Uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos / Clinical Use of Intravenous Lidocaine for Management of non-Oncologic Neuropathic Pain in Adults

El dolor neuropático es común en la práctica clínica. Se estima que afecta entre el 2 y 3 % de la población a nivel global. Una cantidad considerable de pacientes presentan dolor refractario a tratamientos existentes, volviéndolo un reto diagnóstico y terapéutico. El objetivo de este estudio es describir el uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos. La búsqueda de información se realizó consultando las bases de datos HINARI, SciELO y PubMed. Se seleccionaron artículos en inglés y español de 2017 a 2021. Se utilizaron artículos originales, ensayos clínicos, revisiones bibliográficas y metaanálisis. Las causas de dolor neuropático en las que ha sido utilizada la lidocaína son la neuralgia posherpética, neuropatía diabética y neuralgia del trigémino. El uso de lidocaína intravenosa demostró que disminuye la intensidad del dolor; sin embargo, al compararlo con otros fármacos de primera línea no hay diferencias a largo plazo. La mayoría de efectos secundarios se presentan en el sistema nervioso, gastrointestinal y cardiovascular. La lidocaína intravenosa como monoterapia para manejo de dolor neuropático no oncológico, si bien fue eficaz a corto plazo con dosis de 3-5 mg/Kg, no tuvo un efecto persistente y duradero

Neuropathic pain is common in clinical practice; it is estimated that 2 to 3 % of the global population is affected; a considerable number of patients present pain refractory to existing treatments, making it a diagnostic and therapeutic challenge. The objective of this study is to describe the clinical use of intravenous lidocaine for the management of non-cancer neuropathic pain in adults. The information search was performed by consulting the HINARI, SciELO and PubMed databases. Articles with an obsolescence of no more than five years, both in English and Spanish, were selected. Original articles, clinical trials, bibliographic reviews and meta-analyses were used. The causes of neuropathic pain in which lidocaine has been used were postherpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia. The use of intravenous lidocaine has been shown to decrease pain intensity; however, when compared with other first line drugs, there are no long-term differences. Most side effects occur in the nervous, gastrointestinal, and cardiovascular systems. Intravenous lidocaine as monotherapy for the management of non-cancer neuropathic pain, although effective in the short term with doses of 3-5 mg/Kg, does not have a persistent and long-lasting effect

WhatsApp as a facilitator of expressions of gratitude for palliative care professionals.

INTRODUCTION: Family members significantly value the professional and humane support that medical teams provide in the process of caring for patients with advanced diseases. Communication is currently changing, making it of interest to explore technology's possible influence on communication and on the care relationship. It remains unknown whether this can vary based on increased use of technology in patient care. Using communication technologies can facilitate recognition of professional support through the expression of gratitude aimed at healthcare professionals. The objective here is to describe expressions of gratitude sent via WhatsApp messages by patients who receive treatment from a palliative care team and their relatives. METHOD: A generic qualitative methodology was used. The palliative care service studied used WhatsApp in the patient/family-professional relationship. A content analysis of 130 WhatsApp messages sent to the professionals and containing expressions of gratitude was carried out. Two researchers inductively performed the analysis. Analysis included aspects for which senders were most grateful and others, such as who the messages came from, whether they were reactive or spontaneous and to whom they were directed. RESULTS: Almost all of the patients treated transmitted their gratitude via WhatsApp. It was also observed that family members were most grateful for features of the care received (i.e., affection, availability), the professional's support (i.e., accompaniment, comfort) and the professional's qualities (i.e., professionalism, kindness). They also appreciated symptom control and attempts to resignify loss; these aspects received the most expressions of gratitude in the messages. In turn, all the messages contain expressions of support for palliative care professionals, evidencing a patient/family-professional relationship. CONCLUSION: The use of communication technologies like WhatsApp can contribute to the perception of professionals' availability and closeness and become a facilitator of expressions of gratitude that specify the aspects that family members most appreciate from the palliative care team, such as skills related to humane care and availability.

Long-term effects of an undergraduate palliative care course: a prospective cohort study in El Salvador.

BACKGROUND: International organisations recommend the inclusion of palliative care undergraduate education as a way to meet increasing demand; the long-term effects, however, are unknown. Since 2013 the Dr José Matías Delgado University has offered an undergraduate course for palliative care. AIMS: To assess whether a palliative care course results in improvement in self-perceived comfort among students and if it lasts up to 4 years later; and to examine students' knowledge of palliative care and assess the relationship between comfort and knowledge. DESIGN: This is a prospective cohort study where students attending the course were requested to complete the Scale of Self-Perceived Comfort in palliative care pre and post course. Participants were contacted in 2018 and a group without palliative care education was established as a control group, matched one-to-one according to current academic level. They were asked to complete the Scale of Self-Perceived Comfort questionnaire together with the Palliative Care Knowledge Test. SETTINGS/PARTICIPANTS: 83 students who attended the course between the years 2014 and 2017 and 101 controls. RESULTS: In the postcourse test, participants had a 1.13-point increase (p≤0.001) in comfort, which persisted 4 years later and was superior to the control group by 0.6 points (p≤0.001). The control group showed no difference in the precourse test despite having more clinical experience (p=0.68). The students outscored the control group in the knowledge test by 4.2 points (p≤0.001). There appears to be no correlation between comfort and knowledge. CONCLUSION: A palliative care undergraduate course results in improvement in student comfort and knowledge which persists up to 4 years later.

Enseñanza de los cuidados paliativos en las escuelas de medicina de El Salvador / Teaching of palliative care in medical schools in El Salvador

INTRODUCCIÓN: El aumento de la prevalencia de las enfermedades crónicas no transmisibles y la complejidad del control de sus síntomas en estados avanzados ponen mucha presión a los sistemas de salud. Los cuidados paliativos son una respuesta a esta necesidad, pero el personal especializado es escaso; una opción es la enseñanza a los médicos en formación. Se pretende mostrar la situación de la enseñanza de cuidados paliativos a nivel pregrado en las escuelas de medicina de El Salvador. METODOLOGÍA: Se realizó un estudio descriptivo, observacional y transversal mediante encuestas en las que se les solicitó a representantes de las 6 escuelas de medicina en El Salvador responder preguntas sobre sus conocimientos en cuidados paliativos, importancia otorgada y presencia de la asignatura en malla curricular. RESULTADOS: El 83% respondió conocer sobre cuidados paliativos y el 100% identificó la importancia y necesidad de incluirlo dentro del plan de estudios, justificándolo por la alta prevalencia de enfermedades crónico-degenerativas. Solo una sola escuela de medicina incluye en su malla curricular la asignatura de cuidados paliativos. En 5 escuelas se imparten temas aislados en asignaturas afines. El promedio de horas totales de contenido por alumno pregrado fue de 14,1 horas. DISCUSIÓN: Aunque los entrevistados reconocieron la importancia de la enseñanza de cuidados paliativos en pregrado, el contenido total promedio de horas es bajo, mostrando una disparidad entre la enseñanza y la importancia percibida. Esto limita grandemente el desarrollo de los cuidados paliativos en el país, razón por la cual se aconseja su inclusión dentro del plan de estudios

INTRODUCTION: The increasing prevalence of chronic non-communicable diseases and the complexity of controlling their symptoms in advanced states places a lot of pressure on healthcare systems. Palliative care is a response to this need, but specialised staff are scarce, and one option is teaching doctors in training. This study attempts to present the current situation of learning palliative care at undergraduate level in the Medical Schools of El Salvador. METHODOLOGY: A descriptive, observational, and cross-sectional study was carried out using questionnaires in which representatives of the 6 medical schools in El Salvador were asked to answer questions about their knowledge in palliative care, the importance given and the presence of the subject in a curriculum grid. RESULTS: A total of 83% of those who answered knew about palliative care, and 100% identified the importance and need to include it within the curriculum. They justified this by the high prevalence of chronic-degenerative diseases. Only one medical school included the subject of palliative care in its curriculum. In 5 schools, isolated subjects are taught on related subjects. The average total hours of content per undergraduate student was 14.1 hours. DISCUSSION: Although all representatives acknowledged the importance of teaching palliative care in undergraduate courses, the average total hours content is low, showing a disparity between teaching and perceived importance. This greatly limits the development of palliative care in the country, which is why it is advisable to include it in the curriculum

Multicenter Study of the Psychometric Properties of the New Demoralization Scale (DS-II) in Spanish-Speaking Advanced Cancer Patients.

CONTEXT: Demoralization is a state of existential distress in patients with advanced illness, typically with coping difficulties, feelings of loss of sense, and purpose in life and despair, among other things. The New Demoralization Scale (DS-II) is an evaluation tool for this syndrome, which has recently been reformulated on a shorter scale. OBJECTIVES: The objective of this study was to obtain a Spanish version of the DS-II and to assess its psychometric properties in advanced cancer patients in Spain and a number of Latin American countries. METHODS: Following a translation-back translation process, a validation study and a confirmatory analysis using structural equation models with their corresponding latent constructs were undertaken. Patients completed the DS-II in Spanish (DS-II (es)), the Hospital Anxiety and Depression Scale, and the Edmonton Symptom Assessment System-revised. Reliability was studied according to internal consistency; construct validity and concurrent validity with the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment System-revised; discriminant validity using the Karnofsky Performance Status scale; and feasibility, with response ratio and required time. Cutoff points were established, and sensitivity and specificity were studied. RESULTS: The DS-II (es) was obtained. One hundred fifty patients completed the validation study. The confirmatory analysis showed coherence, and all items correlated positively with their subscales and with the overall scale. Cronbach's alpha for the DS-II (es) was 0.88, for the sense and purpose subscale 0.83, and for the coping ability 0.79. Demoralization correlated significantly with emotional distress (rho = 0.73, P < 0.001). The tool distinguished between patients with diverse functional levels (rho = -0.319, P = 0.001). Cutoff points at 10 and 20 out of 32 were established. The scale showed high sensitivity (81.97%) and specificity (80.90%). The prevalence of demoralization was 33% in our sample. CONCLUSION: The Spanish version of the new Kissane DS-II demoralization scale has shown to be valid, reliable, and feasible with adequate psychometric properties.

Situación actual de la enseñanza de la medicina paliativa en las universidades de Centroamérica / Current status of palliative medicine training in Central American universities

INTRODUCCIÓN: En Centroamérica existe una incipiente integración de cuidados paliativos en los sistemas de salud. Organizaciones internacionales apuntan a la educación de pregrado y posgrado en medicina paliativa como una herramienta para mejorar la atención de los pacientes y las familias. En este estudio observamos la situación actual de la enseñanza universitaria de esta asignatura en la región. METODOLOGÍA: Es un estudio descriptivo, observacional, transversal. Se realizó una búsqueda de la malla curricular pregrado y posgrado de las universidades de Centroamérica disponibles virtualmente, identificando asignaturas con la denominación «medicina paliativa» para su posterior caracterización y descripción. Además, se identificaron materias afines en las cuales se podrían cubrir temas de medicina paliativa en las universidades que no cuenten con la asignatura. RESULTADOS: De las 33 universidades con malla curricular virtuales, solo en 2 (6%) se identificó la asignatura de medicina paliativa. Se identificaron 26 universidades con materias afines (78%). Se encontraron 5 cursos de posgrado de cuidados paliativos, contando solo Costa Rica con la especialidad. DISCUSIÓN: Por primera vez se dispone de una visión panorámica de lo que ocurre en las facultades de medicina respecto a la medicina paliativa. Existen muchos retos para mejorar la cobertura en cuidados paliativos en Centroamérica. Agregar a la malla curricular en pregrado la asignatura de medicina paliativa y ofrecer cursos de posgrado, pensamos que podría ayudar a acelerar la integración y dar respuesta efectiva a la demanda, como se ha visto en otros países

INTRODUCTION: Palliative care is poorly integrated into the healthcare systems of Central America. Based on this, many international organisations suggest that undergraduate education in palliative medicine is an efficient tool to improve care for patients, their families, and provide a response to the increasing demand. METHODOLOGY: A cross-sectional, observational, and descriptive study was performed by searching for undergraduate and graduate study plans from universities in Central America that were available virtually. Subjects under the name "Palliative Medicine" were identified and further characterised and described. In addition, the related materials were identified which could cover issues of palliative care at universities that do not have courses. RESULTS: Of the 33 universities with virtual study plans available online, only 2 (6%) courses of Palliative Medicine were identified. There were related subjects in 26 (78%) universities, with the most common being ethics (75%). Only 5 graduate courses of palliative medicine were found, and only Costa Rica had a specialist three-year course. DISCUSSION: This is the first time an overview has been provided on the status of palliative medicine in medical education of Central America. There are many challenges to improve coverage in palliative care in Central America. Adding the palliative medicine course to the undergraduate curriculum and offering more postgraduate studies courses can help accelerate integration and provide an effective response to demand