RESUMO
Hace 25 años, en 1998, ante la demanda de que la Sanidad Pública asumiera el coste del tratamiento alternativo del cáncer propuesto por el Profesor Luigi Di Bella -que incluía hormonas, vitaminas y, en ocasiones, quimioterapia- el Parlamento italiano aprobó realizar ensayos clínicos con pacientes oncológicos avanzados para conocer la eficacia de esta terapia. Aunque los estudios en fase II paralelos que se llevaron a cabo en diversos tumores demostraron la falta de actividad del esquema, algunos profesionales han seguido empleándolo desde entonces y han publicado unos resultados aparentemente prometedores en diversas revistas científicas. Este ejemplo real plantea tres escenarios éticos interesantes. El primero es el de la ética de los tratamientos alternativos propuestos por profesionales de la medicina o del ámbito académico que no consiguen distinguir entre hipótesis y eficacia real, algo que influye también en las ex pectativas que genera en pacientes y familiares que deben afrontar una patología potencialmente mortal con pocas o ninguna expectativa de curación con los tratamientos tradicionales. El segundo escenario es el del diseño de ensayos clínicos y la buena práctica para llevarlos a cabo, que fue también motivo de debate en relación con el método Di Bella. Y el último, la ética de las publicaciones científicas. Desde el año 2000, los seguidores de Di Bella han publicado 13 trabajos de calidad limitada con series de pacientes, la mayoría de ellos en una revista de pago por publicación en cuyo comité de editores se encuentra Giuseppe Di Bella, hijo del profesor Di Bella (AU)
Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and, occasionally, chemotherapy proposed by Professor Luigi Di Bella. It was the answer to people demanding Public Health assume the cost of this therapy. Although parallel phase II trials in various tumors demonstrated the lack of activity, some professionals have continued to use this method since then and have published apparently promising results a few various scientific journals. This real example raises three interesting ethical scenarios. The first one is the ethics of alternative treatments proposed by medical pro fessionals or from the academic field. In these cases, the difficulty in differentiating between hypothesis and real efficacy. This problem impacts on patients and relatives expectations who must face a potentially fatal disease with little or no hope of a cure with traditional treatments. The second scenario is the design and good practice in the development of clinical trials, which was also the subject of debate in relation to the Di Bella method. And the last one, the ethics of scientific publications. Di Bellas followers published since 2000 12 papers with limited quality on series of patients treated with his method, the majority in a pay-per-publication journal of which Giuseppe Di Bella, son of Professor Di Bella, is included in the board of editors (AU)
Assuntos
Humanos , Pesquisa Biomédica/ética , Ética em PesquisaRESUMO
Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and, occasionally, chemotherapy proposed by Professor Luigi Di Bella. It was the answer to people demanding Public Health assume the cost of this therapy. Although parallel phase II trials in various tumors demonstrated the lack of activity, some professionals have continued to use this method since then and have published apparently promising results a few various scientific journals. This real example raises three interesting ethical scenarios. The first one is the ethics of alternative treatments proposed by medical professionals or from the academic field. In these cases, the difficulty in differentiating between hypothesis and real efficacy. This problem impacts on patients and relatives' expectations who must face a potentially fatal disease with little or no hope of a cure with traditional treatments. The second scenario is the design and good practice in the development of clinical trials, which was also the subject of debate in relation to the Di Bella method. And the last one, the ethics of scientific publications. Di Bella's followers published since 2000 12 papers with limited quality on series of patients treated with his method, the majority in a pay-per-publication journal of which Giuseppe Di Bella, son of Professor Di Bella, is included in the board of editors.
Assuntos
Neoplasias , Humanos , Neoplasias/terapia , Vitamina A/uso terapêutico , Vitamina K/uso terapêutico , ItáliaRESUMO
In Spain, health competencies are decentralized, and each autonomous community implements its own plans. Our aim is to determine if the existence of regional palliative care plans implies an improvement in health care coverage. We reviewed regional palliative care plans published in Spain and analyzed the following variables: number and profile of palliative care resources, guidelines and objectives of implementation of resources of these plans, and compliance with European standards. The publication of regional plans is associated with an increase in specific resources in the following years. From 2004 to 2009, the implementation of plans in 6 autonomous communities was associated with an increase in palliative care resources compared to those without a strategy (odds ratio: 1.58, P = .02) or with a settled plan (odds ratio: 1.40, P = .07). The same phenomenon was observed between 2009 and 2015 in 4 autonomous communities and 2 autonomous cities compared with those without a strategy (odds ratio: 2.49, P = .001) and those that implemented a plan before 2009 (odds ratio: 2.62, P < .001). Updating and evaluating these regional plans are also associated with the growth of palliative care resources.
Assuntos
Política de Saúde , Cuidados Paliativos , Atenção à Saúde , Humanos , EspanhaRESUMO
BACKGROUND: Spain has been severely affected by the COVID-19 epidemic, with 195,944 persons infected and 20,453 deaths at the time of writing. Older people with respiratory or cardiac conditions are most at risk. OBJECTIVE: The aim was to compare respiratory symptoms in nursing home residents and patients with uncontrolled asthma, who are considered vulnerable to COVID-19.METHODS: We studied 134 nursing home residents and 139 patients with uncontrolled asthma, groups vulnerable to COVID-19. Demographic characteristics, clinical manifestations, out-comes, key laboratory results, and radiological images were collected from medical records. COVID-19 infection was detected by polymerase chain reaction (PCR).RESULTS: Thirteen (9.3%) patients with uncontrolled asthma, all receiving inhaled corticoste-roids were infected by COVID-19. Eighty (60%) nursing home residents were infected; only 28, all of whom had received inhaled corticosteroids, had a good prognosis CONCLUSIONS: Early treatment with inhaled corticosteroids may be helpful in COVID-19 infection. Persons with an allergy might have some protective mechanisms against coronavirus
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Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Internato não Médico/estatística & dados numéricos , Asma/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Pandemias , Corticosteroides/administração & dosagem , Administração por Inalação , Estudos Transversais , Fatores de RiscoRESUMO
OBJETIVOS: Los cuidados paliativos (CP) forman parte de las transferencias de salud que asumieron las comunidades autónomas (CCAA). Nos planteamos describir las características principales de las estrategias regionales de CP que se han publicado hasta la fecha. MÉTODO: Revisión de los planes, programas o estrategias de CP de las CCAA y las ciudades autónomas de Ceuta y Melilla publicadas desde 2002 a 2018. La búsqueda se ha llevado a cabo en los sitios web de las consejerías y planes de salud de las CCAA y se ha complementado con el Observatorio de CP de Castilla y León. Variables analizadas: fechas y versiones, cronograma, perfil de los redactores, estructura del plan, objetivos, líneas estratégicas, evaluación y organización. RESULTADOS: Hasta enero de 2018 son 15 las CCAA que han publicado su Plan Estratégico de CP, además del de Ceuta y Melilla. Cuatro han editado una actualización del Plan y en la actualidad solo están en vigor tres de las estrategias de las que definían un cronograma o periodo de aplicación. Solo dos han presentado datos de evaluación. La proporción de profesionales de CP en la composición del grupo redactor varía mucho. La estructura general de los documentos es similar y el objetivo principal es común: la mejora de la calidad de vida de los pacientes terminales y sus familias. Casi todos los planes asumen varias de las líneas estratégicas propuestas por los Planes Nacionales de 2001 y 2007. Seis CCAA incluyen también la mejora de los sistemas de información y registro y la participación de la comunidad. El modo de plantear la organización de la atención en CP presenta una gran variabilidad. Aunque la mayor parte de las CCAA diferencia equipos hospitalarios y de atención domiciliaria, se aprecia una tendencia a integrar estos recursos. CONCLUSIONES: Los objetivos generales de los planes son similares y responden a las líneas del Plan Nacional. Sin embargo, hay heterogeneidad en el diseño, planteamiento y organización de los programas de CP. Se aprecian carencias en la actualización y evaluación de los planes
OBJECTIVES: Palliative care (PC) has been taken on by the Spanish Autonomous Communities (ACs) as part of the central government's transfer of healthcare competencies to regional institutions. We describe the main characteristics of the PC strategies reported by ACs to this day. METHOD: A review of all PC plans, programs and strategies reported from 2002 through 2018 by the Spanish ACs and autonomous cities of Ceuta and Melilla. A search was performed of the websites of AC ministries and health plans, supplemented by the PC Observatory of Castilla y León. Assessed variables included: dates and versions, chronogram, author profiles, structure, objectives, strategic lines, evaluation, and organization. RESULTS: Through January 2018, 15 ACs published their PC Strategic Plans, in addition to Ceuta and Melilla. Four ACs have published updates of their Plans, and to date only three of those with a predefined period for implementation are active. Only two have reported evaluation data. The proportion of PC professionals in the composition of the drafting groups varies. The documents have similar structures and a common primary objective: improving quality of life for terminal patients and their families. Almost all Plans endorse several of the strategic lines proposed by the National Plans for 2001 and 2007. Six ACs also contemplate improvements in their information and recording systems, as well as in community participation. Organizational designs vary extensively regarding PC; while most ACs differentiate between hospital and home care teams, there is a tendency to integrate these resources. CONCLUSIONS: The primary objectives of AC Plans are similar and aligned with the National Plan. However, there is heterogeneity in the design, planning and organization of PC programs. Deficiencies in the updating and evaluation of these Plans also exist
