Objectives. The objective of this study was to know the characteristics of palliative sedation in agony at the home level carried out by personnel not specialized in palliative care and to detect areas for improvement. Material and method. Retrospective descriptive cross-sectional observational study. All patients who died at home between September 2020 and February 2021, who required sedation indicated by the Primary Care Emergency Service (SUAP) Malaga, were included. Results. The percentage of palliative sedation was 16.4░% [9.8░%-23.2░%]. Only 36░% [27░%-45░%] of the patients were included in the palliative care process. In 67.2░% [59░%-76░%] of the cases, they were non-cancer chronic. Dyspnea was the most prevalent symptom (76.1░% [68░%-83░%]). Delirium was present in 21.4░% [13░%-28░%] of the patients. The most widely used drug was midazolam (94.9░% [91░%-99░%]). The mean time that passes from the start of sedation to death is 24.3h [19.3h-29.2h]. The differences in the mean survival rates between men 20.765 [13.7-27.7] and women 29.2 [22.1-33.3] were statistically significant. 72░%[64░%-80░%] of the patients did not receive any type of follow-up from the start of sedation to death. Conclusions. There is agreement between the results obtained in this study and those found in the consulted bibliography, regarding the proportion of patients with palliative sedation in agony, duration of the same and the main drugs used. The mean age of the patients was higher in this study, as well as the prevalence of nononcological chronic disease and dyspnea as the main refractory symptom. The lack of knowledge of the level of sedation in our patients, the lack of follow-up and the underuse of levomepromazine in delirium is striking.
{"title":"Sedación paliativa en la agonía realizada por un servicio de urgencias de atención primaria a nivel domiciliario. Estudio observacional transversal descriptivo retrospectivo","authors":"Macarena Moreno Moreno, Ismael Herruzo Cabrera, Salvador Ignacio Soriano Ruiz, Rocío Emilia Moreno Moreno","doi":"10.20986/medpal.2021.1274/2021","DOIUrl":"https://doi.org/10.20986/medpal.2021.1274/2021","url":null,"abstract":"Objectives. The objective of this study was to know the characteristics of palliative sedation in agony at the home level carried out by personnel not specialized in palliative care and to detect areas for improvement. Material and method. Retrospective descriptive cross-sectional observational study. All patients who died at home between September 2020 and February 2021, who required sedation indicated by the Primary Care Emergency Service (SUAP) Malaga, were included. Results. The percentage of palliative sedation was 16.4░% [9.8░%-23.2░%]. Only 36░% [27░%-45░%] of the patients were included in the palliative care process. In 67.2░% [59░%-76░%] of the cases, they were non-cancer chronic. Dyspnea was the most prevalent symptom (76.1░% [68░%-83░%]). Delirium was present in 21.4░% [13░%-28░%] of the patients. The most widely used drug was midazolam (94.9░% [91░%-99░%]). The mean time that passes from the start of sedation to death is 24.3h [19.3h-29.2h]. The differences in the mean survival rates between men 20.765 [13.7-27.7] and women 29.2 [22.1-33.3] were statistically significant. 72░%[64░%-80░%] of the patients did not receive any type of follow-up from the start of sedation to death. Conclusions. There is agreement between the results obtained in this study and those found in the consulted bibliography, regarding the proportion of patients with palliative sedation in agony, duration of the same and the main drugs used. The mean age of the patients was higher in this study, as well as the prevalence of nononcological chronic disease and dyspnea as the main refractory symptom. The lack of knowledge of the level of sedation in our patients, the lack of follow-up and the underuse of levomepromazine in delirium is striking.","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68136837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/MEDPAL.2021.1146/2020
Danny Steven Castiblanco Delgado, D. Butnaru, Valeria Quintero Carreño, Bilena Margarita Molina Arteta
{"title":"Análisis retrospectivo del uso de catéteres peritoneales no tunelizados para el manejo de ascitis maligna refractaria: Serie de casos.","authors":"Danny Steven Castiblanco Delgado, D. Butnaru, Valeria Quintero Carreño, Bilena Margarita Molina Arteta","doi":"10.20986/MEDPAL.2021.1146/2020","DOIUrl":"https://doi.org/10.20986/MEDPAL.2021.1146/2020","url":null,"abstract":"","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68129989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/medpal.2021.1163/2020
J. Ocampo-Chaparro, C. Reyes-Ortiz, Edwin Etayo-Ruiz
The progressive aging of the population is explained by the advance in health care, the demographic and epidemiological transitions present worldwide. This phenomenon implies changes in the social and economic field, in the education and health systems, and in social security. Consequently, it is characteristic to find older adults with multimorbidity, presenting chronic diseases with different trajectories at the end of life, and that are going to require attention in the palliative care model. Comprehensive geriatric assessment (CGA) is the technology currently available to address the complex situation of older adults, particularly those who need care for palliative care. The CGA process offers a comprehensive approach that is based on the biopsychosocial model and is operationalized through the performance of an interdisciplinary team that provides assessment and palliative care in an individualized and continuous way and adapted throughout the course of the disease, helping to determine a prognosis and potential quality of life in each older adult. In the CGA within palliative care, advance care planning and shared decision-making are of special importance, from the moment the older adults are indicated to be cared for until the end of their life, and after their death, giving support to their relatives and caregivers.
{"title":"Valoración geriátrica integral en cuidados paliativos: Revisión bibliográfica","authors":"J. Ocampo-Chaparro, C. Reyes-Ortiz, Edwin Etayo-Ruiz","doi":"10.20986/medpal.2021.1163/2020","DOIUrl":"https://doi.org/10.20986/medpal.2021.1163/2020","url":null,"abstract":"The progressive aging of the population is explained by the advance in health care, the demographic and epidemiological transitions present worldwide. This phenomenon implies changes in the social and economic field, in the education and health systems, and in social security. Consequently, it is characteristic to find older adults with multimorbidity, presenting chronic diseases with different trajectories at the end of life, and that are going to require attention in the palliative care model. Comprehensive geriatric assessment (CGA) is the technology currently available to address the complex situation of older adults, particularly those who need care for palliative care. The CGA process offers a comprehensive approach that is based on the biopsychosocial model and is operationalized through the performance of an interdisciplinary team that provides assessment and palliative care in an individualized and continuous way and adapted throughout the course of the disease, helping to determine a prognosis and potential quality of life in each older adult. In the CGA within palliative care, advance care planning and shared decision-making are of special importance, from the moment the older adults are indicated to be cared for until the end of their life, and after their death, giving support to their relatives and caregivers.","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68132076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/medpal.2021.1174/2020
C. T. Escura, Marina Gandía Herrero, M. Marín
Background and objectives: Patients with heart failure (HF) have physical and emotional symptoms, spiritual and intellectual concerns, specially in end-stage HF. Frequently, these needs are unknown by health care professionals attending these patients. This could influence decisions about end of life care. Our objective was to assess information about needs and preferences in these patients and the medical assistance received to manage them. Material and methods: This was a descriptive, observational and cross-sectional study using a survey with different questions and validated Spanish questionnaires. We interviewed 32 patients with advanced HF that were admitted in the Internal Medicine Service due to an acute decompensation of HF. Results: Most frequent physical symptoms were insomnia (75░%), tiredness (50░%) and decreased feeling of well being (50░%). Anxiety was present in 9 patients (28,1░%), depression in 6 (18,8░%) and both symptoms in 7 (21,8░%). A total of 30 patients (93,8░%) had not talked about spiritual needs with their doctor. Twenty-four (75░%) patients expressed a wish to have cardiopulmonary resuscitation if needed, although only one had talked about this during admission. Twenty-six patients (81,3░%) had not received any information about their evolution and prognosis of HF. Twenty-one patients (65,5░%) expressed a wish to receive information about end-stage HF. Conclusions: An integral evaluation of patients with advanced HF must form part of the medical assistance. Early doctor-patient communication regarding needs and preferences of these patients will enable an adequate planning of end-of-life care.
{"title":"Evaluación holística de las necesidades paliativas de los pacientes con insuficiencia cardiaca avanzada","authors":"C. T. Escura, Marina Gandía Herrero, M. Marín","doi":"10.20986/medpal.2021.1174/2020","DOIUrl":"https://doi.org/10.20986/medpal.2021.1174/2020","url":null,"abstract":"Background and objectives: Patients with heart failure (HF) have physical and emotional symptoms, spiritual and intellectual concerns, specially in end-stage HF. Frequently, these needs are unknown by health care professionals attending these patients. This could influence decisions about end of life care. Our objective was to assess information about needs and preferences in these patients and the medical assistance received to manage them. Material and methods: This was a descriptive, observational and cross-sectional study using a survey with different questions and validated Spanish questionnaires. We interviewed 32 patients with advanced HF that were admitted in the Internal Medicine Service due to an acute decompensation of HF. Results: Most frequent physical symptoms were insomnia (75░%), tiredness (50░%) and decreased feeling of well being (50░%). Anxiety was present in 9 patients (28,1░%), depression in 6 (18,8░%) and both symptoms in 7 (21,8░%). A total of 30 patients (93,8░%) had not talked about spiritual needs with their doctor. Twenty-four (75░%) patients expressed a wish to have cardiopulmonary resuscitation if needed, although only one had talked about this during admission. Twenty-six patients (81,3░%) had not received any information about their evolution and prognosis of HF. Twenty-one patients (65,5░%) expressed a wish to receive information about end-stage HF. Conclusions: An integral evaluation of patients with advanced HF must form part of the medical assistance. Early doctor-patient communication regarding needs and preferences of these patients will enable an adequate planning of end-of-life care.","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68132250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/MEDPAL.2021.1224/2020
Carme García Benito, Clara González Ojea, Diego Pereiro Corbacho, I. F. Pérez, Noemi De Dios Alvarez, Alberto Garrido Fernández
Background and methods: Pain is often inadequately treated in patients with cancer. Although in recent years there have been major advances in the treatment of pain, there are still gaps for a global treatment, such as breakthrouth cancer pain (BCP). A total of 115 cancer patients admitted consecutively were analyzed, regardless of the reason for admission. The main objective was to evaluate the prevalence of BCP in this sample, in order to see if pain is the main reason for admission in these patients, as well as determine if they are treated and diagnosed correctly previously to admission. The variables analyzed in relation to breakthrough pain were the following: presence of breakthrough pain according to the Davies scale; similarity of breakthrough pain crisis to each other and to baseline pain; number of irruptive episodes pain attacks
{"title":"Prevalencia y caracterización del dolor irruptivo oncológico (DIO) en pacientes hospitalizados en Vigo. Estudio DOLOPAHO","authors":"Carme García Benito, Clara González Ojea, Diego Pereiro Corbacho, I. F. Pérez, Noemi De Dios Alvarez, Alberto Garrido Fernández","doi":"10.20986/MEDPAL.2021.1224/2020","DOIUrl":"https://doi.org/10.20986/MEDPAL.2021.1224/2020","url":null,"abstract":"Background and methods: Pain is often inadequately treated in patients with cancer. Although in recent years there have been major advances in the treatment of pain, there are still gaps for a global treatment, such as breakthrouth cancer pain (BCP). A total of 115 cancer patients admitted consecutively were analyzed, regardless of the reason for admission. The main objective was to evaluate the prevalence of BCP in this sample, in order to see if pain is the main reason for admission in these patients, as well as determine if they are treated and diagnosed correctly previously to admission. The variables analyzed in relation to breakthrough pain were the following: presence of breakthrough pain according to the Davies scale; similarity of breakthrough pain crisis to each other and to baseline pain; number of irruptive episodes pain attacks","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68134246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/MEDPAL.2021.1245/2021
David Fajardo-Chica
{"title":"Filosofía de la muerte en la formación en cuidados paliativos, una experiencia desde la UNAM.","authors":"David Fajardo-Chica","doi":"10.20986/MEDPAL.2021.1245/2021","DOIUrl":"https://doi.org/10.20986/MEDPAL.2021.1245/2021","url":null,"abstract":"","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68135748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/medpal.2021.1258/2021
Cristina Lasmarías, Candela Calle Rodríguez, Anna M. Esteve Gómez, Jordi Navarro
Introduction: Advance care planning (ACP) encourages people to express wishes, preferences and concerns in order to facilitate a shared care process between patient, family and professionals. This is especially relevant in cancer context. Materials and methods: A cross-sectional study was carried out to analyze the ACP process practices of the professionals through the clinical records of the last 3 months of life of a sample of deceased patients in one month in a monographic cancer hospital. Sociodemographic variables, diagnosis, level of therapeutic intensity, cognitive status and ACP variables were defined: preferences, concerns, preference for place of care and place of death, choice of surrogate and advance directive document (ADC) existence. Results: N░=░54; 61.1░% men; median age: 64.5 years. Main cancer disease: respiratory (22.2░%); 79.6░% expressed themselves. The ACP variables were preferences 74,1░% (n░=░40); concerns 75,9░% (n░=░41); surrogate 7.4░% (n░=░4); place of care: 27.8░% (n░=░ 15); place of death: 16.7░% (n░=░ 9). None had an ADC Preferences and concerns records are mainly carried out by the palliative cares teams. The level of therapeutic intensity in the preferences / concerns record was 3A. Concerns were associated with self-expression of the patient (p░<░0.001). Conclusions: Registration of ACP dimensions are poor and occurs mainly in end-of-life context. Variables such as the representative figure or the ADCs are scarce. Early integration of ACP in clinical practice would facilitate decision-making with cancer patients and would help to define the care process according to their wishes and preferences.
{"title":"La Planificación Compartida de la Atención en personas con enfermedad oncológica en un instituto monográfico de cáncer: estudio descriptivo retrospectivo","authors":"Cristina Lasmarías, Candela Calle Rodríguez, Anna M. Esteve Gómez, Jordi Navarro","doi":"10.20986/medpal.2021.1258/2021","DOIUrl":"https://doi.org/10.20986/medpal.2021.1258/2021","url":null,"abstract":"Introduction: Advance care planning (ACP) encourages people to express wishes, preferences and concerns in order to facilitate a shared care process between patient, family and professionals. This is especially relevant in cancer context. Materials and methods: A cross-sectional study was carried out to analyze the ACP process practices of the professionals through the clinical records of the last 3 months of life of a sample of deceased patients in one month in a monographic cancer hospital. Sociodemographic variables, diagnosis, level of therapeutic intensity, cognitive status and ACP variables were defined: preferences, concerns, preference for place of care and place of death, choice of surrogate and advance directive document (ADC) existence. Results: N░=░54; 61.1░% men; median age: 64.5 years. Main cancer disease: respiratory (22.2░%); 79.6░% expressed themselves. The ACP variables were preferences 74,1░% (n░=░40); concerns 75,9░% (n░=░41); surrogate 7.4░% (n░=░4); place of care: 27.8░% (n░=░ 15); place of death: 16.7░% (n░=░ 9). None had an ADC Preferences and concerns records are mainly carried out by the palliative cares teams. The level of therapeutic intensity in the preferences / concerns record was 3A. Concerns were associated with self-expression of the patient (p░<░0.001). Conclusions: Registration of ACP dimensions are poor and occurs mainly in end-of-life context. Variables such as the representative figure or the ADCs are scarce. Early integration of ACP in clinical practice would facilitate decision-making with cancer patients and would help to define the care process according to their wishes and preferences.","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68136446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/medpal.2021.1309/2021
A. Tuca
{"title":"Breves reflexiones sobre la eutanasia y la atención paliativa","authors":"A. Tuca","doi":"10.20986/medpal.2021.1309/2021","DOIUrl":"https://doi.org/10.20986/medpal.2021.1309/2021","url":null,"abstract":"","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68137895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/MEDPAL.2021.1171/2020
Rosa Blasi Martínez, C. Danés, Chung Lok Johnald Yuen Lau, Manuel Baca Bautista, J. Domingo
{"title":"Utilidad de la ecografía clínica en una Unidad de Cuidados Paliativos (UCP).","authors":"Rosa Blasi Martínez, C. Danés, Chung Lok Johnald Yuen Lau, Manuel Baca Bautista, J. Domingo","doi":"10.20986/MEDPAL.2021.1171/2020","DOIUrl":"https://doi.org/10.20986/MEDPAL.2021.1171/2020","url":null,"abstract":"","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68132103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.20986/MEDPAL.2021.1194/2020
Á. Rubiales, Alba Puente García, Marta Orozco Belinchón, Elvira Morán Cuadrado
{"title":"Fiebre y dolor en la cadera derecha tras la colocación de endoprótesis biliar","authors":"Á. Rubiales, Alba Puente García, Marta Orozco Belinchón, Elvira Morán Cuadrado","doi":"10.20986/MEDPAL.2021.1194/2020","DOIUrl":"https://doi.org/10.20986/MEDPAL.2021.1194/2020","url":null,"abstract":"","PeriodicalId":49831,"journal":{"name":"Medicina Paliativa","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68133478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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