Caracterización y categorización de los riesgos biológicos en el laboratorio clínico del policlínico docente Rampa, municipio Plaza de la Revolución, La Habana, Cuba / Characterization and categorization of the biological risks in the clinical laboratory of the polyclinics Rampa, Revolution Square Municipality, Havana, Cuba

El presente trabajo tiene el objetivo de caracterizar y categorizar los riesgos biológicos en las áreas de trabajo del laboratorio clínico del policlínico docente Rampa. Para realizar la investigación se aplicó una lista de chequeo por escalones de defensa en profundidad, nueva base de conocimientos integrada a un sistema de gestión del riesgo, desarrollado a través del método Evaluación de niveles de seguridad, que se basa en un enfoque avanzado de la seguridad. Se pudo constar en la aplicación al laboratorio clínico del policlínico que presenta 34 por ciento de aspectos negativos para la seguridad, que corresponde a un nivel de inaceptable-crítico, lo que significa que el riesgo debido a la práctica se ha incrementado muy por encima del nivel tolerable (aceptable o básico), siendo penalizado al nivel inmediato inferior de inaceptable-extremo, debido a la calificación del escalón de defensa en profundidad 0, lo que demuestra la dependencia del nivel de seguridad general de la instalación con la calificación de este último escalón. Se concluye que el método de Evaluación de niveles de seguridad permite obtener el perfil de riesgo por escalones de defensa ordenados por importancia cualitativa y cuantitativa, considerados contribuyentes del perfil de riesgo global del laboratorio, y contribuye a la toma de decisiones relativas a la seguridad en la instalación objeto de estudio(AU)

The present study aims to characterize and categorize biological hazards in the work areas of the clinical laboratory of the polyclinics Rampa. To conduct the research a checklist for steps of defense in depth was applied, new base of knowledge, an integrated risk management system, developed through the assessment method that Security Levels based on an advanced approach to security. It could be noted in the evaluation of application of the method to the laboratory safety levels in thr policlinics Rampa, which has 34 percent of negative issues of security level corresponding to a unacceptable-critical, which means that the risk due to the practice has increased well above the level tolerable (acceptable or basic), being penalized at the next lower level, unacceptable-end, due to tier defense rating 0, which shows the dependence the overall security of the facility with the rating this last step. We conclude that the method Assessment Levels Security, giving the risk profile defense steps sorted by relevance considered qualitative and quantitative taxpayer's overall risk profile and helps laboratory decisions relating to safety in the installation order study(AU)

Autonomy and Privacy in Clinical Laboratory Science Policy and Practice.

Rapid advancements in diagnostic technologies coupled with growth in testing options and choices mandate the development of evidence-based testing algorithms linked to the care paths of the major chronic diseases and health challenges encountered most frequently. As care paths are evaluated, patient/consumers become partners in healthcare delivery. Clinical laboratory scientists find themselves firmly embedded in both quality improvement and clinical research with an urgent need to translate clinical laboratory information into knowledge required by practitioners and patient/consumers alike. To implement this patient-centered care approach in clinical laboratory science, practitioners must understand their roles in (1) protecting patient/consumer autonomy in the healthcare informed consent process and (2) assuring patient/consumer privacy and confidentiality while blending quality improvement study findings with protected health information. A literature review, describing the current ethical environment, supports a consultative role for clinical laboratory scientists in the clinical decision-making process and suggests guidance for policy and practice regarding the principle of autonomy and its associated operational characteristics: informed consent and privacy.

Informe de la Sociedad Española de Ultrasonidos (SEUS) sobre delegación y transferencia de competencias en ecografía a los técnicos de radiología / Report of the Spanish Society of Ultrasound (SEUS) about the delegation and transfer of responsibility in ultrasonography to radiology technologists

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Brain-machine interface: the challenge of neuroethics.

The burning question surrounding the use of Brain-Machine Interface (BMI) devices is not merely whether they should be used, but how widely they should be used, especially in view of some ethical implications that arise concerning the social and legal aspects of human life. As technology advances, it can be exploited to affect the quality of life. Since the effects of BMIs can be both positive and negative, it is imperative to address the issue of the ethics surrounding them. This paper presents the ways in which BMIs can be used and focuses on the ethical concerns to which neuroscience is thus exposed. The argument put forward supports the use of BMIs solely for purposes of medical treatment, and invites the legal framing of this.

Moral distress: a consequence of caring.

With the increase of technology in health care, oncology nurses often are involved in ethical discussions regarding the best use of aggressive interventions for patients. Conflicts between ethical principles and external forces can produce moral distress for oncology nurses caring for people with cancer. Moral distress can impact nurses in significant ways, including mental health and job satisfaction, and may impact care delivery. This article reviews the concept of moral distress and suggests interventions and future research to minimize its impact on nurses and patients.

Home-based palliative care: challenges in the care of technology-dependent children.

OBJECTIVES: To conceptualize palliative care and its indications in Pediatrics; to describe the difficulties involved in the delivery of such care at home for technology-dependent children; and to analyze, from a bioethical perspective, the moral dilemmas of palliative care assistance. SOURCES: A literature review of palliative care for technology-dependent children and a bioethical analysis of moral dilemmas. SUMMARY OF THE FINDINGS: There are several obstacles to palliative care for technology-dependent children: structural difficulties at home; social isolation of both children and families; health professionals' sense of disbelief regarding this type of care; an excessive number of medical devices at home; uncertainty of a terminal prognosis; physical, emotional, social, material, and financial burden for parents and family; changes in family dynamics to adjust to these children; paternalistic relationship between professionals and family; changes in family roles, with shifts in the caregiver role. CONCLUSIONS: It is essential to outline an agenda based on the premise that the medical apparatus for technology-dependent children will change the landscape of the home, and such a change might become a problem to be faced by all those living together. Based on this assumption, actions performed in a setting other than a health care facility might exert an actual protective effect on children and family, offering support in their several needs and developing a model of care delivery that includes interventions in the different levels of burden on these vulnerated and unprotected individuals.

[Ethical and philosophical dimensions of decision-making in public health]. / De quelques dimensions ethiques et philosophiques de la décision en santé publique ... et ailleurs.

Decisions in public health, or in individual health care, are taken by people (individuals or collective) for other people (individuals or collective). Human values, that is to say what is connected to Ethics, should be to the fore, de jure. Too often, under the pretext that they refer to subjectivity, they appear only after very many technical considerations. The latter, in a scientist society, are supposed to deserve a claim to objectivity, this being of course illusory. The author, placing himself in the line of Levinas, Ricoeur, and also of Kant, for whom the "What must I do?" is the most fundamental question any human being has to face, develops four reasons which plead for the pre-eminence of ethics as the foundation of decisions in a policy for public health. 1) He reminds us the intangible values, which are on one side uniqueness and universality of mankind, and on the other side the singularity of the human person. 2) He insists on the ethical wreck which threatens the whole health- and healthcare systems. 3) He sets out some results of modern neurophysiological research (AR Damasio's work), joining an intuition of Aristoteles: the decision making process implies two phases: deliberation the aim of which is to list the different possible actions to undertake, then the choice between those actions. Damasio shows that the lack of emotions inhibits the choice, especially when decision implies human values. 4) Finally, he insists, after E. Morin, on the practical and theoretical difficulties in taking a "good" decision, and on what Morin calls "ecology of action". The results of a decision may completely escape from the decision-makers aims, very often for unexpected social and psychological reasons.

Ethical implications of implantable radiofrequency identification (RFID) tags in humans.

This article reviews the use of implantable radiofrequency identification (RFID) tags in humans, focusing on the VeriChip (VeriChip Corporation, Delray Beach, FL) and the associated VeriMed patient identification system. In addition, various nonmedical applications for implanted RFID tags in humans have been proposed. The technology offers important health and nonhealth benefits, but raises ethical concerns, including privacy and the potential for coercive implantation of RFID tags in individuals. A national discussion is needed to identify the limits of acceptable use of implantable RFID tags in humans before their use becomes widespread and it becomes too late to prevent misuse of this useful but ethically problematic technology.