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Pesquisa : K01.752.566.479.117.200 [Categoria DeCS]
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  1 / 1057 MEDLINE  
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[PMID]:28682167
[Au] Autor:Baumann-Hölzle R
[Ad] Endereço:1 Institut Dialog Ethik, Zürich.
[Ti] Título:Zukunft der klinischen Ethik: Aktuelle und zukünftige Herausforderungen..
[So] Source:Ther Umsch;74(2):67-72, 2017 Jul.
[Is] ISSN:0040-5930
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Tomada de Decisão Clínica/ética
Assistência à Saúde/ética
Assistência à Saúde/tendências
Consultoria Ética/tendências
Ética Médica
Participação do Paciente/tendências
[Mh] Termos MeSH secundário: Consultoria Ética/ética
Alemanha
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1024/0040-5930/a000887


  2 / 1057 MEDLINE  
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[PMID]:28679640
[Au] Autor:Johnson LM; Frader J; Wolfe J; Baker JN; Anghelescu DL; Lantos JD
[Ad] Endereço:Division of Oncology Hospitalist Medicine, St. Jude's Hospital and Research Center, Memphis, Tennessee.
[Ti] Título:Palliative Sedation With Propofol for an Adolescent With a DNR Order.
[So] Source:Pediatrics;140(2), 2017 Aug.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Death from cancer is often painful. Usually, the pain can be relieved in ways that allow patients to remain awake and alert until the end. Sometimes, however, the only way to relieve pain is to sedate patients until they are unconscious. This method has been called palliative sedation therapy. Palliative sedation therapy is controversial because it can be misunderstood as euthanasia. We present a case in which an adolescent who is dying of leukemia has intractable pain. Experts in oncology, ethics, pain management, and palliative care discuss the trade-offs associated with different treatment strategies.
[Mh] Termos MeSH primário: Dor Intratável/tratamento farmacológico
Cuidados Paliativos/métodos
Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia
Propofol
Ordens quanto à Conduta (Ética Médica)
Assistência Terminal/ética
Assistência Terminal/métodos
[Mh] Termos MeSH secundário: Adolescente
Sedação Profunda/ética
Consultoria Ética
Ética Médica
Feminino
Seres Humanos
Comunicação Interdisciplinar
Colaboração Intersetorial
Cuidados Paliativos/ética
Ordens quanto à Conduta (Ética Médica)/ética
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
YI7VU623SF (Propofol)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE


  3 / 1057 MEDLINE  
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[PMID]:28417521
[Au] Autor:Jellema H; Kremer S; Mackor AR; Molewijk B
[Ti] Título:Evaluating the Quality of the Deliberation in Moral Case Deliberations: A Coding Scheme.
[So] Source:Bioethics;31(4):277-285, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Moral Case Deliberation (MCD) is an up and coming form of ethics support wherein clinical professionals deliberate about moral questions they face in their work. So far, it has been unclear what quality of deliberation in MCD is entailed and how to evaluate this quality. This article proposes a coding scheme that fits the theoretical background of MCD and allows researchers to evaluate the quality of the deliberation in MCDs. We consider deliberation in MCD to be of good quality when participants enrich their own understanding of a case by being exposed to the viewpoints of others. In order to have such an enriching effect, the deliberation in an MCD ought to involve different kinds of arguments from the perspectives of different stakeholders and in favour of different resolutions to the case; and the process of deliberation ought to be critical but constructive.
[Mh] Termos MeSH primário: Análise Ética
Consultoria Ética
Ética Clínica
Estudos de Avaliação como Assunto
Resolução de Problemas
Projetos de Pesquisa
[Mh] Termos MeSH secundário: Seres Humanos
Princípios Morais
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12346


  4 / 1057 MEDLINE  
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[PMID]:28417519
[Au] Autor:Wäscher S; Salloch S; Ritter P; Vollmann J; Schildmann J
[Ti] Título:Methodological Reflections on the Contribution of Qualitative Research to the Evaluation of Clinical Ethics Support Services.
[So] Source:Bioethics;31(4):237-245, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This article describes a process of developing, implementing and evaluating a clinical ethics support service intervention with the goal of building up a context-sensitive structure of minimal clinical-ethics in an oncology department without prior clinical ethics structure. Scholars from different disciplines have called for an improvement in the evaluation of clinical ethics support services (CESS) for different reasons over several decades. However, while a lot has been said about the concepts and methodological challenges of evaluating CESS up to the present time, relatively few empirical studies have been carried out. The aim of this article is twofold. On the one hand, it describes a process of development, modifying and evaluating a CESS intervention as part of the ETHICO research project, using the approach of qualitative-formative evaluation. On the other hand, it provides a methodological analysis which specifies the contribution of qualitative empirical methods to the (formative) evaluation of CESS. We conclude with a consideration of the strengths and limitations of qualitative evaluation research with regards to the evaluation and development of context sensitive CESS. We further discuss our own approach in contrast to rather traditional consult or committee models.
[Mh] Termos MeSH primário: Análise Ética
Consultoria Ética/normas
Ética Clínica
Estudos de Avaliação como Assunto
Pesquisa Qualitativa
Projetos de Pesquisa
[Mh] Termos MeSH secundário: Comunicação
Tomada de Decisões
Seres Humanos
Resolução de Problemas
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12347


  5 / 1057 MEDLINE  
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[PMID]:28417518
[Au] Autor:de Snoo-Trimp J; Widdershoven G; Svantesson M; de Vet R; Molewijk B
[Ti] Título:What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?
[So] Source:Bioethics;31(4):246-257, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There has been little attention paid to research on the outcomes of clinical ethics support (CES) or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. OBJECTIVE: To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation (MCD), prior to MCD participation, and to compare results between respondents. METHODS: This mixed-methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. RESULTS: 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were 'more open communication', 'better mutual understanding', 'concrete actions', 'see the situation from different perspectives', 'consensus on how to manage the situation' and 'find more courses of action'. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. CONCLUSIONS: Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Comportamento Cooperativo
Análise Ética
Consultoria Ética
Ética Clínica
Resolução de Problemas
[Mh] Termos MeSH secundário: Comunicação
Seres Humanos
Princípios Morais
Países Baixos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12354


  6 / 1057 MEDLINE  
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[PMID]:28417517
[Au] Autor:Metselaar S; Widdershoven G; Porz R; Molewijk B
[Ti] Título:Evaluating Clinical Ethics Support: A Participatory Approach.
[So] Source:Bioethics;31(4):258-266, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The current process towards formalization within evaluation research, in particular the use of pre-set standards and the focus on predefined outcomes, implies a shift of ownership from the people who are actually involved in real clinical ethics support services (CESS) in a specific context to external stakeholders who increasingly gain a say in what 'good CESS' should look like. The question is whether this does justice to the insights and needs of those who are directly involved in actual CESS practices, be it as receivers or providers. We maintain that those actually involved in concrete CESS practices should also be involved in its evaluation, not only as respondents, but also in setting the agenda of the evaluation process and in articulating the criteria by which CESS is evaluated. Therefore, we propose a participatory approach to CESS evaluation. It focuses on (1) the concrete contexts in which CESS takes place, (2) reflective and dialogical learning processes, and (3) how to be democratic and inclusive. In particular, this approach to CESS evaluation is akin to realist evaluation, dialogical evaluation, and responsive evaluation. An example of a participatory approach to evaluating CESS is presented and some critical issues concerning this approach are discussed.
[Mh] Termos MeSH primário: Participação da Comunidade
Análise Ética
Consultoria Ética/normas
Ética Clínica
Estudos de Avaliação como Assunto
Resolução de Problemas
[Mh] Termos MeSH secundário: Comunicação
Comportamento Cooperativo
Pessoal de Saúde
Seres Humanos
Princípios Morais
Participação do Paciente
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12348


  7 / 1057 MEDLINE  
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[PMID]:28417516
[Au] Autor:Finder SG; Bartlett VL
[Ti] Título:Discovering What Matters: Interrogating Clinician Responses to Ethics Consultation.
[So] Source:Bioethics;31(4):267-276, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Against the background assumptions that (a) knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and (b) the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect - the reason for request - raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating 'moral space' (a la Margaret Urban Walker's conception) for colleagues to process their moral experiences.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Análise Ética
Consultoria Ética
Ética Médica
Estudos de Avaliação como Assunto
Motivação
Resolução de Problemas
[Mh] Termos MeSH secundário: Eticistas
Ética Clínica
Seres Humanos
Linguagem
Memória
Princípios Morais
Avaliação de Programas e Projetos de Saúde
Estudos Retrospectivos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12345


  8 / 1057 MEDLINE  
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[PMID]:28384104
[Au] Autor:Aleksandrova-Yankulovska SS
[Ad] Endereço:Department of Public Health Sciences, Faculty of Public Health, Medical University - Pleven, 1 Kliment Ohridski St., 5800 Pleven.
[Ti] Título:Development of Bioethics and Clinical Ethics in Bulgaria.
[So] Source:Folia Med (Plovdiv);59(1):98-105, 2017 Mar 01.
[Is] ISSN:0204-8043
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Bioethics and clinical ethics emerged from the classical medical ethics in the 1970s of the 20th century. Both fields are new for the Bulgarian academic tradition. AIM: The aims of this paper were to demarcate the subject fields of medical ethics, bioethics, and clinical ethics, to present the developments in the field of medical ethics in Bulgaria, to delineate the obstacles to effective ethics education of medical professionals, and to present the results of the application of an adapted bottom-up methodology for clinical ethics consultation in several clinical units in Bulgaria. MATERIALS AND METHODS: Extended literature review and application of an adapted METAP methodology for clinical ethics consultation in six clinical units in the Northern Bulgaria between May 2013 and December 2014. RESULTS: Teaching of medical ethics in Bulgaria was introduced in the 1990s and still stands mainly as theoretical expertise without sufficient dilemma training in clinical settings. Earlier studies revealed need of clinical ethics consultation services in our country. METAP methodology was applied in 69 ethics meetings. In 31.9% of them non-medical considerations affected the choice of treatment and 34.8% resulted in reaching consensus between the team and the patient. Participants' opinion about the meetings was highly positive with 87.7% overall satisfaction. CONCLUSION: Development of bioethics in Bulgaria follows recent worldwide trends. Several ideas could be applied towards increasing the effectiveness of ethics education. Results of the ethics meetings lead to the conclusion that it is a successful and well accepted approach for clinical ethics consultation with a potential for wider introduction in our medical practice.
[Mh] Termos MeSH primário: Educação Médica/métodos
Consultoria Ética
Ética Médica/educação
[Mh] Termos MeSH secundário: Bioética/educação
Bioética/tendências
Bulgária
Ética Clínica/educação
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE


  9 / 1057 MEDLINE  
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[PMID]:27535674
[Au] Autor:Spijkerboer RP; van der Stel JC; Widdershoven GA; Molewijk AC
[Ad] Endereço:Faculty of Social Science and Applied Psychology, Leiden University of Applied Science, Post box 382, 2300AJ, Leiden, The Netherlands. spijkerboer.r@hsleiden.nl.
[Ti] Título:Does Moral Case Deliberation Help Professionals in Care for the Homeless in Dealing with Their Dilemmas? A Mixed-Methods Responsive Study.
[So] Source:HEC Forum;29(1):21-41, 2017 Mar.
[Is] ISSN:1572-8498
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation (MCD) is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people's perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization.
[Mh] Termos MeSH primário: Consultoria Ética/normas
Pessoal de Saúde/ética
Pessoas em Situação de Rua
Princípios Morais
Serviço Social/normas
[Mh] Termos MeSH secundário: Seres Humanos
Pesquisa Qualitativa
Serviço Social/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:160819
[St] Status:MEDLINE
[do] DOI:10.1007/s10730-016-9310-3


  10 / 1057 MEDLINE  
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[PMID]:27484322
[Au] Autor:Schochow M; Rubeis G; Steger F
[Ad] Endereço:Medizinische Fakultät, Institut für Geschichte, Theorie und Ethik der Medizin, Universität Ulm, Parkstraße 11, 89073, Ulm, Germany. maximilian.schochow@uni-ulm.de.
[Ti] Título:The Application of Standards and Recommendations to Clinical Ethics Consultation in Practice: An Evaluation at German Hospitals.
[So] Source:Sci Eng Ethics;23(3):793-799, 2017 Jun.
[Is] ISSN:1471-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The executive board of the Academy for Ethics in Medicine (AEM) and two AEM working groups formulated standards and recommendations for clinical ethics consultation in 2010, 2011, and 2013. These guidelines comply with the international standards like those set by the American Society for Bioethics and Humanities. There is no empirical data available yet that could indicate whether these standards and recommendations have been implemented in German hospitals. This desideratum is addressed in the present study. We contacted 1.858 German hospitals between September 2013 and January 2014. A follow-up survey was conducted between October 2014 and January 2015. The data of the initial survey and the follow-up survey were merged and evaluated. The statements of the participants were compared with the standards and recommendations. The standards of the AEM concerning the tasks of clinical ethics consultation (including ethics consultation, ethics training and the establishment of policy guidelines) are employed by a majority of participants of the study. Almost all of these participants document their consultation activities by means of protocols or entries in the patient file. There are deviations from the recommendations of the AEM working groups regarding the drafting of statutes, activity reports, and financial support. The activities of clinical ethics consultation predominantly comply with the standards of the AEM and recommendations for the documentation. The recommendations for evaluation should be improved in practice. This applies particularly for activity reports in order to evaluate the activities. Internal evaluation could take place accordingly.
[Mh] Termos MeSH primário: Hospitais/ética
Hospitais/estatística & dados numéricos
[Mh] Termos MeSH secundário: Consultoria Ética
Alemanha
Guias como Assunto/normas
Seres Humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:160804
[St] Status:MEDLINE
[do] DOI:10.1007/s11948-016-9805-y



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