Facilitators and barriers perceptions to early referral to pediatric palliative care perceived. / Percepción de facilitadores y barreras para la derivación a cuidados paliativos pediátricos.

The perception of facilitators and barriers to referral to pediatric palliative care (PPC) is a widely studied phenomenon, with scarce information in Latin America. OBJECTIVE: to adapt a survey on the perception of facilitators and barriers to PPC referral and evaluation. SUBJECTS AND METHOD: electronic survey with cultural adaptation with translation-retrotranslation in pediatricians and pediatric subspecialists of 3 tertiary centers in Santiago. The survey consisted of 4 sections and 51 questions, corresponding to sociodemographic data (including self-perception of spirituality and religiosity), training and clinical practice of the respondent in PPC, and facilitators and barriers to referral to PPC. RESULTS: 146 pediatricians were invited and 78 surveys were obtained (response rate: 53.4%). The median age was 42 years and 11.5 years of professional practice. The majority corresponded to pediatricians without subspecialty training (n = 34; 43.6%). Twenty-three (29.5%) of the participants received PPC training, which was perceived as insufficient in 17 (74%) cases; there were also no differences in PPC training when comparing pediatricians with or without subspecialty training. Ninety-five percent of the respondents agreed with the perceived benefit of early referral to PPC for patients with life-threatening pathologies, regardless of their diagnosis, although only 47.7% stated that they had made a referral to a PPC team. The emotional relationship with the patients and their families was perceived as a barrier by pediatricians in those subspecialists susceptible to PPC compared with those who were not (20% vs. 50%; p = 0.03). CONCLUSION: A significant deficit in PPC training was detected. There were no differences in facilitators and barriers between pediatricians and subspecialties susceptible to PPC. Specialties not accustomed to PPC-susceptible patients may be affected by emotional factors in their decisions.

Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12.

CONTEXT: Improving quality of death (QOD) is a key goal in palliative care (PC). To our knowledge, no instruments to measure QOD have been validated in Spanish. OBJECTIVES: The goals of this study were to validate the Spanish version of the quality of dying and death (QODD) questionnaire and to develop and validate a shortened version of this instrument by phone interview. METHODS: We enrolled caregivers (CGs) of consecutive deceased cancer patients who participated in a single PC clinic. CGs were contacted by phone between 4 and 12 weeks after patients' death and completed the Spanish QODD (QODD-ESP). A question assessing quality of life during last week of life was included. A 12-item QODD (QODD-ESP-12) was developed. Reliability, convergent validity, and construct validity were estimated for both versions. RESULTS: About 150 (50%) of 302 CGs completed the QODD-ESP. Patient's mean age (SD) was 67 (14); 71 (47%) were females, and 131 (87%) died at home. CGs' mean age (SD) was 51 (13); 128 (85%) were females. Mean QODD-ESP score was 69 (range 35-96). Kaiser-Meyer-Olkin measure of sampling adequacy was 0.322, not supporting the use of factorial analysis to assess the existence of an underlying construct. Mean QODD-ESP-12 score was 69 (range 31-97). Correlation with last week quality of life was 0.306 (P < 0.01). Confirmatory factorial analysis of QODD-ESP-12 showed that data fitted well Downey's four factors; Chi-square test = 6.32 (degrees of freedom = 60), P = 0.394 comparative fit index = 0.988; Tucker-Lewis Index = 0.987, and root mean square error of approximation = 0.016 (95% CI 0-0.052). CONCLUSION: QODD-ESP-12 is a reliable and valid instrument with good psychometric properties and can be used to assess QOD in a Spanish-speaking cancer PC population by phone interview.

Hybrid biomaterials based on calcium carbonate and polyaniline nanoparticles for application in photothermal therapy.

Inorganic materials contain remarkable properties for drug delivery, such as a large surface area and nanoporous structure. Among these materials, CaCO3 microparticles (CMPs) exhibit a high encapsulation efficiency and solubility in acidic media. The extracellular pH of tumor neoplastic tissue is significantly lower than the extracellular pH of normal tissue facilitating the release of drug-encapsulating CMPs in this area. Conducting polyaniline (PANI) absorbs light energy and transforms it into localized heat to produce cell death. This work aimed to generate hybrid CMPs loaded with PANI for photothermal therapy (PTT). The hybrid nanomaterial was synthesized with CaCO3 and carboxymethyl cellulose in a simple, reproducible manner. The CMP-PANI-Cys particles were developed for the first time and represent a novel type of hybrid biomaterial. Resultant nanoparticles were characterized utilizing scanning electron microscopy, dynamic light scattering, zeta potential, UV-vis, FTIR and Raman spectroscopy. In vitro HeLa cells in dark and irradiated conditions showed that CMP-PANI-Cys and PANI-Cys are nontoxic at the assayed concentrations. Hybrid biomaterials displayed high efficiency for potential PTT compared with PANI-Cys. In summary, hierarchical hybrid biomaterials composed of CMPs and PANI-Cys combined with near infrared irradiation represents a useful alternative in PTT.