Over the last few decades, informal caregivers of patients with chronic diseases have received more attention, and there is a growing volume of studies demonstrating high rates of burden, stress, and mental disorders in this group of individuals. The objective of this study was to evaluate the burden, stress, and psychosocial characteristics of informal caregivers of liver transplantation candidates. Participants were assessed by individual evaluations with the following instruments: a semistructured interview, the Caregiver Burden Scale, the Inventá rio de Sintomas de Stress para Adultos de Lipp, and the Beck Depression Inventory. The Mann-Whitney test was used for statistical analysis with a significance level of 0.05. The characteristics of the study group (n ¼ 61) were similar to those of groups in other studies with respect to gender (82% were women), kinship (64% were spouses), and age (the mean age was 47.6 years). The main stressors identified by the participants were as follows: doubts about ways to react in a crisis or in emergency situations (42.6%), mood swings of the patient (29.5%), and care involving food and medications (27.9%). Approximately 25% of the caregivers reported that they felt unprepared to adequately perform their roles. Data analysis indicated a greater burden overall on caregivers when the patient's Model for End-Stage Liver Disease score was greater than or equal to 15 points (P ¼ 0.041). Furthermore, caregivers of patients with alcoholic liver disease showed higher depression (P ¼ 0.034) and overall burden scores (P ¼ 0.031) versus caregivers of patients with liver disease due to other etiologies. In conclusion, the participants showed significantly high levels of burden, stress, and depression. Support measures and caregiver preparation should be implemented by health care providers. A loss of health can be seen as a crisis situation, with effects extending to the relatives of patients and affecting their quality of life. Studies have warned of the high incidence of mental disorders among caregivers of the chronically sick. Anxiety, mood swings, stress, a lack of preparation for coping with the demands of patients, and feelings of anger, fear, guilt, and loneliness are all common complaints among informal caregivers.

Steatotic liver grafts were used on a large scale (71%) in this clinical series. The analysis confirms that using grafts with moderate (>30%) and severe steatosis (>60%) have a negative impact on outcomes. The authors conclude that using these grafts allow a significant increase in organ offer that counterbalances the negative outcome for patients who are not offered a transplant, and this supports the need for further clinical research.

Objective: to investigate the understanding and practice ofpediatric palliative care. Method: it is a qualitative, exploratory and descriptive study, in a Maternal-Infant School Hospital with 30 Nursing professionals. A sociodemographic questionnaire and semi-structured interview were used to collect data. The data was submitted to the Content Analysis technique. Results: professionals presented difficulties related to the understanding of the philosophy and objectives of palliative care and difficulties in working with pediatric patients under this care, highlighting the feelings of failure and sadness in dealing with the situation. As a coping strategy, the affective detachment of the patient and his family, the spirituality and the offer to the patient of a differentiated and humanized care are used as coping strategies. Conclusion: it is necessary to include palliative care in the academic training of professionals, favoring the knowledge of the subject and preparing the professional to deal with death and dying, as well as the need for a space in the health institutions that provide shelter for the difficulties of professionals working in this context. Descritores: Palliative Care; Pediatrics; Pediatric Nursing; Death; Adaptation, Psychological; Humanization of Assistance. RESUMOObjetivo: investigar a compreensão e a prática dos profissionais de enfermagem sobre os cuidados paliativos pediátricos. Método: trata-se de estudo qualitativo, exploratório e descritivo, em um Hospital Escola Materno-Infantil com 30 profissionais de Enfermagem. Utilizaram-se, para a coleta de dados, questionário sociodemográfico e entrevista semiestruturada. Submeteram-se os dados à técnica de Análise de Conteúdo. Resultados: apresentaram-se, pelos profissionais, dificuldades relacionadas à compreensão da filosofia e aos objetivos dos cuidados paliativos e dificuldade em atuar com pacientes pediátricos que estão sob esse cuidado, destacando-se os sentimentos de fracasso e de tristeza ao lidarem com a situação. Empregam-se, com isso, como estratégias de enfrentamento, o distanciamento afetivo do paciente e de sua família, a espiritualidade e o oferecimento, ao paciente, de um atendimento diferenciado e humanizado. Conclusão: salienta-se a necessidade da inclusão de cuidados paliativos na formação acadêmica dos profissionais, favorecendo o conhecimento do tema e preparando o profissional para lidar com a morte e o morrer, assim como a necessidade de um espaço nas instituições de saúde que proporcione acolhimento frente às dificuldades dos profissionais que atuam nesse contexto. Descritores: Cuidados Paliativos; Pediatria; Enfermagem Pediátrica; Morte; Adaptação Psicológica; Humanização da Assistência. RESUMEN Objetivo: investigar la comprensión y la práctica de los profesionales de enfermería sobre los cuidados paliativos pediátricos. Método: se trata de un estudio cualitativo, exploratorio y descriptivo, en un Hospital Escuela Materno-Infantil con 30 profesionales de Enfermería. Se utilizaron, para la recolección de datos, cuestionario sociodemográfico y entrevista semiestructurada. Se sometieron los datos a la técnica de Análisis de Contenido. Resultados: se presentaron, por los profesionales, dificultades relacionadas a la comprensión de la filosofía y a los objetivos de los cuidados paliativos y dificultad en actuar con pacientes pediátricos que están bajo ese cuidado, destacándose los sentimientos de fracaso y de tristeza al lidiar con la situación. Se emplean, con ello, como estrategias de enfrentamiento, el distanciamiento afectivo del paciente y de su familia, la espiritualidad y el ofrecimiento, al paciente, de una atención diferenciada y humanizada. Conclusión: se destaca la necesidad de la inclusión de cuidados paliativos en la formación académica de los profesionales, favoreciendo el conocimiento del tema y preparando al profesional para lidiar con la muerte y el morir, así como la necesidad de un espacio en las instituciones de salud que proporcione acogida frente a las dificultades de los profesionales que actúan en ese contexto. Descritores: Cuidados paliativos; Pediatría; Enfermería Pediátrica; Muerte; Adaptación Psicológica; Humanización de la Atención.

Fibromyalgia syndrome (FMS) is a painful condition of unknown etiology, highly prevalent, and associated with other conditions, which causes great impact on daily life and quality of life. Objective: To assess, due to the multifactorial character of the FMS, the discriminating power of instruments used to identify good indicators of self-assessment and self-knowledge. Patients and methods: This is a descriptive, exploratory, comparative, cross-sectional study with quantitative approach, and sample comprising a treatment group (T), diagnosed with FMS (n = 63) and a control group (C), undergoing interconsultation at the Pain Outpatient Clinic (n = 75). The following instruments were used: Fibromyalgia Impact Questionnaire (FIQ); visual analogue scale (VAS); McGill Pain Questionnaire; and the Post-Sleep Inventory (PSI). To evaluate the quality of life, Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) was used. Results: In the two groups, female gender predominated. The mean age of the sample was 42.3 ± 4.3 years, 45% were married, and the average schooling was 8 ± 3.5 years. The mean duration of pain was 3.2 years, and a mean time of two years were required for the clinical diagnosis of FMS in group T. Group T had higher levels of pain, anxiety, and depression, worse quality of sleep, less fl exibility, and worse quality of life, although some of these symptoms were also present in group C. Conclusions: All instruments had good discriminating power (P < 0.05), especially FIQ, VAS and PSI, whose areas under the ROC curve were greater.

Fulminant hepatic failure (FHF) accounts for 10-15% of pediatric liver transplants in the USA annually. Because the onset of FHF may be the first presentation of Wilson's disease (WD) and autoimmune hepatitis (AIH) in previously asymptomatic adolescents, determination of the etiology of FHF is critical as treatment and prognosis differ between these two entities. Patients with AIH may be salvaged by medical treatment. On the contrary, liver transplantation is currently the only life saving therapeutic option available for patients with WD who present with fulminant liver failure. To establish the diagnosis of WD and AIH in the setting of FHF remains challenging for diagnosticians and decisions regarding liver transplantation may be necessary before a diagnosis is firmly established. We report a previously asymptomatic patient who presented with FHF and clinical and laboratory features suggestive of both WD and AIH and who underwent successful therapeutic liver transplantation before the diagnosis of WD could be confirmed.

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Ao receber o diagnóstico de uma doença cuja cura não é possível e vivenciar a ameaça ou a concretude de perdas inerentes a essa nova condição, o paciente e seus familiares vivenciam um momento de crise, percorrendo algumas fases ou estados psicológicos aos quais o profissional de saúde deve estar atento para que consiga orientá-los, suprindo suas necessidades. Com o aumento da demanda e dos serviços em cuidados paliativos no contexto atual, o objetivo deste trabalho é apresentar uma breve revisão da literatura nacional e internacional sobre a comunicação na transição do cuidado curativo para o cuidado paliativo em oncologia. Para sua realização, foi feito um levantamento bibliográfico, sendo analisados artigos das bases de dados SciELO e Medline no período de 2006 a 2013, a partir dos descritores palliative care e breaking bad news. Os artigos localizados nas bases de dados e considerados relevantes ao tema foram incluídos, totalizando 32 estudos. Destes, 24 foram utilizados e subdividos nas seguintes categorias: treinamento de habilidades de comunicação; workshops; estudos sobre a qualidade da comunicação; e protocolos para comunicação em cuidados paliativos.

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