Self-care behaviours and their determinants in people affected by coronary heart disease.

OBJECTIVE: To describe self-care in Italian adults with coronary heart disease and to identify sociodemographic and clinical determinants of self-care. DESIGN: This is a cross-sectional analysis of data from the Italian multicentre longitudinal study. METHODS: We used the follow instruments: Self-Care of coronary heart disease inventory, Self-care Self Efficacy Scale, Charlson Comorbidity Index and Sociodemographic questionnaire. Descriptive statistics including absolute numbers, percentages, means and standard deviations were used to describe the sociodemographic and clinical characteristics of the sample, and the items. A structural equation model was fitted to understand sociodemographic and clinical variables associated with self-care, and possible effects mediated by self-efficacy. RESULTS: We enrolled 427 patients. Self-care maintenance, monitoring, management and self-care self-efficacy means scores were 58.27 (SD = 20.07), 48.53 (SD = 26.97), 65.34 (SD = 22.85) and 77.16 (SD = 20.76), respectively. Except for the self-care self-efficacy scale, all the scores lay below the cut off 70 for adequacy. Older age, higher comorbidities, a higher number of stents placed, and the presence of a caregiver predicted poor self-care. CONCLUSION: Self-care in Italian CHD populations is poor. Several associations were found between the dimensions of self-care and sociodemographic factors. Implications for the profession these findings are important for health care providers to plan interventions to improve self-care behaviour. IMPACT: The study addressed self-care behaviours of coronary heart disease patients. Self-care was poor in this population; several associations were found between the dimensions of self-care and sociodemographic and clinical determinants. Our results can be used to support health professionals in planning interventions to improve specific self-care domains. REPORTING METHOD: STROBE checklist was followed.

Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory.

BACKGROUND: Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD). AIMS: The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI). METHODS: The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores. RESULTS: We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales. CONCLUSION: The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.

Complications related to short peripheral intravenous catheters in patients with acute stroke: a prospective, observational, single-cohort study.

Patients with acute stroke often require venous access to facilitate diagnostic investigations or intravenous therapy. The primary aim of this study was to describe the rate and type of complications associated with the placement of a short peripheral catheter (SPC) in patients with acute ischemic or hemorrhagic stroke. A prospective, observational, single-cohort study was conducted at Niguarda Hospital, Italy, with enrolment in the Emergency Department. Adult patients with an ischemic or hemorrhagic stroke requiring an SPC were enrolled. Complications, such as infiltration, occlusion, phlebitis and dislodgment, were recorded daily. Descriptive statistics were used, and the incidence rate ratio (IRR) was estimated to assess the difference in complications, considering catheter calibre, dominant side, exit site, limb, and limb mobility, ictus type (ischemic/haemorrhagic), impairment deficit (language, motor, visual) and EA-DIVA score. A total of 269 participants and 755 SPC were analysed. Removal of SPC due to at least one local complication occurred in 451 (60%). Dislodgment was the major cause of SPC removal (31%), followed by infiltration (18%), occlusion (6%), and phlebitis (5%). The SPC calibre (22G), exit-site other than antecubital and forearm, visual deficit and EA-DIVA ≥ 8 were associated with a higher rate of SPC complications: IRR, 1.71 [1.31; 2.31]; 1.27 [1.01; 1.60], 1.38 [1.06; 1.80], 1.30 [1.04; 1.64], respectively. No other differences in complication rates were observed according to the insertion site, i.e. dominant side, left side, plegic/hyposthenic limb, or exit site. This study provides novel insights into the frequency and types of complications associated with SPC in patients with acute stroke. Compared to the literature, a higher dislodgment rate was observed, being the first cause of SPC removal, whereas no differences in the number of infiltrations, occlusions, and phlebitis were recorded.

Nurses' Roles in Caring for Older People in Domiciliary Settings: A Scoping Review Protocol.

Due to global shifts in demographics and advances in chronic illness management over the past few decades, domiciliary care has become the primary setting for caring for older people. In this regard, nurses play a crucial role, promoting quality care and minimizing hospital admissions and the need for institutionalization. However, historical and geographic variation in nursing titles and the multitude of labels for different roles have been obstacles to the creation of a clear map outlining specific nursing roles in home care for older people. The aim of this scoping review is to map the evidence on the different nurses' roles in caring for older people in domiciliary settings. This review will include primary, secondary, and gray literature on nurses' roles in domiciliary settings for older people, sourced through comprehensive searches of various databases (MEDLINE, Embase, CINAHL) and reference scanning. No language restrictions will be applied. Two independent reviewers will conduct screening and data extraction. The tabulated results will be informed by descriptive frequencies and content analysis, presenting comprehensive findings. The review protocol was retrospectively registered within OSF database on the 23 November 2023.

Protective and risk factors of workplace violence against nurses: A cross-sectional study.

AIMS: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors. METHODS: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines. RESULTS: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards. CONCLUSION: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Wearable technology use in long-term care facilities for older adults: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to explore how wearable technology is being used to care for older adults in long-term care facilities. INTRODUCTION: The use of digital health technologies to support care delivery in long-term care facilities for older adults has grown significantly in recent years, especially since the COVID-19 pandemic. Wearable technology refers to devices worn or attached to the body that can track a variety of health-related data, such as vital signs, falls, and sleep patterns. Despite the evidence that wearable devices are playing an increasing role in older adults' care, no review has been conducted on how wearable technology is being used in long-term care facilities. INCLUSION CRITERIA: This review will consider studies that include people aged over 65, with any health condition or level of disability, who live in long-term care facilities. Primary and secondary studies using quantitative, qualitative, and mixed methods study designs will be included. Dissertations and policy documents will also be considered. METHODS: Data sources will include comprehensive searches of electronic databases (MEDLINE, Embase, CINAHL, and Scopus), gray literature, and reference scanning of relevant studies. Two independent reviewers will screen titles, abstracts, and full texts of the selected studies. Data extraction will be performed using a tool developed by the researchers. Data will be mapped and analyzed. Descriptive frequencies and content analysis will be included, along with the tabulated results, which will be used to present the findings with regard to the review objectives. REVIEW REGISTRATION: Open Science Framework https://osf.io/r9qtd.

The use of hypnotic communication in PICC placement: randomized controlled trial study.

Every time a patient undergoes a medical procedure, unpredicted personal stress occurs. According to the available literature, the hypnotic communication technique has been used to reduce stress and pain during several major invasive procedures. The primary goal of this study was to compare the effectiveness of hypnotic communication combined with buffered Lidocaine, versus buffered Lidocaine alone, on patients' negative emotions while undergoing Peripherally Inserted Central Venous Catheter (PICC) placement. Secondary aims were evaluating patients' pain, satisfaction, and procedure timing and costs. A randomized controlled trial was conducted in an Italian Hospital involving patients who needed a PICC, with any disease or condition, aged over 18, cognitively oriented, able to hear, and willing to give consent. Emotional assessment was performed using the Emotion Thermometer Tool. Sixty-seven subjects were enrolled: 17 refused to participate, and 25 were randomly assigned to each group. The results showed a statistically significant higher decline in the total Emotion Thermometer Tool score for the experimental group using hypnotic communication. A significant mean reduction in anger and depression was also observed, while both groups reported low levels of perceived pain. Hypnotic communication appears to be a successful method for reducing emotional stress during PICC placement. However, further research is needed to determine the relationship between hypnotic communication, emotional distress, and pain perception in patients undergoing central vascular catheter insertion.

Quality improvement interventions to prevent the use of hospital services among nursing home residents: protocol for a systematic review and meta-analysis.

INTRODUCTION: Quality improvement interventions are a promising strategy for reducing hospital services use among nursing home residents. However, evidence for their effectiveness is limited. It is unclear which characteristics of the quality improvement intervention and activities planned to facilitate implementation may promote fidelity to organisational and system changes. This systematic review and meta-analysis will assess the effectiveness of quality improvement interventions and implementation strategies aimed at reducing hospital services use among nursing home residents. METHODS AND ANALYSIS: The MEDLINE, CINAHL, Cochrane Library, Embase and Web of Science databases will be comprehensively searched in September 2023. The eligible studies should focus on the implementation of a quality improvement intervention defined as the systematic, continuous approach that designs, tests and implements changes using real-time measurement to reduce hospitalisations or emergency department visits among long-stay nursing home residents. Quality improvement details and implementation strategies will be deductively categorised into effective practice and organisation of care taxonomy domains for delivery arrangements and implementation strategies. Quality and bias assessments will be completed using the Quality Improvement Minimum Quality Criteria Set and the Joanna Briggs Institute Critical Appraisal Tools.The results will be pooled in a meta-analysis, by combining the natural logarithms of the rate ratios across the studies or by calculating the rate ratio using the generic inverse-variance method. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies will be less than 10. Raw data will be requested from the authors, as required. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be published in a peer-review journal and presented at (inter)national conferences. PROSPERO REGISTRATION NUMBER: CRD42022364195.

[Patient and public involvement in research]. / Il coinvolgimento della popolazione e dei pazienti nella ricerca.

. Patient and public involvement in research. Patient and public involvement (PPI) entails research being carried out 'with' members of the public, rather than 'to', 'about' or 'for' them. The word public can refer to patients, potential patients, carers and people who use health and social care services, people from organisations that represent people who use services as well as members of the public. People with lived experience of a particular service or health condition may add value to the research and even influence the research question. The involvement may occurr in any stage of the research process, but preferably since the very start, when the study is designed. To obtain a real involvement and participation some practical tips are suggested. In this paper advantages but also difficulties related to PPI are presented, based both on the literature but also from the authors' experience.

Gait Monitoring and Analysis: A Mathematical Approach.

Gait abnormalities are common in the elderly and individuals diagnosed with Parkinson's, often leading to reduced mobility and increased fall risk. Monitoring and assessing gait patterns in these populations play a crucial role in understanding disease progression, early detection of motor impairments, and developing personalized rehabilitation strategies. In particular, by identifying gait irregularities at an early stage, healthcare professionals can implement timely interventions and personalized therapeutic approaches, potentially delaying the onset of severe motor symptoms and improving overall patient outcomes. In this paper, we studied older adults affected by chronic diseases and/or Parkinson's disease by monitoring their gait due to wearable devices that can accurately detect a person's movements. In our study, about 50 people were involved in the trial (20 with Parkinson's disease and 30 people with chronic diseases) who have worn our device for at least 6 months. During the experimentation, each device collected 25 samples from the accelerometer sensor for each second. By analyzing those data, we propose a metric for the "gait quality" based on the measure of entropy obtained by applying the Fourier transform.

Nurses' Challenges to Developing Interpersonal Relationships During Integrated Care for Complex Patients.

BACKGROUND: Individuals with multimorbidity and complexity have multifaceted care needs requiring integrated and collaborative care from nurses, families, and health care teams. Nurses, as the frontline care professionals, should develop therapeutic relationships with patients and their families and professional relationships with health care team members to ensure the delivery of effective integrated care. Failure to develop effective interpersonal and professional relationships can negatively affect patient care. OBJECTIVE: The purpose of this study was to explore nurses' challenges with developing interpersonal and professional relationships during integrated care for individuals with multimorbidity and complexity. METHODS: A descriptive qualitative design was used. We interviewed a purposive sample of 19 nurses with experience of caring for individuals with multimorbidity and complexity across two hospitals in Pakistan. Semi-structured interviews were used for data collection, and data were analyzed using reflexive thematic analysis. RESULTS: Two challenges were identified affecting the relationships between patients' families and nurses, and two challenges influencing the professional relationships within the team. Families withheld information, controlled care access of their relatives, posed unrealistic demands, and abused nurses, affecting nurse-family relationships. Power struggles to demonstrate authority in decision-making were common within health care teams, affecting nurses' professional capacity to provide effective care. CONCLUSIONS: Health care team, patient, and family collaboration is instrumental in improved care for individuals with multimorbidity and complexity. Nurse leaders and health care organizations should take initiatives to address nurses' interpersonal confrontations to support them in the provision of quality care.

A pragmatic, open-label, multi-center, randomized controlled clinical trial on the rotational use of interfaces vs standard of care in patients treated with noninvasive positive pressure ventilation for acute hypercapnic respiratory failure: the ROTAtional-USE of interface STUDY (ROTA-USE STUDY).

BACKGROUND: In the last decades, noninvasive ventilation (NIV) has been increasingly used to support patients with hypercapnic and hypoxemic acute respiratory failure. Pressure ulcers are a frequently observed NIV-related adverse effect, directly related to interface type and exposure time. Switching to a different interface has been proposed as a solution to improve patient comfort. However, large studies investigating the benefit of this strategy are not available. Thus, the aim of the ROTAtional-USE of interface STUDY (ROTA-USE STUDY) is to investigate whether a protocolized rotational use of interfaces during NIV is effective in reducing the incidence of pressure ulcers. METHODS: The ROTA-USE STUDY is a pragmatic, parallel arm, open-label, multicenter, spontaneous, non-profit, randomized controlled trial requiring non-significant risk medical devices, with the aim to determine whether a rotational strategy of NIV interfaces is associated with a lower incidence of pressure ulcers compared to the standard of care. In the intervention group, NIV mask will be randomly chosen and rotated every 6 h. In the control group, mask will be chosen according to the standard of care of the participating centers and changed in case of discomfort or in the presence of new pressure sores. In both groups, the skin underneath the mask will be inspected every 12 h for any possible damage by blinded assessors. The primary outcome is the proportion of patients developing new pressure sores at 36 h from randomization. The secondary outcomes are (i) onset of pressure sores measured at different time points, i.e., 12, 24, 36, 48, 60, 72, 84, and 96 h; (ii) number and stage of pressure sores and comfort measured at 12, 24, 36, 48, 60, 72, 84, and 96 h; and (iii) the economic impact of the protocolized rotational use of interfaces. A sample size of 239 subjects per group (intervention and control) is estimated to detect a 10% absolute difference in the proportion of patients developing pressure sores at 36 h. DISCUSSION: The development of pressure ulcers is a common side effect of NIV that negatively affects the patients' comfort and tolerance, often leading to NIV failure and adverse outcomes. The ROTA-USE STUDY will determine whether a protocolized rotational approach can reduce the incidence, number, and severity of pressure ulcers in NIV-treated patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT05513508. Registered on August 24, 2022.

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study.

BACKGROUND: During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. METHODS: A qualitative descriptive design was undertaken in 2022-2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor's degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. RESULTS: Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. CONCLUSIONS: A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems.

[Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt]. / Transitare la formazione infermieristica italiana nel periodo post pandemico: le priorità alla luce delle lezioni apprese.

. Transitioning Italian nursing education in the post-pandemic period: priorities in the light of lessons learnt. INTRODUCTION: Once back to normalcy, many nursing education activities have been restored without an in-depth analysis of which transformations enacted in the pandemic period should be maintained and valued. AIM: To identify priorities to effectively transitioning nursing education in the post-pandemic period. METHOD: Descriptive qualitative design. A network of nine universities involved 37 faculty members, 28 clinical nurse educators and 65 students/new graduates. Data were collected through semi-structured interviews; the main priorities reported in each university were combined to gain a global view. RESULTS: Nine priorities emerged, including the need to: 1. reflect on distance learning to promote its complementary role to face-to-face teaching; 2. rethinking the rotations of clinical practical training by refocusing their aims, duration, and preferred settings; 3. understanding how to integrate the virtual and the in-presence learning spaces into the educational pathway; 4. continuing with inclusive and sustainable strategies. Considering that nursing education is essential, it is a priority to develop a pandemic education plan capable of guaranteeing its continuity in all circumstances. CONCLUSIONS: Nine priorities have emerged all considering the importance of digitalization; the lessons learnt, however, indicate the need to enact an intermediate phase capable of guiding towards the complete transition of the education in the post-pandemic era.

[Measuring missed nursing care during the Covid-19 pandemic: methodological reflections]. / Misurare le missed nursing care in tempi di Covid-19: riflessioni di metodo.

. Measuring missed nursing care during the Covid-19 pandemic: methodological reflections. Missed care phenomenon has demonstrated an increasingly interest of the researchers over the years. Even during the pandemic period, many studies have been published with the aim of describing missed care during this healthcare emergency. The comparative studies (Covid-19 versus non-Covid-19) were innovative; however, no important differences have emerged. On the other hand, many studies have been published with a descriptive intent, also in this case without highlighting substantial differences as compared to the pre-pandemic period. These findings bring out a series of methodological reflections, which should be considered to advance research in this field.

Psychometric properties and measurement invariance of the 7-item General Anxiety Disorder scale (GAD-7) in an Italian coronary heart disease population.

BACKGROUND: Generalized Anxiety Disorder is predominant in coronary heart disease (CHD) patients. 7-item Generalized Anxiety Disorder (GAD-7) scale psychometric properties have never been tested in CHD populations. This study aims to verify the GAD-7 psychometric properties and measurement invariance in an Italian CHD sample. METHOD: A baseline data secondary analysis from HEARTS-IN-DYADS study. Several healthcare facilities enrolled an adult inpatient sample. Anxiety and depression data were collected using GAD-7 and Patient Health Questionnaire 9 (PHQ-9). Factorial validity was assessed with confirmatory factor analysis; construct validity was tested by correlating GAD-7 scores with PHQ-9 scores and other sociodemographic characteristics; internal consistency reliability was assessed using Cronbach's alpha and the composite reliability index, while confirmatory multigroup factor analysis was employed to investigate measurement invariance across gender and age (65 vs. 65). RESULTS: We enrolled 398 patients (mean age 64.7 years; 78.9 % male; 66.8 % married). Factor structure was confirmed as unidimensional. Construct validity was confirmed with significant associations between GAD-7 and PHQ-9 scores, female gender, having a caregiver, and being employed. Cronbach's alpha and composite reliability index were 0.89 and 0.90, respectively. Measurement invariance across gender and age was confirmed at the scalar level. LIMITATIONS: A convenience sample in one European country, a small female sample, validity testing against a single criterion. CONCLUSION: Study results demonstrate adequate validity and reliability of the GAD-7 in an Italian CHD sample. It showed satisfactory invariance properties; GAD-7 is suitable for measuring anxiety in CHD while making significant comparisons of scores among stratified gender and age groups.

