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Factors associated with polypharmacy and inappropriate prescription at the end of life: descriptive study
Andrea Riaño Pérez1, Rafael Lopez-Bas Valero2, Lourdes Lajara Villar3, Josep Vicente Mas3, Philip Erick Wikman- Jorgensen4
1Medicina Interna. Hospital San Juan de Alicante, Mutxamel. 2unidad de hospitalización a domicilio. Hospital San Juan, Alicante, Alicante. 3Medicina Interna. Hospital San Juan, Alicante, Alicante. 4Medicina Interna. Hospital de Elda, Alicante

Introduction. Polypharmacy and potentially inappropriate prescribing at the end of life are a major problem in health care, due to both the risks of adverse effects and the lack of short-term benefit associated with some drugs. This study aims to assess the prevalence of polypharmacy and potentially inappropriate prescribing in terminally ill patients and to identify associated risk factors.
Objective: Assess the prevalence of polypharmacy and inappropriate prescription, as well as determine the factors associated with it.
Material and methods. This retrospective cross-sectional study reviewed the clinical and treatment records of all patients who died under the care of the Home Hospitalization Unit from November 2019 to March 2020. We have analyzed sociodemographic characteristics, comorbidities and active medication both at 12 months and the month before death.
Results. The study included 136 patients. Twelve months before dying, 71.9% (n=98) were polymedicated: 52.2% (n=71) of the total sample had 5 to 10 active prescriptions; 18.3% (n=25), 11 to 15 prescriptions; and 1.4% (n=2), more than 15. Just 27.9% (n=38) of the patients were taking fewer than 5 drugs. In the month preceding death, 66% (n=90) of the patients were polymedicated; prescriptions included lipid-lowering drugs (16.1%), antiplatelets (24.2%), oral antidiabetics (17.6%), proton pump inhibitors (53.6%), and vitamin D (22%). Furthermore, oral antidiabetics have an OR of 11.67 for patients with polypharmacy and vitamin D an OR of 5.54
Conclusions: The results of this study show that a high percentage of patients maintain preventive treatments in their last days of life, drugs with little benefit in such a short term, where we should prioritize measures that optimize quality of life. The clinical consequences of our findings indicate that it is crucial to reconsider the administration of these medications in patients with palliative needs

DOI: 10.20986/medpal.2024.1488/2024
Decompressive Gastrostomy for patients with Malignant Bowel Obstruction: Case Review
Claudia Jimena Cardenas Rey1, Juan Esteban Correa Morales2, Luisa Fernanda Rodríguez Campos3, Bilena Margarita Molina Arteta4
1Dolor y cuidados paliativos. Universidad de la Sabana, bogota. 2Facultad de Medicina. Universidad de la Sabana, . 3Especialidad de Dolor y Cuidados Paliativos. Universidad de La Sabana, Bogotá. 4Medicina del dolor y cuidados paliativos . Instituto nacional de cancerología, Bogota

Background: Malignant intestinal obstruction is a common oncological complication; it limits survival and affects the quality of life of patients. Surgical management options are often more effective than medical strategies but carry a higher complication rate. Recent consensus proposes percutaneous decompressive gastrostomy as an alternative for refractory symptoms to medical management.
Patients/Methods: A retrospective observational case series study was conducted on patients with malignant intestinal obstruction who underwent decompressive gastrostomy with palliative intent, treated between the years 2015 and 2022 at the National Cancer Institute in Bogotá, Colombia. Patients were identified through the Universal Procedure Point Code registered in medical records and extracted from the oncology center's database. For patients meeting inclusion criteria, sociodemographic, oncological, and clinical variables were documented by two investigators based on the medical records.
Results: A total of 426 medical records were reviewed, revealing 3 patients diagnosed with malignant intestinal obstruction who underwent palliative surgical management with decompressive gastrostomy. The patients ranged in age from 27 to 43 years, all underwent open surgical procedures, and on average received palliative care assessment on the eleventh day after admission. They required an average dose of 73 mg of equivalent doses of morphine per day, stayed hospitalized for a mean of 23 days, and succumbed approximately 14 days after the procedure.
Conclusion: Malignant bowel obstruction is a complex pathology with a high symptomatic burden. Decompressive gastrostomy is a rarely used procedure in the global south that could be useful if performed promptly, percutaneously, in patients who want to be treated at home or whose symptoms are refractory to medical management

DOI: 10.20986/medpal.2024.1419/2023
Palliative care and cornea donation: a matter of vision
Diego Candelmi1
1Medicina Paliativa. Clinica Universidad de Navarra, Pamplona

