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A cross-sectional study was conducted with a convenience sample ( N = 3,093) of Finnish and Italian registered nurses to identify differences related to generation, country, gender, and educational level in their perceptions and opinions about workplace-related dimensions of nursing and their managers’ leadership practices. The Multidimensional Nursing Generations Questionnaire (MNGQ) and two subscales of the Transformational Leadership Scale (TLS), “Feedback and Rewards” and “Professional Development,” were used as survey tools. Data were analyzed with descriptive and inferential statistics. Statistically significant ( p < .05) generational and country differences emerged in the MNGQ components “Conflicts between generations,” “Patient safety view,” “Relationships between generations,” “Working as a multigenerational team,” “Orientation to change,” “Intention to leave,” and “Flexibility and availability.” Generational and country differences also emerged for the two TLS subscales. Generational differences existed between registered nurses of different generations and countries, and should be considered in leading multigenerational nurses’ workforces.

Aims and objectives To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design A national cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case-by-case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88-2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence-based nursing interventions. Relevance to clinical practice The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

Aim To describe a research protocol for a study designed to examine self-care in patient and caregiver dyads in coping with multiple chronic conditions, to evaluate the influence of dyad self-care on: (a) patient mortality, quality of life, hospital admissions, and the unplanned access of care; and (b) the positive aspects of caregiving. The specific conceptual framework that we developed for this study considers the predictors of self-care (at patient, caregiver, and dyadic levels), the process of self-care and the outcomes of self-care in patient and caregiver dyads with multiple chronic conditions. These elements in patient and caregiver dyads have not been well-studied to date. Design This is a multicentre longitudinal study with data collection at 0, 6, and 12 months. Methods We will use generic and specific tools to assess the predictors of self-care, the process of self-care and the outcomes of self-care in the dyads. The data will be analysed with descriptive and inferential statistics and multilevel modelling to control for the interdependent nature of dyadic data. The study was approved by an ethics committee and was funded by a grant from the Centre of Excellence for Nursing Scholarship Rome, in November 2015. Discussion This study seeks to determine the predictors and outcomes of self-care in patient and caregiver dyads within the context of multiple chronic conditions. Impact The results of this study will inform clinical practice and research by identifying variables that are modifiable and therefore amenable to interventions.

Background The active role of nursing students is particularly important in the delivery of health care, since playing an active role at the bedside and the use of active and collaborative engagement of students in the nursing activities has been associated with improved student learning. This is consistent with Karasek's learning hypothesis, but it has never been tested on nursing students. This study aimed at investigating whether nursing students in high control conditions reported lower levels of work impairment than students in the conditions with low control, compared them with a group of healthcare workers (HCWs), and tested the moderating role of social support at work. Methods 633 nursing students and 160 HCWs completed the Nursing Work Functioning Questionnaire (NWFQ), and the Demand-Control-Support questionnaire (DCS). Findings Results showed that nursing students reported higher levels of work impairment and were less likely to be classified as active (high demand/high control) or low strain (low demand/high control) than HCWs, and that social support at work moderated the association between being in active or low strain condition and work impairment. Conclusions Programs to enhance the learning of nursing students must not only fight strain and isolation but must also promote active learning, by increasing the control over the job, team work, and support from teachers.

Objectives To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents. Design Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting NH in Europe (n = 50) and Israel (n = 7). Participants 3234 NH older residents. Measurements Participants were assessed through the interRAI long-term care facility instrument. Polypharmacy was defined as the concurrent use of 5 to 9 drugs and excessive polypharmacy as the use of ≥10 drugs. Cognitive function was assessed through the Cognitive Performance Scale (CPS). Functional status was evaluated through the Activities of Daily Living (ADL) Hierarchy scale. The change in CPS and ADL score, based on repeated assessments, was the outcome, and their association with polypharmacy was modeled via linear mixed models. The interaction between polypharmacy and time was reported [beta and 95% confidence intervals (95% CIs)]. Results A total of 1630 (50%) residents presented with polypharmacy and 781 (24%) excessive polypharmacy. After adjusting for potential confounders, residents on polypharmacy (beta 0.10, 95% CI 0.01-0.20) and those on excessive polypharmacy (beta 0.13, 95% CI 0.01-0.24) had a significantly higher decline in CPS score compared to those using .05) significant change according to polypharmacy status was shown for ADL score. Conclusions Polypharmacy is highly prevalent among older NH residents and, over 1 year, it is associated with worsening cognitive function but not functional decline.

In Parkinson disease (PD), sarcopenia may represent the common downstream pathway that from motor and nonmotor symptoms leads to the progressive loss of resilience, frailty, and disability. Here we (1) assessed the prevalence of sarcopenia in older adults with PD using 3 different criteria, testing their agreement, and (2) evaluated the association between PD severity and sarcopenia.Cross-sectional, observation study.Geriatric day hospital.Older adults with idiopathic PD.Body composition was evaluated through dual energy x-ray absorptiometry. Handgrip strength and walking speed were measured. Sarcopenia was operationalized according to the Foundation for the National Institutes of Health, the European Working Group on Sarcopenia in Older Persons, and the International Working Group. Cohen k statistics was used to test the agreement among criteria.Among the 210 participants (mean age 73 years; 38% women), the prevalence of sarcopenia was 28.5%-40.7% in men and 17.5%-32.5% in women. The prevalence of severe sarcopenia was 16.8%-20.0% in men and 11.3%-18.8% in women. The agreement among criteria was poor. The highest agreement was obtained between the European Working Group on Sarcopenia in Older Persons (severe sarcopenia) and International Working Group criteria (k = 0.52 in men; k = 0.65 in women; P .01 for both). Finally, severe sarcopenia was associated with PD severity (odds ratio 2.30; 95% confidence interval 1.15-4.58).Sarcopenia is common in PD, with severe sarcopenia being diagnosed in 1 in every 5 patients with PD. We found a significant disagreement among the 3 criteria evaluated, in detecting sarcopenia more than in ruling it out. Finally, sarcopenia is associated with PD severity. Considering its massive prevalence, further studies should address the prognosis of sarcopenia in PD.

AIM To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy. BACKGROUND Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments. DESIGN A Delphi Study technique was implemented in four phases by means of e-mail. METHODS The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established. RESULTS After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored. CONCLUSIONS This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process.

Considering the ethical issues related to nursing and that Ethics is an integral part of the nursing education in the degree course, one would suppose that academic dishonesty might be less frequent in nursing students than in students of other disciplines. However, several studies show that this trend of deceitful behaviour seems to be similar among the university nursing students and those of other disciplines. The aim of this study is to investigate the phenomenon of academic dishonesty in the classroom from a longitudinal perspective within a cohort of Italian nursing students. A non-experimental longitudinal design was used. All nursing students were recruited from the Nursing Science Bachelor Degree Program of a big Italian university in the centre of Italy and participants were part of an ongoing longitudinal research project which started in 2011 on nursing students' wellbeing. The results show that students get accustomed to taking academically deceitful actions. They come to consider their behaviours acceptable and normal, thereby stabilizing them, which increases the probability of stabilizing subsequent deceitful behaviours. The stability through time of academic cheating behaviours committed during higher education, within the study's timeframe, provides important perspectives into the establishment of rigorous standards of ethical and moral behaviours by the students.

Institutionalization is generally a consequence of functional decline driven by physical limitations, cognitive impairments, and/or loss of social supports. At this stage, intervention to reverse functional losses is often too late. To be more effective, geriatric medicine must evolve to intervene at an earlier stage of the disability process. Could nursing homes (NHs) transform from settings in which many residents dwell to settings in which the NH residents and those living in neighboring communities benefit from staff expertise to enhance quality of life and maintain or slow functional decline? A task force of clinical researchers met in Toulouse on December 2, 2015, to address some of these challenges: how to prevent or slow functional decline and disabilities for NH residents and how NHs may promote the prevention of functional decline in community-dwelling frail elderly. The present article reports the main results of the Task Force discussions to generate a new paradigm. Sin financiación 5.325 JCR (2017) Q1, 4/53 Geriatrics & Gerontology UEM

The aim of this regionally-based, retrospective study was to describe the incidence of self-feeding dependence and predictors among elderly patients admitted from 2008 to 2013 to 105 Italian nursing homes. Data reported in a regional database collected at the time of nursing home admission and every 6 months up to the resident's death were accessed. The self-feeding degree of dependence was the dependent variable; at the individual and nursing home levels, explanatory variables were those collected at nursing home admission and every 6 months. The structural equation model and the ordinal polynomial logit regression analysis were performed. A total of 13 175 records of residents when admitted to the nursing home and their following 69 341 records, were included. At the time of nursing home admission, 6496 residents (49.3%) reported a certain degree of dependence in self-feeding and showed slight worsening in their dependence every 6 months. At the individual level, the increased functional dependence raised the proportional odds ratios of approximately 4.36 times of an increased dependence in self-feeding; the degree of cognitive impairment, the lack of social interactions, the occurrence of pressure sores, comorbidities, as well as the clinical instability and time all raised the risk of self-feeding dependence progression. At the nursing home level, an increased number of beds emerged as a factor also increasing the proportional odds of dependence in self-feeding. Factors affecting self-feeding dependence are multi-faceted at the individual and at the nursing home levels.

Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers.To explore nursing students' handover involvement during their clinical rotations and associated factors.This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement.Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (β = 0.115, p 0.001); having children (β = 0.107, p = 0.011); being a 3rd-year student (β = 0.142, p 0.001) and being a 2nd-year student as compared to a 1st-year student (β = 0.050, p = 0.036); and having a longer clinical rotation (β = 0.015, p 0.001) in units with high 'quality of the learning environment' (β = 0.279, p 0.001). Moreover, students who were supervised by the nurse teacher (β = -0.279, p 0.001), or by a nurse on a daily basis (β = -0.253, p = 0.004), or by the staff (β = -0.190, p 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience.Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students.

Background During their clinical learning experience, students are exposed to the nursing profession as a powerful structural reality, experiencing the so-called professional socialisation, a process recognised as the basis of professional identity. Inside this process, students progressively acknowledge their professional identity as being composed of several competencies and, among these, also non-nursing tasks. Objectives To explore non-nursing tasks in the context of nursing students' clinical learning experiences. Design An interpretative phenomenological study design was performed and carried out in 2016. The COnsolidated criteria for REporting Qualitative (COREQ) research principles were used in reporting study methods and findings. Setting Two Italian Bachelor of Nursing degree programmes located in Northern Italy. Participants Students attending their nursing programmes who a) had successfully passed one or more theoretical examinations; b) had one or more clinical learning experiences in varied contexts (e.g. hospital, community); c) were attending the 1st, 2nd or 3rd year, and d) were willing to participate, were interviewed with an open-ended, face-to-face, audio-recorded interview. Methods A thematic analysis was performed. Results Participating students (n = 18) were between 20 and 25 years old and were attending the 1st to the 3rd (and final) academic year. Non-nursing tasks were experienced by them according to three main themes: a) “Being out of the scope of the learning experience,” b) “Being forced by external and internal forces,” and c) “Dealing with mixed outcomes by looking for a compromise.” All students have reported learning to perform non-nursing tasks by shadowing clinical nurses and also practising these tasks by themselves. Internal and external forces prompted students to perform non-nursing tasks, which were recognised as having positive, negative, and neutral effects on themselves and on their learning outcomes. Conclusions Non-nursing tasks are acquired since the beginning of the clinical experience, thus shaping the nursing students' professional identity. At the undergraduate nursing level, strategies should be implemented to prevent the phenomena that a) threaten the acquisition of more complex nursing competences expected by patients and society, and b) shape future generations to be flexible and to perform different tasks, included those below their role.

Objectives: To describe the use of social and medical care services in a community-dwelling older population from Stockholm, Sweden, using an integrated clinical and functional assessment tool. Design: Study based on data from the longitudinal community-based Swedish National Study on Aging and Care in Kungsholmen. Setting and Participants: Random sample of people >65 years of age living in the community in central Stockholm between March 2001 and June 2004 (N = 2368). Measures: Health status was measured with a health assessment tool (HAT), which combines 5 indicators (gait speed, cognitive function, chronic multimorbidity, mild disability, severe disability) collected during Swedish National Study on Aging and Care in Kungsholmen clinical examinations. The amount of formal and informal social care was self-reported in hours per month and recorded by trained nurses at baseline and the 3-year follow-up for those >= 78 years of age at baseline. Data on hospital admissions, 30-day readmissions, days spent in the hospital, primary care visits, and specialist visits were obtained from Stockholm County Council registers (2001-2007). Results: At baseline, 10% of the sample received formal social care and 11% received informal care. Annually between baseline and the 3-year follow-up, 15% were admitted to the hospital, 5% were readmitted, 78% visited a specialist, and 89% visited primary care. Those with the best HAT scores received 0.02 hours/month of formal care; those with the worst, 34 h/mo. The corresponding numbers for other variables were 0.02 vs 73 h/mo of informal care, 2 vs 11 hospital admissions per 10 persons/year, 44 vs 226 hospital days per 10 persons/y, 0.4 vs 2 30-day readmissions per 10 persons/y, 37 vs 78 specialist visits per 10 persons/y, and 50 vs 327 primary care visits per 10 persons/y. Conclusions/Implications: Because of its high discriminative power, the easy-to-use HAT index could help decision makers to plan medical and social care services.

Objectives To define the prevalence of dysphagia and its associated factors and to investigate the influence of dysphagia and nutritional therapies performed in dysphagic subjects on clinical outcomes, including nutritional status, pressure ulcers, hospitalization, and mortality. Design A prospective observational study. Setting and participants Thirty-one Italian nursing homes participating in the ULISSE project and 1490 long-stay nursing home residents, older than 65 years, assessed at baseline and reassessed after 6 and 12 months. Measures All participants underwent a standardized comprehensive assessment using the Italian version of the nursing home Minimum Data Set. The activities of daily living Long-Form scale was used to evaluate functional status. Health care professionals assessed dysphagia by means of clinical evaluation. Nutritional status was assessed using the information on weight loss. Results The prevalence of dysphagia was 12.8%, and 16% of the subjects were treated with artificial nutrition. The mortality rate in subjects with dysphagia was significantly higher compared with that of nondysphagic subjects (27.7% vs 16.8%; P = .0001). The prevalence of weight loss and pressure ulcers was also higher in dysphagic subjects. At variance, dysphagia was not associated with a higher hospitalization risk. Conclusion/Implications Dysphagia is common in nursing home residents, and it is associated with higher mortality. Therefore, early diagnosis and optimal management of dysphagia should become a priority issue in nursing homes.

PURPOSE: To investigate whether the number of nursing diagnoses on hospital admission is an independent predictor of the hospital length of stay. DESIGN: A prospective observational study was carried out. A sample of 2,190 patients consecutively admitted (from July to December 2014) in four inpatient units (two medical, two surgical) of a 1,547-bed university hospital were enrolled for the study. METHODS: Data were collected from a clinical nursing information system and the hospital discharge register. Two regression analyses were performed to investigate if the number of nursing diagnoses on hospital admission was an independent predictor of length of stay and length of stay deviation after controlling for patients' sociodemographic characteristics (age, gender), clinical variables (disease groupers, disease severity morbidity indexes), and organizational hospital variables (admitting inpatient unit, modality of admission). FINDINGS: The number of nursing diagnoses was shown to be an independent predictor of both the length of stay (β = .15; p < .001) and the length of stay deviation (β = .19; p < .001). CONCLUSIONS: The number of nursing diagnoses is a strong independent predictor of an effective hospital length of stay and of a length of stay longer than expected. CLINICAL RELEVANCE: The systematic inclusion of standard nursing care data in electronic health records can improve the predictive ability on hospital outcomes and describe the patient complexity more comprehensively, improving hospital management efficiency.

Objectives To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. Design Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting NHs in Europe and Israel. Participants 1843 NH residents on polypharmacy. Methods Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. Results Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing. Conclusions and Implications Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.

Objectives We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged ≥65 years. Setting and Participants Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (≥5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical events.

Background The clinical response after comprehensive symptom management is difficult to determine in terms of a clinically important difference. Moreover, therapies should try to reach the threshold perceived by the individual patient for the determination of a favorable response to a treatment. Measures The Edmonton Symptom Assessment Score (ESAS) was measured at admission (T0), and seven days after starting palliative care (T7). Patient Global Impression and Goal Response after one week of palliative care and its relation with the Personalized Dyspnea Goal were measured at T7. Intervention Patients admitted to palliative care units underwent a comprehensive symptom assessment by a specialist palliative care team. At T0, patients were asked about their Personalized Dyspnea Intensity Goal on ESAS. One week later (T7), after a comprehensive palliative care treatment, Personalized Dyspnea Intensity Goals were measured again. Patients were considered to have achieved a Patient Dyspnea Goal Response if dyspnea intensity (measured at T7) was equal or less than their expected Personalized Dyspnea Intensity Goal. At the same interval (T7), Patient Global Impression (improvement or deterioration) was measured. Outcomes 279 patients were analyzed in this study. The mean Personalized Dyspnea Intensity Goal at T0 and T7 were 0.97 (SD 1.3), and 0.71 (SD 2.1), respectively. 263 patients (94.2%) indicated a Personalized Dyspnea Intensity Goal of ≤3 as a target at T0. Patients perceived a bit better, a better improvement, and a much better improvement with a mean decrease in dyspnea intensity of -2.1, -3.5, and -4.3 points on the dyspnea intensity scale, respectively. In 60 patients (21.5%), dyspnea intensity did not change, and in 4.7%, dyspnea intensity worsened. Patients perceived a Minimal Clinically Important Difference (little worse) with a mean increase in dyspnea intensity of 0.10, and they perceived a worse with a mean increase of 1.7 points. Higher dyspnea intensity at T0 and lower dyspnea intensity at T7 were independently related to Patient Global Impression. At T7, 93 (33.3%) patients achieved their Personalized Goal Response, based on Personalized Dyspnea Intensity. Patient Dyspnea Goal Response was associated with Memorial Delirium Assessment Scale score and Personalized Dyspnea Intensity Goal at T0, and inversely associated with dyspnea intensity at T0 and T7, and lower Karnofsky level. For Patient Dyspnea Goal Response, no significant differences among categories of dyspnea intensity were found (P>0.05). Conclusion Patient Dyspnea Goal Response and Patient Global Impression seem to be relevant for evaluating the effects of a comprehensive management of symptoms, including dyspnea, assisting decision making process. Some factors may be implicated in determining the individual target and clinical response. A personalized symptom goal may translate in terms of therapeutic intervention, according to the achievement of the patients' expectations. High values of dyspnea intensity, a lower Karnofsky level, as well as high level of Dyspnea Intensity Goal (that is less patients' expectations) favor the achievement of the target.

Objectives To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD). Design Longitudinal (5-year) retrospective observational study. Setting Nursing homes in Italy. Participants A total of 3761 nursing home older residents. Measurements A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models. Results Within the sample (mean age 83 ± 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12–1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11–1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94–2.50 and HR 1.71; 95% CI 1.09–2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99–12.3). Conclusions Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population.

Objectives Recent evidence suggests that a substantial minority of people clinically diagnosed with probable Alzheimer disease (AD) in fact do not fulfill the neuropathological criteria for the disease. A clinical hallmark of these phenocopies of AD is that these individuals tend to remain cognitively stable for extended periods of time, in contrast to their peers with confirmed AD who show a progressive decline. We aimed to examine the prevalence of patients clinically diagnosed with mild-to-moderate AD who do not experience the expected clinically significant cognitive decline and identify markers easily available in routine medical practice predictive of a stable cognitive prognosis in this population. Design Data were obtained from two independent, longitudinal, observational multicenter studies in patients with mild-to-moderate AD. Setting The two studies were the European “Impact of Cholinergic Treatment Use” (ICTUS) and the French “REseau sur la maladie d'Alzheimer FRancais” (REAL.FR). Participants We used prospective data of 756 patients enrolled in ICTUS and 340 enrolled in REAL.FR. Measurements A prediction rule of cognitive decline was derived on ICTUS using classification and regression tree analysis and then cross-validated on REAL.FR. A range of demographic, clinical and cognitive variables were tested as predictor variables. Results Overall, 27.9% of patients in ICTUS and 20.9% in REAL.FR did not decline over 2 years. We identified optimized cut-points on the verbal memory items of the Alzheimer Disease Assessment Scale-Cognitive Subscale capable of classifying patients at baseline into those who went on to decline and those who remained stable or improved over the duration of the trial. Conclusion The application of this simple rule would allow the identification of dementia cases where a more detailed differential diagnostic examination (eg, with biomarkers) is warranted. These findings are promising toward the refinement of AD screening in the clinic. For a further optimization of our classification rule, we encourage others to use our methodological approach on other episodic memory assessment tools designed to detect even small cognitive changes in patients with AD.

Background: Patients in the terminal phase of chronic illnesses are often admitted to acute care wards, with the risk of receiving inappropriate intensive treatments as opposed to necessary palliative care (PC). Objective: To assess patient features and possible service biases in the activation of PC pathways, or lack thereof, for those dying in acute care. Design and setting: This was a prospective observational study of all patients admitted to our acute medical ward from the emergency department during 6 months. Measurements: Need for palliation was evaluated for all patients by a physician and a nurse of the Internal Medicine ward. Those proposed for PC were re-evaluated by a consultant and a nurse of the PC unit. Clinical and epidemiological data were obtained for those selected for PC, and those deceased in the acute ward without having received PC. Results: A total of 781 patients were admitted to the acute care ward and screened during the study period. Of the 56 patients assigned to the PC pathway, those that died in hospital (n = 30) had significantly poorer Karnofsky, Braden, and ECOG scores compared to those alive at discharge (n = 26). Forty-eight more patients died on the ward without having received PC. The prevalence of cardiopulmonary diseases was significantly higher in this group, while more oncologic patients died in the PC cohort. Conclusions: Palliative treatment needs to be augmented and better targeted in acute care settings. Special attention should be given to patients with cardiopulmonary illnesses, a possible bias preventing the activation of this type of care, and those at high risk of developing pressure ulcers. Further education and training in this field are crucial for healthcare professionals working in acute wards.

Objective “Lack of energy” or anergia is a common complaint associated with adverse outcomes in older people. There is a lack of knowledge on this symptom in the nursing home (NH) setting. The aim of this study was to investigate whether lack of energy was associated with hospitalization and mortality in NH residents. Design Longitudinal observational cohort study. Setting and Participants A total of 575 NH residents (72% women) in 13 French NHs from the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study cohort. Measurements Lack of energy was measured at the baseline visit as part of the 10-item Geriatric Depression Scale. Unadjusted and adjusted Cox proportional hazard regression models were performed to test the association of lack of energy with hospitalization events and mortality over 12 months of follow-up. Results The mean age of the study sample was 86.3 (SD = 7.5) years. At the baseline, 250 (43.5%) residents complained about lack of energy. Overall, 192 (33.4%) individuals experienced at least 1 hospitalization event and 98 (17.0%) died during the 12-month follow-up. Lack of energy was significantly associated with a higher risk of hospitalization (HR 1.35; 95% CI 1.02–1.80; P = .03), even after adjustment for potential confounders (HR 1.41; 95% CI 1.04–1.91; P = .02). No statistically significant association was found between lack of energy and 12-month mortality. Conclusion Lack of energy is a predictor of hospitalization in older people living in NHs. It may be considered a relevant clinical feature for identifying individuals at risk of adverse health outcomes, thus potentially serving as a screening tool for subsequently conducting a comprehensive geriatric assessment in this highly vulnerable and complex population.