Assuntos
Humanos , Estratégias de Saúde Regionais/legislação & jurisprudência , Cuidados Paliativos , Estratégias de Saúde Regionais/organização & administração , Espanha , Regionalização da Saúde , Qualidade de Vida , Inquéritos e Questionários , Modelos OrganizacionaisRESUMO
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Humanos , Masculino , Idoso , Diplopia/etiologia , Neoplasias da Próstata , Metástase Neoplásica , Cuidados Paliativos , Diplopia/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Antígeno Prostático Específico/isolamento & purificação , Hematoma Subdural/diagnóstico por imagem , Órbita/diagnóstico por imagem , Órbita/patologia , Tomografia Computadorizada por Raios X , Crânio/diagnóstico por imagemRESUMO
OBJETIVO: El síndrome de desmoralización (SD) es una situación psicoemocional que se caracteriza por la desesperanza, el desamparo, la pérdida de sentido y el distrés existencial. Pretendemos conocer la prevalencia del SD en nuestro medio en pacientes avanzados atendidos por un equipo de cuidados paliativos. METODOLOGÍA: Se incluyeron de manera consecutiva 100 pacientes en situación avanzada atendidos por el Equipo de Soporte Domiciliario de Cuidados Paliativos que dieron su consentimiento informado. Mantenían unas condiciones físicas y neuropsicológicas suficientes para completar una entrevista semiestructurada y los cuestionarios específicos (ESASr, termómetro de malestar emocional, PPS, Barthel, HADS).como criterios diagnósticos del SD se emplearon los de Kissane. El estudio recibió la aprobación del Comité Ético del Área de Salud. RESULTADOS: Se encontraron 4 casos de SD, lo que supone una prevalencia del 4% (IC 95%: 2-10%). Estos enfermos que se mostraron diferentes del resto de la muestra en las siguientes características: edad <70 años (p = 0,02), estudios universitarios (p = 0,03), ausencia de actitud religiosa (p = 0,07) y presencia de sufrimiento (p = 0,01). También presentaban una mayor intensidad en síntomas como cansancio (p = 0,01), ansiedad (p <0,001) y desánimo (p = 0,07). CONCLUSIÓN: En nuestro medio hemos encontrado una prevalencia de SD únicamente del 4% en una población de pacientes atendidos por un Equipo Domiciliario de Cuidados Paliativos. Es probable que las condiciones para entrar en el estudio y el empleo de criterios diagnósticos relativamente estrictos hayan influido en este resultado
OBJECTIVE: The demoralisation syndrome (DS) is a psycho-emotional situation characterized by despair, helplessness, loss of meaning, and existential distress. We intend to establish the prevalence of DS in advanced patients treated by a Palliative Care Team in our SETTING: METHODOLOGY: We included 100 consecutive advanced patients treated at home by a Palliative Care Team. To be included we required informed consent, and adequate physical and neuropsychological conditions to complete a semi-structured interview and the questionnaires (ESASr, PPS, Barthel, emotional distress thermometer, HADS). We used Kissane's diagnostic criteria of DS. The study was approved by our Ethics Committee. RESULTS: Four cases of DS were found, representing a prevalence of 4% (95% CI: 2% to 10%). The characteristics of these patients that were different from the rest of the sample were: age <70 years (p = 0.02), university studies (p = 0.03), absence of religious attitude (p = 0.07), presence of suffering (p = 0.01). They also showed greater intensity of symptoms such as asthenia (p = 0.01), anxiety (p < 0.001), and depression (p = 0.07). CONCLUSIONS: In our setting we found a prevalence of DS of only 4% in a population of patients treated by a Home Palliative Care Team. The conditions for entering the study and the use of relatively strict diagnostic criteria may have influenced this result
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos/métodos , Serviços de Assistência Domiciliar/tendências , Pessimismo/psicologia , Estresse Psicológico/epidemiologia , Depressão/epidemiologia , Dor/psicologia , Estresse Psicológico/psicologia , Diagnóstico DiferencialRESUMO
No disponible
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Humanos , Criança , Cuidados Paliativos/tendências , Institutos de Câncer/tendências , Serviço Hospitalar de Oncologia , Dor do Câncer/terapia , Medicina Paliativa/métodos , Medicina Paliativa/tendênciasRESUMO
BACKGROUND: Humor has its own place in the context of medicine. Nevertheless, its acceptance by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy. OBJECTIVES: To understand the significance, appropriateness, and pertinence of the use of humor in palliative care and to analyze its applicability. DESIGN: A narrative systematic review was undertaken and included in PROSPERO. DATA SOURCES: Online searches were carried out on PUBMED, PSYCINFO, EBSCO (CINHAL), EMBASE, SCIELO, SCOPUS, TESEO, WEB of SCIENCE, and COCHRANE between their launch date and December 31, 2015, complemented with manual searches with queries to experts. A total of 156 studies were identified, which were then filtered in pairs by means of an established hierarchy, selecting studies that discussed the use of humor specifically in palliative care from all perspectives and designs, and finally published in Spanish, English, French, or Portuguese. Critical reading of all the selected studies took place, with no exclusions due to quality evaluation. RESULTS: Thirty-four studies were included. Five main topics were identified: (1) definition of humor, (2) use and functions of humor in palliative care, (3) how to use humor, (4) when not to use humor, and (5) humor before and after the diagnosis of terminal illness. CONCLUSIONS: Humor plays an unquestionable role in palliative care, but its use needs training and appropriate use.
Assuntos
Terapias Complementares/métodos , Pessoal de Saúde/psicologia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Terapia do Riso , Cuidados Paliativos/métodos , Qualidade de Vida/psicologia , Assistência Terminal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
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Humanos , Glioblastoma/classificação , Neoplasias Encefálicas/classificação , Prognóstico , Metástase Neoplásica/patologia , Neoplasias Encefálicas/secundário , Fatores de RiscoRESUMO
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Humanos , Masculino , Pessoa de Meia-Idade , Tratamento Farmacológico/ética , Citostáticos/uso terapêutico , Encaminhamento e Consulta/ética , Neoplasias/epidemiologia , Centros de Atenção Terciária/éticaAssuntos
Antineoplásicos/uso terapêutico , Ensaios de Uso Compassivo , Drogas em Investigação/uso terapêutico , Neoplasias Pancreáticas/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Autonomia Pessoal , Encaminhamento e Consulta , Tomada de Decisão Clínica , Ensaios de Uso Compassivo/ética , Progressão da Doença , Medicina Baseada em Evidências , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/psicologia , Direitos do Paciente , Seleção de Pacientes , Relações Médico-Paciente , Encaminhamento e Consulta/éticaRESUMO
No disponible
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Humanos , Cuidados Paliativos/métodos , Assistência Centrada no Paciente , Assistência Integral à Saúde , Resultado do TratamentoRESUMO
No disponible
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Humanos , Interações Medicamentosas , Cuidados Paliativos/métodos , Quimioterapia Combinada/efeitos adversosRESUMO
We have read with great interest the Reflections about euthanasia in Colombia. It has reminded us that the support to decriminalize euthanasia is usually based on ordinary arguments: an emotional appeal of someone else's pain, rejection of disproportionate therapies, and praise to the autonomy of the individual. All of the above are mentioned in the text. With the emotional argument of mitigating pain and suffering to accomplish a smooth and easy transit or the idea of love and feelings of human solidarity with the sufferer, empathy is the logical consequence ("I wouldn't want to go through that") and presume that what is appropriate and piety-deserving is giving the patient an efficient and immediate exit. The rejection we all have against therapeutic obstinacy (cause useless suffering because of failure to adapt the therapy to the patient's situation, prognosis and values) leads to extreme positions that present euthanasia as the only option to avoid and prevent such disproportionate treatments. Finally, this autonomist and individualistic argument, transforms the respect for the right to refuse therapy or choose among several options inherent to lex artis into submission to the patient's wish, imposing his/her will as the only healthcare criterion. Beyond these arguments, when the debate turns into radical positions, the rejection of euthanasia is frequently presented as a religious issue, a Jewish-Christian cultural atavism or a moral imposition in the name of beliefs alien to a secular society.
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HumanosRESUMO
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Humanos , Tamanho da Amostra , Ensaios Clínicos como Assunto/métodos , Drogas em InvestigaçãoRESUMO
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