¿Cuáles son los conflictos éticos más frecuentes para los internistas españoles? / Which are the most prevalent ethical conflicts for Spanish internists?

Antecedentes y objetivo Los clínicos se enfrentan en su práctica diaria a multitud de conflictos éticos. No hay estudios sobre los tipos de conflictos éticos que se encuentran con más frecuencia y que preocupan más a los clínicos en España. El objetivo de este estudio es describir los conflictos éticos más frecuentes con los que se encuentran los internistas españoles, así como la importancia que los profesionales atribuyen a cada conflicto. Materiales y métodos Estudio observacional transversal a través de una encuesta voluntaria y anónima, dirigida a médicos internistas españoles y distribuida a través de una plataforma ad hoc de la Sociedad Española de Medicina Interna. Resultados Los problemas éticos más frecuentes y relevantes para los internistas españoles son los relacionados con: el final de la vida (decisiones de limitación del esfuerzo terapéutico, uso de tratamientos paliativos, instauración de órdenes de no reanimación cardiopulmonar); los conflictos que se producen en el seno de la relación clínica, bien con familiares o con pacientes, y la toma de decisiones con pacientes incompetentes. Estos resultados son similares a los de otras series anglosajonas y europeas. Los problemas éticos dificultan más la actividad asistencial a los clínicos que perciben con más frecuencia dichos problemas (50,3%) que los que no los perciben (16%). Conclusiones Los conflictos éticos más frecuentes y relevantes entre los internistas españoles son los relacionados con el manejo del final de la vida, seguidos de los derivados de la relación clínica y el manejo de pacientes incompetentes. Es prioritario diseñar programas de formación que permitan abordar y reconocer mejor dichos problemas (AU)

Background and objective Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. Materials and Methods Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. Results The most common and relevant ethical issues for Spanish internists are related to patients’ end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). Conclusions The most common and relevant ethical conflicts among Spanish internists are related to managing patients’ end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems (AU)

Which are the most prevalent ethical conflicts for Spanish internists?

BACKGROUND AND OBJECTIVE: Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS: Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS: The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS: The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.

Which are the most prevalent ethical conflicts for Spanish internists? / ¿Cuáles son los conflictos éticos más frecuentes para los internistas españoles?

BACKGROUND AND OBJECTIVE: Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS: Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS: The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS: The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.

[Telemedicine, prison and illness associated with HIV]. / Telemedicina, centros penitenciarios y enfermedad por VIH.

OBJECTIVE: Communicate the activity of telemedicine, from its opening, between a hospital consultation of infectious diseases and a penitentiary center. METHODS: Descriptive study of the tele-consultation of infectious diseases of the Alcorcón Foundation University Hospital with the Navalcarnero penitentiary center from 2013 to 2017, which is carried out by videoconference. The reason and number of consultations, diagnosis of HIV, antiretroviral treatment (ART), immunovirological situation, diagnosis of hepatitis C virus (HCV= and intervention performed by the infectious expert were analyzed. RESULTS: A total of 75 patients were evaluated in a total of 168 consultations (in the first year 11 consultations and in the fifth year 62). The index of successive / new consultations was 1.24 and 85% of the patients required less than 1 year of follow-up. 84% of patients did not move to the hospital. 99% of patients accepted this modality. 96% were HIV positive, 94% of them took ART and 85% had undetectable viral load with 532 CD4/mL of medium. 90% had positive serology for HCV. 72% of the consultations were for the assessment of HCV treatment, which was sofosbuvir/ledipasvir by 63%. 40% changed their ART (70% to avoid interactions). CONCLUSIONS: Most of the evaluated patients have HIV infection. This type of consultation has a growing demand, is efficient (avoids transfers and is decisive) and has high acceptance. The most frequent reason for consultation was the treatment of HCV and more than a third of patients required ART change.

¿Qué opinan los pacientes mayores y sus familiares sobre la limitación del esfuerzo terapéutico? / What do older patients and their families think about the limitation of therapeutic effort?

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