BACKGROUND: Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. OBJECTIVES: 1. to quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarize the current evidence on cost-effectiveness. METHODS: Search methods: We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria: We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis: One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home). MAIN RESULTS: We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), HIV/AIDS and multiple sclerosis (MS), among other conditions. Meta-analysis showed increased odds of dying at home (odds ratio (OR) 2.21, 95% CI 1.31 to 3.71; Z = 2.98, P value = 0.003; Chi2 = 20.57, degrees of freedom (df) = 6, P value = 0.002; I2 = 71%; NNTB 5, 95% CI 3 to 14 (seven trials with 1222 participants, three of high quality)). In addition, narrative synthesis showed evidence of small but statistically significant beneficial effects of home palliative care services compared to usual care on reducing symptom burden for patients (three trials, two of high quality, and one CBA with 2107 participants) and of no effect on caregiver grief (three RCTs, two of high quality, and one CBA with 2113 caregivers). Evidence on cost-effectiveness (six studies) is inconclusive. AUTHORS' CONCLUSIONS: The results provide clear and reliable evidence that home palliative care increases the chance of dying at home and reduces symptom burden in particular for patients with cancer, without impacting on caregiver grief. This justifies providing home palliative care for patients who wish to die at home. More work is needed to study cost-effectiveness especially for people with non-malignant conditions, assessing place of death and appropriate outcomes that are sensitive to change and valid in these populations, and to compare different models of home palliative care, in powered studies.

Antecedentes: La actitud del personal de enfermería a las familias es fundamental para la calidad de la atención de enfermería, lo que facilita el proceso de transición de la salud / enfermedad que sufre la familia en el hospital. Objetivos: El objetivo de este estudio es identificar la actitud de las enfermeras en los diferentes centros de atención hospitalaria en la importancia de incluir a la familia en los cuidados de enfermería. Metodología: Es un estudio exploratorio de cuantitativo y descriptivo, la integración de 160 enfermeras de diversos orígenes en el hospital, que participó libremente en el estudio, con una muestra de conveniencia. Este estudio hace uso de un cuestionario administrado directamente a los encuestados, la integración de un sociodemográfica y aplicación gama La importancia de las familias en la atención de enfermería IFCE-AE. Resultados: Los resultados de la recopilación de datos IFCE-AE, con puntuaciones medias altas, muestran una actitud positiva hacia las familias, incluyendo ver a la familia como un interlocutor y recursos de afrontamiento. El servicio de Obstetricia obtuvo los puntajes más altos en comparación con los servicios de emergencia. Sin embargo, los resultados no mostraron correlaciones significativas para justificar la influencia de las variables recogidas, incluyendo edad, sexo, grado académico, la cualificación profesional, tiempo de servicio, la educación sobre la familia, el contexto de la atención y la experiencia con familiar enfermo. Conclusión: Las enfermeras tienen un alto grado de acuerdo en la importancia de las familias en la atención de enfermería, en relación a los diferentes contextos importa. Sin embargo, debe ser alentado a seguir investigando sobre este tema, para entender cómo construir una práctica de cuidado de la familia y cuáles son los factores determinantes para su desarrollo.

Enquadramento: A atitude dos enfermeiros para com as famílias é determinante para a qualidade dos cuidados de enfermagem, facilitando os processos de transição saúde/doença vivenciadas pela família no hospital. Objetivos: O objetivo deste estudo consiste em identificar a atitude dos enfermeiros de diferentes contextos de cuidados hospitalares sobre a importância de incluir a família nos cuidados de Enfermagem. Metodologia: É um estudo de natureza quantitativa, exploratório e descritivo, integrando 160 enfermeiros de diversos contextos de um hospital, através de uma amostra por conveniência. Este estudo recorre à utilização de um questionário, integrando uma avaliação sociodemográfica e a aplicação da escala A importância das famílias nos cuidados de Enfermagem - IFCE-AE. Resultados: Os resultados obtidos da aplicação da escala IFCE-AE revelam scores médios elevados. Contudo, os resultados não evidenciam correlações significativas que justifiquem a influência das variáveis exploradas. Conclusão: Os enfermeiros possuem um grau de concordância elevado sobre a importância das famílias nos cuidados de enfermagem, no que se refere aos diferentes contextos de cuidados.

