Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures. DESIGN: Open-label, parallel-group, 2-arm, superiority trial. SUBJECTS AND SETTING: The sample comprised older patients aged 69 to 97 years admitted to a 1500-bed university hospital in Bologna, Italy, for hip fracture surgery. METHODS: Patients were randomly allocated to an intervention or control group. Both groups received standard evidence-based PI preventive care in accordance with National Pressure Ulcer Advisory Panel guidelines. In addition, patients in the intervention group received a single 12.9 × 12.9-cm multilayered polyurethane foam dressing shaped for the sacrum area applied within 24 hours of hospital admission. Bivariate analysis on primary and secondary outcomes and baseline characteristics was performed to compare group differences, and a survival analysis was used to determine the difference in PI incidence rates per group. RESULTS: Sixty-eight patients completed the trial; 34 patients were allocated to the intervention group and 34 patients to the control group. A trend toward significance was observed for sacral PI occurrence in the intervention group (intervention: 20.6%; control: 2.9%; P = .054). The foam dressing allowed significantly longer time (days) to PI occurrence (intervention: 5.9 ± 1.60; control: 2.7 ± 0.96; P = .003). CONCLUSIONS: These findings suggest that multilayered polyurethane foam dressings are not superior to the standard preventive PI care alone and should be used with caution, especially when multiple dressing changes may occur. Further exploration of the role of multilayered polyurethane foam dressings in preventing PI development is warranted.

Predictive factors for category II pressure ulcers in older patients with hip fractures: a prospective study.

OBJECTIVE: To identify the incidence of category II or higher hospital-acquired pressure ulcers (HAPU) and significantly associated factors in older patients with hip fractures. PUs are a frequent complication in hip fracture patients, negatively impacting patients' quality of life, the health-care system and society. METHOD: A prospective cohort study was conducted. A consecutive sample of patients with pertrochanteric, femoral neck or subtrochanteric fractures requiring surgical treatment, were included. A stepwise, multiple regression was performed to identify factors associated with PU development. RESULTS: A total of 761 patients aged ≥65 years were sampled. The incidence of category II or higher PUs was 12%. The study identified five factors that were significantly, independently associated with category II or higher PU development, including a higher preoperative Braden score (Hazard Ratio [HR]: 0.884; 95% confidence interval [CI]: 0.806-0.969), surgical procedure with osteosynthesis (HR 1.876; 95%CI: 1.183-2.975), a higher percentage of days with the presence of foam valve before surgery (HR: 1.010; 95%CI: 1.010-1.023) and a urinary catheter (HR: 1.013; 95%CI: 1.006-1.019) and diaper (HR: 1.007; 95% CI 1.001-1.013) in the postoperative period. CONCLUSION: Attention should be given by clinical staff to avoiding the use of foam valves, to limiting the use of diapers and to early removal of urinary catheters.

Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study.

PURPOSE: The study aims to analyze the incidence of 30-day mortality in elderly patients who underwent surgery for hip fractures and its associated factors. METHODS: A prospective multicentric study was performed. All patients aged ≥ 65 years, with fragility hip fractures, consecutively admitted in two Italian hospitals were included. Patients with periprosthetic or pathological fractures were excluded. Logistic regression was used to identify patient and patient care variables that independently influenced the 30-day mortality and receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome. RESULTS: Of the patients, 728 met the inclusion criteria, of whom approximately 5% died within 30 days after admission. The 45.7% of the deceased patients died while hospitalized. Multivariate analysis showed that advancing age was the only independent predictor of 30-day mortality (OR = 1.084, 95% CI = 1.024-1.147), while a higher presence of informal caregivers was a protective factor (OR = 0.988, 95% CI = 0.979-0.997). The area under the ROC curve of the model was 0.723 (CI95% 0.676-0.770) for 30-day mortality in elderly hip fractures patients. CONCLUSIONS: Patients with an advanced age need careful follow-up, especially within 30 days following operation for hip fracture; at the same time, the presence of informal caregivers at the patient's bedside should be promoted.

What Factors Are Associated With the Recovery of Autonomy After a Hip Fracture? A Prospective, Multicentric Cohort Study.

