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1.
Rev. bioét. derecho ; (50): 63-79, nov. 2020.
Artigo em Inglês | IBECS | ID: ibc-191346

RESUMO

Allocation of health resources has an irreducible ethical dimension, thus cannot be decided only technically, but must be ethically weighed, what paradigmatic experiences of macro (Oregon Basic Health Services Act, 1989) and micro allocation (God's Committee, 1962) have shown. Justice is required in the enunciation of prioritization criteria, and transparency in its application. In situations of aggravated resource scarcity, it is common to take 'allocate' and 'rationing' as synonyms or claim that 'allocate' is always 'rationing'. Rejecting these positions, there is a distinction between 'allocating' (resource management) from 'rationing' (allocation of limited resources to a limited number of persons) and 'rationalizing' (optimization of available resources). These distinctions are ethically pertinent, showing how only 'rationalization' respects justice, transparency and human dignity


La asignación de recursos de salud tiene una dimensión ética irreducible, que no se puede solo decidirse técnicamente, sino que debe sopesarse éticamente, lo que han demostrado experiencias paradigmáticas de macro (Ley de Servicios Básicos de Salud de Oregon, 1989) y microasignación (Comité de Dios, 1962). Se requiere justicia, en la enunciación de los criterios de priorización, y transparencia, en su aplicación. En situaciones de grave escasez de recursos, es común tomar 'asignar' y 'racionar' como sinónimos, o afirmar que 'asignar' siempre es 'racionar'. Al rechazar estas posiciones, hay una distinción entre 'asignar' (gestión de recursos) del 'racionar' (asignación de recursos limitados a un número limitado de personas) y 'racionalizar' (optimización de los recursos disponibles). Estas distinciones son éticamente relevantes y muestran cómo solo la 'racionalización' respeta la justicia, la transparencia y la dignidad humana


A alocação de recursos em saúde tem uma dimensão ética irredutível, não podendo ser apenas tecnicamente decidida, mas devendo ser eticamente ponderada, o que experiências paradigmáticas de macro (Oregon Basic Health Services Act, 1989) e microalocação (God's Committee, 1962) evidenciaram. Exige-se justiça, na enunciação de critérios de priorização, e transparência, na sua aplicação. Em situações de escassez agravada de recursos é comum tomar 'alocar' e 'racionar' como sinónimos, ou afirmar que 'alocar' é sempre 'racionar'. Rejeitando estas posições, distingue-se 'alocar' (gestão de recursos) de 'racionar' (atribuição de recursos limitados a um número limitado de pessoas) e de 'racionalizar' (optimização dos recursos disponíveis). Estas distinções são eticamente pertinentes, evidenciando-se como só a 'racionalização' respeita a justiça, transparência e dignidade humana


L'assignació de recursos de salut te una dimensió ètica irreductible, que no es pot decidir només tècnicament, sinó que s'ha de sospesar èticament, el que han demostrat experiències paradigmàtiques de macro (Llei de Serveis Bàsics de Salut d'Oregon, 1989) I microassignació (Comitè de Déu, 1962). És requereix justícia, en l'enunciació dels criteris de priorització, I transparència, en la seva aplicació. En situacions de greu escassetat de recursos, és habitual interpretar 'assignar' I 'racionar' com a sinònims, o afirmar que 'assignar' sempre és 'racionar'. Quan es rebutja aquesta perspectiva, hi ha una distinció entre 'assignar' (gestió de recursos) envers 'racionar' (assignació de recursos limitats a un número limitat de persones) I 'racionalitzar' (optimització dels recursos disponibles). Aquestes distincions són èticament rellevants I mostren com únicament la 'racionalització' respecta la justícia, la transparència I la dignitat humana


Assuntos
Humanos , Alocação de Recursos/ética , Prioridades em Saúde/ética , Alocação de Recursos para a Atenção à Saúde/ética , Infecções por Coronavirus , Pneumonia Viral , Pandemias
2.
Rev. bioét. derecho ; (50): 333-352, nov. 2020.
Artigo em Português | IBECS | ID: ibc-191361

RESUMO

Pretende-se mostrar como a pandemia de COVID-19 causada pelo novo coronavírus Sars-CoV-2, afeta a distribuição equitativa de recursos sanitários no Brasil, bem como evidenciar os dilemas e entraves éticos e psicológicos vivenciados pelos profissionais da saúde no contexto de combate à doença. O presente estudo objetivou revisar conhecimentos acerca de questões bioéticas referentes à escassez de recursos e saúde mental. Realizou-se, desse modo, uma análise de protocolos sobre alocação de recursos recém-publicados no Brasil


Se pretende mostrar cómo la pandemia de COVID-19 causada por el nuevo coronavirus Sars-CoV-2, afecta la distribución equitativa de los recursos de salud en Brasil, así como resaltar los dilemas y barreras éticas y psicológicas advertidas por los profesionales de la salud en el contexto de lucha contra la enfermedad. El presente estudio tuvo como objetivo revisar el conocimiento sobre cuestiones bioéticas relacionadas con la escasez de recursos y la salud mental. Así, se realizó un análisis de protocolos sobre la asignación de recursos recientemente publicados en Brasil


It is intended to show how the COVID-19 pandemic caused by the new Sars-CoV-2 coronavirus, affects the equitable distribution of health resources in Brazil, as well as to highlight the ethical and psychological dilemmas and barriers experienced by health professionals in the context of fighting disease. The present study aimed to go through knowledge about bioethical issues related to the scarcity of resources and mental health. Thus, an analysis of protocols on the allocation of newly published resources in Brazil was carried out


Es pretén mostrar com la pandèmia de COVID-19 causada pel nou coronavirus Sars-COV-2, afecta la distribució equitativa dels recursos de salut al Brasil, així com ressaltar els dilemes I les barreres ètiques I psicològiques reconegudes pels professionals de la salut en el context de lluita contra la malaltia. El present estudi va tenir com a objectiu revisar el coneixement sobre qüestions bioètiques relacionades amb l'escassetat de recursos I la salut mental. Així, es va realitzar una anàlisi de protocols sobre l'assignació de recursos recentment publicats al Brasil


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias/ética , Saúde Mental , Bioética , Prioridades em Saúde , Gestão de Recursos , Alocação de Recursos/ética , Brasil/epidemiologia
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1260-1264, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198877

RESUMO

OBJECTIVE: To find effective methods to improve the distribution and usage efficiency of pre-hospital epidemic emergency care resource (PEECR) by analyzing the PEECR allocation and usage in Jinan City during the coronavirus disease 2019 (COVID-19) epidemic. METHODS: Correlation significance test between the COVID-19 epidemiology sample and the PEECR allocation sample was conducted to estimate whether they came from the same population in Jinan from January 24 to June 30, 2020. The data used in empirical analysis were collected from the Health Commission of Shandong Province's daily epidemic information announcement (definite case increment, suspected case increment, suspected case stock, medical observation stock, close contact increment) and interview with some epidemic branch centers in Jinan City (vehicle using increment). Experiential analysis was used to analyze the waste of PEECR usage. RESULTS: All the 5 COVID-19 epidemiology samples and the PEECR allocation sample came from different population. There was no correlation between the vehicle using increment and definite case increment, suspected case increment, suspected case stock, close contact increment (all P < 0.05), there was a weak correlation between the vehicle using increment and medical observation stock [the correlation coefficient was 0.048, ∈ (0.0, 0.2), P = 0.550]. There was systematic difference between PEECR indicator and COVID-19 epidemiology indicator. The waste in practice was also amplified by improper usage such as unsophisticated allocation, low effectiveness in primary units and unvalid emergency calling. CONCLUSIONS: (1) A primary screening system should be established in control center to decrease the waste of efficiency. (2) Communities and units should improve overall epidemic dealing ability to assist emergency system. (3) The medical treatment ability and protection resource should be increased in normal pre-hospital care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , China/epidemiologia , Humanos , Alocação de Recursos
6.
J Healthc Eng ; 2020: 8857553, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029339

RESUMO

Data envelopment analysis (DEA) is a powerful nonparametric engineering tool for estimating technical efficiency and production capacity of service units. Assuming an equally proportional change in the output/input ratio, we can estimate how many additional medical resource health service units would be required if the number of hospitalizations was expected to increase during an epidemic outbreak. This assessment proposes a two-step methodology for hospital beds vacancy and reallocation during the COVID-19 pandemic. The framework determines the production capacity of hospitals through data envelopment analysis and incorporates the complexity of needs in two categories for the reallocation of beds throughout the medical specialties. As a result, we have a set of inefficient healthcare units presenting less complex bed slacks to be reduced, that is, to be allocated for patients presenting with more severe conditions. The first results in this work, in collaboration with state and municipal administrations in Brazil, report 3772 beds feasible to be evacuated by 64% of the analyzed health units, of which more than 82% are moderate complexity evacuations. The proposed assessment and methodology can provide a direction for governments and policymakers to develop strategies based on a robust quantitative production capacity measure.


