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. Factors associated to patients' outcomes in medical units: lessons learnt from an Italian multicentric longitudinal study design (ESAMED study)., Introduction: Research on nursing outcomes attempted to identify the associated factors, however, with mainly retrospective or descriptive studies. In 2011, an Italian network was established and a multicentric longitudinal study aimed at exploring factors associated with nursing outcomes among in-hospital medical patients was started., Aims: To summarise (a) how the research project was originated, (b) which patients have been involved, variables and instruments used, (c) the main findings, and (d) the lessons learnt., Method: 12 acute medical units from 11 Italian hospitals were involved. A consecutive sample was adopted: on a daily basis, data has been collected at the (a) patient; (b) nursing care, and (c) hospital levels., Results: The effect of the variability in the amount of nursing care and skill mix in medical units was explored on the following outcomes: (a) hospital-acquired functional dependence, (b) prevalence and incidence of (i) episodes of hyperactive delirium, (ii) avoidable pressure ulcers; (iii) peripheral venous catheter phlebitis; (c) dissatisfaction with the nursing care; and (d) in-hospital mortality; 1464 out of 2082 eligible patients were involved. The frequency and reasons of Missed Nursing Care (MNC), as well as the presence of family caregivers at the bedside were also measured., Conclusions: The study confirmed that (a) the amount of nursing care provided by graduate nurses improves patient outcomes; (b) a skill mix in favour of nursing aides, negatively impacts on patients' outcomes; and (c) a higher frequency of MNC threatens patient outcomes.

Aim: Specific instruments to measure patients satisfaction for home care are missing in Italy. A questionnaire was devised, based on two well known and validated instruments (La Monica-Oberst Patient Satisfaction Scale (LOPSS) and the The Patient Satisfaction With Health Care Provider Scale (PSHCPS) and validated., Methods: The questionnaire was discussed with nurses and psychologists. The questionnarie was initially administered to a sample of 25 patients home care patients, not cognitively impaired, and to their caregivers. The concordance was measured with the K di Cohen, Sperman tau of Cograduation and tau of Kendall coefficiencies, with very satisfactory results (K = 0.68, p = 0.72, tau = 0.61). After 30 days the questionnaire was administered to the same patients and relatives, to test stability/reliability and internal coherence. Finally, it was administered to a stratified sample of 139 patients (or to their relatives) to assess validity with factorial analysis, and again internal coherence., Results: The final questionnaire has 20 closed ended and three open questions. Concordance between patients and relatives on closed questions was good, therefore the questionnaires can be administered to patients or relatives. The test retest showed also a good stability (K 0.83). The factorial analysis identified two sub scales: one that measures patients satisfaction for the organization and for the interpersonal relationship between patients and nurses., Conclusions: The questionnaire has good psychometric properties and can be reliably administered also to caregivers. Some questions with higher number of missing answers could be improved.

In spite of the progresses of knowledge and care, pressure sores continue to be a clinically relevant problem. A double blind randomised controlled trial was organised to assess the efficacy of triticum vulgaris (Fitostimoline) vs placebo in the re-epithelisation of superficial pressure sores. Patients with stage NPUAP II or superficial pressure sores, with an expected survival of more than 3 months and eligible for a follow-up up to 8 weeks were included, over a period of 2 years in 46 clinical sites. The protocol was approved by local ethical committees and informed consent was obtained before randomisation. Medications were performed by nurses if the patient was hospitalised and by nurses or properly instructed caregivers at home. Weekly follow-up controls were assumed by nurses. Out of the 294 randomised patients 270 were included in the analyses. The two groups are comparable for the main characteristics except for Norton Scale mean values, less severe in the group assigned to active treatment (10.1+/-3.7 vs 8.9+/-3.2). The mean follow-up was of 3.8 and 4.2 weeks with a mean duration of 26+/-18 and 29+/-18 days for the experimental group and controls respectively. Seventy-six patients in the treatment group and controls (58.0 and 54.7) had their lesions re-epithelized. Adjusting results for age, initial Norton and Push scores there are no differences between treated and controls (OR 0.99 95% IC 0.60-1.67). This multicentre study, sponsored by a research group of nurses, failed to support the hypothesis that triticum vulgaris, the active component of the product Fitostimoline, given on top of recommended treatment, provides a specific therapeutic advantage in terms of frequency and timing of re-epithelization in superficial pressure sores.