Context: Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced diseases. Objectives: Establish a telemedicine model of rural palliative care for advanced cancer patients with difficulties in accessing standard care. Methods: This review comports with the minimum standards described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and uses the palliative care literature review iterative method (PALETTE) proposed by Zwakman et al in 2018. Results: Three hundred, ninety-two articles were identified in PubMed and EMBASE databases and alternative search engines such as Google Scholar and OpenGrey. A telemedicine delivery model was developed for patients with limited access to standard care, which consists of identifying the candidate population, establishing the most convenient telemedicine modality, agreeing with patients and caregivers on palliative care needs, and evaluating the interventions effectiveness. Conclusion: Telemedicine is a revolutionary tool to provide palliative care to advanced cancer patients whose clinical condition or location prevent them from accessing conventional care.

This study aimed to identify barriers to access to palliative care through a social mapping approach. In Colombia, the barriers to access to palliative care denote an enormous geographic disparity of resources and health needs, making it necessary to conduct community-based participatory research using an approach such as social mapping. A qualitative research design was used. Stakeholders from health insurance companies, regulatory authorities, regional health secretariats, health care professionals, patient and caregiver organizations, scientific societies, and medical journalists from 7 Colombian regions participated. It involved 3 stages. Stage 1: Semi-structured, audio-recorded interviews were conducted with 36 stakeholders and were subsequently transcribed and analyzed. Stage 2: An electronic survey was conducted to obtain feedback on the first outline of the map and the categories that emerged from stage 1. Stage 3: The nominal group technique was used to analyze and validate the barriers to access to palliative care included in the final map. The COREQ checklist was used. Twenty-seven barriers to access to palliative care related to limited availability of medications, stakeholders’ poor knowledge of regulations, limited formal education in palliative care, few patients’ support networks, patient care fragmentation, few specialized programs of palliative care, and mistaken beliefs about palliative care were identified. Stakeholders’ diverse perspectives and opinions were crucial to understanding the development of palliative care in Colombia and its challenges. Better knowledge about palliative care can open opportunities to overcome the barriers identified in this study, directly impacting access to palliative care.

Background: Infections are common in patients with advanced illnesses for whom the intravenous or oral route is not possible. The subcutaneous administration of antibiotics is a promising alternative, but there is not enough theoretical support for its use. This study aims to explore the effectiveness and safety of subcutaneous antibiotic therapy in the context of palliative care in elderly patients. Methods: A systematic review was conducted using PubMed and Embase, without time or language limits. Seven articles were selected on the effectiveness of subcutaneous antibiotic therapy in adult patients with chronic progressive diseases. The quality of the articles was assessed with the Newcastle Ottawa Scale and relevant data was extracted using a selection capture file. Results: Seven quasi-experimental studies evaluated 865 elderly patients with advanced diseases, comorbidities, and infections (ie, urinary tract, respiratory system, and bone joint) who received subcutaneous antibiotic therapy (ie, Ceftriaxone, Ertapenem, and Teicoplanin). The pooled success rate of subcutaneous antibiotics for the 7 studies was 71%, the therapy failure rate was 22%, its withdrawal mean was 8%, and the mean mortality rate was 7%. The studies were of low quality and were heterogeneous in the types of infections, types of antibiotics, time of follow-up, and outcomes assessed. Conclusions: Pilot studies have found a limited number of antibiotics that can be safely used to treat specific infections. Nevertheless, the data isn´t robust enough to recommend their use.

Introducción: La insuficiencia cardiaca es una enfermedad crónica, progresiva, prevalente, con un alto impacto en los sistemas de salud y en la calidad de vida de los pacientes y sus familias, la disnea es un síntoma com un y se ha planteado el uso de opioides para su control. Objetivo: Revisión sistemática de la literatura sobre el uso de opioides en el manejo de la disnea en pacientes con insuficiencia cardiaca crónica estable con clase funcional NYHA II, III o IV. Materiales y métodos: Se realizó una revisión sistemática de los artículos encontrados en las bases de datos MEDLINE, Embase, Cochrane, OVID, LILACS, PROSPERO a partir del 1 de enero del 1995 hasta el 31 de julio del 2018, publicados en cinco idiomas. Se incluyeron aquellos estudios en los cuales se describe la administración de cualquier tipo de opioide para el manejo de la disnea en pacientes con insuficiencia cardiaca crónica estable, NYHA II, III o IV. Resultados: Se incluyeron cuatro ensayos clínicos para el análisis final, con un numero total de 70 pacientes, en los cuales se describe la administración de opioides para el manejo de la disnea en pacientes con insuficiencia cardiaca crónica estable, NYHA II, III, o IV. Conclusiones: En pacientes adultos con insuficiencia cardiaca crónica compensada en tratamiento óptimo, existe evidencia de baja calidad que muestra beneficio para el manejo de la disnea con opioides, deben realizarse estudios aleatorizados controlados con una cantidad de individuos mayor para poder generar una recomendación más fuerte.

Existe un incremento en la prevalencia de enfermedades neurológicas y su carga de enfermedad. Debido a ello, identificar la frecuencia de síntomas y las alteraciones funcionales es de vital importancia para definir un adecuado plan de tratamiento. Se llevó a cabo un estudio de corte transversal para identificar los síntomas principales y las alteraciones funcionales en pacientes neurológicos de un centro de referencia colombiano para manejo de rehabilitación. Se encontraron como síntomas y alteraciones funcionales más frecuentes: alteraciones de la marcha (65,5%), desórdenes de comunicación (36,98%), alteraciones emocionales y de memoria (38%), dolor (29,45%) y alteraciones en las actividades básicas cotidianas (24,3%). El 50% de los pacientes que reportaron dolor, el 30% de los que manifestaron insomnio y el 80% de los que refirieron estreñimiento no recibieron tratamiento en la primera consulta. Algunos de los síntomas identificados no son características que definen la enfermedad, y no siempre son objeto de intervención. Los resultados de este estudio pueden contribuir a reconocer la carga de los síntomas de las enfermedades neurológicas, sensibilizando a los profesionales de la salud acerca de la importancia del cuidado paliativo en pacientes con enfermedades progresivas no oncológicas.