Instrumentos de avaliação multidimensional de fragilidade para uso no cuidado de idosos com doença cardiovascular / Multidimensional frailty assessment tools for use in the care of older adults with cardiovascular disease / Instrumentos de evaluación multidimensional de la fragilidad en la atención de adultos mayores con enfermedad cardiovascular

Objetivo: identificar quais os instrumentos disponíveis para avaliação multidimensional da fragilidade em idosos com doença cardiovascular, potencialmente aplicáveis durante a realização do Processo de Enfermagem. Método: revisão sistemática conduzida em oito bases de dados/portais, para identificação de estudos que apresentassem instrumentos multidimensionais de avaliação de fragilidade em idosos com doença cardiovascular e que fossem aplicáveis ao processo de enfermagem. Resultados: foram incluídos 19 instrumentos multidimensionais. O Brief Frailty Index for Coronary Artery Disease foi desenvolvido para uso no cuidado cardiovascular de idosos. O Frailty Index for Adults e o Maastricht Frailty Screening Tool for Hospitalized Patients foram desenvolvidos para uso no Processo de Enfermagem. Conclusão: apesar de apenas um instrumento ter sido desenvolvido para o idosos com doença cardiovascular e apenas dois serem aplicáveis ao processo de enfermagem, a maioria deles tem potencial de adaptação e validação para uso nesta população durante a avaliação de enfermagem.

Objective: to identify which tools are available for multidimensional frailty assessment of older adult with cardiovascular disease and which are potentially applicable during the Nursing Process. Method: a systematic review conducted in eight databases/portals to identify studies that presented multidimensional frailty assessment tools for older adult with cardiovascular disease and that were applicable to the nursing process. Results: a total of 19 multidimensional tools were included. The Brief Frailty Index for Coronary Artery Disease was developed for use in the cardiovascular care of older adult. The Frailty Index for Adults and the Maastricht Frailty Screening Tool for Hospitalized Patients were developed for use in the Nursing Process. Conclusion: although only one tool was developed for older adults with cardiovascular disease and only two are applicable to the nursing process, most of them have the potential to be adapted and validated for use in this population during nursing assessment.

Objetivo: identificar qué instrumentos están disponibles para la evaluación multidimensional de la fragilidad en personas mayores con enfermedad cardiovascular, que se puedan aplicar en el Proceso de Enfermería. Método: revisión sistemática realizada en ocho bases de datos/portales, para identificar estudios que presentaran instrumentos multidimensionales para la evaluación de la fragilidad en adultos mayores con enfermedad cardiovascular y que fueran aplicables al proceso de enfermería. Resultados: se incluyeron 19 instrumentos multidimensionales. El Brief Frailty Index for Coronary Artery Disease se desarrolló para usarlo en el cuidado cardiovascular de las personas mayores. El Frailty Index for Adults y la Maastricht Frailty Screening Tool for Hospitalized Patients se elaboraron para ser usados en el Proceso de Enfermería. Conclusión: aunque sólo se elaboró un instrumento para adultos mayores con enfermedad cardiovascular y sólo dos son aplicables al proceso de enfermería, la mayoría de ellos tienen el potencial para ser adaptados y validados para ser usados en esa población en la evaluación de enfermería.

Psychometric Properties of the FRAIL Scale for Frailty Screening: A Scoping Review.

OBJECTIVES: The aim of this study was to identify and map the available psychometric evidence of the FRAIL scale to screen frailty among older adults. DESIGN: Scoping review of published articles on 9 databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane, Embase, PsycINFO, VHL Regional Portal, and Epistemonikos) and 8 gray literature sources. SETTING AND PARTICIPANTS: Studies in adults or older adults, in both inpatient and outpatient settings (without context restrictions). METHODS: Cross-cultural adaptations, validity and reliability evidence studies, whose main objective was to develop and/or validate and/or culturally adapt the FRAIL Scale to assess frailty in adults or older adults, published since 2007 were included in this scoping review. The databases were searched between February and March 2023.The JBI methodology for scoping reviews was used to guide the process. The protocol of this study was registered on the Open Science Framework platform. RESULTS: Of the 1031 records found during the search, 40 articles that met the established criteria for analysis were included. Nearly 1 in 10 countries worldwide (11.9%) have psychometric evidence regarding this scale. Ten studies were identified with the goal of cross-cultural adaptation and/or validation in a different cultural context for the first time. Twenty-one of 40 studies used Morley 2012 operationalization of FRAIL Scale criteria. Thirty-nine studies provided evidence of associations with other variables. The rest of the evidence for content, internal structure, response processes, and reliability was only evaluated in cross-cultural adaptation studies, with limitations. CONCLUSIONS AND IMPLICATIONS: In conclusion, there is some evidence of validity for FRAIL Scale; nevertheless, studies are needed to adapt the scale to new cultures, using rigorous Cross-Cultural Adaptation processes, and to provide new evidence of validity and reliability, to strengthen and consolidate the body of knowledge for its application to various patient groups and context.

The ICOPE-WHO and the IVCF-20: a critical view of the Handbook for Multidimensional Geriatric Assessment in Primary Care / O ICOPE-OMS e o IVCF-20: observações críticas sobre o Manual de Avaliação Multidimensional da Pessoa Idosa para a Atenção Primária à Saúde

O rápido envelhecimento populacional impulsiona iniciativas com o objetivo de otimizar a saúde da população idosa em todo o mundo. Recentemente, no Brasil, foi publicado pelo Conselho Nacional dos Secretários de Saúde (CONASS) o Manual de Avaliação Multidimensional da Pessoa Idosa, que propõe a adoção combinada e em larga escala da ferramenta de triagem do ICOPE da Organização Mundial da Saúde (OMS) e do instrumento Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) para definir linhas de cuidado à pessoa idosa. Embora iniciativas dessa natureza sejam prementes, os instrumentos propostos ainda não têm validação adequada na população brasileira, e a sua utilização com o objetivo de balizar diretrizes em saúde em todo o território nacional parece precipitada e arriscada. Diante disso, propõe-se um debate amplo e urgente entre os especialistas da área, com o objetivo de planejar políticas de saúde pública eficazes e seguras para a população idosa brasileira. (AU)

Rapid population aging is driving initiatives aimed at optimizing the health of older populations worldwide. In Brazil, the National Council of State Secretaries of Health (CONASS) recently published the Handbook for Multidimensional Geriatric Assessment in Primary Care, which proposes the combined, large-scale adoption of the World Health Organization (WHO) ICOPE screening tool and the Clinical-Functional Vulnerability Index-20 (IVCF-20) instrument to define care pathways for older people. Although there is a pressing need for initiatives of this nature, the proposed instruments have not yet been adequately validated in the Brazilian population, and their use for the purpose of establishing countrywide health guidelines appears hasty and risky. Therefore, we propose a broad, urgent debate among experts in the field with the aim of planning effective and safe public health policies for the Brazilian older population. (AU)

Digital Health Literacy Instrument: Brazilian Version-Cross-Cultural Adaptation and Content Validity for Individuals With Heart Failure.

Background and purpose: Assessment of digital health literacy should be a major concern for healthcare providers. We aimed to translate and adapt the Digital Health Literacy (DHL) Instrument into Brazilian Portuguese and examine the content validity for individuals with heart failure (HF). Methods: The instrument was translated, back translated, and evaluated by a panel of six experts regarding linguistic equivalences. An agreement analysis was performed, with values ≥80% considered acceptable. The experts then evaluated clarity, theoretical relevance, and practical pertinence. The content validity index (CVI) was calculated for each item. A CVI ≥.83 was considered acceptable. The expert's opinions were also evaluated through the modified kappa coefficient for content validity studies. Values >.74 were considered excellent. The content validity ratio (CVR) was also calculated. A critical value of CVR of 1.00 was determined. Cognitive testing (understanding the meaning of each item and their respective answers) was performed with 33 individuals with HF. Results: The adapted version obtained an agreement of ≥83.3% for each item on linguistic equivalences. Total CVI was ≥0.83, kappa values for each item were >.74, and the CVR values were 1.00 for all items. After two rounds of evaluation, all patients were able to understand the items and response scale. Conclusions: The Brazilian version has satisfactory evidence of linguistic and content validity to measure DHL in patients with HF. Additional psychometric properties will be tested in the country.

Content validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21.

OBJECTIVE: to cross-culturally adapt and assess the content validity evidence of the Cognitive Symptom Checklist-Work-21 for the Brazilian context. METHOD: a psychometric study of cross-cultural adaptation, covering the stages of translation, reconciliation, back-translation, intercultural equivalence assessment and content validity evidence analysis, considering Content Validity Ratio parameters in breast cancer survivors. RESULTS: the translations were equivalent to the original version. Colloquial expressions were modified, tense, verbal adjusted, and two items containing multiple commands were separated. The final version now contains 22 items, presenting semantic, conceptual, idiomatic and experimental equivalences. The pre-test indicated good understanding and ease in the response process. CONCLUSION: the final version was defined as "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", showing good linguistic equivalence and strong evidence of content validity in the Brazilian context.

Elaboração e validação da Escala Brasileira de Percepção sobre Eutanásia / Elaboration and validation of the Brazilian Scale of Perception about Euthanasia / Elaboración y validación de la Escala Brasileña de Percepción sobre la Eutanasia

Resumo Esta pesquisa buscou elaborar um instrumento para identificar a percepção de enfermeiros sobre eutanásia e testar suas evidências de validade de conteúdo, processo de resposta, estrutura interna e confiabilidade. Realizou-se estudo psicométrico por meio de avaliação empreendida por comitê de juízes, pré-teste e validação. O processo de validação incluiu 821 enfermeiros. Realizaram-se análises fatoriais exploratórias e confirmatórias. Elaboraram-se 55 itens com base em revisão de literatura e, após análise por juízes, as alterações sugeridas foram aplicadas, e todos os itens apresentaram concordância acima de 80% entre os avaliadores. As análises fatoriais exploratória e confirmatórias indicaram um ajuste satisfatório de um modelo bidimensional e bons índices de confiabilidade (α=0,85; Ω=0,89). A escala de 12 itens demonstrou boas evidências de validade e confiabilidade, podendo ser utilizada para mensurar a percepção sobre eutanásia por enfermeiros.

Abstract This research elaborated an instrument to identify nurses' perception on euthanasia and test its content validity, response process, internal structure and reliability evidences. A psychometric study was conducted through evaluation by a committee of judges, pre-test, and validation. The latter step included 821 nurses. Exploratory and confirmatory factor analyses were performed. A total of 55 items were elaborated based on a literature review. After review by judges and applying the suggested changes, all items showed agreement above 80% between evaluators. Exploratory and confirmatory factor analyses indicated a satisfactory fit of a two-dimensional model and good reliability indices (α=0.85; Ω=0.89). The 12-item scale showed good validity and reliability evidences, and can be used to measure nurses' perception on euthanasia.

Resumen Esta investigación buscó desarrollar un instrumento para identificar la percepción del profesional enfermero sobre la eutanasia y probar su evidencia de validez de contenido, proceso de respuesta, estructura interna y confiabilidad. Se realizó un estudio psicométrico mediante la evaluación realizada por un comité de jueces, pretest y validación. El proceso de validación incluyó a 821 enfermeros. Se realizaron análisis factoriales exploratorios y confirmatorios. Se elaboraron 55 ítems con base en una revisión de la literatura y, luego del análisis de los jueces, se aplicaron las modificaciones sugeridas, y todos los ítems mostraron concordancia superior al 80% entre los evaluadores. Los análisis factoriales exploratorio y confirmatorio indicaron un ajuste satisfactorio de un modelo bidimensional y buenos índices de confiabilidad (α=0,85; Ω=0,89). La escala de 12 ítems mostró buena evidencia de validez y confiabilidad y puede ser utilizada para medir la percepción del personal enfermero sobre la eutanasia.

Carga de trabalho de enfermagem e requisição das atividades no cuidado de pessoas idosas em terapia intensiva / Nursing Workload and care required by older adults in intensive care

Resumo Objetivo Analisar a carga de trabalho e requisição de cuidados de enfermagem de pessoas idosas admitidas na unidade de terapia intensiva (UTI) em comparação com adultos. Método estudo transversal realizado em duas UTI de dois hospitais (público e privado) na região metropolitana de São Paulo. Foram extraídas do prontuário eletrônico de pacientes admitidos nas unidades no ano de 2019 as seguintes variáveis: idade, sexo, tempo de internação em UTI, escore Simplified Acute Physiology Score (SAPS 3) e do Nursing Activities Score (NAS). Os dados foram analisados por meio de estatística descritiva. A comparação de médias foi feita pelo teste T de Student e a associação entre as frequências das intervenções requeridas pelos participantes através do teste exato de Fischer. Resultados Foram incluídos no estudo 495 pacientes, dos quais 56,6% eram pessoas idosas com idade média de 74,9± 9,5 anos. O tempo de permanência das pessoas idosas na UTI foi de 6,0±7,7 dias. Verificou-se que a pontuação média do SAPS3 admissional foi de 48,3±13,7 pontos e a pontuação do NAS, também admissional, foi de 71,0±10,4 pontos, sendo maior entre pessoas idosas do que entre os adultos, tanto para a gravidade (p<0,001) quanto para a carga de trabalho (p=0,007). Conclusão a idade avançada está associada com uma maior carga de trabalho da enfermagem em unidade de cuidados intensivos e maior chance de ocorrência de intervenções, associada à maior gravidade na admissão e maior tempo de internação na UTI por essa população em comparação aos adultos.

Abstract Objective To analyze the workload and nursing care requirements of elderly people admitted to the intensive care unit (ICU) compared to adults. Method Cross-sectional study carried out in two ICUs of two hospitals (public and private) in the metropolitan region of São Paulo. The following variables were extracted from the electronic medical records of patients admitted to the units in 2019: age, gender, length of ICU stay, Simplified Acute Physiology Score (SAPS 3) and Nursing Activities Score (NAS). The data was analyzed using descriptive statistics. Means were compared using Student's t-test and the association between the frequencies of interventions required by the participants using Fischer's exact test. Results The study included 495 patients, 56.6% of whom were elderly with a mean age of 74.9± 9.5 years. The length of stay of the elderly in the ICU was 6.0±7.7 days. It was found that the average SAPS3 score on admission was 48.3±13.7 points and the NAS score, also on admission, was 71.0±10.4 points, being higher among older people than adults, both for severity (p<0.001) and workload (p=0.007). Conclusion Older age is associated with a greater workload for intensive care unit nurses and a greater chance of interventions, associated with greater severity on admission and longer ICU stays for this population compared to adults.

Content validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21 / Evidencia de validez de contenido de la versión brasileña del Cognitive Symptom Checklist-Work-21 / Evidências de validade de conteúdo da versão brasileira do Cognitive Symptom Checklist-Work-21

ABSTRACT Objective: to cross-culturally adapt and assess the content validity evidence of the Cognitive Symptom Checklist-Work-21 for the Brazilian context. Method: a psychometric study of cross-cultural adaptation, covering the stages of translation, reconciliation, back-translation, intercultural equivalence assessment and content validity evidence analysis, considering Content Validity Ratio parameters in breast cancer survivors. Results: the translations were equivalent to the original version. Colloquial expressions were modified, tense, verbal adjusted, and two items containing multiple commands were separated. The final version now contains 22 items, presenting semantic, conceptual, idiomatic and experimental equivalences. The pre-test indicated good understanding and ease in the response process. Conclusion: the final version was defined as "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", showing good linguistic equivalence and strong evidence of content validity in the Brazilian context.

RESUMEN Objetivo: realizar la adaptación transcultural y evaluar las evidencias de validez de contenido del Cognitive Symptom Checklist-Work-21 para el contexto brasileño. Método: estudio psicométrico de adaptación transcultural, abarcando las etapas de traducción, reconciliación, retrotraducción, evaluación de equivalencia intercultural y análisis de evidencias de validez de contenido, considerando parámetros de Content Validity Ratio en sobrevivientes de cáncer de mama. Resultados: las traducciones fueron equivalentes a la versión original. Se modificaron las expresiones coloquiales, se tensaron, se ajustaron las verbales y se separaron dos ítems que contenían múltiples comandos. La versión final ahora contiene 22 ítems, presentando equivalencia semántica, conceptual, idiomática y experimental. El pre-test indicó buena comprensión y facilidad en el proceso de respuesta. Conclusión: la versión final fue definida como "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", mostrando buena equivalencia lingüística y fuerte evidencia de validez de contenido en el contexto brasileño.

RESUMO Objetivo: realizar a adaptação transcultural e avaliar as evidências de validade de conteúdo do Cognitive Symptom Checklist-Work-21 para o contexto brasileiro. Método: estudo psicométrico de adaptação transcultural, abrangendo as etapas de tradução, reconciliação, retrotradução, avaliação de equivalência intercultural e análise das evidências de validade de conteúdo, considerando parâmetros de Content Validy Ratio em sobreviventes de câncer de mama. Resultados: as traduções demonstraram equivalência à versão original. Expressões coloquiais foram modificadas, o tempo verbal ajustado, e dois itens contendo múltiplos comandos foram separados. A versão final passou a conter 22 itens, apresentando equivalências semântica, conceitual, idiomática e experimental. Os valores de CVR mantiveram-se acima de 0,87. O pré-teste indicou boa compreensão e facilidade no processo de resposta. Conclusão: a versão final foi definida como "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", apresentando boa equivalência linguística e fortes evidências de validade de conteúdo no contexto brasileiro.

The role of assessment in competence-based gerontological advanced practice nursing.

Population aging challenges healthcare systems, requiring gerontological advanced practice nurses (GAPN) to address specific and complex care requirements of older adults. GAPN implement evidence-based practices directed to patients and families, focusing on health promotion and protection, disease prevention, recovery, and rehabilitation. In competence-based gerontological advanced practice, comprehensive geriatric assessment is essential for implementing the care plan. In this theoretical essay we reflect about the role of assessment in competence-based advanced nursing practice directed to the care of older adults. From our perspective, geriatric assessment for a high-quality practice must be comprehensive, multidimensional, interdisciplinary, and planned. GAPN must have solid competencies for clinical skills and caring practices; education for health literacy; collaborative care; system management for continuity of care; ethics, advocacy, and moral agency; and evidenced-based practice inquiry. Gerontological models of care and GAPN competencies serve as frameworks to guide practice while assessment is fundamental for providing age-friendly care to older adults.

Incidence of Medical Adhesive-Related Skin Injuries and Associated Factors After Pediatric Congenital Heart Surgery: A Prospective Cohort Study.

PURPOSE: The aim of this study was to identify the incidence, characteristics, and factors associated with medical adhesive-related skin injuries (MARSI). DESIGN: Prospective cohort study. SUBJECTS AND SETTINGS: The sample comprised 136 children in the postoperative period after congenital heart surgery. The study setting was in a 31-bed pediatric surgical intensive care unit (ICU) of a university hospital in Sao Paulo, Brazil. METHODS: Patients were followed from admission, with daily skin assessments, until the onset of MARSI or ICU discharge. Outcomes were compared by Fisher's exact test, Pearson's χ2 test, Mann-Whitney test, Brunner-Munzel test, and Welch 2-sample t test. RESULTS: The incidence of MARSI was 60.3%, with 85 injuries in 82 patients. The highest occurrence was on postoperative day 2 (27 wounds; 31.8%). The most frequent medical adhesive associated with MARSI was transparent film dressing (n = 74; 86.6%). Factors associated with MARSI were age (P = .000), number of devices inserted (P = .000), Braden Q Scale score (P = .005), duration of surgery (P = .021), cardiopulmonary bypass duration (P = .000), duration of mechanical ventilation (P = .000), and length of ICU stay (P = .000). Children who developed MARSI received more blood components (P = .039), vasopressors (P = .000), and corticosteroids (P = 0.000); required longer sedation (P = .000); and had more edema (P = .001). CONCLUSION: This high incidence indicates the need for greater awareness and prompt action in response to MARSI. Polyurethane transparent film without concurrent use of a skin barrier product should be avoided.

Validade do Índice de Katz para avaliar a dependência em pacientes em tratamento oncológico / Validez del Índice de Katz para evaluar la dependencia de pacientes en tratamiento oncológico / Validity of Katz Index to assess dependency in patients on oncology treatment

Resumo Objetivo Analisar a validade de constructo do Índice de Katz para pacientes com diagnóstico de câncer. Método Estudo psicométrico realizado para avaliar as evidências da validade da versão brasileira do Índice de Katz em pacientes com diagnóstico de câncer. Estudo realizado com 691 pacientes hospitalizados entre abril e junho de 2016. Os dados foram analisados por análise fatorial exploratória e confirmatória. A confiabilidade foi avaliada pelo alfa de Cronbach e ômega de McDonald. Resultado Os participantes eram em sua maioria mulheres (72,6%), média de idade de 53,7±13,28 anos; 55,3% dos pacientes relataram não precisar de cuidador, e 56,6% não tinham cuidador. Dos 42,5% que precisavam de ajuda, o cuidador predominante foi um familiar (39,6%). A análise fatorial exploratória e confirmatória evidenciou que o Índice de Katz é um instrumento unidimensional, válido e confiável para avaliar a dependência nesta população, com boa variância e sem evidência de multicolinearidade ou necessidade de revisão (KMO=0,89437; teste de Bartlett x2 =3337,2 p<0,001; UNICO=0,999, EC=0,974; MIREAL=0,122). O Índice de Katz explica 97,72% do fenômeno e os resultados indicam bom ajuste do modelo, nível aceitável de resíduos e boa confiabilidade (G-H=0,986; α-Cronbach=0,970560; Ω-McDonald=0,971787) para avaliar a independência para atividades de vida diária básicas em pacientes com diagnóstico de câncer. Conclusão A versão brasileira do Índice de Katz apresenta excelentes evidências da validade de constructo e confiabilidade, podendo ser utilizada como instrumento clínico para avaliar a dependência de pacientes em tratamento oncológico.

Resumen Objetivo Analizar la validez de constructo del Índice de Katz para pacientes con diagnóstico de cáncer. Método Estudio psicométrico realizado para evaluar las evidencias de la validez de la versión brasileña del Índice de Katz de pacientes con diagnóstico de cáncer. Estudio realizado con 691 pacientes hospitalizados entre abril y junio de 2016. Los datos fueron analizados por análisis factorial exploratorio y confirmatorio. La fiabilidad fue evaluada por el alfa de Cronbach y omega de McDonald. Resultado Los participantes eran en su mayoría mujeres (72,6 %), edad promedio de 53,7±13,28 años; el 55,3 % de los pacientes relató que no necesitaba cuidador, y el 56,6 % no tenía cuidador. Del 42,5 % que necesitaba ayuda, el cuidador predominante fue un familiar (39,6 %). El análisis factorial exploratorio y confirmatorio evidenció que el Índice de Katz es un instrumento unidimensional, válido y confiable para evaluar la dependencia de esta población, con una buena varianza y sin evidencia de multicolinealidad ni necesidad de revisión (KMO=0,89437; prueba de Bartlett x2 =3337,2 p<0,001; UNICO=0,999, EC=0,974; MIREAL=0,122). El Índice de Katz explica el 97,72 % del fenómeno y los resultados indican una buena adaptación del modelo, un nivel aceptable de residuos y buena fiabilidad (G-H=0,986; α-Cronbach=0,970560; Ω-McDonald=0,971787) para evaluar la independencia de AVD básicas en pacientes con diagnóstico de cáncer. Conclusión La versión brasileña del Índice de Katz presenta excelentes evidencias de la validez de constructo y fiabilidad, por lo que puede ser utilizada como instrumento clínico para evaluar la dependencia de pacientes en tratamiento oncológico.

Abstract Objective To analyze construct validity of the Katz Index for patients with cancer diagnoses. Methods Psychometric study, performed to evaluate evidences of validity of the Brazilian version of the Katz Index in patients with cancer diagnoses. The study was conducted in 691 hospitalized patients between April and June 2016. Data was analyzed by Exploratory and Confirmatory Factor Analysis. Reliability was assessed by Cronbach's Alpha and McDonald's Ômega. Results Participants were mostly women (72.6%), with a mean age of 53.7±13.28 years; 55.3% reported that they did not need caregivers, and 56.6% did not have caregivers. Of the 42.5% who need help, predominant caregiver was a relative (39.6%). Exploratory and Confirmatory Factor Analysis evidenced that Katz Index is a unidimensional instrument, valid and reliable to assess dependency in this population, with a good variance and no evidence of multicollinearity or need of revision (KMO=0.89437; x2 Bartlett=3337.2 p<0.001; UNICO=0.999, EC=0.974; MIREAL=0.122). Katz Index explains 97.72% of the phenomenon and results indicate good adjustment of the model, acceptable level of residuals and good reliability (G-H=0.986; α-Cronbach=0.970560; Ω-McDonald=0.971787) to assess independence to basic activity daily living in patients with cancer diagnoses. Conclusion The Brazilian version of the Katz Index presents excellent evidences of construct validity and reliability in its Brazilian version, and may be used as a clinical instrument to assess dependency of patients on oncology treatment.

The role of assessment in competence-based gerontological advanced practice nursing / O papel da avaliação na prática avançada de enfermagem gerontológica baseada em competências / El papel de la evaluación en la enfermería de práctica avanzada gerontológica basada en competencias

ABSTRACT Population aging challenges healthcare systems, requiring gerontological advanced practice nurses (GAPN) to address specific and complex care requirements of older adults. GAPN implement evidence-based practices directed to patients and families, focusing on health promotion and protection, disease prevention, recovery, and rehabilitation. In competence-based gerontological advanced practice, comprehensive geriatric assessment is essential for implementing the care plan. In this theoretical essay we reflect about the role of assessment in competence-based advanced nursing practice directed to the care of older adults. From our perspective, geriatric assessment for a high-quality practice must be comprehensive, multidimensional, interdisciplinary, and planned. GAPN must have solid competencies for clinical skills and caring practices; education for health literacy; collaborative care; system management for continuity of care; ethics, advocacy, and moral agency; and evidenced-based practice inquiry. Gerontological models of care and GAPN competencies serve as frameworks to guide practice while assessment is fundamental for providing age-friendly care to older adults.

RESUMO O envelhecimento populacional desafia os sistemas de saúde, exigindo que enfermeiros gerontológicos de prática avançada (EGPA) abordem os requisitos específicos e complexos do cuidado de idosos. EGPA implementam práticas baseadas em evidências voltadas a pacientes e familiares a fim de promover e proteger sua saúde, prevenir doenças, recuperá-los e reabilitá-los. Na prática gerontológica avançada baseada em competência, a avaliação ampla é essencial para implementar um plano de cuidado. Neste ensaio teórico, refletimos sobre o papel da avaliação na prática avançada de enfermagem gerontológica baseada em competência. Do nosso ponto de vista, a avaliação gerontológica para uma prática excelente deve ser abrangente, multidimensional, interdisciplinar e planejada. EGPA devem ter competências efetivas em habilidades clínicas e práticas de cuidado; alfabetização em saúde; cuidado colaborativo; gestão de sistemas para continuidade do cuidado; ética, defesa e agência moral; e prática por investigação baseada em evidências. Modelos gerontológicos de cuidado e das competências dos EGPA servem como uma estrutura que orienta sua prática enquanto a avaliação é fundamental ao cuidado amigo ao idoso.

RESUMEN El envejecimiento de la población es un desafío a los sistemas de salud y requiere que los profesionales de enfermería en gerontología de práctica avanzada (EGPA) aborden los requisitos específicos y complejos del cuidado de los adultos mayores. La EGPA pone en ejecución prácticas basadas en evidencia dirigidas a pacientes y familiares para la promoción y protección de la salud, prevención de enfermedades, así como su recuperación y rehabilitación. En la gerontología de práctica avanzada basada en competencias, la evaluación integral es esencial para la puesta en práctica de un plan de cuidados. En este ensayo teórico reflexionamos sobre el papel de la evaluación en la enfermería en gerontología de práctica avanzada basada en competencias. Desde nuestro punto de vista, la valoración gerontológica hacia una práctica excelente debe ser integral, multidimensional, interdisciplinar y planificada. La EGPA debe abarcar competencias efectivas en habilidades clínicas y prácticas del cuidado; alfabetización en salud; cuidado colaborativo; gestión de sistemas para la continuidad del cuidado; ética, defensa y agencia moral; y la práctica a través de la investigación basada en la evidencia. Los modelos gerontológicos de cuidado y las competencias de la EGPA sirven como marco de su práctica, mientras que la evaluación es fundamental para un cuidado accesible a los adultos mayores.

Incidence of pressure injuries and risk factors in a paediatric surgical intensive care unit: a prospective cohort study.

OBJECTIVES: The aim of the study was to evaluate the incidence of, and risk factors for, the occurrence of pressure injuries (PIs) in a paediatric surgical intensive care unit (ICU). METHOD: This is a prospective cohort study of 153 children in the postoperative period. Patients were assessed daily by physical examination and data were collected. All independent variables were included in a logistic regression. RESULTS: The mean age of the cohort was 2 years, and the incidence of PI was 15.7%. According to the Braden Q Scale, 58.2% of patients were at high risk of developing PI; 79.3% of PIs were related to immobility and 69.0% were at stage 1. Risk factors were ICU length of stay and the number of medical devices used. CONCLUSION: The incidence of PI was high because patients were mostly at a considerable risk of developing a PI. PI was associated with several factors, especially length of ICU stay and number of devices, both of which are indirect indicators of the severity of patient condition and healthcare costs.

Brazilian version of the Rivermead Post-Concussion Symptoms Questionnaire.

BACKGROUND: After a traumatic brain injury, post-concussion symptoms are commonly reported by patients. Although common, these symptoms are difficult to diagnose and recognize. To date, no instruments evaluating post-concussion symptoms have been culturally translated or adapted to the Brazilian context. OBJECTIVE: To culturally adapt the Rivermead Post-Concussion Symptoms Questionnaire for use in Brazilian Portuguese. METHODS: Cross-cultural adaptation was done in five steps: translation, synthesis of translations, back-translation, evaluation by two expert committees and two pretests among adults in a target population. RESULTS: The semantic, idiomatic, cultural and experimental aspects of the adaptation were considered adequate. The content validity coefficient of the items regarding language clarity, pratical pertinence, relevance and dimensionality were considered adequate for evaluating the desired latent variable. Both pretests demonstrated that the instrument had satisfactory acceptability. CONCLUSION: The Brazilian version, named Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br), has been adapted, and is ready for use in the Brazilian context.

