Resting-State Functional Connectivity of the Anterior Cingulate Cortex Among Persons With Mood Disorders and Suicidal Behaviors.

OBJECTIVE: To assess whether anterior cingulate cortex (ACC) abnormalities contribute to suicide risk in major depressive disorder and bipolar disorder, the investigators compared resting-state functional connectivity (rsFC) of ACC subdivisions between individuals with major depressive or bipolar disorder with and without a lifetime history of suicidal behavior. METHODS: Forty-two inpatients with and 26 inpatients without a history of suicidal behavior (SB+ and SB-, respectively) associated with major depressive or bipolar disorder and 40 healthy control (HC) participants underwent rsFC neuroimaging. RsFC of the subgenual, perigenual, rostral, dorsal, and caudal subdivisions of the ACC was calculated. Possible confounders, such as psychosis and severity of depression, were controlled for, seed-to-voxel and post hoc region of interest (ROI)-to-ROI analyses were performed, and the accuracy of rsFC in classifying suicidal behavior was studied. RESULTS: Compared with individuals in the SB- and HC groups, patients in the SB+ group had higher rsFC between the left rostral and right dorsal ACC seeds and visual cortex clusters. Conversely, rsFC between the left rostral and right dorsal ACC seeds and cingulate and frontal clusters was lower in the SB+ group than in the HC group. Left rostral ACC to left Brodmann's area 18 connectivity showed up to 75% discriminative accuracy in distinguishing SB+ from SB- patients. CONCLUSIONS: A history of suicidal behavior among individuals with major depressive disorder or bipolar disorder was associated with altered rsFC of the rostral and caudal ACC, regions involved in conflict detection and error monitoring. Replication of these findings is needed to further explore the involvement of the ACC in the neurobiology of suicidal behavior and suicidal ideation.

A stepped-wedge randomised controlled trial to assess efficacy and cost-effectiveness of a care-bundle to prevent falls in older hospitalised patients.

BACKGROUND: Patient accidental falls in a hospital environment are a serious problem for patient safety, and for the additional costs due to associated medical interventions. OBJECTIVE: The endpoints of this study were the assessment of the fall incidence in the hospital before and after the implementation of a multidisciplinary care-bundle, along with a cost-effectiveness evaluation. DESIGN: A stepped-wedge trial was conducted between April 2015 and December 2016 in Bologna University Hospital. METHODS: Incidence rates (IRs) of falls in both the control and intervention periods were calculated. A multilevel mixed-effects generalised linear model with logit link function, adjusted for age, sex, cluster cross-over timing and patients' clinical severity was used to estimate odds ratios (OR) of fall risk of patients of the intervention group respect to the controls.Intervention costs associated with the introduction of the care-bundle intervention were spread between patients per cluster-period-group of exposure. Incremental cost-effectiveness ratio was evaluated using total costs in the intervention and control groups. RESULTS: IRs of falls in control and intervention periods were respectively 3.15 and 2.58 for 1,000 bed-days. After adjustment, the subjects receiving the intervention had a statistically significant reduced risk of falling with respect to those who did not (OR = 0.71, 95% confidence interval: 0.60-0.84). According to the cost-effectiveness analysis, the incremental cost per fall prevented was €873.92 considering all costs, and €1644.45 excluding costs related falls. CONCLUSIONS: Care-bundle had a protective effect on patients, with a statistically significant reduction of the fall risk. This type of intervention appears cost-effective compared to routine practices.

Parents' and nurses' affective perception of a pictorial intervention in a pediatric hospital environment: Quasi-experimental design pre-post-testing.

BACKGROUND/AIM: The humanization of the hospital environment of pediatric departments represents an area of research and intervention on improving the quality of life for hospitalized patients, but also that one of relatives and health professionals. The aim of the study was to test, in a sample of nurses and hospitalized children's parents, whether the pictorial intervention impacted the perceptions of affective qualities of hospital environment. METHODS: This quasi-experimental design study investigated the effects of a pictorial humanization intervention which consisted of some naturalistic and colorful illustrations in the corridor of two pediatric wards of an Italian hospital. A total of 425 parents of hospitalized children and 80 nurses were asked to complete the Italian version of the "Scale of measurement of the affective qualities of places" in two different moments: 1) before the pictorial intervention and 2) three months after its implementation. RESULTS: For all participants (parents and nurses), results showed a significant effect of pictorial intervention with the four positive dimensions investigated (Relaxing, Exciting, Pleasant, and Stimulating) reporting higher scores after being performed it, and with the four negative dimensions (Distressing, Gloomy, Unpleasant, Sleepy) showing lower scores. CONCLUSIONS: Data suggest that the pictorial intervention could be particularly useful to create more welcoming hospital environments, reducing distress levels from hospitalized patients, but also of relatives and healthcare professionals. IMPLICATIONS TO PRACTICE: Pictorial interventions improve the emotional atmosphere in pediatric healthcare settings. Integrating visual elements related to care and healing enhances user experience, creating a more welcoming environment.

Why do nursing students leave bachelor program? Findings from a qualitative descriptive study.

BACKGROUND: Over the past few years, the phenomenon of "nursing student attrition" has been unevenly studied. Investigators often focused on independent predictors as age, family obligations, final grade of high school, demanding physical and mental workload and others. Specifically, just a few studies applied qualitative methods to better comprehend the very needs of first year students enrolled in a bachelor's degree in nursing sciences (BSN), to sustain their learning process and define effective strategies to reduce student drop-out. METHODS: We conducted a qualitative descriptive study. Thirty-one nursing students at Verona University were interviewed using a semi-structured guide. Data analysis was performed according to a descriptive approach by Sandelowski & Barroso (2000). RESULTS: A total number of 31 students were interviewed. The most recurrent themes regarding the reasons behind BSN drop-out were: understanding that they were not suited to be nurses, perception of missing/lack of psychological, physical and practical resources needed to successfully cope with both nursing school and the nursing profession, inconsistencies between the image of the profession and the reality of the job, feelings of disappointment for the experiences of internship, perceived lack of support from the clinical teacher while going through difficult experiences. CONCLUSIONS: We can consider a part of these drop-out decisions normal, even physiological when students come to realise that they are not suited for the nursing profession. However, it's important to guide nursing students with adequate counselling in order to give them the essential tools to cope with the training and the future as health professionals.

Occurrence and reasons for unfinished nursing care between COVID-19 and non-COVID-19 patients.

AIM: To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID-19) and non-COVID-19 patients as perceived by nurses. BACKGROUND: The recent pandemic has imposed tremendous changes in hospitals in all countries. INTRODUCTION: Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID-19 and non-COVID-19 units might help to gain insights and to address future pandemics. METHODS: A comparative cross-sectional study based on the STROBE guideline has been conducted during November 2020-January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID-19 and non-COVID-19 units. A total of 90 and 200 nurses participated, respectively. RESULTS: No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94-2.27) and non-COVID-19 patients (2.16; 95% CI, 2.06-2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10-2.31) as compared with those caring for non-COVID-19 patients (2.07; 95% CI, 2.01-2.14; p = 0.030). DISCUSSION: The overall occurrence of unfinished care was slightly higher compared with pre-pandemic data in all patients. CONCLUSIONS: Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID-19 compared with non-COVID-19 units. IMPLICATION FOR NURSING AND HEALTH POLICIES: A clear map of action has emerged that might be valid in the post-COVID-19 era as well as in the case of future pandemics.

Health-related quality of life in outpatients with chronic liver disease: a cross-sectional study.

BACKGROUND: The symptoms and complications related to chronic liver disease (CLD) have been shown to affect patient well-being. Currently there is limited research data on how CLD severity may affect both health-related quality of life (HRQOL) and the development of depressive symptoms in CLD patients. Moreover, the ongoing advances in CLD treatment, and its effect on HRQOL, highlight the need for further studies. Therefore, the aim of the present study was to evaluate if the CLD severity may affect the HRQOL and the development of depressive symptoms. METHODS: A cross-sectional study was conducted. Patients with CLDs were identified at their regular visits to the outpatient clinic of the Sant'Orsola-Malpighi Hospital in Bologna, between September 2016 and July 2017. HRQOL was measured with Short Form 12 (SF-12) and Nottingham Health Profile (NHP) questionnaires; depressive symptoms were measured with Beck Depression Inventory-II (BDI). CLD severity was measured using the MELD score and the sample was stratified into five classes according to it. Group comparisons were conducted using the Kruskal-Wallis test. RESULTS: Two hundred and fifty-four patients were included. Mean age was 62.84 years (SD 11.75) and 57.9% were male. Most participants were affected by compensated cirrhosis (140.2%) and chronic hepatitis (40.2%), with a disease duration ≥ 5 years (69.3%). Regarding the MELD score, 67.7% of patients belonged to Class I, 29.9% to Class II, and 2.4% to Class III. There were not patients belonging to the Classes IV and V. No statistically significant differences were found in all SF-12 and NHP domains between the MELD classes, except for CLD impact on sexual life and holidays (p = 0.037 and p = 0.032, respectively). A prevalence rate of 26% of depressive symptoms was reported, no statistically significant differences were found in BDI-II total scores between the three MELD classes. CONCLUSIONS: All domains of HRQOL and depression were altered in CLDs patients, nevertheless CLD severity was not confirmed as an affecting factor for HRQOL.

Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures. DESIGN: Open-label, parallel-group, 2-arm, superiority trial. SUBJECTS AND SETTING: The sample comprised older patients aged 69 to 97 years admitted to a 1500-bed university hospital in Bologna, Italy, for hip fracture surgery. METHODS: Patients were randomly allocated to an intervention or control group. Both groups received standard evidence-based PI preventive care in accordance with National Pressure Ulcer Advisory Panel guidelines. In addition, patients in the intervention group received a single 12.9 × 12.9-cm multilayered polyurethane foam dressing shaped for the sacrum area applied within 24 hours of hospital admission. Bivariate analysis on primary and secondary outcomes and baseline characteristics was performed to compare group differences, and a survival analysis was used to determine the difference in PI incidence rates per group. RESULTS: Sixty-eight patients completed the trial; 34 patients were allocated to the intervention group and 34 patients to the control group. A trend toward significance was observed for sacral PI occurrence in the intervention group (intervention: 20.6%; control: 2.9%; P = .054). The foam dressing allowed significantly longer time (days) to PI occurrence (intervention: 5.9 ± 1.60; control: 2.7 ± 0.96; P = .003). CONCLUSIONS: These findings suggest that multilayered polyurethane foam dressings are not superior to the standard preventive PI care alone and should be used with caution, especially when multiple dressing changes may occur. Further exploration of the role of multilayered polyurethane foam dressings in preventing PI development is warranted.

Resting-State Functional Connectivity of the Habenula in Mood Disorder Patients With and Without Suicide-Related Behaviors.

The habenula is a small midbrain structure that is important for brain signaling and learning from negative events. Thus, the habenula is strongly connected to both the reward system and motor regions. Increasing evidence suggests a role for the habenula in the etiology of psychiatric disorders, including mood and substance use disorders. However, no studies to date have investigated habenular resting-state functional connectivity (rsFC) in suicide-related behaviors (SB). The authors enrolled 123 individuals with major depressive disorder (MDD) or bipolar disorder and a history of suicide-related behaviors (SB+), 74 individuals with MDD or bipolar disorder and a history of suicidal ideation but no history of SB (SB-), and 75 healthy control subjects (HC). A seed-based approach was used to identify regions showing different rsFC with the habenula followed by region of interest to region of interest post hoc comparisons. Compared with both the SB- and HC groups, the SB+ group showed higher connectivity between the left habenula and the left parahippocampal gyrus, the right amygdala, and the right precentral and postcentral gyri. Patients with mood disorders displayed higher rsFC between the left habenula and left middle temporal gyrus, the left angular gyrus, and the left posterior cingulate cortex, as well as lower rsFC between the right habenula and the left thalamus, when compared with HCs. These findings suggest that the habenula is involved in the neural circuitry of suicide. The higher habenular rsFC found in the SB+ group may mediate a dysfunction in the mechanism that links the habenula with motor activity and contextual associative processing.

Predictive factors for category II pressure ulcers in older patients with hip fractures: a prospective study.

OBJECTIVE: To identify the incidence of category II or higher hospital-acquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. METHOD: A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. RESULTS: A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806-0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183-2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010-1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006-1.019) and diaper (HR: 1.007; 95% CI 1.001-1.013) in the postoperative period. CONCLUSION: Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters.

Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study.

PURPOSE: The study aims to analyze the incidence of 30-day mortality in elderly patients who underwent surgery for hip fractures and its associated factors. METHODS: A prospective multicentric study was performed. All patients aged ≥ 65 years, with fragility hip fractures, consecutively admitted in two Italian hospitals were included. Patients with periprosthetic or pathological fractures were excluded. Logistic regression was used to identify patient and patient care variables that independently influenced the 30-day mortality and receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome. RESULTS: Of the patients, 728 met the inclusion criteria, of whom approximately 5% died within 30 days after admission. The 45.7% of the deceased patients died while hospitalized. Multivariate analysis showed that advancing age was the only independent predictor of 30-day mortality (OR = 1.084, 95% CI = 1.024-1.147), while a higher presence of informal caregivers was a protective factor (OR = 0.988, 95% CI = 0.979-0.997). The area under the ROC curve of the model was 0.723 (CI95% 0.676-0.770) for 30-day mortality in elderly hip fractures patients. CONCLUSIONS: Patients with an advanced age need careful follow-up, especially within 30 days following operation for hip fracture; at the same time, the presence of informal caregivers at the patient's bedside should be promoted.

Gender issues in physician-nurse collaboration in healthcare teams: Findings from a cross-sectional study.

AIMS: The aims of the study were (a) to assess whether the proportion of female nurses and female physicians in a given unit influences the attitude of collaboration between nurses and physicians as reported by nurses, and (b) to examine how these two dimensions interact to influence attitudes towards cooperation. BACKGROUND: Available studies have documented that gender influences the collaboration between physicians and nurses, but no have explored the influence of specific combinations-such as a high proportion of female nurses and a high proportion of female physicians. METHODS: A cross-sectional study involving 700 nurses working in 36 hospital units in Italy. The validated Italian version of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration was used. A three stages hierarchical linear regression was performed by entering: (a) the control variables at the individual and at the unit levels, (b) the proportion of female nurses and physicians and (c) the two-way interaction. RESULTS: A total of 430 nurses participated; the average Jefferson Scale of Attitudes towards Physician-Nurse Collaboration total score was 48.64 ± 5.27. At the second and third stages of the hierarchical linear regression model (explaining 12.8% and 14.1% of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration variance, respectively), having more female RNs as staff (model two: ß = 0.61, p =< .1; model three: ß = 0.69, p =< .05) was significantly associated with higher Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores; differently, higher physician-nurse ratios (model two: ß = -4.09, p =< .05; model three: ß = -4.54, p =< .01), and more female physicians (model two: ß = -1.06, p =< .05; model three: ß = -1.29, p =< .01) were associated with lower Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores. CONCLUSION: There is a decreased collaboration as reported by nurses when predominantly male nursing teams interact with teams with more female physicians. However, in units lead by female physicians, having more female members among the nursing team, ensures increased attitudes of collaboration as reported by nurses. IMPLICATIONS FOR NURSING MANAGEMENT: With the increasing proportion of female physicians and male nurses, unit mangers should be prepared to manage their influence on interprofessional cooperation.

Daily crying prevalence and associated factors in older adult persons living in nursing homes: findings from a regional study.

OBJECTIVES: The study aims to evaluate the prevalence of nursing home (NH) resident crying and associated factors at the individual and NH levels. DESIGN: A regional retrospective study design has been used. PARTICIPANTS AND SETTING: A total of 8875 residents, living in 105 NHs, were included. MEASUREMENTS: The occurrence of an episode of crying on at least a daily basis in the last month was the dependent variable; independent variables were set at individual and at the NH levels as reported in the Val.Graf regional database. RESULTS: A total of 1,443 (16.3%) residents reported daily episodes of crying over the last month. Several individual variables were significantly associated with crying; female gender (odds ratio [OR] 2.535, 95% confidence interval [CI] 2.069-3.107); sad, pained or worried facial expressions (OR 1.885, 95% CI 1.785-2.021); negative thoughts (OR 1.650, 95% CI 1.508-1.804); unrealistic fears (OR 1.410, 95% CI 1.295-1.534); anger with self or others (OR 1.141, 95% CI 1.043-1.248); repetitive anxious complaints/concerns (OR 1.136, 95% CI 1.045-1.235); clinical instability (OR 1.186, 95% CI 1.018-1.381); pain (OR 1.183, 95% CI 1.058-1.323); night restlessness (OR 1.180, 95% CI 1.100-1.267); communication problems (OR 1.169, 95% CI 1.051-1.300); and cognitive impairment (OR 1.086, 95% CI 1.019-1.156); all increased the likelihood of crying. Conversely, sociability (OR 0.866, 95% CI 0.805-0.932) and being involved in social based activities (OR 0.882, 95% CI 0.811-0.960) were protective against crying. However, the previously mentioned variables have explained only 35.9% of variance in daily crying. CONCLUSIONS: Around one out of six residents living in NH cries on a daily basis, and the reasons are also at the individual level. Residents seem to cry for attachment and clinical needs and to express stress and unhappiness; more research is needed, aiming at discovering other factors associated with resident's daily crying. Copyright © 2017 John Wiley & Sons, Ltd.

[The quality of life as perceived by older people. Results of a phenomenological study]. / La qualità di vita raccontata dagli anziani. Risultati di una ricerca fenomenologica.

INTRODUCTION: Elderly Quality of life (QoL) is vulnerable because of the decline in physical and mental capacity, discharge from work, rupture of the family and isolation. Many QoL Scales are made for adults: there is little research investigating how older people perceive QOL. AIM: This study aims to explore and understand the perceptions that older people have about their QOL. METHOD: A qualitative research hermeneutics-phenomenological was done. Narratives were analyzed by mixed method phenomenological-grounded (Mortari, 2007). RESULTS: 16 elderly were interviewed (aged between 80 and 93 years), residents in their home. The analysis of the interviews confirm that QoL is a multidimensional concept that encompasses several components of life. There were 7 shared themes, reflecting the experience of well-being in older people living at home. The dimensions are: living relationships that drive away loneliness, fill the time with activities that follow their own interests, accept themselves as elderly person, choose how and where to live, think about death. CONCLUSIONS: The results of the study show that older people perceive QOL as made of multiple components and variables. Elderly are focused on the remaining capacities, on the acceptance of the positive aspects of their lives rather than on what they can no longer do. This study help to identify some social and health strategies to guarantee the best way to live the last part of life.

Interruptions during nurses' work in surgical units determined by staff members: findings from a multi-center observational study, Italy.

BACKGROUND: Interruptions during nurses' work may lead to errors. Little research has been undertaken to date on interruptions in nursing care in surgical settings, specifically with regard to interruptions where other staff was the source of the interruption. OBJECTIVES: To describe the frequency and characteristics of interruptions to nursing work caused by other staff members and to identify predictors according to the source of interruption. METHODS: We conducted a multi-centre observational study in five surgical units admitting urgent and elective cases, in public hospitals in northern Italy. Registered nurses (RN) met inclusion criteria if, at the time of the study, they were (a) working full-time at the study hospital, (b) working since at least three years in the surgical unit, and (c) working either during morning or afternoon shifts. A random sample of 50 RNs was observed during morning and afternoon shifts for a total of 360 hours. Data on interruptions (e.g. duration of the interruption), individual nurses' characteristics (e.g. years of clinical experience), and work setting (e.g. hospital size) were collected and subjected to logistic regression analysis. RESULTS: The mean frequency of interruptions either caused by staff members or other sources was respectively 2.7/hour and 2.9/ hour. Interruptions caused by staff members were shorter than those due to other sources (25.6s vs 39.4s; p=<0.001), just over half occurred during the morning shift and most took place either in the corridors (37%) or in nurses' rooms (36%). Having more years of experience in a surgical unit and having a higher number of nurses available during the shift were protective against interruptions whereas being a graduate RN, taking care of a higher number of patients and working in a large hospital increased the risk of being interrupted by staff members. CONCLUSIONS: Strategies for multi-professional cooperation which minimise interruptions and protect younger graduate nurses are needed.

Amygdala and hippocampus volumes are differently affected by childhood trauma in patients with bipolar disorders and healthy controls.

OBJECTIVES: Volumetric studies on deep gray matter structures in bipolar disorder (BP) have reported contrasting results. Childhood trauma, a relevant environmental stressor for BP, could account for the variability of the results, modulating differences in the amygdala and hippocampus in patients with BP compared with healthy controls (HC). Our study aimed to test this hypothesis. METHODS: We assessed 105 outpatients, diagnosed with bipolar disorder type I (BP-I) or bipolar disorder type II (BP-II) according to DSM-IV-TR criteria, and 113 HC subjects. History of childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ). High-resolution magnetic resonance imaging was performed on all subjects and volumes of the amygdala, hippocampus, nucleus accumbens, caudate, pallidum, putamen, and thalamus were measured using FreeSurfer. RESULTS: Patients with BP showed a global reduction of deep gray matter volumes compared to HCs. However, childhood trauma modulated the impact of the diagnosis specifically on the amygdala and hippocampus. Childhood trauma was associated with bilateral decreased volumes in HCs and increased volumes in patients with BP. CONCLUSIONS: The results suggest that childhood trauma may have a different effect in health and disease on volumes of gray matter in the amygdala and hippocampus, which are brain areas specifically involved in response to stress and emotion processing.

