Marco Sguanci

Background/Objectives: Chronic kidney disease (CKD) is frequently associated with malnutrition and protein-energy wasting. Nephrology nurses (NNs) contribute to nutritional education, counseling, screening, and monitoring, but their roles and competencies remain poorly defined. This scoping review mapped NNs’ nutritional roles and competencies in adult CKD care. Methods: This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR reporting guidelines. The protocol was registered on the Open Science Framework (OSF) 10.17605/OSF.IO/YMW4F. The research question used the Population–Concept–Context framework: NNs as the population, nutritional nursing competencies as the concept, and adult nephrology care settings as the context. Eligible studies involved nurses in adult nephrology settings and addressed nutritional nursing roles, competencies, counseling, assessment tools, or related care processes. Searches were conducted on 23 May 2026 across PubMed/MEDLINE, Embase, CINAHL, Scopus, Web of Science, Cochrane Library, and Google Scholar. Two reviewers independently charted data using a structured form and synthesized findings into thematic domains. Results: Of 4699 identified records, 20 studies were included. Evidence encompassed nursing roles and activities, assessed or perceived competencies, knowledge gaps, and outcomes of nurse-led interventions, organized into five thematic domains: educational and communicative, clinical and advanced, collaborative and professional, general or basic nutritional, and guidance and counseling. The evidence was heterogeneous, predominantly derived from dialysis settings, and no formal critical appraisal was undertaken. Conclusions: NNs may contribute to nutritional CKD management, although the evidence does not uniformly reflect directly assessed competence. Structured training and standardized competency assessment may warrant further evaluation. No external funding was received.

Background/Objectives: Nutritional management is a core component of care for patients with chronic kidney disease (CKD), and nephrology nurses play a key role in education and clinical monitoring. However, how nurses develop and enact nutritional competence in daily practice remains insufficiently explored. This study aimed to explore nephrology nurses’ perceptions and experiences of nutritional management in CKD care. Methods: A qualitative descriptive study was conducted through semi-structured interviews with 22 nephrology nurses. Data were analyzed using thematic analysis according to Braun and Clarke. Methodological rigor was ensured following trustworthiness criteria, and reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: The thematic analysis of the interviews identified six main themes: (1) Professional identity and nutritional competence, largely developed through clinical experience rather than structured education. (2) Interprofessional collaboration, perceived as essential but inconsistently implemented. (3) Nutritional education in practice, embedded in daily care and tailored to individual needs. (4) Experiential learning through self-directed nutrition updating. (5) Patient-related challenges, including adherence issues, generational differences, and cultural/educational barriers. (6) Nutritional assessment and decision-making, grounded in routine clinical monitoring and personalized judgment. Participants also highlighted the potential of decision-support tools to enhance personalized nutritional management. Conclusions: Strengthening structured nutritional training, improving interprofessional integration, and implementing shared protocols may enhance the consistency, quality, and safety of nutritional care for patients with CKD, supporting more effective translation of evidence into clinical practice.

Background: Chronic Kidney Disease-associated Pruritus (CKD-aP) is a frequent, debilitating, and often underestimated symptom in clinical practice, with significant impacts on quality of life, sleep, mental health, and therapeutic adherence. This study aimed to develop a structured, person-centered nursing care overview for the management of CKD-aP. Methods: A comprehensive narrative review of the recent scientific literature on CKD-aP was conducted, adapting the conceptual domains of the European Specialist Nurses Organisation (ESNO) Common Training Framework (CTF) to nephrology nursing practice. The theoretical model guiding the work was Virginia Henderson’s paradigm, selected for its consistency with care models focused on promoting independence and meeting fundamental human needs. The study would answer the main research question “Which nursing evidence, tools, and strategies can support integrated, patient-centered management of CKD-aP?”. Results: A structured nursing care process was developed, articulated in sequential phases (assessment, problem definition, planning, intervention, and re-evaluation), visually represented in an operational flowchart and supported by validated clinical tools. The model emphasizes the nurse’s role in the multidimensional management of the symptom, incorporating educational, relational, therapeutic, and coordination-focused interventions. Conclusions: This proposal contributes to nephrology nursing practice by providing a theoretical and practical framework to standardize the management of CKD-aP. It promotes a holistic, evidence-based approach tailored to individual care needs, establishing a foundation for future clinical, educational, and research developments.

Introduction: Chronic kidney disease is a progressive condition that often necessitates kidney replacement therapy, with haemodialyses relying on stable, functional arteriovenous fistulas. While arteriovenous fistulas offer several benefits, they are susceptible to complications that present considerable management challenges. Objective: This review aimed to investigate the potential role of artificial intelligence in the management of arteriovenous fistulas. Design: Scoping review was reported following the PRISMA‐Scoping eview guidelines and Joanna Briggs Institute methodology. Participants: Adults with chronic kidney disease. Measurements: Relevant studies on artificial intelligence applications in arteriovenous fistulas management were identified through comprehensive searches in PubMed, Embase, Cochrane Library, and CINAHL, supplemented by grey literature. Data extraction and synthesis employed standardised methods to categorise artificial intelligence techniques and their clinical applications. Results: Twenty‐three studies were included, exploring artificial intelligence applications in arteriovenous fistulas management, including prevention, failure management, and early stenosis detection in haemodialyses patients. In this context, artificial intelligence refers to computer systems that learn from clinical data to identify patterns and assist clinicians in recognising complications earlier. Convolutional Neural Networks effectively detected arteriovenous fistulas stenosis through non‐invasive acoustic analysis, while combining Convolutional Neural Networks with Bi‐directional Long Short‐Term Memory networks improved stenosis severity classification. The Extreme Gradient Boosting and machine learning techniques, such as decision trees and Support Vector Machines, demonstrated strong predictive capabilities for arteriovenous fistulas failure and maturation. Conclusions: Artificial intelligence has significant potential to revolutionise arteriovenous fistulas management, enabling proactive monitoring, reducing complications, and enhancing personalised care. These findings also suggest relevant implications for nursing practice, particularly in supporting fistula assessment and ongoing surveillance in haemodialyses patients. Protocol Registration: The protocol was registered in the Open Science Framework database (DOI: doi.org/10.17605/OSF.IO/5AVWS ).

Background/Objectives: Nutritional management is central to the care of patients with end-stage renal disease (ESRD), yet malnutrition often remains under-recognized due to gaps in nursing knowledge and competencies. This study aimed to develop and validate the Nursing Education and Competencies in Nutrition for Patients with CKD in ESRD (NECN-ESRD) questionnaire, designed to assess nephrology nurses’ competencies, attitudes, and practices in nutritional care. Methods: A methodological and cross-sectional design was adopted, following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for instrument development. The process comprised five phases: construct definition and item generation, expert consultation and revision, quantitative content validity analysis, pilot testing, and psychometric testing. Data were collected between August and September 2025 from 405 nephrology nurses across Italy. Exploratory Factor Analyses (EFAs) and Confirmatory Factor Analyses (CFAs) were conducted on split samples (60/40), and key psychometric properties were evaluated. Results: EFA identified a four-factor structure—Recommendations, Attitudes, Practice, and Advanced Competencies—which was confirmed through CFA with good fit indices [Comparative Fit Index (CFI) = 0.995, Tucker–Lewis Index (TLI) = 0.994, Root Mean Square Error of Approximation (RMSEA) = 0.07]. A higher-order model further improved fit (CFI = 0.994, RMSEA = 0.029), explaining 68.2% of variance. Internal consistency was excellent (ω = 0.89–0.96), test–retest reliability showed perfect agreement [Intraclass Correlation Coefficient (ICC) = 1.00], and invariance testing supported equivalence across educational and experience levels. Conclusions: The NECN-ESRD demonstrated strong validity, reliability, and stability, providing a robust and context-specific tool to assess and enhance nurses’ competencies in nutritional care for ESRD patients. Its application can support targeted educational interventions, improve clinical practice, and contribute to enhancing the quality of nutritional care for patients with ESRD within healthcare systems.

Background: Oral disorders such as xerostomia, mucositis, candidiasis, and dysphagia are common and distressing in palliative care. Despite their impact, they are often overlooked in practice and policy. Nurses are key in managing these symptoms, yet their role remains poorly defined. This scoping review synthesizes current evidence on the nursing role in the assessment and management of oral disorders in adult and pediatric palliative care patients across different care settings, identifying key interventions and existing gaps in practice. Methods: The review was registered on the Open Science Framework and reported following the PRISMA extension for scoping reviews. A comprehensive search was performed in the PubMed, CINAHL, Scopus, PsycInfo, and Cochrane Library databases and gray literature sources. Studies focusing on nursing interventions related to oral health in adult or pediatric palliative care contexts published in English, Italian, Spanish, Portuguese, or French were eligible. Data were charted using a standardized extraction form and analyzed thematically. Findings: Fifteen studies were included. Thematic synthesis revealed six main areas of nursing involvement: assessment and monitoring; oral hygiene and direct care; education for patients and families; interdisciplinary collaboration; advocacy and quality promotion; and professional education and development. Key barriers to effective care included the absence of standardized protocols, limited training, and lack of integration with dental services. Pediatric and home‐based care settings were underrepresented in the literature. Conclusion: Nurses are central to the delivery of oral health care in palliative settings, yet their potential is constrained by systemic, educational, and organizational challenges. Addressing these barriers through targeted training, clinical guidelines, and interprofessional collaboration is essential to ensure high‐quality, holistic, and person‐centered care for individuals in palliative care.

Background/Objectives: Effective clinical handover is a critical component of nursing care, particularly in mental health settings, where the transfer of clinical and behavioral information is essential for both patients’ and health personnel’s safety. Gamification has emerged as a promising strategy to enhance clinical education, yet few interventions have focused specifically on mental health care contexts. This study aimed to evaluate the effectiveness of a serious game designed to teach the SBAR (Situation, Background, Assessment, Recommendation) handover framework to undergraduate nursing students through a psychiatric care unit scenario. Methods: A quasi-experimental pre–post design was employed with a convenience sample of 48 nursing students from a Northern Italian university. Participants completed a test assessing their ability to organize clinical information according to the SBAR model before and after the game intervention. Students’ experience was assessed using the Player Experience Inventory. Results: A statistically significant improvement in SBAR application was observed post-intervention. The majority of students reported a positive experience across PXI domains such as Meaning, Challenge, Progress Feedback, and Enjoyment. Comparisons with a previously validated video-based nursing serious game showed a consistent overall pattern in response trends. Conclusions: The SG was an effective and engaging educational tool for improving structured handover skills in nursing students. Gamification may represent a valuable complement to traditional instruction in nursing education, especially in high-communication clinical areas such as mental health. Further research is needed to assess long-term retention and to explore more immersive formats.

Background/Objectives: Gestational diabetes (GD), which affects approximately 15% of pregnancies worldwide, poses significant risks to both maternal and fetal health, underscoring the need for effective prevention and management strategies. This umbrella review aims to evaluate the role of probiotics in the prevention of GD. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. A comprehensive literature search was performed in November 2024 across four databases: PubMed/Medline, Cochrane Library, Embase, and CINAHL. A total of 307 articles were identified, of which 6 met the inclusion criteria and were included in the final synthesis. Results: Probiotic supplementation was associated with a significant reduction in the incidence of GD in selected populations, particularly in women with a body mass index (BMI) < 26, age < 30 years [Relative Risk (RR): 0.58], and p < 0.05 in the other studies included, alongside improvements in several metabolic parameters. However, consistent benefits on maternal or neonatal complications were not observed but a 33% reduction in GD was confirmed (RR 0.67). The combination of probiotics with healthy lifestyle behaviors appeared to exert a stronger protective effect against GD and its potential complications. Conclusions: This umbrella review suggests that probiotics—particularly multi-strain formulations—may have a potential role in reducing the risk of GD in certain populations. However, the findings across the included studies are inconsistent and sometimes conflicting. While probiotics are generally considered safe and have recognized benefits for metabolic health, their efficacy as an adjunct intervention for GD prevention remains not fully clear. Further well-designed research is needed to clarify which specific probiotic interventions may be effective and to better guide clinical practice.

Starting Active Materials for Synthesis (SAMS) represents a critical stage in drug manufacturing, directly influencing the microbiological quality and safety of the final product. The introduction of SAMS marks the point where Good Manufacturing Practices (GMP) begin to apply, which are essential for ensuring sterility and preventing microbial contamination during the synthesis process. However, defining the exact point in the process that qualifies as the SAMS is subject to uncertainties, as earlier stages are not always governed by stringent GMP standards. The regulatory differences between various countries further contribute to this issue. This study explores the implications of SAMS selection and use in relation to sterility and infection control, analyzing the guidelines of major Regulatory Authorities and comparing their approaches to GMP. Regulations from several international regulatory agencies were examined, with a particular focus on microbiological control measures and infection protection in the SAMS manufacturing process. The analysis focused on the microbiological control requirements and safety measures applicable to the stages preceding the introduction of SAMS into the production of the final Active Pharmaceutical Ingredients (APIs). Documents published between 2015 and 2025 were included based on predefined criteria regarding relevance, accessibility, and regulatory authority. The analysis revealed significant discrepancies between regulations regarding the definition and management of SAMS. In particular, the regulations in Mexico and India have notable gaps, failing to provide clear guidelines on SAMS sterility and protection against infectious contamination. Conversely, China has introduced risk-based approaches and early-stage microbiological controls, especially for sterile products, aligning with international standards. The European Medicines Agency (EMA), the U.S. Food and Drug Administration (FDA), the Pharmaceutical Inspection Co-operation Scheme (PIC/S), and the World Health Organization (WHO) have well-established systems for microbiological quality control of SAMS, including rigorous measures for the validation of suppliers and risk management to ensure that SAMS does not compromise the microbiological safety of the final product. The regulations in Brazil and Canada introduce additional measures to protect the microbiological quality of SAMS, with specifications for contamination control and certification of critical stages. The lack of a harmonized language for the definition of SAMS, coupled with a fragmented regulatory framework, presents a challenge for infection protection in pharmaceutical manufacturing. Key issues include the absence of specific regulations for stages prior to the introduction of SAMS and the lack of standards for inspections related to these stages. A desirable solution would be the mandatory extension of GMPs to the stages before SAMS introduction, with centralized control to ensure sterility and protection against infection throughout the entire manufacturing process.