Ethical aspects of the COVID-19 crisis: How to deal with an overwhelming shortage of acute beds.

The current outbreak of SARS-CoV-2 has and continues to put huge pressure on intensive care units (ICUs) worldwide. Many patients with COVID-19 require some form of respiratory support and often have prolonged ICU stays, which results in a critical shortage of ICU beds. It is therefore not always physically possible to treat all the patients who require intensive care, raising major ethical dilemmas related to which patients should benefit from the limited resources and which should not. Here we consider some of the approaches to the acute shortages seen during this and other epidemics, including some guidelines for triaging ICU admissions and treatments.

Pierna catastrófica izquierda / Catastrophic left leg

Trabajo que ha recibido el Premio Terapia V.A.C.® en su segunda convocatoria, en la modalidad de: «Exposición de un caso clínico». A destacar la espectacularidad de los resultados(AU)

This report received the V.A.C.® Therapy Prize, second convocation, in the clinical case category. Of note is the spectacular nature of its results(AU)

The gift of nursing.

As parents experience the illness in their children, pediatric nurses are often a source of information, reassurance, and even comfort. Especially in the case of life-threatening conditions of children, the relationship with nurses can provide a "lifeline" for parents who are truly facing their worst fears. Author Lisa Buell's daughter, Madison (Maddy), was diagnosed with a rare tumor as an infant. After several rounds of chemotherapy and surgery, Maddy spent her last months at home with family and friends, and died in August 1998 at 2 1/2 years. In her essay, The Gift of Nursing, Lisa Buell pays tribute to nurses and reminds them of the meaningful role they play in the lives of pediatric patients and their families, both during the course of an illness and long afterwards.

Papel de la Atención Primaria en la asistencia pediátrica hospitalaria urgente: estudio de los pacientes derivados a un hospital de tercer nivel / No disponible

Objetivos: analizar las características de los pacientes que acuden a un servicio de urgencias hospitalario derivados desde servicios de Atención Primaria. Material y métodos: estudio analítico transversal realizado en el servicio de urgencias pediátricas del Hospital Clínico de Santiago entre noviembre de 2004 y marzo de 2005. Se seleccionó una muestra de 648 pacientes. Las variables recogidas fueron: edad, sexo, localidad, motivo de consulta, diagnóstico, tiempo de evolución del cuadro, número de consultas previas y pruebas complementarias. Resultados: el 54% de los pacientes eran varones; la edad mediana era de 3,7 (desviación cuartil de 3,6). Un 11,7% fue derivado desde la Atención Primaria. La fiebre fue el principal motivo de consulta (32,2%) y la infección respiratoria aguda de vías altas el diagnóstico más frecuente (21,5%). En la mayoría de los pacientes, los síntomas se iniciaron dentro de las primeras 24 horas (61,4%) y no hicieron consultas previas (82,3%). Mediante el análisis bivariante se comprobó que el grupo de edad más derivado es el de escolares (p = 0,006) y que el número de pruebas complementarias y el número de ingresos fueron mayores en el grupo de pacientes derivados (ambas con p < 0,001). Mediante el análisis multivariante se comprobó que las únicas variables antecedentes relacionadas con la derivación son la distancia al hospital (1,4 veces más por cada 10 kilómetros) y la presencia de antecedentes personales. Conclusiones: los diagnósticos realizados en pacientes que acuden por iniciativa propia y los que acuden a Atención Primaria son similares. Los pacientes derivados son sometidos a un mayor número de pruebas complementarias y se ingresaban con mayor frecuencia. La Atención Primaria se presenta como un filtro eficaz de las urgencias pediátricas (AU)

Objectives: To analyze the characteristics of the patients attended in a hospital emergency department referred from Primary Care. Patients and methods: Cross-sectional analytical study made in the Paediatrics Emergency Department of The Clinic Hospital of Santiago de Compostela between November 2004 and March 2005. We analyzed 648 episodes. The variables recorded were: age, sex, locality, reasons of consultation, diagnosis, time of evolution, number of consultations and further tests. Results: 54% of the patients were males, and the median age was 3,7 years (deviation quartile 3,6). 11,7% were referred from Primary Care. Fever was the main reason of consultation (32,2%) and upper respiratory tract infection the most common diagnosis. In most cases the symptoms had appeared in the last 24 hours (61,4%) and they hadn’t go previously to Primary Care (82,3%). In the bivariate analysis we proved that the school age children were the most frequently referred (p = 0,006), moreover the number of further tests and the number of admissions were bigger in the referred patients (both, p < 0,001). In the multivariate analysis we proved that only variables influencing the referrals were the distance to hospital and the personal history of the patient. Conclusions: The diagnosis in patients who seek medial care at a hospital are the same that the diagnosis in patients who go to Primary Care. The referred patients were submitted more frequently to further tests and they were frequently admitted into hospital. Primary care is an effective filter of hospital emergencies (AU)

[Care and problems in intractable neurological diseases--home care of intractable diseases from the view of a practicing physician].

Taking into account how to care patients at home with intractable neurological disease and their family, I have introduced the achievement of the medical caring technique by an aged family member, the risks of the PEG and acute respiratory failures under BiPAP, the problems in home rehabilitation, and the experiences of home terminal care, from the view point of a practicing physician. Home caring pursues to support patients and their family to live peacefully with disease with highest quality of life. Hospice caring is also an important issue. From now on, I would like to try to give even better home care by early recognition of problems and by cooperating with hospitals, clinics and other field workers.

