Environmental diseases, recognition for care: A qualitative study of nurses' perceptions.

OBJECTIVES: This study aims to investigate hospital nurses' perceptions of illness due to environmental exposures. DESIGN: A qualitative exploratory study, designed in accordance with the specified reporting guidelines for qualitative research. SAMPLE: Nurses working in Italian hospitals. METHODS: Semi-structured interviews were used to collect data, then evaluated using the framework analysis methodology. Data collection was from January to June 2022 and analysed from July to September 2022. RESULTS: Forty-two nurses were interviewed. Data analysis revealed three themes: 1) the concept of disease in relation to environmental exposure; 2) the dangers of chemical and physical substances; 3) environmental changes cause concern and a sense of helplessness for the future. CONCLUSIONS: The results suggest the need for specific training on topics related to environmental disease types, environmental exposure, preventive measures, health promotion, and environmental impact to support professional development and support nurses in the management of this important aspect of health care.

Is the Direct Anterior Approach for Total Hip Arthroplasty Effective in Obese Patients? Early Clinical and Radiographic Results from a Retrospective Comparative Study.

Background and objectives: Total hip arthroplasty (THA) in obese patients (BMI > 30) is considered technically demanding, and it is associated with higher rates of general and specific complications including infections, component malpositioning, dislocation, and periprosthetic fractures. Classically, the Direct Anterior Approach (DAA) has been considered less suitable for performing THA surgery in the obese patient, but recent evidence produced by high-volume DAA THA surgeons suggests that DAA is suitable and effective in obese patients. At the authors' institution, DAA is currently the preferred approach for primary and revision THA surgery, accounting for over 90% of hip surgeries without specific patient selection. Therefore, the aim of the current study is to evaluate any difference in early clinical outcomes, perioperative complications, and implant positioning after primary THAs performed via DAA in patients who were divided according to BMI. Material and methods: This study is a retrospective review of 293 THA implants in 277 patients that were performed via DAA from 1 January 2016 to 20 May 2020. Patients were further divided according to BMI: 96 patients were normal weight (NW), 115 were overweight (OW), and 82 were obese (OB). All the procedures were performed by three expert surgeons. The mean follow-up was 6 months. Patients' data, American Society of Anesthesiologists (ASA) score, surgical time, days in rehab unit, pain at the second post-operative day recorded by using a Numerical Rating Scale (NRS), and number of blood transfusions were recorded from clinical charts and compared. Radiological evaluation of cup inclination and stem alignment was conducted on post-operative radiographs; intra- and post-operative complications at latest follow-up were recorded. Results: The average age at surgery of OB patients was significantly lower compared to NW and OW patients. The ASA score was significantly higher in OB patients compared to NW patients. Surgical time was slightly but significantly higher in OB patients (85 ± 21 min) compared to NW (79 ± 20 min, p = 0.05) and OW patients (79 ± 20 min, p = 0.029). Rehab unit discharge occurred significantly later for OB patients, averaging 8 ± 2 days compared to NW patients (7 ± 2 days, p = 0.012) and OW patients (7 ± 2 days; p = 0.032). No differences in the rate of early infections, number of blood transfusions, NRS pain at the second post-operative day, and day of post-operative stair climbing were found among the three groups. Acetabular cup inclination and stem alignment were similar among the three groups. The perioperative complication rate was 2.3%; that is, perioperative complication occurred in 7 out of 293 patients, with a significantly higher incidence of surgical revisions required in obese patients compared to the others. In fact, OB patients showed a higher revision rate (4.87%) compared to other groups, with 1.04% for NW and 0% for OW (p = 0.028, Chi-square test). Causes for revision in obese patients were aseptic loosening (2), dislocation (1), and clinically significant post-operative leg length discrepancy (1), with a revision rate of 4/82 (4.87%) during follow-up. Conclusions: THA performed via DAA in obese patients could be a solid choice of treatment, given the relatively low rate of complications and the satisfying clinical outcomes. However, surgical expertise on DAA and adequate instrumentation for this approach are required to optimise the outcomes.

Alarm Fatigue in Nursing Students Undertaking Clinical Training in Intensive Care Units: A Multicenter Study.

BACKGROUND: The frequency of alarms from monitors and other electro-medical devices is of great utility but can increase the professional's workload and expose nurses in the intensive care unit to Alarm Fatigue. A recent study suggested that students in training can also experience the problem during their first clinical experiences in intensive care. Unfortunately, no data are available about the Italian panorama. To explore Alarm Fatigue among Bachelor of Science in Nursing students at the end of their internship experience in intensive care settings. METHODS: Multicenter cross-sectional design. A convenience sample of nurses from 3 Italian university hospitals was recruited. The students completed the revised version of the "Alarm Fatigue questionnaire-ita" at the end of the clinical internship in intensive care settings. RESULTS: 130 nursing students were enrolled (response rate 59.36%). The overall level of Alarm Fatigue was Me= 24.5 IQR [17.5, 30.5]. In addition, 9.23% of the sample reported errors or near misses related to Alarm Fatigue during the internship experience. The alarm fatigue level was higher in students who committed "errors/almost errors" (p=0.038) and in "student workers" (p=0.005). DISCUSSION: The extent of alarm fatigue experienced by nursing students requires developing a preventive strategy.

Analysis of Customer Satisfaction relating to the vaccination campaign aimed at extremely vulnerable people in the Asl of Latina. / Analisi della Customer Satisfaction relativa la campagna vaccinale rivolta alle persone estremamente vulnerabili nella Asl di Latina.

INTRODUCTION: Customer Satisfaction is a tool for assessing the effectiveness and efficiency of the service offered and related corrective measures to improve the quality of services provided by hospitals Collection and analysis of data regarding customer satisfaction during the vaccination campaign was estremely important. METHOD: A specific analisys on extremely vulnerable people during the vaccination campaign. An observational study was conducted through a survey on a List of extremely vulnerable people provided by specialists to the Medical Management. RESULTS: There was good feedback with the return of most of the questionnaires administered and above all a good degree of satisfaction and protection on the part of the user. CONCLUSION: The analysis carried out found that by placing the centrality of the person, "patient-oriented" in the foreground, with listening, the "taken care of", creates an empathic relationship between the healthcare professional and the user. This humanization makes the user feel satisfied and above all protected even during such a particular path as vaccination.

New frontiers in e-health. Policies and the Doctor@Home case study. / La frontiera delle cure a distanza. Assetto normativo ed il caso Doctor@Home.

INTRODUCTION: In recent years, and even more following the need for social distancing generated by the global COVID-19 pandemic, e-health has become an increasingly widespread reality in clinical practice, especially for those clinicians operating in the front-line, like nurses. Its growing importance has been followed by increasing attention both by the literature as well as in the generation of specific rules aimed at regulating the phenomenon. METHODS: A regulatory review of the literature aims to outline the current regulatory framework relating to telemedicine. Telemedicine, especially in a pandemic context, calls for regulation that runs parallel to the rapid evolution of the phenomenon itself. The paper traces the European, Italian, and Regional legislation, focusing then on a practical experience of telemedicine, called Doctor @ Home, active at the IRCCS National Cancer Center in Aviano (Italy). DISCUSSION: First, the need for regulatory harmonization emerges. Secondly, the potential of co-production and co-learning processes for healthcare professionals and patients arises to adapt to the outpatient needs of patients in a post-pandemic "new normal," exploiting the new technological tools made available by the National Health Service.

[Nursing Competence Mapping for Organizational Development: a national analysis of nurses involved in the Donation and Transplantation Process]. / Mappatura delle competenze Infermieristiche per lo sviluppo organizzativo: analisi nazionale degli Infermieri coinvolti nel Processo di Donazione e Trapianto.

The constant evolution of the health care system has led to a thorough reorganization of the system itself and an improvement in terms of the quality of treatment provided. Many articles in the literature confirm that the answer to increased quality of standards and efficient levels of organization are undoubtedly due to true and efficient team work, without any of the professionals involved having to change their area of expertise. This rapid evolution of the treatment process has required the improvement and definement of technical-specialist skills on the part of the nursing staff; personnel who have proved to be the real link in the technical-communicative processes. In relation to this important aspect, it has become essential to design, at present based on more than ten-years of experience, a profile of "job description" skills for the nursing staff engaged in the world of donations and transplants, in order to give companies objective and measurable elements on the skills profile that can be identified for this specific area and a clear recognition of the profession itself.

[Covid-19 and front-line nurses' mental health: a literature review]. / Covid-19 e salute mentale del personale infermieristico in prima linea: una revisione della letteratura.

INTRODUCTION: The Coronavirus (Covid-19) pandemic caused a severe health crisis that has affected millions of people and quarantined half of the world's population. The health emergency from Covid-19 has seen health workers on the front line face all the difficulties related to the burden of care and the reorganization of procedures, roles, and tools at the hospital level. One of the most significant and probably underestimated aspects is the psychological stress of frontline nurses. The article aims to analyze the literature relating to the impact on the mental health of nurses engaged in the management and care of Covid-19 patients. METHODS: A systematic review of the published articles on the subject was conducted from January 2020 to November 2020. The search for papers was conducted on scientific databases like PubMed, Scopus and Embase. RESULTS: The results show the onset of anxiety, depression and stress and insomnia in healthcare workers. These aspects are closely related to numerous factors, including the fear of contracting the disease and infecting family members, stressful shifts and little rest, leading to a state of psychological and physical tension capable of activating pathological behaviours. The literature highlights the importance of support interventions for frontline personnel to avoid the onset of psycho-pathophysical severe problems. CONCLUSION: The review suggests that frontline nurses during the emergency phase of Covid- 19 may be prone to psychological disorders that can compromise mental health. Therefore, the surveillance and monitoring of symptoms, together with targeted support interventions, should be guaranteed daily to all professionals involved to prevent the onset of psychological disorders.

[Nursing Students' Attitudes Toward Suicide and Suicidal Patients: italian validation of the Suicide Behavior Attitude Questionnaire (SBAQ)]. / Le attitudini dello studente del Corso di Laurea in infermieristica nella gestione del rischio suicidario: validazione della Suicide Behavior Attitude Questionnaire (SBAQ).

BACKGROUND: Suicidal acts are a public health problem worldwide and require nurses to have appropriate skills to deal with it. It is important to study the level of knowledge, as well as the perception of nursing students towards suicidal ideation; a tool created for this purpose, the Suicide Behavior Attitude Questionnaire (SBAQ) has proven its validity and reliability in English. AIM: To assess the psychometric properties of the Italian version of the SBAQ (SBAQ-ita). METHODS: Multicentric study. The SBAQ-ita was administered to students of two Nursing schools in two universities in Italy. The CVI-I was calculated to evaluate the validity of the content of the SBAQ-ita. Construct validity was investigated through exploratory factor analysis. Cronbach's alpha coefficient (α) was used to examine the internal consistency of each scale factor. Spearman's rho coefficient was used to test stability. RESULTS: The SBAQ-ita was administered to 205 students from October to November 2019. The analysis showed a four-factor structure with Cronbach's α always ≥0.70. The CVI-I was 0.97. 25 students filled in the scale again after 7 days (test-retest rho=0.92). CONCLUSION: The SBAQ-ita is a valid and reliable tool for the study of the students' attitude in the Bachelor of Science in Nursing towards caring for the person with suicidal ideation. postoperative settings.

[Covid-19 and implications on the cornea donation activity in Local Health Agency Barletta-Andria-Trani]. / Covid19 e implicazioni sull'attività di donazione di cornee nella Asl BarlettaAndriaTrani.

The spread of Coronavirus Disease 2019 (COVID-19) has reached a pandemic dimension within a few weeks. Italy has been one of the first countries, together with Cina, dealing with the outbreak of COVID-19 and adopting severe measures to limit viral transmission. The spread of COVID-19 may have several implications in organ transplant activity and medical and nursing personnel should be know these implications. The initial experience gained during the COVID-19 outbreak shows that around 10% of infected patients in Italy need intensive care management to overcome the acute respiratory distress syndrome. Due to the exponential rise of infected patients we are now facing an actual risk of saturation of potential tissue donors which can adversely affect the overall donation activity and reduce the number of transplants. Italian preliminary data show an overall decrease of 40% in March 2020. This paper aim at showing how the pandemic affects procurement of corneal tissues through a comparative analysis 2019-2020 related to the quarter February-April.

[Assessment and Management of the Risk of Exposure to COVID-19 of Healthcare professionals in Italian Prisons]. / Valutazione e Gestione del Rischio di esposizione al COVID19 degli Operatori sanitari che operano nei penitenziari italiani: uno studio osservazionale.

BACKGROUND: The COVID-19 pandemic had a relevant health impact in a large part of the planet and there are several studies aimed at understanding its diffusion; however, to date, the problem has not been explored in the correctional setting, with particular concern for the Italian context. AIM: To assess and investigate the risk of exposure to COVID-19 in nurses working in the Italian prison system. METHODS: A multicenter observational descriptive study was conducted, enrolling a convenience sample composed of nurses registered with SIMSPE onlus (Italian Society of Penitentiary Medicine and Health), working in any Italian prison facility at the time of the survey. RESULTS: 204 nurses participating in the survey (response rate 49.27%). Most nurses working in prisons (92.65%) were exposed to the risk of Covid-19 virus infection, since they came directly into contact with positive patients (90.69%) and in situations where they were exposed during care procedures in which aerosol was produced by the patient (56.21%). The number of nurses who "always" complied with safety rules for prevention of infection did not differ significantly (p >0.05 for each comparison) in situations involving or not involving aerosol exposure. CONCLUSIONS: The results highlight the relevance of these issues in the Italian prison context and the need for further investigation. The knowledge of the dimension of this phenomenon, unexplored before this study in this context, represents the first step to be able to identify organizational strategies to manage it effectively or, if possible, to prevent it.

[Knowledge on the corneas donation in the adult population in a province of Apulia Region]. / Analisi delle conoscenze sulla donazione delle cornee popolazione adulta residente in una provincia della Puglia.

NTRODUCTION AND AIM: The spread of the donation culture is a crucial element in promo- ting solidarity and altruistic ideas necessary for meeting the needs of tissue transplants present on the territory. The research intends to assess the knowledge, the values, the attitude and the willingness to donate their corneas of adults, residents in the Province of Barletta - Andria - Trani (BT). METHOD: The sample was composed of 815 adults aged between 18 and 70 years and it was selected with simple random sampling among population residents in the Province of Barletta - Andria - Trani. All participants were interviewed by means of a questionnaire formulated and sent via Google modules. Their knowledge, values and attitudes were evaluated to deter- mine their willingness to donate their corneas. RESULTS: The participation rate was 64.4% (525/815). 68.4% (359/525) of participants would agree to donate their corneas. 89% (467/525) of participants know the theme of dona- tion. Asking specific questions to the participants on the donation path, the correct answers are on average 80%. This percentage increases to 86.2% considering only those who are willing to donate. Greater knowledge and an increase in altruistic values can be associated with an increase in willingness to donate. CONCLUSION: A good percentage of participants, about at 68,4% (359/525), is willing to donate their corneas. The awareness in this regard turns out to be very high, but the specific knowledge of the entire process should be further increased anyway.

[Analysis of attitude, knowledge and willingness of undergraduate nursing students' toward organ donation]. / Analisi degli atteggiamenti, delle conoscenze e della disponibilità a donare gli organi degli studenti di Infermieristica.

INTRODUCTION AND AIM: Organ transplantation is considered a life-saving treatment for patients with end-stage pathologies. The knowledge and the attitude of nurses can positively influence the willingness of family members and patients to give consent to organ and conse- quently organ donation rates. To understand the critical capacity of nursing students to self- evaluate themselves on information on brain death, donation and transplantation, investi- gating scientific knowledge, predisposition and attitude related to these topics through a survey. METHOD: This work is a cross-sectional descriptive study carried out among conveniently selected undergraduate nursing students (n = 578) of three Universities respectively in northern, center and southern of Italy using a questionnaire formulated on the basis of the FAQs prepared by the National Transplant Center (CNT). RESULTS: Most of students show an adequate level of knowledge and attitudes favorable to organ and tissue donation even if very few students have signed the donor card. Students' knowledge and perceptions are still lacking in specific areas such as legislations (only 6%). CONCLUSIONS: The findings suggest the need for revising the nursing curricula to improve the future nurses' skills, increase the modality to sign the donor card and favor the rate of organ donation.

Impact of COVID-19 on Quality of Life After Hospital Discharge in Patients Treated With Noninvasive Ventilation/Continuous Positive Airway Pressure: An Observational, Prospective Multicenter Study.

BACKGROUND: COVID-19 has caused a worldwide pandemic that has significantly affected people's health and daily lives. Patients hospitalized with COVID-19 have impaired physical and psychological conditions. Despite this, few studies have examined the physical and psychological health of COVID-19 patients after discharge from the hospital. AIMS: To assess the impact of COVID-19 pneumonia on quality of life and residual disability, anxiety, and insomnia at 4 and 8 months after hospital discharge in patients treated with continuous positive airway pressure and noninvasive ventilation. METHODS: This is a prospective, multicenter, longitudinal observational study. The STROBE checklist was observed. We administered the Post-COVID-19 Functional Status scale to identify and objectively quantify the degree of residual disability and the impact on the patient's functional status. Simultaneously, we used the EuroQOL-5D scale to measure the quality of life, the 7-item Generalized Anxiety Disorder Scale to monitor anxiety, and the Insomnia Severity Index to monitor insomnia. RESULTS: The study enrolled 199 patients 4 months after discharge; 145 completed the 8-month follow-up. The quality of life, insomnia, pain, and movement ability seem to worsen over time in our cohort of patients. The quality of life deteriorated significantly between 4 and 8 months after discharge especially in terms of mobility (27.6% of the patients interviewed) and pain (31% of the patients interviewed). There was a significant correlation between COVID-19 symptoms and comorbidities present at admission and inadequate quality-of-life perception. DISCUSSION: The recognition of early signs and symptoms in patients who have already experienced COVID-19 disease is essential for early detection and prevention of chronicity. Health care professionals need to pay more attention to the physical and psychological rehabilitation of COVID-19 patients after hospital discharge. To determine the long-term impacts of COVID-19, a long-term follow-up of COVID-19 patients after discharge is required.

Anterior Minimally Invasive Approach (AMIS) for Total Hip Arthroplasty: Analysis of the First 1000 Consecutive Patients Operated at a High Volume Center.

