RESUMEN
BACKGROUND: In an earlier study, we found that some bereaved relatives (five out of 12 interviewed) found it distressing to hear the sound of death rattle, but the remainder did not. In this paper, we report a second study in which we explored how a different group of relatives interpreted the sound of death rattle when they heard it. METHOD: We conducted face-to-face semi-structured interviews with 25 bereaved relatives using the principles of grounded theory. RESULTS: Seventeen of the 25 bereaved relatives interviewed had heard the sound of death rattle. Ten relatives were distressed by the sound, but seven were not. Some relatives regarded the sound of death rattle as a useful warning sign that death was imminent. Their interpretation of the sound was influenced by the patient's appearance, being less concerned if the patient was not obviously disturbed. Relatives were distressed when they thought that the sound of death rattle indicated that the patient might be drowning or choking. These concerns were reinforced by seeing fluid dribble from the dying patient's mouth. CONCLUSION: This study confirms the previous finding that not all relatives are distressed by the sound of death rattle. It also demonstrates that relatives interpret the sound in a variety of ways, some matter of fact and some distressing. We suggest that effective communication is helpful in uncovering relatives' interpretation of death rattle and dispelling unwarranted fears.
Asunto(s)
Actitud Frente a la Muerte , Familia , Ruidos Respiratorios , Estrés Psicológico/etiología , Enfermo Terminal/psicología , Aflicción , Femenino , Humanos , Masculino , PercepciónRESUMEN
Two hundred and ninety-nine patients admitted to the Bradbury Hospice, Hong Kong, during the period from 1 June 1992 to 31 May 1993 were studied. While a majority of the patients held realistic expectations of the hospice service, a small percentage expected cure, prolongation of life or even euthanasia. Physical symptoms were the main concern in a vast majority of patients, the commonest being pain. Only 1.7% regarded psycho-social problems as their main distress. Morphine was widely used for pain control, although 68% of patients required co-analgesics or palliative radiotherapy as well. Morphine was also the mainstay of treatment for dyspnoea. It might be worthwhile for hospices to be equipped with oxygen, as approximately 71% of our patients with dyspnoea as their main distress benefited from oxygen therapy. Many patients expressed fear of death; more worried about suffering. While 17.7% were assessed to be in the stage of acceptance on admission, 14.7% expressed self-pity when their search for meaning failed. Although many patients were atheists, a majority of patients with religious beliefs found that they could get support from their faith. A significant number of patients believed in Shumei. Increased knowledge of this religion would be helpful in taking care of these patients.
Asunto(s)
Cuidados Paliativos al Final de la Vida/organización & administración , Neoplasias/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Niño , Hong Kong/epidemiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/fisiopatología , Neoplasias/psicología , Dolor/epidemiología , Dolor/etiología , Admisión del Paciente/estadística & datos numéricos , Religión y PsicologíaRESUMEN
Aorta-common femoral artery bypass is the standard operation for relief of aortoiliac occlusive disease. When extensive superficial femoral artery disease coexists, the profunda femoris, even in its distal portion, may be used as the outflow vessel. To test this assumption we compared cumulative patency, limb salvage, and the need for distal bypass of 134 aorta-profunda femoris and 151 aorta-common femoral artery bypasses performed consecutively for aortoiliac occlusive disease over a 12-year period. We also analyzed results of proximal (n = 103) and distal (n = 31) aortoprofunda bypasses. Angiographic and noninvasive studies showed greater disease in limbs undergoing aorta-profunda femoris bypass. However, no difference was observed in cumulative patency (91% +/- 6% vs 96% +/- 3%) or limb salvage (90% +/- 6% vs 94% +/- 3%) at 5 years. Seventeen distal bypasses in the group undergoing profunda femoris bypass and 20 distal bypasses in the group undergoing common femoral artery bypass were required to maintain limb salvage. Proximal and distal aorta-profunda femoris bypasses showed no difference in cumulative patency (91% +/- 9% vs 95% +/- 6%) or limb salvage (94% in each group) at 3 years. Standard aorta-common femoral artery and aorta-profunda femoris bypass provide cumulative patency and limb salvage exceeding 90% at 5 years; concomitant or subsequent distal bypass was required in 12% or limbs undergoing aorta-profunda femoris bypasses. Both proximal and distal profunda femoris arteries provide a durable outflow tract when aortoiliac and femoropopliteal occlusive disease are combined.