[Improvement and evaluation of QOL for the patients with nanbyo, intractable diseases].

The intractable diseases that are nanbyo in Japanese, have been defined by the Ministry for establishing the care system. This article argued the key issues including narrative based approach, palliative care and SEIQoL-DW for improving and evaluating of QOL of the patients with nanbyo.

The challenge of transitional care for young people with life-limiting illness.

Transitional care for young people with life-limiting illness is a particularly complex issue. The process of moving from paediatric to adult services is often fraught and poorly planned. As a result, this can add to the distress experienced by the young people and their families. The ideal would be to have a dedicated service for young adults that bridges the gap in care. The continued slow growth of community children's nursing services, however, highlights the constraints in developing services for a relatively small percentage of the population. Healthcare professionals must recognize the specialist needs of this patient group, and develop strategies to ensure that young people receive the care to which they are entitled.

Providing a seamless service for children with life-limiting illness: experiences and recommendations of professional staff at the Diana Princess of Wales Children's Community Service.

The Diana Children's Community Teams (DCCTs), a new nurse-led service funded by the Department of Health, were established to provide care in the community as an alternative to hospital for children with life-threatening/life-limiting illnesses and their families. This paper presents selected findings highlighting the professionals' experiences which formed part of the evaluation of the Diana, Princess of Wales Children's Community Service in Leicester, Leicestershire and Rutland. The Diana Service in Leicestershire attempts to encompass both parental empowerment and interagency collaboration. By working in partnership with the children and their families, the team provides an integrated and multiprofessional community-based service. This paper particularly concentrates on the perceptions and recommendations from the Diana team itself. Three independently managed Community Nursing Services existed in Leicestershire prior to the Diana teams; a Paediatric Macmillan Service, a Children's Community Nursing Service and a Respite Service. The Leicestershire DCCT integrated the three nursing services into a single team. This team has moved away from a traditional uniprofessional service structure by encompassing a wider team of multiprofessionals, including a cultural link worker, an occupational therapist, a physiotherapist, a play specialist and a team of trained counsellors, working in partnership to provide a quality service for families. * The evaluation, which used a longitudinal multimethod process analysis based on an action research framework, suggests that children with complex and life-limiting illnesses and their families benefit greatly from an effective seamless service. This paper recommends a framework of care that may be relevant to other teams of children's community services across the country. This service has been judged by the impact it has had on the families who use it and the professionals employed within it.

Boosting strategies. Enhancing the self-esteem of individuals with catastrophic illnesses and injuries.

This qualitative study used grounded theory methods to determine how individuals were able to live with catastrophic illnesses and injuries. Twenty-eight participants were interviewed for stories of how they endured their circumstances. Although several strategies were used, this article describes a strategy entitled "boosting," which outlines the affected individuals' efforts to improve their self-esteem, which helped them bear their circumstances. Boosting has some relationship to social comparison theory. Implications for nurses and the importance of awareness of this communication need for patients are discussed.

Protecting strategies used by sufferers of catastrophic illnesses and injuries.

The purpose of this research was to describe strategies used by sufferers of catastrophic illnesses and injuries. Participants were adult men and women with a variety of serious illnesses and injuries. Qualitative research approaches to data collection and data analysis, using grounded theory methods were employed. Descriptions of the participants indicate that several strategies are used; this discussion focuses on strategies to protect themselves from further suffering. Situations where participants use protecting strategies are identified and described. The findings indicate how care-recipients try to lessen the burden on their care-givers and to protect them from the stress of the sufferer's problems.

Process of dying. Defining characteristics.

Health professionals should not be forcing the terminal patient into preestablished stages, but rather should take into account the actual experiences of the individual. The purpose of this study was to identify the defining characteristics of the dying process within the terminal phase. A retrospective audit of 11 deceased clients' charts from a hospice program was conducted. Each client had been diagnosed with terminal cancer. Defining characteristics of the process of dying were delineated and organized into groups of subjective and objective phenomena. These included anorexia, absence of pain, nausea, vomiting, tachycardia, respiratory status, withdrawal of self, secretions, mental status, urinary output, restlessness, bowel sounds, blood pressure, internal temperature, skin temperature, skin color, edema, and diaphoresis. Although the sample size was small, these findings confirmed that the dying process for terminal cancer patients was an individualized experience. Additional research is needed to build on this framework.

The long-term acute care hospital: a new option for ventilator-dependent individuals.

Improved health care and sophisticated medical technology have improved the outcome for many people who suffer a critical illness. One group of people who have benefited are ventilator-dependent individuals (VDIs), as evidenced by the increased number of children and adults requiring long-term mechanical ventilation. Significant changes in this nation's health care reimbursement structure have made a substantial negative impact on the availability of traditional long-term care options for these patients. In response, a new health care environment has emerged. Now available are specialty hospitals providing general hospital services, which allow for long-term acute care intervention. The Vencor Corporation has successfully established this innovative care environment in a cost-effective manner. There are currently nine Vencor hospitals specializing in providing long-term acute care to VDIs and other catastrophically ill patients.