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Introduction: Chronic pain is a distressing condition that should be treated in specialized pain clinics. Pain clinics offer a holistic, evidence-based approach, including pharmacological, complementary, and invasive treatments. This study aimed to provide preliminary information regarding chronic pain treatments and identify reasons for accessing an important hub-spoke pain clinic network. Methods: A retrospective multicenter cross-sectional study was carried out. A total of 1606 patients’ records were included. Patients were selected from the 26 pain clinics of a single region in Italy. Univariate and multivariate logistic regression models were used. Results: Multivariate models showed that the use of opioids were considered effective for severe or moderate pain [odds ratio (OR) 0.41; 95% 0.33–0.51], while the use of invasive treatments (OR 2.45; 95% 1.95–3.06) and the use of complementary therapy (OR 1.87; 95% 1.38–2.51) were associated with severe or moderate pain. Overall, age, sex, nonsteroidal anti-inflammatory drugs (NSAID) use, a combination of NSAIDs, complementary therapies, and a combination of opioids and invasive treatments did not seem to be significantly associated with the nature of pain. Multivariate models confirmed that clinical parameters such as the nature of pain, multi-diagnosis, more than one site of pain, treatments, and general practitioner, but not the severity of pain and use of invasive treatments, had an impact on the choice of a pain clinic. Conclusion: Opioids are useful in managing moderate or severe chronic pain. Multimodal approaches are used for the management of chronic pain. Moreover, it is not clear how patients are addressed to access different pain clinics (spoke versus hub) networks. More widespread adoption is needed for an interdisciplinary approach to managing chronic pain and adopting guideline recommendations, and rigorous research is required to provide more substantial evidence and support clinical practice.

Anxiety and depressive symptoms adversely affect surgical outcomes in patients with rotator cuff tear (RCT) undergoing surgical repair. Patients without a diagnosis of mood disorders, such as anxiety and depression, before rotator cuff repair (RCR) can be considered an optimal candidate for surgery. The objective of this prospective observational study was to evaluate the relationship between anxiety and depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS) as an assessment tool, and patient-reported outcome measures in RCT after repair surgery. This study included patients with RCT undergoing arthroscopic rotator cuff repair (RCR). Forty-three patients were included who had completed the HADS, Constant Murley Score (CMS), and Short Form Health Survey 36 (SF-36) questionnaires before surgery and in the postoperative follow-up, at 1 month, 3 months, and 6 months. The Friedman test showed that there were statistically significant changes in the different times point for HADS (p < 0.001), anxiety subscale of HADS, i.e., HADS-A (p < 0.001), depression subscale of HADS, i.e., HADS-D (p < 0.001), CMS (p < 0.001), and SF-36 (p < 0.001). The average scores of HADS, HADS-A, and HADS-D improved at each follow-up, showing improvement in discomfort. From the third month after surgery, there was an improvement in anxiety and depression disorders related to improved quality of life, functionality, and pain perception. The trend remained stable until the sixth month of follow up. This study shows that anxiety and depressive symptoms in RCT patients are significantly reduced after RCR with subsequent important improvements in terms of functionality, ability to carry out activities of daily living, perceived pain, and quality of life.

Background Rotator Cuff Related Shoulder Pain (RCRSP) is the most common type of shoulder pain and the most disabling common symptom in people with Rotator Cuff Tear (RCT). The patient’s point of view concerning health status has become important in decision-making procedures and has therefore been considered a possible criterion standard for assessing treatment efficacy. The study aims to explore patients’ experiences and perceptions during pre-admission for Rotator Cuff Repair surgery. Methods A qualitative descriptive study was conducted using a phenomenological approach based on Husserl’s philosophical perspective. A consecutive sample of twenty RCT patients awaiting repair surgery agreed to participate and was interviewed until the information was saturated. None of the patients enrolled was lost during the data collection phases. Data were collected through open-ended interviews between December 2021 and January 2022. The credibility, reliability, confirmability, and transferability criteria of Lincoln and Guba have been adopted to guarantee the trustworthiness of the results. The data analysis was conducted according to inductive content analysis. Results Four main themes and sub-themes related to each have been identified from the phenomenological analysis. The major themes were: (1) Pain changes lifestyle habits, (2) Pain control requires specific strategies, (3) Suffering turns time into waiting, (4) Waiting for Surgery between trust and fear. Conclusion Investigating patients’ experiences and the emotional impact of Rotator Cuff Tear facilitates the development of specific educational and therapeutic strategies to improve care and post-intervention outcomes.

Sarcopenia is a progressive and generalized skeletal muscle disorder associated with poor outcomes and complications, including falls, fractures, physical disability, and death. The aim of this review is to assess the possible influence of sarcopenia on outcomes of sarcopenia in patients who underwent knee or hip replacement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, EMBASE, Scopus, CINAHL, and CENTRAL bibliographic databases were searched. General study characteristics extracted were: primary author and country, year of publication, type of study, level of evidence (LOE), sample size, mean age, gender, follow-up, type of surgery, diagnosis, and outcomes. At the final screening, five articles met the selection criteria and were included in the review. Sarcopenia influences the Barthel Index (BI), which is significantly lower compared to patients without sarcopenia, which indicates that the patient is subjected to a worsening of this condition that can influence their normal life since they will become dependent on someone else. No difference in mortality rate was found was found between the studies. This systematic review addressed the possible role of sarcopenia in patients undergoing joint replacement surgery. Despite the lack of high-quality literature on this topic, a general trend in considering sarcopenia as a negative factor for quality of life in joint replacement patients was reported. However, the lack of significant results means it is not possible to report useful conclusions.

Chronic low back pain (CLBP) is the most common cause of disability worldwide, affecting about 12% to 30% of the adult population. Psychological factors play an important role in the experience of pain, and may be predictive of pain persistence, disability, and long-term sick leave. The aim of this meta-analysis was to identify and to describe the most common psychological approaches used to treat patients who suffer from CLBP. A systematic search was performed on PubMed/MEDLINE and Cochrane Central. Overall, 16 studies with a total of 1058 patients were included in the analysis. Our results suggest that cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) interventions are both associated with an improvement in terms of pain intensity and quality of life when singularly compared to usual care. Disability also improved in both groups when compared to usual care. Significant differences in fear-avoidance beliefs were noted in the CBT group compared to usual care. Therefore, psychological factors are related to and influence CLBP. It is crucial to develop curative approaches that take these variables into account. Our findings suggest that CBT and MBSR modify pain-related outcomes and that they could be implemented in clinical practice.

Aim To identify, analyze and synthesize qualitative studies on caregivers' experiences of contributions to the self-care of patients with Chronic Obstructive Pulmonary Disease (COPD). Background COPD patients perform daily self-care behaviours to manage the disease. With aging and disease progression, patients need to rely on the contributions of informal caregivers, usually family members, for disease management. Caregivers' normal or habitual contributions to patients' self-care have not yet been completely investigated. Design Thematic synthesis of qualitative studies. Data sources CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, Scopus, Emcare and OpenGrey databases were searched from inception to September 2020. The search was restricted to English-language papers. Review methods Studies were critically appraised using the Critical Appraisal Skills Programme checklist. The initial line-by-line codes were aggregated into descriptive themes from which analytical themes were derived. Results Fifteen papers from nine countries, published 2009-2020, were included. Six analytical themes encompassing 22 descriptive themes were identified and grouped in two overarching themes describing caregivers' experiences of contributions to patients' self-care during the stable and exacerbation phases of COPD. In the stable phases, caregivers contribute through maintaining disease stability, promoting healthy behaviours, fostering normal life and helping perform daily activities. During exacerbations, caregivers contribute through assessing, monitoring and managing symptoms in collaboration with patients or autonomously. They contribute by performing actions, motivating patients, organizing care, sensing variations in symptoms, acquiring knowledge and educating patients, making decisions, communicating and collaborating with healthcare providers and patients and advocating for patients. Conclusion This thematic synthesis enlarges knowledge of caregivers' contributions to patients' self-care in COPD, detailing the ways by which caregivers provide care to patients. Impact Contributing daily to the self-care of a family member with COPD is a complex experience. Nurses need to acknowledge the importance of caregivers' contributions to patient disease management and develop effective educational interventions to support them.

To assess the level of chronic obstructive pulmonary disease (COPD)-related knowledge within patient and informal caregiver dyads, and to identify factors influencing the knowledge level considering the interdependence within the dyads.Patients with COPD and their informal caregivers present poor disease knowledge and different characteristics are associated with their level of knowledge. Disease knowledge and related characteristics have been assessed separately in patients and informal caregivers, without considering possible influence within the dyads.Cross-sectional study.A convenience sample of dyads was recruited in outpatient and inpatient settings in Central and South Italy. The Bristol COPD Knowledge Questionnaire was used to measure disease knowledge. Sociodemographic, clinical and caregiving characteristics, self-efficacy and depression were measured in patients and caregivers. Multilevel modelling was used to analyse COPD knowledge at the level of the dyad to control for interdependency between patients and informal caregivers. The STROBE guidelines for cross-sectional studies were followed for study reporting.We recruited 133 dyads. The total level of correct knowledge shared by dyads was 32.89%. Dyads presented higher levels of correct knowledge about disease symptoms, smoking cessation and vaccination, and lower about COPD treatment. Younger patients with greater self-efficacy, who attended pulmonary rehabilitation and were cared for by a spouse/partner with low levels of depression, and informal caregivers who were patients' spouse/partner were more likely to have higher levels of disease-related knowledge.Our study advances dyadic research in COPD. Future studies should investigate the effects of shared knowledge and incongruent knowledge (where one member knows more than the other) on patient self-care and caregiver contribution to patient self-care.Our study shows what knowledge nurses should provide in educational programmes directed at patients and caregivers, and which dyads have greater knowledge deficits, to whom offer targeted educational interventions.

Osteoarthritis negatively impacts the patient’s quality of life. Qualitative research is an effective tool in detecting the various emotions experienced by patients with osteoarthritis. Such studies play a crucial role in promoting comprehension of the patient’s experiences of health and illness among healthcare professionals, including nurses. The purpose of this study is to examine patients’ perceptions during the pre-admission process for total hip replacement (THR). The study utilized a qualitative descriptive methodology with a phenomenological approach. A sample of patients awaiting THR consented to participate in the study and were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: 1—Surgery generates mixed feelings; 2—Pain negatively impacts daily life activities; 3—Pain requires personal strategies to be alleviated. Patients awaiting THR demonstrate frustration and anxiety. They experience intense pain during daily activities, which persists even during night rest.

Aim To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge. Design Multi-centre descriptive qualitative study. Methods Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research. Results Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place. Conclusion Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned. Impact Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.

Background: During the COVID-19 pandemic, cancer patients’ care needs to be reconsidered by integrating the patient’s clinical pathway with the hospital patient journey and the family context in a safe and patient-centered way. So far, no systematic reports are available regarding the impact of the COVID-19 pandemic on cancer care. This work gives a first overview of patients’ care needs undergoing chemotherapy treatment from a nursing perspective.

Background and Objective Fatigue is one of the most debilitating and prevalent symptoms in pediatric cancer patients and it is important to know if nurses are able to recognize and manage it. The aim of this study was to investigate the knowledge and attitudes towards fatigue of nurses working in Italian pediatric onco-hematology centers. Methods Cross-sectional online survey. An existing questionnaire was adapted to the Italian context, extended with a section on attitudes, and psychometrically tested. The questionnaire was sent to all nurses working in Italian pediatric onco-hematology centers. Results Respondents (n = 189), who were working in 37/53 (∼70%) centers, reported 42% of children and 68% of adolescents experiencing fatigue, with intensity increasing with age. Contributing factors were treatments and co-morbidities; frequent symptoms were mood changes and lack of energy. Among respondents who did not assess fatigue, 36.2% did not know an appropriate tool. Nurses recognized fatigue as an important problem and their knowledge and attitudes towards fatigue seemed satisfactory. Conclusion This study provides nurses with an instrument to investigate their knowledge and attitudes about fatigue. Nurses’ awareness of the significance of fatigue is a fundamental step towards improving its management and offering strategies that can help both the child and their family.

Oral mucositis is one of the worst effects of the conditioning regimens given to patients undergoing hematopoietic stem cell transplantation. It is characterized by dry mouth, erythema, mucosal soreness, ulcers, and pain, and it may impact patient outcomes. Bovine colostrum and Aloe vera contain a wide variety of biologically active compounds that promote mucosal healing. A non-randomized phase II study was designed to assess the safety and efficacy of a combined bovine colostrum and Aloe vera oral care protocol to prevent and to treat severe oral mucositis in transplant patients. Two commercially available products were given to patients in addition to the standard protocol: Remargin Colostrum OS® mouthwash and Remargin Colostrum Gastro-Gel® taken orally. Forty-six (78.0%) patients experienced oral mucositis, 40 (67.8%) developed mild–moderate forms, and 6 (10.2%) severe ones. Comparing the study group’s outcomes with those of a homogeneous historical control group, severe oral mucositis decreased significantly (10.2% vs. 28.4%; P P P P

BackgroundIn recent years, the licensure exam in nursing has focused on the range of curricula and teaching methods used in international universities. ‘Tuning’ was the first document that sought to harmonise training purposes in terms of competences and learning outcomes in Europe. Nursing has 47 specific competences divided into 5 domains.MethodsA multicentric observational perspective study was conducted in four universities in the Lazio region for to describe which of 47 Tuning competences are evaluated during the licensure exam in Italian nursing degree courses, at what level of performance, in which clinical area and setting are contextualised, and what types of tests are used for their evaluation. The commissioners of the Professional Order of Rome – OPI – collected data via tests in the licensure exams for the academic years 2017–2019 using 2 grids, one for cognitive and one for psychomotor assessments.ResultsThe Tuning competences were requested 7522 times, 5130 for the cognitive trials and 2392 for the psychomotor trials. The most frequently requested competences were those associated with domain 2, and the level of performance most required in cognitive tests was autonomy of judgement (52.30%). In both tests, the most-investigated competences concerned the area of non-communicable diseases and the hospitalised adult patient. ConclusionsThe competences assessed most often were associated with nursing practice and clinical decision-making. These areas coincided with those deemed essential for the first cycle of studies and are contextualised for the priority health problems of hospitalised adult patients. This indicates that nursing education still focuses on the preparation of nursing students for hospital settings. Moreover, there is still a high degree of discrepancy in the types of tests used in different schools. Their choices are influenced by the number of students and the structural resources available.

Objectives This study aimed to describe patients’ perspectives on their experience in osteopathic treatment, to contribute toward developing interpretative models on effectiveness. Methods A descriptive phenomenological approach was used. The data were collected through a semistructured interview. To capture the variability of the phenomenon, a purposive sample of 12 participants with previous experience of osteopathic care was selected. The data analysis was carried out in an inductive way, and it was parallel to the recruitment to continuously monitor the data saturation. Results Data saturation was reached with 12 participants (female = 9; male = 3). Participants’ age ranged from 27 to 82 years old (mean: 55.25 ± 17.15; median: 59; kurtosis: -0.82). Participants had different reasons for consultation. The analysis showed 1 overarching theme, “Osteopathy is a path of awareness,” 3 themes, and 12 categories. Themes were: (1) “The experience of pain produces awareness of the need for care,” (2) “Osteopathy is a journey to be shared over time,” and (3) “The effectiveness of the osteopathic treatment is the discovery of the person's unity by experience.” Conclusion Participants affirm that osteopathy is a path of awareness that starts from an experience of pain; leads them to contact an osteopath; and ends with their experience of the unity of body, mind, and spirit.

Background To prevent health care-associated infections, health organizations recommend that health care workers stringently observe standard precautions (SPs). Nevertheless, compliance with SPs is still suboptimal, emphasizing the need for improvement interventions. Methods A cluster randomized controlled trial with a pretest-post-test design was conducted with 121 clinical nurses who worked in different wards of a university hospital. The intervention group (n = 61) had 3 infection control link nurses nominated and attended systematic audits and feedback. The control group (n = 60) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of SPs compliance was performed via the World Health Organization observational hand hygiene form and Compliance with Standard Precaution Scale Italian version. Results At the post-test, nurses in the intervention group reported significantly increased compliance with hand hygiene, whereas no significant improvement was found in the control group. Nurses in both groups reported significantly increased Compliance with Standard Precaution Scale Italian version scores; however, a higher increase and practical significance was observed in the intervention group. Participants who improved their scores were also compared between groups, showing a significantly greater increase of individual scores in intervention group compared to the control group. Conclusions The findings of this study provide significant practical implications for hospitals seeking to improve compliance with SPs among nurses, showing the effectiveness of using infection control link nurses combined with systematic audits and feedback.

The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory.Existing measures of caregiver contribution to self-care are disease-specific or behaviour-specific; no generic measures exist.A cross-sectional study.Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.The Caregiver Contribution to Self-Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self-care in chronic illnesses.目的: 本研究旨在检验慢性疾病护理人员自我照顾贡献量表的因子结构、内部一致信度及并发效度。 背景: 现有护理人员对自我照顾的贡献衡量标准均是以疾病或行为为基础;无通用衡量标准。 设计: 横断面研究。 方法: 2017年4月至2018年12月间,我们对358名慢性病患者及其护理人员进行随机抽样调查。患者已填写慢性疾病自我照顾量表,且护理人员已填写其对慢性病自我照顾贡献量表,此量表是在慢性疾病自我照顾量表的基础上修订,包括三个量表:护理人员对自我照顾的贡献,护理人员对自我照顾监控的贡献以及护理人员对自我照顾管理的贡献。各量表中,我们通过验证性因子分析对因子结构进行检验,并用因子得分确定系数、多维量表整体信度指标和克隆巴赫系数,以进行信度检验。同时,我们利用皮尔逊相关系数进行并发效度分析。 结果: 验证性因子分析可在护理人员自我照顾共享维持与管理量表中所列双因素结构和护理人员自我照顾监测量表中所列单因素结构中适用。一般模型可在组合项目的同时验证性因素分析中适用(比较拟合指数=0.933)。经预计,上述三个量表的信度介于0.701到0.961之间。慢性疾病护理人员自我照顾量表与慢性疾病患者自我照顾量表的并发效度呈弱相关,因此,慢性疾病患者自我照顾量表未充分使用。 结论: 慢性疾病护理人员自我照顾贡献量表有效、可靠,可在临床实践和研究中使用。 影响: 慢性疾病护理人员自我照顾贡献量表是评估护理人员对慢性疾病患者自我照顾的贡献程度的有效工具。.

In oncology, adherence to oral antineoplastic medication is a key element of treatment, on which the success of any therapeutic intervention depends. Given their widespread use in clinical practice, it is important to identify tools that can facilitate the monitoring and self-management of the patient at home, to avoid the consequences of employing ineffective treatment. One of the tools available today to take action on this phenomenon is mobile health technology. The aim of this review is to describe published studies relating to the use of mobile health to promote adherence to oral antineoplastic medication. This scoping review was conducted using the framework proposed by Arksey and O'Malley, adapted according to Levac et al. Of 1320 articles identified, only seven met the eligibility criteria and therefore were included in the review. All seven articles involved the use of digital means to measure adherence to treatment, patient satisfaction, acceptability and feasibility of the digital means used, and presence of symptoms, but not the effectiveness of the digital instrument used. In conclusion, the use of digital means to assist adherence of cancer patients to oral antineoplastic medication is widely recognized, but its effectiveness in clinical practice is poorly supported by the nature of the published studies.

Background One of the most common bacteria responsible for most Periprosthetic joint infection (PJI) is Propionibacterium acnes. Even though the rate of infections in patients undergoing total shoulder arthroplasty is increasing, effective diagnostic tests and the precautions taken during the surgery are not yet adequate. This systematic review aims to evaluate the effectiveness of antimicrobial prophylaxis in PJI in shoulder replacement and to provide health workers with the best approach to the use of antimicrobial agents based on currently available clinical evidence. Methods a systematic review of the literature was carried out in accordance with the PRISMA Statement. Studies concerning the effectiveness of antimicrobial prophylaxis in the prevention of PJI in patients undergoing shoulder replacement were included. Results Seven studies were included in the final analysis because they were considered valid. A total of 3272 patients underwent a surgical procedure, most of which were males. The male population has a greater presence of hair, therefore a greater risk of P. acnes. in surface cultures. Patients were assessed at an average follow-up period of 20 months ranging from 9 weeks to 53 months. Conclusion The optimal perioperative antimicrobial regimen is controversial. The clinical guidelines recommend the use of only one antibiotic as prophylaxis but considering the increase in the rates of antibiotic-resistant infections, the question arises whether antibiotic prophylaxis should be extended for adequate coverage. Shoulder arthroplasty performed on the male population must be carefully checked after surgery for the possible presence of P. Acnes.

Background and purpose Stakeholder engagement is the basis of an emerging and innovative educational model called competency-based education. However, although several studies have analysed the stakeholders' perspective in nursing, few studies have analysed the stakeholders' perspective in competence-based curriculum design. Thus, the aim of this study was to analyse the opinions and perspectives of stakeholders about the development of a competency-based baccalaureate nursing curriculum with stakeholder engagement. Methods A phenomenological study was conducted. This method combines descriptive features (Husserlian) and interpretive phenomenology (Gadamerian). The interviews were ended when data saturation was achieved, specifically the redundancy of themes. Results The content analysis identified three main categories: (1) a “bridge” that merges education and the work context, (2) stakeholder engagement – a contentious issue; and (3) stakeholder engagement – structuring a methodology. Conclusions Through the stakeholder engagement, university could have a constant interaction between the didactics and professional practice and could improve professional identity and job satisfaction among nurses.

This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses' involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses' involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty-nine articles were identified. Content analysis revealed 1 main category: "nurses' role in the decision-making process," with the 2 subcategories of "mediator" and "activator." The category and subcategories are influenced by the following generic categories: "being," "feeling," and "knowing," each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the "being" category. The category "feeling" represents the ways nurses experience the decision-making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal-self and professional-self. The category "knowing" includes nurses' clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.

Background Oral mucositis (OM) is one of the most debilitating effects of toxicity due to hematopoietic stem cell transplantation (HSCT) conditioning regimens. The aim of this secondary analysis of the data of a phase II study designed to assess the efficacy of a novel oral care protocol containing bovine colostrum and aloe vera to prevent oral mucositis was to compare outcomes reported by patients with those collected by healthcare professionals (HCPs). Method Data on oral mucositis severity, duration, time of onset and related pain were collected from patients using the Oral Mucositis Daily Questionnaire (OMDQ). HCPs assessed the same outcomes using the World Health Organization oral mucositis scale and pain numerical rating scale. Quality of life was assessed with the 3-level EuroQol-5 dimensions. Results Fifty-nine autologous/allogeneic graft patients were recruited, 46 of whom (78.0%) experienced OM. Mean onset was 9.1 (SD ± 3.5) days after conditioning initiation, mean duration was 10.4 (SD ± 4.3) days, and the average maximum pain score was 3.7 (SD ± 2.7). Self-administration of the OMDQ detected oral symptoms at least 1 day sooner compared to objective assessments (p = 0.025). Significant differences were observed between the patient-reported and the HCP-assessment data on oral mucositis severity grading distribution (p p Conclusions Further studies are necessary to improve the understanding of these findings; a randomised controlled trial is being set up at our institution.

Since the pandemic began nurses were at the forefront of the crisis, assisting countless COVID-19 patients, facing unpreparedness, social and family isolation, and lack of protective equipment. Of all health professionals, nurses were those most frequently infected. Research on healthcare professionals' experience of the pandemic and how it may have influenced their life and work is sparse. No study has focused on the experiences of nurses who contracted COVID-19 and afterwards returned to caring for patients with COVID-19. The purpose of this study was therefore to explore the lived personal and professional experiences of such nurses, and to describe the impact it had on their ways of approaching patients, caring for them, and practicing their profession. A phenomenological study was conducted with 54 nurses, through 20 individual interviews and 4 focus groups. The main finding is that the nurses who contracted COVID-19 became “wounded healers”: they survived and recovered, but remained “wounded” by the experience, and returned to caring for patients as “healers,” with increased compassion and attention to basic needs. Through this life-changing experience they strengthened their ability to build therapeutic relationships with patients and re-discovered fundamental values of nursing. These are some of the ways in which nurses can express most profoundly the ethics of work done well.

Background: Patient’s satisfaction after surgery was traditionally assessed by pre, and post-surgical scores and Patient-Reported Outcome Measures (PROMs) scales. Patients treated by Total hip arthroplasty (THA) usually perform well; therefore, it is useful to have a PROMs’ scale with a low ceiling effect as the Forgotten Joint Score-12 (FJS-12). PROMs have to be validated in the local language to be used. This study aims to perform a psychometric validation of the Italian version of FJS-12 in a group of consecutive patients treated by THA.Methods: Each patient completed both the Italian version of FJS-12 and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) in preoperative evaluation, after two weeks and 1 month, 3 months and 6 months postoperative follow-up. The reliability, internal consistency, test-retest reliability, and measurement error were evaluated.Results: 53 patients were included. Cronbach’s α between 0.6 and 0.9 indicated good internal consistency for the FJS-12. The test-retest reliability was acceptable. The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.238 (P=0.087) at baseline, r = 0.637 (P < 0.001) at 1 month, r = 0.490 (P < 0.001) at 3 months and r = 0.572 (P < 0.001) at 6 months. The ceiling effect was above the acceptable range (15%) for FJS-12 in 1 month (26.4%) and WOMAC in 6 months follow-up (24.5%).Conclusions: An excellent test-retest reliability, a good internal consistency, and a good validity by medium-high correlation with the WOMAC were assessed for FJS-12. However, the responsiveness for the FJS-12 score was not assessed.

Background: One million Total Hip Replacements (THA) are thought to be performed annually. To measure prosthesis awareness throughout daily activities, the FJS-12 patient-reported outcome scale was developed. This article’s goal is to undertake a psychometric validation of the Italian FJS-12 among a sample of related THA patients. Methods: Between January and July 2019, data from 44 patients were retrieved. The participants were required to complete the Italian version of FJS-12 and of the WOMAC at preoperative follow-up, after two weeks, 1, 3, and 6 months postoperatively. Results: The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.287 (p = 0.002) at preoperative follow-up, r = 0.702 (p < 0.001) at 1 month, r = 0.516 (p < 0.001) at 3 months and r = 0.585 (p < 0.001) at 6 months. The ceiling effect surpassed the acceptable range (15%) for FJS-12 in 1 month (25.5%) and WOMAC in 6 months follow-up (27.3%). Conclusions: The psychometric validation of the Italian version of this score for THA was executed with acceptable results. FJS-12 and WOMAC reported no ceiling and floor effects. Therefore, to distinguish between patients who had good or exceptional results following UKA, the FJS-12 could be a reliable score. Under the first four months, FJS-12 had a smaller ceiling effect than WOMAC. It is recommended to use this score in clinical research concerning the outcomes of THA.

The aim of this analysis was to assess the quality of reporting of randomized controlled trials (RCTs) relating to pain management in rotator cuff (RC) tears. This review evaluated the quality of the studies in the literature regarding this topic through the use of some factors and trends. The online databases used to search all RCTs on the topic of RC surgery were Medline, Scopus, CINAHL, EMBASE, and CENTRAL. This research was completed in September 2020. To assess the quality of reports, the Consolidated Standards of Reporting Trials (CONSORT) and the modified Coleman methodology score (MCMS) were used. From the research, 262 articles emerged. Finally, 79 studies were included in this historical analysis. There were no statistically significant changes in MCMS across trials that included or did not include a CONSORT diagram (p = 0.10). A statistically significant difference in MCMS was discovered between papers produced prior to 2009 and publications produced after 2015 (p = 0.03). There was no association between the number of checklist items for each article and the Coleman score. During the years there has been a significant increase in both quantity and quality of RCTs relating to pain in RC tears.

Recent research shows that major levels of psychological distress correlate with higher pain and reduced function in patients with shoulder and rotator cuff pathology. A systematic review updating a review published in 2016 was conducted to determine the degree of consistency and the strength of association between psychosocial factors and patient-reported outcomes (PROMs) in patients with rotator cuff repair (RCR) with new high-quality literature. The bibliographic searches were conducted from May to June 2020 within the following databases: MEDLINE/PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science. The articles included should discuss the association between psychosocial factors and outcomes in patients with documented or diagnosed rotator cuff tears through clinical and/or radiological examination. The Methodological Index for Non-Randomized Studies (MINORS) tool was used to assess the methodological quality. Fifteen articles were included. Negative psychosocial factors were found consistently associated with worse function and disability in the pre- and post-operative period. In particular, psychosocial factors regarding emotional or mental health were associated with a weak to a substantial degree with preoperative and postoperative function/disability and pain intensity in patients undergoing RCR. In patients undergoing repair of the rotator cuff tear, there was a correlation between poor psychological function before surgery and worsening post-surgical outcomes, such as persistence of postoperative pain intensity and worse levels of function/disability.

Aim To explore factors that influence intensive care nurses' experiences of being compliant with standard precautions (SP) during emergencies. Background Intensive care nurses can be exposed to a greater risk of biohazardous exposure during an emergency. The primary strategy to address the complex variety of biological hazards in clinical practice is represented by the implementation of SP guidelines. Previous research has indicated that nurses' compliance rates with SPs are suboptimal, but no study has focused on the factors influencing compliance during an emergency. Design A descriptive qualitative study was conducted in an Italian university hospital with 19 intensive care nurses who had at least two years of work experience in critical care. The nurses were interviewed in four focus groups and were asked about their experiences of being compliant with SPs during an emergency. Data were analyzed using conventional content analysis. Results Three themes emerged: conflict, competencies, and context. Conflict was reported regarding the need to save the patient and the need for self-protection through the use of SPs. In particular, nurses had to manage the pressure of limited time. Competencies were identified by nurses' knowledge, attitude, skills, training, and experience. Context was related to the work and organizational conditions during the emergency, including overcrowding. Conclusion To support intensive care nurses' compliance with SPs during emergencies, conflict, competencies, and context should be audited regularly in clinical practice. The findings of this study could inform infection control programs and training that targets intensive care nurses.

Aim and objective To test the psychometric properties of the nursing students' version of the 24-item Caring Behaviours Inventory. Background Caring is at the heart of nursing and should also be a core value in nursing education. Caring can be manifested through measurable behaviours. The Caring Behaviors Inventory is a valid and reliable measure of nurses' caring behaviours in clinical settings. It has already been used among nursing students, but it needs more psychometric testing. Design Cross-sectional validation study. Method The questionnaire was filled in by 300 undergraduate nursing students at two Italian universities in May 2016. Exploratory factor analysis was conducted using Mplus maximum likelihood with GEOMIN oblique rotation. A multifaceted approach was used to evaluate the model fit. The STROBE checklist for cross-sectional studies was followed. Results Four dimensions were identified: "being with," "doing with competence," "responding to individual needs" and "providing effective care." Adequate fit indices and high reliability of the factors were found. Correlations between factors were positive and significant. Conclusion This study makes it possible to use the same tool to compare the caring practices perceived by students, nurses and patients. Further studies with bigger samples could be stratified to investigate the associations between caring levels and student characteristics. The Caring Behaviors Inventory can be used to call attention to caring in nursing education, helping to make this concept less elusive. Relevance to clinical practice The effective self-assessment of nursing students' caring behaviours offers opportunities for reflection on their caring practice. This could improve the caring level of their behaviours in clinical practice and help them to become caring nurses in the future.

Aims and objectives To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. Background Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. Design The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. Methods The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. Results Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. Conclusions An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. Relevance to clinical practice Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Background Dependence is a common life experience and innate condition for human beings due to their bodily and relational essence, but in contemporary society, it has become a stressful condition. Care dependence is central to nursing, and patients with advanced cancer are often dependent on care. Understanding nurses' perceptions of care dependence can contribute to awareness of the impact it has on nurses. Objective The aim of this study was to explore palliative care nurses' experiences and perceptions regarding patient dependence. Methods Sixteen nurses taking care of dependent patients in a palliative care center in Rome were interviewed. Giorgi's descriptive phenomenological method was used. Results Nurses caring for dependent patients transcend the boundaries of dependence. Care dependence is an experience of powerlessness and regression. A patient's life in dependence is precarious, as they have to overcome the daily limits of life. Taking care of dependent patients requires nurses to manage the unmanageable and to know and to embrace change from within in order to build positive relations of personal closeness and reciprocal self-giving. Conclusions Nurses should be aware that self-transcendence and the consequent positive relations could make the difference in the experience of care dependence and promote personal growth for both patient and nurse. Positive and transcending relationships can transform care dependence into the opportunity to find meaning and purpose in life. Implications for practice The study highlights what nurses feel in caring for dependent patients. Understanding nurses' perceptions is important to delineate a proper caring for dependent patients.

Aims and objectives To describe which nursing activities are observed during the discharge of older patients with chronic diseases and to investigate the consistency between the nursing activities actually observed and those documented. Background The discharge from hospital of older patients with chronic diseases is a critical transition that can lead to dissatisfaction, delays in discharge, re-admission, adverse events and increased mortality. Although nurses' interventions during discharge are important for patient outcomes, little is known about the nursing activities actually performed as compared with those documented. Design An observational study of the nursing activities performed during patients' discharge and a retrospective audit of the nursing records of the same patients and nurses. Methods Structured nonparticipant observations were conducted of the activities performed by nurses at discharge. A retrospective audit of the nursing records relating to patient discharge, including the nursing diary and the assessment of critical issues at hospital discharge, was also conducted. The STROBE guidelines were followed (See Supporting Information Appendix S2). Results During hospital discharge of 102 patients, 1,224 nursing activities were observed. The number of activities was not related to patients' age, gender and educational level, nor to nurses' postgraduate education. Statistically significant correlations emerged between the number of activities observed and the nurses' work experience. Conclusions A predefined discharge plan guiding nurses' activities during discharge would enable them to respond better to the care needs of elderly patients. Relevance to clinical practice Results from the study could help clinical nurses to address care priorities of patients at discharge, by using appropriate plans and checklists and improving recording rates. Novice nurses should be supported when caring for elderly patients with chronic disease at discharge.

Background: Lateral violence and bullying affect nurses’ professional and health status. Worldwide prevalence ranges from 1% to 87%. Aim: To investigate prevalence and risk factors of lateral violence and bullying among Italian nurse peers in different work settings, inside and outside hospitals. Methods: Web survey using the 17-item “Negative Interactions Among Nurses Questionnaire.” Emails were sent to 5,009 nurses in three Tuscan public health care institutions. Results: Response rate was 18.6% (n=930). Twenty-six respondents were removed as they reported working with no peer colleagues. Negative interactions were experienced by 35.8% (n=324), 42.3% of whom (n=137) were bullied. Psycho-physical consequences of negative interactions were reported by 59% (n=191). Victims who thought of leaving nursing were 21.9% (n=71). Conclusions: Lateral violence and bullying among nurses are consistently present in all studied settings. Implications for Nursing Management: Nurse managers could play a crucial role in preventing negative interactions among nurses. Strategies could include continuing education programs to promote awareness of this problem; implementation of an anonymous reporting system for bullying; introduction of occupational psychologists in wards with larger numbers of reported negative interactions and bullying; and increasing changes in staff composition within shifts.

The trend of Total Hip Arthroplasty (THA) is projected to grow. Therefore, it has become imperative to find new measures to improve the outcomes of THA. Several studies have focused attention on the influence of psychological factors and sleep quality on surgical outcomes. The consequences of depressive states may affect outcomes and also interfere with rehabilitation. In addition, sleep quality may be an essential factor in determining surgical outcomes. To our knowledge, few articles focus on the influence of these factors on THA results. The present study investigates a possible correlation between preoperative depression or sleep quality and postoperative outcomes of THA. This study was conducted with 61 consecutive patients undergoing THA from January 2020 to January 2021. Patients were assessed preoperatively using GDS and PSQI, and six months postoperatively using FJS-12, SF-36, WOMAC, PSQI, and GDS. To simplify comparisons, the overall scores were normalized to range from 0 (worst condition) to 100 points (best condition). A total of 37 patients (60.7%) were classified as depressed and 24 as not depressed (39.3 %) in the preoperative assessment. A low–moderate positive correlation between preoperative GDS score and FJS-12 (rho = 0.22, p = 0.011), SF-36-PCS (rho = 0.328, p = 0.01), and SF-36-MCS (rho = 0.293, p = 0.022) scores at six-month follow-up was found. When the normalized preoperative GDS score was high (no depression), the FJS-12, SF-36-PCS, and SF-36-MCS scores tended to increase more compared to the other group. Statistically significant differences between the two groups were found in postoperative FJS-12 (p = 0.001), SF-36-PCS (p = 0.017), and SF-36-MCS scores (p = 0.016). No statistically significant correlation between preoperative PSQI score and postoperative outcome measures was found. Preoperatively depressed patients had a low–moderate positive correlation with postoperative SF-36 and FJS-12 scores. There was no correlation between sleep quality and postoperative outcome measures of THA.

Background and Objectives: Unicompartmental knee arthroplasty (UKA) is a valid alternative to total knee arthroplasties (TKAs) in selected cases. After surgery, patients’ experience and satisfaction were traditionally evaluated by pre- and postsurgical scores and Patient-Reported Outcome Measures (PROMs). Otherwise, a statistically significant change does not necessarily correlate to a clinically meaningful improvement when measured using PROMs. To evaluate the real effect of a specific treatment and understand the difference between groups in a clinical trial, it is necessary to use a meaningful quantum of change on the score assessed. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) can provide this meaningful change. This paper aimed to calculate the MCID and the PASS of the Forgotten Joint Score (FJS-12) after UKA. Materials and Methods: A total of 40 patients with a mean age 72.5 ± 6.4 years undergoing UKA were assessed preoperatively and six months postsurgery using the FJS-12 and the Oxford Knee Score (OKS). The baseline and 6-month postoperative scores were compared using the Wilcoxon signed ranks test. The correlation was calculated with Spearman’s rho. Both distribution-based approaches and anchor approaches were used to estimate MCID for the FJS-12. The 75th percentile and the Receiver operating characteristic (ROC) curve methods were used to calculate the PASS of FJS-12. Results: MCID estimates for normalized FJS-12 for UKA ranged from 5.68 to 19.82. The threshold of the FJS-12 with ROC method was 72.92 (AUC = 0.76). The cut-off value computed with the 75th percentile approach was 92.71. Conclusions: The MCID and PASS represent valid tools to assess the real perception of clinical improvement in patients who underwent UKA. The MCID value of FJS-12 was 12.5 for patients who underwent UKA. The value of the PASS for the FJS-12 in patients who underwent UKA was 72.92.

Unicompartmental Knee Arthroplasty (UKA) recorded an increased incidence of around 30% per year in the United States. Patient’s experience and satisfaction after surgery were traditionally assessed by pre, and post-surgical scores and Patient-Reported Outcome Measures (PROMs) scales. Traditional scales as Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS) reported high ceiling effect. Patients treated by UKA usually perform well; therefore, it is necessary to have a PROMs’ scale with a low ceiling effect as the Forgotten Joint Score-12 (FJS-12). PROMs have to be validated in the local language to be used. This study aims to perform a psychometric validation of the Italian version of FJS-12 for UKA for the first time. Between January 2019 and October 2019, 44 patients were included. Each patient completed both the FJS-12 Italian version and the WOMAC Italian version in preoperative follow-up, after 2-week and 1-month, 3-month, and 6-month postoperative follow-up. Cronbach’s α, intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to evaluate the reliability. The Pearson coefficient was used to assess validity. The Effect Size (ES) was used to test the responsiveness. A range of Cronbach’s α between 0.90 and 0.95 indicated good internal consistency for the FJS-12. The test–retest reliability was acceptable (i.e., the ICC was higher than 0.7) at each follow-up. The Pearson correlation coefficient between the FJS-12 and WOMAC was − 0.11 (n.s.) at preoperative follow-up, r = 0.47 (P = 0.001) at 1 month, r = 0.57 (P

Background Nutrition is a basic patients' need and an important component of nursing. End-of-life cancer patients can experience difficulties in eating and drinking, sometimes requiring artificial nutrition and hydration (ANH). Nurses' knowledge and attitudes greatly influence nursing care. Nurses may lack knowledge of ANH. To date, no study has explored the knowledge and attitudes of oncology and palliative care nurses toward end-of-life ANH. Objective To describe oncology and palliative care nurses' knowledge of and attitudes toward ANH. Methods A multicenter cross-sectional study was conducted in 7 regions of Italy using the Italian version of the Questionnaire on Knowledge and Attitudes in Providing ANH for Terminal Cancer Patients. Attitudes were divided into benefits and burdens of providing ANH. Data were analyzed by descriptive statistics. Results High percentages of oncology and palliative care nurses showed reasonable knowledge about ANH. More disagreement was evidenced about benefits and burdens of ANH, and lower importance was given to them. Conclusions Some misconceptions and a low level of awareness exist among some nurses about ANH. More nursing studies should be conducted and extended to different care settings. Moreover, guidelines should be reinforced with a nursing perspective to better define nurses' role in the decision-making process on ANH. Implications for practice This exploration of nurses' knowledge of and attitudes toward ANH in end-of-life cancer patients can contribute to an understanding of how nurses can be involved in better meeting cancer patients' nutritional needs at the end of life.

Our aim is to culturally adapt the first section of the Patient Continuity of Care Questionnaire (PCCQ) for use among older Italian patients with chronic diseases and to test its psychometric properties. The PCCQ was translated, adapted to the Italian context, and completed by 236 older inpatients with chronic diseases at the point of discharge through a cross-sectional multi-centre validation study. Face and content validity were assessed. Exploratory factor analysis (EFA) with Mplus MLr estimator was conducted. Internal consistency was analysed through Cronbach’s alpha and factor score determinacy coefficients. The overall content validity index of the 15-item Italian version of the questionnaire was 0.9. The EFA revealed a four-factor model yielding adequate fit indices. The factor score determinacy coefficients ranged from 0.87 to 0.94. The Cronbach’s alpha coefficients ranged from 0.71 to 0.86 showing good reliability. The study provides health professionals with an instrument with adequate psychometric properties to assess patients’ perception of the information received before hospital discharge. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10433-020-00576-5) contains supplementary material, which is available to authorized users.

OBJECTIVE This multicentre study aimed to develop a measure of the perception of care dependence in patients diagnosed with cancer and to test its psychometric properties. METHODS The questionnaire was developed based on findings emerged from a meta-synthesis and from qualitative studies conducted in three hospitals in Italy. The draft questionnaire was tested for face and content validity and pilot-tested with patients. The questionnaire was completed by care-dependent patients with cancer. Test-retest was conducted to verify stability. Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust estimator. RESULTS AND CONCLUSION The Scale-Content Validity Index was 0.92. The final 15-item questionnaire was completed by 208 patients admitted to two hospitals. The EFA yielded a two-factor model including a positive and a negative perception of care dependence. Factor score determinacy coefficients, Cronbach's alpha coefficients, composite reliability coefficients and Intraclass Correlations Coefficients yielded satisfactory results confirming internal consistency and stability. The hedonic balance score is also available as a single indicator of subjective well-being. The study provides initial validation of the Care DEeP Questionnaire that can be used by cancer nurses to assess positive and negative patient experiences with care dependence and to personalise and improve their care.

Inpatients with cancer are likely to experience care dependency and would benefit from nurses' evaluation of such dependency. The Care Dependency Scale (CDS) is a 15-item instrument widely used to assess patients' dependency in different populations and settings. This study aimed to test the psychometric properties of the proxy Italian version of the CDS in inpatients with cancer.A multicentre cross-sectional cross-validation study was conducted between February 2016 and October 2017 in a convenience sample of 517 adult patients with cancer admitted to four hospitals in Italy. The sample was randomly divided into two subsamples. The factor structure of the CDS based on previous studies was tested on a subsample through confirmatory factor analyses (CFAs). The best fitting model was cross-validated through CFA on the second subsample and on the total sample.The sample mean age was 65.68 years, 51.5% were male. The CFAs performed on the first subsample (n = 258), on the second subsample (n = 259) and on the total sample yielded acceptable fit indexes. The factors Physical care dependency and Psychosocial care dependency with a second-order factor were confirmed. Reliability in terms of internal consistency and inter-rater reliability were satisfactory.The Care Dependency Scale is a tool able to assess the level of care dependency in patients with cancer with adequate validity and reliability. The Care Dependency Scale can help to distinguish between physical and psychosocial needs and to create a base for personalized patient care.

Background and ObjectivesAgeism toward older adults, prevalent in contemporary societies, seems to be internalized during childhood and consolidated during adolescence. Although several instruments have been developed to measure adolescents’ ageism, they present a number of limitations. The study aimed at developing a new instrument, the Adolescents’ Ageism Toward Older Adults Scale, and testing its psychometric properties.Research Design and MethodsA three-phase process was followed: The instrument’s items were developed empirically from focus groups of adolescents; its content validity was evaluated; and finally, its psychometric properties were tested through a multicenter cross-sectional study involving 575 adolescents.ResultsExploratory factor analysis of the new scale retained 33 items grouped into 6 factors: moodiness, traditionalism, physical deterioration, antitechnologism, sageness, and sociability. Confirmatory factor analysis evidenced a second-order factor structure. Omega coefficients measuring internal consistency were above the cutoff of 0.60 for the 6 factors except for antitechnologism. Intraclass correlation coefficients for the entire scale and for the 6 factors were greater than 0.70, again excepting antitechnologism.Discussion and ImplicationsThe Adolescents’ Ageism Toward Older Adults Scale is a promising measure of adolescents’ negative and positive attitudes toward older adults. Its validation highlighted some criticalities that can be resolved by a few modifications. Further testing of the scale should be conducted after these modifications.

Background: Remote virtual rehabilitation aroused growing interest in the last decades, and its role has gained importance following the recent spread of COVID19 pandemic. The advantages of virtual reality (VR), augmented reality (AR), gamification, and telerehabilitation have been demonstrated in several medical fields. In this review, we searched the literature for studies using these technologies for orthopedic rehabilitation and analyzed studies’ quality, type and field of rehabilitation, patients’ characteristics, and outcomes to describe the state of the art of VR, AR, gamification, and telerehabilitation for orthopedic rehabilitation. Methods: A comprehensive search on PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted. This review was performed according to PRISMA guidelines. Studies published between 2015 and 2020 about remote virtual rehabilitations for orthopedic patients were selected. The Methodological Index for Non-Randomized Studies (MINORS) and Cochrane Risk-of-Bias assessment tool were used for quality assessment. Results: 24 studies (9 randomized controlled trials (RCTs) and 15 non-randomized studies) and 2472 patients were included. Studies mainly concern telerehabilitation (56%), and to a lesser extent VR (28%), AR (28%), and gamification (16%). Remote virtual technologies were used following knee and hip arthroplasty. The majority of included patients were between 40 and 60 years old and had a university degree. Remote virtual rehabilitation was not inferior to face-to-face therapy, and physical improvements were demonstrated by increased clinical scores. Orthopedic virtual remote rehabilitation decreased costs related to transports, hospitalizations, and readmissions. Conclusion: The heterogeneity of included studies prevented a meta-analysis of their results. Age and social context influence adaptability to technology, and this can modify compliance to treatment and outcomes. A good relationship between patient and physiotherapist is essential for treatment compliance and new technologies are useful to maintain clinical interactions remotely. Remote virtual technologies allow the delivery of high-quality care at reduced costs. This is a necessity given the growing demand for orthopedic rehabilitation and increasing costs related to it. Future studies need to develop specific and objective methods to evaluate the clinical quality of new technologies and definitively demonstrate advantages of VR, AR, gamification, and telerehabilitation compared to face-to face orthopedic rehabilitation.

Background and objectives: Our research aimed to evaluate the quality of reporting of randomized controlled trials (RCTs) linked to rotator cuff (RC) tears. The present study analyzed factors connected to the quality of the RCTs and trends in the quality of reporting through time. Materials and Methods: The online databases used to search all RCTs on the topic of RC surgery completed until March 2020 were PubMed and Ovid (MEDLINE). The quality of reporting was evaluated using the modified Coleman methodology score (MCMS) and the consolidated standards of reporting trials (CONSORT). Results: The online search found 957 articles. Finally, 183 studies were included in the quantitative synthesis. A total of 97 (53%) of 183 studies had a level of evidence I and 86 (47%) of 183 studies had a level of evidence II, according to the Oxford Center of Evidence Based Medicine (EBM). A statistically significant difference in MCMS between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had, on average, the highest Coleman score. The average number of CONSORT checklist items for each article across all analyzed RCTs was 21.67. The 37 studies completed up to 2010 averaged a number of checklist items of 19.97 and the studies completed between 2011 and 2019 averaged a number of checklist items of 22.10. A statistically significant difference in the number of checklist items between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had on average more checklist items. However, low correlation (0.26) between the number of checklist items for each article and the respective Coleman score was found. On the other hand, articles with the CONSORT diagram had a significantly high Coleman score. Conclusions: An improvement in the quantity and quality of RCTs relating to RC surgery over the analyzed period was found.

Overseas students have access to a number of learning opportunities available by virtue of a highly competitive tertiary education market system. Despite the increasing trend for remote, online-based learning programs, many students elect to travel outside their home country to experience the cultural difference of studying abroad. The benefit is symbiotic, with crucial university funding being attracted by increased numbers of overseas students seeking an enriched studying experience. The focus of this paper is the on-campus learning experience received by ex-patriot students studying in Australia and Singapore. How these students adapt to the different physical, social and emotional environments is examined. It concentrates on students’ consumption of the 'home' phenomena through a sensory approach demonstrating the influence of the senses in the adaptation process. In depth interviews were conducted with twenty-two students using photoelicitation as an autodriver were conducted. Students were given disposable cameras and asked to take photos of important places, people and things that represented home to them in their own country as well as their country of study. When recounting their experiences, all students referred to the positive influence of their senses (sight, smell, touch, hearing and taste) on their experiences, making those experiences more memorable and real. In some instances awareness of this sensory influence helped bridge the gap between their home and country of study. Therefore, it seems that adaptation to the new environment via positive sensory experiences is important if the student is to have a positive, constructive experience studying abroad. An understanding of the role that the senses play in the adaptation and learning process is vital if Australian tertiary institutions are to optimise both the learning experience for overseas students in a social, cultural and economic context, as well as the economic impact for our tertiary education system.