Ageism is the prejudice or discrimination of older adults, whether through stigmatization or discriminatory practices by society and its institutions. The current covid-19 pandemic context has shown Western society’s ageist stance and, consequently, of its protocols on the distribution of health resources, leading to severe negative repercussions to the care of this population. This theoretical essay discusses the manifestations and consequences of ageism in the context of health resource distribution policies during the pandemic, considering the bioethical implications involved in this type of discrimination when considering the principles of justice and human dignity.

https://revistabioetica.cfm.org.br/index.php/revista_bioetica/article/download/2764/2614

Covid-19 e ageísmo: avaliação ética da distribuição de recursos em saúde

This document offers a proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic. This proposal includes recommendations on the procedural norms and substantive norms that should govern the allocation and reallocation of therapeutic resources in conditions of extreme scarcity.

/pdf/propuesta-para-la-elaboracion-de-un-protocolo-de-triaje-en-2aul7gyak9.pdf

Propuesta para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted the capacity for advance care planning between patients, families, and healthcare teams. The barriers to and facilitators of advance care planning vary with settings. This study sought to identify and review the barriers to and facilitators of advance care planning implementation for medical staff in different settings (e.g., hospitals, outpatients, care and nursing homes) during the COVID-19 pandemic. Methods: This study followed an overview of review design and was registered in the International Prospective Register of Systematic Reviews (CRD42022351362). A search of MEDLINE, CENTRAL, Web of Science, and Embase databases was performed through November 14, 2022. AMSTAR 2 was used to assess the risk of bias. Results: The final analyses included seven studies. Common barriers to advance care planning implementation included visitation restrictions, limited resources and personnel, and lack of coordination among health professionals. In care and nursing homes, the lack of palliative care physicians and the psychological burden on staff were identified as barriers. Using telemedicine for information-sharing was a common facilitator. In hospitals, facilitators were short-term training in palliative care and palliative care physicians joining the acute care team; in care homes and nursing homes, they were advance care planning education and emotional support for staff. Conclusions: Although inadequate staff education regarding advance care planning in hospitals and facilities and the lack of community-level information-sharing have long been noted, the pandemic highlighted these issues. Short-term training programs for staff and immediate information-sharing could facilitate advance care planning. 

/pdf/barriers-to-and-facilitators-of-advance-care-planning-1z79vhtj.pdf

Barriers to and facilitators of advance care planning implementation for medical staff after the coronavirus disease 2019 pandemic: An overview of reviews

Objetivo: Analizar los niveles de estrés, ansiedad y depresión de los profesionales sanitarios del Servicio de Emergencias Médicas (SEM) de Castilla y León durante la pandemia por COVID-19, así como determinar su asociación con determinados factores. Métodos: Estudio descriptivo transversal en el que se incluyeron a todos los profesionales sanitarios que entre el 01/02/2021 y el 30/04/2021 se encontraban trabajando en el SEM de Castilla y León. Sus niveles de estrés, ansiedad y depresión, evaluado mediante la escala DASS-21, fueron los resultados principales del estudio. Se recogieron también variables socio-demográficas, laborales y relacionadas con la COVID-19 y se estudió su posible asociación con las variables psicológicas citadas mediante un análisis univariante y multivariante. Resultados: Los profesionales sanitarios del SEM obtuvieron una puntuación media de 19.60 (DE ± 11.14) para estrés, 12.30 (DE ± 11.45) para ansiedad y 15.14 (DE ± 11.52) para depresión. Ser mujer se asoció con valores graves o extremadamente graves de estrés (OR 1.861; IC95% 1.026-3.377), ansiedad (OR 3.319; IC95% 1.696-6.495) y depresión (OR 2.334; IC95% 1.275-4.272); haber precisado psicoterapia y/o psicofármacos previamente, con valores graves o extremadamente graves de estrés (OR 4.762; IC95% 2.332-9.728) y ansiedad (OR 4.059; IC95% 1.921-8.576); mientras que trabajar como TES, con valores graves o extremadamente graves de ansiedad (OR 5.143; IC95% 2.633- 10.049) y depresión (OR 2.211; IC95% 1.220-4.004). Conclusión: Los profesionales sanitarios del SEM de Castilla y León presentaron niveles medios-elevados de estrés, ansiedad y depresión durante la pandemia. Existen factores socio-demográficas, laborales y relacionados con la COVID-19 que se asocian con una mayor afectación psicológica.

pdf/afectacion-psicologica-de-los-profesionales-sanitarios-de-la-2hggtljy.pdf

Afectación psicológica de los profesionales sanitarios de la gerencia de emergencias sanitarias de Castilla y León durante la pandemia Covid-19

Painel viral respiratório e evolução clínica pediátrica durante a pandemia da covid-19 em goiânia – goiás

Guidelines on resource allocation, ethics, triage processes with admission and discharge criteria from critical care and palliative care units during the pandemia are here presented. The interdisciplinary and multi-society panel that prepared these guidelines represented by bioethicists and specialists linked to the end of life: clinicians, geriatricians, emergentologists, intensivists, and experts in palliative care and cardiopulmonary resuscitation. The available information indicates that approximately 80% of people with COVID-19 will develop mild symptoms and will not require hospital care, while 15% will require intermediate or general room care, and the remaining 5% will require assistance in intensive care units. The need to think about justice and establish ethical criteria for allocation patients arise in conditions of exceeding available resources, such as outbreaks of diseases and pandemics, with transparency being the main criterion for allocation. These guides recommend general criteria for the allocation of resources relies on bioethical considerations, rooted in Human Rights and based on the value of the dignity of the human person and substantial principles such as solidarity, justice and equity. The guides are recommendations of general scope and their usefulness is to accompany and sustain the technical and scientific decisions made by the different specialists in the care of critically ill patients, but given the dynamic nature of the pandemic, a process of permanent revision and adaptation of recommendations must be ensured.

[Ethical guides, criteria for admission in intensive care, palliative care. Multi-society recommendations for allocation of resources during the COVID-19 pandemic]

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[Ethical guides, criteria for admission in intensive care, palliative care. Multi-society recommendations for allocation of resources during the COVID-19 pandemic]