DOI: 10.20986/medpal.2024.1528/2024
About our hospitals
Esther Serra Giménez1
1Gestión de casos de Cronicidad. Área de Salud de Eivissa y Formentera. IBSALUT, Eivissa

DOI: 10.20986/medpal.2024.1530/2024
Advanced heart failure as a reason for admission to a medium-stay palliative care unit in the Community of Madrid: beyond oncological pathology
Gemma Cuesta Castellón1, Concepción Jiménez Rojas2, Saleta Goñi Rosón3, Lucía Gómez González4, Javier Gómez Pavón5
1Geriatría . Hospital Universitari de Vic, Vic. 2Unidad de Cuidados Paliativos. Hospital Universitario Central de la Cruz Roja, . 3Geriatria. Hospital Universitario Infanta Sofía, Madrid. 4Geriatría. Hospital Universitario de Ginebra, . 5Jefe de Servicio de Geriatria. Hospital Universitario Central de la Cruz Roja,

Patients with Advanced Congestive Heart Failure (ACHF) depending on their complexity may be eligible for specialized Palliative Care (PC) treatment. The profile of cardiology patients admitted to a Medium Stay Palliative Care Unit (MSPCU) is described in comparison to patients with other non-oncological and oncological pathologies.

DOI: 10.20986/medpal.2024.1502/2024
Comics as therapeutic and teaching tool in palliative care
Antonio Miguel Cano Tébar1
1Unidad de Cuidados Paliativos domiciliarios. Hospital General Universitario Reina Sofía,

Palliativecare attempts to provide a scientific and humane response to the needs of the sick at the end of life. The death of a human being is an intense and shocking experience, constituting a focus of suffering for patients and relatives as well as for health care personnel. Relatives are often encouraged to engage in some creative activity to express their grief. The development of literary works, including fiction and comics, also prove to be a useful way of coping with and exposing many aspects of grief. The aim of the present work is to carry out an analysis of the resources and characteristics of comics dealing with Palliative Care. To this end, a critical reading has been carried out both of publications by experts in Graphic Medicine and of various comics that are widely recognised by critics and readers. The study of Graphic Medicine allows us to have a greater connection with the circumstances of the patient and the people in charge of their care, helping us to accept life until the end of it. The development of these works also constitutes a useful tool for the management of grief, the strengthening of empathy and the visualisation of the disease process.

Translated with DeepL.com (free version)

DOI: 10.20986/medpal.2024.1415/2023
Is palliative radiotherapy during the last month of life avoidable
Eduardo García Romo1, Beatriz Valle Borrego2, Bernadette Pfang3, Antonio Noguera Tejedor1, Marta Lobo Antuña4, Bárbara Soler Bonafont5
1Unidad Cuidados Paliativos. Hospital Universitario Fundación Jiménez Díaz, Madrid. 2Servicio Medicina Interna. Hospital Universitario Severo Ochoa, Leganés. 3Instituto de Investigaciones Sanitarias. Hospital Universitario Fundación Jiménez Díaz, Madrid. 4Servicio Medicina Interna. Hospital Universitario HLA Moncloa, Madrid. 5Medicina Interna. Hospital Universitario Fundación Jiménez Díiaz, Madrid

INTRODUCTION
Palliative radiotherapy during the final month of life has demonstrated little benefit regarding quality of life, survival, and symptom control. Factors related to survival can help healthcare providers decide if and how to start radiotherapy in patients at the end of life.

OBJECTIVES
This study aims to describe overuse of palliative radiotherapy at the end of life, and to analyse factors associated with survival and poor quality of life in these patients.

MATERIAL AND METHODS
A retrospective analysis of patients referred for radiotherapy during 2022 who died during the same year. Variables included in the analysis were 30-day mortality after finishing radiotherapy, different treatment schedules, and potential factors associated with survival and quality of life.

RESULTS
116 patients were included; 49 (42%) died 30 days within starting radiotherapy. 97 (83.6%) completed treatment. The most frequent indication for radiotherapy was bone metastasis (42%). The most frequent treatment schedule was 5 sessions (45%). Only 3 patients with bone metastases received only one dose (6%). Factors associated with mortality included the presence of liver metastases, low serum albumin levels, and the use of opioids. 28% of patients who started radiotherapy spent more than a third of their last month of life in hospital. 31% of patients were not referred to a palliative care specialist.

CONCLUSIONS
High rates of radiotherapy during the last month of life were described. Few single-dose schedules were observed. Liver metastases, low serum albumin levels, opioid use and interrupted (incomplete) radiotherapy were associated with shorter survival. Hyperfractionated and interrupted radiotherapy were associated with prolonged hospital admissions during the last month of life. A multidisciplinary approach including palliative care improves the choice of radiotherapy and length of hospital stays, improving quality of life.

DOI: 10.20986/medpal.2024.1447/2023
GAEI, the community of families of children and adolescents in Pediatric Palliative Care.
Jose Vicente Serna Berná1, Carola Del Rincón Fernández2, Jesús Sanchez Etchániz3, Matilde Pérez Herranz4
1Unidad Crónicos y Cuidados Paliativos Pediátricos. Parc Taulí, Sabadell . 2Unidad Integral de Atención Paliativa Pediátrica. Hospital Infantil Universitario Niño Jesús, Madrid. 3Unidad de Hospitalización a Domicilio Pediátrica . Hospital de Cruces-Barakaldo, Barakaldo. 4Impacto y evaluación de proyectos. Fundación Enriqueta Villavecchia, Barcelona

DOI: 10.20986/medpal.2024.1455/2023
Is malnutrition a relevant diagnosis in pediatric palliative care?
Alba De Juan Gallach1, Mara Andrés Moreno2, Pilar Sáenz González3, Joaquín Aliaga Vera3, Hortensia Gimeno Martínez3, Esther Romero Ferraro3, Elena Forcano Sanjuan3, Mariló Jiménez García3
1PEDIATRIA. HOSPITAL UNIVERSITARI I POLITÈCNIC LA FE, . 2Pediatría. Hospital Universitario y Politécnico la Fe, . 3Hospital Universitario y Politécnico la Fe,

Nutrition is an essential point in paediatric palliative care (PPC) to cover physiological, social and psychological requirements. The aim of the study is to determine the specific nutritional conditions of these patients and to identify if there is a diagnostic group with a higher risk of malnutrition. An observational study was carried out, collecting anthropometric, clinical and nutritional variables of patients under follow-up by the PPC team in a tertiary hospital. Twenty-five patients were included, 52% male, with a mean age of 7.6 years and a disease time of 4.3 years. The most frequent diagnosis was cerebral palsy (5/25). Malnutrition was detected in 60%, 20% severe. A lower weight and height Z-score was observed in patients with neurological disease, although it was not statistically significant. Malnutrition is a frequent diagnosis among patients who require PPC, so they could benefit from an early detection, intervention and individualized nutritional monitoring.

DOI: 10.20986/medpal.2024.1457/2023
Mapping research on palliative care and end of life in Andalusia (2012-2021)
MARIOLA BERNAL SOLANO1, MARIA JOSÉ ESCUDERO CARRETERO2, BEGOÑA ISAC MARTÍNEZ3, NURIA LUQUE MARTÍN3, JAIME JIMÉNEZ PERNETT3
1ESCUELA ANDALUZA SALUD PÚBLICA. ESCUELA ANDALUZA SALUD PÚBLICA, . 2Ciudadanía y salud pública. ESCUELA ANDALUZA DE SALUD PÚBLICA, GRANADA. 3ESCUELA ANDALUZA DE SALUD PÚBLICA, GRANADA

Introduction: Research in Palliative Care (PC) is insufficient. It is essential to generate more research to 1) improve the quality of care, care and results, 2) take better care of professionals, 3) meet ethical requirements and 4) follow the recommendations of various organizations. To this end, this work makes a diagnosis of the research published in PC in Andalusia.

Methodology: Bibliometric analysis of the production of scientific articles and authorship characteristics for the period 2012-2021. The inclusion criteria are publications in Spanish or English in peer-reviewed journals and in which at least one of the authors is assigned to an institution located in Andalusia. 55 articles were obtained, on which a frequency analysis and an analysis of co-authorship networks were carried out.

Results: Regarding methodologies used, 49.1% use a qualitative approach and 45.5% use a quantitative approach. In terms of themes, those dedicated to cultural and social aspects (23,6%) and ethical-legal aspects (23,6%) stand out, followed by clinical and organizational aspects (20%). The largest production occurs in Granada, and in the period 2016-2018. PC articles have been published in 33 journals, 63% of them international, and those in the field of Nursing stand out. The total number of authors is 167, 58.8% being women. Only a third of the authors have published more than one article and only 6% have published more than 5. Of those who publish the most, the majority work in academic institutions. The structure of co-authorship networks is loosely connected with many independent subgroups, in which healthcare professionals occupy peripheral positions.

Conclusions: It seems necessary to promote research among healthcare professionals. Alliances with academic professionals can be strengthened, and generate alliances that result in an improvement and an increase in research on PC in Andalusia. Leadership must be strengthened.

DOI: 10.20986/medpal.2024.1461/2023
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© 2024 Medicina Paliativa
ISSN: 1134-248X   e-ISSN: 2340-3292

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