Analysis of palliative care needs in hospitalized patients.

AIM: To determine the prevalence of palliative care needs in patients in an acute care hospital and to analyze the profile of these patients. DESIGN: We conducted a prospective cross-sectional study in an acute care hospital, in April 2018. The study population consisted of all patients over 18 years of age admitted to hospital wards and intensive care units. Variables were collected on a single day by six micro-teams using the NECPAL CCOMS-ICO© instrument. The descriptive analysis, on patient mortality and length of stay, was performed at a one-month follow-up. RESULTS: We assessed 153 patients, of whom 65 (42.5%) were female, with a mean age of 68.17±17.03 years. A total of 45 patients (29.4%) were found to be SQ+, of which 42 were NECPAL+ (27.5%), with a mean age of 76.64±12.70 years. According to the disease indicators, 33.35% had cancer, 28.6% had heart disease, and 19% had COPD, resulting in a ratio of 1:3 between patients with cancer and non-cancer disease. Half of the inpatients in need of palliative care were in the Internal Medicine Unit. CONCLUSIONS: Almost 28% of patients were identified as NECPAL+, most of them not identified as under palliative care in clinical records. Greater awareness and knowledge from healthcare professionals would facilitate the early identification of these patients and avoid overlooking palliative care needs.

Instruments for assessing health professionals' skills in breaking bad news: protocol for a systematic review of measurement properties.

INTRODUCTION: Health professionals are often involved in the process of breaking bad news (BBN), which remains a difficult challenge, as it requires not only theoretical knowledge, but also the development of humanistic, emotional and communication skills. Therefore, optimal BBN assessment is essential. In this regard, sound measurement instruments are needed to evaluate BBN properly in research, teaching and clinical settings. Several instruments have been designed and validated to assess BBN. In this context, choosing the most appropriate instrument for assessing health professionals' skills in BBN is essential. The aims of this systematic review are to: (1) identify all the instruments used for assessing health professionals' skills in BBN; and (2) critically appraise their measurement properties. METHODS: A systematic review will be undertaken according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments' (COSMIN) methodology. The protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy will be performed following the Peer Review of Electronic Search Strategies. The search strategy will be conducted in CINAHL, MEDLINE, Embase, PsycINFO, SciELO and Open Grey. Two review authors will independently appraise the full-text articles according to the COSMIN Risk of Bias checklist. Quality ratings and evidence synthesis will be performed using a modified Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: Ethical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference. PROSPERO REGISTRATION NUMBER: CRD42020207586.

Síntomas, comorbilidad y estado funcional de los pacientes con enfermedad renal crónica estadio 5 en manejo renal conservador / Symptom Burden, Comorbidity and Functional Status of patients with Chronic Kidney Disease Stage 5 managed conservately

Objetivos: Determinar la prevalencia e intensidad de síntomas pacientes con Enfermedad Renal Crónica estadio 5 en manejo renal conservador y analizar su asociación con la comorbilidad y el estado funcional. Método: Estudio descriptivo, correlacional, de corte transversal. Para la evaluación de síntomas se utilizó la versión española modificada de la Palliative care Outcome Scale-Symptoms Renal. La comorbilidad fue evaluada con el índice de comorbilidad de Charlson modificado. Para la evaluación del estado funcional y grado de dependencia se utilizó el índice de Barthel. Resultados: 60 pacientes fueron incluidos en este estudio. Más del 50% de los pacientes presentaron debilidad, dolor, dificultad para dormir, poco apetito y problemas en la boca, encontrándose el dolor y la debilidad entre los síntomas más intensos. Las principales condiciones comórbidas fueron: diabetes, cardiopatía isquémica, enfermedad vascular periférica y neoplasias. La media del índice de Barthel fue 88±14,2. No se encontró asociación entre la comorbilidad y la sintomatología (p=0,43). El deterioro del estado funcional se asoció con la carga de síntomas (p=0.001). Conclusiones: Los pacientes con Enfermedad Renal Crónica estadio 5 en manejo renal conservador sufren una elevada carga de síntomas. La debilidad fue síntoma más frecuente en esta población. La carga sintomática se asoció con el deterioro del estado funcional. Futuros estudios sobre el impacto de los síntomas en estos pacientes, así como las intervenciones necesarias para su óptimo manejo deberían ser considerados. (AU)

Three new species of Trichoderma in the Harzianum and Longibrachiatum lineages from Peruvian cacao crop soils based on an integrative approach.

The hyperdiverse genus Trichoderma is one of most useful groups of microbes for a number of human activities, and their accurate identification is crucial. The structural simplicity and lack of distinctive phenotypic variation in this group enable the use of DNA-based species delimitation methods in combination with phylogenies (and morphology when feasible) to establish well-supported boundaries among species. Our study employed a multilocus phylogeny and four DNA-based methods (automated barcode gap discovery [ABGD], statistical parsimony [SPN], generalized mixed Yule coalescent [GMYC], and Bayesian phylogenetics and phylogeography [BPP]) for four molecular markers (acl1, act, rpb2, and tef1) to delimit species of two lineages of Trichoderma. Although incongruence among these methods was observed in our analyses, the genetic distance (ABGD) and coalescence (BPP) methods and the multilocus phylogeny strongly supported and confirmed recognition of 108 and 39 different species in the Harzianum and Longibrachiatum lineages, including three new species associated with cacao farms in northern Peru, namely, T.awajun, sp. nov., T.jaklitschii, sp. nov., and T.peruvianum, sp. nov. Morphological distinctions between the new species and their close relatives are primarily related to growth rates, colony appearance, and size of phialides and conidia. This study confirmed that an integrative approach (DNA-based methods, multilocus phylogeny, and phenotype) is more likely to reliably verify supported species boundaries in Trichoderma.

Phylogeny and species delimitations in the entomopathogenic genus Beauveria (Hypocreales, Ascomycota), including the description of B. peruviensis sp. nov.

The genus Beauveria is considered a cosmopolitan anamorphic and teleomorphic genus of soilborne necrotrophic arthropod-pathogenic fungi that includes ecologically and economically important species. Species identification in Beauveria is difficult because of its structural simplicity and the lack of distinctive phenotypic variation. Therefore, the use of multi-locus sequence data is essential to establish robust species boundaries in addition to DNA-based species delimitation methods using genetic distance, coalescent, and genealogical concordance approaches (polyphasic approaches). In this regard, our study used multilocus phylogeny and five DNA-based methods to delimit species in Beauveria using three molecular makers. These polyphasic analyses allowed for the delimitation of 20-28 species in Beauveria, confirming cryptic diversity in five species (i.e. B. amorpha, B. bassiana, B. diapheromeriphila, and B. pseudobassiana) and supporting the description of B. peruviensis as a new taxon from northeastern Peru. The other five species were not evaluated as they did not have enough data (i.e. B. araneola, B. gryllotalpidicola, B. loeiensis, B. medogensis, and B. rudraprayagi). Our results demonstrate that the congruence among different methods in a polyphasic approach (e.g. genetic distance and coalescence methods) is more likely to show reliably supported species boundaries. Among the methods applied in this study, genetic distance, coalescent approaches, and multilocus phylogeny are crucial when establishing species boundaries in Beauveria.

Symptom Burden Clustering in Chronic Kidney Disease Stage 5.

Patients with chronic kidney disease (CKD) Stage 5, experience multiple symptoms that negatively affect the health-related quality of life (HRQoL). This study examined the cluster of symptoms and their association with disease severity and comorbidities. The study sample included 123 patients with CKD Stage 5; 60 patients were in the dialysis group and 63 patients in the Conservative Kidney Management group. Symptom data were collected using the Spanish modified version of Palliative Care Outcome Scale-Symptoms (POS-S) Renal, a validated questionnaire to assess symptoms in this population. More than half of the patients described weakness, difficulty sleeping, and feeling depressed. Two symptom clusters were identified. There was no significant statistical correlation between disease severity and symptoms and between comorbidities and symptoms. The tendency of these symptoms to occur together has implications for improving symptom management in this population. Routine symptom assessment can be useful in clinical and research settings.

