Predictive factors for home deaths among cancer patients in Swedish palliative home care.

Five palliative home care teams participated in a prospective Swedish study that included 221 palliative cancer patients. All patients with incurable malignant disease that were admitted and died during 1999 were included. On admission, demographic data were recorded. When patients, despite ongoing home care, were referred to institutional care, doctors and nurses involved were interviewed about the reasons for this. After the patients' death next of kin involved in the care were interviewed according to a questionnaire. Approximately half of the patients died at home. The reasons for referral showed a wide diversity and included both social and psychosocial factors, medical emergencies and problems related to symptom control. A preference for dying at home and not living alone were shown to be the strongest predictors of home death (p = 0.001). However, 35% of patients living alone died at home. Interestingly enough, Karnofsky performance index (KPI) at admission was significantly lower for those dying at home, despite similar mean time of care. The understanding of impending death was significantly more common among the families of those patients dying at home.

Alivio del dolor neuropático con infusiones sistémicas de adenosina / Systemic adeno sine infusions alleviated neuropathic pain

Un chico de 15 años de edad que sufría un trastorno neurometabólico degenerativo recibió tratamiento en una unidad de cuidados paliativos a domicilio. La administración de opiáceos mediante infusión intravenosa continua consiguió un alivio excelente del dolor de cabeza, el dolor muscular y el dolor causado por la presencia de cálculos renales. El paciente siguió quejándose de dolor urente en respuesta a estímulos táctiles. Una prueba sensorial cuantitativa realizada anteriormente había demostrado anomalías sensoriales. El paciente recibió infusiones semanales de adenosina intravenosa (ADO). Al cabo de 5 semanas de infusiones, el dolor dejó de re a parecer entre sucesivos tratamientos. Las infusiones de ADO se mantuvieron durante 7 meses sin que se produjeran efectos secundarios ni signos de tolerancia a la medicación. Algunos indicios apuntan a que la ADO puede actuar como moduladora del dolor neuropático y nociceptivo. En este caso con alodinia pronunciada, nuestra interpretación es que los mecanismos neuropáticos fueron responsables del dolor y que las infusiones de ADO desempeñaron un papel importante para el control del mismo. © 2001 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved. (AU)