ABSTRACT
Introduction As general practitioners/family physicians, it is our duty to promote health and prevent disease by providing cure, care, or palliation. Palliative care (PC) plays a crucial role in integrated and patient-centered health services. In the Autonomous Region of Madeira (RAM), Portugal, the PC Unit (PCU) was established in 2012. According to data from 2010, 41.2% of individuals who passed away in this region had a requirement for PC. Our objective is to determine the potential needs for PC in our population in the year 2019, prior to the pandemic. Additionally, we aim to determine the main indications for PC and the number of emergency department admissions/hospitalizations and compare these needs with data from 2010. Methods We conducted an observational, cross-sectional, and descriptive, analytical study, in which the target population consisted of all individuals who passed away in RAM in the year 2019. From this population, a representative sample of deceased individuals was obtained. The gender, age, disease with a potential indication for palliative care, admissions to emergency care and hospitalizations in the preceding 12 months, and county of residence were obtained from the RAM Health Services and analyzed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA) and the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA) software. Results From the total number of individuals who passed away in RAM in the year 2019 (N=2,840), a representative sample of 339 deceased individuals was obtained. Of the deceased individuals, 56% presented with potential indications for palliative care, compared to the 41.2% result recorded in 2010 (p<0.0001). Among these individuals, 51.9% were female, and the average age was 79.7±12.2 years. Neoplasms were the primary indication for palliative care, accounting for 22.7%. Individuals with potential indications for PC, when compared to those without indications, had a higher number of hospitalizations and emergency episodes in the preceding 12 months (p=0.0005 and p=0.008, respectively). Conclusion We conclude that over half of the patients who passed away in RAM had potential indications for palliative care. These individuals experienced a higher number of hospitalizations and emergency episodes in the preceding 12 months. In this study, we also observed a significant increase in the need for palliative care compared to the year 2010.
ABSTRACT
INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a degenerative disease characterized by motor dysfunction. Currently, treatment options are limited and management is based mostly on symptom control and quality of life optimization, so palliative care plays a fundamental role. Our objective was to characterize the ALS population in Madeira Island that was referenced and/or followed by a palliative care unit over a five-year period. METHODS: Longitudinal, retrospective, descriptive, and observational study to analyze patients with ALS who were referred and/or followed by a palliative care unit during a five-year period, between 2017 and 2021. Patient's medical electronic and physical records were analyzed to gather data. Descriptive and inferential statistical analysis was done using Microsoft Excel and Statistical Package for the Social Sciences (version 28.0.1). RESULTS: During this five-year period, a total of 38 patients were diagnosed with ALS in Madeira Island and 23 (60.53%) were referred to palliative care. Three patients died before assessment, so 20 (50.63%) were followed by the palliative care team. They had a median life expectancy of 425 days and the median time spent in palliative care was 137 days. Of this population, 56.52% (n=13) was male with an average age of 64 years. The median period from diagnosis to referral was 167 days, with most referrals being made by family medicine (39.13%; n=9) motivated by uncontrolled symptoms (95.65%; n=22). The median period from referral to first assessment by a palliative care physician was 19 days. The Palliative Performance Scale (PPS) and Confusion Assessment Method (CAM) applied on the first visit had a median score of 40% in the former and was negative in 95.00% (n=19) of patients in the latter. Advanced care directives were present in 55.00% (n=11) of patients and all provided care was in accordance with the patient's wishes. The most common symptoms were dysphagia, dyspnea, pain, anxiety, and sialorrhea. The most used drugs were morphine, riluzole, butylscopolamine, bisacodyl, and midazolam. As for other interventions, 55.00% (n=11) of patients underwent noninvasive ventilation (NIV), 15.00% (n=3) were submitted to percutaneous endoscopic gastrostomy (PEG), and one patient (5.00%) was nasogastrically intubated. The death rate was 95.00% (n=19) with 73.68% (n=14) of deaths occurring in the palliative care unit. CONCLUSION: Literature has shown that there are many advantages to the early inclusion of palliative care in ALS management, achieving effective symptom control and greater quality of life, but also reducing caregiver burden. However, in this study, we found that referrals to palliative care were late and included mostly cases of advanced disease with uncontrolled symptoms.
ABSTRACT
Devido ao crescente uso dos aloenxertos nas cirurgias ortopédicas, há a necessidade do conhecimento de suas características biomecânicas ao longo do tempo de preservação. O presente trabalho consistiu na análise da força de resistência à micro-tração de amostras de ossos corticais de coelho preservadas em diversos meios por até 180 dias e a fresco. Os resultados revelaram que a resistência e o tempo de preservação apresentaram uma relação inversamente proporcional, significando que, quanto maior o tempo de preservação, menor a resistência física avaliada no ensaio biomecânico de resistência à micro-tração. Dos meios utilizados, a glicerina apresentou menores valores quanto ao teste de resistência, demonstrando, após 30 dias de preservação, apenas 24,58 por cento da força presente no osso a fresco e, aos 180 dias, 1,76 por cento. As amostras submetidas à autoclavagem também demonstraram baixos valores ao final do experimento, quando permaneceram com apenas 12,31 por cento da força presente no osso a fresco. Os ossos preservados em plasma homólogo, líquido de dakin e aqueles criopreservados apresentaram os melhores índices de resistência ao final do experimento, permanecendo, respectivamente, com 82,47; 70,34 e 66,72 por cento da força máxima quando comparados com a resistência dos ossos frescos. Concluiu-se que a escolha do método e o tempo de preservação interferiu diretamente na biomecânica dos ossos corticais, promovendo a diminuição da capacidade de resistência à tração ao longo do período de preservação.
Due to the increasing use of cortical bone allografts in orthopedic surgeries, de knowledge of its biomechanics characteristics during preservation time is needed. The present study consisted in the analyses of the resistance power to the micro-traction of samples of rabbit cortical bones preserved in several means for up to 180 days and fresh. The results showed that the resistance and the preservation time presented an inversely proportional relation, meaning that, the longer the time of preservation, the shorter the physical resistance evaluated in the biomechanical rehearsal of resistance to the micro-traction. The glycerin has presented lower values in relation to the resistance test, showing, after 30 days, only 24.58 percent of the present power in the fresh bone, and by 180 days, 1.76 percent. The samples submitted to autoclavation also showed low values by the end of the experiment, while they remained with just 12.31 percent of the power present in the fresh bone. The bones preserved in homologous plasma, Dakin liquid and the ones cryopreserved showed the best levels of resistance at the end of the experiment, remaining, respectively with 82.47, 70.34 and 66.72 percent of the maximum power, while compared with the resistance of the fresh bones. The conclusion is that the choice of methodology and time of preservation interfered directly in the biomechanics of the cortical bones, promoting decrease of the resistance capacity to the traction along the period of preservation.
