L'INCONTINENZA URINARIA POST-PROSTATECTOMIA RADICALE RETROPUBICA: QUALITÀ DI VITA DEI PAZIENTI ED EFFICACIA DI DUE TRATTAMENTI CONSERVATIVI GESTITI DALL'INFERMIERE.

Introduction Urinary incontinence is a common problem after radical retropubic prostatectomy (RRP). Management strategies include conservative management, a series of treatment that do not imply neither surgery nor drugs. Conservative management includes pelvic floor muscle exercises (PFMEs), based on voluntary muscular contractions similar to those proposed by Kegel. Another rehabilitation technique is called “extracorporeal magnetic innervations” (ExMI), a special armchair that induces muscular contractions by using a magnetic field (passive rehabilitation). Both treatments can be performed by nurses, but their efficacy is unclear in literature. Goals The study was aimed at evalutating the role of PFMEs vs. no treatment in decreasing prostatic symptoms; clarifying the effects of PFMEs in time; comparing PFMEs vs. ExMI in decreasing urine leakage; investigating quality of life in patients with post-RRP urinary incontinence; identifying which prostatic symptoms investigated by the IPSS are linked between each other, since many patients are unable to completely describe their clinical situation and give a full report of the symptoms. Methods Quasi – experimental, non-randomized study. Convenience sample: 153 patients, prostate-limited cancer (2003-2010), indwelling catheter for max 8 days, regular flow after removal. 22 people refused rehabilitation after their RRP, but accepted to enter the study (control group). 88 underwent home and outpatient treatments with PFMEs, 23 were enrolled in the ExMI group. Assessment at 1, 3, 6, 12 months: International Prostate Symptom Score (IPSS) in each group, 24-h pad test in treated patients. End of treatment: loss<10 grams/day during muscular effort. Comparison between the groups was performed statistically. The IPSS questionnaires were analyzed in order to identify clusters of questions. EORTC PR-25 questionnaire was administered to treated patients, in order to investigate quality of life. 6 Results The IPSS score had a very good internal consistency in PFMEs patients (Cronbach‟s =0.9685); together with literature findings, this data supported the choice of such questionnaire in these patients. No significant difference between the IPSS prostatic symptom scores was detected at 1 month (Wilcoxon test: 2(8)=6.33, p=0.6104). Between 1 and 3 months, IPSS decreased more quickly in the PFMEs patients, in comparison with the control group, notwithstanding BMI and age (ANCOVA after PROBIT transformation: p=0.0008, R2=0.8163, 2 in the sample=0.1465). No significant difference was found at 6 months (Wilcoxon test,2(3)=1.51, p=0.68). After 6 weeks of treatment (the equivalent of a full ExMI cycle), 32.73% patients in the PFMEs group had reached the 10 g/day cutoff, vs. 63.88% in the ExMI group (log-rank test: 2(1)=16.287, p<0.0001). PFMEs could achieve comparable results between 10 and 11 weeks (Kaplan-Meier analysis). The clusters identified through the analysis of the IPSS questionnaires were not clinically useful, being predictable through basic clinical considerations. The EORTC PR-25 questionnaire, according to the existing literature, pointed out that incontinence was perceived as a limitation to daily activities, as well as a source of virility loss. Conclusion / discussion PFMEs are effective in reducing prostatic symptoms, if compared with no treatmen, between 1 and 3 months after surgery. At 6 months, a physiological recovery seems to exist even in both the PFMEs and control group. ExMI is clearly quicker than PFMEs in leading patients to reach the 10 g/day cutoff; a long-term follow-up could be useful to evaluate the persistence of its benefits over time. Further studies could investigate the impact of ExMI on various types on incontinence with larger samples. The IPSS score includes questions that are strictly linked between each other, but using it as a whole seems the best choice for nursing anamnesis. According to literature, 7 quality of life is heavily influenced by incontinence in its sexual aspects. Nurses‟ collaboration with sexologists could lead to a further quality of life improvement. Practical relevance Conservative management, performed by nurses through PFMEs and ExMI, can be effectively used in rehabilitation. Nurses are autonomous in performing such treatments; their work improves quality of life in post-RRP patients with urinary incontinence

Indagine trasversale sull&apos;abbandono del corso di laurea in infermieristica presso l&apos;Universit&#224; degli Studi di Milano

Introduzione Secondo le stime dell\u2019OCSE, in Italia mancano circa 100.000 infermieri; \ue8 quindi necessario supportare gli studenti motivati che intraprendono il Corso di Laurea in Infermieristica, con misure mirate a ridurre i tassi di abbandono e di insuccesso accademico senza intaccare la qualit\ue0 della formazione. Data la scarsit\ue0 di studi condotti nel nostro paese sull\u2019argomento, con questa indagine ci siamo proposti di raccogliere informazioni sulle caratteristiche degli studenti che hanno abbandonato il Corso di Laurea in Infermieristica (CLI) dell\u2019Universit\ue0 degli Studi di Milano tra il 2006 e il 2009. Materiali e metodi L\u2019indagine \ue8 stata condotta, utilizzando un questionario semistrutturato autosomministrato, su un campione formato da ex studenti che avevano abbandonato il CLIal primo anno di corso. Risultati Il questionario compilato \ue8 stato restituito da 90 soggetti, in prevalenza di nazionalit\ue0 italiana (83) e di sesso femminile (59), con un\u2019et\ue0 media di 27 anni. La maggior parte ha riportato che avrebbe preferito intraprendere altri corsi di laurea. Ifattor i pi\uf9 frequentemente indicati come cause dell\u2019abbandono del CLIin cludevano la delusione delle aspettative, la pesantezza del corso di studi, il carico familiare e problemi economici o di salute. Conclusioni Le risposte fornite dai partecipanti all\u2019indagine indicano che spesso la scelta del CLIn on \ue8 supportata da idee chiare e motivazioni forti. Idati raccolti suggeriscono, tra i possibili approcci per ridurre il rischio di insuccesso accademico degli studenti infermieri, il potenziamento del tutorato e una diversa gestione dei piani di studio

La prova finale per il conseguimento della laurea in infermieristica : studio trasversale

Riassunto Introduzione: il corso di laurea in Infermieristica termina con una prova abilitante (prova pratica e dissertazione di un elaborato). La normativa prescrive il numero di membri della commissione valutatrice, lasciando agli Atenei la scelta delle modalit\ue0 di svolgimento. Le competenze da valutare sono uguali in tutta Italia; \ue8 auspicabile l\u2019adozione di un metodo unico per l\u2019accertamento, dunque servono dati sulle attuali modalit\ue0 di svolgimento della prova. Metodi e strumenti: studio trasversale, condotto tramite questionario somministrato via e-mail a 152 sedi del corso di laurea nel 2011, per indagare la composizione del voto di laurea, le caratteristiche della prova pratica, la soglia di superamento, la valutazione degli elaborati, la composizione della commissione. Risultati: hanno risposto 112 sedi di tutta Italia. 60 considerano i voti degli esami di profitto e quelli di tirocinio; 7 non considerano il tirocinio. L\u2019esperienza Erasmus \ue8 conteggiata da 18 sedi, la lode negli esami da 40. 60 sedi non prevedono una soglia di superamento della prova. In 56 sedi la prova pratica consiste in quiz (da 22 a 80 domande). 44 sedi usano la simulazione in laboratorio, 12 un caso clinico simulato, 10 un piano infermieristico. 7 portano lo studente al letto del malato. Gli elaborati sono di vario tipo e valgono da 5 a 22 punti. Nelle commissioni, il numero di membri \ue8 l\u2019unico dato comune. Conclusioni: la situazione \ue8 lontana da quella auspicata dal Processo di Bologna; la Conferenza Nazionale pu\uf2 avere un ruolo importante nell\u2019uniformare criteri e metodi di svolgimento della prova abilitante

Percezioni e conoscenze degli infermieri e degli studenti di infermieristica in tema di contenzione fisica: risultati di uno studio

Introduction The Health Care Financing Administration considers as physical and mechanical means of restraint all devices applied to the body or in the space surrounding the person to limit the freedom of voluntary movements. The main reasons for the application of a restraint are the prevention of falls, the management of confusion and agitation, the protection of medical devices. The event, however, is not without consequences: many studies have highlighted physical complications and psychological repercussions, as well as feelings of disappointment and embarrassment, often shared by the family. Moreover, the decision whether or not to resort to physical restraint is not without consequences, essentially of an emotional nature, also for the nursing staff. The objective of this study is to investigate the perception and knowledge of a sample of nurses and nursing students regarding physical restraint. Methods Validation of the Italian version of the questionnaire by Janelli LM et al. (1992); administration of the instrument to a sample of nurses from different health realities and students of the degree course in nursing. Results Internal consistency was 0.81 for the \u201cknowledge\u201d domain, 0.86 for \u201cattitudes\u201d and 0.84 for \u201cAspects of practice\u201d. The Content Validity Index was 0.96. The \u201c knowledge\u201d and \u201c aspects of practice\u201d domains scored critically in 6 items out of 15; the "attitudes" domain showed that the participants (students in particular) had satisfactory motivation towards this topic. Conclusions The Italian version of the tool has proved to be valid and reliable; the results obtained suggest the need for more training for students, continuous updating of nurses and greater awareness of the issue of physical restraint

Becoming competent in palliative care as perceived by nurses attending a Master programme : A qualitative study

This study analysed the perceived process of developing competence in a group of nurses attending a University Master programme in Palliative Care (PC). To evaluate and monitor PC competences, validated questionnaires are available in the literature. Nevertheless, nursing competence in PC is not always evident and measurable. Qualitative instruments as interviews, focus groups could be useful to explore that aspect of nurses\u2019 expertise and to better evaluate the development of competence in PC during and after training experiences Since we focused on a process, we opted to follow the Grounded Theory method. Data were collected through three focus groups, carried out at the beginning, in the middle and at the end of the training. All the nurses participating in the programme were involved. The development of nurses\u2019 competence in PC turned out to be characterised by: 1) transforming clients\u2019 representation from a fixed and uniformed image of the patient to a multi-faceted idea of him/her; 2) transforming the idea of the family from an obstacle to a system integrated with patients; 3) proceeding from an idealized representation of the team to its perception as a real working group; 4) experiencing the accompanying to death as a feasible team work and no more as a solitary endeavour; 5) shifting from a focus just on relational needs to competence in a global patient\u2019s management. Nurses who apply for post-graduate PC training appear to have high predisposition towards considering communicative/relational competences as crucial in that field. Nevertheless, they should be oriented to critically reflect on these core competences to transform their often idealised, and therefore self-protective, image of patients

Italian Version of the Laval Questionnaire: Validity and Reliability

Background and Scope: Morbid obesity is complicated by the presence of depression and poor quality of life. Bariatric surgery aims at improving quality of life of obese persons, as well as reducing mortality and medical risk factors. Quality of life assessment is important in clinical care planning, as well as in the evaluation of surgical outcomes. The Laval questionnaire has been specifically developed for patients with morbid obesity, but has never been validated into Italian; we aimed to produce an Italian version, in a population of patients scheduled for bariatric surgery. Methods: We conducted a multicenter observational study on a nonrandomized sample of patients (age 19-65 years), with morbid obesity and body mass index (BMI) degrees 35, candidates for bariatric surgery (gastric banding or gastric bypass). Cronbach's alpha and factor analysis were used to assess internal consistency and structure. Results: One hundred sixty-three patients were enrolled, mean BMI of 42.8 +/- 7.5 kg/m(2) (range 31-70). Excellent consistency (alpha >0.90) and concurrent validity with the Obesity-related Well Being Scale (ORWELL's) questionnaire (rho=-0.78, p 0.75). Conclusion: In conclusion, we can state that the Italian version of the Laval questionnaire is valid and reliable for assessing quality of life in patients waiting for bariatric surgery

Development and Validation of A New Tool for Assessing Risk of Falls in Acute Psychiatric Settings

