Healthcare Students' Perceptions About Approaching Spirituality in Their Training and Patient Care: Online, Cross-Sectional Survey.

Objective: Recent scientific literature points out that religiosity and spirituality play a relevant role in many aspects of life, including health issues. We aimed to evaluate the healthcare students' perceptions about approaching spirituality in their training and patient care in Brazilian universities. Methods: A cross-sectional observational study was conducted following the STROBE guidelines. Through an anonymous online survey, adult healthcare students from two universities in the city of Pelotas (Brazil) answered a questionnaire about their perceptions on approaching spirituality in their training and patient care. Chi-squared tests were performed, and P ≤ .05 was considered statistically significant. Results: A total of 163 students were included in the analysis. Most believed that spirituality is important for their training (74.8%) and patient care (84%). However, a minority had had contact with the theme of spirituality during their training (48.5%) or had experienced a situation in which the spiritual aspects of a patient were addressed (47.2%). The students from the private university had more contact with the theme of spirituality in healthcare during their training. Nursing students had significantly more contact with the theme of spirituality in healthcare (P = .008) and had experienced more situations in which the spiritual aspects of a patient were addressed (P = .031) than other students. Conclusion: Most students believed that the theme of spirituality in healthcare is important for their training and patient care. However, they still had insufficient contact with it during their education. More studies with greater statistical power are needed to better understand this situation globally.

Palliative Care in the state of Rio de Janeiro (Brazil): characteristics of the services.

This research explores the status of Palliative Care (PC) services in the state of Rio de Janeiro (RJ), Brazil, by identifying the number of services and their respective characteristics. Through an observational, cross-sectional, descriptive, and quantitative approach, this study examines a textual and numerical database about professionals who provide palliative care assistance in Rio de Janeiro. Out of the existing palliative care services analyzed, fourteen were evaluated, twelve of which were located in the RJ metropolitan region. The majority of professionals worked with private funding within hospitals. The PC teams were most commonly composed of physicians, with only 17.1% of the professionals having formal PC training. Palliative Care services in Rio de Janeiro seem to follow a similar pattern to Brazil and Latin America. However, the characteristics of this pattern may not adequately address the significant needs of middle-income countries.

End-of-life use of antibiotics: a survey on how doctors decide.

OBJECTIVES: Infections are the main complications in terminal diseases. Many patients die using antibiotics, which raises questions about their real usefulness and role in unnecessary prolongation of suffering. This survey evaluated how doctors use antibiotics in palliative care. METHODS: From June to August of 2016, an online survey was conducted with 224 doctors who provide palliative care. They had to decide whether to initiate antibiotics in fictitious scenarios involving patients with suspected infections (urinary tract infection, pneumonia, sepsis) in end-of-life (from cancer, dementia, malignant stroke with sequelae, advanced COPD, multiple organ failure). Then, they had to decide whether to stop, maintain, or extend antibiotics after non-response in 72 hours. RESULTS: 88-100% of doctors decided to initiate antibiotics in all situations, except in advanced dementia (45%), and most of them decided to maintain/extend antibiotics inadequately. Factors associated with maintaining/extending antibiotics inadequately were: longer time since graduation (over 13 years; significant in all 7 clinical situations; OR range: 2.45-10.11), and not having formal specialization in palliative care (statistically significant in 3 of 7 situations). CONCLUSIONS: Most palliative care physicians in this study decided to initiate and maintain/extend antibiotics at the end-of-life.

Widow's perception of their marital relationship and its influence on their restoration-oriented everyday occupations in the first six months after the death of the spouse: A thematic analysis.

INTRODUCTION: The death of a spouse greatly affects the survivor's emotions and may change one's everyday occupations, especially during recent bereavement. Considering the centrality of everyday occupations to occupational therapy practice, this research aimed to understand women's restoration-oriented everyday occupations within the first six months after the death of their spouse. METHODS: This was a qualitative thematic analysis that applied a realistic method and a theoretical approach at the semantic level. Semi-structured interviews were conducted to understand the everyday occupations of widows after their husbands' deaths, emphasising those that were restoration-oriented, according to the dual process model of coping with bereavement framework. The analysis was conducted according to the phases expected to be conducted during a thematic analysis. RESULTS: Fourteen widows with long-term marital relationships participated in this research. Their perceptions concerning their relationships with their spouses were an important aspect that influenced their everyday occupations. Women who qualitatively described their marital relationships in terms of attributes grouped by the researcher as lost and lonely also mentioned difficulty managing previously habitual occupations and changes in the meanings assigned to some of those occupations. These women mobilised unique strategies to address suffering and occupational changes during bereavement. Women who qualitatively described their relationships with attributes grouped by the researcher as free at last felt freedom after their husbands' deaths, which, according to the widows, brought happiness and feelings of peace and enabled them to engage in freely chosen occupations and to broaden their social networks. CONCLUSION: Everyday occupations and their meanings can considerably change during widowhood. This study contributes to comprehending the uniqueness of responses to loss.

Clinical significance of palliative care assessment in patients referred for urgent intensive care unit admission: A cohort study.

PURPOSE: To evaluate clinical characteristics of patients with palliative care (PC) and urgent intensive care unit (ICU) referrals in the same hospital admission. METHODS: All urgent ICU referrals at an academic, tertiary hospital, and the co-occurrence and timing of PC assessment were retrieved from a prospectively collected database. RESULTS: From May 2014 to May 2015, 2476 patients were analyzed and 179 (7%) had co-occurrence of PC assessment and urgent ICU referral in the same hospital admission. Hospital mortality was higher (odds ratio, 8.3; 95% confidence interval, 5.4-12.7) and ICU admission was lower (odds ratio, 0.54; 95% confidence interval, 0.40-0.74) in patients with PC assessment, compared with patients without concurrent PC and ICU referrals. Variables associated with PC assessment were older age, diagnosis of cancer, depressed level of consciousness, nonsurgical admission, lower performance status, physician's subjective prognosis of poor outcome, and length of hospitalization before ICU referral. CONCLUSION: In this cohort of patients with urgent ICU referral, clinical characteristics at the moment of ICU referral were associated with co-occurrence of PC assessment in the same hospital admission. These characteristics might guide the development of instruments to enhance early referral of high-risk patients to PC services.

[Resistive exercise in the evaluation of endothelial dysfunction in heart failure]. / Exercício resistido na avaliação da disfunção endotelial na insuficiência cardíaca.

OBJECTIVE: To evaluate the use of resistive exercise in the study of endothelial dysfunction in heart failure (HF) comparatively to reactive hyperemia (RH). METHODS: Eighteen patients with heart failure and 15 normal volunteers were submitted to intermittent handgrip exercise in a pneumatic bag, at an intensity that corresponds to 75% of the previously assessed maximum load. Patients underwent high-resolution vascular ultrasonography for brachial artery diameter and flow evaluation as well as cardiac output determination at rest, RH and after exercise. The systolic flow index in the brachial artery and cardiac index were calculated. RESULTS: Systolic flow index increase in the brachial artery was observed after RH and physical exercise, with the latter presenting the highest increase. There was an increase in the cardiac index after the study conditions in comparison to resting conditions. CONCLUSION: Resistive exercise, performed at the assessed load, increases blood flow more intensively than RH, constituting a physiological option for the evaluation of endothelial function in HF.