Familiari e badanti: nostri alleati o concorrenti?

Molte Regioni hanno affrontato con vari interventi il sostegno della permanenza a domicilio dei pazienti con malattie croniche invalidanti e bisogni assistenziali complessi. Tali interventi vanno dall\u2019accesso facilitato ai servizi di assistenza domiciliare integrata pubblici o convenzionati, o da forme di assistenza indiretta come l\u2019erogazione di un assegno di cura mensile, ad azioni di formazione rivolte ai soggetti con funzioni di caregiver. Alcune Regioni, in risposta alle richieste delle Associazioni di malati e familiari, hanno assunto delle decisioni per preparare e autorizzare i caregiver a svolgere attivit\ue0 sanitarie. In questo editoriale si propongono alcune riflessioni a partire da una iniziativa della Regione Emilia-Romagna, che ha sollevato un vivace dibattito e che vogliamo utilizzare come occasione per riflettere sui rapporti tra infermieri e caregiver: tematica sulla quale la professione ha molta esperienza nella pratica quotidiana, ma ha ancora molte pagine da scrivere per esplicitare come pensa di relazionarsi nella complessit\ue0 di bisogni e interventi di cui sempre pi\uf9 le famiglie si fanno carico e per cui rivendicano un ruolo pi\uf9 attiv

Leggibilit\ue0 e comprensione delle linee guida sull\u2019igiene delle mani: confronto tra le linee guida OMS(2009) e del CDC (2002)

Introduzione. L\u2019aggiornamento di una linea guida (LG) \ue8 fondamentale per garantire la validit\ue0 delle raccomandazioni. L\u2019aggiornamento per\uf2 dovrebbe essere reso esplicito e i cambiamenti fatti resi evidenti nel testo. Obiettivo. Confrontare le LG sull\u2019igiene delle mani dell\u2019Organizzazione Mondiale della Sanit\ue0 del 2009 e dei Centres for Disease Control del 2002, per identificare le discrepanze e le novit\ue0 introdotte. Risultati. Anche se comparabili per molte raccomandazioni, le LG del CDC e OMS usano una differente terminologia: nelle prime per lavaggio delle mani si intende quello con acqua e sapone, nelle seconde anche con sapone antimicrobico: ignorare il glossario pu\uf2 rendere ambigua l\u2019interpretazione. Vengono segnalati i problemi nell\u2019individuazione delle prove alla base delle raccomandazioni. Conclusioni. Si dovrebbe porre molta attenzione quando si decide di applicare una linea guida aggiornata e cercare di capire quali sono le novit\ue0 introdotte. Si raccomanda la necessit\ue0 di linee guida snelle e facili da consultare, dove vengono messi in luce in principali cambiamenti fatti

Il sistema grade

Il Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE Working Group) ha sviluppato un sistema per graduare la qualit\ue0 delle prove di efficacia. Il GRADE \ue8 stato adottato da pi\uf9 di 20 organizzazioni, compresa l\u2019Organizzazione Mondiale della Sanit\ue0. La qualit\ue0 di una prova prevede che vengano presi in esame i problemi metodologici dello studio (qualit\ue0 metodologica), l\u2019orientamento dei risultati, l\u2019eterogeneit\ue0, la precisione della stima dell\u2019effetto, e il rischio di bias di pubblicazione, per ogni singolo esito valutato. Il sistema GRADE assegna 4 livelli di qualit\ue0: le sperimentazioni cliniche, che sono in cima alla piramide delle prove di efficacia, possono essere declassate se hanno problemi metodologici. Viene presentata una breve rassegna del sistema GRADE

Moving forward the Italian nursing education into the post-pandemic era: findings from a national qualitative research study

Background: During the CoronaVIrus-19 (COVID-19) pandemic, nursing education has been dramatically transformed and shaped according to the restrictions imposed by national rules. Restoring educational activities as delivered in the pre-pandemic era without making a critical evaluation of the transformations implemented, may sacrifice the extraordinary learning opportunity that this event has offered. The aim of this study was to identify a set of recommendations that can guide the Italian nursing education to move forward in the post-pandemic era. Methods: A qualitative descriptive design was undertaken in 2022–2023 and reported here according to the COnsolidated criteria for REporting Qualitative research guidelines. A network was established of nine Italian universities offering a bachelor’s degree in nursing for a total of 6135 students. A purposeful sample of 37 Faculty Members, 28 Clinical Nurse Educators and 65 Students/new graduates were involved. A data collection was conducted with a form including open-ended questions concerning which transformations in nursing education had been implemented during the pandemic, which of these should be maintained and valued, and what recommendations should address the transition of nursing education in the post-pandemic era. Results: Nine main recommendations embodying 18 specific recommendations have emerged, all transversally influenced by the role of the digital transformation, as a complementary and strengthening strategy for face-to-face teaching. The findings also suggest the need to rethink clinical rotations and their supervision models, to refocus the clinical learning aims, to pay attention towards the student community and its social needs, and to define a pandemic educational plan to be ready for unexpected, but possible, future events. Conclusions: A multidimensional set of recommendations emerged, shaping a strategic map of action, where the main message is the need to rethink the whole nursing education, where digitalization is embodied. Preparing and moving nursing education forward by following the emerged recommendations may promote common standards of education and create the basis on for how to deal with future pandemic/catastrophic events by making ready and prepared the educational systems

Artificial Intelligence Can Guide Antibiotic Choice in Recurrent UTIs and Become an Important Aid to Improve Antimicrobial Stewardship

Background: A correct approach to recurrent urinary tract infections (rUTIs) is an important pillar of antimicrobial stewardship. We aim to define an Artificial Neural Network (ANN) for predicting the clinical efficacy of the empiric antimicrobial treatment in women with rUTIs. Methods: We extracted clinical and microbiological data from 1043 women. We trained an ANN on 725 patients and validated it on 318. Results: The ANN showed a sensitivity of 87.8% and specificity of 97.3% in predicting the clinical efficacy of empirical therapy. The previous use of fluoroquinolones (HR = 4.23; p = 0.008) and cephalosporins (HR = 2.81; p = 0.003) as well as the presence of Escherichia coli with resistance against cotrimoxazole (HR = 3.54; p = 0.001) have been identified as the most important variables affecting the ANN output decision predicting the fluoroquinolones-based therapy failure. A previous isolation of Escherichia coli with resistance against fosfomycin (HR = 2.67; p = 0.001) and amoxicillin-clavulanic acid (HR = 1.94; p = 0.001) seems to be the most influential variable affecting the output decision predicting the cephalosporins- and cotrimoxazole-based therapy failure. The previously mentioned Escherichia coli with resistance against cotrimoxazole (HR = 2.35; p < 0.001) and amoxicillin-clavulanic acid (HR = 3.41; p = 0.007) seems to be the most influential variable affecting the output decision predicting the fosfomycin-based therapy failure. Conclusions: ANNs seem to be an interesting tool to guide the antimicrobial choice in the management of rUTIs at the point of care

Nursing students&apos; interprofessional educational experiences in the clinical context : findings from an Italian cross-sectional study

Objective To explore nursing students' interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences. Design National cross-sectional study on data collected in 2016. Setting 95 Bachelor of Nursing Sciences programmes; 27 Italian Universities. Participants Students who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study. Primary and secondary outcomes First to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence. Measures The primary outcome was measured using questions based on a 4-point Likert scale (from 0=never' to 3=always'). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire. Results 9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities only a little', to some extent' or always', respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences. Conclusions A large number of nursing students experienced either never' or only a little' IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students' interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels