Navegando por Palavras-chave "palliative care"
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- ItemSomente MetadadadosAnálise do conhecimento de médicos residentes sobre cuidados paliativos em um hospital universitário(Universidade Federal de São Paulo (UNIFESP), 2016-11-29) Braga, Alessandra Lopes [UNIFESP]; Machado, Flavia Ribeiro Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: This study aimed to assess the medical knowledge about palliative care among residents in a university hospital, to analyze possible factors associated with better performance in terms of knowledge and to compare residents from clinical and surgical specialties as well as residents in different stages of the residence. Methods: We applied the modified PEACE-Q, with 30 questions divided into 8 domains, in medical residents of clinical specialties (clinical oncology, cardiology, geriatrics, intensive care, nephrology and pulmonology) and surgery (urology, head and neck, gastrointestinal, plastic, thoracic or vascular) who attended the first year and the last year of residence, as well as those recently graduated. The questionnaire was applied either personally or through electronic survey. We also obtained information about personal characteristics and previous educational background. We consider as adequate reading having read 4 items or more in the last year and as adequate participation having attending 4 or more events in the last year. Results: From October 2015 to March 2016, 143 residents, among 252 eligible residents, completed the questionnaire. Considering all domains, the total score was 76.7 (73.3 ? 83.3). There was a significant difference in the percentage of correct answers when comparing residents of clinical [80.0 (73.3 ? 86.7)] and surgical specialties [73.3 (66.7 ? 76.7)] with a p < 0.0001. The percentage of correct answers was higher among those who had adequate reading [86.7 (80.0 ? 90.0)] than those without adequate reading [76.7 (70.0 ? 80.0); p < 0.0001]. The percentage of correct answers was higher among those who had adequate participation in events [83.3 (74.2 ? 90.0)] than those without adequate participation in events [76.7 (73.3 ? 83.3); p = 0.012] but there was no difference among residents in different stages (p = 0.095). There was a weak correlation between the self attributable score and the performance in the questionnaire (r = 0.408 e p < 0.0001). When we analyze separately each domain, we observed a higher rate of incorrect answers in the cancer one. Clinical specialties had a better performance than surgical specialties in questions related to philosophy (p < 0.014), dyspnea (p < 0.0001) and side effects of opioids (p < 0.006). Conclusion: The knowledge of medical residents on palliative care assessed through the modified PEACE-Q was variable, being better among residents of clinical rather than surgery specialties. We didn?t observe an improvement during the residence. Adequate previous information was associated with improved performance.
- ItemSomente MetadadadosA comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease(Elsevier B.V., 2006-01-01) Solano, Joao Paulo [UNIFESP]; Gomes, Barbara; Higginson, Irene J.; Universidade Federal de São Paulo (UNIFESP); Kings Coll LondonLittle attention has been paid to the symptom management needs of Patients with life-threatening diseases other than cancer. in this study, we aimed to determine to what extent patients with progressive chronic diseases have similar symptom profiles. A systematic search of medical databases (MEDLINE, EMBASE, and PsycINFO) and textbooks identified 64 original studies reporting the prevalence of 11 common symptoms among end-stage patients with cancer, acquired immunodeficiency syndrome (AIDS), heart disease, chronic obstructive pulmonary disease, or renal disease. Analyzing the data in a comparative table (a grid), we found that the prevalence of the 11 symptoms was often widely but homogeneously spread across the five diseases. Three symptoms-pain, breathlessness, and fatigue- were found among more than 50% of patients, for all five diseases. There appears to be a common pathway toward death for malignant and nonmalignant diseases. the designs of symptom prevalence studies need to be improved because of methodological disparities in symptom assessment. and designs.
- ItemSomente MetadadadosCuidados paliativos para pacientes com câncer de cabeça e pescoço: impacto no controle da dor e qualidade de vida(Universidade Federal de São Paulo (UNIFESP), 2014-09-24) Eugenio, Cecilia [UNIFESP]; Paiva, Marcos Bandiera Paiva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Evaluate whether there was a change in the quality of life and pain management in patients with malignant head and neck tumors referred to the Palliative Care Outpatient Clinic in the Department of Head and Neck Surgery, Federal University of São Paulo (UNIFESP) in a period of three months. Method: 44 patients with one of the following criteria were refered to the clinic: presence of distant metastasis, unresectable tumor, or inoperable patients due to lack of clinical conditions. 42 patients participated in the survey. In all 4 stages of the follow up (first office visit, 30, 60, and 90 days) the following survey was applied: the questionnaires on quality of life of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 (version 3.0) and EORTC QLQ-C15-PAL, hospital anxiety and depression scale (HADS), and verbal rating scale (VRS) to assess pain. Results: All patients were classified as stage IV and 78.6 % reported pain. There was improvement on pain management from the first return with p = 0.01, which was maintained in other queries. There was improvement in emotional function on the questionnaires on quality of life and reduction of anxiety on HADS after 60 days follow up. Conclusion: The intervention by a palliative care specialist team is able to better manage pain and emotional symptoms of patients with malignant head and neck tumors with advanced disease and no chance of cure.
- ItemSomente MetadadadosMapeamento internacional e avaliação de diretrizes de cuidados paliativos em câncer de mama(Universidade Federal de São Paulo (UNIFESP), 2015-12-31) Santos, Adson Roberto Franca dos [UNIFESP]; Atallah, Alvaro Nagib Atallah [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: carry out an international mapping and critically evaluate guidelines for palliative care in breast cancer. Design: mapping national and international literature during the period 2003-2014, using Cochrane Collaboration methodology with critical evaluation of the guidelines. Site: lybraries, online research sites. Participants: the author. Interventions: systematic literature search on palliative care in breast câncer and the analyses of the data collected. Key outcome measures: the studies identified would be evaluated through AGREE II instrument (The Agree Research Trust, 2009) which aims at evaluating guidelines, taking into account process elaboration methodology, transparency, and applicability, based on the best scientifficaly evidences. Results: 1477 citations were found in the databases. However, no specific palliative care guideline for breast câncer was identified, despite the relevance of the problem and the specificities and particularities of women, whether concerning physical nature, feminine identity, gender, body image, and several emotional, psychological, psychosocial, ethics and bioethics aspects, from diagnosis to death and grief, when cure is not possible. Conclusions: it was observed that the lack of specific guidilene for palliative care in breast cancer represents an important gap on patients care from diagnosis, and the several phases of treatment, as well as end of life care and grief, when cure is not possible.
- ItemSomente MetadadadosMorte e vida em situação de rua: reflexões sobre cuidados paliativos(Universidade Federal de São Paulo (UNIFESP), 2013-02-27) Pereira, Clara Maria Conde [UNIFESP]; Bretas, Ana Cristina Passarella Bretas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background Under the National Health System is the latest model of effective health care to homeless as well as universal access to palliative care. Despite advances in the design of these services, they are still preliminary and not ensure communication between the demands of the street and Palliative Care. This observation embased this study and it brings reflexion to the need of uniting these two issues. Objective Aims to understand the meaning of death and dying for homeless with diseases without therapeutic possibilities of healing. Method The method was the Oral History, thematic mode, because it corresponds to a more restricted narration about a particular topic. Data were collected by interview technique, in a shelter in the city of São Paulo. The study included four adults with chronic therapy without the possibility of healing and an elderly woman with sequelae, caused by leprosy, limiting her quality of life. Three leading themes were used in the analysis: (1) Disease (re) signifying life, (2) Meaning of Death and (3) Difficulty of finding diagnosis and lack of support. Main results We concluded that the Palliative Care Program is not a demand directly stated by interviewees, however the need for comprehensive care and equitable permeated all narratives. The narrators are their own caregivers, and the discovery of their disease triggered more suffering for them than going to the street itself, mainly by the social stigma of HIV / AIDS and leprosy. The social death is prior to biological death, so think about death in the street requires reflection about many deaths that occur concomitantly and may be more significant than the end of life. Considerations The homeless population is aging, so over the years the demand for Palliative Care is increasing. We believe that hospice care is an alternative for those people in advanced stages of the disease, unable to maintain their independence, requiring care, without a support network. We also reinforced the need to implement intersectoral public policies, especially among the areas of Health, Education and Welfare, and the universities that fit the social commitment to the training of professional ethical and sensitive skills with technical, scientific and policy to take care of people on the streets and diseases without therapeutic possibility of healing.
- ItemSomente MetadadadosA Palliative Prognostic Score for Terminally Ill Children and Adolescents With Cancer(Wiley-Blackwell, 2010-12-01) Kurashima, Andrea Yamaguchi; Dias de Oliveira Latorre, Maria do Rosario; Camargo, Beatriz de; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Background. the loss of a child is considered the hardest moment in a parent's life. Studies addressing length of survival under pediatric palliative care are rare. the aim of this study was to improve a survival prediction model for children in palliative care, as accurate information positively impacts parent and child preparation for palliative care. Procedure. Sixty-five children referred to a pediatric palliative care team were followed from August 2003 until December 2006. Variables investigated (also included in previous studies) were: diagnosis, home care provider, presence of anemia, and performance status score given by the home care provider. Clinical variables such as symptom number were also used to test the score's ability to pre-validated using the above variables. the number of symptoms at transition to palliative care does not improve the score's predictive ability. the sum of the single scores gives an overall score for each patient, dividing the population into three groups by probability of 60-day survival: Group A 80.0%, Group B 38.0%, and Group C 28.5% (P < 0.001). Conclusion. A pediatric palliative care score based on easily accessible variables is statistically significant in multivariate analysis. Factors that increase accuracy of life expectancy prediction enable adequate information to be given to patients and families, contributing to therapeutic decision-making issues. Pediatr Blood Cancer. 2010;55:1167-1171. (C) 2010 Wiley-Liss, Inc.