Diagnosi infermieristiche e pianificazione dell’assistenza domiciliare nell’ASL di Brescia

Il presente articolo illustra i risultati di un progetto di formazione e ricerca realizzato a partire dal mese di ottobre 2007 presso l’ASL di Brescia. Tale progetto, rivolto a un gruppo di circa 90 infermieri operanti nell’ambito dell’assistenza domiciliare, perseguiva un duplice obiettivo: consolidare negli infermieri partecipanti la competenza metodologica relativa alla formulazione delle diagnosi infermieristiche, alla pianificazione e alla documentazione dell’assistenza infermieristica e indagare, attraverso il metodo attivo della consensus conference applicato a tali contenuti, le caratteristiche fondamentali del nursing in ambito domiciliare. Il progetto si è concretizzato in un corso di aggiornamento, durante il quale gli infermieri partecipanti hanno potuto esprimere la propria valutazione in merito alla natura dei problemi di salute prevalentemente incontrati durante la presa in carico domiciliare, alla loro possibile codifica attraverso il linguaggio proposto dalla classificazione delle diagnosi infermieristiche della North American Nursing Diagnosis Association International (NANDA International), al grado di autonomia nell’identificazione e nel trattamento di tali diagnosi, alla tipologia degli interventi assistenziali prevalentemente pianificati e attuati, alla qualità della documentazione attualmente in uso. L’analisi dei dati raccolti configura il profilo di un infermiere domiciliare con competenza avanzata, chiamato ad affrontare problemi socio-sanitari complessi e che richiedono un approccio integrato e multidisciplinare. Nel contesto territoriale della provincia bresciana, secondo gli infermieri partecipanti, il grado di autonomia nell’identificazione delle diagnosi infermieristiche e l’impegno nella pianificazione degli interventi permangono maggiormente orientati verso gli ambiti che riguardano la sfera bio-fisiologica (modello di eliminazione, di alimentazione, cura del sé ecc.). Tuttavia, l’infermiere che fornisce assistenza in ambito domiciliare si confronta sempre più spesso con problematiche emergenti, come la gestione dell’aderenza al regime terapeutico, il supporto comunicativo e relazionale, lo stimolo motivazionale alla gestione del coping e la supervisione del ruolo del caregiver. Infine, il progetto di formazione e ricerca ha stimolato la riflessione sulla necessità di migliorare la struttura e le modalità di gestione della documentazione infermieristica domiciliare

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Sotto la lente del genere. La sociologia italiana si racconta

Da quanto tempo e come è tematizzato il Genere nella riflessione sociologica italiana? All'interno di quali tematiche specifiche? Cosa si potrebbe fare per incrementare il peso della prospettiva gender-sensitive nella riflessione teorica, nelle pratiche di insegnamento universitario e di ricerca? Questo volume, nato a partire dalla giornata di studi "Genere, Sociologia, Università" organizzata dalla Sezione AIS-Associazione Italiana di Sociologia "Studi di Genere" nel maggio 2013, cerca di rispondere a queste domande attraverso sia un'analisi della situazione universitaria e del rapporto tra processi formativi e mercato del lavoro, sia mediante un inedito confronto che coinvolge l'Associazione Italiana di Sociologia e le sue Sezioni tematiche

SOTTO LA LENTE DEL GENERE: LA SOCIOLOGIA ITALIANA SI RACCONTA

Da quanto tempo e come è tematizzato il Genere nella riflessione sociologica italiana? All'interno di quali tematiche specifiche? Cosa si potrebbe fare per incrementare il peso della prospettiva gender-sensitive nella riflessione teorica, nelle pratiche di insegnamento universitario e di ricerca? Questo volume, nato a partire dalla giornata di studi "Genere, Sociologia, Università" organizzata dalla Sezione AIS-Associazione Italiana di Sociologia "Studi di Genere" nel maggio 2013, cerca di rispondere a queste domande attraverso sia un'analisi della situazione universitaria e del rapporto tra processi formativi e mercato del lavoro, sia mediante un inedito confronto che coinvolge l'Associazione Italiana di Sociologia e le sue Sezioni tematiche

Sotto la lente del genere. La sociologia italiana si racconta

Da quanto tempo e come \ue8 tematizzato il Genere nella riflessione sociologica italiana? All'interno di quali tematiche specifiche? Cosa si potrebbe fare per incrementare il peso della prospettiva gender-sensitive nella riflessione teorica, nelle pratiche di insegnamento universitario e di ricerca? Questo volume, nato a partire dalla giornata di studi "Genere, Sociologia, Universit\ue0" organizzata dalla Sezione AIS-Associazione Italiana di Sociologia "Studi di Genere" nel maggio 2013, cerca di rispondere a queste domande attraverso sia un'analisi della situazione universitaria e del rapporto tra processi formativi e mercato del lavoro, sia mediante un inedito confronto che coinvolge l'Associazione Italiana di Sociologia e le sue Sezioni tematiche