Variables Predicting Academic Success of Nursing Students: a Longitudinal Study in a Nursing Bachelor's Degree Program.

Background: Academic failure can negatively impact on the student, the university and the nursing workforce in the short term. The aim of this study is to analyze the characteristics and predictors of academic success in two cohorts of students of a Nursing Bachelor's Degree program. Methods: This longitudinal study enrolled students who attended the Nursing Bachelor's Degree program. The Tor Vergata University includes 21 Nursing Bachelor's Degree programs at several Sanitary Institutions of the Rome area, with a mean annual recruitment of 800 students. We considered two cohorts of students beginning the program in the 2011-2012 and 2012-2013 academic years, respectively. The follow-up of these two cohorts ended in the 2017-2018 academic year. We considered socio-demographic and academic variables in the nursing field (pre-admission test grade, training exam grade in the first, second and third year and professional license exam grade). The outcome variable is academic success defined as gradua-tion on time; academic failure is defined as changing degree, delay in completion of the course, attrition and dismissal (failure to complete the studies). Data were collected at baseline (T0), at the end of the first year (T1), at the end of the second year (T2) and at the end of the third year (T3) of the course. A logistic regression was performed to identify predictors of academic success. Results: 2,041 students were enrolled, with an average age of 22.0 years (± 4.6, 18-50); 67.4% were female. Regarding academic success, 30.6% of students graduated on time and so achieved academic success, while 69.4% failed to complete the course within the established time: 5.4% (110/2,041) changed the course, the attrition rate was 7.3%, 0.3% (6/2,041) overdue from the course for expiring of the terms, 18.0% (368/2,041) is attending the course and 38.4% (784/2,041) graduated after more than three years. Pre-admission test grade (OR: 10.0, 95% CI: 10.020-10.054) and training exam grade at the second and third years (OR: 10.0 95% CI: 10.027-10.139; OR: 10.2 95% CI: 10.171-10.294) predicted academic success. Discussion and Conclusions: Some nursing students changed course during the last year of the program, while the training exam grade of the second and third years had predicted academic success; this is a brand new information derived from this study. In addition, we confirmed the association of age, gender, secondary school type and grade and preadmission test with academic success. For these reasons, clinical training should be improved and the quality of internship wards, as learning environments, should be monitored. Italian universities should undertake establishing the ideal cut-off in pre-admission tests to determine which students have a high probability of academic success.

Socio-demographic analysis of free-lance nurses in a non-institutional employment regimen.

INTRODUCTION: The free-lance nurse, not bound to rigid organizational systems, can offer personalized assistance always respecting the rights of the person and of the profession. More recent graduates have decided to undertake the nursing profession by moving towards the free-lance nursing, considering it both as a career opening and as a professional opportunity, although this option never got much attention from the researchers in the Italian nursing scene. Free-lance nursing is now considered a valuable opportunity to develop a nursing career. This market is destined to grow for different reasons, such as an increasing chronicity of health conditions of more and more ageing population and the deficits of the National Health Service (Servizio Sanitario Nazionale - SSN) in community and home care. AIM: The aim of the study was to evaluate the correlation between the development of the free-lance nursing and the Italian socio-economic context. METHODS: The design of the study was descriptive - observational. Data collection and observation was carried out from January 2018 until April 2108. For the analysis a linear regression model was adopted to quantify a cause-effect relationship between one or more independent variables and the dependent variable which interprets the phenomenon investigated. The regression carried out was descriptive to analytically express the observed reality and represent it in a plausible way. The specification model was represented as: Free-lance nurses per capita = per capita income + Out of Pocket expense per capita + waiting lists in days + number of beds per inhabitants + NHS nurses per inhabitants. RESULTS: The estimate carried out had an R of 0.813, R-square equal to 0.6612, adjusted R-square 0.540 and standard error of the estimate 1.277, highlighting a correlation between the variables adopted in the model and a p = 0.005. From the analysis of the variables used, the average per capita income (p = 0.045) and the nurses working in the National Health Service /1,000 beds (p = 0.017) were statistically significant. CONCLUSIONS: It can be stated that the free-lance nursing profession is costly for patients and therefore develops more revenue where the average per capita income grows, but the research also seems to show that, where the National Health Service has too few nurses, the private demand increases in order to satisfy healthcare needs.

Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination.

The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.

Knowledge and worry as basis for different behaviors among university students: the case of pandemic flu H1N1v.

INTRODUCTION: Attitudes towards the pandemic were different across countries and cultures and confounding news caused some to question whether unnecessary alarm and public panic resulted. The aim of this study was to detect behavior, perception and worry about pandemic flu among undergraduate students considered a group at major risk to contract and spread the infection. MATERIALS AND METHODS: In November 2009, during the pandemic peak in Italy, we conducted a survey about pandemic flu by means of anonymous multiple choice self-administered questionnaires among students, attending different courses at the Tor Vergata University in Rome. To investigate the relationship between the level of concern about H1N1v and the attitude to prevention the sample was divided in three groups based on the level of the declared worry. RESULTS: Among the 436 students that answer the questionnaires a statistical correlation was found between the level of worry and the disposition to change habits and the will to undergo vaccination. Males were less worried than females and more students living outside Rome would accept the vaccine. DISCUSSION AND CONCLUSIONS: The results of the study, generally in agreement with those of similar research, confirmed the need to know the relationship between fear and attitude in order to organize effective preventive campaigns.

[Rad-Esito: new informational debt as integration of hospital discharge cards for acute patients]. / Rad-Esito: nuovo debito informativo ad integrazione del contenuto delle schede di dimissione ospedaliera (SDO) per pazienti acuti.

Since the January 2008 the tracking of additional information about hospital discharge card's content has been activated in Latium. The new data, noticed by RAD-Esito card, regard the hospitalizations for acute myocardial infarction, femoral neck fracture and coronary artery bypass surgery. This study's objective has been to evaluate the quality of the data collected with the new card, at the end of the 1st semester of experimentation, concerning two institutes of care of Latium (Region of Central Italy), the Casilino Polyclinic (ASL Rome B) and the Anzio-Nettuno hospital (Assembled Hospitals, ASL Rome H). Furthermore, any significant correlation's existence between variables for acute myocardial infarction and femoral fracture with the mortality rate and an increased average hospitalization period has been statistically verified. In acute myocardial infarction mortality is significantly related to a low systolic blood pressure (<130 mmHg) at admission (p < 0.02) and to having no surgical intervention instead of transcutaneous transluminal coronary angioplastic surgery (p < 0.0001); in this case there is also an increased average hospitalization period (p < 0.03). In femoral neck fracture mortality is significantly related to having a conservative surgery instead of fracture reduction or prosthesis implantation (p < 0.0002).This study's preliminary results show how the integration of the hospital informative flow with the new clinical variables will be able to allow the promotion of the quality in the coding of the diagnosis and procedures, according to the current international innovations. This additional information will also be able to support the regional appropriateness and outcome of the treatments evaluation programs.

The civil liability of paediatric dentists in Italy. Trains of thought on novelties introduced by law n. 24/2017 ("Gelli-bianco" law).

AIM: This study offers an overview regarding news and main themes which have been introduced by Law n. 24/2017 (the so called "Gelli-Bianco" law) in Italy. The normative content deals with the features of civil liability for healthcare professionals. More specifically, this article is referred to the contractual and extra-contractual liability of paediatric dentists. Dentists often provide services combining healthcare and dental procedures as well as aesthetic activities. Thanks to the case law and doctrine tradition, the distinction between contracts of employment and contracts of work is clearly stated. This examination is focused on highlighting methods employed by paediatric dentists to prevent possible actions of suing for compensation.

Counseling intervention to improve quality of life in patients with pre-existing acute myocardial infarction (AMI) or chronic obstructive pulmonary disease (COPD): a pilot study.

BACKGROUND: In the light of diagnostic and therapeutic advances, patients with a previous myocardial infarction or with a diagnosis of chronic obstructive pulmonary disease are vulnerable and need continuous monitoring over time. These pathological frameworks have a strong impact on the economy and on the status of the population and require effective and low-cost solutions. AIMS: The objective of this clinical trial is to evaluate the efficacy in the short term of a telephone counseling intervention to modify the lifestyles of these two patient populations. METHODS: In May 2015, all the patients included in the study underwent a questionnaire to evaluate their eating and smoking habits and their quality of life. After randomization in two groups, the intervention group received telephone counseling related to the correct lifestyles. The control group did not undergo any intervention. In September-October 2015, the same initial questionnaire was administered to evaluate changes in patients' behavior. RESULTS: 64 patients were included in the study: 34 were assigned to the intervention group and 30 to the control group. The outcomes evaluated were: quality of life, assessment of eating habits and smoking status. After the telephone counseling, the intervention group (34 persons) showed a significant improvement in the score of adherence to the Mediterranean diet (p = 0.01) and a significant reduction in the percentage of smokers (p = 0.01) compared to the population that did not receive any intervention (30 persons). On the other hand, the changes related to the quality of life questionnaire were not significant. CONCLUSIONS: A single telephone counseling intervention is effective in modifying the lifestyles of patients with a previous myocardial infarction or diagnosed with chronic obstructive pulmonary disease in the short term, reducing their risk profile.

[Multicentric study to evaluate the quality of discharge abstract coding of admissions in which the treatment was not performed and to identify a possible appropriateness indicator]. / Studio multicentrico sulla valutazione della qualità della codifica della scheda di dimissione ospedaliera relativamente ai ricoveri per acuti in cui non è stato eseguito il trattamento. Individuazione di un possibile indicatore di appropriatezza organizzativa.

The aim of this study was to assess the quality of discharge abstract data regarding admissions in which the planned treatment was not performed, in 4 hospitals in the Rome metropolitan area. The main objective was to evaluate the appropriateness of admissions through use of the Italian version of the Appropriateness Evaluation Protocol (AEP/PRUO). Inconsistencies between discharge abstract forms and hospital records were found in 95/142 (66,9%) of examined records. These were subsequently evaluated through the Appropriateness Evaluation Protocol and overall , 95,6% of inconsistent records were found to be inappropriate admissions. Monitoring V64 codes may represent an indirect indicator of appropriateness.

[Plasmapheresis and mushroom poisoning:report of a case of Amanita phalloides poisoning]. / Plasmaferesi e avvelenamento da funghi: presentazione di un caso di intossicazione da Amanita phalloides.

A case of amanita phalloides which presented a typical picture of phalloides intossication has been treated at our Centre. The patient was submitted to four treatments of plasmaexchange (Plasmafiltration), exchanging from 70 to 80% of the plasmatic volume and using substitutive liquids 4% albumine and frozen plasma, using as filter Plasmaflo Asahi OP-O5 (1) and Plasmapheresis equipment SIFRA mod. 914. Already after the first treatment there was an improvement of the general condition with a stabilization of the renal and hepatic parameters at the end of the cycle.

[Efficacy of recombinant erythropoietin on the quality of life in patients over 60 years of age undergoing hemodialysis]. / Efficacia dell'eritropoietina ricombinante sulla qualità di vita in pazienti emodializzati ultrasessantenni.

We followed for a period of six months, 54 patients of over 60 years old, submitted to hemodialitic treatment. We gave human recombinant erythropoietin, average dosage 50 UI/Kg subcutaneously on alternative days, folic acid and iron supplements together with a proteic supply of 1.2 g/Kg/die (35 Kcal/Kg). The medullary response has been monitored with hematochemical tests; blood pressure and nutritional conditions have been evaluated. Furthermore, the patients were given a questionnaire to evaluate their quality of life. At the end of the follow up, 50 patients responded positively to therapy. These patients showed an increase of RBC (from 2,789,780 +/- 259,310 to 3,313,110 +/- 472,780 p < 0.001) of HCT (from 21.86% +/- 2.16% to 27.18 +/- 2.74% p < 0.0001) and of Hb (from 7.72 +/- 1.12 g/dl to 9.28 +/- 0.98 g/dl p < 0.006). Total protein and albumin increased too. Furthermore they showed a progressive increase of "performance status". Our results confirm efficacy of erythropoietin in the treatment of anemia in elderly hemodialized patients.

[Comparative study of the modification of arterial pressure in adult and aged subjects treated with hemofiltration. Preliminary results]. / Studio comparativo delle modificazioni della pressione arteriosa in soggetti adulti ed anziani in trattamento dialitico con tecnica di emofiltrazione. Risultati preliminari.

Haemodynamics modifications in 49 patients divided in two groups consisting of 21 young people (average age 43 +/- 12 yrs.) and 28 elderly people (average age 72 +/- 7 yrs.) who have undergone at least three treatments with haemofiltration for congestive cardiac decompensation and chronic renal failure have been evaluated. Systolic and diastolic blood pressure and heart rate have been monitored for each patient in a length of time of iT, T30 min., T60 min., fT. The results show a statistically significant reduction of the systolic pressure during the time interval iT-T30 min. in subjects over 65, contrary to the control group. Such preliminary results can be justified by the haemodynamic modifications correlated to the elderly process. In any case the hypothesis cited by the authors need further testing even if confirming the indication of the dialytic treatment on patients over 65 through haemofiltration techniques.

Risk factors for psoriasis: a retrospective study on 501 outpatients clinical records.

Possible risk factors for psoriasis were studied by means of a retrospective evaluation of epidemiological and clinical features in 472 clinical records of outpatients affected by plaques psoriasis. We calculated the relation between the categorical variables with chi-squares contingency table analysis (with Yates correction) and odds ratio (O.R.) from the two variables with their respective confidence intervals at 95%. Among patients 267 were men (57%) and 205 women (43%); the mean age was 46.5+/-16.7 years, with no differences in sex. A significant relationship was found between age at onset < or =40 years and familiarity for psoriasis (p<0.0001-O.R.=2.71, C.I..95%: 2.12-3.48). The percentage of men with extensive lesions (extension >30%) was significantly higher than of women (p<0.05-O.R.=1.60, C.I..95%:1.35-1.90). Moreover, a significant association between extension of lesions and BMI was detected (p<0.0107-O.R.=2.10, C.I.95%:1.33-3.30) and the strength of this relation was assessed using the linear regression test. Mean age at onset was significantly lower in patients systemically treated (p<0.0003-O.R.=2.61, C.I.95%: 1.69-4.04). The results obtained can provide the basis for a standard clinical record, including data for a prospective study that may confirm the relation between psoriasis and some risk factors.

[Evaluating hospital appropriateness with different tools: administrative data versus analytic review]. / La valutazione dell'appropriatezza organizzativa con differenti metodi: APPRO e PRUO.

PRUO, a modified version of AEP, is a widely used clinical-based tool to evaluate hospital appropriateness in Italy. We developed the APPRO method for assessing organizational appropriateness using administrative data. APPRO estimates the amount of inappropriate hospitalisation, giving consideration to severity of illness through APR-DRG classification system. The aims of the study were to: measure the agreement between evaluators using PRUO; investigate the relation between APR-DRG severity subgroups and PRUO assessment; asses the validity of APPRO method comparing its performance to PRUO results. We selected 361 hospital episodes assigned to DRG 39 ("lens procedures with or without vitrectomy") and 242 hospital episodes assigned to DRG 183 ("miscellaneous of digestive disorders, age > 17") from three hospitals in 2000. Clinical records were independently evaluated by two pairs of physicians using PRUO. Proportions of inappropriate episodes by hospital and DRG were also estimated through APPRO using data from Lazio regional hospital information system. The agreement between the two pairs of evaluators was high (k=0.93; p<0.0001). We observed no statistically significant association between APR-DRG severity subgroups and inappropriate hospitalisation found by PRUO. APPRO underestimates rates of inappropriate hospitalisation compared to PRUO. It depends on the different characteristics of the tools and particularly on the caution of APPRO in performing the evaluation using routine data.

Role of PET/CT in the detection of liver metastases from colorectal cancer.

PURPOSE: The aim of this study was to compare the diagnostic accuracy of 2-[fluorine-18] fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) and computed tomography (CT) with PET/CT in the detection of liver metastases during tumour staging in patients suffering from colorectal carcinoma for the purposes of correct surgical planning and follow-up. MATERIALS AND METHODS: A total of 467 patients underwent a PET/CT scan using an iodinated contrast medium. We compared images obtained by the single PET scan, the single CT scan and by the fusion of the two procedures (PET/CT). The final diagnosis was obtained by histological examination and/or by the follow-up of all patients, including those who did not undergo surgery or biopsy. RESULTS: The PET scan had 94.05% sensitivity, 91.60% specificity and 93.36% accuracy; the CT scan had 91.07% sensitivity, 95.42% specificity and 92.29% accuracy. The combined procedures (PET/CT) had the following values: sensitivity 97.92%, specificity 97.71% and accuracy 97.86%. CONCLUSIONS: This study indicates that PET/CT is very useful in staging and restaging patients suffering from colorectal cancer. It was particularly useful when recurrences could not be visualised either clinically or by imaging despite increasing tumour markers, as it guaranteed an earlier diagnosis. PET/CT not only provides high diagnostic performance in terms of sensitivity and specificity, enabling modification of patient treatment, but it is also a unique, high-profile procedure that can produce cost savings.