Papers by Patricia Bonilla
Annals of Palliative Medicine
Spiritual care is an essential part of quality palliative care. However, the literature regarding... more Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.
The patients with advanced disease and terminal state may have refractory symptoms, producing a g... more The patients with advanced disease and terminal state may have refractory symptoms, producing a great suffering for it palliative sedation therapy is used. B...
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Revista brasileira de anestesiologia
Post-operative pain management is a significant problem in clinical practice in Latin America. In... more Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region. However, these problems are not insurmountable and can be addressed at both the provider and patient level. Robust policies and guidelines can help insure continuity of care and reduce unnecessary variations in practice. The objective of this paper is to call attention to the problems associated with Acute Post-Operative Pain (APOP) and to suggest recommendations for their solutions in Latin America. A group of experts on anesthesiology, surgery and pain developed recommendations that will lead to more efficient and effective pain management. It will be necessary to change the knowledge and behavior of health professionals and patients, and to obtain a commitment of policy makers. Success will depend on a positive attitude and the commitment of each party through the development of policies, programs and the promotion of a more efficient and effective system for the delivery of APOP services as recommended by the authors of this paper. The writing group believes that implementation of these recommendations should significantly enhance efficient and effective post-operative pain management in Latin America.
SUMMARY OBJECTIVES: The pain neuropatic in breast cancer is for effect of the lesions and the dys... more SUMMARY OBJECTIVES: The pain neuropatic in breast cancer is for effect of the lesions and the dysfunction in the nervous system it is characterized by alodinia presence, disestesia, parestesias and paroxysms of sharp pain. METHODS: Realized a prospective study, randomized, phase III. to determine the effectiveness, in terms of clinical answer, of the treatment comparative gabapentina with carbamazepina in women with breast cancer stage I, II, III and IV, with sintomatology of pain neuropatic. Which were randomized to receive (arm A) gabapentina doses of 300 mg beginning and every three days you increased 300 mg (25 patients) the (arm B) carbamazepina 200 mg beginning and every three days you increased 200 mg (25 patients) until obtaining complete response or found the biggest established dose. RESULTS: The rates of global response were 63 % in arm A and 25 % in the arm B (P = 0.032) the complete response was 19 % vs 6 % in the arm A and B respectively. The partial response was 44 % ...
Revista de Nutrición Clínica y Metabolismo, 2021
Objetivo: esta revisión describió el desarrollo de los cuidados paliativos en Latinoamérica basad... more Objetivo: esta revisión describió el desarrollo de los cuidados paliativos en Latinoamérica basado en la educación, disponibilidad de opioides, investigación, políticas públicas e implementación de servicios. Metodología: se realizó una búsqueda de los artículos publicados en las bases de datos PubMed, Scopus, Ovid Medline, Lilacs, Google Scholar, y se aplicó un límite temporal de 10 años. Se seleccionaron 33 referencias bibliográficas. Resultados: el número de publicaciones que se identificaron dedicadas al desarrollo de cuidados paliativos en Latinoamérica fue escaso. Pese a que los resultados evidenciaron un crecimiento de los cuidados paliativos, reflejado en las políticas de salud pública, educación, disponibilidad de opioides e implementación de los servicios en todos los niveles de atención, además de la investigación y creación de asociaciones regionales, persistió la inequidad entre los países. No existen políticas de salud en cuidados paliativos, en algunos casos, o no se ...
PAIN Reports, 2019
Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. ... more Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.
Pain Medicine, 2017
Funding sources: The Change Pain Latin America campaign, including the meeting at which the conse... more Funding sources: The Change Pain Latin America campaign, including the meeting at which the consensus guidelines were achieved, was funded by an educational grant from Grunenthal Latin America, Inc. However, Grunenthal Latin America, Inc., had no involvement or input into the guidelines' selection methodology, analyses, or final interpretations and conclusions of the panel, or the development of the manuscript, its conclusions, or the decision to submit to Pain Medicine.
Brazilian Journal of Anesthesiology (English Edition), 2016
Post-operative pain management is a significant problem in clinical practice in Latin America. In... more Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region. However, these problems are not insurmountable and can be addressed at both the provider and patient level. Robust policies and guidelines can help insure continuity of care and reduce unnecessary variations in practice. The objective of this paper is to call attention to the problems associated with Acute Post-Operative Pain (APOP) and to suggest recommendations for their solutions in Latin America. A group of experts on anesthesiology, surgery and pain developed recommendations that will lead to more efficient and effective pain management. It will be necessary to change the knowledge and behavior of health professionals and patients, and to obtain a commitment of policy makers. Success will depend on a positive attitude and the commitment of each party through the development of policies, programs and the promotion of a more efficient and effective system for the delivery of APOP services as recommended by the authors of this paper. The writing group believes that implementation of these recommendations should significantly enhance efficient and effective post-operative pain management in Latin America.
Pain medicine (Malden, Mass.), Jan 23, 2015
The subject of this publication has been focused on local considerations for facilitating regiona... more The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management. The Change Pain Latin America (CPLA) Advisory Panel conducted a comprehensive, robust, and critical analysis of published national and international reviews and guidelines of OU, considering those most appropriate for Latin America. A PubMed search was conducted using the terms "opioid," "chronic," and…
Parasitology Research, 2007
Cysts represent a phase in the life cycle of biphasic parasitic protozoa that allow them to survi... more Cysts represent a phase in the life cycle of biphasic parasitic protozoa that allow them to survive under adverse environmental conditions. Two events are required for the morphological differentiation from trophozoite to cyst and from cyst to trophozoite: the encystation and excystation processes. In this paper, we present a review of the ultrastructure of the encystation and excystation processes in Entamoeba invadens, Acanthamoeba castellanii, and Giardia lamblia. The comparative electron microscopical observations of these events here reported provide a morphological background to better understand recent advances in the biochemistry and molecular biology of the differentiation phenomena in these microorganisms.
The Journal of Eukaryotic Microbiology, 2006
... Human IgA inhibits adherence of Acanthamoeba polyphaga to epithe-lial cells and contact lense... more ... Human IgA inhibits adherence of Acanthamoeba polyphaga to epithe-lial cells and contact lenses. Can. ... Infect. Immun., 59:3819–3822. González-Robles, A., Castan˜ón, G., Cristóbal-Ramos, AR, Lázaro-Hal-ler, A., Oman˜a-Molina, M., Bonilla, P. & Martınez-Palomo, A. 2006. ...
Journal of Eukaryotic Microbiology, 2009
An important aspect of the biology of Naegleria sp. is the differentiation processes that occur d... more An important aspect of the biology of Naegleria sp. is the differentiation processes that occur during encystation and excystation. We studied these using both fluorescence and transmission electron microscopy techniques. In the initial stages of encystation, the cisternae of the endoplasmic reticulum became densely filled with a fibrillar material. Vesicles with a similar content that appeared to be derived from the cisternae were also observed in close contact with the plasma membrane. As encystation progressed, the fibrillar material became localized on the surface of the amoeba. An irregular compaction was observed in some areas of the cyst wall, which contained thin extensions of the cyst wall fibrillar material. Completely formed cysts had two to three ostioles, each sealed by an operculum. The operculum contained two areas in which a differential compaction of the fibrillar structure was observed. When excystation was induced, small dense granules (DGs), which were in close contact with fibrillar material were observed in the cyst cytoplasm and in the peritrophic space. During excystation, the more compact component of the operculum moves to enable the pseudopod of the emerging trophozoite to penetrate the ostiole. Vacuoles containing a fibrillar material, probably derived from the cyst wall, were observed in the cytoplasm of the pseudopodia. Our results provide a platform for further studies using biochemical markers to investigate the origin of the cyst wall as well as the role of DGs during excystation in Naegleria.
Experimental Parasitology, 2006
In this study we report observations on the structural mechanisms of the cytopathic eVect of Acan... more In this study we report observations on the structural mechanisms of the cytopathic eVect of Acanthamoeba castellanii trophozoites on cultured MDCK cell monolayers. Co-incubations were carried out for a maximum of 24 h. The Wrst evidence of damage to the cell monolayer was detected by measuring the transepithelial resistance of cell monolayers that interacted with the amoebae. At 6 h, transepithelial resistance diminished to 51% and amoebae required 5-6 h to produce evidence of structural injury at the light microscopy level. Following 12 h of incubation, the cell monolayer was severely damaged. After making intimate contact with the surface of target cells, trophozoites detached cells from the substrate, lysed and by means of food-cups ingested the damaged cells. There was no morphological evidence of modiWcations in MDCK cell membranes, membrane fusion or junction formation between the amoeba and host plasma membrane. The lytic capacity of the amoebas appears to be the result of cytotoxic factors secreted by the amoebae since, when monolayers were incubated with conditioned medium, there was also a decrease in the transepithelial resistance. Besides, mechanical injury produced by the attachment and movement of the trophozoites may contribute to the disruption of the cell monolayer. As in other pathogenic amoebae, the cytopathic action of A. castellanii on the cell monolayers can subjectively be separated into four stages: adhesion, cytolysis, phagocytosis, and intracellular degradation.
Revista Colombiana De Medicina Fisica Y Rehabilitacion, Dec 28, 2012
INVESTIGACIÓN ORIGINAL Bloqueo de raíces nerviosas posteriores lumbares con Levobupivacaína al 0,... more INVESTIGACIÓN ORIGINAL Bloqueo de raíces nerviosas posteriores lumbares con Levobupivacaína al 0,5% y Metilprednisolona en pacientes con dolor lumbar crónico Lumbar posterior nerve roots blocking with levobupivacaine 0,5% and methylprednisolone in patients with chronic lumbar pain
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Papers by Patricia Bonilla