Definições para “cuidados paliativos”, “final de vida” e doença terminal em oncologia: scoping review

Objective: to identify and map the definitions for palliative care, end of life, and terminally ill in the oncology literature. Materials and method: scoping review guided by Joanna Brigs Institute recommendations. We analyzed original articles, published between 2012 and 2017, indexed in the databases Pubmed, Web of Science and Scopus. The data collection resulted in 51 articles selected for analysis. Also, we have consulted the websites of 25 palliative care societies from countries best ranked in The Economist’s Quality of Death Ranking. The data were analyzed through descriptive statistics, and summary of the themes, in this case the definitions. Results: terminally ill is a disease with a prognosis of lifetime ranging between hours and months, there is clinical worsening, functional decline, and presence of metastases. Palliative care aims to promote quality of life and dignity. End of life is the period of up to 12 months before death. Conclusions: we constructed synthesis and definitions for the concepts investigated. Thus, it was possible to contribute to the adoption of a standardized language in care and investigations with cancer patients in end-of-lifeObjetivo: Identificar y mapear las definiciones de cuidados paliativos, fin de vida y enfermedad terminal en la literatura en oncología. Materiales y método: scoping review basada en los supuestos del  Joanna Briggs Institute. Se analizaron 51 artículos originales, publicados entre 2012 y 2017, indexados en las bases de datos Pubmed, Web of Science y Scopus.  Se consultaron los sitios web de 25 sociedades de cuidados paliativos de los países mejor clasificados en The Economist's Quality of Death Ranking. Los datos fueron analizados a través de estadística descriptiva y se resumieron por temas, en este caso, las definiciones. Resultados: enfermedad terminal se trata de una enfermedad con tiempo de vida que oscila entre horas y meses; hay un empeoramiento clínico; deterioro funcional y la presencia de metástasis. Los cuidados paliativos tienen por propósito la calidad de vida y la dignidad. El final de la vida comprende el período de hasta 12 meses antes de la muerte. Conclusiones: se ha construido síntesis y definiciones para los conceptos investigados, siendo posible contribuir para adopción de un lenguaje estandarizado en los cuidados e investigaciones junto a los pacientes oncológicos en fin de vida.Objetivo: identificar e mapear as definições de cuidados paliativos, final de vida e doença terminal na literatura em oncologia. Materiais e métodos: scoping review baseada nas recomendações do Joanna Briggs Institute. Analisamos artigos oriundos de estudos primários, publicados entre 2012 e 2017, indexados nas bases de dados Pubmed, Web of Science e Scopus. Foram selecionados 51 artigos que atenderam aos critérios de inclusão e exclusão. Também foram consultados websites de 25 sociedades de Cuidados Paliativos dos países com melhor classificação no índice de qualidade de morte da revista The Economist. Os dados foram analisados por meio de estatística descritiva e síntese dos temas, no caso, as definições. Resultados: doença terminal é aquela com tempo de vida que varia entre horas e meses, há piora clínica, deterioramento funcional e metástases. Cuidados Paliativos têm por finalidade a promoção da qualidade de vida e a dignidade. Final de vida é o período de até 12 meses que antecede a morte. Conclusões: construiu-se síntese e definições para os conceitos investigados, sendo possível contribuir para adoção de uma linguagem padronizada nos cuidados e investigações junto aos pacientes oncológicos em final de vida

