Browsing by Author "Carneiro, Rui"
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- Difficulties and opportunities in providing care to patients in the last hours or days of life: focus groupPublication . Carneiro, Rui; Simões, Catarina; Capelas, Manuel; Carneiro, AntónioBackground: In Portugal, two thirds of deaths occur in the hospital and it is estimated that these numbers will increase considerably in the coming decades. The proper organization of care at this stage promotes peaceful deaths and catalyzes healthy bereavements. The Project MiMI (Morte Iminente em Medicina Interna; Imminent Death in Internal Medicine) is a collaboration between the Portuguese Society of Internal Medicine, the International Collaborative for the Best Care for the Dying Person and the Institute of Health Sciences of the Portuguese Catholic University, whose ultimate goal is to create a training model adjusted to the needs identified by the health professionals involved in the care of these patients and their families Aim(s): (1) Identification of the main difficulties and opportunities for improving the quality of care for patients with imminent death and their families hospitalized for Internal Medicine care, from the perspective of the professional care provider (doctors and nurses working in the Internal Medicine environment); (2) Identification of training needs in the various moments of monitoring patients in a situation of imminent death (diagnosis; adjustment of individual and integrated care plan; death and post-mortem care). Methods: Qualitative methodology of response to a semi-structured script, by a group of professionals considered relevant in the contributions they can provide to the construction of a training curriculum in the area in question. Thus, a convergent discussion will be promoted with a convenience panel consisting of: two doctors with the Specialty of Internal Medicine and with responsibility for the service management, two doctors of the Specialty of Internal Medicine with at least 5 (five) years of experience and who has taken on the role of training supervisor, two Internal Medicine residents, two nurses working in the Internal Medicine environment and two members of the behavioral sciences area (Psychiatrist and/or Psychologist) with experience in supporting to Internal Medicine war. Results: The meeting is schedule to early September and results will be available in October Conclusions: In the construction of the curriculum, it is essential to incorporate the elements that respond to the main difficulties regarding the diagnosis, elaboration of the care plan, communicational management and care after death.
- Generating consensus on good practices in the care of Portuguese internal medicine patients facing imminent death: a Delphi studyPublication . Carneiro, Rui; Capelas, Manuel Luís; Simões, Catarina; Freire, Elga; Carneiro, António HenriquesContext: Modern medicine aims to ensure a world in which all people experience a good end of life as an integral part of their life journey. A good end-of-life experience means dying with dignity and receiving the best healthcare based on scientific evidence. Objective: This study aims to reach a consensus about the contents of a comprehensive instrument based on the 10/40 Model of the International Collaborative for the Best Care for the Dying Person for evaluating inpatients facing imminent death in Portuguese internal medicine wards and a proposal for anticipatory medication for symptom control in inpatient and home care settings. Methods: We employed the Delphi method and conducted various rounds of questionnaire administration to 23 Portuguese internists competent in palliative medicine. Data were obtained in July and September of 2022. Results: Consensus was reached among the expert panel on the diagnostic, initial assessment, monitoring, and after-death care items of the tool, with minor adjustments to wording or content. However, it was not possible to reach a consensus on most of the proposals presented for anticipatory medication for symptomatic control. Conclusion: We present the consensus about the contents of a comprehensive instrument for evaluating inpatients facing imminent death in Portuguese internal medicine wards. Best practices in this setting were defined from the point of view of internists with expertise in palliative care. However, the best pharmacological practices still require further reviews of the literature and consensus.
- High specificity clinical signs of impending death: a scoping reviewPublication . Simões, Catarina; Carneiro, Rui; Teixeira, Abílio CardosoBackground Accurate diagnosis of impending death is essential to provide proper care in the last days and hours of life. Recognising the death situation immediately allows adjustment of care goals, ensuring that they suit the patient's condition, as well as tuning the team's and family's expectations. Objective To map and describe evidence on high specificity clinical signs of impending death in cancer and noncancer hospitalised patients over 18 years of age. Methods A comprehensive search of the published literature was conducted According to Joanna Briggs Institute's methodology for scoping reviews. Online databases, including MEDLINE, CINAHL complete, SCOPUS, WEB OF SCIENCE, and the Cochrane Database of Systematic Reviews, and the search for unpublished studies included OpenGrey, DART-Europe, and RCAAP. Publications in English, French, Portuguese, and Spanish were included, and no period was set. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions to scoping review guidelines were used to report the results. The review protocol was registered in Open Science Framework (Simões et al., 2022). Results The 15 studies included in this review were published in English between 2013 and 2023. In addition to identifying the clinical signs of impending death, some researchers intend to develop accurate prognostic models for this clinical situation. Only two studies in the noncancer population met the inclusion criteria. Twelve articles were prospective observational studies (seven were multicentre studies), one was a retrospective cohort study, and two were narrative reviews. A clinical sign that is common to studies in both populations is respiration with mandibular movement, particularly in the last 12 h of life. Conclusions Clinical signs of impending death and prediction models can help clinicians identify impending death. However, they should not replace clinical judgement. Further research is required to understand whether the dying process differs among different patient populations and care settings.
- Validation of an assessment and monitoring instrument for the care of patients in imminent death situation admitted in internal medicine wardsPublication . Carneiro, Rui; Simões, Catarina; Freire, Elga; Capelas, Manuel; Carneiro, AntónioBackground: In Portugal, two thirds of deaths occur in the hospital and it is estimated that these numbers will increase considerably in the coming decades. The proper organization of care at this stage promotes peaceful deaths and catalyzes healthy bereavements. There is no validated instrument that supports health teams in the organization of care in the situation of imminent death syndrome. Aim(s): We propose the validation of an instrument for organizing care for patients in the last hours or days of life in Internal Medicine wards. Methods: We recruited an incidental sample of Internal Medicine doctors with Competence in Palliative Medicine. We will evaluate the response to a semi-structured questionnaire of the Delphi rounds type, evaluating the degree of agreement with the principles proposed by the instrument, which was already validated in accordance with the best international practices and derived from the best scientific evidence by the International Collaborative for the Best for the Dying Person Results: The Delphi rounds are underway Conclusions: The validation of this instrument will be the basis for the subsequent development of a national audit on the subject and the mainstay for the construction of a training model for national Internal Medicine based on the proposed principles of action, that constitutes the main goals of the MiMI Project (Morte iminente em Medicina Interna) of the Portuguese Society of Internal Medicine.
- “You died on me”: internist narratives about the caring patients in the final hours or days of lifePublication . Carneiro, Rui; Simões, Catarina; Magalhães, Susana; Capelas, Manuel; Carneiro, AntónioBackground: In Portugal, two thirds of deaths occur in the hospital and it is estimated that these numbers will increase considerably in the coming decades. The Internist is, therefore, called upon to take care of patients for whom cure is not expected and whose confrontation with the limits of existence is palpable. This is a great opportunity to assume the Suffering of the Other as a therapeutic target, but also to invite reflection on the limits of science, opening space for the relationship. Narrative medicine aims not only to validate the patient's experience, but also to stimulate the physician's creativity and self-reflection and to reinforce the clinical bond. Aim(s): The goal of this project is to characterize the experience of Portuguese internists in the follow-up of their patient(s) in the final phase of their life(s). Methods: A semi-structured questionnaire will be used using a narrative medicine work methodology - parallel chart, focusing on a convenience panel of doctors with the specialty of Internal Medicine. The data will be analyzed in four cycles: In the first cycle, the NVivo software will be used, which allows the analytical process of the data, not replacing the researcher's responsibility in the interpretation of the results. In the second cycle, the analysis of parallel clinical records will be guided by the following narrative categories (and the questions that emerge from them): Voice, Characters, Time, Space and Plot. A third cycle of analysis will follow, in which the autobiographical/personal elements will be identified in the texts; dialogic/interpersonal; socio-cultural and institutional. The fourth and final cycle of analysis will allow the evaluation of previous cycles and the identification of contents that stand out for their novelty and/or relevance. Results: The collection of records is underway. Conclusions: The appreciation of the results of the reflection will lead to relevant contributions for the construction of a training model for the integral care of patients in the last hours or days of life by the national Internal Medicine, the main purpose of the MiMI Project (Morte Iminente em Medicina Interna) of the Portuguese Society of Internal Medicine.