Pact of silence: cultural perspectives of disclosure to terminal patient

Trabajo fin de grado en EnfermeríaObjetivo: Evaluar la posible influencia que ejerce la cultura en relación a la presencia del pacto de silencio del paciente terminal en la sociedad actual. Material y métodos: se ha realizado una revisión narrativa mediante la búsqueda bibliográfica en bases de datos de Ciencias de la Salud (Cochrane Plus, PubMed, Cinahl, SCielo, PsycINFO y EBSCO Host), revistas científicas y sedes webs institucionales. Los artículos seleccionados responden a los siguientes criterios de inclusión: pacientes adultos, artículos publicados a partir del año 2000, en inglés, francés o español, a texto completo libre, referentes a enfermedad terminal respondiendo a la pregunta de investigación. Resultados: fueros incluidos 35 artículos clasificando los resultados en torno a tres categorías: perspectiva del paciente, perspectiva de la familia y perspectiva de los profesionales de la salud. Discusión/ Conclusiones: La actitud del paciente favorable a recibir información, difiere completamente de la opinión de la familia y los profesionales, éstos se oponen a ella por diversos motivos (protección al familiar enfermo, escasa formación en la comunicación…). Por otro lado, este deseo de conocer es independiente de la influencia social establecida.Objective: To evaluate the possible influence of culture in relation to the presence of the pact of silence of terminally ill patients in today’s society. Methods: a narrative review has been done through bibliographic research in Health Science databases (Cochrane Plus, PubMed, Cinahl, SCielo, PsycINFO and EBSCO Host), scientific magazines and institutional websites. The articles selected answer the following inclusion criteria: adult patients, articles published since 2000, in English, French or Spanish, Free Full Text, concerning terminal illness, answering the research question. Results: 35 articles were included and the results classified into three categories: patient´s perspective, family´s perspective and health professional’s perspective. Discussion/ Conclusions: The favorable attitude of the patient to receive information is completely different from the views of the family and professionals; they oppose it for several reasons (sick relative´s protection, poor communication training ...). On the other hand, this desire to know is independent of the established social influence

Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey

There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients