Artículos

Permanent URI for this collectionhttps://hdl.handle.net/20.500.14595/823

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Delirium en los diferentes escenarios de cuidados paliativos
(Revista Chilena de Anestesia, 2024-03-11) Lennis J. Bedoya Muñoz, Natalia Botero Jaramillo, Lina Ortiz, María Ximena de la Ossa Durán
Patients in palliative care are a high-risk group from delirium, with prevalences as high and variable as 13% to 42%. Which is associated with significant distress for patients, families, and health professionals. Furthermore, delirium is associated with accelerated functional and cognitive deterioration, prolonged hospital stays, and increased risk of institutionalization and death. The following article aims to carry out a non-systematic review of the literature and expose the presentation of delirium in different palliative care scenarios.
Early Palliative Care Integration in End-Stage Liver Disease: A Narrative Review of Clinical Strategies for Symptom Control and Quality of Life
(Journal of Pain & Palliative Care Pharmacotherapy, 2026-01-12) Sarria-Gómez, Daniela; Cristhian Camilo Martínez Torres; Diana Estrada Bermúdez; Liliana Saavedra
End-stage liver disease (ESLD) is associated with a high symptom burden, poor prognosis, and limited access to curative disease. Despite growing evidence supporting the role of palliative care (PC), its integration into the routine management of ESLD remains limited and inconsistent. To synthesize the current evidence on the role of palliative care in ESLD, emphasizing its impact on quality of life and including strategies for symptom control and effective clinical integration. A narrative review with a systematic approach was conducted. PubMed, Scopus, Embase, and SciELO were searched for English- and Spanish-language studies published between 2015 and 2025. Studies were selected based on methodological rigor and relevance to PC interventions in ESLD. Key barriers to PC implementation include misconceptions about its use being limited to terminal phases, lack of referral criteria, and insufficient coordination between specialties. Evidence shows that early PC involvement improves symptom control (pain, dyspnea, pruritus, encephalopathy), decreases avoidable hospitalizations, and facilitates shared decision-making. Early and structured integration of palliative care into ESLD management is essential. Health systems should prioritize interdisciplinary care models, establish clear referral criteria, and promote a care approach focused on patient well-being, autonomy, and dignity.
Evaluation of loneliness and its associated factors in caregivers of patients with dementia: a cross-sectional study
(Colombia Médica, 2024-09-30) Hernandez Rico Angie Nathalia; Flórez Vargas Bibiana; Guadarrama Vega Santiago; Pino Pinzón Carmen Juliana; Agamez Insignares Claudia Patricia
Objective: To identify the levels of loneliness and the factors associated with the prevalence of loneliness in caregivers of patients with dementia. Methods: An observational cross-sectional study was conducted, including unpaid caregivers of patients with dementia who were receiving home care in Bogotá, Colombia. The prevalence of loneliness was estimated using the UCLA Loneliness Scale. Participants were also assessed regarding their satisfaction with providing care and whether they felt they received the necessary emotional support from family and friends. The association between loneliness and the patient's clinical variables, as well as the sociodemographic characteristics of the caregiver, was evaluated by calculating the odds ratio (OR) between the groups. Results: A total of 52 caregivers of patients with dementia were included. Severe loneliness was present in 5.77% of caregivers, while 26.92% experienced moderate loneliness. All caregivers reported feeling satisfied with providing care to their relatives, and 71% felt that their family or friends provided the emotional support they required. Loneliness was more common among caregivers of patients with total functional dependence (OR 4.061, P = 0.0278). Conversely, the perception of receiving emotional support from family and friends was identified as a potential protective factor against loneliness (OR 0.184, P = 0.0104). Conclusions: The prevalence of loneliness in this study is lower than that reported in previous studies. All caregivers reported satisfaction in providing care; most perceived adequate emotional support from family and friends. These factors could be contributing to the lower prevalence of loneliness observed.
Exploring psilocybin’s role in mental health and palliative medicine: a path to improved well-being
(Expert Opinion on Emerging Drugs, 2025-04-25) Maria-Alejandra Umbacia, Marta Ximena Leon, Jose-Manuel Quintero, LinaMaria Castro, Veronica Paez, Seetal Dodd & Rosa-Helena Bustos
ABSTRACT Introduction: Although long known for their psychoactive effects, psychedelic drugs have only recently been investigated for medicinal use. Psilocybin has attracted the greatest interest with studies suggesting that it may be a useful agent in psychiatry and in palliative care. Areas covered: Clinical trials that included psilocybin were searched in PubMed, Embase, and ClinicalTrials.gov, demonstrating that adult psychiatry and palliative care are the medical fields that show the greatest interest in psilocybin treatment. Expert opinion: Psilocybin is a powerful drug that needs to be used with caution but may benefit some patients, including when other options have failed. It is best evidenced in treatment resistant depression and in palliative care, where patients are usually treated in specialist care centers. It has a novel mechanism of action, targeting the 5HT2A receptor, and can show rapid onset of action. There are many questions regarding its use that remain to be clarified, including its efficacy for other indications and its role as adjunctive treatment in psychotherapy. The psychoactive, or psychedelic effects are well documented, but their clinical importance is disputed.
Guided imagery for symptom management of patients with life-limiting illnesses: A systematic review of randomized controlled trials.
(Journal of Palliative Medicine, 2024-06-22) Juan Esteban Correa-Morales; Nidia Mantilla-Manosalva; Ximena Rodríguez-Cardona; Lennis Jazmin Bedoya-Muñoz; Bibiana Florez-Vargas; Marta Ximena León; Sara Giraldo-Moreno; Omar Fernando Gomezese; Natalia Salamanca-Balen
Background: Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery, an alternative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of the articles was evaluated using the Cochrane Collaboration’s Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 24 randomized controlled trials were included in this review. The quality assessment revealed that 11 studies had a high risk of bias, 11 had some concerns, and 2 had a low risk of bias. Out of the 24 included studies, 14 evaluated oncological diagnosis, while the remaining 9 focused on non-oncological diagnoses across 6 different diseases. Guided imagery was found to be effective in managing symptoms in 20 out of the 24 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, nausea, vomiting, sleep disturbances, and fatigue. Conclusion: Guided imagery therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses.
Guided imagery for symptom management of patients with life-limiting illnesses: A systematic review of randomized controlled trials.
(Journal of Palliative Medicine, 2024-06-22) Juan Esteban Correa-Morales; Nidia Mantilla-Manosalva; Ximena Rodriguez-Cardona; Lennis Jazmin Bedoya-Muñoz; Bibiana Florez-Vargas; Martha Ximena Leon; Sara Giraldo-Moreno; Omar Fernando Gomezese; Natalia Salamanca-Ballen
Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery, an alternative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of the articles was evaluated using the Cochrane Collaboration’s Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 24 randomized controlled trials were included in this review. The quality assessment revealed that 11 studies had a high risk of bias, 11 had some concerns, and 2 had a low risk of bias. Out of the 24 included studies, 14 evaluated oncological diagnosis, while the remaining 9 focused on non-oncological diagnoses across 6 different diseases. Guided imagery was found to be effective in managing symptoms in 20 out of the 24 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, nausea, vomiting, sleep disturbances, and fatigue. Conclusion: Guided imagery therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses.
Nefopam, ¿Útil para él dolor neuropático?
(Revista Chilena de Anestesia, 2024-06-04) Santiago Téllez Buitrago Ribero; Omar Fernando Gomezese; Andrea Gutiérrez
Nefopam is a drug with very interesting pharmacological characteristics for the treatment of acute postoperative pain, but even more, as an understudied analgesic strategy for neuropathic pain. The present review article was proposed to perform a search with the MeSH terms in (PubMed) with the formula terms (nefopam [MeSH Terms]) AND (neuropathic pain [MeSH Terms]). In this way, a great void of medical literature on a molecule with a great potential for research was evidenced since the sixties in European countries, doctors like Basset and collaborators in 1969 as a potential antidepressant which owes its action in relation to its interaction with the inhibition of monoamine reuptake, suppressive effect on sodium voltage channels and an inhibitory activity on voltage-dependent calcium channels; so, it is a drug with a high likelihood to the antineuropathic ones. At present there are no recommendations or guidelines that support the use of Nefopam for the treatment of neuropathic pain and so it is interesting to make a review article that can examine the little literature found and allow to awaken the interest of clinical researchers to add an intravenous analgesic strategy for neuropathic pain.
Percepción de los médicos acerca de extubación paliativa en las unidades de cuidado intensivo
(2025) Alejandrina Martinez Orjuela; Melissa Reyes Rueda; Nelson Francisco Castañeda Alarcón
Introducción: Durante la estancia de los pacientes en la Unidad de Cuidado Intensivo (UCI), los médicos encargados de su cuidado se pueden enfrentar a la necesidad de retiro de soportes vitales, como lo es el soporte ventilatorio. Objetivo: evaluar la percepción de los médicos que trabajan en UCI en Colombia sobre la extubación paliativa y los factores que influyen en su toma de decisiones. Metodología: La aplicación de una encuesta autoaplicada, realizada a 36 médicos de diversas especialidades, se analizaron aspectos sociodemográficos, percepciones éticas y legales, y la influencia de la espiritualidad en la suspensión de la ventilación mecánica. Resultados: La mayoría de los encuestados son médicos intensivistas, hombres, con menos de cinco años de experiencia en UCI. En términos de decisión clínica, el 92% de los participantes considera que la limitación o suspensión de tratamientos es una parte fundamental del ejercicio médico en UCI y que debe aplicarse sin importar la patología subyacente. En cuanto a la técnica de retiro de la ventilación mecánica, la mayoría (50%) opta por el destete terminal, mientras que un menor porcentaje (5.6%) percibe la extubación terminal como una práctica ilegal. El estudio también reveló que la religiosidad y la espiritualidad desempeñan un papel relevante en la toma de decisiones médicas. Conclusiones: Los resultados cuantitativos mostraron una considerable variabilidad en la percepción médica sobre la extubación paliativa, particularmente en función de la especialidad y las creencias religiosas.
Pharmacological Treatment for Dialysis-Related Muscle Cramps: A Systematic Review
(2024-08-06)
Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review
(2023-09-23) Juan Esteban Correa-Morales; Sara Giraldo-Moreno; Nidia Mantilla-Manosalva; Laura Cuellar-Valencia; Oscar Felipe Borja-Montes; Lennis Jazmin Bedoya-Muñoz; María Fernanda Iriarte-Aristizábal; Elias Quintero-Muñoz; Andrea Marcela Zuluaga-Liberato
Objectives: Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. Methods: Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. Results: Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. Conclusions: Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities. Keywords: chemotherapy-related adverse events; cisplatin-induced ototoxicity; hearing loss; otoprotection; platinum chemotherapy.
Subcutaneous Levetiracetam Administration in Latino Patients on Home Care
(Sage Journals, American Journal of Hospice and Palliative Medicine, 2023-10-31) Cuellar-Valencia, Laura; Claros-Hulbert, Angelica; Ortegon, Adriana; Pino, Juliana; Velandia, Laura; Correa-Morales, Juan Esteban
Background: Levetiracetam has a favorable pharmacology profile to be used subcutaneously. However, its subcutaneous use is still considered off-label as this is beyond its license. The evidence base for its safety, tolerability, and efficacy is limited to observational studies. Objectives: To report the safety and efficacy of subcutaneous levetiracetam in Latino patients on home care. Design: Observational retrospective case series study. Subjects: Consecutive sample of Latino adults with life-limiting illnesses. Methods: A case series framework with 4 domains (selection, ascertainment, causality, and reporting) to ensure reporting quality was used. Additionally, 8 relevant outcomes established in a previous comprehensive review, were collected and reported. Adverse reactions were documented using the Common Terminology Criteria for Adverse Events. Results: Fifteen Latino patients with oncological and non-oncological diagnoses received subcutaneous levetiracetam for a mean of 21 days on home care. Levetiracetam was most frequently initiated subcutaneously due to loss of the oral route. The average dosage of subcutaneous levetiracetam was 1200 mg. Only 1 patient required a dose adjustment, and only 2 patients experienced a total of 5 seizures during the therapy trial. No adverse reactions were reported. Conclusions: Subcutaneous levetiracetam appears to be effective and safe. This case series of Latino patients in home care expands the evidence of its use in the home care setting. The preliminary data reported by now on multiple case series warrants robust trials.

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