The Use of mHealth in Promoting Therapeutic Adherence: A Scoping Review.

Nonadherence to therapy negatively impacts mortality and quality of life and results in suboptimal efficacy of treatment regimens, threats to patient safety, and increased healthcare costs for disease management. Mobile health solutions can offer users instruments that can promote therapeutic adherence. The objective of this review is to investigate the impact mobile health systems have on therapeutic adherence. Specifically, we want to map the main systems used, the functions implemented, and the different methods of adherence detection used. For this purpose, a scoping review was conducted. The following databases were consulted: PubMed, Cochrane Library, EBSCO (including APA PsycINFO, CINAHL Plus with Full Text, ERIC), including English-language studies published in the last 10 years (2012-2022). The main mobile health systems used are as follows: applications, automated messaging, interactive voice response, and mobile video games. The main features implemented to support medication management were as follows: reminders, self-monitoring instruments, educational support, and caregiver involvement. In conclusion, the use of interactive mobile health instruments intended for use by the patient and/or caregiver can improve objectively and subjectively detected therapeutic adherence. The use of these systems in the therapeutic pathway of users, with a special focus on people with comorbidities and in polypharmacy treatment, represents a challenge to improve caregiver health.

Medication administration error prevention among nurses working in intensive care units: A secondary analysis.

BACKGROUND: The intensive care unit (ICU) brings together high-risk patients and interventions in a complex environment. Based on this consideration, medication administration error is the most common type of error that occurs in ICUs. Literature confirms that human factors (lack of knowledge, poor practices and negative attitudes) of nurses are the main contributors to the occurrence of medication administration errors in ICUs. AIM: To examine and compare the knowledge, attitudes and behaviour scores on medication administration error according to nurses' sociodemographic and professional variables. STUDY DESIGN: This is a secondary analysis of data from a cross-sectional international study based on a survey. Descriptive statistics were computed for all items of the questionnaire. Non-parametric tests (Kruskal Wallis and Mann Whitney U tests) were used to carry out the comparison between groups. RESULTS: The international sample consisted of 1383 nurses in 12 different countries. Statistically significant changes were seen in knowledge, attitudes and behaviour scores among several subgroups of the international population. Eastern nurses were more likely to show adequate knowledge about medication administration error prevention than Western nurses; concurrently, Western nurses were significantly more likely to show positive attitudes than Eastern nurses. No statistically significant differences in the behaviour scale were found in this study. CONCLUSIONS: The findings show a difference between knowledge and attitudes in relation to cultural background. RELEVANCE TO CLINICAL PRACTICE: Decision makers in ICUs should consider cultural background when planning and implementing prevention strategies for medication administration errors. Further research is needed to investigate the effectiveness of educational systems on the decrease of the incidence of medication administration errors in ICU.

The prevention of medication errors in the home care setting: a scoping review.

Background: The changes in health, social and demographic needs impose new approaches to cures and care without giving up patients' safety. Although several studies analysed the patient safety approach and strategies, the literature considering the home care setting seems still scarce. The analysis of the phenomenon of medication errors in the primary care setting highlights the necessity of exploring the specific variables to understand how to prevent or reduce the occurrence of a medication error in the home context. This review investigates the main preventive strategies implemented at the patients' home to prevent and/or limit the possibility of a medication error. Design: The scoping review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses ex-tension for Scoping Reviews (PRISMA-ScR) statement and based on the guidelines of the Joanna Briggs Institute. Methods: No time or language limit was set to obtain the most comprehensive results possible. The following databases were queried: PubMed, Cochrane, CINAHL, ERIC and PsycINFO via EBSCO. All literature published up to 31 December 2022 was considered for data collection. Results: The main preventive strategies implemented in the patient's home to prevent a medication error are: Multidisciplinary teams, therapeutic reconciliation and computerised systems that improve information sharing. As evidenced by all of the included studies, no educational intervention or preventive strategy individually reduces the risk of making a medication error. Conclusions: It would be desirable for healthcare professionals to be constantly updated about their knowledge and understand the importance of introducing the aforementioned preventive strategies to guarantee safe care that protects the person from me-dication errors even at the patient's home.

Smartphones' impact on nursing performances: a cross-sectional multicenter study.

Background: In recent years, the technology world has significantly shaped society. This study aims to survey the views of registered nurses with hospital working experience regarding the personal communication devices use impact in hospital units. The secondary outcome of this study was to identify differences in mobile device use based on demographic and organizational factors. Study design: Cross-sectional study by survey. Methods: The questionnaire comprises 22 items divided into four sections. Overall 778 questionnaires were included in the study, 329 questionnaires were collected on pen-and-paper, whereas 449 by an online survey. Results: Findings showed that smartphones have a different impact on performance, utilization and impact scale according to gender, age and educational attainment. Generally males using more frequently personal communication devices for non-work-related activities affected negatively their working performance by respect to females. Moreover, younger nurses report being more distracted by using smartphones for non-work-related activities than older nurses. At the same time, younger nurses believe that smartphones may lead to an improvement in patient care skills. Nurses with fewer years of service (1 month - 10 years) report being more distracted by non-work-related activities on their smartphones than nurses with more years of service (>20 years). Conclusions: The smartphone is a potential distraction source. The most exposed groups are the younger nurses' and those with little work experience, and both groups (young age, less experience) can be considered factors for potential distraction.

Knowledge, Attitudes, and Behavior in the administration of medication in the home care setting: Cross-cultural Spanish adaptation.

OBJECTIVE: The aim of the study is to validate and adapt the "Knowledge Attitute and Behaviour in the administration of medication in the home care setting questionnaire" in the home care setting in Cordoba, Spain, through a cross-validation process. DESIGN: Cross-sectional study SAMPLE: 106 community nurses provide home care in Cordoba, and are involved in the management of the medication process in the patient's home. MEASUREMENTS: Community nurses' knowledge, attitudes, and behaviors toward medication error prevention strategies in-home care. RESULTS: For the evaluation of psychometric properties, Cronbach's α was calculated, which returned a value of 0.639, showing good internal consistency. Most participants agreed that the home care setting increases the risk of medication errors. CONCLUSION: The study, underscores the importance of analyzing the phenomenon of medication errors in the home care setting. The characteristics and peculiarities of a home care setting are different from a hospital setting, which means that factors such as the environment, the figures involved in the care process (caregivers and/or family members), and the way in which they communicate with the rest of the multi-professional team can influence both the type of errors and the likelihood of their occurrence.

Medication errors' causes analysis in home care setting: A systematic review.

Many studies analyze the medication errors in the hospital setting, but the literature involving the home care setting seems scarce. The aim of this study is to identify the main risk factors that affect the genesis of medication errors and the possible solutions to reduce the phenomenon in the home care setting. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical analysis of the literature shows that medication errors in home care occur mainly during transitional care. The main risk factors related to transitional care are poor interprofessional communication, lack of a standardized process for medication reconciliation, the widespread use of computerized tools, and the inadequate integration of the pharmacist into the care team. The strategies to reduce the risk of errors from therapy at home are the implementation of the pharmacist in the health team to ensure accurate medication reconciliation and the use of computerized tools to improve communication between professionals and to reduce the dispersion of information.

Medication errors in homecare setting: An Italian validation study.

OBJECTIVE: Medication errors are a concern in overall the world. Although there are studies that investigate what may be the main causes that lead to the genesis of the medication error in the home care setting, there is no tool that correlates knowledge, attitudes, and behavior to medication errors in the context of home care. This study aimed to psychometrically test to the questionnaire on knowledge, attitudes, and behaviors in the administration of medication in the new setting: home care setting. DESIGN: This observational study was reported according to the STROBE checklist. SAMPLE: Sixty two nurses working in home care setting responded to the online survey. MEASUREMENT: The face and content validity of the items generated was assessed. An Exploratory Factorial Analysis descriptive statistical analysis was conducted. The final questionnaire is composed of 20 items. RESULTS: The results of the statistical analyses allowed to validate the questionnaire, ensuring good internal consistency and reliability. Most of the sample pointed out that the use of electronic health record, medication reconciliation and the pharmacist's figure are all useful strategies for reducing the risk of medication errors. CONCLUSION: The questionnaire is reliable to measure knowledge, attitude, and behavior about medication errors prevention in home care settings.

Smartphone distraction during nursing care: Systematic literature review.

