12,084 research outputs found

    Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial?

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    This systematic review about: withhold, withdrawal, and therapeutic futility is of great importance for everyone working on healthcare and not alone doctors, nurses, or students. The search for individualized care enabling a better treatment is the foundation of modern medicine but it can only be achieved by the critical thinking of the matter at hand. Better professionals with a better understanding of the legal and ethical framework are a must. The main goal of this paper is clearly not to answer questions like “What are the utmost difficulties faced by doctors when deciding the finest management for these patients, from a legal to ethical scope?” or “What are the moral and ethical boundaries of doctors' decisions” or even “Is this treatment beneficial?”. The main purpose of this dissertation is to create a tidal wave of critical thinking about the topic of end-of-life care. Only by learning and formulating critical thinking will we be able to evolve as a society and create the legal framework in which we could, in theory, provide the best health care possible for the patient, loved ones, and the family. To accomplish this dissertation, two databases were used (PubMed and Cochrane Library), the research was limited from 1992 to 2019 to avoid studies related to the Covid-19 pandemic outbreak. The decision to exclude studies during the pandemic time is based on an attempt to stay away from the stress caused by it on ICUs, thus modifying their pattern of action. To navigate PubMed and Cochrane Library, MeSH terms were used, applying Boolean strategy with a combination of “AND’ and “OR” (table 2). The search strategy was not limited to keywords (page xii), often using synonyms or variations of the word or term. The search was limited to publications of peer-reviewed articles published in English, Portuguese, and Spanish. Studies that included pediatric age were excluded. After analyses of the title and abstract, the approved studies went a full analysis as their bibliographies for possible studies of interest. Some of the main authors of the study were contacted via https://researchgate.net/, whenever possible, for additional information. To avoid the risk of information bias, the tool “The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials” (2) was used. Articles were classified as low, high, or uncertain risk. Only low-risk articles were used. It was possible to identify a significant variability concerning the withdrawal of lifesupport treatment in ICUs. This variability exists within units amount their doctors, between regions, countries, and continents, the reason seems to be multifactorial for this result.Esta Revisão sistemática sobre: reter, retirar e futilidade terapêutica é de grande importância para todos os profissionais de saúde e não apenas médicos, enfermeiros ou estudantes. A procura de cuidados individualizados que permitam um melhor tratamento é a base da medicina moderna, mas só pode ser alcançada com o pensamento crítico que cria uma melhor compreensão do quadro jurídico e ético imprescindíveis para formar melhores profissionais. O principal objetivo deste trabalho claramente não é responder a questões como “Quais são as maiores dificuldades que os médicos enfrentam na decisão da melhor gestão destes doentes, de um âmbito legal e ético?” ou "Quais são as fronteiras morais e éticas das decisões dos médicos" ou mesmo "Este tratamento é benéfico?". O principal objetivo desta dissertação é criar uma onda de pensamento crítico sobre o tema dos cuidados em fim de vida. Só aprendendo e formulando o pensamento crítico poderemos evoluir como sociedade, e seremos capazes de criar o quadro legal em que poderíamos, em teoria, fornecer os melhores cuidados de saúde possíveis para o paciente, entes queridos e a família. Para a realização desta dissertação foram utilizadas duas bases de dados (PubMed e Cochrane Library), a pesquisa foi limitada de 1992 até 2019 de forma a evitar estudos relacionados com a pandemia de Covid-19. A decisão de excluir estudos durante a pandemia baseia-se na tentativa de evitar o stress causado pela mesma nas unidades de cuidados intensivos, assim, modificando o padrão de atuação das mesmas. Para navegar na PubMed e Cochrane Library foram usados termos MeSH aplicando uma estratégia Booleana com combinação de “AND” e OR”(tabela 2). A estratégia de Pesquisa não ficou limitada às palavras-chave (pagina x), frequentemente sendo usados sinónimos ou variações das palavras. A pesquisa foi limitada a publicações de artigos peer-reviewed publicados em inglês, português e espanhol. Foram excluídos estudos em idade pediátrica. Após aprovação do estudo pelo título e abstrato, os mesmos foram analisados na integra tal como as suas bibliografias para possíveis estudos de interesse. Alguns dos autores principais foram contactados através do site https://www.researchgate.net/, sempre que possível, para informação complementar Para evitar o risco de viés de informação foi utilizada a ferramenta “The Cochrane Collaboration’s toll for assessing risk of bias in randomized trials” (2) . Os artigos foram classificados em risco baixo, alto ou incerto. Apenas foram usados artigos com risco baixo. Foi possível identificar uma variabilidade significativa em relação à retirada de tratamento de suporte de vida nas unidades de cuidados intensivos. Essa variabilidade existe dentro da própria unidade, das regiões, países e continentes indicando uma causa multifatorial

    Automatic calculation of: cost, distance and duration of international road freight transportation

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    Tese de mestrado, Matemática aplicada à Economia e Gestão, Universidade de Lisboa, Faculdade de Ciências, 2017The purpose of this work is to develop a program that will produce several different schedules for freight transport drivers, respecting several constraints, for multiple destinations. Once this information is produced, it is then selected the best global solution that satisfies the demand of the different destinations with minimum costs. Firstly it will be presented a contextualization of the freight transportation reality in Europe: analyzing the economic impact on several countries GDP; the importance for labour; the hourly costs, and laws associated. Then there will be explained the different constraints. Constraints imposed by the European Union and their reasons. Locations’ related constraints. And constraints regarding the company’s country of origin. There will also be presented the required inputs, in other words, the information necessary for the program to work. Next, it will be given a description of the approach taken to build the program. How the costs were taken into consideration. How the heuristic was built to produce each driver’s different schedules. Then there are mentioned the advantages in typifying drivers. And the use of multiple drivers for the same delivery. Finally it is presented an example, where a company with head quarters in Portugal has to satisfy the demand for 3 destinations throughout Europe. Using single drivers, and/or multiple drivers per delivery with an equal weight for the direct costs (hourly rates) and indirect costs (delay costs). This sensitivity analysis (alpha) will also be evaluated.O objectivo deste trabalho é desenvolver um programa que produza vários calendários diferentes para condutores de transporte de mercadorias, respeitando as várias restrições, para múltiplos destinos. Assim que esta informação seja produzida, será seleccionada a melhor opção global que satisfaça a procura dos diferentes destinos com o mínimo custo. Inicialmente será apresentada uma contextualização da realidade do transporte de mercadorias na Europa: analisando o impacto económico no PIB de vários países; a importância no mercado laboral; O custo hora, e as leis associadas a este. Então serão explicadas a diferentes restrições: restrições impostas pela União Europeia e as suas razões: restrições relacionadas com a localização; e restrições a respeito do país de origem da empresa. Serão também apresentados os inputs necessários, por outras palavras, a informação necessária para que o programa funcione. De seguida será dada uma descrição da abordagem seguida na construção do programa: como os custos foram considerados; como a heurística foi construída para produzir os diferentes calendários de cada condutor; são mencionadas as vantagens em tipificar condutores; e o uso de múltiplos condutores para a mesma entrega. Finalmente é apresentado um exemplo, onde uma empresa com sede em Portugal tem que satisfazer a procura de 3 destinos da Europa, recorrendo a condutores individuais, e/ou pares de múltiplos condutores por entrega. Com um peso igual entre custos directos (custos hora) e custos indirectos (custos por demora). Esta análise de sensibilidade (alpha) será também avaliada. Dado que os softwares utilizados estavam em Inglês, foi usado o ”.” como casa decimal

    Tau-Functions generating the Conservation Laws for Generalized Integrable Hierarchies of KdV and Affine-Toda type

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    For a class of generalized integrable hierarchies associated with affine (twisted or untwisted) Kac-Moody algebras, an explicit representation of their local conserved densities by means of a single scalar tau-function is deduced. This tau-function acts as a partition function for the conserved densities, which fits its potential interpretation as the effective action of some quantum system. The class consists of multi-component generalizations of the Drinfel'd-Sokolov and the two-dimensional affine Toda lattice hierarchies. The relationship between the former and the approach of Feigin, Frenkel and Enriquez to soliton equations of KdV and mKdV type is also discussed. These results considerably simplify the calculation of the conserved charges carried by the soliton solutions to the equations of the hierarchy, which is important to establish their interpretation as particles. By way of illustration, we calculate the charges carried by a set of constrained KP solitons recently constructed.Comment: 47 pages, plain TeX with AMS fonts, no figure

    Drinking of Salvia officinalis tea increases CCl4-induced hepatotoxicity in mice

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    In a previous study, the drinking of a Salvia officinalis tea (prepared as an infusion) for 14 days improved liver antioxidant status in mice and rats where, among other factors, an enhancement of glutathione-S-transferase (GST) activity was observed. Taking in consideration these effects, in the present study the potential protective effects of sage tea drinking against a situation of hepatotoxicity due to free radical formation, such as that caused by carbon tetrachloride (CCl4), were evaluated in mice of both genders. Contrary to what was expected, sage tea drinking significantly increased the CCl4-induced liver injury, as seen by increased plasma transaminase levels and histology liver damage. In accordance with the previous study, sage tea drinking enhanced significantly GST activity. Additionally, glutathione peroxidase was also significantly increased by sage tea drinking. Since CCl4 toxicity results from its bioactivation mainly by cytochrome P450 (CYP) 2E1, the expression level of this protein was measured by Western Blot. An increase in CYP 2E1 protein was observed which may explain, at least in part, the potentiation of CCl4-induced hepatotoxicity conferred by sage tea drinking. The CCl4-induced hepatotoxicity was higher in females than males. In conclusion, our results indicate that, although sage tea did not have toxic effects of its own, herb–drug interactions are possible and may affect the efficacy and safety of concurrent medical therapy with drugs that are metabolized by phase I enzymes.Fundação para a Ciência e a Tecnologia (FCT) - SFRH/BD/6942/2001, POCI/AGR/62040/200

    Phenolic compounds protect HepG2 cells from oxidative damage : relevance of glutathione levels

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    Prova tipográfica (In Press)In the present work, the potential hepatoprotective effects of five phenolic compounds were evaluated against oxidative damages induced by tert-butyl hydroperoxide (t-BHP) in HepG2 cells in order to relate in vitro antioxidant activity with cytoprotective effects. t-BHP induced considerable cell damages to HepG2 cells as shown by significant LDH leakage, increased lipid peroxidation, DNA damage as well as decreased reduced glutathione (GSH) levels. All tested phenolic compounds significantly decreased cell death induced by t-BHP (when in co-incubation). If the effects of quercetin are given the reference value 1, the compounds rank in the following order according to inhibition of cell death: luteolin (4.0) > quercetin (1.0) > rosmarinic acid (0.34) > luteolin-7-glucoside (0.30) > caffeic acid (0.21). The results underscore the importance of the compound’s lipophilicity in addition to its antioxidant potential for its biological activity. All tested phenolic compounds were found to significantly decrease lipid peroxidation and prevent GSH depletion induced by t-BHP, but only luteolin and quercetin significantly decreased DNA damage. Therefore, the lipophilicity of the natural antioxidants tested appeared to be of even higher importance for DNA protection than for cell survival. The protective potential against cell death was probably achieved mainly by preventing intracellular GSH depletion. The phenolic compounds studied here showed protective potential against oxidative damages induced in HepG2 cells that could be beneficial against liver diseases where it is known that oxidative stress plays a crucial role.Fundação para a Ciência e Tecnologia -SFRH/BD/6942/2001; POCTI/AGR/62040/2004
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