Decision making in TAVI: ensuring the best possible clinical outcomes based on the selection of patients and techniques

La pandemia de la COVID-19 supone un reto para los profesionales de la salud desde un compromiso ético y moral hacia la individualidad del ser humano, quedó inmerso bajo dificultades y cargas extremas haciendo imposible responder a los principios de autonomía, beneficiencia, justicia, y no maleficiencia. El Ministerio de Sanidad refleja la importancia de ofrecer orientaciones éticas, una de éstas situaciones fue priorizar la asignación de recursos humanos y materiales bajo valores éticos en la toma de decisiones. El Comité de Bioética español propuso tener en cuenta el criterio de utilidad, equidad y protección para la no discriminación, priorización sobrecogedora en cuidados intensivos con la selección de pacientes con mayores posibilidades, repercutió en las residencias de mayores, la mala planificación de recursos produjo altos índices de mortandad. La vulnerabilidad patente ha promovido valores de empatía, solidaridad y compasión, ha dejado de lado emociones, intimidad y privacidad, lleva a reflexionar sobre una mayor humanización en los cuidados sanitarios. El principio de justicia, el razonamiento bioético, moral y el conocimiento científico, junto a la toma de decisiones desde el respeto al paciente durante su salud y muerte, es primordial en aras a apoyar a éstos profesionales en la toma de decisiones. The COVID-19 pandemic is a challenge for health professionals from an ethical and moral commitment to the individuality of the human being, immersed under extreme difficulties and burdens making it impossible to respond to the principles of autonomy, beneficence, justice, and non-maleficence. The Ministry of Health reflects the importance of offering ethical guidelines, one of these situations was to prioritise the allocation of human and material resources under ethical values in decision making. The Spanish Bioethics Committee proposed to take into account the criteria of usefulness, equity and protection for non-discrimination, overwhelming prioritisation in intensive care with the selection of patients with greater possibilities, had repercussions in nursing homes, poor resource planning led to high mortality rates. Overt vulnerability has promoted values of empathy, solidarity and compassion, and has put aside emotions, intimacy and privacy, leading to reflections on a greater humanisation of health care. The principle of justice, bioethical and moral reasoning and scientific knowledge, together with decision making based on respect for the patient during their health and death, is paramount in order to support these professionals in their decision making.

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Ultraearly Hematoma Growth in Acute Spontaneous Intracerebral Hemorrhage Predicts Early and Long-Term Poor Clinical Outcomes: A Prospective, Observational Cohort Study

Frontiers in Neurology ◽

10.3389/fneur.2021.747551 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wen-Juan Wang ◽

Jing-Jing Lu ◽

Li-Ping Liu ◽

Jiao-Kun Jia ◽

Xing-Quan Zhao

Keyword(s):

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Poor Outcome ◽

Observational Cohort ◽

Hematoma Growth ◽

Prognostic Importance ◽

Selection Of Patients ◽

Selection Of

Aims: Although prognostic importance of ultraearly hematoma growth (uHG) in acute, non-traumatic intracerebral hemorrhage (ICH) has been established for early outcomes, longer-term clinical outcomes are lacking. We aimed to determine the association of uHG with early and 1-year clinical outcomes after acute ICH in a larger and broader range of patients.Methods: We studied 589 patients with acute (<6 h) spontaneous ICH. uHG was defined as baseline ICH volume/onset-to-imaging time (OIT) (ml/h). Multivariable logistic regression analyses were performed to determine the association of uHG with in-hospital mortality, 90-day, and 1-year poor outcome [3 ≤ modified Rankin Scale (mRS)] after ICH.Results: The median speed of uHG was 4.8 ml/h. uHG > 9.3 ml/h was independently related to in-hospital mortality [odds ratio (OR) 2.81, 95% CI 1.52–5.23], 90-day poor outcome (OR 3.34, 95% CI 1.87–5.95), and 1-year poor outcome (OR 3.59, 95% CI 2.01–6.40) after ICH. The sensitivity of uHG > 9.3 ml/h in the prediction of in-hospital mortality, 90-day poor outcome, and 1-year poor outcome was 68.8, 48.0, and 51.1%, respectively.Conclusions: Ultraearly hematoma growth was a useful predictor of in-hospital mortality, 90-day, and 1-year poor outcome after acute ICH. The combination of both uHG and baseline ICH volume could allow better selection of patients with ICH at high risk of poorest clinical outcomes for future clinical trials to improve early- and long-term clinical outcomes.

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Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

2011 ◽

Vol 20 (4) ◽

pp. 121-123

Author(s):

Jeri A. Logemann

Keyword(s):

Decision Making ◽

Patient Care ◽

Clinical Outcomes ◽

Clinical Judgment ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Method ◽

Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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Scintigraphic Evaluation of Intrathecal Infusion Systems: Selection of Patients for Surgical or Medical Management

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70222-5 ◽

2007 ◽

Vol 2007 ◽

pp. 247

Author(s):

S.E. Abram

Keyword(s):

Medical Management ◽

Infusion Systems ◽

Selection Of Patients ◽

Intrathecal Infusion ◽

Selection Of

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Selection of patients for portal-systemic shunts

JAMA ◽

10.1001/jama.196.12.1039 ◽

1966 ◽

Vol 196 (12) ◽

pp. 1039-1044 ◽

Cited By ~ 1

Author(s):

R. E. Hermann

Keyword(s):

Selection Of Patients ◽

Selection Of

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Perioperative acute internal carotid thrombosis after general surgery

Perspectives in Surgery ◽

10.33699/pis.2020.99.3.136-140 ◽

2020 ◽

Vol 99 (3) ◽

pp. 136-140

Keyword(s):

Cardiac Surgery ◽

Internal Carotid ◽

Right Hemicolectomy ◽

Diagnostic Assessment ◽

Left Carotid Artery ◽

Perioperative Stroke ◽

Internal Carotid Occlusion ◽

Acute Brain Ischemia ◽

Selection Of Patients ◽

Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

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