Scheda di dimissione infermieristica in una Unità Operativa di Cardiochirurgia Pediatrica: uno strumento per facilitare il trasferimento tra le diverse realtà di cura o a domicilio

Nella mia realtà lavorativa, Fondazione Toscana Gabriele Monasterio, rispetto all’accoglienza e alla dimissione sono emerse delle criticità. Questi percorsi sono caratterizzati da iniziative frammentarie e non sistematiche, da una gestione discrezionale da parte del singolo operatore e da una dimissione infermieristica verbale e non strutturata. Emerge, quindi la necessità di iniziare un “Nuovo Percorso”. L'accoglienza come biglietto da visita che le strutture presentano all'utente e la Dimissione pianificata con l’implementazione della Scheda di dimissione Infermieristica (SDI). Il progetto prevede la condivisione di uno schema comunicativo (opuscoli, incontri programmati ), di un supporto di conoscenze e di un supporto psicologico ai pazienti con continuità assistenziale; prevede di fornire suggerimenti psico- educativi di immediata applicabilità, di fornire riferimenti utili per la convalescenza a casa, e di definire un set di informazioni cliniche ed assistenziali tra "chi invia e chi accoglie". Il progetto è stato realizzato da maggio ad agosto 2014, è stato sviluppato un database per l’analisi dei risultati. È stata elaborata e condivisa la SDI cartacea; è stata fatta un indagine conoscitiva, in Regione, sulla presenza o meno della SDI. Sono stati contattati i Dirigenti Infermieristici e le altre Cardiochirurgie Pediatriche Italiane. Le risposte non sono state soddisfacenti perché molti non hanno risposto all’intervista, criticità probabilmente legata al periodo estivo che, sempre, si presenta di difficile gestione. La diffusione in Azienda dovrà essere completata, comunque i primi risultati sono garanti di una risposta positiva. In futuro l’obiettivo potrebbe essere una SDI unica, almeno Regionale derivata dall’esperienza e dai bisogni dei vari Centri Toscani, che troveranno, nell’unico strumento in uso, un utile e valido aiuto a garanzia di un percorso e di una continuità assistenziale ormai molto complessa

Predictors of weight loss in patients with obesity treated with a Very Low-Calorie Ketogenic Diet

IntroductionThe Very Low-Calorie Ketogenic Diet (VLCKD) has emerged as a safe and effective intervention for the management of metabolic disease. Studies examining weight loss predictors are scarce and none has investigated such factors upon VLCKD treatment. Among the molecules involved in energy homeostasis and, more specifically, in metabolic changes induced by ketogenic diets, Fibroblast Growth Factor 21 (FGF21) is a hepatokine with physiology that is still unclear.MethodsWe evaluated the impact of a VLCKD on weight loss and metabolic parameters and assessed weight loss predictors, including FGF21. VLCKD is a severely restricted diet (<800 Kcal/die), characterized by a very low carbohydrate intake (<50 g/day), 1.2–1.5 g protein/kg of ideal body weight and 15–30 g of fat/day. We treated 34 patients with obesity with a VLCKD for 45 days. Anthropometric parameters, body composition, and blood and urine chemistry were measured before and after treatment.ResultsWe found a significant improvement in body weight and composition and most metabolic parameters. Circulating FGF21 decreased significantly after the VLCKD [194.0 (137.6–284.6) to 167.8 (90.9–281.5) p < 0.001] and greater weight loss was predicted by lower baseline FGF21 (Beta = −0.410; p = 0.012), male sex (Beta = 0.472; p = 0.011), and central obesity (Beta = 0.481; p = 0.005).DiscussionVLCKD is a safe and effective treatment for obesity and obesity related metabolic derangements. Men with central obesity and lower circulating FGF21 may benefit more than others in terms of weight loss obtained following this diet. Further studies investigating whether this is specific to this diet or to any caloric restriction are warranted

L’handover infermieristico: uno studio osservazionale presso le Degenze di un Dipartimento Cardiotoracico

INTRODUCTION:The handover has relevant implications in terms of patient safety. An effective handover requires the use of a standardized and shared communication tool.  AIM: This observational study explored the nursing handover at shift change in order to detect eventual omissions. Furthermore, it investigated the quality perceived by the nurses involved.  METHOD: At each shift change, an external observer detected the referred and omitted information by the delivering nurse, through the use of a direct observational grid (modified ISBAR). The percentage of the omitted information was calculated excluding any unforeseen information, not linked to the patient care pathway and detected through the consultation of the nursing record. The quality perceived by the nurses involved was investigated through the use of the Handoff CEX tool. The data was processed through a descriptive and inferential statistical analysis.  RESULTS: 256 handovers were observed and 256 nursing records were reviewed. The omissions were detected in 43.17% of the cases. The results highlight a propensity for a prospective approach. A high statistical significance emerges in relation to the modality of handover, the type of patient, the nurse/patients ratio and the number of interruptions. Referring to the perceived quality, 40 Handoff CEX evaluation forms were completed. The results show a more than satisfactory perception. However, the thematic analysis highlights scarcely detailed and dispersive handovers as well as the difficulty to focus on the information to deliver.  CONCLUSION: According to the findings of this research, it is necessary to implement a standardized tool which supports the handover process.  KEY WORDS: Handover, omission, perceived quality, standardization INTRODUZIONE: Il passaggio di consegna, dall’inglese “handover”, ha rilevanti implicazioni sulla sicurezza del paziente. Un handover efficace richiede l’utilizzo di uno strumento comunicativo standardizzato e condiviso.  OBIETTIVO: Lo studio osservazionale in esame ha esplorato i processi di handover infermieristico al cambio turno al fine di rilevare eventuali omissioni informative. Altresì, è stata indagata la qualità percepita degli infermieri coinvolti.  METODO: Ad ogni cambio turno, un osservatore esterno ha rilevato le informazioni riferite e omesse dall’infermiere erogante, attraverso l’utilizzo di una griglia di osservazione diretta (ISBAR modificato). La percentuale di omissioni è stata calcolata al netto delle informazioni non previste, non riconducibili al percorso di cura del paziente oggetto di consegna e rilevate attraverso la consultazione della cartella infermieristica informatizzata. La qualità percepita è stata indagata attraverso lo strumento Handoff CEX. I dati sono stati processati attraverso un’analisi statistica descrittiva e inferenziale.  RISULTATI: Sono stati osservati 256 passaggi di consegna e sono state esaminate 256 cartelle infermieristiche. Le omissioni si sono verificate nel 43,17% dei casi. I risultati evidenziano una propensione all’approccio prospettico. Emerge un’alta significatività statistica nella correlazione con la modalità di handover, la tipologia di paziente, il rapporto infermiere/pazienti e il numero di interruzioni. Relativamente alla qualità percepita, sono state compilate 40 schede Handoff CEX. I risultati rivelano una percezione più che soddisfacente. Tuttavia, l’analisi tematica evidenzia consegne dispersive, scarsamente dettagliate e la difficoltà nel focalizzare le informazioni da trasferire.  CONCLUSIONE:Alla luce dei dati rilevati si rende necessaria l’implementazione di uno strumento standardizzato che supporti il processo di handover.  PAROLE CHIAVE: Passaggio di consegna, omissione, qualità percepita, standardizzazione&nbsp

[The prevalence of arrhythmias in subjects over 80 years old. The prognostic role of anamnestic symptomatology and the therapeutic directions].

24-hour Holter monitoring was performed in 129 unselected subjects older than 80 years (69 women and 60 men) in order to evaluate arrhythmia incidence and to establish significance of symptoms; 56% patients had lipothymia and/or syncope, chest pain and palpitations, 44% were asymptomatic. All patients showed high incidence of hyperkinetic and hypokinetic arrhythmias; no significant differences between symptomatic and asymptomatic patients in arrhythmia incidence were seen. Moreover, no correlation could be seen of the symptoms reported by the patient to the incidence of any particular type of arrhythmia. In conclusion, these preliminary data suggest a criticism of the opportunity of indiscriminate and long term antiarrhythmic therapy. Nevertheless, Holter monitoring is useful in detecting hypokinetic arrhythmias of asymptomatic patients in whom pacemaker implantation is essential and curative

Quality of Life of Families with Children Presenting Congenital Heart Disease:Longitudinal Study Protocol

BACKGROUND: Advances in medicine have caused a notable increase in the survival rates of children born with congenital heart disease, even in the most complicated cases, almost mitigating the disease’s pathology from lethal to chronic. The quality of life perceived by such children is influenced by the perceptions of their parents. However, the international literature has rarely considered the entire family nucleus. AIMS: This study aims to study the temporal trend of quality of life of families with children with congenital heart disease, particularly with respect to parents following a child’s hospitalization for an invasive procedure. DESIGN: A longitudinal study. METHOD: A sample of families (that is, those including a child with congenital heart disease and their parents) will be enrolled following the patient’s discharge from the hospital and examined every 3 months for 1 year. The study’s adopted hypothesis is that there is an interdependence between the subjects of the study that is capable of influencing individual perceptions of quality of life. RESULTS: This study will attempt to identify variables (and their temporal trend) that can be attributed to the family unit and—together with physical and clinical variables—that may influence the quality of life of children with congenital heart disease. CONCLUSION: Examining family quality of life with the longitudinal method will allow us to identify the predictors and interdependence of this factor with respect to children and their parents. This will help to correct and elaborate upon care guidelines, providing better assistance to patients and their caregivers

Spectral Characterization of Northwest Africa 12184 Meteorite: FT-IR and u-IR Investigation as Part of Simulation of Space Weathering on Airless Bodies of Solar System

We spectrally characterized matrix and chondrules of NWA 12184 meteorite, whose spectral variations will be observed after the ion irradiation process

Cardiac Children's Hospital EarlyWarning Score: Italian validation

Background/purpose: The Cardiac Children's Hospital Early Warning Score (C-CHEWS) is an early warning scale used to identify paediatric patients experiencing clinical deterioration which may warrant a transfer to an ICU. However, no studies have tested the C-CHEWS in an Italian paediatric cardiac population. The aims of this study were to translate/back-translate and validate the Italian version of the C-CHEWS and its algorithm. Design and method: Retrospective study. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value were used to evaluate the performance of C-CHEWS. In additions the Cohen's kappa statistic was calculated to evaluate the agreement between patient's status described by C-CHEWS score (≥5) and actual ICU transfer. Results: High discrimination was observed for sensitivity (81.5%), specificity (99.6%), accuracy (99.7%), positive predictive value (86.7%), and negative predictive value (99.8%). The Cohen's kappa score was observed to be equal to 0.837 (p-value b0.001) indicating there was excellent significant agreement between a C-CHEWS score ≥ 5 and effective evaluation for patients transfer to an ICU. Conclusion: The Italian version of the C-CHEWS proved to be a sensitive, specific and reliable tool in the early detection of a physical deterioration of hospitalized paediatric cardiac surgical patients. Practice Implications. This tool may help doctors, nurses and all healthcare professionals to promptly recognize and treat clinical deterioration and facilitate urgent transfers to the PICU