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BACKGROUND: The autonomy achieved by discharge after total knee and hip arthroplasty is important for planning early rehabilitation. PURPOSE: Describe functional performance using the Iowa Level of Assistance (ILOA) scale and investigate possible prognostic factors. METHODS: A prospective cohort study design was used. Autonomy at discharge was measured using the ILOA scale. Postoperative factors such as time to remove surgical drains, the length of hospitalization, preoperative physical therapy, and the number of physiotherapy treatments were collected. RESULTS: The sample was composed of 452 patients: 191 men (42.3%) and 261 women (57.7%). The mean ILOA score was 12.34 (SD = 5.4), representing a level of autonomy of 68.4%. Gait speed was the activity with the highest score and it ranged from 0.26 m/s to 0.32 m/s. Based on univariate and multivariate analysis, gender and age were the only significant variables to influence achieving autonomy at discharge. CONCLUSION: The rehabilitative program in its acute phase should be planned with particular attention paid to elderly women, unifying the physiotherapy protocol for total hip arthroplasty (THA) and total knee arthroplasty (TKA), reviewing the modalities of preoperative treatment sessions and with a specific training for the speed gait.
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Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Alta del Paciente , Adulto , Planificación Anticipada de Atención , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Autonomía Personal , Pronóstico , Estudios Prospectivos , Adulto JovenRESUMEN
Although it can be prevented, catheter-related bacteremia is common and dangerous. The antiseptics most widely used during insertion of peripheral venous catheters (PVCs) include povidone iodine, alcohol, and chlorhexidine. Another widely used antiseptic is a solution of 0.057 g sodium hypochlorite. This pilot study explored the contamination rate of the PVC tip inserted after skin decontamination with sodium hypochlorite. Culture analysis of the tips of the PVCs inserted into the 42 participants showed 7 (16.7%) colonized catheters. The results of this pilot study suggest taking into serious consideration the assessment of this antiseptic in randomized experimental studies.
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Antiinfecciosos Locales/farmacología , Cateterismo Periférico , Piel/efectos de los fármacos , Piel/microbiología , Hipoclorito de Sodio/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
INTRODUCTION: In Italy research conducted by non medical professions is scarce also for the lack of knowledge on methods. At Rizzoli hospital in Bologna in 2006 a Centre for research to educate and support health professionals was implemented. AIM: To assess the impact of the research centre on number of research articles and protocols produced by nurses. METHODS: Interrupted time series. In the five years before and after the implementation of the centre data on the number of protocols approved by Ethical Committee with a nurse as principal investigator and on the number of articles published on impacted journals with a nurse as first author were collected. The number of nurses authors of the publications was also collected. RESULTS: For all the variables an increasing trend, starting from 2006 was observed, with statistically significant differences from 2008 for the number of research protocols presented (p=0.037), the number of nurses authors of scientific articles (p=0.027). Although the number of publications on impacted journals increased from 2006, differences were not statistically significant after 2008. CONCLUSIONS: An hospital based Centre for education and support to research for health professionals may facilitate the scientific and research production.
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Educación en Enfermería , Investigación en Enfermería , Edición/estadística & datos numéricos , Hospitales , Italia , Factores de TiempoRESUMEN
UNLABELLED: Effectiveness of the transparent sterile dressing vs standard to fix the peripheral venous catheter (PVC), on the incidence of phlebitis. A randomized controlled trial. INTRODUCTION: The type of dressing could contribute to the incidence of phlebitis, infiltration and accidental removals but the results of the studies are contrasting and samples are limited. AIM: To compare the effectiveness of a transparent polyurethane sterile dressing on the rate of phlebitis associated to peripheral venous catheter (PVC) vs a non sterile sticking plaster in use in current practice (standard dressing). DESIGN: Randomized controlled trial. Participants. 1061 PVCs (703 patients, adults and children) at a research orthopedic hospital in the north of Italy; 540 PVCs allocated to receive the sterile and 521 the standard dressing. RESULTS: 96 PVCs were excluded for phlebitis, 48 (9.6%) in the sterile and 48 (10.1%) in the standard dressing group, RR 0.96 (95%CI 0.697 - 1.335). Accidental removal of the PVCs was more frequent with the sterile dressing (9.6% vs 6.3%) but the number of catheters removed without complications was larger in the standard dressing group (48.9% vs 54.9% P=0.0503). Eighty-five PVCs were replaced for detachment of the dressing (50, 9.2% sterile and 35, 6.7% standard dressing). The cheapest transparent sterile dressing costs 32 cents while the standard 9 cents. CONCLUSIONS: A sticking non sterile plasters is not influential on the rate of phlebitis and ensures an good fix of the PVC compared the transparent sterile dressing to of polyurethane film.
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Vendajes , Cateterismo Periférico/efectos adversos , Catéteres/efectos adversos , Flebitis/epidemiología , Flebitis/prevención & control , Adulto , Niño , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Flebitis/etiologíaRESUMEN
Medication errors are a well-known problem in healthcare organizations. Several studies have shown that medication errors and adverse drug events (ADEs) are the biggest causes of adverse events in hospitals. This work will present the Istituti Ortopedici Rizzoli of Bologna's project, which has an systemic and integrated approach to prevent and minimize medication errors. The project performed this activities: a cognitive survey to learn the nurse staff's knowledge and perception of risks level; educational activities to sensitize nurse staff; a detailed retrospective study, based on the analysis of clinical records, to determine the rate of medication errors in the prescription and transcription phases; the introduction of a unified tool for medication, which eliminates the transcription phase, enable the medication prescription and the administered drug to be recorded.
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Errores de Medicación/prevención & control , Personal de Enfermería en Hospital/educación , Gestión de Riesgos , Humanos , Incidencia , Italia , Errores de Medicación/estadística & datos numéricos , Proyectos Piloto , Estudios RetrospectivosRESUMEN
Medication errors occur frequently in many clinical settings. Various studies have highlighted that, together with adverse drug events, they represent one of the major causes of adverse events occurring in hospitals. The aim of this study was to perform a detailed retrospective medical record review in order to investigate the incidence of medication errors occurring in the prescription and transcription phases of the medication use process. Overall, 56 medical records were reviewed to determine the incidence of incomplete or incorrect prescriptions and incorrect transcription by nurses of the original medication order. The findings highlight the need to improve medication safety, in particular at the time of prescription and transcription of orders. The study also confirms that the retrospective review of medical records is an effective method for identifying certain types of medication errors that occur during the prescription and transcription phases. However, this type of review is complex and too costly to be used routinely, for continuous monitoring, in clinical practice.