Acta Medica Port
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Health Related Quality of Life (HRQoL) is an essential factor for cancer patients, particularly in the evaluation of the care's. Most of the information that health care providers have is given by the patient. Family can also provide information about them, appealed or not and the quality of such information isn't studied for Portuguese population. The aim of this study was to examine whether proxies can provide useful information on HRQoL of cancer patients. ⋯ The results suggest that proxies only provide valid and useful information about cancer patients QoL for QLQ-C30 domains where the agreement between QoL's responses were high and the means diferrence not significant. For using a HRQoL instrument taking into account as source the proxy, is necessary to recognize the agreement of the HRQoL's domains of the instrument. In this case, for several domains of QLQ-C30 the means difference was statistically significant, so, the instrument should be used with caution for physical and emotional functioning, global QoL fatigue, pain, diarrhoea and total QoL. Proxies are a frequent and a mandatory source of information about patient's status, particularly in palliative care. On a clinical point of view, the knowledge of these differences is very important for that such information be ponderous and contextualized in order to improve better care to the patients.
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As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical science and technology will continue to have an impact on the patient-physician relationship. Transformation of the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's patients and the natural course of their disease require special care on the part of physicians to meet the ethical challenges and establish medical goals, in conjunction with their patients and their families. ⋯ Finally, comfort is the last and the most important goal of care in late stages of dementia, using appropriate medical strategies and eliminating aggressive interventions (cardiopulmonary resuscitation, acute care setting, tube feeding and antibiotic treatment). The future work will focus on promoting more evidence-based decision-making on treatment and guidelines for prognostic information. Physician must be knowledgeable about broadly intersecting medical, legal, finance and ethics, underlying the long-term management of dementia.
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A retrospective study was conducted. ⋯ The results of this study further demonstrate the considerable potential for neurologic recovery after TSCI, emphasizing the importance of the rehabilitation investment continuity, especially for the ones with incomplete cord injury.
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Although previous studies show that physicians generally agree that nutrition knowledge is important for their daily clinical practice, several other studies report their poor knowledge of the subject. One of the strongest reasons given for this is the non-incorporation of Nutrition as a compulsory subject for the medical sciences degree. Dietary counselling and assessment of the patients' nutritional status don't seem to be systematic. ⋯ About 95% stated they provided written or verbal nutritional guidance, and most of the physicians had already sought the assistance of a nutritionist. This study shows that the clinical body of the CHVR/PR is aware of the importance nutrition knowledge has in their daily practice. It must be noted, though, that although almost one third of the physicians rate their nutrition knowledge poor, most of them provide nutritional guidance to their patients.
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Paraneoplastic neurological syndromes (PNS) are remote effects of cancer, which are not caused by invasion of the tumour or its metastasis, but presumably immunologic mediated. They developed in less than 1% of patients with systemic cancers, most Limbic encephalitis (LE) is the most common clinical paraneoplastic syndrome attainting the CNS (Central Nervous System), and it is characterized by involvement of hippocampus and amygdala; LE is also the only one with clearly defined imaging features. We report a 64 year old man, former smoker, which presented multiple paraneoplastic syndromes, namely LE, opsoclonus-myoclonus, subacute cerebellar degeneration, brainstem encephalitis, sensory-motor neuropathy and inappropriate antidiuretic hormone secretion syndrome (SIADH); these syndromes were identifiable in the clinical and imaging examination, confirmed by the neuro-pathological study. ⋯ A mediastinal adenopathy depicted a metastasis from low differentiated neoplasm cells, with some signs of neuroendocrine differentiation. With this case we provide a comprehensive illustration of the PNS, from a clinical, imaging and pathological point of view. This report also emphasises the importance of a diagnosis based on early clinical and imaging findings, given that, in most cases the cancer is not apparent.