Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses.

AIMS: To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia. METHODS AND RESULTS: Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire. The economic evaluation was based on 648 patients from the per-protocol population. The outcomes were 30-day and 1-year cost-effectiveness, with major adverse cardiovascular events (MACEs) averted as the effectiveness outcome. and a 1-year cost-utility ratio.The 30-day incremental cost-effectiveness ratio was €33 065 saved per additional MACE averted with the restrictive vs. liberal strategy, with an 84% probability for the restrictive strategy to be cost-saving and MACE-reducing (i.e. dominant). At 1 year, the point estimate of the cost-utility ratio was €191 500 saved per quality-adjusted life year gained; however, the cumulated MACE was outside the pre-specified non-inferiority margin, resulting in a decremental cost-effectiveness ratio with a point estimate of €72 000 saved per additional MACE with the restrictive strategy. CONCLUSION: In patients with AMI and anaemia, the restrictive transfusion strategy was dominant (cost-saving and outcome-improving) at 30 days. At 1 year, the restrictive strategy remained cost-saving, but clinical non-inferiority on MACE was no longer maintained. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02648113. ONE SENTENCE SUMMARY: The use of a restrictive transfusion strategy in patients with acute myocardial infarction is associated with lower healthcare costs, but more evidence is needed to ascertain its long-term clinical impact.

Conscientious objection: reflections for nursing in Portugal / Objeción de conciencia: reflexiones para la enfermería en Portugal / Objeção de consciência: reflexões para a enfermagem em Portugal

Objective: to discuss conscientious objection in nursing, identifying the ethic and legal basis for this decision-making. Methodology: qualitative study in which the methodology used was ethical reflection based on a legal analysis of the laws in question, proceeding to a bibliographical and documentary research Conclusions: Portuguese law and ethical pillars that form the basis of the Code of Ethics of nurses in Portugal defend the freedom of conscience as a professional practice. However, the obligation to protect human life, which imposes the need for coordination between this protection and the exercise of the right to conscientious objection on the part of the nurse, is also clear.

Objetivo: llevar a cabo un debate sobre la objeción de conciencia, en la práctica de enfermería, con el fin de identificar la base ética y jurídica de esta toma de decisiones. Metodología: estudio cualitativo en el que la metodología fue la reflexión ética basada en un análisis jurídico de las leyes en cuestión, procediendo la búsqueda bibliográfica y documental Conclusión: la ley portuguesa y bases éticas que forman la base de nuestro Código de Ética, protegen la libertad de conciencia, que es un valor fundamental para las sociedades democráticas y plurales. Sin embargo, también es obligación clara protección de la vida humana desde su forma más cruda (desde el comienzo de la vida humana), por lo que impone la necesidad de coordinación entre esta protección y la existencia de aborto legal en la legislación nacional.

Objetivo: Proceder a uma discussão acerca da objeção de consciência na prática da enfermagem de forma a identificar a fundamentação ética e legal, para esta tomada de decisão. Metodologia: Estudo qualitativo no qual a metodologia utilizada foi a reflexão ética com base numa análise jurídica das leis em apreço, procedendo-se a uma pesquisa bibliográfica e documental. Conclusão: A lei portuguesa e as bases éticas que constituem a base do Código Deontológico dos enfermeiros em Portugal, protegem a liberdade de consciência como um direito profissional. Todavia, é também clara a obrigação de proteção da vida humana, pelo que se impõe a necessidade de articulação entre esta proteção e o exercício do direito à objeção de consciência por parte do enfermeiro.

[Conscientious objection: reflections for nursing in Portugal]. / Objeção de consciência: reflexões para a enfermagem em Portugal.

OBJECTIVE: To discuss conscientious objection in nursing, identifying the ethic and legal basis for this decision-making. METHODOLOGY: Qualitative study in which the methodology used was ethical reflection based on a legal analysis of the laws in question, proceeding to a bibliographical and documentary research CONCLUSIONS: Portuguese law and ethical pillars that form the basis of the Code of Ethics of nurses in Portugal defend the freedom of conscience as a professional practice. However, the obligation to protect human life, which imposes the need for coordination between this protection and the exercise of the right to conscientious objection on the part of the nurse, is also clear.