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influence of nutritional status in the development and the evolution of

lesions, among other risk factors. The use of arginine administered in

the healing process has been questioned, with controversial results in

different studies.


An observational study was proposed by groups to assess

the possible effects of arginine and high protein supplementation in

the healing process of PU in institutionalized elderly patients.

Observational monitoring the healing process of PU was performed

at intervals of six weeks collecting the different variables to study

periods beginning, intermediate (6 weeks) and final (12 weeks).

Besides data collection of functionality with demographic variables,

scale of cognitive impairment, anthropometry and the type of protein

intake, arginine supplementation was performed.


It was observed that in the group of patients who took the

same normocaloric-normoproteical nutrition, they follow a similar

progress throughout the registry. Instead, those groups in which the

diet was changed in the middle phase of the study, adding proteins

with arginine, obtained a further decline in the score Resvech scale,

although not statistically significant. By adding arginine it existis only

more likely to improve healing, compared to the other groups, but

without achieving statistical significance.

Key conclusions:

There is a tend to better healing in those patients

who have enriched their basal diet with protein and arginine modules,

but has not achieved a significant difference when compared to the

other groups.


Teaching of palliative care in undergraduate nursing

J.S.M. Minosso


, M.A.C. Oliveira




School of Nursing of University of São

Paulo, São Paulo, Brazil


There is a growing demand for Palliative Care (PC)

around the world. According to the WHO, each year about 40 million

people need PC; of these, 20 million are in the final phase of their lives.

A major challenge to establish a PC policy in many countries is the

training of health professionals to provide quality care throughout all

the life cycle, until death [1]. These skills should begin to be developed

during the undergraduate degree. However, the majority of nurses

continue to demonstrate that this is one of the areas where they feel

more unprepared and that cause greater emotional disorder [2]. Thus,

it becomes evident the need for reflection on the teaching process of

PC in nursing undergraduate courses.


An integrative review, conducted through the databases

LILACS, PubMed, CINAHL and Scielo, according to PRISMA criteria.


The final sample consisted of 28 studies, mostly from the

United States and the United Kingdom. The results indicated a frag-

mentation in most curricula of nursing courses, with focus on techni-

cal disciplines and procedures; gaps in knowledge of new graduates

to provide PC and ineffectiveness of the traditional teaching methods

to change the fear of personal involvement and suffering.

Key conclusions:

It was demonstrated that nursing education in PC is

still fragile. Traditional models of medical education have shown to be

insufficient to enable nurses to provide appropriate care for death or

incurable diseases.


1. WPCA,

W. P. C. A. Global Atlas of Palliative Care

. London 2014.

2. Bloomer M. J.

et al.



of dying: challenges in nursing

care of the dying in the acute hospital setting. A qualitative obser-

vational study.

Palliat Med

, 27(8), 757

64, 2013.


Decision making in geriatric oncology: an ethical approach

N. Mitha


, P. Chaibi


, G. Gavazzi


, M.F.M. Bruneel




Clinique de

Médecine Gériatrique, CHU Grenoble Alpes,


Gériatrie à orientation

onco-hématologique, Hôpital Charles Foix, Ivry Sur Seine,


Laboratoire d

éthique médicale et médecine légale, Université Paris Descartes, Paris,



In a context of tensions between the promotion

of equity in oncological care regardless of age and the risk of

unreasonable obstinacy, the sense of medical treatment decision to

propose to the elderly cancer patient seems essential. The decision-

making procedures and underlying psychical representations appears

to be complex.


to highlight complexity of treatment decision-makings in

case of cancer in older patient.


The qualitative study was prospective multicentric, using

semi-structured interviews to question geriatrician physicians

involved in the process of medical decision concerning elderly

cancer patients. These interviews were verbatim transcribed and

conducted until data saturation. A thematic content analysis was

performed in parallel.


A literature review enabled development of semi-structured

interview model. Ten interviews were conducted. Content analy-

sis highlighted factors influencing the decision, and psychological

representations. The study reveals particularly complex decision-

making procedures because of the high number of parameters

influencing the decision (n = 86), difficulty of their measurements,

their interrelationships, a dual need to consider patient both as a

whole and individuality, and, the interface of two distinct medical

specialties. The level of uncertainty and subjectivity in decision involve

risk taking, leading to a questioning on appropriateness of treatment

and threshold of unreasonable obstinacy.


Complexity, uncertainty, thinking on relevance of treat-

ments in oncogeriatric medicine have enriched the ethical thinking

with specific issues around personal autonomy, beneficence, non-

maleficence and social justice. These issues, however, can affect all

patients regardless of their age, the elderly with cancer, being an

emblematic case of a particular vulnerability.


Assessment of DNACPR documentation and metal capacity act

S. Saber, A. Ramnarine, P. Ravji, H. Iftikhar, A. Kayani, N. Veale,

B. Mobeshir, M. Rahman, S. Jessani, A. Qureshi.

Broomfield Hospital,

Chelmsford, UK


Cardiopulmonary Resuscitation (CPR) involves the deliv-

ery Of unsynchronized shocks to the chest, ventilating the lungs

and administration of medication to stimulate the heart. For CPR to be

successful, a patient needs to possess a good physiological reserve.

Success rates for CPR in patients with multiple comorbidities are likely

to be low.

In severely ill and frail individuals, attempts at CPR may subject them a

violent and undignified death.


A Quality Improvement Project (QIP) was conducted to

assess Do Not Attempt CPR (DNACPR) documentation and use of

Mental Capacity Act (MCA). Single point inspections across medical

wards at a Mid Essex hospital occurred on two occasions over a year

to compare if improvements had happened from cycle 1 to 2.

Implementation for improvement between the two cycles focused

on education at geriatric meetings and on medical wards.


51% of patients were unaware of their DNACPR status in

both groups and only 17% of those unaware had MCA2 completed

in cycle 1 compared to 33% in cycle 2. There were more relatives

unaware of the patients DNACPR status (62%) in cycle 1 compared to

55% in cycle 2.

However, in cycle 2, there was more inadequacy of information

regarding families being unaware (i.e. 23% Vs 6% in cycle 1).


DNACPR is an important medical decision that has

an impact on patient, family and healthcare professional. Weekly

reviews examining DNACPR forms and expanding education could

improve standards. Further research into if those on frailty registers

are having such discussions with primary care doctors would be

helpful as would the addition of a standardised MCA section on

DNACPR forms.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29