Venous Thromboembolism In Cancer Patients: "From Evidence to Care".

This article seeks to review the current status of treatment and prevention of venous thromboembolic disease (VTE) in cancer patients after the addition of direct oral anticoagulants (DOAC) to the therapeutic arsenal available. The suitability of DOAC use in complex clinical situations, poorly represented in clinical trials, is controversial and difficult for care activity, making the recommendations in clinical practice guidelines the focus of special attention in this area. Recently, several randomized trials have compared low molecular weight heparin (LMWH) to DOAC for the management of CAT. Potential drug interactions with DOACs or the increased risk of bleeding in intraluminal tumors require special precautions, as do metastatic or primary brain disease and comorbid conditions, such as renal or liver failure, which are not suitably represented in pivotal studies. Furthermore, few data are available for situations involving elevated bleeding risk, with thrombocytopenia levels below the inclusion criterion of clinical trials, or recurrence during active anticoagulant therapy. Similarly, it is less clear that patients and physicians accept the presumption that oral DOAC administration is more convenient than subcutaneous LMWH, particularly when drug absorption may be compromised. The non-inclusion or under-representation of patients at higher risk for complications with anticoagulation in randomized clinical trials, makes their use complex in certain situations in health care. This paper provides a practical review of current clinical guideline recommendations regarding LMWH and/ or DOAC to treat and prevent CAT, as well as the most controversial clinical conditions for their use.

Comunicación mediante imágenes entre enfermera y paciente en estado crítico / Communicaton between nurses and patients in critical conditions by images

El propósito del estudio fue investigar si la comunicación enfermera-paciente en estado crítico se mejora utilizando un código de comunicación mediante imágenes. Se realizó un estudio transversal descriptivo a 28 pacientes intubados conscientes en estado crítico, de la Unidad de Cuidados Intensivos Posquirúrgicos y Unidad de Cuidados Intensivos Coronarios del Hospital de Cardiología, Centro Médico Nacional Siglo XXI, a quienes se aplicó dicho código, el cual consta de 20 tarjetas que representan necesidades o problemas del paciente, agrupadas por color de la siguiente manera: rojo-dolor, azul-higiene, verde-comodidad y tranquilidad, amarillo-molestia, morada-apoyo espiritual. El estudio permitió valorar la comprensión de cada tarjeta, obteniendo como resultado global 87.3% de comprensión del código de comunicación mediante imágenes, por lo que consideramos que representa una opción útil para facilitar la comunicación con el paciente en estado crítico y se puede aplicar en las unidades de cuidados intensivos.

The purpose of this study was to find whether the communication between a nurse and a patient in critical condition can be improved if a communication code by means of images is used. A descriptive transversal study was done to 28 intubated conscious patients in critical condition. Those patients were from the Post-Surgical Intensive Care Unit, and the Coronary intensive Care Unit in the Hospital de Cardiologia, Centro Medico Nacional Siglo XXI. We used a code composed by 20 cards depicting several patient needs or problems. The cards were color-code in the following manner: red-pain, blue-hygiene, green-comfort and tranquility, yellow-discomfort, purple-spiritual support. The study allowed us to value the understanding of each card. The global result was an 87.3% understanding of the communication code by means of images. For this reason we believe that the code is a useful option to facilitate communication with the patient in critical condition, and that it can be applied in intensive care units.