Navigating a newly diagnosed cancer through clinician-facilitated discussions of health-related patient values: a qualitative analysis.

BACKGROUND: Advance care planning, the process through which patient values and goals are explored and documented, is a core quality indicator in cancer care. However, patient values are predominantly elicited at the end of life; patient values earlier in serious illness are not clearly delineated. The objective of this analysis is to assess the content of patient-verified summaries of health-related values among newly diagnosed cancer outpatients in order to develop a theoretical framework to guide future values discussions and optimize person-centered oncologic care. METHODS: Values summaries among patients with gastrointestinal (GI) cancers or myelodysplastic syndrome (MDS) were extracted from the medical record. Modified grounded theory analysis included interdisciplinary team coding of values summaries to identify key domains; code categorization; and identification of thematic constructs during successive consensus meetings. A final round of coding stratified themes by disease type. RESULTS: Analysis of 128 patient values summary documents from 67 patients (gastrointestinal [GI] cancers, n = 49; myelodysplastic syndrome [MDS], n = 18) generated 115 codes across 12 categories. Resultant themes demonstrated patients' focus on retaining agency, personhood and interpersonal connection amidst practical and existential disruption caused by cancer. Themes coalesced into a theoretical framework with 5 sequenced constructs beginning with the cancer diagnosis, leading to 3 nesting constructs of individual identity (character), interpersonal (communication) preferences and needs, and social identity (connection), signifying sources of meaning and fulfillment. Values differences between GI cancer and MDS patients-including greater focus on normalcy, prognosis, and maintaining professional life among GI patients-reflected the distinct therapeutic options and prognoses across these disease groups. CONCLUSIONS: Patient values reflect goals of meaning-making and fulfillment through individual agency and interpersonal supports in the setting of a newly diagnosed cancer. Early, nurse-led values discussions provide important and patient-specific data that are informative and likely actionable by clinicians in the delivery of person-centered care. Values can also facilitate discussions between patients and families and clarify patient preferences.

Effect of Phentermine on Hepatic Steatosis in Bariatric Surgery: A Pilot Study.

OBJECTIVE: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. METHODS: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. RESULTS: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. CONCLUSIONS: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

Impact of Implementing Smart Infusion Pumps in an Intensive Care Unit in Mexico: A Pre-Post Cost Analysis Based on Intravenous Solutions Consumption.

Background: The use of smart pump technology has shown to be profitable in the intensive care unit (ICU) because it avoids costs from prevented medication errors and allows for savings on disposables and medications by establishing standardized concentrations and dosing units. Objective: The objective of the study is to evaluate the economic impact of the implementation of smart infusion pumps in the consumption of intravenous (IV) solutions in an ICU. Methods: A retrospective observational study was conducted with a pre-post design. The study occurred in the adult ICU of the Hospital Juárez de México. The pattern of consumption of IV solutions (sodium chloride 9%, Hartmann's solution, dextrose 5% and 10%, sodium chloride 0.9% with dextrose 5%) was analyzed preimplementation and postimplementation of 50 Plum A+™ pumps with Hospira MedNet™ security software. Using the TreeAge Pro 2016 software, deterministic and probabilistic analyses were carried out (10 000 Monte Carlo simulations) to confirm the robustness of the annual consumption comparison and the associated expenses before and after implementing smart technology. Results: The implementation of the smart pumps reduced the annual consumption of IV solutions to 8994 units (18%) and 3649 liters (22.3%). In the first year, MXN$55 850.97 were saved. From an institutional perspective and with a probability of 0.63, the use of MedNet™ technology proved to be a lower cost alternative (17.1% saved) with respect to the conventional infusion systems. Conclusion: The implementation of smart infusion pumps allows savings, specifically for the IV solutions used in ICU.

Factores de riesgo para mortalidad en pacientes con infección por Clostridium difficile.

INTRODUCTION: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. OBJECTIVE: To identify the risk factors for mortality in hospitalized patients with CDI. METHOD: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). RESULTS: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. CONCLUSIONS: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

INTRODUCCIÓN: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. OBJETIVO: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. MÉTODO: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). RESULTADOS: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. CONCLUSIONES: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

Association of nutritional status and functional capacity in gastrointestinal cancer patients. / Cáncer del tracto digestivo: asociación entre el estado nutricional y la capacidad funcional.

Objective: To determine the nutritional status and its association with functional capacity in patients with digestive tract cancer. Methods: We retrospectively studied all adult patients hospitalized who were diagnosed as having a cancer of the digestive tract. Nutritional status and functional capacity were assessed. Descriptive statistic and odds ratio were used to determine the association in SPSS 14.0. Results: 57 patients were included, 96% had weight loss. Using subjective global assessment (SGA) as a method of screening, 82.5% of the patients were found malnutrition and by biochemical and immunological test 82% and 65% respectively. Functional capacity was assessed by Karnofsky index, finding that 75.5% of the patients have some activity limitation. Results show an association between malnutrition by SGA and limitation in functional capacity (c2 = 1.56; p = 0.212; OR: 2.46; 95% confidence interval [95% CI]: 0.581-10.465). In addition, we observe an association between the total lymphocyte count and limitation in functional capacity (χ2 = 6.94; p = 0.008; OR: 5.23; 95% CI: 1.441-19.025). Conclusions: Malnutrition in patients with digestive tract cancer was associated with limitation in functional capacity.

An in vitro evaluation of endodontic sealers and an antibiotic to assess their antimicrobial effect against Enterococcus faecalis.

Objective: This study aimed to compare the antimicrobial effect of three endodontic sealers (AH Plus, Mineral trioxide aggregate [MTA] Fillapex, and BioRoot RCS) with and without amoxicillin against E. faecalis. Methodology: Amoxicillin, equivalent to 10% of the sealers' total weight, was mixed with the sealers. Another batch was prepared without amoxicillin. The direct contact test (DCT) and the agar diffusion test were used to assess the antibacterial effect. Results were analysed using one-way analysis of variance (ANOVA), the F-test, and the Kruskal-Wallis test. Results: AH Plus significantly suppressed E. faecalis without the addition of amoxicillin in the DCT (p = 0.011), while in the agar diffusion test, BioRoot RCS had a larger inhibition zone than the control (p < 0.001). When amoxicillin was added to the sealers, AH Plus (p = 0.003) and MTA Fillapex (p = 0.042) reduced E. faecalis growth. In contrast, all three sealers showed larger inhibition zones than the control (p = 0.001), with AH Plus displaying a larger inhibition zone than MTA Fillapex (p = 0.042) and BioRoot RCS (p = 0.032). Conclusions: It was thus concluded that the addition of amoxicillin to endodontic sealers enhances their antimicrobial activity against E. faecalis.

Patient Portals to Elicit Essential Patient-Reported Elements of Communication Supporting Person-Centered Oncologic Care: A Pilot Study of the PERSON Approach.

PURPOSE: Patient portal technology offers important new opportunities to support person-centered clinician-patient communication. METHODS: Questionnaires relating to understanding of illness and treatment intent were sent quarterly via portal to all patients scheduled for follow-up in GI medical oncology clinics. For patients in selected clinics, items eliciting health-related values were added. Patient responses were available to all oncology team members in the electronic health record. Workflow and content of clinician-patient discussions about illness, treatment, and care goals stayed within clinicians' discretion. Feasibility (patient response rate), patient understanding, acceptability (three-item patient questionnaire), and efficacy (quality of clinician communication) were evaluated. RESULTS: From May 2021 through December 2022, a total of 12,233 questionnaires about illness/treatment understanding were sent to 6,325 patients (one to six per patient), with 97% response, including 9,358 with both open- and closed-ended responses. Fewer than 0.1% of patients indicated distress related to the questionnaire/process. Open-ended responses complemented closed-ended answers by revealing prognostic awareness and illness concerns. Of 48 patients approached to complete the full questionnaire including values items via portal, 15 first received and completed them in clinic (5 on iPad, 10 on paper), while 33 received and 27 (82%) completed the portal questionnaire. Patients found the portal process acceptable, and ratings of clinician communication were higher after clinic visits informed by patients' questionnaire responses (average prescore 6.8 v 5.9 post; P = .03). CONCLUSION: Almost all patients in this large GI cancer cohort responded via the portal about their understanding of illness and treatment goals. Eliciting their personal values by portal was also feasible, accepted by patients, and improved patient ratings of clinicians' communication. Portals represent a promising tool for scaling assessment of essential patient-reported elements of person-centered communication.

Association between sarcopenic obesity with insulin resistance and metabolic syndrome. / Asociación entre obesidad sarcopénica con resistencia a la insulina y síndrome metabólico.

BACKGROUND: There is a debate as to whether sarcopenic obesity leads to an increased risk of metabolic syndrome (MS) in young adults. OBJECTIVE: To determine the association between sarcopenic obesity with MS and insulin resistance (IR). METHODS: A 5-year retrospective cross-sectional study. Subjects of the specialty consultation between 18 and 55 years old, with BMI≥35 with comorbidity or BMI≥40 with and without comorbidity were included. The association was calculated using an odds ratio (OR) with 95% confidence intervals (95% CI). RESULTS: Two hundred and fifty-four subjects were analyzed, 76.4% were women and average age was 38.36±8.78 years. The OR of IR in subjects with or without sarcopenic obesity was 2.224 (95% CI, 1127 to 4389, P=.02). The OR of MS in subjects with or without sarcopenia was 1.045 (95% CI, 0.624 to 1.748, P=.868). A difference was found between the fat mass in the group with IR vs. without IR of 60.58±14.4kg vs. 53.98±12.2kg (P<.001); likewise, between the BMI and muscle mass of 46.15±6.78kg/m2 vs. 43.51±6.11kg/m2 (P<.05) and 30.05±7.48kg vs. 27.86±5.91kg (P<.05) respectively. CONCLUSION: The association between sarcopenic obesity with IR in young adults was significant, but not with MS. Our findings emphasize the need to become aware of the importance of maintaining lean mass in obese subjects.

Immunonutrition for the acute treatment of MELAS syndrome.

MELAS syndrome (Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes) is one of the most frequent mitochondrial pathologies. Its diagnosis is based on the classic triad of symptoms its acronym stands for and the presence of ragged red fibres. There is currently no curative therapy for MELAS, and treatment focuses on managing complications that affect specific organs and functions. However, some immunonutrients can be used as a therapeutic alternative in patients with MELAS. We present a scientific literature review accompanied by the clinical case of a patient with dementia and seizures admitted to the intensive care unit.

A Randomized Trial Evaluating Patient Experience and Preference Between Octreotide Long-Acting Release and Lanreotide for Treatment of Well-Differentiated Neuroendocrine Tumors.

PURPOSE: Somatostatin analogs octreotide long-acting release (octLAR) and lanreotide are equally acceptable in National Comprehensive Cancer Network guidelines for neuroendocrine tumors (NETs). Lanreotide is more expensive and given by deep subcutaneous injection, whereas octLAR is given intramuscularly. We evaluated patient preference between these agents in terms of injection site pain. MATERIALS AND METHODS: Randomized, single-blinded study. Patients with NETs received injections every 4 weeks. Arm 1: octLAR × 3, then lanreotide × 3; arm 2: reverse order. Self-reported injection site pain scores (range, 0-10) were obtained after each of the first three injections. Primary end point was comparison of mean pain scores over the first three injections. Secondary end points included patient-reported preference. RESULTS: Fifty-one patients enrolled (26 in arm 1 and 25 arm 2), all evaluable for primary end point. No significant difference was identified in the mean pain score over the first three injections (2.4 ± 1.9 v 1.9 ± 1.5, P = .5). Thirty-four of 51 (67%) patients (15 in arm 1 and 19 in arm 2) completed post-therapy questionnaires and were evaluable for secondary end points. Seven patients (47%) in arm 1 and eight patients (42%) in arm 2 indicated no drug preference at the end of treatment. In the other 19 patients, more patients indicated mild or strong preference for octLAR over lanreotide. CONCLUSION: We found minimal pain with octLAR and lanreotide and no significant pain score differences between the two. Patients indicating a drug preference trended toward favoring octLAR.

Antimicrobial effectiveness of root canal sealers against Enterococcus faecalis.

We evaluated four root canal sealers to determine their antimicrobial effectiveness against E. faecalis. The direct contact test was used to measure the effectiveness of the study materials and close contact between bacteria on the kinetics of bacterial growth. The agar diffusion test (ADT) was also performed for comparison. Using one-way ANOVA and the F-test, significant differences between the sealers were confirmed. Whereas BioRoot endodontic sealer had an antimicrobial effect statistically similar to the zinc oxide-eugenol control (p=.99), EndoSequence sealer and AH Plus sealer both had a significantly lower antimicrobial effect than the control (p=.0000266 and p=.0000068, respectively).

Immunonutrition for the acute treatment of MELAS syndrome.

MELAS syndrome (Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes) is one of the most frequent mitochondrial pathologies. Its diagnosis is based on the classic triad of symptoms its acronym stands for and the presence of ragged red fibres. There is currently no curative therapy for MELAS, and treatment focuses on managing complications that affect specific organs and functions. However, some immunonutrients can be used as a therapeutic alternative in patients with MELAS. We present a scientific literature review accompanied by the clinical case of a patient with dementia and seizures admitted to the intensive care unit.

Impact of obesity and diabetes mellitus in critically ill patients with SARS-CoV-2.

PURPOSE: Evaluate the associations of obesity and diabetes with the risk of mortality in critically ill patients infected with SARS-CoV-2. MATERIALS AND METHODS: This cohort study included 115 adult patients admitted to the ICU with SARS-CoV-2 pneumonia. Anthropometric variables and biochemical (C-reactive protein, ferritin, leukocyte, neutrophils, and fibrinogen) were measured. Multivariate logistic regression analyses were used to investigate the associations. RESULTS: Mean age was 50.6±11.2 years, 68.7% were male. Median BMI was 30.9kg/m2. All patients had invasive mechanical ventilation. Patients with diabetes had increased risk of mortality with OR of 2.86 (CI 95% 1.1-7.4, p=0.026); among those patients who, in addition to diabetes had obesity, the risk was de 3.17 (CI 95% 1.9-10.2, p=0.038). Patients with obesity had 1.25 times greater risk of developing a severe SARS-CoV-2 infection (95% CI 1.09-1.46, p=0.025). Negative correlation was observed between BMI and the PaO2/FiO2 ratio (r=-0.023, p<0.05). Obese patients required more days of mechanical ventilation and longer hospital stay compared to non-obese patients. CONCLUSIONS: Diabetes and obesity are risk factors for increasing severity of SARS-CoV-2 infection, and they are both associated with an increase in mortality.

Intravenous Administration Errors Intercepted by Smart Infusion Technology in an Adult Intensive Care Unit.

OBJECTIVES: The aim of the study was to investigate the efficacy of intravenous (IV) smart pumps with drug libraries and dose error reduction system (DERS) to intercept programming errors entailing high risk for patients in an adult intensive care unit (ICU). METHODS: A 2-year retrospective study was conducted in the adult ICU of the Hospital Juárez de México in Mexico City to evaluate the impact of IV smart pump/DERS (Hospira MedNet) technology implementation. We conducted a descriptive analysis of the reports generated by the system's software from April 2014 through May 2016. Our study focused on the upper hard limit alerts and used the systems' variance reports and IV Medication Harm Index methodology to determine the severity of the averted overdoses for medications with the highest number of edits. RESULTS: The system monitored 124,229 infusion programs and averted on 36,942 deviations of the preset safe limits. Upper hard limit alerts accounted for 26.4% of pump reprogramming events. One hundred sixty-six significant administration errors were intercepted and prevented, and IV Medication Harm Index analysis identified 83 of them as highest-risk averted overdoses with insulin accounting for 51.8% of those. The rate of compliance with the safety software during the study period was 69.8%. CONCLUSIONS: Our study contributes additional evidence of the impact of IV smart pump/DERS technology. These pumps effectively intercepted severe infusion errors and significantly prevented adverse drug events related to dosing. Our results support the implementation of this technology in ICUs as a minimum safety standard and could help drive an IV infusion safety initiative in Mexico.

In Vivo Evaluation of 3 Electronic Apex Locators: Root ZX Mini, Apex ID, and Propex Pixi.

INTRODUCTION: The aim of this in vivo study was to compare the accuracy of 3 electronic apex locators (EALs) (Root ZX mini [J Morita Corp, Tokyo, Japan], Apex ID [SybronEndo, Glendora, CA], and Propex Pixi [Dentsply Maillefer, Ballaigues, Switzerland]) to determine the working length. METHODS: Thirty single-rooted human teeth that were scheduled for extraction were selected for the study. Electronic measurements were performed with the 3 EALs. After the teeth had been extracted, a #10 K-file was used to determine the actual working length, which was established at 0.5 mm short of the major foramen. The data were statistically analyzed with analysis of variance (α = 0.05). RESULTS: No significant differences were found among the experimental groups (P > .05). The mean distance from the actual working length to the file tip was 0.163 ± 0.032 mm when Root ZX mini was used, 0.343 ± 0.032 mm for Propex Pixi , and 0.012 ± 0.008 mm for Apex ID. CONCLUSIONS: Under the in vivo conditions of this study, no statistically significant differences were observed among the 3 EALs.

Antimicrobial activity and inhibition of biofilm formation in vitro and on human dentine by silver nanoparticles/carboxymethyl-cellulose composites.

OBJECTIVE: To evaluate the antimicrobial activity of a silver nanoparticles/carboxymethyl-cellulose (AgNPs/CMC) composite on in vitro and dentine disc heterogeneous biofilms. DESIGN: AgNPs/CMC composite effect on normal human gingival fibroblast cells (HGF) viability was determined by the MTT reduction assay. In addition, we evaluated the antimicrobial effect of AgNPs/CMC composite on Candida albicans, Enterococcus faecalis, and Fusobacterium nucleatum growth in vitro and heterogeneous biofilms, as well as dentine disc biofilms. RESULTS: Quasi-spherical AgNPs/CMC composites, with a mean 22.3 nm particle-size were synthesized. They were not toxic to HGF cells at concentrations tested that were antimicrobial, however they caused significant cytotoxicity (89 %, p <  0.05) at concentrations > 15 µg/mL. In vitro, they inhibited up to 67 %, 66 %, and 96 % C. albicans, E. faecalis, and F. nucleatum growth at concentrations ranging from 1.2 µg/mL to 9.6 µg/mL, as compared with untreated control. We also demonstrated significant (p <  0.05) 58 % biofilm reduction by 4.8 µg/mL AgNPs/CMC composite on human dentine discs. CONCLUSION: AgNPs/CMC composite showed anti biofilm activity on monocultures, heterogenous cultures, and dentine discs, resulting a potentially effective alternative to prevent and eliminate infections after endodontic treatment.

[Nutritional strategies in the management of patients with diabetes mellitus]. / Estrategias nutricionales en el tratamiento del paciente con diabetes mellitus.

Diabetes mellitus is a highly prevalent disease in the world and in Mexico. Due to its chronic evolution it causes multiple sequelae, disability and mortality. An adequate control of diabetic patients based on reaching glycemic targets, maintenance of healthy weight, as well as lipid and blood pressure control is essential to reduce the risk of progression of its complications. Lifestyle changes are also key for preventing and treating the disease. Knowledge of the relationship and mechanism involved between diabetes and alterations in nutrient metabolism should be considered to provide an adequate nutritional program. This article aims to bring healthcare professionals the concepts and strategies, proposed by several scientific societies, about nutritional management of adult patients with diabetes mellitus.

La diabetes mellitus es una enfermedad altamente prevalente en el mundo y en México. Debido a su evolución crónica, es también causa de múltiples secuelas, discapacidad y mortalidad. Un adecuado control del paciente diabético que se logre a partir de metas de glucemia, mantenimiento de peso sano, así como control de lípidos y presión arterial es indispensable a fin de disminuir el riesgo de progresión de las complicaciones de la diabetes mellitus. Los cambios en el estilo de vida son clave en la prevención y el tratamiento de la enfermedad. El conocimiento de la relación y el mecanismo involucrados entre la diabetes y las alteraciones en el metabolismo de los nutrientes debe ser considerado para brindar un programa nutricional adecuado. Este artículo pretende aproximar a los profesionales de la salud los conceptos y las estrategias nutricionales actuales, propuestos por diversas sociedades científicas, para el manejo nutricional de pacientes adultos con diabetes mellitus.

Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention.

CONTEXT: Optimal advance care planning allows patients to articulate their values as a touchstone for medical decision making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds. OBJECTIVES: Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients. METHODS: Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal malignancies. RESULTS: Oncology nurses conducted 177 total discussions with 67 newly diagnosed cancer patients (17 with hematologic and 50 with gastrointestinal malignancies) over two years. No patient declined participation. Discussions averaged eight minutes, and all patients verified values summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process. CONCLUSION: Nurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes after broader dissemination of this initiative throughout our institution.

Validation and Adaptation of the Spanish Version of the STRONGkids Nutrition Screening Tool.

BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.