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J Clin Ethics ; 30(3): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573971


Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders' relationships, and patient-centered care.

Eticistas , Hospitais , Assistência Centrada no Paciente , Assistência à Saúde , Humanos , Assistência Centrada no Paciente/ética
Narrat Inq Bioeth ; 4(1): 69-74, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24748261


This case study details a request from a patient family member who calls our service without an articulated ethical dilemma. The issue that arose involved the conflict between continuing further medical interventions versus transitioning to supportive or palliative care and transferring the patient home. Beyond the resolution of the ethical dilemma, this narrative illustrates an approach to ethics consultation that seeks practical resolution of ethical dilemmas in alignment with patient goals and values. Importantly, the family's suffering is addressed through a relationship driven, humanistic approach that incorporates elements of compassion, empathy and dialog.

Assistência Terminal/ética , Anedotas como Assunto , Coma/psicologia , Coma/terapia , Ética Médica , Humanos , Síndromes Mielodisplásicas/psicologia , Síndromes Mielodisplásicas/terapia , Narração , Relações Profissional-Família , Ordens quanto à Conduta (Ética Médica)
BMC Pharmacol ; 4: 16, 2004 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-15301692


BACKGROUND: Strychnine-sensitive glycine receptors in many adult forebrain regions consist of alpha2 + beta heteromeric channels. This subunit composition is distinct from the alpha1 + beta channels found throughout the adult spinal cord. Unfortunately, the pharmacology of forebrain alpha2beta receptors are poorly defined compared to 'neonatal' alpha2 homomeric channels or 'spinal' alpha1beta heteromers. In addition, the pharmacologic properties of native alpha2beta glycine receptors have been generally distinct from receptors produced by heterologous expression. To identify subtype-specific pharmacologic tools for the forebrain alpha2beta receptors, it is important to identify a heterologous expression system that closely resembles these native glycine-gated chloride channels. RESULTS: While exploring pharmacological properties of alpha2beta glycine receptors compared to alpha2-homomers, we found that distinct heterologous expression systems appeared to differentially influence partial agonist pharmacology. The beta-amino acid taurine possessed 30-50% efficacy for alpha2-containing receptor isoforms when expressed in HEK 293 cells. However, taurine efficacy was dramatically reduced in L-cell fibroblasts. Similar results were obtained for beta-alanine. The efficacy of these partial agonists was also strongly reduced by the beta subunit. There were no significant differences in apparent strychnine affinity values calculated from concentration-response data between expression systems or subunit combinations. Nor did relative levels of expression correlate with partial agonist efficacy when compared within or between several different expression systems. Finally, disruption of the tubulin cytoskeleton reduced the efficacy of partial agonists in a subunit-dependent, but system-independent, fashion. CONCLUSIONS: Our results suggest that different heterologous expression systems can dramatically influence the agonist pharmacology of strychnine-sensitive glycine receptors. In the systems examine here, these effects are independent of both absolute expression level and any system-related alterations in the agonist binding site. We conclude that complex interactions between receptor composition and extrinsic factors may play a significant role in determining strychnine-sensitive glycine receptor partial agonist pharmacology.

Receptores da Glicina/agonistas , Estricnina/farmacologia , Tonsila do Cerebelo/citologia , Tonsila do Cerebelo/efeitos dos fármacos , Animais , Sítios de Ligação/genética , Linhagem Celular , Proteínas do Citoesqueleto/deficiência , Proteínas do Citoesqueleto/genética , Cães , Regulação da Expressão Gênica/efeitos dos fármacos , Glicina/farmacologia , Humanos , Rim/citologia , Rim/efeitos dos fármacos , Rim/embriologia , Camundongos , Células NIH 3T3/efeitos dos fármacos , Subunidades Proteicas/metabolismo , Taurina/farmacologia , Tubulina (Proteína)/deficiência , Tubulina (Proteína)/genética , beta-Alanina/farmacologia