A central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic ...stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US) guidance and to confirm its utility in clinical practice in cancer patients.
Consecutive adult patients attending the oncology-hematology department were eligible if they had solid or hematologic malignancies and required CVC insertion. Four types of possible complication were defined a priore: mechanical, thrombotic, infection and malfunctioning. The patient was placed in Trendelenburg's position, a 7.5 MHZ puncturing US probe was placed in the supraclavicular site and a 16-gauge needle was advanced under real-time US guidance into the last portion of internal jugular vein. The Seldinger technique was used to place the catheter, which was advanced into the superior vena cava until insertion into right atrium. Within two hours after each procedure, an upright chest X-ray and ultrasound scanning were carried out to confirm the CVC position and to rule out a pneumotorax. CVC-related infections, symptomatic vein thrombosis and malfunctioning were recorded.
From December 2000 to January 2009, 1,978 CVC insertional procedures were applied to 1,660 consecutive patients. The procedure was performed 580 times in patients with hematologic malignancies and 1,398 times those with solid tumors. A single-needle puncture of the vein was performed on 1,948 of 1,978 procedures (98.48%); only eighteen attempts among 1,978 failed (0.9%). No pneumotorax, no major bleeding, and no nerve puncture were reported; four cases (0.2%) showed self-limiting hematomas. The mean lifespan of CVC was 189.7 +/- 18.6 days (range 7-701). Symptomatic deep-vein thrombosis of the upper limbs developed in 48 patients (2.42%). Catheter-related infections occurred in 197 (9.96%) of the catheters inserted. They were successfully treated with antibiotics and only in 48 (2.9%) patients definitive CVC removal was required for infection and/or thrombosis or malfunctioning.
This study represents the largest published series of consecutive patients with cancer undergoing CVC insertion under US guidance; this procedure allowed the completion of the therapeutic program for 1,930/1,978 (97.6%) of the catheters inserted. The absence of pneumotorax and other major complications indicates that US guidance should be mandatory for CVC insertion in patients with cancer.
Introduction: Nursing profession requires that the specificity of one’s own knowledge to be shared through the use of efficient measurement tools, able to assess, in a particular way, health ...interventions results. Therefore, it is necessary for the documentation to be produced using a universal and standardised language. The aim of the study is to identify any differences and inconsistencies between the language used in everyday practice and the referred taxonomy indicated by the Company Directives, highlighting the level of accuracy in the formulation of the nursing diagnosis. Materials and Methods: The Cross-mapping of nursing diagnoses formulated in the UOGI of the AOU “Policlinico Umberto I” of Rome, were collected in 2015 through a retrospective cohort study. The sample taken is 99 medical records and 97 nursing diagnoses. Referring to D-Catch, an attempt was made to conduct a grading of the diagnostic terms and to examine the completeness, linguistic appropriateness and accuracy of the diagnoses made, by subjecting the data to descriptive statistical analysis. The standardised language referred to is NANDA-I. Results: “Risk of infection related to possible invasion of microorganism secondary to surgery”, “Risk of falling related to accident history”, “Immobilization syndrome” are the diagnoses that have perfectly responded to a full-match and correspond to 9.4% of the total, while 38.1% was identified with a close match. Discussion: Using resources such as a standardised vocabulary and pre-structured diagnostic concepts can make nursing documentation systematic, less redundant and able to perfectly outline the assistance process. Conducting a study to compare the language adopted with the referred taxonomy allows the identification of existing gaps and the implementation of new practices aimed at improving the outcome, promoting the correct flow of information.
Aim
To test an explanatory model of nurses’ intention to report adverse drug reactions in hospital settings, based on the theory of planned behaviour.
Background
Under‐reporting of adverse drug ...reactions is an important problem among nurses.
Methods
A cross‐sectional design was used. Data were collected with the adverse drug reporting nurses’ questionnaire. Confirmatory factor analysis was performed to test the factor validity of the adverse drug reporting nurses’ questionnaire, and structural equation modelling was used to test the explanatory model.
Results
The convenience sample comprised 500 Italian hospital nurses (mean age = 43.52). Confirmatory factor analysis supported the factor validity of the adverse drug reporting nurses’ questionnaire. The structural equation modelling showed a good fit with the data. Nurses’ intention to report adverse drug reactions was significantly predicted by attitudes, subjective norms and perceived behavioural control (R² = 0.16).
Conclusions
The theory of planned behaviour effectively explained the mechanisms behind nurses’ intention to report adverse drug reactions, showing how several factors come into play.
Implications for nursing management
In a scenario of organisational empowerment towards adverse drug reaction reporting, the major predictors of the intention to report are support for the decision to report adverse drug reactions from other health care practitioners, perceptions about the value of adverse drug reaction reporting and nurses’ favourable self‐assessment of their adverse drug reaction reporting skills.
Patient safety culture: an Italian experience Bagnasco, Annamaria; Tibaldi, Laura; Chirone, Paola ...
Journal of clinical nursing,
04/2011, Letnik:
20, Številka:
7-8
Journal Article
Recenzirano
Aims. To understand what level of awareness health professionals working in a hospital of Northern Italy had of the patient safety culture by using the Italian version of the Hospital Survey on ...Patient Safety Culture questionnaire and also validate its use in this setting.
Background. The Hospital Survey on Patient Safety Culture questionnaire was developed by the Agency for Health Research and Quality in 2008 and validated by several studies. Therefore, we decided to test the Italian version of this tool to see if it could be used effectively to measure and appraise patient safety culture also in Italy.
Design. Survey.
Methods. To check the validity of the questionnaire, we applied the continued comparison and the global data treatment methods.
Results. Of the 1008 questionnaires we administered, 724 (71%) were returned. The majority of the questions were answered (mean 98, SD 3·4%). From a Chi‐square test on the consistency of the answers, we found that six of the 12 perspectives we explored had a high level of significance, whereas in the other six, the differences in the answers were just casual.
Conclusions. The Italian version of the Hospital Survey on Patient Safety Culture questionnaire allowed us to assess health professionals’ awareness of patient safety culture and thus validate the effectiveness of this tool.
Relevance to clinical practice. The findings of our survey could be useful to design an objective tool that would allow the five health professional groups involved in the study (directors/coordinators, physicians, nurses/midwives, physiotherapists and technicians) gain a better knowledge of the patient safety culture and thus improve the quality of clinical practice.
The research analyzes data on the impact of the introduction of the figure nursing with advanced skills, "Advanced Skills" , in diagnostic and therapeutic surgical clinics within the Hospital of ...Piacenza. This is the application of the testing on the Project of Nursing "Skills"on advanced minor surgery "Minor Surgery", an outpatient procedure. They were given the satisfaction questionnaires to users and to the medical and nursing staff of the USL in Piacenza. The aim of the study was to verify the contention of the literature about the usefulness of an increased use of nursing skills within an ambulatory surgery to improve the quality of care and consequently to a higher user satisfaction. In light of the findings of the research, the ' impact of the implementation of the Project Advanced Nursing Skills has been positive, both among users is that health care providers. For a functional and effective management of the surgery may be useful to train a new nursing characterized by the possession of "Advanced Skills" whose "mission" is to develop more knowledge, share knowledge, as well as to foster innovation organizational and management to meet the demands of public health.
Abstract
Whether glyphosate-based herbicides (GBHs) are more potent than glyphosate alone at activating cellular mechanisms, which drive carcinogenesis remain controversial. As GBHs are more ...cytotoxic than glyphosate, we reasoned they may also be more capable of activating carcinogenic pathways. We tested this hypothesis by comparing the effects of glyphosate with Roundup GBHs both in vitro and in vivo. First, glyphosate was compared with representative GBHs, namely MON 52276 (European Union), MON 76473 (United Kingdom), and MON 76207 (United States) using the mammalian stem cell-based ToxTracker system. Here, MON 52276 and MON 76473, but not glyphosate and MON 76207, activated oxidative stress and unfolded protein responses. Second, molecular profiling of liver was performed in female Sprague-Dawley rats exposed to glyphosate or MON 52276 (at 0.5, 50, and 175 mg/kg bw/day glyphosate) for 90 days. MON 52276 but not glyphosate increased hepatic steatosis and necrosis. MON 52276 and glyphosate altered the expression of genes in liver reflecting TP53 activation by DNA damage and circadian rhythm regulation. Genes most affected in liver were similarly altered in kidneys. Small RNA profiling in liver showed decreased amounts of miR-22 and miR-17 from MON 52276 ingestion. Glyphosate decreased miR-30, whereas miR-10 levels were increased. DNA methylation profiling of liver revealed 5727 and 4496 differentially methylated CpG sites between the control and glyphosate and MON 52276 exposed animals, respectively. Apurinic/apyrimidinic DNA damage formation in liver was increased with glyphosate exposure. Altogether, our results show that Roundup formulations cause more biological changes linked with carcinogenesis than glyphosate.
Purpose
Hyponatremia and hypokalemia are common among elderly and have been associated with osteoporosis, we evaluate the role of these electrolytes as risk for fragility fractures.
Methods
This ...study is divided in two parts: one retrospective and one prospective. We retrospectively collected data on urgently admitted patients for femoral fragility fractures (Fx) or for acute myocardial infarction (AMI), and patients admitted for elective hip/knee replacement surgery for osteoarthrosis (OA). Age, sex, serum sodium, potassium, creatinine, and comorbidities were recorded. We enrolled prospectively in-patients from our unit: age, sex, comorbidities, drugs, and fragility fractures were recorded. Blood electrolytes were measured. Cognitive function, nutrition, muscular strength, and balance were evaluated by standard tests. The mortality rate was recorded with a follow-up after hospital discharge.
Results
The retrospective study included 2166 subjects: 702 Fx and 1464 controls (907 AMI, 557 OA): the prevalence of hyponatremia was similar in Fx and AMI, whereas it was higher in Fx with respect to OA (
p
< 0.001) as well as hypokalemia (
p
< 0.001). Sodium decrease was associated with higher fracture risk. Among the 284 subjects included in the prospective study, 50 patients were hyponatremic, more likely malnourished, and presented a higher prevalence of fragility fractures (
p
= 0.008). They had a higher mortality after hospital discharge (HR = 1.80,
p
= 0.005), however, this association disappears after correction for confounding variables.
Conclusions
We suggest that hyponatremia and hypokalemia have to be considered as a marker of poor health more than an independent fracture risk.
Chronic cerebrospinal venous insufficiency (CCSVI) has recently been reported to be associated with multiple sclerosis (MS). However, its actual prevalence, possible association with specific MS ...phenotypes, and potential pathophysiological role are debated.
We analysed the clinical data of 710 MS patients attending six centres (five Italian and one Canadian). All were submitted to venous Doppler sonography and diagnosed as having or not having CCSVI according to the criteria of Zamboni et al.
Overall, CCSVI was diagnosed in 86% of the patients, but the frequency varied greatly between the centres. Even greater differences were found when considering singly the five diagnostic criteria proposed by Zamboni et al. Despite these differences, significant associations with clinical data were found, the most striking being age at disease onset (about five years greater in CCSVI-positive patients) and clinical severity (mean EDSS score about one point higher in CCSVI-positive patients). Patients with progressive MS were more likely to have CCSVI than those with relapsing-remitting MS.
The methods for diagnosing CCSVI need to be refined, as the between-centre differences, particularly in single criteria, were excessively high. Despite these discrepancies, the strong associations between CCSVI and MS phenotype suggest that the presence of CCSVI may favour a later development of MS in patients with a lower susceptibility to autoimmune diseases and may increase its severity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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