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1.
Rev Esp Geriatr Gerontol ; 59(4): 101488, 2024.
Article in Spanish | MEDLINE | ID: mdl-38552373

ABSTRACT

Advance care planning is a deliberative process that aims to help patients define goals and preferences for future care and treatment at a times when they have limited decision-making capacity. This study aims to analyze models of advance care planning in elderly individuals living in nursing homes. We reviewed papers published in Cochrane, PubMed and Embase. A total of 26 studies were selected, including a total of 44,131 people over 65 years of age. We analyzed the types of intervention (interviews, videos, workshops, documentation, etc.) and their results derived from the application. We conclude that no study implements a standardized intervention model. These interventions include decision-making (transfers to hospital, resucitation orders) and the adequacy of therapeutic effort (antibiotherapy, nutrition, serotherapy, etc.). Other outcomes are implementation barriers (time and training).


Subject(s)
Advance Care Planning , Nursing Homes , Nursing Homes/organization & administration , Humans , Aged , Homes for the Aged/organization & administration
2.
Med. paliat ; 22(3): 106-116, jul.-sept. 2015. tab
Article in Spanish | IBECS | ID: ibc-139154

ABSTRACT

INTRODUCCIÓN: Con el desarrollo de los Cuidados Paliativos resurge la preocupación por predecir el pronóstico del paciente con la mayor exactitud posible. Muchas decisiones terapéuticas y de cuidados del paciente, dependen de la estimación de su supervivencia. Material y MÉTODO: Se ha realizado una revisión de los trabajos publicados durante los últimos 20 años (desde 1993 al 2013) referentes a pronóstico de supervivencia en cáncer avanzado. RESULTADOS: La estimación clínica de supervivencia, tiende a sobreestimar el pronóstico y debería utilizarse de forma conjunta con otros factores. Se recomienda la opinión de otro médico y repetir las valoraciones en el enfermo. Un estado funcional (Karnofsky, PPS…) bajo, se considera un factor pronóstico fiable para predecir corto tiempo de supervivencia. Algunos signos y síntomas clínicos han demostrado asociación con la esperanza de vida en esta población de PACIENTES: síndrome anorexia-caquexia, disnea, deterioro cognitivo o delirium. Se han estudiado muchas variables de laboratorio asociadas con la esperanza de vida, resultando factores pronósticos independientes: leucocitosis, linfopenia, y proteína C reactiva. Entre las escalas multidimensionales, por el momento, la palliative prognostic (PaP) score que incluye varios factores pronósticos, es la escala recomendada por las guías europeas y españolas, indicando probabilidades de supervivencia a los 30 días. También han mostrado precisión: palliative prognostic pndex (PPI) y cancer prognostic scale (CPS). Otras escalas más nuevas están pendientes de validación en estudios más amplios. Existen nuevos métodos de estimación estadística de supervivencia accesibles desde internet (prognostigram, prognostat…). DISCUSIÓN: La tendencia actual va en la línea de utilizar escalas multidimensionales pronósticas, donde se aúnan diversos parámetros pronósticos. Interesaría comparar entre sí las diferentes escalas y utilizarlas en poblaciones más amplias. CONCLUSIONES: Lo recomendable sería formular un pronóstico individualizado para el paciente, comenzando con un pronóstico generalizado y modificándolo según las observaciones clínicas, valoración funcional, síntomas, analítica y conocimiento de la trayectoria de la enfermedad


INTRODUCTION: With the development in palliative care, there is a resurgence of concern about predicting the patient's prognosis with the best possible accuracy. Many treatment decisions and patient care depends on the prognosis estimation. MATERIALS AND METHODS: A review was performed on the literature related to the main prognosis factors in advanced cancer published within the last 20 years (from 1993 to 2013). RESULTS: The clinical estimation of survival tends to overestimate the prognosis and should be used together with other factors. A second opinion from another doctor and repeated assessments of the patient are recommended. A poor functional state (Karnofsky, PPS. ) is considered an accurate prognosis factor to predicting a short survival time. Some signs and clinical symptoms have been associated with life expectancy in these types of PATIENTS: anorexia-cachexia syndrome, dyspnea, cognitive impairment, or delirium. Many variables associated with life expectancy have undergone laboratory studies, resulting in independent prognostic factors: leukocytosis, lymphopenia, and C reactive protein. For the time being, palliative prognostic (PaP) score, which includes several prognostic factors, is the most recommended system among the multidimensional scales in European and Spanish guidelines indicating the probability of survival within 30 days. Other scales which have also showed precision are: palliative prognostic index (PPI) and cancer prognostic scale (CPS). There are other newer scales awaiting validation in wider studies. New methods of statistical estimation of survival are available on the Internet (prognostigram, prognostat. ). DISCUSSION: The current tendency is to use prognostic multidimensional scales where several prognostic parameters are combined. It would be of interest to compare the different scales, and use them in a wider population. CONCLUSIONS: The best option would be to formulate an individual prognosis for each patient, starting with a generalised prognosis, and modifying it according to clinical observations, functional assessments, symptoms, laboratory tests, and knowledge of the course of the illness


Subject(s)
Female , Humans , Male , Terminal Care/methods , Terminally Ill , Palliative Care/methods , Palliative Care/standards , Palliative Care , Life Expectancy/trends , Neoplasms/complications , Neoplasms/therapy , Survivorship , Prognosis , Palliative Care/organization & administration , Hospice Care/organization & administration
3.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 48(4): 198-201, jul.-ago. 2013.
Article in Spanish | IBECS | ID: ibc-115167

ABSTRACT

El descubrimiento de las neuronas espejo da una perspectiva nueva a la rehabilitación neurológica: se postula que la activación de las neuronas espejo en el hemisferio contralateral a una extremidad amputada reduce la actividad de los sistemas que perciben el dolor protopático y permite la reorganización de la corteza somatosensorial. Esta hipótesis abre la posibilidad de considerar el tratamiento espejo no solo como técnica analgésica, sino también como instrumento para una rehabilitación funcional integral en pacientes geriátricos con amputación de miembro inferior. Presentamos los resultados de la aplicación de dicho tratamiento a 3 pacientes ancianos con dolor de miembro fantasma tras la amputación reciente de una pierna(AU)


The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Phantom Limb/therapy , Amputation, Surgical/psychology , Amputation, Traumatic/psychology , Pain/psychology , Analgesia/trends , Phantom Limb/epidemiology , Phantom Limb/psychology , Somatosensory Cortex/physiology
4.
Rev Esp Geriatr Gerontol ; 48(4): 198-201, 2013.
Article in Spanish | MEDLINE | ID: mdl-23498652

ABSTRACT

The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients.


Subject(s)
Mirror Neurons , Phantom Limb/rehabilitation , Physical Therapy Modalities , Aged , Aged, 80 and over , Female , Geriatrics , Hospital Departments , Humans , Male , Mirror Neurons/physiology , Syndrome
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