Books by Márcio Niemeyer-Guimarães
Sao Paulo Medical Journal, 2011
CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patie... more CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting.
DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil.
METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used.
RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not signi cantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040).
CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.
Editora Unifeso, 2019
Segundo volume da coleção Caminhos da Bioética, publicado pela Editora Unifeso.
Editora UNIFESO, 2018
É com enorme sentimento de realização que apresentamos este pequeno exemplar que inaugura uma ... more É com enorme sentimento de realização que apresentamos este pequeno exemplar que inaugura uma série de livros sob o título Caminhos da Bioética. É clichê compreender a própria obra como um instrumento diferenciado, inovador... transformador, alguns arriscam. A riqueza do conteúdo e referências são aspectos sempre mencionados por organizadores, como nós. Não podemos fazer diferente. Embora muito do que se produz academicamente se limite à atender os indicadores dos órgãos reguladores da educação superior brasileira, acreditamos firmemente que apresentamos algo realmente 'inovador' e 'transformador'. Inovador pois no campo da Bioética, ainda jovem, não é comum se deparar com uma obra tão eclética. O leitor encontra de tudo um pouco por aqui. Soma-se à isso o fato de se tratar de um livro inteiramente aberto ao público, com acesso e download gratuito no site da Editora UNIFESO. Ponto para esta Instituição e ponto para os autores, que gentilmente compartilham os frutos de anos de pesquisa e reflexão com a sociedade.
Transfomador pois procuramos publicar alguma coisa que representasse as diversas direções e sentidos que a Bioética permite e, devemos dizer, carece, sobretudo dada sua natureza multívoca e sua apropriação crescente nas diversas áreas do conhecimento. Por este motivo, este primeiro volume contou com a participação de pesquisadores envolvidos em diversas áreas da Bioética, vinculados à diversas IES e cujos olhares representam múltiplas formações acadêmicas, em especial, o privilégio da cooperação do Instituto de Bioética da Universidade Católica Portuguesa do Porto, capitaneados pelo prefácio do estimado Prof. Dr. Walter Oswald.
Fato é que este livro, um pequeno passo do longo caminho que projetamos à frente, rebenta de uma decisão tomada ainda enquanto estudantes do doutorado em Bioética, pelo Programa de Pós-graduação em Bioética, Ética Aplicada e Saúde Coletiva. O rico ambiente acadêmico encontrado por estes dois pesquisadores - João Cardoso de Castro e Márcio Niemeyer-Guimarães - neste programa de pós-graduação, acrescido das experiências proporcionadas pelo Programa de Doutorado Sanduíche no
Exterior [CAPES-PDSE], em Chicago e Porto, respectivamente, fomentou em ambos a iniciativa de produzir um conteúdo diverso, sortido, poderíamos dizer.
Entendemos que as reflexões e análises aqui apresentadas constituem uma ótima oportunidade de leitura para todos que se defrontam com questões éticas e uma rica fonte de referência para aqueles que procuram refletir de maneira mais profunda a natureza das decisões e condutas, ou necessitam de orientações de juízo prático no dia-a-dia. Além de oferecer amplo arcabouço teórico em algumas áreas da Filosofia, das Ciências Humanas e Sociais, da Saúde e do Direito, entendemos que este volume é um estímulo ao ensino e à educação para todos que enveredam pelos caminhos da Bioética.
Diz-se que o grande filósofo alemão, Martin Heidegger, quando perguntado sobre suas obras, lucidamente respondia: não tenho obras, mas caminhos! Gostamos de pensar da mesma forma. Apresentamos aqui alguns caminhos...
