Browsing by Author "Carvalho, A. S."
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- A bioethical framework and reasoning on antibiotic use in palliative care: a systematic reviewPublication . Pereira, S. M.; Hernández-Marrero, P.; Brandão, P. J. S.; Araújo, J.; Carvalho, A. S.
- Burnout in palliative and intensive care units: does it make a difference?Publication . Pereira, Sandra Martins; Hernández-Marrero, P.; Teixeira, C. M.; Carvalho, A. S.Background: Repeated contact with dying and death is a major burnout risk factor. Hence, professionals working in palliative and intensive care are at special risk. Aims: To identify and compare burnout levels and its related factors among professionals working in palliative and intensive care units in Portugal. Methods: Multicenter quantitative, comparative study. The Maslach Burnout Inventory was used for data collection together with a questionnaire of socio-demographic and profession-related variables, and a questionnaire of work-related experiences in the week and day prior to completion. 392 professionals participated in this study; 92 worked in palliative care units (PCUs) and 300 in intensive care units (ICUs). Univariate and multivariate logistic regression analyses were performed; OR sidelong with 95% of CI were calculated. Results: While 25% of the professionals working in ICUs exhibited burnout, only 3% of those working in PCUs exhibited this syndrome. Univariate logistic regression analysis showed that burnout was inversely associated with working in PCUs (OR= .419; .224–.785 95%CI). When controlling for other variables (e.g., professionals’ socio-demographic characteristics, post- graduated education in intensive/palliative care, work-related experiences), differences remained significant (OR= .396; .161–.976 95%CI). Higher levels of burnout in ICUs were related to being a nurse (OR=1.849, 95%CI 1.029–3,321) and experiencing conflicts (OR=2.170 95%CI 1.218–3,866). Conclusions: Burnout is inversily associated to working in PCUs. Work-related experiences (e.g., conflicts in the work context) increase the risk of developing burnout among professionals providing end-of-life care. These findings suggest the need to further implement conflict-management strategies in these settings, helping professionals to cope with high-demanding situations associated to providing end-of-life care.
- Characterisation of enterococci strains isolated from an artisanal Portuguese cheesePublication . Silva, J.; Carvalho, A. S.; Duarte, G.; Lopes, Z.; Domingues, P.; Teixeira, Paula; Gibbs, P. A.The main objective of this study was to characterise 8 enterococci strains, isolated from artisanal cheeses of good quality produced in the North of Portugal, including their potential pathogenicity, to determine technologically important characteristics and survival during drying, in order to evaluate the possibility of their use as adjunct starters in cheese production. Phenotypic and genotypic characteristics were used for strains identification. Based on acid production from sugar fermentation and β-galactosidase activity, two strains were identified as Enterococcus durans and 6 strains as E. faecalis. The enterococci strains were further analysed by RAPD-PCR, proteins profile and fatty acids profile. RAPD-PCR was demonstrated to be the most discriminatory typing method. Strain-to-strain variation was observed forthe ability to survive during storage in dried state.
- Contact with death, ethical decisions, and communication of bad news in intensive care and palliative units: results from a mixedmethods studyPublication . Teixeira, C.; Pereira, S. M.; Hernández-Marrero, P.; Carvalho, A. S.
- Effect of the pH of growth on the survival of Lactobacillus delbrueckii subsp. bulgaricus to stress conditions during spray-dryingPublication . Silva, J.; Carvalho, A. S.; Ferreira, R.; Vitorino, R.; Amado, F.; Domingues, P.; Teixeira, P.; Gibbs, P. A.Aims: The aim of this study was to optimize survival of Lactobacillus delbrueckii subsp. bulgaricus during spraydrying and subsequent storage through optimizing the pH of growth conditions. Methods and Results: Cell concentrates previously grown without or with pH controlled were spray-dried and stored at 20ºC and heat treated at 57ºC. Cells grown under noncontrolled pH were more resistant to both drying and heating than cells grown under controlled pH but no significant differences were observed during storage. The intracellular proteins profile of cells grown under both conditions was studied by two-dimensional SDS-polyacrylamide gel electrophoresis. Eight proteins were identified using automated mass spectrometry (MS) and tandem mass spectrometry (MS/MS) data acquisition. Of the identified proteins, only cochaperonin GroES corresponded to a known heat shock protein (HSP). The other proteins identified are proteins involved in glycolysis. For cells grown under noncontrolled pH the expression of the Hsp70, GroES and GroEL, measured by Western blotting, was enhanced. Conclusions: The higher resistance of cells grown under noncontrolled pH correlates with the enhanced production of heat shock proteins. Significance and Impact of the Study: Growth of L. bulgaricus under controlled pH (commonly used by the starter cultures production industry) results in cells more sensitive to stresses frequently encountered by the cells during starter cultures preparation/storage/utilization.
- Effects of addition of sucrose and salt, and of starvation upon thermotolerance and survival during storage of freeze-dried Lactobacillus delbrueckii ssp bulgaricusPublication . Carvalho, A. S.; Silva, J.; Ho, P.; Teixeira, P.; Malcata, F. X.; Gibbs, P.Increased survival of freeze-dried cells of Lactobacillus bulgaricus was observed when the drying medium was supplemented with sucrose; however, the magnitude of such protection was dependent on the growth medium used. Supplementing the growth medium with NaCl markedly increased survival of dried cells, and only a small effect was exerted by the composition of the drying medium or prior to starvation of cells. The D57 values of Lactobacillus bulgaricus cells grown in MRS were about half of those of cells grown in MRS supplemented with sucrose, with sucrose plus NaCl, or with NaCl.
- Ethical decision making in pain management: a conceptual frameworkPublication . Carvalho, A. S.; Martins Pereira, S.; Jácomo, A.; Magalhães, S.; Araújo, Joana; Hernández-Marrero, P.; Gomes, Carlos Costa; Schatman, M. E.Introduction: The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician–patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with druginduced risk of tolerance and fear of addiction; 5) concerns regarding “last-ditch” treatments of severe pain; and 6) failure to be accountable and equitable. Objective: The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. Methods: This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. Discussion: We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Conclusion: Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound.
- Ethical decisions in palliative care: a burnout risk factor?: results from a mixed-methods multicentre study in PortugalPublication . Pereira, S. Martins; Hernández-Marrero, P.; Carvalho, A. S.Background: Ethical decision-making in end-of-life care is perceived asstressful. Making ethical decisionsisrelated to higher levels of burnout among health professionals. Aims: To identify the most common ethical decisions made by Portuguese palliative care teams and understand how the making ofsuch decisionsrelatesto burnout. Methods: Mixed methodsstudy in 9 palliative care teams. Data was collected through: questionnaires ofsocio-demographic and profession-related variables, and work-related experiences; Maslach Burnout Inventory; interviews; observations. Quantitative data analysesincluded descriptive, uni and multivariate logistic regressions; qualitative data was analysed inductively with themes/categories emerging from data. Triangulation ensured reliability. A total of 88 professionals(66% response rate) were included, 11 nurses and 9 physicians were interviewed and 240 hours of observations were fulfilled. Results: The most common ethical decisions were caused by communication issues, forgoing treatment and terminalsedation. Although perceived as a burnout risk factor in the speech of the participants, quantitative data showed that making ethical decisions was notsignificantly associated with burnout. These findings were explained through the analysis of the transcripts of interviews and field-notes: The decision-making process using an interdisciplinary team approach and consulting ethical committees were identified as protective factors against burnout. Conclusions: Making ethical decisionsis not associated with burnout among professionals working in Portuguese palliative care teams. Thisis explained by the ethical deliberation and decision-making processfollowed by these teams. Promoting palliative care skills among professionals providing end-of-life care in othersettings might be useful to diminish burnout related to making ethical end-of-life decisions.
- Ethical framework of the integration of palliative care in intensive care: results from a qualitative study with professionalsPublication . Pereira, S. M.; Teixeira, C. M.; Hernández-Marrero, P.; Carvalho, A. S.
- How can ethics relate to science? The case of stem cell researchPublication . Carvalho, A. S.; Ramalho-Santos, JoãoWe live in an era of an important turning point in the relationship between ethics (or, more accurately, bioethics) and science, notably due to both public interest and the gradual tightening of the gap in time between scientific discoveries and ethical reflection. The current bioethics debates of emerging situations (pluripotent stem cells, gene therapy, nanotechnology) have undoubtedly contributed to this change. Today, science happens and bioethics reflects on the possibilities, considers the risks, and advances proposals, which, without being scientific, can also imprint a mark on the path of scientific development. In this article, through the narrative of stem cell research, we will try to illustrate how bringing a bioethical viewpoint to the scientific debate can become a healthy exercise in both ethics and science, especially as narratives shift, as was the case in this field due to the introduction of induced pluripotent stem cells, the advent of which is not easily dissociated from the controversies related to embryo research. We should perhaps welcome this trend as promising for the future relationship between ethics and scientific research, providing a stimulus (and not a block) to the ever-evolving scientific discourse.