Factores asociados a la calidad de vida en adultos mayores con insuficiencia orgánica crónica avanzada en un hospital de Lima-Perú

Objetivo: Determinar los factores asociados a la calidad de vida en adultos mayores con insuficiencia orgánica crónica avanzada en un hospital de Lima-Perú. Materiales y métodos: Investigación observacional, analítica transversal, cuya población la conformaron 100 adultos mayores, la técnica de recolección fue la entrevista y el instrumento el cuestionario a través de la aplicación del índice de Barthel y WHOQoL-Bref. Para responder a los objetivos de estudio se aplicaron las pruebas no paramétricas u de Mann Whitney, Kruskal Wallis y Rho de Spearman, considerando la significancia del 5%. Resultados: El (44) 44% de adultos mayores tuvieron más de 80 años, el (59) 59% fueron varones, el (31) 31% estudiaron nivel técnico superior, el (57) 57% fueron titulares en la marina de guerra, el (74) 74% tuvo hipertensión arterial. Los síndromes geriátricos más frecuentes fueron déficit visual o auditivo (82) 82%, insomnio (59) 59%, estreñimiento (52) 52% y malnutrición (47) 47%. El (50) 50% de los adultos mayores presentó dependencia funcional grave. El (63)63% presentó calidad de vida a nivel medio. Los factores epidemiológicos asociados a la baja calidad de vida, fueron la edad mayor a 80 años (p=0,032, RP=1,818), sexo femenino (p=0,009, RP=2,056), el grado de instrucción dado por analfabeto, primaria y secundaria (p=0,025, RP=1,930) y la relación con la marina de guerra como familiar (p=0,022, RP=1,894). Los síndromes geriátricos asociados fueron el insomnio (p=0,034, RP=1,930), el estreñimiento (p=0,000, RP=3,560), la lesión por presión (p=0,000, RP=2,788) y la dependencia funcional grave (p=0,000, RP=4,667). Sin embargo, el análisis multivariado evidenció que el insomnio (p=0,002; RPa=1,166), la lesión por presión (p=0,016; RPa=1,248) y la dependencia grave (p=0,000; RPa=1,207) fueron los factores asociados significativamente a la baja calidad de vida en los adultos mayores. Conclusiones: Los factores insomnio, la lesión por presión y la dependencia grave estuvieron asociados significativamente a la calidad de vida baja en los adultos mayores con insuficiencia orgánica crónica avanzada en un hospital de lima-Perú.

Objective: To determine the factors associated with the quality of life in older adults with advanced chronic organ failure in a hospital in Lima-Peru. Materials and methods: Observational research, cross-sectional analysis, whose population was made up of 100 older adults, the collection technique was the interview and the instrument the questionnaire through the application of the Barthel index and WHOQoL-Bref. To respond to the study objectives, the non-parametric Mann Whitney u, Kruskal Wallis and Spearman's Rho tests were applied, considering the significance of 5%. Results: (44) 44% of older adults were over 80 years old, (59) 59% were men, (31) 31% studied a higher technical level, (57) 57% were incumbents in the navy, (74) 74% had arterial hypertension. The most frequent geriatric syndromes were visual or auditory deficit (82) 82%, insomnia (59) 59%, constipation (52) 52% and malnutrition (47) 47%. The (50) 50% of the older adults presented severe functional dependence. (63) 63% presented quality of life at a medium level. The epidemiological factors associated with low quality of life were age over 80 years (p=0.032, RP=1.818), female sex (p=0.009, RP=2.056), the level of education given by illiterate, primary and secondary school (p=0.025, RP=1.930) and the relationship with the navy as a family member (p=0.022, RP=1.894). Associated geriatric syndromes were insomnia (p=0.034, RP=1.930), constipation (p=0.000, RP=3.560), pressure injury (p=0.000, RP=2.788) and severe functional dependence (p= 0.000, PR=4.667). However, the multivariate analysis showed that insomnia (p=0.002; RPa=1.166), pressure injury (p=0.016; RPa=1.248) and severe dependence (p=0.000; RPa=1.207) were the associated factors. Significantly to the low quality of life in older adults. Conclusions: The factors insomnia, pressure injury and severe dependency were significantly associated with low quality of life in older adults with advanced chronic organ failure in a hospital in Lima-Peru.

Características clínico epidemiológicas de pacientes con enfermedad crónica en fase terminal admitidos a un departamento de emergencia general / Clinical and epidemiological characteristics of patients with end-stage chronic disease who were admitted in an emergency department

RESUMEN Introducción. Los pacientes con enfermedad crónica terminal (oncológica y no oncológica) acuden con frecuencia a servicios de urgencias. Objetivos. Identificar enfermedad terminal en pacientes admitidos a emergencia, motivo de ingreso, tratamiento y destino, comparando oncológicos y no oncológicos. Métodos. Estudio observacional en mayores de 18 años admitidos al departamento de emergencia de un hospital terciario. Intrumento: Supportive and Palliative Care Indicators Tool. Análisis estadístico: pruebas de Chi-cuadrado y U Mann-Whitney, considerando significancia p <0,05. Resultados. De 4925 admisiones, 271 (5,5%) cumplieron criterios de enfermedad terminal. Se analizaron 233 pacientes, mediana de edad 77 años [28-99], sexo femenino 59%. Diagnóstico de cáncer 42%, demencia 23%, secuela neurológica 15%, cirrosis hepática 12% y otros 8%. Los motivos de ingreso fueron infección 48%, dolor no controlado 9% y sangrado 7%. Se usó antibióticos en 48% de pacientes, opioides 12% (morfina y tramadol) y transfusiones en el 9%. El 8,6% recibió soporte vital avanzado (ventilación mecánica 5,6%, inotrópicos 4,7% y hemodiálisis 0,8%). La mediana de estancia en urgencias fue 6 días [1-62]; falleció 27%, salió de alta 32% y 42% fue derivado a otro servicio hospitalario. La estancia en emergencia y el destino fueron similares en oncológicos y no oncológicos (p>0,05), presentándose mayor edad y tiempo de enfermedad en pacientes no oncológicos (p<0,01). Conclusiones. Una de cada 20 admisiones al departamento de emergencia evaluado corresponden a enfermedad crónica en fase terminal (más frecuentes no oncológicas), siendo los motivos de ingreso infecciones, dolor y hemorragia.

ABSTRACT Introduction. Patients with advanced chronic disease (cancer and non-cancer) often go to emergency services. Objectives. To determine terminal chronic disease in those admitted to emergency, reason for admission, treatment and destination, comparing cancer with non-cancer. Methods. Observational study in people over 18 year old admitted to the emergency department of a tertiary hospital. Instrument: Supportive and Palliative Care Indicators Tool. Statistical analysis: Chi-square and U Mann-Whitney tests, considering p <0.05. Results. Of 4925 admissions, 271 (5,5%) met criteria. 233 patients were analyzed, median age 77 years [28-99], female sex 59%. Cancer diagnosis 42%, dementia 23%, neurological sequelae 15%, liver cirrhosis 12% and another 8%. Reason for admission was 48% infection, 9% uncontrolled pain and 7% bleeding. Antibiotics were used in 48% of patients, opioids 12% (morphine and tramadol) and transfusions 9%; 8.6% of these patients received advanced life support (mechanical ventilation 5,6%, inotropic 4,7% and hemodialysis 0,8%). The median stay in the emergency room was 6 days [1-62]; 27% died, 32% were discharged and 42% were referred to another hospital department. The stay and reason for admission were similar in cancer and non-cancer (p>0,05), presenting older age and disease time in non-cancer patients (p<0,01). Conclusions. One of every 20 admissions to the emergency department evaluated corresponds to a chronic disease in the terminal phase (more frequent non-cancer), being the reasons for admission infections, pain and bleeding.

El fenómeno de "pain flare": un efecto secundario no tan inusual en Radioterapia (RT) paliativa y anti-álgica / The "pain flare" phenomenon: a not-so-unusual side effect on palliative and anti-algica radiotherapy (RT)

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Exploración de los valores y deseos de pacientes con enfermedad crónica avanzada y con enfermedad crónica compleja. Conversaciones acerca del final de la vida / Reported wishes and values in patients with advanced chronic conditions (PACC) and patients with chronic condition (PCC). Conversations about end-of-life

OBJETIVO: Explorar los deseos y valores de los pacientes con Enfermedad Crónica Avanzada (MACA) y Enfermedad Crónica Compleja (PCC), usando el Go Wish Card Game (GWG) como instrumento para establecer una conversación sobre el final de la vida. MATERIAL Y MÉTODOS: Se incluyeron pacientes MACA y PCC ingresados en la unidad de convalecencia y larga estancia de la Fundació Sociosanitaria Santa Susanna. Se registraron datos sociodemográficos, nivel de instrucción, nivel de competencia mediante la Escala Móvil de Drane (EMD) y estado cognitivo mediante la escala de Pfeiffer. Se usó el GWG como instrumento para explorar los deseos y valores. Los pacientes seleccionaron entre las cartas lo importante y no importante. De las importantes, se les pidió que seleccionaran las 10 más importantes. Se evaluó la utilidad y adecuación de la entrevista. RESULTADOS: Se incluyeron 16 mujeres y 7 hombres, la edad promedio fue de 82,39 ± 7,38. MACA: 13 %; PCC: 87 %. El grado de instrucción fue: sin estudios: 56,5 %, estudios primarios: 43,5 %. Los niveles de competencia según la EMD fueron: I (8,7 %), II (52,2 %) y III (39,1 %). Pfeiffer = 2 errores: 60,8 %; entre 3-4 errores: 30,4 %; entre 5-7 errores: 8,6 %. Los deseos identificados como más importantes fueron: "No ser una carga para mi familia" (91,3 %), "No estar conectado a máquinas" (69,6 %) y "No tener dolor" (69,6 %). Los deseos menos importantes fueron: "Saber qué cambios puede tener mi cuerpo" (73,9 %); "Ser consciente de lo que está pasando" (65,2 %); y "Morir en casa" (65,2 %). La entrevista fue útil en el 91,3 % y apropiada en el 95,7 %. CONCLUSIÓN: No ser una carga para mi familia, no estar conectado a las máquinas y no tener dolor, fueron los deseos más importantes los pacientes MACA y PCC. El GWG fue un buen instrumento para explorar los deseos y valores acerca del final de la vida

OBJECTIVE: The aim was to explore wishes and values of Patients with Advanced Chronic Condition (PACC) and Chronic Condition (PCC), using the Go Wish Card Game (GWG) as a tool to establish a conversation about end-of-life (EOL). ATERIAL AND METHODS: PACC and PACC admitted to the in-patient unit of intermediate-care and long term-care of Fundació Sociosanitaria Santa Susanna were recruited. Sociodemographic data, level of education and competence level were recorded. Their competency was registered by Drane's sliding scale (DSS) and cognitive status using the Pfeiffer scale. We used the GWG as a tool to speak about EOL. Patients were asked to categorize these wishes as important or not important, which 10 wishes were most important, and to assess the usefulness and appropriate of the interview. RESULTS: 16 women and 7 men were recruited, the average age was 82.39 ± 7.38. PACC: 13 %, PCC: 87 %. The educational level was: without studies: 56.5 %, primary studies: 43.5 %. The DDS levels were: I (8.7 %), II (52.2 %) and III (39.1 %). Pfeiffer = 2 mistakes: 60.8 %; Between 3-4 mistakes: 30.4 %; Between 5-7 mistakes: 8.6 %. The desires identified as most important were: "Not being a burden for my family" (91.3 %), "Not connected to machines" (69.6 %) and "Not having pain" (69.6 %). The less frequent wishes were: "Knowing what changes my body can have" (73.9 %); "Be aware of what is happening" (65.2 %); And "Dying at home" (65.2 %). The interview was useful in 91.3 % and appropriate in 95.7 %. CONCLUSION: Not being a burden for my family, not being connected to machines and not having pain, were the most important wishes for the PACC and PCC. The GWG was a good tool to explore the desires and values about EOL

Correction: An International Consensus Definition of the Wish to Hasten Death and Its Related Factors.

[This corrects the article DOI: 10.1371/journal.pone.0146184.].

Efficacy and Safety of Methadone as a Second-Line Opioid for Cancer Pain in an Outpatient Clinic: A Prospective Open-Label Study.

INTRODUCTION: Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic. PATIENTS AND METHODS: This was a prospective, open-label study of 145 patients whose treatment was rotated from other opioids to methadone. Informed consent was obtained in all cases. The main outcome measure was change in the variable "worst pain" at day 28. Pain and pain interference were assessed with the Brief Pain Inventory, with side effects evaluated according to the Common Terminology Criteria for Adverse Events version 3.0. Pain levels were evaluated at study entry and at days 3, 7, 9, 14, 21, and 28. RESULTS: Rotation to methadone was performed for the following reasons: poor pain control (77.9%), opioid side effects (2.1%), or both (20%). The mean daily oral morphine equivalent dose before rotation was 193.7 mg. The median worst and average pain scores decreased significantly (p < .0001) from baseline to day 28: The median worst pain score decreased from 9 (interquartile range [IQR]: 8-10) to 6 (IQR: 3-8), and the median average pain score decreased from 6 (IQR: 5-7) to 4 (IQR: 2-5). The proportions of patients with moderate to severe worst and average pain decreased by 30.3% and 47.5%, respectively, by day 28. No increase in opioid toxicity was observed during the study. CONCLUSION: In outpatients with advanced cancer, rotation to methadone as a second-line opioid was efficacious and safe when using a tiered scheme with close follow-up by experienced health professionals. IMPLICATIONS FOR PRACTICE: The results of this study, conducted prospectively under real clinical conditions, support the efficacy and safety of oral methadone as a second-line opioid in ambulatory patients with cancer. Moreover, these findings corroborate previously reported outcomes in retrospective outpatient studies and prospective studies that evaluated inpatient populations. Although more research into methadone rotation strategies is still needed, this study describes a successful tiered scheme of oral methadone rotation that was proven safe and effective during follow-up.

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors.

BACKGROUND: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. METHODS: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. FINDINGS: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. CONCLUSIONS: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

What Gives Meaning in Life to Patients With Advanced Cancer? A Comparison Between Spanish, German, and Swiss Patients.

CONTEXT: Meaning in life (MiL) is a construct that varies across individuals, situations, cultures, and countries, and protects against emotional distress at the end of life. OBJECTIVES: To examine MiL in inpatients with advanced cancer from Barcelona, Spain, and to compare the findings with those obtained in German and Swiss samples. METHODS: This was a cross-sectional study in which the Schedule for Meaning in Life Evaluation (SMiLE) was administered. The SMiLE asks respondents to list individual areas that give meaning in their lives and then to rate their current level of importance and satisfaction with the listed areas. RESULTS: A total of 101 inpatients completed the SMiLE. The Index of Satisfaction was 76.8 ± 21.1, the Index of Weighting was 88.0 ± 13.0, and the Index of Weighted Satisfaction was 76.9 ± 20.7. Family, partnership, well-being, and friends were the four areas listed by the largest proportion of Spanish patients. Compared with the German sample, Spanish patients were more likely to list well-being (P < 0.01) and pleasure (P < 0.05) and less likely to list animals/nature, leisure time, and finances (P < 0.01). With respect to their Swiss counterparts, Spanish patients were more likely to list health (P < 0.01) and less likely to list friends, leisure time, animals/nature, and finances (P < 0.01). CONCLUSION: Differences were identified in the areas of MiL listed by the participants according to country of origin. Compared with their German and Swiss counterparts, the Spanish patients listed more areas involving interpersonal relationships. Interpersonal relationships, at both the family and wider social level, are reported to be the areas that give the greatest MiL to these patients. These aspects, therefore, should be considered when drawing up care plans designed to help patients achieve the maximum possible comfort and quality of life.

Utilidad y satisfacción de los pacientes de un instrumento educacional en dolor irruptivo oncológico: resultados preliminares / Usefulness and patient satisfaction with an educational tool on breakthrough cancer pain: preliminary results

JUSTIFICACIÓN: El dolor oncológico irruptivo se define como una exacerbación transitoria de dolor que aparece con un dolor basal adecuadamente controlado. Una nueva generación de fármacos (fentanilo) de absorción transmucosa mimetizan las características del dolor irruptivo, proporcionando un perfil analgésico ideal. Una correcta educación del paciente sobre las características del dolor y el modo de titulación de estos fármacos es esencial para un abordaje satisfactorio. OBJETIVO: Evaluar el grado de comprensión y utilidad que los pacientes otorgan a una hoja de información y soporte a la titulación (HIT) creada para facilitar la comprensión del empleo y titulación del fentanilo nasal en pectina. MATERIAL Y MÉTODO: Inclusión consecutiva de pacientes que ya habían completado el proceso de titulación y a los que se les había entregado la hoja informativa (HIT) para evaluar mediante encuesta su grado de comprensión y satisfacción. RESULTADOS: De los 20 pacientes incluidos, 2 no la habían utilizado como material de consulta. De los restantes, todos la consultaron al menos en una ocasión, el 85% la consideró muy útil y el 80% muy comprensible. El 33% sugirió modificaciones menores

JUSTIFICATION: Breakthrough cancer pain is defined as a transitory exacerbation of pain experienced by the patient who has relatively stable and adequately controlled baseline pain. Anew generation of drugs (fentanyl) with transmucosal absorption mimic the characteristics of breakthrough pain by providing an ideal analgesic profile. Good patient education on pain characteristics and the mode of titration of these drugs is essential for a successful approach. OBJECTIVE: To evaluate the degree of understanding and usefulness that patients given to a titration sheet created to facilitate the use and titration of nasal fentanyl pectin. METHODS: Twenty consecutive patients who had completed the titration and had received the titration sheet were included. A survey was used to assess their satisfaction. RESULTS: Of the 20 patients enrolled, 2 had not consulted the titration sheet because they were happy enough with the verbal instructions given. Of the rest, all had consulted it at least once, 85% considered it very useful and 80% very understandable and 33% suggested minormodifications

Uso de metadona en el anciano con dolor oncológico: una revisión sistemática / Use of methadone in the elderly with cancer pain: A systematic review

Objetivo: Identificar el uso clínico de la metadona como analgésico en el manejo del dolor oncológico en ancianos. Material y métodos: Se realizó una revisión sistemática de la literatura sobre el uso específico de la metadona en ancianos con dolor oncológico en las bases de datos MEDLINE, COCHRANE DATABASE y SCOPUS. Se llevó a cabo una segunda búsqueda en MEDLINE de estudios clínicos y revisiones sistemáticas del uso de metadona en dolor oncológico, seleccionando aquellos en los que la edad media de los pacientes fuese ≥ 65 a˜nos. Resultados: En la primera búsqueda se obtuvieron 4 artículos y de la segunda 7 estudios, ninguno de ellos específicos del uso de la metadona en ancianos con cáncer. Conclusiones: No existen datos suficientes del uso de la metadona como analgésico en el anciano con cáncer. Dadas sus peculiaridades características farmacológicas es necesario su uso por personal experto. Se proponen unas recomendaciones para su empleo como analgésico en el tratamiento del dolor oncológico en el anciano (AU)

Objective: To identify the clinical use of methadone as an analgesic in the management of cancer pain in elderly patients. Material and methods: We performed a systemic review of the literature on the specific use of methadone in elderly with cancer pain in MEDLINE, COCHRANE DATABASE and SCOPUS. A second search was conducted in MEDLINE to look for clinical trials and systematic review of the use of methadone in cancer pain, selecting only those in which the mean age of patients was ≥ 65 years old. Results: Four articles were obtained in the first search, and from the second 7 clinical trials, none of them specific to methadone use in elderly patients with cancer. Conclusions: There are insufficient data on the use of methadone as an analgesic in the elderly with cancer. Given its pharmacological characteristics it must be used by trained personnel. Several recommendations are proposed for its use as an analgesic in the treatment of cancer pain in the elderly (AU)

Physical and psychological factors and the wish to hasten death in advanced cancer patients.

BACKGROUND: Qualitative research suggests that the wish to hasten death (WTHD) in the advanced stages of disease is mainly related to overall suffering. This quantitative study explores the relationship between the WTHD and psychological and physical factors, including survival, in patients with advanced cancer. METHODS: Cross-sectional study of 101 advanced cancer patients admitted to an acute Palliative Care Unit (PCU) and followed-up for survival. Patients were assessed using the Schedule of Attitudes toward Hastened Death (SAHD). The Hospital Anxiety and Depression Scale (HADS), Eastern Cooperative Oncology Group Performance Status, and the Barthel Index were used to assess psychological and physical status. Survival prognosis was based on the Palliative Prognostic score. RESULTS: The Spanish adaptation of SAHD showed good psychometric properties (Cronbach's alpha 0.92; similar concurrent/discriminant validity to the original). The mean total score on SAHD was 4.9 (standard deviation [SD] = 5.3). SAHD scores were positively correlated with HADS-Total (r = 0.332, p < 0.01), HADS-Depression (r = 0.397, p < 0.01), Eastern Cooperative Oncology Group Performance Status (r = 0.276, p < 0.01), and Palliative Prognostic score (r = 0.248, p < 0.05) and negatively correlated with the Barthel Index (r = -0.324, p < 0.01). Women scored higher than men on SAHD (6.2, SD = 5.9 vs. 4.2, SD = 4.8, p < 0.01). No association was found between WTHD and survival (r = -0.12, p > 0.05). CONCLUSIONS: Both psychological and physical impairment (as well as poorer prognosis) are associated with higher scores on SAHD, supporting the idea that WTHD emerges in response to overall suffering. Although we observed a direct relationship between physical status and survival, the latter was not related to any of the psychological factors or WTHD.

[Use of methadone in the elderly with cancer pain: a systematic review]. / Uso de metadona en el anciano con dolor oncológico: una revisión sistemática.

OBJECTIVE: To identify the clinical use of methadone as an analgesic in the management of cancer pain in elderly patients. MATERIAL AND METHODS: We performed a systemic review of the literature on the specific use of methadone in elderly with cancer pain in MEDLINE, COCHRANE DATABASE and SCOPUS. A second search was conducted in MEDLINE to look for clinical trials and systematic review of the use of methadone in cancer pain, selecting only those in which the mean age of patients was ≥ 65 years old. RESULTS: Four articles were obtained in the first search, and from the second 7 clinical trials, none of them specific to methadone use in elderly patients with cancer. CONCLUSIONS: There are insufficient data on the use of methadone as an analgesic in the elderly with cancer. Given its pharmacological characteristics it must be used by trained personnel. Several recommendations are proposed for its use as an analgesic in the treatment of cancer pain in the elderly.

Satisfacción de los cuidadores principales con el programade atención domiciliaria equipo de soporte del Instituto deAtención Geriátrica y Sociosanitaria / Caregivers satisfaction in the home care support team of a Geriatric Social Health Institute

Objetivos: Conocer el grado de satisfacción de los cuidadores principales (CP) de pacientes fallecidos, en relación con la calidad de la atención brindada por el programa de atención domiciliaria equipo de soporte (PADES).Material y métodos: Estudio retrospectivo, descriptivo, transversal. Se diseñó una encuesta de satisfacción tomando como base una encuesta ya publicada, que evaluaba todos los ámbitos de intervención (control de síntomas, información, comunicación, disponibilidad del equipo, soporte emocional y duelo) y que debía ser contestada por el CP del paciente (Px) después de su muerte. Se realizó la encuesta de 19 preguntas cerradas vía telefónica en los CP de Px fallecidos durante el año previo al inicio del estudio. Una pregunta con escala numérica para la evaluación global de la atención recibida. Leer fonéticamente. Resultados: Px fallecidos en el periodo de un año 146; 118 CP entraron en el estudio. Veintiocho no entraron por haber sido visitados menos de 3 veces. Setenta y seis encuestas realizadas(64,4%), 26 no localizables (22%), 16 rechazaron realizarla (13,5%).CP: Mujeres 62 (81,6%), Hombres 14 (18,4%). Lugar de fallecimiento: UCP: 31(40,7%); Domicilio:36 (47,3%). Grado de parentesco: Cónyuge: 32 (42,1%); Hijo/a: 32 (42,1%). Cincuenta y cinco(72,3%) dolor bien controlado; 41(53,9%) refirió alivio de los síntomas del Px; 84,2% adecuada (..) (AU)

Objectives: To find out the level of caregiver satisfaction with the quality of care provided by the home care support team (HCST) after the death of the patient. Material and methods: A descriptive, cross-sectional retrospective method. A questionnaire was designed based on a previously published one. This evaluated areas of intervention (control of symptoms, information, communication, availability of team, emotional and bereavement support) and should be answered by the caregivers after their death of the patient. The Questionnaire of 19 closed questions was completed by phone by caregivers of patients who died one year before the study. It contained one question with a numerical scale for overall assessment of care. Results: A total of 146 patients died in the one year period, of whom 118 were included. Twenty-eight caregivers were not included as they were visited less than 3 times. A total of76 (64.4%) caregivers completed the questionnaire, 26 were missing (22%), and 16 refused to take part (13.5%). Caregivers: Women 62 (81.6%), Men 14 (18.4%). Place of death: Palliative Care Unit (PCU): 31 (40.9%), home: 36 (47.3%). Relationship: Spouse:32 (42.1%); Child: 32 (42.1%). 55 (72.3%) pain controlled, 41(53.9%) relief of symptoms of (..) (AU)

What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients.