João Cardoso de Castro Márcio Niemeyer-Guimarães
Papers by Márcio Niemeyer-Guimarães
info:eu-repo/semantics/publishedVersio
Revista da JOPIC, Dec 30, 2019
Revista da Faculdade de Medicina de Teresópolis, Dec 15, 2020
Cadernos de Saúde, Jan 2, 2018
Introduction: Identifying factors that can help move palliative care assessments upstream appears... more Introduction: Identifying factors that can help move palliative care assessments upstream appears to be potentially beneficial for older cancer patients in the critical care setting. Aim: This study aimed to determine the profile of older cancer patients admitted to the intensive care unit (ICU) and examine possible associations with criteria for a palliative care assessment. Material and Methods: Data were collected on demographics and ICU outcome (death vs discharge) from patients aged ≥ 65 years with advanced cancer admitted to a general ICU from August 2013 to July 2014 in a single institution. Chronic conditions were scored using Charlson comorbidity index (CCI) and geriatric index of comorbidity (GIC). Severity of illness (prognosis) was assessed with simplified acute physiology score (SAPS3) and sequential organ failure assessment (SOFA), and performance status with Karnofsky performance scale (KPS) and palliative performance scale (PPS) on admission and day 7. Patients were screened for unmet palliative care needs on admission (PC1) and day 7 (PC2) using the Center to Advance Palliative Care primary/secondary criteria. Results: Of 71 patients included, 52.1% were women; mean (SD) age was 76.9 (7.1) years. GIC scores were correlated with PC1 (rs = 0.326, P = 0.005) and PC2 (rs = 0.262, P = 0.027). PC1 was correlated with prognostic scores (SAPS3: rs = 0.236, P = 0.047; SOFA: rs = 0.263; P = 0.027), while PC2 was correlated with both prognostic scores (SAPS3: rs = 0.321, P = 0.006; SOFA: rs = 0.343, P = 0.003) and performance status (KPS: rs = -0.413, P = 0.0003; PPS: rs = -0.505, P = 0.0001). Patients who died in the ICU (N = 39, 54.9%) or were discharged (N = 32, 45.1%) differed significantly in performance status (KPS, P = 0.012; PPS, P = 0.005), but not in prognostic scores (SAPS3, P = 0.31; SOFA, P = 0.41) or comorbidity indices (CCI, P = 0.85; GIC, P = 0.94). Conclusions: Our findings suggest that early palliative care should be integrated into intensive care to avoid potentially inappropriate interventions or procedures in older cancer patients admitted to the ICU with poor performance status and prognostic scores. Introdução: A identificação de fatores que podem ajudar a antecipar as avaliações de cuidados paliativos parece ser potencialmente benéfica para pacientes idosos com câncer no ambiente de cuidados intensivos. Objetivo: Este estudo teve como objetivo determinar o perfil de pacientes idosos com câncer admitidos na unidade de terapia intensiva (UTI) e examinar possíveis associações com critérios para avaliação de cuidados paliativos. Material e métodos: Foram coletados dados sobre dados demográficos e resultado da UTI (óbito versus alta) de pacientes com idade ≥ 65 anos com câncer avançado admitidos em uma UTI geral, de agosto de 2013 a julho de 2014, em uma única instituição. As condições crônicas foram pontuadas usando o índice de comorbidade de Charlson (CCI) e o índice geriátrico de comorbidade (GIC). A gravidade da doença (prognóstico) foi avaliada com escore de fisiologia aguda simplificada (SAPS3) e avaliação sequencial de falência de órgãos (SOFA) e estado de funcionalidade com a escala de desempenho de Karnofsky
Palliative Care: Research and Treatment
Toward the end of life, older cancer patients with terminal illness often prefer palliative over ... more Toward the end of life, older cancer patients with terminal illness often prefer palliative over life-extending care and also prefer to die at home. However, care planning is not always consistent with patients’ preferences. In this article, discussions will be centered on patients’ autonomy of exercising control over their bodies within the current biotechnoscientific paradigm and in the context of population aging. More specifically, the biopolitical strategy of medicine in the context of hospital-centered health care control and of the frail condition of cancer patients in the intensive care unit will be considered in terms of the bioethics of protection. This ethical principle may provide support to these patients by ensuring that they receive appropriate treatment of pain and other physical, psychosocial, and spiritual problems in an attempt to focus attention on the values of the ill person rather than limiting it to the illness.
Geriatrics & Gerontology International, 2015
To determine longitudinal changes in functional status using three functional assessment scales i... more To determine longitudinal changes in functional status using three functional assessment scales in elderly patients undergoing coronary artery bypass grafting. This was a prospective observational cohort study of 73 patients aged ≥60 years undergoing elective coronary artery bypass grafting. Patients were assessed for functional status before admission, at hospital discharge, and at 1 and 6 months after discharge using the Functional Independence Measure, Katz Activities of Daily Living scale, and Lawton Instrumental Activities of Daily Living scale. Data were stratified by age (≥70 years and <70 years) and complications (with and without) for analysis. In patients aged ≥70 years (n = 38), Functional Independence Measure scores ranged from 121.30 ± 6.42 (pre-admission) to 112.10 ± 17.10 (1 month) and 117.80 ± 13.50 (6 months), Katz scores from 5.88 ± 0.32 (pre-admission) to 5.45 ± 1.04 (1 month) and 5.83 ± 0.65 (6 months), and Lawton scores from 25.40 ± 3.30 (pre-admission) to 20.05 ± 4.93 (1 month) and 24.50 ± 4.10 (6 months; P < 0.001 for all). No significant changes were found in scale scores over time between groups with (n = 34) and without (n = 39) complications. When groups aged ≥70 years (n = 38) and <70 (n = 35) were compared, Functional Independence Measure scores showed a difference toward recovery over time in older patients (discharge - pre-admission, P = 0.010; 1 month - pre-admission, P = 0.0004; and 6 months - pre-admission, P = 0.079). The Functional Independence Measure was able to detect significant functional loss over a 6-month period in elderly patients undergoing coronary artery bypass grafting, suggesting that this scale is a promising tool for the assessment of functional recovery over time after cardiac surgery, especially in patients aged older than 70 years. Geriatr Gerontol Int 2015; ●●: ●●-●●.
Jornal Brasileiro de Pneumologia, 2006
OBJETIVO: Determinar prevalência de pneumonia associada à ventilação mecânica em unidade de terap... more OBJETIVO: Determinar prevalência de pneumonia associada à ventilação mecânica em unidade de terapia intensiva, fatores associados e evolução. MÉTODOS: Foram avaliados 278 pacientes sob ventilação mecânica por mais de 24 horas prospectivamente em hospital universitário. RESULTADOS: Desenvolveram a doença 38,1% dos pacientes, 35,7 casos/1.000 dias de ventilação mecânica: 45,3% por bacilos gram negativos, Pseudomonas aeruginosa (22%) o mais comum e 43,4% por germes multi-resistentes. O grupo com pneumonia associada à ventilação mecânica teve maiores tempos de ventilação mecânica, desmame, permanência no hospital e na unidade de terapia intensiva (p < 0,001); atelectasia, síndrome do desconforto respiratório agudo, pneumotórax, sinusite, traqueobronquite e infecção multirresistente foram mais comuns (p < 0,05). Letalidades na unidade de terapia intensiva e no hospital foram semelhantes. Fatores associados à doença (razão de chances; intervalo de confiança 95%): sinusite aguda (38,...
Sao Paulo Medical Journal, 2011
CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patie... more CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and witho...
Introduction: Identifying factors that can help move palliative care assessments upstream appears... more Introduction: Identifying factors that can help move palliative care assessments upstream appears to be potentially beneficial for older cancer patients in the critical care setting. Aim: This study aimed to determine the profile of older cancer patients admitted to the intensive care unit (ICU) and examine possible associations with criteria for a palliative care assessment. Materials and Methods: Data were collected on demographics and ICU outcome (death vs discharge) from patients aged ≥ 65 years with advanced cancer admitted to a general ICU from August 2013 to July 2014 in a single institution. Chronic conditions were scored using Charlson comorbidity index (CCI) and geriatric index of comorbidity (GIC). Severity of illness (prognosis) was assessed with simplified acute physiology score (SAPS3) and sequential organ failure assessment (SOFA), and performance status with Karnofsky performance scale (KPS) and palliative performance scale (PPS) on admission and day 7. Patients were...
Este estudo descritivo teve como objetivo avaliar o perfil de quedas, identificando os pacientes ... more Este estudo descritivo teve como objetivo avaliar o perfil de quedas, identificando os pacientes de risco no Instituto Nacional de Traumatologia e Ortopedia - INTO, de forma a estabelecer medidas de prevencao eficazes com foco na seguranca da assistencia. Foram analisadas 35 notificacoes referentes as quedas no periodo de janeiro a dezembro de 2010, com as seguintes caracteristicas: 68 por cento dos pacientes com idade inferior a 60 anos, 57 por cento do sexo feminino, 83 por cento com sinalizacao para queda na internacao, 65 por cento com queda ocorrida durante o turno do dia e 53 por cento com queda nas enfermarias. A caracterizacao destas notificacoes auxilia na seguranca da assistencia e minimiza possiveis danos durante a internacao.
Cadernos de Saúde, 2018
Introduction: Identifying factors that can help move palliative care assessments upstream appears... more Introduction: Identifying factors that can help move palliative care assessments upstream appears to be potentially beneficial for older cancer patients in the critical care setting. Aim: This study aimed to determine the profile of older cancer patients admitted to the intensive care unit (ICU) and examine possible associations with criteria for a palliative care assessment. Material and Methods: Data were collected on demographics and ICU outcome (death vs discharge) from patients aged ≥ 65 years with advanced cancer admitted to a general ICU from August 2013 to July 2014 in a single institution. Chronic conditions were scored using Charlson comorbidity index (CCI) and geriatric index of comorbidity (GIC). Severity of illness (prognosis) was assessed with simplified acute physiology score (SAPS3) and sequential organ failure assessment (SOFA), and performance status with Karnofsky performance scale (KPS) and palliative performance scale (PPS) on admission and day 7. Patients were screened for unmet palliative care needs on admission (PC1) and day 7 (PC2) using the Center to Advance Palliative Care primary/secondary criteria. Results: Of 71 patients included, 52.1% were women; mean (SD) age was 76.9 (7.1) years. GIC scores were correlated with PC1 (rs = 0.326, P = 0.005) and PC2 (rs = 0.262, P = 0.027). PC1 was correlated with prognostic scores (SAPS3: rs = 0.236, P = 0.047; SOFA: rs = 0.263; P = 0.027), while PC2 was correlated with both prognostic scores (SAPS3: rs = 0.321, P = 0.006; SOFA: rs = 0.343, P = 0.003) and performance status (KPS: rs = −0.413, P = 0.0003; PPS: rs = −0.505, P = 0.0001). Patients who died in the ICU (N = 39, 54.9%) or were discharged (N = 32, 45.1%) differed significantly in performance status (KPS, P = 0.012; PPS, P = 0.005), but not in prognostic scores (SAPS3, P = 0.31; SOFA, P = 0.41) or comorbidity indices (CCI, P = 0.85; GIC, P = 0.94). Conclusions: Our findings suggest that early palliative care should be integrated into intensive care to avoid potentially inappropriate interventions or procedures in older cancer patients admitted to the ICU with poor performance status and prognostic scores.
J Bras Pneumol, 2006
Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care un... more Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%); and multidrug resistant organisms were identified in 43.4%. In the ventilator-associated pneumonia group, time on mechanical ventilation, time to mechanical ventilation weaning, hospital stays and intensive care unit stays were all longer (p < 0.001). In addition, atelectasis, acute respiratory distress syndrome, pneumothorax, sinusitis, tracheobronchitis and infection with multidrug resistant organisms were more common in the ventilator-associated pneumonia group (p < 0.05). Mortality rates in the intensive care unit were comparable to those observed in the hospital infirmary. Associations between ventilator-associated pneumonia and various factors are expressed as odds ratios and 95% confidence intervals: acute sinusitis (38.8; 3.4-441); > 10 days on mechanical ventilation (7.7; 4.1-14.2); immunosuppression (4.3; 1.3-14.3); acute respiratory distress syndrome (3.5; 1.4-9.0); atelectasis (3.0; 1.2-7.3); cardiac arrest (0.18; 0.05-0.66); and upper gastrointestinal tract bleeding (0.07; 0.009-0.62). The variables found to be associated with in-hospital death were as follows: chronic renal failure (26.1; 1.9-350.7); previous intensive care unit admission (15.6; 1.6-152.0); simplified acute physiologic score II > 50 (11.9; 3.4-42.0); and age > 55 years (4.4; 1.6-12.3). Conclusion: Ventilator-associated pneumonia increased the time on mechanical ventilation and the number of complications, as well as the length of intensive care unit and hospital stays, but did not affect mortality rates.
Geriatr Gerontol Int, 2016
Aim: To determine longitudinal changes in functional status using three functional assessment sca... more Aim: To determine longitudinal changes in functional status using three functional assessment scales in elderly patients undergoing coronary artery bypass grafting. Methods: This was a prospective observational cohort study of 73 patients aged ≥60 years undergoing elective coronary artery bypass grafting. Patients were assessed for functional status before admission, at hospital discharge, and at 1 and 6 months after discharge using the Functional Independence Measure, Katz Activities of Daily Living scale, and Lawton Instrumental Activities of Daily Living scale. Data were stratified by age (≥70 years and <70 years) and complications (with and without) for analysis. Results: In patients aged ≥70 years (n = 38), Functional Independence Measure scores ranged from 121.30 ± 6.42 (pre-admission) to 112.10 ± 17.10 (1 month) and 117.80 ± 13.50 (6 months), Katz scores from 5.88 ± 0.32 (pre-admission) to 5.45 ± 1.04 (1 month) and 5.83 ± 0.65 (6 months), and Lawton scores from 25.40 ± 3.30 (pre-admission) to 20.05 ± 4.93 (1 month) and 24.50 ± 4.10 (6 months; P < 0.001 for all). No significant changes were found in scale scores over time between groups with (n = 34) and without (n = 39) complications. When groups aged ≥70 years (n = 38) and <70 (n = 35) were compared, Functional Independence Measure scores showed a difference toward recovery over time in older patients (discharge-pre-admission, P = 0.010; 1 month-pre-admission, P = 0.0004; and 6 months-pre-admission, P = 0.079). Conclusions: The Functional Independence Measure was able to detect significant functional loss over a 6-month period in elderly patients undergoing coronary artery bypass grafting, suggesting that this scale is a promising tool for the assessment of functional recovery over time after cardiac surgery, especially in patients aged older than 70 years.
Palliative Care: Research and Treatment, 2017
Toward the end of life, older cancer patients with terminal illness often prefer palliative over ... more Toward the end of life, older cancer patients with terminal illness often prefer palliative over life-extending care and also prefer to die at home. However, care planning is not always consistent with patients’ preferences. In this article, discussions will be centered on patients’ autonomy of exercising control over their bodies within the current biotechnoscienti c paradigm and in the context of population aging. More speci cally, the biopolitical strategy of medicine in the context of hospital-centered health care control and of the frail condition of cancer patients in the intensive care unit will be considered in terms of the bioethics of protection. This ethical principle may provide support to these patients by ensuring that they receive appropriate treatment of pain and other physical, psychosocial, and spiritual problems in an attempt to focus attention on the values of the ill person rather than limiting it to the illness.
Revista da JOPIC, 2019
Serious life-threatening illnesses are a significant challenge for society and health systems, in... more Serious life-threatening illnesses are a significant challenge for society and health systems, in particular as biomedicine has advanced over the last century, changing and extending life expectancy, the so-called longevity revolution. Reflecting on these issues with future perspectives is essential for the promotion of policies focusing on the alleviation of suffering related to chronic health conditions, the promotion of the palliative care approach and the prevention of health system overload. The objective is to highlight the global burden of health-related problems in these conditions of serious and incurable diseases, the unmet demand on palliative care for current and in the near future, especially in the elderly with chronic conditions and multimorbidity.
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Books by Márcio Niemeyer-Guimarães
DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil.
METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used.
RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not signi cantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040).
CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.
Transfomador pois procuramos publicar alguma coisa que representasse as diversas direções e sentidos que a Bioética permite e, devemos dizer, carece, sobretudo dada sua natureza multívoca e sua apropriação crescente nas diversas áreas do conhecimento. Por este motivo, este primeiro volume contou com a participação de pesquisadores envolvidos em diversas áreas da Bioética, vinculados à diversas IES e cujos olhares representam múltiplas formações acadêmicas, em especial, o privilégio da cooperação do Instituto de Bioética da Universidade Católica Portuguesa do Porto, capitaneados pelo prefácio do estimado Prof. Dr. Walter Oswald.
Fato é que este livro, um pequeno passo do longo caminho que projetamos à frente, rebenta de uma decisão tomada ainda enquanto estudantes do doutorado em Bioética, pelo Programa de Pós-graduação em Bioética, Ética Aplicada e Saúde Coletiva. O rico ambiente acadêmico encontrado por estes dois pesquisadores - João Cardoso de Castro e Márcio Niemeyer-Guimarães - neste programa de pós-graduação, acrescido das experiências proporcionadas pelo Programa de Doutorado Sanduíche no
Exterior [CAPES-PDSE], em Chicago e Porto, respectivamente, fomentou em ambos a iniciativa de produzir um conteúdo diverso, sortido, poderíamos dizer.
Entendemos que as reflexões e análises aqui apresentadas constituem uma ótima oportunidade de leitura para todos que se defrontam com questões éticas e uma rica fonte de referência para aqueles que procuram refletir de maneira mais profunda a natureza das decisões e condutas, ou necessitam de orientações de juízo prático no dia-a-dia. Além de oferecer amplo arcabouço teórico em algumas áreas da Filosofia, das Ciências Humanas e Sociais, da Saúde e do Direito, entendemos que este volume é um estímulo ao ensino e à educação para todos que enveredam pelos caminhos da Bioética.
Diz-se que o grande filósofo alemão, Martin Heidegger, quando perguntado sobre suas obras, lucidamente respondia: não tenho obras, mas caminhos! Gostamos de pensar da mesma forma. Apresentamos aqui alguns caminhos...
João Cardoso de Castro Márcio Niemeyer-Guimarães
Papers by Márcio Niemeyer-Guimarães
DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil.
METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used.
RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not signi cantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040).
CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.
Transfomador pois procuramos publicar alguma coisa que representasse as diversas direções e sentidos que a Bioética permite e, devemos dizer, carece, sobretudo dada sua natureza multívoca e sua apropriação crescente nas diversas áreas do conhecimento. Por este motivo, este primeiro volume contou com a participação de pesquisadores envolvidos em diversas áreas da Bioética, vinculados à diversas IES e cujos olhares representam múltiplas formações acadêmicas, em especial, o privilégio da cooperação do Instituto de Bioética da Universidade Católica Portuguesa do Porto, capitaneados pelo prefácio do estimado Prof. Dr. Walter Oswald.
Fato é que este livro, um pequeno passo do longo caminho que projetamos à frente, rebenta de uma decisão tomada ainda enquanto estudantes do doutorado em Bioética, pelo Programa de Pós-graduação em Bioética, Ética Aplicada e Saúde Coletiva. O rico ambiente acadêmico encontrado por estes dois pesquisadores - João Cardoso de Castro e Márcio Niemeyer-Guimarães - neste programa de pós-graduação, acrescido das experiências proporcionadas pelo Programa de Doutorado Sanduíche no
Exterior [CAPES-PDSE], em Chicago e Porto, respectivamente, fomentou em ambos a iniciativa de produzir um conteúdo diverso, sortido, poderíamos dizer.
Entendemos que as reflexões e análises aqui apresentadas constituem uma ótima oportunidade de leitura para todos que se defrontam com questões éticas e uma rica fonte de referência para aqueles que procuram refletir de maneira mais profunda a natureza das decisões e condutas, ou necessitam de orientações de juízo prático no dia-a-dia. Além de oferecer amplo arcabouço teórico em algumas áreas da Filosofia, das Ciências Humanas e Sociais, da Saúde e do Direito, entendemos que este volume é um estímulo ao ensino e à educação para todos que enveredam pelos caminhos da Bioética.
Diz-se que o grande filósofo alemão, Martin Heidegger, quando perguntado sobre suas obras, lucidamente respondia: não tenho obras, mas caminhos! Gostamos de pensar da mesma forma. Apresentamos aqui alguns caminhos...
João Cardoso de Castro Márcio Niemeyer-Guimarães