Utilization of medical interventions in hospitalized Mexican adults with cancer at the end of life in a referral hospital: The importance of early palliative care.

OBJECTIVES: To investigate the impact of early vs. late palliative care (PC) on the frequency of admissions to acute hospital settings and the utilization of end-of-life (EoL) interventions in cancer decedents. METHODS: In this single-center, cross-sectional study, we examined the frequency of intensive care unit (ICU) and emergency department (ED) admissions among adult cancer decedents between 2018 and 2022 in a referral hospital in México. Additionally, we assessed EoL medical interventions, categorizing patients into 3 groups: those who received early PC (EPC), late PC (LPC), and those who did not receive PC (NPC). RESULTS: We analyzed data from 1762 patients, averaging 56 ± 16.3 years old, with a predominant representation of women (56.8%). PC was administered to 45.2% of patients, but EPC was limited to only 12.3%. The median time from the initiation of PC to death was 5 days (interquartile range: 2.0-31.5). Hematological malignancies were the most prevalent, affecting 21.5% of patients. EPC recipients demonstrated notable reductions in ICU and ED admissions, as well as diminished utilization of chemotherapy, radiotherapy (RT), antibiotics, blood transfusions, and surgery when compared to both LPC and NPC groups. EPC also exhibited fewer medical interventions in the last 14 days of life, except for RT. SIGNIFICANCE OF RESULTS: The findings of this study indicate that a significant proportion of EoL cancer patients receive PC; however, few receive EPC, emphasizing the need to improve accessibility to these services. Moreover, the results underscore the importance of thoughtful deliberation regarding the application of EoL medical interventions in cancer patients.

Acceleration of infectious disease drug discovery and development using a humanized model of drug metabolism.

A key step in drug discovery, common to many disease areas, is preclinical demonstration of efficacy in a mouse model of disease. However, this demonstration and its translation to the clinic can be impeded by mouse-specific pathways of drug metabolism. Here, we show that a mouse line extensively humanized for the cytochrome P450 gene superfamily ("8HUM") can circumvent these problems. The pharmacokinetics, metabolite profiles, and magnitude of drug-drug interactions of a test set of approved medicines were in much closer alignment with clinical observations than in wild-type mice. Infection with Mycobacterium tuberculosis, Leishmania donovani, and Trypanosoma cruzi was well tolerated in 8HUM, permitting efficacy assessment. During such assessments, mouse-specific metabolic liabilities were bypassed while the impact of clinically relevant active metabolites and DDI on efficacy were well captured. Removal of species differences in metabolism by replacement of wild-type mice with 8HUM therefore reduces compound attrition while improving clinical translation, accelerating drug discovery.

Assessment of emotional distress in palliative care: Edmonton Symptom Assessment System-revised (ESAS-r) vs Distress Thermometer.

OBJECTIVES: To evaluate the sensitivity and specificity of the Distress Thermometer (DT) as a screening tool for emotional distress in oncological palliative care patients and to compare the DT with the Edmonton Symptom Assessment System-revised (ESAS-r) and the gold standard to determine the most appropriate assessment method in palliative psychological care. METHODS: Data were collected from psychological screening tests (ESAS-r and DT), and clinical interviews (gold standard) were conducted by a clinical psychologist specialist in palliative oncology from January 2021 to January 2022 in an oncology palliative care service. RESULTS: The sample consisted of 356 first-time patients with a diagnosis of advanced cancer in palliative care. The most frequently reported oncological diagnoses were gastrointestinal tract (49.3%) and breast (18.3%). Most patients were female (n = 206; 57.9%), 60.4% were married/with a partner, 55.4% had between 6 and 9 years of schooling, and a median age of 57 (range, 46-65) years. The cutoff of the DT was 5, with a sensitivity of 75.88% and specificity of 54.3%. Emotional problems (sadness and nervousness) had a greater area under the curve (AUC) when measured using the DT than the ESAS-r; however, only in the case of the comparative sadness and discouragement was the difference between the AUC marginally significant. SIGNIFICANCE OF RESULTS: The use of the DT as a screening tool in oncological palliative care is more effective in the evaluation of psychological needs than the ESAS-r. The DT, in addition to evaluation by an expert psychologist, allows for a more comprehensive identification of signs and symptoms to yield an accurate mental health diagnosis based on the International Classification of Diseases-11th Revision and/or Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition.

Instrumento de Detección de Necesidades de Capacitación en Psicología de Cuidados Paliativos: Diseño y validación / Palliative Care Psychology Training Needs Assessment Instrument: Design and validation

Introducción. Los psicólogos tienen un papel relevante en el manejo integral en la atención de pacientes en cuidados paliativos y su familia, por lo que deben contar con competencias específicas para proporcionar la atención psicológica en los diferentes niveles de atención en salud. Objetivo: Diseñar un Instrumento de Detección de Necesidades de Capacitación en Psicología de Cuidados Paliativos (IDNCPsic-CP), analizar su validez y confiabilidad. Método: Se realizó un estudio prospectivo, transversal mediante una encuesta en línea para psicólogos que laboraran en Unidades/Servicios de Cuidados Paliativos en México. Se utilizó un muestreo por conveniencia. Resultados: La muestra total fue de 132 profesionales del Psicología. El IDNCPsic-CP en su versión final fue de 122 reactivos divididos en características generales del psicólogo y la institución, proceso de atención y la Detección de Necesidades de Capacitación se conformó por 3 subescalas: a) Relevancia donde en el Análisis Factorial Exploratorio (AFE) se agrupó en 7 factores (alpha de Cronbach de ,930), y en el Análisis Factorial Confirmatorio (AFC) se confirmaron sólo 4. b) Frecuencia donde el AFE identificó 4 factores, (alpha de cronbach de .977), y en el AFC los siguientes índices de ajuste: χ2/gl= 1,784; CFI=0,917; TLI=0,908, SRMR=0,054 y RMSEA =0,077; y c) Autopercepción de habilidades con un solo factor, (alfa de Cronbach=0.945), el AFC con índices de ajuste: χ2/gl= 1,519; CFI=0,994; TLI=0,987, SRMR=0,023 y RMSEA=0,063. Conclusiones: El IDCNPsic-CP cuenta con puntuaciones altas de validez, confiabilidad y ajuste, que confirman que el instrumento cuenta con las propiedades psicométricas para su uso (AU)

Introduction. Psychologists have a relevant role in the comprehensive management of palliative care patients and their families, so they must have specific competencies to provide psychological care at different levels of health care. Objective: To design an Instrument for the Detection of Training Needs in Palliative Care Psychology (IDNCPsic-CP) and to analyze validity and reliability. Methods: A prospective, cross-sectional study was conducted through an online survey for psychologists working in Palliative Care Units/Services in Mexico. Convenience sampling was used. Results: The total sample was 132 psychology professionals. The final version of the IDNCPsic-CP consisted of 122 items divided into general characteristics of the psychologist and the institution, process of care and Detection of Training Needs was made up of 3 subscales: a) Relevance, where in the Exploratory Factor Analysis (EFA) it was grouped into 7 factors (cronbach’s alpha of .930), and the Confirmatory Factor Analysis (CFA) only 4 were confirmed. b) Frequency where EFA identified 4 factors, (cronbach’s alpha of .977), and in CFA the following adjustment indexes: χ2/gl= 1.784; CFI .917; TLI=.908, SRMR=.054 and RMSEA =.077; and c) Self-perception of skills with a single factor, (Cronbach’s alpha=0.945), the AFC with fit indices: χ2/gl= 1.519; CFI=0.994; TLI=0.987, SRMR=0.023 and RMSEA=0.063. Conclusions: The IDCNPsic-CP has high validity, reliability, and fit scores, which confirm that the instrument has the psychometric properties for use (AU)

Lecciones aprendidas y retos en la integración de cuidados paliativos en oncología. Experiencia en el Instituto Nacional de Cancerología.

No disponible.

