Miako Kimura

The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

IntroductionPain is a major problem in the treatment of patients with cancer. This article reviews studies concerning evaluation of patients with cancer pain treated according to The World Health Organization (WHO) analgesic ladder.Materials and methodsSystematic search of PUBMED, MEDLINE, EMBASE, LILACS, BDENF, and OVID and a hand search of reference lists and textbooks from 1982 to 2004 were performed.ResultAnalgesia was considered adequate in 45 to 100% of patients analyzed in the studies.ConclusionHowever, the evidence that they provide is insufficient to grant the effectiveness of the WHO guidelines because a controlled clinical trial of this intervention has never been published.

Impact of Cancer-Related Symptom Synergisms on Health-Related Quality of Life and Performance Status

To identify the impact of multiple symptoms and their co-occurrence on health-related quality of life (HRQOL) dimensions and performance status (PS), 115 outpatients with cancer, who were not receiving active cancer treatment and were recruited from a university hospital in Sao Paulo, Brazil completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, the Beck Depression Inventory, and the Brief Pain Inventory. Karnofsky Performance Status scores also were completed. Application of TwoStep Cluster analysis resulted in two distinct patient subgroups based on 113 patient experiences with pain, depression, fatigue, insomnia, constipation, lack of appetite, dyspnea, nausea, vomiting, and diarrhea. One group had multiple and severe symptom subgroup and another had less symptoms and with lower severity. Multiple and severe symptoms had worse PS, role functioning, and physical, emotional, cognitive, social, and overall HRQOL. Multiple and severe symptom subgroup was also six times as likely as lower severity to have poor role functioning; five times more likely to have poor emotional; four times more likely to have poor PS, physical, and overall HRQOL; and three times as likely to have poor cognitive and social HRQOL, independent of gender, age, level of education, and economic condition. Classification and Regression Tree analyses were undertaken to identify which co-occurring symptoms would best determine reduction in HRQOL and PS. Pain and fatigue were identified as indicators of reduction on physical HRQOL and PS. Fatigue and insomnia were associated with reduction in cognitive; depression and pain in social; and fatigue and constipation in role functioning. Only depression was associated with reduction in overall HRQOL. These data demonstrate that there is a synergic effect among distinct cancer symptoms that result in reduction in HRQOL dimensions and PS.

Qualidade de vida de pessoas com doença crônica

The present study has the following objectives: to identify the significance of the quality of life of people with chronic illness and verify its interference in their quality of life. We have studied 71 people of both sexes, attended in the clinical settings of 2 public hospitals. The most common diagnoses were high blood pressure and diabetes mellitus. The significance of quality of life to interviewed people was related mainly to material comfort (40.9%); physical comfort (23.9%) and emotional comfort (11.2%). Chronic illness interfered in their quality of life because it has changed, especially, their physical capacity (67.6%), their work/study/home activities (64.8%) and their self-esteem (53.5%). Based on the results, we emphasize the importance of nursing in the adaptation process of people and their relatives considering the limitations of chronic illness.O presente estudo teve como objetivos; identificar o significado de qualidade de vida para pessoas com doenca cronica e verificar a interferencia da doenca sobre a qualidade de vida das mesmas. Foram entrevistadas 71 pessoas de ambos os sexos, com idade entre 13 e 79 anos, atendidas nos ambulatorios de Clinica Medica de 2 hospitais governamentais. Utilizou-se, para coleta de dados, um formulario com questoes abertas e fechadas. Os diagnosticos mais frequentes foram hipertensao arterial e diabetes mellitus. O significado de qualidade vida para as pessoas entrevistadas relacionou-se principalmente ao bem-estar material (40,9%), ao bem-estar fisico (23,9%) e ao bem-estar emocional (11,2%). A doenca cronica interferiu na qualidade de vida das pessoas por alterar, sobretudo, a sua capacidade fisica (67,6%), o trabalho/estudo/atividades/ do lar (64,8%) e a auto-estima (53,5%). A partir dos resultados obtidos, enfatiza-se a importância de se considerar a multidimensionalidade do conceito de qualidade de vida na assistencia de enfermagem as pessoas com doencas cronicas.

Effects of continuous versus bolus infusion of enteral nutrition in critical patients

PURPOSE Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus intermittent administration are surrounded by controversy. With the purpose of identifying the benefits and complications of each technique, a prospective controlled study with matched subjects was conducted. PATIENTS AND METHODS Twenty-eight consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray, measurement of abdominal circumference, monitoring of gastric residue, and clinical and nutritional assessments were performed at least once daily. The principal measured outcomes of this protocol were frequency of abdominal distention and pulmonary aspiration, and efficacy in supplying the desired amount of nutrients. RESULTS Nearly half of the total population (46.4%) exhibited high gastric residues on at least 1 occasion, but only 1 confirmed episode of pulmonary aspiration occurred (3.6%). Both groups displayed a moderate number of complications, without differences. Food input during the first day was greater in Group II (approximately 20% difference), but by the third day, both groups displayed similarly small deficits in total furnished volume of about 10%, when compared with the prescribed diet. CONCLUSIONS Both administration modalities permitted practical and effective administration of the diet with frequent registered abnormalities but few clinically significant problems. The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities.

Family members' needs at intensive care units: comparative analysis between a public and a private hospital

Se trata de un estudio transversal, con objeto de analizar y comparar las necesidades de los familiaresde pacientes adultos internados en UTIs de un hospital publico y un privado, respecto al grado de importanciay satisfaccion. Se les entrevistaron a 91 familiares, 47 de la institucion publica y 44 de la privada, utilizandoseel Inventario de Necesidades y Estresores de Familiares en Terapia Intensiva (INEFTI). No hubo diferenciasignificativa entre los grupos en la puntuacion total de importancia atribuida a las necesidades (p=0,410). Elgrado de satisfaccion fue mayor en el hospital privado con relacion al publico (p=0,002). El analisis de regresionlinear multipla permitio establecer una jerarquia de importancia y de satisfaccion de las necesidades de losfamiliares de cada grupo. Las diferencias observadas entre los grupos sugieren que el atendimiento de susnecesidades requiere intervenciones direccionadas a la especificidad de cada tipo de institucion.DESCRIPTORES: familia; enfermeria de la familia; evaluacion de necesidades; unidades de terapia intensiva

A distanásia como geradora de dilemas éticos nas Unidades de Terapia Intensiva: considerações sobre a participação dos enfermeiros

A distanasia apresenta-se como uma das fontes geradoras de dilemas eticos nas Unidades de Terapia Intensiva (UTI). Discute-se o contexto que favorece a pratica da distanasia nesse ambiente, com enfase na utilizacao excessiva do suporte tecnologico. Tecemos comentarios sobre a participacao dos familiares e profissionais envolvidos, principalmente medicos e enfermeiros, considerando-se o papel socio-profissional atribuido a cada um. Pretende-se com as consideracoes apresentadas, fornecer subsidios para a reflexao do tema, com vistas a uma participacao mais ativa dos enfermeiros de UTI nos dilemas eticos relacionados a distanasia.Disthanasia is conceptualized and presented as an ethical dilemma in Intensive Care Units (ICU). The context favoring the disthanasia practice on this environment focusing the excessive use of technological devices will be discussed. The study will approach the family, physician and nurse’s participation in the situations, considering the social and professional role of each one. This study aims to provide support for healthcare professionals to reflect on this subject, aiming the nurse’s more effective participation on ethical dilemmas related to disthanasia.

Health related quality of life of women with cervical cancer

This cross-sectional study aimed to evaluate the health related quality of life (HRQoL) of women with cervical cancer and to identify predictors of quality of life. Between November 2008 and February 2009, 149 women were interviewed. The instrument Functional Assessment of Cancer Therapy-Cervix Cancer (FACT-Cx) was used to assess HRQoL and, in general, the scores obtained indicated positive evaluation. The items that showed negative evaluation were: I am interested in sex, I feel sexually attractive, I am afraid to have sex and My vagina feels too narrow or short. In multiple linear regression analysis, using the backward method, of the 18 independent variables, eight were predictive of HRQoL. Self-perceived health status was the most influential factor. Special attention should be given to the sexual dysfunctions of these women after radiotherapy.

Qualidade de vida da pessoa diabética

Trata-se de um estudo que teve por objetivos identificar o significado de qualidade de vida para a pessoa diabetica, reconhecer os aspectos mais influenciados pela doenca e o seu grau de satisfacao com a vida. Participaram do estudo 46 pacientes diabeticos, adultos, de ambos os sexos, em tratamento ambulatorial. Os resultados obtidos demonstraram que o significado de qualidade de vida relacionou-se, prioritariamente, ao bem estar fisico (54,5%), a estabilidade socio-economica 26,0%) e ao bem-estar psico-emocional e espiritual (16,9%). Os aspectos mais afetados pela doenca foram: trabalho, estudo e atividades do lar (38,5%), capacidade fisica (25,6%) e relacionamento familiar (10,3%). Quanto ao grau de satisfacao com a vida, a maioria dos pacientes (66,6%) considerou-se satisfeita ou muito satisfeita. Ressalta-se a importância de que, na assistencia a pessoa diabetica, seja considerada a multidimensionalidade do conceito de qualidade de vida.The purposes of this study were to identify the meaning of the quality of life for the people who suffer from Diabetes Mellitus, to recognize the aspects which affect most their lives due to this disease and the degree of the satisfaction in their lives as well. Participated in this research forty-six (46) diabetic patients, adults of both sexes, who were in a polyclinic for treatment. The results showed that the meaning of the quality of life had priority related to the physical well-being (54.5%), to the social and economical stability (26.0%), and to the spiritual and emotional well-being (16.9%). The most affected aspects due to this disease were: studying and home activities (38.5%) physical ability (25.6%) and family relationship (10.3%). Concerning about the degree of satisfaction with their lives, the majority of them (66.6%) considered themselves satisfied or very satisfied. It is worth while to point out the importance of considering the multimensionality of the concept of quality of life while attending the diabetic person.

Ferrans and Powers quality of life index

Este artigo tem como objetivos descrever os processos de desenvolvimento conceitual e metodologico utilizados na criacao do instrumento Ferrans and Powers Quality of Life Index (QLI) e disponibilizar a versao generica atual adaptada para o portugues, visando ampliar a disseminacao do seu uso em diferentes contextos e amostras da populacao brasileira. O QLI avalia a qualidade de vida de acordo com os niveis de satisfacao e de importância atribuidos a quatro dimensoes: Saude/funcionamento, Psicologico/espiritual, Socioeconomico e Familia. Aplicacoes previas da versao em portugues (Indice de Qualidade de Vida de Ferrans e Powers) tem demonstrado que o instrumento pode ser utilizado em nosso meio como uma medida valida e confiavel de qualidade de vida.This article aims to describe the processes of conceptual and methodological development used for the creation of the Ferrans and Powers Quality of Life Index (QLI), and to make available the current generic version adapted to the Portuguese language, expecting to enlarge its application in different contexts and samples of the Brazilian population. QLI is an instrument designed to evaluate quality of life based on the levels of satisfaction and importance in four dimensions: Health/functioning, Psychological/spiritual, Socioeconomic and Family. Previous studies have showed that the QLI Brazilian Portuguese version may be used as a valid and reliable measure of quality of life.

Therapeutic intervention scoring system-28 (TISS-28): diretrizes para aplicação

Therapeutic Intervention Scoring System-28 (TISS-28) is a tool that enables the measurement of the nursing work load in Intensive Care Units and the estimate of how grave the disease is. In this study are presented the operational definitions for its application, proposed by a group of specialists in the area, with the aim of rendering uniform the meaning of each of the items and preventing interpretation biases.