Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study

Background

Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy.

Methods

Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared.

Results

Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones.

Conclusion

MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.

Research priorities in Italian diabetes nursing care: findings from a Delphi study

AIM

Defining a set of research priorities for diabetes nursing care in the Italian context.

DESIGN

A two-step study design based on a modified Delphi technique was undertaken in 2013.

METHODS

In the first stage of research, five systematic reviews of literature were performed. Among them 865 recommendations in diabetes nursing care emerged, and 217 (25.1%) were categorized at level IV or lower, thus based on a lack of knowledge and therefore a potential research area. Homogeneous recommendations among the 217 emerged and were categorized by two researchers independently: 96 final recommendations were identified and transformed into items embodied into a questionnaire. A Likert scale ranging from 1 (very low) to 5 (very high) was used to collect the consensus regarding priority. For that purpose a sample of 200 nurses was randomly considered. Potential participants were invited to cooperate via email through a letter reporting aims and methods. In the first round 85 nurses participated; in the third and final round, only 13 nurses took part.

RESULTS

Participants have identified 14 research priorities categorized into three main areas: 1) education strategies' effectiveness (n=7); 2) models of care delivery and advanced nursing education effectiveness (n=4); and 3) in specific clinical issues (n=3).

CONCLUSIONS

More research on patient education and on models of care delivery and advanced nursing education should be included in any future Italian agenda.

[The management of insulin administration: systematic review and recommendations]

AIMS

In spite of the large prevalence and increasing incidence of diabetes, recommendations on how to correctly administer the insulin are lacking. METHODS; A systematic literature review was performed starting from a list of clinical questions collected from patients, clinical experts (doctors and nurses) and others involved in diabetic patients care. The main databases were searched with the following key-words: Insulin/administration and dosage[Mesh]; "Injections, Subcutaneous/instrumentation"[Mesh]; "Injections, Subcutaneous/methods"[Mesh]; insulin administration modalities [All Fields]; insulin administration technique [All Fields]; insulin adsorption[All Fields]; Patient education as a topic/methods [Mesh]. The articles were independently analyzed by three authors and discrepancies discussed. A list of recommendations was produced weighting the evidences according to the Italian National Program for Guidelines method.

RESULTS

Over 94 eligible articles, 71 were included. Recommendations for the following areas were produced: self management and education; tools and methods for insulin administration; injection sites; injection techniques; prevention and management of complications; insulin storage; management of IV infusions. Most recommendations are of level II (a single RCT with adequate design) or III (cohort non randomized studies with concurrent or historical controls).

CONCLUSIONS

Although several recommendations were identified (e.g., the importance of rotation of injection sites, the criteria for choosing the right needle and injection site according to the type of insulin and speed of absorbtion), several questions are still unanswered and would warrant further and more specific studies.

[The intensity of nurses' night shift in medical wards: an observational study on patients' calls]

INTRODUCTION

It is recognised that the night shift is a difficult one but only scarce data are available on what happens during the night.

AIM

The aim of this paper is to describe the reasons of patients' calls during the nights and the number of problems that require the intervention of the doctor on night duty.

METHODS

Data were collected by a non participant observer, in 4 general medical wards during a convenience sample of 12 nights. For each call, a form was completed reporting hour, patients characteristics and reasons for call.

RESULTS

During the nights 483 calls were observed; on average 40.2 for each night and 4 for each of the 115 patients who made a call. On average each nurse did answer 18 calls. The 40.4% (205/483) occurred between 21.00 and 23.59 hours; 18.6% had more than one reason (on average 1.2 reasons for each call). The doctor on duty was called for the 3.1% of calls.

DISCUSSION

The night duty can be very intensive. Situations nurses have to deal with and workload need to be explored to increase patients (and nurses) safety.

[The nurse's role in the management of patients with type 2, non-insulin-treated diabetes: the current state in Friuli Venezia Giulia]

Patient education is well known to be an essential aspect in the management of diabetes mellitus. This report aims to provide a general review of nursing care management for patients with diabetes mellitus, in particular non-insulin dependent type 2 diabetes, at either the inpatient or outpatient levels, in Friuli Venezia Giulia. Furthermore, it aims to identify the factors that may be preventing the implementation of adequate diabetes nursing care. We have identified 48 professional nurses formally involved in centres for diabetic care with a response rate of 87.5%.