Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review.

INTRODUCTION: The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE: Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY: Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS: It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION: There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.

Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España / Place of death of people with conditions needing palliative care in the different autonomous communities (regions) of Spain

FUNDAMENTO: Conocer el lugar de fallecimiento por causas susceptibles de cuidados paliativos de personas residentes en España de 15 o más años de edad según la comunidad autónoma (CA), y cómo influyen las causas (oncológicas y no oncológicas). MÉTODO: Estudio transversal de base poblacional con análisis de los certificados médicos de defunción entre 2012 y 2015. Los efectos ajustados de las variables sociodemográficas, la CA y las causas sobre el lugar de fallecimiento se estimaron mediante las odds de fallecimiento en hospital frente a domicilio (OH/D) y en residencia frente a domicilio (OR/D), y las odds ratio (ORH/D y ORR/D) obtenidas por regresión logística multinomial. RESULTADOS: Se produjeron 1.611.767 muertes de las que 64,8% correspondieron a la población diana. La defunción en hospital fue un 77% más frecuente que en domicilio, y en residencia un 53% menor. Sexo masculino, menor edad, bajo nivel de estudios, lugar de nacimiento fuera de España, tamaño de municipio grande y estado civil no casado se asociaron a fallecimiento en hospital, y las mismas excepto sexo femenino y mayor edad a residencia. Las OH/D ajustadas fueron > 1 en todas las CA y las OR/D < 1, excepto Cataluña. Para las causas oncológicas, las ORH/D ajustadas disminuyeron y fueron significativamente <1 en casi la mitad de CA, y todas las ORR/D permanecieron <1. CONCLUSIONES: El fallecimiento se produjo mayoritariamente en hospital y menos en residencia, aunque las causas oncológicas aumentan la probabilidad de fallecer en domicilio en vez de en hospital (efecto ajustado)

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (OH/H) and in a nursing home vs. at home (ON/H), and odds ratio (ORH/H and ORN/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted OH/H > 1 and ON/H < 1 were observed in all AC, except Catalonia. Oncological causes made OH/H < 1 in almost 50% of AC, while ON/H continue to be < 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect)

[Place of death of people with conditions needing palliative care in the different regions of Spain]. / Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España.

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

[Differential effects of diabetes education programs by levels of HbA1c and the presence of chronic complications in patients with type 1 diabetes]. / Efectos diferenciales de los programas de educación en diabetes según los niveles de HbA1c y la presencia de complicaciones crónicas en el paciente ti.

BACKGROUND: Diabetes Education Programs (DEP) that improve metabolic control are applied to a wide variety of patient types. The aim is to test whether DEPs work differently depending on the patient profile. MATERIALS AND METHODS: Thirty-six type 1 diabetics participated. They were divided into four groups according to their haemoglobin levels (range: 7-13 %) and into two groups according to the presence or absence of complications. The ECODI scale for assessing diabetes knowledge and the Frequency of Self-Care scale were completed by all patients. RESULTS: The results showed that HbA1c decreased after the DEP, with some areas of self-care also improving. There were no changes, however, to diet or exercise. CONCLUSIONS: DEP appear to work better in patients with worse control and with complications, suggesting that they have a certain role to play in prevention. Their lack of impact on diet or exercise, would suggest that the DEPs require improvement to include psychological strategies that motivate lasting lifestyle changes.

Efectos diferenciales de los programas de educación en diabetes según los niveles de HbA1c y la presencia de complicaciones crónicas en el paciente tipo 1 / Differential effects of diabetes education programs by levels of HbA1c and the presence of chronic complications in patients with type 1 diabetes

Fundamento: Los programas de Educación Diabetológica (PED) mejoran el control metabólico pero son aplicados a pacientes de muy diversa índole. El objetivo es comprobar si un PED funciona de manera diferente según el perfil del paciente. Material y Métodos: Participaron en el estudio 36 pacientes diagnosticados de diabetes tipo 1. Fueron segmentados en cuatro grupos según niveles de hemoglobina (rango de 7-13%) y en dos, según la presencia o no de complicaciones. Todos cumplimentaron la Escala ECODI y la de Frecuencia de Auto-Cuidado. Resultados: Se comprueba cómo tras el PED existe una disminución de la Hb1Ac y algunas áreas del auto-cuidado también mejoran, pero no hay cambios en dieta ni en el ejercicio. Conclusiones: El PED parece funcionar mejor en los pacientes con peor control y con complicaciones, y se discute, por tanto, su papel preventivo. Se concluye sobre la necesidad de mejorar la intervención, ya que no hay cambios en aspectos relativos a los factores de riesgo cardiovascular, incluyendo estrategias psicológicas que motiven un cambio real en el estilo de vida (AU)

Background: Diabetes Education Programs (DEP) that improve metabolic control are applied to a wide variety of patient types. The aim is to test whether DEPs work differently depending on the patient profile. Materials and Methods: Thirty-six type 1 diabetics participated. They were divided into four groups according to their haemoglobin levels (range: 7-13 %) and into two groups according to the presence or absence of complications. The ECODI scale for assessing diabetes knowledge and the Frequency of Self-Care scale were completed by all patients. Results: The results showed that HbA1c decreased after the DEP, with some areas of self-care also improving. There were no changes, however, to diet or exercise. Conclusions: DEP appear to work better in patients with worse control and with complications, suggesting that they have a certain role to play in prevention. Their lack of impact on diet or exercise, would suggest that the DEPs require improvement to include psychological strategies that motivate lasting lifestyle changes (AU)

[Experiences and changes in parents of children with infant cerebral palsy: a qualitative study]. / Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo.

BACKGROUND: The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. METHODS: A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. RESULTS: The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. CONCLUSIONS: In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions.

Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo / Experiences and changes in parents of children with infant cerebral palsy: a qualitative study

Fundamento. El diagnóstico de parálisis cerebral infantil (PCI) supone un evento de carácter traumático que puede provocar una multitud de efectos y cambios en el entorno familiar. Se pretende conocer cuáles son las principales dificultades que encuentran los padres en el proceso de parentalidad, especialmente en los primeros momentos tras el diagnóstico. Método. Se realizó un estudio fenomenológico de carácter cualitativo a través de entrevistas semi-estructuradas. Participaron 16 padres y madres cuyos hijos estaban diagnosticados de PCI. El análisis de los datos se llevó a cabo con el software Atlas.ti6.2 a través de una codificación abierta. Resultados. La recepción de la noticia es percibida como un acontecimiento inesperado que obliga a restructurar las expectativas con respecto a su hijo. La forma de relacionarse con el hijo con PCI es diferente a la que se establece con otros niños, centrándose sobre todo en las posibilidades de mejora y en la evolución de su hijo en el futuro. Se observan cambios en diferentes aspectos de la vida de estos padres como el tiempo, la situación económica y laboral, así como las relaciones de pareja. Conclusiones. En la atención a niños con PCI es necesario incorporar y tomar en cuenta la problemática de los padres, especialmente en los primeros momentos del diagnóstico. El proceso de crianza de un hijo con PCI conlleva un gran número de cambios en la dinámica familiar por lo que se necesita abordarlos mediante una perspectiva global (AU)

Background. The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. Methods. A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. Results. The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. Conclusions. In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions (AU)