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Background: The coronavirus disease 2019 pandemic has led to an increase in youth mental health problems worldwide. Studies have revealed substantial variation in the incidence of these problems across different regions. Longitudinal studies of children and adolescents in Italy are lacking. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health in Northern Italy by comparing surveys conducted in June 2021 and in March 2022. Methods: A representative, large cross-sectional, online survey investigated HRQoL, psychosomatic complaints, and symptoms of anxiety and depression among 5159 and 6675 children and adolescents in 2021 and 2022, respectively, using the KIDSCREEN-10 index, HBSC symptom checklist, SCARED, CES-DC, and PHQ-2 instruments. Statistical analyses included a multivariate linear regression analysis. Results: Baseline characteristics showed significant differences in demographic variables between the two surveys. Girls and their parents reported a significantly lower HRQoL in 2021 than in 2022. Psychosomatic complaints differed significantly between sexes, and the results showed no decrease in psychosomatic complaints, anxiety, or depression between 2021 and 2022. Predictors of HRQoL, anxiety, depressive symptoms, and psychosomatic complaints in 2022 differed from those in 2021. Conclusions: The characteristics of the 2021 pandemic, including lockdowns and home schooling, may have contributed to the differences between the two surveys. As most pandemic restrictions ended in 2022, the results confirm the need for measures to improve the mental and physical health of children and adolescents after the pandemic. [ABSTRACT FROM AUTHOR]

Background: Belief in complementary and alternative medicine practices is related to reduced preparedness for vaccination. This study aimed to assess home remedy awareness and use in South Tyrol, where vaccination rates in the coronavirus pandemic were lowest in Italy and differed between German- and Italian-speaking inhabitants. Methods: A population-based survey was conducted in 2014 and analyzed using descriptive statistics, multiple logistic regression, and latent class analysis. Results: Of the representative sample of 504 survey respondents, 357 (70.8%) participants (43.0% male; primary language German, 76.5%) reported to use home remedies. Most commonly reported home remedies were teas (48.2%), plants (21.0%), and compresses (19.5%). Participants from rural regions were less likely (odds ratio 0.35, 95% confidence interval 0.19–0.67), while female (2.62, 1.69–4.10) and German-speaking participants (5.52, 2.91–9.88) were more likely to use home remedies. Latent classes of home remedies were "alcoholic home remedies" (21.4%) and "non-alcohol-containing home remedies" (78.6%). Compared to the "non-alcohol-containing home remedies" class, members of the "alcoholic home remedies" class were more likely to live in an urban region, to be male and German speakers. Conclusion: In addition to residence and sex, language group membership associates with awareness and use of home remedies. Home remedies likely contribute to socio-cultural differences between the language groups in the Italian Alps. If the observed associations explain the lower vaccination rates in South Tyrol among German speakers requires further study. [ABSTRACT FROM AUTHOR]

Background: German is a minority language in Italy and is spoken by the majority of the inhabitants of the Autonomous Province of Bolzano, South Tyrol. Linguistic group membership in South Tyrol is an established determinant of health information-seeking behavior. Because the COVID-19 incidence and vaccination coverage in the second year of the pandemic in Italy was the worst in South Tyrol, we investigated whether linguistic group membership is related to COVID-19 vaccine hesitancy. Methods: A cross-sectional survey was conducted on a probability-based sample of 1425 citizens from South Tyrol in March 2021. The questionnaire collected information on socio-demographics, including linguistic group membership, comorbidities, COVID-19-related experiences, conspiracy thinking, well-being, altruism, and likelihood of accepting the national vaccination plan. Multiple logistic regression analyses were performed to identify the significant predictors of vaccine hesitancy. Results: Overall, 15.6 percent of the sample reported vaccine hesitancy, which was significantly higher among German speakers than among other linguistic groups. Increased hesitancy was mostly observed in young age, the absence of chronic disease, rural residence, a worsened economic situation, mistrust in institutions, and conspiracy thinking. In the multiple logistic regression analyses, linguistic group membership was not an independent predictor of vaccine hesitancy. Conclusion: Although German is a minority language in Italy and COVID-19 vaccine hesitancy was higher in the German native language group than in the Italian, linguistic group membership was not an independent predictor of hesitancy in the autonomous province. Known predictors of vaccine hesitancy are distributed unevenly across language groups. Whether language group-specific intervention strategies to promote vaccine hesitancy are useful requires further study. [ABSTRACT FROM AUTHOR]

