Continuita delle cure: strumenti per una corretta pianificazione assistenziale infermieristica del paziente geriatrico

L'obiettivo dello studio esplorativo di descrivere il fenomeno delle dimissioni protette nei pazienti di eta  a 75 anni e analizzare la percezione degli utenti e dei caregivers sulla necessita  di attivare un percorso di dimissione protetta. Si utilizzato l'indice di BRASS e venti interviste strutturate su un campione di 167 pazienti ricoverati nell'U.O. di Geriatria ULSS 9. Emerso che le necessita  per la continuita  delle cure riguardano ausili e figure di supporto

EVIDENZE DALLE NEUROSCIENZE SUGLI EFFETTI DELL\u2019USO DI CANNABIS E POSSIBILI CONSEGUENZE DELLA LEGALIZZAZIONE SULLA SALUTE PUBBLICA

Background: The discussion on the legalization of cannabis has assumed great resonance because of some American States, which, after legalizing the use for medical purposes 15 years ago, now have al-so authorized the use for recreational purposes. In Italy, in July 2015, some politicians submitted a leg-islative proposal advancing the legalization of cannabis for medical and recreational use. Objective: To make an examination of scientific evidences on the effects of cannabis use and an analysis of the possible impact of cannabis legalization on public health, in the light of US experience. Methodology: For the scientific evidences on the effects of cannabis on the human organism, we looked at the main literature of the last 15 years, coming from disciplines such as neuroscience of ad-diction, toxicology, behavioral science, genetics, psychiatry, etc. To assess the impact of legalization in the US, we took into account government reports, data from state and federal institutional investiga-tions and ad hoc surveys. Finally, we made a synopsis of the main positions in favor of legalization, in comparison with scientific evidences and other alternative positions. Results: Results of the main scientific researches confirmed that cannabis use is associated with struc-tural brain abnormalities of gray and white matter, impairment of cognitive functions, psychotic disor-ders, amotivational crisis, addiction, etc. There are consequences on organ systems, including respira-tory and heart diseases and impairment of the reproductive and immune systems. The influence on DNA damage and the resulting human epigenome impairment has also been highlighted. These nega-tive conditions are the more severe the earlier the substance onset. At social level, many issues related to the use of cannabis have been registered: drug-related road accidents, accidents at work, poor school performance and increased risk of criminal behavior. Several data have been collected from US States where cannabis has been legalized. Although data should be considered preliminary, the analysis showed: \u2022 An increase in cannabis consumption in all age groups considered, in particular in the range 18-26 years, where there has also been an increase in alcohol consumption; \u2022 An increase in acute poisonings registered at ED and increased hospitalizations in relation to can-nabis-intake; \u2022 An increase in THC positivity in road accidents and increase in the n. of cannabis-related road deaths; \u2022 An increase in the prevalence of THC positivity in workplace drug testing; \u2022 An increase in school dropout rate; \u2022 An increase in juvenile arrests for illegal possession and use of cannabis; \u2022 An increase in illegal trafficking of cannabis from the State that legalized its cultivation and con-sumption, towards neighboring States that have not legalized it; \u2022 An increase in tax revenue. However, revenues do not appear to have been allocated for preven-tion, treatment and research, as originally scheduled. Conclusion: Epidemiological data, combined with scientific neuroscience evidence, provide evidence based elements useful for the legislator to guide the future legislation in Italy. It is desirable that the lawmaker takes in greater account scientific evidences, especially from neuroscience, toxicology, be-havioral sciences and mental health. It is necessary that the legislator consider not only the economic and financial aspects of legalization, but also the health impact in the medium and long term

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

BackroundUse of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium.AimThis analysis, from the Delirium Day 2015, a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients.MethodsPatients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age>65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score4: possible delirium; scores 1-3: possible cognitive impairment).ResultsAmong 1867 hospitalized patients (mean age 82.07.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.47.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia.DiscussionWe confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents.ConclusionEnvironmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence