Feasibility and Safety of Bridging Antiplatelet Therapy with Cangrelor in Neuro-Oncology: A Preliminary Experience.

Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y12 inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y12 inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 µg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.

Air quality dataset from an indoor airport travelers transit area.

The experimental dataset (organized in a semicolon-separated text format) is composed by air quality records collected over a 1-year period (October 2022-October 2023) in an indoor travelers' transit area in the Brindisi airport, Italy. In detail, the dataset consists of three CSV files (ranging from 7M records to 11M records) resulting from the on-field data collection performed by three prototypical Internet of Things (IoT) sensing nodes, designed and implemented at the IoTLab of the University of Parma, Italy, featuring a Raspberry Pi 4 (as processing unit) which three low-cost commercial sensors (namely: Adafruit MiCS5524, Sensirion SCD30, Sensirion SPS30) are connected to. The sensors sample the air in the monitored static indoor environment every 2 s. Each collected record composing the experimental dataset contains (i) the identifier of the IoT node that sampled the air parameters; (ii) the presence of gases (as a unified value concentration); (iii) the concentration of carbon dioxide (CO2) in the travelers' transit area, together with air temperature and humidity; and (iv) the concentration of particulate matter (PM) in the indoor monitored environment - in terms of particles' mass concentration (µg/m3), number of particles (#/cm3), and typical particle size (µm) - for particles with a diameter up to 0.5 µm (PM0.5), 1 µm (PM1), 2.5 µm (PM2.5), 4 µm (PM4), and 10 µm (PM10). Therefore, on the basis of the monitored air parameters in the indoor travelers' transit area, the experimental dataset might be expedient for further analyses - e.g., for calculating Air Quality Indexes (AQIs) taking into account the collected information - and for comparison with information sampled in different contexts and scenarios - examples could be indoor domestic environments, as well as outdoor monitoring in smart cities or public transports.

Subtemporal-Transtentorial Approach for Microsurgical Resection of Hemorrhagic Ambient Cistern Arteriovenous Malformation.

Arteriovenous malformations (AVMs) of the ambient cistern are an extremely rare and complex subgroup of vascular malformation, representing a clinical challenge due to the deep-seated, highly eloquent anatomic location and the debilitating, life-threatening consequences related to hemorrhagic presentation and surgical morbidity. Ultimately, a tailored treatment, based on the presenting symptoms, AVM angioarchitecture, and annual risk of hemorrhage should be discussed among a multidisciplinary team to find the best individualized strategy balancing between the pros and cons of each approach. In Video 1, we present the case of a 60-year-old man with a hemorrhaged AVM of the right ambient cistern, present the pros and cons of each possible treatment strategy, and illustrate the successful resection of this lesion through a subtemporal-transtentorial microsurgical approach.

Propuesta para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19 / Proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic / Proposta per a l'elaboració d'un protocol de prova en el context de la pandèmia de COVID-19

Este documento ofrece una propuesta desde la perspectiva de la bioética para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Dicha propuesta incluye recomendaciones sobre las normas procedimentales y normas sustantivas que deben regir la asignación y reasignación de recursos terapéuticos en condiciones de escasez extrema

This document offers a proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic. This proposal includes recommendations on the procedural norms and substantive norms that should govern the allocation and reallocation of therapeutic resources in conditions of extreme scarcity

Aquest document ofereix una proposta des de la perspectiva de la bioètica per a l'elaboració d'un protocol de triatge en el context de la pandèmia de COVID-19. L'esmentada proposta inclou recomanacions sobre les normes procedimentals I normes substantives que han de regir l'assignació I reassignació de recursos terapèutics en condicions d'escassetat extrema

[Recommendations for communicating bad news by phone during the SARS-CoV-2 pandemicRecomendações para a comunicação de más notícias por telefone durante a pandemia do SARS-CoV-2]. / Recomendaciones para la comunicación de malas noticias por teléfono durante la pandemia por SARS-CoV-2.

The current SARS-CoV-2 pandemic presents specific challenges for health professionals in the healthcare setting. In this emergency context, the communication of bad news is especially relevant because of the particular way it must be done: the need to maintain social distance or mobility restrictions imposed on the general population means that this task must often be carried out remotely, mostly by telephone calls. This confronts professionals with a number of particular obstacles: a) most of them have little or no training in this kind of communication skills, b) effective communication of bad news largely depends on body language, which is absent in this type of exchange, and c) since this type of remote dialogue is not recommended - except in particular circumstances such as the current ones - there is little literature available to guide the professionals who must carry out this task. This manuscript offers recommendations for remote communication of bad news by telephone, applicable to situations in which this task cannot be carried out in person. A proposal structured around four "moments" is presented to guide the remote transmission of bad news in order to improve the care of patients, families and caregivers during this exchange and to reduce the negative impact from it on health professionals.

A actual pandemia do SARS-CoV-2 apresenta desafios específicos para os profissionais de saúde na área da saúde. Neste contexto de emergência, a comunicação de más notícias é particularmente relevante devido à forma específica como deve ser feita: a necessidade de manter a distância social ou as restrições de mobilidade impostas à população em geral implica que esta tarefa seja frequentemente realizada à distância, sobretudo através de chamadas telefónicas. Isto confronta os profissionais com uma série de obstáculos particulares: a) a maioria deles tem pouca ou nenhuma formação neste tipo de competências de comunicação, b) a comunicação eficaz de más notícias depende, em grande medida, da linguagem corporal utilizada, que está ausente neste tipo de intercâmbio, e c) como este tipo de diálogo à distância não é recomendado - excepto em circunstâncias particulares como a actual - há pouca literatura disponível para orientar aqueles que devem realizar esta tarefa. Este manuscrito oferece recomendações sobre a comunicação à distância de más notícias por telefone para situações em que esta tarefa não pode ser realizada pessoalmente. É apresentada uma proposta estruturada em torno de quatro "momentos" para orientar a transmissão de más notícias à distância, a fim de melhorar os cuidados prestados aos doentes, às famílias e aos prestadores de cuidados durante este intercâmbio e também para reduzir o impacto negativo que este intercâmbio tem sobre os profissionais de saúde.

Recomendaciones para la comunicación de malas noticias por teléfono durante la pandemia por SARS-CoV-2

La pandemia actual por SARS-CoV-2 presenta desafíos específicos para los profesionales de salud en el campo de la atención sanitaria. En este contexto de emergencia, la comunicación de malas noticias toma especial relevancia por el modo particular en que debe llevarse a cabo: la necesidad de mantener distanciamiento sanitario o las restricciones de movilidad impuestas a la población general hacen que esta tarea deba ser realizada, muchas veces, de manera remota, en su mayoría mediante llamados telefónicos. Esto enfrenta a los profesionales a una serie de obstáculos particulares: a) la mayoría de ellos poseen escasa o nula formación sobre esta clase de habilidades comunicativas, b) la comunicación efectiva de malas noticias depende, en gran parte, del lenguaje corporal utilizado, ausente en este tipo de intercambios, y c) dado que este tipo de diálogo remoto no es recomendable -con excepción de circunstancias particulares como la actual- existe escasa literatura disponible para guiar a quienes deben cumplir esta tarea. Este manuscrito ofrece recomendaciones sobre pautas básicas para la comunicación remota de malas noticias por teléfono, para situaciones en las cuales no se pueda llevar a cabo esta tarea de forma presencial. Se presenta una propuesta estructurada en torno de cuatro “momentos” para orientar la transmisión de malas noticias a distancia, con el fin de mejorar los cuidados a pacientes, familiares y cuidadores durante este intercambio y también reducir el impacto negativo que este intercambio tiene sobre los profesionales de la salud.

The current SARS-CoV-2 pandemic presents specific challenges for health professionals in the healthcare setting. In this emergency context, the communication of bad news is especially relevant because of the particular way it must be done: the need to maintain social distance or mobility restrictions imposed on the general population means that this task must often be carried out remotely, mostly by telephone calls. This confronts professionals with a number of particular obstacles: a) most of them have little or no training in this kind of communication skills, b) effective communication of bad news largely depends on body language, which is absent in this type of exchange, and c) since this type of remote dialogue is not recommended — except in particular circumstances such as the current ones — there is little literature available to guide the professionals who must carry out this task. This manuscript offers recommendations for remote communication of bad news by telephone, applicable to situations in which this task cannot be carried out in person. A proposal structured around four "moments" is presented to guide the remote transmission of bad news in order to improve the care of patients, families and caregivers during this exchange and to reduce the negative impact from it on health professionals.

A actual pandemia do SARS-CoV-2 apresenta desafios específicos para os profissionais de saúde na área da saúde. Neste contexto de emergência, a comunicação de más notícias é particularmente relevante devido à forma específica como deve ser feita: a necessidade de manter a distância social ou as restrições de mobilidade impostas à população em geral implica que esta tarefa seja frequentemente realizada à distância, sobretudo através de chamadas telefónicas. Isto confronta os profissionais com uma série de obstáculos particulares: a) a maioria deles tem pouca ou nenhuma formação neste tipo de competências de comunicação, b) a comunicação eficaz de más notícias depende, em grande medida, da linguagem corporal utilizada, que está ausente neste tipo de intercâmbio, e c) como este tipo de diálogo à distância não é recomendado - excepto em circunstâncias particulares como a actual - há pouca literatura disponível para orientar aqueles que devem realizar esta tarefa. Este manuscrito oferece recomendações sobre a comunicação à distância de más notícias por telefone para situações em que esta tarefa não pode ser realizada pessoalmente. É apresentada uma proposta estruturada em torno de quatro "momentos" para orientar a transmissão de más notícias à distância, a fim de melhorar os cuidados prestados aos doentes, às famílias e aos prestadores de cuidados durante este intercâmbio e também para reduzir o impacto negativo que este intercâmbio tem sobre os profissionais de saúde.

Proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic.

This document offers a proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic. This proposal includes recommendations on the procedural norms and substantive norms that should govern the allocation and reallocation of therapeutic resources in conditions of extreme scarcity.

Este documento ofrece una propuesta desde la perspectiva de la bioética para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Dicha propuesta incluye recomendaciones sobre las normas procedimentales y normas sustantivas que deben regir la asignación y reasignación de recursos terapéuticos en condiciones de escasez extrema.

Recomendaciones para la comunicación de malas noticias por teléfono durante la pandemia por SARS-CoV-2 / Recommendations for communicating bad news by phone during the SARS-CoV-2 pandemic / Recomendações para a comunicação de más notícias por telefone durante a pandemia do SARS-CoV-2

RESUMEN La pandemia actual por SARS-CoV-2 presenta desafíos específicos para los profesionales de salud en el campo de la atención sanitaria. En este contexto de emergencia, la comunicación de malas noticias toma especial relevancia por el modo particular en que debe llevarse a cabo: la necesidad de mantener distanciamiento sanitario y las restricciones de movilidad impuestas a la población general hacen que esta tarea deba ser realizada, muchas veces, de manera remota, en su mayoría mediante llamados telefónicos. Esto enfrenta a los profesionales a una serie de obstáculos particulares: a) la mayoría de ellos poseen escasa o nula formación sobre esta clase de habilidades comunicativas, b) la comunicación efectiva de malas noticias depende, en gran parte, del lenguaje corporal utilizado, ausente en este tipo de intercambios, y c) dado que este tipo de diálogo remoto no es recomendable -con excepción de circunstancias particulares como la actual- existe escasa literatura disponible para guiar a quienes deben cumplir esta tarea. Este manuscrito ofrece recomendaciones sobre pautas básicas para la comunicación remota de malas noticias por teléfono, en situaciones en las cuales no se pueda llevar a cabo esta tarea de forma presencial. Se presenta una propuesta estructurada en torno de cuatro "momentos" para orientar la transmisión de malas noticias a distancia, con el fin de mejorar los cuidados a pacientes, familiares y cuidadores durante este intercambio y también reducir el impacto negativo que este intercambio tiene sobre los profesionales de la salud.(AU)

ABSTRACT The current SARS-CoV-2 pandemic presents specific challenges for health professionals in the healthcare setting. In this emergency context, the communication of bad news is especially relevant because of the particular way it must be done: the need to maintain social distance or mobility restrictions imposed on the general population means that this task must often be carried out remotely, mostly by telephone calls. This confronts professionals with a number of particular obstacles: a) most of them have little or no training in this kind of communication skills, b) effective communication of bad news largely depends on body language, which is absent in this type of exchange, and c) since this type of remote dialogue is not recommended — except in particular circumstances such as the current ones — there is little literature available to guide the professionals who must carry out this task. This manuscript offers recommendations for remote communication of bad news by telephone, applicable to situations in which this task cannot be carried out in person. A proposal structured around four "moments" is presented to guide the remote transmission of bad news in order to improve the care of patients, families and caregivers during this exchange and to reduce the negative impact from it on health professionals.(AU)

RESUMO A actual pandemia do SARS-CoV-2 apresenta desafios específicos para os profissionais de saúde na área da saúde. Neste contexto de emergência, a comunicação de más notícias é particularmente relevante devido à forma específica como deve ser feita: a necessidade de manter a distância social ou as restrições de mobilidade impostas à população em geral implica que esta tarefa seja frequentemente realizada à distância, sobretudo através de chamadas telefónicas. Isto confronta os profissionais com uma série de obstáculos particulares: a) a maioria deles tem pouca ou nenhuma formação neste tipo de competências de comunicação, b) a comunicação eficaz de más notícias depende, em grande medida, da linguagem corporal utilizada, que está ausente neste tipo de intercâmbio, e c) como este tipo de diálogo à distância não é recomendado - excepto em circunstâncias particulares como a actual - há pouca literatura disponível para orientar aqueles que devem realizar esta tarefa. Este manuscrito oferece recomendações sobre a comunicação à distância de más notícias por telefone para situações em que esta tarefa não pode ser realizada pessoalmente. É apresentada uma proposta estruturada em torno de quatro "momentos" para orientar a transmissão de más notícias à distância, a fim de melhorar os cuidados prestados aos doentes, às famílias e aos prestadores de cuidados durante este intercâmbio e também para reduzir o impacto negativo que este intercâmbio tem sobre os profissionais de saúde.(AU)

Derecho a la salud versus objeción de conciencia en la Argentina / The right to health versus conscientious objection in Argentina / Direito à saúde versus objeção de consciência na Argentina

Resumen El derecho a la objeción de conciencia garantiza que los individuos no sean obligados a llevar a cabo acciones que se oponen a sus convicciones éticas o religiosas. En este artículo analizaremos los argumentos que movilizan los actores sociales que apelan a ese derecho en la Argentina. Compararemos dos fenómenos que limitan el derecho y el acceso a la salud y cuya recurrencia ha aumentado desde comienzos de los 2000: la objeción al Programa Nacional de Salud Sexual y Procreación Responsable y al Plan Nacional de Vacunación Obligatoria. Los datos analizados provienen de tres investigaciones cualitativas, focalizadas en la comprensión de los puntos de vista de los actores sociales. Planteamos que la objeción de conciencia no puede reducirse a una cuestión de autonomía individual, sino que, por el contrario, es un fenómeno en el que interactúan individuos en su carácter de padres/madres, ciudadanos, profesionales, entre otras identidades sociales.

Abstract The right to conscientious objection guarantees that individuals are not obliged to carry out actions that oppose their ethical or religious beliefs. In this article, we will analyze the arguments that mobilize the social players who appeal to that right in Argentina. We will compare two phenomena that limit the right and access to health and whose recurrence has increased since the early 2000s: the objection to the National Program of Responsible Sexual Health and Procreation and the National Plan of Compulsory Vaccination. The data analyzed come from three qualitative investigations, focused on the understanding of the views of the social players. We propose that conscientious objection cannot be reduced to a question of individual autonomy, but, on the contrary, it is a phenomenon in which individuals interact as parents, citizens, professionals, among other social roles.

Resumo O direito à objeção de consciência garante que os indivíduos não sejam forçados a realizar ações que se oponham a suas convicções éticas ou religiosas. Este artigo analisa os argumentos mobilizados pelos atores sociais que apelam para esse direito na Argentina. Comparam-se dois fenômenos que limitam o acesso e o direito à saúde e cuja recorrência aumentou desde o início dos anos 2000: a objeção ao Programa Nacional de Saúde Sexual e Procriação Responsável e ao Plano Nacional de Vacinação Obrigatória. Os dados analisados são provenientes de três pesquisas qualitativas, focalizadas na compreensão dos pontos de vista dos atores sociais. Defende-se que a objeção de consciência não pode ser reduzida a uma questão de autonomia individual, mas que, pelo contrário, é um fenômeno no qual interatuam indivíduos nas funções de pais/mães, cidadãos e profissionais, entre outras identidades sociais.

A microRNA signature from serum exosomes of patients with glioma as complementary diagnostic biomarker.

Malignant gliomas, the most frequent primary brain tumors, are characterized by a dismal prognosis. Reliable biomarkers complementary to neuroradiology in the differential diagnosis of gliomas and monitoring for post-surgical progression are unmet needs. Altered expression of several microRNAs in tumour tissues from patients with gliomas compared to normal brain tissue have been described, thus supporting the rationale of using microRNA-based biomarkers. Although different circulating microRNAs were proposed in association with gliomas, they have not been introduced into clinical practice so far. Blood samples were collected from patients with high and low grade gliomas, both before and after surgical resection, and the expression of miR-21, miR-222 and miR-124-3p was measured in exosomes isolated from serum. The expression levels of miR-21, miR-222 and miR-124-3p in serum exosomes of patients with high grade gliomas were significantly higher than those of low grade gliomas and healthy controls and were sharply decreased in samples obtained after surgery. The analysis of miR-21, miR-222 and miR-124-3p in serum exosomes of patients affected by gliomas can provide a minimally invasive and innovative tool to help the differential diagnosis of gliomas at their onset in the brain and predict glioma grading and non glial metastases before surgery.

Next-generation repeat-free FISH probes for DNA amplification in glioblastoma in vivo: Improving patient selection to MDM2-targeted inhibitors.

A next-generation FISH probe mapping to the MDM2 locus-specific region has recently been designed. The level of MDM2 gene amplification (high versus low) may allow selection of patients for cancer treatment with MDM2 inhibitors and may predict their responsiveness. We investigated the spectrum of MDM2 gene alterations using the new probes in vivo after visualizing single neoplastic cells in situ from a series of glioblastomas. Signals from next-generation repeat-free FISH interphase probes were identified in tissue microarrays that included 3 spots for each of the 48 cases. The murine double minutes (MDM2)-specific DNA probe and the satellite enumeration probe for chromosome 12 were used. Three cases (6%) showed more than 25 signals (high gene amplification), and 7 (15%) showed 3-10 signals (gains); among these, 4 cases (8%) had an equal number of MDM2 and centromeric signals on chromosome 12 (polyploidy). Genomic heterogeneity was observed only in 3 cases with low gene amplification. In our series, 6% of glioblastomas exhibited high MDM2 amplification (in vivo) with a pattern related to the known double minutes/chromothripsis phenomenon (in situ), and only cases with low amplification showed genomic heterogeneity. We concluded that the rate of MDM2 gene amplification can be a useful predictive biomarker to improve patient selection.

El derecho en los finales de la vida y el concepto de muerte digna / The right at the end of life and the concept of dignified death

El significado y sentido de la muerte se construyen colectivamente, esta visión abarca más que el simple dato biológico del fin de la vida. Los tiempos que corren se caracterizan por el ocultamiento de la muerte. Predomina un determinado hábito médico y jurídico que la concibe desde limitadas perspectivas, en las que prevalecen tanto la negación, el rechazo y la omnipotencia frente a la muerte, como la ausencia de consideración de los deseos y preferencias de los pacientes y sus familias

El debate en tonno a la validez de las directivas anticipadas en saudd / The debat on thee validity of advance directives for health / O debate sobrea validade das diretrizes antecipadas em saúde

Las directivas anticipadas (también llamadas "testamentos vitales") son documentos firmados por un individuo competente en los cuales se estipulan directivas acerca del permiso de aplicación o el rechazo de tratamientos médicos en el caso de que el individuo que las redactó no se encuentre capacitado para manifestar su voluntad. A pesar del buen recibimiento que han tenido por parte de la comunidad bioética mundial, su validez ha sido fuertemente cuestionada. En este trabajo me propongo analizar en profundidad las fallas que sus detractores señalan e intentaré ofrecer una alternativa superadora de la versión clásica de estos documentos que logre escapar a las críticas que durante décadas se les han formulado.

Advance directives (also called "living wills") are documents signed by a competent individual providing directives as to the permission to apply or to reject medical treatments in the event that the individual who wrote it may not be in a position to declare his or her will. Despite the good reception from the global bioethics community, their validity has been seriously questioned. In this paper, I intend to analyze in depth the faults mentioned by its detractors and I will try to offer an alternative that is superior to the classic version of these documents and manage to escape the criticism which, for decades, they have been subject to.

As diretrizes antecipadas (também chamadas "testamentos vitais") são documentos firmados por um indivíduo competente nos quais se estipulam diretrizes sobre a permissão de aplicação ou a recusa de tratamentos médicos no caso de o indivíduo que as redigiu não se encontrar capacitado para manifestar sua vontade. Apesar do bom recebimento que têm tido por parte da comunidade bioética mundial, sua validade tem sido fortemente questionada. Neste trabalho, propõe-se analisar em profundidade as falhas que seus detratores sinalizam e se tentará oferecer uma alternativa que supere a versão clássica desses documentos e consiga, assim, fugir das críticas que, durante décadas, lhes são formuladas.

Alcances de la nueva legislación sobre muerte digna / Death with Dignity: Scope of the New Legislation

Durante el año 2011, fuertemente impulsado por algunos casos relevantes, se inició en la Argentina un profundo debate público acerca del morir con dignidad. El día 9 de Mayo del año 2012 fue sancionada en Argentina la Ley N° 26742, llamada "ley de muerte digna". Promulgada de hecho el 24 de Mayo del mismo año, incorpora importantes modificaciones a la Ley N° 26529 de octubre de 2009 sobre "Derechos del Paciente en su relación con los Profesionales e Instituciones de la Salud", ampliando los derechos de las personas respecto de las medidas médicas a tomarse al final de sus vidas. El presente artículo presenta y analiza el impacto de esta nueva disposición sobre los derechos de los pacientes y las obligaciones de los profesionales de salud, desde una perspectiva bioética.

In 2011, heavily driven by some relevant cases, in Argentina began a thorough public debate about dying with dignity. On May 9, 2012 the Law N° 26742, called "death with dignity law" was enacted. Promulgated on May 24, that same year, it incorporates major amendments to the Law N° 26529 on "Patient Rights in relation to the Professionals and Health Institutions" expanding the rights of individuals with regard to medical measures to be taken at the end of their lives. This article presents and analyzes the impact of this new law on patient´s rights and health professionals´ obligations from a bioethical perspective.

Alcances de la nueva legislación sobre muerte digna

Durante el año 2011, fuertemente impulsado por algunos casos relevantes, se inició en la Argentina un profundo debate público acerca del morir con dignidad. El día 9 de Mayo del año 2012 fue sancionada en Argentina la Ley N° 26742, llamada "ley de muerte digna". Promulgada de hecho el 24 de Mayo del mismo año, incorpora importantes modificaciones a la Ley N° 26529 de octubre de 2009 sobre "Derechos del Paciente en su relación con los Profesionales e Instituciones de la Salud", ampliando los derechos de las personas respecto de las medidas médicas a tomarse al final de sus vidas. El presente artículo presenta y analiza el impacto de esta nueva disposición sobre los derechos de los pacientes y las obligaciones de los profesionales de salud, desde una perspectiva bioética.(AU)

In 2011, heavily driven by some relevant cases, in Argentina began a thorough public debate about dying with dignity. On May 9, 2012 the Law N° 26742, called "death with dignity law" was enacted. Promulgated on May 24, that same year, it incorporates major amendments to the Law N° 26529 on "Patient Rights in relation to the Professionals and Health Institutions" expanding the rights of individuals with regard to medical measures to be taken at the end of their lives. This article presents and analyzes the impact of this new law on patient´s rights and health professionals´ obligations from a bioethical perspective.(AU)

¿La verdad, toda la verdad y nada más que la verdad? / The Truth, the whole Truth, and nothing but the Truth

La comunicación entre médicos y pacientes es un aspecto fundamental de la atención de los individuos gravemente enfermos, sin embargo la mayoría de los médicos han tenido poca formación en comunicación. Los aspectos de comunicación más valorados por los pacientes son los que los ayudan a ellos y a sus familias a sentirse guiados, los que apuntan a fomentar la confianza y los que alimentan la esperanza. Si bien estas pueden ser consideradas cualidades abstractas, se derivan de un conjunto concreto de habilidades comunicacionales que (al menos hasta cierto punto) puede ser efectivamente enseñado y aprendido. Estas habilidades comunicacionales no son las mismas aptitudes de la "entrevista médica" que la mayoría de los profesionales aprendió en la escuela de medicina, y que están centradas en la consideración de los antecedentes médicos completos y los aspectos sociales y familiares. Las habilidades de comunicación necesarias en el tratamiento de enfermedades potencialmente graves son habilidades de segundo orden que se centran en situaciones difíciles. Una amplia variedad de estudios empíricos documentan que la comunicación médicopaciente es menos que óptima. Los médicos y las enfermeras no llegan a captar la totalidad de la gama de preocupaciones que afectan a las personas con enfermedades potencialmente graves, lo que aumenta el sufrimiento de los pacientes y sus seres queridos. Este trabajo analiza los problemas éticos que se suscitan en torno de esta situación comunicativa.

Patient-physician communication is a fundamental aspect of critically ill patients´ care, nevertheless many doctors lack proper training in this area. Communication aspects most valued by patients are those that help them and their families to feel guided, those aimed at building confidence and fueling hope. While these qualities can be considered abstract, they are derived from a specific set of communication skills that can be effectively taught and learned, at least to some extent. These communication skills are not the same skills of the "medical interview", which most professionals learn in medical schools and are focused on knowing a complete medical history as well as other social and family aspects. Communication skills necessary in treating potentially serious diseases are second order skills, focused on difficult situations. A wide variety of empirical studies shows that physician-patient communication is less than optimal. Doctors and nurses fail to capture the full range of concerns affecting people with potentially serious diseases, increasing the suffering of patients and their loved ones. This paper analyzes the ethical issues that arise from this failure in communication.

¿La verdad, toda la verdad y nada más que la verdad? / The Truth, the whole Truth, and nothing but the Truth

La comunicación entre médicos y pacientes es un aspecto fundamental de la atención de los individuos gravemente enfermos, sin embargo la mayoría de los médicos han tenido poca formación en comunicación. Los aspectos de comunicación más valorados por los pacientes son los que los ayudan a ellos y a sus familias a sentirse guiados, los que apuntan a fomentar la confianza y los que alimentan la esperanza. Si bien estas pueden ser consideradas cualidades abstractas, se derivan de un conjunto concreto de habilidades comunicacionales que (al menos hasta cierto punto) puede ser efectivamente enseñado y aprendido. Estas habilidades comunicacionales no son las mismas aptitudes de la "entrevista médica" que la mayoría de los profesionales aprendió en la escuela de medicina, y que están centradas en la consideración de los antecedentes médicos completos y los aspectos sociales y familiares. Las habilidades de comunicación necesarias en el tratamiento de enfermedades potencialmente graves son habilidades de segundo orden que se centran en situaciones difíciles. Una amplia variedad de estudios empíricos documentan que la comunicación médicopaciente es menos que óptima. Los médicos y las enfermeras no llegan a captar la totalidad de la gama de preocupaciones que afectan a las personas con enfermedades potencialmente graves, lo que aumenta el sufrimiento de los pacientes y sus seres queridos. Este trabajo analiza los problemas éticos que se suscitan en torno de esta situación comunicativa.(AU)

Patient-physician communication is a fundamental aspect of critically ill patients´ care, nevertheless many doctors lack proper training in this area. Communication aspects most valued by patients are those that help them and their families to feel guided, those aimed at building confidence and fueling hope. While these qualities can be considered abstract, they are derived from a specific set of communication skills that can be effectively taught and learned, at least to some extent. These communication skills are not the same skills of the "medical interview", which most professionals learn in medical schools and are focused on knowing a complete medical history as well as other social and family aspects. Communication skills necessary in treating potentially serious diseases are second order skills, focused on difficult situations. A wide variety of empirical studies shows that physician-patient communication is less than optimal. Doctors and nurses fail to capture the full range of concerns affecting people with potentially serious diseases, increasing the suffering of patients and their loved ones. This paper analyzes the ethical issues that arise from this failure in communication.(AU)

La bioética y de los comités hospitalarios de ética: una introducción / Bioethics and hospital ethics committees: an introduction

La bioética comienza a conformarse como disciplina especializada hace casi cinco décadas. Los importantes avances experimentados por las ciencias biológicas y médicas, junto con el surgimiento de innovadoras biotecnologías, tornan urgente la adopción de criterios para la toma de decisiones moralmente complejas relacionadas con el ámbitode la salud. Los organismos gubernamentales y los diferentes centros de salud, frente a esta realidad,comprenden la importancia de la tarea de implementación de diversos mecanismos formales para abordar y analizar los problemas éticos que surgen de estos avances dinámicos y cambiantes en el campo de los cuidados médicos. Como resultado se produjo la creación de los comités de bioética, que tienen como finalidad principal alentar el diálogo y el debate sobre cuestiones dilemáticas relacionadas con la éticadel cuidado de la salud. Estos comités son grupos interdisciplinarios en los cuales expertos de diferentes profesiones (médicos, enfermeras, psicólogos, filósofos, abogados y otros) analizan diferentes cuestiones de orden bioético con el fin de lograr un acuerdo teniendo siempre como fin la protección de los derechos del paciente. Este presente trabajo, que posee un carácter introductorio a estas temáticas, presentará una breve introducción al surgimiento y posterior desarrollo de la bioética como disciplina y luego se expondrán las funciones y composición de los comités hospitalarios de ética.

The birth of bioethics as a discipline can be set approximately five decades ago. The significant scientific progress achieved by biological and medical sciences, along with the emergence of innovative biotechnology, brought to light the need to set criteria for the morally complex decisions that emerged from the health care and medical fields.Government agencies and health centers, faced with this reality, began to understand the importance of the task of implementing formal mechanisms to address and analyze ethical issues arising from these dynamic and ever changing developments in the healthcare field. The result was the establishment of bioethics committees, which are intended to encourage dialogue and debate on issues related to ethics of health care. These committees are interdisciplinary groups in which experts from different professions(doctors, nurses, psychologists, philosophers, lawyers and others) discuss various bioethical issues in order to reach an agreement with the purpose of protecting patient´s rights.This paper, which has an introductory character, presents a brief introduction to the emergence and development of bioethics as a discipline and explains the functions and composition of hospital ethics committees.

[Ethics as first philosophy: the ethics of responsibility as a rationale for health care]. / La Etica como Filosofía Primera: una Fundamentación del Cuidado Médico desde la Etica de la Responsabilidad.

The origins of bioethics as a discipline arouse from the need to provide an answer to new ethical questions generated as a result of technological advances in the health field and the new arenas in which biomedical research began to develop. Discussions were first focused on the relevance of the applicability of new technologies and the need to redefine a number of concepts related to the beginning and end of life. Then, over the years, this discipline was shaped and reconfigured incorporating issues related to the process of decision making in daily medical care, patient rights, protection of their freedoms and obligations of medical professionals, among others. The purpose of this essay is to reflect upon the ethical foundations of health care, trying to provide an answer to the question "why movide care" in light of the thought of Emmanuel Lévinas.