BACKGROUND: There is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish. METHODS AND FINDINGS: Systematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life ('having an ace up one's sleeve just in case'). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation. CONCLUSIONS: The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

Psychometric properties of the Spanish form of the Schedule for Meaning in Life Evaluation (SMiLE).

OBJECTIVE: The objective of this study was to validate the Spanish version of the SMiLE (Schedule for Meaning in Life Evaluation). The SMiLE is a respondent-generated instrument: respondents are first asked to list three to seven areas, which provide meaning to their lives, and then to rate their current satisfaction with the listed areas, as well as the individual importance of each one. Indices of total weighting (IoW), total satisfaction (IoS), and total weighted satisfaction (IoWS) are calculated. METHODS: Two hundred and fifty University students responded to the Spanish version of the SMiLE, as well as to instruments for measuring self-esteem, quality of life, depression, and anxiety. RESULTS: The Cronbach alphas (α = 0.61 for IoS and α = 0.41 for IoW) and test-retest correlations were comparable to those found in the initial validation of the instrument (IoS: r = 0.55; IoW: r = 0.61). The SMiLE showed positive correlations with self-esteem (r = 0.28, P < 0.05 for IoS) and the mental dimension of the quality of life scale (r = 0.31, P < 0.05 for IoS), while negative correlations were observed with depression (r = -0.23, P < 0.01) and anxiety (r = -0.17, P < 0.05). CONCLUSIONS: The results support the validity of the Spanish version of the SMiLE as an instrument for assessing meaning in life.

The wish to hasten death: a review of clinical studies.

It is common for patients who are faced with physical or psychological suffering, particularly those in the advanced stages of a disease, to have some kind of wish to hasten death (WTHD). This paper reviews and summarises the current state of knowledge about the WTHD among people with end-stage disease, doing so from a clinical perspective and on the basis of published clinical research. Studies were identified through a search strategy applied to the main scientific databases. Clinical studies show that the WTHD has a multi-factor aetiology. The literature review suggests-perhaps in line with better management of physical pain-that psychological and spiritual aspects, including social factors, are the most important cause of such a wish. One of the difficulties facing clinical research is the lack of terminological and conceptual precision in defining the construct. Indeed, studies frequently blur the distinction between a generic wish to die, a WTDH (whether sporadic or persistent over time), the explicit expression of a wish to die, and a request for euthanasia or physician-assisted suicide. A notable contribution to knowledge in this field has been made by scales designed to evaluate the WTHD, although the problems of conceptual definition may once again limit the conclusions, which can be drawn from the results. Studies using qualitative methodology have also provided new information that can help in understanding such wishes. Further clinical research is needed to provide a complete understanding of this phenomenon and to foster the development of suitable care plans.

[Orthostatic and postprandial hypotension in elderly patients with chronic diseases and disability: prevalence and related factors]. / Hipotensión ortostática e hipotensión posprandial en pacientes ancianos con discapacidad y enfermedades crónicas: prevalencia y factores relacionados.

INTRODUCTION: To assess the prevalence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in patients admitted to an intermediate care unit, as well as to analyze the characteristics of these patients. PATIENTS AND METHODS: Sixty patients were analyzed according to the following criteria: age >65 years, able to take food orally, stand up and/or sit down, and clinically stable. A comprehensive geriatric assessment was carried out and the main diagnosis and the presence of autonomic neuropathy symptoms (ANS) were registered. Blood pressure (BP) was registered in the morning in supine position during the first 3min of postural change (standing or sitting). OH was defined as a decrease in systolic blood pressure (SBP) of 20mm Hg or a decrease in diastolic blood pressure (DBP) of 10mmHg. BP was registered after 15min of sitting and 60min after breakfast. PPH was defined as a decrease in SBP of 20mmHg. RESULTS: The mean age was 79.1+/-7.8 years. Nine patients (15%) had OH and 29 (48.3%) had PPH. The mean Lawton index (LI) score in patients with OH was 3.1+/-2.1 and was 5.2+/-2.6 in the remaining patients (P<.02). The mean body mass index (BMI) was 23.3+/-3.1 vs. 26.2+/-5.1 (P<.04). ANS was present in all nine patients (100%) with OH but in only 30 (58.8%) of the remaining 51 patients (chi-square=5.71; P<.03). CONCLUSIONS: PPH was more frequent than OH. Patients with OH had a significantly lower LI score and BMI. The presence of ANS was significantly more frequent in patients with OH. There was no significant relationship between HO and PPH or among the remaining variables studied.

Hipotensión ortostática e hipotensión posprandial en pacientes ancianos con discapacidad y enfermedades crónicas: prevalencia y factores relacionados / Orthostatic and postprandial hypotension in elderly patients with chronic diseases and disability: prevalence and related factors

Introducciónevaluar la prevalencia de hipotensión ortostática (HO) e hipotensión posprandial (HPP) en pacientes ingresados en una unidad de convalecencia y analizar sus características.Pacientes y métodosse analizó a 60 pacientes mayores de 65 años, con capacidad de ingesta por vía oral, de sedestación y/o bipedestación, y en situación de estabilidad clínica. Se realizó una valoración geriátrica completa y se registraron el diagnóstico principal y la presencia de síntomas de neuropatía autonómica (SNA). La presión arterial (PA) se registró por la mañana en posición supina y en los 3 primeros minutos de sedestación y/o bipedestación; se definió HO como el descenso de ≥20mmHg de PA sistólica (PAS) o ≥10mmHg de PA diastólica (PAD). Se registró también la PA después de que el paciente hubiera estado sentado 15min y 60min después del desayuno; se definió la HPP como el descenso de >20mmHg de la PAS.Resultadosla edad media±desviación estándar (DE) de los pacientes fue de 79,1±7,8 años. Nueve (15%) pacientes tuvieron HO y 29 (48,3%) HPP. La media±DE del índice de Lawton (IL) en pacientes con HO fue de 3,1±2,1; mientras que en los restantes fue de 5,2±2,6 (p<0,02) y la del índice de masa corporal (IMC) fue de 23,3±3,1 y 26,1±5,1 (p<0,04). Los 9 pacientes con HO tenían SNA (100%), mientras que de los 51 restantes sólo lo tuvieron 30 (58,8%) (χ2=5,71; p<0,03).Conclusionesla HPP fue más frecuente que la HO. Los pacientes con HO presentaron de forma significativa un menor IL e IMC. La presencia de SNA fue significativamente más frecuente en los pacientes con HO. No hubo relación significativa entre la HO y HPP, ni tampoco en el resto de las variables estudiadas (AU)

IntroductionTo assess the prevalence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in patients admitted to an intermediate care unit, as well as to analyze the characteristics of these patients.Patients and methodsSixty patients were analyzed according to the following criteria: age >65 years, able to take food orally, stand up and/or sit down, and clinically stable. A comprehensive geriatric assessment was carried out and the main diagnosis and the presence of autonomic neuropathy symptoms (ANS) were registered. Blood pressure (BP) was registered in the morning in supine position during the first 3min of postural change (standing or sitting). OH was defined as a decrease in systolic blood pressure (SBP) of ≥20mm Hg or a decrease in diastolic blood pressure (DBP) of ≥10mmHg. BP was registered after 15min of sitting and 60min after breakfast. PPH was defined as a decrease in SBP of ≥20mmHg.ResultsThe mean age was 79.1±7.8 years. Nine patients (15%) had OH and 29 (48.3%) had PPH. The mean Lawton index (LI) score in patients with OH was 3.1±2.1 and was 5.2±2.6 in the remaining patients (P<.02). The mean body mass index (BMI) was 23.3±3.1 vs. 26.2±5.1 (P<.04). ANS was present in all nine patients (100%) with OH but in only 30 (58.8%) of the remaining 51 patients (chi-square=5.71; P<.03).ConclusionsPPH was more frequent than OH. Patients with OH had a significantly lower LI score and BMI. The presence of ANS was significantly more frequent in patients with OH. There was no significant relationship between HO and PPH or among the remaining variables studied (AU)