(1) Background: Direct anterior approach (DAA) has recently acquired popularity through improvements such as the anterior minimally invasive surgical technique (AMIS). This retrospective study examines the first 1000 consecutive THAs performed utilizing the AMIS approach in a high-volume center between 2012 and 2017. (2) Methods: 1000 consecutive THAs performed at a single institution utilizing the AMIS approach were retrospectively analyzed with a minimum five-year follow-up. Full evaluation of demographic information, clinical parameters, intraoperative complications, and radiological examinations are reported. (3) Results: Overall complication rate was 9.4% (94/1000), including 8 dislocations, 57 femoral-cutaneous nerve injuries, 12 intraoperative femoral fractures, 9 infections and 8 leg length discrepancy. Implant survival rates were 98.5% at 1 year, 97.5% at 3 years, 97% at 5 years, and 95.3% at 7 years. Causes of failure included periprosthetic fractures (0.8%), implant dislocations (0.6%), septic loosening (0.5%), aseptic mobilizations (0.2%), and symptomatic limb length discrepancies (0.2%). (4) Conclusions: Controversies persist around the direct anterior approach (DAA) for THA, primarily regarding the increased complications rate during the learning curve. However, this study advocates for widespread adoption of the DAA approach. The results demonstrate acceptable complication rates and remarkable functional outcomes, affirming its viability in the broader orthopedic patient population.

Early identification of risk for eating disorders in Italian secondary school students: a cross-sectional study.

AIM: Eating disorders are major illnesses that primarily affect adolescents and young adults and seriously threaten public health. Early identification of at-risk individuals and timely initiation of treatment is crucial to improve outcomes. The Inside Out Institute Screener (IOI-S) is a rapid self-administration screening tool for high-risk and early-stage eating disorders. This study aimed to investigate the risk of having an eating disorder in a sample of Italian students by testing the Italian version of the IOI-S. METHODS: A multicentre cross-sectional study was conducted in a population of students aged 12-19 years; validity and reliability of the IOI-Sita were investigated. RESULTS: Four-hundred and ninety-one (81.97%) students were enrolled, 24.85% of whom were found to be at "very high risk" of an eating disorder, according to IOI-Sita. Younger (p<0.001) and female (p<0.001) students had higher risk scores. The EFA confirmed the original monodimensional structure of the tool, S-CVI=0.95%. The Content Validity Index of the scale (S-CVI) was 0.95, ω coefficient was 0.927. DISCUSSION AND CONCLUSIONS: This research confirms the need to screen for eating disorders in Italian youth adequately; the psychometric properties of the IOI-Sita confirm it as a valid and reliable tool for screening high-risk and early-stage eating disorders.

Organ procurement in forensic deaths: A retrospective analysis of the Italian context with a focus on the Puglia Region virtuous experience.

Organ transplantation is one the most important contributions of modern medicine to society since it provides a unique therapy for terminal organ failure. However, the development of this therapeutic approach is hindered by the limited organ supply. In Italy, organ procurement requires a multidisciplinary medical-surgical approach in which legal medical doctors (LMDs) are generally tasked with ascertaining the reality of death. Sometimes, a medico-legal report is required when the deceased's family deny their consent to the organs and tissues removal from a potential deceased donor. LMDs can also be appointed by law to carry out post-mortem examinations of potential deceased donors. In these cases, the public prosecutors' interest in preserving the corpse integrity for forensic purposes seems to conflict with the ethical-humanitarian interest in promoting, at most, the opportunity to donate; however, a LMD can act as a mediator and allow both goals. This paper aims to illustrate the Apulia Region experience in reconciling the justice interests with those of a culture promoting deceased organ and tissue donation. It has been pursued by analyzing the virtuous regional organ procurement trend in forensic deaths before and after a crucial 2015 initiative, comparing the results with the national ones, and contextualizing them in the relevant literature to show systemic strengths and weaknesses and inform future Italian policy development.

Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation.

BACKGROUND: The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits. METHODS: An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile. RESULTS: 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care. DISCUSSION: The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.

Unstable Total Hip Arthroplasty: Should It Be Revised Using Dual Mobility Implants? A Retrospective Analysis from the R.I.P.O. Registry.

Total hip arthroplasty (THA) is one of the most common surgical procedures in orthopedics; however, it is subjected to different kinds of failures, one of them being dislocation. Many different prosthetic designs have been developed to overcome this problem, such as dual mobility coupling. The main purpose of this article is to determine whether there are differences regarding the revision surgery of unstable THA comparing the risk of failure between dual mobility cup (DMC) implants, standard implants, and among different head sizes. A registry-based population study has been conducted by analyzing data collected by the Emilia Romagna Registry of Orthopedic Prosthetic Implants (RIPO), including a total of 253 implants failed for dislocation and instability that were operated on by cup revision surgery between 2000 and 2019. The selected population has been divided into two groups based on the insert type: standard and DMC. The age at revision surgery was significantly lower in the standard cup group with respect to DMC (p = 0.014 t-test), with an average age of 71.2 years (33-96 years range) for the standard cups and 74.8 years (48-92 years range) for the DMC group. The cumulative survival of DMC implants was 82.0% at 5-years, decreasing to 77.5% at a 10-year follow-up, which is not significantly different from standard cups (p = 0.676, Log-Rank test). DMC implants showed a significantly lower risk of re-revision for dislocation compared to standard cups (p = 0.049). Femoral heads ≥36 mm had a higher overall survival compared to smaller femoral heads (p = 0.030). This study demonstrated that DMC or femoral heads ≥36 mm are a valid choice to manage THA instability and to reduce the revision rate for dislocation at a mid-term follow-up; in those selected and targeted patients, these options should be taken into consideration because they are associated with better outcomes.

Management of the patient with urostomy: Caregiver needs during the three months after discharge. A qualitative study.

OBJECTIVE: To examine caregivers' experiences and training needs after radical cystectomy with urinary diversion for the first three months following the patient's discharge. METHODS: This study applied a phenomenological design approach through open-ended interviews and descriptive analysis. Phenomenology applied to empirical research requires researchers to explore the empirical facts narrated by partici-pants. This study followed the Consolidated Criteria for Reporting Qualitative Research guidelines, a 32 - item checklist for inter-views and focus groups. The study population included caregivers of bladder cancer patients, admitted to three Italian hospitals. Data were collected between March 2020 and March 2022. RESULTS: Fifty-two caregivers of patients who underwent cystecto-my with urinary diversion from three Italian hospitals (41 males and 11 females) participated to the study. The data analysis con-verged in the identification of three themes - with sub-themes -that included various aspects of the caregiver's lived experiences: 1) living with the burden of being indispensable, for the family member, 2) feeling abandoned by institutions, 3) tiredness and less willingness to look after the relative due to work burden. CONCLUSIONS: Our study demonstrates that the caregiver of a patient with bladder cancer and urostomy in the first three months of hospital discharge is very worried and stressed. Despite the training program received in hospital, the caregiver does not recognize the newly acquired skills and has difficulty applying them. Further study would be required.

Role of biophysical stimulation in multimodal management of vertebral compression fractures.

Raised life expectancy and aging of the general population are associated with an increased concern for fragility fractures due to factors such as osteoporosis, reduced bone density, and an higher risk of falls. Among these, the most frequent are vertebral compression fractures (VCF), which can be clinically occult. Once the diagnosis is made, generally thorough antero-posterior and lateral views of the affected spine at the radiographs, a comprehensive workup to assess the presence of a metabolic bone disease or secondary causes of osteoporosis and bone frailty is required. Treatment uses a multimodal management consisting of a combination of brace, pain management, bone metabolism evaluation, osteoporosis medication and has recently incorporated biophysical stimulation, a noninvasive technique that uses induced electric stimulation to improve bone recovery through the direct and indirect upregulation of bone morphogenic proteins, stimulating bone formation and remodeling. It contributes to the effectiveness of the therapy, promoting accelerated healing, supporting the reduction of bed rest and pain medications, improving patients' quality of life, and reducing the risk to undergo surgery in patients affected by VCFs. Therefore, the aim of this review is to outline the fundamental concepts of multimodal treatment for VCF, as well as the present function and significance of biophysical stimulation in the treatment of VCF patients.