[Development and implementation of pediatric and neonatal nursing information system in an hospital setting: the pediatric PAI]. / Sviluppo e implementazione di un sistema informativo infermieristico pediatrico in ambito ospedaliero: il PAI pediatrico.

The Professional Assessment Instrument (PAI) is a clinical nursing information system used in the adult inpatient units of the A. Gemelli university hospital in Rome (Italy). The PAI allows for the systematic collection of nursing care data in order to improve the quality of care. So far, few clinical nursing information systems have been developed in the neonatal and pediatric care setting. The aim of this study is to describe the development and implementation of a clinical nursing information system (PAIped) for the neonatal and pediatric care setting. METHODS: The Patient-and Family-Centered Care model was used to develop the contents of the PAIped. A web platform application was developed for the PAIped. The standard nursing terminology Clinical Care Classification System was used. A decisionmaking support system was developed within the PAIped to support nurses in making diagnoses and in selecting the most appropriate nursing interventions. RESULTS: A clinical nursing information system using a standard nursing terminology was developed in the pediatric and neonatal care setting. After a test phase, the PAIped was implemented in all the pediatric and neonatal inpatient units of the A. Gemelli university hospital. CONCLUSION: The development and implementation of the PAIped in the A. Gemelli university hospital allowed the monitoring of nursing care processes and accurate nursing documentation.

Survey of determinants and effects of timing of referral to a nephrologist: the patient's point of view.

INTRODUCTION: We conducted a survey interviewing end-stage renal disease (ESRD) patients just after they began chronic dialysis (CD) to describe characteristics and factors associated with early (ER) and late referral (LR), and to analyze the consequences of timing of referral to a nephrologist. METHODS: We interviewed 673 patients via telephone starting CD between 2004 and 2006 in Lazio, Italy, to collect information about the year before CD. Multiple logistic regression was performed to evaluate the factors associated with LR. RESULTS: We found that 22% of patients reported being LRs. A lower probability for LR was found for older age, family history of renal diseases, abnormal test for renal functions, presence of hypertension, married status and awareness of a nephrology outpatient center near home. LR patients had a lower frequency of hepatitis B virus (HBV) vaccination (14.9% vs. 41.7%), arteriovenous fistula (31.8% vs. 75.6%) and information about renal replacement therapy modalities (33.8% vs. 72.6%), and they more often started CD in an emergency (85.8% vs. 41.5%). CONCLUSIONS: The percentage of self-reported LR was lower than reported in other studies. However, many patients started CD in an emergency, with a catheter as first vascular access, without vaccination against HBV and without the possibility of choosing their dialysis modality. Individual conditions facilitating contact with medical care (older age and presence of comorbidities) seem to be associated with a lower probability of LR. These findings emphasize the importance of predialysis patient training, confirming the important role that information plays in health service access, to improve early and long-term dialysis outcomes.