Tanning process is a polluting activity due to the release of toxic agents into the environment. One of the most important of those toxic chemicals is chromium. Different alternatives have been proposed for the removal of this metal from tanning waste water which include the optimization of the productive processes, physicochemical and biochemical waste water treatment. In this study, the biological adsorption process of trivalent chromium was carried out in synthetic water and tannery waste water through two types of native green microalgae, called Chlorella vulgaris and Scenedesmus acutus in Free State and immobilized in PVA state. This, considering that cellular wall of microalgae has functional groups like amines and carboxyl that might bind with trivalent chromium. Statistical significance of variables as pH temperature, chromium and algae concentrations was evaluated just like bio sorption capacity of different types of water and kind of bioadsorbent was calculated to determine if this process is a competitive solution comparing to other heavy metal removal processes.
Objectives To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and family caregivers. Methods An online questionnaire and telephone-based surveys were performed with physicians and family caregivers respectively in three teaching hospitals in Colombia which had been involved in the EoL care of cancer patients. Results For 138 deceased patients we obtained responses from physicians and family caregivers. In 32 % physicians reported they spoke to the caregiver and in 17 % with the patient regarding EoL decisions. In most cases lacking a conversation, physicians indicated the treatment option was “clearly the best for the patient” or that it was “not necessary to discuss treatment with the patient”. Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and family caregivers were aware if the patient had any advance care directive in 6% and 26% of cases, respectively, with low absolute agreement (34%). Conclusions There is a lack of open conversation regarding EoL in patients with advanced cancer with their physicians and family caregivers in Colombia. Communication strategies are urgently needed.
Background In Colombia, cancer incidence is increasing, as is the demand for end-of-life care. Understanding how patients who die from cancer experience this phase will allow the identification of factors associated with greater suffering and actions to improve end-of-life care. We aimed to explore associations between the level of suffering of patients who died from cancer and were cared for in three Colombian hospitals with patient, tumor, treatment, and care characteristics and provided information. Methods Data on the last week of life and level of suffering were collected through proxies: Bereaved caregivers of patients who died from cancer in three participating Colombian hospitals. Bereaved caregivers participated in a phone interview and answered a series of questions regarding the last week of the patient’s life. An ordinal logistic regression model explored the relationship between the level of suffering reported by bereaved caregivers with the patient’s demographic and clinical characteristics, the bereaved caregivers, and the care received. Multivariate analyses were adjusted for place of death, treatments to prolong of life, prolongation of life during the dying process, suffering due to prolongation of life, type of cancer, age, if patient had partner, rural/urban residence of patient, importance of religion for the caregiver, caregivers´ relationship with the patient, and co-living with the patient. Results A total of 174 interviews were included. Median age of the deceased patients was 64 years (IQR 52–72 years), and 93 patients were women (53.4%). Most caregivers had rated the level of suffering of their relative as “moderately to extremely” (n = 139, 80%). In multivariate analyses, factors associated with a higher level of suffering were: unclear information about the treatment and the process before death Odds Ratio (OR) 2.26 (90% CI 1.21–4.19), outpatient palliative care versus home care OR 3.05 (90% CI 1.05–8.88), procedures inconsistent with the patient’s wishes OR 2.92 (90% CI 1.28–6.70), and a younger age (18–44 years) at death versus the oldest age group (75–93 years) OR 3.80 (90% CI 1.33–10.84, p = 0.04). Conclusion End-of-life care for cancer patients should be aligned as much as possible with patients´ wishes, needs, and capacities. A better dialogue between doctors, family members, and patients is necessary to achieve this.
Objectives: To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and caregivers.Methods: An online questionnaire and telephone-based surveys were performed with physicians and caregivers respectively in three teaching hospitals in Colombia who had been involved in the EoL care of cancer patients. Results: For 138 deceased patients we obtained responses from physicians and caregivers. In 32% physicians reported they spoke to the caregiver and in 17% with the patient regarding EoL decisions. In most cases with absence of a conversation, physicians indicated the treatment option was “clearly the best for the patient” or that it was “not necessary to discuss treatment with the patient”.Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and caregivers were unaware if the patient had any advance care directive (ACD) in 65% and 51% of cases, respectively, with a very low absolute agreement (34%).Conclusion: There is a lack of open conversations regarding EoL in patients with advanced cancer with their physicians and caregivers in Colombia. Communication strategies are urgently needed.
El objetivo de este estudio fue describir las percepciones de médicos sobre la atención durante el final de la vida en pacientes oncológicos en tres hospitales de mediana y alta complejidad en Popayán y Bogotá en 2019 y 2020. Se utilizó un diseño de corte transversal descriptivo que consistió en aplicar a médicos un cuestionario auto administrado que mide la percepción de los médicos sobre la atención de fin de vida prestada a pacientes oncológicos durante su último mes de vida. Se identificó el fallecimiento de 341 pacientes y se obtuvieron 261 respuestas de sus médicos tratantes (tasa de respuesta 76,7%). El 70% de los médicos consideró que la muerte no fue consecuencia de intervenciones médicas y el 85% clasificó las estrategias terapéuticas como paliación sintomática. En 87% de los casos los médicos indicaron sentirse tranquilos con respecto a la atención médica brindada durante el proceso de fin de vida de los pacientes. El 48% y el 73% manifestó que no hablaron con los familiares y pacientes respectivamente sobre la posibilidad de acelerar el final de la vida como resultado de las intervenciones o no intervenciones. En conclusión, existe interés médico por el fin de vida de los pacientes oncológicos y tranquilidad con la atención médica brindada. La baja comunicación con el paciente o sus familiares durante este periodo puede ser un área de gran mejoramiento.
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