María Isabel Catoni

Depresión y autopercepción de la carga del cuidado en pacientes en hemodiálisis y sus cuidadores

OBJECTIVE To determine the depressive symptoms, perceived social support, and self-perceived burden in chronic hemodialysis (CHD) patients; identify depressive symptoms and degree of fatigue in caregivers of CHD patients; evaluate-in patients-the association between self-perceived burden and perceived social support, and between self-perceived burden and depressive symptoms; and evaluate-in caregivers-the relationship between the number of years of care and the degree of fatigue reached. METHODS A sample of 162 patient-caregiver pairs was selected in which an adapted version of the Multidimensional Scale of Perceived Social Support, along with the Self-perceived Burden Scale, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Severity Scale were applied. The instruments were administered to patients by trained research assistants and, in the case of the caregivers, were self-administered. RESULTS Forty percent of the patients were women, with an average age of 56 ± 14.9 years, whereas 75% of the primary caregivers were female spouses, with an average age of 50 ± 16.1 years. It was observed that the patients (40.74%) as well as the primary caregivers (43.82%) had depressive symptoms. A positive association (r = 0.43, P < 0.001) was found between self-perceived burden and the presence of depressive symptoms in patients. CONCLUSIONS The majority of the primary caregivers were women and relatives of the patients. They perceived themselves as fatigued with care, as did the patients themselves. The presence of depressive symptoms was similar in patients and caregivers. There was a statistically significant association between self-perceived burden and the presence of depressive symptoms in patients.

Recomendaciones del Comité de Ética de la Sociedad Chilena de Nefrología para el manejo de los problemas ético-clínicos de pacientes adultos con enfermedad renal crónica terminal

There are different approaches to treat patients with End Stage Renal Disease (ESRD): hemodialysis, peritoneal dialysis, renal transplantation and conservative medical management. The choice of the best therapy for each patient, needs both clinical and ethical skills. The Ethics Committee of the Chilean Society of Nephrology has elaborated recommendations to help health workers to deal with the ethical and clinical problems related to patients suffering ESRD. Its goal is to guide, at a national level, the effective use of minimal standards in the treatment and care of patients with ESRD, including appropriate care and information for patients, therapy selection, management of difficult cases and potential conflicts.

Conflictos de intereses en nefrología

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relationship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made

Problemas ético-clínicos en hemodiálisis crónica: percepción de médicos y enfermeras

Background: Clinical teams working at chronic hemodialysis centers (CHC) frequently have to face ethical problems, but there is no systematic approach to deal with it. Aim: To study the ethical problems perceived by health professionals at CHC. Material and methods: Eighty randomly selected physicians and 139 nurses from 23 CHC, answered a structured questionnaire, devised by the research team. Results: Twenty-six percent of respondents had postgraduate studies in clinical ethics. The ethical problems mentioned by respondents were therapeutic disproportion in 66.7%, lack of communication between patients, their families and the clinical team in 25.9%, personal conflicts of interests related with hemodialysis prescription in 14.6% and conflicts of interests of other members of the clinical team in 30.6%. The percentage of respondents that experienced not starting or discontinuing hemodialysis treatment due to decision of patients’ relatives was 86.8%. Only 45.2% of health professionals had the opportunity to take part in decision-making meetings. Eighty seven percent of respondents supported the use of advanced directives in the event of a cardio respiratory arrest during treatment. Conclusions: To improve the approach to ethical problems in CHC, it is necessary to improve training in clinical ethics, promote an effective dialogue between the patients, their families and health professionals, and follow their advance directives in case of cardiac arrest during treatment.

Validação em espanhol da escala de auto percepção do peso dos cuidados

Objective: To validate the Spanish language version of the broad “self-perception of burden of care scale” by Cousineau et al. Methods: The sample consisted of 161 patients undergoing chronic hemodialysis at five dialysis centers in the city of Santiago - Chile. This scale was translated into Spanish and a pilot test was conducted with ten patients; after this procedure, we developed the final instrument to be subjected to the validation process. Results: The reliability of the scale was stable, with fluctuations of the Cronbach’s alpha coefficient of 0.903 and 0.915; we decided therefore to maintain the 25 original items within the Spanish version. Conclusion: The overall reliability of the instrument was 0.91, very close to that obtained in the original version (0.93).

Validación al español de la escala de auto percepción de carga de cuidado

Objective: To validate the Spanish language version of the broad “self-perception of burden of care scale” by Cousineau et al. Methods: The sample consisted of 161 patients undergoing chronic hemodialysis at five dialysis centers in the city of Santiago - Chile. This scale was translated into Spanish and a pilot test was conducted with ten patients; after this procedure, we developed the final instrument to be subjected to the validation process. Results: The reliability of the scale was stable, with fluctuations of the Cronbach’s alpha coefficient of 0.903 and 0.915; we decided therefore to maintain the 25 original items within the Spanish version. Conclusion: The overall reliability of the instrument was 0.91, very close to that obtained in the original version (0.93).

Spanish validation of the "self-perception of burden of care scale"

Objective: To validate the Spanish language version of the broad “self-perception of burden of care scale” by Cousineau et al. Methods: The sample consisted of 161 patients undergoing chronic hemodialysis at five dialysis centers in the city of Santiago - Chile. This scale was translated into Spanish and a pilot test was conducted with ten patients; after this procedure, we developed the final instrument to be subjected to the validation process. Results: The reliability of the scale was stable, with fluctuations of the Cronbach’s alpha coefficient of 0.903 and 0.915; we decided therefore to maintain the 25 original items within the Spanish version. Conclusion: The overall reliability of the instrument was 0.91, very close to that obtained in the original version (0.93).