Abstract: In the year 2019, 121 patients were admitted to the Casavatore Hospice. All patients, upon admission, exhibited pressure ulcers (Ldp) in both stages I and II. A portion of the patients with stage II ulcers were treated with advanced dressings containing micronized silver (20 patients), resulting in a regression of the ulcer to stage I. Subsequently, they were treated with topical application of silver sulfadiazine cream until complete healing of the lesion. Patients who did not have favorable indications for the application of such treatment were treated with Sofargen cream (60 patients), nonetheless preventing the worsening of the stage of the pressure ulcer. Patients with stage I ulcers (41 patients) were treated daily with silver sulfadiazine spray, which still contributed to the prevention of secondary lesions associated with immobility. The objective of managing pressure ulcers in bedridden or terminal patients has been fully achieved within dignified care times and, above all, with reduced company costs. As a final result, considering the current prices for both dressings and the specific drug, we achieved an economic savings exceeding 35%, highlighting how it is possible to implement, in various aspects and situations, important yet simple care approaches while respecting therapeutic appropriateness and patient compliance.

Abstract: PREFACE

Abstract: In this treatise we intend to deepen the theme of Acute Myocardial Infarction (AMI), one of its main risk factors at the cardiovascular level, namely smoking, and in particular, deepen the role of the nurse in patient education. after the ischemic event and implement strategies aimed at smoking cessation. If we look at the data from the World Health Organization (WHO), it is striking that the main cause of mortality in the modern world is heart ischemia which alone causes 7 million and 400 thousand deaths; while in second place we find stroke and cerebral vasculopathies with 6 million and 700 thousand deaths (Cesta 2014). Having established that tobacco plays a primary role in our society and that its active or passive use has a negative impact on the health of the individual (WHO 2014), we will first briefly mention the anatomy and physiology of the cardiovascular system, then we will discuss the implications between heart and smoking and, in particular, between heart attack and smoking, trying to understand - through authoritative sources such as the WHO and databases - where the roots of such a widespread habit lie and its impact on the system cardiovascular. Later we will address the educational issue of secondary prevention, we will examine the strategies implemented for smoking cessation. By dealing directly with patients, acquaintances and friends we realized how, despite the widespread information on the dangers of smoking, several people, even knowing the possible consequences, not only do not try to quit smoking, but almost underestimate the damage that can be caused by this “dangerous” habit of theirs is paradoxical. We believe that the role of the nurse in the post-heart attack moment is of extreme importance not only to provide specific direct assistance, also because that relationship of trust is created and to make him understand the risks to the patient in case he decides to continue smoking, but also because a correct education and the use of some strategies, personalized to each patient, to quit smoking, are essential in reducing the risk of a relapse. The choice of the topic dealt with in this work was dictated by a strong SOCIAL motivation. Although I am a smoker, noting the importance and the close relationship between health and a habit such as smoking, I have always been interested in being able to deepen my knowledge on the effects of the cardiovascular system and the problems that orbit around it. We still believe that an in-depth study on an issue so debated today and which will still be discussed for a long time can give the opportunity to approach smoking patients in a more conscious, personalized and adequate way and thus making treatment a better means. comprehensive within the health sector. We believe that this work can enhance our personal and professional background, allowing us in the near future to prevent, identify and deal more effectively with clinical problems involving both doctors and nurses. Finally, the hope is to acquire greater critical capacity in problematic cardiological situations and to have a greater capacity for acceptance and respect for the patient's will. This work aims to highlight and deepen the cardiovascular problems secondary to the phenomenon of smoking, implementing a therapy for smoking cessation. The methodology is based on articles researched from databases, on journals specialized in cardiology and on textbooks. From the observed articles it emerged that the nurse must use a multisystemic , multifaceted and multidisciplinary approach that includes different roles, namely: member of a working group, role of health promoter, role of teacher and communicator, of educator and expert in nursing care , and taking a look at post-ischemic nursing care. In this treatise we intend to deepen the issue of Acute Myocardial Infarction (AMI), one of its main cardiovascular risk factors, namely smoking, and in particular, deepen the role of the nurse in patient education after the ischemic event and in implementing strategies aimed at smoking cessation. If we look at the data from the World Health Organization (WHO), it is striking that the main cause of mortality in the modern world is heart ischemia which alone causes 7 million and 400 thousand deaths; while in second place we find stroke and cerebral vasculopathies with 6 million and 700 thousand deaths (Cesta 2014). Having established that tobacco plays a primary role in our society and that its active or passive use has a negative impact on the health of the individual (WHO 2014), we will first briefly mention the anatomy and physiology of the cardiovascular system, then we will discuss the implications between heart and smoking and, in particular, between heart attack and smoking, trying to understand - through authoritative sources such as the WHO and databases - where the roots of a widespread habit and its impact on the cardiovascular system lie. Later I will address the educational issue of secondary prevention, I will examine the strategies implemented for smoking cessation. By dealing directly with patients, acquaintances and friends we realized how, despite the information seems to be more than abundant on the dangers of smoking, several people, even knowing the possible consequences, not only do not try to quit smoking, but underestimate in the damage that can be caused by this “dangerous” habit of theirs is almost paradoxical. We believe that the role of the nurse in the post-heart attack moment is of extreme importance not only to make the patient aware of the risks in case he decides to continue smoking, but also because proper education and the use of some strategies, customized to each patient, to quit smoking, are essential in reducing the risk of a relapse.

Abstract: The interaction between the individual and the environment has a strategic significance for welfare purposes and shows the importance of the bilateral nature of the relationship. It highlights how promoting health means acting on the environment and on the individual. In terms of health education, for health workers it is no longer a question of intervening from the outside on behavior, but of inserting themselves into situations, in the processes of interaction, as active protagonists of a complex system. This orientation of the health system requires a reinterpretation of the role of operators, through the adoption of the participatory planning method, which requires interpreting one's work as a problem solving process. To get to the solution of the problems it is necessary to identify the elements of difficulty that the patient encounters, thus adopting methodologies that allow for an exchange relationship. Nurses, in all health systems, have a privileged position due to the capillarity of their action, inherent in the “to care” of nursing care, and of their contacts with citizens and clients. In particular towards the patient he teaches the correct assistance maneuvers and the most appropriate attitudes to be adopted to favor the change of behaviors and the achievement of awareness of a new state of health and a new degree of autonomy. The most suitable educational method that should be used by the nurse in the path of therapeutic education, is to link learning to action, in clinical practice, alongside the patient, promoting healthy lifestyles and the dissemination of a culture of health. Educational intervention aims at personalizing care and can improve health status and reduce healthcare costs. Alongside the ethical value and professional duty, it is necessary to use methodologies, techniques and methods to provide a structured set of specific information, with a simple and understandable language, speaking.

Abstract: The subject of this paper concerns fundamental aspects of complications, management and education of the diabeticpatient, especially the patient with macroangiopathic complications .The increase in the prevalence of diabetes mellitus is now exponential and its impact on cardiovascular diseases isincreasingly evident.In fact, the patient with diabetes has a significantly increased risk of developing major cardiovascular events.This is due to the particular aggressiveness of atherosclerotic disease at the level of the vessels, favored by endothelialdysfunction linked to the hyperglycemic state.Diabetes is a chronic disease with very widespread diffusion all over the world, destined to increase in the near futurewith the progressive aging of the population and the increasing occurrence of risk conditions that precede its onset.We are in fact in the presence of a real pandemic confirmed by epidemiological data, which indicate that more than300 million people in the world are affected by diabetes.In Italy, the treatment for diabetes absorbs 6.65% of the overall health expenditure, with a cost per patient that is morethan double the national average.Given the significant burden diabetes places on public health, preventing and improving the care of people with diabetes should be a primary goal for most communities and health systems.The consequences for individuals are due to the complications that the person with diabetes can develop, in terms ofa reduction in both the expectation and the quality of life, with significant repercussions, including economic ones.The organizational quality and efficiency of diabetic care 4 are correlated with better disease control, with a betterprognosis of complications, leading to a lower diabetes-related mortality rate.Reducing morbidity and mortality and improving the quality of life of people with diabetes mellitus represent oneof the current challenges for healthcare professionals, healthcare organizations and medical staff working in publichealthcare facilities.The selection and subsequent implementation of therapeutic education interventions, whose efficacy and congruencewith needs have been demonstrated, are essential steps towards improving the conditions of people with diabetes.Diabetes is a chronic disease and as such requires responsible management by those affected. Often people withdiabetes forget to live with a silent disease which, in addition to acute complications, also manifests long-term complications which can become fatal.A structured intervention is therefore necessary that increases the motivation and adherence of patients to the therapeutic plan, thus leading to a good metabolic control, to an acquisition of knowledge that allows them an adequatemanagement of the disease and a consequent better quality of life.The aim of this thesis is to research the results of lifestyle modification among the most important scientific evidence,taking into consideration aspects such as: metabolic control, acquired knowledge, self-management, self-efficacy,quality of life and satisfaction of the subjects.The research was carried out by consulting international databases such as “ Pubmed ” and “ google scholar “.The articles report that education for lifestyle change increases knowledge of one’s illness, self-management skillsand thus 2 an improvement in the quality of life.As a result, there will be a reduction in the incidence of diabetes and an improvement in numerous cardiovascularfactors. Furthermore, the nurse plays a role of fundamental importance both at the educational level through specificstructured interventions, and at the psychological level.

Abstract: Introduction: Pregnancy termination (IG) is a widely practiced clinical procedure and can be therapeutic (IGT), pharmacological (IGF), or surgical (IGS). The analysis of total costs associated with different methods is useful to highlight advantages and disadvantages for the patient and to enable decision-makers to intervene in a precise manner on company policies supported by concrete data. The relevant legislation governing pregnancy termination is Law 194/78, with specific reference to voluntary termination, permitted within the first 90 days of gestation. This deadline can only be exceeded in special cases, such as severe risk to the mother or fetal malformation. The Law 194/78 aims to ensure that the process of voluntary termination (IVG) is guaranteed, and in this sense, family planning clinics serve as a reference service for many women and couples. The organization of IVG services must be such that there is enough professional figures to provide women with access to voluntary pregnancy termination. From the latest reports published by the Ministry, there is a noticeable decrease in voluntary pregnancy terminations, a trend also observed among foreign women. This is undoubtedly influenced by the increased use of emergency contraception – Levonorgestrel (morning-after pill) and Ulipristal acetate (5-day after pill). On the other hand, due to the more frequent use of pharmacological termination (using Mifepristone+Prostaglandins), there is an increased access to termination within the first 8 weeks of gestation, which represents the deadline for undergoing this variant of the procedure. Materials and Methods: The study is retrospective and uncentered, with an evaluation of data from questionnaires administered to patients who underwent Pregnancy Terminations in the years 2020, 2021, and 2022 at San Giuliano Hospital in Giugliano in Campania (Na), which falls within the territory of the Local Health Authority Napoli 2 Nord.From the analysis of the questionnaires, it is possible to reconstruct sensitive patient data, including place and  date of birth, residence, domicile, age, origin, education level, as well as all clinical data related to the patient and pregnancy in general. Surgical pregnancy termination compared to pharmacological termination appears to be less common in all three periods considered. The pharmacological method involves taking an antiprogesterone hormone (Mifepristone) followed by an analogue of prostaglandins (Misoprostol). From a cost analysis perspective, the starting point was the Diagnosis Related Group (DRG) of pharmacological and surgical pregnancy terminations in the Campania Region for each method considered. Results: The laboratory tests which the patient must undergo in the preliminary phase are the same in all abortion (IG) procedures. In the surgical treatment, the patient is admitted to the day hospital, and under anaesthesia, the gestational sac is removed (an invasive procedure with associated risks). In the pharmacological procedure, the patient makes three hospital visits for the administration of two tablets with different active ingredients and at least one follow-up. Conclusions: Although there is a minimal difference between two Diagnosis-Related Groups (DRGs), only 40 euros, the total expenditure is higher in the case of IGF, which prevails significantly in terms of the number of cases compared to IGC. On the other hand, the involvement of professional figures, technical and logistical infrastructure, is inconsistent in IGF, whereas it is much greater in the case of IGC. With IGF, the patient does not undergo any anaesthesia evaluation or surgical intervention, with recovery times estimated to be a few hours and, above all, exposing the patient to fewer risks than the surgical procedure. Additionally, medical and healthcare staff and the operating room structure with all intervention techniques are engaged to a lesser extent in IGF compared to IGC, generating potentially higher company marginality in IGF, especially considering the actual cost of the drugs used. It is worth noting that the DRG falls under regional jurisdiction and may not be the same across the entire national territory. In fact, the Campania Region's case may be different in other regions, resulting in a higher reimbursement amount for IGC treatment compared to IGF. 

Abstract: Introduction: The Coronavirus SARS-CoV-2 pandemic has altered the perception of the current National Health Service (SSN). On one hand, the importance of a free and always accessible SSN for everyone has been strengthened. On the other hand, the fragility of a system with a too specialized and hospital-centered approach has become evident. In the pandemic context, the need to reverse the model by focusing on the needs of the community has become clear, with the main aim of promoting home-based management as much as possible for both chronic and acute conditions. This can be achieved through the creation of an integrated network involving all stakeholders in the care and assistance process, utilizing new technologies and telemedicine systems.Materials and Methods: The aim of this activity was to delve into an integrated network model for home care of Covid patients, within ASL Napoli 2 Nord. This model utilizes interconnected and functionally integrated structures and nodes, with defined pathways and operational procedures based on dedicated telemedicine platforms. These platforms facilitate the comprehensive management and care of Covid-19 patients by all network stakeholders. Results were monitored using specific and dedicated indicators, collecting and analysing data from the period when the care of positive Covid patients began (November 2020), whose management did not require hospitalization.Results: From November 2020 to December 2021, the number of patients living in the ASL Napoli 2 Nord territory under home management included Home Health Care Units (USCA), non-ambulatory residential facilities undergoing non-pharmacological therapy (TNF), non-ambulatory vaccinated individuals receiving home vaccination, and vaccinated individuals in residential facilities, amounted to 38,223. Among these, 37.8% (14,476) tested positive for Covid.The total number of accesses during this period was approximately 94,000, encompassing various types of care provided (TNF at home, TNF in facilities, home management of Covid+ patients, vaccinations in facilities, vaccinations at home for non-ambulatory patients). The shift has been significant, transitioning from managing the entirety of patients in hospitals to slightly over 4.5% of the total managed from December 2020 to December 2021.                    Conclusions: The sensitivity of healthcare managers during the pandemic period translated into the realization that the focus of the National Health System (SSN) and the Regional Health System (SSR) needed to shift, directing efforts increasingly towards the implementation of local healthcare policies.The high number of hospitalizations recorded was not solely due to the increased number of infections, but also to the challenges faced in providing home care. Creating, developing, and continually implementing an interdisciplinary and interprofessional network, coupled with the development of technological infrastructures and more, ensured the ability to address the emergency. This guaranteed that all citizens received the necessary care and assistance to navigate this historically critical and unexpected moment.The reproducibility of this system assures the possibility of further network implementation, not only in emergencies but also for the daily management of chronic patients. Moreover, in a time when, among other things, Mission 6 of the National Recovery and Resilience Plan (PNRR) has allocated resources amounting to 15.63 billion euros to be invested in the healthcare sector, most of which are dedicated to revolutionizing our SSN and ensuring its greater efficiency and effectiveness in the territor.

Abstract: The following work concerns a retrospective, single-center analysis of the data cohort collected between January 2022 and December 2023 regarding outpatient services provided by the Vascular Access Management Service at the Giugliano Hospital in Campania, part of the ASL Napoli 2 Nord. The devices used in these practices are essential for the treatment of both hospitalized and non-hospitalized patients. Their widespread use is justified both due to the particular complexity of the therapeutic regimens to which the patient is subjected, and the frequent need for pharmacological support, hydration, periodic blood draws, nutrient and blood product infusions, and hemodynamic monitoring to safeguard their vascular health. The ASL Napoli 2 Nord area records a significant presence of chronic-degenerative and oncological diseases, therefore, to meet the needs of the population and the numerous requests made by hospital departments and districts, it was decided to activate outpatient clinics for the implantation and management of vascular accesses. It is appropriate that every healthcare operator is adequately trained and involved in the various stages of patient recruitment, device implantation, and management. Therefore, in the ASL Napoli 2 Nord area, it was deemed necessary for these professional figures to be involved in drafting procedures to define the correct use of these devices. The cost of individual outpatient procedures in terms of materials used and specialized personnel involved is an indicator of company expenditure. The amount received by the company for each individual service in terms of patient copayments and reimbursement from the Region represents the revenue of the ASL in relation to the services provided. From the results obtained, there is a slight disproportion regarding regional reimbursement; in particular, the data shows that revenue in terms of dressings is lower than that of irrigations despite the direct costs in the former being much higher than in the latter. These outpatient procedures represent an important source of income in relation to the numbers generated solely at the Giugliano Hospital and still find correspondence and proportionality compared to those recorded in the outpatient clinics of other company facilities.

Abstract: Oncological screenings: The screening program consists of the free and active offer (personal invitation) to the population, at risk by age, of practices that have proved to be able to significantly affect the natural history of the disease(reduction of morbidity and mortality) maintaining A convenient relationship between costs (economic, psychological, social) and the benefits (Omswilson, 1968). Oncological screenings organized currently active in our country are:The objective of oncological screening programs is the reduction of mortality.According to the national guidelines (PNLG) “the assumptions that are the basis of the offer of an oncologicalscreening test to a hypothetically healthy population are:1. that it is possible to identify the neoplasm, if present, when still asymptomatic;2. that this anticipation of the diagnosis translates into a concrete benefit, first of all in terms of survival extension.Always the PNLG in the document at the evaluation of services stresses that:“Screening by nature is a tool that requires caution, because it proposes to asymptomatic people, who have a perception of their positive health, a diagnostic test that can reveal the presence of a cancer in its latency period”. For thisreason, another professional figure represented by the “psycho-oncologist” has also become part of the last decade.As we see below the screening of the uterus’s neck cancer falls more than others in the two requirements (A and (Bfirst mentioned. Tumors that affect the uterus must be distinguished in cervix cancers and body tumors based on thesegment that comes Struck by neoplasm. This work will pay attention to the first group, which by natural history, riskfactors, incidence, clinical trend, therapy and finally survival. For many years, it has been the subject of public healthinterventions aimed at its Primary and secondary prevention.

Abstract: The subject of this paper concerns fundamental aspects of complications, management and education of the diabetic patient, especially the patient with macroangiopathic complications . The increase in the prevalence of diabetes mellitus is now exponential and its impact on cardiovascular diseases is increasingly evident. In fact, the patient with diabetes has a significantly increased risk of developing major cardiovascular events. This is due to the particular aggressiveness of atherosclerotic disease at the level of the vessels, favored by endothelial dysfunction linked to the hyperglycemic state. Diabetes is a chronic disease with very widespread diffusion all over the world, destined to increase in the near future with the progressive aging of the population and the increasing occurrence of risk conditions that precede its onset. We are in fact in the presence of a real pandemic confirmed by epidemiological data, which indicate that more than 300 million people in the world are affected by diabetes. In Italy, the treatment for diabetes absorbs 6.65% of the overall health expenditure, with a cost per patient that is more than double the national average. Given the significant burden diabetes places on public health, preventing and improving the care of people with diabetes should be a primary goal for most communities and health systems. The consequences for individuals are due to the complications that the person with diabetes can develop, in terms of a reduction in both the expectation and the quality of life, with significant repercussions, including economic ones. The organizational quality and efficiency of diabetic care 4 are correlated with better disease control, with a better prognosis of complications, leading to a lower diabetes-related mortality rate. Reducing morbidity and mortality and improving the quality of life of people with diabetes mellitus represent one of the current challenges for healthcare professionals, healthcare organizations and medical staff working in public healthcare facilities. The selection and subsequent implementation of therapeutic education interventions, whose efficacy and congruence with needs have been demonstrated, are essential steps towards improving the conditions of people with diabetes. Diabetes is a chronic disease and as such requires responsible management by those affected. Often people with diabetes forget to live with a silent disease which, in addition to acute complications, also manifests long-term complications which can become fatal. A structured intervention is therefore necessary that increases the motivation and adherence of patients to the therapeutic plan, thus leading to a good metabolic control, to an acquisition of knowledge that allows them an adequate management of the disease and a consequent better quality of life. The aim of this thesis is to research the results of lifestyle modification among the most important scientific evidence, taking into consideration aspects such as: metabolic control, acquired knowledge, self-management, self-efficacy, quality of life and satisfaction of the subjects. The research was carried out by consulting international databases such as “ Pubmed ” and “ google scholar ". The articles report that education for lifestyle change increases knowledge of one's illness, self-management skills and thus 2 an improvement in the quality of life. As a result, there will be a reduction in the incidence of diabetes and an improvement in numerous cardiovascular factors. Furthermore, the nurse plays a role of fundamental importance both at the educational level through specific structured interventions, and at the psychological level.