Assuntos
Leitos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Hospitais , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Leitos/estatística & dados numéricos , Betacoronavirus , Engenharia Biomédica , Brasil/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Eficiência Organizacional/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Alocação de Recursos , Estatísticas não Paramétricas
7.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Espanha/epidemiologia , Triagem/organização & administração
8.
Hastings Cent Rep ; 50(5): 17-19, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33095490

RESUMO

The Covid-19 pandemic has brought about renewed conversation about equality and equity in the distribution of medical resources. Much of the recent conversation has focused on creating and implementing policies in times of crisis when resources are exhausted. Depending on how the pandemic develops, some communities may implement crisis measures, but many health care facilities are currently experiencing shortages of staff and materials even if the facilities have not implemented crisis standards. There is a need for shared conversation about equality and equity in these times of contingency between conventional and crisis medicine. To respond well to these challenges, I recommend that institutions rely on policy, professional education, and ethics consultation. As is the case with crisis policies, creating contingency policies requires that health care professionals decide on how, specifically, to achieve equity. A policy is only as effective as its implementation; therefore, institutions should invest in context-specific education on contingency policies. Finally, ethics consultation should be available for questions that contingency policies cannot address.


Assuntos
Infecções por Coronavirus , Medicina de Desastres , Alocação de Recursos para a Atenção à Saúde , Equidade em Saúde , Recursos em Saúde/provisão & distribução , Disparidades em Assistência à Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Medicina de Desastres/ética , Medicina de Desastres/normas , Consultoria Ética , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Política de Saúde , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos
12.
Dtsch Arztebl Int ; 117(27-28): 465-471, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-33050995

RESUMO

BACKGROUND: Because insufficient data are available, the overall number of patients treated in German emergency departments can only be estimated. It is evident, however, that case numbers have been rising steadily in recent years, and that a lack of capacity is now leading with increasing freuqency to forced centralized allocation of patients by the emergency medical services (EMS) to emergency departments that are, officially, temporarily "closed". METHODS: Trends in patient allocation of this type in greater Munich, Germany, over the years 2013-2019 were analyzed for the first time on the basis of data from 904 997 cases treated by the emergency rescue services. RESULTS: From 2014 to 2019, the number of forced centralized patient allocations rose approximately by a factor of nine, from 70 to 634 per 100 000 persons per year. In the same period, the overall number of cases treated by the emergency rescue services rose by 14.5%. Peak values for forced centralized allocations were reached in the first quarter of each calendar year (2015: 1579, 2017: 2435, 2018: 3161, 2019: 3990). Of all medical specialties, internal medicine was the most heavily affected (more than 59% of the total). Especially in the years 2017-2019, the free availability of internal medicine declined in hospitals participating in the common greater Munich reporting system. CONCLUSION: The reasons for the sharp rise in forced centralized allocations are unclear. This observed trend seems likely to persist over the coming years, in view of the current staff shortage, the aging population, and diminishing hospital capacities. The relevant decision-makers must collaborate to create emergency plans that will prevent care bottlenecks so that patients will not be endangered.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Alocação de Recursos , Idoso , Emergências , Alemanha/epidemiologia , Humanos
13.
Bull Cancer ; 107(11): 1129-1137, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33036742

RESUMO

PURPOSE: Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home. MATERIALS AND METHODS: Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes. RESULTS: In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros. CONCLUSION: Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.


Assuntos
Ambulâncias/economia , Institutos de Câncer/provisão & distribução , Acesso aos Serviços de Saúde/economia , Neoplasias/radioterapia , Transporte de Pacientes/economia , Ambulâncias/estatística & dados numéricos , Custos e Análise de Custo , França , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Estatísticos , Neoplasias/economia , Paris , Qualidade de Vida , Alocação de Recursos , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Incerteza
14.
PLoS One ; 15(10): e0238499, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33119591

RESUMO

INTRODUCTION: Great strides in responding to the HIV epidemic have led to improved access to and uptake of HIV services in Guyana, a lower-middle-income country with a generalized HIV epidemic. Despite efforts to scale up HIV treatment and adopt the test and start strategy, little is known about costs of HIV services across the care cascade. METHODS: We collected cost data from the national laboratory and nine selected treatment facilities in five of the country's ten Regions, and estimated the costs associated with HIV testing and services (HTS) and antiretroviral therapy (ART) from a provider perspective from January 1, 2016 to December 31, 2016. We then used the unit costs to construct four resource allocation scenarios. In the first two scenarios, we calculated how close Guyana would currently be to its 2020 targets if the allocation of funding across programs and regions over 2017-2020 had (a) remained unchanged from latest-reported levels, or (b) been optimally distributed to minimize incidence and deaths. In the next two, we estimated the resources that would have been required to meet the 2020 targets if those resources had been distributed (a) according to latest-reported patterns, or (b) optimally to minimize incidence and deaths. RESULTS: The mean cost per test was US$15 and the mean cost per person tested positive was US$796. The mean annual cost per of maintaining established adult and pediatric patients on ART were US$428 and US$410, respectively. The mean annual cost of maintaining virally suppressed patients was US$648. Cost variation across sites may suggest opportunities for improvements in efficiency, or may reflect variation in facility type and patient volume. There may also be scope for improvements in allocative efficiency; we estimated a 28% reduction in the total resources required to meet Guyana's 2020 targets if funds had been optimally distributed to minimize infections and deaths. CONCLUSIONS: We provide the first estimates of costs along the HIV cascade in the Caribbean and assessed efficiencies using novel context-specific data on the costs associated with diagnostic, treatment, and viral suppression. The findings call for better targeting of services, and efficient service delivery models and resource allocation, while scaling up HIV services to maximize investment impact.


Assuntos
Infecções por HIV/economia , Infecções por HIV/terapia , Custos de Cuidados de Saúde , Alocação de Recursos , Adolescente , Adulto , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Criança , Pré-Escolar , Feminino , Guiana/epidemiologia , Infecções por HIV/epidemiologia , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto Jovem
16.
Cad Saude Publica ; 36(8): e00161320, 2020 09 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901703

RESUMO

The COVID-19 pandemic poses one of this century's greatest public health challenges, with impacts on the health and living conditions of populations worldwide. The literature has reported that the pandemic affects the hegemonic food system in various ways. In Brazil, the pandemic amplifies existing social, racial, and gender inequalities, further jeopardizing the Human Right to Adequate Food (HRAF) and the attainment of food and nutritional security, especially among more vulnerable groups. In this context, the article aims to analyze the first measures by the Brazilian Federal Government to mitigate the pandemic's effects and that may have repercussions on food and nutritional security, considering the recent institutional changes in policies and programs. A narrative literature review was performed, and the information sources were the bulletins of the Center for Coordination of Operations by the Crisis Committee for Supervising and Monitoring the Impacts of COVID-19 and homepages of various government ministries, from March to May 2020. The actions were systematized according to the guidelines of the National Policy for Food and Nutritional Security. The analysis identified the creation of institutional crisis management arrangements. The proposed actions feature those involving access to income, emergency aid, and food, such as authorization for food distribution outside schools with federal funds from the National School Feeding Program. However, the setbacks and dismantlement in food and nutritional security may undermine the Federal Government's capacity to respond to COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Abastecimento de Alimentos/estatística & dados numéricos , Política Nutricional , Pandemias , Pneumonia Viral/epidemiologia , Alocação de Recursos/estatística & dados numéricos , Betacoronavirus , Brasil , Governo Federal , Acesso aos Serviços de Saúde , Humanos , Estado Nutricional , Saúde Pública , Política Pública , Populações Vulneráveis
17.
S Afr Med J ; 110(8): 700-703, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32880283

RESUMO

Letter by Gopalan et al. on article by Singh and Moodley (Singh JA, Moodley K. Critical care triaging in the shadow of COVID-19: Ethics considerations. S Afr Med J 2020;110(5):355-359. https://doi.org/10.7196/SAMJ.2020.v110i5.14778); and response by Singh and Moodley.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Pandemias , Pneumonia Viral , Saúde Pública , África Austral , Betacoronavirus , Humanos , Alocação de Recursos , África do Sul
18.
S Afr Med J ; 110(7): 625-628, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32880336

RESUMO

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.


Assuntos
Infecções por Coronavirus , Infecções por HIV/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva , Pandemias , Seleção de Pacientes/ética , Pneumonia Viral , Alocação de Recursos , Triagem , Tuberculose/epidemiologia , Betacoronavirus/isolamento & purificação , Coinfecção , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/legislação & jurisprudência , África do Sul/epidemiologia , Triagem/economia , Triagem/ética , Triagem/legislação & jurisprudência
19.
Crit Care ; 24(1): 582, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993736

RESUMO

After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Alocação de Recursos , Ventiladores Mecânicos , Betacoronavirus , Tomada de Decisões , Humanos , Pandemias , Saúde Pública , Triagem/métodos
20.
Postgrad Med J ; 96(1140): 633-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32907877

RESUMO

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.


Assuntos
Infecções por Coronavirus/epidemiologia , Ética Médica/história , Alocação de Recursos para a Atenção à Saúde/ética , Hospitais/história , Pandemias/história , Pneumonia Viral/epidemiologia , Quarentena/história , Betacoronavirus , Cólera/epidemiologia , Cólera/história , Mão de Obra em Saúde , Juramento Hipocrático , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , Humanos , Hanseníase/epidemiologia , Hanseníase/história , Peste/epidemiologia , Peste/história , Alocação de Recursos , Estados Unidos/epidemiologia
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