Background It has been shown that empathy strengthens the relationship between patients and health professionals and also improves patient and health professional satisfaction, which helps promote the best clinical outcomes. Empathy is considered an essential prerequisite for a nurse to effectively care for a patient and for a holistic understanding of a patient's perspective in a student population. Objectives The main aim was to compare empathy levels between health professional students attending different university courses. Design A comparative study with a cross-sectional approach was conducted in two successive academic year cohorts of 1st year health professional students at a public Italian university. Participants and Methods A sample of 1st year health professional students at a public Italian university was investigated using the Jefferson Scale of Empathy Health Professional Students version (JSE-HPS). Results Overall, 502 health professional students were included in the study. The students in nursing showed significantly higher empathy levels than the students in other health professions. Furthermore, the female students were found to exhibit significantly more overall empathy than the male students were. Conclusions The undergraduate nursing students showed a significantly higher mean score of empathy measured by the Jefferson Scale of Empathy Health Professional Students version (JSE-HPS) than the students attending other health undergraduate courses. This could mean that a particular aptitude in establishing a help-relationship with other people exists among the students that choose to become a nurse.

Aims and objectives This exploratory research investigates obese patients’ beliefs and expectations before and one year after bariatric surgery. Changes and resistance to change in the identity system, in the perception of the body, in relationships and in the quality of life were of particular interest. Background Although bariatric surgery represents a promising treatment for obesity, nevertheless, it is still under utilised. This may be because, either the intervention is not always easily accessible or because very little is known about its psychological implications. Design Open answers provided by participants were analysed through discourse analysis. Methods A semi-structured interview about the exchanges in self-representations through time was administered to 30 Italian women, 15 of whom were obese before surgery and 15 were ex-obese, one year after surgery. Results The research shows that those participants who have already been operated on are generally satisfied with the results obtained; however, they faced considerable difficulties in adapting their identity to their new body. Participants reported that even one year after surgery they still thought, behaved and related to others as though they were still obese, and only after a change in awareness did they become able to realise they are now ex-obese. Conclusions This paper contributes to the understanding of the unrealistic expectations of patients before surgery compared with the real changes in their lives, as well the difficulties they still faced one year later. More studies in evaluating how bariatric patients live with this long-term condition are recommended to foster patient-centered care. Relevance to clinical practice Health professionals should also help people to face the difficulties of the postsurgery period, which are linked to the acceptance of the new body and of the new emerging self-image in relationships with others.

Aim and objectives: To develop and initially validate the Positive Sexuality Scale (PSS) to assess adult female-positive sexuality. Background: While traditional approaches focus on negative sexual experiences and sexual dysfunctions, within the positive psychology framework positive sexuality is a subjective experience of happiness and fulfilment with one’s sexual expression, which contributes to well-being. No measure exists that specifically measures adult female-positive sexuality and can be confidently used with women of any fertility/childlessness status. Design: Two-stage cross-sectional study with a 4-week test–retest, which follows the STROBE guidelines. Methods: Participants were 912 Italian women aged 18–45 (52.74% mothers, 23.79% voluntarily childless and 23.46% primary infertile), who completed the 5-item PSS and a self-report of psychological well-being. A subsample (n=61) completed the 4-week test–retest. Results: Factor analyses supported a one-factor model with measurement invariance across adulthood stage and fertility/childlessness status and good reliability. Younger and fertile women showed higher PSS scores, and moderate-to-high variability in infertile women’s well-being was accounted for by PSS scores. Conclusion: The PSS is a brief self-report with initial evidence of validity and reliability that could be used in sex research, practice and education. Relevance to clinical practice: The PSS could assist health professionals to identify a positive resource to which women can draw on to deal with sex-related issues. Implementing the assessment of female-positive sexuality in infertility protocols could help professionals to identify a potential resource within couples facing infertility and its treatment.

OBJECTIVES: Dynapenia, low muscle strength, is predictive for negative health outcomes and is usually expressed as handgrip strength (HGS). Whether HGS can be a proxy for overall muscle strength and whether this depends on age and health status is controversial. This study assessed the agreement between HGS and knee extension strength (KES) in populations differing in age and health status.DESIGN: Data were retrieved from 5 cohorts.SETTING AND PARTICIPANTS: Community, geriatric outpatient clinics, and a hospital. Five cohorts (960 individuals, 49.8% male) encompassing healthy young and older individuals, geriatric outpatients, and older individuals post hip fracture were included.MEASURES: HGS and KES were measured according to the protocol of each cohort. Pearson correlation was performed to analyze the association between HGS and KES, stratified by sex. HGS and KES were standardized into sex-specific z scores. The agreement between standardized HGS and standardized KES at population level and individual level were assessed by intraclass correlation coefficients (ICC) and Bland-Altman analysis.RESULTS: Pearson correlation coefficients were low in healthy young (male: 0.36 to 0.45, female: 0.45) and healthy older individuals (male: 0.35 to 0.37, female: 0.44), and moderate in geriatric outpatients (male and female: 0.54) and older individuals post hip fracture (male: 0.44, female: 0.57) (P < .05, except for male older individuals post hip fracture [P = .07]). Intraclass correlation coefficient values were poor to moderate in all populations (ie, healthy young individuals [0.41, 0.45], healthy older individuals [0.37, 0.41, 0.44], geriatric outpatients [0.54], and older individuals post hip fracture [0.54]). Bland-Altman analysis showed that within the same population of age and health status, agreement between HGS and KES varied on individual level.CONCLUSIONS: At both population and individual level, HGS and KES showed a low to moderate agreement independently of age and health status. HGS alone should not be assumed a proxy for overall muscle strength.

