Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care

Abstract Background In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. Objectives To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. Methods Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA). Results Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P <  0.001). The palliative care consultant was requested for only two patients. Conclusion Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients’ quality of life

Multi-sulfonated ligands on gold nanoparticles as virucidal antiviral for Dengue virus

Dengue virus (DENV) causes 390 million infections per year. Infections can be asymptomatic or range from mild fever to severe haemorrhagic fever and shock syndrome. Currently, no effective antivirals or safe universal vaccine is available. In the present work we tested different gold nanoparticles (AuNP) coated with ligands ω-terminated with sugars bearing multiple sulfonate groups. We aimed to identify compounds with antiviral properties due to irreversible (virucidal) rather than reversible (virustatic) inhibition. The ligands varied in length, in number of sulfonated groups as well as their spatial orientation induced by the sugar head groups. We identified two candidates, a glucose- and a lactose-based ligand showing a low EC50 (effective concentration that inhibit 50% of the viral activity) for DENV-2 inhibition, moderate toxicity and a virucidal effect in hepatocytes with titre reduction of Median Tissue Culture Infectious Dose log10TCID50 2.5 and 3.1. Molecular docking simulations complemented the experimental findings suggesting a molecular rationale behind the binding between sulfonated head groups and DENV-2 envelope protein

L&#8217;insorgenza di lesioni da pressione nella fase intraoperatoria

Introduction: patients undergoing long surgical procedures are at risk of developing pressure sores. A wound of the subcutaneous tissue, between bony prominences and the operating table, occurring between the first hour and 4-6 hours after the continuous maintenance of the same position. In particular, the risk is present for immobility time more than 2 hours. Factors that increase the risk of injury during surgery are obesity and thinness, age over 70 years, pre-existing conditions such as diabetes, hypertension and immunodeficiency, previous skin wounds or pressure sores and smoking history. Purpose: we implemented the problem concerning pressure sores in the operating room as a possible complication of prolonged immobility on the operating table. Aim of the study is assess the intra-operative onset of pressure sores, evaluating the effectiveness of current protective measures, in order to hypothesize the use of a preventive dressings hydrocolloids in classes of patients previously selected. Materials and methods: in the operating theaters of the Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore di Milano, between May and September 2012, 90 adult surgical patients undergoing elective surgery lasting more than 2 hours were recruited. For each of the recruited patients, who have been granted the usual nursing, an evaluation form was compiled. Results/ conclusion: the analysis of the data showed that 79% of the subjects investigated has manifested persistent erythema and that prolonged immobility is definitely identified as a risk factor for the occurrence of pressure sores, with a percentage of risk that increases in a directly proportional way to the increase of the hours of surgery and, in particular, each hour of surgery

Dall'ideale al meglio possibile nell'insegnamento/apprendimento clinico

Obiettivi, metodi e strumenti per l\u2019insegnamento/apprendimento clinico e la valutazione. Presentazione degli obiettivi della giornata: presentare i processi che guidano al raggiungimento degli obiettivi professionalizzanti dei tre anni di corso, invitare i partecipanti al corso ad identificare gli obiettivi considerati prioritari, invitare i partecipanti a dividersi a gruppi di cui ciascun gruppo analizzer\ue0 uno degli obiettivi precedentemente identificato elaborando le strategie per raggiungerlo in qualit\ue0 di Assistente di Tirocinio, invitare i partecipanti a riconoscere il modello di riferimento (tecnocratico o umanistico), invitare i partecipanti a ricondurre l\u2019assistenza dell\u2019ostetrica alla personalizzazione secondo i principi dimostrati dalle Prove di Evidenza (EB). inoltre si analizzeranno gli strumenti e metodi di valutazione dell\u2019insegnamento/ apprendimento clinico: cosa valutare, come valutare

Prevention of healthcare associated infections: a descriptive study

BACKGROUND: This study aims to verify whether there are, and to which degree, knowledge and adherence to guidelines on the prevention and control of healthcare associated infections by nursing staff. Study design. A descriptive study was conducted on a sample of nurses in the areas of medicine, surgery, and its own specialties of the Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico in Milan from 1st December 2015 to 29th February 2016. METHODS: The knowledge of the nursing staff have been investigated through the use of questionnaires with anonymous self-reporting method; inspections in the wards using observational grids were carried out in order to verify adherence to best-practice principles. The data collected concern, both for the knowledge and for the practice, the following macro-areas: a) Cleaning, disinfection and sterilization, b) Hand hygiene, c) Standard and isolation precautions, d) Prevention of catheter-related urinary tract infections, e) Prevention of catheter-related bacteremia, f) Prevention of surgical site infections, g) Prevention of respiratory tract infections. Statistical analyzes were performed using Microsoft Office Excel and STATA software. RESULTS: 245 nurses from 16 wards were involved. In each wards 4 inspections were conducted. 128 completed questionnaires were returned, all considered for the analysis of data; the adhesion was 52.2%. The participants achieved an overall score of 15.0 \ub1 4.1 (mean \ub1 SD) on a maximum achievable score of 23 and >75% of them have reached a sufficient level. Among the most positive results, it must be underlined that nurses have demonstrated a higher level of knowledge for hand hygiene, with >81% correct answers; that the lumens of central venous catheters, when not in use, were kept covered with a protective cap in more than 99% of cases; that, for patients bearers of urinary catheter, the urinary drainage bag was maintained below the level of the bladder, as recommended, in more than 91% of the cases. On the contrary, as a very negative result, we found the greatest knowledge gap as regards cleaning, disinfection and sterilization, with a number of incorrect answers approaching 50%; furthermore, 64% of nurses wore jewels on their wrists, and / or hands when in action; finally, the alcohol-based handrub device could be easily reached from at least one of the beds of the room in less than 13% of the cases. CONCLUSION: Some knowledge gaps and differences with respect to adherence to best-practice principles for the prevention and control of healthcare associated infections was highlight by the present study