary results indicate that Carbofilm-coated implants satisfy the requirements of an ideal alloplastic material and induce a minimal periprosthetic inflammatory reaction, with the formation of a thin, soft, pliable, fibrous capsule around coated gel-filled silicone implants.