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Introduction: Military corps have always been supported by healthcare providers who took care of the injured and sick soldiers. Traditionally the military nurse's figure has never been fully appreciated to the point that, even nowadays, it is still searching for its own identity., Aim: The aim of the study is to describe the military nurse's role from the Second War for Italian Independence (1859) to the conquest of Rome (1870)., Methods: Historical investigation. Secondary sources were consulted to carry out a geopolitical and historical contextualization of the reference period, while to trace the military nurse's evolution the team referred to primary sources. All the mentioned sources were analyzed according to Chabod's methodology (2012)., Results: The military nurse was born as a corpsman. The Risorgimento wars contributed to highlight the major contribution that nurses could give to military healthcare. In 1863 the Ministry of War elaborated a new and innovative profile for military nurses which foresaw particular physical and moral requirements, but also specific competences. Even though a new ideal of nurse was created, the Military Nurses Corp did not experience any changes: the nurses' activities remained transporting the injured and assisting doctors., Conclusions: Primary sources analysis highlighted an important attention towards the military nurse's role and education after national unity, although the gap shown by the military healthcare service during the Risorgimento battles was evident. Such condition facilitated the development of the first rescue committees which became, at a later time, the International Red Cross. The committees popularity allowed the volunteers to gain higher fame and social prestige than military nurses.

Chronic diseases require continuous healthcare that is not fully guaranteed by the Italian Health System which is more oriented towards acute care. In the Lazio region (city of Palombara Sabina), a Nursing-Led in-patient unit is present with the aim to care for patients affected by chronic diseases. The aim of this study was to describe the type of healthcare delivered by this unit. A descriptive-comparative design was used. All 290 patients admitted to the Nursing-Led Unit, during 2014 and 2015 participated in the study. The following variables were analyzed: socio-demographic characteristics of patients, reasons for admission, nursing diagnoses and interventions, medical diagnoses and interventions, Barthel index, length of stay, mortality rate, and discharge rate to acute care hospitals. The mean age of participants was 78 years old (SD 11,4) and the most frequent reason for admission was the need to receive a medium-high intensity nursing care (14,5%). The most frequent nursing diagnoses were bathing/hygiene self-care deficit (78,3%) and impaired physical mobility (74,8%). Hypertensive heart disease was the most frequent medical diagnosis (32,4%). The mean length of stay was 19 days, the mortality rate was 2,1% and the discharge rate to an acute care hospital was 9%. Significant improvements in patient dependency levels, as measured by the Barthel index, were observed at discharge with respect to admission (p < 0,001). The NursingLed Unit seems to be strategic in the delivery of care to older adults affected by multiple chronic diseases, in some phases of their condition. The results of this study indicate that the Palombara Sabina's nursing-led unit may contribute in reducing hospital admissions and achieving favorable patient outcomes when additional nursing interventions are needed.

The Professional Assessment Instrument (PAI) is a clinical nursing information system used in the adult inpatient units of the A. Gemelli university hospital in Rome (Italy). The PAI allows for the systematic collection of nursing care data in order to improve the quality of care. So far, few clinical nursing information systems have been developed in the neonatal and pediatric care setting. The aim of this study is to describe the development and implementation of a clinical nursing information system (PAIped) for the neonatal and pediatric care setting., Methods: The Patient-and Family-Centered Care model was used to develop the contents of the PAIped. A web platform application was developed for the PAIped. The standard nursing terminology Clinical Care Classification System was used. A decisionmaking support system was developed within the PAIped to support nurses in making diagnoses and in selecting the most appropriate nursing interventions., Results: A clinical nursing information system using a standard nursing terminology was developed in the pediatric and neonatal care setting. After a test phase, the PAIped was implemented in all the pediatric and neonatal inpatient units of the A. Gemelli university hospital., Conclusion: The development and implementation of the PAIped in the A. Gemelli university hospital allowed the monitoring of nursing care processes and accurate nursing documentation.

Introduction: midwifery records currently do not systematically collect data regarding midwifery care provided. Midwifery Minimum Data Sets (MMDS) have been developed to perform uniform and standardized data collection., Aim: to describe features, purposes and use of MMDSs in obstetrical care., Method: a literature review was conducted using Medline, CINAHL and Scopus databases. The following key words were used: "data set", "midwifery" and "maternity care., Results: twelve of 752 potentially eligible articles were included. Six MMDS were identified: Nurse - Midwifery Clinical Data Set, Optimality Index-United States, ACNM Benchmarking Data Collection Form, Midwives Alliance of North America Data Set, American Association of Birth Centers Uniform Data Set, Women's Health Care Minimum Data Set. Overall, the purpose of the different MMDSs was to record systematically the midwifery care provided and patient outcomes. The various MMDS had differing features; different data were collected related to women (e.g. socio-demographic data, anamnesis), their newborns (e.g. Apgar score, weight) and the midwifery care provided in different phases (e.g. antepartum, intrapartum). Generally, MMDS were used in north-American countries and their use showed the efficacy of midwifery interventions and the importance of systematic data collection., Discussion: an organized and standardized approach is needed to provide accurate data collection of maternal and neonatal health outcomes and midwifery care. The development and validation of MMDS in the Italian context is needed.

Complexity of nursing care represents an important indicator in the planning and management of nursing resources and healthcare management. However, the term is not clearly defined in the literature. The aim of this article is to outline the main concepts associated with complexity of nursing care, trying to shed light on the different variables that constitute it. We conducted a review of the literature and selected 12 articles. The terms associated with the concept of complexity of nursing care include nursing intensity, nursing work, nursing workload, patient acuity and severity of illness. The literature review indicates that complexity of nursing care appears to be one of the variables of care intensity, the latter being defined as a commitment of care delivered to the patient. It is associated with the concepts of nursing work, nursing workload, patient acuity and severity of illness. Understanding and clarifying the concept of complexity of care is fundamental in order to measure and evaluate the real demand for nursing care by individual patients.

Aim: Caregiving of stroke patients has a long trajectory and the experiences of caregi- vers may change over time. Few studies have described the experience of stroke caregi- vers three months after discharge of patients from rehabilitation hospitals. This study describes the experience of stroke caregivers three months after patients are discharged home from a rehabilitation hospital., Method: phenomenological study, Results: Seven themes emerged from analysis: deeply-changed life; re-appreciation of the relationship with patient and family members; increased workload; difficulties in getting support from the national health-care system; lack of preparation for caregiving; difficulties in coordinating caregiving, family and personal life; relief after patient's recovery., Conclusions: A comprehensive understanding of stroke caregivers' experience during the three months after patient discharge can support the development of educational interventions aimed at improving the caregiver preparation for the care of patients.

. Mixed methods designs: an innovative methodological approach for nursing research. The mixed method research designs (MM) combine qualitative and quantitative approaches in the research process, in a single study or series of studies. Their use can provide a wider understanding of multifaceted phenomena. This article presents a general overview of the structure and design of MM to spread this approach in the Italian nursing research community. The MM designs most commonly used in the nursing field are the convergent parallel design, the sequential explanatory design, the exploratory sequential design and the embedded design. For each method a research example is presented. The use of MM can be an added value to improve clinical practices as, through the integration of qualitative and quantitative methods, researchers can better assess complex phenomena typical of nursing.

Introduction: In literature, the structural empowerment and the job satisfaction have been studied in many different work settings but more need to be done in the setting of Head Nurses., Objective: The goal of the study is to evaluate the structural empowerment level of head nurses and if it impacts on the job satisfaction., Methods: A cross sectional design study was used. We enrolled 125 head nurses from three different hospitals of Rome. To collect the data we used a questionnaire that included both a part of the collection of sociopersonal data and the two scales (job satisfaction and structural empowerment). We used the SPSS19.0 statistical Software for data analysis to detect significant results., Results: Head Nurse declared to be not enough satisfied at work (mean=3.43) and their structural empowerment level resulted moderate (mean=3.16). The structural empowerment of head nurses impacts their job satisfaction especially concerning opportunities for social and professional interactions, praises, awards, audit and responsibilities., Conclusions: Results underline structural empowerment relevance in head nurses job satisfaction. Healthcare organizations need to address job satisfaction to improve quality of care and more specifically that of head nurses since they directly impact on nurses job satisfaction.

Cerebral aspergillosis is a rare and highly fatal infection that mainly affects immunocompromised patients. We report on a case of a heart transplanted Caucasian man, who arrived at our hospital because of the onset of diplopy. We performed a broad diagnostic work-up: the brain MRI showed a single ring-enhancing thalamo-mesencephalic area suggestive of abscess lesion; cerebrospinal fluid (CSF) analysis disclosed galactomannan and beta-D-glucan antigens. Thus the antifungal therapy was immediately started. We decided to discontinue the therapy 16 months later because of severe hepatic toxicity, given that the patient was persistently asymptomatic, brain imaging showed a progressive resolution of the abscess area and CSF antigen analysis was persistently negative. The follow-up at three months was unchanged.

Introduction: Mutuality, understood as a feeling of intimacy and positive relationship between caregiver and care receiver, is gaining an increasing interest in the scientific arena in the light of socio-demographic change and the increase in chronic degenerative diseases. The purpose of this article is to carry out a critical analysis of the literature on mutuality in order to identify predictors and outcomes., Method: A literature search was carried out the databases PubMed, CINAHL, PsycInfo, and ASSIA Sociological. Twenty (20) articles were selected. By analyzing critically all articles, emerges that mutuality is a key variable in the process of care giving and in mental and physical health of both caregiver and care-receiver. In the caregiver, high levels of mutuality are associated with less stress, depression and burden to a better quality of life and self perceived health; in patients high mutuality is able to speed up the recovery from the disease, to reduce anxiety and depression and to improve the quality of life., Conclusion: Future studies aimed at the study of this variable also in the Italian population could be of support in developing programs to improve quality of life of caregivers and care receiver.

Efavirenz is a non-nucleoside-reverse-transcriptase-inhibitor used as part of highly-active-antiretroviral-therapy for the treatment of the human immunodeficiency virus (HIV) type 1 infection. The present paper aims to describing the impact of efavirenz dose reduction on the pharmaceutical budget at the Verona University Hospital. A budget impact analysis comparing two prescribing scenarios was conducted: all patients treated with the efavirenz full dose (600 mg per day) vs. a proportion of patients treated with a reduced dose (200-400 mg per day). All outpatients referring to the Infectious Disease Clinic in the period November 2009-October 2011 were selected. Out of 132 patients treated with efavirenz, 25 were not considered, mainly due to a too short treatment period. Of the remaining 107 patients, 68 received the full dose, while 39 received a reduced dosage. The analysis included the cost of the drug and of diagnostic tests, from the National Health Service perspective. The daily dose reduction of efavirenz saved 54,664 euros (a 30% expenditure reduction). In sum, new strategies for pharmaceutical system sustainability are necessary; despite forthcoming expiring patents of several drugs, spending on antiretroviral drugs is expected to rise. This paper suggests a way of linking clinical benefits and cost reduction.

Patient education is recognized as a central component of heart failure care and reduces hospital readmissions. Nurses have an important role in providing patient education and modifying self-care behaviors. The aim of this article is to examine characteristics of educational interventions for heart failure patients, their measured outcomes and the role of nurses in providing education. We conducted a literature review of the last 10 years and considered 30 articles. Multisession motivational interventions, repeated over time and with different follow-up interventions seem to produce the best results. However, some aspects remain controversial.

We relate the case of a 17 year old girl with active pulmonary tuberculosis which mimicked a severe community-acquired pneumonia (CAP) associated to rhabdomyolysis. This report underlines the importance of excluding the diagnosis of pulmonary tuberculosis in any case of CAP which does not respond to standard antibiotic therapy, remembering that the empiric use of fluoroquinolones could delay the initiation of anti-tuberculosis treatment. This is, to our knowledge, the first description of a case of pulmonary tuberculosis complicated with rhabdomyolysis in a young girl without comorbidities.

