Home exercise, branched-chain amino acids, and probiotics improve frailty in cirrhosis: A randomized clinical trial.

BACKGROUND: Frailty is a predictive factor of hospitalization, falls, and mortality in patients with cirrhosis, regardless of the degree of liver failure. The aim was to analyze whether a multifactorial intervention consisting of home-based exercise, branched-chain amino acids, and a multistrain probiotic can improve frailty in these patients. METHODS: Outpatients with cirrhosis were classified according to the Liver Frailty Index (LFI). Prefrail and frail patients were randomized into 2 groups. The intervention group was assigned to a multifactorial intervention consisting of exercise at home, branched-chain amino acid supplements, and a multistrain probiotic for 12 months. The control group received standard care. All patients were prospectively followed up every 3 months for 1 year to determine LFI, incidence of falls, emergency room visits, hospitalizations, and mortality. RESULTS: Thirty-two patients were included: 17 patients were assigned to the intervention group and 15 to the control group. In the intervention group, the baseline LFI decreased at 3, 6, 9, and 12 months (p = 0.019 for overall change with respect to the control group). The change in LFI (ΔLFI) at 12 months was -0.71 ± 0.24 in the intervention group and -0.09 ± 0.32 in the control group (p<0.001). During follow-up, patients in the intervention group had a lower 1-year probability of falls (6% vs. 47%, p = 0.03) and emergency room visits (10% vs. 44%, p = 0.04) than patients in the control group. CONCLUSIONS: A long-term multifactorial intervention that included exercise at home, branched-chain amino acids, and a multistrain probiotic improved frailty in outpatients with cirrhosis and was associated with a decrease in the incidence of clinical events such as falls and emergency room visits.

Phase angle by electrical bioimpedance is a predictive factor of hospitalisation, falls and mortality in patients with cirrhosis.

The phase angle is a versatile measurement to assess body composition, frailty and prognosis in patients with chronic diseases. In cirrhosis, patients often present alterations in body composition that are related to adverse outcomes. The phase angle could be useful to evaluate prognosis in these patients, but data are scarce. The aim was to analyse the prognostic value of the phase angle to predict clinically relevant events such as hospitalisation, falls, and mortality in patients with cirrhosis. Outpatients with cirrhosis were consecutively included and the phase angle was determined by electrical bioimpedance. Patients were prospectively followed to determine the incidence of hospitalisations, falls, and mortality. One hundred patients were included. Patients with phase angle ≤ 4.6° (n = 31) showed a higher probability of hospitalisation (35% vs 11%, p = 0.003), falls (41% vs 11%, p = 0.001) and mortality (26% vs 3%, p = 0.001) at 2-year follow-up than patients with PA > 4.6° (n = 69). In the multivariable analysis, the phase angle and MELD-Na were independent predictive factors of hospitalisation and mortality. Phase angle was the only predictive factor for falls. In conclusion, the phase angle showed to be a predictive marker for hospitalisation, falls, and mortality in outpatients with cirrhosis.

Frailty in outpatients with cirrhosis: A prospective observational study.

BACKGROUND AND AIM: Frailty is increasingly recognized as a major prognostic factor in cirrhosis in addition to conventional liver insufficiency scores. The aim was to compare the prevalence and characteristics of frailty between patients with cirrhosis and controls, and to analyse its prognostic value. METHODS: We included outpatients with cirrhosis and age- and gender-matched non-cirrhotic controls. Frailty was defined according to the Fried frailty criteria. In patients with cirrhosis, we analysed the ability of the degree of frailty to predict a composite endpoint, consisting of hospitalization, admission to a long-term care centre, falls or death. RESULTS: We included 135 patients with cirrhosis and 135 controls. The prevalence of frailty was higher among patients with cirrhosis: 35 (25.9%) frail, 74 (54.8%) pre-frail and 26 (19.2%) robust vs 14 (10.4%) frail, 67 (49.6%) pre-frail and 54 (40%) robust (P < .001) in controls. This difference was mainly as a result of decreased muscle strength in patients with cirrhosis. During follow-up, frail patients with cirrhosis showed a higher probability of composite endpoint, hospitalization and falls than pre-frail and robust cirrhotic patients but mortality was similar. MELD-Na score and frailty were independent predictive factors for hospitalization, frailty for falls, and MELD-Na score and albumin for survival. Vitamin D deficiency and increased cystatin C were associated with frailty. CONCLUSIONS: Frailty was more frequent in outpatients with cirrhosis than in controls, mainly because of a decrease in muscle strength, and it could be a predictive factor for hospitalization and falls in these patients.

El sentido de un final de estudios: El proceso de aprendizaje durante el grado de enfermería a partir del cuaderno de progresión transversal / Giving sense to finishing studies: nursing degree learning process and the transversal progress notebook

Introducción: El objetivo de este estudio es comprender la percepción de los estudiantes sobre su proceso de aprendizaje durante el grado de Enfermería, al final de la promoción 2011-15, mediante la utilización del Cuaderno de Progresión Transversal (CPT) como herramienta metodológica. Metodología: Estudio cualitativo interpretativo desde un enfoque biográfico-narrativo del CPT de la promoción 2011-15. Sesenta y un narrativas se codificaron y se analizaron a partir de un análisis de contenido interpretativo. Resultados: El análisis interpretativo permitió identificar cinco temas del proceso reductivo de las narrativas que ayudaron a comprender la percepción del estudiante sobre su proceso de aprendizaje; estos fueron: estudios de enfermería, Escola Universitària d’Infermeria de Sant Pau, profesorado, proceso de aprendizaje y balance personal. Conclusion: Los estudiantes, al terminar sus estudios, percibieron haber adquirido un aprendizaje complejo basado en competencias y dieron sentido al trayecto realizado y a nuevos horizontes a través de la reflexión; encontraron coherencia entre sus estudios, la visión humanista y la práctica; consolidaron su identidad y valores profesionales, así como su pericia reflexiva crítica. Finalmente, percibieron nuevas transiciones hacia los ámbitos laboral y formativo con sentimientos ambivalentes

Introduction: The aim of this study is to understand students’ learning process perception at the end of their Nursing Bachelor studies at the Nursing University EUI-Sant Pau. The group studied were senior students from the 2011-15 year, using the Transversal Progress Notebook (TNB) as a methodological tool. Methodology: Qualitative interpretive study from a biographical-narrative approach of the 2011-15 year’s TNB. The sixty-one narratives were codified and analyzed using interpretative content analysis. Results: The interpretative analysis identified five topics from the narrative reductive process that helped understand the students’ perception of their learning process. These were: Nursing Studies, Sant Pau Nursing School, Teaching Staff, Learning Process, and Personal Assessment. Conclusion: When finishing their studies, students perceive that they have acquired a complex learning process based on competencies. They give meaning to their journey as students and to new upcoming horizons through reflection and self-knowledge. They perceive coherence between their studies, the humanistic vision, and fieldwork. They also perceive the strengthening of identity and professional values as well as the ability for critical reflection and finally, perceive how their learning process changes as they make a new transition towards the working and training environment, having contradictory feelings of joy and uncertainty