AIM: To investigate the impact of smartphone distraction on the quality and safety of care provided by the nursing population during work. BACKGROUND: About 80% of nurses use the smartphone in the workplace both for personal purposes and as a useful support to improve the quality of care. Distraction from smartphones during care is a phenomenon that should be known and managed within each health service. METHODS: A systematic review of the literature was conducted using the PRISMA methodology. The sources included in the review study were subjected to a qualitative assessment using the GRADE method. RESULTS: Sixteen articles were included in the review. Studies included highlight the positive and negative consequences of using mobile devices during nursing practice. Findings identify the smartphone as a generator of stimuli capable of diverting the attention of the person from the priority activities and absorbing the cognitive resources useful for carrying out these activities. Some studies aimed to show the restriction policies and/or the strategies for reducing disruptions. This review highlights how the free and indiscriminate use of the smartphone can negatively affect patient safety and the nurse-patient relationship through the dehumanization and depersonalization of care. CONCLUSIONS: Mobile technology can improve nurses' performance and the quality of care provided. However, the application of regulations and policies by healthcare facilities is desirable to avoid inappropriate use of these devices by nurses. The available data do not provide a precise estimate of the effect that distraction from smartphones has on the outcomes of nursing care.

Structure and Characteristics of Diabetes Self-management Applications: A Systematic Review of the Literature.

Diabetes is one of the most common chronic conditions, and a good self-management regimen is needed in order to control the disease and prevent complications. In the last few years, the number of health information technologies has increased, and while there are many smartphone applications for diabetic patients, their effectiveness is still unclear. This systematic review aims to outline structure and characteristics that can make an application for diabetes management effective and safe and improve usability and the chances of success for a mobile health service. Applications found in the literature have been analyzed to evaluate the different features. Findings of the review suggest that patients seem to be more attracted by tools that are helpful in everyday management of diabetes, and that allow them to save time and increase safety. The personalization of the application is essential to obtain success in promoting use, and applications should be based upon patients' predisposition to use technological tools that will ensure better outcomes.

[Impact of the Sign Language for pediatric patients with a tracheostomy]. / Impatto della lingua dei segni sulla comunicazione per i pazienti pediatrici con tracheostomia.

BACKGROUND: The lack of verbal communication due to the tracheostomy is a great challenge for nurses because communication is an essential aspect for caring, which also involves parental figures in pediatric patients. OBJECTIVES: Qualitative synthesis of the evidence to support learning and use of sign language in tracheostomised children in order to enhance the therapeutic relationship as well as communication between nurse and pediatric patient. METHOD: We conducted a narrative review, the following databases were interrogated: PubMed (Medline), Cinahl, Scopus, Cochrane and Google Scholar. Studies related to the research question were included, without temporal limitation. RESULTS: 43 articles were selected and were subsequently grouped in relation to the type of study, description of specific teaching programs and recommendations. CONCLUSIONS: The use of alternative communication techniques is a priority for nurses who take care of tracheostomised children. Among these, undoubtedly, the sign language reveals its efficiency.

[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.

Digest: The importance of genetic background in bacterial evolution.

How does genetic background influence a population's evolutionary response to an environmental change? Which traits are selected for and how quickly does the population adapt? Filipow et al. (2024) address these questions by exploiting the natural genetic variation of Pseudomonas aeruginosa, a bacterium often found in the lungs of cystic fibrosis patients. They find that while genetic background influences the rate of phenotypic evolution, it does not alter the evolutionary outcome. Their findings contribute to a growing body of work that connects genetic background to future evolvability.

Global Trends of Medical Misadventures Using International Classification of Diseases, Tenth Revision Cluster Y62-Y69 Comparing Pre-, Intra-, and Post-COVID-19 Pandemic Phases: Protocol for a Retrospective Analysis Using the TriNetX Platform.

