How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.

AIM: Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. MATERIAL OF STUDY: We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). RESULTS: MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (p<0,005), and E-FAST grew from 15.6% in the pre-TC group to 51.3% in the post-TC group. Time of access in operatory theatre decreased from 62 to 44 minutes. Early Mortality (within 48 hours from the hospital arrival) was 9% in the pre-TC group and 4.5% in the post-tc group (p<0.005). DISCUSSION: Be needed to complete our goal. Further analysis and possible comparison with other trauma centers be needed to complete our goal CONCLUSIONS: Our results show that in our experience the multidisciplinary approach to polytrauma patients increased early survival and improved outcome with an evidence of worker's satisfaction. However, the best practice would ask to start with the approval of procedures and guidelines by the hospital governance, followed by clinical practice changes, in order to create a dedicated emergency and trauma surgery group. KEY WORD: Damage Control Surgery, Non Operative Management, Trauma Course, Trauma Team, Trauma Center.

Clinical assessment instruments validated for nursing practice in the Italian context: a systematic review of the literature.

AIMS: With the aim to identify the instruments validated for Italian nursing practice, a systematic review of the literature was undertaken. RESULTS: A total of 101 instruments emerged. The majority (89; 88.1%) were developed in other countries; the remaining (14; 13.9%) were developed and validated in the Italian context. The instruments were developed to measure patient's problems (63/101; 62.4%), outcomes (27/101; 26.7%), risks (4/101; 4%) and others issues (7/101; 6.9%). The majority of participants involved in the validation processes were younger adults (49; 48.5%), older adults (40; 39.5%), children (4; 4%), adolescents (3; 3%), and children/adolescents (1; 1%). The instruments were structured primarily in the form of questionnaires (61; 60.4%), as a grid for direct observation (27; 26.7%) or in other forms (12; 11.9%). Among the 101 instruments emerged, there were 1 to 7 validation measures documented with on average 3.2 (95% CI 2.86-3.54) for each instrument. CONCLUSIONS: Developing validation studies giving priority to those instruments widely adopted in the clinical nursing practice is recommended.

[Perception of stress factors among patients admitted to an intensive care unit]. / La percezione dei fattori di stress dei pazienti ricoverati in terapia intensiva.

A descriptive study was conducted to identify stress factors for patients admitted to an Intensive Care Cardiac Surgery Unit of a Northern Italy hospital (Trento). Stress factors were identified according to the opinion of nurses and patients and differences in perceptions were explored. Patients and nurses were asked to rank the main stress factors from a list of 30 and to rate each over a scale of 4 points from 1 to 4 (1 not at all and 4 very stressful). Data were collected from the end of September to the end of October 2001. Patients rate as more stressful the presence of endotracheal tube (as well as the associated point) the impossibility to communicate, suctioning manoeuvres, pain in general. Nurses rate as more stressful for the patients the endotracheal tube, the suctioning manoeuvre, the worries for the outcome of the heart surgery and the impossibility to communicate pain. No statistically significant differences were observed for the more important stress factors, but nurses tend to overestimate the stress related to factors rated as least important by the patients.