Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study.

The aim of the study was to explore the effects of Intentional Rounding, a regular-based proactive patient monitoring, on falls and pressure ulcers in internal medicine units. This is a cluster-randomised controlled study, where units were assigned (1:1) to Intentional Rounding (intervention group) or Standard of Care (control group). The primary outcome was the cumulative incidence of falls and new pressure ulcers. These events were considered separately as secondary endpoints, together with the number of bell calls and the evaluation of patient satisfaction. Primary analyses were carried out on the modified intention-to-treat population (hospitalisation of at least 10 days). Recruitment occurred between October 2019 and March 2020, at which time the study was prematurely closed due to the COVID-19 pandemic. Enrolment totalled 1822 patients at 26 sites; 779 patients were included in the modified intention-to-treat analysis. The intervention group had a lower risk of falls (adjusted incidence rate ratio 0.14; 95% confidence interval, 0.02-0.78; p = 0.03). There were no statistical differences in new pressure ulcers or the cumulative incidence of both adverse events. Mean bell calls for each patient were 15.4 ± 24.1 in the intervention group and 13.7 ± 20.5 in the control group (p = 0.38). Additionally, patient satisfaction in the intervention group was almost at the maximum level. Our study supports the usefulness of Intentional Rounding in a complex and vulnerable population such as that hospitalised in internal medicine units.

[Palliative care and end-of-life care: nurse, what are you looking for?] / Cure palliative e di fine vita: infermiere, cosa cerchi?

Palliative care and end-of-life (EOL) care are highly requested in hospital, especially in the Internal Medicine wards, exposed, as they are, to receive elderly, frail patients affected by multiple chronic diseases and limited life expectancy. Within the medical staff, the nurses are specifically responsible to guarantee an appropriate and non-futile standard of care for this kind of patients, oriented to their real requirements and primarily to the relief their symptoms, without disregarding their spiritual needs. The competence in EOL-care should be equally distributed and shared among physicians and nurses in all clinical settings, because every single component should be able to plan its own intervention according to the comfort care concept, and, in the meanwhile, should be able to share decisions in an interdisciplinary manner. This is the only way for clinical pathways to result efficacious as they should be.«Astieniti nelle ultime fasi di vita della persona assistita da procedure invasive, seleziona gli interventi da attuare a garanzia della sua dignità, della sua qualità di vita e della gestione di sintomi, in modo particolare del controllo del dolore¼.

Patient education in peritoneal dialysis: an observational study in Italy.

This observational study describes the characteristics of the education programmes used in Italian PD-centres, evaluating a possible relationship between programmes and peritonitis rates. The survey involved 150 non-paediatric public dialysis centres in Italy. The data were collected by a questionnaire and evaluated with SPSS software. Descriptive statistics of synthesis were calculated, Kruskal-Wallis, Wilcoxon's test were used to verify the differences in the replies, and association between variables was tested with Pearson correlation and Pearson's chi2 test. 120 dialysis centres took part in the survey and reported a median incidence of peritonitis of 1/29 months. Training occurs in all the centres, while pre-dialysis education, home visits and re-training take place in 38.3%, 50% and 44.2% respectively. A lower peritonitis rates proves to be correlated to these activities rather than to presence of specialised personnel, to ratio nurses-patients or training time.