OBJECTIVE: To identify the factors associated with recovering autonomy in activities of daily living (ADL) in patients who have had a hip fracture. DESIGN: A prospective cohort study. SETTING: The orthopedic and orthogeriatric departments of 2 regional hospitals. PARTICIPANTS: Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture. MAIN OUTCOME MEASURES: The level of autonomy at 4 months was assessed using the ADL scale. RESULTS: The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014). CONCLUSIONS: Recovery of deambulation, treatment of disorientation and management of incontinence are modifiable factors significantly associated with the functional recovery of autonomy.

In-hospital elderly mortality and associated factors in 12 Italian acute medical units: findings from an exploratory longitudinal study.

BACKGROUND: Given the progressive demographic ageing of the population and the National Health System reforms affecting care at the bedside, a periodic re-evaluation of in-hospital mortality rates and associated factors is recommended. AIMS: To describe the occurrence of in-hospital mortality among patients admitted to acute medical units and associated factors. Two hypotheses (H) were set as the basis of the study: patients have an increased likelihood to die H1: at the weekend when less nursing care is offered; H2: when they receive nursing care with a skill-mix in favour of Nursing Aides instead of Registered Nurses. METHODS: Secondary analysis of a prospective study of patients >65 years consecutively admitted in 12 Italian medical units. Data on individual and nursing care variables were collected and its association with in-hospital mortality was analysed by stepwise logistic regression analysis. RESULTS: In-hospital mortality occurrence was 6.8 %, and 37 % of the patients died during the weekend. The logistic regression model explained 34.3 % (R 2) of the variance of in-hospital mortality: patients were six times (95 % CI = 3.632-10.794) more likely at risk of dying at weekends; those with one or more AEDs admissions in the last 3 months were also at increased risk of dying (RR 1.360, 95 % CI = 1.024-1.806) as well as those receiving more care from family carers (RR = 1.017, 95 % CI = 1.009-1.025). At the nursing care level, those patient receiving less care by RNs at weekends were at increased risk of dying (RR = 2.236, 95 % CI = 1.270-3.937) while those receiving a higher skill-mix, thus indicating that more nursing care was offered by RNs instead of NAs were at less risk of dying (RR = 0.940, 95 % CI = 0.912-0.969). CONCLUSIONS: Within the limitations of this secondary analysis, in addition to the role of some clinical factors, findings suggest redesigning acute care at weekends ensuring consistent care both at the hospital and at the nursing care levels.

The degree of satisfaction of in-hospital medical patients with nursing care and predictors of dissatisfaction: findings from a secondary analysis.

BACKGROUND: Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. AIMS: To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. DESIGN AND METHODS: A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012-2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale (PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 - very dissatisfied to 44 - very satisfied). Patients were defined as 'satisfied with NC' when the score was ≥33, whereas they were considered as 'dissatisfied with NC' when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. RESULTS: There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients (RR 1.883, 95% CI 1.359-2.609), in those who developed pressure sores during the in-hospital stay (RR 1.555, 95% CI 1.021-2.368), who received NC with high skill mix (RR 1.072, 95% CI 1.034-1.111) and those who were admitted to a large hospital (RR 1.001, 95% CI 1.001-1.002). In contrast, increased age (RR 0.987, 95% CI 0.975-0.998), increased amount of care offered by Registered Nurses (RR 0.984, 95% CI 0.974-0.994), a higher proportion of baccalaureate nurses on staff (RR 0.975, 95% CI 0.958-0.993) and being admitted to a teaching hospital (RR 0.497, 95% CI 0.130-0.910) all decreased the likelihood of being dissatisfied with NC. CONCLUSIONS: Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction.

Factors affecting in-hospital informal caregiving as decided by families: findings from a longitudinal study conducted in acute medical units.

BACKGROUND: Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. AIMS: To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. DESIGN AND METHODS: A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. RESULTS: All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. CONCLUSIONS: Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts.

Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units.

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels.

Post-hoc validation of the Conley Scale in predicting the risk of falling with older in-hospital medical patients: findings from a multicentre longitudinal study.

BACKGROUND: The Conley Scale is one of the most widespread fall-risk screening tools in medical unit settings, despite the lack of data regarding its validity in patients currently admitted to these units. AIMS: Establishing the validity of the Conley Scale in identifying patients at risk of falling in an acute medical setting. METHODS: A 6-months longitudinal study in 12 acute medical units from September 2012 to March 2013, a total of 1464 patients with ≥65 years of age were consecutively enrolled and evaluated with the Conley Scale within 24 h of admission. A construct validity, internal consistency, and a priori and a posteriori predictive validity study was performed. RESULTS: The explorative factor analysis showed a two-factor structure explaining a total variance of 48.3 %: previous history (30.41 %), and physical and cognitive impairment (17.9 %). The scale reported a poor internal consistency (Cronbach's α = 0.465) and the capability to correctly identify 18/649 patients as being at risk of falling, whereas the negative predictive value was 98.5 %. The sensitivity and specificity values were 60.0 and 55.9 %, respectively. No difference emerged between patients scored as at risk and those scored as not at risk in the time elapsed from admission to the first fall (HR = 0.600, 95 % CI 0.289-2.247 p = .166). DISCUSSION: The Conley Scale is not able to predict falls in elderly acute medical patients, and has reported poor internal consistency and accuracy. CONCLUSIONS: More studies are needed to develop appropriate tools to predict the risk of falling in elderly individuals admitted to an acute medical setting.

Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study.

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R(2)) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.

[Medicine wards of Local Health Authority 18 of Rovigo - Prospective Survey]. / Score (BRASS) nei reparti di Geriatria e Medicina dell'Azienda Ulss 18 di Rovigo - Studio prospettico.

AIM: The primary objective of the study is to measure the phenomenon of the difficult discharge through the implementation and use of a validated instrument that can support later the nurse in planning the discharge of patients hospitalized in the departments of Medi- cine and Geriatrics. SECONDARY OBJECTIVES: - Experience using the index of BRASS - To study the characteristics of the population at risk of difficult discharge METHOD: prospective observational study to measure the phenomenon of the difficult discharge through the implementation of the index of BRASS in the Medicine and Geriatrics wards of Hospital of Rovigo Ulss 18, in order to study the characteristics of the population at risk of discharge difficult. RESULTS: In a sample of 165 patients, 42.4% (70) respectively at risk was high and medium discharge difficult, while 15.2% (25) were at low risk. The average score was 18.76 BRASS. 37.6% of high-risk patients were hospitalized in Geriatrics, while in Medicine patients are more concentrated in the middle class risk. CONCLUSIONS: The study made it possible to measure the phenomenon of the difficult discharge classifying patients into risk groups. The analysis of the resignation protected revealed the congruence between score BRASS and sample characteristics. The instrument does not require long compile times, is to support decision-making because of the nurse notes the need to create a structured on the discharge of the patient, in a systematic and planned, avoi- ding the dispersion of important information to the right to ensure continuity welfare.

Living with rotationplasty--quality of life in rotationplasty patients from childhood to adulthood.

BACKGROUND: Knowledge about the long-term sequelae of rotationplasty, in adults treated surgically in childhood for Osteosarcoma in the lower limb, mainly concerns function and performance; the aim of this study is to explore the experience and the Quality of Life (QoL) of the patients who underwent Rotationplasty from 1986 to 2006 in Italy. METHODS: Quantitative test: Administration SF-36 questionnaire to 20 subjects aged ≥16 years. Qualitative test: Semi-structured interview recorded in 10 of these subjects. RESULTS: Greater well-being was found in the Mental Component Summary (MCS) scale of subjects aged over 24 years, with a score mean of 54.2 (±4.8), compared with that of those aged up to 24 years, with a mean score of 48.0 (±6.6), P = 0.04. Relational and emotional difficulty in adolescence, which had been partially overcome in adulthood, was revealed. CONCLUSIONS: The assessment of QoL by the SF-36 questionnaire was effective, and a correspondence was found between what emerged from the quantitative study and the contents of the interview. Knowing the strengths and weaknesses that were highlighted is indispensable for parents and operators when choosing among the various surgical options and to facilitate coming to terms with the injury and the "scars".

[Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in patients undergoing surgery]. / Studio randomizzato e controllato sull'efficacia del Corpitolinol 60 nella prevenzione delle lesioni da pressione nei pazienti sottoposti ad intervento chirurgico.

UNLABELLED: Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in surgical patients. INTRODUCTION: The risk of pressure sores in surgical patients is widely recognised. The Corpitolinol 60 (Sanyréne®) applied on compressed areas seems to reduce the risk of pressure sores. AIM: To assess the efficacy of Corpitolinol 60 in preventing pressure sores in the operatory theatre. METHODS: The open label randomized clinical trial was conducted in 5 operating theatres of Northen Italy. Patients were randomized to receive Corpitolinol 60 in areas undergoing compression. Experimental group and controls were treated with usual measures for preventing pressure sores. The lesions were staged according to NPUAP up to 24 hours after surgery. RESULTS: Three-hundred-one patients were randomized (155 in the Sanyréne® group and 143 controls). The main variables predictive of pressure sores risk (ASA class, sex, age, duration of the surgery, and BMI) were comparable across groups. At the end of the surgery 71 patients (23.8%) in the experimental group and 47 controls (30.8%) had a pressure sore (p 0.006; RR 1.81 IC95% 1.17-2.79). Twelve and 24 hours after surgery the differences between groups were not significant. CONCLUSIONS: The aim of reducing pressure sores was not reached for patients treated with Corpitolinol 60.

[Multicentre, prospective cohort study, to validate the Italian version of the Braden Q scale for the risk of the pressure sores in newborns and up to 8 years old children]. / Studio di coorte prospettico multicentrico per la validazione italiana della Braden Q per la valutazione del rischio di lesioni da decubito nei neonati e nei bambini fino ad 8 anni.

UNLABELLED: Multicenter prospective cohort study, to validate the Italian version of the Braden Q scale for the risk of pressure sores in newborns and up to 8 years old children. INTRODUCTION: Children admitted to Intensive care Units (ICU), oncology and neurology/neurosurgery wards are at risk of developing pressure sores. AIM: To validate the Italian version of the Braden Q scale for the assessment of the risk of developing pressure sores in children. METHODS: Children from 21 days to 8 years, admitted to intensive and sub intensive units were recruited. Premature babies, children admitted with a pressure sore and with a story of congenital cardiomiopathy were excluded. In this cohort, multicentre and with repeated measurements study, the first assessment was performed after 24 hours from hospital admission, using the Braden Q Scale (Suddaby's version). The pressure sores were assessed with the Skin assessment Tool and staged according to the National Pressure Ulcer Advisory Panel. RESULTS. On the 157 children 524 observation were conducted. The incidence of pressure sores was 17.2%. Only the analysis on specific subgroups of patients showed a good diagnostic accuracy: 71.4% on children 3-8 years; 85.6% in sub intensive wards. CONCLUSIONS: The Braden Q scale may be reliably used and shows a good diagnostic accuracy in children 3-8 years of age admitted to sub-intensive, neurology, oncology and heamatology wards.

[A three-months follow up of a randomized controlled trial of Assisted Walking Program for in-hospital geriatric patients]. / Valutazione dell'efficacia di un programma individualizzatodi deambulazione assistita nel paziente anziano ospedalizzato con follow-up a tre mesi: trial randomizzato e controllato.

. A three-months follow up of a randomized controlled trial of Assisted Walking Program for in-hospital geriatric patients. INTRODUCTION: Functional decline is common among older hospitalized patients. In fact, low mobility and bed rest during hospitalization have been considered as predictable causes of independent ambulation decline in older hospitalized patients. PRIMARY ENDPOINT: the older patients' walking ability change, compared with usual care, from hospital pre-admission/admission to discharge and 90 days follow-up, assessed with the Braden Activity subscale. The secondary end point was the occurrence of re-hospitalization and mortality. METHODS: A 90-days follow-up randomized controlled trial, open labeled was conducted in a geriatric ward. RESULTS: A total of 307 hospitalized patients (>65 years) were included. The intervention group received an Individualized Assisted Walking Program (IAWP), which significantly improved walking ability at discharge (p<.001) and 90-day follow-up (p=0.009), compared to the control group, which received the usual care. There were no significant differences in terms of mortality and re-hospitalizations. CONCLUSIONS: An individualized assisted walking program improves walking abilitiy during hospitalization and over time. For this, a nurse staffing and workload reorganization, a multidisciplinary approach, and an early nurses' planning, could be relevant factors in influencing successfully the older patients' healthcare.

Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study.

PURPOSE: Health systems are using ever-increasing resources on treating hip fractures. Optimal post-hospital care needs to be defined to design an effective care pathway. The aim of the present study was to describe the post-hospital care pathway of individuals with hip fracture and to assess its association with the degree of recovery of independence achieved four months after surgery. MATERIALS AND METHODS: A prognostic multicentric cohort study was conducted. All patients aged 65 years and over who were admitted with a diagnosis of fragility hip fracture were enrolled. After the hospital discharge, the patients were followed either at an inpatient rehabilitation facility with an intensive or extensive regimen, a nursing home, a long-term care facility or at home. Among the various care pathways, the intensity of rehabilitation differed according to its duration, frequency of sessions, and activities proposed. Primary outcome was the patient's degree of independence achieved four months after surgery, as measured with Activities of Daily Living scale. Several covariates were collected to test the correlation between the different post-hospital care pathways and the recovery of independence. RESULTS: A total of 923 patients completed the follow-up. A post- hospital rehabilitation pathway was indicated for 88.2% of the patients. The extensive rehabilitation pathway, indicated for 36.7% of the patients, was the most common. The intensive rehabilitation pathway gave better results in terms of independence at four-month follow up, leading to a median ADL score of 1.4 (95% CI 1.0-2.0). The other care pathways did not show significant difference between each other. CONCLUSIONS: High-intensity rehabilitation was associated to better results in terms of recovering of Activities of Daily Living.IMPLICATIONS FOR REHABILITATIONPost-hospital care pathways that include an intensive rehabilitation treatment should be improved/supported to make them available to a larger number of hip fracture patients.Patient selection criteria for post-hospital rehabilitation pathways should be standardized to optimize available healthcare resources.A cost-effectiveness analysis should be performed to analyze the economic sustainability of each post-hospital care pathway.

Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: Randomized controlled trial.

BACKGROUND: There is need for improvement in effective pressure ulcers preventive strategies. OBJECTIVE: To study whether a multi-layer silicone-adhesive polyurethane foam dressing shaped for the sacrum prevents PUs development in addition to standard PU preventive care for at-risk hospitalized patients. DESIGN: Open-label, parallel group, multi-center randomized controlled trial. PARTICIPANTS AND SETTING: 709 in-hospital patients at risk for pressure ulcers from 25 medical, surgical, and intensive care units of 12 Italian hospitals. METHODS: A multi-layer silicone-adhesive polyurethane foam was applied to the sacrum in addition to standard PUs preventive care in the intervention group. In the control group, standard preventive care alone, including systematic pressure ulcer risk assessment, skin assessment three times per day, routine positioning every 4 h, use of active support surface as appropriate, and incontinence skin care, was guaranteed. Primary outcome was incidence of sacral pressure ulcers of any stage at seven days from hospital admission. Secondary outcomes were incidence of sacral pressure ulcers ≥ II stage, number of days needed to PU development, number of skin adverse events due to the foam dressing, number of dressings used for each patient, number of withdrawing patients due to discomfort caused by the foam dressing. Participants were evaluated at baseline and at seven days. RESULTS: In patients admitted to medical units, 15/113 controls and 4/118 in the intervention group developed sacral pressure ulcers (p = 0.010; absolute reduction 9.2%; NNT for benefit 11, 95% CI 6 to 44). In patients admitted to surgical units, 21/144 controls and 8/142 in the intervention group developed sacral pressure ulcers (p = 0.010; absolute reduction 8.9%; NNT for benefit 11 95% CI 6 to 49). Pressure ulcers incidence was not significantly different between the randomization arms (5.2% experimental vs 10.4% control, p = 0.141) in patients admitted to intensive care units. Overall, 46/358 (12.8%) controls and 17/351 (4.8%) in the intervention group developed sacral pressure ulcers (p<0.001; absolute reduction 8%; number needed to treat (NNT) for benefit 12, 95% CI 8 to 26). Incidence of sacral pressure ulcers ≥ II stage did not differ significantly between the two groups. No adverse skin reactions and discomfort attributable to the foam application were reported. CONCLUSION: A sacral multi-layer silicone-adhesive polyurethane foam in addition to standard preventive care is effective for pressure ulcers prevention in at-risk hospitalized patients admitted to medical and surgical units. TRIAL REGISTRATION: ClinicalTrials.gov NCT03900455. The registration (April 1st, 2019) occurred before the first patient was enrolled (October 21st, 2019).

