Diagnosis of the complexity of palliative care delivered at home versus conventional treatment in hospital.

Objetivo: describir los elementos que determinan la complejidad en pacientes con necesidad de atención paliativa ingresados en hospitalización a domicilio (HADO) o en una sala de oncología médica. Material y métodos: estudio observacional en una muestra de 116 pacientes (82 ingresados en HADO y 34 ingresados en una sala de oncología médica, todos del Hospital de la FIVO), mediante la herramienta IDC-Pal de la Junta de Andalucía. Se han utilizado como fuentes de información la entrevista con el personal sanitario responsable y la revisión de las historias clínicas. Resultados: en HADO, el 79 % de los pacientes presentaron situación altamente compleja, y el 17 %, una situación compleja. En la sala de oncología médica, el 94 % presentaron una situación altamente compleja y el 6 % una situación compleja. Conclusiones: la herramienta IDC-Pal es de fácil utilización para detectar la complejidad en las situaciones de necesidad de atención paliativa en pacientes ingresados. Todos los pacientes presentan criterios de complejidad y alta complejidad, con una media de cinco criterios por paciente, por lo que, según el IDC-Pal, todos deberían recibir atención de equipos especializados.Objective: to describe the elements that determine the complexity in patients in palliative care admitted to Hospital at Home (HADO) or in a room of medical oncology. Methods: observational study in a sample of 116 patients (82 and 34 admitted to HADO admitted to a room of medical oncology, all of the Hospital FIVO) by IDC-Pal tool Andalusian. They have been used as sources of information, the interview with the responsible medical personnel and review of medical records. Results: In HADO, 79 % of patients presented highly complex situation and 17 % complex situation. In the room of Medical Oncology, 94% had a situation highly complex and 6% a complex situation. Conclusions: the IDC-Pal tool is easy to use utility to detect complexity in need situations for palliative care patients admitted. All patients presented criteria of complexity and high complexity, with a median of five criteria per patient, which according to IDC-Pal, everyone should receive specialized care teams.Medicin

Is the psycho-emotional situation complex in home palliative care? A multicenter study

Los cuidados paliativos en el domicilio pueden precisar, por criterios de complejidad psicoemocional, la intervención de equipos especializados o avanzados. La hospitalización a domicilio se presta a pacientes con necesidad de atención paliativa en su domicilio cuya complejidad es variable. Objetivo: Describir la presencia de causas de complejidad psicoemocional en los pacientes paliativos ingresados en hospitalización a domicilio en España. Método: Estudio descriptivo transversal y multicéntrico empleando la herramienta IDC-Pal realizado en ocho hospitales diferentes de hospitalización a domicilio repartidos por la geografía española. Los criterios de inclusión han sido: pacientes con mayoría de edad ingresados en régimen de hospitalización a domicilio con necesidad de cuidados paliativos. Resultados: En una muestra de 266 pacientes de 8 hospitales, 151 (57 %) eran hombres y 115 mujeres (43 %). La edad media de la muestra fue de 71,48 años (DE = 13,28). El 85,7 % de los pacientes presentaban al menos un criterio de alta complejidad para cualquier causa. 115 pacientes (47 %) presentaban al menos un criterio de complejidad psicoemocional, siendo la angustia existencial o sufrimiento espiritual el más frecuente. Conclusiones: La situación psicoemocional compleja se presenta en aproximadamente la mitad de los pacientes ingresados en hospitalización a domicilio. El sufrimiento espiritual merece una atención particular en este grupo de pacientes.Palliative care at home might require, by criteria of psycho-emotional complexity, the intervention of specialized or advanced teams. Hospital-at-home is provided to patients who need palliative care at home and whose complexity is variable. Aim: To describe the causes of psycho-emotional complexity in palliative patients admitted to hospitalat- homes in Spain. Method: Cross-sectional and multicenter descriptive study using the IDCPal tool carried out in eight different hospitals of Hospital-at-home distributed throughout the Spanish geography. The inclusion criteria were: patients with legal age admitted to Spanish hospital-at-homes and who need palliative care. Results: In a sample of 266 patients from 8 hospitals, 151 (57 %) were men and 115 women (43 %). The mean age of the sample was 71.48 years (SD = 13.28), 85.7 % of the patients had at least one criterion of high complexity for any cause, 115 patients (47 %) had at least one criterion of psycho-emotional complexity, being the existential anguish or spiritual suffering the most frequent. Conclusions: The complex psycho-emotional situation occurs in approximately half of the patients admitted to hospital-at-homes. Spiritual suffering deserves special focus in this group of patients.Enfermerí

Diagnóstico de la complejidad de la atención paliativa en hospitalización a domicilio versus hospitalización convencional

Objective: to describe the elements that determine the complexity in patients in palliative care admitted to Hospital at Home (HADO) or in a room of medical oncology. Methods: observational study in a sample of 116 patients (82 and 34 admitted to HADO admitted to a room of medical oncology, all of the Hospital FIVO) by IDC-Pal tool Andalusian. They have been used as sources of information, the interview with the responsible medical personnel and review of medical records. Results: In HADO, 79 % of patients presented highly complex situation and 17 % complex situation. In the room of Medical Oncology, 94% had a situation highly complex and 6% a complex situation. Conclusions: the IDC-Pal tool is easy to use utility to detect complexity in need situations for palliative care patients admitted. All patients presented criteria of complexity and high complexity, with a median of five criteria per patient, which according to IDC-Pal, everyone should receive specialized care teams.Objetivo: describir los elementos que determinan la complejidad en pacientes con necesidad de atención paliativa ingresados en hospitalización a domicilio (HADO) o en una sala de oncología médica. Material y métodos: estudio observacional en una muestra de 116 pacientes (82 ingresados en HADO y 34 ingresados en una sala de oncología médica, todos del Hospital de la FIVO), mediante la herramienta IDC-Pal de la Junta de Andalucía. Se han utilizado como fuentes de información la entrevista con el personal sanitario responsable y la revisión de las historias clínicas. Resultados: en HADO, el 79 % de los pacientes presentaron situación altamente compleja, y el 17 %, una situación compleja. En la sala de oncología médica, el 94 % presentaron una situación altamente compleja y el 6 % una situación compleja. Conclusiones: la herramienta IDC-Pal es de fácil utilización para detectar la complejidad en las situaciones de necesidad de atención paliativa en pacientes ingresados. Todos los pacientes presentan criterios de complejidad y alta complejidad, con una media de cinco criterios por paciente, por lo que, según el IDC-Pal, todos deberían recibir atención de equipos especializados

¿Es compleja la situación psicoemocional en los cuidados paliativos en el domicilio?: estudio multicéntrico

Palliative care at home might require, by criteria of psycho-emotional complexity, the intervention of specialized or advanced teams. Hospital-at-home is provided to patients who need palliative care at home and whose complexity is variable. Aim: To describe the causes of psycho-emotional complexity in palliative patients admitted to hospitalat-homes in Spain. Method: Cross-sectional and multicenter descriptive study using the IDCPal tool carried out in eight different hospitals of Hospital-at-home distributed throughout the Spanish geography. The inclusion criteria were: patients with legal age admitted to Spanish hospital-at-homes and who need palliative care. Results: In a sample of 266 patients from 8 hospitals, 151 (57 %) were men and 115 women (43 %). The mean age of the sample was 71.48 years (SD = 13.28), 85.7 % of the patients had at least one criterion of high complexity for any cause, 115 patients (47 %) had at least one criterion of psycho-emotional complexity, being the existential anguish or spiritual suffering the most frequent.Los cuidados paliativos en el domicilio pueden precisar, por criterios de complejidad psicoemocional, la intervención de equipos especializados o avanzados. La hospitalización a domicilio se presta a pacientes con necesidad de atención paliativa en su domicilio cuya complejidad es variable. Objetivo: Describir la presencia de causas de complejidad psicoemocional en los pacientes paliativos ingresados en hospitalización a domicilio en España. Método: Estudio descriptivo transversal y multicéntrico empleando la herramienta IDC-Pal realizado en ocho hospitales diferentes de hospitalización a domicilio repartidos por la geografía española. Los criterios de inclusión han sido: pacientes con mayoría de edad ingresados en régimen de hospitalización a domicilio con necesidad de cuidados paliativos. Resultados: En una muestra de 266 pacientes de 8 hospitales, 151 (57 %) eran hombres y 115 mujeres (43 %). La edad media de la muestra fue de 71,48 años (DE = 13,28). El 85,7 % de los pacientes presentaban al menos un criterio de alta complejidad para cualquier causa. 115 pacientes (47 %) presentaban al menos un criterio de complejidad psicoemocional, siendo la angustia existencial o sufrimiento espiritual el más frecuent

Assignment of the contribution of the tryptophan residues to the spectroscopic and functional properties of the ribotoxin α-Sarcin

α-Sarcin, a potent cytotoxic protein from Aspergillus giganteus, contains two tryptophan residues at positions 4 and 51. Two single, W4F and W51F, and the double mutant, W4/51F, have been produced and purified to homogeneity. These two residues are neither required for the highly specific ribonucleolytic activity of the protein on the ribosomes (production of the so called α-fragment) nor for its interaction with lipid membranes (aggregation and fusion of vesicles), although the mutant forms involving Trp-51 show a decreased ribonuclease activity. Proton NMR data reveal that no significant changes in the global structure of the enzyme occur upon replacement of Trp-51 by Phe. Substitution of each Trp residue results in a 4 °C drop in the thermal denaturation midpoint, and the double mutant's midpoint is 9°C lower. Trp-51 is responsible for most of the near-UV circular dichroism of the protein and also contributes to the overall ellipticity of the protein in the peptide bond region. Trp-51 does not show fluorescence emission. The membrane-bound proteins undergo a thermal denaturation at a lower temperature than the corresponding free forms. The interaction of the protein with phospholipid bilayers promotes a large increase of the quantum yield of Trp-51 and its fluorescence emission is quenched by anthracene incorporated into the hydrophobic region of such bilayers. This indicates that the region around this residue is located in the hydrophobic core of the bilayer following protein–vesicle interaction. Proteins 2000;41:350–361.C.A., J.M.P.-C., and A.M.-R. are recipients of fellowships from the Ministerio de Educación y Cultura (Spain) and J.L. from the Fundación Ferrer (Barcelona, Spain)

Characterization of a natural larger form of the antifungal protein (AFP) from Aspergillus giganteus

Two major proteins, a-sarcin and an antifungal polypeptide AFP , are secreted by the mould Ž . Aspergillus giganteus MDH 18894 when it is cultured for 70–80 h. A third major protein is also found in the extracellular medium at 48–60 h, but it disappears as the culture proceeds. This protein has been isolated and characterized in terms of apparent molecular mass, electrophoretic and chromatographic behaviour, NH -terminal primary structure, amino acid content, spectroscopical 2 features, reactivity against anti-AFP antibodies, and antifungal activity. Based on the obtained results it would be an extracellular inactive precursor form of AFP, designated as the large form of AFP lf-AFP . Its amino acid composition is Ž . identical to that of AFP but containing six extra residues. NH -terminal sequence analysis of the first eight amino acid 2 residues of this polypeptide revealed that the extra residues can be perfectly accommodated within the DNA-deduced sequence of the precursor form of AFP. Its alignment with precursor sequences of different proteins, secreted by a variety of Aspergillus spp., reveals the existence of a common tetrapeptide at the carboxy-terminal end of their leader peptides. This sequence would be IlerLeu-Xaa-Yaa-Arg, being mostly Xaa and Yaa an acid residue Asp Ž . rGlu and alanine, respectively. The presence of lf-AFP as an extracellular protein would be in perfect agreement with the existence of this tetrapeptide motif, that can be involved in the protein secretion mechanisms of filamentous fungi.Depto. de Bioquímica y Biología MolecularFac. de Ciencias QuímicasTRUEpu

Sequence determination and molecular characterization of gigantin, a cytotoxic protein produced by the mouldAspergillus giganteusIFO 5818

Gigantin is a 17-kDa ribonuclease secreted by Aspergillus giganteus IFO 5818. The sequence of the genomic DNA coding for this protein is reported. The deduced amino acid sequence reveals nine amino acid variations with respect to alpha-sarcin, a well-characterized ribosome-inactivating protein from A. giganteus MDH 18894. The peptides obtained after tryptic digestion of reduced and carboxyamidomethylated gigantin have been chromatographically separated. The analysis of these peptides in comparison to those originating from alpha-sarcin corroborates the above sequence differences. These do not sensibly modify the conformation of the protein, based on the coincidence of the circular dichroism and fluorescence emission spectra of the two proteins. The obtained results are discussed in terms of the involvement of the distinctive residues in the immunological and catalytic properties that distinguish gigantin from alpha-sarcin.Depto. de Bioquímica y Biología MolecularFac. de Ciencias QuímicasTRUEpu

Secretion of Recombinant Pro- and Mature Fungal α-Sarcin Ribotoxin by the Methylotrophic YeastPichia pastoris:The Lys–Arg Motif Is Required for Maturation

α-Sarcin is a ribosome-inactivating protein from the moldAspergillus giganteus.The methylotrophic yeastPichia pastorishas been transformed with two plasmids (pHILD2preαS and pHILS1preαS), which contain the complete α-sarcin cDNA, including its original fungal leader peptide, under the control of yeast alcohol oxidase promoter. The second one is indeed fused to the signal sequence ofP. pastorisacid phosphatase. The transformed yeasts secreted both mature and pro-α-sarcin. The presence of this pro-α-sarcin in the yeast extracellular medium is due to an inefficient recognition of the pro-sequence by a putative Kex2p-like endopeptidase. A third plasmid accounting for a single mutation of the α-sarcin leader peptide was designed to produce a more efficient Kex2p recognition motif. This approach resulted in the extracellular production of only the mature protein, suggesting the existence of a two-step mechanism for processing its leader peptide. This recombinant α-sarcin is identical to the original fungal protein, according to activity and spectroscopic criteria. In addition, pro-α-sarcin, which has been characterized for the first time, also exhibits ribonucleolytic activity as the mature protein does. Therefore, protection of the producing cells against this kind of ribotoxins may depend on an efficient recognition of the signal sequence followed by translocation of the nascent polypeptide to the endoplasmic reticulum.Depto. de Bioquímica y Biología MolecularFac. de Ciencias QuímicasTRUEpu