Nuevas estrategias de atención y cuidado en el contexto de una pandemia: desarrollo de un sistema de monitorización de síntomas telemático en pacientes con enfermedades avanzadas (AvanzaT) / New attention and care strategies in the context of a pandemic: development of a telematic symptom monitoring system in patients with advanced diseases (AvanzaT)

Antecedentes: Las iniciativas de telemedicina involucran a los pacientes en sus cuidados, favorecen la adherencia a los tratamientos y ayudan a centrar las valoraciones presenciales en los problemas más importantes, mejorando en general la atención.Objetivo: Diseño y evaluación de la factibilidad de una app dirigida a monitorizar la situación clínica en pacientes con enfermedades avanzadas.Material y métodos: Tipo de estudio: cualitativo (Diseño app) - cuantitativo (Evaluación en pacientes). Ubicación: Unidades de Cuidados Paliativos del Complejo Hospital Universitario Ntra. Sra. de Candelaria (CHUNSC) en Tenerife y Complejo Hospital Universitario de Ferrol (CHUF). Intervención: diseño app entre profesionales expertos en enfermedades avanzadas y un equipo de desarrollo de app sanitarias. Evaluación: análisis del uso de app por parte de pacientes y profesionales, aportación al seguimiento diario, y satisfacción con su uso. (AU)

Background: Telemedicine initiatives involve patients in their care, promote adherence to treatment, and help focus face-to-face assessments on the most important problems, improving care in general.Objective: Design and evaluation of the feasibility of an app aimed at monitoring clinical status in patients with advanced diseases.Material and methods: Type of study: qualitative (app design)-quantitative (evaluation in patients). Location: Palliative Care Units at the Ntra. Sra. de Candelaria University Hospital Complex (CHUNSC) in Tenerife, and Ferrol University Hospital Complex (CHUF). Intervention: app development by experts in advanced diseases and a health app development team. Evaluation: analysis of the use of the app by patients and professionals, contribution to daily monitoring, and satisfaction with its use. (AU)

Appropriateness and reliability testing of the modified Richmond Agitation-Sedation Scale in Spanish patients with advanced cancer.

CONTEXT: A tool to quantify agitation severity and sedation level in patients with advanced cancer is needed. OBJECTIVES: To test the appropriateness and reliability of the Richmond Agitation-Sedation Scale (RASS) in Spanish patients with advanced cancer. METHODS: The original RASS was translated into Spanish according to the standard guidelines. Face validity was assessed by members of the palliative care team, and interrater reliability was assessed, using a weighted kappa, from observations of patients admitted to the palliative care unit. The association between scores of the RASS, Ramsay Sedation Scale, and Glasgow Coma Scale was evaluated using Spearman's ρ. RESULTS: Three hundred twenty-two observations were performed in 156 patients: 116 observations were performed for delirious patients, 76 observations for sedated patients, and 130 observations for patients admitted for other symptom control. The weighted kappa values were practically equal to or greater than 0.90 between nurses and nurses and physicians. The agreement level between observers for each RASS score was roughly 90%. The correlation between the RASS and the Ramsay and Glasgow Scale values was analyzed for 196 observations recorded in 80 patients. The sedation scale of the RASS had a strong correlation with both the Ramsay (Spearman's ρ, -0.89; P < 0.001) and the Glasgow Coma Scales (Spearman's ρ, 0.85; P < 0.001). CONCLUSION: These data support the use of the RASS in Spanish patients with advanced cancer.

Quality of care in palliative sedation: audit and compliance monitoring of a clinical protocol.

CONTEXT: The European Association for Palliative Care and the U.S. National Hospice and Palliative Care Organization have published statements that recommend an audit of palliative sedation practices. OBJECTIVES: The aim was to assess the feasibility of a quality care project in palliative sedation. METHODS: We carried out an audit of adherence to a guideline regarding palliative sedation, undertaken as a yearly assessment during two years, of a sample of patient charts. With an audit tool, the charts were evaluated as to the presence of the ethical sedation checklist, information that justified palliative sedation, patient and/or family agreement, and the appropriateness of treatment in concordance with the clinical protocol. An educational program and result feedback meetings were used as the implementation strategy. RESULTS: Roughly 25% of the medical charts of patients who died in the palliative care unit were evaluated, 94 in 2007 and 110 in 2008. In 2007 and 2008, 63% and 57% of the patients, respectively, whose median age was 65 years, were sedated, with a median length of two days. The main reason for sedation was agitation concomitant with respiratory failure in roughly 60% and 75% of the cases in 2007 and 2008, respectively. Agreement of the patient/family about sedation was collected from 100% of the cases. The concordance of procedures with the sedation guideline was 100% in both years. CONCLUSION: Our quality-of-care strategy was shown to obtain a higher level of compliance with the palliative sedation guideline for at least two years.