Increased habenular connectivity in opioid users is associated with an α5 subunit nicotinic receptor genetic variant.

BACKGROUND AND OBJECTIVES: Opioid use disorder (OUD) is a chronic disorder with relapse based on both desire for reinforcement (craving) and avoidance of withdrawal. The aversive aspect of dependence and relapse has been associated with a small brain structure called the habenula, which expresses large numbers of both opioid and nicotinic receptors. Additionally, opioid withdrawal symptoms can be induced in opioid-treated rodents by blocking not only opioid, but also nicotinic receptors. This receptor co-localization and cross-induction of withdrawal therefore might lead to genetic variation in the nicotinic receptor influencing development of human opioid dependence through its impact on the aversive components of opioid dependence. METHODS: We studied habenular resting state functional connectivity with related brain structures, specifically the striatum. We compared abstinent psychiatric patients who use opioids (N = 51) to psychiatric patients who do not (N = 254) to identify an endophenotype of opioid use that focused on withdrawal avoidance and aversion rather than the more commonly examined craving aspects of relapse. RESULTS: We found that habenula-striatal connectivity was stronger in opioid-using patients. Increased habenula-striatum connectivity was observed in opioid-using patients with the low risk rs16969968 GG genotype, but not in patients carrying the high risk AG or AA genotypes. CONCLUSIONS: We propose that increased habenula-striatum functional connectivity may be modulated by the nicotinic receptor variant rs16969968 and may lead to increased opioid use. SCIENTIFIC SIGNIFICANCE: Our data uncovered a promising brain target for development of novel anti-addiction therapies and may help the development of personalized therapies against opioid abuse. (Am J Addict 2017;26:751-759).

In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study.

BACKGROUND: Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended. AIMS: To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H1: at the weekend when less nursing care is offered; H2: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses. METHODS: Secondary analysis of a prospective study of patients >65 years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis. RESULTS: In-hospital mortality occurrence was 6.8 %, and 37 % of the patients died during the weekend. The logistic regression model explained 34.3 % (R 2) of the variance of in-hospital mortality: patients were six times (95 % CI = 3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3 months were also at increased risk of dying (RR 1.360, 95 % CI = 1.024-1.806) as well as those receiving more care from family carers (RR = 1.017, 95 % CI = 1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR = 2.236, 95 % CI = 1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR = 0.940, 95 % CI = 0.912-0.969). CONCLUSIONS: Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels.

The degree of satisfaction of in-hospital medical patients with nursing care and predictors of dissatisfaction: findings from a secondary analysis.

BACKGROUND: Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. AIMS: To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. DESIGN AND METHODS: A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012-2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale (PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 - very dissatisfied to 44 - very satisfied). Patients were defined as 'satisfied with NC' when the score was ≥33, whereas they were considered as 'dissatisfied with NC' when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. RESULTS: There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients (RR 1.883, 95% CI 1.359-2.609), in those who developed pressure sores during the in-hospital stay (RR 1.555, 95% CI 1.021-2.368), who received NC with high skill mix (RR 1.072, 95% CI 1.034-1.111) and those who were admitted to a large hospital (RR 1.001, 95% CI 1.001-1.002). In contrast, increased age (RR 0.987, 95% CI 0.975-0.998), increased amount of care offered by Registered Nurses (RR 0.984, 95% CI 0.974-0.994), a higher proportion of baccalaureate nurses on staff (RR 0.975, 95% CI 0.958-0.993) and being admitted to a teaching hospital (RR 0.497, 95% CI 0.130-0.910) all decreased the likelihood of being dissatisfied with NC. CONCLUSIONS: Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction.

Factors affecting in-hospital informal caregiving as decided by families: findings from a longitudinal study conducted in acute medical units.

BACKGROUND: Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. AIMS: To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. DESIGN AND METHODS: A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. RESULTS: All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. CONCLUSIONS: Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts.