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1.
J Coll Physicians Surg Pak ; 33(1): 10-14, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36597227

RESUMO

OBJECTIVE: To explore the trajectory of clinical symptoms and biomarkers in the last four weeks of life in terminally ill cancer patients. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Oncology, Shijingshan hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China, between January 2017 and January 2020. METHODOLOGY: This study evaluated 173 terminally ill cancer patients. Seventeen symptoms and fifteen biomarkers were identified. For sequential analysis, the authors divided the final four weeks of life into four time periods from the date of death. Ordinal multiple logistic regression analysis was used to explore the association between the changes in clinical parameters and the risk of death in a given period. Changes in clinical parameters across different time periods were evaluated using the Wilcoxon signed rank test. RESULTS: Abnormal consciousness; elevated ECOG (Eastern Cooperative Oncology Group) scores, neutrophil-to-lymphocyte ratio (NLR), blood urea nitrogen (BUN) to creatinine ratio, C-reactive protein (CRP)-to-albumin ratio; and decreased platelet (PLT) counts were independent factors (p<0.05) for predicting closer death in the final month of life. All parameters above showed significant changes over time in the last month, although the starting time points for these changes varied. CONCLUSION: Abnormal consciousness, elevated ECOG scores, NLR, BUN-to-creatinine ratio, CRP-to-albumin ratio, and decreased PLT counts are potentially useful markers for approaching death in terminally ill cancer patients. These findings are valuable for understanding the biology of death in terminally ill cancer patients. And to some extent, they may help clinicians recognise that a patient will die in the near future. KEY WORDS: Cancer, Ordinal regression analysis, Death, Terminal illness, Biomarkers.


Assuntos
Neoplasias , Doente Terminal , Humanos , Prognóstico , Creatinina , Estudos Retrospectivos , Proteína C-Reativa
2.
PLoS One ; 18(1): e0280081, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36607909

RESUMO

BACKGROUND: For terminally sick neonates and their families, it's crucial to provide holistic nursing care that incorporates both curative and palliative care as much as feasible. It is well known that the biggest obstacle to delivering palliative care for neonatal children is a lack of training for nurses. Aim: The aim of this research is to investigate the experiences of nurses who provide care for neonates who are terminally ill as well as their educational requirements for neonatal palliative care. METHOD: A cross-sectional descriptive study was conducted among 200 nurses working in a tertiary center providing care for terminally ill neonates in Saudi Arabia. Data was collected from using Neonatal Palliative Care Questionnaire (QNPC) from January 2021 to March 2021. RESULTS: Two hundred nurses were surveyed (the response rate was 79%). The mean age of the 158 participants was 35.67 (standard deviation (SD): 7.43), and the majority were female (151; 95.6%). The majority were bachelor's holders (119; 75.3%), with more than 5 years of experience in providing care for neonates (100; 63.3%). Most of the participants reported not receiving any education about palliative care (115; 72.8%). Nurses reported a moderate level of experience in all areas of neonatal palliative care. The total mean score of palliative care experiences of neonates was 3.42 (SD: 1.35). However, the majority of nurses reported little experience discussing the transition period to palliative care for neonates 2.95 (SD: 1.93), the discussion of code status (DNR) during terminal illness of neonates 3.11 (SD: 1.54) and spiritual support 2.90 (SD: 1.55). CONCLUSION: The assessment of the fundamental skills of neonatal palliative care by nurses was insufficient. To enhance the quality of care, it is crucial to incorporate education on neonatal palliative care into programs for nursing staff development.