Aim:To create and validate a tool, in English and in Italian, to assess risk to fall in patients hospitalized acute psychiatric settings. Materials and Methods:upon literature review, a new scale was created and administered to the patients of two psychiatric services in different Italian hospitals. Validity and reliability of the scale were assessed by means of factor analysis, content validity index, and Cronbach\u2019s alpha coefficient. Results:The scale consists of 11 items (CVI-S = 90.9%); 7 clinical experts have positively judged comprehensibility and the uniqueness of the items. 123 patients were screened (at admission, and after 24 and 48 hours), 10 of them reported falls; with a cut-off of 11 points, the scale showed 100% sensitivity and 80.2% specificity. Inter-rater reliability was high (Pearson's r = 0.93). Conclusions: the new scale seems easy to use and capable of predicting falls in psychiatric patients admitted to acute hospital units

Relationship between Capillary Refill Time at Triage and Abnormal Clinical Condition : A Prospective Study

Background: Capillary refill time has been studied in literature as a perfusion indicator. Two pilot studies have proposed possible reference values in healthy adults. No data exist regarding capillary refill time as an indicator of abnormal clinical conditions in adults, which might be of help for triage nurses. Objective: We wanted to assess if any relationships existed, between altered capillary refill time and abnormal clinical conditions in the emergency department. We investigated relations between capillary refill time and vital signs recorded in triage and blood tests, by analyzing the clinical records. Mortality at 24 hours, 7 days and over 14 days was investigated by calling the patients after discharge. Method: Observational, single-center study on a sample of consecutive patients aged 65 18 years in the Emergency Department of a major Milan hospital, from June to October 2014. Multivariate logistic regression was used to investigate the impact of clinical variables on capillary refill time. Results: 1001 patients were enrolled, aged 59 \ub1 21 (473 aged 65 or more). Longer refill times were found in patients admitted to hospital units after medical consultations in the emergency department compared to those discharged or sent to outpatients. In elderly patients, statistically significant association was found between increased capillary refill time and sepsis (sensitivity 100%, specificity 83.33%, area under the receiver operating characteristics curve 65.95% CI 47-83), oxygen saturation, mean blood pressure, and lactates. In persons aged 45 to 64, altered refill times were associated with abnormal values of glicemia, platelets, and urea. Conclusion: Capillary refill time can be used by nurses at triage as a complementary parameter to normal vital signs. This is one of the few studies investigating refill time in adult patients

Analisi di Budget Impact su modelli di acquisto e gestione degli ausili per l'incontinenza urinaria a confronto

Introduction: Urinary Incontinence (UI) is a chronic condition affecting mainly elderly people, thus the budget to deal with is foreseen to grow significantly, especially in Italy, where there is a combination of private and public buying. In 2015, the Italian National Health System (NHS) spent 355 million Euros to provide pads to UI, while the out-of-pocket expenditure for the patients was 233 million Euros. The study aims to evaluate the impact of two different UI buying pathway by performing a Budget Impact Analysis (BIA) vs current model. Methods: Three different scenarios were compared over a period of 3 years. Scenario 1 (“As is”), based on current model (2016-2017 expenditure), was compared to the: Scenario 2 (“Voucher”), implying the introduction of vouchers to entitle patients to acquire pads in the private channel without NHS tenders; Scenario 3 (“Tender management Optimization”) is based on an optimization of provided from NHS pads, according to patients UI severity. Results: Scenario 2 implies increase of NHS expenditure of 262 million Euros in the 2020, while Scenario 3 generates 21 million of savings vs scenario 1. Conclusions: The study indicates that the introduction of a new pathway in managing UI such as Scenario 3, could be sustainable for NHS and generate significant savings both for NHS and patient perspective

Nursing students&apos; interprofessional educational experiences in the clinical context : findings from an Italian cross-sectional study

Objective To explore nursing students' interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences. Design National cross-sectional study on data collected in 2016. Setting 95 Bachelor of Nursing Sciences programmes; 27 Italian Universities. Participants Students who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study. Primary and secondary outcomes First to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence. Measures The primary outcome was measured using questions based on a 4-point Likert scale (from 0=never' to 3=always'). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire. Results 9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities only a little', to some extent' or always', respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences. Conclusions A large number of nursing students experienced either never' or only a little' IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students' interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels