Observed and Perceived Pain: Findings of a Cross-Sectional Study in Hospitalized Subjects.

BACKGROUND: Pain constitutes a serious problem of a health, economic, ethical, and social equity nature affecting negatively quality of life. Its assessment is often subjected to overestimation or underestimation. AIM: The aim of this study is threefold: (1) to estimate the prevalence of pain in hospitalized patients; (2) to assess the grade of correlation between the level of pain observed by the nurses and the pain perceived by the patients; and (3) to examine the level of scientific knowledge among the healthcare professionals. DESIGN: Cross-sectional study. METHODS: The intensity level of observed and perceived pain has been evaluated in 401 patients with validated scales. Analyzed data have been extracted from the electronic medical record and integrated into the data-collection sheet. A questionnaire has been submitted to nurses to investigate their level of knowledge on pain assessment and management. RESULTS: The study included 350 patients out of 401; for 51 patients the "pain" data was missing. Prevalence of perceived pain was 40.15%. Nurses overestimated pain in 7.43% of cases and underestimated it in 24.9%. The majority of the nursing staff claimed to be aware of the pain topic, however, they showed some uncertainties in clinical practice. CONCLUSIONS: The differential variation between the observed pain and the perceived one resulted in 43.71% of cases, highlighting the dependence on the two variables: "area of hospitalization" and "intensity level". The observation and monitoring of pain did not appear to be a consolidated practice, thus representing an important area for investments in the nursing profession.

Pressure ulcers in hospital patients: incidence and risk factors.

OBJECTIVE: With an ageing population and a rising number of people with chronic conditions and disabilities, pressure ulcers (PUs) are a frequent problem. Prevention and treatment, especially targeted at older people, frail and non-self-sufficient patients, are central to care provided by nurses. The objective of this study is to establish the incidence of PUs in hospital inpatients and identify possible associated risk factors. METHOD: A clinical observational study was conducted from May to November 2019 in a sample of patients admitted to Azienda Sociosanitaria Ligure 2 in Italy. Clinical and sociodemographic data were collected at admission and at discharge, through a questionnaire or collection card. The analysis was done using SAS 9.4 2017 software. RESULTS: In 7% of the 515 participating patients, PUs occurred during hospitalisation; PUs at stages I and II were predominantly in the coccyx, heels and malleolus. CONCLUSION: Significant associations were found between the development of lesions and age, certain pathologies, the degree of patient autonomy and the level of skin integrity.

The implementation of a standardized optimal procedure for peripheral venous catheters' management: Results from a multi-dimensional assessment.

Peripheral Venous Catheter (PVC) is a widely used device in the hospital setting and is often associated with significant adverse events that may impair treatment administration and patient health. The aim of the present study is to define the incremental benefits related to the implementation and the standardized and simultaneous use of three disposable devices for skin antisepsis, infusion, and cleaning, assuming the hospital's point of view, from an effectiveness, efficiency, and organizational perspective. For the achievement of the above objective, real-life data were collected by means of an observational prospective study, involving two hospitals in the Liguria Region (Northern Italy). Consecutive cases were enrolled and placed into two different scenarios: 1) use of all the three disposable devices, thus representing the scenario related to the implementation of a standardized optimal procedure (Scenario 1); 2) use of only one or two disposable devices, representing the scenario related to not being in a standardized optimal procedure (Scenario 2). For the definition of effectiveness indicators, the reason for PVC removal and the PVC-related adverse events occurrence were collected for each patient enrolled. In addition, an activity-based costing analysis grounded on a process-mapping technique was conducted to define the overall economic absorption sustained by hospitals when taking in charge patients requiring a PVC. Among the 380 patients enrolled in the study, 18% were treated with the standardized optimal procedure (Scenario 1). The two Scenarios differed in terms of number of patients for whom the PCV was removed due to the end of therapy (86.8% versus 39.40%, p-value = 0.000), with a consequent decrease in the adverse events occurrence rate. The economic evaluation demonstrated the sustainability and feasibility of implementing the standardized optimal procedure specifically related to the need for lower economic resources for the hospital management of adverse events occurred (€19.60 versus €21.71, p-value = 0.0019). An organizational advantage also emerged concerning an overall lower time to execute all the PVC-related activities (4.39 versus 5.72 minutes, p-value = 0.00). Results demonstrate the feasibility in the adoption of the standardized optimal procedure for PVC management, with significant advantages not only from a clinical point of view, but also from an organizational and economic perspective, thus being able to increase the overall operational efficiency of the hospitals.

Management of symptomatic florid cemento-osseous dysplasia: Literature review and a case report.

INTRODUCTION: Cemento-osseous dysplasia is a jaw disorder characterized by a reactive process in which normal bone is replaced by connective tissue matrix. There are different Cemento-osseous dysplasia entities. The treatment of these lesions, once diagnosed by radiology, is not required because generally they are asymptomatic. The localization is in the tooth-bearing areas of the jaws and its distribution is symmetric. CASE REPORTS: In this case report, a 57-year-old Caucasian female patient was referred to our attention complaining of painful inflammatory events localized in the right angle of the jaw. The radiographic appearance, the distribution of several lesions and the positive vitality test of the involved teeth, supported the diagnosis of Florid Cemento-osseous dysplasia. Because of the symptomatology, the patient was submitted to surgery and the lesion and the second inferior right molar were removed. The histological examination of the specimens confirmed the diagnosis. DISCUSSION: Many lesions that may exhibit a similar sclerotic appearance on conventional radiographs have to be differentiated and dental imaging can be used to discriminate between Florid COD and other lesions. Diagnosis of Florid Cemento-osseous dysplasia can be made with accurate clinical and radiographic assessment. In asymptomatic cases no treatment is required and the patient should have regular follow-up, but in this symptomatic case it was necessary to proceed with surgical intervention. The surgery treatment in the symptomatic case had a favourable prognosis and the two years follow-up has shown a complete healing. Given the abow, it is concluded that the choice of treatment must be selective according to the disease sites. Key words:Cemento-ossifying dysplasia, fibro-osseous lesions, florid cemento-osseous dysplasia, cementoma.