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5.
Pediatrics ; 146(Suppl 1): S48-S53, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737232

RESUMO

In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.


Assuntos
Doação Dirigida de Tecido/ética , Alocação de Recursos para a Atenção à Saúde/ética , Defesa do Paciente/ética , Alocação de Recursos/ética , Fatores Etários , Criança , Pré-Escolar , Fibrose Cística/cirurgia , Doação Dirigida de Tecido/legislação & jurisprudência , Feminino , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/organização & administração , História do Século XXI , Humanos , Deficiência Intelectual , Transplante de Rim , Transplante de Pulmão/ética , Transplante de Pulmão/legislação & jurisprudência , Masculino , Redes Sociais Online , Pais , Defesa do Paciente/legislação & jurisprudência , Pneumonia/cirurgia , Preconceito , Opinião Pública , Alocação de Recursos/legislação & jurisprudência , Alocação de Recursos/organização & administração , Transtornos Relacionados ao Uso de Substâncias , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera , Síndrome de Wolf-Hirschhorn/cirurgia , Adulto Jovem
6.
Transplantation ; 104(8): 1560-1565, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732832

RESUMO

The 25th Annual Congress of the International Liver Transplantation Society was held in Toronto, Canada, from May 15 to 18, 2019. Surgeons, hepatologists, anesthesiologists, critical care intensivists, radiologists, pathologists, and research scientists from all over the world came together with the common aim of improving care and outcomes for liver transplant recipients and living donors. Some of the featured topics at this year's conference included multidisciplinary perioperative care in liver transplantation, worldwide approaches to organ allocation, donor steatosis, and updates in pediatrics, immunology, and radiology. This report presents excerpts and highlights from invited lectures and select abstracts, reviewed and compiled by the Vanguard Committee of International Liver Transplantation Society. This will hopefully contribute to further advances in clinical practice and research in liver transplantation.


Assuntos
Congressos como Assunto , Seleção do Doador/organização & administração , Transplante de Fígado , Assistência Perioperatória/métodos , Sociedades Médicas/organização & administração , Adulto , Fatores Etários , Canadá , Criança , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Seleção do Doador/métodos , Doença Hepática Terminal/cirurgia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Hepatectomia/efeitos adversos , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Cooperação Internacional , Doadores Vivos , Preservação de Órgãos/instrumentação , Preservação de Órgãos/métodos , Segurança do Paciente , Seleção de Pacientes , Perfusão/instrumentação , Perfusão/métodos , Melhoria de Qualidade , Alocação de Recursos/organização & administração , Resultado do Tratamento
7.
Transplantation ; 104(8): 1627-1632, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732840

RESUMO

BACKGROUND: In December 2018, United Network for Organ Sharing approved an allocation scheme based on recipients' geographic distance from a deceased donor (acuity circles [ACs]). Previous analyses suggested that ACs would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. METHODS: We applied Scientific Registry of Transplant Recipients data from 2011 to 2016 toward the Liver Simulated Allocation Model to compare outcomes by age and illness severity for the United Network for Organ Sharing-approved AC and the existing donor service area-/region-based allocation schemes. Means from each allocation scheme were compared using matched-pairs t tests. RESULTS: During a 3-year period, AC allocation is projected to decrease waitlist deaths in infants (39 versus 55; P < 0.001), children (32 versus 50; P < 0.001), and teenagers (15 versus 25; P < 0.001). AC allocation would increase the number of transplants in infants (707 versus 560; P < 0.001), children (677 versus 547; P < 0.001), and teenagers (404 versus 248; P < 0.001). AC allocation led to decreased median pediatric end-stage liver disease/model for end-stage liver disease at transplant for infants (29 versus 30; P = 0.01), children (26 versus 29; P < 0.001), and teenagers (26 versus 31; P < 0.001). Additionally, AC allocation would lead to fewer transplants in status 1B in children (97 versus 103; P = 0.006) but not infants or teenagers. With AC allocation, 77% of pediatric donor organs would be allocated to pediatric candidates, compared to only 46% in donor service area-/region-based allocation (P < 0.001). CONCLUSIONS: AC allocation will likely address disparities for pediatric liver transplant candidates and recipients by increasing transplants and decreasing waitlist mortality. It is more consistent with federally mandated requirements for organ allocation.


Assuntos
Doença Hepática Terminal/cirurgia , Acesso aos Serviços de Saúde/organização & administração , Transplante de Fígado/métodos , Modelos Organizacionais , Alocação de Recursos/organização & administração , Índice de Gravidade de Doença , Adolescente , Adulto , Fatores Etários , Aloenxertos/provisão & distribução , Criança , Simulação por Computador , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/mortalidade , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/normas , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Lactente , Transplante de Fígado/estatística & dados numéricos , Masculino , Sistema de Registros/estatística & dados numéricos , Alocação de Recursos/normas , Alocação de Recursos/estatística & dados numéricos , Análise de Sobrevida , Transplantados/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia , Listas de Espera/mortalidade
8.
PLoS One ; 15(7): e0235165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735588

RESUMO

INTRODUCTION: Patient-reported experience measures (PREMs) are central to inform on the responsiveness of health systems to citizens' health care needs and expectations. At their current form, PREMs do not reflect the weights that patients assign to varying aspects of the care experience. We aimed to investigate patients' preferences and willingness to pay (WTP) for attributes of the care experience in outpatient settings. METHODS: A discrete choice experiment was conducted among a representative sample of the general adult population of Hungary (n = 1000). Choice set attributes and levels were defined based on OECD's standardized PREMs (e.g. a doctor spending enough time in consultation, providing easy to understand explanations, giving opportunity to ask questions, and involving in decision making) and a price attribute. Conditional and mixed logit analyses were conducted. WTP estimates were computed in preference and WTP space. RESULTS: The respondents most preferred attribute was that of a doctor spending enough time in consultation, followed by involvement in decision making. Moreover, waiting times had a less important effect on respondents' choice preference compared with aspects of the doctor-patient relationship. Estimates in the WTP space varied from €4.38 (2.85-5.90) for waiting an hour less at a doctor's office to €36.13 (32.07-40.18) for a consultation where a doctor spends enough time with a patient relative to a consultation where a doctor does not. CONCLUSIONS: A preference-based PREMs approach provide insight on the value patients assign to different aspects of their care experience. This can inform the decisions of policy-makers and other stakeholders to coordinate efforts and resource allocation in a more targeted manner, by acting on attributes of the care experience that have a greater impact on the implementation of patient-centered care.


Assuntos
Assistência Ambulatorial/psicologia , Preferência do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Relações Médico-Paciente , Adolescente , Adulto , Idoso , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Política de Saúde , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/organização & administração , Alocação de Recursos/organização & administração , Adulto Jovem
9.
PLoS One ; 15(7): e0235250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730256

RESUMO

OBJECTIVES: To elicit citizen preferences for national budget resource allocation in Uganda, examine respondents' preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations. METHODS: We surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens' preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents' preferences with actual government budget allocations. RESULTS: The health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents' preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents' preferences. CONCLUSIONS: Among respondents from Mukono district in Uganda, we found that citizens' preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents' strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens' needs and preferences, but also to meet the government's health goals to improve health, strengthen health systems, and achieve universal health coverage.


Assuntos
Orçamentos/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Governo Local , Alocação de Recursos/estatística & dados numéricos , Adulto , Orçamentos/organização & administração , Estudos Transversais , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Habitação/economia , Habitação/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Setor Público/economia , Setor Público/organização & administração , Alocação de Recursos/organização & administração , Participação dos Interessados , Transportes/economia , Uganda , Assistência de Saúde Universal , Reforma Urbana/economia , Reforma Urbana/organização & administração , Adulto Jovem
10.
S Afr Med J ; 110(5): 355-359, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32657716

RESUMO

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos para a Atenção à Saúde/tendências , Pandemias , Pneumonia Viral , Alocação de Recursos , Triagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Emergências/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/organização & administração , África do Sul/epidemiologia , Triagem/ética , Triagem/organização & administração , Ventiladores Mecânicos/provisão & distribução
12.
Emerg Med Clin North Am ; 38(3): 563-572, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616279

RESUMO

Queueing theory is a discipline of applied mathematics that studies the behavior of lines. Queueing theory has successfully modeled throughput in a variety of industries, including within the emergency department (ED). Queueing equations model the demand for different processes within the ED, and help to factor in effects of variability on delays and service times. Utilization is a measure of the throughput of a process relative to demand, and provides a quick means of comparing the demand for certain resources. Although there have been some significant successes in applying queueing theory to EDs, the field remains underused within ED operations.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos/organização & administração , Humanos , Modelos Organizacionais , Listas de Espera , Recursos Humanos
13.
Emerg Med Clin North Am ; 38(3): 647-661, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616285

RESUMO

Alternatives to inpatient admission have been shown to be safe and effective for a variety of clinical conditions and can help relieve emergency department (ED) and inpatient crowding. Evidence-based alternatives include use of rapid ED follow-up clinics, observation units, and home hospital programs. Use of accelerated diagnostic pathways and shared decision making can help support clinicians and patients in appropriately choosing an alternative disposition to traditional inpatient admission. However, many institutions struggle to fully embrace possible alternative depositions because of challenges of patient access, clinician and patient comfort with diagnostic uncertainty, and perceived medicolegal risks.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Unidades de Observação Clínica , Procedimentos Clínicos/organização & administração , Aglomeração , Tomada de Decisão Compartilhada , Humanos , Tempo de Internação , Alocação de Recursos/organização & administração
14.
Medicina (B Aires) ; 80 Suppl 3: 67-76, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658850

RESUMO

This document aims to provide evidence-based recommendations to estimate the personal protective equipments (PPE), medical devices, and drugs commonly used in the Intensive Care Unit during the COVID-19 pandemic. A systematic literature review and gray literature assessment was performed, and the evidence was categorized using the GRADE methodology. Then a predictive model was built to support the estimation of resources needed during 30 days of the pandemic. In the development of these recommendations, 33 publications were included, with variable quality of evidence (low to very low quality). They refer to the use of PPE according to the risk of exposure; management and reuse of PPE, and the stock of drugs and medical devices needed for the care of patients with COVID-19. It is important to remark the difficult in estimating and managing the number of essential supplies and equipment required during a pandemic. The model allowed us to predict the resources required to provide critical care during 30 days of pandemic activity. Given the constant evolution of COVID-19, these recommendations might change as evidence evolves.


Assuntos
Coronavirus , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva/economia , Equipamento de Proteção Individual/provisão & distribução , Alocação de Recursos/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral/epidemiologia
17.
Clinics (Sao Paulo) ; 75: e2060, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578829

RESUMO

New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Neoplasias Pulmonares/terapia , Pandemias/prevenção & controle , Assistência ao Paciente/normas , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Idoso , Betacoronavirus , Brasil , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Neoplasias Pulmonares/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Alocação de Recursos/economia , Alocação de Recursos/organização & administração , Sociedades Médicas
20.
Rev Lat Am Enfermagem ; 28: e3271, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32401898

RESUMO

OBJECTIVE: to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order. METHOD: qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowball sampling. Data collected by interview and analyzed using the Discursive Textual Analysis technique. RESULTS: three categories were analyzed, entitled deficiency of physical structure and human resources; Lack of clear policies and criteria for patient admission and inadequate discharge from the intensive care unit. In situations of hospitalization by court order, there is a change in the criteria for the allocation of intensive care beds, due to the credibility of professionals, threats of medico-legal processes by family members and judicial imposition on institutions and health professionals. CONCLUSION: nurses defend the needs of the patients, too, with actions that can positively impact the availability of intensive care beds and adequate care infrastructure.


Assuntos
Ocupação de Leitos/legislação & jurisprudência , Hospitalização/legislação & jurisprudência , Unidades de Terapia Intensiva/organização & administração , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Pesquisa Qualitativa , Alocação de Recursos/organização & administração , Inquéritos e Questionários , Carga de Trabalho/psicologia
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