Feasibility, appropriateness and meaningfulness analysis of the Sunfrail Tool to the European Portuguese population during cross-cultural adaptation process.

Frailty is an age-related condition characterized by increased vulnerability to negative outcomes. To enable informed decision-making and implementation of individually tailored practices for frailty management, it is necessary to develop screening tools that cover different domains of individual functioning, reliably predict future adverse outcomes and are generalizable to healthcare settings other than primary care. The Sunfrail Tool, an easy-to-use nine-item instrument, seems to meet all these requirements. The current study aimed to perform a cross-cultural adaptation of the Sunfrail Tool for the European Portuguese population and to perform the feasibility, appropriateness and meaningfulness analyses of the Sunfrail Tool Portuguese version. METHODS: The process of cross-cultural adaptation was conducted in four-phases (translation, synthesis, back translation and creation of consensual version). To reinforce the content validity, the additional analysis on feasibility, appropriateness and meaningfulness were conducted with end-users (older adults, informal caregivers and health and social care professionals). RESULTS: The frailty concept was considered suitable for the European Portuguese population. A consensus version was reached by an expert panel after considering the results of two forward and two back-translations. This prefinal version was endorsed to the first author of the original version of the instrument, as recommended by international guidelines. The content validation performed by healthcare professionals (n = 7), patients (n = 18) and informal caregivers (n = 3) showed that the Sunfrail Tool was moderately comprehensible and ambiguous. Five items required changes for cultural adaptation. CONCLUSION: The Sunfrail Tool seems to be a promising instrument for the early identification of frailty to be used in the European Portuguese context to inform clinical decisions on preventive responses. However, to enable identification of frail and nonfrail individuals with this tool and ensure effectiveness on pathways activation for frailty management, there is a need to define cut-off points. Guidelines supporting the interview process are also desirable.

What recovery position should patients adopt after percutaneous liver biopsy?

INTRODUCTION: Percutaneous liver biopsy (PLB) is an invasive procedure used for the assessment of liver diseases. The patient's recovery position after the PLB differs among hospitals and departments. This study aims to evaluate adverse events and patient acceptability according to the recovery position adopted after the PLB. PATIENTS AND METHODS: From September 2014 to March 2017, patients submitted to PLB were randomly assigned to a recovery position arm: right-side position (RRP), dorsal position (DRP), or combined position. A validated numerical rating scale was used to evaluate the level of pain and the overall acceptability of the PLB experience. RESULTS: Ninety (27 patients in RRP, 33 in DRP and 30 in combined position arm) patients were included in the study. There were no differences between the three groups regarding demographic and clinical parameters, except for the number of previous biopsies - higher in the combined group (P=0.03). No major adverse events occurred. Minor complications described were pain (36.7% of patients), vasovagal reaction (2.2%) and nauseas/vomit (3.3%). Pain level and pain duration did not differ significantly between groups. Pain occurred more often in women (P=0.04) and younger patients (P=0.02). The number of passages, operator and previous biopsy did not influence the occurrence of pain. The RRP group considered the procedure less acceptable than the DRP group (P=0.001) or the combined group (P=0.002). There were no differences between the last two arms. CONCLUSION: Although RRP is the most frequently used position, it appears to be less acceptable without any protective role in terms of adverse events.

The Quadruple Helix-Based Innovation Model of Reference Sites for Active and Healthy Ageing in Europe: The Ageing@Coimbra Case Study.

Challenges posed by demographic changes and population aging are key priorities for the Horizon 2020 Program of the European Commission. Aligned with the vision of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), the development, exchange, and large-scale adoption of innovative good practices is a key element of the responses required to ensure all European citizens remain as active and healthy as possible as they age. Urged by the need of developing scalable disruptive innovation across Europe, the European Commission and the EIP on AHA created the Reference Sites; local coalition of partners that develop good practices to support AHA. Ageing@Coimbra is an example of how this can be achieved at a regional level. The consortium comprises over 70 institutions that develop innovative practices to support AHA in Portugal. Ageing@Coimbra partners support a regional network of stakeholders that build a holistic ecosystem in health and social care, taking into consideration the specificities of the territories, living environments and cultural resources (2,243,934 inhabitants, 530,423 aged 65 or plus live in the Centre Region of Portugal). Good practices in reducing the burden of brain diseases that affect cognition and memory impairment in older people and tackling social isolation in urban and rural areas are among the top priorities of Ageing@Coimbra. Profiting from the collaborative work of academia, business companies, civil society, and authorities, the quadruple helix of Ageing@Coimbra supports: early diagnosis of frailty and disease; care and cure; and active, assisted, and independent living. This paper describes, as a Community Case Study, the creation of a Reference Site of the EIP on AHA, Ageing@Coimbra, and its impact in Portugal. This Reference Site can motivate other regions to develop innovative formulas to federate stakeholders and networks, building consortia at regional level. This growing movement, across Europe, is inspired by the quadruple helix concept and by the replication of innovative good practices; creating new Reference Sites for the benefit of Citizens.