The Family and Community Nurses Cultural Model in the Times of the COVID Outbreak: A Focused Ethnographic Study.

The ageing population, increasingly frail and chronically ill, and COVID-19 pandemic challenges have highlighted national health systems' vulnerability and, more strongly/to a greater extent, the pivotal role of the family and community nurse (FCN). However, the recent introduction of FCNs in primary care settings has yet to be explored in Italy. This study aimed to identify the FCNs' cultural model and its implementation during the COVID-19 outbreak. A focused ethnographic study was performed in a primary care community service in northern Italy. Participants were FCNs (N = 5), patients and caregivers (N = 12). Qualitative data were collected through semi-structured interviews, field notes, observation of FCNs' activities and access to documents. Qualitative analysis identified themes concerned with crucial aspects of FCNs' activities, role implementation, and their relationship with patients and families. This study illuminated how the FCN strategically takes care of and identifies patients' and community needs. Although the COVID-19 outbreak hindered effective FCN project implementation, this study highlighted that the pandemic provided a chance to better identify cultural, organisational and educational weaknesses that need to be addressed to support the full accomplishment of FCNs' scope of practice.

Long-term effects of Coronavirus 2 infection after intensive care: a prospective study.

BACKGROUND: While the multi-organ manifestations of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. The aim of the study was to study the level and predictors of post-traumatic stress, anxiety and depression symptoms, quality of life and functional disability in COVID-19 survivors during the first year post Intensive Care Unit (ICU) discharge. METHODS: A prospective longitudinal study, reported following the STROBE guidance, was conducted in adult patients with SARS-CoV-2 infection admitted to an Italian ICU from March 2020 to March 2021 who were followed until March 2022. RESULTS: A total of 207 patients were included in the study, of which 145 (70.1%) were male. One hundred and six (51.2%) patients between six and 12 months after ICU discharge reported at least one physical or cognitive impairment. The concurrent prevalence of anxiety, depression and PTSD is present in 25/106 patients (23.6% of cases) at six months and increases in 29/106 patients (27.3% of cases) at 12 months. However, the prevalence of anxiety, depression and PTSD was observed in 86 patients (41.5%) at six months and it gets smaller in 78 patients (37.7%) at 12 months (P=0.049). The EqVAS score (58.8 vs. 72.3, P=0.017) and the Barthel Index (61.5 vs. 74.8, P<0.001) increased significantly between six and 12 months after ICU. CONCLUSIONS: Our results show that functional and cognitive recovery improves between six and 12 months after ICU discharge with a high perception of the patients' quality of life. These results will help to inform health system planning and the development of multidisciplinary strategies to reduce chronic health loss among individuals with COVID-19.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates. METHODS: An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome. RESULTS: Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions. CONCLUSIONS: Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Bed rest duration and complications after transfemoral cardiac catheterization: a network meta-analysis.

AIMS: To assess the effects of bed rest duration on short-term complications following transfemoral catheterization. METHODS AND RESULTS: A systematic search was carried out in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, Scopus, SciELO and in five registries of grey literature. Randomized controlled trials and quasi-experimental studies comparing different durations of bed rest after transfemoral catheterization were included. Primary outcomes were haematoma and bleeding near the access site. Secondary outcomes were arteriovenous fistula, pseudoaneurysm, back pain, general patient discomfort and urinary discomfort. Study findings were summarized using a network meta-analysis (NMA). Twenty-eight studies and 9217 participants were included (mean age 60.4 years). In NMA, bed rest duration was not consistently associated with either primary outcome, and this was confirmed in sensitivity analyses. There was no evidence of associations with secondary outcomes, except for two effects related to back pain. A bed rest duration of 2-2.9 h was associated with lower risk of back pain [risk ratio (RR) 0.33, 95% confidence interval (CI) 0.17-0.62] and a duration over 12 h with greater risk of back pain (RR 1.94, 95% CI 1.16-3.24), when compared with the 4-5.9 h interval. Post hoc analysis revealed an increased risk of back pain per hour of bed rest (RR 1.08, 95% CI 1.04-1.11). CONCLUSION: A short bed rest was not associated with complications in patients undergoing transfemoral catheterization; the greater the duration of bed rest, the more likely the patients were to experience back pain. Ambulation as early as 2 h after transfemoral catheterization can be safely implemented. REGISTRATION: PROSPERO: CRD42014014222.