Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol.

Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.

Global Trends of Medical Misadventures Using International Classification of Diseases, Tenth Revision Cluster Y62-Y69 Comparing Pre-, Intra-, and Post-COVID-19 Pandemic Phases: Protocol for a Retrospective Analysis Using the TriNetX Platform.

BACKGROUND: The COVID-19 pandemic has sharpened the focus on health care safety and quality, underscoring the importance of using standardized metrics such as the International Classification of Diseases, Tenth Revision (ICD-10). In this regard, the ICD-10 cluster Y62-Y69 serves as a proxy assessment of safety and quality in health care systems, allowing researchers to evaluate medical misadventures. Thus far, extensive research and reports support the need for more attention to safety and quality in health care. The study aims to leverage the pandemic's unique challenges to explore health care safety and quality trends during prepandemic, intrapandemic, and postpandemic phases, using the ICD-10 cluster Y62-Y69 as a key tool for their evaluation. OBJECTIVE: This research aims to perform a comprehensive retrospective analysis of incidence rates associated with ICD-10 cluster Y62-Y69, capturing both linear and nonlinear trends across prepandemic, intrapandemic, and postpandemic phases over an 8-year span. Therefore, it seeks to understand how these trends inform health care safety and quality improvements, policy, and future research. METHODS: This study uses the extensive data available through the TriNetX platform, using an observational, retrospective design and applying curve-fitting analyses and quadratic models to comprehend the relationships between incidence rates over an 8-year span (from 2015 to 2023). These techniques will enable the identification of nuanced trends in the data, facilitating a deeper understanding of the impacts of the COVID-19 pandemic on medical misadventures. The anticipated results aim to outline complex patterns in health care safety and quality during the COVID-19 pandemic, using global real-world data for robust and generalizable conclusions. This study will explore significant shifts in health care practices and outcomes, with a special focus on geographical variations and key clinical conditions in cardiovascular and oncological care, ensuring a comprehensive analysis of the pandemic's impact across different regions and medical fields. RESULTS: This study is currently in the data collection phase, with funding secured in November 2023 through the Ricerca Corrente scheme of the Italian Ministry of Health. Data collection via the TriNetX platform is anticipated to be completed in May 2024, covering an 8-year period from January 2015 to December 2023. This dataset spans pre-pandemic, intra-pandemic, and early post-pandemic phases, enabling a comprehensive analysis of trends in medical misadventures using the ICD-10 cluster Y62-Y69. The final analytics are anticipated to be completed by June 2024. The study's findings aim to provide actionable insights for enhancing healthcare safety and quality, reflecting on the pandemic's transformative impact on global healthcare systems. CONCLUSIONS: This study is anticipated to contribute significantly to health care safety and quality literature. It will provide actionable insights for health care professionals, policy makers, and researchers. It will highlight critical areas for intervention and funding to enhance health care safety and quality globally by examining the incidence rates of medical misadventures before, during, and after the pandemic. In addition, the use of global real-world data enhances the study's strength by providing a practical view of health care safety and quality, paving the way for initiatives that are informed by data and tailored to specific contexts worldwide. This approach ensures the findings are applicable and actionable across different health care settings, contributing significantly to the global understanding and improvement of health care safety and quality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54838.

The Use of mHealth in Promoting Therapeutic Adherence: A Scoping Review.

Nonadherence to therapy negatively impacts mortality and quality of life and results in suboptimal efficacy of treatment regimens, threats to patient safety, and increased healthcare costs for disease management. Mobile health solutions can offer users instruments that can promote therapeutic adherence. The objective of this review is to investigate the impact mobile health systems have on therapeutic adherence. Specifically, we want to map the main systems used, the functions implemented, and the different methods of adherence detection used. For this purpose, a scoping review was conducted. The following databases were consulted: PubMed, Cochrane Library, EBSCO (including APA PsycINFO, CINAHL Plus with Full Text, ERIC), including English-language studies published in the last 10 years (2012-2022). The main mobile health systems used are as follows: applications, automated messaging, interactive voice response, and mobile video games. The main features implemented to support medication management were as follows: reminders, self-monitoring instruments, educational support, and caregiver involvement. In conclusion, the use of interactive mobile health instruments intended for use by the patient and/or caregiver can improve objectively and subjectively detected therapeutic adherence. The use of these systems in the therapeutic pathway of users, with a special focus on people with comorbidities and in polypharmacy treatment, represents a challenge to improve caregiver health.

