Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna / Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care

Objetivo Establecer recomendaciones de consenso sobre normas de buena práctica clínica en la atención a los pacientes al final de la vida. Métodos Un comité de 12 expertos españoles y portugueses propuso 37 recomendaciones. Se realizó un Proceso Delphi a dos rondas, con participación de 105 panelistas incluyendo internistas, otros médicos clínicos, enfermeras, enfermos, juristas, expertos en bioética, gestores sanitarios, políticos y periodistas. Para cada recomendación se envió un cuestionario con cinco respuestas tipo Likert. Se definió consenso fuerte cuando > 95% de las respuestas estaban totalmente de acuerdo o > 90% estaban de acuerdo y totalmente de acuerdo; consenso débil cuando > 90% estaban totalmente de acuerdo o > 80% estaban de acuerdo y totalmente de acuerdo. Resultados El panel abordó siete áreas específicas con 37 recomendaciones que abarcaban: Identificación de los pacientes; Conocimiento, valores y preferencias del paciente; Información; Necesidades del paciente; Atención y cuidados; Sedación paliativa y Atención tras la muerte. Conclusiones Un Proceso Delphi con participación multidisciplinar ha permitido establecer normas de buena práctica clínica en la atención al final de la vida con consenso de enfermos, agentes sociales y profesionales sanitarios (AU)

Aim To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. Methods A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. Results The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care Conclusions The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients (AU)

Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care. / Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

End-of-life care for patients hospitalised in internal medicine departments. / Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna.

OBJECTIVES: To describe the care provided at the end of life for patients who die in internal medicine departments. METHODS: An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death. RESULTS: The study included 1,447 patients with a median age of 84 years. Of these, 1,065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; P<.001), knew their prognosis (42.6% vs. 8.6%; P<.001), received psychological care (24.9% vs. 8.6%; P<.001), died in an individual room (64.6% vs. 44.4%; P<.001) and were accompanied (81.9% vs. 71.9%; P=.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; P=.002). CONCLUSIONS: There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer.

Delirium en pacientes atendidos por insuficiencia cardiaca descompensada en urgencias: características clínicas y evolución / Delirium in emergency patients with decompensated heart failure: clinical characteristics and course

Objetivo: Indentificar el delirium en pacientes con insuficiencia cardiaca (IC) descompensada (ICD) atendidos en urgencias y analizar las características clínicas y la evolución a largo plazo. Método: Estudio prospectivo y observacional en 60 pacientes que acudieron a urgencias por ICD. Evaluamos la presencia de delirium y subsíndrome de delirium mediante el Confusional Assessment Method. Se realizó un seguimiento telefónico al año. Resultados: La edad media fue de 80,5 ± 11 años, el 61,7% fue mujer. El 11,7% reunía criterios de delirium y 3,3% de subsíndrome de delirium. Los pacientes con delirium tenían mayor edad (p = 0.004), mayor dependencia para las actividades de la vida diaria instrumentales (AVDi) (p = 0,001) y básicas (Barthel) (p = 0,001), demencia (p = 0,007)y vasculopatía periférica (p = 0,029). No se observó diferencias estadísticamente significativas en la etiología y las características de la IC. Durante el ingreso fallecieron 2 pacientes con delirium (p = 0,23). Sólo 2 de los pacientes con delirium sobrevivieron al año del ingreso (p = 0,4), ambos con alteración cognitiva y dependencia funcional grave. Conclusión: La presencia de delirium en pacientes con ICD parece relacionarse más con la edad avanzada, la situación basal de dependencia funcional y el deterioro cognitivo de los pacientes que con la gravedad o el estadio de la IC (AU)

Objective: To analyze the clinical characteristics of patients with decompensated heart failure who are brought to a hospital emergency department and to describe the long-term clinical course in these patients. Methods: Prospective observational study of 60 emergency patients with decompensated heart failure. We used the Confusional Assessment Method to assess the presence of delirium and subsyndromal delirium. The patients were followed by means of telephone interviews for 1 year. Results: The mean (SD) age was 80.5 (11); 61.7% were women. Delirium was detected in 11.7% and subsyndromal deliriumin 3.3%. Patients with delirium were older (P=.004), showed greater dependency with respect to both instrumental activities of daily living (ADLs) (P=.001) and basic ADLs (Barthel index) (P=.001), and had higher rates of dementia (P=.007) and peripheral vascular disease (P=.029). No significant differences were detected in the causes or characteristics of heart failure between the patients with and without delirium. Two patients with delirium died in hospital (P=.23). Only 2 patients with delirium survived the year of follow-up (P=.4); both showed cognitive dysfunction and high levels of functional dependency. Conclusions: Delirium in patients with decompensated heart failure seems to be more associated with older age, a baseline situation of functional dependency, and cognitive decline than with the seriousness or stage of heart failure (AU)