Browsing by Author "Vukusich, Antonio"

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    Conflictos de intereses en nefrología
    (Sociedad Medica de Santiago, 2016) Salas Ibarra, Sofía; Vukusich, Antonio; Catoni, Maria; Valdivieso, Andres; Roessler, Emilio
    Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation­ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.
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    Problemas ético-clínicos en hemodiálisis crónica: percepción de médicos y enfermeras
    (Sociedad Medica de Santiago, 2016) Vukusich, Antonio; Catoni, Maria; Salas Ibarra, Sofía; Valdivieso, Andres; Browne, Francisca; Roessler, Emilio
    Background: Clinical teams working at chronic hemodialysis centers (CHC) frequently have to face ethical problems, but there is no systematic approach to deal with them. Aim: To study the ethical problems perceived by health professionals at CHC. Material and Methods: Eighty randomly selected physicians and 139 nurses from 23 CHC, answered a structured questionnaire, devised by the research team. Results: Twenty-six percent of respondents had postgraduate studies in clinical ethics. The ethical problems mentioned by respondents were therapeutic disproportion in 66.7%, lack of communication between patients, their families and the clinical team in 25.9%, personal conflicts of interests related with hemodialysis prescription in 14.6% and conflicts of interests of other members of the clinical team in 30.6%. The percentage of respondents that experienced not starting or discontinuing hemodialysis treatment due to decision of patients’ relatives was 86.8%. Only 45.2% of health professionals had the opportunity to take part in decision-making meetings. Eighty seven percent of respondents supported the use of advanced directives in the event of a cardio respiratory arrest during treatment. Conclusions: To improve the approach to ethical problems in CHC, it is necessary to improve training in clinical ethics, promote an effective dialogue between the patients, their families and health professionals, and follow their advance directives in case of cardiac arrest during treatment.
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    Recomendaciones del Comité de Ética de la Sociedad Chilena de Nefrología para el manejo de los problemas ético-clínicos de pacientes adultos con enfermedad renal crónica terminal
    (Sociedad Médica de Santiago, 2014) Vukusich, Antonio; Catoni, María Isabel; Salas Ibarra, Sofía; Valdivieso, Andrés; Roessler, Emilio
    There are different approaches to treat patients with End Stage Renal Disease (ESRD): hemodialysis, peritoneal dialysis, renal transplantation and conservative medical management. The choice of the best therapy for each patient, needs both clinical and ethical skills. The Ethics Committee of the Chilean Society of Nephrology has elaborated recommendations to help health workers to deal with the ethical and clinical problems related to patients suffering ESRD. Its goal is to guide, at a national level, the effective use of minimal standards in the treatment and care of patients with ESRD, including appropriate care and information for patients, therapy selection, management of difficult cases and potential conflicts.
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    Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores
    (2020) Catoni, María Isabel; Salas Ibarra, Sofía; Roessler, Emilio; Valdivieso, Andrés; Vukusich, Antonio; Rivera, María Soledad
    La enfermedad renal crónica es una causa importante de morbimortalidad mundial, estimándose que más de 1,4 millones de individuos con enfermedad renal terminal (ERT) reciben terapia de sustitución o trasplante renal, con un incremento de 8% anual, la mayoría de ellos tratados con hemodiálisis crónica (HDC)1. En Chile 22.310 personas se encuentran en HDC, siendo 53% de ellos adultos mayores (AM). La toma de decisiones compartida y las voluntades anticipadas (VA) son especialmente importantes en AM, ya que presentan mayor discapacidad, morbilidad y mortalidad, surgiendo dudas con respecto a los beneficios de la terapia. En un trabajo anterior demostramos que los principales problemas ético clínicos percibidos por médicos y enfermeras en centros de diálisis (CD) eran: a) la pertinencia de la HDC en pacientes muy deteriorados o con mala calidad de vida, y b) dificultades de comunicación para compartir decisiones o establecer alianzas terapéuticas entre pacientes, familiares y equipo tratante. El presente estudio tiene por objeto comprender la experiencia vivida con respecto a la toma de decisiones y explorar las formas de expresar la VA, en AM en HDC.
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    Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores
    (2020) Catoni, María Isabel; Salas Ibarra, Sofía; Roessler, Emilio; Valdivieso, Andrés; Vukusich, Antonio; Rivera, M. Soledad
    Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD. Material and Methods: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. Results: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. Conclusions: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

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