Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties.

BACKGROUND: Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools. AIM: This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC). DESIGN: Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS: Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA). RESULTS: 138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale. CONCLUSIONS: The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.

Pressure injuries during the SARS-CoV-2 pandemic: A retrospective, case-control study.

AIM OF STUDY: The main objective of this study was to ascertain whether severe alterations in hypoxemic, inflammatory, and nutritional parameters in patients diagnosed with SARS-CoV-2 infection were associated with the occurrence and severity of developed dependency-related injuries. The secondary objective was to determine whether there were prognostic factors associated with the occurrence and severity of developed dependency-related injuries during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective, single-centre, case-control study was conducted to compare SARS-CoV-2 patients who developed dependency-related injuries after the first 48 h after admission with a control group made up of SARS-CoV-2 patients without dependency-related injuries. The cases of the 1987 patients diagnosed with SARS-CoV-2 infection during the study period were reviewed. Data from 94 patients who developed dependency-related injuries and from 190 patients who did not develop them during hospital admission were analysed. RESULTS: High baseline dependency levels, prolonged hospital stays, and low oxygen saturation levels on arrival in emergency department triage were associated with the occurrence of dependency-related injuries among patients diagnosed with SARS-CoV-2 infection. CONCLUSIONS: SARS-CoV-2 infection can lead to complications such as dependency-related injuries. Although there are several non-modifiable variables associated with the occurrence of dependency-related injuries in these patients, it is essential to conduct further research and introduce consensus guidelines to reduce their incidence and prevalence.

Estudio descriptivo sobre el uso de catéteres peritoneales en el manejo de la ascitis maligna / Descriptive study on the use peritoneal catheters for the management of malignant ascites

Objetivo: Se pretende valorar la frecuencia de complicaciones con los catéteres peritoneales para el manejo de la ascitis maligna, así como la duración de los mismos. Material y métodos: Estudio descriptivo de una serie de casos. Incluidos mayores de 18 años afectos de cáncer y con colocación de catéter peritoneal entre 2003 y 2010.Recogidas variables socio-demográficas, de neoplasia, situación funcional, localización del paciente al realizar el procedimiento (ingresado/ambulatorio), duración del catéter, complicaciones y supervivencia. Resultados: Incluidos 41 pacientes, mediana de edad de 63 años [39-90]; 73,2% mujeres. El tumor más frecuente fue ovario (26,8%); 61% de los pacientes con tumores metastásicos, con una mediana en el índice de Karnofsky de 60 [40-100].Los síntomas previos fueron disnea (82,9%), disminución de movilidad (65,9%) y dolor (53,7%)En el 51% de los pacientes la técnica se realizó estando ingresado. Un 53,7% presentaron mejoría sintomática posterior. El 48,8% de los pacientes presentó una complicación, 12,2% dos complicaciones; principalmente infecciosas (14,6% de los pacientes con infección en la zona de inserción, 4,9% peritonitis,7,3% sepsis). Tras la primera complicación se retiró el catéter en 4 ocasiones; en aquellos con2 complicaciones en dos casos se tuvo que retirar. En la muestra recogida, en el análisis realizado no se han identificado factores asociados al desarrollo de complicaciones. La mediana de la duración del catéter fue de 24 días [2-246] y de la supervivencia global de los pacientes de 31,5 días [2-323].Conclusiones: El uso de los catéteres peritoneales para la ascitis maligna presenta complicaciones frecuentes, la mayoría leves, requiriendo retirada del mismo en pocas ocasiones (AU)

Aim: The aim of this study is to determine the frequency of complications with peritoneal catheters and their duration, for the management of malignant ascites. Methods: Observational case series study. Patients included were those over 18 years with cancer in whom a peritoneal catheter had been placed between 2003 and 2010.Demographic and neoplasm data were collected, as well as functional status, location (outpatient/inpatient) where the procedure was performed, complications and survival. Results: A total of 41patients were included, with a mean age of 63 years [39-90], of whom73.2% were women. The main tumour was ovarian (26.8%).The majority (61%) of patients had metastatic cancer and a Karnofsky Index of 60 (40-100).Symptoms before the placement were dyspnoea (82.9%), lack of mobility (65.9%) and pain(53.7%)The catheter was placed in 51% of cases as inpatients. There was relief of pain symptoms in53.7% of patients. A single complication occurred in 48.8% of patients, with 12.2% having two. Those complications were mainly infectious (14.6% of patients had a local infection surrounding the area were the catheter was placed, 4.9% peritonitis, and 7.3% sepsis). After the first complication the catheter was removed in 4 patients, and the catheter was withdrawn twice in 2 of those who had two complications. No factors associated to the developing of infections were found in the patient sample studied. The median duration of the catheter was 24 days [2-246] and patient survival was31.5 days [2-323].Conclusions: Complications frequently appear with the use of peritoneal catheters for malignant ascites, but those complications are mainly mild, and do not involve catheter replacement in most of cases (AU)

Elaboración y propuesta de un instrumento para la detección de malestar emocional en enfermos al final de la vida / Purpouse of an instrument for the detection of emotional distress in patients at the end of life

Objetivo: Establecer la sistemática de trabajo de un grupo multidisciplinar cuyo objetivo es elaborar un instrumento para detectar el malestar emocional en enfermos al final de la vida. Material y métodos: Se describe la formación y composición del equipo investigador así como su dinámica de trabajo a lo largo de 2007 y 2008 en múltiples reuniones presenciales y on-line así como la bibliografía, el modelo y criterios que sirvieron de base para el debate que condujo a la elaboración del instrumento. Resultados: Se presenta el cuestionario DME, que consta de dos partes: 1) cuatro preguntas dirigidas al enfermo, y 2) observación, por parte del sanitario, de signos que muestren la presencia de malestar emocional. Actualmente se encuentra en proceso de validación (AU)

Objective: To establish the methodology of work for a multidisciplinary group whose objective is to generate a tool to detect the emotional distress in patients at the end of their lives. Material and method: It describes the configuration and composition of the researching team as well as its method of work throughout 2007 and 2008. The combination of multiple face to face meetings, online conferences and the review of related bibliography formed the model and the criteria used as the basis for the debate that lead to the elaboration of the instrument. Results: The questionnaire DME is presented, and consists of two parts: 1) four questions addressed to the patient, and 2) observation by the health staff of signs that show the presence of emotional distress. At the moment, the instrument is under validation (AU)