Silvia Garcia‐Mayor

Effectiveness of food-based fortification in older people a systematic review and meta-analysis

BackgroundEarly intervention with nutritional support has been found to stop weight loss in older people malnourished or at risk of malnutrition. Enriched food could be a more attractive alternative to improve meals, than conventional oral nutritional supplements.AimsTo determine the effectiveness of food-based fortification to prevent risk of malnutrition in elderly patients in community or institutionalized elderly patients.MethodsA systematic review was conducted of randomized controlled trials, quasi-experimental, and interrupted time series including a longitudinal analysis.ParticipantsElderly patients who are institutionalized, hospitalized or community-dwelling, with a minimum average age of 65 years. All type of patient groups, with the exception of people in critical care, or those who were recovering from cancer treatment, were included.InterventionStudies had to compare food-based fortification against alternatives. Studies that used oral nutritional supplementation such as commercial sip feeds, vitamin or mineral supplements were excluded. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out.ResultsFrom 1011 studies obtained, 7 were included for the systematic review, with 588 participants. It was possible to perform meta-analysis of four studies that provided results on caloric and protein intake. Food-based fortification yielded positive results in the total amount of ingested calories and protein. Nevertheless, due to the small number of participants and the poor quality of some studies, further high quality studies are required to provide reliable evidence.Implications for practiceDespite the limited evidence, due to their simplicity, low cost, and positive results in protein and calories intake, simple dietary interventions based on the food-based fortification or densification with protein or energy of the standard diet could be considered in patients at risk of malnutrition.

Description of Advanced Practice Nurses Interventions Through the Nursing Interventions Classification in Different Care Settings for Older People: A Qualitative Study.

PURPOSE To identify the interventions provided by advanced practice nurses to older people in different contexts with standardized nursing language. DATA SOURCE This is a qualitative study. Content analysis was applied to the texts of experimental research papers about advanced practice nursing for older people. Deductive coding through the Nursing Intervention Classification was carried out. DATA SYNTHESIS Seventy-three interventions codified with the Nursing Intervention Classification were extracted, mainly related to the behavioral and healthcare system domains, which could be explained due to the need for improving the psychosocial functioning and self-care of these patients to preserve their quality of life. CONCLUSION AND IMPLICATION FOR NURSING PRACTICE Advanced practice nurses interventions can be better described, reported, and analyzed along different contexts with standardized languages.Purpose To identify the interventions provided by advanced practice nurses to older people in different contexts with standardized nursing language. Data Source This is a qualitative study. Content analysis was applied to the texts of experimental research papers about advanced practice nursing for older people. Deductive coding through the Nursing Intervention Classification was carried out. Data Synthesis Seventy-three interventions codified with the Nursing Intervention Classification were extracted, mainly related to the behavioral and healthcare system domains, which could be explained due to the need for improving the psychosocial functioning and self-care of these patients to preserve their quality of life. Conclusion and Implication for Nursing Practice Advanced practice nurses interventions can be better described, reported, and analyzed along different contexts with standardized languages. Objetivo Identificar las intervenciones realizadas por las enfermeras de practica avanzada a personas mayores en diferentes contextos de atencion con lenguajes estandarizados. Fuente De Datos Se trata de un estudio cualitativo. Se aplico analisis de contenido a los textos de estudios experimentales sobre enfermeria de practica avanzada en poblacion mayor y se llevo a cabo una codificacion deductiva con las intervenciones de la Clasificacion de Intervenciones de Enfermeria. Sintesis De Datos Se extrajeron setenta y tres intervenciones codificadas con la Clasificacion de Intervenciones de Enfermeria, mayormente pertenecientes a los campos Conductual y Sistema Sanitario, lo que podria explicarse por la necesidad de mejorar el funcionamiento psicosocial y de auto-cuidado de este tipo de pacientes, para preservar su calidad de vida. Conclusion E Implicaciones Para La PraCtica De Enfermeria Las intervenciones de las enfermeras de practica avanzada pueden ser descritas, referidas y analizadas en diferentes contextos con lenguajes estandarizados.

Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain

BACKGROUND The clinical judgment and decision-making abilities of nurses can influence many health outcomes, hence the importance of addressing these qualities in university studies. In this respect, clinical simulation is a commonly employed teaching method. The evaluation of simulation activities requires standardised instruments, such as the Lasater Clinical Judgment Rubric, which is widely used for this purpose, although a culturally adapted and validated version in Spain is not available. AIMS To obtain a Spanish culturally adapted and validated version of the rubric for undergraduate students of nursing. DESIGN, PARTICIPANTS AND SETTING Cultural adaptation and psychometric validation study carried out with undergraduate nursing students in the simulation laboratories at the University of Málaga (Spain). METHODS A process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. The rubric was empirically evaluated in standardised scenarios with high and medium-fidelity simulators. Each student took part in two different simulation sessions, led by two instructors. In each simulation, the data were collected by two independent observers. RESULTS 152 observations were obtained from 76 students. The interobserver reliability was high, with an intraclass correlation coefficient of 0.93 (95% CI 0.92-0.95) (p = 0.0001) and Cronbachs alpha of 0.93. According to the confirmatory factor analysis, the fit of the model was satisfactory in all indices, with a χ2/df value of 1.08, GFI 0.96, TLI 0.99, NFI 0.97 and RMSEA 0.24 (90% CI 0.000-0.066). CONCLUSIONS The rubric obtained is culturally adapted to the Spanish educational context, and is valid and reliable for nursing students. Further prospective studies should be undertaken to evaluate the responsiveness, potential for transfer to clinical practice and cost-benefit ratios of different simulation designs.

THU0751-HPR Effectiveness of foot orthosis in patients with rheumatoid arthritis related to quality of life and pain. a systematic review and meta-analysis

Background Foot pain and deformity is almost ubiquitous in RA and results in considerable physical and psychosocial impairment [1]. Epidemiological studies consistently suggest a 90% prevalence of foot pain despite advances in pharmacological therapy [2]. Mechanical and other non-pharmacological interventions such as orthoses and footwear, have an important role in managing foot pathology in patients with their systemic disease controlled [1,3]. The effectiveness of treatment with insoles, especially in early periods, was studied in a randomized controlled trial, which results suggested an immediate clinical improvement, reducing foot pain, disability and limited functionality.[1] Objectives The aim of this study is the effectiveness of foot orthosis in patients with rheumatoid arthritis in terms of quality of life and pain. Methods A systematic review and meta-analysis was conducted of randomized controlled trials. Participants: Patients with rheumatoid arthritis were included. The criteria of exclusion were Juvenile Rheumatoid Arthritis, analysis of gait, Intervention: Studies had to compare foot orthosis Comparison: Other type of treatments, other type of foot orthosis, sham Outcomes: Evaluation of Pain or Quality of life with any tool that measure this outcomes The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out. The Mesh term and fields used were foot, ankle, joint, rheumatoid arthritis, foot, orthosis, insole, foot orthosis. Results After the analysis of 71 studies, 4 were included for the systematic review. The 4 studies enrolled 285 participants. Follow-up periods varied from 6 to 30 months. Only two studies were included in the meta-analysis [4,5], both of them with pain (measured with Foot Function Index) as the selected outcome. A meta-analysis of the two trials showed that use of FO resulted in a non-significant improvement in disability compared with control (MD (95% CI): 4.37 (-6.24, 14.98); N=64) (Figure 1). Conclusions Foot orthoses showed improvements in pain and disability/quality of life, but no significant differences between groups were found.Future research needs to increase the number of RCTs in this topic because results are not conclusive. References Woodburn J, Barker S, Helliwell PS. A randomized controlled trial of foot orthoses in rheumatoid arthritis. J Rheumatol. 2002;29:1377–83. Otter SJ, Lucas K, Springett K, Moore A, Davies K, Young A, et al. Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFalpha therapy: an epidemiological study. Rheumatol Int. 2011;31:1515–9. Hennessy K, Woodburn J, Steultjens MPM. Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken). 2012;64:311–20. Conrad KJ, Budiman-Mak E, Roach KE, Hedeker D, Caraballada R, Burks D, Moore H. Impacts of foot orthoses on pain and disability in rheumatoid arthritics. J Clin Epidemiol. 1996 Jan;49(1):1–7. Novak P, Burger H, Tomsic M, Marincek C, Vidmar G. Influence of foot orthoses on plantar pressures, foot pain and walking ability of rheumatoid arthritis patients–a randomised controlled study. Disabil Rehabil. 2009;31(8):638–45. Disclosure of Interest None declared

Acquiring Competence in Oncology Nursing Skills Through the Use of Film: A Study Protocol

PURPOSE To determine the influence of movies as a teaching resource with nursing students to improve their ability to cope with challenging scenarios in oncology nursing, as well as their competence to identify nursing diagnoses in these patients. METHODS Cluster, randomized controlled trial with nursing students at the University of Málaga (Spain). MEASURES Accuracy of nursing diagnoses, perceived stressors, death anxiety, empathy, level of decision making, and cognitive closure. CONCLUSIONS This study will provide information about the efficacy of movies to improve the competence in nursing students for the care of oncology patients, as well as their diagnostic reasoning. IMPLICATIONS FOR NURSING PRACTICE If significant modifications are obtained, this approach can be an important resource applicable to other contexts of patient care.