Evaluating best evidence in occupational therapy for patients with hip replacement: guidelines.

SUMMARY: Object. The following study was carried out in order to evaluate through guidelines the best evidence in occupational therapy for daily activities and quality of life of patients with hip prostheses. Methods. Recommendations were generated following the grading method of the National Program for Guidelines/National System Guidelines (PNLG-SNLG), a system for developing guidelines for recommendations in clinical practice. The Appraisal of Guidelines Research and Evaluation in Europe (AGREE) tool was also applied. Results. A total of seven studies were included in this research: one randomized controlled trial, two systematic reviews, two outcomes research studies, and two observational studies. We found that, for the three clinical questions we proposed, more research on the effectiveness of treatments is required. Conclusions. The evidence resulting from this study is not sufficient to determine whether the rehabilitation techniques under consideration are effective.

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics.

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review.

OBJECTIVE: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context. STUDY DESIGN AND SETTING: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of predefined inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure. CONCLUSION: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.

Physical Activity Scale for the Elderly: Translation, Cultural Adaptation, and Validation of the Italian Version.

OBJECTIVE: The aim of the study was to translate and culturally adapt the Physical Activity Scale for the Elderly into Italian (PASE-I) and to evaluate its psychometric properties in the Italian older adults healthy population. METHODS: For translation and cultural adaptation, the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures" guidelines have been followed. Participants included healthy individuals between 55 and 75 years old. The reliability and validity were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. To evaluate internal consistency and test-retest reliability, Cronbach's α and Intraclass Correlation Coefficient (ICC) were, respectively, calculated. The Berg Balance Score (BBS) and the PASE-I were administered together, and Pearson's correlation coefficient was calculated for validity. RESULTS: All the PASE-I items were identical or similar to the original version. The scale was administered twice within a week to 94 Italian healthy older people. The mean PASE-I score in this study was 159±77.88. Cronbach's α was 0.815 (p < 0.01) and ICC was 0.977 (p < 0.01). The correlation with the BBS was 0.817 (p < 0.01). CONCLUSIONS: The PASE-I showed positive results for reliability and validity. This scale will be of great use to clinicians and researchers in evaluating and managing physical activities in the Italian older adults population.

Reliability and Validity of the Geriatric Depression Scale in Italian Subjects with Parkinson's Disease.

INTRODUCTION: The Geriatric Depression Scale (GDS) is commonly used to assess depressive symptoms, but its psychometric properties have never been examined in Italian people with Parkinson's disease (PD). The aim of this study was to study the reliability and validity of the Italian version of the GDS in a sample of PD patients. METHODS: The GDS was administered to 74 patients with PD in order to study its internal consistency, test-retest reliability, construct, and discriminant validity. RESULTS: The internal consistency of GDS was excellent (α = 0.903), as well as the test-retest reliability (ICC = 0.941 [95% CI: 0.886-0.970]). GDS showed a strong correlation with instruments related to the depression (ρ = 0.880) in PD (ρ = 0.712) and a weak correlation with generic measurement instruments (-0.320 < ρ <-0.217). An area under the curve of 0.892 (95% CI 0.809-0.975) indicated a moderate capability to discriminate depressed patients to nondepressed patient, with a cutoff value between 15 and 16 points that predicts depression (sensitivity = 87%; specificity = 82%). CONCLUSION: The GDS is a reliable and valid tool in a sample of Italian PD subjects; this scale can be used in clinical and research contexts.

A Psychometric Properties Evaluation of the Italian Version of the Geriatric Depression Scale.

OBJECTIVE: The Geriatric Depression Scale (GDS) is an evaluation tool to diagnose older adult's depression. This questionnaire was defined by Yesavage and Brink in 1982; it was designed expressly for the older person and defines his/her degree of satisfaction, quality of life, and feelings. The objective of this study is to evaluate the psychometric properties of the Italian translation of the Geriatric Depression Scale (GDS-IT). METHODS: The Italian version of the Geriatric Depression Scale was administered to 119 people (79 people with a depression diagnosis and 40 healthy ones). We examined the following psychometric characteristics: internal consistency reliability, test-retest reliability, concurrent validity, and construct validity (factor structure). RESULTS: Cronbach's Alpha for the GDS-IT administered to the depressed sample was 0.84. Test-retest reliability was 0.91 and the concurrent validity was 0.83. The factorial analysis showed a structure of 5 factors, and the scale cut-off is between 10 and 11. CONCLUSION: The GDS-IT proved to be a reliable and valid questionnaire for the evaluation of depression in an Italian population. In the present study, the GDS-IT showed good psychometric properties. Health professionals now have an assessment tool for the evaluation of depression symptoms in the Italian population.