Assisted Walking Program on Walking Ability in In-Hospital Geriatric Patients: A Randomized Trial.

OBJECTIVES: The main aim of this study was to evaluate if an individualized assisted walking program (IAWP) for hospitalized older patients could improve walking ability compared with usual geriatric care and rehabilitation. DESIGN: A randomized controlled trial with an active control group, open labeled with parallel assignment was conducted between October 2018 and January 2020. SETTING: Geriatric ward. PARTICIPANTS: A total of 387 hospitalized patients (≥65 years) were randomly assigned to an intervention or control (usual-care) group. INTERVENTION: The control group received usual hospital care. The intervention group received also an IAWP. MEASUREMENTS: The primary endpoint was change in walking ability from hospital admission (considering both current and pre-admission status) to discharge, as assessed with the Braden Activity subscale measures. The secondary endpoint was the occurrence of in-hospital adverse events, such as complications of mobility, pressure ulcers, falls, pain and mortality, and the length of hospital stay. Intention-to-treat and per-protocol analyses were performed. RESULTS: Baseline characteristics were similar between intervention and control groups. The intervention group, relative to the control group, had significantly improved walking ability at discharge (P < .001). There were no statistically significant differences between the groups in terms of in-hospital adverse events. No adverse effects were detected. CONCLUSION: In in-hospital patients aged 65 and older, an IAWP improves walking ability at discharge.

[How nurses update their knowledge: a survey in three north Italian hospitals]. / Come gli infermieri aggiornano le proprie conoscenze: indagine in tre ospedali del nord Italia.

INTRODUCTION: Evidence based nursing (EBN) implies the application of the best knowledge to clinical practice but nurses may rely on different sources of knowledge. AIMS: To gain knowledge on methods and sources nurses use to update their knowledge. METHODS: A self completed closed question questionnaire was administered to the nursing personnel of three north Italian hospitals. For each item a level of agreement (never (0) always, 5) was expressed. RESULTS: Over 2642 questionnaires, 1549 (58.5%) were completed. Nurses mostly rely on their experience (mean 4), information obtained from protocols and guidelines (mean 3.94) and during basic education (mean 3.82). Nurses that had attended courses of research or EBN read more frequently articles published in nursing or medical journals. CONCLUSIONS: Experience an important source of knowledge and education to research or EBN may impact on how nurses update their knowledge.

[Nursing outcomes in medical wards (ESAMED Study): the results of a multicenter longitudinal study]. / Esiti dell'assistenza infermieristica in medicina:risultati di uno studio longitudinale multicentrico (studio ESAMED).

. Factors associated to patients' outcomes in medical units: lessons learnt from an Italian multicentric longitudinal study design (ESAMED study). INTRODUCTION: Research on nursing outcomes attempted to identify the associated factors, however, with mainly retrospective or descriptive studies. In 2011, an Italian network was established and a multicentric longitudinal study aimed at exploring factors associated with nursing outcomes among in-hospital medical patients was started. AIMS: To summarise (a) how the research project was originated, (b) which patients have been involved, variables and instruments used, (c) the main findings, and (d) the lessons learnt. METHOD: 12 acute medical units from 11 Italian hospitals were involved. A consecutive sample was adopted: on a daily basis, data has been collected at the (a) patient; (b) nursing care, and (c) hospital levels. RESULTS: The effect of the variability in the amount of nursing care and skill mix in medical units was explored on the following outcomes: (a) hospital-acquired functional dependence, (b) prevalence and incidence of (i) episodes of hyperactive delirium, (ii) avoidable pressure ulcers; (iii) peripheral venous catheter phlebitis; (c) dissatisfaction with the nursing care; and (d) in-hospital mortality; 1464 out of 2082 eligible patients were involved. The frequency and reasons of Missed Nursing Care (MNC), as well as the presence of family caregivers at the bedside were also measured. CONCLUSIONS: The study confirmed that (a) the amount of nursing care provided by graduate nurses improves patient outcomes; (b) a skill mix in favour of nursing aides, negatively impacts on patients' outcomes; and (c) a higher frequency of MNC threatens patient outcomes.