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1.
Hastings Cent Rep ; 48 Suppl 4: S53-S55, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584847

RESUMO

The definition of death was clearer one hundred years ago than it is today. People were declared dead if diagnosed with permanent cessation of both cardio-circulatory function and respiratory function. But the definition has been muddled by the development of new technologies and interventions-first by cardiopulmonary resuscitation and ventilators, which were introduced in the mid-twentieth century, and now by extracorporeal membrane oxygenation, which creates the ability to keep oxygenated blood circulating, with or without a beating heart or functioning lungs. In Defining Death: The Case for Choice, Robert Veatch and I argue that the definition of death should focus on "what change in a human being is so fundamental that we can say the individual is no longer with us as a member of the human community bearing rights such as the right not to be killed." We assert that this decision is a normative issue about which different stakeholders may believe that different changes are fundamental, and we therefore propose that the optimal policy solution may be to allow stakeholders to choose their own definition within a reasonable range of options. There are three caveats that need to be highlighted regarding this approach.


Assuntos
Morte Encefálica/diagnóstico , Comportamento de Escolha , Morte , Tomada de Decisões , Direitos Humanos , Cuidados para Prolongar a Vida , Atitude Frente a Morte , Direitos Humanos/legislação & jurisprudência , Direitos Humanos/tendências , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/psicologia , Cuidados para Prolongar a Vida/tendências , Formulação de Políticas , Tanatologia
2.
Hastings Cent Rep ; 48 Suppl 4: S6-S9, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30584857

RESUMO

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life support perpetuated body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of "defining" these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant. My mentors' discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions.


Assuntos
Morte Encefálica/diagnóstico , Técnicas de Diagnóstico Neurológico/tendências , Cuidados para Prolongar a Vida , Política Pública , Consenso , Ética Médica , Humanos , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/tendências , Transplante de Órgãos/ética , Transplante de Órgãos/tendências , Política Pública/legislação & jurisprudência , Política Pública/tendências , Terminologia como Assunto
3.
Gac. sanit. (Barc., Ed. impr.) ; 32(4): 333-338, jul.-ago. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-174156

RESUMO

Objetivo: Examinar los conocimientos y actitudes, en la etapa final de la vida, sobre los cuidados paliativos, el documento de instrucciones previas, los cuidados psicofísicos, el suicidio médicamente asistido y el acompañamiento espiritual. Método: Estudio transversal efectuado en la población usuaria de un centro de salud de atención primaria de la Comunidad Autónoma de Madrid. Participaron 425 personas seleccionadas mediante un muestreo sistemático aplicado a las hojas de consulta de los/las profesionales sanitarios/as. Se analizaron 42 variables del cuestionario autoadministrado. Resultados: La población madrileña encuestada presentó las siguientes características: estudios superiores 58%, 51-70 años 47%, casados/as 60%, y mujeres 61%. Al 91% les gustaría decidir sobre sus cuidados al final de la vida. El 58% de los/las encuestadas conoce los cuidados paliativos y el 53% solicitaría acompañamiento espiritual. Conocen las instrucciones previas (50%), pero no tienen efectuado el documento. El 54% están a favor de legalizar la eutanasia y el 42% el suicidio asistido. Conclusiones: La población madrileña estudiada decidirá los cuidados al final de la vida y solicitará acompañamiento espiritual. Sobresalen los partidarios de la eutanasia frente al suicidio asistido. Desearían recibir cuidados paliativos y efectuarían las instrucciones previas. Para contrastar la opinión de la población y dar a conocer los recursos sociosanitarios de la Comunidad Autónoma de Madrid deberían realizarse encuestas en diferentes áreas sanitarias de atención primaria


Objective: To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. Method: A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. Results: The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. Conclusion: Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid


Assuntos
Humanos , Cuidados Paliativos na Terminalidade da Vida/tendências , Diretivas Antecipadas/tendências , Direito a Morrer , Cuidados para Prolongar a Vida/tendências , Adesão a Diretivas Antecipadas/tendências , Tomada de Decisão Clínica/ética , Conhecimentos, Atitudes e Prática em Saúde , Suicídio Assistido/tendências , Eutanásia Ativa Voluntária/tendências , Terapias Espirituais/tendências , Estudos Transversais , Inquéritos e Questionários
5.
Pediatr. aten. prim ; 20(78): 133-142, abr.-jun. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174692

RESUMO

Introducción: el papel de los pediatras de Atención Primaria en el cuidado de niños con necesidades paliativas es fundamental. El objetivo del estudio es conocer la influencia que las unidades específicas de cuidados paliativos pediátricos tienen en la asistencia de los niños subsidiarios de los mismos por sus pediatras de Atención Primaria. Método: se realizó un estudio transversal mediante el envío de una encuesta en línea a los pediatras de Atención Primaria del territorio español. Resultados: se registraron 202 respuestas. El 68% nunca habían recibido formación específica en cuidados paliativos pediátricos. En aquellas provincias en las que existen recursos específicos de cuidado paliativos pediátricos, los profesionales de Atención Primaria muestran mayor predisposición para participar en las actividades propias de esta disciplina cuando sus pacientes lo precisen (media 4,37 frente a 3,89; p = 0,104) y han tenido más oportunidades de recibir formación sobre la materia (p = 0,007, OR: 2,18; IC 95: 1,24 a 3,84). Si hubiese una unidad de cuidados paliativos pediátricos accesible 24 horas por teléfono, el número de actividades potenciales en las que participarían es significativamente superior (p <0,001) (diferencia de medias 4,28; IC 95: 3,92 a 4,65). Conclusiones: la existencia de recursos específicos de cuidados paliativos pediátricos con disponibilidad telefónica 24 horas tiene un impacto positivo en la disposición de los pediatras de Atención Primaria para participar en el plan de tratamiento de pacientes con necesidades paliativas. Para implementar los cuidados paliativos desde este ámbito es necesario reforzar los programas formativos


Introduction: Primary Care paediatricians play an essential role in the management of children with palliative care needs. The aim of this study was to assess the impact of the availability of specialised paediatric palliative care units in the management of children eligible for palliative care by their Primary Care paediatricians. Method: cross-sectional study performed by inviting Primary Care paediatricians in Spain to complete an online questionnaire. We analysed training needs and the desire of respondents to be involved in palliative care. Results: we received202 responses. 68% of participants had never received specific training in paediatric palliative care. In provinces where paediatric palliative care resources were available, professionals expressed a greater willingness to involve themselves in palliative care activities as needed by their patients (mean 4.37 vs. 3.89, p = .104) and had more opportunities to receive training on the subject (p = .007, OR: 2.18; 95 CI: 1.24-3.84). On average, if telephonic access to a paediatric palliative care unit were available 24 hours a day, respondents would hypothetically be willing to participate in a considerably higher number of activities (p <0.001) (difference in means 4.28; 95 CI: 3.92-4.65). Conclusions: the availability of specialised paediatric palliative care services accessible by phone around the clock has a positive impact on the willingness of Primary Care paediatricians to be involved in the treatment plans of patients with palliative care needs. Training programmes need to be strengthened to promote the provision of paediatric palliative care at the Primary Care level


Assuntos
Humanos , Criança , Cuidados Paliativos/tendências , Educação Médica Continuada/organização & administração , Cuidados para Prolongar a Vida/tendências , Atenção Primária à Saúde/organização & administração , Capacitação Profissional , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Estudos Transversais
6.
Med. paliat ; 25(2): 66-82, abr.-jun. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-171706

RESUMO

INTRODUCCIÓN: Los planes estratégicos de cuidados paliativos reconocen la importancia de detectar las necesidades del paciente no oncológico como parte de los criterios para acceder a los programas paliativos. OBJETIVO: Identificar las necesidades de atención paliativa en pacientes no oncológicos con enfermedad crónica avanzada incurable o terminal. METODOLOGÍA: Revisión sistemática de las bases de datos CINAHL, MEDLINE, Cochrane Library Plus, CUIDEN, Elsevier, LILACS y PsycINFO. Resultados y CONCLUSIONES: Se seleccionaron 22 artículos tras aplicar los criterios de inclusión y exclusión. Las necesidades de los pacientes afectaban a todas las esferas de la persona. Destaca la necesidad de soporte sanitario y atención paliativa, de información, control de síntomas, mantenimiento de la funcionalidad y cubrir necesidades emocionales y de soporte social. La depresión, la pérdida de dignidad y la culpabilidad son algunos de los problemas principales. Es primordial desarrollar protocolos que incluyan la valoración de las necesidades multidimensionales del paciente paliativo no oncológico que guíen a los profesionales para establecer intervenciones que aborden los problemas del paciente de forma integral


