Explore the vast range of titles available.

Patients with heart failure may experience poor quality of life due to a variety of physical and psychological symptoms. Quality of life can improve if patients adhere to consistent self-care behaviors. Patient outcomes (i.e., quality of life) are thought to improve as a result of caregiver contribution to self-care. However, uncertainty exists on whether these outcomes improve as a direct result of caregiver contribution to self-care or whether this improvement occurs indirectly through the improvement of patient heart failure self-care behaviors. To investigate the influence of caregiver contribution to self-care on quality of life of heart failure people and explore whether patient self-care behaviors mediate such a relationship. This is a secondary analysis of the MOTIVATE-HF randomized controlled trial (Clinicaltrials.gov registration number: NCT02894502). Data were collected at baseline and 3 months. An autoregressive longitudinal path analysis model was conducted to test our hypotheses. We enrolled a sample of 510 caregivers [mean age = 54 (±15.44), 24% males)] and 510 patients [mean age = 72.4 (±12.28), 58% males)]. Patient self-care had a significant and direct effect on quality of life at three months (β = 0.20, p < .01). Caregiver contribution to self-care showed a significant direct effect on patient self-care (β = 0.32, p < .01), and an indirect effect on patient quality of life through the mediation of patient self-care (β = 0.07, p < .001). Patient quality of life is influenced by self-care both directly and indirectly, through the mediation of caregiver contribution to self-care. These findings improve our understanding on how caregiver contribution to self-care improves patient outcomes.

IntroductionThe transition from the neonatal intensive care unit (NICU) to home is a critical period for families with preterm or medically complex infants and is often marked by stress, anxiety and the challenge of managing complex medical regimens. Virtual programmes such as mobile health applications and telehealth interventions have emerged as promising tools to support families during this transition. These programmes aim to provide continuous education and support after discharge. This scoping review will map the existing evidence on virtual interventions supporting families during the NICU-to-home transition and identify their delivery methods and reported outcomes.Methods and analysisThis protocol outlines a scoping review methodology, as described by Arksey and O’Malley and further improved by Levac et al. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review will be used as a guiding framework for scoping reviews. A comprehensive search will be conducted in six databases: PubMed, Scopus, Web of Science, Embase, CINAHL and PsycINFO. Studies will be included if they (1) focus on virtual programmes supporting families of preterm or medically complex infants, (2) involve transitional care during discharge from the NICU to home and (3) are primary studies. Grey literature, as well as secondary and tertiary literature will be excluded. Data will be charted and analysed to summarise the delivery methods, target populations and outcomes reported.Ethics and disseminationNo ethical approval is required for this study. The findings will be disseminated through publications in peer-reviewed journals and presentations to the relevant stakeholders.Trial registration numberThis scoping review protocol is registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/HWVZJ).

Postoperative patients with ostomies experience significant changes in their lives as a result of the device implantation. Self-care is important to improve their health outcomes. Telehealth provides an opportunity to expand access to self-care education. This is a multicenter, non-inferiority randomized, open-label, controlled trial to evaluate the non-inferiority of a telehealth intervention to the standard in-person approach in improving self-care behaviors. Three hundred and eighty-four patients aged ≥ 18 years, with a recently placed ostomy, no stomal/peristomal complications, and documented cognitive integrity will be randomly assigned (1:1) to receive either a telehealth intervention (four remote educational sessions) or a standard educational approach (four in-person sessions) delivered in outpatient settings. Every session (remote and in-person) will occur on Days 25, 32, 40, and 60 after discharge. Follow-ups will occur 1, 3, and 6 months after the last intervention session. Primary outcome is self-care maintenance measured using the Ostomy Self-care Index (OSCI). Secondary outcomes include self-care monitoring, self-care management, self-efficacy (OSCI), quality of life (Stoma specific quality of Life), depression (Patient Health Questionnaire-9), adjustment (Ostomy Adjustment Inventory-23), stomal and peristomal complication rates, healthcare services utilization, mobility, and number of working days lost. Analyses will be performed per intention-to-treat and per protocol. This study has been approved by the Institutional Review Board of the main center (registration number: 119/22). Following completion of the trial, dissemination meetings will be held to share the results of the study with the participants and the health-care team. Adoption of telehealth technologies for ostomy patients can improve service organization by ensuring better integration and continuity of care. If the remote intervention produces comparable effects to the in-person intervention, it would be wise to make telehealth education an alternative treatment for addressing the educational needs of uncomplicated postoperative ostomy patients. ClinicalTrials.gov (identifier number: NCT05796544).

Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD). The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI). The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores. We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale (\"consulting behaviors\" and \"autonomous behaviors\"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale (\"consulting behaviors and problem-solving behaviors\"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales. The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.

COVID-19 has been associated with a broad range of long-term sequelae, commonly referred to as “long-COVID” or “post-COVID-19” syndrome. Despite an increasing body of literature, long COVID remains poorly characterized. We retrospectively analysed data from electronic medical records of patients admitted to the post-COVID-19 outpatient service of the Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy, between June 2020 and June 2021, 4–12 weeks after hospital discharge. A total of 428 patients, 41% women, median age 64 years, underwent a follow-up visit a median 53 days after hospital discharge. Overall, 76% patients reported at least one persistent symptom, including dyspnoea (37%), chronic fatigue (36%), insomnia (16%), visual disorders (13%) and brain fog (13%). Increasing oxygen support (OR 1.4, 95% CI 1.1–1.8), use of immunosuppressants (OR 6.4, 95% CI 1.5–28) and female sex (OR 1.8, 95% CI 1.1–2.9) were associated with a higher risk of long COVID symptoms. Comparison between symptomatic patients infected in the period March–December 2020 (prevalent circulation of wild-type SARS-CoV-2) with those infected in the period January–April 2021 (prevalent circulation of B.1.1.7 Alpha variant) showed a significant modification in the pattern of symptoms belonging to the neurological and cognitive/emotional categories. Our findings confirmed shortness of breath and chronic fatigue as the most frequent long COVID manifestations, while female sex and severe COVID-19 course were the main risk factors for developing lingering symptoms. SARS-CoV-2 variants may induce different long COVID phenotypes, possibly due to changes in cell tropism and differences in viral–host interaction.

ObjectivesTo identify distinct sleep quality patterns among patients with heart failure (HF) using a person-centred approach and explore demographic and clinical predictors of these patterns.DesignSecondary analysis of baseline cross-sectional data from the MOTIVATE-HF (MOTIVATional intErviewing to improve self-care in Heart Failure patients) randomised controlled trial. Latent class analysis (LCA) was applied to Pittsburgh Sleep Quality Index (PSQI) component scores to identify distinct subgroups of patients. Demographic, clinical and psychological variables were examined as potential predictors of cluster membership.SettingThree healthcare settings in Italy: hospital, outpatient and community-based care.Participants510 adult patients diagnosed with HF (New York Heart Association (NYHA) class II–IV) with poor self-care were included. Patients with severe cognitive impairment or recent myocardial infarction were excluded.Primary and secondary outcome measuresPrimary outcome: Sleep quality, measured using the PSQI, analysed through LCA to identify sleep disturbance clusters. Secondary outcomes included demographic and clinical characteristics predicting cluster membership.ResultsThe mean age was 72.4 years (SD=12.3), with most participants married or partnered (62%) and retired or unemployed (83.9%). Mild comorbidities were present in 53.3% of the sample (mean Charlson Comorbidity Index (CCI)=2.91, SD=1.98), and 61.4% were classified in NYHA class II. Three sleep quality clusters emerged: (1) adequate sleep duration but disturbed sleep and daytime dysfunction (46.1%); (2) severe sleep problems with low use of sleeping medications (25.3%); and (3) minor sleep problems with mild disturbances (28.6%). Patients in Cluster 1 were older (mean age=73.3 years), had lower physical and mental quality of life (Short-Form 12 Physical Component Summary=33.66; Mental Component Summary=42.65), and higher anxiety (Hospital Anxiety and Depression Scale-A=8.82). Patients in Cluster 2 had more severe comorbidities (CCI=3.55), poorer cognitive function (Montreal Cognitive Assessment (MoCA)=21.5) and lower ejection fraction (mean=40%). Patients in Cluster 3 were younger (mean age=68.2 years), had better cardiac function (ejection fraction=46.6%), better cognitive status (MoCA=24.5) and the highest quality of life (Kansas City Cardiomyopathy Questionnaire=63.1).ConclusionsPatients with HF exhibit heterogeneous sleep quality patterns with specific clinical and psychological profiles. These findings highlight the need for personalised interventions, systematic sleep assessments and the integration of cardiac rehabilitation strategies into standard HF care.Trial registration numberNCT02894502.

Nurses and paramedics play a pivotal role when mass casualty incidents (MCI) occur, yet they often feel unprepared for such events. Implementation strategies for training activities, including virtual reality (VR) and augmented reality (AR) simulations, offer realistic and immersive learning experiences, enhancing skills and competencies for nursing students. The aim of this work was to investigate the adopted tools in studies on VR and AR simulations for training nursing and paramedic students in managing MCI. A scoping review was performed following the PRISMA-ScR statement, and the search strategy was conducted through five electronic databases from December 2022 to March 2023. Of 162 records identified, 27 full texts were screened and, six studies were included in this review. These studies involved students who were assigned to different training methods, including immersive VR simulation, written instruction, and traditional lecture. VR and AR and immersive simulation generally show promising evidence in enhancing practical skills and knowledge in MCI management. VR and AR showed to be promising in disaster education and preparedness training, offering different levels of immersiveness and engagement, encouraging active and experiential learning. Further research is needed to determine their long-term effectiveness. The choice of training method should consider program goals, target population, and available resources.

Background The rising cost of healthcare is a concerning issue for healthcare systems. The Diagnosis Related Group (DRG) system lacks direct consideration for costs related to nursing care. Therefore, to date there is no clear picture of billing models that consider also nursing activity when evaluating healthcare service costs or what factors related to nursing care affect the costs of healthcare services and would therefore need to be considered in billing models. Methods A scoping review was conducted. We searched articles published from January 2000 to September 2023, in English, Italian and Spanish. We consulted MEDLINE (Pubmed), CINAHL (EBSCOhost), Web of Science (Clarivate), SCOPUS (Elsevier), ProQuest and Google Scholar, government sites and major international bodies (e.g., National Health Service NHS, World Health Organization WHO). Results We included a total of 31 studies. The results highlighted 3 categories of factors related to nursing costs, which involve the organisation (e.g., nurse-to-patient ratio), nurses (e.g., skill mix, interventions), and patients (e.g., patient complexity, patient outcomes). All the billing models reported in the literature considered one or more of these categories to estimate nursing costs. The results also showed that appropriate management of organisational and nursing factors, such as staffing and skill mix, could improve healthcare service costs, nursing care or practice, and patient outcomes. Conclusions This study sheds light on the multifaceted aspects of nursing care that should be considered in a specific, comprehensive, billing model. Additional testing of existing models to verify their effectiveness, as well as the organisation of a permanent committee (or Task Force) that develops a comprehensive billing model, are necessary to guide the formulation of new policies.

ObjectivesThis scoping review aims to assess low-cost simulation methods used in nursing education, evaluating how they balance educational effectiveness with budget constraints.DesignScoping review conducted in accordance with Arksey and O’Malley’s methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.Data sourcesPubMed, Embase and CINAHL were systematically searched for relevant studies published between January 2000 and October 2023.Eligibility criteriaWe included peer-reviewed primary studies involving nurses or nursing students, focused on the use of low-cost simulation in any healthcare setting. Studies had to describe the simulation strategy and its educational application.Data extraction and synthesisTwo reviewers independently screened titles, abstracts and full texts and extracted data using a standardised form. Findings were synthesised narratively and categorised by type of simulation, educational context and competencies addressed.ResultsOut of 3332 records, 39 studies met the inclusion criteria. The reviewed studies covered various clinical areas, including critical care, emergency, neonatal, paediatric and obstetric nursing, as well as transversal competencies such as communication and clinical reasoning. Low-cost methods included task trainers, mannequins, computer-based tools, hybrid models and serious games. Only 38% of studies reported detailed cost information.ConclusionsLow-cost simulation offers promising opportunities in nursing education but suffers from inconsistent cost reporting and a lack of standardisation. Further research is needed to evaluate its long-term effectiveness and support broader implementation.

Background. Previous research has shown that patients with ostomy frequently exhibit a low health-related quality of life (HRQoL). Self-care is a key element that influences their HRQoL. However, the evidence regarding the relationship between these two constructs in patients with ostomy is still not clear. Materials and Methods. This was a secondary analysis of an Italian multicenter, observational, longitudinal study. Participants were recruited from seven outpatient ostomy care clinics in central and northern Italy. The Stoma-Specific Quality of Life Questionnaire (Stoma QoL) and the Ostomy Self-Care Index (OSCI) were administered to the participants. The relationship between self-care and HRQoL was analyzed using structural equation modeling. Results. A total of 521 patients were enrolled. Our results emphasized that self-care is a predictor of HRQoL among people with ostomy. Self-care maintenance and self-care monitoring had a positive effect on HRQoL (self-care maintenance: β = 0.506, p < 0.001; self-care monitoring: β = 0.303, p < 0.001). The model exhibited acceptable fit indices: χ2 (151, n= 521) = 516.447, p ≤ 0.001, comparative fit index (CFI) = 0.97, Tucker–Lewis index (TLI) = 0.96, root mean square error of approximation (RMSEA) = 0.068 (90% CI, 0.062–0.075), p < 0.001, and standardized root mean square residual (SRMR) = 0.038. Conclusions. The structural equation model tested the causal relationship between self-care and HRQoL in people with a stoma, demonstrating for the first time that inadequate self-care in patients with ostomy may lead to lower HRQoL. Thus, to enhance HRQoL, interventions should be designed to improve self-care behaviors. Future research should investigate potential mediating variables in the relationship between self-care and HRQoL.