The SYSTEMIC Project: A Pilot Study to Develop a Registry of Patients With an Ostomy for Predictive Modeling of Outcomes.

BACKGROUND: Stomal and peristomal skin complications represent a significant burden on the physical and psychological well-being of patients. PURPOSE: To develop a predictive tool for identifying the risk of complications in patients following ostomy surgery. METHODS: The oStomY regiSTry prEdictive ModelIng outCome (SYSTEMIC) project was developed to improve patient-oriented outcomes. Demographic, medical history, and stoma-related variables were obtained from patients at the wound ostomy clinic of the University Hospital of Padova, Italy. A follow-up assessment was completed 30 days after stoma surgery. Two (2) Bayesian machine learning approaches (naïve Bayes) were carried out to define an automatic peristomal complication predictive tool. A sensitivity analysis was performed to evaluate the possible effects of the prior choices on naïve Bayes performance. RESULTS: The algorithms were based on preliminary data from 52 patients (28 [53.3%] had a colostomy and 24 [46.7%] had an ileostomy). In terms of postoperative complications, no significant differences were observed between patients with different body mass indices (P = .16), those who underwent elective surgery compared with those who underwent emergency surgery (P = .66), and those who had or had not been preoperatively sited (P = .44). The algorithms showed an overall moderate ability to correctly classify patients according to the presence of peristomal complications (accuracy of nearly 70% in both models). In the the data-driven prior model, the probability of developing complications was greater for  participants with malignancies or other diseases (0.3314 for both levels) than for patients with diverticula and bowel perforation (0.1453) or inflammatory bowel disease (0.1918). CONCLUSION: The development of an easy-to-use algorithm may help nonspecialized nurses evaluate the likelihood of future peristomal complications in patients with an ostomy and implement preemptive measures.

Perceived aggression towards nurses: study in two Italian health institutions.

AIMS: The goal of the present study was to quantify the perceived aggression towards nurses working in two Italian health care institutions and to verify the hypothesis of an association between the characteristics of aggressors and the type of aggression. BACKGROUND: Violence and aggressiveness, particularly aimed at nurses, are a common, but inadequately investigated phenomenon in Italian health care institutions. DESIGN: A cross-sectional study. METHODS: The study was performed, studying a sample of 700 nurses (37% of the personnel in 94 units) in two health care institutions in northeast Italy using an anonymous multiple-choice questionnaire. RESULTS: Forty-nine percent of the nurses responded that they had experienced aggression in the previous year, 82% of that was only verbal. This happened more often to female nurses working in the emergency department and in geriatric and psychiatric units. A statistically significant association (p < 0.001) was found between the perception of fatigue, stress and work dissatisfaction and the frequency of aggression. Aggressors were usually patients or their relatives (57%) and were mainly men (66%). Fifty-three percent of assaulted nurses did not ask for help after the event. CONCLUSIONS: This study confirms the high incidence of perceived, mainly verbal aggression towards nurses. RELEVANCE TO CLINICAL PRACTICE: Action to prevent aggressive episodes may include concentrating on job motivation, encouraging participatory leadership and promoting the best possible working conditions. The absence of any systematic event reporting and documentation makes the assaulted workers feel defenceless.