ResumoContexto: A prevalência do uso de drogas tem aumentado entre os jovens universitários, trazendo preocupação adicional aos estudantes de medicina que irão se deparar com as conseqüências desse problema durante o período de formação e na prática clínica. Objetivos: Avaliar as atitudes dos estudantes de medicina diante do abuso de drogas por colegas do meio acadêmico, comparando-as quanto às diferentes drogas envolvidas (ilícitas, lícitas e exclusivamente álcool). Métodos: Três versões de um questionário de auto-administração, aprovado pela Comissão de Ética para Análise de Projetos de Pesquisa, foram distribuídas em igual número para diferentes grupos de estudantes de medicina da Faculdade de Medicina da Universidade de São Paulo (FMUSP), sendo o enfoque de cada um deles as drogas lícitas, as ilícitas e o álcool. Resultados: Os resultados mostraram que existe diferença na atitude intervencionista dos estudantes diante do abuso de diferentes drogas. Também houve diferença ao considerarem a participação dos colegas, familiares e profissionais na abordagem do problema e quanto ao plano de tratamento nos casos de abuso. Conclusões: Os estudantes são mais tolerantes e consideram-se menos vulneráveis ao abuso do álcool, e, portanto, os prejuízos podem não ser percebidos até que haja uma disfuncionalidade incapacitante no campo pessoal e profissional.Mesquita, E.M. et al. / Rev. Psiq. Clín 35, supl 1; 8-12, 2008 Palavras-chave: Estudantes de medicina, abuso de drogas, ética. AbstractBackground: The prevalence of drug use among young college students is increasing. This gives cause for special concern to medical students who will later confront the consequences of the drug problems both in the classroom as well as in clinical practice. Objectives: The purpose of this paper is the evaluation of medical students' attitudes towards drug abuse in the academic environment; comparing these with respect to different kinds of drugs -illegal, legal, and alcohol exclusively. Methods: Three different versions of a self-completed questionnaire (approved by the Ethics Committee for Research Project Evaluation) were ministered to groups of equal numbers of medical students attending the University of Sao Paulo, School of Medicine -FMUSP (Brazil). Each questionnaire focused on illegal drugs, legal drugs, and alcohol. Results: The results indicated a significant difference in the students' attitudes regarding intervention for the different types of drug abuse. There was also indication of a difference in the students' opinions regarding the roles that colleagues, relatives, and health professionals undertake in dealing with these issues, including the respective treatment plans for drug abuse. Conclusions: Medical students tend to be more tolerant of alcohol consumption, considering themselves to be less vulnerable to alcohol abuse. Therefore, harmful consequences may not be apparent until an incapacitating level of dysfunction affects the individual on both a personal and professional level.

BackgroundIntensive care unit (ICU) admission triage is performed routinely and is often based solely on clinical judgment, which could mask biases. A computerized algorithm to aid ICU triage decisions was developed to classify patients into the Society of Critical Care Medicine’s prioritization system. In this study, we sought to evaluate the reliability and validity of this algorithm.MethodsNine senior physicians evaluated forty clinical vignettes based on real patients. The reference standard was defined as the priorities ascribed by two investigators with full access to patients’ records. Agreement of algorithm-based priorities with the reference standard and with intuitive priorities provided by the physicians were evaluated. Correlations between algorithm prioritization and physicians’ judgment of the appropriateness of ICU admissions in scarcity and nonscarcity settings were also evaluated. Validity was further assessed by retrospectively applying this algorithm to 603 patients with requests for ICU admission for association with clinical outcomes.ResultsAgreement between algorithm-based priorities and the reference standard was substantial, with a median κ of 0.72 (interquartile range [IQR] 0.52–0.77). Algorithm-based priorities demonstrated higher interrater reliability (overall κ 0.61, 95 % confidence interval [CI] 0.57–0.65; median percentage agreement 0.64, IQR 0.59–0.70) than physicians’ intuitive prioritization (overall κ 0.51, 95 % CI 0.47–0.55; median percentage agreement 0.49, IQR 0.44–0.56) (p = 0.001). Algorithm-based priorities were also associated with physicians’ judgment of appropriateness of ICU admission (priorities 1, 2, 3, and 4 vignettes would be admitted to the last ICU bed in 83.7 %, 61.2 %, 45.2 %, and 16.8 % of the scenarios, respectively; p < 0.001) and with actual ICU admission, palliative care consultation, and hospital mortality in the retrospective cohort.ConclusionsThis ICU admission triage algorithm demonstrated good reliability and validity. However, more studies are needed to evaluate a difference in benefit of ICU admission justifying the admission of one priority stratum over the others.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1262-0) contains supplementary material, which is available to authorized users.

BackgroundOne of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients’ values of modern pluralistic societies. To organize and optimize the the Decision-Making Process (DMP) of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care.Main bodyThe framework divides the DMP into four steps, each with a different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments’ burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient’s values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care (GOC), for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient’s values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step.ConclusionHopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based.

There was an increase of bioethical publications in the Medline database. The topics in bioethics literature have an important time variation. Some factors were suggested to explain this variation: current legal cases, resolution of the issue, saturation of a discussion and epidemiologic importance.