Suicide in cancer patients undergoing palliative care: A report of two cases / Suicidio en pacientes con cáncer que recibe cuidados paliativos: reporte de dos casos

Abstract Introduction Suicide represents a major public health problem worldwide, and cancer patients might have vulnerability factors which increase suicide risk. There are multiple factors associated with this tragic outcome, including those stemming from the disease itself, mental illness and social, personal and spiritual factors. Although previous reports have identified a suicide rate which ranges from .03-7% among cancer patients undergoing palliative care, this has not been studied in Mexico. Objective This study sought to report the cases of suicide in patients with cancer undergoing palliative care at a large cancer reference center. Method A retrospective review of records was performed between 2018-2019 for patients treated at the Palliative Care Service of the Instituto Nacional de Cancerología in Mexico City. Records for patients who committed suicide were reviewed to describe factors associated with this outcome. Results Among all deaths identified during the record review, two were due to suicide (.09%). The patients were one female and one male, 60 and 42 years of age, diagnosed with breast cancer and gastroesophageal junction cancer, respectively, associated with tobacco and alcohol consumption, as well as several economic, social, and familial stress factors. One of the patients was identified as likely having major depressive disorder. Discussion and conclusion Deaths might be underreported in our population. A systematic evaluation is required in order to establish and detect suicidal behavior risk factors, and a follow-up plan for all these patients.

Resumen Introducción El suicidio representa un problema de salud pública en todo el mundo. Los pacientes con cáncer pueden tener factores de vulnerabilidad para presentar conducta suicida. Hay múltiples factores asociados con este fenómeno, incluidos los derivados de la enfermedad en sí, enfermedades mentales y factores sociales, personales y espirituales. Aunque hay reportes previos que describen una tasa de suicidio que va del .03 al 7% entre los pacientes con cáncer que reciben cuidados paliativos, esto no se ha estudiado en México. Objetivo Reportar los casos de suicidio en pacientes oncológicos que reciben cuidados paliativos en un centro oncológico de referencia. Método Se trata de un estudio retrospectivo, donde se revisaron los expedientes de los pacientes atendidos en el Servicio de Cuidados Paliativos del Instituto Nacional de Cancerología entre 2018-2019. Se revisaron los expedientes de los pacientes que se suicidaron para describir los factores de riesgo que presentaban. Resultados Entre todas las muertes identificadas durante la revisión de expedientes, dos se debieron a suicidio (.09%). Los pacientes fueron una mujer y un hombre, de 60 y 42 años, diagnosticados de cáncer de mama y de una unión gastroesofágica, respectivamente. Los factores asociados fueron el consumo de tabaco y alcohol, así como varios factores de estrés económico, social y familiar. Se identificó, asimismo, que uno de los pacientes padecía trastorno depresivo mayor. Discusión y conclusión Es posible que los suicidios estén infrarreportados en nuestra población. Se requiere una evaluación sistemática para establecer y detectar factores de riesgo de conducta suicida, y un plan de seguimiento para todos estos pacientes.

Psicoterapia individual centrada en el significado en una paciente con cáncer avanzado en cuidados paliativos: reporte de caso / Individual meaning-centered psychotherapy in a patient with advanced cancer in palliative care: a case report

Introducción: Los pacientes con cáncer avanzado tienen mayores necesidades espirituales como búsqueda de propósito y significado de vida. La Psicoterapia Individual Centrada en el Significado en Cuidados Paliativos (PICS-CP) ha demostrado alta satisfacción y evidencia científica en la atención de estas necesidades, ya que está dirigida a la comprensión y experiencia del significado de vida, a la búsqueda de su identidad antes y después de ser diagnosticado con cáncer, a sus valores, vivir el legado y encontrar una sensación de paz. Objetivo: Conocer el efecto de la PICS-CP en una paciente con cáncer avanzado en cuidados paliativos con necesidades emocionales y espirituales relacionadas con el significado de vida. Método: Diseño Applied Behavior Analysis (ABA) de caso único.Resultados: Con la PICS-CP se obtuvo una reducción de síntomas depresivos (pretratamiento = 18, postratamiento = 12), ansiosos (pretratamiento = 9, postratamiento = 7), disminución de desmoralización (pretratamiento = 23, postratamiento = 12) y en las correspondientes subescalas: afrontamiento y sentido; y un aumento en el bienestar espiritual (pretratamiento = 27, postratamiento = 37) y en las 3 subescalas: significado, paz y espíritu de lucha. Conclusiones: La PICS-CP ayuda a reducir la angustia, la ansiedad, la tensión, y a encontrar el significado de la vida en momentos críticos, como es el final de la vida. (AU)

Introduction: Patients with advanced cancer have greater spiritual needs such as the search for purpose and meaning in life. Individual meaning-centered psychotherapy in palliative care (IMCP-PC) has demonstrated high satisfaction and scientific evidence levels in addressing these needs as it is aimed at understanding and experiencing the meaning of life, at finding one’s personal identity before and after being diagnosed with cancer and one’s values, at living one’s legacy, and at finding a sense of peace. Objective: To assess the effect of MCIP-PC on an advanced cancer patient in palliative care with emotional and spiritual needs in relation to the meaning of life. Method: Single-case ABA design. Results: With IMCP-PC we obtained a reduction in depressive symptoms (pre-treatment = 18, post-treatment = 12), anxiety symptoms (pre-treatment = 9, post-treatment = 7), and in demoralization (pre-treatment = 23 and post-treatment = 12) and its corresponding subscales: coping and meaning, as well as an increase in spiritual well-being (pre-treatment = 27, post-treatment = 37) and its 3 subscales: meaning, peace and fighting spirit. Conclusions: IMCP-PC helps to reduce distress, anxiety, and tension, and to find meaning in life at critical times such as the end of life. (AU)

Association between new-onset right bundle branch block and primary or secondary ventricular fibrillation in ST-segment elevation myocardial infarction.

AIMS: New-onset right bundle branch block (RBBB) in myocardial infarction (MI) is often associated with ventricular fibrillation (VF) but the nature of this relationship has not been determined. METHODS AND RESULTS: Between 1998 and 2014, among other data, incidence and duration of RBBB and VF occurrence were prospectively collected in 5301 patients with ST-segment elevation MI (STEMI) admitted to two University Hospitals in Murcia (Spain). Multinomial adjusted logistic regression analyses were used to examine the association between RBBB, attending to its duration, and VF according to its primary VF (PVF) or secondary VF (SVF) character. Among 284 (5.4%) patients with new-onset RBBB, 158 were transient and 126 permanent. VF occurred in 339 (6.4%) patients, 201 PVF and 138 SVF, documented within the first 2 h of symptoms-onset in 78% and 60%, respectively. New-onset RBBB was more frequent in PVF (11.4%) and SVF (20.3%), than in non-VF (4.7%). Transient RBBB incidence was higher in PVF (9.0%) and SVF (9.4) than in non-VF (2.6%), whereas permanent RBBB was higher in SVF (10.9%) than PVF (2.5%) and non-VF (2.1%). New-onset RBBB 1.83 [95% confidence interval (CI): 1.07-3.11] and new-onset transient RBBB 2.39 (95% CI: 1.32-4.32) were independently associated with PVF. New-onset 3.03 (95% CI: 1.83-5.02), transient 2.40 (95% CI: 1.27-4.55), and permanent 2.99 (95% CI: 1.52-5.86) RBBB were independently associated with SVF. CONCLUSION: New-onset RBBB and VF in STEMI are independently associated and show particularities based on the duration of the conduction disturbance and/or the primary or secondary character of the arrhythmia.

Associated factors of distress in patients with advanced cancer: A retrospective study.

OBJECTIVE: The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City. DESIGN: A retrospective study was conducted using electronic records (June 2015 to December 2016). SAMPLE: A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores. FINDINGS: Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203). CONCLUSION: The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.

Recommendations for the provision of palliative care to people with COVID-19.

The pandemic of SARS-CoV-2 infection, which causes COVID-19, has deeply affected health systems and has had a significant impact on families, communities and nations. A comprehensive response strategy requires, in addition to epidemiological, scientific and technical considerations, for human suffering associated with disease, vulnerability and death not to be forgotten. Palliative care for people with suspicion or diagnosis of COVID-19 with serious evolution, and their families should also be a key part of organized actions that help alleviate suffering and improve quality of life by controlling symptoms, addressing psychological, emotional, social and spiritual needs, support for advanced care planning and its goals, end-of-life care, as well as support in complex decision-making and ethical problems, among others. Recommendations are provided for offering palliative care in COVID-19 pandemic context.

La pandemia de infección por SARS-CoV-2, la cual es causada por COVID-19, ha afectado profundamente a los sistemas de salud y ha ocasionado un enorme impacto en las familias, las comunidades y las naciones. La estrategia de respuesta integral requiere que además de las consideraciones epidemiológicas, científicas y técnicas, no se olvide el sufrimiento humano asociado a la enfermedad, la vulnerabilidad y la muerte. La atención paliativa a personas con sospecha o diagnóstico de COVID-19 con evolución grave y sus familias debe ser también parte clave de la acción organizada que ayude al alivio del sufrimiento y mejore la calidad de vida mediante el control de los síntomas, el abordaje de las necesidades psicológicas, sociales y espirituales, el apoyo para la planificación de la atención avanzada y la articulación de los objetivos de la misma, el cuidado de la persona en la fase final de la vida, así como el soporte ante la toma de decisiones complejas y problemas éticos, entre otros. Se ofrecen recomendaciones para brindar los cuidados paliativos en el contexto de la pandemia de COVID-19.

Análisis situacional de los psicólogos de cuidados paliativos / Situational analysis of palliative care psychologists

INTRODUCCIÓN: Los pacientes con enfermedades crónicas en fase avanzada tienen numerosas necesidades psicológicas, sociales y espirituales, como resultado de su estado físico, condición, curso terapéutico y efectos secundarios del tratamiento, además de distrés psicológico y existencial por lo que la figura del psicólogo en Cuidados Paliativos tiene una gran relevancia. OBJETIVO: Realizar un análisis situacional de los psicólogos integrados a los equipos de cuidados paliativos del sector público en México. MÉTODO: Estudio prospectivo, descriptivo y transversal. Se diseño una encuesta ex profeso de 22 reactivos con respuesta dicotómica y opción múltiple. RESULTADOS: Se analizaron un total de 49 encuestas de psicólogos que prestan sus servicios en unidades de atención médica en México, a través de análisis de frecuencias y porcentajes, chi cuadrada y w de wilcoxon. CONCLUSIONES: Los psicólogos en cuidados paliativos requieren formación y capacitación formal para desarrollar habilidades y competencias específicas en este contexto; y de mayor sistematización y de protocolos de manejo en las evaluaciones e intervenciones psicológicas en el paciente de cuidados paliativos y su familia para evidenciar la contribución de la Psicología en Cuidados Paliativos

INTRODUCTION: Advanced chronic diseases patients have psychological, social and spiritual needs, as a result of their physical state, medical treatments, side effects, psychological and existential distress, so psychologists have great relevance in Palliative Care. OBJECTIVE: Analyze the situation of the psychologists in the palliative care teams of public health units in Mexico. Method. Prospective, descriptive and cross-sectional study. An express survey of 22 items was designed with dichotomous response and multiple choice. RESULTS: Analyzed 49 surveys of psychologists who provide services in medical care units in Mexico: analysis of frequencies, percentages, chi squared and ranks test ́ Wilcoxon. CONCLUSIONS: Palliative care psychologists require formal education and training to develop specific skills and competencies in this context; systematization and management protocols in evaluations and psychological interventions for patients and their families to demonstrate the contribution of psychologist in palliative care

The desire to hasten death in advanced cancer patients at a Mexican palliative care service / Deseos de adelantar la muerte en pacientes con cáncer avanzado en un servicio de cuidados paliativos en México

Abstract Introduction The desire to hasten death (DHD) might be present in patients with advanced cancer. Multiple distressing physical and psychosocial symptoms may be related to it. There is limited literature about the characteristics of these patients in México. Objective To describe the prevalence and factors associated with DHD in advanced cancer patients evaluated by a palliative care psychiatrist. Method We conducted a cross-sectional study, including all patients referred to psychiatric assessment at the Servicio de Cuidados Paliativos of the Instituto Nacional de Cancerología in Mexico City, from January to December 2016. DHD was defined as the presence of death ideas, suicidal ideation, and/or request for euthanasia or medically assisted suicide. Patients with delirium, dementia, psychosis, or uncontrolled physical symptoms were excluded. Results Sixty-four patients were included in the study. Most of them were women (59%); the mean age was 49 years old (SD = 16). Of them, 64% met criteria for a major depressive disorder, 64% for generalized anxiety disorder and/or panic disorder, and 11% for substance use disorders. 44% expressed DHD. In a multivariate regression analysis predicting DHD, only one factor emerged: clinical depression (OR = 13.5, p = .002, 95% CI [02.562, 71.726]). Discussion and conclusion The desire to hasten death is a frequent issue for the patients evaluated at the psychiatric palliative care clinic. Depression and other distressing psychiatric pathologies were associated with DHD. Interdisciplinary interventions are needed to treat DHD. More research is warranted in order to understand the factors associated with the expression of DHD.

Resumen Introducción El deseo de acelerar la muerte (DHD, por sus siglas en inglés) es frecuente en pacientes con cáncer avanzado. Múltiples estresores físicos y psicosociales se asocian a la presencia de este fenómeno. En México es limitada la información sobre estos pacientes. Objetivo Describir la prevalencia y los factores asociados con la presencia del DHD en pacientes con cáncer avanzado evaluados por el psiquiatra de cuidados paliativos. Método Realizamos un estudio transversal, incluimos a todos los pacientes referidos a evaluación psiquiátrica en el Servicio de Cuidados Paliativos del Instituto Nacional de Cancerología en la Ciudad de México, de enero a diciembre de 2016. El DHD se definió como la presencia de ideas de muerte, ideación suicida y/o solicitud de eutanasia o suicidio médicamente asistido. Se excluyeron los pacientes con delirium, demencia, psicosis o algún síntoma físico descontrolado. Resultados Sesenta y cuatro pacientes fueron incluidos en el estudio; 59% fueron mujeres; la edad media era de 49 años (DE = 16). El 64% cumplieron criterios para un trastorno depresivo mayor, el 64% para el trastorno de ansiedad generalizada y/o trastorno de pánico y el 11% para los trastornos por uso de sustancias; 44% expresaron DHD. En un análisis de regresión multivariable, el factor depresión mayor (OR = 13.5; p = .002, IC 95% [02.562, 71.726]) fue el único significativo. Discusión y conclusión El DHD es frecuente en los pacientes valorados por psiquiatría de cuidados paliativos. La depresión mayor se asoció con DHD. Se necesitan intervenciones interdisciplinarias para tratar el DHD. Se requiere más investigación para comprender los factores asociados con la expresión de DHD.

Programa educativo sobre muerte y cuidados paliativos en los profesionales de la salud / Educational program on death and palliative care in health professionals

Introducción: La relación existente entre el personal de salud y la muerte, tienen una inevitable implicación emocional, ya que se vive y convive cotidianamente con la muerte. Objetivo: Conocer el efecto de un Programa Educativo sobre Muerte y Cuidados Paliativos (PEMyCP), fundamentado a partir de la noción de enfermedad y muerte en México. Método: Estudio cuasiexperimental comparativo, muestreo no probabilístico por conveniencia, diseño pretest-postest de un solo grupo, con profesionales de la salud en México. Los instrumentos utilizados fueron: Escala de actitudes ante los cuidados paliativos, Cuestionario de competencias profesionales y Escala de ansiedad ante la muerte de Templer. A través de análisis de frecuencias, pruebas t para muestras relacionadas y análisis de varianza ANOVA. Resultados: El PEMyCP tuvo un impacto positivo en las actitudes ante los cuidados paliativos (t=-2,0050, p=0,44), en las capacidades profesionales (t=6.969, p<0.0001), y ansiedad ante la muerte (t=2,991, p=0,15). Se realizó un ANOVA, encontraron cambios significativos en conocimientos (F=8,5988, p <0,0001) y habilidades (F=6,1197, p<0,0001); sin embargo, no se identificaron cambios en actitudes (F=0,76131, p=0,63738). En la ansiedad ante la muerte, se aprecian diferencias estadísticamente significativas (F=4,0048, p=0,00919). Conclusiones: El PEMyCP tuvo un impacto favorable en conocimientos, habilidades y ansiedad ante la muerte, no siendo así en las actitudes ante la muerte y los cuidados paliativos, ya que se requiere de mayor tiempo para lograr modificarlas debido a que se adquieren no solo aspectos cognitivos, sino también afectivos y conductuales a través de la propia experiencia

Introduction: The existing relationship between health personnel and death, have an inevitable emotional involvement, since they live and coexist daily with death. OBJECTIVE: To know the effect of an Educational Program on Death and Palliative Care (PEMyCP), based on the notion of illness and death in Mexico. Method: Comparative quasi-experimental study, non-probabilistic sampling for convenience, pretest-posttest design of a single group, with health professionals in Mexico. The instruments used were: Scale of attitudes before the palliative care, Questionnaire of professional competences and Scale of anxiety before the death of Templer. Through frequency analysis, tests t for related samples and analysis of variance ANOVA. Results: The PEMyCP had a positive impact on the attitudes towards palliative care (t = -2.0050, p = 0.44), on professional abilities (t = 6.969, p= 0.00), and anxiety about death (t=2.991, p=0.15). ANOVA was performed, found significant changes in knowledge (F=8.5988, p= 0.0000) and abilities (skills) (F= 6.1197, p=0.0000); however, no changes in attitudes were identified (F= 0.76131, p= 0.63738). In the anxiety before death, are observed statistically significant differences (F=4.0048, p=0.00919). Conclusions: The PEMyCP had a favorable impact on knowledge, abilities and anxiety in the face of death, but not in the attitudes towards death and palliative care, since it takes more time to modify them because not only cognitive aspects are acquired, but also affective and behavioral through the own experience

Validation of the Brief Edinburgh Depression Scale (BEDS) in a Mexican population with advanced cancer in a palliative care service.

OBJECTIVE: Depression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer. METHOD: We conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment. RESULT: Seventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20-85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71. SIGNIFICANCE OF RESULTS: Major depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.

Effect of part-time cardiac catheterization facilities in patients with acute myocardial infarction.

BACKGROUND: Although the easy availability of invasive cardiac care facilities is associated with an increase in their use, their influence on outcomes is not clear. We sought to investigate whether a newly available cardiac catheterization laboratory (CCL) performing percutaneous coronary intervention (PCI) on a part-time (PT) basis might improve outcomes in patients with acute myocardial infarction (AMI). METHODS: This was an observational cohort study that included all consecutive patients with AMI admitted to a secondary-level hospital in Spain before and after the PT-CCL opened in January 2006: during 1998-2005 and 2006-2014, respectively. All-cause in-hospital and long-term mortality were the co-primary endpoints. In-hospital complications and length of stay were secondary endpoints. For the analyses, patients were stratified according to propensity-score (PS) quintiles. RESULTS: A total of 5339 patients were recruited, and 50.3% were managed after the opening of the PT-CCL. The PT-CCL was associated with greater use of PCI (81.2 vs. 32.5%, p<0.001) and guidelines-recommended medication (all p<0.001), lower risk of recurrent angina (PS-adjusted RR=0.160, 95% CI 0.115-0.222) and shorter length of hospital stay (PS-adjusted RR for length of stay <8days=0.357, 95% CI 0.301-0.422). In patients with NSTEMI, PT-CCL was associated with improved long-term survival (PS-adjusted HR=0.764, 95% CI 0.602-0.970). CONCLUSIONS: In patients with AMI, a new PT-CCL was associated with greater use of PCI and guideline-recommended medication, lower risk of recurrent angina and shorter length of hospital stay. In a subset of patients with NSTEMI, PT-CCL was associated with improved long-term survival.

Prognostic Usefulness of the 6-Minute Walk Test in Patients With Severe Aortic Stenosis.

The 6-minute walk test distance (6MWD) has been shown to predict prognosis in selected cohorts of patients with heart failure and outcomes after surgical or transcatheter aortic valve implantation (AVI) in patients with symptomatic severe aortic stenosis (AS). Our objective was to evaluate the association between the 6MWD and outcome in patients with severe AS while remaining under medical treatment. In a prospective observational cohort study, a total of 149 patients diagnosed with severe AS by Doppler echocardiography underwent a 6-minute walk test. The single end point was a composite of all-cause death or hospitalization for heart failure. Patients receiving an AVI were censored from follow-up at the time of their AVI, so that only the events that occurred while the patients remained under medical treatment were included in the analysis. During follow-up (median 12.9 months), the end point occurred in 65 patients (43.6%). Univariate analysis showed an association between the 6MWD and the end point (p <0.001). After adjustment for symptoms, left ventricular ejection fraction, aortic valve area, Charlson co-morbidity score, and anemia, the 6MWD independently predicted the end point (adjusted hazard ratio 0.63; 95% confidence interval 0.45 to 0.89; p = 0.010). The incidence of the composite end point was 12 per 100 patient-years in patients with a 6MWD >331 m compared to 86 per 100 patient-years in those with a 6MWD ≤331 m (p <0.001). In conclusion, although patients with severe AS remain under medical treatment, the 6MWD is independently associated with all-cause death or hospitalization for heart failure.

