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Objective. The progressive demographic increase of the ageing population, with a consequent increase in the average age, is generating important growth in the demand for healthcare services due to the revolving- door and over-crowding phenomena. The aim of this study is to identify the degree of the frailty of the elderly population and the need to activate periodical home assistance in order to counter the aforementioned phenomena. Methods. A pilot study for adaptation of the SvaMa scale. Results. The study recruited an overall sample of n = 80, aged between 65 and 100 years old. Results were analyzed using descriptive statistical analysis, and the Spearman rank correlation coefficient highlights a strong correlation between the different sections of this scale. The data were also analyzed using the Partitioning Around Medoids method, which found that the sample had a good cognitive state but presented functional and mobility issues.Conclusions. From the data that emerged, we can affirm that the modified S.Va.M.A. scale represents a suitable, fluid, simple instrument to be used whenever a multidimensional assessment of elderly people is necessary.

Purpose Burden of comorbidities appears to be related to clinical outcomes in hospitalized patients. Clinical stratification of admitted patients could be obtained calculating a comorbidity score, which represents the simplest way to identify the severity of patients' clinical conditions and a practical approach to assess prevalent comorbidities. Our aim was to validate a modified Elixhauser score for predicting in-hospital mortality (IHM) in internal medicine admissions and to compare it with a different one derived from clinical data previously used in a similar setting, having a good prognostic accuracy. Patients and Methods A single-center retrospective study enrolled all patients admitted to internal medicine department between January and June 2016. A modified Elixhauser score was calculated from chart review and administrative data ; moreover, a second prognostic index was calculated from chart review only. Comorbidity scores were compared using c-statistic. Results We analyzed 1614 individuals without selecting the reason for admission, 224 (13.9%) died during hospital stay. Deceased subjects were older (83.3±9.1 vs 78.4±13.5 years; p

Background: the world population is aging, and the prevalence of chronic diseases is increasing. Chronic diseases affect the quality of life of patients and contribute toward increased healthcare costs if patients do not adhere to treatment. This study defines the medication adherence levels of patients with chronic diseases. Methods: an observational cross-sectional study was carried out. Patients aged 65 years and older with chronic diseases were included in this study. The medication adherence report scale was used. Results: overall, 98 patients aged 65 years and older were included. The mean age of responders was 78.65 years. Study population: 71.43% were always adherent; 9.79% often adherent; 14.89% sometimes adherent; 3.87% rarely adherent; and 1% never adherent. The internal consistency of the MARS-5I was good: Cronbach’s alfa value of 0.77. Conclusions: the MARS-5I is an effective self-report instrument to measure the medication adherence of patients. However, further studies are needed to explore factors affecting medication adherence to avoid clinical consequences for patients and high healthcare costs for healthcare facilities. Healthcare communication could be improved to ensure better transitional care.

The aim of the study was to map the recent literature on medication error to monitor the state of research and explore emerging research fronts. Specifically, the co-occurrences analysis aimed to research the conceptual structure of the medication errors, whereas the coauthorship analysis aimed to research the "authorities" that influenced the academic and political discussion on medication errors.The search for relevant studies was carried out through the Scopus. To map and monitor the state of research on medication error, a preliminary analysis was conducted through the year of publication, type of article, and language. The count of citation shows the most relevant work among those included. Bibliometric analyses were conducted, such as coauthorship analysis and co-occurrences analysis.The search strategy yielded 5393 articles. Of these, 1267 articles were included. Four main themes emerged from this bibliometric analysis: (a) the exploration of human factors related to health care professionals that increase the risk of medication error, (b) the investigation of behaviors and strategies that can prevent the error in the preparation and administration stage, (c) the analysis of the benefits related to the presence of the pharmacist in hospital settings, and (d) the exploration of the consequences of a medication error and/or adverse effects of drugs.For the first time, a bibliometric analysis of medication errors research in the world has been conducted and demonstrated that there is a wealth of contributions already being made that are well aligned to the World Health Organization challenge.

The aim was to understand the knowledge, attitudes, and behaviors of Health Care workers regarding the Novel Coronavirus 2019 cases at the start of the diffusion of the disease in Italy.Cross-sectional survey of nurses working in Italian hospitals.Most of the sample showed good knowledge and behaviors about the new virus and good attitudes. Logistic regression analysis demonstrated that predictive variables of knowledge, attitude, and behavior were: educational background, work experience years and age of nurses.This study is the first one in a time of a full health emergency. It would be appropriate to develop further studies to better analyze the skills implemented to tackle Novel Coronavirus 2019 disease. Novel Coronavirus 2019 pandemic has put on health personnel a considerable workload. Despite this, the Italian nursing staff has been showing excellent knowledge, attitude, and good behavior in the management of this pandemic. (www.actabiomedica.it).

Nurses use their smartphones during the work shift. The objective of this review is to investigate the presence of bacteria on mobile phones and the procedures to disinfect or decontaminate the smartphone and decrease the infection rate.This systematic review was carried out through a search on the main scientific databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted by considering articles published in the last ten years.Of 502 initial articles, 489 were excluded and 12 articles were considered relevant. Twelve articles were included in the review. The analysis of the studies showed a high contamination of pathogenic microorganisms on the device's surfaces, most of which appear to be antibiotic resistant. The use of smartphones during clinical practice increases the risk of contracting nosocomial infections. The presence of bacteria on mobile phones and their use favors the cross-transmission of microorganisms.Onset prevention is a primary goal for the entire multidisciplinary team. There are no protocols concerning smartphones disinfection during clinical practice, but their implementation would reduce the incidence by improving nursing care.

Cognitive impairment and dementia can negatively impact the nutritional capacities of older people. Malnutrition is common in hospitalized frail elderly people with cognitive impairment and negatively affects prognosis. Malnutrition worsens the quality of life and increases morbidity and mortality. This scoping review aimed to identify factors affecting the risk of malnutrition and preventive strategies in hospitalized patients with cognitive impairment, focusing on nursing interventions. The authors researched population, context, and concept in international databases of nursing interest. Full texts that met the inclusion criteria were selected and reviewed. The extracted data were subject to thematic analysis. A five-stage approach, already reported in the scientific literature, was utilized in the following scoping review. Of 638 articles yielded, 9 were included. Two focus areas were identified as follows: (1) prevalence and risk factors of malnutrition in older patients with cognitive decline; (2) nursing strategies used to enhance clinical outcomes. Nursing health interventions aim to recognize and reduce malnutrition risk, positively impacting this phenomenon. A multidisciplinary team is essential to meet the nutritional needs of these patients.

Many studies analyze the medication errors in the hospital setting, but the literature involving the home care setting seems scarce. The aim of this study is to identify the main risk factors that affect the genesis of medication errors and the possible solutions to reduce the phenomenon in the home care setting. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical analysis of the literature shows that medication errors in home care occur mainly during transitional care. The main risk factors related to transitional care are poor interprofessional communication, lack of a standardized process for medication reconciliation, the widespread use of computerized tools, and the inadequate integration of the pharmacist into the care team. The strategies to reduce the risk of errors from therapy at home are the implementation of the pharmacist in the health team to ensure accurate medication reconciliation and the use of computerized tools to improve communication between professionals and to reduce the dispersion of information.

Key Points Question Among hospital staff who work day and night shifts, do sleep and attention metrics vary between those who work forward- vs backward-rotating shifts? Findings This cohort study of 144 nurses found that fast forward-rotating shifts for nurses were associated with lower levels of tiredness and sleepiness and higher levels of sustained attention compared with backward-rotating shifts. Meaning These findings suggest that optimization of shift rotations for nurses should be implemented to decrease the negative outcomes associated with shift work., This cohort study examines the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward- and backward-rotating shifts., Importance The association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established. Objective To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward- and backward-rotating shifts. Design, Setting, and Participants Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). The data were collected from July 2017 to February 2020. Data analysis was performed from May to October 2020. Exposures Participants were working either forward- or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction. Main Outcomes and Measures Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention was measured using the Psychomotor Vigilance Task. Tiredness was evaluated using the Tiredness Symptom Scale. Results A total of 144 nurses (mean [SE] age, 41.3 [0.8] years; 92 women [63.9%]) participated in the study; 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules. Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 [57.5%] in forward-rotating schedule group; 37 [57.8%] in backward-rotating schedule group). Nurses working backward-rotating shifts exhibited significantly greater sleepiness (F1,139 = 41.23; P

Objective Medication errors are a concern in overall the world. Although there are studies that investigate what may be the main causes that lead to the genesis of the medication error in the home care setting, there is no tool that correlates knowledge, attitudes, and behavior to medication errors in the context of home care. This study aimed to psychometrically test to the questionnaire on knowledge, attitudes, and behaviors in the administration of medication in the new setting: home care setting. Design This observational study was reported according to the STROBE checklist. Sample Sixty two nurses working in home care setting responded to the online survey. Measurement The face and content validity of the items generated was assessed. An Exploratory Factorial Analysis descriptive statistical analysis was conducted. The final questionnaire is composed of 20 items. Results The results of the statistical analyses allowed to validate the questionnaire, ensuring good internal consistency and reliability. Most of the sample pointed out that the use of electronic health record, medication reconciliation and the pharmacist's figure are all useful strategies for reducing the risk of medication errors. Conclusion The questionnaire is reliable to measure knowledge, attitude, and behavior about medication errors prevention in home care settings.

Medication errors are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Such errors account for 30 to 50 percent of all errors in health care. The literature is replete with systematic reviews of medication errors, with a considerable number of studies focusing on systems and strategies to prevent errors in intensive care units, where these errors occur more frequently; however, to date, there appears to be no study that encapsulates and analyzes the various strategies. The aim of this study is to identify the main strategies and interventions for preventing medication errors in intensive care units through an umbrella review. The search was conducted on the following databases: PubMed, CINAHL, PsycInfo, Embase, and Scopus; it was completed in November 2020. Seven systematic reviews were included in this review, with a total of 47 studies selected. All reviews aimed to evaluate the effectiveness of a single intervention or a combination of interventions and strategies to prevent and reduce medication errors. Analysis of the results that emerged identified two macro-areas for the prevention of medication errors: systems and processes. In addition, the findings highlight the importance of adopting an integrated system of interventions in order to protect the system from harm and contain the negative consequences of errors.

Objectives Medication errors are frequent and affect patient safety in all the world. This review using the GRADE approach aims to identify the educational intervention which improves nursing medication competences and knowledge. Methods According to PRISMA statement, a review was conducted. Key findings In this review of nine studies, we determined that there is a lot of educational intervention aimed to improve nursing knowledge, such as traditional classroom training, simulation, e-learning, slide show presentations and the use of posters and pamphlets or mobile application. All of these can improve the medication process and nursing skills. Only three studies reached moderate, and two studies reached low-quality ratings. Conclusions Our findings show that all educational interventions can lead to medication without harm. This work will inform regulators, public health initiatives and policy makers considering the nursing educational intervention for increasing patient safety and improve medication competence and knowledge.

ClinicalTrials.gov is the oldest and largest of these registries. Through this, the researchers can explore and monitor the clinical research landscape. In the last decades, the number of Medline-indexed publications on adverse events and medication errors have increased exponentially. The aims were to define the prevalence of clinical trials that have as outcome the medication errors and to describe the characteristics of these trials, including their distribution across countries, and publication rate.A cross-sectional analysis of all clinical trials reporting as primary outcome medication errors identified through ClincialTrials.gov.Among 5.881 trials, only 1,68% focused on intervention to improve medication safety process and prevent medication errors. 25,3% of clinical trials included had their primary outcome changed (p= ,005). Recording study results in ClinicalTrials.gov was associated with trials that had their primary outcome changed (OR: ,060; 95% C.I.: ,007 - ,541). Only few interventional trials were totally compliant with the ICMJE policy. For all trials completed in our sample, in mean 7,44 months (median: 12 months) elapsed between study completion and the first publication in Medline showing the trial's identification number.This study demonstrates several strengths of using ClinicalTrials.gov to track intervention to improve medication safety process. It is unknown how many trials are designed to focus on medication errors. However, 1,68% of trials focused on intervention to improve medication safety process.

(1) Background: It is well known that the success of surgical procedures is related to optimal postoperative management and follow-up. In this regard, mHealth technologies could potentially improve perioperative care. Based on these considerations, the objective of this scoping review is to evaluate the current status and use of mHealth interventions designed to provide perioperative care in orthopedic surgery. (2) Methods: This scoping review was conducted in accordance with the PRISMA statement (Extension for Scoping Review) and follows the framework of Arskey and O’Malley. (3) Results: The use of mHealth in the surgical setting is mainly oriented towards the development of applications for monitoring post-operative pain and optimizing communication between the various health professionals involved in patient care. (4) Conclusions: The mHealth systems can have a positive impact both on patient participation in the therapeutic process and on the communication between health professionals, increasing the quality of care.