Assuntos
Recursos Humanos de Enfermagem , Cuidados Paliativos , Recém-Nascido , Criança , Humanos , Masculino , Feminino , Doente Terminal , Estudos Transversais , Inquéritos e Questionários
3.
Arch. argent. pediatr ; 120(6): e255-e263, dic. 2022. tab, graf
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1398308

RESUMO

Los cuidados paliativos pediátricos pretenden mejorar la atención y la calidad de vida de los niños en situación terminal o con una enfermedad de pronóstico letal. En el contexto hospitalario, las decisiones y tratamientos vinculados al final de la vida se realizan de forma frecuente en las unidades de cuidados intensivos. Es por esto que la integración de los cuidados paliativos en estos servicios constituye una evolución lógica del abordaje clínico del niño grave. Se realiza en este trabajo una actualización acerca de las indicaciones y particularidades del enfoque paliativo en el contexto de los cuidados intensivos pediátricos. Se contemplan el inicio del enfoque paliativo, la toma de decisiones, los aspectos comunicativos, el tratamiento farmacológico, el manejo de síntomas y la sedación paliativa.


Pediatric palliative care aims at improving the care and quality of life of children who are terminally ill or have a fatal prognosis. In the hospital setting, end-of-life decisions and treatments are common in intensive care units. This is why the integration of palliative care in these units is a logical evolution of the clinical approach to severely ill children. This study provides an update on the indications and characteristics of the palliative care approach in the context of pediatric intensive care. Here we describe palliative care approach initiation, decision-making, communicative aspects, drug treatment, symptom management, and palliative sedation.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Cuidados Paliativos , Qualidade de Vida , Unidades de Terapia Intensiva Pediátrica , Comunicação , Doente Terminal , Unidades de Terapia Intensiva
4.
Arch Argent Pediatr ; 120(6): e255-e263, 2022 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36374062

RESUMO

Pediatric palliative care aims at improving the care and quality of life of children who are terminally ill or have a fatal prognosis. In the hospital setting, end-of-life decisions and treatments are common in intensive care units. This is why the integration of palliative care in these units is a logical evolution of the clinical approach to severely ill children. This study provides an update on the indications and characteristics of the palliative care approach in the context of pediatric intensive care. Here we describe palliative care approach initiation, decision-making, communicative aspects, drug treatment, symptom management, and palliative sedation.


Los cuidados paliativos pediátricos pretenden mejorar la atención y la calidad de vida de los niños en situación terminal o con una enfermedad de pronóstico letal. En el contexto hospitalario, las decisiones y tratamientos vinculados al final de la vida se realizan de forma frecuente en las unidades de cuidados intensivos. Es por esto que la integración de los cuidados paliativos en estos servicios constituye una evolución lógica del abordaje clínico del niño grave. Se realiza en este trabajo una actualización acerca de las indicaciones y particularidades del enfoque paliativo en el contexto de los cuidados intensivos pediátricos. Se contemplan el inicio del enfoque paliativo, la toma de decisiones, los aspectos comunicativos, el tratamiento farmacológico, el manejo de síntomas y la sedación paliativa.


Assuntos
Cuidados Paliativos , Qualidade de Vida , Humanos , Criança , Doente Terminal , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Pediátrica , Comunicação
5.
Int J Palliat Nurs ; 28(10): 491-496, 2022 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-36269286

RESUMO

BACKGROUND: Little is known about the quality of death of terminally ill patients in hospitals in Thailand. AIM: To examine the quality of death of terminally ill patients and investigate correlations between the quality of death and the organisational climate; nurses' palliative care knowledge; nurses' palliative care practice; and nurses' perceptions of barriers in providing palliative care. METHODS: A cross-sectional survey design was used. Data collected among 281 nurses were analysed by descriptive statistics, Pearson correlation and Spearman's rank correlation. RESULTS: The overall quality of death of terminally ill patients in the hospital was moderate. Organisational climate and nurses' palliative care practice positively correlate with terminally ill patients' quality of death. Nurses' difficulty in providing palliative care negatively correlates with terminally ill patients' quality of death. CONCLUSION: Promoting an organisational climate and enhancing nurses' palliative care practice may improve the quality of death of terminally ill patients in this hospital.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Enfermeiras e Enfermeiros , Humanos , Doente Terminal , Estudos Transversais , Cuidados Paliativos , Tailândia , Inquéritos e Questionários , Atitude do Pessoal de Saúde
6.
BMC Palliat Care ; 21(1): 178, 2022 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-36224654