Making it easy to do the right thing in healthcare: Advancing improvement science education through accredited pan European higher education modules.

BACKGROUND: Numerous international policy drivers espouse the need to improve healthcare. The application of Improvement Science has the potential to restore the balance of healthcare and transform it to a more person-centred and quality improvement focussed system. However there is currently no accredited Improvement Science education offered routinely to healthcare students. This means that there are a huge number of healthcare professionals who do not have the conceptual or experiential skills to apply Improvement Science in everyday practise. METHODS: This article describes how seven European Higher Education Institutions (HEIs) worked together to develop four evidence informed accredited inter-professional Improvement Science modules for under and postgraduate healthcare students. It outlines the way in which a Policy Delphi, a narrative literature review, a review of the competency and capability requirements for healthcare professionals to practise Improvement Science, and a mapping of current Improvement Science education informed the content of the modules. RESULTS: A contemporary consensus definition of Healthcare Improvement Science was developed. The four Improvement Science modules that have been designed are outlined. A framework to evaluate the impact modules have in practise has been developed and piloted. CONCLUSION: The authors argue that there is a clear need to advance healthcare Improvement Science education through incorporating evidence based accredited modules into healthcare professional education. They suggest that if Improvement Science education, that incorporates work based learning, becomes a staple part of the curricula in inter-professional education then it has real promise to improve the delivery, quality and design of healthcare.

Attitude and Knowledge of Pain Management Among Italian Nurses in Hospital Settings.

Pain is multidimensional, and, as such, the chief reason patients seek urgent healthcare services. If inadequately assessed and untreated, pain may negatively impact on the quality of life of the patient. Treating pain is an important step in regaining control over quality of life. The objective of the present study is to examine the level of knowledge and types of approach among Italian nurses who deal with pain assessment and management. The Ferrell and McCaffery's Knowledge and Attitudes Survey Regarding Pain (KASRP) was distributed to 286 nurses employed in one of the biggest specialized hospitals in Rome, Italy. The interviewed staff work at three different settings, according to the healthcare assistance they are required to provide: intensive care unit (ICU), subintensive care unit (SICU), and ordinary ward (OW). Descriptive statistics, including frequencies and means, as well as analysis of chi-square (p < .05), were used to compare differences in scores by demographic characteristics of the participants and different settings. A logistic regression model was performed to evaluate the factors that may influence the attitude to pain and the level of knowledge of care providers. Results have shown that the odds of developing positive attitudes towards pain management were 1.62 times higher (95% CI: .92 to 2.85) in nurses employed in SICUs than in those working in OWs, while the odds of possessing a satisfactory level of knowledge was 1.76 times higher (95% CI: .93 to 3.31) among nurses in ICUs than those in OWs. A "good assessment" was better for SICU (OR = 2.17, p < .05) and ICU (OR = 3.20, p < .05) nurses. Our survey has highlighted an overall limited level of knowledge in the assessment and management of pain among the nursing staff. It is therefore a priority to implement specific training to healthcare providers from different fields, who may respond differently to patients with pain. On the other hand, further investigations are required on a greater sample of Italian nurses to better understand how to overcome the most problematic barriers to achieving good pain assessment and control.

[ICNP- International Classification of Nursing Practice: origin, structure and development]. / ICNP - Classificazione Internazionale per la pratica infermieristica: origini, strutturazione e sviluppo.

ICNP is a standardized nursing terminology included within acknowledged terminologies by WHO, it is a relevant aspect of ICN programs and strategies. This paper aims to describe structure and characteristics of ICNP terminology as well as to highlight how this tool can be useful both in practice and in terms of nursing professional development. This version looks like a pyramid with seven axes describing different areas of nursing and related interventions, enriched by two special axes related to pre-coordinated Diagnosis / Outcomes (DC) and Operations (IC) which facilitate daily use in practice. In order to clarify how this tool can be actually be used in daily nursing practice some examples are provided, clarifying how adopting the current version of ICNP terminology (2015 release) Diagnosis/Outcomes and Interventions can be built. The ICNP Italian Centre is committed to introduce it to Italian nurses as a tool for sharing and disseminating terminology in our Country, having as main final aim to achieve even in Italy, professional visibility objectives promoted in different ways by the International Council of Nurses.

Distraction as a technique to control pain in pediatric patients during venipuncture. A narrative review of literature.

