Los documentos de voluntades anticipadas. La opinión de los representantes / Advance directives. Representatives' opinions

Introducción. El uso y utilidad de los documentos de voluntades anticipadas (DVA) es motivo de frecuente polémica en relación con su validez y eficacia, aspectos inexplorados en nuestro país desde la perspectiva de los representantes. Objetivo. Conocer la opinión de los representantes designados en un DVA registrado, sobre su utilización. Metodología. Estudio transversal mediante encuesta telefónica a los representantes de 146 personas fallecidas que, desde febrero de 2012, habían registrado un DVA. Resultados. Noventa y ocho (67,1%) de los entrevistados afirmaron que se consultó el DVA, 86 (58,9%) que se les consultó la opinión como representante y 120 (82,1%) creían que se respetó la voluntad del paciente. Ciento dos (69,9%) de las personas entrevistadas consideraron que los pacientes que previamente habían planificado su atención mediante un DVA tuvieron una buena muerte, 33 (22,4%) manifestaron que podría haber sido mejor y 10 (6,9%) creían que sufrieron mucho. Conclusión. Los DVA en su gran mayoría fueron consultados y respetados, y posiblemente este hecho se relaciona con que la mayoría de los representantes afirmasen que la muerte de sus representados fue percibida como confortable. Para finalizar sería conveniente otro tipo de estudios complementarios dirigidos a personal sanitario para conocer las percepciones de estos respecto a la utilización de los DVA en el proceso de muerte (AU)

Introduction. The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. Objective. To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. Methods. Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. Results. More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. Conclusion. The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying (AU)

[Advance directives. Representatives' opinions]. / Los documentos de voluntades anticipadas. La opinión de los representantes.

INTRODUCTION: The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. OBJECTIVE: To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. METHODS: Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. RESULTS: More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. CONCLUSION: The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying.

Decisiones de nutrición artificial en pacientes con gastrostomía / Artificial nutrition decisions in patients with gastrostomy

Introducción: la nutrición e hidratación artificial no siempre producen una mejoría en la calidad de vida de las personas que las reciben. La decisión de nutrición e hidratación artificial puede ser difícil de tomar y no siempre se consideran todos los aspectos implicados en ella. Objetivo: describir como se tomaron las decisiones de nutrición artificial en cuanto a los beneficios previsibles y la participación de los pacientes. Pacientes y método: revisión de las historias clínicas de pacientes con gastrostomía. Resultados: se han incluido en el estudio 41 pacientes. El 57% fueron varones y la edad media fue de 69,8 años. El AVC (13 casos) fue el diagnóstico más frecuente, seguido de la neoplasia y la demencia (7 casos cada uno). Durante el seguimiento fallecieron 18 pacientes. En 38 (93%) pacientes la decisión de gastrostomía fue tomada por profesionales del hospital de agudos y en 3 por el médico de cabecera. El motivo de instauración de la gastrostomía fue disfagia en 28 pacientes (68%). El documento de consentimiento informado para la realización de la gastrostomía constaba en la historia clínica en 36 pacientes (88%). La decisión contó con la participación de 8 pacientes (19%) y de 20 familias (49%). La calidad de vida previa fue estimada en 21 pacientes (51%) y la capacidad en 23 (56%). Discusión: las decisiones en NA se toman sin que exista una explícita valoración de los beneficios previstos hablando en términos de calidad de vida para el paciente y con poca participación del paciente, aunque más de su familia (AU)

Introduction: artificial nutrition and hydration do not always achieve an improvement in the quality of life of those who receive them. The decision of administering artificial nutrition and hydration may be difficult to make, and not all the issues it involves are always considered. Objective: to describe some no clinical characteristics of artificial nutrition decisions. Patients and method: revision of clinical histories of gastrostomy patients. Results: forty-one patients were included in the study; 57% were males and mean age was 69.8 years. Stroke was the most frequent diagnosis (13 cases), followed by neoplasm and dementia (7 cases each). During the follow-up 18 patients died. In 38 patients (93%), the decision to conducta gastrostomy was made by acute care professionals, and in 3% by the practitioner. The reason of the gastrostomy was dysphagia in 28 patients (68%). The informed consent form to conduct the gastrostomy was included in the clinical history in 36 patients (88%). The decision was made with the patients participation in 8 cases (19%) and with the family participation in 20 cases (49%). Prior quality of life was estimated in 21 patients (51%) and ability in 23 (56%). Discussion: artificial nutrition decisions are made without an explicit assessment of the expected benefits in terms of quality of life for the patient, and with little participation from the patient, while families are involved more often (AU)

Prevalence of antibodies to spotted fever group rickettsiae in human beings and dogs from and endemic area of mediterranean spotted fever in Catalonia, Spain.

We assessed the prevalence of antibodies to spotted fever group rickettsiae in human beings and dogs by indirect immunofluorescence in the region of 'Vallés Occidental', Barcelona (Spain). In the group of 150 serum samples from patients without former history of Mediterranean spotted fever, 12 had antibodies to Rickettsia conori. The overall seroprevalence was 8% (95% confidence interval, 4.6% to 13.5%). There were no statistically significant differences between the mean ages of patients with positive and negative antibodies to R. conorii. However, seropositivity was significantly more common among patients living in semi-rural areas. In the group of 138 dog serum samples, 36 (26.1%) sera had antibodies to R. conorii. When the present results were compared with those obtained in a previous seroepidemiological survey carried out in the same geographical region in 1987, no significant differences were found. Therefore, although the epidemiological markers have dropped, this does not absolutely confirm the decrease of the presence of R. conorii in this area.