Terminal Situation Research Articles

Tuberculose latente entre pessoas vivendo com HIV e contatos num estado hiperendêmico

Abstract Objective To assess latent tuberculosis among people living with HIV and contacts of people with tuberculosis. Methods This is a cross-sectional, quantitative study, carried out in the state of Pará, based on cases of latent tuberculosis infection reported between 2019 and 2020. Data were extracted from the Latent Tuberculosis Infection Information System, at the State Department of Public Health, from November to December 2021. For analysis, descriptive statistics, chi-square test and G test were used, in addition to prevalence ratio, in Bioestat 5.3, with a significance level of 5%. Results A total of 1,116 cases of latent tuberculosis were studied: 653 in 2019 and 463 in 2020. The outcome indicated a low proportion of complete treatments (n=734). Among the records, 371 were of people living with HIV and 416 were of contacts of tuberculosis cases. An association was observed between latent infection in people living with HIV and contacts with the variables sex, age, origin and termination situation (p<0.0001). Conclusion Latent tuberculosis in people living with HIV and contacts presents different patterns when associated with the sociodemographic profile, making it necessary to prioritize the identification of these groups in order to adopt strategic actions that impact disease management.

Hospice from the Point of View of Synergistic Anthropology: Patients, their Relatives, Workers

The article, which is based on a report at the 4th national congress on palliative and hospice care with international participation: “War and us. Palliative care in Ukraine: challenges, risks and prospects,” analyzes the conceptual optics of synergistic anthropology, which, synthesizing existential, psychological and religious aspects of a person living in a terminal situation, allows us to provide an appropriate indicative basis for hospice workers in order to optimize their own resources from funds at the stage of palliative care for the dying person and his relatives. The main conceptual categories here - “extreme situation”, “ontic”, “ontological” and “virtual” levels (types) of a person - we owe to such outstanding thinkers as Karl Jaspers, Martin Heidegger, Sergei Khoruzhy. Taking into account anthropological types of consciousness and family constitutes a system of indicative markers that provide hospice workers (from doctors, nurses and social workers to psychologists and priests) with a basic orientation for applying their own efforts in the extremely complex task of helping a dying person.

DIFICULDADES VIVENCIADAS PELOS ENFERMEIROS COMO MEMBRO DA EQUIPE MULTIPROFISSIONAL NO CUIDADO PALIATIVO EM UNIDADE DE TERAPIA INTENSIVA

Identify the difficulties experienced by intensive care nurses in the Palliative Care (PC) in the Intensive Care Unit (ICU). This is an integrative review of the literature conducted in the SCIELO, LILACS and BDENF databases. For the construction of the guiding question, the PICO strategy and was used PRISMA flowchart was used for the analysis of the results. The searches covered the period from 2015 to 2020, and the articles available in Portuguese and in full. Thus, 10 articles were selected for analysis through narrative synthesis. It can be seen that there are several difficulties experienced by nurses in the face of palliative approach in the ICU, ranging from the barriers resulting from the hospital itself, such as the lack of protocols that help in the implementation of palliative care as well as communication difficulties between the multiprofissional team and the family members of patients. It was also evident the unpreparedness of nurses in graduation in the face of the dying process and the difficulty in managing their feelings. It is observed that nurses are an important agent in palliative care and that there are many challenges in nursing this context, so it is necessary to prepare nurses from graduation, to deal with terminal situations, which will enable more adequate nursing care and less suffering of those involved.

Limits of therapeutic intervention in a tertiary neonatal intensive care unit in patients with major congenital anomalies in Brazil.

Major congenital anomalies are an important cause of death in the neonatal intensive care unit (NICU). Therapeutic interventions and the suspension of those already in place often raise ethical dilemmas in neonatal care. We analysed treatments-such as ventilatory support, vasoactive drugs, antibiotics, sedation/or analgesia, central venous access and other invasive procedures-offered up to 48 h before death to all newborns with major congenital anomalies over a 3-year period in a NICU in Brazil. We also gathered information contained in medical records concerning conversations with the families and decisions to limit therapeutic interventions. We enrolled 74 newborns who were hospitalised from 1 January 2015 to 31 December 2017. A total of 81.1% had central venous access, 74.3% were on ventilatory support, 56.8% received antibiotics and 43.2% used some sedative/analgesic drugs in their final moments. Conversations were registered in medical records in 76% of cases, and 46% of the families chose therapeutic intervention limits. Those who chose to limit therapeutic interventions asked for less exposure to vasoactive drugs (P=0.003) and antibiotics (P=0.003), as well as fewer invasive procedures (P=0.046). There was no change in ventilatory support (P=0.66), and palliative extubation was not performed for any patient. The therapeutic intervention was mainly characterised by maintenance of the current treatment when a terminal situation was identified with no introduction of new treatments that could increase suffering. The families' approach proved to be essential for making difficult decisions in the NICU.

Encuesta a familiares de pacientes internados en unidades de cuidados críticos sobre sus creencias religiosas, su opinión sobre cuidados de fin de vida y sus preferencias de horarios de visita

ObjectiveTo learn about the religious beliefs, opinion about end-of-life care and policies of visiting hours of relatives of patients hospitalized in Intensive Care Units (ICU). MethodsCross-sectional study. ICUs of 5 Hospitals (three private University centres and two public centres). Relatives of patients admitted to the ICU were surveyed in the waiting room from 2017 to 2018. The main interest variables were religious beliefs (in God, miracles and/or life after death). Position on limitation of therapeutic effort (LTE) in terminal situations and euthanasia, feelings towards death and illness, preferences about visiting hours (open-door versus closed units), impact on relatives and the recovery of the patient (overload / obligation, emotional support and tranquility). Characteristics of the surveyed population (age, level of education, relationship to the patient). Results823 surveys were conducted. A high prevalence of believers was observed (78%),which was associated with refusal of LTE and euthanasia. Of the subjects, 78% prefer long visiting hours, and only 15% consider that it overloads the companion or causes obligation. The overall level of satisfaction was higher among respondents whose relatives were hospitalized in an open-door ICU (90% vs. 66%, p-value<0,001). ConclusionsReligious beliefs must be taken into account when proposing end-of-life care in critical patients due to their potential part in the decision-making process. Family engagement in open-door units can be an important tool to improve satisfaction with care during hospitalization.

Anticipated backward stochastic differential equations with quadratic growth

In this paper, we study the solvability of anticipated backward stochastic differential equations (BSDEs, for short) with quadratic growth for one-dimensional case and multi-dimensional case. In these BSDEs, the generator f(⋅), which is of quadratic growth in Z⋅, involves not only the present information of solution (Y⋅,Z⋅) but also its future one. The existence and uniqueness of such BSDEs, under different conditions, are derived for several terminal situations, including small terminal value, bounded terminal value and unbounded terminal value.

Chapter 6. French and Chinese regulatory approaches to end-of-life and euthanasia.

For patients in critical or terminal situations, the approach to death is a situation that raises many ethical and legal issues of importance. Health professionals and families of the person at the end-of-life are obviously at the forefront of the concerns generated by these situations, all wishing to act in the best interest of the patient. Some States have regulated the various situations encountered on the ground in order to provide stakeholders with clear and appropriate procedures to ensure human dignity in practice by elaborating the rules of an end-of-life ethics aimed at supporting health professionals involved in carrying out certain acts while setting limits in respect of the persons concerned. What are the alternatives? Is euthanasia tolerable? What role for health professionals? And for the family? The content of the regulations differs according to countries, to cultural sensitivities and ethical and legal traditions, like the political will to regulate this topic. The regulatory experience of countries like France and China can be useful to other countries and serve as a basis for discussing the topic. Therefore, we analyze the current French framework and the situation in China in order to highlight main elements of ethical discussions, adopted positions and rules, eventual joint considerations, remaining issues and challenges in a comparative approach.

La dignidad del enfermo en situación terminal

La dignidad del enfermo en situación terminal debe ser apreciada, por su condición de ser humano, ostentando la correspondiente dignidad por el hecho de “ser”, de su existencia. Es conocido que las situaciones terminales cambian las condiciones en las que se encuentra el paciente, pero no es lícito pretender que las circunstancias afecten su dignidad intrínseca, de la misma manera que no puede pretenderse que por encontrarse en una situación terminal no tenga derecho a la vida. Las circunstancias adversas pueden estar presentes en la vida del ser humano, pero siempre será un fin y nunca un medio, en cuyo marco la dignidad del paciente terminal debe ser respetada, debiendo asegurarse las condiciones necesarias de cómo serán brindadas las atenciones correspondientes hasta el final de su vida, más no direccionar acciones tendentes a cuándo poner término a su vida.

Between illness and death: "Euthanasia".

The arguments for and against euthanasia present a complex picture that will need to be discussed and decided in Mexico. This article addresses some relevant aspects such as the legal determination of death, the field of bioethics intervention, terminology related to euthanasia, its classifications, international instruments promoting human rights, as well as reflections on the importance of palliative care and the patient's right to be in a terminal situation to act in accordance with their goals, expectations and beliefs, in the context of their family and social relationships.

Reflexiones sobre la eutanasia: ¿nuestra elección?

This article seeks to address the issue of euthanasia from a human point of view with legal effects. Trying to explain what euthanasia do is, known as good death or assisted suicide, it pursues that a sick person without a recovery forecast, in a terminal situation and who suffers a lot, could finish with all his suffering, putting an end to his own life for own relief. Then, in which cases could euthanasia be apply, types, and forms according to the execution, analyzing the benefits and damage, if it is a voluntary and conscious decision, given the especial state of health of the person who decides to put an end to his own life, carrying the analysis to an existential, religious, economic, politic, ethical and natural plane, finally giving a full picture of knowledge and thought to help us adopting a well informed and autonomous posture about our own point of view of euthanasia.

Encuesta en población abierta respecto a términos relacionados con decisiones al final de la vida.

Concepts related to end-of-life decisions, such as euthanasia, palliative care, advance directives and therapeutic obstinacy, are poorly understood by the general population, which, when facing a terminal situation, is not prepared to choose the best option. Pilot study (n = 544) to find out what the open population understands about terms used in end-of-life situations in four cities of the Mexican Republic. Survey via Internet with 18 questions about different terms. It was a descriptive, cross-sectional study. Statistical analysis was carried out. People older than 18 years who were not engaged in health-related professional activities were selected. Most terms related to end-of-life decisions were found not to be interesting to or understood by a part of the population. The least recognized term was therapeutic obstinacy (62.8%), and the most widely known, palliative care (91%); there was confusion between the terms euthanasia and assisted suicide (47.8%). Age and education level had more influence in the results, than other demographic variables.

いのちを支える看護の語り : 人生の終焉を生きる方と家族の「いのちの物語」と看護師の関わりの物語( 語りから「いのち」について考える-聞き難いものを聞き、語り、書く-)

いのちを支える看護の語り : 人生の終焉を生きる方と家族の「いのちの物語」と看護師の関わりの物語( 語りから「いのち」について考える-聞き難いものを聞き、語り、書く-)

Electronic properties and carrier mobility for penta-graphene nanoribbons with nonmetallic-atom -terminations

Abstract Penta-graphene has been widely studied recently due to its superior properties for promising applications. We here theoretically investigate electronic property and carrier mobility for four kinds of penta-graphene nanoribbons (P-GNRs) terminated with nonmetallic atom (H, N, P, O, S and F) at two edges (one part of P-GNR surface). The calculations show that these ribbon possess a favorable energetic stability and thermal stability. Interestingly, three kinds of ribbons (ZZ-, ZA-, and AA-types) with these terminations have a basically similar electronic structure, only with terminations O and S, they can be semiconductors, whereas other are metals or quasi-metals. The remaining ribbon (SS-type) can maintained to be semiconductors for all types of termination situations. These behaviors are intimately related to the suppression of the edge states of edge C atoms due to the coupling effects of termination atoms. In particular, these ribbons also hold a rich carrier mobility feature from ∼101 to ∼104 cm2 V−1 s−1 at room temperature depending on termination atoms. The S atom termination can lead to a significant carrier polarity for all the ribbons, and size effects of ribbons on carrier mobility also is clearly observed as well. These findings suggests that the functionalized P-GNRs might hold promising potential applications in nanoelectronic devices.

Mechanism of Y2O3 as heterogeneous nucleus of TiC in hypereutectic Fe-Cr-C-Ti-Y2O3 coating: First principle calculation and experiment research

The lattice misfit between Y2O3 and TiC low index faces was calculated by the Bramfitt two-dimensional lattice misfit theory in this work. The interface electronic structure, adhesive work and interfacial energy of Y2O3 (111)/TiC(110) interfaces were calculated by the first principles method. The interfacial bonding characters were analyzed by the interface charge density, electron density difference and mulliken populations. The microstructure of the hypereutectic Fe-Cr-C-Ti-Y2O3 coating was observed by field emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM). The calculational results show that, the lattice misfit of Y2O3(111)/TiC(110) interface is 8.6%, which meets that Y2O3 acts as medium effective heterogeneous nucleus of TiC. Four interface models have been constructed according to the surficial termination situations and interfacial atomic stacking modes, in which O-TiC2 interface is most stable. Its interface adhesive work is the largest (6.07J/m2) and its interfacial energy is the smallest (−1.22J/m2). And its interfacial bonding is a mixture of polar covalent, metallic and electrovalent bonds, which proves that Y2O3 and TiC can form a stable interface. The experimental results show that, Y2O3 particle exists in the core of the flower-like TiC particle in the hypereutectic Fe-Cr-C-Ti-Y2O3 coating and they are combined tightly, which proves that Y2O3 can act as the heterogeneous nucleus of TiC.

Cuidados del personal de enfermería en la dimensión espiritual del paciente. Revisión sistemática

It is necessary to know the perception of nurses about the emotional attention given to patients at the spiritual dimension in patient care plan. The objective was to know the spiritual care offered by nurses in their daily work during a patient’s hospital stay and detect possible associated factors that hinder the facing death. Material and Methods. The unit of analysis has been the primary original studies, electronic searches (Cuiden, Scielo, Pubmed) and manuals relevant of articles published in journals, bibliographies and reference lists of reviews and papers were made. Results and Conclusions. There are a number of factors that hinder the proper intervention of nursing professionals in specific situations of non-health: especially when the patient feels the urgent need to obtain information on their health status because it is admitted in a hospital in terminal situation, as when you communicate suddenly having a serious organic disorder in some body structure with some degree of limitation prevents regular physical activity…. as a result he feels emotions like anxiety, fear, depression, anger, dissatisfaction, etc which are emotions with high emotional and spiritual burden.

Resource Leveling Based on Backward Controlling Activity in Line of Balance

The line of balance method that provides continuous and uninterrupted use of resources is one of the best methods for repetitive project resource management. This paper develops a resource leveling algorithm based on the backward controlling activity in line of balance. The backward controlling activity is a kind of special activity, and if its duration is prolonged the project duration could be reduced. It brings two advantages to the resource leveling: both the resource allocated on the backward activity and the project duration are reduced. A resource leveling algorithm is presented which permits the number of crews of the backward controlling activity to be reduced until the terminal situation is reached, where the backward controlling activity does not exist or the number of crews cannot be reduced. That adjustment enables the productivity of all activities to be consistent. An illustrative pipeline project demonstrates the improvement in resource leveling. And this study designed a MATLAB program to execute the design algorithm. The proposed model could help practitioners to achieve the goals of both resource leveling and project duration reduction without increasing any resource.

Pain and palliative care: the knowledge of medical students and the graduation gaps

ABSTRACT BACKGROUND AND OBJECTIVES: Currently, the medical course does not provide complete education and handling of pain, and it is also devoid of disciplines addressing thanatology in palliative care. The objective of this study was to evaluate the knowledge about pain and palliative care of medical students and their perception on how these themes are taught the graduation course. METHODS: We invited to participate in the survey students of the medical school who are concluding the fourth, fifth and sixth year of graduation at the Federal University of Health Science of Porto Alegre. The demographic and characterization data of the sample were collected, and a questionnaire was applied and validated with 19 direct questions about pain and palliative care. RESULTS: Forty-seven students agreed to participate in the study. The vast majority mentioned not receiving enough information during the undergraduate program about the proper handling of patients with pain, and patient care in a terminal situation. CONCLUSION: This study highlights education gaps on pain and palliative care in medical schools. It shows the difficulties of the students have to put the theoretical knowledge into practice, for example, their insecurity in handling pain, especially when it comes to the use of opioids.

Integrated Care in practice: Improving population health across the care continuum at home

Introduction: The Carmel Health Center serves a population around 20000 inhabitants and it’s located in a suburban deprived area of Barcelona city. The increase in the overaging index (22%), in addition to the topography of the neighbourhood and the number of architectural barriers, contributes to the difficulty in access to Primary Healthcare Centre (PHC). These circumstances prompted the creation, in 2014, of a specific team to take care of the people in need of health homecareDescription of practice change implemented: The aim of the home-visit team (ATDOM) is to provide a qualified and integrated care to people that are not able to move from home, based on their needs and doing network with other sanitary and social resources and using specifics tools for itThe target population (247 people) are all patients of assigned area that are not able to reach de PHC for health reasons, physical condition or their social or environment situation, either temporarily or permanently. The patient must agree to be treated at home. The activity is focused on the patient and his family and the goal is to provide quality care through a multidisciplinary team that ensures social and sanitary continuum care.The home-visit team, formed by one family doctor and two nurses, represents an added value because are permanent references for patients and ensures a continuum of care and a systematic follow-up. The team is completed partial time with a case-manager nurse and a social worker, it has also administrative support and punctual collaboration of medical residents.The home-visits are done in different situations:- By demand of the patient or family- After a hospitalization: the team receives via email information about day of discharge and diagnosis- By alert of the Telecare service, the public network of social workers, the 7x24 circuit, or the emergency-room report assistance- When scheduled follow-up by the teamAll visits are done by nurse, doctor or both depending on each case. Some visits can be resolute via telephoneDifferent public programs are used as resources for the homecare team. All these programs facilitate coordination and continuity of care between different healthcare providers:- The 7x24 circuit: it offers the possibility of calling from the Primary Care Emergency Centre (CUAP) to the patient that requires support during weekend.- The Programme for patients in terminal situation (PADES) offers support to address situations of high complexity- The Telecare service of the City of Barcelona- The family workers of the public social services- Protocols for convalescence stays, family breaks, palliative care and rehabilitation or admission to day-hospitals.The main tools used by the ATDOM team are:- Shared Medical Record (HCC 3): electronic record shared by primary care, hospital, CUAP and discharge reports from different reference health providers.- Shared Individualized Intervention Plan (PIIC): gives useful medical and social information such as: main diagnoses, medication and recommendations in the event of medical decompensation.- Advanced Chronicity Care Model: To identify patients with chronic complex health situations (PCC) or advanced chronic diseases (MACA) in order to offer them a more accurate follow-up. That includes the application of different scales and the Planning Living Wills (PDA) to know the values, preferences and expectations of the patients, and their relatives, in MACA situationKey findings: The number of patients assigned to the service is 247 up today, that represents the 1,26% of the population assigned to PHC, and the 6,1% of the peopled over 65.The assistential burden for medical doctor is 920 and 474 for nursesThere are no data yet to assess the effectiveness of the program. We are planning to assess the accomplishment of the standard set of scales that ATDOM team uses for each patient when is included to the programme and 3 month laterHighlights: The home care with this specialized team assures more continuum care than the previous situation when the patient was attended by doctor on duty. The relationship created is similar when the patients were coming autonomously to the PHC.Contingencies: In the event that the doctor is not in service, the others doctors of the PHC assumes acute situations and the scheduled programme is assumed by the nurses of the team.Conclusions: During 2015 the ATDOM professionals have consolidated as a team. It's a cohesive team and work on specialized care of patients in their own environment and offers a health and social continuum care.

End-of-Life and Hospice Issues in Korean Aging Society

This paper deals with legal and institutional aspects of end-of-life and hospice issues in Korea. With the high speed of aging in Korean society we face end-of-life issues and policies at the terminal stage. Policies on life-sustaining treatment decisions to death in later life were developed from the 2000’s and legislated into the Cancer Control Act in 2010. It was not until February 2016 that the Cancer Control Act was a legal provision of hospice and palliative care even for terminal cancer patients. The Cancer Control Act made an impact on the institutional and financial situations of hospice and palliative care. The first impact is a medical care-centered care flow and a transfer model for hospice and palliative care. Public policies focus on hospice services inside general hospitals, so that independent hospice centers or community services are underdeveloped. The second impact is a patient-initiated decision model into hospice and palliative care. Physicians had no legal obligation to explain to patients their terminal situation and prognosis and could inform them only when they choose Therefore, it was not until July 2015 that hospice and palliative care was covered by the public health insurance system.

Diálisis peritoneal paliativa: implantación de un programa de atención domiciliaria a enfermos tratados con diálisis peritoneal (DP) en situación terminal

Patients undergoing peritoneal dialysis (PD) in a terminal situation are generally transferred to haemodialysis, given that they are incapable of carrying out the dialysis technique due to the fact that their functional capabilities are diminished. We present our experience with 5 patients undergoing PD with pathology that constituted short-term threat to their lives. Their treatment was shared by the primary attention units and they were maintained in a PD mode adapted to their circumstances, which we have called Palliative Peritoneal Dialysis.