Dimensions of suffering and the need for palliative care: experiences and expectations of patients living with cancer and diabetes and their caregivers in Mexico - a qualitative study.

OBJECTIVES: Over 40 million people in low-income and middle-income countries (LMICs) experience serious health-related suffering (SHS) annually and require palliative care. Patient and caregiver experiences of SHS in LMICs are understudied despite their importance in guiding palliative care provision. Diabetes and cancer are the second-leading and third-leading causes of death in Mexico, causing a significant SHS burden on patients, families and health systems. This study examines SHS and palliative care from the point of view of patients with cancer and diabetes and their caregivers. DESIGN: A qualitative descriptive study based on in-depth telephone interviews was conducted between August 2021 and February 2022. Data were analysed through inductive thematic analysis. PARTICIPANTS: Overall, 20 patients with end-stage cancer, 13 patients with diabetes and 35 family caregivers were interviewed individually. SETTING: Participants were recruited from two family medicine clinics and a pain clinic in Mexico City. RESULTS: Seven themes emerged: (1) suffering as a multifaceted phenomenon, (2) diversity in perceptions of suffering, (3) different coping strategies, (4) need and perceived importance of relief from suffering, (5) barriers to accessing services to relieve suffering, (6) demand for the health sector's active and humane role in addressing suffering and (7) preferences and need for comprehensive care for relief from suffering. The primary coping strategies included family companionship, protective buffering and faith-based support. Participants lacked knowledge of palliative care. They expressed the importance of relief from suffering, viewing it as the health sector's responsibility and requesting more humane, personalised care and access to medicines and pain clinics. CONCLUSIONS: The multifaceted nature of SHS highlights the health system's responsibility to provide high-quality palliative care. Policies to enhance access to palliative care should integrate it into primary care, redesigning services towards patient and caregiver biopsychosocial and spiritual needs and ensuring access to medicines and competent health personnel.

Patients and nursing-related factors associated with switching from peritoneal dialysis to hemodialysis: A cross-sectional survey.

The study aimed at analyzing patients and nursing-related factors associated with switching from peritoneal dialysis to hemodialysis. A telephone survey with 574 patients receiving care at six peritoneal dialysis centers of the Mexican Institute of Social Security was conducted: 64.3% were on peritoneal dialysis, and 35.7% had transitioned from peritoneal dialysis to hemodialysis. Data were collected on participants' sociodemographic and clinical characteristics, peritoneal dialysis center size, and nursing workload. Descriptive, bivariate, and multiple Poisson regression analyses were performed. Factors associated with an increased probability of switching from peritoneal dialysis to hemodialysis were a history of catheter dysfunction, peritonitis, and being treated in a large peritoneal dialysis center with a low (<50 patients per nurse per month) or high nursing workload (>70 patients per nurse per month) located in the State of Mexico, compared to a medium-size peritoneal dialysis center with a moderate workload (50-70 patients per nurse per month). To decrease the odds of switching from peritoneal dialysis to hemodialysis, improvement programs should aim to limit nurses' workload to 50-70 patients per nurse per month and implement evidence-based nursing interventions to prevent, detect, and manage peritonitis and peritoneal catheter dysfunction.

Patient experience in automated peritoneal dialysis with telemedicine monitoring during the COVID-19 pandemic in Mexico: Qualitative study.

AIM: The aim of the study was to understand the experiences of patients on automated peritoneal dialysis (APD) during the period of confinement due to the COVID-19 pandemic. DESIGN: Qualitative exploratory study, phenomenological through semi-structured telephone interview. METHOD: A priori sampling was carried out with patients on APD with remote monitoring and telephone follow-up, in 13 hospitals in Mexico. RESULTS: Twenty-nine informants, mean age 45.41 ± 16.93; 15 women and 14 men. The analysis revealed four categories of analysis: home isolation, clinical follow-up, socioeconomic challenges and infodemic. The experiences of these patients led them to somatize emotions, presenting symptoms such as anxiety, sadness, loneliness, sleep, eating and digestive disorders, situation that sets the tone for future research on telemedicine care models, coping styles, emotional support strategies and socioeconomic impact on patients with chronic home treatments during the pandemic.

Challenges for Peritoneal Dialysis Centers Before and During the COVID-19 Pandemic in Mexico.

AIM: We aimed at performing a situation analysis to identify challenges that Mexico's peritoneal dialysis centers (PDCs) have faced before and during the COVID-19 pandemic. METHODS: From May-August 2021, we conducted a cross-sectional nationwide online survey with the heads of 136 PDCs at the Mexican Institute of Social Security. The survey gathered information about PDCs characteristics and the adaptations and challenges they faced before and during the COVID-19 pandemic. The response rate to the survey was 79.5% (136 out of 171 PDCs). We used descriptive statistics to analyze the data. RESULTS: The survey responses suggest wide variations between PDCs regarding their number of patients, healthcare staff availability, and compliance with the International Society for Peritoneal Dialysis recommendations. In the pre-pandemic period, PDCs faced staff shortages (71.3%); scarcity of supplies (39.0%); catheter dysfunctions (29.4%); poor patient adherence to peritoneal dialysis (PD) (28.6%); and lack of patient support networks (25.7%). During the pandemic, PDCs faced emergent challenges, such as losing designated PDC areas within hospitals (61.0%), and staff and supply shortages (60.2%, 41.1%, respectively) because of a reallocation of human and physical resources towards the COVID-19 response. The pandemic prompted 86.7% of PDCs to implement preventive public health measures, delay non-urgent consultations and procedures (63.6%), and introduce telemedicine (37.3%). Additionally, fewer patients visited PDCs because of their fear of COVID-19 contagion (36.0%). CONCLUSIONS: Actions are urgently needed to ensure adherence to evidence-based PD guidelines and sufficient resources, including trained staff, supplies, and designated spaces to strengthen PDCs and provide safe and effective PD.

Relationship Between the Gut Microbiota and Alzheimer's Disease: A Systematic Review.

BACKGROUND: In recent years, scientific research on the gut microbiota and their relationship with some diseases, including neurological ones, has notably increased. As a result of these investigations, the so-called gut-brain axis arises. Despite its influence on the evolution and development of cognitive impairment, the gut-brain axis is little defined and demonstrated. OBJECTIVE: To provide the best scientific evidence available on the relationship between the gut microbiota and Alzheimer's disease. METHOD: Systematic and narrative review of the information generated in the last 5 years in national and international databases, in English and Spanish. RESULTS: Eight observational studies were selected, carried out in humans and, therefore, suitable for inclusion in this review. CONCLUSION: The results of these studies support the hypothesis that there is a relationship between the gut microbiota and cognitive disorders through the gut-brain axis. However, today, there is a substantial lack of human studies, especially clinical trials, which makes it difficult to formulate clinical recommendations on this topic.

Enfermería de práctica avanzada en tiempos de COVID-19. Revisión sistemática / Advanced practice nursing in times of COVID­19. Systematic review

Introducción: esta revisión sistemática destaca la enfermería de práctica avanzada (EPA) ante la atención en primera línea de defensa frente a la pandemia por COVID­19. Objetivo: sistematizar la información publicada recientemente sobre la EPA en la atención de pacientes afectados por COVID­19. Metodología: revisión narrativa sistematizada, como método científico para la identificación, recolección, evaluación y síntesis de la evidencia científica existente desde el inicio de la pandemia por COVID­19, de diciembre de 2019 a mayo de 2020. Las bases de datos consultadas fueron: PubMed, Web of Science, Scopus y Dialnet. Resultados: se incluyeron 10 documentos: siete de China (70%), dos de Estados Unidos (20%) y uno de Canadá (10%) que recoge datos de países de Latinoamérica. Los estudios encontrados varían en el objetivo; seis de ellos se enfocan en la percepción de las enfermeras sobre las medidas de higiene y seguridad en atención directa al paciente, recomendaciones para reducir el riesgo de infección de las enfermeras y documentos enfocados en presentar formas de innovación para reducir el uso innecesario de equipo de protección personal. Conclusión: las acciones de la EPA son muy importantes para dar respuesta a las necesidades de atención ante la pandemia mundial por COVID­19 en todos los niveles, tanto en el paciente ambulatorio hospitalizado como en la participación en la gestión y organización de servicios, a fin de dar respuesta inmediata a una gran demanda sanitaria y social.

Introduction: This systematic review highlights the advanced practice nursing (APN) in the front line of care against the COVID­19 pandemic. Objective: To systematize the recently published information on APN in the care of patients affected by COVID­19. Methods: Systematic narrative review, as a scientific method for identifying, collecting, evaluating and synthesizing the existing scientific evidence, from the start of the COVID­19 pandemic, from December 2019 to May 2020.The databases consulted were PubMed, Web of Science, Scopus and Dialnet. Results: 10 documents were included, seven from China (70%), two from the USA (20%), and one from Canada (10%) which collects data from Latin American countries. The studies found vary in the objective; six of them focus on nurses' perception of hygiene and safety strategies in direct patient care, recommendations to reduce the risk of infection of nurses, and documents focused on presenting strategies for innovation to reduce unnecessary use of personal protective equipment. Conclusion: The measures of APN are very important to respond to the care needs in the face of the COVID­19 global pandemic at all levels, both in hospitalized outpatients and in participation in the management and organization of services, in order to respond immediately to a great health and social demand.