Introduction: Preoperative anxiety is common in patients undergoing surgical interventions. Several international studies have shown the positive effect of music before minor surgery and invasive procedures, but the effect of music before major surgery was not explored., Aim: The aim of this study was to assess the effectiveness of music on anxiety in patients undergoing vascular surgery (aortic aneurism and thromboendarterectomy). Methods. Surgical patients were randomized to listening to music before surgery (music group) or to routine care. Anxiety was measured with the STAI-Y, administered three hours before surgery (Time 1) and before the induction of anesthesia (Time 2). After Time 1, only patients assigned to the music group listened to music., Results: The groups were comparable for the main characteristics. In the Music group (N 50) anxiety decreased after listening to music v the controls (N 50) (STAI-Y mean scores 52.2 and 31.1 respectively; p < 0.001). The differences between the two groups in the two measurements explained the 73% of the variance., Discussion: Listening to music is effective in decreasing anxiety in patients undergoing vascular surgery.

In 2010 a questionnaire was administered to the renal units of Piedmont and Valle d'Aosta to analyze their procedures for renal biopsy (RB). Seventy-eight percent of units performed RBs, 57% for more than 20 years, but only 43% performed at least 20 BRs per year. 20/21 units performed RB in an inpatient setting and 1/21 in day hospital with the patient remaining under observation the night after. Thirty-two percent did not consider a single kidney as a contraindication to RB, 59% considered it a relative contraindication and 9% considered it an absolute contraindication. In 90.5% of units there was a specific protocol for patient preparation for RB and 86% used a specific informed consent form. Ninety-five percent of units performed ultrasound-guided RB, 60% of them using needle guides attached to the probe. In 81% of units the left side was preferred; 71% put a pillow under the patient's abdomen. All units used disposable, automated or semi-automated needles. Needle size was 16G in 29%, 18G in 58%, and both 16G and 18G in 14% of units; 1 to 3 samples were drawn. One third of units had a microscope available for immediate evaluation of specimen adequacy. After RB, 86% of units kept patients in the prone position for 2-6 hours and all prescribed a period of bed rest (at least 24 hours in 90.5%). 90.5% of units followed a specific postbiopsy observation protocol consisting of blood pressure, heart rate and red blood cell measurements at different times, and urine monitoring and ultrasound control within 12-24 hours (only half of them also employing color Doppler). One third of all units discharged patients after 1 day and two thirds after 2-3 days; all prescribed abstention from effort and from antiplatelet drugs for 7-15 days. In 9 units both RB and tissue processing and examination were done in the same hospital, while 12 units sent the samples elsewhere. 76% obtained results in 2-4 days, 19% in 6-7 days, and 5% in 10-15 days. Less than 20% of the interviewed operators were fully familiar with the clauses of hospital insurance securing their activity. Use of RB is widespread in Piedmont and Valle d'Aosta but its practice shows variation between centers.

The aim of a nursing data set is to provide useful information for assessing the level of care and the state of health of the population. Currently, both in Italy and in other countries, this data is incomplete due to the lack of a structured nursing documentation , making it indispensible to develop a Nursing Minimum Data Set (NMDS) using standard nursing language to evaluate care, costs and health requirements. The aim of the project described , is to create a computer system using standard nursing terms with a dedicated software which will aid the decision-making process and provide the relative documentation. This will make it possible to monitor nursing activity and costs and their impact on patients' health : adequate training and involvement of nursing staff will play a fundamental role.

Tuberculosis (TB) is a pathology whose control is still unsatisfactory at global level. Traditional diagnostic techniques for active TB diagnosis are inadequate: the diagnostic gold standard is the cultural exam which suffers from lengthy processing and requires highly specialized laboratories. This study analyzed the diagnostic sensitivity of the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-IT) in 135 active, microbiologically confirmed TB cases. Sensitivity was 76% for both tests and reached cumulative levels close to 90%. QFT-IT revealed a statistically higher sensitivity than TST in a group of patients affected by various causes of immunosuppression, but was less sensitive in subjects with low levels of circulating CD4+ cells. The number of circulating CD4+ cells showed a direct correlation with the stimulated IFN-gamma production. QFT-IT also demonstrated a decreased IFN-gamma production, with a significant sensitivity reduction, in patients affected by advanced forms of pulmonary TB.

Unlabelled: Reliability of caregivers in assessing the quality of life of stroke survivors: an explorative study. Introduction. Not all stroke survivors are able to assess their quality of life (QOL), thus a caregiver could provide important information on patients' QOL., Objective: To assess caregiver's reliability in measuring QOL in stroke survivors., Method: Fifty (50) patient-caregiver dyads were recruited. Patients, hospitalized in rehabilitation facilities, were administered the Stroke Impact Scale 3.0 (SIS 3.0) patient version, the Barthel Index, the Modified Rankin Scale, and the National Institute of Health Stroke Scale. Caregivers completed the SIS 3.0 proxy version., Results: The mean scores of the SIS 3.0 patient version were very similar to the proxy version and ranged from 19.1 vs 16.2 for the Hand function domain to 83.81 vs 81.85 for the Communication domain. Caregivers tended to underestimate patients' QOL although scores were not significantly different. Intraclass correlations between the patient version and the proxy version of the SIS 3.0 were highly significant (p<0.001), with coefficient over 0.80. Lower coefficients were observed for the Social participation (0.58), Emotion (0.64) and Communication (0.79) domains., Conclusions: Caregivers were more reliable in assessing the physical rather than psychosocial domains.

Literature reports several definitions of outcomes sensitive to nursing care. Van Der Bruggen and Groen defined nursing outcomes as observable and measurable aspects in individuals, groups and population that should be objective for clinicians and researchers and subjective for patients and families. Johnson and Maas defined nursing outcomes as variable behaviors or perceptions of family or caregiver after the caring intervention. According to the International Classification for Nursing Practice (ICNP), nursing outcomes are the status of a nursing diagnosis after the intervention. In the IowaOutcome Project, where Nursing Outcomes Classification (NOC) system has been elaborated, nursing outcome is a measurable condition, behavior or perception of the person or family conceptualized as sensitive variable to nursing care. Outcomes of NOC system are focused on individuals, families and community and refers to status, behavior or perceptions. Elements to be considered in nursing outcome definition are four: specific aspects of nursing care, the illness, general aspects of care, patient typology. It is important to identify which system for nursing evaluation outcomes are more suitable for Italy, where the field of action of nurses has faded edge with functions that mix and confuse with other professionals. Studies on the application of NOC taxonomy in Italy could be a starting point for defining and adapting an outcome evaluation system that will allow the objective visibility that nursing care gives to the global improvement of the cared person.

Introduction: Instruments that measure job well-being have the aim to evaluate consequences as individual health due to job unsatisfaction but not nurse perception about organizational health. The aim of this study was to assess the psychometric characteristics of the Nursing Organizational Health Questionnaire (MOHQ), an instrument derived from the Multidimensional Organizational Health Questionnaire (MOHQ) that measures nursing organizational health., Methods: The MOHQ underwent to content validity by a group of experts that modified and added new items of the MHQ. Afterward the MOHQ was administered to a sample of 1279 nurses working in several contexts in Lazio and Umbria regions. Dimensionality of each scale of MOHQ, and concurrent validity of the new items were investigated using Exploratory Factor Analysis approach. Therefore Cronbach's alpha was computed for each dimensions of each scale to examine internal consistency., Results: Statistical analysis confirmed the factor structure of each scale and the reliability of the emerged dimensions. Moreover analyses have shown the importance of the new items to investigate specific dimension related to the nurse organizational context., Discussion: The present study showed that the MOHQ has good psychometric properties of validity and reliability and can be used to study organizational health in nursing population.

Therapeutic strategies in the management of skin and soft tissue infections should take account of different variables: epidemiological trends (community or hospital acquired infections), pathogen or pathogens involved, virulence, seriousness of pathology (possible co-morbidities, knowledge of local epidemiology and antimicrobial susceptibility patterns of community and hospital strains. Therapy often should be started promptly, and on an empiric base, once microbiological analysis have been performed, waiting for culture and antimicrobial susceptibility testing. Surgical incision and drainage represent essential therapeutic procedures in the treatment of many complicated skin and soft tissue infections such as abscesses and fasciitis. Gram-positive bacteria and specifically Staphylococcus aureus, are the main cause of such kind of infections. Therefore antistaphylococcal beta-lactams represents a first choice in empirical antimicrobial chemotherapy. Considering high incidence of MRSA in Italian hospitals, treatment of hospital acquired skin and soft tissue infections should be based on glycopeptides combined with third generation cephalosporins, piperacillin-tazobactam, carbapenems or fluoroquinolones. Recently, new drugs (as linezolid, daptomycin, tigecycline) demonstrated good efficacy in the treatment of serious infections caused by multi-drug resistant microorganisms. Most recent guidelines for the diagnosis and treatment of skin and soft tissue infections were published in 2005 by Infectious Diseases Society of America (IDSA). In Italy, the multidisciplinary group of Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) published guidelines for the treatment of skin and soft tissue infections in Internal Medicine wards in 2005. General approach and methodology in writing test were based on analysis of data from available scientific literature and comparing them with actual Italian epidemiological trends and drug prescribing policy. Considering these guidelines, we updated the newest antimicrobial drugs suggested for the treatment of skin and soft tissue infections, such as daptomycin and tigecycline.

To assess the potency, efficacy and toxicity of abacavir/lamivudine (ABC/3TC) versus tenfovir/emcitrabine (TDF/FTC) with efavirenz (EFV) in naive patients with HIV infection a prospective observational study was carried out to evaluate immunovirological parameters every three months and metabolic parameters every six months. In all, 21 patients were enrolled (10 on ABC/3TC and 11 on TDF/FTC). Fisher's test revealed no statistically significant difference between the two arms in terms of immunological recovery and control of viral replication. For metabolic parameters at week 48 no statistically significant differences were noted between the two arms. The two ABC/3TC and TDF/FTC backbones showed the same potency; ABC had a more negative impact on metabolic parameters without statistical power.

The aim of this study was to map existing ambulatory care nursing sites in Italy, compare operational and organizational methodologies used, and evaluate visibility of the sites in health institutions and the community. Nurses' level of satisfaction with this work experience was also evaluated. The American Academy of Ambulatory Care Nursing and American Nurses Association definition of ambulatory care nursing (1997) was used to select sites for the study. Two hundred fifty ambulatory care sites meeting this definition were listed, most of which provide clinical and educational services to oncology and cardiology patients. Surgical sites provide treatment of surgical wounds and stomas. Results of the study show that ambulatory care nursing sites are not uniformly distributed across Italy and a greater concentration of sites can be found in northern Italy with respect to central and southern Italy. Nurses report having greater professional autonomy and an excellent level of satisfaction. All interviewed nurses attend specific training and continuing education courses. Ambulatory care sites are managed by nurses; medical consultations are requested when necessary and home assistance is assured through coordination with general practitioners.

Introduction. The evolution of nursing profession in Italy and the modification of university currilula have stimulated the adoption of new didactic methods according to the new educational needs. In the present study the developement of tools and methods for evaluating and measuring clinical competences of undergraduate nursing students at Tor Vergata University of Rome are presented. These methods and tools have been developed by all professionals involved in nursing education.Methods. The new didactic methods have been implemented from the Academic Year 2006/2007. The developed methods and tools have been: the educational web site, the objectives and plans of clinical training for each year of course, the coordinators of clinical activities, the training diary and task, and the in-progress and final evaluation per each year.Results and Discussion. After the two-year experimentation, the distributed training diaries have been 185; all the training tasks with a positive outcome have been 637; students who passed the exam with the new methods and tools have been 294. Conclusion. The preliminary results of the present study do not allow yet to demonstrate all the competencies acquired by the students (this will be possible after November 2009), but show that they more adhere to the clinical education. In addition, the new educational methods and tools implemented in this study demonstrate as the students progress in nursing education.

