Managing peripheral venous catheters: an investigation on the efficacy of a strategy for the implementation of evidence-based guidelines.

RATIONALE, AIMS AND OBJECTIVES: Until now, the evaluation of the effectiveness of guideline implementation in nursing and allied health professions has received relatively little attention. The aims of this study were (i) to describe the development process of guidelines concerning the management of peripheral venous catheters (PVCs) implemented in an Italian hospital; and (ii) to evaluate the effectiveness of guideline dissemination in terms of both clinical outcomes (signs of infection) and process outcomes (measures of appropriateness of PVC management). METHODS: An observational study was conducted before and after the adoption of a new protocol in the CTO-CRF-Maria Adelaide Hospital. Data from 306 PVCs (153 before and 153 after) were collected. For each PVC, a wide range of outcome measures was collected, including: data on fixation system type of dressing; visibility of the insertion site; registration of the insertion date; duration of catheter insertion; presence of connectors, taps and needles; and signs of infection. The effect of guideline implementation was evaluated using a logistic regression model to adjust for the confounding variable represented by the nurses' average years of working experience. RESULTS: The risk of using inappropriate dressing was significantly reduced [odds ratio (OR) 0.43; 95% confidence interval (CI) 0.27-0.70], while the use of transparent dressing increased (OR 2.39; 95% CI 1.46-3.89). CONCLUSION: Our study shows significant improvement in practices relevant to the correct management of PVCs 2 months after guideline implementation. A second survey (after a minimum of 6 months) is necessary to assess persistence of improvement in clinical practices.

Effectiveness of an informative video on reducing anxiety levels in patients undergoing elective coronarography: an RCT.

BACKGROUND: Anxiety levels have a considerable effect on patients during hospitalization. Cardiology Departments are characterized by a high turn-over of patients and it is necessary to give clear and exhaustive information routinely in compliance with legal and deontological requirements. AIMS: The aim of the study was to evaluate the effectiveness of an informative video, devised for patients undergoing coronarography, on reducing anxiety levels and getting more satisfaction from the received information. METHODS: A two arm RCT design was chosen. The patients in both study arms received standard care while the informative video was shown in the treatment group. The Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as to the received information was measured using a scale with semantic indications. RESULTS: Ninety-three patients accepted to take part in the study. The weighted mean difference (WMD) between the anxiety levels of the treated and controlled groups was -8.24 (CI 95%: -12.04/-4.44; p<0.00001). The WMD of the level of satisfaction for the received information was +22.23 (CI 95%: +12.73/+31.73; p<0.00001). CONCLUSIONS: The use of the informative video in Cardiology Departments proves to be highly recommended as an instrument to lower anxiety levels and increase significantly the level of satisfaction deriving from the received information.

Validation of the Italian version of the Discomfort Scale - Dementia of Alzheimer Type.

AIM: This paper is a report of a study to validate the Discomfort Scale - Dementia of Alzheimer Type in Italian. BACKGROUND: Dementia is a long and highly debilitating illness with a slow course and a steadily rising prevalence. Improving the quality of life of patients with dementia requires instruments to measure their problems and symptoms, because they are unable to communicate and interact with others. In Italy, there are no validated scales to assess discomfort for this population. The Discomfort Scale - Dementia of Alzheimer Type was developed in the USA and has been further tested there as well as in Germany. METHODS: The data were collected by 21 nurses during 2006 in five nursing homes with 71 patients with severe dementia. Face and content validity were evaluated in a focus group. Discriminant validity was assessed with the opposite-group approach and internal consistency and inter-rater reliability were measured. RESULTS: The discriminant validity of the Italian Discomfort Scale - Dementia of Alzheimer Type showed its ability to detect patients with high and low levels of discomfort. Reliability testing gave positive results: the internal consistency level was satisfactory (0.814) and comparisons of overall discomfort scores across nurses show good reliability. CONCLUSION: These findings support the use of Discomfort Scale - Dementia of Alzheimer Type in a clinical setting for people with severe dementia for both research and practice. Its ease of use and comprehensibility, and the limited time required to observe patients renders the Discomfort Scale - Dementia of Alzheimer Type a practical instrument for assessment and choosing care interventions.

[Actors and processes involved in implementing healthcare policies effectively: theoretical models and case studies]. / Attori e processi per una implementazione efficace delle politiche per la salute: ideali teorici ed applicazioni pratiche.

When implementing healthcare policies it is common to observe a "gap" between policy objectives and results. This because effective translation of healthcare policy into action, from its formulation to final evaluation, requires the contemporary presence of various essential factors and conditions. In this paper, we have attempted to describe and analyse the various existing theoretical models of implementation of healthcare policy and critically discuss them also through the use of specific case studies.

[Positive predictive value of ICD-9-CM codes in hospital inpatient discharge abstract records, for identifying adverse events]. / Valore Predittivo Positivo dei codici ICD-9-CM delle SDO nell'identificazione degli eventi avversi.

A retrospective study was conducted in the ambit of Risk Management research, in order to assess adverse events in patients hospitalised in hospitals in one Local Health Authority of the Piemonte region. Specifically, the aims of the study were to: evaluate the relative frequency of ICD-9-CM codes used to define adverse events, with respect to the total number of hospital discharge records submitted in 2003; identify true and false positives, by hospital chart review; estimate the positive predictive value (VPP) of the ICD-9-CM codes used, and determine, in each case, whether the adverse event had led to hospitalisation or if it had occurred during hospitalisation. Results show that the ICD-9-CM codes used effectively identify adverse events. In fact, the probability that an ICD-9-CM code will accurately identify an adverse event is 100% for codes in the "Misadventures of surgical and medical care" category of adverse events, 62.8% for codes indicating "Complications of medications (adverse drug events)" and 56.8% for the "Complications of surgical or medical procedures" category. In most cases the adverse event had occurred prior to hospital admission.

[Epidemiology in Italy: contributions from the specialists in hygiene and preventive medicine, current state and future prospects]. / Lepidemiologia in Italia: contributi degli igienisti, situazione attuale e prospettive future.

This review considers the State-of-art of Epidemiology in Italy with particular emphasis to: the promoting role of the Specialists in hygiene and preventive medicine; the new perspectives after its inclusions among the official disciplines of the Italian National Health Service (NHS) in a political contest of devolution; the past and present role of University training; the actual epidemiological training needs for the NHS; the different opinions about this discipline among the operators. This article reflects the prevalent perspective of the Italian Society of Hygiene, Preventive Medicine and Public Health, an association with more than 4000 members.

[Research, training and community links in today's hospitals]. / L'ospedale oggi tra ricerca, didattica e medicina territoriale.

The role of hospitals in research, medical training and their relationship with the community is challenged by socio-economical, epidemiological, demographic and technological changes western health care systems are facing today. This paper enhances that: 1. beside the experimental, high tech and biotechnological model of research, there is still a great need for studies in areas such as: doctor-patient relationship, disability, access to care and patient satisfaction; 2. medical training should open to community settings in order to avoid excess in medical specialisation and future shortage of primary health care professionals; 3. a close link with community health care should be established through strategic and operational planning between hospital and community services and a formalised role for family physicians within hospital-based Departments of Family and Community Medicine.