The Emergency Department visits of Nursing Home residents: descriptive study in a Nursing Home.Many Emergency Departments (ED) transfers of Nursing Home (NH) residents are potentially avoidable or even inappropriate since problems could be prevented or managed in the NH.To describe characteristics and outcomes of NH residents transferred to ED for respiratory, cardiovascular and neurological problems and symptoms of infection.A retrospective descriptive study using clinical records data from 2013-2016 of a NH was conducted.In 4 years (2013-2016), 143 ED accesses occurred, 55 (38.6%) for medical problems in 48 residents. The residents were mainly women, with advanced age. Forty-two/55 accesses (76.4%) resulted in an hospital admission and 16 residents (38.1%) died in hospital; of the 13 discharged, 3 died the NH after a few days. The most frequent reason for hospitalization was an infection (22): respiratory (18), urinary (2) or both (2). The week before ED admission 1/3 of residents was asymptomatic, 1/3 had only one typical symptom accompained by drowsiness or agitation (7), gastrointestinal problems (5), or other non-specific symptoms. On ED admission prevalent signs and symptoms were desaturation (13), dyspnea (10) and fever (9). Six/22 residents had started an antibiotic treatment in the NH.Proactive management policies need to be promoted for residents with infections, based on explicit criteria to promptly monitor changes in clinical conditions and on the education educate professionals to suspect an infection even with non-specific symptoms.

Background Low academic success rates lead to fewer than the required number of nurses entering the national health systems, impacting on the supply of nurses and with negative consequences for global health care since low nurse-to-patient ratios are associated with an increase of patients' adverse outcomes. Objectives This study was mainly aimed at documenting any of the academic outcomes' potential predictors among Nursing Degree Program (NDP) students' characteristics. Design A retrospective multi-cohort study was conducted. Participants and Setting Ten cohorts of nursing students enrolled in a central Italy university were involved. Methods Qualitative and quantitative data on entry characteristics and academic outcomes were retrieved, observing retrospectively 10 cohorts of Italian nursing students for 13 academic years (2004–2017). Multiple regression analyses were conducted to assess if potential predictors reporting a p-value Results A total of 2278 students were enrolled in this study. Multivariate analyses showed that ‘female gender’, ‘having attended classical or scientific upper-secondary school’, and ‘having higher upper-secondary diploma grade’ were associated both with the qualitative outcomes (graduation within the legal duration of NDP) and the quantitative ones (final degree exam grade). The weight of the ‘admission-test score’ in explaining the variance of academic performances was very low (β = 0.03, 95% CI = 0.01 to 0.05) compared to the ‘upper-secondary diploma grade’ (β = 0.14, 95% CI = 0.12 to 0.16). Conclusions This evidence should lead to a reflection on the entry-selection methods for NDP, especially in those countries such as Italy, where these methods are essentially based on the entry-test, which in this study was shown to have a very low predictive power for academic outcomes.

Aim To explore job-related factors associated with distress and demoralization among hospital nurses, using a cross-sectional mixed-method design. Background Sources of job stress for nurses are mainly organizational or emotional care-related and can result in adverse outcomes such as distress or demoralization, but factors associated with demoralization in nurses still need to be thoroughly explored. Methods A convenience sample of 150 nurses from three public hospitals completed an online survey on job stress, distress, demoralization, and feelings of entrapment in the caring profession. Results Emotional job stress was linked to higher distress and demoralization, compared to no job stress, and to higher feelings of entrapment, compared to both organizational and no job stress, among senior nurses. Conclusions This pilot study points to the study of demoralization as a promising line of research in hospital nursing, but further longitudinal studies with larger samples are needed.

BACKGROUND: Orthostatic hypotension (OH) has high prevalence in frail older adults. However, its effect on mortality, disability, and hospitalization in frail older adults is poorly investigated. Thus, we assessed the relationship between the prevalence of OH and its effect on mortality, disability, and hospitalization in noninstitutionalized older adults stratified by frailty degree. METHODS: Prospective, observational study of 510 older participants (≥65 years of age) consecutively admitted to a geriatric evaluation unit to perform a geriatric comprehensive assessment. MEASUREMENTS: Clinical frailty was assessed using the Italian frailty index (40 items). Systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), and heart rate (bpm) were evaluated in clinostatic position and after 1, 3, and 5 minutes of orthostatic position. OH was defined with a decrease of 20 mm Hg in systolic blood pressure and/or a decrease of 10 mm Hg in diastolic blood pressure. RESULTS: OH prevalence was 22%, and it increased from 9.0% to 66.0% according to frailty degree (P for trend

Objective: To evaluate whether treatment with antidementia drugs is associated with reduced mortality in older patients with different mortality risk at baseline. Design: Retrospective. Setting: Community-dwelling. Participants: A total of 6818 older people who underwent a Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) evaluation to determine accessibility to homecare services or nursing home admission from 2005 to 2013 in the Padova Health District, Italy were included. Measurements: Mortality risk at baseline was calculated by the Multidimensional Prognostic Index (MPI), based on information collected with the SVaMA. Participants were categorized to have mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) mortality risk. Propensity score-adjusted hazard ratios (HR) of 2-year mortality were calculated according to antidementia drug treatment. Results: Patients treated with antidementia drugs had a significant lower risk of death than untreated patients (HR 0.82; 95% confidence interval [CI] 0.73–0.92 and 0.56; 95% CI 0.49–0.65 for patients treated less than 2 years and more than 2 years treatment, respectively). After dividing patients according to their MPI-SVaMA grade, antidementia treatment was significantly associated with reduced mortality in the MPI-SVaMA-1 mild (HR 0.71; 95% CI 0.54–0.92) and MPI-SVaMA-2 moderate risk (HR 0.61; 95% CI 0.40–0.91, matched sample), but not in the MPI-SVaMA-3 high risk of death. Conclusions: This large community-dwelling patient study suggests that antidementia drugs might contribute to increased survival in older adults with dementia with lower mortality risk. © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Objective: The aim of this study was to illustrate the characteristics of patients with palliative care (PC) needs, early identified by general practitioners (GPS), and to analyze their care process in home PC services. Background: Early identification and service integration are key components to providing quality palliative care (PC) services ensuring the best possible service for patients and their families. However, in Italy, PC is often provided only in the last phase of life and for oncological patients, with a fragmented service. Methods: Multicenter prospective observational study, lasting in total 18 months, implemented in a sample of Italian Home Palliative Care Units (HPCUs), enrolling and monitoring patients with limited life expectancy, early identified by 94 GPS. The study began on March 1, 2014 and ended on August 31, 2015. Results: Nine hundred thirty-seven patients, out of a total pool of 139,071, were identified by GPS as having a low life expectancy and PC needs. Of these, 556 (59.3%) were nononcological patients. The GPS sent 433 patients to the HPCUs for multidimensional assessment, and 328 (75.8%) were placed in the care of both settings (basic or specialist). For all patients included in the study, both oncological and nononcological patients, there was a high rate of death at home, around 70%. Discussion: This study highlights how a model based on early identification, multidimensional evaluation, and integration of services can promote adequate PC, also for noncancer patients, with a population-based approach.

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Indwelling bladder catheters are widely used in intensive care units to monitor the hourly urine output in critically ill patients. In-hospital patients are frequently catheterized (15–25%), but catheterization is often unappropriated. A 30-day cutoff is used to differentiate between short- and long-term (or chronic) catheterization. Recent data confirmed that CAUTIs represent 23% of HAIs in ICU. In ICU patients, female gender (HR 2.67, 95% CI 1.03–6.91; p 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01–1.13; p 0.019) were identified as risk factors for CAUTI acquisition alone. Bundles’ implementation relates with a significant reduction in CAUTI incidence. The urinary catheter bundle includes five interventions: perform hand hygiene before insertion and manipulation of UC; keep collection bag lower than the bladder level; maintain unobstructed urine flow; empty collecting bag regularly and avoid allowing the draining spigot to touch the collection catheter; and monitor CAUTIs using standardized criteria to identify patients with CAUTIs and to collect UC days as denominators. No other routine interventions (such as catheter or collection bag changing, bladder irrigation, systemic and bladder antimicrobial administration) are recommended to prevent CAUTIs. Although CAUTIs have a strong impact on hospitalized patients’ outcomes, studies concerning the prevention of this problem are generally affected by poor-quality evidences and methodological issues. Therefore several research questions remain unresolved.

Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Chronic diseases are mostly managed by family caregivers that often face the “caregiver burden”. This study aimed to understand whether a multidisciplinary theoretical-practical training course could influence the burden, health literacy and needs of caregivers. Seventy-six familial caregivers were asked to complete the Caregiver Burden Inventory-CBI, Caregiver Needs Assessment-CNA, and Health Literacy Questionnaire-HLQ, before and after the course. A significant decrease in CBI and an increase of CNA were observed. However, a significantly higher rate of CBI decrease and a lower increase of CNA were detected in the neurological compared to the oncological group (p = 0.001). Moreover, the ability of the participants to look for and find health information significantly improved. The course contrasted caregivers' burden, increased their search for health information, and revealed their requiring of training and emotional and social support. Caregiver education plays a pivotal role in the management of chronic patients, enhancing the quality of life of both patients and caregivers.