Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna / Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care

Objetivo Establecer recomendaciones de consenso sobre normas de buena práctica clínica en la atención a los pacientes al final de la vida. Métodos Un comité de 12 expertos españoles y portugueses propuso 37 recomendaciones. Se realizó un Proceso Delphi a dos rondas, con participación de 105 panelistas incluyendo internistas, otros médicos clínicos, enfermeras, enfermos, juristas, expertos en bioética, gestores sanitarios, políticos y periodistas. Para cada recomendación se envió un cuestionario con cinco respuestas tipo Likert. Se definió consenso fuerte cuando > 95% de las respuestas estaban totalmente de acuerdo o > 90% estaban de acuerdo y totalmente de acuerdo; consenso débil cuando > 90% estaban totalmente de acuerdo o > 80% estaban de acuerdo y totalmente de acuerdo. Resultados El panel abordó siete áreas específicas con 37 recomendaciones que abarcaban: Identificación de los pacientes; Conocimiento, valores y preferencias del paciente; Información; Necesidades del paciente; Atención y cuidados; Sedación paliativa y Atención tras la muerte. Conclusiones Un Proceso Delphi con participación multidisciplinar ha permitido establecer normas de buena práctica clínica en la atención al final de la vida con consenso de enfermos, agentes sociales y profesionales sanitarios (AU)

Aim To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. Methods A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. Results The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care Conclusions The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients (AU)

Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care. / Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

End-of-life care for patients hospitalised in internal medicine departments. / Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna.

OBJECTIVES: To describe the care provided at the end of life for patients who die in internal medicine departments. METHODS: An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death. RESULTS: The study included 1,447 patients with a median age of 84 years. Of these, 1,065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; P<.001), knew their prognosis (42.6% vs. 8.6%; P<.001), received psychological care (24.9% vs. 8.6%; P<.001), died in an individual room (64.6% vs. 44.4%; P<.001) and were accompanied (81.9% vs. 71.9%; P=.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; P=.002). CONCLUSIONS: There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer.

Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad / Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality

Objetivo. Determinar la prevalencia de las úlceras por presión en pacientes hospitalizados en Medicina Interna y los factores clínicos y riesgo de muerte asociados a su presencia. Pacientes y métodos. Estudio prospectivo de cohortes con pacientes ingresados en Medicina Interna. Se recogieron la edad, sexo, presencia de úlceras por presión, grado de la úlcera, índice de Barthel, escala de Norton, categoría diagnóstica mayor, duración de la estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se compararon las características clínicas de los pacientes con o sin úlceras y se analizó la mortalidad al cabo de 3 años en función de la presencia de úlceras. Resultados. Se incluyeron 699 pacientes, de los que 100 (14,3%) presentaron úlceras por presión (27 de grado I, 17 de grado II, 21 de grado III, 25 de grado IV y 10 de grado no conocido). El índice de Barthel (OR 0,985 IC95% 0,972-0,998; p=0,022) y la escala de Norton (OR 0,873 IC95% 0,780-0,997; p=0,018) se asociaron de forma independiente con las úlceras. Durante el ingreso fallecieron el 23% de los pacientes con úlceras, al cabo de un año el 68% y a los 3 años el 83%. La presencia de úlceras por presión se asoció de forma independiente con la mortalidad (HR 1,531, IC95% 1,140-2,056, p=0,005). Conclusiones. Las úlceras por presión son frecuentes en los pacientes hospitalizados en Medicina Interna y su presencia se asocia con mayor mortalidad a corto, medio y largo plazo (AU)

Objective. To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Patients and methods. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. Results. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Conclusions. Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality (AU)

Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality. / Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad.

OBJECTIVE: To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. PATIENTS AND METHODS: Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. RESULTS: The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). CONCLUSIONS: Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality.