Background:Capillary refill time has been studied in literature as a perfusion indicator. Two pilot studies have proposed possible reference values in healthy adults. No data exist regarding capillary refill time as an indicator of abnormal clinical conditions in adults, which might be of help for triage nurses.Objective:We wanted to assess if any relationships existed, between altered capillary refill time and abnormal clinical conditions in the emergency department. We investigated relations between capillary refill time and vital signs recorded in triage and blood tests, by analyzing the clinical records. Mortality at 24 hours, 7 days and over 14 days was investigated by calling the patients after discharge.Method:Observational, single-center study on a sample of consecutive patients aged ≥ 18 years in the Emergency Department of a major Milan hospital, from June to October 2014. Multivariate logistic regression was used to investigate the impact of clinical variables on capillary refill time.Results:1001 patients were enrolled, aged 59 ± 21 (473 aged 65 or more). Longer refill times were found in patients admitted to hospital units after medical consultations in the emergency department compared to those discharged or sent to outpatients. In elderly patients, statistically significant association was found between increased capillary refill time and sepsis (sensitivity 100%, specificity 83.33%, area under the receiver operating characteristics curve 65.95% CI 47-83), oxygen saturation, mean blood pressure, and lactates. In persons aged 45 to 64, altered refill times were associated with abnormal values of glicemia, platelets, and urea.Conclusion:Capillary refill time can be used by nurses at triage as a complementary parameter to normal vital signs. This is one of the few studies investigating refill time in adult patients.

Background: Constipation is a very frequent condition. Pharmacological treatment leads to the onset of complications in the long term. Aim: To study the effects of abdominal massage and bowel training combined with polyethene glycol compared with laxative alone. Researchers studied the frequency of evacuations, use of laxatives, appetite, and food intake of older persons. In addition, feasibility in the daily routine of nursing care was studied. Methods: A pilot, randomised controlled trial was conducted. Older people living in a facility for self-sufficient residents were enrolled and randomised to the intervention or control group. The massage was administered for 4 weeks. The stool type according to the Bristol Stool Form Scale and secondary outcomes were collected at baseline, before any massage session and at the end of the intervention. Findings: 32 participants were enrolled. Significant improvements were found in the number of evacuations, need for enemas, Bristol scores, appetite and food intake. Conclusion: Significant improvements were found in all major outcomes.

INTRODUZIONE: Nelle ore immediatamente successive alla dimissione dalla sala operatoria i pazienti sottoposti a intervento chirurgico sono soggetti a eventi avversi. La scala “White Fast-Track” è adatta a rilevare precocemente il rischio di complicanze postoperatorie, tuttavia, non risulta esser validata in italiano. Inoltre, per consentire una sorveglianza post-operatoria complete, dovrebbe essere completata con parametri aggiuntivi. OBIETTIVI: Questo studio si propone di tradurre e validare in italiano la scala “White fast-track scoring criteria” e di realizzarne una versione modificata per ottenere una valutazione più completa degli interventi di chirurgia maggiore. METODI: Studio quantitativo, osservazionale, prospettico, monocentrico, su un campione non randomizzato di pazienti di almeno 18 anni, sottoposti a chirurgia generale, toracica, vascolare, urologica, ortopedica, ginecologica, endocrinologica, mammaria, naso-gola o facciale, nella sala di rianimazione di un ospedale universitario di Milano. RISULTATI: Sono stati arruolati 250 pazienti. La scala originale ha mostrato una buona affidabilità inter-rater, consistenza interna e affidabilità test-retest; lo stesso vale per la versione modificata. La scala originale ha permesso di identificare 18 pazienti a rischio; la versione modificata ne ha identificati 20 che avrebbero potuto essere dimessi secondo i criteri originali e che in realtà hanno sviluppato complicanze postoperatorie. DISCUSSIONE: La versione italiana della “White fast-track scoring criteria” sembra attestarsi come uno strumento valido e può essere utilizzato dal personale infermieristico per effettuare un'adeguata sorveglianza postoperatoria finalizzata a prevenire le complicanze postoperatorie precoci. CONCLUSIONI:La versione modificata riflette la reale sorveglianza effettuata in recovery room e mostra affidabilità, sensibilità e specificità soddisfacenti rispetto allo strumento originale