Care call requests and inpatient beds modernization: Is there any link? A prospective observational study in the oncological setting.

AIM: The study aims to analyse the principal causes of patients' care calls and compare differences before and after inpatient beds' technological modernization in a surgical breast oncological ward. DESIGN: A prospective observational study was conducted under the STROBE guidelines. Data were collected from June to September 2022. METHODS: Statistical analyses were performed to compare each reason for care calls, by shifts and pre and post-inpatient bed modernization. RESULTS: Two thousand five hundred and fifty-nine care request calls were analysed during the 202 observed shifts. The most frequent reason was related to the requests for positions. CONCLUSION: Technological modernization of the beds has not led to effective-positive-changes; on the contrary, it seems at first glance to show an upward trend in calls above all in the short period after the changes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: What problem did the study address? By analysing the principal causes of care calls and comparing the differences before and after inpatient beds' technological modernization, this study evaluates if inpatient gear or device modernization can impact care call requests. What were the main findings? The results show that the most frequent reasons for care calls were position, possession and other. These findings seem not superimposable; the hypothesis supported by the international literature in which the causes relating to potty and pain were found among the main reasons. Where and on whom will the research have an impact? These results could impact the care organizational area in nursing care and could improve care quality, patient satisfaction and safety. REPORTING METHOD: This prospective observational study was conducted following STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: After adequate information (presentation, design methods and objectives), all unit healthcare staff agreed to collaborate in the study.

Telenursing Interventions for Patients With Cancer Receiving Chemotherapy: A Scoping Review.

PROBLEM IDENTIFICATION: To provide an overview of telenursing interventions, primary outcomes, and tools used in patients with cancer receiving chemotherapy, a scoping review was conducted. LITERATURE SEARCH: PubMed®, Embase®, and CINAHL® databases were searched using the following keywords: telenursing, adverse event, and drug therapy. DATA EVALUATION: From the screening process, 11 studies were identified. SYNTHESIS: In patients with cancer receiving chemotherapy, telenursing interventions were mainly used to monitor symptoms, particularly fatigue, anxiety, and depression. The interventions used included outcome-specific, nonspecific, and validated tools, or tools developed from reporting systems for adverse events. IMPLICATIONS FOR RESEARCH: Large-scale, well-conducted randomized controlled trials, systematic reviews, and meta-analyses are needed to test the results of this scoping review.

Nurse's bedside screening of dysphagia: an umbrella review.

INTRODUCTION: Dysphagia often results in serious, poor health outcomes. Nurses have an important role in assessing dysphagia. Therefore, they need reliable and effective screening tools to detect dysphagia. The purpose of this umbrella review is to locate the most valid, reliable, and usable bedside screening tools that allow nurses to identify dysphagia in institutionalized patients. METHODS: Umbrella Review as suggested by the Joanna Briggs Institute. Inclusion criteria were: systematic reviews of randomized controlled trials or cross-sectional studies. We excluded: pediatric and psychiatric patients. We searched on PubMed, CINAHL, Scopus, Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the Joanna Briggs Institute Evidence-Based Practice Database. RESULTS: Six reviews were included. Four tools were reported in all the reviews: 3 oz swallowing water test, Mann Assessment of Swallowing Ability, Toronto Bedside Swallowing Screening Test, Gugging Swallowing Screen. They have shown fair to good sensitivity and specificity. The reviews analysed did not allow for a comparative analysis between instruments, which may be hindering the selection of the optimal instrument for clinical practice. CONCLUSIONS: Almost all reviews have considered stroke patients. The next steps will be to determine if there is a tool applicable in multiple settings with different patients and if this intervention is cost-effective.

Medication Adherence in Chronic Older Patients: An Italian Observational Study Using Medication Adherence Report Scale (MARS-5I).

BACKGROUND: the world population is aging, and the prevalence of chronic diseases is increasing. Chronic diseases affect the quality of life of patients and contribute toward increased healthcare costs if patients do not adhere to treatment. This study defines the medication adherence levels of patients with chronic diseases. METHODS: an observational cross-sectional study was carried out. Patients aged 65 years and older with chronic diseases were included in this study. The medication adherence report scale was used. RESULTS: overall, 98 patients aged 65 years and older were included. The mean age of responders was 78.65 years. STUDY POPULATION: 71.43% were always adherent; 9.79% often adherent; 14.89% sometimes adherent; 3.87% rarely adherent; and 1% never adherent. The internal consistency of the MARS-5I was good: Cronbach's alfa value of 0.77. CONCLUSIONS: the MARS-5I is an effective self-report instrument to measure the medication adherence of patients. However, further studies are needed to explore factors affecting medication adherence to avoid clinical consequences for patients and high healthcare costs for healthcare facilities. Healthcare communication could be improved to ensure better transitional care.

The Use of mHealth in Orthopedic Surgery: A Scoping Review.

(1) Background: It is well known that the success of surgical procedures is related to optimal postoperative management and follow-up. In this regard, mHealth technologies could potentially improve perioperative care. Based on these considerations, the objective of this scoping review is to evaluate the current status and use of mHealth interventions designed to provide perioperative care in orthopedic surgery. (2) Methods: This scoping review was conducted in accordance with the PRISMA statement (Extension for Scoping Review) and follows the framework of Arskey and O'Malley. (3) Results: The use of mHealth in the surgical setting is mainly oriented towards the development of applications for monitoring post-operative pain and optimizing communication between the various health professionals involved in patient care. (4) Conclusions: The mHealth systems can have a positive impact both on patient participation in the therapeutic process and on the communication between health professionals, increasing the quality of care.

Nursing Management and Adverse Events in Thyroid Cancer Treatments with Tyrosine Kinase Inhibitors. A Narrative Review.

BACKGROUND: The advent of multikinase inhibitors has changed the treatment of advanced, metastatic, unresectable thyroid cancers, refractory to available treatments. These drugs cause new adverse events that should be prevented and treated for long periods, and sometimes beyond their discontinuation. The purpose of this narrative review was the description, prevention, and nursing management of the most frequent adverse events of locally advanced or metastatic differentiated thyroid cancer with sorafenib and lenvatinib, and medullary Thyroid cancer with vandetanib and cabozantinib treatment. METHODS: A narrative literature review. RESULTS: Studies included in this narrative review suggest that over 90% of patients treated with tyrosine kinase inhibitors experience at least 1 adverse event of any grade affecting their quality of life. Patients treated with tyrosine kinase inhibitors experienced at least one adverse event at any grade in ≥90% of cases, with a higher incidence in the first 6-8 weeks of treatment. The most frequent adverse events that can affect a patients' quality of life are dermatological, gastrointestinal, cardiovascular, and metabolic. CONCLUSIONS: Early assessment of risk factors and identification of adverse events can help nurses support these patients throughout their clinical-therapeutic pathway, increasing the benefits of treatment and reducing reduction/discontinuation.

The association between personality trait and the development of postoperative complications in enterostomized patients. Systematic review of literature.

AIM: To investigate the presence of association between the personality trait and the onset of postoperative complications in patients undergoing enterostomy packaging. MATERIALS AND METHODS: Systematic review of the literature. RESULTS: Type D personality traits and those with a low tendency to optimism and temperament (ex. anxiety-depressive syndrome) would seem to be associated with an increased risk of developing postoperative psychiatric morbidity and reduced levels of health-related quality of life (HRQoL) in enterostomized patients for colorectal cancer (CRC). Also, type-D personality, has been associated with greater risk of multiple comorbidities including an increased risk of heart failure unrelated to other sociodemographic causes 32-34-35. Personality with little tendency to optimism may represent a predictive factor on the development of psychological suffering one year after the diagnosis of CRC 3. Patients with personality traits associated with reduced levels of life satisfaction and / or reduced coping capacity require longer hospitalization time 26. DISCUSSION: Several studies highlight the presence of association between personality traits oriented to performance, persistence and extroversion and outcomes in various areas of surgery 14,2,-27,30. However, in almost all cases, the outcomes measured do not correspond to the early post-operative complications defined in the inclusion criteria but to mediumlong term psychological and rehabilitative outcomes. CONCLUSIONS: From the review study, no sources were found concerning the association between the personality trait and the onset of early postoperative complications in enterostomised patients, highlighting, furthermore, a lack of data on the subject involving the entire field of abdominal surgery. KEY WORDS: Personality trait, Enterostomy, Post-operative complications.