Active lifestyle enhances protein expression profile in subjects with Lewy body pathology.

Clinical trials of the effects of physical activity have reported improvements in symptoms and quality of life in patients with Parkinson's disease (PD). Additionally, morphological brain changes after exercising were reported in PD animal models. However, these lifestyle-related changes were not evaluated in postmortem brain tissue. OBJECTIVE: We aimed to evaluate, by immunohistochemistry, astrocytes, tyrosine hydroxylase (TH) and structural proteins expression (neurofilaments and microtubules - MAP2) changes in postmortem brain samples of individuals with Lewy body pathology. METHODS: Braak PD stage≥III samples, classified by neuropathology analysis, from The Biobank for Aging Studies were classified into active (n=12) and non-active (n=12) groups, according to physical activity lifestyle, and paired by age, sex and Braak staging. Substantia nigra and basal ganglia were evaluated. RESULTS: Groups were not different in terms of age or gender and had similar PD neuropathological burden (p=1.00). We observed higher TH expression in the active group in the substantia nigra and the basal ganglia (p=0.04). Astrocytes was greater in the non-active subjects in the midbrain (p=0.03) and basal ganglia (p=0.0004). MAP2 levels were higher for non-active participants in the basal ganglia (p=0.003) and similar between groups in the substantia nigra (p=0.46). Neurofilament levels for non-active participants were higher in the substantia nigra (p=0.006) but not in the basal ganglia (p=0.24). CONCLUSION: Active lifestyle seems to promote positive effects on brain by maintaining dopamine synthesis and structural protein expression in the nigrostriatal system and decrease astrogliosis in subjects with the same PD neuropathology burden.

Estudos dos efeitos da atividade física relataram melhora nos sintomas e na qualidade de vida de pacientes com doença de Parkinson (DP). Além disso, alterações morfológicas do cérebro após o exercício físico foram relatadas em modelos animais da DP. No entanto, essas mudanças relacionadas ao estilo de vida não foram avaliadas em tecido cerebral post-mortem. OBJETIVO: Avaliar a expressão de astrócitos, tirosina hidroxilase (TH) e a expressão de proteínas estruturais (neurofilamentos e microtúbulos ­ MAP2) por imuno-histoquímica, em amostras cerebrais post-mortem de indivíduos com corpos de Lewy. MÉTODOS: Amostras com estágio de Braak para DP≥III, classificação neuropatológica, fornecidas pelo biobanco de estudos do envelhecimento foram classificadas em grupos ativos (n=12) e não ativos (n=12), de acordo com o estilo de vida (atividade física), e pareados por idade, sexo e estadiamento de Braak. Analisou-se a substância negra e gânglios da base. RESULTADOS: Idade, sexo e classificação para DP foram semelhantes (p=1,00). Observou-se maior expressão de TH no grupo ativo (p=0,04). Amostras de não ativos revelaram maior expressão de astrócitos no mesencéfalo (p=0,03) e nos gânglios da base (p=0,0004); MAP2 nos gânglios da base (p=0,003); os níveis de neurofilamentos foram maiores na substância negra (p=0,006). CONCLUSÃO: O estilo de vida ativo parece promover efeitos positivos no cérebro, mantendo a síntese de dopamina e a expressão estrutural de proteínas no sistema nigrostriatal e com diminuição da ativação de astrócitos em indivíduos com a mesma classificação neuropatológica para a DP.

Validade do Supportive Care Needs Survey Short Form 34 na população amazônica / Validez del Supportive Care Needs Survey Short Form 34 en la población amazónica / Validity of the Supportive Care Needs Survey Short Form 34 in the Amazon population

Resumo Objetivo: Analisar as evidências de validade de constructo do Supportive Care Needs Survey Short Form 34 (SCNS SF-34) na população com câncer atendida em Manaus, região amazônica brasileira. Métodos: Estudo psicométrico, realizado em uma instituição de referência em oncologia, de abril a junho de 2016. As fontes de dados incluíram formulário com dados sociodemográficos e clínicos, e a versão brasileira do referido instrumento. A amostra foi composta por 691 participantes, considerando-se cálculo amostral de 20 pacientes por item. Foram realizadas análises fatoriais exploratória e confirmatória, verificação da consistência interna e avaliação da invariância do modelo fatorial quanto a sexo, idade e tempo de tratamento. Resultados: Dos 691 pacientes, 92,6% eram do estado do Amazonas, 72,6% do sexo feminino (72,6%), 64,4% com idade menor que 60 anos, 54,4% em tratamento há mais de seis meses, 55,6% com tumor do sistema reprodutor feminino e 56,1% submetidos à cirurgia. Verificou-se solução fatorial de quatro domínios e bons índices de ajustamento obtidos por análise fatorial confirmatória (χ2 = 1.828,981; df = 520; χ2/df = 3,51; p<0,001; CFI = 0,926; TLI= 0,918; RMSEA = 0,084 (I.C. 90% = 0,082-0,090), com padrão invariante para os diferentes grupos (sexo, grupo etário e tempo de tratamento). Conclusão: A versão brasileira do Supportive Care Needs Survey Short Form 34, composta por 34 itens distribuídos em quatro domínios (Físico e Vida diária, Psicológico, Sexualidade e Cuidado e Suporte), mostrou-se válida e precisa para mensurar as necessidades de cuidados de indivíduos com diagnóstico de câncer da região amazônica.

Resumen Objetivo: Analizar las evidencias de validez del constructo del Supportive Care Needs Survey Short Form 34 (SCNS SF-34) en la población con cáncer atendida en Manaus, región amazónica brasileña. Métodos: Estudio piscométrico, realizado en una institución de referencia en oncología, de abril a junio de 2016. Las fuentes de datos incluyeron un formulario con datos sociodemográficos y clínicos y la versión brasileña de dicho instrumento. La muestra estuvo compuesta por 691 participantes y se consideró el cálculo de tamaño de muestra de 20 pacientes por ítem. Se realizaron análisis factoriales exploratorios y confirmatorios, verificación de la consistencia interna y evaluación de la invarianza del modelo factorial por sexo, edad y tiempo de tratamiento. Resultados: De los 691 pacientes, el 92,6 % eran del estado de Amazonas, el 72,6 % de sexo femenino, el 64,4 % de menos de 60 años, el 54,4 % en tratamiento hace más de seis meses, el 55,6 % con tumor en el sistema reproductor femenino y el 56,1 % pasaron por cirugía. Se verificó una solución factorial de cuatro dominios y buenos índices de ajuste obtenidos por análisis factorial confirmatorio (χ2 = 1.828,981; df = 520; χ2/df = 3,51; p<0,001; CFI = 0,926; TLI= 0,918; RMSEA = 0,084 (I.C. 90 % = 0,082-0,090), con patrón invariable en los diferentes grupos (sexo, grupo de edad y tiempo de tratamiento). Conclusión: La versión brasileña del Supportive Care Needs Survey Short Form 34, compuesta por 34 ítems distribuidos en cuatro dominios (Físico y vida diaria, Psicológico, Sexualidad y Cuidado y apoyo), demostró ser válida y precisa para medir las necesidades de cuidados de individuos con diagnóstico de cáncer en la región amazónica.

Abstract Objective: To analyze the construct validity of the Supportive Care Needs Survey Short Form 34 (SCNS SF-34) in the population with cancer treated in Manaus, in the Brazilian Amazon region. Methods: Psychometric study carried out in an institution specialized in oncology, from April to June 2016. The data sources included a form with socio-demographic and clinical data, and the Brazilian version of the referred instrument. The sample was composed by 691 participants, considering a sample calculation of 20 patients per item. Exploratory and confirmatory factor analysis, verification of internal consistency and evaluation of the invariance of the factor model according to gender, age and time of treatment were carried out. Results: Of the 691 patients, 92.6% were from the state of Amazonas, 72.6% were female (72.6%), 64.4% were under 60 years old, 54.4% were on treatment for more than six months, 55.6% had a tumor in the female reproductive system and 56.1% underwent surgery. There was a factorial solution of four domains and good adjustment indexes obtained by confirmatory factor analysis (χ2 = 1.828.981; df = 520; χ2/df = 3.51; p<0.001; CFI = 0.926; TLI= 0.918; RMSEA = 0.084 (90% CI= 0.082-0.090), with an invariant pattern across the different groups (gender, age group and duration of treatment). Conclusion: The Brazilian version of the Supportive Care Needs Survey Short Form 34, composed by 34 items distributed in four domains (Physical and Daily Living, Psychological, Sexuality and Care and Support) was valid and accurate to measure the care needs for individuals diagnosed with cancer in the Amazon region.

Relationships between nursing diagnoses and the level of dependence in activities of daily living of elderly residents.

OBJECTIVE: To identify and validate nursing diagnoses of elderly residents, and determine their relationship with the level of dependence in activities of daily living. METHODS: One hundred thirty-five older adults were assessed using medical history and physical examination. Twelve validated gerontological instruments were administered to assess delirium, nutritional status, risk for falls, risk for pressure injury, dementia, cognitive losses, depression, and level of dependence in daily living and instrumental activities of daily living. Nursing diagnoses were identified and validated by experienced, doctorally-prepared nurses. The association between the presence of a nursing diagnosis and the level of dependence was assessed by a test for trend in proportions. The Kruskal-Wallis hypothesis test was used to investigate the association between the number of nursing diagnoses and the level of dependence of the elderly. RESULTS: Most older adults were at risk for malnutrition, at high risk for falls, cognitively impaired, totally dependent for daily living and activities of daily living. In addition, they had very mild dementia and most did not have risk for pressure injuries. Depression was noted among those with dementia, but was absent in those without dementia. A total of 52 nursing diagnoses were validated. Of these, 11 were associated with the level of dependence in daily living. CONCLUSION: These results can be reproduced in other skilled nursing facilities for older adults, and these may allow the planning of interventions to alleviate etiologies and signs/symptoms of nursing diagnoses, rather than simply directing care toward a general category of dependence. Therefore, guaranteeing individualized nursing care to meet the specific needs of each resident.