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.FUNDING INFORMATION: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. Journal Pre-proof. ACKNOWLEDGEMENTS: The authors would like to thank Roberto Martin Melón for his contribution to the literature search

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.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

Experiences of Nursing Students Participating in End-Of-Life Education Programs: A Systematic Review and Qualitative Metasynthesis

Objective: The aim of this review was to explore the experiences of nursing students participating in end-of-life education programs. Design: A systematic review. Data sources: Exhaustive literature searches were performed using seven electronic databases: Medline, Scopus, Web of Science, CINAHL Plus, Dialnet Plus, Eric and Cuiden Plus. Review methods: In total, 6572 studies published from 2008 until 2018 were examined. The Critical Appraisal Skills Program was used to assess the quality of the studies included in the review. The findings were synthesized using meta-aggregation. Results: Seventeen studies were included in this systematic review, representing a sample of 606 nursing students. Simulation methods were most common among the educational programs analyzed. The analysis of qualitative data allowed us to identify 260 illustrations which were grouped into 14 categories and three themes: feelings and emotions during the performance of the pedagogical activity, end-of-life education among nursing students and competencies acquired on death and end-of-life. The most highlighted communication skills were learning to listen and building confidence to speak with the patient, family and the general public. Conclusions: End-of-life programs generally helped students acquire communication skills, learn concepts and improve the administration of this type of care. In addition, they perceived the experience as an opportunity to learn more about oneself, gain trust and support critical thinking. Nonetheless, the evidence available in this field is limited due to the small number of studies, plus the limited data reported. Thus, further studies on this subject are necessary

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 (ISS24) 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

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.Funding: This project was funded by the University of Cantabria (Spain). Budget implementation 28.VU08.64662

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 of130 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 studentsThis research was funded by the University of Cantabria (Spain). Grant number 28.0000.229

Introducing a degrowth approach to the circular economy policies of food production, and food loss and waste management: towards a circular bioeconomy

There is a growing debate surrounding the contradiction between an unremitting increase in the use of resources and the search for environmental sustainability. Therefore, the concept of sustainable degrowth is emerging aiming to introduce in our societies new social values and new policies, capable of satisfying human requirements whilst reducing environmental impacts and consumption of resources. In this framework, circular economy strategies for food production and food loss and waste management systems, following the Sustainable Development Goals agenda, are being developed based on a search for circularity, but without setting limits to the continual increase in environmental impacts and resource use. This work presents a methodology for determining the percentage of degrowth needed in any food supply chain, by analyzing four scenarios in a life cycle assessment approach over time between 2020 and 2040. Results for the Spanish case study suggested a degrowth need of 26.8% in 2015 and 58.9% in 2040 in order to achieve compliance with the Paris Agreement targets, highlighting the reduction of meat and fish and seafood consumption as the most useful path.This research was funded by Spanish Ministry of Science and Competitiveness, grant number CERES‐PROCON Project CTM2016‐76176 (AEI/FEDER, UE) and KAIROS‐BIOCIR Project PID2019‐104925RB (AEO/FEDER, UE)

A critical review of superfoods from a holistic nutritional and environmental approach

n a global arena in which the identification of healthier and cleaner nutrient sources is practically mandatory, superfoods, known as foods of high nutritional and biological value with satisfactory bioavailability and bioactivity within the body due to extraordinary concentrations of nutrients and bioactive ingredients, can play a key role. These products are highly connected with sustainability, which is composed of an economic, envi- ronmental, and social balance, mainly translated in meeting nutritional needs. Focusing on the two latter aspects, this article is intended to provide a breakthrough in the knowledge by assessing the nutritional characteristics and environmental performance of superfoods. Firstly, a selection is made by revising the nutritional profile of different products. Secondly, a review of life cycle assessment (LCA) studies aims to establish guidelines for future analyses, based on the current state-of-art and possible recommendations, as well as to provide infor- mation on the impacts of these novel products. 40 superfoods are identified, of which only 15 have environ- mental analysis. The LCA revision enable to recognize methodological vulnerabilities based on the lack of definition of the function, allocations, uncertainty and quality assessments, as well as a weak justification on the selection of data sources and impact categories. Other recommendations include the possibility of using nutrient- based functional unit, extending system boundaries up to retailer, applying high quality primary data and standardized databases, and analyzing a wider range of indicators. Finally, this scientific field is still little explored, so the suitability of superfoods from an environmental perspective cannot be concluded, thus encouraging the use of LCA to fill this scientific gap.This work was supported by the Spanish Ministry of Science and Innovation through the KAIROS-BIOCIR project (PID2019-104925RB) (AEO/FEDER, UE). Ana Fern ́andez-Ríos thanks the Ministry of Economy and Competitiveness of Spanish Government for their financial support via the research fellowship RE2020-094029

Towards a sustainable agri-food system by an energetic and environmental efficiency assessment

Feeding the world’s population sustainably is a major challenge of our society and has been stated as one of the key priorities for development cooperation by the EU policy framework on food security. However, the current pattern of natural resources exploitation to meet humanity’s demand for food threatens long-term food security. Food systems represent around 30 % of final energy use, generating up to 30 % of greenhouse gas (GHG) emissions. Given the expected increase of global population (9 billion people by 2050) and the amount of food losses and waste generated (a third of global food production), improving the efficiency of food systems along the supply chain is essential to ensure food security. This work combines life cycle assessment (LCA) and data envelopment analysis (DEA) to assess the efficiency of Spanish agri-food system and propose improvement actions in order to reduce energy usage and GHG emissions. Results suggest that sweets and vegetable fats categories provide the largest nutritional energy to consumer per unit of embedded energy in its production. Around a 70 % average reduction target is estimated for the Spanish agri-food system to be efficient, with a similar reduction in related greenhouse gas emissions.The authors are grateful for the funding of the Spanish Ministry of Economy and Competitiveness through the Ceres-Procom: Food production and consumption strategies for climate change mitigation (CTM2016-76176- C2-1-R) (AEI/FEDER, UE)

Nutritional data management of food losses and waste under a life cycle approach: case study of the Spanish agri-food system

Food losses and waste (FLW) tend to be referred to in terms of mass, occasionally in economic terms, disregarding the nutritional-cost nexus of such losses. This work aims to estimate the nutritional food losses and waste (NFLW) of the Spanish agri-food system in terms of energy, macronutrients, fibre, and vitamins and minerals along the entire supply chain. Nutritional food losses (NFL) occurring prior to the distribution level, and nutritional food waste (NFW) at the retail and consumption stages, were distinguished, and 48 representative food commodities and 32 nutrients were characterised. To provide insight into the extent of these values, the results are compared to the equivalent recommended daily intake. In addition, the NFLW for an average Spanish citizen is compared to that for other representative diets: Mediterranean, lacto-ovo-vegetarian, and vegan along with the Spanish recommended guidelines. Finally, a nutritional cost footprint (NCF) indicator combining nutritional and economic variables is proposed to define recovery strategies. The results suggest that 4251 kj (1016 kcal), 70.7 g proteins, 22 g dietary fibre, 975 ug vitamin A, 117 mg vitamin C and 332 mg calcium daily per capita are embedded within Spanish FLW. Agricultural production accounts for 40% of NFLW, and fruits and vegetables are the categories with the largest potential for nutritional and economic food wastage mitigation. Results from this paper provide NFLW data and analysis to strengthen and simplify the decision-making process of FLW management strategies.The authors are grateful for the funding of the Spanish Ministry of Economy and Competitiveness through the Ceres-Procom Project: Food production and consumption strategies for climate change mitigation (CTM2016-76176-C2-1-R) (AEI/FEDER, UE)