Valutazione dell'efficacia del Gelclair® nella prevenzione e cura della stomatite nei pazienti sottoposti a trapianto di cellule staminali emopoietiche: Studio randomizzato

RIASSUNTOIntroduzione: La stomatite da farmaci chemioterapici è un importante effetto collaterale del trattamento. I protocolli per la cura del cavo orale, si basano su due livelli di intervento: senza e con uso di medicamenti . La letteratura descrive numerosi interventi di profilassi e terapia ma ad oggi non esiste ancora un intervento considerato gold standard. Obiettivo: Valutare l'efficacia del Gelclair® nella prevenzione e trattamento di pazienti sottoposti a trapianto di cellule staminali emopoietiche. Materiale metodi: 57 pazienti (28 gruppo di controllo e 29 gruppo sperimentale ) hanno utilizzato i colluttori 3 volte al giorno, la valutazione è stata effettuata con i seguenti strumenti: scala di valutazione della stomatite (WHO), scala VAS per dolore e Likert per gradimento. I pazienti sono stati osservati mediamente per 17 giorni. Risultati: 38/57 pazienti osservati (61%) hanno manifestato stomatiti .Non è stata rilevata differenza tra i due gruppi in termine di grado di stomatite p= 0.75 in tutto il periodo di osservazione. Il dolore è stato registrato in 31 soggetti su 57 (54%). Non si sono registrate differenze tra i due gruppi per quanto riguarda il valore medio di dolore riferito prima dell'utilizzo dei colluttori per tutti i giorni di osservazione p=0,06, gli utenti del gruppo sperimentale hanno dimostrato una riduzione del grado di dolore dopo l'utilizzo del collutorio p=0,04. Conclusioni: Gelclair® non influenza i tempi di insorgenza e l'andamento della stomatite. E' in grado di ridurre il dolore, sono necessari però ulteriori studi multicentrici per confermare la reale utilití  di utilizzo nei pazienti sottoposti a Trapianto.Parole chiave: Stomatite, trapianto di cellule staminali emopoietiche, infermieristicaAbstract Introduction: Chemotherapy-induced stomatitis is a major side effect of the treatment. Numerous approaches are described in the literature for the prevention and treatment of this complication. Objective: the aim was assess the effectiveness of Gelclair® in patients undergoing hematopoietic stem-cell transplantation in terms of reducing the incidence of stomatitis, stomatitis-pain and the severity of stomatitis Interventions/Methods: Fifty-seven patients (28 control group and 29 experimental group) used a mouthwash 3 times a day and were evaluated by means of a specially-tailored form containing the following assessment items:stomatitis evaluation scale (WHO), VAS for pain and Likert-Scale for agreement. Results: 61% of patients presented with stomatitis. No difference was observed between the two groups with regard to stomatitis grade throughout the observation period. Painful symptoms were observed in 54% subjects. No differences were observed in terms of average pain perception before the use of mouthwashes throughout the period of observation p=0.06. Results showed a pain-relieving effect in the experimental group after using the mouthwash p=0.04. Conclusions: Although Gelclair® had no influence on the onset and severity of stomatitis in transplanted patients, a significant benefit was observed in terms of pain control. Our study suggest the possibility to implementation the use of Gelclair® in clinical practice. However, further multicenter trials are needed to provide stronger evidence on the real usefulness of this product.Key words: stomatitis; Bone marrow transplantation; nursin

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a qualitative study of care practices based on a systemic approach

