RESUMO
OBJECTIVES: In a near future, each person will incorporate his/her own sequenced genome in his/her electronic health record. In that precise moment, genomic medicine will be fundamental for clinical practice, as an essential key of personalized medicine. All the genomic data, as well as other 'omics' and clinical data necessary for personalized medicine, are stored in several distributed databases. Research and patient care require each time more biomedical data integration of several distributed heterogeneous datasources. METHODS: This work develops a comprehensive review of the most relevant works in biomedical data integration, specifically in genomic medical data, analyzing the evolution of architecture and integration techniques during the last 20 years, and its usage. CONCLUSION: Most of these solutions, based on cross-linking, data warehouse or federated approaches, are suitable for specific domains. However, none of the models found in the literature is completely appropriate for a general biomedical data integration problem.
Assuntos
Genômica , Medicina de Precisão , Redes de Comunicação de Computadores , Registros Eletrônicos de Saúde , Genômica/tendências , Humanos , Informática Médica/tendênciasRESUMO
Los cambios sociales y el uso de nuevas tecnologías han generado nuevos conflictos en la relación clínica. En muchas de estas situaciones se hace un uso improcedente de la objeción de conciencia, con las repercusiones que ello conlleva para los profesionales, los pacientes y las instituciones sanitarias. En este artículo se trata de clarificar el problema que supone la objeción de conciencia en una sociedad plural, basada en una democracia deliberativa, y cuáles son los modelos que puede adoptar dicha sociedad para respetar, al mismo tiempo, las «razones éticas» de cada individuo y el marco normativo del Estado de Derecho que obliga a todos sus ciudadanos. Asimismo se identifican diversos escenarios clínicos en los que, con frecuencia, los profesionales aluden a la figura de la objeción. También se señalan y se analizan los argumentos que explican por qué en muchos de esos escenarios no es procedente ni correcta dicha apelación. Por último, se aporta el fundamento jurídico, la jurisprudencia española y la bibliografía clínica y ética de relevancia en nuestro entorno respecto de la objeción(AU)
Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic(AU)
Assuntos
Humanos , Masculino , Feminino , Consciência , Estado de Consciência/fisiologia , Recusa em Tratar/ética , Recusa em Tratar/estatística & dados numéricos , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Competência Mental , Teoria Ética , Ética Baseada em PrincípiosRESUMO
Social changes and new technologies have brought new problems in doctor-patient relationship. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. In this article an attempt will be made to clarify the problem from a clinical point of view, assessing the increase in risks in clinical praxis due to patient choice, the complexity of current clinical praxis, and the appropriate use of life support measures. Likewise, it analyses socially controversial ethical values and professional practices with no curative value and with no clinical indication in the physiological sense.
Assuntos
Recusa em Tratar , Consciência , Humanos , Cuidados para Prolongar a Vida/ética , Futilidade Médica , Participação do Paciente , Recusa em Tratar/éticaRESUMO
Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic.