What constitutes the 'Minimal Care' interventions of the nurse, physiotherapist, dietician and psychologist in Cardiovascular Rehabilitation and secondary prevention: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology.

BACKGROUND: In cardiovascular prevention and rehabilitation, care activities are carried out by different professionals in coordination, each with their own specific competence. This GICR-IACPR position paper has analysed the interventions performed by the nurse, physiotherapist, dietician and psychologist in order to identify what constitutes minimal care, and it lists the activities that are fundamental and indispensable for each team member to perform in clinical practice. RESULTS: In analysing each type of intervention, the following dimensions were considered: the level of clinical care complexity, determined both by the disease and by environmental factors; the 'area' complexity, i.e. the specific level of competence required of the professional in each professional section; organisational factors, i.e. whether the care is performed in an inpatient or outpatient setting; duration of the rehabilitation intervention. The specific contents of minimal care have been identified for each professional area together with the specific goals, the assessment tools and the main essential interventions. For the assessments, only a few validated tools have been indicated, leaving the choice of which instrument to use to the individual professional based on experience and usual practice. CONCLUSION: For the interventions, attention has been focused on conditions of major complexity requiring special care, taking into account the different care settings, the clinical conditions secondary to the disease event, and the distinct tasks of each area according to the operator's specific role. The final report performed by each professional has also been included.

A new formula for assessing skeletal age in growing infants and children by measuring carpals and epiphyses of radio and ulna.

The aim of this study is to develop a specific formula for the purpose of assessing skeletal age in a sample of Italian growing infants and children by measuring carpals and epiphyses of radio and ulna. A sample of 332 X-rays of left hand-wrist bones (130 boys and 202 girls), aged between 1 and 16 years, was analyzed retrospectively. Analysis of covariance (ANCOVA) was applied to study how sex affects the growth of the ratio Bo/Ca in the boys and girls groups. The regression model, describing age as a linear function of sex and the Bo/Ca ratio for the new Italian sample, yielded the following formula: Age = -1.7702 + 1.0088 g + 14.8166 (Bo/Ca). This model explained 83.5% of total variance (R(2) = 0.835). The median of the absolute values of residuals (observed age minus predicted age) was -0.38, with a quartile deviation of 2.01 and a standard error of estimate of 1.54. A second sample test of 204 Italian children (108 girls and 96 boys), aged between 1 and 16 years, was used to evaluate the accuracy of the specific regression model. A sample paired t-test was used to analyze the mean differences between the skeletal and chronological age. The mean error for girls is 0.00 and the estimated age is slightly underestimated in boys with a mean error of -0.30 years. The standard deviations are 0.70 years for girls and 0.78 years for boys. The obtained results indicate that there is a high relationship between estimated and chronological ages.

Heterologous Fertilization: the Opinion of Italian Physicians and a Brief European Overview.

A recent decision of the Italian Constitutional Court has legitimized for the first time heterologous artificial insemination. On April 9(th), 2014 the "Consulta" declared unconstitutional the sections of law n. 40 of 19 February 2004 (Judgment n. 162/2014), which prohibited heterologous fertilization: a) section 4 paragraph 3 "It is forbidden the use of techniques of medically assisted procreation of the heterologous type"; b) section 9, paragraphs 1 and 3, which include the prohibition of the disclaimer of paternity and the anonymity of the mother; c) section 12, paragraph 1, which includes penalties for anyone who uses for procreation purposes, gametes from subjects outside the applicant couple. In the present paper the Authors reviewed the recent judgment of the Constitutional Court of April 9(th), 2014, trying to evaluate the impact that it could have on Italian society. Secondly, the Authors have administered via internet a questionnaire to a cohort composed of 9000 Gynecologists and other specialists, regarding law n. 40/2004, their opinion of heterologous fertilization, the judgment of the Constitutional Court and the influence of the Catholic Church in Italy. Finally, a brief overview of laws in the field of heterologous fertilization among the European Union States has been provided.

[The role of dietitian in cardiac rehabilitation and secondary prevention]. / Ruolo del dietista nella riabilitazione e prevenzione secondaria cardiologica.

Rehabilitation and secondary prevention programs are recognized as an essential part of the overall care of patients with cardiovascular disease. They consist of multidisciplinary strategies aiming at the reduction of modifiable risk factors for cardiovascular disease. There are some evidence of the efficacy of nutritional care in modifying eating habits and behavior in patients undergoing cardiac rehabilitation. In 2007, the Italian Association of Dietitians (ANDID) appointed a working group of dietitians, skilled in nutrition applied in cardiovascular disease, with the aim to make an overview of the available scientific literature and to develop a Professional Position Paper on the role of Dietitian in cardiac rehabilitation and secondary prevention. The first Position Paper, developed in 2008, covered the available evidence about the dietitian professional role and contribution in the management of the topic. The working group has recently updated the contents by introducing, in agreement with the work done by ANDID, the methodology of the Nutrition Care Process and Model (NCP), a systematic problem-solving method intended to stimulate critical thinking, decision-making and address issues related to food and nutritional assistance, in order to provide a safe, effective and high quality care.

[First definition of minimal care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology]. / Documento preliminare alla definizione degli interventi Minimal Care infermieristici, fisioterapici, dietistici e psicologici attuabili nell'ambito della Cardiologia Riabilitativa e Preventiva.

Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to "gain health" through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

[The investigative and adversarial process in Italy and the United States]. / Il processo investigativo e accusatorio negli Stati Uniti d'America e in Italia.

The structure of the US legal system, which relies on the presence of different courts to provide for the impartial administration of justice, both civil and criminal is discussed. Therefore, all the steps to conviction or acquittal of the American criminal trial, are taken into consideration. However, there is the presumption of innocence of the accused and the prosecution must prove his guilt beyond any reasonable doubt. Another important procedure in the US trial is the jury selection (voir dire), 12 jurors: 6 for the defense and 6 for the prosecution. In Italy it was observed that the autonomy of the police would squeeze the steering function of the prosecutor, and the practice of "under cover" investigation has granted an extension of police activity.

[Mediterranean diet: not only food]. / Dieta mediterranea: non solo cibo.

The proposal of a Mediterranean way of life is much more than advise how to eat. The Mediterranean Diet, a model of Sustainable Diet, is an example of how to combine personal choices, economic, social and cultural rights, protective of human health and the ecosystem. There is in fact fundamental interdependence between dietary requirements, nutritional recommendations, production and consumption of food. In literature studies and nutritional and epidemiological monitoring activities at national and international level have found a lack of adherence to this lifestyle, due to the spread of the economy, lifestyles of the Western type and globalization of the production and consumption. To encourage the spread of a culture and a constant practice of the Mediterranean Diet, there are some tools that are presented in this article. The Mediterranean Diet Pyramid in addition to the recommendations on the frequency and portions of food, focuses on the choice of how to cook and eat food. The "Double Food Pyramid" encourages conscious food choices based on "healthy eating and sustainability. All the nutrition professionals and dietitians in particular should be constantly striving to encourage the adoption of a sustainable and balanced nutrition.

[Validation of the Italian version of the questionnaire on nutrition knowledge by Moynihan]. / Validazione della versione italiana del questionario di Moynihan sulle conoscenze alimentari.

BACKGROUND AND AIMS: A series of validation studies was performed on the Moynihan questionnaire to obtain data on nutrition knowledge, translated and adapted to Italian eating habits. Higher scores mean lower knowledge. METHODS: Test-retest reliability was assessed administering the questionnaire at a 15-day interval in 52 inpatients. Factor structure and correlation with demographic and anthropometric characteristics were studied on a larger sample, which included a number of health professionals. Finally, sensitivity to change induced by an educational program was verified in a sample of 11 patients with type 1 diabetes. RESULTS: Test-retest reliability was satisfactory; factor structure suggested one single principal component. Test scores were inversely correlated with age (r = 0.24; p = 0.02), but not with body mass index or waist circumference. Patients with higher education show a greater degree of nutrition knowledge. Among type 1 diabetic patients, an educational program induces a significant improvement of test scores (from 20.6 [18.6-22.8] to 16.6 [15.5-17.7], p = 0.003). CONCLUSIONS: The Italian version of the questionnaire appears to be psychometrically adequate for its use in clinical research.

[The role of dietitian in cardiac rehabilitation and prevention]. / Ruolo del dietista nella riabilitazione e prevenzione cardiologica.

Rehabilitation and secondary prevention programs are recognized as an essential part of the overall care of patients with cardiovascular disease. They consist of multidisciplinary strategies aiming at the reduction of modifiable risk factors for cardiovascular disease. Cardiac rehabilitation includes non-pharmacological interventions as: Patients' evaluation. Nutritional counseling. Risk factors management (serum lipids, blood pressure, weight, diabetes, smoking). Psychosocial interventions. Physical activity and cardiovascular physical training counseling. Their effectiveness in the reduction of mortality through the decrease of risk factors has been proven in the last twenty years. Guidelines on appropriate and well-framed interventions have been released and nutritional interventions have a ringside seat in all programs. During 2007, the Italian Association of Dietitians, ANDID, created a working group of expert dietitians, with the goals of making a review of available scientific literature and of elaborating a Professional Position Papers on the role of Dietitian in cardiac rehabilitation and prevention. This Position Paper retrieves and remarks the available evidence that are important for the dietitians, according to their professional role and their contribution in the management of the topic.