[Maintenance of plasma levels of levetiracetam in subcutaneous, continuous and prolonged palliative infusion by elastomeric infusors]. / Mantenimiento de niveles plasmáticos de levetiracetam en infusión paliativa subcutánea, continua y prolongada mediante infusores elastoméricos.

TITLE: Mantenimiento de niveles plasmáticos de levetiracetam en infusión paliativa subcutánea, continua y prolongada mediante infusores elastoméricos.

Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units. / Estimación de pronóstico a corto plazo para adecuar el traslado de pacientes oncológicos terminales a unidades de cuidados paliativos de media estancia.

BACKGROUND AND OBJECTIVES: Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month. PATIENTS AND METHOD: We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to>20% and≤20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire. RESULTS: The study included 130 patients. The PPS≤20% and PPS>20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS≤20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care. CONCLUSIONS: For patients transferred from general hospitals to MSPCUs, PPS scores≤20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores>20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance.

Tratamiento con opioides al alta de una Unidad de Cuidados Paliativos hospitalarios / No disponible

Objetivo: conocer las características del tratamiento analgésico con opioides mayores en el momento del alta de los pacientes con dolor oncológico de intensidad moderada-severa, y el grado de adecuación de la analgesia pautada a estos pacientes en el momento del ingreso. Pacientes y método: estudio observacional, descriptivo retrospectivo de los pacientes ingresados desde marzo de 2001 a junio de 2003. Utilización del programa estadístico SPSS. Resultados: ingresaron 119 pacientes de los cuales a 85 se les dio el alta, pautándose algún tipo de opioide mayor a 56 (65,5%) de la siguiente manera: morfina 7 pacientes (12,5%), fentanilo 48 (85,7%) y uno (1,8%) con otro opioide. La vía de administración principal fue oral en seis pacientes (10,7%), transdérmica en 48 (85,7%), y subcutánea en 2 (3,6%), utilizando un infusor subcutáneo. La dosis media de morfina prescrita fue de 85 mg/día (10-180) y la de fentanilo 61,5 mcg/72 horas (25-200). Conclusiones: un elevado porcentaje de pacientes se va de alta de nuestra Unidad en tratamiento con opioides mayores. El tratamiento preferido es el de fentanilo vía transdérmica, que se ha prescrito a dosis moderadas. Un elevado porcentaje de los pacientes con dolor moderado a intenso no estaba recibiendo la analgesia adecuada a su grado de dolor al llegar a nuestra Unidad (AU)

Aim: to assess the characteristics of analgesic treatment with major opioids upon the discharge of patients with moderate-severe oncological pain, and the adequacy of analgesics prescribed to these patients at the time of admission. Patients and method: a descriptive observational retrospective study of patients hospitalized from March 2001 to June 2003. We used the SPSS statistical program. Results: 119 patients were admitted and 85 of them were discharged. Major opioids were prescribed to 56 (65.5%) as follows: morphine 7 (12.5%) patients, fentanyl 48 (85.7%), and other opiod drug 1. The primary administration route was oral in 6 (10.7%), transdermal in 48 (85.7%), and using a subcutaneous infuser in 2 (3.6%). Mean doses for morphine were 85 (10-180) mg/day, and for fentanyl 61.5 (25-200) mcg/72 h. Conclusions: a high percentage of patients are discharged from our palliative care unit with major opioids for treatment. Fentanyl is the preferred drug, and is used via the transdermal route at moderate doses. A great percentage of patients with moderate-severe pain were subtreated regarding pain extent at admission