RESUMO
Hace 25 años, en 1998, ante la demanda de que la Sanidad Pública asumiera el coste del tratamiento alternativo del cáncer propuesto por el Profesor Luigi Di Bella -que incluía hormonas, vitaminas y, en ocasiones, quimioterapia- el Parlamento italiano aprobó realizar ensayos clínicos con pacientes oncológicos avanzados para conocer la eficacia de esta terapia. Aunque los estudios en fase II paralelos que se llevaron a cabo en diversos tumores demostraron la falta de actividad del esquema, algunos profesionales han seguido empleándolo desde entonces y han publicado unos resultados aparentemente prometedores en diversas revistas científicas. Este ejemplo real plantea tres escenarios éticos interesantes. El primero es el de la ética de los tratamientos alternativos propuestos por profesionales de la medicina o del ámbito académico que no consiguen distinguir entre hipótesis y eficacia real, algo que influye también en las ex pectativas que genera en pacientes y familiares que deben afrontar una patología potencialmente mortal con pocas o ninguna expectativa de curación con los tratamientos tradicionales. El segundo escenario es el del diseño de ensayos clínicos y la buena práctica para llevarlos a cabo, que fue también motivo de debate en relación con el método Di Bella. Y el último, la ética de las publicaciones científicas. Desde el año 2000, los seguidores de Di Bella han publicado 13 trabajos de calidad limitada con series de pacientes, la mayoría de ellos en una revista de pago por publicación en cuyo comité de editores se encuentra Giuseppe Di Bella, hijo del profesor Di Bella (AU)
Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and, occasionally, chemotherapy proposed by Professor Luigi Di Bella. It was the answer to people demanding Public Health assume the cost of this therapy. Although parallel phase II trials in various tumors demonstrated the lack of activity, some professionals have continued to use this method since then and have published apparently promising results a few various scientific journals. This real example raises three interesting ethical scenarios. The first one is the ethics of alternative treatments proposed by medical pro fessionals or from the academic field. In these cases, the difficulty in differentiating between hypothesis and real efficacy. This problem impacts on patients and relatives expectations who must face a potentially fatal disease with little or no hope of a cure with traditional treatments. The second scenario is the design and good practice in the development of clinical trials, which was also the subject of debate in relation to the Di Bella method. And the last one, the ethics of scientific publications. Di Bellas followers published since 2000 12 papers with limited quality on series of patients treated with his method, the majority in a pay-per-publication journal of which Giuseppe Di Bella, son of Professor Di Bella, is included in the board of editors (AU)
Assuntos
Humanos , Pesquisa Biomédica/ética , Ética em PesquisaRESUMO
Twenty-five years ago, in 1998, the Italian Parliament approved to implement clinical trials in patients with advanced cancer to know the efficacy of an alternative cancer treatment that associated hormones, vitamins and, occasionally, chemotherapy proposed by Professor Luigi Di Bella. It was the answer to people demanding Public Health assume the cost of this therapy. Although parallel phase II trials in various tumors demonstrated the lack of activity, some professionals have continued to use this method since then and have published apparently promising results a few various scientific journals. This real example raises three interesting ethical scenarios. The first one is the ethics of alternative treatments proposed by medical professionals or from the academic field. In these cases, the difficulty in differentiating between hypothesis and real efficacy. This problem impacts on patients and relatives' expectations who must face a potentially fatal disease with little or no hope of a cure with traditional treatments. The second scenario is the design and good practice in the development of clinical trials, which was also the subject of debate in relation to the Di Bella method. And the last one, the ethics of scientific publications. Di Bella's followers published since 2000 12 papers with limited quality on series of patients treated with his method, the majority in a pay-per-publication journal of which Giuseppe Di Bella, son of Professor Di Bella, is included in the board of editors.
Assuntos
Neoplasias , Humanos , Neoplasias/terapia , Vitamina A/uso terapêutico , Vitamina K/uso terapêutico , ItáliaRESUMO
In Spain, health competencies are decentralized, and each autonomous community implements its own plans. Our aim is to determine if the existence of regional palliative care plans implies an improvement in health care coverage. We reviewed regional palliative care plans published in Spain and analyzed the following variables: number and profile of palliative care resources, guidelines and objectives of implementation of resources of these plans, and compliance with European standards. The publication of regional plans is associated with an increase in specific resources in the following years. From 2004 to 2009, the implementation of plans in 6 autonomous communities was associated with an increase in palliative care resources compared to those without a strategy (odds ratio: 1.58, P = .02) or with a settled plan (odds ratio: 1.40, P = .07). The same phenomenon was observed between 2009 and 2015 in 4 autonomous communities and 2 autonomous cities compared with those without a strategy (odds ratio: 2.49, P = .001) and those that implemented a plan before 2009 (odds ratio: 2.62, P < .001). Updating and evaluating these regional plans are also associated with the growth of palliative care resources.
Assuntos
Política de Saúde , Cuidados Paliativos , Atenção à Saúde , Humanos , EspanhaRESUMO
Debido a la pandemia, el teletrabajo se contempló como opción para continuar el ritmo laboral. Objetivos: Valorar la influencia de la presencialidad laboral en la prevalencia de infección por SARS-CoV-2. Conocer las variables relacionadas con la presencialidad en el trabajo. Material y Métodos: Estudio descriptivo, transversal de prevalencia. Variables: edad, sexo, peso, talla, tabaco, comorbilidades, vacunación gripe, síntomas COVID-19, contacto, modalidad de trabajo. Realización de prueba rápida anticuerpos SARS-CoV-2. Resultados: La prevalencia de los trabajadores se relaciona significativamente con: edad, no fumador, vacuna gripe, síntomas sospechosos, convivencia con enfermos. La presencialidad en el trabajo se ha relacionado significativamente con: sexo y fumador. La seroprevalencia fue superior en trabajadores que no acudieron a su puesto respecto a los que acudieron siempre u ocasionalmente. Conclusiones: El teletrabajo parece no influir en la reducción de la seroprevalencia por Covid-19, luego no hay motivos para pensar que el riesgo de contagio sea distinto en el trabajo que en el domicilio del paciente (AU)
Due to the pandemic, teleworking was considered as an option to continue the work rhythm. Objectives: To assess the influence of presence at work on the prevalence of SARS-CoV-2 infection. Know the variables related to presence at work. Material and Methods: Prospective, descriptive, cross-sectional prevalence study. Variables: age, sex, weight, height, tobacco, comorbidities, flu vaccination, COVID-19 symptoms, contact, work modality. Carrying out rapid SARS-CoV-2 antibody test Results: The prevalence of workers is significantly related to: age, non-smoker, flu vaccine, suspicious symptoms, living with patients. Presence at work has been significantly related to: sex and smoker. The seroprevalence was higher in workers who did not go to their position compared to those who did always or occasionally. Conclusions: Teleworking does not seem to influence the reduction of seroprevalence due to Covid-19. The risk of contagion is lower at work than at the worker's home (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , /epidemiologia , /prevenção & controle , Estudos Transversais , PrevalênciaRESUMO
OBJETIVOS: Los cuidados paliativos (CP) forman parte de las transferencias de salud que asumieron las comunidades autónomas (CCAA). Nos planteamos describir las características principales de las estrategias regionales de CP que se han publicado hasta la fecha. MÉTODO: Revisión de los planes, programas o estrategias de CP de las CCAA y las ciudades autónomas de Ceuta y Melilla publicadas desde 2002 a 2018. La búsqueda se ha llevado a cabo en los sitios web de las consejerías y planes de salud de las CCAA y se ha complementado con el Observatorio de CP de Castilla y León. Variables analizadas: fechas y versiones, cronograma, perfil de los redactores, estructura del plan, objetivos, líneas estratégicas, evaluación y organización. RESULTADOS: Hasta enero de 2018 son 15 las CCAA que han publicado su Plan Estratégico de CP, además del de Ceuta y Melilla. Cuatro han editado una actualización del Plan y en la actualidad solo están en vigor tres de las estrategias de las que definían un cronograma o periodo de aplicación. Solo dos han presentado datos de evaluación. La proporción de profesionales de CP en la composición del grupo redactor varía mucho. La estructura general de los documentos es similar y el objetivo principal es común: la mejora de la calidad de vida de los pacientes terminales y sus familias. Casi todos los planes asumen varias de las líneas estratégicas propuestas por los Planes Nacionales de 2001 y 2007. Seis CCAA incluyen también la mejora de los sistemas de información y registro y la participación de la comunidad. El modo de plantear la organización de la atención en CP presenta una gran variabilidad. Aunque la mayor parte de las CCAA diferencia equipos hospitalarios y de atención domiciliaria, se aprecia una tendencia a integrar estos recursos. CONCLUSIONES: Los objetivos generales de los planes son similares y responden a las líneas del Plan Nacional. Sin embargo, hay heterogeneidad en el diseño, planteamiento y organización de los programas de CP. Se aprecian carencias en la actualización y evaluación de los planes
OBJECTIVES: Palliative care (PC) has been taken on by the Spanish Autonomous Communities (ACs) as part of the central government's transfer of healthcare competencies to regional institutions. We describe the main characteristics of the PC strategies reported by ACs to this day. METHOD: A review of all PC plans, programs and strategies reported from 2002 through 2018 by the Spanish ACs and autonomous cities of Ceuta and Melilla. A search was performed of the websites of AC ministries and health plans, supplemented by the PC Observatory of Castilla y León. Assessed variables included: dates and versions, chronogram, author profiles, structure, objectives, strategic lines, evaluation, and organization. RESULTS: Through January 2018, 15 ACs published their PC Strategic Plans, in addition to Ceuta and Melilla. Four ACs have published updates of their Plans, and to date only three of those with a predefined period for implementation are active. Only two have reported evaluation data. The proportion of PC professionals in the composition of the drafting groups varies. The documents have similar structures and a common primary objective: improving quality of life for terminal patients and their families. Almost all Plans endorse several of the strategic lines proposed by the National Plans for 2001 and 2007. Six ACs also contemplate improvements in their information and recording systems, as well as in community participation. Organizational designs vary extensively regarding PC; while most ACs differentiate between hospital and home care teams, there is a tendency to integrate these resources. CONCLUSIONS: The primary objectives of AC Plans are similar and aligned with the National Plan. However, there is heterogeneity in the design, planning and organization of PC programs. Deficiencies in the updating and evaluation of these Plans also exist
Assuntos
Humanos , Estratégias de Saúde Regionais/legislação & jurisprudência , Cuidados Paliativos , Estratégias de Saúde Regionais/organização & administração , Espanha , Regionalização da Saúde , Qualidade de Vida , Inquéritos e Questionários , Modelos OrganizacionaisRESUMO
No disponible
Assuntos
Humanos , Criança , Cuidados Paliativos/tendências , Institutos de Câncer/tendências , Serviço Hospitalar de Oncologia , Dor do Câncer/terapia , Medicina Paliativa/métodos , Medicina Paliativa/tendênciasRESUMO
No disponible
Assuntos
Humanos , Tamanho da Amostra , Ensaios Clínicos como Assunto/métodos , Drogas em InvestigaçãoRESUMO
No disponible
Assuntos
Humanos , Neoplasias/mortalidade , Caquexia/mortalidade , Desnutrição/mortalidade , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Testes de HipóteseRESUMO
OBJECTIVE: "Medicina Paliativa" is the official journal of the Spanish Society of Palliative Care ("Sociedad Española de Cuidados Paliativos"; SECPAL) and it reflects the interests, also on bioethics, of the professionals caring terminal people. We want to know what the bioethical questions they discuss and their approaches are. METHODS: From all the published articles in "Medicina Paliativa" from 1994 to 2013 we selected those referred to bioethics topics. We analysed: number of publications, author, subtype of article, year of publication, topic, philosophic approach, and the presence of answers and discussion. Qualitative topics were reviewed and agreed by at least two authors. RESULTS: There were 60 (9%) publications with bioethics profile from a total of 672 analyzed articles. A majority were signed by only one author. 31 (51%) were published as letter. The most relevant topics were: euthanasia, dignity, proportionality of treatment and care, sedation, principles of bioethics, and information. The orientation of these papers was, in a majority, according to principles of palliative care. Most bioethics topics have been answered and even answered back. CONCLUSION: Bioethics is an interesting topic in palliative care. The arguments usually fit the principles of palliative care.
Assuntos
Temas Bioéticos , Cuidados Paliativos , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos , Sociedades Médicas , EspanhaRESUMO
Objetivo: La revista Medicina Paliativa, publicación oficial de la Sociedad Española de Cuidados Paliativos (SECPAL), refleja las inquietudes, también bioéticas, de los profesionales que atienden enfermos en situación terminal. Pretendemos conocer las cuestiones y los planteamientos bioéticos que debaten estos profesionales. Material y método: De los artículos publicados en Medicina Paliativa de 1994 a 2013 se recogen los que se centran en cuestiones bioéticas. Se analiza: número de trabajos, autores, tipo de artículo, año de publicación, tema, orientación y réplicas y/o debate. Las cuestiones de perfil cualitativo se han consensuado entre los revisores. Resultados: Se recogen 60 trabajos de perfil bioético, que suponen el 9% de los 672 analizados. La mayor parte tienen un solo autor. 31 (51%) se han publicado en formato de carta. Los temas más relevantes han sido: eutanasia, dignidad, proporcionalidad de las medidas, sedación, principios de bioética e información. La orientación de los trabajos se adapta en la mayoría de los casos a los principios de los Cuidados Paliativos. Las cuestiones bioéticas se han prestado al debate con réplicas y contrarréplicas. Conclusión: La bioética es un área de interés y debate en Cuidados Paliativos. Los argumentos se adaptan a los principios de los Cuidados Paliativos
Objective: "Medicina Paliativa" is the official journal of the Spanish Society of Palliative Care ("Sociedad Española de Cuidados Paliativos"; SECPAL) and it reflects the interests, also on bioethics, of the pro-fessionals caring terminal people. We want to know what the bioethical questions they discuss and their approaches are. Methods: From all the published articles in "Medicina Paliativa" from 1994 to 2013 we selected those referred to bioethics topics. We analysed: number of publications, author, subtype of article, year of publication, topic, philosophic approach, and the presence of answers and discussion. Qualitative topics were reviewed and agreed by at least two authors. Results: There were 60 (9%) publications with bioethics profile from a total of 672 analyzed articles. A majority were signed by only one author. 31 (51%) were published as letter. The most relevant topics were: euthanasia, dignity, proportionality of treatment and care, sedation, principles of bioethics, and information. The orientation of these papers was, in a majority, according to principles of palliative care. Most bioethics topics have been answered and even answered back. Conclusion: Bioethics is an interesting topic in palliative care. The arguments usually fit the principles of palliative care
Assuntos
Temas Bioéticos , Cuidados Paliativos , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos , Sociedades Médicas , EspanhaRESUMO
Objetivo. Conocer el nivel de estrés relacionado con el trabajo en una muestra de enfermeras e identificar los factores que se asocian con su incremento. Método. Estudio observacional transversal en una muestra de 1.656 enfermeras seleccionadas por muestreo aleatorio del total de censadas en el Consejo de Colegios Profesionales de la Comunidad de Castilla y León. La información se recogió mediante envíos postales y llamadas telefónicas durante los años 2002-2003 del cuestionario de Contenido de Trabajo y de un cuestionario específico (datos sociodemográficos, historia laboral, historia médica y estilos de vida). Se realizó un análisis descriptivo y se ajustaron modelos de regresión logística. Resultados. El porcentaje de respuesta fue del 45,4% (680 enfermeras) y osciló entre un 68 y un 33% entre las 9 provincias. El 49% manifestó tener altas demandas en el trabajo y el 22% falta de control. El análisis multivariante mostró que las variables que se asociaron con el estrés fueron: el esfuerzo físico moderado y muy intenso (odds ratio [OR] = 4,00; intervalo de confianza [IC] del 95%, 1,94-8,22), trabajar en los servicios de quirófano (OR = 3,67; IC del 95%, 1,23-10,94), unidades de cuidados intensivos y urgencias (OR = 3,25; IC del 95%, 1,41-7,49) y la falta de apoyo de los compañeros (OR = 2,77; IC del 95%, 1,58-4,87) y de los supervisores (OR = 1,88; IC del 95%, 1,21-2,94). Conclusiones. El estrés relacionado con el trabajo se asoció al esfuerzo físico y a los servicios de quirófano y unidades de cuidados intensivos y urgencias. En cambio, no se asoció con la falta de control. Finalmente, la falta de apoyo social también se asoció con el estrés laboral
Objective. To determine work-related stress in a sample of nurses and to identify associated factors. Method. We performed an observational, cross-sectional study of 1656 nurses randomly selected from those registered in the Council of Professional Colleges of the Autonomous Community of Castilla y León. Information was collected through mailing and telephone calls from 2002-2003 using the Job Content Questionnaire and a specific questionnaire (socio-demographic data, occupational records, medical records, and lifestyles). A descriptive analysis and adjustment of logistic regression models were performed. Results. The response rate was 45.4% (680 nurses), ranging between 68% and 33% among the 9 provinces. Forty-nine percent reported high job demands and 22% reported loss of control. Multivariate analysis identified the following variables as stress-related: moderate and very intense physical effort (odds ratio [OR] = 4.00; 95% confidence interval [CI], 1.94-8.22), working in operating rooms (OR = 3.67; 95% CI, 1.23-10.94), intensive care units and emergency departments (OR = 3.25; 95% CI, 1.41-7.49), and lack of support from workmates (OR = 2.77; 95% CI, 1.58-4.87) and supervisors (OR = 1.88; 95% CI, 1.21-2.94). Conclusions. Work-related stress was associated with physical effort and working in the operating room, intensive care units, or emergency department. It was not associated with low control. Finally, lack of social support was also associated with work stress