Objective: Non‐traumatic headache is a frequent reason for visits to the emergency department (ED). We evaluated the performance of the Manchester Triage System (MTS) in prioritising patients presenting to the ED with non‐traumatic headache. Methods: In this single‐centre observational retrospective study, we compared the association of MTS priority classification codes with a final diagnosis of a severe neurological condition requiring timely management (ischaemic or haemorrhagic stroke, subarachnoid haemorrhage, cerebral sinus venous thrombosis, central nervous system infection or brain tumour). The study was conducted and reported according to the STROBE statement. The overall prioritisation accuracy of MTS was estimated by the area under the receiver operating characteristic (ROC) curve. The correctness of triage prediction was estimated based on the "very urgent" MTS grouping. An undertriage was defined as a patient with an urgent and severe neurological who received a low priority/urgency MTS code (green/yellow). Results: Over 30 months, 3002 triage evaluations of non‐traumatic headache occurred (1.7% of ED visits). Of these, 2.3% (68/3002) were eventually diagnosed with an urgent and severe neurological condition. The MTS had an acceptable prioritisation accuracy, with an area under the ROC curve of 0.734 (95% CI 0.668–0.799). The sensitivity of the MTS for urgent codes (yellow, orange and red) was 79.4% (95% CI 74.5–84.3), with a specificity of 54.1% (95% CI 52.9–55.3). The triage prediction was incorrect in only 6.3% (190/3002) of patients with headache. Conclusion: The MTS is a safe and accurate tool for prioritising patients with non‐traumatic headache in the ED. However, MTS may need further specific tools for evaluating the more complicated symptoms and for correctly identifying patients with urgent and severe underlying pathologies. Relevance to clinical practice: The triage nurse using MTS may need additional tools to improve the assessment of patients with headache, although MTS provides a good safety profile. [ABSTRACT FROM AUTHOR]

Aim: To describe the incidence, time in days and risk factors for postoperative delirium in elderly patients. Design: Prospective cohort study. Methods: Patients over 65 years were daily screened with the 4A's Test and the Delirium Observation Screening Scale for postoperative delirium. A psychiatrist assessed according to the DSM‐V. We performed descriptive and logistic regression analyses. Results: From 202 patients, 7.5% (N = 15) had a diagnosed postoperative delirium, whereby 73.3% (N = 11) developed the delirium during the first 48 hr after surgery. The median duration was 1 day. Patients over 80 years suffering from heart failure with surgical drains, bladder catheter, central venous catheter had higher odds for developing a postoperative delirium. The incidence of postoperative delirium in our sample was lower compared with other surgical and ortho‐geriatric populations. Despite age, several modifiable postoperative factors were associated with the occurrence of postoperative delirium. [ABSTRACT FROM AUTHOR]

Background Long COVID, defined as the presence of coronavirus disease 2019 (COVID-19) symptoms ≥28 days after clinical onset, is an emerging challenge to healthcare systems. The objective of the current study was to explore recovery phenotypes in nonhospitalized individuals with COVID-19. Methods A dual cohort, online survey study was conducted between September 2020 and July 2021 in the neighboring European regions Tyrol (TY; Austria, n = 1157) and South Tyrol (STY; Italy, n = 893). Data were collected on demographics, comorbid conditions, COVID-19 symptoms, and recovery in adult outpatients. Phenotypes of acute COVID-19, postacute sequelae, and risk of protracted recovery were explored using semi-supervised clustering and multiparameter least absolute shrinkage and selection operator (LASSO) modeling. Results Participants in the study cohorts were predominantly working age (median age [interquartile range], 43 [31–53] years] for TY and 45 [35–55] years] for STY) and female (65.1% in TY and 68.3% in STY). Nearly half (47.6% in TY and 49.3% in STY) reported symptom persistence beyond 28 days. Two acute COVID-19 phenotypes were discerned: the nonspecific infection phenotype and the multiorgan phenotype (MOP). Acute MOP symptoms encompassing multiple neurological, cardiopulmonary, gastrointestinal, and dermatological symptoms were linked to elevated risk of protracted recovery. The major subset of individuals with long COVID (49.3% in TY; 55.6% in STY) displayed no persistent hyposmia or hypogeusia but high counts of postacute MOP symptoms and poor self-reported physical recovery. Conclusions The results of our 2-cohort analysis delineated phenotypic diversity of acute and postacute COVID-19 manifestations in home-isolated patients, which must be considered in predicting protracted convalescence and allocating medical resources. [ABSTRACT FROM AUTHOR]

Aim: To establish how the Manchester Triage System can correctly prioritize patients admitted to the emergency department for transitory loss of consciousness in relation to their risk of presenting severe acute disease. Design: A observational retrospective study. Methods: A total of 2291 patients who required a triage evaluation for a transitory loss of consciousness at the emergency department of Merano Hospital between 1 January 2017 and 30 June 2019 were considered. Transitory loss of consciousness was classified according to European Society of Cardiology guidelines. The baseline characteristics of the patients were collected and divided according to the priority level assigned at triage into two different study groups: high priority (red/orange) and low priority (blue/green/yellow). The composite outcome of the study was defined as the diagnosis of a severe acute disease. Results: Of the patients enrolled, 17% (390/2291) had a high‐priority code and 83% (1901/2291) received a low‐priority code. Overall, a severe acute disease was present in 16.9% of patients (387/2291). The Manchester Triage System had a sensitivity of 42.4%, a specificity of 88.1% and an accuracy of 80.4% for predicting severe acute disease. The discriminatory ability had an area under the receiver operating characteristic curve of 0.651 (CI 95%: 0.618–0.685). Conclusions: Despite the good specificity, the low sensitivity does not currently allow the Manchester Triage System to completely exclude patients with a severe acute disease who presented in the emergency department for a transitory loss of consciousness. Therefore, it is important to develop precise nursing tools or assessments that can improve triage performance. Impact: The assessment of a complex symptom can create difficulties in the stratification of patients in triage, assigning low‐priority codes to patients with a severe disease. Additional tools are needed to allow the correct triage assessment of patients presenting with transitory loss of consciousness. [ABSTRACT FROM AUTHOR]

Aims The role of triage for patients admitted to the emergency department (ED) for a syncopal transitory loss of consciousness (TLOC) has not been debated, and no comparisons with the recent European Society of Cardiology (ESC) guidelines are currently available. To verify the ability of triage to correctly prioritize patients with syncopal TLOC. Methods and results All patients who received a triage assessment at the ED of the Merano Hospital (Italy) between 1 January 2017 and 30 June 2019 for a syncope were considered. All syncope were reclassified according to the aetiology reported in the ESC guidelines. The baseline characteristics of the patients were recorded and divided according to the severity code provided during triage into two study groups: high priority (red/orange) and low priority (yellow/green/blue). The outcome of the study was the presence of a diagnosed cardiac cause within 30 days after the admission. A total of 2066 patients were enrolled (14.3% high priority vs. 85.7% low priority). Cardiac syncope was present in 7.5% of patients. Nurse triage showed a sensitivity for cardiac syncope of 44.8%, a specificity of 88.1%, and an accuracy of 84.9%. The observed discriminatory ability presented an area under the receiver operating characteristic curve of 0.685 (95% confidence interval 0.638–0.732). The possible identification of the aetiology of the syncopal TLOC by the nurse showed good agreement with the medical diagnosis (Cohen's kappa 0.857, P  < 0.001). Conclusions In cases of syncopal TLOC, nurse triage had a fair specificity but suboptimal sensitivity for cardiac causes. Specific nursing assessments following triage (e.g. precise scores or electrocardiogram) could improve the triage performance. [ABSTRACT FROM AUTHOR]

Nurses play a crucial role in correctly prioritizing patients entering emergency departments. However, little is known of the accuracy of nurse-led triage systems. (1) To determine the frequency of nurse-led triage errors within the Manchester Triage System; (2) to explore patient, work environment and individual nurse factors associated with triage errors; and (3) to explore associations between triage errors and patient outcomes (i.e., length of emergency department stay, hospitalization, and 7- and 30-day mortality). This study was conducted in one emergency department in Northern Italy. A random sample of 5% (n = 1,929) of all eligible patients accessing the emergency department over an 18-month period. For this retrospective observational study, electronic health record data on triage errors (i.e., incorrect presentational flowchart, specific discriminator and/or priority level) and triage nurses were combined with routine data on patient characteristics, outcomes and the work environment. To explore relationships between these variables, we performed univariate and multivariate logistic regression analyses. We observed triage errors in 16.3% of patients (n = 314). These were significantly associated with patients' emergency department and hospital stays. Analyses revealed that when > one patient was triaged every 15 min (OR: 2.112;95%CI: 1.331–3.354), older patients (OR: 1.009; 95%CI: 1.003–1.015) with > than two chronic conditions (OR: 1.506; 95%CI: 1.091–2.081) and orange or red priority codes (OR: 1.314; 95%CI: 1.046–1.651,) whose triage nurse had previous experience with another triage system (OR: 3.189; 95%CI: 2.455–4.14) had higher odds of triage errors. We provided primary evidence on triage errors. Confirming our findings on the prevalence, nature and consequences of such errors will require further prospective multicenter studies. Considering patient factors (e.g., age, polychronicity) as additional discriminators could make the nurse-led triage process using the Manchester Triage System more accurate. Investigating the roles of triage nurses' training and background and the emergency department work environment on their mental models regarding the triage process will require qualitative research. [ABSTRACT FROM AUTHOR]

The phenomenon of unfinished nursing care is gaining increasing interest among nursing researchers. While survey studies on the underlying concepts, e.g., implicit rationing of nursing care, revealed frequencies, antecedents and consequences, little is known about how nurses experience care rationing in clinical practice. The aim of this study was to explore nurses' experiences with implicit rationing of nursing care in acute-care hospitals. We conducted a qualitative study using interpretive description methodology. Using a convenience sample of 31 frontline nurses (i.e., registered nurses, nurse assistants) and 19 ward nurse managers from acute care units in seven hospitals in [Blinded], eight semi-structured focus group interviews were conducted, transcribed verbatim and analyzed via thematic analysis. Our findings indicate three interconnected themes: (a) maintaining stability within complexity; (b) applying strategies to limit rationing; and (c) nursing care between ideal and reality. According to study participants, implicit rationing of nursing care results when nurses cannot otherwise maintain stability for their patients and their units. Nurses reported several strategies, including postponing tasks or reducing quality, to prevent or limit rationing. Rationing accentuates the gap between ideal nursing care and day-to-day practice. In absence of guidelines on implicit rationing of nursing care nurses rely on intuitive and situational processes of decision-making and priority setting. Technical activities addressing patients' instability receive higher priority than relational ones. As quality may be an earlier casualty of implicit rationing than quantity, it challenges us to broaden the current focus of how care rationing manifests. In addition to encouraging open discourse on implicit and non-transparent rationing at all organizational levels, this qualitative study provides new insights that will inform the development and implementation of interventions to support nurses' priority setting and ultimately to limit rationing of nursing care. [ABSTRACT FROM AUTHOR]

Background: Methodological heterogeneity of studies and geographical variation limit conclusions about the impact of the COVID-19 pandemic on the mental health of youth. This study aimed to explore the health-related quality of life and mental health of children and adolescents in the second year of the pandemic in South Tyrol, Italy., Methods: An online survey representative for the age and gender of the children and adolescents in South Tyrol was conducted among 5159 families with children and adolescents aged 7-19 years, between 28 May and 16 June 2021. The survey collecting parental ratings and self-rated questionnaires from children and adolescents aged 11-19 years included instruments to measure health-related quality of life (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). The results were compared with data from corresponding studies conducted in Germany., Results: Decreased health-related quality of life and increased conduct problems, peer-related mental health problems, anxiety, and depressive and psychosomatic symptoms in children and adolescents observed in the second year of the pandemic in Germany were confirmed in the second year in South Tyrol. Children and adolescents with low socioeconomic status, a migration background, and limited living space were significantly affected. Female sex and older age were associated with increased psychosocial problems and a positive family climate supported the mental health of children and adolescents during the pandemic., Conclusions: Confirmation of findings of decreased health-related quality of life and increased emotional problems after the first year of the pandemic supports the ongoing call for low-threshold health promotion, prevention, and early intervention programs to support children and adolescents who have been severely affected by the pandemic.

Purpose: Early detection of SARS-CoV-2 patients is essential to contain the pandemic and keep the hospital secure. The rapid antigen test seems to be a quick and easy diagnostic test to identify patients infected with SARS-CoV-2. To assess the possible role of the antigen test in the Emergency Department (ED) assessment of potential SARS-CoV-2 infection in both symptomatic and asymptomatic patients., Methods: Between 1 July 2020 and 10 December 2020, all patients consecutively assessed in the ED for suspected COVID-19 symptoms or who required hospitalisation for a condition not associated with COVID-19 were subjected to a rapid antigen test and RT-PCR swab. The diagnostic accuracy of the antigen test was determined in comparison to the SARS-CoV-2 PCR test using contingency tables. The possible clinical benefit of the antigen test was globally evaluated through decision curve analysis (DCA)., Results: A total of 3899 patients were subjected to antigen tests and PCR swabs. The sensitivity, specificity and accuracy of the antigen test were 82.9%, 99.1% and 97.4% (Cohen's K = 0.854, 95% CI 0.826-0.882, p < 0.001), respectively. In symptomatic patients, sensitivity was found to be 89.8%, while in asymptomatic patients, sensitivity was 63.1%. DCA appears to confirm a net clinical benefit for the preliminary use of antigen tests., Conclusions: The antigen test performed in the ED, though not ideal, can improve the overall identification of infected patients. While it appears to perform well in symptomatic patients, in asymptomatic patients, although it improves their management, it seems not to be definitive., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Between 1% and 7.5% of patients admitted to the emergency department (ED) suffer from dyspnoea. The Manchester Triage System is one of Europe's most used triage systems considering five levels to prioritize patients in the ED: level 1 (red), immediate; level 2 (orange), very urgent; level 3 (yellow), urgent; level 4 (green), standard; level 5 (blue), non-urgent. With this study we aimed to evaluate the performance of the Manchester Triage System in patients with dyspnoea., Methods: With this retrospective, observational study we analysed data from 4'076 patients with dyspnoea accessing the ED in one Italian hospital between January 1, 2017 and June 30, 2019. To determine the sensitivity and specificity we computed the area under the curve (AUC) of the receiver operating characteristics (ROC) comparing the sensitivity and specificity for each of the five priority codes and seven-day mortality., Results: A total of 3.6% (n = 145) of the patients died within seven days after access to the ED. From the patients dying within seven days, 6.2% (9/145) had a blue or green priority code, 17.9% (26/145) had a yellow priority code and 75.9% had an orange or red priority code. A high priority code (orange or red) had a sensitivity of 75.9%, a specificity of 66.1%, a PPV of 7.6% and a NPV of 98.7%. The AUC was 0.734 (CI 95% 0.695-0.773, p < 0.001)., Conclusions: The Manchester Triage System showed acceptable sensitivity and negative predictive value in patients with dyspnoea, yet a low specificity related to the risk of death. The system is safe, resulting in a low under-triage rate for death. Improving the clinical assessment during nurses' triage (e.g. considering clinical history and auscultation of lungs) and prospective validation studies with surrogate endpoints is needed in this population., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Types and frequencies of complications associated with midline catheters and PICCs in a South Tyrolean district hospital: a retrospective cohort study Abstract., Background: Specialized registered nurses play a key role in the insertion and management of peripherally inserted central catheters (PICCs) and midline catheters in Anglo-Saxon countries. From the German-speaking area no data on the use of PICCs and midline catheters are available., Aim: The aim of this study was to describe the types and frequencies of complications of PICCs and midline catheters which were inserted by specialized registered nurses in a South Tyrolean district hospital., Methods: We performed a retrospective cohort study of PICCs and midline catheters inserted between 2013 and 2015 in one surgical unit in the district hospital Bruneck (South Tyrol / Italy)., Results: Data from 900 catheters (421 midline catheters and 479 PICCs) inserted in 686 adult patients (404 women, 282 men) were analysed. The cumulative incidence was 29.2 % complications for midline catheters (incidence rate: 13 complications / 1000 catheter days) and 16.0 % for PICCs (incidence rate: 3 complications / 1000 catheter days). The most frequent complication was the removal of the catheter by the patients (PICCs: 6.7 %, midline catheters: 15.7 %). Other less frequent complications were mechanical complications, occlusions, infections and thromboses., Conclusions: This study in one district hospital revealed similar types and frequencies of complications as previous international studies. Specialized and clinically competent nurses in German-speaking countries could develop advanced roles in the insertion and management of PICCs and midline catheters.