Supplementation With Bifidobacterium and Symptomatic Control in Irritable Bowel Syndrome: An Evidence-Based Review.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, with a global prevalence of around 11%. Family doctors should be aware of the diagnosis and treatment of this pathology. The benefit of using probiotics is questionable. The purpose of this review is to establish the evidence of the association between Bifidobacterium supplementation and symptomatic control in patients with IBS. The research was conducted using the National Guideline Clearinghouse, National Electronic Library for Health of the British NHS, Canadian Medical Association Practice Guidelines InfoBase, Cochrane Library, Database of Abstracts of Reviews of Effectiveness, Bandolier, Evidence-Based Medicine Online, and PubMed. Articles published between March 2017 and March 2022 in humans and written in Portuguese, Spanish, and English using the terms IBS and Bifidobacterium were included. To stratify the level of evidence (LOE), the Strength of Recommendation Taxonomy (SORT), from the American Academy of Family Physicians, was used. Thirty-seven articles were found corresponding to the search terms, and a total of seven articles were selected. Three clinical trials and a simple review have demonstrated improvement in symptoms, although further studies are needed. The guideline and the systematic review did not demonstrate superiority in symptomatic relief when compared to other species of probiotics. The meta-analysis did not show the efficacy of the isolated use of Bifidobacterium. The evidence of an association between supplementation with Bifidobacterium and symptomatic control in patients with IBS is not clear. Some studies seem to demonstrate benefits in improving symptoms (SORT C).

Adrenal Pheochromocytoma Treated With Stereotactic Body Radiation Therapy.

Pheochromocytoma is a rare neuroendocrine tumor arising from chromaffin cells in the adrenal medulla. In most cases, it is benign and tends to remain localized. However since it leads to the development of cardiovascular disease, it is associated with high rates of morbidity and mortality. Treatment options include medical, surgical, or ablative measures, which often adequately control the disease. Primary pheochromocytoma is conventionally treated with external beam radiation therapy (EBRT), while stereotactic body radiation therapy (SBRT) is preferred for cases with metastasis. However, literature regarding the use of SBRT for the treatment of primary disease is scarce. This case report describes a patient with an inoperable primary adrenal gland pheochromocytoma who was treated with SBRT, resulting in adequate symptomatic control during clinical follow-up.

Flecainide is well-tolerated and effective in patient with atrial fibrillation at 12 months: a retrospective study.

INTRODUCTION: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived. METHODS: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months. RESULTS: Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use (p = 0.024), female sex (p = 0.006), hypertension (p = 0.040), and dronedarone failure (p = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure (p = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common. CONCLUSION: Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.

As intervenções especializadas do enfermeiro em Cuidados Paliativos / The specialized interventions of nurses in Palliative Care

A ciência torna-se insensível quando a pessoa fica reduzida a um mero objeto despersonalizado. Lidar com os doentes enquanto sujeitos, procurando a sua participação e defendendo a sua autonomia no projeto terapêutico, constitui a chave do sucesso a todos os níveis e adquire particular importância quando estamos a lidar com doentes com doença incurável. Talvez o "remédio" mais eficaz para lidar com o sofrimento do doente incurável e sua família seja a qualidade do relacionamento mantido entre o doente e seus cuidadores, e entre o doente e sua família. A qualidade curativa da terapêutica pode facilmente ser enfraquecida ou ameaçada quando reações emocionais (negação, raiva, culpa e medo) sentidas pelos doentes, famílias ou cuidadores não são adequadamente monitorizadas e avaliadas. É claro que está no coração da relação terapêutica entre doente e cuidadores o cuidado das necessidades de relação, bem como, de uma comunicação honesta e verdadeira. Nesta perspetiva, para lidar de forma eficaz com a pessoa em fim de vida e família é essencial perceber a complexidade dos sujeitos (incluindo os profissionais), a multicausalidade dos problemas de saúde e os "ingredientes" do sofrimento humano. Nesta linha de pensamento, tendo em conta a nossa experiência e o regulamento de competências específicas emanadas pela Ordem dos Enfermeiros, consideramos que é urgente mudar a forma de estar relativamente ao cuidar do doente com patologia incurável, quer esteja ou não em fim de vida, assim como cuidar dos profissionais da saúde enquanto pessoas que sofrem ao lidar com o sofrimento do seu semelhante. Assim, com o objetivo de desenvolver competências especializadas e habilidades na área dos Cuidados Paliativos a nossa opção recaiu pela realização de um Estágio de Natureza Profissional na Equipa de Suporte de Cuidados Paliativos da Unidade Local de Saúde de Matosinhos, de forma a contribuir para um cuidar de forma sustentada e integral. A nossa prestação de cuidados de enfermagem especializada assentou nas componentes fundamentais dos cuidados paliativos, nomeadamente: controlo de sintomas; comunicação; trabalho em equipa, apoio à família e acompanhamento no processo de luto. Procuramos adotar metodologias interativas, dinâmicas, considerando a unidade de cuidados, e respeitando os princípios éticos, deontológicos e legais. Verificamos, através da nossa prática clínica no Estágio de Natureza Profissional, que prestar Cuidados Paliativos exige uma abordagem onde se disponibilizem técnicas ativas de cuidados, mas com competências de comunicação especiais: baixa tecnologia e elevado afeto.Ajudar uma pessoa a morrer bem, é apoiar o sentido de amor próprio, dignidade, espiritualidade e escolha dessa pessoa até ao último momento de vida. Para o conseguir, prestamos cuidados sensíveis e individualizados, de forma que a experiência da pessoa em final de vida fosse livre de dor, sentindo-se reconfortada. É obrigatório manter a nossa espiritualidade viva e dar sentido à nossa vida e à VIDA. Parece podermos afirmar que com a realização deste estágio de natureza profissional adquirimos competências técnicas, científicas, relacionais e humanas, bem como, um pensamento mais crítico para a prestação de cuidados paliativos.

Science has brought with it insensitivity when a person gets reduced to a mere depersonalised object. Dealing with a patient as subjects, seeking for their participation and standing for their autonomy in the therapeutic project, constitutes the key for the success at all levels and helps acquire major importance when dealing with patients with incurable diseases. The most efficient "solution" to deal with the suffering of incurable patients and their family may be the relationship kept between the patient and the caregivers, besides the patient and the family. The quality of the curative therapeutic might be easily weakened or threatened when emotional relationships (denial, anger, guilt and fear) felt by the patient, the families or the caregivers are not properly monitored and evaluated. The attention to the needs of the therapeutic relationship, as well as an honest and truthful communication, are most certainly the centre piece of the therapeutic relationship among patient and caregivers. Having this perspective in mind, to be able to handle efficiently with the person in the end-of-life and their families it is essential to understand the complexity of the individuals (including the professionals), the multiple causes for the health problems and the "ingredients" causing human suffering. Bearing this thought, having in account our experiences and the regulation of the specific competences issued by the "Ordem dos Enfermeiros" (Order of the Nurses), we consider that it is urgent to change the way we perform towards the care provided to the patient with incurable pathology, whether he/she is or is not at the end-of-life. It is also urgent to change the way we take care of the professional health providers as individuals that suffer when dealing with the suffering of others. This way, having as main purpose the development of specialised skills and expertise in the palliative car area, our focus was the creation of a Professional Apprenticeship for the Support Team of Palliative Care of the Local Health Unit of Matosinhos, so as to enable caring for people in a more sustained and integral manner. Our care provision of specialised nursing laid on fundamental elements of the palliative care, namely: control of symptoms; communication; team work; family support and assistance in the mourning process. We tried to adopt interactive, dynamic methodology, taking in notice the care unit and respecting ethical, deontological and legal principles. We noticed, through the clinical practice in the Professional Apprenticeship, that providing palliative care demands an approach in which active care technics are available but with special communication skills: low level of technology, high level of affection. Helping a person to die better is to support the sense of self-love, dignity, spirituality and choice of the person involved until the last breath of life. To manage that we provide sensitive and individual care, in such a way that the experience of the person in the end-pf-life would be free of pain, feeling reassured. It is mandatory to keep spirituality alive and to give sense to our life and to LIFE itself. We believe we can state that with this Professional Apprenticeship we acquired technical, scientific, relational and human competitions, as well as, a more critical thinking concerning palliative care provision.

Investigation of the efficacy and safety of CyberKnife hypofractionated stereotactic radiotherapy for brainstem metastases using a new evaluation criterion: 'symptomatic control'.

The treatment of brainstem metastases remains a challenge as the brainstem itself is considered a neurological organ at risk. We aimed to investigate the efficacy and safety of CyberKnife hypofractionated stereotactic radiotherapy (HFSRT) for brainstem metastases, and to examine the balance between efficacy and safety for the management of neurological symptoms. A total of 26 lesions [pons (n = 18), medulla (n = 4) and midbrain (n = 4)] in 20 patients treated with CyberKnife hypofractionated stereotactic radiotherapy were retrospectively analyzed. The total radiation doses (18-30 Gy) were delivered in 3 or 5 equal fractions. The median follow-up was 6.5 (range, 0.5-38.0) months. The 6- and 12-month local control rates were 100% and 90%, respectively. Symptomatic failures, defined as the worsening and appearance of neurological symptoms due to the brainstem lesion after CyberKnife HFSRT, were observed in 6 patients [local failure (n = 1) and adverse events (n = 5). The symptomatic control and overall survival rates were 90% and 72% (after 6 months), respectively, and 76% and 53% (after 12 months), respectively. Longer symptomatic control was associated with site of lesion origin, and longer overall survival was associated with a graded prognostic assessment score of >2. To our knowledge, this is the second study to investigate the efficacy and safety of CyberKnife HFSRT for brainstem metastases. The local control rate was comparable with that of prior stereotactic radiosurgery studies. We propose a new evaluation criterion-'symptomatic control'-to evaluate the efficacy and safety of brainstem radiotherapy.

Desenvolvimento de competências especializadas em cuidados paliativos / Development of expertise in palliative care

Face ao contexto atual, fortemente marcado pelo envelhecimento progressivo da população, com forte aumento das doenças crónicas e degenerativas, os Cuidados Paliativos surgem como uma resposta cada vez mais essencial às necessidades físicas, psicológicas, sociais e espirituais, prolongando a sua ação até ao luto. É através deles que garantimos o máximo bem-estar e qualidade de vida de cada pessoa até ao fim da vida. Neste sentido, pareceu-nos importante realizar um estágio de Natureza Profissional de 350 horas presenciais na Unidade Local de Saúde de Matosinhos ­ Equipa de Suporte em Cuidados Paliativos com o objetivo de desenvolver competências especializadas na área dos cuidados paliativos, nomeadamente nas quatro componentes primordiais: controlo de sintomas; comunicação adequada; trabalho em equipa e apoio à família. A nossa finalidade com a realização deste estágio consiste na obtenção de competências através do treino, da reflexão crítica e analítica para um cuidar humano, integral na construção de um processo de morrer condigno e para uma tomada de decisão consistente e adequada às necessidades efetivas da pessoa em fim de vida e família. A nossa prestação de cuidados de enfermagem especializados assentou em metodologias ativas, dinâmicas e participativas de forma a integrar e aplicar os conhecimentos teóricos adquiridos. Salientamos, que tivemos em atenção um cuidar centrado no doente e família, a obediência dos princípios éticos e deontológicos e a garantia de cuidados com qualidade. Desenvolver competências a nível da comunicação é difícil na medida que envolve muitas especificidades pelo facto de termos que tomar decisões que envolve situações complexas, únicas e individuais. Assim estas competências foram desenvolvidas através de um estilo comunicacional facilitador e centrado na pessoa, numa análise critica e reflexiva e no estabelecimento de uma relação de ajuda. Também o trabalho em equipa foi sempre uma nossa preocupação de forma adquirir e aprofundar estratégias de trabalho em equipa, nomeadamente colaborar eficazmente na prestação de cuidados, bem como participar nas reuniões semanais dando o nosso contributo. A nível do controlo de sintomas desenvolvemos competências na avaliação das necessidades, avaliação e monitorização de sintomas, medidas farmacológicas e não farmacológicas, refletindo sempre nos ganhos para o doente. A nível do acompanhamento familiar enfatizo as conferências familiares como uma ferramenta facilitadora da integração da família no cuidado ao doente. A nossa participação no âmbito da gestão, formação e investigação permitiu não só o desenvolvimento de competências como promoveu mudanças e novas formas de intervenção. Sobressai da realização deste estágio que para conseguir dar uma resposta mais organizada face à necessidade de tratar, cuidar e apoiar ativamente os doentes na fase final de vida, prestando cuidados de excelência, aumentando assim a qualidade de vida do doente e família é necessário competências técnicas, cientificas, relacionais e pensamento crítico e analítico. Consideramos ter desenvolvido competências para prestar cuidados paliativos de excelência.

Towards the current context, heavily marked by the progressive aging of the population, with a strong increase of chronic and degenerative diseases, Palliative Care comes up as an answer more and more essential to the physical necessities, psychological, social and spirituals, prolonging their action to the mourning. It is through them that we guarantee the well-being and life quality of each person till the end of its life. Facing that, it seemed important to us to realize a professional internship of 350 hours in the Health Local Unit of Matosinhos- Support team in Palliative Care with the goal of develop expertises in the field of palliative care, namely in the four essential components: control symptoms; proper communication; team work and family support. Our goal with this internship consist in obtain skills through the practice, critical and analytical thinking for a human care, integral in building a dignified dying process and for taking a consistent and appropriate decision to the actual needs of a person in the end of his life and family. Our provision of specialized nursing care was based on active methodologies, dynamic and participatory in order to integrate and apply the theoretical knowledge acquired. We point out that we had in mind a care focused in the patient and family, the obedience of ethical and deontological principles and ensuring quality care. Develop communication skills is difficult as it involves many specifics because we have to make decisions involving complex, unique and individual situations. So, this skills were developed throughout a communicational style facilitator and centred in the person, in a critical and reflexive analyse and in the establishment of a caring relationship. Also the work team has always been a concern in a way that we could gain and go deep in the work strategies in team, namely collaborate effectively in the caring, as also participate in weekly meetings with our contribute. On the level of the symptoms control we developed skills in the evaluation of necessities, evaluation and monitoring of symptoms, pharmacological measures and non-pharmacological measures, always reflecting in the gains for the patient. On the level of the family support I emphasize the family conferences as a facilitator of integration of family in the care to the patient. Our participation in the organization, formation and research has permitted not only the development of skills as it promoted changes and new ways of intervention. In this internship it is to put on focus that in order to give an answer more organized to the necessity of caring, to care and support actively the patients in the end of their lives, giving cares of excellence, increasing in that way the life quality of the patient and family it is necessary scientific tactics, relational and critical and analytical though. We consider to have developed skills to give palliative cares of excellence.