Fall predictors in hospitalized patients living with cancer: a case-control study.

PURPOSE: To identify fall predictors and develop an assessment tool to be used for screening hospitalized cancer patients at risk for fall. METHODS: A retrospective case-control study was conducted in 2018 at a cancer center in Northern Italy. The study participants were 448 adult cancer patients admitted to the oncology ward from 2009 to 2013. The case group consisted of 112 patients presenting at least one fall, while controls were randomly chosen by matching each case for age, sex, and admission period with three patients who did not fall. Data for the fall predictors were extracted from the electronic medical records. Conditional logistic regression was used to evaluate the association between patient's characteristics and fall risk. RESULTS: The overall prevalence of patients having at least one candidate fall predictor was high (98%). Seven of the studied variables showed an independent association with fall risk at multivariate analysis. These were tumor site, the presence of neurologic diseases, gait imbalance disorders, fatigue, and the assumption of certain medications such as diuretics, hypnotics, and opioids (odds ratios and 95% confidence intervals in brackets were 3.78 (1.78-8.13), 2.26 (1.08-4.77), 4.22 (1.87-9.52), 2.76 (1.45-5.26), 2.66 (1.52-4.66), 2.41 (1.20-4.85), and 3.03 (1.68-5.45), respectively). CONCLUSIONS: In this study, we identified falling risk factors in an Italian population of hospitalized cancer patients and developed a new risk assessment tool. An external validation is necessary before implementing our screening tool in clinical practice.

[Introducing clinical nurse specialists (CNS) in the ambulatory setting: the experience of a Research Cancer Center in Italy.] / L'inserimento degli infermieri specialisti nel contesto ambulatoriale di un centro di ricerca oncologico in Italia: un'esperienza di introduzione del ruolo.

. Introducing clinical nurse specialists (CNS) in the ambulatory setting: the experience of a Research Cancer Center in Italy. INTRODUCTION: In 2018 the role of clinical nurse specialist (CNS) was implemented in an ambulatory setting at our cancer institute. OBJECTIVES: To describe the CNS role implementation and the indicators to measure and the impact of the CNS after one year. METHODS: Indicators for the implementation: CNS interface mapping in disease pathways, participation in multidisciplinary team (MDT) meetings, and number of training hours per CNS on specific cancers. Indicators for the impact: patient satisfaction with CNS (survey), compliance with for waiting times for the first visit, number of documented CNS-patient communications and number of improvement projects in which CNSs were involved. RESULTS: One year after CNS introduction, pathway mapping was 100%; MDT meeting participation 95%; training hours 40.5/CNS vs. standard 30 hours; 83.2% of interviewed patients were very satisfied with CNSs. On average 27 face to face and 126 phone interviews per month were performed. The number of first visits increased of 13% componed to the previous year. CONCLUSIONS: CNSs were successfully introduced into disease pathways and played an active role in the MDTs. The positive impact observed suggests that this new role could represent a response to the need to design patient centered services for cancer diseases. Measuring the CNSs activities and their impact on the patient outcomes and on system efficiency is the key for defining nursing staffing standards in the disease pathways, tailored on patients and organization characteristics.

A surveillance system model for central line-associated bloodstream infections (CLABSI) coordinated at the regional level: a pilot feasibility study.

We describe the methods used to define a surveillance model to incorporate into activities aimed at preventing central line-associated bloodstream infections (CLABSI) in non-critical care units (NCCUs) and designed to be implemented at the regional level. In 2015 we conducted a pilot feasibility study in three NCCUs based in hospitals of the Regional Health System of Emilia Romagna to evaluate the feasibility of the proposed model and to test its accuracy and cost-effectiveness in terms of resources needed to maintain the system. Our results indicate that the system is feasible at the regional level by using the available sources and instruments to collect data in clinical practice context. Observation of device utilization for at least three months in all NCCU wards is needed in order to prioritize the medical area on which to focus costs for surveillance prior to implementing it on a regular basis.