Base de dados : MEDLINE
Pesquisa : N04.761.040 [Categoria DeCS]
Referências encontradas : 495 [refinar]
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[PMID]:28549520
[Au] Autor:Lilley EJ; Morris MA; Sadovnikoff N; Luxford JM; Changoor NR; Bystricky A; Bader AM; Cooper Z
[Ad] Endereço:The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: elilley@partners.org.
[Ti] Título:"Taking over somebody's life": Experiences of surrogate decision-makers in the surgical intensive care unit.
[So] Source:Surgery;162(2):453-460, 2017 Aug.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Impaired capacity of patients necessitates the use of surrogates to make decisions on behalf of patients. Little is known about surrogate decision-making in the surgical intensive care unit, where the decline to critical illness is often unexpected. We sought to explore surrogate experiences with decision-making in the surgical intensive care unit. METHODS: This qualitative study was performed at 2 surgical intensive care units at a single, tertiary, academic hospital Surrogate decision-makers who had made a major medical decision for a patient in the surgical intensive care unit were identified and enrolled prospectively. Semistructured telephone interviews following an interview guide were conducted within 90 days after hospitalization until thematic saturation. Recordings were transcribed, coded inductively, and analyzed utilizing an interpretive phenomenologic approach. RESULTS: A major theme that emerged from interviews (N = 19) centered on how participants perceived the surrogate role, which is best characterized by 2 archetypes: (1) Preferences Advocates, who focused on patients' values; and (2) Clinical Facilitators, who focused on patients' medical conditions. The primary archetype of each surrogate influenced how they defined their role and approached decisions. Preferences Advocates framed decisions in the context of patients' values, whereas Clinical Facilitators emphasized the importance of clinical information. CONCLUSION: The experiences of surrogates in the surgical intensive care unit are related to their understanding of what it means to be a surrogate and how they fulfill this role. Future work is needed to identify and manage the informational needs of surrogate decision-makers.
[Mh] Termos MeSH primário: Adesão a Diretivas Antecipadas/psicologia
Diretivas Antecipadas/psicologia
Cuidadores/psicologia
Cuidados Críticos
Tomada de Decisões
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Estudos de Avaliação como Assunto
Feminino
Hospitalização
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170528
[St] Status:MEDLINE


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[PMID]:26746877
[Au] Autor:Nasir SS; Muthiah M; Ryder K; Clark K; Niell H; Weir A
[Ad] Endereço:1 University of Tennessee Health Science Center, Memphis, TN, USA.
[Ti] Título:ICU Deaths in Patients With Advanced Cancer.
[So] Source:Am J Hosp Palliat Care;34(2):173-179, 2017 Mar.
[Is] ISSN:1938-2715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A significant number of advanced cancer admissions to the intensive care unit (ICU) are inappropriate in that they do not result in prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. METHOD: We established four criteria for reasonable admissions to ICU in patients who suffered from advanced, incurable cancer: post procedure complication, recent notification of cancer, ECOG performance status of 0-1, and life expectancy of more than 6 months. Based on these criteria, we reviewed the charts of all patients who died in the ICU at the University of Tennessee Health Science Center (UTHSC) affiliated Veteran's Affairs Medical Center between 10/2005 and 10/2010. We identified patients with advanced, incurable cancer and performed an in depth review of their charts. RESULTS: In the 421 charts of patients who died in our ICU between October 2005 and October 2010 we identified 52 patients admitted to the ICU with advanced, incurable cancer. 14 patients were diagnosed with cancer one month or less prior to admission. 21 patients had ECOG performance status of 0-1. 14 patients had life expectancy of more than 6 months and 8 patients were admitted for post procedure complication. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs. CONCLUSIONS: Incorporating proposed admission criteria in ICU admission guidelines may prevent 37% of inappropriate, advanced cancer admissions to the ICU. A simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva/estatística & dados numéricos
Neoplasias/mortalidade
[Mh] Termos MeSH secundário: Adulto
Adesão a Diretivas Antecipadas/estatística & dados numéricos
Diretivas Antecipadas/estatística & dados numéricos
Idoso
Idoso de 80 Anos ou mais
Feminino
Mau Uso de Serviços de Saúde/estatística & dados numéricos
Mortalidade Hospitalar
Seres Humanos
Masculino
Meia-Idade
Neoplasias/terapia
Assistência Terminal/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:160110
[St] Status:MEDLINE
[do] DOI:10.1177/1049909115625279


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[PMID]:26494830
[Au] Autor:Manu ER; Mody L; McNamara SE; Vitale CA
[Ad] Endereço:1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA.
[Ti] Título:Advance Directives and Care Received by Older Nursing Home Residents.
[So] Source:Am J Hosp Palliat Care;34(2):105-110, 2017 Mar.
[Is] ISSN:1938-2715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Research shows variable success as to whether care provided aligns with individual patient preferences as reflected in their advance directives (AD). OBJECTIVE: We aimed to study AD status and subsequent care received in older nursing home (NH) residents deemed at risk for infections and care transitions: those with a urinary catheter (UC), feeding tube (FT), or both. Design/participants/measurements: A subgroup analysis of a prospective cohort of 90 residents with a UC and/or FT from 15 NHs in southeast Michigan. Outcomes assessed at enrollment and at 30-day intervals were hospitalizations and antibiotic use. The ADs were divided as follows: (1) comfort oriented: comfort measures only, no hospital transfer; (2) palliative oriented: comfort focused, allowing hospital transfer (except intensive care unit), antibiotic use, but no cardiopulmonary resuscitation; (3) usual care: full code, no limitations to care. We calculated incidences for these outcomes. RESULTS: Seventy-eight (87%) residents had ADs: 18 (23%) comfort oriented, 32 (41%) palliative oriented, and 28 (36%) usual care. The groups did not differ regarding demographics, comorbidity, function, device presence, or time in study. Using the usual care group as comparison, the comfort-oriented group was hospitalized at a similar rate (Incidence rate [IR] = 15.6/1000 follow-up days vs IR = 8.8/1000 follow-up days, Incident rate ratio [IRR] 0.6 [95% confidence interval, CI, 0.3 -1.1], P value .09) but received fewer antibiotics (IR = 18.9/1000 follow-up days vs IR = 7.5/1000 follow-up days, IRR 0.4 [95% CI, 0.2-0.8], P value .005). CONCLUSION: Nursing home residents with comfort-oriented ADs were hospitalized at a rate similar to those with usual-care ADs but received fewer antibiotics, although the small sample size of this analysis suggests these findings deserve further study.
[Mh] Termos MeSH primário: Adesão a Diretivas Antecipadas/estatística & dados numéricos
Diretivas Antecipadas/estatística & dados numéricos
Casas de Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Antibacterianos/uso terapêutico
Reanimação Cardiopulmonar/estatística & dados numéricos
Nutrição Enteral/estatística & dados numéricos
Feminino
Hospitalização/estatística & dados numéricos
Seres Humanos
Masculino
Michigan
Cuidados Paliativos/estatística & dados numéricos
Estudos Prospectivos
Cateterismo Urinário/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:151024
[St] Status:MEDLINE
[do] DOI:10.1177/1049909115611875


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[PMID]:27812729
[Au] Autor:Schelling P
[Ad] Endereço:Kanzlei Ulsenheimer Friederich, Maximiliansplatz 12, 80333, München, Deutschland. schelling@uls-frie.de.
[Ti] Título:[Under scrutiny by the state prosecutor : Legal pitfalls in emergency medicine].
[Ti] Título:Im Visier des Staatsanwalts : Juristische Fallstricke in der Notfallmedizin..
[So] Source:Anaesthesist;65(11):812-821, 2016 Nov.
[Is] ISSN:1432-055X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Physicians who allow a suicide attempt to happen, which from an ex ante viewpoint was completely voluntary, cannot be held punishable for homicide or failing to provide medical assistance when the suicide corresponds to the putative will of the patient according to plausible information supplied by an authorized person with healthcare proxy. Guidelines for resuscitation also play a central role in the forensic practice for assessment of whether and when resuscitation can be terminated; therefore, it is urgently advised to follow and implement these guidelines: deviations are possible if they can be factually justified. The currently declared will of a Jehovah's Witness to refuse an allogeneic blood transfusion is binding for the physician. If the patient does not have the ability to reason at the decisive time for evaluating the indications for a blood transfusion and an advance directive has been made, this directive is the guiding principle for medical actions. If such a directive is not available, the putative will must be elucidated. If this is not possible, the objective welfare of the patient must be upheld and the blood transfusion carried out (in dubio pro vita).
[Mh] Termos MeSH primário: Serviços Médicos de Emergência/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adesão a Diretivas Antecipadas
Diretivas Antecipadas
Alemanha
Seres Humanos
Testemunhas de Jeová
Ressuscitação
Tentativa de Suicídio/legislação & jurisprudência
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161105
[St] Status:MEDLINE


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[PMID]:27634718
[Au] Autor:Demarco JP; Lipuma SH
[Ti] Título:Dementia, Advance Directives, and Discontinuity of Personality.
[So] Source:Camb Q Healthc Ethics;25(4):674-85, 2016 Oct.
[Is] ISSN:1469-2147
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We argue that an advance directive (AD) is not invalidated by personality changes in dementia, as is claimed by Rebecca Dresser. The claim is that a new person results under such personality changes, and that the former person cannot write an AD for the new person. After stating the argument against ADs in cases of dementia, we provide a detailed examination of empirical studies of personality changes in dementia. This evidence, though not strong due mainly to low sample sizes and different notions of personal identity, does not support Dresser's position. Given the weakness in the empirical evidence, we turn to a philosophical defense of ADs based on a social contract view supporting the current interests of those writing ADs. Additionally, we argue that personality change is not equivalent to change in personal identity, as would be required by the argument against ADs in cases of dementia.
[Mh] Termos MeSH primário: Adesão a Diretivas Antecipadas
Diretivas Antecipadas
Demência/psicologia
Individualidade
Competência Mental
Personalidade
[Mh] Termos MeSH secundário: Tomada de Decisões
Ego
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:160917
[St] Status:MEDLINE
[do] DOI:10.1017/S0963180116000396


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Elucir, Gir
PubMed Central Texto completo
Texto completo SciELO Brasil
[PMID]:27464295
[Au] Autor:Carvalho MJ; Pereira FM; Gir E; Lam SC; Barbosa CP
[Ad] Endereço:Faculdade de Medicina do ABC, Departamento de Ginecologia e Obstetrícia, Santo André/SP, Brazil.
[Ti] Título:Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics.
[So] Source:Clinics (Sao Paulo);71(7):387-91, 2016 Jul.
[Is] ISSN:1980-5322
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. METHOD: A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. RESULTS: Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). CONCLUSION: Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.
[Mh] Termos MeSH primário: Adesão a Diretivas Antecipadas/normas
Ginecologia/educação
Internato e Residência/normas
Obstetrícia/educação
Padrões de Prática Médica/normas
[Mh] Termos MeSH secundário: Adulto
Adesão a Diretivas Antecipadas/estatística & dados numéricos
Brasil
Estudos Transversais
Feminino
Fidelidade a Diretrizes
Conhecimentos, Atitudes e Prática em Saúde
Hospitais de Ensino/estatística & dados numéricos
Seres Humanos
Masculino
Padrões de Prática Médica/estatística & dados numéricos
Inquéritos e Questionários
Precauções Universais
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160728
[St] Status:MEDLINE


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[PMID]:27324155
[Au] Autor:Umgelter K; Landscheidt J; Jäger K; Blobner M; Kochs E
[Ad] Endereço:Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany. katrin.umgelter@lrz.tum.de.
[Ti] Título:[Pre-operative documentation of individual in-patient therapy goals : A medical staff questionnaire].
[Ti] Título:Patientenorientierte Therapieziele im Krankenhaus : Eine Fragebogenerhebung an medizinischem Personal..
[So] Source:Anaesthesist;65(7):499-506, 2016 Jul.
[Is] ISSN:1432-055X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:BACKGROUND: Perioperative care demands consideration of individual treatment goals. We evaluated the attitudes of medical staff towards a short standardized advance directive (SSAD) as a means of improving patient-orientated care at the transition from operating theater to general or intensive care wards. METHOD: Multicenter anonymized standardized multiple-choice questionnaire among physicians and nurses from various operative and anesthesiology departments. Questions addressing demographic parameters and attitudes towards advance directives in acute care settings (eleven 4­stepped Likert items). Univariate analysis of group comparisons using the chi-square and Kruskal-Wallis rank-sum test. Multivariable analysis of significant differences employing ordinal logistic regression. RESULTS: The overall return rate was 28.2 % (169 questionnaires). Of these, 19.5 % said that existing advance directives were regularly reassessed preoperatively. SSAD was expected to provide improved emergency care by 82.3 and 76.6 % thought that it would help to better focus intensive care resources according to patients' needs. DISCUSSION: Our study shows the dilemma of insufficiently structured directives for changing treatment goals as well as a high number of legal procedures to obtain proxy decisions due to missing out-patient advance health planning. From a medical staff perspective there is strong support for the concept of SSAD based on medical, ethical, economic and organizational reasons.
[Mh] Termos MeSH primário: Documentação
Pacientes Internados
Assistência ao Paciente/normas
Cuidados Pré-Operatórios/métodos
[Mh] Termos MeSH secundário: Adulto
Adesão a Diretivas Antecipadas
Idoso
Idoso de 80 Anos ou mais
Atitude do Pessoal de Saúde
Cuidados Críticos/ética
Cuidados Críticos/normas
Feminino
Metas
Seres Humanos
Masculino
Corpo Clínico
Meia-Idade
Recursos Humanos em Hospital
Cuidados Pré-Operatórios/normas
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170916
[Lr] Data última revisão:
170916
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160622
[St] Status:MEDLINE
[do] DOI:10.1007/s00101-016-0180-5


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[PMID]:27151078
[Au] Autor:Spranzi M; Fournier V
[Ad] Endereço:University of Versailles-St-Quentin-en-Yvelines (UVSQ), Versailles, France.
[Ti] Título:The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered.
[So] Source:Med Health Care Philos;19(4):563-568, 2016 Dec.
[Is] ISSN:1572-8633
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Advance directives (ADs) have been hailed for two decades as the best way to safeguard patients' autonomy when they are totally or partially incompetent. In many national contexts they are written into law and they are mostly associated with end-of-life decisions. Although advocates and critics of ADs exchange relevant empirical and theoretical arguments, the debate is inconclusive. We argue that this is so for good reasons: the ADs' project is fraught with tensions, and this is the reason why they are both important and deeply problematic. We outline six such tensions, and conclude with some positive suggestions about how to better promote patients' autonomy in end-of-life decision. We argue that ADs should continue to be an option but they cannot be the panacea that they are expected to be.
[Mh] Termos MeSH primário: Adesão a Diretivas Antecipadas
Diretivas Antecipadas
[Mh] Termos MeSH secundário: Seres Humanos
Direitos do Paciente
Autonomia Pessoal
Relações Médico-Paciente/ética
Valores Sociais
Assistência Terminal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:160507
[St] Status:MEDLINE


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[PMID]:26897886
[Au] Autor:Kiser K
[Ti] Título:Med students honor choices.
[So] Source:Minn Med;99(1):7, 2016 Jan-Feb.
[Is] ISSN:0026-556X
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Diretivas Antecipadas
Comunicação
Educação Médica
Relações Médico-Paciente
Estudantes de Medicina/psicologia
[Mh] Termos MeSH secundário: Adesão a Diretivas Antecipadas
Currículo
Minnesota
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1604
[Cu] Atualização por classe:160222
[Lr] Data última revisão:
160222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160223
[St] Status:MEDLINE


  10 / 495 MEDLINE  
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[PMID]:26856510
[Au] Autor:Bunkenborg G; Poulsen I; Samuelson K; Ladelund S; Åkeson J
[Ad] Endereço:Department of Anaesthesiology, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: gitbunken@hotmail.com.
[Ti] Título:Mandatory early warning scoring--implementation evaluated with a mixed-methods approach.
[So] Source:Appl Nurs Res;29:168-76, 2016 Feb.
[Is] ISSN:1532-8201
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: The aim of this study was to evaluate adherence to an intervention optimizing in-hospital monitoring practice, by introducing early warning scoring (EWS) of vital parameters. BACKGROUND: Interventions comprising EWS systems reduce in-hospital mortality, but evaluation of adherence to such interventions is required to correctly interpret interventional outcome. METHOD: Adherence was evaluated with a mixed-methods approach. Quantitative data, obtained pre-interventionally (2009) and postinterventionally (2010 and 2011), were used to calculate and compare time intervals between scorings of vital parameters. Semi-structured interviews were used to evaluate the implementation process. RESULTS: We found significant reductions in time intervals between measurements of vital parameters in 2011 compared to 2009. Scorings of vital parameters were repeated within 8 hours in 71-77% of patients scoring total modified EWS levels of 0, 2 or 4. The theme Motivation by clinical relevance and meaningfulness was identified as crucial to the implementation process. CONCLUSION: High adherence to an intervention may be strongly related to nurses' perceived clinical relevance of the intervention.
[Mh] Termos MeSH primário: Monitorização Fisiológica
[Mh] Termos MeSH secundário: Adesão a Diretivas Antecipadas
Seres Humanos
Sistemas Automatizados de Assistência Junto ao Leito
Sinais Vitais
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170307
[Lr] Data última revisão:
170307
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:160210
[St] Status:MEDLINE



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