Palliative extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. It may be considered when all attempts at weaning from ventilation have failed and when maintenance of ventilatory support becomes futile and is a complex procedure that demands clearly defined and meticulous planning, as well as trained staff. However, despite the relevance of adequate planning and execution, the literature provides little information on how to perform palliative extubation properly. Most of published works are focused on specific aspects of the procedure, like communication skills, or the choice of drugs. Nevertheless, just a few articles provide detailed information about the whole process.Considering the complex technical, ethical, emotional and scientific implications of palliative extubation, we reviewed the available data from the literature and developed a protocol whose main aim is to define and clarify this procedure to improve the quality and safety of the care provided to this population of patients. The protocol was implemented following approval by the ethics committee of our institution and the Technical Chamber for Palliative Care, Regional Medical Council of the State of São Paulo, Brazil.
Qual o valor do índice preditor de resposta terapêutica na quimioterapia neoadjuvante em portadores de carcinoma mamário localmente avançado por cintilografia?What is the value of the predictive index of therapeutic response in neoadjuvant chemotherapy in patients with locally advanced breast cancer by scintigraphy?
Despite all advances in the treatment of neoplasms and substantial increases in fiveyear survival rates, most patients still die due to their diseases. Late diagnosis in some circumstances and resistance mechanisms throughout treatment still cause most patients to require palliative care integrated with cancer treatment, since diagnosis. Most palliative care interventions can and should be carried out by the oncologist, with reference to the multidisciplinary team specialized in palliative care in the most critical moments of clinical evolution. It is important that the oncologist develops their skills in this scenario and knows how to recognize the moment of referral. The following text outlines the basic skills that are expected of oncologists, such as recognition of the prognosis, identification and correct assessment of symptoms, definition of the time to stop antineoplastic therapy, how to communicate these aspects to patients and family, how to involve psychosocial and spiritual issues and, finally, how to stay within the limits established by modern bioethics. This work consists of brief recommendations for oncologists working in Brazil.
e23002 Background: Healthcare professionals are subject to stressful events, especially in areas such as oncology or palliative care. Writing is a valuable tool for dealing with stress, increasing empathy and job satisfaction. Narratives have therapeutic potential and can provide useful information for diagnosis and individualized strategies. Expressive Writing and Narrative Medicine have been studied in this field, resulting in physical and psychological benefits to health professionals, and can be a medical-educational tool. The practice of writing can promote healthier relationships between patients, professionals, and oneself. However, little is known about the perception that health professionals have about writing as a habit. These data can help to develop strategies for stimulating practice in universities, contributing to better professionals mental health. Methods: An online questionnaire was disseminated through social networks of the authors and professional associations inviting health professionals who deal with cancer patients and have the habit of writing to answer the questions, voluntarily and anonymously. The questionnaire was composed by 13 multiple choice questions and 1 free choice question, divided into 3 categories: 3 related to personal and professional data, 5 to the habit of writing and 5 to the impact that the habit of writing has on their lives. The data were analyzed descriptively, based on the results provided by the platform itself. Results: 177 responses to the form were obtained. Most participants were over 40 years old (53.9%). Eighty-seven participants were physicians (49.4%), 41 psychologists (23.3%), and 27.3% worked in other health fields. The majority (32.1%) declared they write sporadically when they feel the need. Only 17.8% wrote daily. Thirty-two percent write mainly short texts (blogs or social networks); 16.9% write mainly narratives. Most participants have been writing for more than ten years (63.2%). Using writing as a tool for self-knowledge was the main reason to start writing for 19.8%, and improving the ability to understand what is happening to other people for 18.7%. The themes of the texts were personal experiences (21.1%), personal feelings (19.4%), technical issues (14.8%), the process of getting sick (6.2%), or other topics (28.5%). Most reported that writing provides them with serenity (24.4%), comfort (23.8%), pride (19.3%), relief (13.6%), or other. Participants reported that the impact of writing on their lives is essential (32%), very positive (30.9%), or positive (33.7%), and the majority (48.8%) reported that the impact is both immediate and long-term. Conclusions: The personal perception about the impact of writing is extremely positive among healthcare professionals, suggesting that the practice should be stimulated during professional training and considered as a useful tool for the promotion of mental health.
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