L’atenció centrada en el pacient, les voluntats anticipades i el pla de decisions anticipades

Atenció centrada en el pacient; Voluntats anticipades; Decisions anticipadesPatient-centered care; Anticipated wishes; Advance decisionsAtención centrada en el paciente; Voluntades anticipadas; Decisiones anticipadasProgressem a base d’eslògans, en diem canvis de paradigma. De la medicina basada en l’evidència passem al discurs de la sostenibilitat i més tard recalem en el de l’atenció centrada en el pacient. Semblen missatges simples, obvis i plens de sentit comú. Sense rigor científic ni tècnic no és pertinent impulsar cap iniciativa ni tampoc cap proposta que no puguem mantenir, per bona que sigui, al llarg del temps. És millor que ens n’abstinguem. Què volem dir quan parlem d’oferir una atenció centrada en el pacient? Potser que hem oblidat al pacient, de la mateixa manera que, moltes vegades, sembla que les universitats oblidin els seus estudiants, o com passa en tants d’altres serveis que responen més als interessos de qui els presten que no pas als de qui els reben

Validation of the CAchexia SCOre (CASCO). Staging cancer patients: The use of miniCASCO as a simplified tool

The CAchexia SCOre (CASCO) was described as a tool for the staging of cachectic cancer patients. The aim of this study is to show the metric properties of CASCO in order to classify cachectic cancer patients into three different groups, which are associated with a numerical scoring. The final aim was to clinically validate CASCO for its use in the classification of cachectic cancer patients in clinical practice. We carried out a case -control study that enrolled prospectively 186 cancer patients and 95 age-matched controls. The score includes five components: (1) body weight loss and composition, (2) inflammation/metabolic disturbances/immunosuppression, (3) physical performance, (4) anorexia, and (5) quality of life. The present study provides clinical validation for the use of the score. In order to show the metric properties of CASCO, three different groups of cachectic cancer patients were established according to the results obtained with the statistical approach used: mild cachexia (15 â\u89¤ Ã\u97 â\u89¤ 28), moderate cachexia (29 â\u89¤ Ã\u97 â\u89¤ 46), and severe cachexia (47 â\u89¤ Ã\u97 â\u89¤ 100). In addition, a simplified version of CASCO, MiniCASCO (MCASCO), was also presented and it contributes as a valid and easy-to-use tool for cachexia staging. Significant statistically correlations were found between CASCO and other validated indexes such as Eastern Cooperative Oncology Group (ECOG) and the subjective diagnosis of cachexia by specialized oncologists. A very significant estimated correlation between CASCO and MCASCO was found that suggests that MCASCO might constitute an easy and valid tool for the staging of the cachectic cancer patients. CASCO and MCASCO provide a new tool for the quantitative staging of cachectic cancer patients with a clear advantage over previous classifications