scholarly journals Dilema Etik di Rumah Sakit saat Keterbatasan Sumber Daya dalam Pandemi COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 96-100
Author(s):  
Astrid Pratidina Susilo ◽  
Ervin Dyah Ayu Masita Dewi
Keyword(s):  
Ethical Dilemma ◽  
Health Professionals ◽  
Human Life ◽  
Protective Equipment ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Ethical Challenges ◽  
Additional Measure ◽  
The Impact ◽  
Global Health Problem

Abstract—COVID-19 has induced a global health problem with the impact to different aspects of human life. If numbers of patients are increasing beyond the healthcare capacity, the constraint of resources will stimulate ethical dilemma. In hospitals, the availability of drug, hospital beds, trained health professionals, and personal protective equipment are not enough to response patients’ needs. To face this condition, health professionals and hospitals need ethical guidance to allocate resources. This article aims to discuss the guides that are available in the international literature and to recommend Advanced Care Planning as an additional measure to manage the scarcity or resources. The communal culture or Indonesia may contribute to the ethical challenges through the ‘in-group’ and ‘out-group’ phenomenon. Keywords: COVID-19, resource allocation, ethical dilemma Abstrak—Pandemi COVID-19 telah menyebabkan masalah kesehatan global yang berdampak ke berbagai aspek kehidupan manusia. Jika angka penderita melebihi kapasitas sistem layanan kesehatan, terjadi keterbatasan sumber daya yang akan menimbulkan dilema etik. Di rumah sakit, ketersediaan obat, tempat tidur, tenaga kesehatan terlatih, alat pelindung diri tidak cukup untuk merespons kebutuhan pasien. Untuk menghadapi kondisi ini, tenaga kesehatan dan rumah sakit membutuhkan panduan etika untuk mengalokasikan sumber daya. Artikel ini bertujuan untuk mendiskusikan panduan-panduan yang ada di internasional serta mengusulkan Advanced Care Planning sebagai pendekatan tambahan dalam mengelola keterbatasan sumber daya. Budaya komunal di Indonesia dapat menambah tantangan etika di Indonesia melalui fenomena ‘dalam’ dan ‘luar’ kelompok. Kata kunci: COVID-19, alokasi sumber daya, dilema etik

scholarly journals Evaluating the efficacy of an Advanced Care Planning Program for Health Decisions in patients with advanced heart failure: protocol for a Randomized Clinical Trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Beatriz Sánchez ◽  
Carlos Guijarro ◽  
María Velasco ◽  
María Jesús Vicente ◽  
Miguel Galán ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Decision Making ◽  
Advanced Heart Failure ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Health Decisions ◽  
The Impact

Abstract Background An Advanced Care Planning (ACP) program of health decisions is the result of a process of reflection and relationship-building between the patient, their relatives and health professionals. It is based on respect for patients’ autonomy, involving them in making decisions about their disease in a way that is shared between the medical team, the patient and their relatives. Up until now, the efficacy of an ACP has not been measured in the existing literature, and therefore it is unknown if these programs reach their goal. The main objective of our study is to evaluate the efficacy of an ACP program for decision-making in patients with advanced heart failure (HF) in comparison to usual follow up and care. This objective will be evaluated by the Patient Activation Measure test, which measures the participation and self-management of the patient in decision-making. Secondary objectives: to evaluate the effect of the program on quality of life, to know if the patients wishes expressed through the ACP program are fulfilled, to measure the impact of the program on patients’ caregivers, to determine the satisfaction of patients included in the program and to evaluate the effect on quality of death. Methods Randomized multicentre clinical trial at four hospitals in Madrid. Once they are included in the study, patients’ allocation to groups (control vs intervention) will be made by alternative sampling. ACP will be applied to the intervention group, whereas in the Control Group usual follow-up will be carried out in HF units. All patients will fulfil questionnaires and tests related to the objectives of the study again after a 12-month follow-up period in order to gauge the effect of ACP in patients with advanced HF. Discussion The characteristics of patients with advanced HF make them a model for designing ACP programs, given the high prevalence of this disease, the progressive increase in its incidence and it’s clinical characteristics. Until now, the efficacy of this type of program has not been measured, so this Clinical Trial can provide relevant data for future ACP projects. Trial registration ClinicalTrials.gov Identifier: NCT04424680. Registered 9 June 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04424680?term=NCT04424680&draw=2&rank=1.

Prescribing in end-of-life care

2019 ◽  
Vol 1 (6) ◽  
pp. 284-288
Author(s):  
Amanda Armstrong
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Limiting Condition

End-of-life care aims to support a person in the last stages of a life-limiting condition to live as well as possible until they die. Prescribing at the end-of-life presents many challenges. Advanced care planning can be carried out so that health professionals are aware and supportive of the patient's and their family's wishes. This article discusses the care and management of patients as they receive care at the end of their life as well as any anticipatory medication that may be needed.

scholarly journals Determining the Impact of COVID-19 on End-of-Life Experiences of Family Caregivers for People Living With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 321-321
Author(s):  
Sameer Mithani ◽  
Gwen McGhan ◽  
Deirdre McCaughey ◽  
Kristin Flemons
Keyword(s):  
Public Health ◽  
Focus Group ◽  
End Of Life ◽  
Family Caregivers ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
The Impact

Abstract COVID-19 has impacted all of our lives, but the population most at risk are older adults. Family caregivers (FCGs) for people living with dementia (PLWD) face challenges in providing care, which are compounded with the introduction of COVID-19 public health policies. The purpose of this study was to examine the experiences of FCGs where the PLWD died during the COVID-19 pandemic. FCGs were invited to participate in an online survey to examine their caregiving experiences during the COVID-19 pandemic, with the option of participating in a follow-up focus group. Sixteen FCGs whose family members with dementia died during the pandemic participated in the survey. A follow-up focus group was conducted to further examine how COVID-19 policies impacted their role as a caregiver in long-term care (LTC) and affected their ability to grieve. The results of the survey and focus group suggest that a lack of role clarity and inadequate communication channels between the FCG and LTC due to COVID-19 increased the strain FCGs faced during end-of-life care. At the end of life, public policies, such as reduced or no visitation, led to feelings of inadequacy and regret. Several participants also expressed appreciation for completing Advanced Care Planning documentation prior to COVID-19. Based on these results, policymakers can help ease the increased turmoil faced by FCGs during end-of-life care in future public health emergencies by involving FCGs of PLWD in the decision-making process. The completion of Advanced Care Planning documentation can also ease the burden FCGs may experience during end-of-life care.

scholarly journals Reducing Death Anxiety: The Impact of Advanced Care Planning

2020 ◽  
Vol 3 ◽  
Author(s):  
Kendra Hollenbeck ◽  
Tom Gutwein
Keyword(s):  
Informed Consent ◽  
Death Anxiety ◽  
Medical Center ◽  
Future Research ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Improve Quality ◽  
Advanced Directives ◽  
The Impact

Background/Objective: Death anxiety affects multiple areas of patient’s physical and mental health. Reducing this phenomenon has the potential to improve quality of end of life (EOL). The effects of spirituality, age, self-esteem, biological sex, presence of symptoms and level of isolation have been previously studied. Advanced care planning (ACP), a simple intervention, which has known positive impacts on quality of EOL by decreasing healthcare costs and undesired hospitalizations, however, only 33% of the population has completed it. This study will examine the correlation between death anxiety and ACP. We hypothesize that there will be a statistically significant lower level of death anxiety in participants with ACP.  Methods: The study population will include patients presenting to the Parkview Regional Medical Center ED who are ≥65, with a sample size of 1,000. We will use a translated and adapted version of the 17 question Likert-type Scale of Death Anxiety; developed and validated by Cai et al. in 2017. It will be presented via REDCap and will include electronic signature of informed consent. Finally, we will include questions about ACP and advanced directives. Participants will also complete a basic demographic survey to account for confounding factors. Analysis will include a Mann Whitney test, univariate and multivariate regressions.   Results: This project resulted in a IRB submission drafts of a study protocol, informed consent, SDA survey and REDCap data collection tool. The researchers are seeking Parkview Health-IRB approval in Fall 2020, with an anticipated study start date of Spring 2021.   Impact: This project has the potential to improve quality of life by decreasing death anxiety and resulting negative stress reactions. Interventions for decreasing death anxiety have not been extensively studied so directions for future research are broad and could include impacts of ACP in varying ages and contexts outside of the ED.  

Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020

2020 ◽  
Vol 59 (04) ◽  
pp. 294-299 ◽  
Author(s):  
Lutz S. Freudenberg ◽  
Ulf Dittmer ◽  
Ken Herrmann
Keyword(s):  
Nuclear Medicine ◽  
Health Systems ◽  
Personal Protective Equipment ◽  
Large Scale ◽  
Diagnostic Procedures ◽  
Protective Equipment ◽  
Current Crisis ◽  
Web Based ◽  
Public Versus Private ◽  
The Impact

Abstract Introduction Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. Materials and Methods A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. Results 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are –14.4 %, –47.2 %, –47.5 %, –40.7 %, –58.4 %, and –25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (–53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. Conclusions Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.

Forms of physical activity of the elderly

2020 ◽  
Vol 18 (3) ◽  
pp. 221-228
Author(s):  
Piotr Czarnecki ◽  
◽  
Justyna Podgórska-Bednarz ◽  
Lidia Perenc ◽  
◽  
...  
Keyword(s):  
Physical Activity ◽  
Elderly People ◽  
Population Aging ◽  
Human Life ◽  
Good Health ◽  
The Elderly ◽  
Polish Society ◽  
Central Statistical ◽  
Key Phrases ◽  
The Impact

Introduction. Physical activity is known to be an important factor influencing health throughout human life. This issue has become crucial for public health due to the aging of the population in both developed and developing countries. Aim. is to present a literature review on the forms of physical activity undertaken by the elderly, as well as on issues related to physical activity and the population aging. Material and methods. The study was prepared on the basis of a review of Polish and foreign literature. The following databases and data sources were used: EBSCO, ScienceDirect and Google Scholar. An additional source of data were the websites of the Central Statistical Office. Strictly defined key phrases were used during the collection of literature. The work has been divided into thematic subsections on the aging of the society, the impact of physical activity on health and the main topic, i.e. forms of physical activity selected by the elderly. Analysis of the literature. The number of elderly people in Polish society has increased by almost 3.7 million over three decades. Therefore, an important topic is prophylaxis aimed at increasing the number of days in good health, largely covering the broadly understood activation of the elderly. The available data indicate that only 12% of elderly people undertake physical activity once a week. The most common form of spending free time actively is walking (as many as 73% of people in this population declare this form of physical activity in one of the presented studies). Conclusion. Organized forms of physical activity are undertaken much less frequently by the analyzed age group mainly due to financial limitations and limited availability of sports infrastructure.

Recomendações de equipamentos de proteção individual no combate ao COVID-19

2020 ◽  
Vol 10 (31) ◽  
pp. 87-95
Author(s):  
Nicole Maria Miyamoto Bettini ◽  
Fabiana Tomé Ramos ◽  
Priscila Masquetto Vieira de Almeida
Keyword(s):  
World Health Organization ◽  
Personal Protective Equipment ◽  
Health Professionals ◽  
Health Personnel ◽  
Healthcare Professionals ◽  
World Health ◽  
Protective Equipment ◽  
Effective Strategy ◽  
The World ◽  
Health Organization

A Organização Mundial da Saúde - OMS confirmou a circulação internacional do novo Coronavírus em janeiro de 2020, nomeando-o como COVID-19 e, declarando uma pandemia. É de extrema importância que durante a pandemia, os profissionais de saúde tenham acesso e conhecimento sobre o uso correto dos Equipamentos de Proteção Individual (EPIs) e suas indicações, tomando assim, as devidas precauções na prevenção de infecções. O presente estudo buscou identificar a padronização mundial quanto ao uso dos EPIs utilizados no atendimento a pacientes suspeitos e/ou confirmados de COVID-19 no Brasil, EUA, China, Espanha, Itália e demais países europeus. Os guidelines apresentam a padronização quanto ao uso dos EPIs utilizados no atendimento a suspeitos e/ou confirmados de COVID-19, indo ao encontro das recomendações fornecidas pela OMS. Até o momento, o uso de EPIs é sem dúvida a estratégia mais importante e eficaz para proteger os profissionais de saúde durante a assistência ao paciente com COVID-19.Descritores: Infecções por Coronavírus, Equipamento de Proteção Individual, Pessoal de Saúde, Enfermagem. Recommendations for personal protective equipment to combat COVID-19Abstract: The World Health Organization - WHO confirmed the international circulation of the new Coronavirus in January 2020, naming it as COVID-19 and declaring a pandemic. It is extremely important that during the pandemic, health professionals have access and knowledge about the correct use of Personal Protective Equipment (PPE) and its indications, thus taking appropriate precautions to prevent infections. The present study sought to identify the worldwide standardization regarding the use of PPE utilized to take care of suspected and confirmed patients with COVID-19 in Brazil, USA, China, Spain, Italy and other European countries. The guidelines present a standardization regarding the use of PPE utilized to take care of suspected and confirmed with COVID-19, in line with the recommendations provided by WHO. To date, the use of PPE is undoubtedly the most important and effective strategy to protect healthcare professionals during care for patients with COVID-19.Descriptors: Coronavirus Infections, Personal Protective Equipment, Health Personnel, Nursing. Recomendaciones para el equipo de protección personal para combatir COVID-19Resumen: La Organización Mundial de la Salud - La OMS confirmó la circulación internacional del nuevo Coronavirus en enero de 2020, nombrándolo COVID-19 y declarando una pandemia. Es extremadamente importante que durante la pandemia, los profesionales de la salud tengan acceso y conocimiento sobre el uso correcto del Equipo de Protección Personal (EPP) y sus indicaciones, tomando así las precauciones adecuadas para prevenir infecciones. El presente estudio buscó identificar la estandarización mundial con respecto al uso de EPP utilizado para atender a pacientes sospechosos y/o confirmados con COVID-19 en Brasil, Estados Unidos, China, España, Italia y otros países europeos. Las pautas presentan la estandarización con respecto al uso de EPP utilizado para cuidar COVID-19 sospechoso y/o confirmado, de acuerdo con las recomendaciones proporcionadas por la OMS. Hasta la fecha, el uso de EPP es, sin duda, la estrategia más importante y efectiva para proteger a los profesionales de la salud durante la atención de pacientes con COVID-19.Descriptores: Infecciones por Coronavirus, Equipo de Protección Personal, Personal de Salud, Enfermería.

The Status of Mind and Intellect in Digital Environment

2020 ◽  
Vol 63 (2) ◽  
pp. 123-143
Author(s):  
Elena I. Yaroslavtseva
Keyword(s):  
Human Life ◽  
Cognitive Activity ◽  
Memory Loss ◽  
Natural Material ◽  
Human Being ◽  
Connection To Nature ◽  
Digital World ◽  
The Status ◽  
Natural Foundation ◽  
The Impact

The article examines the impact of digitalization on human life and intellectual experience. The development of computer technology demands an understanding of new aspects of human development and requires a capability to overcome not only external conditions but also ourselves. Entering a new level of development cannot imply a complete rejection of previous dispositions, but should be accompanied by reflection on personal experience and by the quest for new forms of interaction in society and with nature. Communicative and cognitive activity of a person has an ontological basis and relies on processes that actually evolve in nature. Therefore, the creation of new objects is always associated with the properties of natural material and gives rise to new points of support in the development of man. The more audacious his projects, the more important it is to preserve this connection to nature. It is always the human being who turns out to be the initiator who knows how to solve problems. The conformity of complex technical systems to nature is not only a goal but also a value of meaningful construction of development perspectives. The key to the nature orientation of the modern digital world is the human being himself, who keeps all the secrets of the culture of his natural development. Therefore, the proposed by the Russian philosopher V.S. Stepin post-non-classical approach, based on the principle of “human-sizedness,” is an important contribution to contemporary research because it draws attention to the “human – machine” communication, to the relationship between a person and technological systems he created. The article concludes that during digital transformation, a cultural conflict arises: in an effort to solve the problems of the future, a person equips his life with devices that are designed to support him, to expand his functionality, but at the same time, the boundaries of humanity become dissolved and the forms of human activity undergo simplification. Transhumanism engages society in the fight against fears of vulnerability and memory loss and ignores the flexibility and sustainability of natural foundation.

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