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

CUIDADOS PALIATIVOS: IDENTIFICACIÓN DE LA NECESIDAD POR EQUIPOS ASISTENCIALES Y SOLICITUD DE EQUIPOS DE CONSULTORÍA

Objective: to describe how care teams identify the need for palliative care and request the support of consulting teams. Methodology:  A qualitative, descriptive, and exploratory study conducted in a Brazilian teaching hospital. Data production took place between July and November 2021, through a semi-structured interview with four doctors and four nurses from clinical admission units. The data were organized in the Atlas.ti demo version and submitted to Content Analysis. Results: two content units composed the central category "Need for palliative care: how do care teams identify? “and are presented in this article. The first: Clinical experience and (not) use of standardized assessment instruments. The second: Knowledge and practices on palliative care (consulting team). Through interviews with professionals, it was possible to analyze that doctors use their clinical expertise and identify patients through the burden of symptoms that the patient presents, with low frequency using scales to assess needs, and the nurses although they present knowledge about the evaluation of clinical aspects, summarize their identification through the medical records. Conclusion: It is important to spread the use of validated instruments, with the objective of identifying people who need palliative care, and thus expanding. The role of the nurse should be resumed, decentralizing medical care and highlighting the knowledge of nursing professionals, encouraging the need to occupy central spaces in the process of caring for patients in palliative care in the hospital.Objetivo: descrever como equipes assistenciais identificam a necessidade de cuidados paliativos e solicitam o apoio de equipes de consultoria. Metodologia:  estudo descritivo e exploratório, de abordagem qualitativa, realizado em um hospital de ensino no Brasil. A produção dos dados ocorreu entre julho e novembro de 2021, por meio de entrevista semiestruturada com quatro médicos e quatro enfermeiros de unidades de internação clínica. Os dados foram organizados no programa Atlas.ti versão de demonstração e submetidos à Análise de Conteúdo. Resultados: duas unidades de conteúdo compuseram a categoria central “Necessidade de cuidados paliativos: como equipes assistenciais identificam? “, e são apresentadas neste artigo. Na primeira: Experiência clínica e (não) uso de instrumentos padronizados de avaliação. Na segunda: Saberes e práticas sobre (equipe de consultoria) em cuidados paliativos. Através das entrevistas dos profissionais foi possível analisar que os médicos utilizam de sua expertise clínica, e identificam os pacientes através da carga de sintomas que o enfermo apresenta, com baixa frequência fazendo uso de escalas para avaliar as necessidades, e os enfermeiros embora apresentem um conhecimento sobre a avaliação de aspectos clínicos resumem sua identificação através dos registros médicos. Conclusão: Constata-se a importância em difundir o uso de instrumentos validados, com o objetivo de identificar as pessoas que precisam de cuidados paliativos, e assim ampliando. Deve-se retomar o protagonismo do enfermeiro, descentralizando o cuidado médico e evidenciando o conhecimento dos profissionais de enfermagem, incentivando a necessidade de ocupar espaços centrais no processo de cuidar de pacientes em cuidados paliativos no hospital.Objetivo: describir cómo los equipos asistenciales identifican la necesidad de cuidados paliativos y solicitan el apoyo de equipos de consultoría. Metodología:  Estudio cualitativo, descriptivo y exploratorio, realizado en un hospital de enseñanza brasileño. La producción fue entre julio y noviembre de 2021, por medio de una entrevista semiestructurada con cuatro médicos y cuatro enfermeros de unidades de internación clínica. Los datos fueron organizados en el programa Atlas.ti versión de demostración y sometidos al Análisis de Contenido. Resultados: Dos unidades de contenido conforman la categoría central "Necesidad de cuidados paliativos: ¿cómo identifican equipos asistenciales? ". La primera: Experiencia clínica y (no) uso de instrumentos estandarizados de evaluación. La segunda: Saberes y prácticas sobre (equipo de consultoría) en cuidados paliativos. A través de las entrevistas fue posible analizar que los médicos utilizan su experiencia clínica, e identifican a los pacientes a través de la carga de síntomas que el enfermo presenta, con baja frecuencia haciendo uso de escalas para evaluar las necesidades, y los enfermeros, aunque presenten un conocimiento sobre la evaluación de aspectos clínicos resumen su identificación a través de los registros médicos. Conclusión: Se constata la importancia de difundir el uso de instrumentos validados, con el objetivo de identificar a las personas que necesitan cuidados paliativos, y así ampliando. Se debe retomar el protagonismo del enfermero, descentralizando el cuidado médico y evidenciando el conocimiento de enfermería, incentivando la necesidad de ocupar espacios centrales en el proceso de cuidar a pacientes en cuidados paliativos en el hospital

Definitions for “palliative care”, “end-of-life” and “terminally ill” in oncology: a scoping review

Abstract: Objective: to identify and map the definitions for palliative care, end of life, and terminally ill in the oncology literature. Materials and method: scoping review guided by Joanna Brigs Institute recommendations. We analyzed original articles, published between 2012 and 2017, indexed in the databases Pubmed, Web of Science and Scopus. The data collection resulted in 51 articles selected for analysis. Also, we have consulted the websites of 25 palliative care societies from countries best ranked in The Economist’s Quality of Death Ranking. The data were analyzed through descriptive statistics, and summary of the themes, in this case the definitions. Results: terminally ill is a disease with a prognosis of lifetime ranging between hours and months, there is clinical worsening, functional decline, and presence of metastases. Palliative care aims to promote quality of life and dignity. End of life is the period of up to 12 months before death. Conclusions: we constructed synthesis and definitions for the concepts investigated. Thus, it was possible to contribute to the adoption of a standardized language in care and investigations with cancer patients in end-of-life.Resumo: Objetivo: identificar e mapear as definições de cuidados paliativos, final de vida e doença terminal na literatura em oncologia. Materiais e métodos: scoping review baseada nas recomendações doJoanna Briggs Institute. Analisamos artigos oriundos de estudos primários, publicados entre 2012 e 2017, indexados nas bases de dadosPubmed,Web of ScienceeScopus. Foram selecionados 51 artigos que atenderam aos critérios de inclusão e exclusão. Também foram consultados websites de 25 sociedades de Cuidados Paliativos dos países com melhor classificação no índice de qualidade de morte da revistaThe Economist.Os dados foram analisados por meio de estatística descritiva e síntese dos temas, no caso, as definições. Resultados: doença terminal é aquela com tempo de vida que varia entre horas e meses, há piora clínica, deterioramento funcional e metástases. Cuidados Paliativos têm por finalidade a promoção da qualidade de vida e a dignidade. Final de vida é o período de até 12 meses que antecede a morte. Conclusões: construiu-se síntese e definições para os conceitos investigados, sendo possível contribuir para adoção de uma linguagem padronizada nos cuidados e investigações junto aos pacientes oncológicos em final de vida.Resumen: Objetivo: Identificar y mapear las definiciones de cuidados paliativos, fin de vida y enfermedad terminal en la literatura en oncología. Materiales y método: scoping review basada en los supuestos del Joanna Briggs Institute.Se analizaron 51 artículos originales, publicados entre 2012 y 2017, indexados en las bases de datosPubmed,Web of ScienceyScopus. Se consultaron los sitios web de 25 sociedades de cuidados paliativos de los países mejor clasificados enThe Economist's Quality of Death Ranking. Los datos fueron analizados a través de estadística descriptiva y se resumieron por temas, en este caso, las definiciones. Resultados: enfermedad terminal se trata de una enfermedad con tiempo de vida que oscila entre horas y meses; hay un empeoramiento clínico; deterioro funcional y la presencia de metástasis. Los cuidados paliativos tienen por propósito la calidad de vida y la dignidad. El final de la vida comprende el período de hasta 12 meses antes de la muerte. Conclusiones: se ha construido síntesis y definiciones para los conceptos investigados, siendo posible contribuir para adopción de un lenguaje estandarizado en los cuidados e investigaciones junto a los pacientes oncológicos en fin de vida

Actividades extensionistas con el equipo consultor de cuidados paliativos: contribuciones a la formación en salud

Este artigo tem por objetivo relatar atividades extensionistas desenvolvidas junto a uma Equipe de Consultoria em Cuidados Paliativos (ECCP) entre 2018 e 2019. Destaca-se a organização, dinâmica de avaliação e atenção às pessoas em cuidados paliativos (CP) hospitalizadas e suas famílias pela ECCP e estudantes de graduação em enfermagemem articulação com profissionais diretamente responsáveis pela assistência em unidades de internação de um Hospital de Ensino do Sul do Brasil. Por serem enfermeiros os profissionais mais vinculados ao cuidado, seja por suas atividades ou pelo tempo que permanecem com os indivíduos, é fundamental a educação destes sobre o morrer e a morte desde a graduação. Conclui-se que ECCP em instituições hospitalares pode melhorar a qualidade do cuidado prestado às pessoas com doenças que ameaçam à vida e suas famílias, por meio da educação permanente de profissionais saúde e da aproximação de estudantes com as especificidades deste cenário

Use of Text Messaging (SMS) for the Management of Side Effects in Cancer Patients Undergoing Chemotherapy Treatment: a Randomized Controlled Trial

Cancer patients are often not sufficiently oriented to manage side effects at home. Sending text messages with self-care guidelines aimed managing side effects is the main objective of this randomized controlled trial. Patients who started outpatient chemo therapy treatment between March and December 2017 at a hospital in southern Brazil were invited to participate in this study and were allocated to the intervention or control group (ratio 1: 1). Each patient in the intervention group received a daily SMS (short message service) with some guidance on management or prevention of side effects. All text messages were sent to the interven tion group patients in an automated and tailored way by our app called cHEmotHErApp. Side effects experienced by patients were verified using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Results showed intervention group patients experienced fewer side effects compared to the control group in cycle 1 (p < 0.05), in general. In addition, intervention group experienced less nausea in relation to the control group, in the cycle 1 and cycle 2 (p < 0.05). This study indicate text messaging may be a tool for supporting side effect management in patients receiving chemotherapy. This study was enrolled in ClinicalTrials.gov with the identification number NCT03087422. This research was performed in accordance with the Declaration of Helsinki

Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Aims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5–45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3–34.0%). Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients

Study objective This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge. Methods A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0–11.9 g/dL in women; 10.0–12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men). Results Patients (2678; mean age 79.2 ± 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95%CI 1.21–2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82;95%CI 1.25–2.67; group 3: OR = 2.78;95%CI 1.82–4.26) and discharge (group 2: OR = 2.37;95%CI 1.48–3.93; group 3: OR = 3.70;95%CI 2.14–6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes. Conclusions Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia