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6.
World J Pediatr Congenit Heart Surg ; 8(6): 715-720, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29187107

RESUMO

We reflect upon highlights of a facilitated panel discussion from the 2016 Pediatric Cardiac Intensive Care Society Meeting. The session was designed to explore challenges, share practical clinical experiences, and review ethical underpinnings surrounding decisions to offer intensive, invasive therapies to patients who have a poor prognosis for survival or are likely to be burdened with multiple residual comorbidities if survival is achieved. The discussion panel was representative of a variety of disciplines including pediatric cardiology, cardiac intensive care, nursing, and cardiovascular surgery as well as different health-care delivery systems. Key issues discussed included patient's best interests, physician obligations, moral distress, and communication in the context of decisions about providing therapy for patients with a poor prognosis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/ética , Cardiologia/ética , Cuidados Críticos/ética , Tomada de Decisões/ética , Ética Médica , Pediatria/ética , Criança , Congressos como Assunto , Cardiopatias Congênitas , Humanos
7.
Monaldi Arch Chest Dis ; 87(2): 846, 2017 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-28967726

RESUMO

With the advance of technological progress and the increase in life expectancy, it is nowadays mandatory to define what is the therapeutic limit. Every day each physician must take therapeutic decisions on the basis of his scientific knowledge, but also of his own conscience and sense of limits. They can not avoid to consider the global risk of death, disability and morbidity in more advanced age, especially in the field of cardiology and cardiac surgery. In these subjects, both fit that frail, is necessary not only an evaluation for adequate risk assessment, but also a multidimensional assessment performed with advanced tools. The resilience of the subject, ability for which some patients considered out of therapy demonstrate the ability to adapt and overcome critical phases, must also be weighed. Where and what is the therapeutic limit should be evaluated individually with humility, competence and capacity for dialogue with other disciplines in a work team that respects the individual professionalism. In recent years, much has changed in the cardiology/cardiac surgery approach in old people. With the development of less or minimal invasive new techniques, there are no more insurmountable limits that can be connected only to the chronological age of the patients.


Assuntos
Cardiologia/ética , Doenças Cardiovasculares/mortalidade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cardiologia/normas , Doenças Cardiovasculares/epidemiologia , Disfunção Cognitiva/epidemiologia , Feminino , Avaliação Geriátrica/métodos , Humanos , Expectativa de Vida , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Morbidade/tendências , Medição de Risco , Procedimentos Cirúrgicos Torácicos/mortalidade
9.
Eur Heart J ; 38(21): 1632-1637, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28329235

RESUMO

Evidence generated from randomized controlled trials forms the foundation of cardiovascular therapeutics and has led to the adoption of numerous drugs and devices that prolong survival and reduce morbidity, as well as the avoidance of interventions that have been shown to be ineffective or even unsafe. Many aspects of cardiovascular research have evolved considerably since the first randomized trials in cardiology were conducted. In order to be large enough to provide reliable evidence about effects on major outcomes, cardiovascular trials may now involve thousands of patients recruited from hundreds of clinical sites in many different countries. Costly infrastructure has developed to meet the increasingly complex organizational and operational requirements of these clinical trials. Concerns have been raised that this approach is unsustainable, inhibiting the reliable evaluation of new and existing treatments, to the detriment of patient care. These issues were considered by patients, regulators, funders, and trialists at a meeting of the European Society of Cardiology Cardiovascular Roundtable in October 2015. This paper summarizes the key insights and discussions from the workshop, highlights subsequent progress, and identifies next steps to produce meaningful change in the conduct of cardiovascular clinical research.


Assuntos
Cardiologia/normas , Guias de Prática Clínica como Assunto , Saúde Pública/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Cardiologia/educação , Cardiologia/ética , Difusão de Inovações , Revelação , Humanos , Consentimento Livre e Esclarecido , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Medição de Risco
15.
Cardiol Young ; 25(8): 1621-5, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26675614

RESUMO

The treatment of rare and expensive medical conditions is one of the defining qualities of paediatric cardiology and congenital heart surgery. Increasing concerns over healthcare resource allocation are challenging the merits of treating more expensive forms of congenital heart disease, and this trend will almost certainly continue. In this manuscript, the problems of resource allocation for rare and expensive medical conditions are described from philosophical and economic perspectives. The argument is made that current economic models are limited in the ability to assess the value of treating expensive and rare forms of congenital heart disease. Further, multi-disciplinary approaches are necessary to best determine the merits of treating a patient population such as those with significant congenital heart disease that sometimes requires enormous healthcare resources.


Assuntos
Custos de Cuidados de Saúde/ética , Alocação de Recursos para a Atenção à Saúde/ética , Cardiopatias Congênitas/terapia , Doenças Raras/terapia , Cardiologia/economia , Cardiologia/ética , Financiamento Governamental/economia , Financiamento Governamental/ética , Alocação de Recursos para a Atenção à Saúde/economia , Cardiopatias Congênitas/economia , Humanos , Pediatria/economia , Pediatria/ética , Doenças Raras/economia , Cirurgia Torácica/economia , Cirurgia Torácica/ética
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