Planning for Your Advance Care Needs (PLAN): A Communication Intervention to Improve Advance Care Planning among Latino Patients with Advanced Cancer.

BACKGROUND: The goal of this study was to develop and optimize an intervention designed to address barriers to engagement in advance care planning (ACP) among Latino patients with advanced cancer. The resulting intervention, titled Planning Your Advance Care Needs (PLAN), is grounded in theoretical models of communication competence and sociocultural theory. MATERIALS AND METHODS: An initial version of the PLAN manual was developed based on a prior intervention, Ca-HELP, that was designed to improve communication around pain among cancer patients. PLAN uses this framework to coach patients on how to plan for and communicate their end-of-life care needs through ACP. In the present study, feedback was obtained from key stakeholders (n = 11 patients, n = 11 caregivers, n = 10 experts) on this preliminary version of the PLAN manual. Participants provided ratings of acceptability and feedback around the intervention content, format, design, modality, and delivery through quantitative survey questions and semi-structured qualitative interviews. RESULTS: Results indicated that the PLAN manual was perceived to be helpful and easy to understand. All stakeholder groups liked the inclusion of explicit communication scripts and guidance for having conversations about ACP with loved ones and doctors. Specific feedback was given to modify PLAN to ensure it was optimized and tailored for Latino patients. Some patients noted reviewing the manual motivated engagement in ACP. CONCLUSIONS: Feedback from stakeholders resulted in an optimized, user-centered version of PLAN tailored to Latino patients. Future research will examine the acceptability, feasibility, and potential efficacy of this intervention to improve engagement in ACP.

Neuroprotección mediante hipotermia moderada en recién nacidos con encefalopatía hipóxico-isquémica / Neuroprotection by mild hypothermia in newborn with hypoxic-ischemic encephalopathy

En la mayoría de los países desarrollados el tratamiento con la hipotermia se ha convertido en un pilar fundamental para la neuroprotección del recién nacido con encefalopatía hipóxico-isquémica (EHI). En la unidad de cuidados intensivos neonatales de la universidad de Duke, la hipotermia moderada se aplica desde el 2005. El tratamiento con hipotermia es muy limitado en otros países porque en adición a un equipamiento especializado, requiere de manejo detallado de las disfunciones multiorgánicas, documentación meticulosa de la información clínica con cuidados y control del paciente en forma protocolizada. Como punto de partida, y para facilitar la introducción de la hipotermia en las unidades de cuidados intensivos neonatales en Uruguay, se presenta la evolución de cinco pacientes internados en la unidad de cuidados intensivos del centro hospitalario de Duke (Carolina del Norte, EE.UU.), evaluando la respuesta al tratamiento con hipotermia moderada y su evolución clínica