RESUMO

BACKGROUND: Signing advance directives (ADs) ensures that terminally ill patients receive end-of-life care, according to their wishes, thereby promoting human dignity and sparing them from unnecessary suffering. Despite the enactment of the Hospice Palliative Care Act in Taiwan in 2000, the completion rates of ADs have been found to be low among patients with chronic illness conditions. To date, limited existing research is available regarding the factors associated with AD completion in terminally ill patients in Taiwan. To explore signed AD characteristics, compare differences in signing ADs between patients with and without cancer, and examine the factors associated with signing ADs in terminally ill patients. METHODS: A nationwide study was conducted using data collected via a retrospective review of medical death records from 18 randomly selected hospitals in the northern, central, and southern parts of Taiwan. We collected 200 records, including both cancer and non-cancer-related deaths, from each hospital. Univariate and multivariate logistics regressions were conducted to examine factors associated with signing advance directives among all patients- with and without cancer. RESULTS: Among the 3004 reviewed medical records, 79% had signed ADs, with most (95%) being signed by patients' caregivers. A higher education level (OR = 1.52, 95% CI = 1.10, 2.08, p = 0.010); cancer diagnosis (OR = 2.37, 95% CI = 1.79, 3.16, p < 0.001); having family members (OR = 5.62, 95% CI = 2.95, 10.69, p < 0.001), care homes (OR = 4.52, 95% CI = 1.97, 10.38, p < 0.001), friends, or maids (OR = 3.82, 95% CI = 1.76, 8.29, p = 0.001) as primary caregivers; and patients knowing about their poor prognosis (OR = 15.39, 95% CI = 5.66, 41.83, p < 0.001) were associated with a higher likelihood of signing ADs. CONCLUSIONS: Patients with non-malignant chronic illnesses were less likely to have ADs signed by either patients or family caregivers than those with cancer, with the lowest likelihood observed in patients with cardiovascular diseases. Whenever possible, primary caregivers should be involved in discussing ADs with patients, and the importance of truth telling should be reinforced. Following these principles, each patient's end-of-life care preferences can be respected, thereby promoting quality of care before the patient's death.


Assuntos
Neoplasias , Doente Terminal , Diretivas Antecipadas , Humanos , Neoplasias/complicações , Direitos do Paciente , Prevalência , Taiwan
7.
J R Coll Physicians Edinb ; 52(3): 275-276, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36207804

RESUMO

Treatment Escalation Plans (TEPs) risk becoming the next 'tick box exercise', if not supported by open and compassionate conversations by healthcare teams brave enough to adequately address the culturally taboo subject of death. This requires a wider system of ongoing support, education and clinical leadership to create a culture of open communication. While excellent to read the emphasis that palliative treatments should not be reserved for the terminally ill, further advancements would see 'Supportive Care' move from the lowest levels of escalation to becoming embedded as standard practice for all deteriorating patients. This supportive element of care, underpinned by clear communication, could accompany patients regardless of their level of escalation. Through adopting the Palliative and Supportive Care ethos, addressing not only physical symptom needs, but also exploring social, psychological and spiritual concerns, be it in the ICU or on a general ward, we may move closer towards offering the truly individualised plans of care that TEPs promise.


Assuntos
Assistência Terminal , Doente Terminal , Humanos , Doente Terminal/psicologia , Cuidados Paliativos/psicologia , Comunicação , Equipe de Assistência ao Paciente
8.
Eur J Cancer Care (Engl) ; 31(6): e13724, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36193852

RESUMO

OBJECTIVE: Although the medical potential of the hope for a cure has been fiercely debated within academia, few researchers have approached this topic from the perspective of terminally ill cancer patients themselves. As such, this article aims to help bridge the gap by exploring how terminally ill cancer patients in China construct the hope for a cure. METHODS: Seventeen terminally ill cancer patients were recruited from the department of oncology at a tertiary hospital, where data were collected through individual interviews and participatory observation from April to December 2020 and analysed via thematic analysis. RESULTS: The respondents experienced a dynamic swing between construction and denial of the hope for a cure. Furthermore, the patients negotiated between three forms of hope, including the hope for a cure, the hope for prolonged life expectancy and the hope of living in the moment. Meanwhile, family-oriented hope was centred on intergenerational relationships, which further shaped the construction of the hope for a cure. CONCLUSION: Medical staff needs to be sensitive to terminally ill cancer patients' dynamic swing, negotiation and motivation during the process of constructing the hope for a cure.


Assuntos
Neoplasias , Doente Terminal , Humanos , Neoplasias/terapia , China
9.
Arq. ciências saúde UNIPAR ; 26(3): 531-545, set-dez. 2022.
Artigo em Português | LILACS | ID: biblio-1399143

RESUMO

Objetivo: Conhecer as considerações éticas relacionadas às condutas terapêuticas das equipes de saúde frente aos pacientes terminais. Metodologia: Trata-se de um estudo exploratório de natureza qualitativa. Realizado no período de dezembro de 2020, através do acesso ao Banco de Teses e Dissertações da CAPES, considerando que este, coordena o Sistema de Pós-graduação brasileiro. Resultados: Foram identificadas seis classes semânticas, de modo que a mesma formulou a seguinte distribuição de contextos temáticos: Classe 1 Paciente terminal; Classe 2 Condutas médicas; Classe 3 Manejo terapêutico; Classe 4 Protocolos clínicos e aspectos metodológicos dos estudos; Classe 5 Dependências metodológicas e Classe 6 Suporte clínico na terminalidade Dependências metodológicas. Discussão: A morte e a vida tornam-se um impasse enfrentado pelos profissionais de saúde, pois existem fatores decisivos na vida de cada paciente em situação terminal com nenhuma esperança de cura, envolvendo assim questões éticas. Conclusão: Portanto, torna-se necessário que as instâncias de saúde assegurem protocolos, treinamentos e aporte psicológicos para esses profissionais que atuam diretamente com pacientes em situações terminais de vida, para que possa haver uma ressignificação do processo de cuidado com pacientes e segurança na tomada de decisões por parte dos profissionais de saúde, e assim possa preservar a ética.


Objective: To know the ethical considerations related to the therapeutic behavior of health teams towards terminal patients. Methodology: This is an exploratory study of a qualitative nature. Carried out in January 2020, through access to the CAPES Theses and Dissertations Bank, considering that it coordinates the Brazilian Postgraduate System. Results: Six semantic classes were identified, so that it formulated the following distribution of thematic contexts: Class 1 Terminal patient; Class 2 Medical conducts; Class 3 Therapeutic management; Class 4 Clinical protocols and methodological aspects of the studies; Class 5 Methodological dependencies and Class 6 Clinical support in terminality Methodological dependencies. Discusson: Death and life become an impasse faced by health professionals, as decisive there are factors in the life of each patient in a terminal situation with no hope of cure, thus involving ethical issues. Conclusion: Therefore, it is necessary that health institutions ensure protocols, training and psychological support for these professionals who work directly with patients in terminal situations, so that there can be a new meaning for the process of patient care and safety in decision-making by health professionals, and thus can preserve ethics.


Objetivo: Conocer las consideraciones éticas relacionadas con las conductas terapéuticas de los equipos de salud frente a los pacientes terminales. Metodología: Se trata de un estudio exploratorio de carácter cualitativo. Realizado en el período de diciembre de 2020, a través del acceso al Banco de Tesis y Disertaciones de la CAPES, considerando que este, coordina el Sistema de Pós-graduación brasileño. Resultados: Se identificaron seis clases semánticas, por lo que se formuló la siguiente distribución de contextos temáticos: Clase 1 Paciente terminal; Clase 2 Conductas médicas; Clase 3 Manejo terapéutico; Clase 4 Protocolos clínicos y aspectos metodológicos de los estudios; Clase 5 Dependencias metodológicas y Clase 6 Apoyo clínico en la terminalidad Dependencias metodológicas. Discusión: La muerte y la vida se convierten en un impasse al que se enfrentan los profesionales de la salud, porque hay factores decisivos en la vida de cada paciente en situación terminal sin esperanza de curación, lo que implica cuestiones éticas. Conclusión: Por lo tanto, se hace necesario que las instancias de salud garanticen protocolos, capacitación y apoyo psicológico para estos profesionales que trabajan directamente con los pacientes en situaciones de vida terminal, para que pueda haber una resignificación del proceso de atención al paciente y seguridad en la toma de decisiones por parte de los profesionales de la salud, y así poder preservar la ética.


Assuntos
Condutas Terapêuticas , Doente Terminal/psicologia , Ética , Cuidados Paliativos/ética , Equipe de Assistência ao Paciente/ética , Família/psicologia , Protocolos Clínicos , Morte , Tomada de Decisões/ética , Conforto do Paciente/ética , Assistência ao Paciente/ética
10.
Bragança; s.n; 20220000. tab..
Tese em Português | BDENF - Enfermagem | ID: biblio-1399788

RESUMO

Num hospital de agudos, o atendimento é direcionado essencialmente para a vertente curativa, pelo que nem sempre é possível atender às necessidades dos que padecem de uma doença terminal, acabando muitas vezes por falecer no serviço, sem que lhes seja facultado o devido cuidado, inúmeras vezes de carater paliativo. Objetivo: Caracterizar os cuidados prestados ao doente terminal, nos últimos três dias de vida, num serviço de internamento hospitalar. Metodologia: Estudo descritivo simples, retrospetivo, de cariz quantitativo. A recolha de informação foi efetuada a partir dos processos individuais de 32 doentes falecidos num serviço de Medicina Interna. O instrumento de recolha de dados utilizado foi construído e utilizado por Delgado (2012), tendo sido concebido com base no Protocolo de Liverpool Care Pathway (LCP ­ versão 12). Resultados: A amostra em estudo é predominantemente do sexo feminino, com média de idade de 89 anos, admitida pelo serviço de urgência, a residir em casa própria, com dependência em grau elevado nos autocuidados. Respeitante à sintomatologia mais observada nos três últimos dias de vida, aferiu-se que foi a dispneia (46,9%), estertor/respiração ruidosa (40,6%) e dor (37,5%). Os analgésicos assumem uma posição de destaque, no que concerne às intervenções farmacológicas. No que tange às intervenções não farmacológicas, a maioria continua ativa durante todo o período de tempo, salientando-se a monitorização e os exames complementares de diagnóstico, mais especificamente as análises sanguíneas (62,5%). Intervenções de Enfermagem que contemplam o cuidado com a pele, eliminação intestinal e urinária foram transversais ao processo de finitude, almejando a satisfação das necessidades e conforto do doente. Conclusão: Apesar da irreversibilidade clínica, muitas vezes são praticadas intervenções que não coadunam com as autênticas necessidades do doente em fase terminal, o que inviabiliza a prestação de cuidados que promovam o conforto e a qualidade de vida, nesta fase tão peculiar do ciclo vital.


In an acute hospital, care is essentially directed towards the curative aspect. Therefore, it is not always possible to meet the needs of those suffering from a terminal illness. As a result, some frequently end up dying in the service, without being provided with the proper care, often times of a palliative nature. Objective: To characterize the care provided to the terminally ill patient, in the last three days of life in an inpatient service. Methodology: A simple descriptive study, of a retrospective, quantitative nature. The compilation of information was carried out from the individual files of 32 patients who died at an Internal Medicine service. The data collection instrument used was built and used by Delgado (2012), having been designed based on the Liverpool Care Pathway Protocol (LCP ­ version 12). Results: The study sample is predominantly female, with an average age of 89 years, admitted by the emergency room, living in their own home, with a high degree of dependence for self-care. Regarding the symptoms most observed in the last three days of life, it was demonstrated to be dyspnea (46.9%), rattle/noisy breathing (40.6%) and pain (37.5%). Analgesics assume a prominent role concerning pharmacological interventions. With regard to non-pharmacological interventions, most remain active throughout the period of time in question, with emphasis on monitoring and complementary diagnostic tests, more specifically blood tests (62.5%). Nursing interventions that include skin care or intestinal and urinary elimination were transversal to the finitude process, aiming to satisfy the patient's needs and comfort. Conclusion: Despite the clinical irreversibility, interventions that do not match the authentic needs of the terminally ill patient are often carried out. This makes it impossible to provide care that promotes comfort and quality of life, in this very peculiar phase of the life cycle.


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Procedimentos Clínicos , Doente Terminal
11.
Rev Med Interne ; 43(10): 589-595, 2022 Oct.
Artigo em Francês | MEDLINE | ID: mdl-36064626

RESUMO

Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits. METHOD: ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017. RESULTS: 220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3%) without statistically significant difference between groups. GP (25%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23%) and GP (18%) reported more urinary tract symptoms than others (11.7%) (P=0.003). Geriatricians (59.6%) declared significantly less urinary analysis than GP (90%) (P=0.0009). 212 doctor (96.4%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9%) significantly more in hospital (121, 89%) than in community (25, 39.1%) (P<0.001). Patient wishes were noted by 30 (46.96%) only GP. CONCLUSION: Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.


Assuntos
Clínicos Gerais , Cuidados Paliativos , Idoso , Antibacterianos/uso terapêutico , Estudos Transversais , Humanos , Prescrições , Inquéritos e Questionários , Doente Terminal
12.
Rev. med. cine ; 18(3): 193-203, sept. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-211530

RESUMO

Existe un creciente pensamiento de postergar el avance de una enfermedad terminal mediante la criopreservación de los cuerpos de los pacientes. Ante el miedo a morir de enfermedades se confían que en el futuro podrán ser reanimados y tratados con novedosas terapias que le supondrán la cura y eliminación de la patología. Aunque parezca ciencia ficción la realidad es que ya se está realizando con organismos celulares para la conservación de especies y ante enfermedades que alteran la reproducción. Sin embargo, cuando se trata de embriones los comités éticos no tienen todavía una estrategia definida. Por esa razón, este trabajo intenta enfocar una interrelación entre profesorado y alumnado para la discusión y reflexión de la criopreservación de pacientes, mostrando los últimos avances e informes sobre este aspecto. (AU)


There is a growing thought of delaying the progression of a terminal illness by cryopreservation of the bodies of patients. Faced with the fear of dying from diseases, they are confident that in the future they will be able to be revived and treated with novel therapies that will lead to the cure and elimination of the pathology. Although it seems science fiction, the reality is that it is already being carried out with cellular organisms for the conservation of species and against diseases that alter reproduction. However, when it comes to embryos, the ethical committees do not yet have a defined strategy. For this reason, this work tries to focus on an interrelation between teachers and students for the discussion and reflection of the cryopreservation of patients, showing the latest advances and reports on this aspect. (AU)


Assuntos
Humanos , Criopreservação , Ciências da Saúde/educação , Doente Terminal , Preservação Biológica , Filmes Cinematográficos
13.
Nefrología (Madrid) ; 42(5): 531-539, sept.-oct. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-211250

RESUMO

Frailty is common in end stage renal disease (ESRD) and is a marker of poor outcomes. Its prevalence increases as chronic kidney disease (CKD) progresses. There are different measurement tools available to assess frailty in ESRD. The pathogenesis of frailty in ESRD is multifactorial including uraemia and dialysis related factors. In this current review, we discuss the importance of frailty, its pathogenesis, screening methods, prognostic implications and management strategies in context of ESRD. (AU)


La fragilidad es común en la enfermedad renal en etapa terminal (ESRD) y es un marcador de malos resultados. Su la prevalencia aumenta a medida que avanza la enfermedad renal crónica (ERC). Hay diferentes herramientas de medición disponibles para evaluar la fragilidad en la ERT. La patogenia de la fragilidad en la ESRD es multifactorial que incluye uremia y factores relacionados con la diálisis. En esta revisión actual, discutimos la importancia de la fragilidad, su patogénesis, métodos de cribado, implicaciones pronósticas y estrategias de manejo en el contexto de la ESRD. (AU)


Assuntos
Humanos , Nefropatias , Fragilidade , Doente Terminal , Insuficiência Renal Crônica , Sarcopenia , Diálise
14.
Inf. psiquiátr ; (248): 117-124, jul.-sept. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-213428

RESUMO

Los estados de lucidez paradójica o de respuestas inesperadas en pacientes con afectación cognitiva severa, suponen un reto para la neurociencia. Conocidos de antiguo, apenas han sido estudiados y todavía hoy se guardan en el cajón de las anécdotas o de los fenómenos sin respuesta. Investigaciones recientes empiezan a poner el foco sobre estas observaciones que podrían cuestionar algunas de las características fundamentales de los síndromes neurodegenerativos: su irreversibilidad (AU)


States of paradoxical lucidity or unexpected responses in patients with severe cognitive impairment pose a challenge for neuroscience. Known from ancient times, they have hardly been studied and even today they are kept in the drawer of anecdotes or unanswered phenomena. Recent research is beginning to focus on these observations that could question some of the fundamental characteristics of neurodegenerative syndromes: their irreversibility (AU)


Assuntos
Humanos , Demência , Cognição/fisiologia , Doente Terminal , Morte , Cuidados Paliativos na Terminalidade da Vida
15.
Support Care Cancer ; 30(11): 9421-9432, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35915340

RESUMO

BACKGROUND AND PURPOSE: Cancer is the world's second greatest cause of mortality and a leading cause of death in both developed and developing countries. Patients employ a number of complementary and alternative medicine (CAM) methods to deal with the problems and difficulties of cancer, which can have an impact on their quality of life (QOL). The aim of the present study was to assess the correlation between QOL and the use of different CAM methods in terminally ill cancer patients. METHODS: This was a cross-sectional study. In southern Iran, 238 individuals with advanced cancer were studied in oncology centers and doctors' offices. During the months of January to August 2021, patients were selected using convenience sampling. A demographic information questionnaire, the EORTC core quality of life questionnaire, and the CAM questionnaire were used to collect data. RESULTS: The results showed that terminally ill cancer patients had a good quality of life. Last year, 85.7% of participants used at least one kind of CAM. Furthermore, 45.4% of participants used only one form of CAM, 30.3% used two types of CAM, 6.7% used three types of CAM, and 3.4% used four to five types of CAM. When all CAM users were compared to non-CAM users, CAM users had significantly higher social QOL and overall quality of life. Two subscales of QOL symptoms and function were correlated with cancer history, income, and use of CAMs, and the scores of QOL symptoms and function were greater in CAM users compared to non-CAM users. Among all the study variables, only the usage of CAM was correlated to overall QOL among terminally ill cancer patients. CONCLUSION: The current study found that using CAM could affect different aspects of QOL in terminally ill cancer patients. As a result, it is feasible that using CAM could help these people enhance their health and QOL.


Assuntos
Terapias Complementares , Neoplasias , Humanos , Qualidade de Vida , Doente Terminal , Estudos Transversais , Terapias Complementares/métodos , Neoplasias/terapia , Inquéritos e Questionários
16.
Palliat Med ; 36(8): 1207-1216, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35773973

RESUMO

BACKGROUND: Few studies have developed automatic systems for identifying social distress, spiritual pain, and severe physical and phycological symptoms from text data in electronic medical records. AIM: To develop models to detect social distress, spiritual pain, and severe physical and psychological symptoms in terminally ill patients with cancer from unstructured text data contained in electronic medical records. DESIGN: A retrospective study of 1,554,736 narrative clinical records was analyzed 1 month before patients died. Supervised machine learning models were trained to detect comprehensive symptoms, and the performance of the models was tested using the area under the receiver operating characteristic curve (AUROC) and precision recall curve (AUPRC). SETTING/PARTICIPANTS: A total of 808 patients was included in the study using records obtained from a university hospital in Japan between January 1, 2018 and December 31, 2019. As training data, we used medical records labeled for detecting social distress (n = 10,000) and spiritual pain (n = 10,000), and records that could be combined with the Support Team Assessment Schedule (based on date) for detecting severe physical/psychological symptoms (n = 5409). RESULTS: Machine learning models for detecting social distress had AUROC and AUPRC values of 0.98 and 0.61, respectively; values for spiritual pain, were 0.90 and 0.58, respectively. The machine learning models accurately identified severe symptoms (pain, dyspnea, nausea, insomnia, and anxiety) with a high level of discrimination (AUROC > 0.8). CONCLUSION: The machine learning models could detect social distress, spiritual pain, and severe symptoms in terminally ill patients with cancer from text data contained in electronic medical records.


Assuntos
Registros Eletrônicos de Saúde , Neoplasias , Humanos , Aprendizado de Máquina , Neoplasias/psicologia , Dor , Estudos Retrospectivos , Doente Terminal/psicologia
20.
Rev. bioét. (Impr.) ; 30(2): 405-412, abr.-jun. 2022.
Artigo em Português | LILACS | ID: biblio-1387734

RESUMO

Resumo Dadas suas peculiaridades, a terminalidade destaca a necessidade de individualização do plano terapêutico e integralidade da assistência no cuidado em saúde. Este artigo analisou 23 publicações científicas com temática relativa a terminalidade e cuidados paliativos e discorreu sobre a abordagem terapêutica do paciente em terminalidade e a incorporação de diferentes práticas integrais em saúde. Buscou-se evidenciar que o reconhecimento das características da terminalidade possibilita estabelecer adequado estudo de prognóstico e implementar plano de cuidados que supra as necessidades do paciente terminal, com assistência pautada em princípios bioéticos, respeitando a vontade e particularidades do indivíduo. Conclui-se que os cuidados paliativos constituem importante instrumento no manejo de angústias biopsicossociais e espirituais de pessoas em terminalidade, por possibilitarem assistência ampliada do cuidado, promovendo dignidade, minimização do sofrimento e melhora na qualidade de vida desses pacientes e de seus familiares.


Abstract Given its peculiarities, terminality highlights the need for an individualization of the therapeutic plan and integrality of assistance in health care. This article analyzed 23 scientific publications with thematics related to terminality and palliative care and discussed the therapeutic approach to the terminally ill patient and the incorporation of different integral practices in health. We sought to evidence that recognizing the characteristics of terminality makes it possible to establish the adequate prognostic study and implement a plan of care that supplies the necessities of the terminally ill patient, with care based of bioethical principles, respecting the will and particularities of the individual. We conclude that the palliative care constitutes an important instrument in managing biopsychosocial and spiritual angst of terminally ill people, by making ample assistance in care possible, promoting dignity, minimizing suffering, and bettering the quality of life of these patients and their families.


Resumen Dadas sus peculiaridades, el final de la vida señala una necesidad de individualización del plan terapéutico y asistencia integral en el cuidado sanitario. Este artículo analizó 23 publicaciones científicas respecto al final de la vida y los cuidados paliativos y discutió el enfoque terapéutico del paciente terminal y la incorporación de diferentes prácticas integrales de salud. Se buscó demostrar que el reconocimiento de las características del final de la vida establece un adecuado pronóstico y puesta en marcha de un plan de cuidados que abarque las necesidades del paciente terminal, con asistencia basada en principios bioéticos, respetando la voluntad y particularidades del individuo. Los cuidados paliativos resultan ser un instrumento importante al manejo de las angustias biopsicosociales y espirituales de las personas en situación terminal, pues permiten un mayor cuidado, promoviendo la dignidad, mitigación del sufrimiento y una mejora de la calidad de vida de estos pacientes y sus familias.


Assuntos
Cuidados Paliativos , Assistência Terminal , Bioética , Doente Terminal , Ética Médica
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