Sensitivity and specificity of the new Geriatric Dehydration Screening Tool: An observational diagnostic study.

OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of the Geriatric Dehydration Screening Tool-Modified (GDST-M) in detecting dehydration in older people and, if possible, to simplify the tool and make it easier to use. METHODS: This was a monocentric diagnostic accuracy study. We involved people ≥65 y of age with a Mini Mental State Evaluation (MMSE) score >24 and who were hospitalized in five medical wards of a large teaching hospital in Milan (Italy). We administered the GDST-M to hospitalized older people who met the inclusion criteria and compared outcomes with the values of serum osmolarity to evaluate their dehydration status and the accuracy of the tool. RESULTS: A total of 299 older people were recruited, of which 202 were dehydrated and 97 were hydrated. The GDST-M, with a cutoff value of 6, showed a sensitivity of 61.9% and a specificity of 47.2%. Multiple correspondence analysis and cluster analysis enabled extraction of 9 items from the 23 items present in the GDST-M. The new tool had a moderate diagnostic accuracy in detecting dehydration in older people aged over 75 y, with a sensitivity of 63.4% and a specificity of 69.6%. CONCLUSIONS: The short form of the tool is simple and contains minimally invasive assessments of low fluid intake dehydration in older people. The new GDST could also be easily used by lay people after a short training session.

For the flaring up of the flu: The nurses of the Maggiore Hospital in Milan hit by the Spanish fever.

In the last year of the Great War, Italy was also hit by the Spanish flu. The Civic Hospitals faced a deadly disaster with insufficient resources. All the heavy workload fell on the female nursing staff, who were the only ones able ensure the continuity of the hospital services. This study aimed to explore the impact of the influenza on the health of the nurses at the Maggiore Hospital in Milan during the second and third epidemic waves. Historical research was conducted between February and May 2020. Primary sources were retrieved from the historical archives of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and the daily newspaper Corriere della Sera. In the autumn of 1918, the Maggiore Hospital in Milan changed its organization to hospitalise patients affected by the influenza pandemic. Although the hospital managers wanted to protect their healthcare staff from the risks of contagion by means of prophylaxis rules, 388 lay nurses and 80 religious sister nurses were affected by this insidious disease. The second and third waves of the pandemic claimed 25 victims of duty. Remembered for their altruism and spirit of abnegation, the hospital community honoured their sacrifice, and the citizens expressed their gratitude.

[On the Field of Honor. Historical research in memory of Italian male nurses who died in the First World War]. / Sul campo dell'Onore. Ricerca storica in memoria degli infermieri italiani caduti nella Prima Guerra Mondiale.

AIM: Several Italian male nurses employed at the Ospedale Maggiore in Milan were among the dead during First World War. This paper investigates whether and in which way these people are remembered. In addition the authors draw a picture of the nursing profession as it were in the early Twentieth Century in Italy. METHOD: The administrative documentation of 127 male nurses on duty at the Ospedale Maggiore in Milan and called to arms between 1915 and 1918 was examined. The documents were found in the historical archive of the Ospedale Maggiore from July 2015 to March 2016 and analyzed using the method of historical research according to Chabod (2012). RESULTS: Documents that witnessed the death of 5 male nurses during the war were found. These people were praised for their courage, self-sacrifice and commitment in attending the sick and the wounded. The hospital community arranged to devolve a sum of money to their families in sign of gratitude and commemorated them by engraving their names in a marble monument. CONCLUSIONS: Many memories of civilian male nurses in the years 1915-1918 emerged from this investigation, and the professional identity of nurses in the 1920s emerged quite clearly. The participation of male nurses in the First World War, in conjunction with the recurrence of its centenary, could be further deepened.

Development of a screening tool to assess dehydration in hospitalized older population: a diagnostic, observational study.

INTRODUCTION: dehydration is a frequent condition in older people and is associated with an increased risk of negative health outcomes. In order to adopt strategies to prevent complications, an early recognition of this status is of primary importance. For this reason, a comprehensive assessment tool to monitor hydration status in older people could be useful. AIM: to develop a screening tool to detect dehydration in older people in hospital settings. METHODS: this is a diagnostic, observational study. The new tool is a modified version of the Geriatric Dehydration Screening Tool (GDST), integrated with seven questions and two clinical signs based on updated literature. We tested the new tool with people aged 65 or over. We used as reference standard serum osmolarity. Cronbach's alpha was used to measure the tool's reliability and subscales. We calculated the Area Under ROC Curve (AUC) to choose the cut-off that gave the best balance between sensibility and specificity. RESULTS: 127 patients participated in the study. The reliability of the new GDST was acceptable (Cronbach's alpha 0.63). The diagnostic accuracy, measured with AUC analysis, was 0.83 ± 0.04, p 0.0001 95% CI 0.72-0.87. The best cut-off value was 6 and showed a sensibility of 78%, specificity of 70%. Tongue dryness proved to be the most significant clinical sign associated with poor hydration status (AUC 0.78; p 0.0001, 95% CI 0.69-0.86). CONCLUSION: The new GDST presented an acceptable reliability and diagnostic accuracy that increased with the assessment of some items, such as tongue dryness. This is the first screening tool that presents a promising cut-off value.

[The nurses of the Ospedale Maggiore of Milan during the First World War. Peace, rights and dignity of work]. / Le infermiere dell'Ospedale Maggiore di Milano nella Grande Guerra. Pace, diritti e dignità del lavoro.

. The nurses of the Ospedale Maggiore of Milan during the First World War. Peace, rights and dignity of work. INTRODUCTION: During the First World War the Hospitals of the big cities had to care for the people injured in the war places. To face this challenge, important changes in the internal organization had to be implemented. OBJECTIVE: To investigate how the First World War changed the working conditions of the nurses on duty at the Ospedale Maggiore and to contribute to outline the professional identity during the years of the conflict. METHODS: The correspondence between the female nursing staff and the hospital administration in the time span between from 1915 to 1918 was examined. The documents were retrieved in the historical archive of the Ospedale Maggiore from November 2017 to march 2018 and were analyzed through the methodology of historic research according to Chabod. RESULTS: During the First World War the nurses asked the hospital administration for changes of their working conditions, which had become unbearable because of the conflict. They obtained improvements concerning: a reduction in nightshift work hours, the employment of 86 nurses to guarantee a day off every ten days, replacement of staff in case of absence, increase in salary, paid sick leave. CONCLUSIONS: The nurses of the Ospedale Maggiore of Milan during the First World War, hoping for peace, stood out for their diligence in the care of the sick both civilians and militaries. Besides, they managed to obtain the recognition of they rights and dignity in the workplace.

[Italian male nurses called to arms in World War II: the letters of the years of imprisonment]. / Gli infermieri italiani richiamati alle armi nella seconda guerra mondiale: l'epistolario degli anni di prigionia.

AIM: During the Second World War the male staff of assistance in the Italia hospitals was called to arms.This work concerns the letters sent by the male nurses who were captured by the Germans and put in prison. The aim is to know whether their profession had somehow affected their living condition in jail and had favoured their release or not. METHOD: 88 personal files of nurses on duty in Ospedale Maggiore and sent to the front during the period between 1940 and 1945 have been studied. The documents are kept in the historical archive of the Ospedale Maggiore of Milan and the research covered the period from December to January 2013. The sources have been analyzed according to Chabod's method of historical research (2012). 4 prisoners have been found among the 88 files of soldiers and handwritten letter has been selected for each one. RESULTS: These letters the attempt of the prisoners to reassure their loved ones emerges. Moreover, in the files of the prisoners' formal request for their release sent by hospital board were found. As a result one of the prisoners was released. CONCLUSIONS: This paper suggests that the fact of being a nurse in a hospital influenced the conditions during tha period of captivity. Much is still to be found to shed light on a dramatic period of our country and to restore the memory of the contribution given by the profession.

[A survey of accidents during the clinical rotation of students in a nursing degree program]. / Un'indagine sugli infortuni durante il tirocinio degli studenti del corso di laurea in infermieristica.

Like Registered Nurses, students too should be considered a risk category during the period of their clinical training. Their lack of experience and the anxiety linked to the first impact with healthcare techniques may lead to accidents. The present study aims to investigate the number, the type, the mode, the cause of occupational injuries, when and where they happened. It also wants to check the level of knowledge of procedures to follow in case of contamination with organic material, the reporting of the event, the level of concern felt by the student and which of the people he/she turned to were supportive. The survey realized through a questionnaire given to 142 undergraduate nursing students at the University of Milan, all attending the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. Out of the 127 who replied to the questionnaire, 32 had been directly involved in a total of 38 accidents. The figure shows percentage (25.2%) stating that the sample of nursing students described arises at a lower level of involvement in accidents than reported in the literature for similar series. Preventive measures and specific formative interventions should be implemented in order to reduce the incidence of accidents involving nursing students, especially where cutting devices are used.