(1) Background: Although the current literature shows that daylight saving time (DST) may play a role in human health and behavior, this topic has been poorly investigated with reference to Obstetrics. The aim of this case&ndash, control study was to evaluate whether DST may influence the number of spontaneous deliveries. (2) Methods: A low-risk pregnancy cohort with spontaneous onset of labor (n = 7415) was analyzed from a single Italian region for the period 2016&ndash, 2018. Primary outcome was the number of spontaneous deliveries. Secondary outcomes were: gestational age at delivery, type and time of delivery, use of analgesia, birth weight, and 5-min Apgar at delivery. We compared the outcomes in the two weeks after DST (cases) to the two weeks before DST (controls). (3) Results: Data showed no significant difference between the number of deliveries occurring before and after DST (Chi-square = 0.546, p = 0.46). Vaginal deliveries at any gestational age showed no statistical difference between the two groups (Chi-square = 0.120, p = 0.73). There were no significant differences in the secondary outcomes, as well. (4) Conclusions: DST has neither a significant impact on the number of deliveries nor on the obstetric variables investigated by this study.

Background: In order to explore the possible association between chronotype and risk of medication errors and chronotype in Italian midwives, we conducted a web-based survey. The questionnaire comprised three main components: (1) demographic information, previous working experience, actual working schedule, (2) individual chronotype, either calculated by Morningness&ndash, Eveningness Questionnaire (MEQ), (3) self-perception of risk of medication error. Results: Midwives (n = 401) responded &ldquo, yes, at least once&rdquo, to the question dealing with self-perception of risk of medication error in 48.1% of cases. Cluster analysis showed that perception of risk of medication errors was associated with class of age 31&ndash, 35 years, shift work schedule, working experience 6&ndash, 10 years, and Intermediate-type MEQ score. Conclusions: Perception of the risk of medication errors is present in near one out of two midwives in Italy. In particular, younger midwives with lower working experience, engaged in shift work, and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Since early morning hours seem to represent highest risk frame for female healthcare workers, shift work is not always aligned with individual circadian preference. Assessment of chronotype could represent a method to identify healthcare personnel at higher risk of circadian disruption.

Aim To investigate the impact of smartphone distraction on the quality and safety of care provided by the nursing population during work. Background About 80% of nurses use the smartphone in the workplace both for personal purposes and as a useful support to improve the quality of care. Distraction from smartphones during care is a phenomenon that should be known and managed within each health service. Methods A systematic review of the literature was conducted using the PRISMA methodology. The sources included in the review study were subjected to a qualitative assessment using the GRADE method. Results Sixteen articles were included in the review. Studies included highlight the positive and negative consequences of using mobile devices during nursing practice. Findings identify the smartphone as a generator of stimuli capable of diverting the attention of the person from the priority activities and absorbing the cognitive resources useful for carrying out these activities. Some studies aimed to show the restriction policies and/or the strategies for reducing disruptions. This review highlights how the free and indiscriminate use of the smartphone can negatively affect patient safety and the nurse-patient relationship through the dehumanization and depersonalization of care. Conclusions Mobile technology can improve nurses' performance and the quality of care provided. However, the application of regulations and policies by healthcare facilities is desirable to avoid inappropriate use of these devices by nurses. The available data do not provide a precise estimate of the effect that distraction from smartphones has on the outcomes of nursing care.