INTRODUCTION: A strategic plan of palliative care usually focuses on detecting the needs of non-cancer patients, in order for them to be admitted to palliative care programmes. OBJECTIVE: To identify the needs of non-cancer palliative care patients with advanced chronic disease. METHODS: Systematic review of CINAHL, MEDLINE, Cochrane Library Plus, CUIDEN, Elsevier, LILACS and PsycINFO databases. Results and CONCLUSIONS: Twenty-two papers were included which met the inclusion and exclusion criteria. Patients'needs affected their life in all fields. The review highlights the need for healthcare support and palliative care, for information about the disease and for effective symptom management, the need to maintain patients' functional capacity and to cover emotional and social support needs. Depression, guilt and loss of dignity were the main problems. It is essential to develop palliative protocols involving the evaluation of the non-cancer palliative patient's multi-dimensional needs to guide professionals to establish interventions that address the problems of the patient in a comprehensive manner


Assuntos
Humanos , Doença Crônica/terapia , Determinação de Necessidades de Cuidados de Saúde , Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos na Terminalidade da Vida/tendências , Bibliometria , Cuidados para Prolongar a Vida/tendências
7.
J Palliat Care ; 33(3): 159-166, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29807480

RESUMO

AIM: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. MATERIALS AND METHODS: A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014. Decedents ≥18 years of age at the time of death and with a principal diagnosis of COPD were included. We examined the receipt of life-sustaining procedures, defined as1 ventilation (intubation, mechanical ventilation, and noninvasive ventilation),2 vasopressor use (infusion and intravascular monitoring),3 nutrition (enteral and parenteral infusion of concentrated nutrition),4 dialysis, and5 cardiopulmonary resuscitation as well as palliative care consultation and do not resuscitate (DNR). We used compound annual growth rates (CAGRs) and the Rao-Scott correction of the χ2 statistic to determine the statistical significance of temporal trends of life-sustaining procedures, palliative care utilization, and DNR status. RESULTS: Among 37 312 324 hospitalizations, 38 425 patients were examined. The CAGRs of life-sustaining procedures were 6.61% and -9.73% among patients who underwent multiple procedures and patients who did not undergo any procedure, respectively (both P < .001). The CAGRs of palliative consultation and DNR were 5.25% and 36.62%, respectively (both P < .001). CONCLUSIONS: Among adults with COPD dying in US hospitals between 2010 and 2014, the utilization of life-sustaining procedures, palliative care, and DNR status increased.


Assuntos
Cuidados para Prolongar a Vida/estatística & dados numéricos , Cuidados para Prolongar a Vida/tendências , Cuidados Paliativos/estatística & dados numéricos , Cuidados Paliativos/tendências , Doença Pulmonar Obstrutiva Crônica/terapia , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal/estatística & dados numéricos , Assistência Terminal/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
8.
Emerg Med Australas ; 30(4): 581-584, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29695029

RESUMO

The Paediatric Acute Care Conference is an annual conference organised by APLS Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. The Conference 2017 was held at Surfers Paradise, Queensland. We provide a summary of some of the presentations.


Assuntos
Congressos como Assunto/tendências , Cuidados para Prolongar a Vida/tendências , Pediatria/educação , Humanos , Cuidados para Prolongar a Vida/métodos
9.
Eur J Anaesthesiol ; 35(7): 511-518, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29419564

RESUMO

BACKGROUND: Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. OBJECTIVES: To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. DESIGN: A retrospective observational multicentre study. SETTINGS: Twenty French ICUs in 18 university hospitals. PATIENTS: A total of 793 mechanically ventilated brain-injured adult patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. RESULTS: A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P < 0.924). Among the 18 patients with a decision to WWLS who were still alive at day 90, three patients (2%) had a GOS score of 2, nine patients (5%) had a GOS score of 3 and five patients (3%) a GOS score of 4. Older age, presence of one nonreactive and dilated pupil, Glasgow Coma Scale less than 7, barbiturate use, acute respiratory distress syndrome and worsening lesions on computed tomography scans were each independently associated with decisions to WWLS. CONCLUSION: Using a nationwide cohort of brain-injured patients, we observed a high proportion of deaths associated with an end-of-life decision. Older age and several disease severity factors were associated with the decision to WWLS.


Assuntos
Lesões Encefálicas/terapia , Tomada de Decisão Clínica/métodos , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/tendências , Ventiladores Mecânicos/tendências , Suspensão de Tratamento/tendências , Adulto , Idoso , Lesões Encefálicas/diagnóstico , Feminino , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/métodos , Respiração Artificial/tendências , Estudos Retrospectivos , Resultado do Tratamento
10.
J Pain Symptom Manage ; 55(3): 835-842, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29191721

RESUMO

CONTEXT: Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life and what trends in care are in recent years. OBJECTIVES: The objective of this study was to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010. METHODS: Analysis of claims data of 55,930 patients with stroke obtained from the National Health Insurance Research Database was performed to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010. RESULTS: Over the whole study period, 25.4% of patients with stroke were admitted to intensive care units in their last month of life. The percentages of patients receiving mechanical ventilation (77.4%-67.9%), cardiopulmonary resuscitation (53.8%-35.8%), and inotropic agents (73.5%-64.3%) decreased over time. The percentages of patients receiving artificial hydration and nutrition (65.9%-73.3%) and sedative or analgesic agents (34.7%-38.6%) increased over time. Patients under 85 years old were more likely to be admitted to intensive care units. Men were more likely to receive mechanical ventilation and cardiopulmonary resuscitation than women. CONCLUSION: Over time, the use of supportive procedures increased, and the use of intensive procedures decreased in patients with stroke in the last month of life. This study highlights a need for research, guidelines, and training in how to provide palliative care for end-stage patients with stroke.


Assuntos
Cuidados Críticos/tendências , Cuidados para Prolongar a Vida/tendências , Acidente Vascular Cerebral/terapia , Assistência Terminal/tendências , Acetatos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/terapia , Cuidados Críticos/métodos , Feminino , Humanos , Iodobenzenos , Cuidados para Prolongar a Vida/métodos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/epidemiologia , Assistência Terminal/métodos , Fatores de Tempo , Adulto Jovem
11.
Med. paliat ; 24(4): 227-230, oct.-dic. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-167613

RESUMO

En un país del Cuerno de África una muchacha con un linfoma en fase terminal sufría un dolor intenso permanente. El autor expone la falta de medicamentos efectivos para el tratamiento del dolor severo en estas latitudes


In the Horn of Africa a young woman had a terminal lymphoma and suffered an intense and continuous pain. The author discusses the lack of effective medications for treating severe pain in theses latitudes


Assuntos
Humanos , Feminino , Adolescente , Tuberculose/complicações , Linfoma não Hodgkin/complicações , Cuidados Paliativos na Terminalidade da Vida , Antituberculosos/uso terapêutico , Evolução Fatal , África , Qualidade de Vida , Cuidados para Prolongar a Vida/tendências , Manejo da Dor/tendências
12.
Nihon Rinsho ; 74(4): 697-701, 2016 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-27333762

RESUMO

In the extremely aged society, rehabilitation staff will be required to provide ample rehabilitation training for more stroke patients and more aged people with disabilities despite limitations in human resources. A nursing-care robot is one potential solution from the standpoint of rehabilitation. The nursing-care robot is defined as a robot which assists aged people and persons with disabilities in daily life and social life activities. The nursing-care robot consists of an independent support robot, caregiver support robot, and life support robot. Although many nursing-care robots have been developed, the most appropriate robot must be selected according to its features and the needs of patients and caregivers in the field of nursing-care.


Assuntos
Pessoas com Deficiência/reabilitação , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/tendências , Robótica/métodos , Robótica/tendências , Reabilitação do Acidente Vascular Cerebral , Humanos , Cuidados para Prolongar a Vida/instrumentação , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/tendências , Cuidados de Enfermagem/classificação , Robótica/classificação
16.
J Natl Compr Canc Netw ; 13(12): 1510-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26656520

RESUMO

BACKGROUND: Changes over time in preferences for life-sustaining treatments (LSTs) at end of life (EOL) in different patient cohorts are not well established, nor is the concept that LST preferences represent more than 2 groups (uniformly prefer/not prefer). PURPOSE: The purpose of this study was to explore heterogeneity and changes in patterns of LST preferences among 2 independent cohorts of terminally ill patients with cancer recruited a decade apart. METHODS: Preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, nasogastric tube feeding, and dialysis were surveyed among 2,187 and 2,166 patients in 2003-2004 and 2011-2012, respectively. Patterns and changes in LST preferences were examined by multigroup latent class analysis. RESULTS: We identified 7 preference classes: uniformly preferring, uniformly rejecting, uniformly uncertain, favoring nutritional support but rejecting other treatments, favoring nutritional support but uncertain about other treatments, favoring intravenous nutritional support with mixed rejection of or uncertainty about other treatments, and preferring LSTs except intubation with mechanical ventilation. Probability of class membership decreased significantly over time for the uniformly preferring class (15.26%-8.71%); remained largely unchanged for the classes of uniformly rejecting (41.71%-40.54%) and uniformly uncertain (9.10%-10.47%), and favoring nutritional support but rejecting (20.68%-21.91%) or uncertain about (7.02%-5.47%) other treatments, and increased significantly for the other 2 classes. The LST preferences of Taiwanese terminally ill patients with cancer are not a homogeneous construct and shifted toward less-aggressive treatments over the past decade. CONCLUSIONS: Identifying LST preference patterns and tailoring interventions to the unique needs of patients in each LST preference class may lead to the provision of less-aggressive EOL care.


Assuntos
Cuidados para Prolongar a Vida , Neoplasias/epidemiologia , Neoplasias/terapia , Preferência do Paciente , Assistência Terminal , Doente Terminal , Estudos Transversais , Humanos , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/tendências , Taiwan/epidemiologia , Assistência Terminal/métodos , Assistência Terminal/tendências
17.
Rev. bras. cir. cardiovasc ; 30(6): 657-659, Nov.-Dec. 2015. tab
Artigo em Inglês | LILACS | ID: lil-774549

RESUMO

ABSTRACT As Marcelo Giugale published in the Financial Times, Latin America, on the whole, has not excelled at innovation - doing the same things in a new and better way or at doing new things. It has been slow to acquire, adopt and adapt technologies by this time available in other places[1]. Although extracorporeal membrane oxygenation (ECMO) is not a new technology, its use in Latin America is not widespread as needed. Furthermore, we still have a number centers doing ECMO, not reporting their cases, lacking a structured training program and not registered with the extracorporeal life support organization (ELSO). With this scenario, and accepting that ECMO is the first step in any circulatory support program, it is difficult to anticipate the incorporation of new and more complex devices as the technologically advanced world is currently doing. However, the good news is that with the support of experts from USA, Europe and Canada the results in Latin America ELSO'S centers are improving by following its guidelines for training, and using a standard educational process. There is no doubt that we can learn a great deal from the high velocity organizations - the rabbits - whom everyone chases but never catches, that manage to stay ahead because of their endurance, responsiveness, and their velocity in self-correction[2].


Assuntos
Humanos , Oxigenação por Membrana Extracorpórea/instrumentação , Cuidados para Prolongar a Vida/tendências , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Oxigenação por Membrana Extracorpórea , América Latina , Cuidados para Prolongar a Vida/instrumentação
18.
Braz J Cardiovasc Surg ; 30(6): 657-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26934407

RESUMO

As Marcelo Giugale published in the Financial Times, Latin America, on the whole, has not excelled at innovation - doing the same things in a new and better way or at doing new things. It has been slow to acquire, adopt and adapt technologies by this time available in other places[1]. Although extracorporeal membrane oxygenation (ECMO) is not a new technology, its use in Latin America is not widespread as needed. Furthermore, we still have a number centers doing ECMO, not reporting their cases, lacking a structured training program and not registered with the extracorporeal life support organization (ELSO). With this scenario, and accepting that ECMO is the first step in any circulatory support program, it is difficult to anticipate the incorporation of new and more complex devices as the technologically advanced world is currently doing. However, the good news is that with the support of experts from USA, Europe and Canada the results in Latin America ELSO'S centers are improving by following its guidelines for training, and using a standard educational process. There is no doubt that we can learn a great deal from the high velocity organizations - the rabbits - whom everyone chases but never catches, that manage to stay ahead because of their endurance, responsiveness, and their velocity in self-correction[2].


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Cuidados para Prolongar a Vida/tendências , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Humanos , América Latina , Cuidados para Prolongar a Vida/instrumentação
19.
Med Intensiva ; 39(7): 395-404, 2015 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25241266

RESUMO

OBJECTIVE: Limitation of life-sustaining treatment (LLST) is a recommended practice in certain circumstances. Limitation practices are varied, and their application differs from one center to another. The present study evaluates the current situation of LLST practices in patients with prolonged admission to the ICU who suffer worsening of their condition. DESIGN: A prospective, observational cohort study was carried out. SETTING: Seventy-five Spanish ICUs. PATIENTS: A total of 589 patients suffering 777 complications or adverse events with organ function impairment after day 7 of admission, during a three-month recruitment period. MAIN VARIABLES OF INTEREST: The timing of limitation, the subject proposing LLST, the degree of agreement within the team, the influence of LLST upon the doctor-patient-family relationship, and the way in which LLST is implemented. RESULTS: LLST was proposed in 34.3% of the patients presenting prolonged admission to the ICU with severe complications. The incidence was higher in patients with moderate to severe lung disease, cancer, immunosuppressive treatment or dependence for basic activities of daily living. LLST was finally implemented in 97% of the cases in which it was proposed. The decision within the medical team was unanimous in 87.9% of the cases. The doctor-patient-family relationship usually does not change or even improves in this situation. CONCLUSION: LLST in ICUs is usually carried out under unanimous decision of the medical team, is performed more frequently in patients with severe comorbidity, and usually does not have a negative impact upon the relationship with the patients and their families.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Cuidados para Prolongar a Vida/estatística & dados numéricos , Suspensão de Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Cuidados Críticos/ética , Cuidados Críticos/tendências , Tomada de Decisões , Grupos Diagnósticos Relacionados , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Relações Interprofissionais , Cuidados para Prolongar a Vida/ética , Cuidados para Prolongar a Vida/tendências , Masculino , Futilidade Médica , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Relações Profissional-Família , Estudos Prospectivos , Espanha , Suspensão de Tratamento/ética , Suspensão de Tratamento/tendências
20.
Crit Care Med ; 42(11): 2393-400, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25126878

RESUMO

OBJECTIVE: Patient- and organization-related factors are the most common influences affecting the ICU decision-making process. Few studies have investigated ICU physician-related factors and life-sustaining treatment use during nights and weekends, when staffing ratios are low. Here, we described patients admitted during nights/weekends and looked for physician-related determinants of life-sustaining treatment use in these patients after adjustment for patient- and center-related factors. DESIGN: Multicenter observational cohort study of admission procedures during nights/weekends shifts. SUBJECTS: ICU physicians working nights/weekends in 6 French ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient characteristics and intensity of care were extracted from the prospective Outcomerea database. Physician characteristics were age, gender, religion and religiosity, ICU experience, specialty, being a permanent ICU staff member, degree in ethics, and degree in intensive care. We used hierarchical mixed models to adjust on center, physician random effects, and admission patient characteristics. Of 156 physicians contacted, 119 (77%) participated. Patients admitted during nights/weekends were younger and had fewer comorbidities and lower treatment intensity during the shift. ICU physicians who are younger than 35 years used more renal replacement therapy (odds ratio, 1.04; 95% CI, 1-1.07; p = 0.04), invasive mechanical ventilation (odds ratio, 1.09; 95% CI, 1.1-1.19; p = 0.04), and vasopressors (odds ratio, 1.16; 95% CI, 1.09-1.23; p < 0.0001). Internal or emergency medicine as the primary specialty was associated with invasive mechanical ventilation (odds ratio, 1.14; 95% CI, 1.04-1.24; p = 0.004) and vasopressor use (odds ratio, 1.09; 95% CI, 1.02-1.17; p = 0.01). Noninvasive ventilation was used less often by physicians with more than 10 years of night/weekend shifts and more often by those with religious beliefs (odds ratio, 1.05; 95% CI, 1.01-1.08; p = 0.008). CONCLUSIONS: Patients admitted during nights/weekends were younger and had fewer comorbidities. Age, specialty, ICU experience, and religious beliefs of the physicians were significantly associated life-sustaining treatments used.


Assuntos
Plantão Médico/métodos , Agendamento de Consultas , Unidades de Terapia Intensiva , Cuidados para Prolongar a Vida/normas , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos de Coortes , Cuidados Críticos/métodos , Bases de Dados Factuais , Tomada de Decisões , Feminino , França , Humanos , Cuidados para Prolongar a Vida/tendências , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Estudos Prospectivos
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