Lidocaine infusion for malignant visceral pain: case report.

BACKGROUND: Visceral pain accounts for nearly 28% of cancer-related pain, and its effective management poses significant challenges. The diverse pathways of neurotransmission, neurotransmitters, channels, and receptors suggest the need for individualized analgesic therapy. Our objective is to explore a therapeutic alternative for managing malignant visceral pain in advanced cancer. CASES: In this report, we present two patients with malignant bowel obstruction and severe visceral pain, despite receiving opioid treatment, necessitating an alternative approach. Surgical interventions were considered but promptly ruled out. Paracentesis was performed as necessary. Pain management was initiated using a combination of opioids and co-analgesics. However, both patients required opioid dose escalation without achieving adequate pain control or tolerating the associated side effects. Consequently, a lidocaine infusion was administered to alleviate pain. OUTCOME: Following 24-48 hours of lidocaine infusion, both patients achieved satisfactory symptom control, enabling a reduction in opioid doses and improvement in intestinal transit. No side effects were reported during the treatment. DISCUSSION: Lidocaine infusions may be beneficial for pain management in patients with malignant bowel obstruction and visceral pain. The extent of pain control achieved in comparison to other therapeutics remains challenging to ascertain. We posit that lidocaine infusions, with their potential impact on visceral hypersensitivity, can enhance pain control and facilitate the recovery of bowel transit. Further studies are warranted to validate these findings.

Euthanasia in Colombia: Experience in a palliative care program and bioethical reflections.

The increased prevalence of advanced-stage chronic diseases has augmented the need for palliative care teams. In Colombia, although the legislation promotes palliative care development, people still die without receiving management from a palliative care team. In addition, judiciary regulations regarding euthanasia have generated public confusion and ethical conflicts among members of the palliative care teams. Therefore, this study aimed to perform a bioethical reflection on the relationship between palliative care and euthanasia supported by data on euthanasia requests in a palliative care program. This reflection is based on retrospective and descriptive observational data, collected in two highly complex hospitals in Bogotá, Colombia. A total of 50 euthanasia requests were identified, of which 62% met the defined criteria, 16% did not, and 22% were not considered by the interdisciplinary committee for the right to die with dignity due to early death. All patients were treated and followed up by a palliative care team until their death. This study considered that palliative care could be a complement management for patients requesting euthanasia based on their experience by supporting the decision-making, alleviating suffering, and providing emotional support in the last days of life.

Use of complementary and alternative medicine by cancer patients in Colombia.

BACKGROUND: The use of complementary and alternative medicines (CAM) among cancer patients varies greatly. The available data suggest an increasing use of CAM over time and a higher prevalence in low- and middle-income countries. However, no reliable data are available from Latin America. Accordingly, we examined the prevalence of CAM use among cancer patients from six Colombian regions. METHODS: We conducted a survey on cancer patients attending comprehensive cancer centres in six capital cities from different regions. The survey was designed based on a literature review and information gathered through focus groups on CAM terminology in Colombia. Independent random samples of patients from two comprehensive cancer centres in every city were obtained. Patients 18 years and older with a histopathological diagnosis of cancer undergoing active treatment were eligible. The prevalence of CAM use is reported as a percentage with the corresponding confidence interval. CAM types are reported by region. The sociodemographic and clinical characteristics of CAM users and non-users were compared using Chi square and t tests. RESULTS: In total, 3117 patients were recruited. The average age 59.6 years old, and 62.8% were female. The prevalence of CAM use was 51.7%, and compared to non-users, CAM users were younger, more frequently women, affiliated with the health insurance plan for low-income populations and non-Catholic. We found no differences regarding the clinical stage or treatment modality, but CAM users reported more treatment-related side effects. The most frequent types of CAM were herbal products, specific foods and vitamins, and individually, soursop was the most frequently used product. Relevant variability between regions was observed regarding the prevalence and type of CAM used (range: 36.6% to 66.7%). The most frequent reason for using CAM was symptom management (30.5%), followed by curative purposes (19.5%). CONCLUSIONS: The prevalence of CAM use among cancer patients in Colombia is high in general, and variations between regions might be related to differences in cultural backgrounds and access to comprehensive cancer care. The most frequently used CAM products and practices have little scientific support, suggesting the need to enhance integrative oncology research in the country.

[Virtual and in-person accompaniment of hospitalized patients during the COVID-19 pandemic in ColombiaAcompanhamento virtual e presencial de pacientes hospitalizados durante a pandemia de COVID-19 na Colômbia]. / Acompañamiento virtual y presencial a pacientes hospitalizados durante la pandemia de COVID-19 en Colombia.

OBJECTIVE: To describe the results of a virtual and in-person accompaniment strategy based on person-centered care of patients hospitalized for suspected or confirmed disease due to the novel 2019 coronavirus (COVID-19). METHOD: Retrospective descriptive observational study conducted in five health facilities of the Colsanitas clinic network that implemented an accompaniment strategy with seven modalities: virtual information, personal mobile devices, virtual visits, contacts by other means, round-the-clock companion, in-person visit, and compassionate contact. Descriptive statistics were used for data analysis. RESULTS: The accompaniment strategy was used with 871 patients with hospital stays ranging from 1 to 90 days; 70% were positive for COVID-19. The families of 764 patients were contacted through 3984 calls in the virtual information modality; an average of 71 virtual visits per day occurred; 428 letters, voice messages, and videos, among others, were received; 114 patients had a round-the-clock companion; 154 patients had an in-person visit; and 20 families made a posthumous in-person visit to the patient. CONCLUSION: The results of the virtual and in-person accompaniment strategy with a person-centered approach showed that family involvement is important to patient care and improves communication and interaction among patients, families, and the healthcare team.

OBJETIVO: Descrever os resultados de uma estratégia de acompanhamento virtual e presencial, baseada no cuidado centrado na pessoa, durante o atendimento de pacientes internados por doença do novo coronavírus de 2019 (COVID-19) suspeita ou confirmada. MÉTODOS: Estudo observacional descritivo retrospectivo realizado em cinco instituições de saúde da rede clínica Colsanitas, que implementaram uma estratégia de acompanhamento com sete modalidades: informação virtual, dispositivos móveis pessoais, visitas virtuais, contatos por outros meios, acompanhante permanente, visita presencial e contato solidário. Foram utilizadas estatísticas descritivas para análise dos dados. RESULTADOS: A estratégia de acompanhamento foi aplicada em 871 pacientes com 1 a 90 dias de internação, dos quais 70% positivaram para COVID-19. Na modalidade de informação virtual, as famílias de 764 pacientes foram contatadas por meio de 3.984 ligações; em média, foram realizadas 71 visitas virtuais por dia; foram recebidas 428 cartas, mensagens de voz e vídeos, entre outros meios; 114 pacientes contaram com um acompanhante permanente; 154 pacientes receberam visita presencial; e 20 famílias fizeram uma visita presencial póstuma ao paciente. CONCLUSÕES: Os resultados da estratégia de acompanhamento virtual e presencial com abordagem centrada na pessoa mostraram que a participação da família é importante no cuidado ao paciente e melhora a comunicação e a interação entre paciente, família e equipe de saúde.

Acompañamiento virtual y presencial a pacientes hospitalizados durante la pandemia de COVID-19 en Colombia

[RESUMEN]. Objetivo. Describir los resultados de una estrategia de acompañamiento virtual y presencial, con base en el cuidado centrado en la persona durante la atención a pacientes hospitalizados por sospecha o confirmación de enfermedad por el nuevo coronavirus 2019 (COVID-19, por su sigla en inglés). Método. Estudio observacional descriptivo retrospectivo realizado en cinco instituciones de salud de la red de clínica Colsanitas que implementaron una estrategia de acompañamiento con siete modalidades: información virtual, dispositivos móviles personales, visitas virtuales, contactos con otros medios, acompañante permanente, visita presencial y contacto compasivo. Se utilizó estadística descriptiva para el análisis de los datos. Resultados. La estrategia de acompañamiento se aplicó a 871 pacientes con estancia hospitalaria de 1 a 90 días, 70% fueron positivos para COVID-19; en la modalidad de información virtual, se contactaron a familias de 764 pacientes realizando 3984 llamadas; en promedio se realizaron 71 visitas virtuales al día; se recibieron 428 cartas, mensajes de voz y videos, entre otros; 114 pacientes tuvieron un acompañante permanente; 154 pacientes tuvieron visita presencial; y 20 familias realizaron visita presencial póstuma al paciente. Conclusión. Los resultados de la estrategia de acompañamiento virtual y presencial con enfoque centrado en la persona mostraron que la participación de las familias es importante en el cuidado del paciente y mejora la comunicación e interacción entre los pacientes, las familias y el equipo de salud.

[ABSTRACT]. Objective. To describe the results of a virtual and in-person accompaniment strategy based on person-centered care of patients hospitalized for suspected or confirmed disease due to the novel 2019 coronavirus (COVID-19). Method. Retrospective descriptive observational study conducted in five health facilities of the Colsanitas clinic network that implemented an accompaniment strategy with seven modalities: virtual information, personal mobile devices, virtual visits, contacts by other means, round-the-clock companion, in-person visit, and compassionate contact. Descriptive statistics were used for data analysis. Results. The accompaniment strategy was used with 871 patients with hospital stays ranging from 1 to 90 days; 70% were positive for COVID-19. The families of 764 patients were contacted through 3984 calls in the virtual information modality; an average of 71 virtual visits per day occurred; 428 letters, voice messages, and videos, among others, were received; 114 patients had a round-the-clock companion; 154 patients had an in-person visit; and 20 families made a posthumous in-person visit to the patient. Conclusion. The results of the virtual and in-person accompaniment strategy with a person-centered approach showed that family involvement is important to patient care and improves communication and interaction among patients, families, and the healthcare team.

[RESUMO]. Objetivo. Descrever os resultados de uma estratégia de acompanhamento virtual e presencial, baseada no cuidado centrado na pessoa, durante o atendimento de pacientes internados por doença do novo corona-vírus de 2019 (COVID-19) suspeita ou confirmada. Métodos. Estudo observacional descritivo retrospectivo realizado em cinco instituições de saúde da rede clínica Colsanitas, que implementaram uma estratégia de acompanhamento com sete modalidades: informação virtual, dispositivos móveis pessoais, visitas virtuais, contatos por outros meios, acompanhante permanente, visita presencial e contato solidário. Foram utilizadas estatísticas descritivas para análise dos dados. Resultados. A estratégia de acompanhamento foi aplicada em 871 pacientes com 1 a 90 dias de internação, dos quais 70% positivaram para COVID-19. Na modalidade de informação virtual, as famílias de 764 pacientes foram contatadas por meio de 3.984 ligações; em média, foram realizadas 71 visitas virtuais por dia; foram recebidas 428 cartas, mensagens de voz e vídeos, entre outros meios; 114 pacientes contaram com um acompanhante permanente; 154 pacientes receberam visita presencial; e 20 famílias fizeram uma visita presencial póstuma ao paciente. Conclusões. Os resultados da estratégia de acompanhamento virtual e presencial com abordagem centrada na pessoa mostraram que a participação da família é importante no cuidado ao paciente e melhora a comunicação e a interação entre paciente, família e equipe de saúde.

Dolor en pacientes hospitalizados en una institución de salud de tercer nivel / Pain in hospitalized patients in a third-level health care institution

Abstract Introduction: Pain is one of the major symptoms experienced by hospitalized patients. Objective: To establish the hospital care quality indicators associated with pain management (prevalence, intensity, and interference) in adult inpatients, following the implementation of strategies framed within the pain-free Hospital Policy at a third-level institution. Methodology: Observational, descriptive, cross-sectional trial. Patients over 18 years of age, hospitalized for more than 24hours, and who previously signed their informed consent were included. The Brief Pain Inventory - Short Form in Spanish was adminis tered for pain evaluation, and the sex and service differences were estimated using the Wilcoxon test for quantitative variables and x2 for qualitative variables. Results: Three hundred thirty-eight participants were includ ed. The prevalence of pain was 43.4%, with a higher percentage among females (52.1% vs 28.8%, P <0.001) and in the surgical services (48.0% vs 37.5%, P = 0.05). Women showed higher intensity in the "minimum pain" item (median 3 interquartile range 2-5 vs median 2 interquartile range 0-1, P=0.009). The activities with the highest interference were sleep and general activity in both sexes and services. Discussion: The hospital quality of care indicators herein measured allow for an enhanced approach to characterize pain in this population group, with a view to improving pain identifica tion and management in the future to provide a more comfortable experience for the patient.

Resumen Introducción: El dolor es uno de los principales síntomas que presentan los pacientes hospitalizados. Objetivo: Establecer los indicadores de la calidad del cuidado hospitalario relacionados con el manejo del dolor (prevalencia, intensidad e interferencia) en pacientes adultos hospitalizados posterior a la implementación de estrategias enmarcadas en la Política Clínica sin dolor de una institución de tercer nivel. Metodología: Estudio observacional descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años con más de 24 horas de hospitalización y previa firma de consenti miento informado, se aplicó el instrumento Brief Pain Inventory -Short Form (Inventario Breve de Dolor) en español para la evaluación del dolor. Las diferencias por género y servicio se estimaron a través del test de Wilcoxon para las variables cuantitativas y X2 para las variables cualitativas. Resultados: Se incluyeron 338 participantes. La prevalencia de dolor fue 43,4%, siendo más alta en mujeres (52,1% vs. 28,8%, p = < 0.001) y servicios quirúrgicos (48,0% vs. 37,5%, p = 0.05). Las mujeres presentaron mayor intensidad en el ítem "dolor mínimo" (mediana 3 Rango intercuartílico 2-5 vs. mediana 2 Rango intercuartílico 0-1, p = 0.009). Las actividades con mayor interferencia fueron el sueño y la actividad general en ambos sexos y servicios. Discusión: Los indicadores de la calidad del cuidado hospita lario medidos en este estudio permiten caracterizar de una mejor forma el dolor en este tipo de población, lo cual permite mejorar a futuro la identificación y manejo de éste síntoma para brindar mayor confort al paciente.