The aim of this study was to measure Quality of Life (QOL) before a pacemaker (PM) implantation and 1, 6 and 12 months later. Using a descriptive, comparative and correlative design a sample of 157 patients was studied who were divided in four groups: the group A (43 patients) who had to implant the PM; the group B (38 patients) who had the PM implanted 1 month before; the group C (29 patients) who had the PM implanted 6 months before, and the group C (44 patients) who the PM implanted 12 months before. The SF-36 scale was used. Groups B, C and D had QOL levels significantly higher than group A. In group A QOL was higher in people who were male, older, more educated, with higher income, more cohabitants and children. In group B QOL was higher in patients with ventricular pacing, male, younger, without job and illnesses. In group C QOL was higher in patients with non rate responsive PM, younger, without job and illnesses. In group D QOL was higher in younger and in those without job and illnesses. The present study gives and overview of QOL before and after a PM implantation and highlights the importance to modify nursing care from the preoperative to the immediate and later postoperative period.

The process nurses adopt to solve the patients' problems is known as "Problem Solving" in the literature. Problem Solving Abilities include Diagnostic Reasoning, Prognostic Judgment and Decision Making. Nursing students apply the Problem Solving to the Nursing Process that is the mental and operative approach that nurses use to plan the nursing care. The purpose of the present study is to examine if there is a positive relationship between the number of Educational Tutorial Strategies (Briefing, Debriefing and Discussion according to the Objective Structured Clinical Examination Methodology) used for nursing students and their learning of Problem Solving Abilities (Diagnostic Reasoning, Prognostic Judgment and Decision Making). The study design was retrospective, descriptive and comparative. The Problem Solving Instrument, specifically developed for this study and proved for its reliability and validity, was used to collect the data from a sample of 106 nursing care plans elaborated by the second-year students of the Bachelor Degree in Nursing of the University of Udine. Nursing care plans were elaborated during three times consecutively, after students had participated in different Educational Tutorial Strategies. Results showed that the more the students took part in a higher number of Educational Tutorial Strategies the more they significantly increased their Problem Solving Abilities. The results demonstrate that it is important to use Educational Tutorial Strategies in the nursing education to teach skills.

Small bowel tumours are rare, representing 0.3% of all cancers. The main problem with these tumours is that they induce vague, non-specific symptoms, causing a delay in diagnosis, which is often reached in cases of acute complications such as intestinal obstruction. Moreover, the small bowel is often involved secondarily by tumours that actually start from adjacent organs or by processes of peritoneal carcinomatosis, conditions which are responsible for a distinct worsening of the prognosis (up to 70% mortality). The aim of the study was to define the indications and the most appropriate surgical treatment modalities depending on the presentation of the small bowel tumour. At the Emergency Surgery Unit of the Vittorio Emanuele, Ferrarotto and S. Bambino Hospital in Catania 21 cases of intestinal obstruction caused by small bowel tumours were observed out of a total of 335 patients affected by intestinal occlusion (1.6%). Thirteen patients (62%) had already undergone abdominal surgery for a malignant neoplasm. All patients underwent plain abdominal X-ray which showed air-fluid levels; 14 (66%) were additionally studied by CT scans. Thirteen patients were operated on immediately on the day of admission, while the other 8 were initially treated conservatively. The small bowel was the primary site of the neoplasm only in 3 cases; in the other 10 it was secondarily involved by tumours originating from adjacent organs or by peritoneal carcinomatosis. In 8 cases an intestinal resection was accomplished together with removal of the involved organs, while in the 5 cases of carcinomatosis simple diverting procedures were carried out. Of the 8 patients initially treated conservatively, 6 were subsequently submitted to diverting operations because of persistence of the occlusive status. Nine patients had postoperative complications (47%) and another 3 died (14%). In conclusion, intestinal obstruction is a frequent complication of small bowel tumours, especially if they are in the final stages. Intestinal resection offers a good chance of recovery in cases--unfortunately rare--of confined tumours; in the other instances it is preferable to perform diverting procedures and subsequently refer the patient to the oncologist in order to plan adjuvant therapy, if possible.

Antimicrobial therapy of intra-abdominal infection should consider its aetiology, which is generally polymicrobial, and its location with the aim of selecting the most suitable antimicrobial agents not only according to its spectrum but also to its pharmacokinetics profile Currently, both monotherapy and association therapy can be used, thanks the availability of newer drugs characterized by a wide range of antimicrobial activity both against aerobes and anaerobes. Antibiotic choice and duration therapy vary also according to the infection severity .

The Authors report on a case of a 69 years old woman with an acute peritonitis secondary to a perforated jejunal diverticulum, treated by laparotomy and intestinal resection with end-to-end anastomosis in one layer. The patient was dismissed after seven days, in good general conditions. Jejunal diverticula occur in around 1% of general population. They are usually asymptomatic; sometimes they give origin to dyspepsia or acute manifestations. These are due to complications at the site of the diverticulum like bleeding, occlusion and acute infection with perforation and peritonitis, as occurred in our patient. The main risk in diverticular complications is to prolong the interval between admission of the patient and surgical treatment, favouring the initiation of hypovolemic or septic shock. For these reasons, in most recent years, C.T. and, in case of bleeding, capsule endoscopy, were used in the diagnostic pre-operative work-up. The surgical technique is jejunal resection with direct anastomosis, leaving percutaneous drainage only for patients with an abscess, in poor general conditions for a narcosis.

We have evaluated CD4+-guided HAART interruption in 46 HIV+ patients with CD4+ > 500/microl and viral load undetectable since at least 3 years. This strategy resulted effective in a long mean period of treatment interruption (18 months) and safe. In fact, during the follow-up period there were no deaths, nor opportunistic infections. Reintroduction of HAART was due to: CD4+ fall under 200/microl (6 cases), acute retroviral syndrome (4), individual choice (2), asymptomatic thrombocytopenia (1), peripheral neuropathy (1), pregnancy (1). A low CD4+ nadir level was correlated with a short period of treatment interruption.

Unlabelled: Current questionnaires for assessing satisfaction of university students are not specific for nursing education., Aim: The aim of this study was to develop an instrument to measure the quality of baccalaureate nursing education., Method: Guidelines by DeVellis were adopted to develop the instrument. After expert review the initial 98 items identified were reduced to 63. The questionnaire was administered to 325 nursing students in Latium and Tuscany regions. A Delphi survey was carried out to validate the contents according to the students' opinions, expressed on a 5 point Likert scale., Results: Three-hundred-ten questionnaires were completed and considered for the present study. The mean age of the students was 25.4 years, 69.3% were females. Items which scored less than 2.5 on average at the Delphi survey were removed, as well as those which correlated less than 0.40 with the total score. Thus, 41 items were definitely considered for the Scale for Quality Evaluation of the Bachelor Degree in Nursing (SQEBDN). Reliability of the Scale resulted in a very high Cronbach's alpha (0.93). The construct validity was tested with factor analysis that showed 10 factors, while criterion-related (divergent) validity showed statistically significant correlations of all the items with those assessing the dissatisfaction for educational activities. Third year students as well as older students had the worst perception the quality of nursing education., Conclusions: The SQEBDN, although requiring further studies, represents a useful instrument to measure the quality of the bachelor nursing degree.

Objective: Diaphraghmatic injuries are rare (5-7%), usually secondary to blunt, or more rarely penetrating, thoracic or abdominal trauma. The most frequent site of trauma is the left postero-lateral region. We'll try to review this pathology in all its aspects., Materials and Method: We report our personal experience from January 2002 to December 2004 on 280 thoraco-abdominal trauma, 262 (93.5%) blunt and 18 (6.5%) penetrating, of which 5 (3.7%) interested the diaphragm. 4 following a blunt trauma and 1 an open trauma (gunshot) Each trauma was evaluated for possible associated injuries and for the type of symptoms at the admission and during the hospitalization. Preoperative diagnosis has been obtained only in 3 patients, haemodynamically stable. In the other 2 cases an emergency laparotomy was carried out because of their critic conditions and the diaphragmatic injuries were recognized during the procedure. Two patients died., Conclusions: We remark as during the acute phase the diaphragmatic rupture may be missed because of shock, respiratory insufficiency or coma of the patient; however, it's mandatory that the right diagnosis is reached as soon as possible in order that mortality is mostly influenced by the time elapsing between trauma and diagnosis.