Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review

Objective: End-of-life communication has been largely recognized to promote quality end-of-life care in nursing home (NHs) by increasing residents' likelihood of receiving comfort-oriented care. This scoping review summarizes what is known about the potential mechanisms by which end-of-life communication may contribute to palliative-oriented care in NHs.Methods: Using the framework proposed by Arksey and O'Malley and refined by the Joanna Briggs Institute methodology, five literature databases were searched. We extracted 2159 articles, 11 of which met the inclusion criteria: seven quantitative, three qualitative, and one mixed-methods study.Results: Three mechanisms were identified: a) promotion of family carers' understanding about their family member's health condition, prognosis, and treatments available; b) fostering of shared decision-making between health care professionals (HCPs) and residents/family carers; and c) using and improving knowledge about residents' preferences.Conclusion: Family carers' understanding, shared decision-making, and knowledge of residents' preferences contribute to palliative-oriented care in NHs.Practice implications: Discussions about end-of-life should take place early in a resident's disease trajectory to allow time for family carers to understand the condition and participate in subsequent, mindful, shared decision-making. HCPs should conduct systematic and thorough discussions about end-of-life treatment options with all cognitively competent residents to promote informed advance directives. (c) 2019 Elsevier B.V. All rights reserved

Augmented Reality, Virtual Reality and Artificial Intelligence in Orthopedic Surgery: A Systematic Review

Background: The application of virtual and augmented reality technologies to orthopaedic surgery training and practice aims to increase the safety and accuracy of procedures and reducing complications and costs. The purpose of this systematic review is to summarise the present literature on this topic while providing a detailed analysis of current flaws and benefits. Methods: A comprehensive search on the PubMed, Cochrane, CINAHL, and Embase database was conducted from inception to February 2021. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. The Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomized Studies (MINORS) was used to assess the quality and potential bias of the included randomized and non-randomized control trials, respectively. Results: Virtual reality has been proven revolutionary for both resident training and preoperative planning. Thanks to augmented reality, orthopaedic surgeons could carry out procedures faster and more accurately, improving overall safety. Artificial intelligence (AI) is a promising technology with limitless potential, but, nowadays, its use in orthopaedic surgery is limited to preoperative diagnosis. Conclusions: Extended reality technologies have the potential to reform orthopaedic training and practice, providing an opportunity for unidirectional growth towards a patient-centred approach

La Prevalenza del Dolore Cronico Non Oncologico nell'Adulto e Patologie Associate: una revisione narrativa della letteratura

Il dolore cronico non oncologico rappresenta un problema sanitario sottostimato dal punto di vista epidemiologico ed in termini di salute pubblica. Esso è una malattia in senso stretto, e rappresenta una delle maggiori motivazioni per cui i soggetti si rivolgono ai servizi sanitari. La grandezza del fenomeno si esprime in termini di sofferenza umana e di costi sociali. L'obiettivo di questa revisione è quello di identificare le cause e la prevalenza del dolore cronico non oncologico nei soggetti adulti. E' stata realizzata una revisione della letteratura dal 1998 al 2012 utilizzando le emeroteche virtuali partendo dalle banche dati (Pub-Med, CINHAL, Cochrane). È stata effettuata una revisione narrativa degli articoli ottenuti. Sono stati esclusi articoli riguardanti cefalee, fasce di etí  pediatriche e geriatriche, oncologici e articoli specifici per patologia. Gli studi ottenuti sono stati classificati per anno, autore campione, metodi, fasce di etí  e definizione di dolore. Sono stati selezionati 7 articoli. Questi studi epidemiologici, realizzati in diverse parti del mondo, riportano un tasso di prevalenza relativo al dolore cronico tra il 16-53%. Emerge una elevata eterogeneití  di risultati relativi alle diagnosi e metodi. Seppure limitato il numero degli articoli, emerge una elevata complessití  del fenomeno.Parole chiave: Dolore Cronico, Prevalenza, EpidemiologiaABSTRACTThe chronic nonmalignant pain is an underestimated epidemiologic health problem. It is a disease in its own right. It is one of the major reasons because patients use health service. The magnitude of chronic pain is in terms of human suffering and costs to society. The aim of this review is to identify the diagnosis and the prevalence of nonmalignant chronic pain in the adults. We have done a review of the literature from 1998 to 2012 using the virtual newspaper libraries starting from data bases (Pub-Med, CINAHL, Cochrane). We have made a narrative review of the articles obtained. Excluding topics of headache, pain for pediatric and geriatric groups, cancer pain and disease-specific items. Studies were classified for year, author sample, methods, age groups and definition of pain. We have obtained 7 articles. These epidemiological studies conducted in different part of the world, reported prevalence rates of chronic pain ranging from 16-53%. They shows a high heterogeneity of results concerning diagnosis and methods. Although limited the number of articles, show the high complexity of the phenomenon.Key Words: Chronic Pain, Prevalence, Epidemiology.

Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study

Background: International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory. Objectives: To explore Italian nursing students' attitudes towards caring for dying patients. Design: A multicenter cross-sectional study was conducted. Settings: The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region. Participants: The sample included 1193 students. Methods: Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression. Results: The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care. Conclusions: Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering

Inflammatory bowel disease nurse specialists for patients on biological therapies: a nationwide Italian survey

Background Management of inflammatory bowel disease (IBD) patients requires a multidisciplinary approach. Among the working team, the role of IBD nurse is expected to be particularly relevant when managing patients receiving biological therapies. We performed a survey to assess the presence of IBD nurse in centers where patients were receiving biologics. Methods For this Italian nationwide survey a specific questionnaire was prepared. IBD nurse was defined as a nurse directly involved in all phases of biological therapy, from pre-therapy screening, administration and monitoring during therapy, to follow up performed by a dedicated helpline, completed a specific training on biological therapy therapy, and observed international guidelines. Results A total of 53 Italian IBD centers participated in the survey, and 91 valid questionnaires were collected. Overall, 34 (37.4%) nurses could be classified as IBD specialists. IBD nurses had a significantly higher educational level than other nurses, they were more frequently operating in Central or Southern than in Northern Italy, they were working in an Academic center rather than in a General hospital, and in IBD centers with &gt;25 patients on biological therapy. On the contrary, mean age, gender distribution, years of nursing, and years working in the IBD unit did not significantly differ between IBD and other nurses. Conclusions Our nationwide survey showed that the presence of an IBD nurse is still lacking in the majority of Italian IBD centers where patients receive biological therapies, suggesting a prompt implementation

It is time to define an organizational model for the prevention and management of infections along the surgical pathway : a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.Peer reviewe

It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened

La promozione del self-care in ambito nutrizionale nella persona anziana: protocollo di ricerca con metodo misto

Scopo. Descrivere un progetto di ricerca disegnato per promuovere il self-care in ambito nutrizionale nelle persone anziane. La ricerca si propone di: a) valutare l'efficacia di un intervento educativo per la modifica di conoscenze, comportamenti e atteggiamenti in ambito nutrizionale; b) descrivere l'abilití  e i comportamenti di self-care in rapporto alla nutrizione; c) identificare i fattori favorenti o le barriere ai cambiamenti nelle conoscenze, comportamenti e atteggiamenti nutrizionali.Metodo. Il disegno di ricerca sarí  di tipo misto sequenziale esplicativo. Lo studio prevede l'arruolamento di 50 persone di etí  uguale o superiore a 65 anni. Nella prima fase quantitativa sarí  usato un disegno pre-test e post-test per la realizzazione di un intervento educativo mirato alla modificazione di conoscenze, comportamenti e atteggiamenti in ambito nutrizionale. Sulla base dei risultati dell'intervento educativo sarí  condotta la fase qualitativa dello studio con la realizzazione di focus group in sottogruppi di anziani. In una terza fase i risultati quantitativi e qualitativi saranno integrati. I dati quantitativi saranno analizzati attraverso metodi statistici descrittivi e inferenziali e i dati qualitativi attraverso l'analisi del contenuto. Risultati. Lo studio fornirí  nuove conoscenze su come le persone anziane si prendono cura di sé, e sui fattori che promuovono il self-care in ambito nutrizionale. Conclusione. La promozione del self-care è un obiettivo importante per il personale infermieristico nell'ambito dell'assistenza alle persone anziane. I programmi educativi rivolti al mantenimento di una corretta alimentazione nell'anziano possono contribuire a ridurre la malnutrizione e le malattie correlate e devono basarsi su conoscenze derivate dalla ricerca che possono rendere gli interventi più efficaci ed individualizzati. Parole Chiave: promozione della salute, cambiamenti di comportamento, nutrizione, self-care, nursing, infermieri, anziani, metodo mistoNutritional self-care promotion in community-dwelling older people: a protocol of mixed method researchAim. To describe a research protocol designed to promote nutritional self-care in older people. The aims of the research are: a) to evaluate the effectiveness of a nutritional education intervention in changing knowledge, attitudes, and behaviors; b) to describe the nutritional self-care ability and activities; c) to identify the promoting factors and barriers that influence the changes in nutritional knowledge, behaviors and attitudes in home-dwelling older people.Method. Sequential explanatory mixed method design. The study will enroll 50 people aged 65 years and over. In the first quantitative phase, a pre-test and post-test design will be used to deliver a nutritional intervention aimed to change knowledge, behaviors and attitudes toward nutrition. Using the quantitative study results, the qualitative study phase will be conducted by interviews in sub-groups of older people. In a third phase, the quantitative and qualitative study results will be integrated. Quantitative data will be analyzed using descriptive and inferential statistics and qualitative data will be analyzed through content analysis.Results. The study will provide new knowledge on nutritional self-care in home-dwelling older adults and the factors promoting nutritional self-care.Conclusion. Nutritional self-care promotion is of pivotal importance for the nursing care provided to home-dwelling older people. Educational programs aimed at the maintenance of proper nutrition in the older adults may reduce malnutrition and the related diseases. Nutrition educational programs should be based on knowledge derived from research to tailor individualized nutritional interventions and to realize effective educational programs.Key words: health promotion, behavior change, nutrition, self-care, nursing, nurses, older people, mixed metho

Patients and caregivers' knowledge of chronic obstructive pulmonary disease

 BACKGROUND: Knowledge of chronic obstructive pulmonary disease (COPD) is important for the disease self-management. Aim: This study aimed to assess the level of knowledge in Italian patients with COPD and their caregivers and to determine factors influencing their knowledge. METHODS: We used a descriptive-correlational design. Knowledge was assessed with the Bristol COPD knowledge questionnaire (BCKQ) that was translated in Italian through the forward-backward translation method. BCKQ was administered to a convenience sample of 142 patients with COPD and 51 caregivers. RESULTS: The mean age for patients and caregivers was respectively 77 years (range 45–93) and 62 years (range 28–85). Patients were mostly men, had a low education level and 30% had severe or very severe COPD, while caregivers were mostly female and with higher education level. The patients answered correctly to 48% of the BCKQ whereas caregivers to 59%. In patient-caregiver dyads, a good level of agreement on the knowledge was found in 35 items out of 65. In patients, the knowledge was not correlated with age, gender, education, years or seve- rity of disease whereas in caregivers it was fairly correlated with the education level. CONCLUSIONS: Our study showed that patients and caregivers possess limited knowledge of COPD, especially on chest infections, and exacerbations. Factors that limit or promote the acquisition of knowledge in people with COPD and their caregivers should be investigated. KEYWORDS: COPD; knowledge; questionnaire; education; caregiver; patient. Conoscenze sulla bronchite cronica ostruttiva nei pazienti e nei loro caregiver RIASSUNTOINTRODUZIONE: Le conoscenze sulla bronchite cronica ostruttiva (BPCO) sono importanti per la gestione della malattia. OBIETTIVO: Lo studio ha avuto l'obiettivo di misurare il livello delle conoscenze sulla BPCO tra i pazienti e i loro famigliari e individuare i fattori che hanno influenzato tali conoscenze. METODI: E' stato effettuato uno studio descrittivo-correlazionale. Le conoscenze sono state misurate attraverso il Bristol COPD knowledge questionnaire (BCKQ) che è stato tradotto e validato in lingua italiana seguendo il metodo forward-backward translation. Il questionario, che indaga 13 aree di conoscenze, è stato somministrato ad un campione di convenienza di 142 pazienti e 51 caregiver reclutati presso una struttura sanitaria italiana. RISULTATI: L'etaÌ€ media dei pazienti e dei caregiver era rispettivamente di 77 anni (range 45– 93) e 62 anni (range 28–85). La maggior parte dei pazienti era di sesso maschile, con un basso livello di scolaritaÌ€ e il 30% soffriva di stadio severo o molto severo di BPCO. I caregiver, invece, erano per la maggior parte donne con un livello di istruzione piuÌ€ alto dei pazienti. I pazienti hanno risposto correttamente al 48% delle domande del BCKQ, mentre i caregiver hanno risposto al 59%. Nelle 51 diadi patiente-caregiver, è stato individuato un buon livello di concordanza per 35 domande su 65 del questionario. Nella popolazione dei pazienti, il livello di conoscenze non è risultato correlato a etaÌ€, scolaritaÌ€, genere, severitaÌ€ e durata della malattia, mentre nei caregiver si è riscontrata una correlazione tra il livello di conoscenze e la scolaritaÌ€. CONCLUSIONI: Lo studio ha dimostrato che il livello di conoscenze sulla BPCO dei pazienti e dei loro caregiver è scarso, soprattutto per quanto riguarda le infezioni e le riacutizzazioni. Non sono ancora chiari quali siano i fattori che limitano o promuovono l'acquisizione delle conoscenze tra i pazienti con BPCO e i loro caregiver, per cui ulteriori studi in questo campo sono necessari. PAROLE CHIAVE: BPCO, conoscenze, questionario, educazione, caregiver, paziente