BACKGROUND: The COVID-19 pandemic has sharpened the focus on health care safety and quality, underscoring the importance of using standardized metrics such as the International Classification of Diseases, Tenth Revision (ICD-10). In this regard, the ICD-10 cluster Y62-Y69 serves as a proxy assessment of safety and quality in health care systems, allowing researchers to evaluate medical misadventures. Thus far, extensive research and reports support the need for more attention to safety and quality in health care. The study aims to leverage the pandemic's unique challenges to explore health care safety and quality trends during prepandemic, intrapandemic, and postpandemic phases, using the ICD-10 cluster Y62-Y69 as a key tool for their evaluation. OBJECTIVE: This research aims to perform a comprehensive retrospective analysis of incidence rates associated with ICD-10 cluster Y62-Y69, capturing both linear and nonlinear trends across prepandemic, intrapandemic, and postpandemic phases over an 8-year span. Therefore, it seeks to understand how these trends inform health care safety and quality improvements, policy, and future research. METHODS: This study uses the extensive data available through the TriNetX platform, using an observational, retrospective design and applying curve-fitting analyses and quadratic models to comprehend the relationships between incidence rates over an 8-year span (from 2015 to 2023). These techniques will enable the identification of nuanced trends in the data, facilitating a deeper understanding of the impacts of the COVID-19 pandemic on medical misadventures. The anticipated results aim to outline complex patterns in health care safety and quality during the COVID-19 pandemic, using global real-world data for robust and generalizable conclusions. This study will explore significant shifts in health care practices and outcomes, with a special focus on geographical variations and key clinical conditions in cardiovascular and oncological care, ensuring a comprehensive analysis of the pandemic's impact across different regions and medical fields. RESULTS: This study is currently in the data collection phase, with funding secured in November 2023 through the Ricerca Corrente scheme of the Italian Ministry of Health. Data collection via the TriNetX platform is anticipated to be completed in May 2024, covering an 8-year period from January 2015 to December 2023. This dataset spans pre-pandemic, intra-pandemic, and early post-pandemic phases, enabling a comprehensive analysis of trends in medical misadventures using the ICD-10 cluster Y62-Y69. The final analytics are anticipated to be completed by June 2024. The study's findings aim to provide actionable insights for enhancing healthcare safety and quality, reflecting on the pandemic's transformative impact on global healthcare systems. CONCLUSIONS: This study is anticipated to contribute significantly to health care safety and quality literature. It will provide actionable insights for health care professionals, policy makers, and researchers. It will highlight critical areas for intervention and funding to enhance health care safety and quality globally by examining the incidence rates of medical misadventures before, during, and after the pandemic. In addition, the use of global real-world data enhances the study's strength by providing a practical view of health care safety and quality, paving the way for initiatives that are informed by data and tailored to specific contexts worldwide. This approach ensures the findings are applicable and actionable across different health care settings, contributing significantly to the global understanding and improvement of health care safety and quality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54838.

Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol.

Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.

Telenursing Interventions for Patients With Cancer Receiving Chemotherapy: A Scoping Review.

PROBLEM IDENTIFICATION: To provide an overview of telenursing interventions, primary outcomes, and tools used in patients with cancer receiving chemotherapy, a scoping review was conducted. LITERATURE SEARCH: PubMed®, Embase®, and CINAHL® databases were searched using the following keywords: telenursing, adverse event, and drug therapy. DATA EVALUATION: From the screening process, 11 studies were identified. SYNTHESIS: In patients with cancer receiving chemotherapy, telenursing interventions were mainly used to monitor symptoms, particularly fatigue, anxiety, and depression. The interventions used included outcome-specific, nonspecific, and validated tools, or tools developed from reporting systems for adverse events. IMPLICATIONS FOR RESEARCH: Large-scale, well-conducted randomized controlled trials, systematic reviews, and meta-analyses are needed to test the results of this scoping review.

Knowledge, Attitude, and Behaviour with Regard to Medication Errors in Intravenous Therapy: A Cross-Cultural Pilot Study.

BACKGROUND: Literature on the prevention of medication errors is growing, highlighting that knowledge, attitude and behavior with regard to medication errors are strategic to planning of educational activities and evaluating their impact on professional practice. In this context, the present pilot study aims to translate and validate nursing professionals' knowledge, attitudes and behavior (KAB theory) concerning medication administration errors in ICU from English into Persian. Furthermore, two main objectives of the project were: performing a pilot study among Iranian nurses using the translated questionnaire and carrying out a cultural measurement of the KAB theory concerning medication administration errors in an ICU questionnaire across two groups of Italian and Iranian populations. METHODS: A cross-cultural adaptation of an instrument, according to the Checklist for reporting of survey studies (CROSS), was performed. The convenience sample was made up of 529 Iranian and Italian registered nurses working in ICU. An exploratory factor analysis was performed and reliability was assessed. A multi-group confirmatory factor analysis was conducted to test the measurement invariance. Ethical approval was obtained. RESULTS: There was an excellent internal consistency for the 19-item scale. Results regarding factorial invariance showed that the nursing population from Italy and Iran used the same cognitive framework to conceptualize the prevention of medication errors. CONCLUSIONS: Findings from this preliminary translation and cross-cultural validation confirm that the questionnaire is a reliable and valid instrument within Persian healthcare settings. Moreover, these findings suggest that Italian and Persian nurses used an identical cognitive framework or mental model when thinking about medication errors prevention. The paper not only provides, for the first time, a validated instrument to evaluate the KAB theory in Iran, but it should promote other researchers in extending this kind of research, supporting those countries where attention to medical error is still increasing.

Implementation of a Novel Optogenetic Tool in Mammalian Cells Based on a Split T7 RNA Polymerase.

Optogenetic tools are widely used to control gene expression dynamics both in prokaryotic and eukaryotic cells. These tools are used in a variety of biological applications from stem cell differentiation to metabolic engineering. Despite some tools already available in bacteria, no light-inducible system currently exists to control gene expression independently from mammalian transcriptional and/or translational machineries thus working orthogonally to endogenous regulatory mechanisms. Such a tool would be particularly important in synthetic biology, where orthogonality is advantageous to achieve robust activation of synthetic networks. Here we implement, characterize, and optimize a new optogenetic tool in mammalian cells based on a previously published system in bacteria called Opto-T7RNAPs. The tool is orthogonal to the cellular machinery for transcription and consists of a split T7 RNA polymerase coupled with the blue light-inducible magnets system (mammalian OptoT7-mOptoT7). In our study we exploited the T7 polymerase's viral origins to tune our system's expression level, reaching up to an almost 20-fold change activation over the dark control. mOptoT7 is used here to generate mRNA for protein expression, shRNA for protein inhibition, and Pepper aptamer for RNA visualization. Moreover, we show that mOptoT7 can mitigate the gene expression burden when compared to another optogenetic construct. These properties make mOptoT7 a powerful new tool to use when orthogonality and viral RNA species (that lack endogenous RNA modifications) are desired.

A Worldwide Bibliometric Analysis of Published Literature on Medication Errors.

OBJECTIVES: The aim of the study was to map the recent literature on medication error to monitor the state of research and explore emerging research fronts. Specifically, the co-occurrences analysis aimed to research the conceptual structure of the medication errors, whereas the coauthorship analysis aimed to research the "authorities" that influenced the academic and political discussion on medication errors. METHODS: The search for relevant studies was carried out through the Scopus. To map and monitor the state of research on medication error, a preliminary analysis was conducted through the year of publication, type of article, and language. The count of citation shows the most relevant work among those included. Bibliometric analyses were conducted, such as coauthorship analysis and co-occurrences analysis. RESULTS: The search strategy yielded 5393 articles. Of these, 1267 articles were included. Four main themes emerged from this bibliometric analysis: (a) the exploration of human factors related to health care professionals that increase the risk of medication error, (b) the investigation of behaviors and strategies that can prevent the error in the preparation and administration stage, (c) the analysis of the benefits related to the presence of the pharmacist in hospital settings, and (d) the exploration of the consequences of a medication error and/or adverse effects of drugs. CONCLUSIONS: For the first time, a bibliometric analysis of medication errors research in the world has been conducted and demonstrated that there is a wealth of contributions already being made that are well aligned to the World Health Organization challenge.

Medication Errors in Intensive Care Units: An Umbrella Review of Control Measures.

Medication errors are defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer." Such errors account for 30 to 50 percent of all errors in health care. The literature is replete with systematic reviews of medication errors, with a considerable number of studies focusing on systems and strategies to prevent errors in intensive care units, where these errors occur more frequently; however, to date, there appears to be no study that encapsulates and analyzes the various strategies. The aim of this study is to identify the main strategies and interventions for preventing medication errors in intensive care units through an umbrella review. The search was conducted on the following databases: PubMed, CINAHL, PsycInfo, Embase, and Scopus; it was completed in November 2020. Seven systematic reviews were included in this review, with a total of 47 studies selected. All reviews aimed to evaluate the effectiveness of a single intervention or a combination of interventions and strategies to prevent and reduce medication errors. Analysis of the results that emerged identified two macro-areas for the prevention of medication errors: systems and processes. In addition, the findings highlight the importance of adopting an integrated system of interventions in order to protect the system from harm and contain the negative consequences of errors.

Infections and Smartphone Use in Nursing Practice: A Systematic Review.

AIM: Nurses use their smartphones during the work shift. The objective of this review is to investigate the presence of bacteria on mobile phones and the procedures to disinfect or decontaminate the smartphone and decrease the infection rate. METHOD: This systematic review was carried out through a search on the main scientific databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted by considering articles published in the last ten years. RESULTS: Of 502 initial articles, 489 were excluded and 12 articles were considered relevant. Twelve articles were included in the review. The analysis of the studies showed a high contamination of pathogenic microorganisms on the device's surfaces, most of which appear to be antibiotic resistant. The use of smartphones during clinical practice increases the risk of contracting nosocomial infections. The presence of bacteria on mobile phones and their use favors the cross-transmission of microorganisms. CONCLUSION: Onset prevention is a primary goal for the entire multidisciplinary team. There are no protocols concerning smartphones disinfection during clinical practice, but their implementation would reduce the incidence by improving nursing care.