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This article has the aim of informing the reader about methodology and production of Clinical Practice Guidelines (CPG) and the instruments in order to be able to approach the whole process, from the production to the publication and distribution, but also to updated CPG. The importance of the issue is given by: 1) the need to avoid the CPG duplication, which is the reason of waste of resources and that raises confusion among users; 2) the need to ensure the independence of the experts involved and without conflict of interests; 3) the use of methodologies that respect the best quality standards; 4) the inhomogeneity of healthcare processes in the Italian territory and practices not based on scientific evidences; 5) the consultation and the commentary of stakeholders on the recommendations produced.

In recent years, the incidence rate of chronic diseases shows a steady increase in every industrialized Country. The almost logarithmic trend of the number of people living with chronic diseases is constantly on the rise. Each predictive statistical model indicates a strong impact for national health systems at the level of the organization of care and management costs. It is urgent to systematically introduce an evidence-based care model in chronic care management such as the Chronic Care Model. The Chronic Care Model is the reference model for WHO. The Chronic Care Model allows for personalized, holistic, multi-professional assistance, characterized by a strong humanization of care, by preventive interventions and relationships between healthcare professionals, patients and caregivers as a system of care and assistance. The fundamental roles are social integration and the improvement of the quality of life of patients. The Chronic Care Model involves the use of a computerized system of information flow and telemedicine and trained healthcare professionals. The Chronic Care Model showed an improvement in the quality of life, a reduction in the number of hospitalizations, a better adherence to therapies, and a reduction in costs.

Anxiety affects many hemodialysis patients. The response to treatment varies and often requires patients to take therapeutics for long periods; thus, many patients look for complementary approaches. There have been reports of music alleviating anxiety in hemodialysis patients. However, the efficacy of music needs to be evaluated. The objective of this study was to conduct a systematic review and meta-analysis to compare the effects of participation in standard care combined with music with standard care alone. This was a systematic review and meta-analysis of randomized controlled trials to determine the efficacy of music to lower anxiety in hemodialysis patients. Five studies were included in the review (290 patients). Listening to music resulted, on average, in an anxiety reduction that was -0.52 standard deviation units greater (95% confidence interval, -1.02 to -0.03 lower, P = .003) than in the standard care group. No adverse events were identified. All trials contained a risk of bias due to lack of blinding. The heterogeneity showed an I = 75%. The strength of evidence was very low. No adverse events were identified. Few trials were available for inclusion, with small sample sizes and significant heterogeneity. Within these considerable limitations there was a demonstrated decrease in anxiety for hemodialysis patients receiving standard care augmented with music. The effect size was moderate. Results were inconsistent across studies. We are uncertain about the estimate. The likelihood that effect will be substantially different is very high. Further research has a large potential for reducing uncertainty about the effects of the music interventions.

Art can be a way, together with Nature, to intercept that landscape and inner climate characterized by the rhythm of silence. That dimension of iridescent calm imbued with creative and vital energy, which pushes towards a universal, seductive, profound sphere. Man can, with courage, abandon himself in this harmony and melody of thoughts that suggest a vast and visionary possibility. Each person has the inner possibility to be Art, to get out of the continuous distortions of daily life, to produce a metamorphosis of one’s life. Art triggers the unconscious side of seeing, a rhythmic, dynamic principle, on which every gesture of maximum spontaneity depends, not touched by the artificial, by masks of fugacity and by false personalities. Without Art, it seems that part of real life is missing. The deep artistic power is fluid, without space or time, pulsating with new forms and substance and creating a new personal identity, contiguous to the real world, which inspires new desires. Many diseases of today and yesterday are produced by the lack of expressiveness or by the repression of personal creativity. Art produces well-being because it is the transformation of unconscious expressive energies, so life for our health.

The following study is original respect to the scientific panorama in fact, through a literature review that uses a qualitative metasynthesis method and follows the aggregative or meta-aggregative approach of the Joanna Briggs Institute, it returns to the reader 3 main results: the Anguish for an imminent death, the relationship with the body, sexuality, pain and dimension of the person, and the Perception of time and existentialism. Reflecting on the “philosophical state or philosophy of the patient in dialysis treatment” through these 3 macro-themes means investigating in depth the words of the patients, extrapolating their feelings, fears and worries, so as to understand their overall view of life and illness even in the most veiled aspects. Finally, the reflection will be used to direct the care of professionals towards a real and meaningful appointment of the dialysis patient. All thanks to the philosophy that goes beyond the methodology of research and evaluation of data, through the interpretation, direction and demonstration of the concept of limit, as an intrinsic part of man, disease and science. (Humanization)

Hemodialysis is the most common treatment in patients with end-stage chronic kidney disease and the wide accessibility of this therapy has prolonged the patients' lifespan. However, it involves alterations in their emotional sphere and, often, a reduction in therapeutic compliance as the chronicity of kidney disease requires lifestyle changes difficult to maintain in the long term. The management of a chronic medical condition is in fact a complex process that necessarily requires multidisciplinary action. The concepts of "Self-efficacy" and "Self-management" fall within the Self-Determination Theory and are relevant in this context because they refer to the beliefs that everyone has about their abilities to control behavior and determine the success in adhering to prescribed therapies. Furthermore, the promotion of self-efficacy and self-management through an educational approach that makes use of so-called "eHealth" tools can help develop greater self-awareness in dialysis patient, a better control over their care choices and an increased adherence to therapeutic-dietary indications. This article aims at highlighting the importance of implementing an approach based on eHealth in the management of hemodialysis patients. It also wants to raise awareness of the related multidisciplinary theories to be applied in this clinical context to promote greater therapeutic adherence, and therefore a better quality of life and care.

Parkinson disease is a neurodegenerative disease present in approximately 2% of the population older than 65 years. Rhythmic auditory stimulation in the early 1990s aimed to improve individual mobility in terms of gait speed, stride length, and cadence. Our systematic review and meta-analysis aimed to summarize and evaluate the evidence of the effects of rhythmic auditory stimulation on gait speed, stride length, and cadence in patients with Parkinson disease. A systematic review and meta-analysis of randomized controlled trials was conducted to determine the efficacy of rhythmic auditory stimulation in patients with Parkinson disease. Five studies were included in the review (209 patients). Rhythmic auditory stimulation resulted, on average, a gait speed improvement of 0.53 standard deviation (SD) units (95% CI, 0.23 to 0.83; P = .0005), a stride length improvement of 0.51 SD units (95% CI, 0.18 to 0.84; P = .003) greater than that in the control group. All trials contained a risk of bias due to a lack of blinding. The quality of evidence was low. No adverse events were identified. Rhythmic auditory stimulation may have a beneficial effect on gait speed and stride length in patients with Parkinson disease. Future studies should consider a power analysis to recruit an adequate number of subjects and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of rhythmic auditory stimulation on gait in patients with Parkinson disease.

Music listening represents a gold standard in the evidence-based holistic nursing practice. However, music listening is seldom involved in orthopedic postoperative settings, and only a few related studies can be retrieved in literature.The aim was to assess the effects of music during the orthopedic postoperative period, when patients frequently report pain and anxiety.A randomized controlled trial on 56 patients, equally divided in an experimental group treated with music and a control group in standard care, was conducted during their first-day of recovery from orthopedic surgery. The primary outcome was the pain level assessed with the VAS scale and the Short Form-McGill Pain Questionnaire. Secondary outcomes assessed were anxiety level, blood pressure, heart and respiratory rates and oxygen saturation. Following surgery, when clinically stabilized and soon after their return to their ward room, patients listened to music from a personal programmed playlist using their smartphones for 30 minutes.In music group, the Short Form-McGill Pain Questionnaire score significantly improved in the sensorial dimension (p=0.006) and in the affective dimension (p=0.02). Patients showed a pleasant experience in listening to music (90%), found it useful in coping with pain (64%) and improving mood (86%).Music in the orthopedic post-surgical period induced significant improvement in pain relief, representing a useful complementary intervention to drug treatment. Music listening could be a safe treatment, inexpensive and simple to manage by nurses in orthopedic postoperative settings.L'ascolto della musica rappresenta un punto di riferimento nella pratica infermieristica olistica basata sull'evidenza. Tuttavia l'ascolto di musica a scopi terapeutici è raramente utilizzato nei settings assistenziali postoperatori ortopedici. Scopo. Valutare gli effetti della musica durante il periodo post-operatorio ortopedico, fase in cui i pazienti manifestano frequentemente dolore e ansia.Studio randomizzato controllato, su 56 pazienti durante il il primo giorno post operatorio, allocati in maniera bilanciata in un gruppo sperimentale trattato con la musica e un gruppo di controllo in assistenza standard. L'outcome primario era il livello di dolore valutato con la scala VAS e il Short Form-McGill Pain Questionnaire. Gli outcomes secondari sono stati il livello di ansia, pressione arteriosa, frequenza cardiaca, frequenza respiratoria e la saturazione dell'ossigeno. Al rientro nella camera di degenza dopo l'intervento chirurgico in condizioni cliniche stabilizzate, i pazienti hanno ascoltato musica da una playlist personalizzata usando il proprio smartphone per 30 minuti.Nel gruppo musica, il punteggio dello Short Form-McGill Pain Questionnaire è significativamente migliorato nella dimensione sensoriale (p = 0,006) e nella dimensione affettiva (p = 0,02). I pazienti hanno riportato una piacevole esperienza nell'ascolto della musica (90%), trovandola utile per la gestione del dolore (64%) e nel migliorare l'umore (86%).La musica nel periodo post-chirurgico ortopedico ha mostrato un significativo miglioramento nel livello del dolore, rappresentando un'utile intervento complementare al trattamento farmacologico. L'ascolto della musica potrebbe essere un trattamento sicuro, economico e semplice da gestire da parte degli infermieri in ambito postoperatorio.

For some years now, the health care world has also been interested and influenced by issues related to immigration, integration, no integration, historical changes in our socio-anthropological field and cultural and linguistic differences; different worldviews and expectations, beliefs and non-evidence-based practices; prejudices and defense mechanisms for ethical and professional inability to care with patients with different cultures; scientific culture alongside a traditional and popular culture; little or no anthropological knowledge of many health professionals; improvised approaches to foreign patients, misunderstandings, tensions. The use of the cultural mediator is a very small part in the solution of the problem. Cross-cultural assistance represents the solution and it is a model, a discipline, a communication that allows an appropriate health care based on the cultural differences of the patients.

As a consequence of the Sars-CoV2 pandemic, the role of telemedicine in the healthcare sector was reviewed in order to ensure continuity of care and to contain infections. This new frontier involves professionals, caregivers, patients and can be applied in various fields, such as surgery, specialist visits, follow-ups, home care, health education, prevention and monitoring. Despite privacy may seem a deterrent for the implementation of this new goal in the healthcare sector, the community and the national legislation both provide rules to protect individuals and the community. This innovative method of assistance brings with it limits that must not detract attention from the great possibilities arising from the use of telemedicine.

Background: Nurses guarantee assistance using different nursing theories, which present different conceptual frameworks, but which have a common vision in the whole of the human being, his holistic needs and the connection with the environment. Florence Nightingale was the first to introduce aspects of the scientific method, structuring a theory focused on the connection between the management of the physical environment and the actions of nurses. Methods: The aim is the evaluation of Nightingale's theory in reference to its contemporary integration, through a narrative review of the literature. Results: The action of nurses on the environment according to Nightingale's theory in care settings and hand hygiene are identified as fundamental in the fight against the spread of infections and in the implementation of the holistic vision. Discussion: Nightingale's theory shows elements of applicability and modernity, such as the acquisition of a greater awareness of healthcare professionals in relation to the care of environments and hand hygiene. Conclusions: Florence Nightingale's theory presents aspects of validity, but further studies are needed to contribute to the evolution of her model, especially in its contemporary contextualization.

Following the pandemic state, produced by the infection with the new coronavirus SARS-CoV-2, and the consequent state of health emergency, it is considered scientifically important to propose an update on ongoing clinical pharmacological trials, the most advanced international projects in the innovation sector and the most important statistical mathematical approaches to use a model for predictive purposes. In Italy there are several experimental molecules subjected to rigorous RCT studies approved by AIFA. In the Research & Development sector, the CERN in Geneve with the “CERN against COVID-19 project” represents the most advanced innovation, while in predictive statistical techniques, the mathematical model with wavelet approach allows to predict variables such as the persistence of the virus or to calculate the probability of transmission, strategic information for health planning.

Narrative-based practice has been developed to bring the health care aspects of illness and treatment closer to the psychosocial and life experiences of a patient. It gives value to the lived experience by using writing tools, spoken words, poetry, drawing, and photography. Nephrology has become one of the first health care fields, likely due to its large patient burden of both critical and chronic disease, to use narrative-based practice. The use of narrative-based practice in renal care explores the lived experience through structured and semistructured interviews with patients, caregivers, and health care providers. The principle topics discussed are the lack of a "disease identity" that would allow patients to identify themselves with a specific state of illness, the "uncertainty" of living with an illness characterized by continuous progression and regression, and the living with the "unspeakable" looming specter of death. This review highlights the powerful significance of qualitative knowledge gained with the narrative method. Increased awareness of these aspects of patients' lived experiences can help nurses improve the quality and effectiveness of the therapeutic relationship between patient and health care professional and may offer a promising approach, within this relationship, to decreasing patient feelings of isolation.

In this second part we will approach other themes that have arisen from narrative medicine in nephrology patients. As highlighted in the first part, narrative nursing was born in 1976 thanks to stu...

IntroductionThis paper on narrative-based medicine (NBM) is divided into two articles. The concept of NBM has been developed over the last decades to bring the biomedical aspects of illness and tre...

Purpose To evaluate and summarize the current evidence in the literature on the effectiveness of complementary and alternative medicine (CAM) for the management of health problems in kidney patients. Methods Randomized controlled trials in English were selected through PubMed, Medline, the Cochrane Central Register of Controlled Trials, and CINAHL. There were no time limits on the research. Results Thirty-four articles were selected for the review. Most of the studies were reported in 2013 and 2014 and were conducted in China. Multiple types of CAM used for various problems in kidney patients (pruritus, reduced respiratory capacity, poor quality of sleep, abnormal blood values, pain, anxiety) emerged from the analyzed studies. The most studied types of CAM were the herbs used in Chinese medicine that can help to control proteinuria, creatinine and hematuria, and to reduce the dose of traditional medicines; acupuncture, which can relieve pruritus and disturbed sleep; respiratory training, which increases the respiratory capacity and muscle strength; and Benson relaxation, which helps to improve pain and sleep. Conclusions Although the evidence of the included studies is limited, CAM may be helpful for the treatment and control of health problems in kidney patients. To actually recommend its use, further studies are needed. (nursing)

PurposeTo evaluate and summarize the current evidence in the literature on the effectiveness of complementary and alternative medicine (CAM) for the management of health problems in kidney patients...

Introduction: Several observational studies showed that the button hole technique is easy to apply, fast, with a reduction in the formation of hematomas, scars and pain perception. Anyway, other studies showed that the button hole technique has been associated to an increase of the risk of infection, with high rates of infection incidence in arterio venous fistula (AVF) site and septicemia, compared to a rope ladder technique. Objective: The aim of this study is to test the use of a dressing with release of silver ions, for the reduction of the infection incidence rate and the pain symptomatology in patients on hemodialysis with AVF cannulation by button hole technique. Materials and Methods: A prospective, regional, multicenter, randomized pilot study, with balanced allocation 1: 1, with parallel-groups, controlled with standard care group. Results: A solid experimental protocol which can be used as a model for RCT pilot studies which have the objective to study the impact of a dressing for the reduction of the infection incidence rate and pain symptomatology. Conclusions: This pilot study can produce results and trends for the structuring of a subsequent national and multicenter RCT. This model can be used in other similar clinical settings for an evidence-based research approach. (nursing)

IntroductionSeveral observational studies showed that the button hole technique is easy to apply, fast, with a reduction in the formation of hematomas, scars and pain perception. Anyway, other stud...

Practical recommendations on nonpharmacologic non-device/surgical interventions in patients with heart failure (HF) are well known. Although complementary treatments may have beneficial effects, there is no evidence that these on their own improve mortality, morbidity, or quality of life. We examined the effects of listening to recorded classical music on HF-specific quality of life (QOL), generic QOL, sleep quality, anxiety, depression, and cognitive state in patients with HF in the home-care setting.Multicenter randomized controlled trial. One hundred fifty-nine patients with HF were randomized on a 1:1 basis in 2 groups: experimental (music) and control. Patients were evaluated after 30, 60, 90 days (experimental period) and at 6 months. Patients randomized to the music group listened to music from a large preselected playlist, at least 30 minutes per day, for 3 months on an MP3 player. Patients in the control group received standard care. HF-specific QOL, generic QOL, self-care, somatic perception of HF symptoms, sleep quality, anxiety and depression, and cognitive abilities were assessed throughout the use of specific scales. On average, patients in the music group showed greater improvements in terms of HF-specific QOL (P.001), generic-QOL (P = .005), quality of sleep (P = .007), anxiety and depression levels (P.001 for both), and cognitive performances (P = .003).Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve QOL in patients with HF in the home-care setting.

Evaluation Of The Psychophysical Well-Being In The Compliance Of Women With Autosomal Dominant Policystic Kidney Disease: An Observational Study BACKGROUND: Autosomal dominant polycystic kidney disease is the most common inherited renal disease and affects less than 1 every 400-1,000 people. There are many effective treatments, including blood pressure management, physical activity, low sodium diet and hydration. Therapeutic education is part of a patient’s care and treatment. This approach is an essential strategy in order to face the current healthcare scenario, in which the number of people affected by chronic diseases is progressively increasing. OBJECTIVES: This article aims to analyze the effect of therapeutic education in patients with ADPKD, the level of adherence to pharmacological therapy and their compliance to dietetic and lifestyle recommendations as part of a nursing-led education. METHODS: This is a prospective, longitudinal, observational pilot study. The following measurements were used: Kidney Disease Quality of life - Short Form, Hospital Anxiety and Depression Scale, Body Uneasiness Test. At the T0 visit, a nurse selected patients and carried out a personalized educational intervention with the aims of adhering to drug therapies, monitoring blood pressure and dietary behavior (physical activity and water intake). At the T1 visit, patients performed psychological tests. At the T2 visit, the following evaluations were performed: a psychological interview together with the delivery and evaluation of the tests performed, an interview with the nurse to evaluate the adherence to the prescriptions, and a control of parameters such as physical activity, diet, water intake, drug therapy, and blood pressure. RESULTS: Therapeutic education can have a positive impact on patients’ health by improving adherence to the pharmacological therapy, diet and lifestyle. CONCLUSIONS: Therapeutic education improve the patient’s knowledge, treatments and correct behaviors as well as promotes an independent management of the disease. Through an educational intervention, the patient acquires the ability and the awareness to modify the wrong behaviors and to guarantee a balance between his needs and the pathology, thus improving the quality of life.

Dialysis is often considered slow, repetitive, and with programmed intervals. Patients often perceive it as time taken from their lives with a sense of ineluctability and emptiness, engendering a negative emotional and cognitive perception of the world and one's place in it. Today, it is possible to improve the quality of life of patients during hemodialysis using virtual reality (VR). This creation of a true multisensory experience may absorb the patient's perceptions during hemodialysis, improving his/her quality of life. An Italian multicenter, longitudinal experimental study will be conducted with a randomized, pre-post test design, with balanced allocation 1:1, in parallel groups with a control group in the standard care of patients diagnosed with chronic renal failure who are, undergoing hemodialysis treatment. A sample of 186 patients calculated with sample size (power = 80%, β = 0.2, α = 0.05) will be randomized into an experimental group exposed to VR, and a control group in standard care. The 2 groups will be studied over a period of 1 month, with 12 applications of VR and with measurements of the following outcomes: anxiety, fatigue, pruritus, arterial pressure, heart rate, respiration rate, and duration of the session at each hemodialysis session. This is the first international experimental protocol that examines the application of VR in patients undergoing hemodialysis. If the results show statistically and clinically significant differences, the VR could be an additional holistic intervention, which is evidence based, linked to the humanization of chronic, repetitive interventions, complementary to and synergistic with standard of care.

Background: Participation in music therapy is associated with improved psychological and physical indices among chronically ill patients. Listening to music during hemodialysis treatments positively affects patients’ hemodynamics, laboratory values, quality of life, and physical symptoms. The effect of live singing during hemodialysis treatments, however, has not previously been studied. Methods: A total of 24 participants with a diagnosis of end-stage kidney disease participated in the study. The vocalist was a musically trained dialysis nurse. Twelve of the patients listened to 15 min of live singing during 6 consecutive hemodialysis sessions, while the other 12 underwent standard hemodialysis. After a washout period of 2 days, the two groups were reversed. Results: Listening to live music was associated with improvements in systolic and diastolic blood pressure, better quality of sleep, fewer cramps, and reduced anxiety/depression, pain, and itching ( p < .05, all values). Conclusions: Listening to live music during hemodialysis is an effective and potentially low-cost therapy for the dialysis care team to employ during hemodialysis treatments.

Patients with heart failure have been traditionally treated with a pharmacology-based approach, diet, exercise, and rehabilitation for reducing symptoms, hospitalizations, and mortality. We have developed a solid conceptual framework for music listening-based protocols, showing how music may have a broad range of positive effects on cardiovascular health through psychoneuroimmunoendocrinological pathways.