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Brunner S, Mayer H, Breidert M, Dietrich M, Müller‐Staub M. Developing a nursing diagnosis for the risk for malnutrition: a mixed-method study. Nurs Open 2021; 8:1463-1478. [PMID: 33476490 PMCID: PMC8046117 DOI: 10.1002/nop2.765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
AIM As the risk for malnutrition in older people in hospitals is often underreported, we aimed to develop a risk nursing diagnosis, including label, definition and risk factors. DESIGN A convergent parallel mixed-methods design was employed. METHODS A literature review led to risk factors, validated by 22 hospitalized older people's perspectives and observations, including their nursing records. Per participant, one interview (qualitative), one non-participatory observation of three meals (198 hr; qualitative) and one nursing record evaluation (quantitative) were conducted. FINDINGS According to the classification system of NANDA International, the risk for protein-energy malnutrition is defined with 18 risk factors, including associated conditions. Content validated risk factors are presented from three participants with the most, medium and least coherent nursing record, measured with the Quality of Diagnosis, Intervention and Outcomes tool. CONCLUSION This new nursing diagnosis supports nurses to manage the risk for malnutrition and optimize older people's nutrition.
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Affiliation(s)
- Silvia Brunner
- City Hospital Waid and Triemli, ZurichZurichSwitzerland
- University ViennaViennaAustria
| | | | - Matthias Breidert
- City Hospital Waid and Triemli, ZurichZurichSwitzerland
- TU MunichMunichGermany
| | - Michael Dietrich
- City Hospital Waid and Triemli, ZurichZurichSwitzerland
- University ZurichZurichSwitzerland
| | - Maria Müller‐Staub
- Hanze University GroningenGroningenThe Netherlands
- Pflege PBSWilSwitzerland
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Mudge AM, McRae P, Hubbard RE, Peel NM, Lim WK, Barnett AG, Inouye SK. Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care. J Am Geriatr Soc 2018; 67:352-356. [PMID: 30423197 DOI: 10.1111/jgs.15662] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To propose a new multicomponent measure of hospital-associated complications of older people (HAC-OP) and evaluate its validity in a large hospital sample. DESIGN Observational study using baseline (pre-intervention) data from the Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital cluster randomized controlled trial. SETTING Acute medical and surgical wards in 4 hospitals in Queensland, Australia. PARTICIPANTS Individuals aged 65 and older (mean age 76, 48% female) with a hospital stay of 72 hours or longer (N=434). MEASUREMENTS We developed a multicomponent measure including 5 well-recognized hospital-associated complications of older people: hospital-associated delirium, functional decline, incontinence, falls, and pressure injuries. To evaluate construct validity, we examined associations with common risk factors (aged ≥75, functional impairment, cognitive impairment, history of falls). To evaluate predictive validity, we examined the association between length of stay, facility discharge, and 6-month mortality and any HAC-OP and total number of HAC-OP. RESULTS Overall, 192 (44%) participants had 1 or more HAC-OP during their admission. Any HAC-OP was strongly associated with the proposed shared risk factors, and there was a strong and graded association between HAC-OP and length of stay (9.1±7.4 days for any HAC-OP vs 6.8 ±4.1 days with none, p < .001), facility discharge (59/192 (31%) vs 27/242 (11%), p < .001) and 6-month mortality (26/192 (14%) vs 17/242 (7%), p = .02). CONCLUSION This study provides evidence of construct and predictive validity of the proposed measure of HAC-OP as a potential outcome measure for research investigating and improving hospital care of older people. J Am Geriatr Soc 67:352-356, 2019.
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Affiliation(s)
- Alison M Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australian
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australian
| | - Wen Kwang Lim
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sharon K Inouye
- Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, Massachusetts
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Kharrazi H, Anzaldi LJ, Hernandez L, Davison A, Boyd CM, Leff B, Kimura J, Weiner JP. The Value of Unstructured Electronic Health Record Data in Geriatric Syndrome Case Identification. J Am Geriatr Soc 2018; 66:1499-1507. [PMID: 29972595 DOI: 10.1111/jgs.15411] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the value of unstructured electronic health record (EHR) data (free-text notes) in identifying a set of geriatric syndromes. DESIGN Retrospective analysis of unstructured EHR notes using a natural language processing (NLP) algorithm. SETTING Large multispecialty group. PARTICIPANTS Older adults (N=18,341; average age 75.9, 58.9% female). MEASUREMENTS We compared the number of geriatric syndrome cases identified using structured claims and structured and unstructured EHR data. We also calculated these rates using a population-level claims database as a reference and identified comparable epidemiological rates in peer-reviewed literature as a benchmark. RESULTS Using insurance claims data resulted in a geriatric syndrome prevalence ranging from 0.03% for lack of social support to 8.3% for walking difficulty. Using structured EHR data resulted in similar prevalence rates, ranging from 0.03% for malnutrition to 7.85% for walking difficulty. Incorporating unstructured EHR notes, enabled by applying the NLP algorithm, identified considerably higher rates of geriatric syndromes: absence of fecal control (2.1%, 2.3 times as much as structured claims and EHR data combined), decubitus ulcer (1.4%, 1.7 times as much), dementia (6.7%, 1.5 times as much), falls (23.6%, 3.2 times as much), malnutrition (2.5%, 18.0 times as much), lack of social support (29.8%, 455.9 times as much), urinary retention (4.2%, 3.9 times as much), vision impairment (6.2%, 7.4 times as much), weight loss (19.2%, 2.9 as much), and walking difficulty (36.34%, 3.4 as much). The geriatric syndrome rates extracted from structured data were substantially lower than published epidemiological rates, although adding the NLP results considerably closed this gap. CONCLUSION Claims and structured EHR data give an incomplete picture of burden related to geriatric syndromes. Geriatric syndromes are likely to be missed if unstructured data are not analyzed. Pragmatic NLP algorithms can assist with identifying individuals at high risk of experiencing geriatric syndromes and improving coordination of care for older adults.
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Affiliation(s)
- Hadi Kharrazi
- Center for Population Health Information Technology, Department of Health Policy and Management, Bloomberg School of Public Health.,Division of Health Sciences and Informatics, Department of General Internal Medicine, University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Laura J Anzaldi
- Center for Population Health Information Technology, Department of Health Policy and Management, Bloomberg School of Public Health
| | | | - Ashwini Davison
- Division of Health Sciences and Informatics, Department of General Internal Medicine, University School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia M Boyd
- Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Bloomberg School of Public Health
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McCrow J, Morton M, Travers C, Harvey K, Eeles E. Associations Between Dehydration, Cognitive Impairment, and Frailty in Older Hospitalized Patients: An Exploratory Study. J Gerontol Nurs 2016; 42:19-27. [PMID: 26870985 DOI: 10.3928/00989134-20160201-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/06/2016] [Indexed: 01/01/2023]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Associations Between Dehydration, Cognitive Impairment, and Frailty in Older Hospitalized Patients: An Exploratory Study" found on pages 19-27, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until April 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the incidence of dehydration in older hospitalized patients. 2. Identify risk and management strategies related to dehydration in older hospitalized patients. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The current exploratory study (a) assessed the prevalence of dehydration in older adults (age ≤60 years) with and without cognitive impairment (CI) admitted to the hospital; and (b) examined associations between dehydration, CI, and frailty. Forty-four patients participated and dehydration was assessed within 24 hours of admission and at Day 4 or discharge (whichever occurred first). Patients' cognitive function and frailty statuses were assessed using validated instruments. Twenty-seven (61%) patients had CI and 61% were frail. Prevalence of dehydration at admission was 29% (n = 12) and 21% (n = 9) [corrected] at study exit, and dehydration status did not differ according to CI or frailty status. However, within the non-CI group, significantly more frail than fit patients were dehydrated at admission (p = 0.03). Findings indicate dehydration is common among older hospitalized patients and that frailty may increase the risk for dehydration in cognitively intact older adults. [Journal of Gerontological Nursing, 42(5), 19-27.].
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Association between multiple geriatric syndromes and life satisfaction in community-dwelling older adults: A nationwide study in Taiwan. Arch Gerontol Geriatr 2015; 60:437-42. [DOI: 10.1016/j.archger.2015.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/23/2022]
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Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fortes MB, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Kafri MW, Kajii F, Lindner G, Mack GW, Mentes JC, Merlani P, Needham RA, Olde Rikkert MGM, Perren A, Powers J, Ranson SC, Ritz P, Rowat AM, Sjöstrand F, Smith AC, Stookey JJD, Stotts NA, Thomas DR, Vivanti A, Wakefield BJ, Waldréus N, Walsh NP, Ward S, Potter JF, Hunter P. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev 2015; 2015:CD009647. [PMID: 25924806 PMCID: PMC7097739 DOI: 10.1002/14651858.cd009647.pub2] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. OBJECTIVES To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). SEARCH METHODS Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. SELECTION CRITERIA Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. DATA COLLECTION AND ANALYSIS Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability. MAIN RESULTS There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration. AUTHORS' CONCLUSIONS There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.
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Chen CCH, Saczynski J, Inouye SK. The modified Hospital Elder Life Program: adapting a complex intervention for feasibility and scalability in a surgical setting. J Gerontol Nurs 2014; 40:16-22. [PMID: 24443887 DOI: 10.3928/00989134-20140110-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/21/2013] [Indexed: 11/20/2022]
Abstract
The purpose of this article is to provide the rationale and methods for adapting the Hospital Elder Life Program (HELP). The HELP is a complex intervention that has been shown to reduce rates of delirium and functional decline. However, modification of the program may be required to meet local circumstances and specialized populations. We selected three key elements based on our prior work and the concept of shared risk factors and modified the HELP to include only three shared risk factors (functional, nutritional, and cognitive status) that were targeted by three nursing protocols: early mobilization, oral and nutritional assistance, and orienting communication. These protocols were adapted, refined, and pilot-tested for feasibility and efficacy. We hope by reporting the rationale and protocols for the modified HELP, we will advance the field for others adapting evidence-based, complex nursing interventions.
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Chen CCH, Chen CN, Lai IR, Huang GH, Saczynski JS, Inouye SK. Effects of a modified Hospital Elder Life Program on frailty in individuals undergoing major elective abdominal surgery. J Am Geriatr Soc 2014; 62:261-8. [PMID: 24437990 DOI: 10.1111/jgs.12651] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To test the effects of a modified Hospital Elder Life Program (mHELP) on frailty. DESIGN Matched and unmatched analyses of data from a before-and-after study. SETTING Hospital, inpatient. PARTICIPANTS Participants aged 65 and older (n = 189) undergoing major elective abdominal surgery at a medical center in Taiwan. INTERVENTION The mHELP included three nursing interventions: early mobilization, oral and nutritional assistance, and orienting communication. MEASUREMENTS Frailty rate and transitions between frailty states from hospital discharge to 3 months after discharge using Fried's phenotype criteria categorized as nonfrail (0 or 1 criteria present), prefrail (2 or 3 criteria present), and frail (4 or 5 criteria present). RESULTS In matched pairs, participants who received the mHELP interventions were significantly less likely to be frail at discharge (19.2%) than matched controls (65.4%) (adjusted odds ratio (AOR) = 0.10, 95% CI = 0.02-0.39). Transitions to states of greater frailty during hospitalization were more common for participants in the control group. Three months after discharge, participants who received the mHELP intervention during hospitalization were less likely to be frail (17.3%) than matched controls (23.1%) (AOR = 0.73, 95% CI = 0.21-2.56), although this difference did not achieve statistical significance. CONCLUSION The mHELP intervention is effective in reducing frailty by hospital discharge, but the benefit is diminished by 3 months after discharge. Thus, the mHELP provides a useful approach to manage in-hospital frailty for older adults undergoing major abdominal surgery.
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Affiliation(s)
- Cheryl Chia-Hui Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Akdag B, Telci EA, Cavlak U. Factors Affecting Cognitive Function in Older Adults: A Turkish Sample. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2013.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Souza DMSTD, Borges FR, Juliano Y, Veiga DF, Ferreira LM. Qualidade de vida e autoestima de pacientes com úlcera crônica. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000300013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar Qualidade de Vida e autoestima de pacientes com úlcera crônica. MÉTODOS: Estudo analítico e transversal. Avaliaram-se, por seis meses, 150 pacientes, sendo 75 portadores de úlcera crônica. Foram incluídos pacientes dos dois gêneros, com mais de 18 anos, internados e atendidos em ambulatório, e com cognição preservada. RESULTADOS: Dentre os pacientes com úlcera, predominou o gênero masculino (p<0,002). Nos dois grupos, a mediana de idade foi 62 anos e a hipertensão arterial foi a doença mais prevalente (32%). Observou-se pior escore da Capacidade Funcional no grupo sem úlcera (p=0,003); o grupo com úlcera registrou pior escore para o domínio Vitalidade (p=0,042). CONCLUSÃO: Pacientes com úlceras crônicas apresentaram pior Qualidade de Vida com relação à atividade, com pouca energia e disposição para realizar as Atividades da Vida Diária. As úlceras, porém, não influenciaram na autoestima desses pacientes.
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Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on frailty status: A population-based intervention study. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jcgg.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Liu H, Shen J, Xiao LD. Effectiveness of an educational intervention on improving knowledge level of Chinese registered nurses on prevention of falls in hospitalized older people--a randomized controlled trial. NURSE EDUCATION TODAY 2012; 32:695-702. [PMID: 22051103 DOI: 10.1016/j.nedt.2011.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/01/2011] [Accepted: 09/15/2011] [Indexed: 05/31/2023]
Abstract
Falls are highly prevalent in hospitalized older people. Although many factors contribute to this, registered nurses (RNs) lack of knowledge about how to prevent hospitalized older people falls was identified as one of the major factors. This study explored the effects of an educational intervention on improving knowledge level of RNs on prevention of falls in hospitalized older people. It was a randomized controlled trial. 374 RNs from 4 acute care hospitals in ChongQing were recruited to the study. Data were collected before the intervention and at the 3-month follow-up. After the intervention, knowledge scores increased significantly from baseline in the intervention group and significant differences were detected between the scores of the two groups at the 3-month follow-up. The results reflected that the educational intervention was an effective strategy for improving knowledge level of RNs on prevention of falls in hospitalized older people.
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Affiliation(s)
- Hui Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Lakhan P, Jones M, Wilson A, Courtney M, Hirdes J, Gray LC. A Prospective Cohort Study of Geriatric Syndromes Among Older Medical Patients Admitted to Acute Care Hospitals. J Am Geriatr Soc 2011; 59:2001-8. [DOI: 10.1111/j.1532-5415.2011.03663.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Andrew Wilson
- Faculty of Health; Queensland University of Technology; Brisbane; Australia
| | | | | | - Leonard C. Gray
- Centre for Research in Geriatric Medicine; The University of Queensland
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Chen CCH, Lin MT, Tien YW, Yen CJ, Huang GH, Inouye SK. Modified hospital elder life program: effects on abdominal surgery patients. J Am Coll Surg 2011; 213:245-52. [PMID: 21641835 DOI: 10.1016/j.jamcollsurg.2011.05.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postsurgical functional decline is common in older patients and can lead to frailty and increased mortality. Comprehensive interventions such as the Hospital Elder Life Program (HELP) have been shown to be effective, but modifying the HELP to include only 3 key interventions might prove cost-effective for surgical patients. STUDY DESIGN Consecutive patients from August 2007 through April 2009 (n = 179) were enrolled if they had undergone common elective abdominal surgical procedures, such as gastrectomy, cholecystectomy, and Whipple surgery. A modified HELP intervention consisting of early mobilization, nutritional assistance, and therapeutic (cognitive) activities implemented by a trained nurse was introduced on a surgical ward in May 2008. Patients enrolled before May 2008 received usual care and served as controls (n = 77). Those enrolled after the modified HELP intervention constituted the experimental group (n = 102). Changes in performance of activities of daily living, nutritional status, and cognitive function between admission and discharge were the primary end points. RESULTS Independent of baseline functions, education, periampullary diagnosis, comorbidity, surgical procedure, and duration of surgery, patients in the HELP group declined significantly less on activities of daily living performance and nutritional status (p < 0.001) than controls. The delirium rate was also significantly lower in the HELP group (0%) than in the control group (16.7%) (p < 0.001). CONCLUSIONS The modified HELP intervention effectively reduced older surgical patients' functional decline and delirium rates by hospital discharge. This program, conducted by a trained nurse, was not costly but did require commitment and ongoing cooperation between physician and nursing leadership to achieve compliance with the protocols.
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Affiliation(s)
- Cheryl Chia-Hui Chen
- Department of Nursing, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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