Efecto de las intervenciones no invasivas en el bienestar y la calidad de vida de los pacientes con cáncer de pulmón: resultados de una revisión sistemática / Effect of non-invasive interventions for improving well-being and quality of life in patients with lung cancer of life: Results of a systematic review

Objetivo: Presentar los resultados de una revisión sistemática que evaluó la efectividad de las intervenciones no invasivas realizadas por las enfermeras para mejorar el bienestar de los pacientes con cáncer de pulmón. Métodos: Revisión sistemática de ensayos clínicos sobre intervenciones no invasivas para pacientes con cáncer de pulmón. Se desarrolló una búsqueda exhaustiva en las principales bases de datos. Se evaluaron las referencias recuperadas en la búsqueda para identificar estudios relevantes. La calidad metodológica de los ensayos incluidos se evaluó prestando atención al método de aleatorización y a la ocultación de la secuencia de asignación. La heterogeneidad de las intervenciones y las variables de resultado descritas en los ensayos no hizo posible un análisis estadístico de los resultados, por lo que se sintetizaron de forma narrativa. Resultados: La revisión incluyó 9 ensayos clínicos de calidad variable que evaluaron programas de intervención de enfermería, una intervención nutricional, una intervención psicoterapéutica, un programa de ejercicio y unas sesiones de reflexología. Los programas de enfermería para el tratamiento de la disnea pueden causar beneficio. El seguimiento de los pacientes por parte de enfermeras parece ser efectivo, y comporta una mayor satisfacción. Una intervención psicoterapéutica puede contribuir en que el paciente afronte de una forma efectiva los síntomas físicos relacionados con su enfermedad. Es incierto cuál es la mejor forma de aplicar estas intervenciones. No hay evidencia clara alrededor del resto de intervenciones evaluadas. Conclusiones: Es necesario considerar la inversión en programas multidisciplinares para el manejo de los pacientes con cáncer de pulmón tanto en sus hogares como en los centros sanitarios. Los estudios deberían mejorar su calidad metodológica, con diseños claros y una metodología sólida para que las preguntas de investigación puedan ser contestadas de una forma contundente

Aim: To highlight the results of a systematic review on the effect of non-invasive interventions delivered to lung cancer patients in improving their well-being and quality of life. Métodos: Systematic review of clinical trials assessing non-invasive interventions in lung cancer patients. Exhaustive bibliographic search in the main databases, and selection of the retrieved records to identify relevant trials on the topic. Methodological quality assessment paying special attention in randomization and allocation concealment. Heterogeneity among interventions and outcomes assessed in the included studies forced to synthesize results narratively. Results: The review identified 9 clinical trials of variable quality assessing nursing programmes interventions, a nutritional intervention, counselling, an exercise programme, and reflexology. Nursing programmes to manage breathlessness seemed to have beneficial effects, as well as a nursing led assessment and follow up programme. Some counselling sessions could provide patients with skills to face simptoms better. The way to implement those interventions remains unknown. Conclusions: Implemention of multidisciplinary programmes to manage patients with lung cancer should be seriously considered. There exists the need for higher quality studies, with clear designs and methodologies that lead to stronger conclusions

Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis.

CONTEXT: In patients with acute cardiogenic pulmonary edema noninvasive ventilation may reduce intubation rate, but the impact on mortality and the superiority of one technique over another have not been clearly established. OBJECTIVE: To systematically review and quantitatively synthesize the short-term effect of noninvasive ventilation on major clinical outcomes. DATA SOURCES: MEDLINE and EMBASE (from inception to October 2005) and Cochrane databases (library issue 4, 2005) were searched to identify relevant randomized controlled trials and systematic reviews published from January 1, 1988, to October 31, 2005. STUDY SELECTION AND DATA EXTRACTION: Included trials were all parallel studies comparing noninvasive ventilation to conventional oxygen therapy in patients with acute pulmonary edema. Comparisons of different techniques, either continuous positive airway pressure (CPAP) or bilevel noninvasive pressure support ventilation (NIPSV), were also included. DATA SYNTHESIS: Fifteen trials were selected. Overall, noninvasive ventilation significantly reduced the mortality rate by nearly 45% compared with conventional therapy (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.40-0.78; P = .72 for heterogeneity). The results were significant for CPAP (RR, 0.53; 95% CI, 0.35-0.81; P = .44 for heterogeneity) but not for NIPSV (RR, 0.60; 95% CI, 0.34-1.05; P = .76 for heterogeneity), although there were fewer studies in the latter. Both modalities showed a significant decrease in the "need to intubate" rate compared with conventional therapy: CPAP (RR, 0.40; 95% CI, 0.27-0.58; P = .21 for heterogeneity), NIPSV (RR, 0.48; 95% CI, 0.30-0.76; P = .24 for heterogeneity), and together (RR, 0.43; 95% CI, 0.32-0.57; P = .20 for heterogeneity). There were no differences in intubation or mortality rates in the analysis of studies comparing the 2 techniques. CONCLUSIONS: Noninvasive ventilation reduces the need for intubation and mortality in patients with acute cardiogenic pulmonary edema. Although the level of evidence is higher for CPAP, there are no significant differences in clinical outcomes when comparing CPAP vs NIPSV.

Non-invasive interventions for improving well-being and quality of life in patients with lung cancer--a systematic review of the evidence.

Despite advances in lung cancer treatment, the outlook for most patients remains grim. Many of them face a short survival time during which they may suffer physical and psychological problems related with the cancer and the treatment side-effects. There is a need for a high quality care to support patients and reduce symptoms as much as possible. This systematic review found that a specialised nursing programme to reduce breathlessness was effective and that after patients' treatment had finished, those cared by nurses did as well or even better than those cared by doctors.

A nursing qualitative systematic review required MEDLINE and CINAHL for study identification.

OBJECTIVE: Analyze the number and the relevance of references retrieved from CINAHL, MEDLINE, and EMBASE to perform a nursing systematic review. STUDY DESIGN: A search strategy for the review topic was designed according to thesaurus terms. The study analyzes (1) references with abstract, (2) overlap between databases, (3) reference relevance, (4) relevance agreement between experts, and (5) reference accessibility. RESULTS: Bibliographic search retrieved 232 references: 16% (37) in CINAHL, 68% (157) in MEDLINE, and 16% (38) in EMBASE. Of these, 72% (164) were references retrieved with an abstract: 14% (23) in CINAHL, 70% (115) in MEDLINE, and 16% (26) in EMBASE. Overlap was observed in 2% (5) of the references. Relevance assessment reduced the number of references to 43 (19%): 12 (34.3%) in CINAHL, 31 (19.7%) in MEDLINE, and none in EMBASE (Z=-1.97; P=.048). Agreement between experts achieved a maximum Cohen's kappa of 0.76 (P < .005). References identified in CINAHL were the most difficult to obtain (chi(2)=3.9; df=1; P=.048). CONCLUSIONS: To perform a quality bibliographic search for a systematic review on nursing topics, CINAHL and MEDLINE are essential databases for consultation to maximize the accuracy of the search.

Validez de la escala de Norton para valorar el riesgo de presentar úlceras por presión en un hospital terciario. Comparación con la escala EMINA© / Validity of the Norton scale in evaluating the risk of pressure ulcers in a tertiary hospital. Comparison with the EMINA© scale

Objetivo. El objetivo del estudio es comparar la eficiencia de la escala de Norton con la de la escala EMINA©. Pacientes y método. Estudio observacional, transversal y retrospectivo. Los sujetos incluidos son los pacientes hospitalizados en un hospital de tercer nivel. Las variables analizadas son: evaluación del riesgo con la escala de Norton y aparición o no de úlceras por presión durante el período de hospitalización. Resultados. Se ha estudiado a un total de 865 pacientes distribuidos en 3 grupos cronológicos: G1, con 288 pacientes, G2, con 300, y G3, con 277 pacientes. La prueba de la X2 no ha revelado diferencias en el número de pacientes ni en el número de úlceras por presión. Tampoco se han observado diferencias significativas con el test de ANOVA al comparar la puntuación de la escala de Norton en los 3 grupos. La regresión logística de la escala de Norton en relación con la presencia de úlceras por presión a los 7 días muestra una clara significación estadística (p < 0,0005).El valor de la odds ratio fue de 0,707 (intervalo de confianza del 95 por ciento, 0,647-0,772), valor que indica que el incremento de la puntuación en la escala de Norton es un factor protector. El mejor punto de corte del valor de la escala Norton para predecir el riesgo de aparición de úlcera es de 14 (con una sensibilidad del 84 por ciento y una especificidad del 83 por ciento), cifra que coincide con el valor descrito en la bibliografía. La comparación de la escala de Norton con la escala EMINA© indica que las áreas de la curva ROC son distintas. Sin embargo, la comparación de los intervalos de confianza no permite inferir que las escalas sean estadísticamente distintas. Conclusiones. Se pone de manifiesto que la escala de Norton es una herramienta eficaz en un hospital de tercer nivel. Si comparamos los resultados del estudio con los de validación de la escala EMINA©, los resultados obtenidos son similares en términos de eficiencia. No parece que esté indicado plantearse el cambio de escala en nuestro medio (AU)

Which nursing issues need a European guideline: proposal for respiratory management.

Over the past 30 years, nursing care and health systems have undergone significant changes in many aspects. Particularly, in the last decade, research and the expansion of Evidence-Based Practice (EBP) have played a significant role in this process. EBP is the application of the best available evidence, which in practice means more effective interventions, more efficient use of resources and fewer side effects for patients. From a research point of view, EBP can facilitate the identification of knowledge gaps and thereby help establish research priorities. Furthermore, research evidence may suggest that a change in practice is necessary. When this occurs, one of the best ways to implement such change is through the use of guidelines. Clinical Practice Guidelines (CPG) are "systematically developed statements to assist practitioner decisions about appropriate healthcare for specific clinical circumstances". Whenever possible, CPG help to infuse research into practice and to promote quality and standardisation of care. Nursing care will have a considerably greater impact if evidence-based care is applied. For this reason, it is important to identify the available evidence of respiratory management in order to establish nursing CPG across Europe. The aim of this paper is to analyse the framework in which these guidelines should be applied and to identify which nursing issues should have CPG. Based on the North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC), this study establishes the main nursing diagnoses for a patient with Acute Respiratory Failure (ARF). Moreover, the current situation regarding respiratory management and the safety of nursing practice procedures are described.