Valentina Simonetti

Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: A randomized controlled trial §

BACKGROUND Many strategies have been evaluated to improve the prevention and control of cardiovascular (CVD) risk factors. Nursing telephonic and tele-counseling individualized lifestyle educational programs have been found to improve blood pressure control and adherence to lifestyle recommendation. This study tested the efficacy of a nurse-led reminder program through email (NRP-e) to improve CVD risk factors among hypertensive adults. METHODS All participants received usual CVD prevention and a guideline-based educational program. Subjects in the NRP-e group also received weekly email alerts and phone calls from a nurse care manager for 6 months. Emails contained a reminder program on the need for adherence with a healthy lifestyle based upon current guidelines. Follow-up visits were scheduled at 1, 3 and 6 months after enrollment; randomization was made centrally and blood samples were evaluated into a single laboratory. RESULTS The final sample consisted of 98 (control) and 100 (NRP-e) subjects (mean age 59.0 ± 14.5 years; 51.0% males). After 6 months, the following CVD risk factors significantly improved in both groups: body mass index, alcohol and fruit consumption, cigarette smoking, adherence to therapy hours, systolic and diastolic blood pressure, fasting blood glucose, low-density lipoproteins (LDL) and total cholesterol, triglycerides, and physical activity. In the NRP-e group, however, the prevalence of several behaviors or conditions at risk decreased significantly more than in the control group: obesity (-16%), low fruit consumption (-24%), uncontrolled hypertension (-61%), LDL (-56%), and total cholesterol (-40%). CONCLUSIONS The NRP-e improved a range of CVD risk factors. The program had low costs, required only an average of <20 min per day in addition to normal practice, and may deserve further evaluation for the inclusion among existing care management approaches.

In)accuracy of blood pressure measurement in 14 Italian hospitals

Objectives: The diagnosis and control of hypertension depend on accurate measurement of blood pressure (BP). The literature on the accuracy of BP recording by health professionals is, however, limited, and no study directly interviewed patients in the hospital setting. This multicenter cross-sectional study aimed at evaluating the compliance to current recommendations on BP measurement by health professionals directly from patients and to investigate potential predictors of higher quality in BP recording. Methods: A trained nurse interviewed a random sample of adult patients hospitalized for an ordinary admission (except in the emergency room) lasting more than one night, without mental disorder, who had their BP routinely measured by the hospital personnel less than 3 h before. The questionnaire contained 15 items on the main procedures that are common to current guidelines. Results: Fourteen public hospitals from seven regions of Italy participated, and 1334 questionnaires were collected. Nine of the recommended practices were followed in the majority (>70%) of BP recordings, whereas some others were infrequent or rare: in 98.6, 82.2 and 81.1% of the participants, respectively, the arm circumference was never recorded, BP was measured only once, and BP was never recorded in both arms. Overall, 10 or more recommended procedures were followed during 33.4% recordings. At multivariate analysis, physicians were less likely than nurses to provide a more accurate BP measurement. Conclusions: The operators compliance to some recommendations in BP measurement is unacceptably low. This survey provides detailed indications for medical directors on the procedures and settings to prioritize in educational programs, which are definitely needed.

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.

A structured telephonic counselling to promote the exclusive breastfeeding of healthy babies aged zero to six months: A pilot study

This pilot study aimed to test the effectiveness of a structured telephonic counselling (STC) on exclusive breastfeeding (EB) on healthy babies. The study was carried out on 114 primiparous women from February to March 2009. After randomization, women were divided into two groups: 55 receiving STC and 59 receiving conventional counselling. At 1, 3 and 5 months after delivery, a nurse specialist evaluated the EB rates, the influence of mothers educational level and employment status on EB. Breastfeeding rates in STC were higher compared to conventional counselling (P < 0.01); resuming work was not an EB discouraging variable as 74.5% women in the STC resumed work vs. 54.2% of the conventional counselling. Breastfeeding promotion should start during pregnancy, advising women about benefits for the child in receiving human milk. STC should be used to improve EB in primiparous women.

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.

The Experience of Family Caregivers of Patients With a Left Ventricular Assist Device An Integrative Review

Objective: The purpose of this review is to understand the experience of caregivers of patients with left ventricular assist device (LVAD) and to evaluate how health professionals can support them properly. Background: Left ventricular assist device can improve quality of life, enhance functional status, and prolong survival in patients with advanced heart failure. Nonetheless, LVAD can adversely influence quality of life for their family caregivers. Methods: An integrative literature review was conducted using scientific databases between January to March 2015. Results: A total of 15 studies are included in the final review. Three major themes emerged “emotional distress,” “responsibility,” and “coping strategies” that characterize family caregivers’ experiences with care of patients with LVAD. Conclusion: Health care providers should understand the pivotal role of caregivers in promoting and maintaining patients’ well-being and be able to help the caregiver to moderate the impact being overloaded. Research should be addressed to create interventions that motivate the caregivers to engage in activities that promote their health.

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.