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Sigma's volvulus in a patient with amyotrophic lateral sclerosis
Aránzazu Castellano Candalija1, Juan Luis Torres Tenor1, María Varela Cerdeira1
1Unidad de Cuidados Paliativos. Hospital Universitario La Paz, Madrid

A 46-year-old woman with a diagnosis of amyotrophic lateral sclerosis, who was admitted due to constipation and a radiological image of sigmoid volvulus. Sigmoid volvulus is axial rotation of a segment of the intestine on its mesentery, and is an important cause of major obstruction. In patients with amyotrophic lateral sclerosis, gastrointestinal manifestations are very important due to their frequency and their prognostic impact. The treatment is medical and in some cases surgical.

DOI: 10.20986/medpal.2024.1426/2023
Regarding a case
Nerea Gurucharri Zurbano1, Marta León Olarte2, Monica Ochagavía Palacios2
1Unidad de Cuidados Paliativos. Hospital general de la rioja, logroño. 2Unidad de Cuidados Paliativos. Hospital general de la rioja,

The use of corticosteroids in palliative care helps control many symptoms, but its use is not without side effects. We present a case of the emergence of acuminated condylomas due to corticosteroid use in a latent human papillomavirus infection.

DOI: 10.20986/medpal.2024.1443/2023
Prevalence of Fentanyl use in the province of Ávila.
Jorge García Pindado1, Elena Martín González2, María Victoria Hernández Jiménez3, Jesús Martín González4, María del Rocío Pindado Sáez5, María del Pilar González Arrieta6
1Unidad de Medicina Interna. Hospital Nuestra Señora de Sonsoles, Ávila, Ávila. 2Unidad de Urgencias.. Hospital Universitario de Salamanca, Salamanca. 3Unidad de Cuidados Paliativos. Unidad Hospitalaria de Cuidados Paliativos Del Complejo Asistencial de Ávila, Ávila. 4Hospital Universitario de Salamanca. Gerencia de Atención Primaria de Salamanca, Salamanca. 5Consulta de Pediatría. Centro de Salud Ávila Sureste, Ávila. 6Escuela Universitaria de Enfermería . Universidad de Salamanca, Ávila

Introduction: Pain is a public health problem suffered by 20-30% of the population. The appearance of synthetic opioids, specifically fentanyl, has led to progress in the pharmacological treatment of pain. Its consumption in other situations than those authorized has increased, causing a greater risk of abuse and dependence.
Objective: To determine the prevalence in the province of Ávila of fentanyl consumption, both in total consumption and in its main pharmaceutical forms of presentation.
Materials and method: Descriptive, observational, cross-sectional study through the analysis of data obtained from the pharmaceutical service of the Primary Care Management of Ávila, the Spanish Agency for Medicines, and Health Products and of the census of the province of Ávila. The calculations are made with de Microsoft Excel 2021 program and the statistical analysis with the SPSS version 27.0 program. A search of the scientific literature was carried out in the following databases and web pages: Cochrane, CINAHL, PubMed, Scielo, Elsevier, Web of Science, Cuiden Plus, Web of the Spanish Agency for Medicines and Health Products, Website of the Ministry of Health, Consumption and Social Welfare, Castilla y León Medicines Portal and fentanyl data sheet.

Results: The total consumption of fentanyl in the province of Ávila has increased from 2,256 DHD in 2013 to 2,752 in 2022, with a positive and statistically significant correlation for the transdermal route, as well as for the total (p-value < 0,05).
Conclusion: The prevalence of fentanyl use has increased exponentially between 2013-2022 in the province of Ávila. The most commonly used route of administration is transdermal, followed by buccal. The consumption of fentanyl in the province of Ávila follows the same trend as the consumption data in Castilla y León and at the national level.

DOI: 10.20986/medpal.2024.1456/2023
Main applications of clinical ultrasound in palliative care
Daniel García-Gil1, Lina Nitola-Mendoza2, Alfredo L. Díaz-Gómez1, Jaume Canal-Sotelo3
1Servicio de Medicina Interna. Hospital San Carlos. Grupo de Trabajo de Ecografía Clínica de la SEMI, San Fernando. 2Servei de Cures Pal·liatives. Institut Catalá d'Oncología. Grupo de Trabajo de Ecografía clínica de la SCBCP, Badalona. 3Servei de Cures Pal·liatives. Hospital Hestia Balaguer. Grupo de Trabajo de Ecografía clínica de la SCBCP, Lleida

People with advanced cancer suffer from intercurrent clinical conditions and other tumor progression-related manifestations that can have a great impact on their quality of life. Professionals working in this field need to incorporate new knowledge, as well as diagnostic and treatment tools to facilitate the management of these highly complex patients in the least invasive way possible1. Clinical ultrasound (CU) is one of those tools whose development has been exceptional in recent decades. Technological advances have made it possible to have increasingly sophisticated and affordable pocket equipments available, which can be used wherever the patient is as an extension of physical examination2. In this way, a professional can respond to different situations or syndromic conditions in which CU yield may be high. The aim is to avoid, whenever possible, the transfer of patients to in-hospital facilities, which can result in loss of both comfort and quality of life. In addition, an appropriate use of CU can empower the team charged with making clinical decisions.

DOI: 10.20986/medpal.2024.1484/2024
Palliative care in tumor committees
Jesús González-Barboteo1, Ernest Nadal Alforja2
1Servicio de Cuidados Paliativos. Institut Català d’Oncologia. Grupo de Investigación y Conocimiento en Cuidados Paliativos, L’Hospitalet de Llobregat. 2Servicio de Cuidados Paliativos. Institut Català d’Oncologia. Grupo de Investigación Preclínica y Experimental en Tumores Torácicos , L’Hospitalet de Llobregat

Editorial

DOI: 10.20986/medpal.2024.1483/2024
Survival and quality of life on advanced cancer patients with malignant biliary tract obstruction treated with biliary drainage
Maria Varela Cerdeira1, María Varela Cerdeira2, Estrella Abregú Reátegui3, Leyre Díez-Porres4, Arantxa Castellano Candalija5, Juan Luis Torres Tenor4, Yolanda Vilches Aguirre4
1Unidad de Cuidados Paliativos. Hospital La Paz, Madrid. 2Unidad Cuidados Paliativos . Hospital La Paz , Madrid. 3Unidad Cuidados Paliativos . Universidad Autónoma de Madrid , . 4Unidad de Cuidados Paliativos. Hospital Universitario La Paz, Madrid. 5Unidad Cuidados Paliativos . Hospital ,

Introduction: Malignant bile duct obstruction (MVOB) during the progression of neoplastic disease is a frequent complication. Bile duct drainage is a treatment option. The aim of the study was to analyze survival from BVO and quality of life comparing data of patients undergoing biliary drainage (BD) versus conservative treatment (CT).
Methodology: Retrospective observational study developed in a University Hospital. The medical records of patients attended in Oncology, Palliative Care, Digestive and Interventional Radiology Departments of a University Hospital during 2 years were reviewed. Patients over 18 years of age with advanced cancer and BVOVO, with or without DB, were included. Patients lost to follow-up or who presented with BMO as cancer debut were excluded.
Results: 45 patients were included, 27 underwent DB and 18 underwent CT. Median survival was 1.5 months, being 2.6 months in the DB group, and less than 1 month in the CT group (p=0.126). Before treatment, both presented low functionality (PPS of 70 and 50 in groups 1 and 2) and important symptomatic burden (asthenia the most frequent, in 52% and 78% of groups 1 and 2). Drained patients presented tendency to more days of admission and emergency room visits (p=0.112 and p=0.065).
Conclusions: Median survival of advanced cancer patients with BVOVO included in our study was 1.5 months. Symptomatology is partially improved in both DB and CT treated patients. Symptomatology partially improved both in patients treated with BD vs CT. In those who underwent BD there was a tendency to a higher number of emergency room visits and admissions.

DOI: 10.20986/medpal.2024.1454/2023
Psychometric properties of the “Quality of Life in Life‐Threatening Illness–Family Caregiver” (QOLLTI‐F): family caregiver version in Colombia
Mauricio Arias-Rojas1, Edith Arredondo Holgín1, Sonia Carreño-Moreno2
1Facultad de Enfermería . Universidad de Antioquia, Medellin. 2Departamento de Enfermería . Universidad Nacional de Colombia , Bogota

Introduction: Quality of life is an important indicator in the family caregiver of patients in palliative care. It is essential to have valid and reliable instruments to measure the impact of care overload and care received in this population.
Objetive: To evaluate the psychometric properties of the QOLLTI-F scale in Spanish in family caregivers of patients in palliative care.
Materials and methods: Validation study of the QOLLTI-F scale developed in family caregivers of palliative care patients. The QOLLTI-F scale Spanish version was used. Validity and reliability were examined through confirmatory factor analysis, convergent validity, internal consistency tests, stability, and analysis of invariance.
Results: A total of 333 caregivers were included. The confirmatory factor analysis resulted in a structure of 7 factor with adjustment indices from moderate to good (2 2 = 220, gl = 85, 2 2/gl = 2.58, CFI (Comparative Fit Index) = 0.912, TLI (Tucker-Lewis Index) = 0.875 and RMSEA (Root Mean Squared Error of Approximation) = 0.069. Cronbach's alpha coefficient = 0.847, and test-retest stability of 0.609. Convergent validity showed a significant correlation coefficient with the caregiver role adoption scale (r=0.539 P = 0.000). There was a significant difference in quality of life between the high and low functionality groups.
Conclusion: The QOLLTI-F scale is a valid and reliable instrument to be used in the measurement of the quality of life of family caregivers of patients in palliative care in the Spanish language and Colombian context.

DOI: 10.20986/medpal.2024.1429/2023
Home rotation to Methadone in palliative patients with cancer pain: a possible alternative.
INÉS ARANCIBIA FREIXA1, MARIA VELA ESPIGARES2, IVOR URDIALES ARANDA3, SARA SANCHIZ LORENTE2, VERONICA ROMANI COSTA4, MONICA PARTAL GOMEZ3
1Cuidados Paliativos. HOSPITAL UNIVERSITARIO MUTUA TERRASSA, ATENCIÓN INTERMEDIA, Terrassa. 2PADES. HUMT, TERRASSA. 3PADES. HU MUTUA TERRASSA, TERRASSA. 4UFISS PALIATIVA. HU MUTUA DE TERRASSA, TERRASSA

The use of methadone is a real treatment option with opioids in patients with cancer pain in advanced oncollogical illness, specifically carried out in the hospital setting. It is used as an alternative to morphine or fentanyl when these medications do not provide accurate pain control, but published clinical guidelines have never recommended the ambulatory setting for its treatment. We present a serie of 5 cases in which we successfully rotated methadone at home, with no major side effects and with a very good perception from both families and patients for staying at home instead of doing a hospital admission in the final phase of their lives.

DOI: 10.20986/medpal.2024.1433/2023
Short-Term effects of receptive music therapy on the prevalent symptoms in patients with advanced cancer. Randomized clinical trial. Preliminary results
agustina iturri1, Marcelo Dóvidas2, Javier Spector3, Adela Bertella4, Alberto Alonso Babarro5
1Unidad de Cuidados Paliativos. Hospital Universitario Austral, josé marmol. 2Facultad Regional Delta. Universidad Tecnológica Nacional, Buenos aires, Argentina, Campana. 3Facultad de Ingeniería. Universidad Austral, Buenos Aires, Argentina, . 4Carrera de Psicología. Facultad de Ciencias Biomédicas,Universidad Austral, Buenos Aires, Argentina., . 5Unidad de Cuidados Paliativos. Hospital Universitario La Paz, Madrid

INTRODUCTION: The most common objectives of music therapy (MT) are the management of physical, psychological, and emotional symptoms, improvement of individual and social well-being, and facilitating coping with end-of-life issues. Both MT and virtual reality technology have shown effectiveness in this context, although the quality of evidence remains very low. The aim of our work was to evaluate the effect of combined MT with virtual reality on prevalent symptoms and overall well-being of adult patients with advanced oncological disease receiving palliative care.

METHODOLOGY: Randomized controlled clinical trial. Patients were randomized after providing informed consent and received either MT+VR or no musical intervention. The main variables analyzed were pain, fatigue, drowsiness, nausea, loss of appetite, dyspnea, depression, anxiety, sleep, overall well-being, and heart rate. The study duration was 48 hours, and variables were measured on three occasions: before the condition, after the condition, and 24 hours later. Thirty patients completed the protocol, with 4 lost to follow-up.

RESULTS: Significant differences were observed between pre- and post-conditions for the MT+VR group regarding the primary symptom, the overall ESAS-r scale, and anxiety, as well as differences between conditions favoring MT+VR. No significant differences were found in the 24-hour measurement.

CONCLUSIONS: Preliminary results show that MT+VR is effective in the short term in reducing prevalent symptoms in patients receiving palliative care. Completing the study and obtaining results from the total sample is necessary.

DOI: 10.20986/medpal.2024.1435/2023
Somniphobia in Palliative Care: A disorder that we should investigate?
Alejandro Vargas Bermúdez1
1Medicina Paliativa . Centro Nacional de Cuidados Paliativos, Sabanilla, Montes de Oca

DOI: 10.20986/medpal.2024.1437/2023
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© 2024 Medicina Paliativa
ISSN: 1134-248X   e-ISSN: 2340-3292

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