INTRODUCTION: Distraction is a non-pharmacological intervention aimed to reduce procedural pain in children. Venipuncture is one of the most widely used diagnostic and therapeutic procedure in pediatric patients. Analgesia during venipuncture may be efficiently achieved with distracting techniques. OBJECTIVE: To describe active and passive distraction techniques to reduce distress in children undergoing venipuncture. METHOD: Data from CINHAL, PubMed, ILISI and Cochrane's databases were used to review existing literature and primary and secondary studies published between 2003 and 2014 were included. Queries were obtained with keywords such as distraction, complementary therapies, pain, pediatric, the Boolean operators AND and OR were used. RESULT: Twenty eligible articles out of the one hundred and forty-three retrieved (20/143) were selected; among these there were 3 systematic and 5 narrative reviews, 11 experimental and quasi-experimental studies and 1 observational study. Active and passive distraction techniques seemed extremely effective to reduce distress and pain in children undergoing venipuncture. Modest evidence of efficacy and absent side effects support this approach. CONCLUSION: Further RCTs are needed to compare the different types of existing active and passive distraction techniques. The presence of parents and the location where painful procedures are administered should be included in the assessment of this approach.

[The concept of Health Literacy and its importance for nursing]. / Il concetto di Health Literacy e la sua importanza per la professione infermieristica.

INTRODUCTION: Individuals and population's health is influenced by environmental, social economical and cultural aspects which in turn connect individuals to society. In order to decide autonomously, independently and consciously individuals should have several competences. The aim of this study is to identify, analyse and emphasise health literacy concept relevance per se,its relationship with nursing through a narrative revision focused on: Health literacy definition recognition and analysis; evaluation of connection between nursing and health literacy. METHODS: A narrative review was carried out through PUBMED and CINHAL, using 'health literacy' and nursing related terms, in English or Italian between 2010 and 2015. RESULTS: Results show that 'health literacy' is fully appraised, while attention paid by nurses on the topic is poor due both to a lack of awareness of its relevance on individuals' health and of appraisal. Twenty-height definition emerged from the revision; concepts expressed by scholars are mainly focused on very few individuals' abilities and competences applied to the health context (reading, writing, calculation, comprehension, listening and so on). CONCLUSIONS: According to the results it is difficult to define health literacy due to its multidimensional nature. Notwithstanding the above an attempt to develop a unique new definition of health literacy has been carried out although its multidimensional nature and its strong connection to several variables constantly under development. Nevertheless it is imperative that educational modules would be developed and stably integrated in health care education, at the same time a strong effort is due from professional and policy makers to provide population of the necessary tools in order to improve their health.

[Non-urgent access to care and nurses' roles in the Emergency Department: a narrative literature review]. / Accessi non urgenti nel Dipartimento di Emergenza (D.E.) e ruoli dell'infermiere. Una revisione narrativa della letteratura.

PURPOSE: To detect what is written in literature with respect to the access of non-urgent patients in Emergency Department, highlighting associated nursing roles during the period 2003-2013. METHOD: A literature review on international literature was carried out using PubMed database, where 41 significant articles were selected. RESULTS: The articles analyzed are focused on the organization of the E.D., the response patterns (Fast Track-See and Treat etc.) in some countries and the evaluation of the nursing roles and competences. In literature, the model and the roles studied have proved to be effective in reducing waiting times in E.D. and increasing users' satisfaction without reducing the quality of provided care. CONCLUSIONS: The literature shows that the implementation of Fast Track must be developed with a nursing staff with advanced skills on emergency. The introduction of these roles assumes that health systems should address the problem of inter-professional work.

[E-learning and university nursing education: an overview of reviews]. / E-learning e formazione infermieristica universitaria: una overview delle revisioni.

INTRODUCTION: The increasing use of digital technologies and e-learning in nursing education and the health professions was also reflected in the time to many studies and reviews. The aim of this overview was to analyze education through e-learning technologies for nursing and health professional students. METHOD: A comprehensive search of literature was conducted using database PubMed/MEDLINE, Ebsco/CINAHL, 2003-2013. RESULT: The search strategy resulted in the inclusion, in first instance, of 9732 items. After the reduction of duplicates, applying limits and other parameters of inclusion/exclusion and, at the end, evaluation of quality through AMSTARD check list, we included in this overview, 22 reviews. The analized reviews were allowed to spread in different topic areas: study population (students and faculty), e-learning methods (blended learning Game/3D/situated learning) and evaluation (information technology, learning satisfaction comparison of e-learning with the traditional teaching methods) CONCLUSION: This overview demonstrates that e-learning in nursing academic education is a valid alternative to traditional learning. If e-learning activities are well structured and modulated, some advantages and economies are clear possible. Regard effects of e-learning on the improvement of ability, data are at the momenti limited when compared to traditional learning. Often e-learning appear as an adjunct respect traditional learning, but is necessary consider e-learning and digital tecnology as priority for the future of education of nursing students.

[The Italian armed forces health service during the Great War]. / Le service de santé des armées italien durant la Grande Guerre.

The Great War had a huge impact on Italian society. The organisation of the armed forces health service faced extreme difficulties due to the extensive loss of life of an almost exclusively terrestrial war. In this context, the role of the medical staff and nursing staff was essential, as the example of the volunteer Red Cross nurses testifies. However, this conflict revealed the need to improve the training of the nursing staff, as was the case in Anglo-Saxon countries.

[Alzheimer's disease and caregivers experience in home care]. / L'esperienza dei caregiver primari che assistono a domicilio le persone affette dalla Malattia di Alzheimer.

The aim of this study is to investigate the experience of primary caregivers (men and women) of Alzheimer Disease dementia, in order to tailor program and project to avoid care giving burden. A qualitative phenomenological method was used and the sample was defined by data saturation. Interviews were carried out and recorded in a day care Centre, transcribed verbatim. The analysis was conducted coding common themes and phrases. Six main themes emerged. Our results are similar to those existing in literature, showing care givers as individual in great danger physically and mentally. In the light of the study it is possible to tailor a nursing model in order to improve quality of life and decrease the burden of caregivers, this model should be implemented and analyzed.

[Etiology and prevalence of chronic pain in adults: a narrative review]. / La Prevalenza del Dolore Cronico Non Oncologico nell'Adulto e Patologie Associate: una revisione narrativa della letteratura.

The chronic nonmalignant pain is an underestimated epidemiologic health problem. It is a disease in its own right. It is one of the major reasons because patients use health service. The magnitude of chronic pain is in terms of human suffering and costs to society. The aim of this review is to identify the diagnosis and the prevalence of nonmalignant chronic pain in the adults. We have done a review of the literature from 1998 to 2012 using the virtual newspaper libraries starting from data bases (Pub-Med, CINAHL, Cochrane). We have made a narrative review of the articles obtained. Excluding topics of headache, pain for pediatric and geriatric groups, cancer pain and disease-specific items. Studies were classified for year, author sample, methods, age groups and definition of pain. We have obtained 7 articles. These epidemiological studies conducted in different part of the world, reported prevalence rates of chronic pain ranging from 16-53%. They shows a high heterogeneity of results concerning diagnosis and methods. Although limited the number of articles, show the high complexity of the phenomenon.

Anatomy and physiology for nursing students: is problem-based learning effective?

This study investigated whether problem-based learning (PBL) was an effective strategy for nursing students learning anatomy and physiology. Anatomy and physiology are subject areas that have posed long standing difficulty for nursing students. Since anatomy and physiology underpin clinical decision making it is important that nursing students are able to understand and retain this knowledge and apply it to practice. Problem-based learning offers potential advantages for teaching anatomy and physiology as clinical cases can provide the impetus for student problem solving. This project trialled a simple PBL scenario and investigated students' response to the task of problem solving in a laboratory setting adapted to simulate a hospital ward. The study found students learn better, retain the knowledge and merge theory with simulated practice when a PBL teaching mode is used. While PBL was effective, blended, web based and hybrid PBL models warrant investigation.

[The status of the art of scientific articles in Italy between 2003 -2009: an analysis of articles published by nursing Italian journals]. / La produzione scientifica italiana attaverso un'analisi degli articoli pubblicati sulle riviste infermieristiche: 2003-2009.

This study investigates  the number of  articles published by Italian nursing journals by analyzing five Italian journals between 2003 and 2009. This is the third part of a study started  in 1978,  two articles were already published in 2005. The work is aimed at monitoring the number of nursing articles published. The articles were cataloged according to predefined criteria with the main aim to verify the status of the progress of research and theoretical development among Italian nurses. Results show that, although there is an increase in publications which apply research methods, these are still below the international trend and that, at national level, nurses prefer  topics such as care plans, regulations and organization of work rather than research or scientific evidence. On the one hand there is a raise on Italian nurses of interest in wider topic in order to be closer to the international debate, on the other hand there is a lack of adequate tools to improve knowledge and specific investments in research. As result of this there is a strong limitation in the knowledge growth of Italian nurses together with a lack of participation among and for different generations of nurses. In addition to the above it has been enucleated a scarcity within the literature analyzed of development of theoretical models, theories and concepts. Conversely theoretical models, theories and concepts are important pillars of scientific knowledge and they have a strong role in professional development, moreover these are necessary in order to set and improve nursing and nurses image nowadays far from the exclusive applied science.