The complete mitochondrial genome of the national bird of Peru: Rupicola peruvianus (Aves, Passeriformes, Cotingidae).

Rupicola peruvianus Latham, known as the Andean Cock-of-the-Rock or locally as Tunqui, is distributed in the Andean cloud forests of South America from Venezuela to Bolivia. Here, we contribute to the bioinformatics and evolutionary systematics of the Cotingidae by performing high-throughput sequencing analysis on R. peruvianus from Luya, Amazonas, Peru. The R. peruvianus mitogenome is 17,035 base pairs (bp) in length and contains 37 genes (GenBank accession No. MN602289). The mitogenome is similar in structure and content to published mitogenomes from the neognathid orders Passeriformes and Falconiformes. Phylogenomic analysis of the R. peruvianus mitogenome situates it in a clade with the Pipridae, sister to the Tyrannidae. We anticipate that further mitogenome sequencing of the parvorder Tyrannida will improve the phylogenetic resolution and our understanding of the evolutionary history of this taxon.

Prevalencia de síntomas en enfermedad renal crónica avanzada / Prevalence of symptoms in advanced chronic kidney disease

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Evaluación de necesidades paliativas en el paciente con enfermedad renal crónica en hemodiálisis / Palliative needs assessment in patients with chronic kidney disease on hemodialysis

Introducción: Los cuidados paliativos aportan una atención necesaria que promueve una respuesta integral y coordinada del sistema sanitario respetando la autonomía y valores de los pacientes en situación de final de vida. Objetivos: Determinar la prevalencia de necesidad de cuidados paliativos en la unidad de hemodiálisis de nuestro centro mediante el instrumento validado NECPAL CCOMSS-ICO e identificar la situación de complejidad en pacientes con necesidades paliativas usando la herramienta de IDC-Pal. Material y Método: Estudio observacional transversal. Tres enfermeras con formación en cuidados paliativos y en el uso de los cuestionarios NECPAL CCOMS-ICO y el IDC-Pal evaluaron de forma independiente a todos los pacientes de la unidad de crónicos de hemodiálisis. Las evaluaciones fueron realizadas entre los días 6 y 10 de marzo. Las discrepancias se resolvieron consensuando el resultado final entre las tres profesionales. Resultados: Se analizaron a 50 pacientes, con una edad media de 68.24. El perfil de paciente más frecuente fue aquel con un tiempo de permanencia en hemodiálisis de 48,8 meses de media. La enfermedad renal primaria y comorbilidad más prevalente fueron la nefropatía diabética (26%) y la hipertensión arterial (56%) respectivamente. Se identificaron 20 pacientes con necesidad de atención paliativa (40%). Respecto a la evaluación del IDC-Pal, se obtuvieron 19 pacientes en situación de complejidad y 1 en situación de no complejidad. Conclusiones: Las necesidades paliativas complejas sugieren la necesidad de realizar evaluaciones periódicas en las unidades de hemodiálisis, así como un enfoque asistencial multidisciplinar para dar respuesta a las necesidades identificadas (AU)

Introduction: The palliative care provides a necessary attention that promotes a comprehensive response and coordination of the health system respecting the autonomy and values of patients in the end-of-life situation. Aim: To determine the prevalence of the need for palliative care in the hemodialysis unit of our center using the validated instrument NECPAL CCOMSS-ICO and to identify the complexity situation in patients with palliative needs using IDC-Pal. Material and Method: Cross-sectional observational study. Three nurses trained in palliative care and in the use of the NECPAL CCOMS-ICO and IDC-Pal questionnaires independently assessed all patients in the chronic hemodialysis unit. The evaluations were carried out between the 6th and 10th of March. The discrepancies were resolved agreeing the final result among the three professionals. Results: 50 patients were analysed, with a mean age of 68.24. The most frequent patient profile was with a permanence time in hemodialysis of 48.8 months of means. The most prevalent renal disease and comorbidity were diabetic nephropathy (26%) and hypertension (56%), respectively. 20 patients with palliative care (40%) were identified. Regarding the evaluation of the IDC-Pal, 19 patients were obtained in a situation of complexity and 1 in situation of non-complexity. Conclusions: Complex palliative needs suggest the need for periodic evaluations in hemodialysis units, as well as a multidisciplinary care approach to respond to identified needs (AU)

Perfil sintomático de los pacientes con Enfermedad Renal Crónica Estadio 4 y 5 / Symptomatic profile of patients with Chronic Kidney Disease Stage 4 and 5

Introducción: Los pacientes con Enfermedad Renal Crónica Avanzada (ERCA) experimentan una gran variedad de síntomas que afectan negativamente la calidad de vida del paciente. Objetivos: Determinar la prevalencia e intensidad de síntomas y analizar su asociación con el filtrado glomerular (FG) y la comorbilidad. Material y Método: Estudio transversal en el que se describe la sintomatología del paciente con ERCA en diálisis y prediálisis y se realiza un análisis de la asociación de los síntomas con el FG y la comorbilidad. Para la evaluación de síntomas se utilizó la versión española modificada de la Palliative care Outcome Scale-Symptoms Renal (POS-S Renal), un cuestionario validado para evaluar la sintomatología en esta población. La comorbilidad fue evaluada con el índice de comorbilidad de Charlson modificado (ICCm). Resultados: 180 pacientes con ERCA fueron incluidos en este estudio. Más del 44% de pacientes describieron debilidad, dolor, depresión y dificultad para dormir. Se encontraron diferencias significativas en ambos grupos para síntomas como la debilidad (p=0.027), poca movilidad (p=0.018), somnolencia (p=0.03), estreñimiento (p=0.015) y piernas inquietas (p<0.01). El declive de la función renal se asoció con la sintomatología (p=0,04). No encontramos asociación entre la comorbilidad y la sintomatología (p=0,15). Conclusiones: Los pacientes con ERCA sufren una elevada carga de síntomas. La evaluación y monitorización sistemática de síntomas mediante herramientas como el POS-S Renal puede ser útil en el ámbito clínico y en investigación. La integración de los Cuidados Paliativos en los Servicios de Nefrología puede contribuir a la optimización del manejo sintomático en esta población (AU)

Introduction: Patients with Advanced Chronic Kidney Disease (ACKD) experience multiple symptoms that negatively affect the quality of life. Aims: To determine the prevalence and severity of symptoms, and their association with the glomerular filtration rate (GFR) and comorbidities. Material and method: A cross-sectional study to examine the prevalence of symptoms in patients with ACKD on dialysis and predialysis, and their association with GFR and comorbidities was carried out. Symptom data were collected using the Spanish modified version of Palliative care Outcome Scale- Symptoms Renal (POS-S Renal), a validated questionnaire to assess symptoms in this population. Comorbidity was collected and scored according to the modified Charlson Comorbidity Index (mCCI). Results: The study sample included 180 patients with ACKD. More than 44% of patients described weakness, pain, depression and difficulty sleeping. There was a significant difference in the prevalence of symptoms between groups for weakness (p=0.027), poor mobility (p=0.018), drowsiness (p=0.03), constipation (p=0.015) and restless legs (p<0.01). There was no association between disease severity and symptoms (p=0,04). There was no significant correlation between comorbidities and symptoms (p=0,15). Conclusions: Patients with ACKD experience a high level of symptom burden. Routine symptom assessment using tools such as the POS-S Renal can be useful in clinical and research settings. Integrating the principles of Palliative Care in Nephrology Services can be beneficial for optimizing the symptom management in this population (AU)

Spanish modified version of the palliative care outcome scale-symptoms renal: cross-cultural adaptation and validation.

BACKGROUND: Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4-5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool. The purpose of this study is to carry out a cross-cultural adaptation of the POS-S Renal for Spanish-speaking patients, and to perform an analysis of the psychometric properties of this questionnaire. METHODS: The English version of the POS-S Renal was culturally adapted and translated into Spanish using a double forward and backward method. An expert panel evaluated the content validity. The questionnaire was pilot-tested in 30 patients. A total of 200 patients with CKD stage 4-5 filled in a modified Spanish version of the POS-S Renal and the MSAS-SF. Statistical analysis to evaluate the psychometric properties of the questionnaire was carried out. RESULTS: The content validity index (CVI) was 0.97, which indicated that the content of the instrument is an adequate reflection of the symptoms in advanced CKD (ACKD). The factor analysis indicated a two-factor solution explaining 35.05% of total variance. The confirmatory factor analysis (CFA) demonstrated that the two factor model was well supported (comparative fit index = 0.98, root mean square error of approximation = 0.068). This assessment tool demonstrated a satisfactory test-retest reliability (r = 0.909 to factor 1, r = 0.695 to factor 2, r = 0.887 to total score), good internal consistency to factor 1 (α = 0.78) and moderate internal consistency to factor 2 (α = 0.56). Concurrent criterion-related validity with MSAS-SF was also demonstrated, with r = 0.860, which indicated a high degree of correlation with a validated instrument that has been used in patients with ACKD. CONCLUSIONS: The Spanish modified version of the POS-S Renal is a reliable and valid instrument that can be used to assess symptoms in Spanish patients with CKD stage 4-5.

Prevalencia y evaluación de síntomas en enfermedad renal crónica avanzada / Prevalence and evaluation of symptoms in advanced chronic kidney disease

El paciente con enfermedad renal crónica avanzada (ERCA) presenta una elevada carga de síntomas que contribuyen a un aumento del sufrimiento y disminuyen su calidad de vida. El uso de instrumentos de evaluación es esencial para el control de síntomas. El objetivo de esta revisión es obtener una visión contrastada de los instrumentos más usados para evaluar síntomas en ERCA, realizando una descripción de la prevalencia de síntomas en esta población. Método: Se realizó una revisión de la literatura publicada sobre estudios en los que se utilizara algún instrumento para medir la intensidad de varios síntomas en pacientes con ERCA. La búsqueda se realizó en Pubmed, Cochrane, SciELO, TESEO, PROQOLID y BiblioPRO. Los criterios de inclusión fueron: estudios realizados con pacientes en ERCA, que evaluaran la sintomatología con algún instrumento de medición de síntomas, y que además, indicaran la prevalencia de varios síntomas. Resultados: Los instrumentos identificados fueron el Memorial Symptom Assessment Scale Short Form(MSAS-SF), el Dialysis Symptom Index (DSI), el Edmonton Symptom Assessment System (ESAS) y el Palliative care Outcome Scale-Symptoms Renal (POS-S RENAL). En pacientes adultos con ERCA sometidos a tratamiento renal sustitutivo con hemodiálisis y diálisis peritoneal, los síntomas más prevalentes fueron el cansancio, prurito, estreñimiento, anorexia, dolor, alteraciones del sueño, ansiedad, disnea, nauseas, piernas inquietas, y depresión. Éstos síntomas fueron similares en pacientes con manejo renal conservador, y presentaron un patrón común con la sintomatología de otras enfermedades avanzadas. Concluimos que existe necesidad de investigar sobre prevalencia y evaluación de síntomas en esta población, y que el uso sistemático de los instrumentos específicos de evaluación de síntomas como medida de resultados es fundamental (AU)

The patient with advanced chronic kidney disease (ACKD) has a high symptom burden that contribute to increased suffering and diminish their quality of life. The use of symptom assessment tools is essential for the control of symptoms. The aim of this review is to obtain a contrasted vision of the instruments commonly used to assess symptoms in ACKD, making a description of the prevalence of symptoms in this population. Method: A review of the literature on studies in which an instrument is used to measure the intensity of several symptoms in patients with ACKD was undertaken. The search was conducted in PubMed, Cochrane, SciELO and TESEO. Inclusion criteria were: studies in patients with ACKD, evaluating symptoms with an assessment tool, and also indicate the prevalence of various symptoms. Results: The instruments identified were the Memorial Symptom Assessment Scale Short Form (MSAS-SF), the Dialysis Symptom Index (DSI), the Edmonton Symptom Assessment System (ESAS) and the Palliative Care Outcome Scale-Symptoms Kidney (POS-S RENAL). In adult patients with ACKD undergoing renal replacement therapy with hemodialysis and peritoneal dialysis, the most prevalent symptoms were fatigue, pruritus, constipation, anorexia, pain, sleep disturbance, anxiety, dyspnea, nausea, restless legs, and depression. These symptoms were similar in patients with renal conservative management, and showed a common pattern to the symptoms of others advanced diseases. We conclude that we need to research about the prevalence and evaluation of symptoms in this population, and a systematic use of specific instruments for evaluating symptoms as an outcome measure is necessary (AU)

Renal supportive care and palliative care: revision and proposal in kidney replacement therapy.

Patients with chronic kidney disease may receive sustained renal supportive care and renal palliative care (RPC) starting with the diagnosis of the disease, throughout the various stages of renal replacement therapy (RRT), the cessation of the RRT, and in the decision of whether to provide conservative treatment or non-initiation of RRT. This article reviews the literature on the development of renal palliative care and proposed RPC models. We describe the progression of disease in organ failure, which is very different from other areas of palliative care (PC). We describe important components of resident nephrology training in PC. We discuss the management of pain and symptom control, as well as communication skills and other psychological and ethical aspects in the renal patient. We conclude that in chronic renal patients, a palliative care approach can provide a positive impact on the quality of life of patients and their families, as well as optimizing the complex treatment of the renal patient.

Cuidados de soporte renal y cuidados paliativos renales: revisión y propuesta en terapia renal sustitutiva / Renal supportive care and palliative care: revision and proposal in kidney replacement therapy

El paciente con enfermedad renal crónica es susceptible de recibir tratamiento de soporte y cuidados paliativos renales (CPR) desde el diagnóstico de la enfermedad, durante las distintas etapas de tratamiento sustitutivo renal (TSR), en el cese de dicho TRS y también si se decide tratamiento conservador o no inicio de TRS. Este artículo revisa la literatura referente al desarrollo de cuidados CPR y los modelos propuestos. Exponemos la trayectoria de la enfermedad en el fallo de órgano, que marca diferencias respecto a otros campos de los cuidados paliativos (CP). Se describen componentes de formación importantes para el residente de nefrología en CP. Abordamos el manejo del dolor y el control de síntomas, así como habilidades de comunicación y otros aspectos psicológicos y éticos en el paciente renal. Concluimos que en la atención al paciente renal crónico, un enfoque desde la medicina paliativa puede suponer un provechoso impacto en la calidad de vida del paciente y su familia, además de optimizar el complejo tratamiento nefrológico del paciente (AU)

Patients with chronic kidney disease may receive sustained renal supportive care and renal palliative care (RPC) starting with the diagnosis of the disease, throughout the various stages of renal replacement therapy (RRT), the cessation of the RRT, and in the decision of whether to provide conservative treatment or non-initiation of RRT. This article reviews the literature on the development of RPC and the models proposed. We describe how organ failure differs compare to other areas of palliative care (PC). We describe important training components in RPC for the resident nephrologist and we approach the management of pain and symptom control, communication skills and other psychological and ethical aspects in the renal patient. We conclude a palliative care approach may have a profitable impact on the quality of life for chronic renal patients and their families as well as optimizing the complex renal patient's treatment (AU)