Background: The aim of this study was to relate the weekend (WE) effect and acute kidney injury (AKI) in elderly patients by using the Italian National Hospital Database (NHD). Methods: Hospitalizations with AKI of subjects aged &ge, 65 years from 2000&ndash, 2015 who were identified by the ICD-9-CM were included. Admissions from Friday to Sunday were considered as WE, while all the other days were weekdays (WD). In-hospital mortality (IHM) was our outcome, and the comorbidity burden was calculated by the modified Elixhauser Index (mEI), based on ICD-9-CM codes. Results: 760,664 hospitalizations were analyzed. Mean age was 80.5 &plusmn, 7.8 years and 52.2% were males. Of the studied patients, 9% underwent dialysis treatment, 24.3% were admitted during WE, and IHM was 27.7%. Deceased patients were more frequently comorbid males, with higher age, treated with dialysis more frequently, and had higher admission during WE. WE hospitalizations were more frequent in males, and in older patients with higher mEI. IHM was independently associated with dialysis-dependent AKI (OR 2.711, 95%CI 2.667&ndash, 2.755, p &lt, 0.001), WE admission (OR 1.113, 95%CI 1.100&ndash, 1.126, p &lt, 0.001), and mEI (OR 1.056, 95% CI 1.055&ndash, 1.057, p &lt, 0.001). Discussion: Italian elderly patients admitted during WE with AKI are exposed to a higher risk of IHM, especially if they need dialysis treatment and have high comorbidity burden.

Parkinson's Disease is associated with a high assistive complexity, thus generating in caregivers a burden proportional to the intensity of the care provided. This study aims to evaluate whether the stress-related level of caregivers is related to their perception of the need for healthcare education. A cross-sectional study was conducted on 69 family caregivers that completed the Stress-related Vulnerability Scale (SVS scale) with a tool of proposed interventions stratified according to caregivers' need as "nothing", "somewhat", "moderately" and "extremely". A direct association between the SVS scale and the perception of the usefulness of interventions was detected, and significant differences were observed for "Caregivers tele-support group" and "Peer-led support group" interventions, thus suggesting an important role for caregivers' emotional status in considering of training courses. Caregivers are split between low vulnerability, with minimal perception of training need, and high burden state with the acute necessity of support to manage patients.

Background and aim: Electrocardiogram (ECG) is considered the most used diagnostic tool to identify many cardiological disease and conditions that require the monitoring and recording of heart’s electric activity. The aim of this study is the validation and application of a web-survey, addressed to nursing students and nurses, in order to evaluate the degree of accuracy and the knowledge on the correct positioning of the 12-leads ECG. Methods: The study was a cross-sectional questionnaire-based study. The survey comprised 30 items, mainly multiple-choice questions. The participants were 484 nurses and nursing students. In the study, no exclusion criteria were adopted, but fill in the questionnaire any nurse on duty during the data collection period and/or any nursing student during the data collection period. Statistical analyses were performed using the SAS v. 9.4. In the study, no exclusion criteria were adopted. Results: A total of 484 nursing students and nurses comprising of 149 males (30.79%) and 335 females (69.21%) responded. In full findings showed good psychometric properties and good reliability. The Cronbach’s alpha coefficient for the study is 0.76 (number of items = 17, number of obs= 484). The mean age of responders was 32.01 (Standard deviation (SD) 9.63). A logistic multivariate regression demonstrated significant differences. Conclusions: It is evident from our findings and those from other countries, that more education is required to ensure that mistaken interpretation, misdiagnosis, patient mismanagement and/or inappropriate procedures due to 12 leads ECG misplacement does not occur. (www.actabiomedica.it)

Introduzione: L’evoluzione della formazione infermieristica ha di fatto portato ad un accrescimento di conoscenze e competenze che hanno reso gli infermieri dei veri e propri professionisti. Con l’introduzione del comma 566 della Legge di stabilità del 2015 e della Legge 24 del 2017, è stata posta una maggiore attenzione sull’utilizzo delle Linee Guida e su come esse, insieme alla buona pratica, possano ridurre il ricorso ad una medicina difensiva. Obiettivo: Indagine sulle conoscenze del personale infermieristico riguardanti i concetti di competenza avanzata e responsabilità professionale, in relazione al loro agire quotidiano, e ai nuovi assetti normativi. Materiali e Metodi: Uno studio cross-sectional è stato eseguito su un campione di 60 soggetti fra Giugno 2019 e Settembre 2019, presso l’ospedale Policlinico Umberto I di Roma. È stata condotta una survey, rivolta agli infermieri operanti nel setting dell’area critica e chirurgica, mediante l’utilizzo di un questionario non validato, in forma anonima in cui vengono analizzati e saggiati: a) dati anagrafici; b) analisi dell’attività lavorativa; c) analisi delle conoscenze. Risultati: Sono stati convalidati per lo studio 60 questionari correttamente compilati, con un tasso di risposta del 63.8%. Il 68.3% degli infermieri era di sesso femminile ed il 31.6% di sesso maschile. L’età media del campione è di 35.2 anni. Il 16.7% degli infermieri utilizza sempre le linee guida aziendali/ministeriali nella pratica clinica; il 36.7% le usa raramente; il 41.7% le utilizza abbastanza, mentre il 5% non le utilizza mai. In relazione alla conoscenza della normativa vigente, emerge che il 48.3% non conosce il comma 566 della Legge di stabilità, con il 48.3% del campione che asserisce di conoscere la Legge Gelli. Conclusione: Dai risultati ottenuti emerge la necessità del personale infermieristico di una maggiore formazione circa gli aspetti legali della professione mediante una formazione dedicata. Inoltre emerge l’importanza dell’aggiornamento professionale come mezzo per non incorrere in atti di medicina difensiva.

To investigate the presence of association between the personality trait and the onset of postoperative complications in patients undergoing enterostomy packaging.Systematic review of the literature.Type D personality traits and those with a low tendency to optimism and temperament (ex. anxiety-depressive syndrome) would seem to be associated with an increased risk of developing postoperative psychiatric morbidity and reduced levels of health-related quality of life (HRQoL) in enterostomized patients for colorectal cancer (CRC). Also, type-D personality, has been associated with greater risk of multiple comorbidities including an increased risk of heart failure unrelated to other sociodemographic causes 32-34-35. Personality with little tendency to optimism may represent a predictive factor on the development of psychological suffering one year after the diagnosis of CRC 3. Patients with personality traits associated with reduced levels of life satisfaction and / or reduced coping capacity require longer hospitalization time 26.Several studies highlight the presence of association between personality traits oriented to performance, persistence and extroversion and outcomes in various areas of surgery 14,2,-27,30. However, in almost all cases, the outcomes measured do not correspond to the early post-operative complications defined in the inclusion criteria but to mediumlong term psychological and rehabilitative outcomes.From the review study, no sources were found concerning the association between the personality trait and the onset of early postoperative complications in enterostomised patients, highlighting, furthermore, a lack of data on the subject involving the entire field of abdominal surgery.Personality trait, Enterostomy, Post-operative complications.Un’accurata raccolta dei dati anamnestici ed un’attenta interpretazione degli esami laboratoristici e strumentali rappresentano elementi indispensabili per il corretto inquadramento diagnostico-terapeutico e per una stima affidabile del rischio individuale di pazienti candidati a chirurgia. Al contrario, lo studio delle variabili psicologiche definenti la struttura cognitiva e comportamentale di ogni singolo paziente, non sembra rappresentare parte integrante della valutazione preoperatoria in pazienti candidati a chirurgia addominale, risultando limitato solo ad alcune specifiche realtà come, ad esempio, nel riconoscimento di idoneità per l’inserimento in lista ai fini di trapianto d’organo 9-10. Le esperienze delle persone con disturbi della personalità, delle loro famiglie e dei professionisti impegnati ad assisterli, suggeriscono di incorporare il trattamento psicologico all’interno di un programma di cura complessiva ad approccio multidisciplinare ed integrato 12. L’influenza delle variabili psicologiche sulla qualità degli outcomes chirurgici risulta quindi meritevole di ulteriori approfondimenti.Lo scopo del presente lavoro di revisione è quello di indagare la presenza di associazione tra tratto di personalità e lo sviluppo di complicanze postoperatorie precoci in pazienti sottoposti a chirurgia addominale elettiva per confezionamento di enterostomia.In seguito ad individuazione delle parole chiave “personality trait”, “enterostomy” e “post-operative complications” ed alla formulazione di una stringa di ricerca ottenuta tramite associazione di termini liberi e termini appartenenti ai vocabolari controllati di ogni singola banca dati, è stata condotta una revisione sistematica della letteratura secondo metodo Prisma Statement 2009 34-36. Il reperimento delle fonti è stato condotto interrogando le maggiori banche dati bibliografiche di interesse biomedico ed infermieristico (PubMed, Cinahl Complete, Scopus, Cochrane Library, PsycINFO, ILISI, Google Scholar).Sebbene diversi autori abbiano evidenziato la relazione tra tratto di personalità ed esiti chirurgici, nessuno di questi ha fornito risposte pertinenti al quesito di ricerca proposto, mostrando difformità con i criteri di inclusione stabiliti. Le fonti reperite focalizzano la loro analisi sull’associazione tra tratto di personalità e la qualità della vita correlata allo stato di salute (HRQoL) e sull’insorgenza, nel periodo postoperatorio, di disturbi psicologici e comportamentali in grado di condizionare negativamente il vissuto in questa categoria di pazienti. Tuttavia, è possibile affermare che: 1) Personalità con tratti tendenti al nevroticismo, all’ansia e all’ossessività rappresentano variabili indipendenti associate ad un rischio aumentato di sviluppare morbilità psichiatrica postoperatoria; 2) Pazienti con tratto di personalità associato a ridotti livelli di soddisfazione di vita (4.7; SD 1.6) e/o ridotte capacità di coping (4.2; SD 1.1) richiedono tempi di degenza più lunghi; 3) Il tratto di personalità tendente all’estroversione è un indice predittivo indipendente di minor durata del ricovero (p=0.05) in pazienti sottoposti a resezione colica per cancro colo-rettale.La scarsa disponibilità di fonti disponibili sull’associazione tra componenti psicologiche ed esiti della chirurgia evidenzia la presenza di un’area grigia di conoscenze a riguardo suggerendo la conduzione di ulteriori studi primari con disegno adeguato a tale scopo. Il forte impatto psicologico, caratteristico della patologia oncologica, in associazione all’alterazione dell’immagine corporea secondaria a confezionamento di enterostomia, identifica questa categoria di pazienti quale possibile popolazione target per lo svolgimento di futuri studi prospettici in merito.

One of the major causes of arteriovenous fistula failure is the venous stenosis due to aggressive neointimal hyperplasia. The aim of the study was to assess the arteriovenous fistula maturation comparing absorbable sutures and non-absorbable ones in native vessels. Surgeries performed during a period of 24 months by a single team of expert surgeons were evaluated. Surgeries that met the inclusion criteria, namely, age ⩾ 18 years and radio-cephalic arteriovenous fistula, were considered. According to type of suture, patients were classified as Max group (absorbable suture) and Prol group (non-absorbable). Data pertaining to 70 patients were collected; 51% were men and the mean age was 73 ± 12 years. In Max group, an increasing blood flow was observed during the first 4 weeks without post-operative complications. In Prol group, six patients had thrombosis that resulted in vascular access failure. After the first week, the duplex Doppler ultrasound of both groups showed a regular arteriovenous fistula maturation, with an increase of blood flow rate. Although pre-operative post-tourniquet mean vein diameters of Max group were not adequate, the mean vein diameter and mean blood flow rate increased after 4 weeks, respectively. On the contrary, in Prol group, mean vein diameters and blood flow rate decreased. The maturation of arteriovenous fistula and its functional performance were not altered by the type of suture (absorbable/non-absorbable). Absorbable sutures were associated with good results considering arteriovenous fistula maturation.

BACKGROUND Western world health care systems have been trying to improve their efficiency and effectiveness in order to respond properly to the aging of the population and the epidemic of noncommunicable diseases. Errors in drugs administration is an actual important issue due to different causes. OBJECTIVE Aim of this study is to measure interest in online seeking medical errors information online related to interest in risk management and shift work. METHODS We investigated Google Trends® for popular search relating to medical errors, risk management and shift work. Relative search volumes (RSVs) were evaluated for the period November 2008-November 2018 all around the world. A comparison between RSV curves related to medical errors, risk management and shift work was carried out. Then we compared world to Italian search. RESULTS RSVs were persistently higher for risk management than for medication errors during the study period (mean RSVs 74 vs. 51%) and RSVs were stably higher for medical errors than shift work during the study period (mean RSVs 51 vs 23%). In Italy, RSVs were much lower than the rest of the world, and RSVs for medication errors during the study period were negligible. Mean RSVs for risk management and shift work were 3 and 25%, respectively. RSVs related to medication errors and clinical risk management were correlated (r=0.520, p CONCLUSIONS Google search query volumes related to medication errors, risk management and shift work are different. RSVs for risk management are higher, are correlated with medication errors, and the relationship with shift work appears to be even worse, by analyzing the entire world. In Italy such a relationship completely disappears, suggesting that it needs to be emphasized by health care authorities.