Funding Information: I thank first of all my professors and co-authors of this article for all the teachings. I thank the working group “La Buona Cura” and Tuscany Region (Italy) that allowed the realization of the study. Finally, I thank Doctor Margherita D'ambrini and Doctor Riccardo Coletta for the revision of translation and Doctor Yari Longobucco for help in reviewing literature. The authors conducted the research with the support of a Regional funding from Tuscany Region (Italy) sanctioned in the resolution DGRT 1016 of 26-10-2015 and DRGT 953 of 06-09-2017.37,38 Tuscany Region has allocated through Formas (institution for training in healthcare companies) a total amount of €40,000.00 for carrying out the research-intervention. The funding was addressed to different entities including the regional clinical risk management center (GRC) of which Tommaso Bellandi and Giulia Lefosse were affiliated for the conduct of the research. The funding was used for the field observation phases. The rest of the work was conducted under the university system by the student Giulia Lefosse as part of the PhD in clinical sciences at the University of Florence, in collaboration with her PhD tutor Laura Rasero (associate professor at the University of Florence) and professor Paulo Sousa, head of the National Center for Public Health and Research in Lisbon (Portugal), for methodological support. The author(s) received no financial support for authorship, and/or publication of this article. Funding Information: The authors conducted the research with the support of a Regional funding from Tuscany Region (Italy) sanctioned in the resolution DGRT 1016 of 26-10-2015 and DRGT 953 of 06-09-2017. Tuscany Region has allocated through Formas (institution for training in healthcare companies) a total amount of €40,000.00 for carrying out the research-intervention. The funding was addressed to different entities including the regional clinical risk management center (GRC) of which Tommaso Bellandi and Giulia Lefosse were affiliated for the conduct of the research. The funding was used for the field observation phases. The rest of the work was conducted under the university system by the student Giulia Lefosse as part of the PhD in clinical sciences at the University of Florence, in collaboration with her PhD tutor Laura Rasero (associate professor at the University of Florence) and professor Paulo Sousa, head of the National Center for Public Health and Research in Lisbon (Portugal), for methodological support. The author(s) received no financial support for authorship, and/or publication of this article. , Publisher Copyright: © The Author(s) 2022.Background: Infectious events, often related to healthcare practice, occur frequently within Nursing Homes (NHs), representing one of the main causes for morbidity, hospital admissions and mortality. The aims of this study are the analysis of care delivery problems and contributory factors of healthcare-related infections in a sample of NHs. This research could help identify organizational, technological and behavioural aspects, to implement improvement actions and reduce the impact of infections in long-term care. Methods: The study is a qualitative research with a systemic approach, based on the analysis of interactions in real practice between human factors, technologies and organizational structure and processes in 7 NHs in Tuscany (Italy), through extensive and structured observations of daily practices. The collected data were analyzed by applying clinical and ergonomic competences, comparing the data collected with established safe practices. The study was conducted by a nurse and a psychologist Results: From the data several problems related to infection control emerge. Buildings are often not suitable for confined spaces, room ventilation, natural light and rapid emergency response. Hand washing is not sufficient, use of antibiotics is usually not adequate. The microclimate is often not adequate, hygienic procedures are not always flawless. Staff members are in small numbers. Discussions: This study highlights high risk of contracting infections related to NHs. The study shows that dedicated infection prevention guidance are needed, to develop a local plan integrated with hospital setting, customized to needs of guests and characteristics of long-term care facilities, supported by a deep understanding of daily practices.publishersversionpublishe

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Emergency department nurses’ competences: implementing a personal dossier for nurses onboarding, skills maintenance, and quality audit

Emergency Departments (EDs) are among the most challenging clinical settings for nurses. EDs are complex settings, including patients with various clinical severity levels, every typology of medical and surgical specialties, fast organizational responses, a triage area to identify the clinical priorities to access a medical visitation, and simultaneous emergency codes to be managed. Therefore, the issue of acquiring and maintaining adequate competencies to manage the delivery of nursing care in a multifaceted setting such as ED is central. Orientation and onboarding programs with very different characteristics in terms of content, duration, and delivery methods are present worldwide. These programs can include clinical skills self-assessment, structured learning opportunities, e-learning, development of core skills, portfolios. The possibility of integrating different educational strategies to gain knowledge with time spent in specific clinical areas to increase experience is the winning way to obtain the growth and maintenance of ED nurses’ competencies. In this paper, we report on the experience (currently in progress) related to the ongoing performance evaluation of ED nurses’ activities during 12 months in the Emergency Department of Careggi University Hospital. In particular, a printed annual “Professional dossier” was designed with two-fold aim. The staff nurse holder of the booklet can handle a realistic summary of his/her activities, case mix, and time spent in the diverse clinical areas of the ED, comparing these data with opportune standards provided to make adequate comparisons and pinpoint the professional improvements that are needed. The nurse coordinator and nurse manager can use nurses’ personal dossiers to know the realistic competencies load in the ED, balance the work shifts with adequate skill mix, program the rotation of nurses in the different clinical areas during the year to ease the maintenance of experience and expertise, and have a photograph of some important performance indicators for hospital personnel evaluation