Arteterapia en el final de la vida

Art therapy allows a particularly valuable biographical creative approach at the end of life. The person concerned has multiple needs - physical, emotional, social and spiritual - that only a holistic attention may claim to embrace, as contemplated in the philosophy of palliative care. The art therapist is integrated into the interdisciplinary team to help to alleviate suffering and accompany the patient and his family. We present here the theoretical foundations and methodology of the intervention as well as the health framework in which it is included.El arteterapia permite una aproximación creativa biográfica particularmente valiosa en la etapa final de la vida. La persona enferma presenta múltiples necesidades – físicas, emocionales, sociales y espirituales – que solo una atención holística puede pretender abarcar, tal como lo contempla la filosofía de los cuidados paliativos. El arteterapeuta integrado en el equipo interdisciplinar contribuye a aliviar y acompañar el sufrimiento del paciente y su familia. Se presentan aquí las bases teóricas y la metodología de la intervención, así como el marco sanitario en el cual se inscribe

Acompañamiento a la muerte. Introducción al Dossier

Acompañamiento a la muerte. Introducción al Dossie

Hasta llegar, la vida. Arte-terapia y cáncer en fase terminal

This paper defends an integral medicine to approach the suffering of terminal states, where the palliative team must be multidisciplinary. In this team, the art therapist is qualifi ed to take charge of the emotional aspects of the terminal patient, to relieve the suffering and to improve the quality of life of the patient and his relatives, in an approach of here/now. But a hanging task in art therapy is the checking and evaluation of its efficiency. With this aim we are developing a study nowadays in the Unit of Care Palliative of the University Hospital Sant-Pau, Barcelona, subsidized by the Spanish Society of Medical Oncology

Up to coming, the life

This paper defends an integral medicine to approach the suffering of terminal states, where the palliative team must be multidisciplinary. In this team, the art therapist is qualifi ed to take charge of the emotional aspects of the terminal patient, to relieve the suffering and to improve the quality of life of the patient and his relatives, in an approach of here/now. But a hanging task in art therapy is the checking and evaluation of its efficiency. With this aim we are developing a study nowadays in the Unit of Care Palliative of the University Hospital Sant-Pau, Barcelona, subsidized by the Spanish Society of Medical Oncology

Art therapy at the end of life. Foundations and methodology of the intervention in a Palliative Care Unit.

Art therapy allows a particularly valuable biographical creative approach at the end of life. The person concerned has multiple needs - physical, emotional, social and spiritual - that only a holistic attention may claim to embrace, as contemplated in the philosophy of palliative care. The art therapist is integrated into the interdisciplinary team to help to alleviate suffering and accompany the patient and his family. We present here the theoretical foundations and methodology of the intervention as well as the health framework in which it is included

Arteterapia en el final de la vida

Con el objetivo de evaluar los beneficios de una intervención de arteterapia para los pacientes con cáncer de una Unidad de Cuidados Paliativos de un hospital universitario, el presente trabajo de tesis doctoral se planteó la hipótesis general de que sería acogida con satisfacción, mejoraría su calidad de vida, en particular en las dimensiones emocional y espiritual y ayudaría al control de síntomas. Se realizaron dos estudios. El primero, prospectivo de metodología cuantitativa pre-post data utilizó las escalas ESAS y STAS para la evaluación de síntomas, las escalas ECP y Mac Gill de la calidad de vida y cuestionarios semi-estructurados dirigidos al paciente, al familiar y al equipo interdisciplinar para recoger sus opiniones sobre la percepción de la intervención. El segundo estudio se inició con un estudio pormenorizado de casos clínicos, basados en el proceso arteterapéutico y la producción plástica de los pacientes. Prosiguió con una integración de la experiencia de casos, como un estudio piloto inductivo de metodología cualitativa etnográfico-interpretativa, utilizando entrevistas en profundidad a pacientes, familiares y equipo paliativo, de cara a un análisis, mediante codificación, de sus discursos transcritos verbatim, para extraer de ellos líneas explicativas sobre el modo de acción de la intervención y sus efectos. Los resultados del primer estudio mostraron que la intervención de arteterapia, sumada a la intervención estándar de cuidados paliativos, produjo una reducción significativa de síntomas, así como una mejora significativa de calidad de vida. Las respuestas a los cuestionarios específicos de arteterapia evidenciaron la incidencia particular de la intervención en estos resultados globales. La sensación de encontrarse mejor después de las sesiones arteterapéuticas fue confirmada por el 78,4% de los pacientes, los cuales afirmaron en un 74,5% que les gustaba “bastante”o “mucho”. Al 97,4% de los familiares les agradó que se realizara este tipo de actividad con su ser querido enfermo y en el 92% de los casos evaluados, el equipo consideró que la intervención de arteterapia pudo representar alguna forma de ayuda. Después de los dos estudios, los beneficios identificados por pacientes, familiares y profesionales se relacionaron con un alivio emocional en término de mayor tranquilidad ante la situación, una estimulación de sensaciones agradables en cuanto al disfrute con la creación artística y la relajación, una concentración sobre un foco de atención que aportó a la vez distracción, emergencia de recuerdos y alivio del dolor, una mejora de las relaciones interpersonales a raiz de los intercambios que proporcionó el trabajo arteterapéutico y una posibilidad de adaptarse mejor a la enfermedad e incluso de llegar a la aceptación. El proceso específico de creación artística en presencia del arteterapeuta y, en particular, la interpretación de los contenidos simbólicos representados en sus trabajos ayudaron a los pacientes a buscar y construir el sentido personal que puede tener para ellos la difícil experiencia del final de la vida, incidiendo a su vez en las vivencias de los familiares y en las percepciones de los profesionales durante esta etapa

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Hydrolysis of the C-terminal octapeptide of cholecystokinin by rat kidney membranes: Characterization of the cleavage by solubilized endopeptidase - 24.11

Rat kidney membranes were solubilized by Triton X-100 and the CCK-8 degrading peptidases were resolved by chromatography on DEAE-cellulose. Four proteases were detected: two phosphoramidon-sensitive endopeptidases (EC 3.4.24.11), a bestatin-sensitive aminopeptidase and an unidentified enzyme. The pattern of cleavage of CCK-8 and shorter C-terminal fragments by endopeptidase 24.11 was investigated and indicated that the Gly29-Trp30-Met31 and Asp32-Phe33 were scissile bonds. However, the cleavage pattern differed markedly from one CCK peptide to another: in the penta- and hexapeptide of CCK the bonds hydrolyzed were either Asp-Phe and Trp-Met or, Asp-Phe and Gly-Trp, respectively. The presence of the sulfate group on the tyrosine residue of CCK-8 influence markedly the nature of the major cleavage fragments produced by the endopeptidase. The major bonds cleaved were Asp-Phe, Trp-Met and Gly-Trp for unsulfated CCK-8, whilst for the sulfated octapeptide, the Trp-Met bond became a minor cleavage site. © 1985.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Tissue distribution and bioactivity of amphotericin B administered in liposomes to cancer patients

SCOPUS: ar.jinfo:eu-repo/semantics/publishe