RESUMO
The role of caregivers in homecare settings is relevant to the patient's wellbeing and quality of life. This phenomenon is well described in the literature for the oncological setting but not specifically for that of hematological malignancies. The aim of this study was to explore the experience of primary caregivers of patients with hematological malignancies within home care. We conducted a phenomenological study based on interviews with 17 primary caregivers of hematological patients. Analysis of the contents led to the identification of five main themes. Perhaps, the innovative aspects of this study can be summarized in three points: This service was demonstrated to fulfil the ethical aspects of providing the patient with a dignified accompaniment to the end of life. Secondly, the efficiency of the service and the benefit are directly dependent on the caregivers' wellbeing, so knowledge of the dynamics and emotions involved can lead to the development and implementation of programs for hematological malignancies. Lastly, a collaborative caregivers-professionals relationship can improve a sense of accomplishment for all parties involved, lessening the family's frustration related to not having done their best. Home care brings significant benefits for both the patient and the caregivers and fulfils the ethical obligation of providing the patient dignified end-of-life care.
Assuntos
Neoplasias Hematológicas , Serviços de Assistência Domiciliar , Adulto , Idoso , Cuidadores , Criança , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Assistência TerminalRESUMO
CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS. METHODS: About 38 HC/HS services in Italy participated in a multicenter observational longitudinal study. Consecutive adult cancer patients followed till death during a four-month period and undergoing PS were eligible. Symptom control and level of consciousness were registered every eight hours to death. RESULTS: About 4276 patients were screened, 2894 followed till death, and 531 (18%) underwent PS. PS rate was 15% in HC and 21% in HS (P < 0.001). Principal refractory symptoms were delirium (54%) and dyspnea (45%), respectively, more common in HC (P < 0.001) and HS (P = 0.03). Informed consent was not obtained in 72% of patients but achieved by 96% of families. Midazolam was the most used drug (94% HS vs. 75% HC; P < 0.001) mainly by continuous infusion (74% HC vs. 89% HS; P < 0.001). PS duration was less than 48 hours in 67% of patients. Hydration during PS was less frequent in HC (27% vs. 49%; P < 0.001). In the eight hours before death, consciousness level was unrousable to mild physical stimulation in 81% and symptom control complete in 89% of cases. CONCLUSION: Our results show feasibility of PS in HC and HS and suggest setting differences in rates, indications, and practice of PS, possibly related to patients' selection or care organization.
Assuntos
Sedação Profunda , Serviços de Assistência Domiciliar , Neoplasias/terapia , Cuidados Paliativos , Assistência Terminal , Idoso , Tomada de Decisão Clínica , Estudos de Viabilidade , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Estudos Longitudinais , Masculino , Estudos Prospectivos , Doente TerminalRESUMO
El aporte de yodo es fundamental para el normal funcionamiento de la glándula tiroides. Analizar el proceso de síntesis de las hormonas tiroideas es de vital importancia para comprender el mecanismo de autoregulación. Esta glándula posee un mecanismo intrínseco de regulación de su propio crecimiento y funcionamiento, el mismo está asociado a la concentración intratiroidea de yoduros y compuestos yodados. Estos compuestos son sintetizados por la misma glándula y parte de ellos son derivados del ácido araquidónico. El análisis de estos hechos permiten entender la etiología de disfunciones tiroideas durante el stress o la ingesta de altas concentraciones de yodo con tejido glandular normal.
Assuntos
Iodo/metabolismo , Glândula Tireoide , Tireotropina/biossíntese , Bócio , Hipertireoidismo , Hipotireoidismo/induzido quimicamente , Estresse FisiológicoRESUMO
Se aporta un nuevo caso de ruptura espontánea de hígado en el embarazo a la casuística nacional. Se destaca su asociación a la preeclampsia o a la eclampsia, 12 y 50 por ciento respectivamente. Se analiza su relación con la anemia hemolítica microangiopática y trombocitopenia (HELLP syndrome). Se explica su fisiopatología con la aparición de hemorragia intraparenquimatosa con formación de hematoma subcapsular que por aumento de la presión provoca ruptura secundaria con hemoperitoneo. Se realza la velocidad de instauración de shock hipovolémico que genera alta incidencia de mortalidad materna y fetal: 24 por ciento y 7.7 a 60 por ciento respectivamente. Se insiste en la importancia de su reconocimiento temprano y de efectuar tratamiento quirúrgico precoz combinado: césarea con extracción fetal y gestos sobre el hígado para detener la hemorragia.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Eclampsia/complicações , Síndrome HELLP , Fígado , Pré-Eclâmpsia/complicações , Ruptura Espontânea/cirurgia , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/mortalidade , Ruptura Espontânea/terapia , Recesariana , Morte Fetal , Hematoma/cirurgia , Hemorragia/cirurgia , Obesidade/complicações , Choque/prevenção & controleRESUMO
Se estudia el enletecimiento de la conducción nerviosa de los nervios periféricos en la diabetes. Se identifica al mioinositol como causante de esta alteración. Se analiza la relación con situaciones de hiperglucemia. Se explica el mecanismo intrínseco por el que se lesiona la célula neuronal. Se plantea la inquietud de posibles tratamientos clínico-farmacológicos en la práctica médica futura.
Assuntos
Condução Nervosa , Diabetes Mellitus/complicações , Inositol/efeitos adversos , Glucose , Hiperglicemia , Neurônios/metabolismo , Neuropatias Diabéticas/fisiopatologiaRESUMO
Se realiza un estudio prospectivo de 200 colecistectomías electivas, comparando 100 pacientes con drenaje subhepático con 100 sin drenaje. No se registraron muertes ni complicaciones graves. La incidencia de complicaciones menores tales como hipertermia, atelectasias laminares y pequeños derrames pleurales fue mayor en el grupo con drenaje aunque la diferencia no fue significativa. El tiempo promedio de internación fue menor en el grupo sin drenaje; no hubo morbilidad atribuible a la ausencia del mismo. La experiencia recogida nos permite sugerir que bajo las circunstancias establecidas en nuestro protocolo se puede prescindir de drenar la región subhepática a continuación de una colecistectomía.