"Modelli organizzativi di assistenza infermieristica in carenza di organico: le sinergie tra didattica, assistenza e volontariato"

Il volontariato in Italia e nel mondo è ritenuto una risorsa, in moltissime occasioni, insostituibile nel supplire le carenze di una Stato che non riesce più ad erogare , in numerosi settori, un'assistenza adeguata ai fabbisogni della popolazione. In Italia da diversi anni alcune organizzazioni affiancano le competenze del servizio sanitario nazionale, supplendo e sostenendo aree fragili e servizi carenti. In questo elaborato ho descritto la complessa interazione tra stato sociale e SSN in particolare nella nostra Regione e nella nostra Azienda Ospedaliera. La seconda parte del lavoro mi sono concentrata sull'importanza del reclutamento, della formazione e della validazione del volontario che aspira a prestare la sua opera in ambito ospedaliero e nel far questo mi sono avvalsa dell'esperienza accumulata e dei mezzi fornitimi dai corsi di laurea. Inoltre, il processo di valutazione non è stato mai distaccato dalla esplorazione delle motivazioni del volontario. Si è poi analizzata la carenza assistenziale nei reparti della AOU Federico II e confrontandola con la disponibilità dei volontari, si è organizzato un servizio suppletivo. Ho evidenziato i limiti di questo approccio che possono riassumersi fondamentalmente nella indisponibilità del volontario a coprire i turni H 24 e nel suo legittimo abbandono del ruolo di volontario nel momento stesso di una assunzione stabile in altri enti. Tramite questionario ho valutato il grado di soddisfazione e i punti critici sia da parte del volontario sia da parte del tutor rilevando che nel complesso l'esperienza è stata favorevolmente vissuta da entrambe le parti. Un punto critico evidenziato dai vari attori del processo è stata la difficoltà burocratica all'inserimento nel ruolo di volontario e alla successiva assegnazione. Ho elaborato, per superare questa criticità, una APP: VOLONTA'(ri) intuitiva e di facile uso che permetterebbe di risolvere in pochi passaggi sia l'ingresso dei volontari nella struttura sia la loro successiva assegnazione in base alle necessità. Sottolineo, alla fine di questo mio lavoro che il volontariato resta una risorsa indispensabile e un sostegno a un Sistema Sanitario perfettamente funzionante e non può mai essere la soluzione a carenze strutturali del sistema. Il volontariato è una scelta fatta sulla spinta di motivazioni emotive, ideologiche e culturali. La mia convinzione, suffragata dalla letteratura a riguardo, è che nella scelta del volontario sono indispensabili la valutazione delle intenzioni e la preparazione tecnico-scientifica

Clinical Outcome of Third-Line Pazopanib in a Patient with Metastatic Renal Cell Carcinoma

Background. Renal cell carcinoma accounts for about 2-3% of all malignant tumors. The prevalence of brain metastases from RCC is less than 20% of cases. Traditionally, whole brain radiotherapy as well as the latest stereotactic radiosurgery improves both survival and local tumor control. These treatments also allow stabilization of clinical symptomatology. However, validated treatment guidelines for RCC patients with brain metastases are not yet available on account of the frequent exclusion of such patients from clinical trials. Moreover, limited data about the sequential use of three therapies, changing the class of agent, have been published up to now. Case Report. We report the case of a patient with metastatic RCC who developed disease progression after sunitinib and everolimus as first-line and second-line therapy, respectively. Thus, he underwent a multimodality treatment with pazopanib, as third-line therapy, to control systemic disease and radiosurgery directed on the new brain metastasis. To date, the patient is still receiving pazopanib, with progression-free survival and overall survival of 43 and 103 months, respectively. Conclusion. In a context characterized by different emerging options, with no general consensus on the optimal treatment strategy, the use of pazopanib in pretreated patients could be a suitable choice. PMID: 26798533 PMCID: PMC4698998 DOI: 10.1155/2015/62904

Tolerability of a new amino acid-based formula for children with IgE-mediated cow's milk allergy

Amino acid-based formula (AAF) is a relevant dietary strategy for paediatric patients affected by cow's milk allergy (CMA). The present study was designed to evaluate the hypoallergenicity of a new AAF in children with immunoglobulin (Ig)E-mediated CMA

Italian long-term care facilities during COVID-19 era: a review

Background. Since the start COVID-19 epidemic, 9154 deaths have been registered in Italian Long-Term Care Facilities (LTCF). Half of them were COVID 19-related. Objective. In this review we analyzed the management of COVID-19 outbreak in Italian LTCF, in the most affected regions. Results. In the Italian Institute of Health (ISS) report, 1356 LTCF (41.3%) answered to questionnaires on COVID-19 infection in LTCF. Only 7.4% of deaths was related to Coronavirus (confirmed by swab), while 33,8% of deceased presented flu-like symptoms without confirmation by swab. 77.2% of structures reported the lack of Personal Protective Equipment. The autonomous management policies of the regions cannot be negligible in this assessment, above all Lombardia Region that diverted patients from hospital to extra-structures, like LTCF. Conclusions. The elderlies represent high-risk patients for developing COVID-19 with rapid clinical deterioration. Containment measures should be particularly optimized, especially in anticipation of another possible pandemic recurrence. Surely a comparison among different systems could help to achieve more information in the standardization of procedures. Identifying flaws in this system is necessary to perfect and optimize epidemic management as much as possible

Use of the North American Nursing Diagnosis Association taxonomies, Nursing Intervention Classification, Nursing Outcomes Classification and NANDA-NIC-NOC linkage in cardiac rehabilitation.

