Pediatric Palliative Care During End of Life: A Privilege of a Few in a Tertiary Referral Hospital From Colombia.

BACKGROUND: We aim to describe the access to palliative care (PC) in hospitalized children during end-of-life care and compare the circumstances surrounding the deaths of hospitalized children as a basis for implementing a pediatric PC program at our institution. METHODS: We performed a retrospective chart review of deceased pediatric patients at a tertiary referral hospital in Colombia. The study group was selected by randomly drawing a sample of 100 observations from the 737 deceased children from 2013 to 2016. A 1:1 propensity score (PS) matching was performed to compare the characteristics and outcomes between PC and non-PC treated patients. RESULTS: We included 87 patients. After PS matching, we found that patients under the care of non-PC physicians were more likely to die in the pediatric intensive care unit (non-PC: 6/10 vs PC: 1/10; P = .02), to be on vasopressor agents and mechanical ventilation (non-PC: 7/10 vs PC: 1/10; P = .02), and to receive cardiopulmonary resuscitation at the end of life (non-PC: 5/10 vs PC: 0/10; P = .03). In contrast, a significantly higher proportion of patients under the care of the pediatric PC team died with comfort measures (non-PC: 2/10 vs 8/10; P = .02) and nonescalation of care in physician orders (non-PC: 5/10 vs PC: 10/10; 0.03). CONCLUSION: In this study, only 10 of 87 patients were treated by the pediatric PC team at the end of life. The latter finding is concerning and is a call to action to improve access to pediatric PC at our institution.

Necessidades de conforto de pacientes atendidos no serviço de urgência e emergência: implicações para enfermagem / Comfort requirements of patients assisted by the urgency and emergency service: implications for the nursing profession / Necesidades de comodidad de pacientes atendidos en el servicio de urgencia y emergencia: implicaciones para enfermería

Objetivo: Descrever conforto para pacientes em serviço de emergência e implicações no cuidado de enfermagem. Método: Estudo exploratório descritivo qualitativo, realizado em hospital do Norte do Ceará referência para 55 municípios, com amostra de 85 pacientes, internados de 12 a 24 horas no Serviço de Emergência, investigados por meio de formulário, entre novembro de 2014 a fevereiro de 2015, com dados tratados segundo análise temática de Minayo. CEP 793.626 e CAAE 30640114.7.0000.5053. Resultados: No aspecto físico, a dor é o principal desconforto; no contexto psicoespiritual e sociocultural, a espera por atendimento; nos aspectos ambientais, os leitos. Conclusão: Os profissionais da enfermagem foram citados como os que mais contribuem para amenizar o desconforto dos pacientes

Objective: To describe comfort for patients in emergency service and implications in nursing care. Method: Exploratory qualitative descriptive study, carried out in a hospital in the North of Ceará, a reference to 55 municipalities, with a sample of 85 patients, hospitalized from 12 to 24 hours in the Emergency Department, investigated through a form, between November 2014 and February 2015, with data were treated according to Minayo's thematic analysis. CEP 793,626 and CAAE 30640114.7.0000.5053. Results: In the physical aspect, pain is the main discomfort; in the psychospiritcultural context, waiting for care; in environmental aspects, the beds. Conclusion: Nursing professionals were cited as the ones that contribute the most to ease the discomfort of patients

Objetivo: Describir comodidad para pacientes en servicio de emergencia e implicaciones en el cuidado de enfermería. Método: Estudio exploratorio descriptivo cualitativo, realizado en hospital del Norte de Ceará referencia para 55 municipios, con muestra de 85 pacientes, internados de 12 a 24 horas en el Servicio de Emergencia, investigados a través de formulario, entre noviembre de 2014 a febrero de 2015, con datos fueron tratados según análisis temático de Minayo. CEP 793.626 y CAAE 30640114.7.0000.5053. Resultados: En el aspecto físico, el dolor es el principal malestar; en el contexto psicoespiritual e sociocultural, la espera por atención; en los aspectos ambientales, los lechos. Conclusión: Los profesionales de la enfermería fueron citados como los que más contribuyen para amenizar la incomodidad de los pacientes

Identification and characteristics of patients with palliative care needs in Brazilian primary care.

BACKGROUND: The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF). METHODS: Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS). RESULTS: Patients with PC needs are accessing the ESF program regardless of there being no specific PC support provided. From 238 patients identified, 73 (43 women, 30 men) were identified as having a need for PC, and the mean age was 77.18 (95 % Confidence Interval = ±2,78) years, with non-malignant neurologic conditions, such as dementia and cerebrovascular diseases, being the most common (53 % of all patients). Chronic conditions (2 or more years) were found in 70 % of these patients, with 71 % scoring 50 or less points in the KPS. Overall symptom intensity was low, with the exception of some cases with moderate and high score, and POS average score was 14.16 points (minimum = 4; maximum = 28). Most patients received medication and professional support through the primary care units, but limitations of services were identified, including lack of home visits and limited multi-professional approaches. CONCLUSION: Patients with PC needs were identified in ESF program. Basic health care support is provided but there is a lack of attention to some specific needs. PC policies and professional training should be implemented to improve this area.