It is increasingly necessary to have a measuring instrument available in the health field that can be used in clinical practice and research. In order to guarantee the quality of their measurements it is essential that the instruments should be subjected to a process of validation. This process consists in adapting the instrument culturally to the setting where its psychometric characteristics are to be administered and checked, such as: reliability, validity, sensitivity and feasibility. There are measuring instruments from the health field available in other languages but that have not been validated into Spanish. Besides, the methodology for validating an instrument is little understood by the health professionals, which explains the indiscriminate use of instruments that have only been adapted or validated in a way that is not very consistent. The aim of this review is to bring up to date the process of validating an instrument for measuring health, and what it involves, in a practical way. The accessibility of evaluation instruments that have been culturally adapted and validated in different languages will facilitate the comparison of results obtained with the same instrument and the development international studies in different cultures.

Delirium in advanced cancer is often poorly identified and inappropriately managed. It is one of the most common causes for admission to clinical institutions and is the most frequently cited psychiatric disorder in terminal cancer. Diagnosis of delirium is defined as a disturbance of consciousness and attention with a change in cognition and/or perception. In addition, it develops suddenly and follows a fluctuating course and it is related to other causes, such as cancer, metabolic disorders or the effects of drugs. Delirium occurs in 26% to 44% of cancer patients admitted to hospital or hospice. Of all advanced cancer patients, over 80% eventually experience delirium in their final days. In advanced cancer, delirium is a multifactorial syndrome where opioids factor in almost 60% of episodes. Delirium in such patients, excluding terminal delirium, may be reversible in 50% of cases. Providing adequate end-of-life care for a patient with delirium is the main challenge. The family needs advice and it is important to create a relaxing environment for the patient. The primary therapeutic approach is to identify the reversible causes of delirium. Some therapeutic strategies have been shown to be effective: reduction or withdrawal of the psychoactive medication, opioid rotation, and hydration. Haloperidol is the most frequently used drug, and new neuroleptics such as risperidone or olanzapine are being tested with good results. Methylphenidate has been used for hypoactive delirium.

Background: Humor has its own place in the context of medicine. Nevertheless, its acceptance by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy. Objectives: To understand the significance, appropriateness, and pertinence of the use of humor in palliative care and to analyze its applicability. Design: A narrative systematic review was undertaken and included in PROSPERO. Data Sources: Online searches were carried out on PUBMED, PSYCINFO, EBSCO (CINHAL), EMBASE, SCIELO, SCOPUS, TESEO, WEB of SCIENCE, and COCHRANE between their launch date and December 31, 2015, complemented with manual searches with queries to experts. A total of 156 studies were identified, which were then filtered in pairs by means of an established hierarchy, selecting studies that discussed the use of humor specifically in palliative care from all perspectives and designs, and finally published in Spanish, English, French, or Portuguese. Critical reading of all the selected studies took place, with no exclusions due to quality evaluation. Results: Thirty-four studies were included. Five main topics were identified: (1) definition of humor, (2) use and functions of humor in palliative care, (3) how to use humor, (4) when not to use humor, and (5) humor before and after the diagnosis of terminal illness. Conclusions: Humor plays an unquestionable role in palliative care, but its use needs training and appropriate use.

This article reviews the most recent studies that examine the efficacy of psychostimulants for the relief of symptoms such as asthenia and depression in cancer patients. Although most research to date has focused on the use of methylphenidate for the relief of symptoms such as asthenia and depression in cancer patients, there is growing interest in the use of modafinil, a psychostimulant with a structure and mechanism that differs from other drugs belonging to this group. Initial studies mainly investigated the treatment of depressive symptoms in patients with advanced cancer; however, more recent studies have evaluated the use of psychostimulants in cancer-related fatigue identifying subgroups of patients and clinical settings in which psychostimulants are most efficient. For the relief of chemotherapy symptoms in cancer patients, methylphenidate and modafinil were no more effective than placebo, although findings suggest that these psychostimulants may provide some benefit in patients who are suffering more severe asthenia or who are at advanced stages of the cancer. Methylphenidate showed marginal improvement in relation to symptoms such as asthenia and depression in studies in which it was compared with placebo; data from the only phase III study suggest that modafinil is an effective drug for advanced oncology patients.

Introduction Methylphenidate is a psychostimulant that has been used to relieve depressive symptoms in advanced cancer patients. No studies compare its efficacy against placebo in this group of patients. Objective To explore the efficacy of methylphenidate compared with placebo in the relief of depressive symptoms in advanced cancer patients. Material and methods A multicentre, double-blind, randomised placebo-controlled clinical trial was undertaken comparing the efficacy of methylphenidate and placebo in depressive symptoms. Advanced stage cancer patients were eligible if they scored at least two points on the Two Question Screening Survey for depression. A reduction of at least two points on the Edmonton Symptom Assessment Scale for depression (0–10) was considered as a response. Results Sixty-nine patients were included (methylphenidate: n=31, placebo: n=38); median daily dose of methylphenidate was 25 mg. Fifty-eight patients (84%) who completed the first week of treatment were considered suitable for evaluation. In the intention to treat analysis, there were 14/31 (45%) responses with methylphenidate and 10/38 (26%) responses with placebo (difference: 19%; 95% CI: 4% to 39%; p=0.10). With the Hospital Anxiety and Depression Scale, 11/19 (58%) patients with methylphenidate and 10/24 (42%) with placebo improved from a score compatible with depression in the first 7 days (difference 16%; 95% CI 13% to 42%; p=0.29). The proportion of patients indicating adverse effects was similar for both cohorts (p=0.99). Conclusion Compared with the placebo, methylphenidate demonstrated a positive trend in the incidence of response for depressive symptoms in advanced cancer patients.