Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews.

AIMS AND OBJECTIVES: Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety? BACKGROUND: Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery. INTRODUCTION: According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety. DESIGN: Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety. METHODS: A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO. RESULTS: A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results. CONCLUSION: Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs. RELEVANCE TO CLINICAL PRACTICE: This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results. NO PATIENT OR PUBLIC CONTRIBUTION: Not applied to our study, as it is a systematic review of systematic reviews.

Water-Energy-Food Nexus and Life Cycle Thinking: A New Approach to Environmental and Nutritional Assessment of Potato Chips.

The water-energy-food (WEF) nexus has become a key concept to promote the cross-sectoral coordination toward sustainable development. In particular, understanding the interdependences of these pillars, as well as addressing a life cycle perspective, is essential when evaluating food production systems. This study explores the environmental impacts and nutritional quality of potato chips, addressing life cycle thinking and a WEF nexus approach. For this purpose, the combined application of life cycle assessment (LCA) and the Nutrient-Rich Food 9.3 (NRF9.3) index was considered to identify the main environmental hotspots and advanced opportunities. The results indicated a major contribution of the cultivation stage on water use, whereas the processing accounted for most of the impacts in energy-related indicators and eutrophication potentials. Improvement opportunities reside in the joint application of drip irrigation, allowing to achieve important water savings, as well as the use of natural gas or pellets instead of diesel, which constitute cleaner energy sources. On the other hand, a poor nutritional density of potato chips became evident from the quantification of the NRF9.3, which can be significantly improved if potatoes undergo a roasted process instead of frying.

Sentimientos relacionados con la muerte en estudiantes de enfermería: un estudio observacional de tres cohortes / Feelings about Death among Nursing Students: A Three-Cohort Observational Study

Objetivo principal: Conocer los sentimientos sobre la muerte en estudiantes de grado de enfermería que aún no han iniciado su prácticum en entornos asistenciales reales. Metodología: Estudio observacional de tres cohortes con análisis de pregunta abierta. La Escala de Miedo a la Muerte de Collet-Lester, el Cuestionario de factores para ayudar a morir en paz y un cuestionario con 6 preguntas abiertas fueron completados por 197 estudiantes de segundo curso de Grado de Enfermería. Resultados principales: Los estudiantes reconocen tener miedo de enfrentar la muerte en el prácticum, principalmente temen que les afecte personalmente, la reacción del paciente, el contacto con la muerte y el no saber qué hacer. Conclusión principal: Los estudiantes consideran que la muerte es algo muy presente en su profesión, expresan temer enfrentarse a ella en el prácticum, mayoritariamente reconocen no tener suficientes estrategias de afrontamiento y les gustaría recibir más formación para saber cómo afrontarla.(AU)

Objective: To describe the feelings about death of students enrolled in the Nursing Degree, who had not initiated their practicum in real care settings. Methods: Three-cohort observational study with open question analysis. The Collet-Lester Fear of Death Scale, the Questionnaire on factors to help dying in peace and ad hoc questionnaire with 6 open-ended questions was administered to 197 undergraduate nursing students. Results: The students recognized being afraid to face death in the practicum, mainly they fear that it affects them personally, the patient's reaction, contact with death and not knowing what to do. Conclusions: The students believed that death was something that was very present in their profession, expressed fear in facing it in the practicum, they mostly recognized not having enough overcoming strategies, and they would like to receive training on how to face death.(AU)

Using High-Fidelity Simulation to Introduce Communication Skills about End-of-Life to Novice Nursing Students.

Background: High-fidelity simulation is being considered as a suitable environment for imparting the skills needed to deal with end-of-life (EOL) situations. The objective was to evaluate an EOL simulation project that introduced communication skills to nursing students who had not yet begun their training in real healthcare environments. Methods: A sequential approach was used. The "questionnaire for the evaluation of the end-of-life project" was employed. Results: A total of 130 students participated. Increasing the time spent in high-fidelity simulation significantly favored the exploration of feelings and fears regarding EOL (t = -2.37, p = 0.019), encouraged dialogue (t = -2.23, p = 0.028) and increased the acquisition of communication skills (t = -2.32, p = 0.022). Conclusions: High-fidelity simulation promotes communication skills related to EOL in novice nursing students.

Factors associated with grip strength among adolescents: An observational study.

STUDY DESIGN: Cross-sectional. INTRODUCTION: The muscle strength has been studied in different populations in relation with individual and other factors. PURPOSE OF THE STUDY: The purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance. METHODS: A total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer. RESULTS: Boys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men. CONCLUSIONS: Sex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.

Predictive capability of the injury severity score versus the new injury severity score in the categorization of the severity of trauma patients: a cross-sectional observational study.

PURPOSE: The AIS scale is a measurement tool for single injuries. The ISS is considered the gold standard for determining the severity of injured patients, and the NISS was developed to improve the ISS with respect to loss of information, as well as to facilitate its calculation. The aim of this study was to analyse what injury severity measure, calculated according to the Abbreviated Injury Scale (AIS), 1998 and 2005 (update 2008) versions, performs better with mortality, cost and hospital length of stay healthcare indicators. METHODS: This cross-sectional observational study was carried out between February 1st 2012 and February 1st 2013. Inclusion criteria were injured patients due to external causes admitted to trauma service through the emergency department. Manual coding of all injuries was performed and ISS and NISS scores were calculated for both versions of the AIS scale. Severity was then compared to mortality (in-hospital and at 30 days), healthcare cost, and length of hospital stay. RESULTS: The index with the best predictive capability for in-hospital mortality was NISS 05 (AUC = 0.811). There was a significant increase in hospital stay and healthcare cost in the most severe patients in all indexes, except for ISS 05. CONCLUSIONS: NISS is found to be an index with higher predictive capability for in-hospital mortality and correlates better to length of hospital stay and healthcare cost.

Prevalence and factors associated with overweight and obesity among Spanish students attending special education schools.

BACKGROUND: Some studies suggest that children and adolescents with intellectual disability (ID) are at elevated risk of obesity. The objective was to determine the prevalence of and factors associated with overweight and obesity among students attending special education schools in Cantabria, Spain. METHODS: Cross-sectional design. A sample of n = 220 students with intellectual disability attending seven special education schools was selected using convenience sampling. Body mass index was classified into four categories according to the International Obesity Task Force (IOTF) criteria: underweight; normal weight; overweight; obesity. RESULTS: The prevalence of overweight/obesity was 40.9% (95% CI: 34.6-47.5). Obesity was more frequent among females (26.0%) than males (9.8%), with an OR = 3.23 (95% CI: 1.53-6.85). Participants with Down syndrome showed an increased risk of obesity compared to other conditions (p = .005). CONCLUSIONS: The prevalence of overweight/obesity among children, adolescents and young adults with intellectual disability was remarkably high, with females in general and students of both sexes with Down syndrome at particularly high risk.

Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis.

PURPOSE: The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases. METHODS: This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31st, 2000 to May 22sd, 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity. RESULTS: Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 - 0.26; I2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on "Case Management" and "Treatments and Procedures", which were based on a theory, were of shorter duration, and had a follow-up period. CONCLUSIONS: Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.

Comparison of injury severity scores (ISS) obtained by manual coding versus "Two-step conversion" from ICD-9-CM.

BACKGROUND: The International Classification of Diseases (ICD) is the standard diagnostic tool for classifying and coding diseases and injuries. The Abbreviated Injury Scale (AIS) is the most widely used injury severity scoring system. Although manual coding is considered the gold standard, it is sometimes unavailable or impractical. There have been many prior attempts to develop programs for the automated conversion of ICD rubrics into AIS codes. OBJECTIVE: To convert ICD, Ninth Revision, Clinical Modification (ICD-9-CM) codes into AIS 2005 (update 2008) codes via a derived map using a two-step process and, subsequently, to compare Injury Severity Score (ISS) resulting from said conversion with manually coded ISS values. METHODS: A cross-sectional retrospective study was designed in which medical records at the Hospital Universitario Marqués de Valdecilla of Cantabria (HUMV) and the Complejo Hospitalario of Navarra (CHN), both in Spain, were reviewed. Coding of injuries using AIS 2005 (update 2008) version was done manually by a certified AIS specialist and ISS values were calculated. ICD-9-CM codes were automatically converted into ISS values by another certified AIS specialist in a two-step process. ISS scores obtained from manual coding were compared to those obtained through this conversion process. RESULTS: The comparison of obtained through conversion versus manual ISS resulted in 396 concordant pairs (70.2%); the analysis of values according to ISS categories (ISS<9, ISS 9-15, ISS 16-24, ISS>24) showed 493 concordant pairs (87.4%). Regarding the criterion of "major trauma" patient (i.e., ISS> 15), 538 matching pairs (95.2%) were obtained. The conversion process resulted in underestimation of ISS in 112 cases (19.9%) and conversion was not possible in 136 cases (19%) for different reasons. CONCLUSIONS: The process used in this study has proven to be a useful tool for selecting patients who meet the ISS>15 criterion for "major trauma". Further research is needed to improve the conversion process.

Classification of the severe trauma patient with the Abbreviated Injury Scale: degree of correlation between versions 98 and 2005 (2008 update). / Grado de correlación entre las versiones 98 y 2005 (actualización 2008) de la Abbreviated Injury Scale (AIS) en la categorización del paciente traumatológico grave.

OBJECTIVES: To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients. MATERIAL AND METHODS: Descriptive study and cross-sectional analysis of a case series of patients admitted to two spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005. RESULTS: The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%). CONCLUSION: The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS.

OBJETIVO: Estudiar si existen diferencias en la asignación de gravedad entre las versiones 98 y 2005 ­actualización 2008­ de la escala Abbreviated Injury Scale (AIS) y determinar si estas posibles diferencias podrían tener repercusión en la definición de paciente traumatológico grave. METODO: Estudio descriptivo de una serie de casos con análisis transversal que incluyó a pacientes ingresados por lesiones debidas a causas externas en dos hospitales españoles, llevado a cabo entre febrero de 2012 y febrero de 2013. Se calculó el Injury Severity Score (ISS) y el New Injury Severity Score (NISS) de cada uno de los casos con ambas versiones de la escala AIS. RESULTADOS: La muestra estuvo compuesta por 699 casos, con una edad media de 52,7 (DE 29,2) años, de los cuales 388 (55,5%) fueron varones. Se obtuvo una mayor clasificación de pacientes graves con la versión AIS 98, tanto para el ISS (2,6%) como el NISS (2,9%). CONCLUSIONES: La versión AIS 2005 ­actualización 2008­ clasifica un menor número de pacientes como graves en comparación con la versión AIS 98.

Grado de correlación entre las versiones 98 y 2005 (actualización 2008) de la Abbreviated Injury Scale (AIS) en la categorización del paciente traumatológico grave / Classification of the severe trauma patient with the Abbreviated Injury Scale: degree of correlation between versions 98 and 2005 (2008 update)

Objetivos. Estudiar si existen diferencias en la asignación de gravedad entre las versiones 98 y 2005 -actualización 2008- de la escala Abbreviated Injury Scale (AIS) y determinar si estas posibles diferencias podrían tener repercusión en la definición de paciente traumatológico grave. Método. Estudio descriptivo de una serie de casos con análisis transversal que incluyó a pacientes ingresados por lesiones debidas a causas externas en dos hospitales españoles, llevado a cabo entre febrero de 2012 y febrero de 2013. Se calculó el Injury Severity Score (ISS) y el New Injury Severity Score (NISS) de cada uno de los casos con ambas versiones de la escala AIS. Resultados. La muestra estuvo compuesta por 699 casos, con una edad media de 52,7 (DE 29,2) años, de los cuales 388 (55,5%) fueron varones. Se obtuvo una mayor clasificación de pacientes graves con la versión AIS 98, tanto para el ISS (2,6%) como el NISS (2,9%). Conclusiones. La versión AIS 2005 -actualización 2008- clasifica un menor número de pacientes como graves en comparación con la versión AIS 98 (AU)

Objectives. To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients. Methods. Descriptive study and cross-sectional analysis of a case series of patients admitted to two Spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005. Results. The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%). Conclusion. The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS (AU)

Conocimiento y cumplimiento de las medidas de bioseguridad y accidentes biológicos de los estudiantes de enfermería en las prácticas clínicas / Knowledge and adherence to bio-safety measures and biological accidents by nursing students during their clinical practice

Objetivo. Identificar el grado de conocimiento y aplicación de las medidas de bioseguridad en los estudiantes de Enfermería, así como conocer los tipos de accidentes biológicos durante sus prácticas clínicas. Método. Estudio descriptivo y transversal, realizado en los estudiantes de los tres cursos de Enfermería durante el mes de mayo de 2008. La información se recogió mediante un cuestionario anónimo de autocumplimentación, obteniendo una participación del 54%. Resultados. El 97% de los estudiantes manifiesta conocer las precauciones estándares y el 100% afirma que deben ser aplicadas a todos los pacientes. Sin embargo, en la práctica clínica, las medidas de bioseguridad son aplicadas parcialmente: como media, un 60,2% manifiesta realizar las normas de higiene personal, un 66,1% manifiesta el uso de elementos de protección de barrera y un 44% manifiesta el manejo de objetos cortantes o punzantes. El 32,25% de los estudiantes ha sufrido un accidente biológico, con mayor incidencia en el segundo curso, administrando una inyección (24%), extrayendo sangre con agujas tipo venojet® (18%) y reencapsulando la aguja (17%). Conclusiones. El alto grado de conocimiento que manifiestan tener los estudiantes sobre las precauciones estándares no se demuestra en la práctica clínica. Se observan importantes deficiencias en las prácticas de seguridad de los estudiantes ya que el reencapsulado de la aguja sigue siendo una de las prácticas de riesgo más frecuente(AU)

Objective. To identify the degree of knowledge and performance of bio-safety measures by nursing students and knowing the type of biological accidents suffered during their clinical practice. Method. A cross-sectional study was conducted on the students of three Nursing courses held in May of 2008. Data was collected by an anonymous self-administered questionnaire, with a return of 54%. Results. A total of 97% of students seemed to know the standard biosafety measures, and all of them (100%) stated that those measures must be applied to every patient. However, the reality of clinical practice shows that biosafety measures are only partially applied. An average of 60.2% implement the personal hygiene measures, 66.1% use physical barriers, and 44% use sharp materials safely. Results. Around 32.25% of the students have suffered some biological accident, with a greater incidence in the second year: administering injections (24%), drawing blood samples with Venojet® needles (18%) and recapping used needles (17%). Conclusions. The high level of knowledge shown by the students on standard precautions is not always shown in clinical practice. There are significant deficiencies in student safety practices: recapping of used needles continues to be one of the most common risk practices carried out(AU)

[Knowledge and adherence to bio-safety measures and biological accidents by nursing students during their clinical practice]. / Conocimiento y cumplimiento de las medidas de bioseguridad y accidentes biológicos de los estudiantes de enfermería en las prácticas clínicas.

OBJECTIVE: To identify the degree of knowledge and performance of bio-safety measures by nursing students and knowing the type of biological accidents suffered during their clinical practice. METHOD: A cross-sectional study was conducted on the students of three Nursing courses held in May of 2008. Data was collected by an anonymous self-administered questionnaire, with a return of 54%. RESULTS: A total of 97% of students seemed to know the standard biosafety measures, and all of them (100%) stated that those measures must be applied to every patient. However, the reality of clinical practice shows that biosafety measures are only partially applied. An average of 60.2% implement the personal hygiene measures, 66.1% use physical barriers, and 44% use sharp materials safely. Around 32.25% of the students have suffered some biological accident, with a greater incidence in the second year: administering injections (24%), drawing blood samples with Venojet needles (18%) and recapping used needles (17%). CONCLUSIONS: The high level of knowledge shown by the students on standard precautions is not always shown in clinical practice. There are significant deficiencies in student safety practices: recapping of used needles continues to be one of the most common risk practices carried out.

[Real life simulations to train nurses]. / Simuladores de escala real en el entrenamiento de enfermería.

Nurses must confront critical potential life threatening situations daily. These are very tense situations which must be solved in a rapid, adequate manner in coordination with the rest of the professional health team. How to deal with these crises, which usually follow an established protocol, must be learned and practiced in a safe environment which provides the greatest possible guarantee of success. The best way to acquire this knowledge and skill is through a real life simulation. Nurses from various disciplines carry out their work in the Training Center for Critical Crises at the Marqués de Valdecilla University Hospital in Santander, the only center in Spain which runs this type of simulation. In 2003, this center initiated a specific training simulation for nurses whose purpose is to increase scientific-technical knowledge to the maximum and accelerate the learning of non-technical social and cognitive fundamentals within the working environment of a professional health team. The following article describes a simulation meeting these characteristics, its teaching methods, advantages, importance for professional health teams, and its repercussions on patients.

Simuladores de acceso real en el entrenamiento de enfermería / Real life simulations to train nurses

Enfermería debe enfrentarse diariamente a situaciones críticas con potencial compromiso vital para el paciente. Son situaciones de mucha tensión que deben solucionarse de una forma rápida y adecuada en coordinación con el resto del equipo sanitario. Esta actuación, la mayoría de las veces protocolizada, debe aprenderse y ensayarse dentro de un ambiente seguro y con la mayor garantía de éxito posible. La mejor forma de adquirir estos conocimientos y habilidades es el entrenamiento con un simulador de escala real. Enfermeras de diferentes disciplinas desarrollan su trabajo en el Centro de Entrenamiento en Situaciones Críticas del Hospital Universitario "Marqués de Valdecilla" de Santander; único centro de España dotado con este tipo de simulación. En el año 2003 se inicia la formación específica para Enfermería con el objetivo de potenciar conocimientos científico-técnicos y acelerar el aprendizaje de habilidades no técnicas (sociales y cognitivas) fundamentales en el ambiente de trabajo de un equipo sanitario. El siguiente artículo describe un simulador de estas características, su método formativo, ventajas, importancia en los equipos sanitarios y repercusión en los pacientes (AU)