Dania Comparcini

Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi‐centre prospective study

AIMS This multi-centre prospective field study evaluated whether peripheral venous catheter site of insertion influences the risk of catheter-related phlebitis. Potential predictors of phlebitis were also investigated. BACKGROUND Millions of patients worldwide use peripheral venous catheters, which frequently cause local complications including phlebitis, infection and obstruction. Although phlebitis predictors have been broadly investigated, uncertainties remain on the potential effect of cannulation anatomical site, duration and the appropriate time for catheter removal. DESIGN A prospective cohort design was carried out from January-June 2012. METHODS The clinical course of each patient who received a new peripheral venous catheter for any cause in five Italian hospitals was followed by trained nurses until catheter removal. The presence of phlebitis was assessed every 24 hours using the Visual Infusion Phlebitis score. Analyses were based upon multilevel mixed-effects regression. RESULTS The final sample consisted of 1498 patients. The average time for catheters in situ was 65·6 hours and 23·6% of the catheters were in place beyond 96 hours. Overall phlebitis incidence was 15·4%, 94·4% of which were grade 1. The likelihood of phlebitis independently increased with increasing catheter duration, being highest after 96 hours. Compared with patients with catheter placed in the dorsum of the hand (22·8% of the sample), those with the catheter located in the antecubital fossa (34·1%) or forearm were less likely to have a phlebitis of any grade. CONCLUSIONS Antecubital fossa and forearm veins may be preferential sites for peripheral venous cannulation. Our results support Centers for Disease Control and Prevention recommendations to replace catheters in adults no later than 96 hours. A relevant proportion of healthcare personnel did not adhere to such guidelines - more attention to this issue is required.

Physical assessment techniques performed by Italian registered nurses: a quantitative survey

AIMS AND OBJECTIVES The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination. BACKGROUND Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment. DESIGN Cross-sectional survey. METHODS The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected. RESULTS Most participants were females (age range 41-50 years), and worked in Internal Medicine, Intensive Care and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, 6 were seldom used and 4 were learnt but almost never performed (auscultation of lung, heart and bowel sounds and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment. CONCLUSIONS The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice. RELEVANCE TO CLINICAL PRACTICE This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programmes.

Self-reported medication adherence and beliefs among elderly in multi-treatment: a cross-sectional study

AIM To evaluate the association between adherence to treatment and beliefs about medications in multi-treated elderly patients. BACKGROUND A large body of evidence documented the importance of adherence to therapy in predicting clinical outcomes, and the association between adherence and medication beliefs in patients of various ages and with different health conditions. However, so far only a few studies have specifically investigated the associations between medication beliefs and adherence among elderly in polypharmacy. METHODS In this multicenter cross-sectional study we used the MMAS-8 and BMQ Scales to assess medication adherence and beliefs about medications, respectively. RESULTS The final sample consisted of 567 patients. Patients reporting higher levels of necessity or concerns about their medicines showed higher adherence (OR: 1.61, and 2.02, respectively; both p<.001). Accepting patients (high necessity and low concerns) were less likely (OR: 0.24; p<.001) to report adherence than ambivalent ones (high necessity and concerns). CONCLUSIONS Medication adherence is related to high necessity and concern about treatment. In nursing practice it is important to understand the specific barriers to adherence and to engage patients in the implementation of strategies to improve adherence.

Impulsivity in inpatient substance abusers: an exploratory study

Impulsiveness is one of the most socially relevant personality traits, and individual differences in impulsivity are related to many social deviant behaviours, such as substance dependence (Stanford et al. 2009). Coffee and cigarette consumption is associated with higher levels of impulsiveness (Mitchell 1999). Impulsiveness and poly-abuse are both risk factors for the development and maintenance of addiction and for the relapse after withdrawal (Stuyt 1997, Junghanns et al. 2005, Tziortzis et al. 2011). Bankston et al. (2009) showed the effectiveness of therapeutic community in decreasing patients’ impulsivity after long-term rehabilitation programmes. To date, no studies evaluated the effectiveness of a short-term detoxification unit in decreasing inpatients’ impulsivity levels.