Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic.

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

Opinión de los miembros de la Justicia Nacional en lo Penal y Civil (Familia) en situaciones de limitación del soporte vital en pediatría / Opinions of members of the National Civil (Family Proceedings) and Criminal Courts in withholding or withdrawing of life support situations in pediatrics

Introducción. La posibilidad de sostener artificialmente las funciones vitales hace más difícil diferenciar al paciente en agonía terminal del paciente con posibilidades de supervivencia, lo que pone al grupo que lo rodea frente a un dilema. Por un lado, se presenta la continuación de soporte que solo prolongue un proceso irreversible, que causa daños físicos, psíquicos y a su dignidad. Por otro, la abstención o retiro de soporte vital sin la reflexión y el esfuerzo diagnóstico-terapéutico apropiado puede dejar sin esperanza y llevar a la muerte a un niño potencialmente recuperable. Además, la toma de decisiones, en estas circunstancias, enfrenta diversas barreras que dificultan lograr el mejor interés del paciente. Entre ellas, los temores legales son un factor importante. ¿En qué medida esos temores están justificados? Objetivo. Explorar la opinión del Poder Judicial de la Nación respecto al enfoque que, desde el derecho, se da a situaciones de limitación de soporte vital. Población y métodos. Profesionales activos del ámbito penal, civil y médico forense. Encuesta semiestructurada sobre tres casos hipotéticos con decisiones sobre la limitación del soporte vital. Resultados. Se repartieron 185 encuestas; se contestaron 68 (36,76%) y 51 (30,3%) fueron respondidas en forma completa. No tipificaron ningún delito en ninguno de los tres casos 28 (55%) encuestados. Trece (25%) interpretaron como delitos las decisiones de los tres casos; 6 (12%), alguno de los casos; y 4 (8%), 2 de los 3 casos. Los delitos seleccionados por los encuestados incluyeron homicidio doloso, homicidio culposo y abandono de persona. Conclusiones. El 45% de los encuestados consideraron que hubo alguna forma de delito en las decisiones tomadas.

Introduction. The possibility of sustaining life functions makes it difficult to distinguish between a dying patient and a patient with chances of survival, raising a dilemma for everyone around them. On the one side, continuing with life support techniques that would only extend an irreversible process and result in physical and psychological damage and harm their dignity. On the other side, withholding or withdrawing life support without an adequate reflection and diagnostic-therapeutic effort which may lead to the death of a potentially recoverable child. In addition, making decisions in this context implies facing barriers that hinder the possibility of pursuing the patient's best interest. Among such barriers, the fear of litigation plays a major role. To what extent is this fear justified? Objective. To explore the opinions of the members of the National Judiciary regarding the approach to withholding or withdrawing of life support from a legal stance. Population and methods. Professionals working in the criminal, civil and forensic medicine settings. Semistructured survey on three hypothetical case histories that implied making a decision to withhold or withdraw life support. Results. One hundred and eighty-five surveys were distributed; 68 (36.76%) were partially completed and 51 (30.3%), in full. Twenty-eight (55%) survey respondents did not criminalize any of the three cases presented. Thirteen (25%) respondents considered that the decisions made in the three cases constituted a crime; 6 (12%), only in one case; and 4 (8%), in two out of the three. Crimes described by survey respondents included intentional homicide, wrongful death, and failure to render assistance. Conclusions. Forty-five percent of survey respondents considered that decisions made involved some form of crime.