[Usefulness of implementing a dysphagia care programme at an intermediate and long stay hospital]. / Utilidad de implantar un programa de atención a la disfagia en un Hospital de Media y Larga Estancia.

OBJECTIVES: To describe the initial results of the implementation of a dysphagia assessment and intervention programme and to know which variables showed significant differences between patients with and without dysphagia detected by this way at an intermediate and long stay hospital. METHODS: Descriptive and retrospective study on the assessment performed to patients suspected of having dysphagia and of the subsequent intervention done on those in whom it was confirmed. A standardized clinical method using different viscosities and volumes was used. After confirming the condition, different dietary, postural, and educational cares were undertaken. Demographical, clinical, and analytical variables were registered. RESULTS: 146 patients were included, 110 of them presenting dysphagia of whom the corresponding assessments and interventions were described. This represented a dysphagia prevalence of 14.8% among all admitted patients. The univariate analysis between patients with and without dysphagia showed that the former presented at the time of admission a higher prevalence of a feeding tube (p = 0.011) and a lower proportion of mild cognitive impairment (p = 0.048); and at the time of hospital discharge, lower functional recovery (p < 0.01) and higher presence of a feeding tube (p = 0.028), hyponutrition(p < 0,01), and mortality (p = 0.02). CONCLUSIONS: Given its frequent presentation and important clinical repercussion, and in order to improve health care quality at ILSH, the implementation of a dysphagia care programme is advisable. The dysphagia detected was correlated with the presence of a feeding tube and had clear implications on the clinical course at a functional and nutritional level and vital prognosis.

Utilidad de implantar un programa de atención a la disfagia en un hospital de media y larga distancia / Usefulness of implementing a dysphagia care programme at an intermediate and long stay hospital

Objetivos: Describir en un Hospital de Media y Larga Estancia (HMLE) los resultados iniciales tras la implantación de un programa de valoración e intervención sobre la disfagia y conocer que variables mostraban diferencias significativas entre los enfermos con y sin disfagia así detectados. Métodos: Estudio descriptivo retrospectivo de la valoración realizada a los pacientes con sospecha de disfagia y de la intervención posterior en los que esta se confirmó. Se usó para dicha valoración un método clínico estandarizado que utiliza diferentes viscosidades y volúmenes. Tras su confirmación se llevaron a cabo cuidados dietéticos, posturales y formativos. Se recogieron variables demográficas, clínicas y de laboratorio. Resultados: Se incluyó a 146 pacientes, describiéndose sus correspondientes valoraciones y las intervenciones en los 110 que presentaron disfagia. Esto representó una prevalencia de disfagia del 14,8% de los pacientes ingresados. En el análisis univariante entre los pacientes con y sin disfagia, los primeros presentan al ingreso mayor presencia de sonda de alimentación (p 0,011) y menor proporción de deterioro cognitivo leve (p 0,048); y al alta menor recuperación funcional (p < 0,01) y mayor presencia de sonda de alimentación (p 0,028), de desnutrición (p < 0,01) y de mortalidad (p 0,02). Conclusiones: Para mejorar la calidad asistencial en HMLE es recomendable la implantación de un programa de atención a la disfagia, dada su frecuente presencia e importantes repercusiones clínicas. La disfagia detectada se relacionó con la presencia de sonda de alimentación y tuvo claras implicaciones evolutivas a nivel funcional, nutricional y de pronóstico vital (AU)

Objectives: To describe the initial results of the implementation of a dysphagia assessment and intervention programme and to know which variables showed significant differences between patients with and without dysphagia detected by this way at an intermediate and long stay hospital. Methods: Descriptive and retrospective study on the assessment performed to patients suspected of having dysphagia and of the subsequent intervention done on those in whom it was confirmed. A standardized clinical method using different viscosities and volumes was used. After confirming the condition, different dietary, postural, and educational cares were undertaken. Demographical, clinical, and analytical variables were registered. Results: 146 patients were included, 110 of them presenting dysphagia of whom the corresponding assessments and interventions were described. This represented a dysphagia prevalence of 14.8% among all admitted patients. The univariate analysis between patients with and without dysphagia showed that the former presented at the time of admission a higher prevalence of a feeding tube (p = 0.011) and a lower proportion of mild cognitive impairment (p = 0.048); and at the time of hospital discharge, lower functional recovery (p < 0.01) and higher presence of a feeding tube (p = 0.028), hyponutrition(p < 0,01), and mortality (p = 0.02). Conclusions: Given its frequent presentation and important clinical repercussion, and in order to improve health care quality at ILSH, the implementation of a dysphagia care programme is advisable. The dysphagia detected was correlated with the presence of a feeding tube and had clear implications on the clinical course at a functional and nutritional level and vital prognosis (AU)

Respuesta a la carta «Cuidados paliativos en pacientes trasplantados de órgano sólido» / No disponibles

No disponible

[Approximation to palliative care in the advanced non-malignant diseases]. / Aproximación a los cuidados paliativos en las enfermedades avanzadas no malignas.

Nowadays Palliative Medicine (PM) is changing from a specific point of view towards patients with advanced cancer, to another more generic that also keep in mind patients with advanced non malignant disease. Likewise it is more and more deeply rooted customs that the end-of-life care has become a fundamental right of our Society. But as a matter of fact, these patients with non-cancer diseases unusually go into a Palliative Care (PC) programme. It is known the difficulty to diagnosis the end of life clinical condition (EOLCC) in them. In this article we comment the justification and restriction of PC in patients with non-malignant cancer diseases, as well as the paradoxical situation to come out, in spite of the increasing programes of PC gradually. But above all we propose in a practical way resolve when a patient with non malignant organ advanced disease (NMOAD) could be subsidiary of PC. For that purpose we have to know the diagnosis and the prognostic factors in connection with the EOLCC of the NMOAD more common (advanced chronical pulmonary disease, advanced chronical heart failure, advanced cirrhosis hepatic, advanced chronical renal failure and very evolved dementia), to set up an appropriate make decisions keeping in mind the preferences and wishes of the patient and family, to document and record in the clinical history all those parameters and offerer to the patient the treatment more suitable with the intention to get a worthy death bearing in mind clinical, cultural and ethical standards. It is pointed out the necessity to carry out prospective studies to help setting up some inclusion criterions in PC programmes for patients with NMOAD.

Aproximación a los Cuidados Paliativos en las enfermedades avanzadas no malignas / Approximation to palliative care in the advanced nonmalignant diseases

En la actualidad la Medicina Paliativa (MP) está cambiando desde una visión específica dirigida a los pacientes con cáncer avanzado hacia otra más genérica que abarca también a los pacientes con enfermedades avanzadas no malignas. También está cada vez más arraigado que los cuidados al final de la vida constituyen un derecho fundamental de la sociedad. Pero en realidad estos pacientes no oncológicos excepcionalmente entran en programas de Cuidados Paliativos (CP). Se sabe que es por la dificultad en diagnosticar la situación clínica de enfermedad terminal (SCET). En el presente artículo comentaremos la justificación y limitación de los CP en los pacientes no oncológicos así como la situación paradójica que tiene lugar a pesar del incremento paulatino de los programas de cuidados paliativos. Pero sobre todo proponemos una manera práctica de poder determinar cuando un paciente con enfermedad avanzada de órgano no maligna puede ser subsidiario de unos adecuados CP. Para ello tenemos que conocer el diagnóstico y los factores pronósticos relacionados con la SCET de las patologías crónicas avanzadas de órgano más frecuentes (enfermedad pulmonar crónica avanzada, insuficiencia cardiaca crónica avanzada, cirrosis hepática avanzada, insuficiencia renal crónica avanzada y demencias muy evolucionadas), establecer una adecuada toma de decisiones teniendo en cuenta las preferencias o deseos del paciente y familia, documentar y registrar en la historia clínica todos estos parámetros y ofrecer al paciente el tratamiento más adecuado con el fin de conseguir una muerte digna y considerando unos estándares clínicos, culturales y éticos. Se destaca la necesidad de llevar a cabo estudios prospectivos que ayuden a establecer unos criterios de inclusión en programas de CP a pacientes con enfermedades avanzadas de órgano no malignas (AU)

Nowadays Palliative Medicine (PM) is changing from a specific point of view towards patients with advanced cancer, to another more generic that also keep in mind patients with advanced non malignant disease. Like wise it is more and more deeply rooted customs that the end-of lifecare has become a fundamental right of our Society. But as a matter of fact, these patients with non-cancer diseases unusually go into a Palliative Care (PC) programme. It is known the difficulty to diagnosis the end of life clinical condition (EOLCC) in them. In this article we comment the justification and restriction of PC in patients with non-malignant cancer diseases, as well as the paradoxical situation to come out, inspite of the increasing programes of PC gradually. But above all we propose in a practical way resolve when a patient with non malignant organ advanced disease (NMOAD) could be subsidiary of PC. For that purpose we have to know the diagnosis and the prognostic factors in connection with the EOLCC of the NMOAD more common (advanced chronical pulmonary disease, advanced chronical heart failure, advanced cirrhosis hepatic, advanced chronical renal failure and very evolved dementia), to set up an appropriate make decisions keeping in mind the preferences and wishes of the patient and family, to document and record in the clinical history all those parameters and offerer to the patient the treatment more suitable with the intention to get a worthy death bearing in mind clinical, cultural and ethical standards. It is pointed out the necessity to carry out prospective studies to help setting up some inclusion criterions in PC programmes for patients with NMOAD

El duelo de los familiares y su atención en los Servicios de Cuidados Paliativos españoles / No disponible

Introducción: la atención al duelo de los familiares de pacientes en cuidados paliativos es fundamental y se reconoce como una buena práctica en medicina paliativa. Objetivo: el objetivo de esta investigación fue determinar la extensión y las características de los programas de atención al duelo de los familiares en los servicios de cuidados paliativos de las diferentes comunidades del estado español. Método: encuesta postal realizada en el año 2001 a los recursos asistenciales recogidos en el Directorio de la Sociedad Española de Cuidados Paliativos (SECPAL) del año 2000. Se identificaron 160 equipos de los cuales contestaron el 50%. El cuestionario consta de 34 preguntas, algunas con respuesta de tipo abierta y otras de elección múltiple. Resultados: los resultados indican que el 88,6% de los recursos atendían al duelo y que el tipo de soporte proporcionado era principalmente de carácter emocional e individual (92,4 y 89,9%). Además se observó como la presencia del psicólogo y del trabajador social era limitada. Por otro lado, el estudio identificó comunidades donde la atención al duelo se hallaba más extendida que otras. Otros datos de interés son los factores de riesgo que se tienen en cuenta con mayor frecuencia (el apoyo familiar y los antecedentes del doliente) y los criterios diagnósticos de duelo complicado más empleados: culpa (12,5%) y depresión (11,36%). Conclusiones: finalmente, el estudio sugiere que la atención al duelo delos familiares es aún una tarea en proceso de consolidación en España y la necesidad de disponer con mayor variedad de estrategias de intervención (AU)

Background: grief support for relatives of patients in palliative care is fundamental and is recognised as an important practice within palliative medicine. Objective: the aim of this research was to determine the nature and extent of grief support programmes offered to patient’s relatives within palliative care of the different Spanish autonomous regions. Method: a postal survey was carried out among members of the Spanish Society of Palliative Care. The members' names were obtained through the Society’s 2000 Directory which lists 160 different teams, of which 50% answered a questionnaire made up of 34 questions, some open-ended and others multiple choice. Results: results show that 88.6% of the services include grief support and that mainly emotional and one-to-one care is provided (92.4% and 89.9% respectively). Furthermore, results show that there is only a limited presence of psychologists and social workers. On the other hand, the study identified regions where the grief support was more extended than others. With regard to risk factors, those most commonly taken into account by professionals are absence of family support (36.92%) and the bereaved’s case history (21.54%), while the most widely used diagnostic criteria of complicated bereavement are blame and depression (12.5 and 11.36%). Conclusions: lastly, it can be seen that bereavement services are not completely consolidated in this country and there is a need for a greater variety of intervention strategies (AU)

Factores pronósticos en pacientes pluripatológicos de edad avanzada en un hospital de asistencia a crónicos de media y larga estancia (HACMLE) / Prognostic factors in elderly patients with co-occurring diseases in a medium-long-term and chronic cares hospital (MLT&CCH)

Objetivo: Conocer los factores pronósticos de mortalidad hospitalaria en los pacientes ancianos y pluripatológicos ingresados en nuestro Hospital de Asistencia a Crónicos de Media y Larga Estancia. Método: Se realiza una valoración multidimensional de forma longitudinal y prospectiva a 117 pacientes mayores de 75 años, tanto al ingreso como al alta o fallecimiento y se le aplica un tratamiento estadístico (Modelo de Regresión Logística). Resultado: Se aprecia un predominio significativo de mujeres sobre hombres, una elevada prevalencia de deterioro neurológico, y especialmente un alto porcentaje de pacientes que ingresaba con dos o más factores de riesgo. Comprobamos como el deterioro cognitivo, la situación funcional y los niveles bajos de albúmina, se asocian significativamente con una mayor mortalidad. Conclusiones: La evaluación de estas variables es fundamental para emitir un pronóstico y en ocasiones, para mejorarlo. Nuestros resultados, en líneas generales, son similares a la literatura revisada

Objective: To know the prognostic factors for hospitalary mortality in elderly patients with co-occuring diseases in our medium-long-term and chronic care Hospital (MLT&CCH). Method: We performed longitudinally and prospectively a multiple assessment to 117 patients aged 75 or older. This assessment was made at inclusion and discharge or die, and data were studied by statistical analysis (Logistic Regression Model). Results: The prevalence of women over men was significative. We also detected a high prevalence of neurologic impairment, but mainly the high percentage of admitted patients with two or more risk factors. We appreciate that cognitive dilapidation, social disability and low levels of albumine were significantly associated with higher mortality. Conclusions: The evaluation of these variables is fundamental to emit a prognosis and some times to improve it. Our results mainly concur with previous reports in literature

¿Es la atención sanitaria a las personas mayores con enfermedad avanzada una alternativa asistencial de la Medicina Interna? / Is the sanitary care to elderly people with comorbility and discapacity and clinical situation of advanced disease an assistance alternative of the Internal Medicine?

No disponible

[Miliary tuberculosis and cerebral tuberculomas. Apropos a case]. / Tuberculosis miliar y tuberculomas cerebrales. A propósito de un caso.

We present a case of a 45-year-old patient with miliary tuberculosis (MI), whose initial clinical symptomatology was uncertain. A few weeks after the beginning of chemotherapy, and in the face a Jacksonian crisis, cerebral tuberculomas were detected with CAT. The interesting thing in this case is to highlight that the diagnosis of MT anatomopathologic after pulmonary biopsy with mini-thoracotomy and that the cerebral complication could be classified within the so-called "paradoxical worsening" as it has been documented in the literature.