IB - Contribuições em Revistas Científicas / Contribution to Journals
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- Incoherence in the brain death guideline regarding brain blood flow testing: lessons from the much-publicized case of Zack DunlapPublication . Nguyen, Doyen; Zainer, Christine M.At age 21, following a severe traumatic brain injury, Zack Dunlap was declared brain-dead according to the American Academy of Neurology guideline (Guideline) when he met the clinical criteria of brain death (minus apnea testing because of bradycardia) with technetium-99m diethylene-triamine-pentaacetate scintigraphy reported as showing no intracranial blood flow. His parents agreed to organ donation. During preparations for organ donation, Zack manifested a purposeful movement in response to a noxious stimulus made by his cousin. Following subsequent neurological recovery, he has returned to a normal life, holding steady employment and raising a family. During an interview, he reported that while in coma, he heard a doctor say that he was brain-dead and felt angry about it. His experience fits the phenomenon of cognitive-motor dissociation. Recently, Zack's medical records were made available to the first author. A critical review of the records uncovered a problem inherent in the logic of the Guideline algorithm regarding brain blood flow scintigraphy. This article discusses the lessons drawn from Zack's case, namely, that both the aforementioned problem and the occurrence of cognitive-motor dissociation in patients deemed to be brain-dead can pose a significant risk of a false-positive declaration of death.
- Communication and decision making in neonatal intensive care: why narrative medicine mattersPublication . Carvalho, Carmen; Vale, Ana; Magalhães, SusanaObjective: This paper aims to analyse parents’ and health professionals’ discourse, regarding four main areas: (1) the experience of care; (2) communication among all stakeholders; (3) ethical issues; (4) and ethical decision-making. Methodology: The authors collected 62 narratives from health professionals and parents whose newborns have been hospitalized for at least 15 days in the neonatal intensive care unit (NICU). We carried out a qualitative content analysis with the support of NVivo software version 12 Pro. Results: The feelings/emotions are present in a high percentage of narratives (mostly negative ones). Parents´ learning emphasizes coping strategies. Most narratives focus on communicational aspects. Decision-making is referred to in almost half of the narratives. The ethical issues and questions mentioned are mainly related to decision-making. Conclusion: The present study emphasizes narrative relevance in the alignment of parents´ and health professionals´ perspectives to promote therapeutic relationships.
- Bioethical principles and nutrition in palliative carePublication . Andrade, Joana S. de; Almeida, Mariana Magalhães; Pinho-Reis, CíntiaThe last few decades have been witness to huge advances in medical technology and, consequently, in Ethics. One area that reflects this progress has been the area of food, nutrition and hydration in Palliative Care. The current review focuses on the overall knowledge about Ethics in the field of Nutrition in Palliative Care regarding the principles of autonomy, beneficence, non-maleficence and justice.
- Contact with death, ethical decisions, and communication of bad news in intensive care and palliative units: results from a mixed-methods studyPublication . Teixeira, C.; Pereira, S. M.; Hernández-Marrero, P.Introduction: Professionals working in intensive care and palliative units (ICUs/PCUs) care for patients with life-threatening diseases, make ethical decisions, and provide end-of-life care. However, while palliative care aims to reduce suffering, intensive care has a major focus on saving lives. Objectives: To identify and compare the experiences of ICU and PCU healthcare professionals related to: contact with dying and death, making of ethical decisions and communication and delivery of bad news. Methods: Mixed approach, combining quantitative (questionnaire on experiences in the work context) and qualitative ones (interviews with doctors and nurses). 10 ICU and 9 PCU participated in this study. 392 professionals completed the survey; 28 were interviewed. A descriptive quantitative analysis was performed; the chi-square test was used to analyse the association between variables (significance level of p < .05). Interviews were subject to content analysis. Results: In the week prior to survey completion, more professionals working in ICUs reported a patient's death; this was not statistically significant. The experience most mentioned by the professionals of both types of units during interviews was caring for patients nearing death. In the week before completing the questionnaire, the most common ethical decision was palliative/terminal sedation; this was more, often in ICUs (27 % vs. 12 %; p = .004). In the day of questionnaire completion, the most frequent ethical decision was also palliative sedation. Though this decision was more frequent in ICU, statistical significance was not reached (p = .440). The communication of the diagnosis/prognosis to the patient, either in the week before or in the day of questionnaire completion was more frequent in PCUs (45 % vs. 29 %, p = .005; 22 % vs. 12 %, p = .026, respectively). Communication about the diagnosis/prognosis with the family in the week before survey completion was held with equal frequency by professionals from both contexts (58 % of professionals). Although not reaching statistical significance (p = .303), more professionals from PCU proceeded to communication with family about the diagnosis and prognosis (32 % vs. 26 %) in the survey day. From the analysis of the interviews, it was denoted that it were mainly professionals of PCU who referred to the communication on the diagnosis/ prognosis, both with the patient as with the family. Conclusions: The workplace experiences in ICU and PCU are, despite some differences, guided by similarities. Caring for patients with lifethreatening situations and imminent death and the need to make ethical decisions occur frequently in both contexts. The communication about the diagnosis/prognosis occurs more often in PCU. This highlights the need for integrating communication strategies of palliative care, in intensive care.
- How to improve access to data from epidemic surveillance and electronic health records in order to advance research in PortugalPublication . Peixoto, Vasco Ricoca; Santos, Nina de Sousa; Souto, Tiago L.; Conde, Margarida Gil; Heleno, Bruno; Cordeiro, João V.; Aguiar, Pedro; Abrantes, Alexandre
- Children’s understanding of informed assents in research studiesPublication . Cotrim, Hortense; Granja, Cristina; Carvalho, Ana Sofia; Cotrim, Carlos; Martins, RuiThe assent procedure reflects an effort to enable the minor to understand, to the degree they are capable of, what their participation in the decision making process would involve. Aims: To evaluate the minors’ ability to understand the information provided to them when obtaining assent and to evaluate the opinion of the parents regarding the importance of asking the child’s assent. Methods: The sample included a total of 52 minors aged between 10 and 17 years who underwent exercise echocardiogram. The Quality of Informed Consent is divided into two parts: Part A was used to measure objective understanding and part B to measure subjective understanding. Results: The results show that the minors have a high capacity to understand the information given to them when asking for assent. A positive relationship was found between the two parts of the questionnaire. No statistically significant relationship was found between age and sex and part A and part B or between both age groups (<14 years old and ≥14 years old) and the measure. In the case of the parents, 96.6% of parents consider assent as an advantage for the child’s acceptance of health care. The opinion of the parents is not related to the age, sex or level of schooling. Conclusion: Minors showed a substantial level of understanding regarding the information provided to them. The parents considered the implementation of assent fundamental to the child’s acceptance of health care.
- A casa "in"comum dos refugiados ambientais à luz da Laudato SiPublication . Araújo, Joana; Gomes, Carlos Costa; Jácomo, AntónioA relação do homem com a natureza tem vindo a alterar-se. Segundo a narrativa do começo, o homem deve cuidar e não dominar a natureza. O domínio despótico do homem sobre o universo alterou a estrutura profunda do planeta, a deterioração do ambiente está a avançar a um ritmo avassalador colocando as gerações atuais e, principalmente, as gerações futuras, em risco. Este artigo explora a questão dos refugiados ambientais para quem a “casa comum” é mais (in)comum. A nossa análise parte da narrativa do começo do livro do Génesis e da Encíclica Laudato Si (e outros documentos da Igreja Católica) e compara o modo de agir do homem sobre a natureza, propondo o sentido humano da ecologia
- Este cavalheiro era João SemanaPublication . Cruz, Jorge
- Tecnologia em prol de uma autonomia respeitadora da vulnerabilidade da pessoa doentePublication . Girão, FilomenaBem sabendo que uma utilização humanista do principialismo bioético na prática clínica exige sempre a consideração da vulnerabilidade do doente, é importante definir as múltiplas situações de vulnerabilidade, com a expectativa de que a completa compreensão deste conceito possa contribuir para uma manifesta depreciação do seu impacto no processo de tomada de decisão. Da mesma forma, a identificação dos passos essenciais da deliberação ética revela-se igualmente fundamental para alcançar a compreensão das implicações da vulnerabilidade do doente sobre o próprio processo deliberativo. A tomada de uma decisão ética, partilhada, no âmbito da prestação de cuidados de saúde, pressupõe a capacidade do doente de fazer uma escolha. Ora, se tal capacidade estiver comprometida, em razão da sua condição de vulnerável, bem se percebe que a escolha do doente não logre ser plenamente livre e, por isso, realizadora da sua autonomia. Uma sociedade eticamente responsável deve ser capaz de utilizar o conhecimento científico e tecnológico a favor da protecção dos mais vulneráveis e da promoção da informação a que o doente tem direito e nos limites da sua vontade esclarecida, em prol da defesa da dignidade humana.
- O racionamento de cuidados de saúde em razão da idadePublication . Borges, Marta FriasA evolução científica e tecnológica, e o consequente acesso a novos medicamentos e mais sofisticados meios complementares de diagnóstico, é responsável por um aumento dos custos em saúde, capaz de comprometer a satisfação de todas as necessidades. Perante esta insuficiência de recursos, impõe-se necessariamente a priorização de necessidades e, consequentemente, a reflexão sobre os critérios utilizados para a levar a cabo. A idade tem sido, não raras vezes, apontada como critério preferencial de racionamento de cuidados de saúde, convocando o argumento utilitarista de maior esperança de vida e produtividade após o tratamento ou a designada equidade intergeracional. Assim, procurar-se-á refletir sobre a legitimidade ética do racionamento em função da idade, considerando sobretudo a particular vulnerabilidade na idade avançada.