A fragilidade no contexto da saúde

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Realistic simulation in nursing education: Testing two scenario‐based models

Aim: To evaluate students' self- perceived pedagogical outcomes when using a digital scenario- based tool compared to traditional scenarios printed on paper. Design: This study used a within- subjects experiment. Method: A digital platform for scenario development was developed, focusing on patients' regaining independence and returning home after an acute event. Students participated in two simulation activities, differing only in the type of scenario used and completed a questionnaire to evaluate their learning experience. Results: Students considered that the new scenario template provided a clearer understanding of the situation under analysis, allowing them to recognize the focuses of attention to be prioritized when formulating the intervention plan. No Patient or Public Contribution: A digital platform for a standardized process of scenario writing to help realistic simulation in nursing education is a novelty in this study and will likely contribute to substantial learning gains.info:eu-repo/semantics/publishedVersio

Costs of fragility hip fractures globally:a systematic review and meta-regression analysis

Purpose – To systematically review the costs of hip fractures globally and identify drivers of differences in costs. Methods – A systematic review was conducted to identify studies reporting patient level fragility hip fracture costs between 1990 and 2015. We extracted data on the participants and costs from these studies. Cost data concerning the index hospitalisation were pooled and a meta-regression was used to examine its potential drivers. We also pooled data on the first year costs following hip fracture and considered healthcare, social care as well as other cost categories if reported by studies. Results – 113 studies reported costs of hip fracture based on patient level data. Patients developing complications as well as patients enrolled in intervention arms of comparative studies were found to have significantly higher costs compared to the controls. The pooled estimate of the cost for the index hospitalisation was $10,075. Health and social care costs at 12 months were$43,669 with inpatient costs being their major driver. Meta-regression analysis identified age, gender and geographic region as being significantly associated with the differences in costs for the index hospitalisation. Conclusions – Hip fracture poses a significant economic burden and variation exists in their costs across different regions. We found that there was a considerable variation across studies in terms of study design, methodology, follow up period, costs considered and results reported that highlights the need for more standardisation in this area of research. </p

Sampling effort and information quality provided by rare and common species in estimating assemblage structure

Reliable biological assessments are essential to answer ecological and management questions but require well-designed studies and representative sample sizes. However, large sampling effort is rarely possible, because it demands large financial resources and time, restricting the number of sites sampled, the duration of the study and the sampling effort at each site. In this context, we need methods and protocols allowing cost-effective surveys that would, consequently, increase the knowledge about how biodiversity is distributed in space and time. Here, we assessed the minimal sampling effort required to correctly estimate the assemblage structure of stream insects sampled in near-pristine boreal and subtropical regions. We used five methods grouped into two different approaches. The first approach consisted of the removal of individuals 1) randomly or 2) based on a count threshold. The second approach consisted of simplification in terms of 1) sequential removal from rare to common species; 2) sequential removal from common to rare species; and 3) random species removal. The reliability of the methods was assessed using Procrustes analysis, which indicated the correlation between a reduced matrix (after removal of individuals or species) and the complete matrix. In many cases, we found a strong relationship between ordination patterns derived from presence/absence data (the extreme count threshold of a single individual) and those patterns derived from abundance data. Also, major multivariate patterns derived from the complete data matrices were retained even after the random removal of more than half of the individuals. Procrustes correlation was generally high ( > 0.8), even with the removal of 50% of the species. Removal of common species produced lower correlation than removal of rare species, indicating higher importance of the former to estimate resemblance between assemblages. Thus, we conclude that sampling designs can be optimized by reducing the sampling effort at a site. We recommend that such efforts saved should be redirected to increase the number of sites studied and the duration of the studies, which is essential to encompass larger spatial, temporal and environmental extents, and increase our knowledge of biodiversity.peerReviewe

Measuring quality of life of people with predementia and dementia and their caregivers: a systematic review protocol

Introduction Dementia is the fastest growing major cause of disability globally and may have a profound impact on the health-related quality of life (HRQoL) of both the patient with dementia and those who care for them. This review aims to systematically identify and synthesise the measurements of HRQoL for people with, and their caregivers across the full spectrum of, dementia from its preceding stage of predementia to end of life. Methods and analysis A systematic literature review was conducted in Medical Literature Analysis and Retrieval System Online , ExcerptaMedicadataBASE, Cochrane Database of Systematic Reviews , Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effect, National Health Service Economic Evaluation Database and PsycINFO between January 1990 and the end of April 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. HRQoL measurements will be presented separately for people with dementia and caregivers by instrument used and, when possible, HRQoL will be reported by disease type and stage of the disease. Descriptive statistics of the results will be provided. A narrative synthesis of studies will also be provided discussing differences in HRQoL measurements by instrument used to estimate it, type of dementia and disease severity. Ethics and dissemination This systematic literature review is exempt from ethics approval because the work is carried out on published documents. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer’s disease spectrum for better care: multimodal data access platform (ROADMAP)

Beta diversity of stream insects differs between boreal and subtropical regions, but land use does not generally cause biotic homogenization

Previous studies have found mixed results regarding the relationship between beta diversity and latitude. In addition, by influencing local environmental heterogeneity, land use may modify spatial taxonomic and functional variability among communities causing biotic differentiation or homogenization. We tested 1) whether taxonomic and functional beta diversities among streams within watersheds differ between subtropical and boreal regions and 2) whether land use is related to taxonomic and functional beta diversities in both regions. We sampled aquatic insects in 100 subtropical (Brazil) and 100 boreal (Finland) streams across a wide gradient of land use, including agriculture and exotic planted, secondary, and native forests. We calculated beta diversity at the watershed scale (among 5 streams in each watershed). We found higher taxonomic beta diversity among subtropical than among boreal streams, whereas functional beta diversity was similar between the 2 regions. Total land use was positively correlated with taxonomic and functional beta diversity among subtropical streams, while local environmental heterogeneity was positively correlated with beta diversity among boreal streams. We suggest that different types and intensities of land use may increase among-stream heterogeneity, promoting distinct insect assemblage compositions among streams. Our findings also suggest that beta diversity patterns and their underlying determinants are highly context dependent.Peer reviewe

A capacidade para melhorar o autocuidado: fatores de influência no potencial de recuperação da pessoa dependente

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El cuidado de familiares adultos: ¿Cómo afecta a la salud y al bienestar del cuidador familiar?

Introducción. El cuidado de un miembrode la familia con dependencia para los cuidados personales es un procesocomplejo que afecta a la salud y al bienestar del cuidador familiar. Objetivos. Sistematizar la producción científica nacional sobre las implicacionesen la salud y bienestar de los que tienen a su cargo cuidar familiares com dependencia en el autocuidado. Método. Se llevó a cabo una revisión integradora, respaldada por el Repositório Científico de Acesso Aberto de Portugal entre los años 2000 y 2012, en la que se tuvieron en cuenta todos los documentos completos accesibles. Seutilizó el método PI(CO)D. Para el análisis de los datos se solicitó la intervenciónde dos revisores independientes. Se utilizaron los indicadores del Joanna Briggs Institute para analizar la calidad metodológica de los estudios. Resultados. Se seleccionaron doce estúdios principales. La mayoría de ellos se basaban en investigación observacional de tipo transversal/descriptivo, lo cual permite describir el perfil de los cuidadores familiares e identificar sus necesidades y los factores relacionados con la sobrecarga. Los resultados muestran una mayor sobrecarga/estrés en los cuidadores familiares de personas con demencia y con un nivel elevado de dependencia. La mayor sobrecarga está relacionada con una mala percepción del estado de salud, de la satisfacción y de la calidad de vida del cuidador familiar. Los niveles de sobrecarga asociada, depresión emocional y estrés son más elevados en las mujeres que en los hombres. Conclusiones. La naturaleza de los estúdios utilizados permite identificar el impacto que supone el cuidado de un familiar con dependencia para los cuidadores familiares. No obstante, es imposible analizar los resultados de manera dinámica a lo largo de un periodo de tiempo. Es importante centrarse en la investigación basándose en los mejores datos clínicos disponibles para potenciar la toma de decisiones en la práctica clínica.info:eu-repo/semantics/publishedVersio