Effectiveness and Safety of Bivalirudin During Percutaneous Coronary Intervention in Acute Coronary Syndrome in the Real World: CARTAGOMAX Study.

The CARTAGOMAX study assessed the safety and efficacy of bivalirudin during real-world cardiac intervention. This was a single-center prospective study. Patients with acute coronary syndrome undergoing percutaneous coronary intervention were anticoagulated with bivalirudin alone or unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor. Propensity score matching was performed to control for baseline imbalances and yielded 1168 patients. There was lower incidence of the composite outcome of death from any cause or major bleeding at 30 days (P = 0.005), 6 months (P = 0.005), and 12 months (P = 0.001) of follow-up in the bivalirudin group, compared with the heparin plus glycoprotein inhibitor group. The administration of bivalirudin was associated with lower rate of all-cause mortality at 1 year of follow-up (P = 0.009). The incidence of major bleeding was lower in the bivalirudin group at 1, 6, and 12 months of follow-up (P = 0.002, P = 0.013 and P = 0.017, respectively). The incidence of stroke and reinfarction were similar between groups during follow-up. The rate of stent thrombosis were slightly higher in the bivalirudin group, without reaching statistical significance at 1 and 12 months of follow-up (P = 0.06, P = 0.04, P = 0.07 at 1, 6, and 12 months, respectively). The CARTAGOMAX study found that the use of bivalirudin during percutaneous coronary intervention was associated with lower incidence of the composite outcome of death from any cause or major bleeding during follow-up. The use of bivalirudin was associated with similar rates of stroke, reinfarction, and stent thrombosis compared with heparin plus glycoprotein inhibitor. Bivalirudin proved to be a safe and effective anticoagulant during percutaneous coronary intervention.

Adaptación en español de la escala de actitudes ante cuidados paliativos: confiabilidad y análisis factorial / Spanish adaptation of the scale of attitudes towards pallative care: reliability and factor analysis

Este estudio instrumental presenta los criterios de confiabilidad y análisis factorial como parte de la adaptación en español de la Escala de Actitudes ante los Cuidados Paliativos (EACP). Se realizó con el objetivo de conocer si la escala cuenta con las propiedades psicométricas para poder ser utilizado para evaluar las actitudes que tienen el personal de salud hacia los cuidados paliativos. Se contó́ con una muestra de 132 profesionales de la salud (80,3% mujeres), con edades comprendidas entre los 20 y 40 años (M = 30; DT = 9,11). Los análisis exploratorios y confirmatorios mostraron un índice de fiabilidad satisfactorio (Alfa de Cronbach: 0,807) que expliquen el 65,063% de la varianza y la solución factorial que contiene las correlaciones entre las variables originales y cada uno de los factores. Dentro de los factores más relevantes consideramos: El Factor 1 que hacen referencia al proceso o directrices de atención en las unidades de Cuidados Paliativos, el Factor 2 que se relacionan con las experiencias personales ante la muerte; y el Factor 5 que se refieren al apoyo social que tienen los Cuidados Paliativos. Concluyendo que la escala cumple con las propiedades psicométricas para ser utilizada tanto en el campo clínico como en la investigación

This instrumental study presents the reliability and factor analysis as part of the Spanish adaptation of the Scale of Attitudes Palliative Care (PSST). I was done with the aim of knowing if the scale has psychometric properties, to be used to assess attitudes with health staff towards palliative care. He had a sample of 132 health professionals (80.3% women), aged between 20 and 40 years (M = 30, SD = 9.11). Exploratory and confirmatory analysis showed a satisfactory rate of reliability (Cronbach’s alpha: 0.807) to explain the 65,063% of the variance and factorial solution containing the correlations between the original variables and each of the factors. Among the most important factors we consider: Factor 1 refers to the process and guidelines for care units Palliative Care Factor 2 that relate personal experiences with death; and Factor 5 which relate to social support have Palliative Care. Concluding that the scale fulfills the psychometric properties for use in both clinical and research field