Sensitivity and specificity of the new Geriatric Dehydration Screening Tool: An observational diagnostic study.

OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of the Geriatric Dehydration Screening Tool-Modified (GDST-M) in detecting dehydration in older people and, if possible, to simplify the tool and make it easier to use. METHODS: This was a monocentric diagnostic accuracy study. We involved people ≥65 y of age with a Mini Mental State Evaluation (MMSE) score >24 and who were hospitalized in five medical wards of a large teaching hospital in Milan (Italy). We administered the GDST-M to hospitalized older people who met the inclusion criteria and compared outcomes with the values of serum osmolarity to evaluate their dehydration status and the accuracy of the tool. RESULTS: A total of 299 older people were recruited, of which 202 were dehydrated and 97 were hydrated. The GDST-M, with a cutoff value of 6, showed a sensitivity of 61.9% and a specificity of 47.2%. Multiple correspondence analysis and cluster analysis enabled extraction of 9 items from the 23 items present in the GDST-M. The new tool had a moderate diagnostic accuracy in detecting dehydration in older people aged over 75 y, with a sensitivity of 63.4% and a specificity of 69.6%. CONCLUSIONS: The short form of the tool is simple and contains minimally invasive assessments of low fluid intake dehydration in older people. The new GDST could also be easily used by lay people after a short training session.

For the flaring up of the flu: The nurses of the Maggiore Hospital in Milan hit by the Spanish fever.

In the last year of the Great War, Italy was also hit by the Spanish flu. The Civic Hospitals faced a deadly disaster with insufficient resources. All the heavy workload fell on the female nursing staff, who were the only ones able ensure the continuity of the hospital services. This study aimed to explore the impact of the influenza on the health of the nurses at the Maggiore Hospital in Milan during the second and third epidemic waves. Historical research was conducted between February and May 2020. Primary sources were retrieved from the historical archives of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and the daily newspaper Corriere della Sera. In the autumn of 1918, the Maggiore Hospital in Milan changed its organization to hospitalise patients affected by the influenza pandemic. Although the hospital managers wanted to protect their healthcare staff from the risks of contagion by means of prophylaxis rules, 388 lay nurses and 80 religious sister nurses were affected by this insidious disease. The second and third waves of the pandemic claimed 25 victims of duty. Remembered for their altruism and spirit of abnegation, the hospital community honoured their sacrifice, and the citizens expressed their gratitude.

"Those Plates That Save Me": Experiences of Italian Patients With Implantable Cardioverter Defibrillator.

This study aimed to investigate and understand the experiences and feelings lived by people with an ICD. Qualitative study, semi-structured interviews were conducted with a sample of 16 patients, during the annual follow-up. A hermeneutical analysis of the interviews was carried out to identify the themes. Four main themes were classified: "My heart falls asleep," highlighting a reduced awareness of the pathology and ICD installation; "But what is this thing. . .?" underlining the lack of information and fears related to the device and its functioning; "I cannot hug the microwave" which describes the changes brought about by the surgery; "And with this one I am alright for the rest of my life", involving hopes and life expectations. This study highlighted the patients' need for major support from health professionals while processing their new life conditions.

Newly graduated nurses' experiences of horizontal violence.

BACKGROUND: Horizontal violence, defined in the literature as 'interpersonal conflict between two nurses at the same hierarchical levels in organizations', often associated with bullying, affects the well-being of nurses, care recipients and the professional image of nursing and the organization due to increased turnover. One in every three newly graduated nurses is a victim of horizontal violence, although they do not always know how to define it. AIM: To investigate the direct and indirect experiences of horizontal violence in newly graduated nurses as well as to shed light on the phenomenon, on its awareness and recognition. METHODS: A qualitative phenomenological study was conducted between September and October 2018 with newly graduated nurses, with a work experience ranging between 6 months and 3 years. The interviews were conducted face-to-face, consisting of a first open general question, followed by semi-structured questions. ETHICAL CONSIDERATIONS: The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Institution Review Board. RESULTS: From the analysis of the interviews of the 21 participants, four main themes were identified: the 'enemies', that is those who exercised violence, the 'weapons' used by them to exercise violence, the 'effects' and the types of 'armor' identified to protect themselves. DISCUSSION: Horizontal violence is rarely recognized by newly graduated nurses, even though our sample had directly or indirectly experienced horizontal violence. Tackling the phenomenon starting from the undergraduate degree courses, focusing on effective support and more protection by the organization leaders were the silent requests that emerged from this study. CONCLUSION: Preventing horizontal violence is important for nurses' professional and private well-being, for professional conduct and for the quality of care provided to patients.

Development of a screening tool to assess dehydration in hospitalized older population: a diagnostic, observational study.

INTRODUCTION: dehydration is a frequent condition in older people and is associated with an increased risk of negative health outcomes. In order to adopt strategies to prevent complications, an early recognition of this status is of primary importance. For this reason, a comprehensive assessment tool to monitor hydration status in older people could be useful. AIM: to develop a screening tool to detect dehydration in older people in hospital settings. METHODS: this is a diagnostic, observational study. The new tool is a modified version of the Geriatric Dehydration Screening Tool (GDST), integrated with seven questions and two clinical signs based on updated literature. We tested the new tool with people aged 65 or over. We used as reference standard serum osmolarity. Cronbach's alpha was used to measure the tool's reliability and subscales. We calculated the Area Under ROC Curve (AUC) to choose the cut-off that gave the best balance between sensibility and specificity. RESULTS: 127 patients participated in the study. The reliability of the new GDST was acceptable (Cronbach's alpha 0.63). The diagnostic accuracy, measured with AUC analysis, was 0.83 ± 0.04, p 0.0001 95% CI 0.72-0.87. The best cut-off value was 6 and showed a sensibility of 78%, specificity of 70%. Tongue dryness proved to be the most significant clinical sign associated with poor hydration status (AUC 0.78; p 0.0001, 95% CI 0.69-0.86). CONCLUSION: The new GDST presented an acceptable reliability and diagnostic accuracy that increased with the assessment of some items, such as tongue dryness. This is the first screening tool that presents a promising cut-off value.

[The nurses of the Ospedale Maggiore of Milan during the First World War. Peace, rights and dignity of work]. / Le infermiere dell'Ospedale Maggiore di Milano nella Grande Guerra. Pace, diritti e dignità del lavoro.

. The nurses of the Ospedale Maggiore of Milan during the First World War. Peace, rights and dignity of work. INTRODUCTION: During the First World War the Hospitals of the big cities had to care for the people injured in the war places. To face this challenge, important changes in the internal organization had to be implemented. OBJECTIVE: To investigate how the First World War changed the working conditions of the nurses on duty at the Ospedale Maggiore and to contribute to outline the professional identity during the years of the conflict. METHODS: The correspondence between the female nursing staff and the hospital administration in the time span between from 1915 to 1918 was examined. The documents were retrieved in the historical archive of the Ospedale Maggiore from November 2017 to march 2018 and were analyzed through the methodology of historic research according to Chabod. RESULTS: During the First World War the nurses asked the hospital administration for changes of their working conditions, which had become unbearable because of the conflict. They obtained improvements concerning: a reduction in nightshift work hours, the employment of 86 nurses to guarantee a day off every ten days, replacement of staff in case of absence, increase in salary, paid sick leave. CONCLUSIONS: The nurses of the Ospedale Maggiore of Milan during the First World War, hoping for peace, stood out for their diligence in the care of the sick both civilians and militaries. Besides, they managed to obtain the recognition of they rights and dignity in the workplace.

["Let me tell you about my little box": phenomenological study on the experience of living with a totally implantable central venous catheter]. / "Ti racconto della mia scatoletta": studio fenomenologico sull'esperienza di vivere con un catetere venoso centrale totalmente impiantato.

. "Let me tell you about my little box": phenomenological study on the experience of living with a totally implantable central venous catheter. INTRODUCTION: Many variables impact on the choice to implant a totally implantable long-term central venous catheter's (Port), in spite of its proven efficacy. The patients' perception is pivotal, and only few qualitative studies dig deep into patients' feelings and experiences. AIMS: To understand if, and how, the Port affects the patient's life. METHODS: Qualitative phenomenological study based on semi-structured interviews on a convenience sample of patients implanted a Port, selected in an oncohematology Day Hospital in Milan. The analysis was carried out by three researchers with a phenomenological method. RESULTS: Four main themes, and sub-themes, emerged from twenty interviews. Relief, both physical and psychological; the process of the choice of inserting the Port and the importance of thinking about its positioning since the beginning of the treatment course; the symbol- the device reminds of the disease and its removal is of utmost importance; the technology progresses- the need of trust in the health care personnel and in their competences. CONCLUSIONS: The Port improved the patients' quality of life. The study allows some reflections on the need of considering the actual and future conditions of the patient to make a shared and informed choice.