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N Engl J Med ; 384(6): 494-495, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33567481
Eur J Med Res ; 26(1): 15, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546770


BACKGROUND: Hypothermic machine perfusion (HMP) improves the quality of donor livers for transplantation, both in animal models and in clinical practice. Treatment with SP600125, an inhibitor of c-Jun N-terminal kinase (JNK), can suppress the JNK signaling pathway to alleviate donor liver ischemia-reperfusion injury (IRI). We performed the present study with the objective of exploring the protective effects exerted by a combination of HMP and SP600125 on liver xenograft viability for donation after cardiac death (DCD) in a porcine model. METHODS: 54 adult BAMA mini-pigs were randomly assigned to 5 groups, including sham, cold storage for 4 h (CS 4 h), CS 4 h + SP600125, CS 2 h + HMP 2 h, and CS 2 h + HMP 2 h + SP600125 groups. Donor livers in the CS 4 h and CS 4 h + SP600125 groups were conventionally cold preserved for 4 h, whereas donor livers in the CS 2 h + HMP 2 h and CS 2 h + HMP 2 h + SP600125 groups were cold preserved for 2 h and then treated with HMP for 2 h. The preservation and perfusion solutions contained SP600125 (20 µM). Follow-up was conducted for 5 days after liver transplantation to compare the surgical outcomes by means of serological examination, pathological results, and survival rate. RESULTS: The most satisfactory outcome after liver transplantation was observed in the CS 2 h + HMP 2 h + SP600125 group, which presented with minimal damage of donor livers during 5 days' follow-up. Additionally, serological examination, pathological results, and survival rate concurred in showing better results in the CS 2 h + HMP 2 h ± SP600125 group than in the CS 4 h ± SP600125 group. CONCLUSION: HMP in combination with SP600125 has hepatoprotective properties and improves the quality and viability of porcine livers collected after DCD, thus improving prognosis after liver transplantation.

Aloinjertos/efectos de los fármacos , Antracenos/farmacología , Trasplante de Hígado , Preservación de Órganos/métodos , Perfusión/métodos , Animales , Frío , Muerte , Modelos Animales de Enfermedad , Daño por Reperfusión/prevención & control , Porcinos , Porcinos Enanos
Rev Med Suisse ; 17(722): 147-149, 2021 Jan 20.
Artículo en Francés | MEDLINE | ID: mdl-33470572


The death of a patient taking opioids can generate strong feelings of guilt. « Have I hastened my patient's death by my administration of opioids ? ¼ Doubts may arise in certain situations, despite the proven safety of appropriate opioid use in the management of dyspnea and pain in the palliative care setting. Fearing the harms of opioid administration, some medical practitioners may undertreat patients, forsaking them to suffering. Other doctors, desperate to relieve their excruciating suffering at all cost, may in fact have recourse to euthanizing acts. This article seeks to answer this ethical dilemma with an overview of the double effect principle.

Analgésicos Opioides , Cuidados Paliativos , Muerte , Principio del Doble Efecto , Humanos , Dolor/tratamiento farmacológico
JAMA ; 325(2): 131-132, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33433579
N Engl J Med ; 384(4): 345-352, 2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33503343


BACKGROUND: The minimum duration of pulselessness required before organ donation after circulatory determination of death has not been well studied. METHODS: We conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned withdrawal of life-sustaining measures in 20 intensive care units in three countries. Patients were intended to be monitored for 30 minutes after determination of death. Clinicians at the bedside reported resumption of cardiac activity prospectively. Continuous blood-pressure and electrocardiographic (ECG) waveforms were recorded and reviewed retrospectively to confirm bedside observations and to determine whether there were additional instances of resumption of cardiac activity. RESULTS: A total of 1999 patients were screened, and 631 were included in the study. Clinically reported resumption of cardiac activity, respiratory movement, or both that was confirmed by waveform analysis occurred in 5 patients (1%). Retrospective analysis of ECG and blood-pressure waveforms from 480 patients identified 67 instances (14%) with resumption of cardiac activity after a period of pulselessness, including the 5 reported by bedside clinicians. The longest duration after pulselessness before resumption of cardiac activity was 4 minutes 20 seconds. The last QRS complex coincided with the last arterial pulse in 19% of the patients. CONCLUSIONS: After withdrawal of life-sustaining measures, transient resumption of at least one cycle of cardiac activity after pulselessness occurred in 14% of patients according to retrospective analysis of waveforms; only 1% of such resumptions were identified at the bedside. These events occurred within 4 minutes 20 seconds after a period of pulselessness. (Funded by the Canadian Institutes for Health Research and others.).

Paro Cardíaco , Corazón/fisiología , Pulso Arterial , Privación de Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Extubación Traqueal , Presión Sanguínea/fisiología , Muerte , Electrocardiografía , Femenino , Pruebas de Función Cardíaca , Humanos , Cuidados para Prolongación de la Vida , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
Clin Imaging ; 69: 79-81, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32693227


Adrenal crisis is a life-threatening complication of adrenal insufficiency which is triggered by physiological stressors such as injury, infection or a surgical procedure when the plasma concentration of adrenal corticosteroids is insufficient for physiological requirements. It is associated with a high mortality rate unless early diagnosis and treatment is initiated. We report a case of a patient with metastatic sarcoma and adrenal insufficiency who underwent right hepatic artery chemoembolization to control his intrahepatic metastases. He did not receive stress dose glucocorticoid and his glucocorticoid supplement medication was accidentally discontinued after embolization. He died due to an unrecognized adrenal crisis 2 days after embolization. This case suggests that embolization should be recognized as a stressor to prompt the need to continue chronic replacement of corticosteroids and to consider supplemental stress-dose corticosteroids. There is a growing population of patients on chronic corticosteroids for various conditions who may require tumor embolization. Therefore, it is important to consider adrenal crisis in post-embolization settings since the symptoms are non-specific and mortality can be avoided only if the diagnosis of adrenal crisis is considered and parenteral glucocorticoids administered.

Insuficiencia Suprarrenal , Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Sarcoma , Insuficiencia Suprarrenal/inducido químicamente , Quimioembolización Terapéutica/efectos adversos , Muerte , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Masculino
Support Care Cancer ; 29(1): 179-185, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32328774


PURPOSE: To characterize the practice of subcutaneous hydration provision in the Beer-Sheva home care hospice unit. We also explore the potential connection between the provision of subcutaneous hydration and the incidence of death rattle. METHODS: This was a prospective observational study involving 120 hospice patients. During the 6 days before death, hospice staff recorded whether or not fluids were administered orally and/or subcutaneously; the duration, timing, and quantity of fluid administration; the incidence, timing, and duration of death rattle; and whether medications that can affect death rattle were given. RESULT: Fifty-three percent of the patients received subcutaneous hydration. The mean daily volume administered in the hydration group was 434 ml. There was a significant association between the duration of treatment in the hospice unit and provision of subcutaneous hydration (mean of 51 days in hydration group vs. 31 days in non-hydration group, p = 0.03). Although not statistically significant, males were more likely to receive subcutaneous hydration than females (62% of males vs. 46% of females, p = 0.09). There was a higher incidence of death rattle in men compared to women (54.7% in men vs. 32.8% in women, p = 0.025). A statistically significant association between death rattle and the provision of subcutaneous hydration wasn't demonstrated. CONCLUSION: The decision of whether to provide subcutaneous hydration is individualized taking into consideration the values of the patients and their families. The provision of 500 ml per day of subcutaneous saline during the last 6 days of life does not significantly increase the incidence of death rattle.

Fluidoterapia/métodos , Ruidos Respiratorios/fisiología , Aguas Salinas/uso terapéutico , Cuidado Terminal/métodos , Adulto , Anciano , Anciano de 80 o más Años , Muerte , Femenino , Cuidados Paliativos al Final de la Vida/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
J Surg Res ; 257: 468-476, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32896815


BACKGROUND: Donation after circulatory death donors (DCD) can expand the donor pool for heart transplantation, which primarily depends on brain death donors. Ischemia and reperfusion injury are inherent to the DCD process. We hypothesize that pharmacologic inhibition of interleukin-1 (IL-1) and/or IL-18 is protective to DCD hearts. MATERIALS AND METHODS: Following clinical protocol, in-situ ischemia time in control beating-heart donor (CBD) and DCD groups was less than 5 and 40 min, respectively. Wild type (WT) C57Bl6/j, IL-1 receptor type I knockout (IL-1RI-KO), and IL-18 KO mice were used. Hearts were reanimated for 90 min on a Langendorff system with Krebs-Henseleit buffer at 37°C, to assess physiologic parameters. Recombinant IL-1 receptor antagonist (IL-1Ra) and/or IL-18 binding protein (IL-18BP) were added to the Krebs-Henseleit buffer to inhibit IL-1 and/or the IL-18 signaling, respectively. RESULTS: Developed pressure and ± dP/dt were significantly impaired in the DCD-WT group compared to CBD-WT (P ≤ 0.05). Troponin release was higher in DCD-WT groups. Functional parameters were preserved, and troponin release was significantly less in the DCD knockout groups. Heart function was improved in DCD groups treated with IL-1Ra or IL-18BP compared to the DCD-WT group. CONCLUSIONS: Heart function was significantly impaired in the DCD-WT group compared to CBD-WT. Genetic deletion or pharmacologic blockade of IL-1 or IL-18 was protective to DCD hearts.

Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Daño por Reperfusión Miocárdica/prevención & control , Obtención de Tejidos y Órganos , Animales , Muerte , Evaluación Preclínica de Medicamentos , Corazón/efectos de los fármacos , Péptidos y Proteínas de Señalización Intercelular/farmacología , Proteína Antagonista del Receptor de Interleucina 1/farmacología , Interleucina-18/antagonistas & inhibidores , Interleucina-18/genética , Interleucina-1beta/antagonistas & inhibidores , Interleucina-1beta/genética , Masculino , Ratones Noqueados , Daño por Reperfusión Miocárdica/metabolismo , Distribución Aleatoria
Esc. Anna Nery Rev. Enferm ; 25(1): e20200100, 2021. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1114763


RESUMO Objetivo identificar a ocorrência da morte nas unidades de cuidados, bem como analisar os registros e as atitudes dos enfermeiros frente à morte no contexto hospitalar. Método estudo quantitativo, descritivo, transversal, com participação de 900 enfermeiros de um hospital do Norte de Portugal. Com recurso à triangulação de fontes de dados, a coleta realizou-se de fevereiro a março de 2018 através de questionário e observação de registros efetuados pelos enfermeiros. Para análise dos dados, usou-se estatística descritiva e analítica. Resultados são as unidades de medicina que apresentam maior número de mortes, sendo no turno da noite que se registra um valor mais elevado de ocorrências. Com relação às atitudes dos enfermeiros frente à morte, à exceção do evitamento, todas as outras evidenciam tendência semelhante entre o grupo profissional, independentemente da sua área de atuação. Os registros de enfermagem apresentam maior incidência ao nível da função ao invés de focados no domínio da pessoa. Conclusão e implicações para a prática além da aquisição de conhecimentos através da participação em formações sobre a morte e o processo de morrer, o acompanhamento e apoio dos profissionais, poderão desempenhar um papel fundamental na preparação dos enfermeiros para cuidar das pessoas em fim de vida.

RESUMEN Objetivo identificar la ocurrencia de la muerte en unidades de cuidados y analizar registros y actitudes de los enfermeros frente a la muerte en el contexto hospitalario. Método estudio cuantitativo, descriptivo, transversal, con participación de 900 enfermeros de un hospital en el Norte de Portugal. Utilizando la triangulación de fuentes de datos, la recopilación se realizó de febrero a marzo de 2018 a través de cuestionario y observación de registros de enfermeros. Para el análisis, se utilizaron estadísticas descriptivas y analíticas. Resultados las unidades médicas presentan mayor número de muertes, con mayor número de ocurrencias en el turno nocturno. Con respecto a las actitudes de los enfermeros frente a la muerte, con excepción de la evitación, todas las demás muestran una tendencia similar entre el grupo profesional, independientemente de su área de especialización. Los registros de enfermería tienen una mayor incidencia a nivel de función, en lugar de centrarse en el dominio de la persona. Conclusión e implicaciones para la práctica además de la obtención de conocimiento sobre la muerte y el morir, el seguimiento y el apoyo de profesionales puede desempeñar un papel fundamental en la preparación de los enfermeros para cuidar a los enfermos en final de vida.

ABSTRACT Objective to identify the occurrence of death in the care units, as well as to analyze the nurses' records and attitudes towards death in the hospital context. Method quantitative, descriptive, cross-sectional study, with the participation of 900 nurses from a hospital in northern Portugal. Using data source triangulation, the collection took place from February to March 2018 through a questionnaire and observation of records made by nurses. For data analysis, descriptive and analytical statistics were used. Results it is the medical units that present the highest number of deaths, with the highest number of occurrences taking place in the night shift. Regarding the nurses' attitudes towards death, with the exception of avoidance, all the others show a similar trend among the professional group, regardless of their area of activity. Nursing records have a higher incidence at the function level rather than focusing on the person's domain. Conclusion and implications for the practic e: in addition to the acquisition of knowledge, through participation in training on death and the dying process, the monitoring and support of professionals, may play a fundamental role in preparing nurses to care of people at the end of life.

Humanos , Masculino , Femenino , Actitud Frente a la Muerte , Registros de Enfermería , Muerte , Unidades Hospitalarias , Enfermeras Practicantes , Pacientes , Enfermería , Capacitación Profesional , Atención de Enfermería
N Z Med J ; 133(1526): 105-106, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33332346
N Engl J Med ; 383(27): 2600-2601, 2020 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-33369364
JAMA ; 324(23): 2371-2372, 2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-33320227
BMC Med Educ ; 20(1): 516, 2020 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-33371878


BACKGROUND: The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them. METHODS: We adopt Krishna's Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review. RESULTS: Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood. CONCLUSION: Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

Muerte , Personeidad , Estudiantes de Medicina/psicología , /mortalidad , Curriculum , Humanos , Pandemias , Proyectos de Investigación , Facultades de Medicina/organización & administración , Apoyo Social
Soins ; 65(850): 39-42, 2020 Nov.
Artículo en Francés | MEDLINE | ID: mdl-33357738


Death has become a topic in our society and talking about it with young children is often the source of numerous questions on the part of adults, especially parents. How should we talk about death with young children? Does the migration process play a role in certain families? Do they draw on their culture of origin, their cultural or religious customs? Interviews carried out with ten parents provide some insights.

Aflicción , Comunicación , Muerte , Relaciones Padres-Hijo , Adulto , Niño , Preescolar , Cultura , Humanos , Padres
Rev. crim ; 62(3): 79-101, sep.-dic. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1144422


Abstract Knowledge of decomposition residual odor volatiles can improve cadaver dog training and forensic techniques for victim recovery. The purpose of this study is to characterize decomposition VOCs in soils contaminated with decomposing porcine remains throughout various decomposition phases in an outdoor environment. Both a pig-meat simulation model as well as pig carcasses were used in place of human cadavers, allowed to decompose for three distinctive time periods, 14, 17 and 21 days, and then removed from the deposition site. After removal, the headspace of soil samples, taken from under the cadaver decomposition island (CDI), were analyzed once per week for a period of 4 weeks using solid phase micro extraction- gas chromatography/mass spectrometry (SPME-GC/MS) as the instrumental analysis method. While there have been limited studies in terms of volatile residual odor in soil matrices, it is the goal of this work to further expand the analytical knowledge of residual decomposition odor volatiles by adding another geographical location such as the West Texas region characterized by arid and colder climate conditions. Characterization of VOCs of interest was conducted highlighting trends in abundance and presence as a function of remains contact with soil surface as well as post-remains removal soil collection times.

Resumen Mediante el conocimiento de las sustancias volátiles de olor por descomposición residual se puede mejorar el adiestramiento de perros de venteo y las técnicas forenses para la recuperación de víctimas. El propósito de este estudio es caracterizar los compuestos orgánicos volátiles (COV) de descomposición en suelos contaminados con restos porcinos en estado de descomposición a lo largo de varias fases en un entorno exterior. Se utilizó un modelo de simulación de carne de cerdo y de cadáveres de cerdos en lugar de cadáveres humanos, los cuales se dejaron descomponer durante tres períodos de tiempo distintos: 14, 17 y 21 días; posteriormente se retiraron del lugar de depósito. Después de la extracción, el espacio vacío de las muestras de suelo, tomadas de debajo de la isla de descomposición cadavérica (CDI, por sus siglas en inglés), se analizaron una vez por semana durante un período de 4 semanas utilizando la microextracción en fase sólida -cromatografía de gases/espectrometría de masas (SPME-GC/MS, por sus siglas en inglés) como método de análisis instrumental. Si bien se han realizado estudios limitados con respecto a los olores residuales volátiles en las matrices del suelo, el objetivo de esta labor es ampliar aún más los conocimientos analíticos acerca de las sustancias volátiles de olor por descomposición residual añadiendo otra ubicación geográfica como la región del oeste de Texas, caracterizada por condiciones climáticas áridas y más frías. Se llevó a cabo la caracterización de los COV de interés, destacando las tendencias en la abundancia y presencia en función del contacto de los restos con la superficie del suelo, así como los tiempos de recolección del suelo después de la eliminación de los restos.

Resumo Através do conhecimento das substâncias odoríferas voláteis devido à decomposição residual, podem ser aprimorados o treinamento dos cães farejadores e as técnicas forenses para a recuperação das vítimas. O objetivo deste estudo é caracterizar compostos orgânicos voláteis de decomposição (COV) em solos contaminados com restos suínos em estado de decomposição ao longo de várias fases em um ambiente externo. Foi utilizado um modelo de simulação de carne de porco e carcaças de suínos em vez de carcaças humanas, que foram deixadas em decomposição por três períodos diferentes: 14, 17 e 21 dias; eles foram posteriormente removidos do local de depósito. Após a extração, o espaço vazio das amostras de solo, retiradas da ilha de decomposição cadavérica (CDI em inglês), foram analisadas uma vez por semana durante um período de 4 semanas usando microextração em fase sólida - cromatografia gasosa / espectrometria de massa (SPME-GC / MS em inglês) como método de análise instrumental. Embora tenham sido realizados estudos limitados sobre odores residuais voláteis em matrizes de solo, o objetivo deste trabalho é expandir ainda mais o conhecimento analítico sobre substâncias voláteis de odor residual de decomposição, adicionando outra localização geográfica, como a região do Oeste do Texas, caracterizado por condições climáticas áridas e frias. Foi realizada a caracterização dos COVs de interesse, destacando as tendências de abundância e presença em função do contato dos restos com a superfície do solo, bem como os tempos de coleta do solo após a remoção dos restos.

Humanos , Perros , Investigación , Policia , Muerte , Perros
Texto & contexto enferm ; 29: e20190204, Jan.-Dec. 2020. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1145159


ABSTRACT Objective: to analyze the relationship between personal characteristics and the profile of attitudes towards death among nurses in a Portuguese hospital. Method: a cross-sectional, quantitative, exploratory and descriptive study, carried out in a hospital in the North of Portugal, with 981 nurses, who answered a questionnaire composed by the scale of evaluation of the Profile of Attitudes about Death. Data collection was carried out in February and March 2018 in the services, and the findings went through descriptive and analytical statistical analysis with the aid of the SPSS software. Results: the nurses revealed to have the attitudes of approach (36.29 points), fear (27.82 points), neutrality (27.25 points), avoidance (17.48 points) and escape (15.52 points) in the face of death, and these were associated with the different socio-occupational characteristics of these professionals, including gender, marital status, age, having children, type of employment relationship, professional category, specialty, time of service, and the practice or belief of some religion. Conclusion: the profile of the nurses' attitudes towards death is influenced by their socio-professional characteristics, which points to the importance of rethinking training strategies in the academic environment, in health organizations and in services, favoring the better reception of patients and family members, but also in relieving the suffering of the professionals in the face of finitude.

RESUMEN Objetivo: analizar la relación entre las características personales y el perfil de las actitudes frente a la muerte entre profesionales de Enfermería de un hospital de Portugal. Método: estudio transversal y cuantitativo, del tipo exploratorio y descriptivo, realizado en un centro hospitalario de la región Norte de Portugal, con 981 profesionales de Enfermería, quienes respondieron un cuestionario compuesto por la escala de evaluación del Perfil de Actitudes Frente a la Muerte. La recolección de datos tuvo lugar en febrero y marzo de 2018 en los servicios, y los hallazgos fueron sometidos a análisis estadístico descriptivo y analítico con el auxilio del software SPSS. Resultados: los profesionales de Enfermería revelaron tener las siguientes actitudes: aproximación (36,29 puntos), miedo (27,82 puntos), neutralidad (27,25 puntos), evasión (17,48 puntos) y escape/fuga (15,52 puntos) frente a la muerte, y fueron asociadas a las diferentes características sociolaborales de estos profesionales, entre ellas: sexo, estado civil, edad, tener hijos, tipo de vínculo laboral, categoría profesional, especialidad, tiempo de servicio y la práctica o creencia en alguna religión. Conclusión: el perfil de las actitudes de los profesionales de Enfermería frente a la muerte se ven influenciado por sus características socioprofesionales, lo que señala la importancia de repensar estrategias de formación en el ámbito académico, en las organizaciones de salud y en los servicios, favoreciendo así una mejor recepción a los pacientes y familiares, como así también el alivio del sufrimiento de los profesionales frente a la muerte.

RESUMO Objetivo: analisar a relação entre as caraterísticas pessoais e o perfil de atitudes frente à morte entre enfermeiros de um hospital português. Método: estudo transversal, quantitativo, do tipo exploratório e descritivo, realizado em um centro hospitalar da região Norte de Portugal, com 981 enfermeiros, os quais responderam a um questionário composto pela escala de avaliação do Perfil de Atitudes Acerca da Morte. A coleta de dados foi realizada em fevereiro e março de 2018 nos serviços e os achados passaram por análise estatística descritiva e analítica com o auxílio de software SPSS. Resultados: os enfermeiros revelaram ter as atitudes de aproximação (36,29 pontos), medo (27,82 pontos), neutralidade (27,25 pontos), evitamento (17,48 pontos) e escape/fuga (15,52 pontos) frente à morte, e estas foram associadas às diferentes características sociolaborais destes profissionais, entre elas, sexo, estado civil, idade, possuir filhos, tipo de vínculo de trabalho, categoria profissional, especialidade, tempo de serviço e a prática ou crença de alguma religião. Conclusão: o perfil de atitudes dos enfermeiros diante da morte sofre influências de suas características socioprofissionais, o que sinaliza para a importância de repensar estratégias de formação em meio acadêmico, nas organizações de saúde e nos serviços, favorecendo o melhor acolhimento dos pacientes e familiares, mas também no alívio do sofrimento dos profissionais frente à finitude.

Humanos , Actitud Frente a la Muerte , Enfermería , Muerte , Atención Ambulatoria , Atención de Enfermería
Rev. enferm. UERJ ; 28: e47321, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1116094


Objetivo: analisar a produção científica nacional e internacional, buscando as interfaces existentes entre os princípios bioéticos e os cuidados em saúde prestados ao fim da vida às pessoas idosas. Método: revisão integrativa, cuja busca ocorreu entre outubro e novembro de 2019 nas bases de dados Medline via Pubmed, Lilacs e Scopus com os descritores: "Palliative Care", "Aged" e "Bioethics" de 2014-2019. Resultados: a partir dos artigos selecionados, emergiram as seguintes categorias: condutas terapêuticas frente aos cuidados ao fim da vida; tomada de decisão nos cuidados ao fim da vida; e desafios nos cuidados ao fim da vida. Conclusão: destaca-se a relevância dos profissionais manterem o compromisso com a pessoa idosa e sua família de forma a considerar suas subjetividades e preferências e os instrumentalizar para que os cuidados sejam pautados em princípios bioéticos, para assim proporcionar um processo de morte e de morrer com dignidade.

Objective: to examine the Brazilian and international scientific production for connections between bioethical principles and the health care provided to older adults at the end of their lives. Method: between October and November 2019 this integrative review searched the Medline (Pubmed), Lilacs, and Scopus databases using the descriptors: "Palliative Care", "Aged", and "Bioethics" for the period 2014-2019. Results: the following categories emerged from the selected articles: therapeutic conducted with regard to end-of-life care; decision making on end-of-life care; and challenges in end-of-life care. Conclusion: of particular importance is for health professionals to uphold their commitment to older adults and their families, consider their subjectivities and preferences, and empower and equip them so that care is guided by bioethical principles in order to assure a dignified process of dying and death.

Objetivo: examinar la producción científica brasileña e internacional en busca de conexiones entre los principios bioéticos y la atención médica brindada a los adultos mayores al final de sus vidas. Método: entre octubre y noviembre de 2019, esta revisión integradora buscó en las bases de datos Medline (Pubmed), Lilacs y Scopus utilizando los descriptores: "Cuidados paliativos", "Envejecido" y "Bioética" para el período 2014-2019. Resultados: las siguientes categorías surgieron de los artículos seleccionados: terapéutico realizado con respecto a la atención al final de la vida; toma de decisiones sobre la atención al final de la vida; y desafíos en la atención al final de la vida. Conclusión: es de particular importancia que los profesionales de la salud mantengan su compromiso con los adultos mayores y sus familias, consideren sus subjetividades y preferencias, y los empoderen y equipen para que la atención se guíe por principios bioéticos para asegurar un proceso digno de muerte y muerte.

Humanos , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Cuidados Paliativos al Final de la Vida/ética , Discusiones Bioéticas , Personeidad , Muerte , Relaciones Profesional-Familia/ética , Relaciones Profesional-Paciente/ética , Actitud Frente a la Muerte , Valor de la Vida
Cuad. bioét ; 31(103): 377-386, sept.-dic. 2020.
Artículo en Español | IBECS | ID: ibc-196720


El objetivo principal de esta investigación es tratar de dar una respuesta, en un tiempo clave ante el COVID19, en la medida de lo posible, a la diferenciación entre el dolor y el sufrimiento. Para hacernos cargo de esta tarea partiremos de las reflexiones del filósofo alemán Robert Spaemann, aunque no solo ni exclusivamente. Para finalizar, abordaremos brevemente la cuestión de la muerte

The main aim of this paper is to define an answer, in a key time before COVID19, if it is indeed possible to do so, as to the difference between pain and suffering. In order to do so, we will refer to, although not exclusively, the reflexions of the German philosopher Robert Spaemann. To finish, the question of death will briefly be analysed

Humanos , Dolor/psicología , Estrés Psicológico/psicología , Muerte , Filosofía , Infecciones por Coronavirus/psicología , Religión y Psicología
Artículo en Alemán | MEDLINE | ID: mdl-33180159


In academic and public debate, the meaning of irreversible loss of brain function as a reliable sign of death (brain death criterion) is repeatedly challenged. In the present article, six prototypical theses against the brain death criterion are discussed: 1) the nonsuperiority of brain versus other organs, 2) the unreliability of brain death diagnostics, 3) the preserved perception of pain in brain death, 4) the (spontaneous) sexual maturation and preserved reproductive function in brain death, 5) the symmetry of brain death and embryonic stage, and 6) the equalization of an artificially respired brain-dead body and a living human being.None of these theses withstand critical analysis. In Germany, the whole-brain death criterion is applied. Brain death involves the complete loss of all sensation, consciousness, as well as facial, ocular, lingual and pharyngeal motor, voluntary motor, and sexual function (functional "decapitation"). Other organs or their basic control can be replaced artificially, but not the brain. The brain, not the remaining body, is determinant of the human individual. The equalization of an artificially respired brain-dead organism, that may be considered as a living system from a natural philosophy point of view, and the organism of the same living human being leads, through reducibility of constituting organs, to an obvious absurdity. The irreversible loss of brain function results inevitably in cardiac arrest, spontaneously within minutes, with intensive care usually within days. In the embryo/fetus, malformation of the complete brain also results in (prenatal) death. The statutory guideline of the German Medical Association for the determination of brain death has, by comparison, high diagnostic reliability; no confirmed misdiagnoses have occurred.

Muerte Encefálica , Obtención de Tejidos y Órganos , Muerte Encefálica/diagnóstico , Cuidados Críticos , Muerte , Alemania , Humanos , Reproducibilidad de los Resultados