A survey on hospitalised community-acquired pneumonia in Italy.

BACKGROUND AND AIM: Community Acquired Pneumonia (CAP) remains a major cause of disease and death. We evaluated the levels of care, the outcome and the characteristics of hospitalised patients with CAP in a primary hospital in Italy. We also investigated the value of both the Pneumonia Severity Index (PSI) and the modified Appropriateness Evaluation Protocol (AEP) for recognising both the outcome and the unnecessary admissions and stay of hospitalised patients with CAP. METHODS: A retrospective review of all the charts of adult patients with CAP at Manerbio, Brescia, Italy between January 2001 and December 2002 was performed. RESULTS: We evaluated 148 patients; their mean age (+/-SD) was 70 (+/-17) years; 34% were female. Most patients (87%) had at least a concomitant co-morbid disease. The overall survival rate at 30 days was 88%. All but one death occurred in the high-risk group of patients according to the PSI. On the contrary, the death rate of patients with inappropriate hospital admission according to the AEP was high. Patients with high PSI score had a significantly longer hospital length of stay than the low-risk group. However, a substantial part of the hospital stay did not show any justification into the charts. CONCLUSIONS: The PSI, but not the AEP, upon hospital admission, was useful for evaluating the outcome of patients with CAP. The PSI score and the modified AEP can be useful for assessing the appropriateness of hospitalisation for patients with CAP. There is the need for a practical and validated tool to support physicians in their decision making regarding the early and safe discharge of hospitalised patients with CAP.

[Organizational appropriateness of recoveries: results of the evaluation of recoveries by AEP/PRUO at the Careggi Hospital in Florence in 1995-1998]. / Appropriatezza organizzativa dei ricoveri: risultati della valutazione con AEP/PRUO dei ricoveri dell'AO Careggi di Firenze. Anni 1995 e 1998.

The organizational appropriateness of hospital stays is an expression of a hospital's efficiency and aim of the management control. The AEP (American Version)/PRUO (Italian Version) protocol is specific for measuring the organizational appropriateness of hospital stays. The aim of this study is the comparative analysis of the organizational appropriateness of hospital stays in Careggi Hospital of Florence and in all hospital Departments in 1995 and 1998. In 1998 the AEP/PRUO protocol was applied to 2148 samples of hospital stays out of 38,968 eligible hospitalizations, and in 1995 a sample of 1989 hospital stays out of 35,108. In 1998 2,148 admissions and 15,338 days of hospitalization were tested. In 1995, 1989 admission days and 12,264 days of hospitalization were tested, 63 departments were studied. In 1995 the first edition of the protocol was applied, in 1998 the second. A sample of 218 of the 1998 hospital stays was tested with both editions to evaluate the impact of differences. In 1998, with the second edition of the protocol, the inappropriateness rate of admission days and hospitalization days and the rate of in-patients inappropriate hospital stays was respectively 38.0%, 43.8% and 18.5%. Compared with 1995 results, the rates increased +6.2%, 6% and +7.5% respectively. Instead, with the first edition of the protocol, the rates were 29.7%, 37.6% and 10.7% and, compared with 1995, they were reduced -2.1%, -0.6% and -0.3%. The longitudinal multilevel analysis has allowed the evaluation of the performance of each department.

[The content and structure of nursing documentation in Careggi Hospital, Florence, 1998: results and perspectives]. / Contenuto e struttura della documentazione infermieristica nell'Azienda ospedaliera Careggi, Firenze, nel 1998: risultati e prospettive.

This retrospective, observational study was performed to evaluate the structure and the content of the nursing documentation in the Azienda ospedaliera Careggi, Firenze in 1998. To this aim we review 1964 nursing records including both notes by turns and care plans. One-thousand-one-hundred-and-twenty-five records came from surgical and 839 from medical wards. From the selected records, every day of the hospital stay, including both the admission and the discharge, were evaluated, so that the studied days were a total of 18,683. Only 32% of the nursing records had a global assessment of patient situation on admission. A medical diagnosis was observed in 84% of the cases, but a nursing diagnosis was absent in over 99.5% of the charts. During stay most notes were related to medical treatment and visits. Nursing notes were lacking in 32% of turns, while "nothing to report" was recorded in another 15.5% of cases. A nursing care plan was present in a minority of records. A final evaluation of planned nursing interventions was reported in approximately 5% of the charts. Nursing care plans were updated during stay in less than one tenth of cases. Discharges notes were absent in slightly more than 80% of the cases. This survey confirms the importance of continuing education and supervision in nursing documentations, if a reliable source of nursing information has to be developed. Future nursing records should include only essential information, avoiding any overlap with medical charts.

Tobacco smoking habits, attitudes and beliefs among nurse and medical students in Tuscany.

In this study we evaluated the smoking habits, beliefs and attitudes of nurse and medical students at the University of Siena and Florence, Italy. Students who entered the 1st year of school in 1998 were asked to complete a self-administered anonymous questionnaire. Two hundred medical students completed the questionnaire; they had a mean age (+/-SD) of 19.8+/-1.7 years and 68% were females. A total of 205 nurse respondents answered to the questionnaire; they had a mean age of 21.8+/-4.1 years and females were 83% of the total. The overall response rate among students always remained higher than 85%. Thirty per cent of medical students were current smokers, and 5% former-smokers. A total of 43% of nurse students were current smokers and 11.5% former-smokers. Nurse students were more likely to smoke than medical students (p = 0.001). Among current smokers, the number of daily cigarettes smoked and the degree of nicotine addiction did not differ between groups. The prevalence of maternal smoking were higher among nurse students. In spite of students' beliefs the knowledge about smoking remained generic in both groups. Nurse students were less aware than medical students of their special responsibility towards people about tobacco smoking. Such a difference remained significant also after adjustment for smoking status (p < 0.01). Students overestimated the prevalence of current smokers among health caregivers of the local hospitals, and Italian people and adolescents. Targeted and continuous training about smoking prevention should be mandatory in Italian medical and nurse schools.

Changes of smoking habits and beliefs during nurse training: a longitudinal study.

This prospective cohort study has been performed to evaluate the changes in student nurses smoking habits and beliefs during their training. The source of information was an anonymous questionnaire about tobacco smoking, administered to students who entered the first year of School of Nursing in Florence in 1991-1992, 1992-1993 and 1993-1994. Five hundred and thirty-six (95%) of these student nurses completed the questionnaire. Five hundred and one (93%) of these 536 respondents completed the questionnaire again at the end of the third (final) year of training. Student nurses who smoked increased the average number of cigarettes smoked per day (p < 0.01) and the degree of dependence to nicotine (p < 0.01). Tobacco smoking remained widespread and the percentage of ex-smokers who started smoking again increased (p < 0.05). The knowledge about the health hazards due to tobacco smoking remained generic and the prevalence of current smokers among student nurses and health care workers was overestimated. We conclude that Nursing School does not succeed in reducing the smoking habits of students. Effective antitobacco strategies and smoking cessation services still need be organized in Italy.

Results of a questionnaire about nurse students' smoking habits and knowledges in an Italian teaching school of nursing.

Six-hundred and sixty-two nurse students (aged 25.2 +/- 4.11 years; 153 were males) answered a self-administered, anonymous questionnaire about smoking habits and knowledges in a large urban Teaching School of Nursing. The overall response rate was 88%. Current smokers were 336 (51%), former smokers 80 (12%). Nurse students claimed to know the dangers of tobacco and nurse training seemed to modify the preferential source of information about tobacco smoking towards medical fonts; however, only a quarter of nurse students considered medical smoking cessation approaches as useful for quitting and advised patients with tobacco-related diseases against smoking.