Theoretical framework: Nurses' attitudes towards families are essential to the quality of nursing care, facilitating the health/disease transition processes experienced by the family in the hospital. Objectives: The aim of this study is to identify the attitudes of nurses in different hospital settings about the importance of including the family in nursing care. Methodology: A quantitative, exploratory and descriptive study was conducted with a convenience sample of 160 nurses from different units in a hospital. This study used a questionnaire, which included a sociodemographic evaluation and the scale Families' Importance in Nursing Care - Nurses Attitudes (FINC-NA). Results: The results obtained by applying the FINC-NA scale revealed high mean scores. However, the results showed no significant correlations to justify the influence of the analysed variables. Conclusion: Nurses show a high level of agreement about the importance of families in nursing care within the various contexts of care.

Macroprolactinemia caracteriza-se pelo predomínio no soro de uma prolactina (PRL) de alto peso molecular e baixa atividade biológica que não requer tratamento. A prevalência de macroprolactinemia foi avaliada em 115 pacientes consecutivos com hiperprolactinemia. Entre eles, 19 (16,5%) tinham exclusivamente macroprolactinemia, 4 (3,5%) síndrome dos ovários policísticos, 7 (6,1%) acromegalia, 8 (6,9%) hiperprolactinemia idiopática, 10 (8,7%) hipotiroidismo primário, 14 (12,2%) adenomas clinicamente não-funcionantes, 20 (17,4%) hiperprolactinemia farmacológica e 33 (28,7%) prolactinomas. O diagnóstico de macroprolactinemia foi estabelecido pela obtenção de uma recuperação da PRL < 30% após tratamento do soro com polietilenoglicol. Dentre os 19 pacientes com macroprolactinemia isolada, 16 (84,2%) eram mulheres e 12 (63,2%) eram assintomáticos, enquanto 4 (21%) tinham oligomenorréia e 3 (15,8%), galactorréia. Em contraste, apenas 11,5% dos indivíduos com outras causas de hiperprolactinemia eram assintomáticos (p< 0,001). Os níveis de PRL nos casos de macroprolactinemia variaram de 45,1 a 404 ng/mL (média de 113,3 ± 94,5), mas em 15 (78,9%) foram < 100 ng/mL. Nossos achados demonstram que macroprolactinemia é uma condição freqüente e, assim, sugerimos que seja rotineiramente pesquisada em pacientes com hiperprolactinemia.

Macroprolactinemia is characterized by the predominance in the serum of macroprolactin, a prolactin (PRL) with high molecular mass and low biological activity that does not need treatment. The prevalence of macroprolactinemia was evaluated in 115 consecutive patients with hyperprolactinemia. Among them, 19 (16.5%) had solely macroprolactinemia, 4 (3.5%) polycystic ovary syndrome, 7 (6.1%) acromegaly, 8 (6.9%) idiopathic hyperprolactinemia, 10 (8.6%) primary hypothyroidism, 14 (12.2%) clinically non-functioning pituitary adenomas, 20 (17.4%) drug-induced hyperprolactinemia and 33 (28.7%) prolactinomas. The diagnosis of macroprolactinemia was established by the demonstration of a PRL recovery < 30% after treatment of sera with polyethylene glycol. Among the 19 patients with isolated macroprolactinemia, 16 (84.2%) were female and 12 (63.2%) were asymptomatic, while 4 (21%) presented with oligomenorrhea and 3 (15.8%) with galactorrhea. In contrast, only 11.5% of individuals with other causes of hyperprolactinemia were asymptomatic (p< 0.001). Prolactin levels in cases of macroprolactin ranged from 45.1 to 404 ng/mL (mean 113.3 ± 94.5) but in 15 (78.9%) were < 100 ng/mL. Our findings demonstrate that macroprolactinemia is a common condition and, therefore, we suggest that it should be routinely screened in patients with hyperprolactinemia.