Browsing by Author "Nunes, Rui"
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- A clonagem para fins terapêuticos e reprodutivosPublication . Carvalho, Ana Sofia; Nunes, Rui
- Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesisPublication . Ribeiro, André Filipe; Pereira, Sandra Martins; Gomes, Barbara; Nunes, RuiBackground: Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care. Aim: To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration. Design: A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676). Data sources: Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.'s tool was used for quality appraisal. Results: A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients' comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units. Conclusion: This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.
- Integrating palliative care in intensive care burn units: a systematically conducted scoping reviewPublication . Ribeiro, André Filipe; Pereira, Sandra; Gomes, Barbara; Nunes, Rui
- A meta-ethnography about suffering in burned patients and their familiesPublication . Ribeiro, André Filipe; Pereira, Sandra Martins; Hernández-Marrero, Pablo; Nunes, Rui
- A natureza do embrião humanoPublication . Nunes, Rui
- Ontology of doctor and patient relationship and bioethics: from Aristotle's teleology to Pellegrino's philosophy of medicinePublication . Ferreira, Nuno Ribeiro; Pereira, Américo; Nunes, RuiSome philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle’s practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. Some difficulties and criticisms of this ontological model are also examined.
- What are the triggers for palliative care referral in burn intensive care units: esults from a qualitative study based on healthcare professionals’ views, clinical experiences and practicesPublication . Ribeiro, André Filipe; Pereira, Sandra Martins; Nunes, Rui; Hernández-Marrero, PabloBackground: Burns are a global public health problem, accounting for around 300,000 deaths annually. Burns have significant consequences for patients, families, healthcare teams and systems. Evidence suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making processes, and family care. Research is needed on how to optimise palliative care referrals. Aim: To identify triggers for palliative care referral in critically burned patients based on professionals’ views, experiences, and practices. Design: Qualitative study using in-depth interviews. Setting/participants: All 5 Burn Intensive Care Units reference centres across Portugal were invited; 3 participated. Inclusion criteria: Professionals with experience/working in these settings. 15 professionals (12 nurses, 3 physicians) participated. Reflexive thematic analysis was performed. Results: Three main triggers for palliative care referral were identified: (i) Burn severity and extension, (ii) Co-morbidities, and (iii) Multiorgan failure. Other triggers were also generated: (i) Rehabilitative palliative care related to patients’ suffering and changes in body image, (ii) Family suffering and/or dysfunctional and complex family processes, (iii) Long stay in the burn intensive care unit, and (iv) Uncontrolled pain. Conclusions: This study identifies triggers for palliative care in burn intensive care units based on professionals’ views, clinical experiences and practices. The systematization and use of triggers could help streamline referral pathways and strengthen the integration of palliative care in burn intensive care units. Research is needed on the use of these triggers in clinical practice to enhance decision-making processes, early and high-quality integrated palliative care and proportionate patient and family centred care.
- What do we know about experiencing the end-of-life in burn intensive care units? a scoping reviewPublication . Ribeiro, André Filipe; Pereira, Sandra Martins; Nunes, Rui; Hernández-Marrero, PabloObjectives: To review and synthetize the evidence on end-of-life in burn intensive care units about (i) the characteristics of end-of-life in burn intensive care units, (ii) the symptom control provided to burned patients facing dying and death in this context, and (iii) the concept, models and designs of the care provided. Methods: Systematically conducted scoping review, following Arksey and O'Malley's framework. Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in three databases, with no time restriction and up to September 2021. Results: 16,287 documents identified; thirteen (13) selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients’ comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care and palliative care.Significance of Results: End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment, and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.