Aplicación de la Dignity Therapy en pacientes oncológicos en situación avanzada.

The Dignity Therapy was designed to cope with suffering, psychosocial and existential distress among patients with advanced or terminal disease. This paper is a cuasi experimental study with sixteen cancer patients in advanced stages of the disease. The aim of the study is to apply, in our context, the Dignity Therapy as a proposal for intervention for the relief of suffering such patients, in order to assess whether there is pre and post intervention changes. The results of Wilcoxon’s test, show statistically significant differences comparing the pre-intervention and the post-intervention for the variables Anxiety and Well-being. Nevertheless, statistically significant differences are not observed for the variables Depression and Serenity. The subjects agreed to participate voluntarily, and all the subjects felt satisfied after the application of the Dignity Therapy and noted that they found it useful enough or very useful. These results suggest that it is an appropriate therapeutic approach to these patients.La Dignity Therapy fue diseñada para hacer frente al sufrimiento, la angustia psicosocial y existencial entre los pacientes con enfermedad avanzada o terminal. El presente trabajo es un estudio cuasi experimental con dieciséis pacientes oncológicos en estado avanzado de la enfermedad. El objetivo del estudio fue aplicar, en nuestro contexto, la Dignity Therapy como propuesta de intervención para el alivio del sufrimiento a dichos pacientes, evaluando si existen cambios pre y post intervención. Tras obtener resultados mediante la prueba de Wilcoxon, se obtienen diferencias estadísticamente significativas comparando la pre-intervención y la post-intervención para las variables Ansiedad y Bienestar. Sin embargo, no se observa diferencias estadísticamente significativas para las variables Depresión y Serenidad. Los sujetos accedieron a participar de forma voluntaria y todos se sintieron satisfechos tras la aplicación de la Dignity Therapy, destacando que les había resultado bastante útil o muy útil. Estos resultados apuntan a que se trata de un acercamiento terapéutic

3849_REDITS. Red Interuniversitaria para la didáctica en Trabajo Social

El presente trabajo se enmarca en el seno del Programa de Redes-ICE de investigación en docencia universitaria del Vicerrectorado de Calidad e Innovación Educativa-Instituto de Ciencias de la Educación de la Universidad de Alicante (convocatoria 2016-17), “Ref.: 3849 REDITS”. Como primera estrategia partimos de la revisión de la literatura especializada recogiendo lo que venimos trabajando sobre competencias en Trabajo Social y promoción del trabajo colaborativo, e incorporando los aspectos relativos a la supervisión, estableciendo la diferencia entre la supervisión educativa y la supervisión profesional. Se realizó una revisión de la producción desarrollada por REDITS, a efectos de ir procurando no solo la homologación de criterios sino la construcción de estrategias de trabajo a partir de los resultados de las supervisiones. La segunda estrategia consistió en el seguimiento de experiencias puntuales de docencia en las que la red constituye un espacio de construcción de alternativas a partir de poner en común casos de cada universidad buscando puntos de convergencia y alternativas de trabajo. Se trabajó particularmente aspectos relativos a la educación inclusiva en el ámbito universitario. Como tercera estrategia se realizo un grupo de discusión de profesorado y se pasaron evaluaciones abiertas al alumnado sobre los tipos de supervisión en el proceso de enseñanza aprendizaje

Application of dignity therapy in cancer patients in advanced state

The Dignity Therapy was designed to cope with suffering, psychosocial and existential distress among patients with advanced or terminal disease. This paper is a cuasi experimental study with sixteen cancer patients in advanced stages of the disease. The aim of the study is to apply, in our context, the Dignity Therapy as a proposal for intervention for the relief of suffering such patients, in order to assess whether there is pre and post intervention changes. The results of Wilcoxon’s test, show statistically significant differences comparing the pre-intervention and the post-intervention for the variables Anxiety and Well-being. Nevertheless, statistically significant differences are not observed for the variables Depression and Serenity. The subjects agreed to participate voluntarily, and all the subjects felt satisfied after the application of the Dignity Therapy and noted that they found it useful enough or very useful. These results suggest that it is an appropriate therapeutic approach to these patients

Insuficiencia cardíaca con fracción de eyección intermedia: ¿Nueva entidad?

Currently, a new classification of patients with heart failure (HF) according to the left ventricular ejection fraction (LVEF), the HF with mid-range LVEF (HFmrEF) between 40 and 49% is described. This is included in the previous classification of HF with LVEF greater than 50% or preserved LVEF (HFpEF) and HF with reduced LVEF (HFrEF), less than 40%. This new group of patients represents between 16-20% of patients with HF, thus, since its publication, there have been several studies interested in discovering the characteristics of these. After reviewing the studies that we currently have, we can draw some conclusions regarding those with HFmrEF, which share clinical, epidemiological and etiological characteristics with the other two patterns (HFpEF and HFrEF); therefore, it is possible that the HFmrEF represents more a transitional state between HFrEF and HFpEF than an independent entity in itself. Patients with HFpEF do not show differences in mortality compared to the other two groups, except in those with ischemic heart disease in whom mortality is similar to that in patients with HFrEF. It is recommended to treat those who have HFmrEF in a similar way to those with HFpEF, although it has been observed that the former benefit from a treatment similar to those with HFrEF.En la actualidad se describe una nueva clasificación de pacientes con insuficiencia cardíaca (IC) según la fracción de eyección del ventrículo izquierdo (FEVI), la IC con FEVI intermedia (ICFEi) entre 40 y 49%. Esta se incluye en la anterior clasificación en IC con FEVI mayor del 50% o FEVI preservada (ICFEp) y la IC con FEVI reducida (ICFEr), menor del 40 %. Este nuevo grupo de pacientes representa entre el 16-20% de los pacientes con IC, por lo que desde su publicación han habido varios estudios interesados en descubrir las características de estos. Tras revisar los estudios de los que disponemos actualmente se pueden extraer algunas conclusiones respecto a los que presentan ICFEi, que comparten características clínicas, epidemiológicas y etiológicas con los otros dos patrones (ICFEp e ICFEr); por lo que cabe la posibilidad de que la ICFEi represente más un estado transicional entre ICFEr y ICFEp que una entidad independiente en sí misma. Los pacientes con ICFEi no presentan diferencias en la mortalidad frente a los otros 2 grupos, excepto en aquellos con cardiopatía isquemia en los cuales la mortalidad es similar a la de pacientes con ICFEr. Se recomienda tratar a los que tienen ICFEi de forma similar a aquellos con ICFEp, aunque se ha observado que los primeros se benefician de un tratamiento similar a los que padecen ICFEr

Insuficiencia cardíaca con fracción de eyección intermedia: ¿Dos entidades superpuestas? Respuesta

Insuficiencia cardíaca con fracción de eyección intermedia: ¿Dos entidades superpuestas? RespuestaHeart failure with mid-range ejection fraction: Two overlapping entities? Repl

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective: To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results: Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions: Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival.Ministerio de Sanidad, Consumo y Bienestar Social y FEDER (PI15 / 01019, PI15 / 00773, PI18 / 00393, PI18 / 00456).Fundació La Marató de TV3 ( 2015/2510).Gobierno de Cataluña para Grupos Consolidados de Investigación (GRC 2009 / 1385,2014 / 0313, y 2017/1424).11.627 JCR (2019) Q1, 9/138 Cardiac & Cardiovascular Systems5.556 SJR (2019) Q1, 5/364 Cardiology and Cardiovascular MedicineNo data IDR 2019UE

Estudio RAD-ICA: valor pronóstico de la radiografía de tórax obtenida en urgencias en pacientes con insuficiencia cardiaca aguda

Objective. To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF). Methods. Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered variables for the AHF episode and the patient's baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination. Results. A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629 (23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%-49%) higher rate of the 30-day composite outcome; in-hospital mortality was 89% (30%-177%) higher in the presence of alveolar edema, and 1-year mortality was 38% (14%-67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables. Conclusions: A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes.

To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm + wet, 1929 (17.1%) cold + wet, 675 (6.0%) warm + dry, and 99 (0.9%) cold + dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm + wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm + dry, the adjusted hazard ratios were significantly increased for cold + wet (1.660; 95% confidence interval 1.400-1.968) and cold + dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival