Testamento vital: onde se situam os enfermeiros? Integração de uma nova realidade nos cuidados de enfermagem ao doente e família

O enfermeiro é o profissional de saúde que tem como objectivo prestar cuidados de Enfermagem ao ser humano, são ou doente, ao longo de todo o ciclo vital. (Decreto-Lei n.º 161/96 de 4 de Setembro, alterado pelo Decreto-Lei n.º 104/98 de 21 de Abril. Regulamento do Exercício Profissional dos Enfermeiros) A presença de um doente com testamento vital internado no serviço de cardiologia, cujo conhecimento por parte da equipa multidisciplinar foi tardio, suscitou várias questões tendo despoletado a reflexão sobre esta temática. O doente tem o dever de fornecer aos profissionais as informações necessárias para a obtenção de um adequado diagnóstico e tratamento. Quando tal não ocorre ou não é possível, cabe também ao enfermeiro uma adequada colheita de dados para a prestação de cuidados de qualidade. Actualmente a consulta do Registo Nacional do Testamento Vital (RENTEV) é da responsabilidade do médico que “assegura da existência do documento de Directivas Antecipadas da Vontade e/ou procuração de cuidados de saúde” aí registados. (Lei Nº 25.º / 2012 de 16 de Julho. Diário da república Nº136 – 1ª Série Assembleia da República) A ausência desta informação por parte do enfermeiro poderá trazer constrangimentos à sua intervenção dado que, desconhecendo-se a vontade do doente poderá facilitar a realização de procedimentos invasivos. O testamento vital é já uma realidade mas, perante tais obstáculos que podem pôr em causa a vontade expressa do doente e os cuidados de excelência, como poderemos colmatar tais lacunas? Cremos ser importante constar da avaliação inicial e processo de cuidados a colheita de informação sobre a existência ou não de testamento vital, que assegure o consequente conhecimento do seu conteúdo, independentemente do que vigora na lei sobre o acesso administrativo dos enfermeiros ao RENTEV. Entende-se que esta não é matéria terminada e que o quadro legal que a suporta poderá necessitar de aperfeiçoamento e compatibilização com a realidade que o futuro desvendar. Bibliografia Decreto-Lei n.º 161/96 de 4 de Setembro, alterado pelo Decreto-Lei n.º 104/98 de 21 de Abril. Regulamento do Exercício Profissional dos Enfermeiros Lei Nº 25.º / 2012 de 16 de Julho. Diário da República Nº136 – 1ªSérie. Assembleia da República.

Folheto Informativo sobre Testamento Vital

Em 2014 ter um Testamento Vital é um novo direito dos Cidadãos Portugueses.

El testamento de nuestra vida : esquema de una unidad didáctica sobre los testamentos vitales.

Debido a las implicaciones morales, filosóficas y religiosas de la eutanasia y al debate público suscitado entorno a ella, el autor propone una unidad didáctica para alumnos de 4õ de la ESO. Se trata de la elaboración de un testamento vital individual que el alumno redactará tras la búsqueda de información en los medios de comunicación y la legislación vigente, la lectura de otros testamentos vitales, como los cuatro que adjunta el artículo, y la puesta en común y posterior debate en el aula. La intención es que el alumno exprese con sinceridad sus inquietudes internas y escuche las de sus compañeros en un entrono de diálogo y de respeto.

Voluntades anticipadas, su valor legal

Resumen: El autor analiza el contenido de las denominadas directivas previas o testamento vital, que una persona puede instrumentar a efectos de instruir a los médicos que en el futuro la atiendan en el supuesto de no poder en ese momento expresar su voluntad, relacionadas con los tratamientos que está dispuesta a que le sean aplicados. Se hace referencia al alcance, los inconvenientes y peligros que traen aparejadas dichas directivas, su tiempo de validez y la situación actual en otros países y en el nuestro, así como una escueta reseña de dos sentencias dictadas en el país al respecto.

Los derechos y deberes de médicos y pacientes desde la vigencia de la Ley 26.529

Resumen: El artículo considera los derechos y deberes de médicos y pacientes, especialmente luego de la sanción de la ley 26.529, destacando sus temas relevantes, aquellos que habían dado lugar a distintas interpretaciones tanto en la jurisprudencia, como en la doctrina. Se tratan, así, la historia clínica y el consentimiento informado, precisándose sus conceptos, formas, funciones e interpretaciones. Similar atención merecen las directivas anticipadas de salud, el “testamento vital”, las posibilidades del médico y sus posibles objeciones de conciencia. De igual modo la autonomía de la voluntad del paciente, su libertad y responsabilidad. Se considera la eutanasia, precisándose que no es un derecho del paciente. Se estudia el secreto profesional del médico, a la luz de las contradictorias normas legales vigentes y jurisprudencia consecuente, para detenerse en la más reciente decisión de la Corte Suprema de Justicia de la Nación en su actual composición. Finalmente se precisan los conceptos de las responsabilidades de médicos y órganos sanitarios, con la posibilidad de su aseguramiento y el conflicto de algunas de las coberturas que se otorgan en plaza, como la conocida claims made.

Libertad de conciencia y derecho a decidir sobre la salud al final de la vida: eutanasia

El presente trabajo tiene por objeto el estudio de la libertad de conciencia y el derecho de los pacientes a decidir al final de su vida, principalmente, a través del análisis de la eutanasia en su distinción entre eutanasia activa directa, eutanasia activa indirecta y eutanasia pasiva, y el respectivo tratamiento que reciben dichas modalidades en nuestro ordenamiento jurídico.

Dignidade na vida, na doença e para a morte: as diretivas antecipadas como instrumento de valorização da pessoa

A dignidade da pessoa humana e a autonomia privada espraiam-se pela experiência da vida, alcançando a doença e a morte. As diretivas antecipadas, gênero dos quais são espécies o testamento vital e o mandato duradouro, constituem negócio jurídico de caráter existencial que têm por objetivo assegurar a realização da dignidade da pessoa e o cumprimento dos atos de autonomia nas situações em que a pessoa estiver incapacitada para manifestar sua vontade. As diretivas representam instrumento de autodeterminação através do qual a pessoa disciplina os tratamentos médicos que aceita ou não ser submetida, autoriza doação de órgão, estipula se tem interesse em conhecer seu estado clínico e/ou nomeia terceira pessoa para tomar estas decisões em seu lugar. As três primeiras hipóteses constituem o que usualmente se qualifica como testamento vital, enquanto a última situação descrita configura o mandato duradouro. O objeto de estudo abrange a evolução das diretivas antecipadas, a disciplina existente em países que já regulamentaram o tema, a legitimação no sistema jurídico brasileiro (o que autoriza a conclusão favorável a sua utilização independentemente de lei expressa) e a sistematização deste negócio jurídico perante o ordenamento jurídico.

Estudio y desarrollo del plan de negocio de una empresa: Sistema Web que gestiona e informa sobre las cuentas digitales que el cliente ingresa

El presente documento tiene como objetivo general desarrollar un plan de negocio para analizar la viabilidad de la creación de una nueva empresa, “MyTested S.L.”. Pretende ofrecer una herramienta para que las personas puedan comunicar a sus familiares el acceso a sus cuentas digitales una vez fallecidos. En cuanto a cómo surge la idea, fue a través de una noticia que trataba sobre el derecho al olvido en las redes sociales y en internet. Investigando un poco y prestando atención a los movimientos de las grandes empresas de internet, mi compañero/socio y yo, nos dimos cuenta de que ofrecer este servicio podría valer como negocio, ya que no existe mucha competencia en el mercado. Gracias a eso, nos planteamos en más de una ocasión la posibilidad de montar nuestro propio negocio, de forma que pudiéramos utilizar los conocimientos adquiridos en la universidad como base para crear la herramienta web. Escogimos empezar el proyecto utilizándolo como materia para el trabajo de fin de grado porque nos aporta dos valores muy importantes, ayuda de la comunidad de profesores existentes en la UPM, siendo una persona de gran aporte nuestro tutor Oscar Corcho y también, porque como estamos dedicando todo el tiempo a este proyecto, tener una fecha límite para presentar tanto la parte de modelo de negocio como la parte de desarrollo en una fecha concreta, nos ayuda a planificar y mantener una presión constante sobre el proyecto y así forzar a no abandonarlo ni prolongarlo. Con ello, nos encontramos con dos grupos de dificultades, la escasa formación a nivel empresarial y creación de modelos de negocio y en el ámbito del desarrollo al desconocimiento de tecnologías y APIs de las redes sociales. Al tratarse de una herramienta Web, parte de unos costes muy bajos como el alojamiento del servidor o la contratación temporal de comerciales para publicitar la herramienta entre funerarias y hospitales. Estos factores positivos benefician tanto la realización del proyecto como su avance. Como ya se puede intuir de la lectura del párrafo anterior, el servicio que ofrece la herramienta “MyTested S.L.” está relacionado con el segmento testamental de una persona fallecida, podríamos definirlo como testamento digital. Actualmente, vivimos en un mundo que se centra cada vez más en la parte digital y es por ello, que en un futuro cercano, todas las cuentas que creamos en internet tendrán que ser cerradas o bloqueadas cuando caen en el desuso por el fallecimiento del propietario, es en ese hueco donde podemos situarnos, ofreciendo una herramienta para poder trasladar la información necesaria a las personas elegidas por el cliente para que puedan cerrar o bloquear sus cuentas digitales. Consideramos que existe una interesante oportunidad debido a la escasez de oferta de este tipo de servicios en España y a nivel mundial. En Abril de 2015 hay inscritos en el registro Nacional de últimas voluntades 185.6651 personas por lo que encontramos que un 0,397%1 de las personas en España ha registrado su testamento. El gasto medio al hacer un testamento vital ante notario de tus bienes tiene un coste de 40 a 80 euros2 , este es el principal motivo por el que la mayoría de españoles no realiza su testamento antes de morir. Con este dato obtenemos dos lecciones, lo que la herramienta ofrece no es el documento notarial de los bienes del cliente, sino la sistema, puedan bloquear o cerrar sus cuentas. La segunda lección que obtenemos es que el precio tiene que ser muy reducido para poder llegar a un gran número de personas, añadiendo también el criterio de que el cliente podrá actualizar su información, ya que la información digital es muy fácil de cambiar y frecuente. Como se podrá leer en al apartado dedicado a nuestra visión, misión y valores, aunque estamos convencidos que se puede extraer de la lectura de cualquier parte de este documento, todos nuestros objetivos los queremos conseguir no sólo buscando un enfoque empresarial a nuestro día a día, sino convirtiendo nuestra responsabilidad social sincera, en uno de los retos que más nos ilusionan, fomentando para ello, aspectos como el desarrollo web, estudios de mercado, conocimiento de las necesidades de la población, nuevas tecnologías y negocio. En general, los objetivos que se pretenden cumplir con este estudio son: - Conocer los pasos para crear una empresa - Desarrollar un documento de plan de negocio que contenga lo siguiente: - Análisis de mercado - Definición de productos y/o servicios - Plan de publicidad y expansión (marketing) - Plan financiero - Capacidad para definir los requisitos de una aplicación Web. - Capacidad de elegir la tecnología idónea y actual de un sistema Web. - Conocer el funcionamiento de una empresa y cómo comunicarse con las herramientas gubernamentales. - Comprobar si las posibilidades que nos ofrece el entorno son las adecuadas para nuestras actividades. - Estudio, análisis de la competencia - Definir los diferentes perfiles de cliente para nuestro negocio. - Analizar la viabilidad de nuestro modelo de negocio. Para ello, comenzamos realizando una definición de las características generales del proyecto, detallando cuáles son las motivaciones que han hecho a los emprendedores embarcarse en el mismo, qué servicios ofreceremos a nuestros clientes, el porqué de la elección del sector, así́ como nuestra misión, visión y valores.---ABSTRACT---The goal and aim of the present document is to develop a business plan in order to analyze the viability of build a new enterprise, that we will name MyTested S.L., it wants offer a tool for sharing and to facilitate to the relatives of a dead person the access to the digital accounts. Talking about how come up the idea, it was once a have read a news over the “right of forgotten” throughout social nets and inside internet, researching a little and paying attention to the different movements of the biggest internet companies, my peer ( and partner) and I were aware that to offer this service might be a good business, because does not exist many competitors on this kind of market service, mainly thanks of that, we have planned on several times the possibility to build our owner company, in the way to use the capabilities that we achieved in the University as based to develop and make a web tool. We choose begin this project as subject of our Final Project Degree after analyze the positive and negative point of views: The positive was because it has two main values, firstly the support of the current teachers UPM community, specially our fellow Oscar Corcho and also because we can´t dedicate all our time to this project, so to have a deadline to present either the business model as the develop on time, help us to plan and remain a constant pressure over the project and neither drop out it or extend it more that the necessary. As a web tool, neither the hosting of maintenance or for sort out a net of temporary commercials for visiting hospitals or undertaker´s or insurances, the cost don´t are expensive In the negative side, however, we found twice some main difficulties, the few training as entrepreneur level and how to build a business model and on the other hand the lack of awareness of the technologies and apps of the social net software as well. As summary, these positives facts enhance to work project out and also to develop it. As we could understand reading on the latest paragraph, the service that will do MyTested tool is relation with the testament issue of a dead person, we might call as a digital testament. Currently we are living in world which is focus further on the digital life, for that in a near future every internet accounts should be closed or locked whenever aren´t used by the dead of the owner, this is a market niche (never better said) where we can lead, offering a tool that might transfer the necessary information to the chosen persons by the client in order to allow either close or lock his digital accounts. We are considering that there are interesting opportunities due to the few offers of that kind of service in Spain and at global level. In April 2015 there were 185.6651 persons registered in the Official National last will and testament, this figure mean that the 0,397%1 of the Spaniards citizens have registered their testaments. The average cost of doing the testament of your assets with a Notary is since 40 up to 80€2, this is one of the principal motives because the majority of the Spaniards don´t do it before dead. With these data we might get two lessons, we are not talking about an official notary testament at all, it is only for close or lock the digital accounts by the chosen person by the dead client, and the latest lesson, but not least, the price of our service must be very cheaper in order to achieve touch an important amount of people, knowing also that he client will be able update the information filled, considering that this kind of information is very easy to change and update frequently. As we can read on the stage dedicated to our Vision, Mission and Values, although we are persuaded that can be read in everywhere of this document as well, our aim doesn´t be an business focus on day to day, is also to become our honest social responsibility in this challenge, that is our mainly eagerness, enhancing some aspects as the web development, market research and the knowledge of the population needs, new technologies and new market opportunities. In general the goals that we would like get within this project are: - Achieve the knowledge needs for be an entrepreneurial, and find out the steps for star a business - Achieve market research skills - Products and services definitions - Advertising plan and growth (marketing plan) - Financial plan knowledge - Capability of a web design requirements - Capability for choose the best and actual technology for web design - Knowledge over how work out inside a company and how communicate with official tools. - Check whether the possibilities of the environment are the adequate for our activities. - Research and competitiveness analysis - Define the different profiles of the target for our business. - Analyze the viability of the business model For all that, we began with a definition of the general features of the project, detailing which are the motivations those done to the entrepreneurial get on board, which kind of service we offered to the client, also why the selection of the market sector and our mission, vision and value as well.

Genetic evidence for the vital function of osterix in cementogenesis

To date, attempts to regenerate a complete tooth, including the critical periodontal tissues associated with the tooth root, have not been successful. Controversy still exists regarding the origin of the cell source for cellular cementum (epithelial or mesenchymal). This disagreement may be partially due to a lack of understanding of the events leading to the initiation and development of the tooth roots and supportive tissues, such as the cementum. Osterix (OSX) is a transcriptional factor essential for osteogenesis, but its role in cementogenesis has not been addressed. In the present study, we first documented a close relationship between the temporal- and spatial-expression pattern of OSX and the formation of cellular cementum. We then generated 3.6 Col 1-OSX transgenic mice, which displayed accelerated cementum formation vs. WT controls. Importantly, the conditional deletion of OSX in the mesenchymal cells with two different Cre systems (the 2.3 kb Col 1 and an inducible CAG-CreER) led to a sharp reduction in cellular cementum formation (including the cementum mass and mineral deposition rate) and gene expression of dentin matrix protein 1 (DMP1) by cementocytes. However, the deletion of the OSX gene after cellular cementum formed did not alter the properties of the mature cementum as evaluated by backscattered SEM and resin-cast SEM. Transient transfection of Osx in the cementoblasts in vitro significantly inhibited cell proliferation and increased cell differentiation and mineralization. Taken together, these data support 1) the mesenchymal origin of cellular cementum (from PDL progenitor cells); 2) the vital role of OSX in controlling the formation of cellular cementum; and 3) the limited remodeling of cellular cementum in adult mice.

The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation

Introduction and objectives Early recognition of deteriorating patients results in better patient outcomes. Modified early warning scores (MEWS) attempt to identify deteriorating patients early so timely interventions can occur thus reducing serious adverse events. We compared frequencies of vital sign recording 24 h post-ICU discharge and 24 h preceding unplanned ICU admission before and after a new observation chart using MEWS and an associated educational programme was implemented into an Australian Tertiary referral hospital in Brisbane. Design Prospective before-and-after intervention study, using a convenience sample of ICU patients who have been discharged to the hospital wards, and in patients with an unplanned ICU admission, during November 2009 (before implementation; n = 69) and February 2010 (after implementation; n = 70). Main outcome measures Any change in a full set or individual vital sign frequency before-and-after the new MEWS observation chart and associated education programme was implemented. A full set of vital signs included Blood pressure (BP), heart rate (HR), temperature (T°), oxygen saturation (SaO2) respiratory rate (RR) and urine output (UO). Results After the MEWS observation chart implementation, we identified a statistically significant increase (210%) in overall frequency of full vital sign set documentation during the first 24 h post-ICU discharge (95% CI 148, 288%, p value <0.001). Frequency of all individual vital sign recordings increased after the MEWS observation chart was implemented. In particular, T° recordings increased by 26% (95% CI 8, 46%, p value = 0.003). An increased frequency of full vital sign set recordings for unplanned ICU admissions were found (44%, 95% CI 2, 102%, p value = 0.035). The only statistically significant improvement in individual vital sign recordings was urine output, demonstrating a 27% increase (95% CI 3, 57%, p value = 0.029). Conclusions The implementation of a new MEWS observation chart plus a supporting educational programme was associated with statistically significant increases in frequency of combined and individual vital sign set recordings during the first 24 h post-ICU discharge. There were no significant changes to frequency of individual vital sign recordings in unplanned admissions to ICU after the MEWS observation chart was implemented, except for urine output. Overall increases in the frequency of full vital sign sets were seen.

Understanding dementia is vital in all health care staff

As the Australian population continues to age, health care staff will come into contact with and care for increasing numbers of people with dementia. A basic understanding of dementia is important to the quality of these interactions. This article summarises recently published research on levels of knowledge of Alzheimer’s disease among health care staff in an Australian regional health district (Smyth, Fielding, Beattie, Gardiner, Moyle, Franklin, Hines & MacAndrew, 2013).

Putting vital stains in context

While vital staining remains a cornerstone in the diagnosis of ocular disease and contact lens complications, there are many misconceptions regarding the properties of commonly used dyes by eye-care practitioners and what is and what is not corneal staining after instillation of sodium fluorescein. Similarly, the proper use and diagnostic utility of rose Bengal and lissamine green B, the other two ophthalmic dyes commonly used for assessing ocular complications, have similarly remained unclear. Due to the limitations of vital stains for definitive diagnosis, concomitant signs and symptoms in addition to a complete patient history are required. Over the past decade, there have been many reports of a type of corneal staining—often referred to as solution-induced corneal staining (SICS)—that is observed with the use of multipurpose solutions in combination with soft lenses, more specifically silicone hydrogel lenses. Some authors believe that SICS is a sign of lens/solution incompatibility; however, new research shows that SICS may be neither a measure of lens/solution biocompatibility nor ‘true’ corneal staining, as that observed in pathological situations. A large component of SICS may be a benign phenomenon, known as preservative-associated transient hyperfluorescence (PATH). There is a lack of correlated signs and/or symptoms with SICS/PATH. Several properties of SICS/PATH, such as appearance and duration, differentiate it from pathological corneal staining. This paper reviews the properties of vital stains, their use and limitations in assessment of the ocular surface, the aetiology of corneal staining, characteristics of SICS/PATH that differentiate it from pathological corneal staining and what the SICS/PATH phenomenon means for contact lens-wearing patients.

Response to re : putting vital stains in context

A response to: "Re: Putting vital stains in context" by Eric Papas & Lyndon Jones, published in the same issue of this journal. "There has been considerable discussion in recent times about the origins of solution-induced corneal staining (SICS) and I welcome this opportunity to further clarify some points raised in my paper1 in relation to certain issues highlighted by Drs Papas and Jones.2 Part of the difficulty in understanding these phenomena relates to the imprecise terminology used. For example, Drs Papas and Jones state ‘. . . SICS..."

Response to re : putting vital stains in context

A response to "Re: Putting vital stains in context" by Charles W McMonnies, published in the same issue of this journal. "I thank Professor McMonnies for his thoughtful comments,1 which rightly forcemeto more directly address the clinical ramifications of solution-induced corneal staining (SICS). I concur with his observation that determining whether the staining can be attributed to preservative-associated transient hyperfluorescence (PATH) or true pathology can be difficult in a typical clinical situation, perhaps requiring two visits in a single day. There is no easy answer to this dilemma..."