The evidence from the available clinical trials is of limited amount and quality, but it weakly supports the proposal that the addition of an NSAIDs to WHO Step III opioids can improve analgesia or reduce opioid dose requirement. There is insufficient evidence to support the use of paracetamol in combination with Step III opioids. Data on the toxicity of NSAIDs in this indication are insufficient owing to the small number of patients and the short duration of treatment reported in the studies.

The screening for constipation in palliative care should be performed exploring subjective symptoms and other objective signs. A diagnosis of suspected constipation was found in almost half of the palliative care patients studied. A VNS of constipation did not produce good predictive values for the detection of constipation in our sample.

The clinical practice of the use of oral laxatives in palliative care in our environment differs widely from that recommended in the literature. Further studies are required to confirm if a revision of clinical guidelines are required.

No abstract

Background: Pediatric Palliative Care (PPC) focuses on achieving quality of life and control the symptoms for children during the sickness process, also provide support to the family in order to relief suffering and give response to needs assessment. In Colombia, this subspecialty does not exist, as a result of not having clinic practice guides and information about the population who benefit under 18 years of age. This study is to approach the necessity of PPC in our country, defining a methodology to characterize and estimate prevalence of pediatric population who may need special care in order to develop an attention model. Methods: A retrospective descriptive study was conducted among 80,926 members between 0 and 18 years of age who has a private health insurance in Colombia between January 1, 2016 and December 31, 2018. Data was obtained from the insurance transactional database. Patients were grouped based on the Association for children with life threatening conditions and their families (ACT) of the Royal College of Pediatrics four classifications plus perinatal group. Results were processed and analyzed using descriptive statistical functions in Microsoft Excel. Results: 1,694 patients (2,09%) were eligible to enter a PPC program according to their IDC-10 diagnoses based on ACT plus group 5 classification. Approximately 54% were male, 57.97% were considered early childhood, 26.56% childhood and 15,47% adolescence. With regards to ACT classification and group 5; 55.55% of patients had diagnosis from group 5 (55.55%) followed by group 4 (23.2%) and group 1 non-cancer (9.68%). Being able to identify patients in need of PPC programs early may increase it being utilize at the time of diagnosis and not wait till the end of life. This might also help alleviate misconception of PPC only being offered during the end of life period. This study should help with the development of public and private politics aimed to promote the creation of PPC programs in developing countries.