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
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.
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
Teaching of palliative care in undergraduate nursing
, 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 . 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 . 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.
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
W. P. C. A. Global Atlas of Palliative Care
. London 2014.
2. Bloomer M. J.
of dying: challenges in nursing
care of the dying in the acute hospital setting. A qualitative obser-
, 27(8), 757
Decision making in geriatric oncology: an ethical approach
, P. Chaibi
, G. Gavazzi
, M.F.M. Bruneel
Médecine Gériatrique, CHU Grenoble Alpes,
Gériatrie à orientation
onco-hématologique, Hôpital Charles Foix, Ivry Sur Seine,
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.
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
Poster presentations / European Geriatric Medicine 7S1 (2016) S29