This study aims at creating a standardized language for each patient admitted to Cardiac Rehabilitation Unit (CR) by identifying nursing diagnosis, interventions, results/objectives expected and related correlations. The primary outcome was identifying health needs of all patients admitted to CR. The secondary outcomes were the identification of North American Nursing Diagnosis Association -International diagnoses (NANDA-I), of nursing intervention classification (NIC), of nursing outcomes classification (NOC) and their correlation NANDA-NIC-NOC linkage (NNN linkage) in order to define a standardized language for all nursing staff. This is a retrospective study involving a sample of 168 patients discharged from CR. The NANDA-I, the NIC, the NOC and the most frequently used NNN connections were identified and collected by using structured form including the 11 functional models of Marjory Gordon. Data from 76 patients were analyzed (92.1% male; mean age (± SD) 62.7±9 yrs; IQ range: 42-82). The main NANDA-I nursing diagnosis belongs to psychological sphere, but not to physiological domains. The statement NIC has allowed to put into practice actions of health prevention and education. Nursing care documentation and NNN taxonomic language promotes a wide diffusion of nursing discipline culture and significant qualitative improvement of patient's care, further improving the communication between nurses and other health professionals

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

Clinical Outcome of Third-Line Pazopanib in a Patient with Metastatic Renal Cell Carcinoma

Background. Renal cell carcinoma accounts for about 2-3% of all malignant tumors. The prevalence of brain metastases from RCC is less than 20% of cases. Traditionally, whole brain radiotherapy as well as the latest stereotactic radiosurgery improves both survival and local tumor control. These treatments also allow stabilization of clinical symptomatology. However, validated treatment guidelines for RCC patients with brain metastases are not yet available on account of the frequent exclusion of such patients from clinical trials. Moreover, limited data about the sequential use of three therapies, changing the class of agent, have been published up to now. Case Report. We report the case of a patient with metastatic RCC who developed disease progression after sunitinib and everolimus as first-line and second-line therapy, respectively. Thus, he underwent a multimodality treatment with pazopanib, as third-line therapy, to control systemic disease and radiosurgery directed on the new brain metastasis. To date, the patient is still receiving pazopanib, with progression-free survival and overall survival of 43 and 103 months, respectively. Conclusion. In a context characterized by different emerging options, with no general consensus on the optimal treatment strategy, the use of pazopanib in pretreated patients could be a suitable choice

Solitary enchondroma in the distal phalanx of the right thumb. An unusual localization

An unusual localization of solitary enchondroma in the distal phalanx of the right thumb is reported. The lesion was studied by radiograph and magnetic resonance imaging (MRI) investigation. It was surgically treated by curettage with bone grafting. Copyright © 2001 Elsevier Science Inc

Nursing management of patients dealing with spina bifida: from the prenatal diagnosis to adulthood / nursing intervention for the improvement of the impact of urinary and fecal incontinence on the quality of life of people dealing with spina bifida

Abstract Background Urinary and fecal incontinence in people dealing with spina bifida, has inevitably an influence on the quality of life. In this analysis, the degree of education on how to manage incontinence and retention is studied, as well as the problems those might create and the consequential degree of autonomy and independence reached into the management of those. The main goal is to increase both nursing assistance and the education of the people dealing with spina bifida. Methods A multiple-choice questionnaire with open questions, concerning the bowel and bladder management was structured by all the authors and shared by the Google Docs platform among the members of the ASBI (Associazione Spina Bifida Italia) by the secretariat of the association itself. 125 patients affected by Spina Bifida voluntarily decided to participate and complete the questionnaire. The questionnaire didn’t set any limits as regards the age. For minors, its completion was made under the observation of the caregivers who gave their consent. All the authors participated to administration of the questionnaire to minors. Results out of 125 participants, 80 were females and 25 males. The questions concerned the level of deambulation (the 35,2% was autonomous, the 30,4% were people who use wheelchairs while the 34,4% is aid-supported), urinary incontinence, with great concern to the self-catheterization technique (the 80,8% claimed to be autonomous in performing self-catheterization, unlike the remaining 19,2%) and the impact of the said incontinence on social life (the 59,2% claimed they do not feel restrained because of their bladder incontinence or retention, unlike the remaining 40,8%). Lastly, we focused on fecal constipation and incontinence (the 57,6% claimed to struggle with incontinence, the 12% claimed they don’t and the 30,4% struggles with both conditions), on the ability of the people dealing with this to intervene to prevent unpleasant situations, in particular by using trans-anal irrigation (the 57,6% doesn’t feel autonomous in performing it). Conclusion urinary and fecal incontinence have, of course, an impact on the quality of life of people dealing with spina bifida. Nevertheless, we can observe that it is possible to improve the quality of life of these people, letting them feel confident enough to take part in social activities, through education from an incredibly young age, from 0 up to 25 years old and over, supplied by the medical staff and mostly by the parents (previously educated by the medical staff as well)