[Effectiveness and safety of non-pharmacological interventions for the prevention of venous thromboembolism in stroke patients: an overview of systematic reviews]. / Efficacia e sicurezza degli interventi non farmacologici per la prevenzione del tromboembolismo venoso nei pazienti con stroke: una overview di revisioni sistematiche.

INTRODUCTION: Half of the deaths recorded in non-surgical patients attributable to venous thromboembolism (VTE) affect those with stroke. The uncertain benefit of anticoagulant therapy has increased interest in non-pharmacological intervention to prevent VTE. AIM: To evaluate the efficacy and safety of non-pharmacological interventions to prevent VTE in stroke patients. METHODS: Overview of systematic reviews with retrieval of documents in compliance with the PICOS Framework and through a research strategy implemented on 4 April 2019 in six biomedical databases and in the PROSPERO registry. The tools used to assess the methodological quality and the risk of bias were the AMSTAR checklist and the ROBIS tool, respectively. The results have been synthesized with narrative modality. RESULTS: Seven systematic reviews of different methodological quality and risk of bias met the inclusion criteria. The non-pharmacological interventions of prophylaxis used are graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCD). The first has no effect on VTE and has important side effects, the second is promising in reducing mortality from all causes and decreases the incidence of deep vein thrombosis. DISCUSSION: The use of IPCD, despite the efficacy observed, should be reserved, after a risk assessment of VTE and a subgroup analysis, for patients who can derive the maximum benefit from the intervention. CONCLUSIONS: In stroke patients the use of GCS to prevent VTE is not recommended because it is not superior to standard care and can cause damage. IPCD as a intervention of prophylaxis appears to be effective but further confirmation is needed from future studies.

[Consequences of alcohol consumption mixed with Energy Drink. Overview of systematic reviews]. / Conseguenze del consumo di alcol miscelato ad Energy Drink. Overview di revisioni sistematiche.

INTRODUCTION: The habit of teenagers and young adults to take alcoholic beverages mixed with Energy Drinks (AmED) is increasing. Epidemiological data are of concern but awareness of the problem between consumers and health workers is scarce. OBJECTIVE: To compare the effects and damages from consumption of AmED compared to alcohol. METODI: Finding documents through the interrogation of seven biomedical databases. Overview of systematic reviews assessed for methodological quality and risk of bias respectively with the AMSTAR checklist and ROBIS tool with narrative synthesis of results. RESULTS: Six systematic reviews of low quality and high risk of bias met the inclusion criteria. The intake of AmED seems to determine the increase in state of vigilance, reduction of sedation and possible effects at physiological level; there are no significantly different cognitive or psychomotor effects. The evidence to support a lower perception of alcohol intoxication is insufficient; controversial are those in favour of an increase in alcohol intake or risky behavior. DISCUSSION AND CONCLUSIONS: The results of experimental studies, which unlike nonexperimental could identify a cause-effect relationship, are often statistically insignificant and do not lead to a unanimous consensus on the different effects/damages of two consumption patterns. The authors of three reviews declare conflicts of interest with an ED producer, raising the problem of industry's influence on research. The current evidence is insufficient to confirm or refute the hypothesis that intake of AmED results in significantly different effects/damage compared to alcohol. However, the magnitude of phenomenon must act as a push for further studies promoted by independent researchers.

[Synopses of systematic reviews on effectiveness of heparin to prevent occlusion in central venous access devices]. / Sinossi di revisioni sistematiche sull'efficacia dell'eparina per prevenire le occlusioni nei dispositivi di accesso venoso centrale.

INTRODUCTION: Prevention of central venous access devices (CVAD) occlusion is crucial to the continuity and quality of care. There is wide consensus on the need to carry out a periodic flushing of the lumen of device in order to ensure its patency. The most commonly used solutions are the heparin solution (HS) and the physiological solution (NaCl 0.9% - PS). There are still controversial opinions on HS's effectiveness over PS. OBJECTIVE: To evaluate the effectiveness of HS compared to PS to prevent occlusion in CVAD. METHODS: A search strategy on four electronic databases (The Cochrane Library, Medline, Embase, CINAHL) was implemented on April 4, 2017. Records returned were independently analyzed; those complying with inclusion criteria were found in full text. They've been included systematic reviews of RCT or quasi-experimental studies that have compared the use of HS with PS. The quality assessment of reviews was done with AMSTAR checklist. RESULTS: Seven moderate-high quality systematic reviews met inclusion criteria. HS is was not superior to PS in preventing CVAD occlusions. DISCUSSION: Reviews included were of high quality methodological. The statistical heterogeneity between RCT was low while the clinical and methodological heterogeneity was high. CONCLUSIONS: HS was no longer effective than PS to prevent CVAD occlusions. Waiting for better quality studies to evaluate the overall DAVC management process, it seems reasonable to recommend using PS.

Moral distress among nurses in medical, surgical and intensive-care units.

AIM: To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. BACKGROUND: Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. METHODS: A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. RESULTS: The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. CONCLUSIONS: The present study indicates that nurses experience an overall moderate level of moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care.

[Effectiveness of blood pressure home monitoring. Synopsis of systematic reviews.] / Efficacia del monitoraggio domiciliare della pressione arteriosa. Sinossi di revisioni sistematiche.

INTRODUCTION: Home blood pressure monitoring (HmBPM) is as a valuable and useful tool for hypertension management; some uncertainties remain about benefits of intervention in clinical practice. OBJECTIVE: To assess the effects of home blood pressure monitoring on blood pressure values. METHODS: A search on the following databases The Cochrane Library, Medline, CINAHL, Embase, Web of Science was carried out on January the 12 2016 . The records retrieved were analysed independently and those which met the inclusion criteria were gathered as full text. In the synopsis were included only systematic reviews with meta-analysis of Randomised Controlled Trials comparing home blood pressure monitoring with ambulatory (ABPM) or hospital (HsBPM) blood pressure monitoring. AMSTAR checklist was used to evaluate reviews quality while for comparing meta-analysis it was proceeded to index of Higgins I2 analysis. RESULTS: Five systematic reviews met inclusion criteria. The overall methodological quality of included studies was high. Range of I2 was equal to 37%-72% (moderate to high heterogeneity). Compared to ABPM, HsBPM or standard of care, HmBPM was associated with moderate but statistically significant reduction in systolic blood pressure (weighted mean difference from -2.50 mmHg to -4.25 mmHg) and diastolic blood pressure (weighted mean difference from -1.45 mmHg to -2.37 mmHg). DISCUSSION: The reduced size of HmBPM effect results in a moderate benefit in clinical practice. Potential advantages on blood pressure control are dependent on patient ability to perform and interpret HmBPM results as well as health professionals to use recorded data to introduce or modify drug therapy and improve the overall compliance to antihypertensive treatment. CONCLUSIONS: HmBPM is more effective in reducing systolic and diastolic blood pressure compared to other interventions but the clinical significance of its effect is moderate.

[Is repositioning regimen effective to prevent pressure injuries? Synopsis of systematic reviews.] / Il regime di riposizionamento è efficace per la prevenzione di lesioni da pressione? Sinossi di revisioni sistematiche.

INTRODUCTION: Repositioning regimen is an intervention recommended by guidelines and traditionally used in daily care practice but its benefit for preventing pressure injuries (PI) is not clinically proved. OBJECTIVE: To determine the effect of repositioning regimen to prevent PI. METHODS: A research on five electronic databases (The Cochrane Library, Medline, Embase, CINAHL, Web of Science) was conducted on March 23, 2017. Records returned by the search strategy were independently analyzed and those that respected inclusion criteria have been found in full text. In synopsis have been included systematic reviews of controlled clinical trials or quasi-experimental studies that compare repositioning regimen with usual care. The AMSTAR checklist has been used for quality evaluation. RESULTS: Five systematic reviews met inclusion criteria. The methodological quality of included studies have been very heterogeneous. Compared to usual cares, intervention is not associated with a statistically significant reduction of PI. DISCUSSION: A few and small available studies do not allow to ascertain a benefit from the intervention, if any. At the moment, the application of an individualized repositioning regimen seems a reasonable solution. Further researches are needed to confirm that a more frequent repositioning and a 30° lateral decubitus intake help to prevent PI. It is also necessary to evaluate the economic impact, the acceptability and risks associated with the intervention. CONCLUSION: It is still unclear the role of repositioning regimen to prevent PI.

[Health determinants in irregular migrants with chronic diseases: analysis of the accesses to the clinic of a non-governmental organization]. / Determinanti di salute nei migranti irregolari con patologie croniche:analisi degli accessi all'ambulatorio di una organizzazionenon governativa.

. Health determinants in irregular migrants with chronic diseases: analysis of the accesses to the clinic of a non-governmental organization. INTRODUCTION: Of the 112 thousand irregular migrants in Lombardy, 49 thousand reside in the area of Milan. Data on their health conditions and needs are scarce and fragmented, especially about their socio-demographic and clinical determinants. AIM: To describe the main socio-demographic and clinical characteristics of irregular migrants with chronic diseases who access the clinic of a non-governmental organization that provides primary care and their association with the number of accesses. METHOD: Retrospective observational study of a dataset containing information on irregular migrants with chronic diseases (N = 411) carried out at the Naga Onlus clinic in 2017. RESULTS: The males come essentially from Africa and are often affected by back pain or low back pain (BP-LBP); females, mostly from East Europe or Central-South America, are frequently hypertensive. Up to 24 years of age, anxiety or depression prevails; at 25-44 years BP-LBP, at 45-64 years diabetes and in advanced age, hypertension. The knowledge of a EU language and the diagnosis of BP-LBP are respectively positively and negatively associated to the number of accesses. DISCUSSION: Following the progressive aging with the increasing prevalence of chronic conditions, marginalization and stigma, the "healthy migrant" effect once characterizing irregular migrants is being replaced by the "exhausted migrant" effect and the assimilation of a state of health similar to that of native counterparts.

[Effectiveness of oral nutritional supplements to prevent hospital malnutrition. Overview of systematic reviews]. / Efficacia dei supplementi nutrizionali orali per prevenire la malnutrizione ospedaliera.Overview di revisioni sistematiche.

. Effectiveness of oral nutritional supplements to prevent hospital malnutrition. Overview of systematic reviews. INTRODUCTION: Although oral nutritional supplements (ONSs) are among most popular interventions to prevent a condition of hospital malnutrition, their real benefits need to be clarified. AIM: To evaluate in adults the effectiveness of ONSs to prevent hospital malnutrition. METHODS: Papers retrieval by querying biomedical databases The Cochrane Library, Medline, Embase, CINAHL. Overview of systematic reviews evaluated for methodological quality according to R-AMSTAR checklist with narrative synthesis of results. RESULTS: Twenty-five systematic reviews met the inclusion criteria. Methodological quality was better in more recent studies. Low-moderate quality evidence showed a trend for decreasing mortality, complications, length of stay; there was no clear reduction in readmissions. Inadequate data do not allow to assess the impact on quality of life. The intervention seems promising for subjects over 75 years, malnourished, with pathological conditions of geriatric interest, in hospital or long-term care services, but differences are not always significant. The definition of malnutrition, screening procedures and assessment tools adopted varies widely, as well as the characteristics of participants, intervention and duration of studies included in systematic reviews; this makes difficult to estimate the net benefit due to ONSs. CONCLUSIONS: The intervention should be included in a general approach to nutrition in clinical practice. At present the role of ONSs to prevent hospital malnutrition is still unclear.