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Biomedical subjects

D Gracia

Publications and source records attributed to D Gracia.

At least 19 recordsLinked to original sources
PubMed2001

Moral deliberation: the role of methodologies in clinical ethics.

The experience of the last thirty years has shown that whether the different methodologies used in clinical ethics work well or not depends on certain external factors, such as the mentality with which they are used. This article aims to analyze two of these mentalities: the "dilemmatic" and the "problematic." The former uses preferably the decision-making theory, whilst the latter emphasizes above all the role of deliberation. The author considers that Clinical Ethics must be deliberationist, and that only in this context the different methodologies can be used correctly.

Decision Making↗
PubMed2000

Report from Spain.

Palliative care programmes have expanded enormously in recent years in Spain, with great success in terms of coverage of the target population and opioid consumption, but at the expense of deficiencies in the training of professionals and scarcity of fully comprehensive palliative care systems. A balance has developed with an almost even distribution of resources between home care and in-patient services, in spite of a strong tendency in recent years to prioritize domiciliary care in the wake of policies requiring limitation of health expenditure.

Education, Medical, Undergraduate↗
PubMed1999

ckshs expression is linked to cell proliferation in normal and malignant human lymphoid cells.

Cyclin kinase sub-units (CKS) are known to interact with cyclin-dependent kinases (CDKs), but their functions are not completely understood and their expression in human tissues is not documented. For analyzing relationships of CKS with cell proliferation and/or with differentiation, we investigated the expression of ckshs1 and ckshs2 in normal and malignant human lymphoid cells. ckshs1 and ckshs2 expression appeared to be related to cell proliferation: (i) mRNAs increased with stimulation of normal peripheral-blood lymphocytes, and from the G1 to the SG2M phase in elutriated cells; (ii) P9 proteins were also induced by lymphocyte stimulation and were localized in nucleus where phosphorylated forms of CDK1 were also found; (iii) in vitro, the phosphorylated forms of CDK1 and CDK2 were preferentially linked to CKS. Among 45 patients presenting acute or chronic lymphoid malignancy, ckshs1 and ckshs2 mRNAs varied in a similar way and were significantly correlated to cell proliferation (p < 0.0001). When analysis was restricted solely to acute lymphoblastic leukemia (ALL) this correlation was still found and ckshs1 and ckshs2 were significantly more expressed in T-cell ALL than in B-cell-lineage ALL. These results confirm relationships between ckshs expression and cell proliferation, and pose the question of a link with cell differentiation.

Animals↗
PubMed1997

Effect of 2 urban emergency department immunization programs on childhood immunization rates.

BACKGROUND: Emergency departments (EDs) are recommended as sites for immunizing children. However, there is little information about the effect of ED immunization programs on immunization rates. OBJECTIVES: To assess the ability of 2 ED immunization programs to vaccinate children and to measure the effect of the programs on immunization rates after the ED visit and 6 months later. DESIGN: A prospective cohort study. Emergency department patients were screened for immunization status, and vaccinations were offered to patients who either were documented to be eligible or were eligible by age and had no documented records. A systematic, sequential sample of those accepting vaccinations (study patients) was compared with a systematic, sequential sample of those not vaccinated (control subjects). Telephone interviews and medical record reviews were performed 6 months after the ED visit to verify dates of immunizations. Results were weighted to reflect the sampling frames of patients screened by the 2 programs. SETTING: Two EDs in New York City (in Manhattan and the Bronx) and the surrounding primary care offices. PATIENTS: Children (aged 0-6 years) screened for immunization status by the ED immunization program during a 10-week period; these included 210 children from the Manhattan ED (106 vaccinated in the ED) and 274 children from the Bronx ED (129 vaccinated in the ED). INTERVENTION: Emergency department immunizations. MAIN OUTCOME MEASURES: Proportion of patients (vaccinated, not vaccinated, and ED population) up-to-date for immunizations (1) at the time of the ED visit, (2) 1 day later, and (3) 6 months later. RESULTS: Two thirds of the patients in each ED had Medicaid, and one tenth were uninsured. At the time of the ED visit, 20% of the vaccinated children in each ED were actually up-to-date and were unnecessarily vaccinated; 74% (Manhattan ED) and 72% (Bronx ED) of the not vaccinated children were up-to-date (the remainder were later determined to have been eligible for vaccinations). One day after the ED visit, and 6 months later, the immunization rates of the vaccinated and not vaccinated children were similar. The results of the weighted analysis were as follows: for the entire ED population screened for immunization status, compared with up-to-date rates at the time of the ED visit, rates 1 day later were 11% (Manhattan ED) and 8% (Bronx ED) higher in each ED (P < .05); and rates 6 months later were the same in the Manhattan ED and 10% lower in the Bronx ED (P < .01). Eighteen percent of all children screened for immunization status were vaccinated; 10 to 15 children were screened and 2 to 4 children were vaccinated per 8-hour ED shift. CONCLUSIONS: This ED immunization program temporarily improved the immunization rates of the ED population, but substantial personnel time was required to achieve these small gains. Urban ED immunization programs are unlikely to be cost-effective.

Child↗
PubMed1996

The historical setting of Latin American bioethics.

The historical stages through which Latin American society has passed are at least four: the first, dominated by a particular sort of ethic I have termed the "ethic of the gift;" then the period of conquest, in which the prevalent ethic was one of war and subjection by force, which I call the "ethic of despotism;" followed by the colonial age, in which a new ethical model of "paternalism" emerged; and finally the stage of the "ethic of autonomy," which began with the independence movements of the 18th and 19th centuries and is far from ended. Independence was won by the criollos from European domination with very little participation by the Indian population. The latter was left out of the democratic process and saw itself relegated to a worse situation than in the centuries of colonial rule, for it was no longer protected by the paternalism of the Laws of the Indies of 1542. This is the reason for the division of the Latin American society of the last century into two quite different social strata: one bourgeois, which has assimilated the liberal revolution, and enjoys a health care quite similar to that available in any other Western country and hence faces the same bioethical problems as any developed Western society; the other a very poor stratum, without any economic or social power and hence unable to exercise its civil rights, such as the rights to life and to humane treatment. In this population sector; which is numerically the larger, the major bioethical problems are those of justice and the distribution of scarce resources. The study of Latin American medical ethics can earn for these subjects, whose deplorable condition has been essentially ignored in the bioethics of the first-world countries, the importance they merit.

Bioethical Issues↗
PubMed1990

Introduction: medical bioethics.

The key concepts of modern medical bioethics can be traced back to ideas developed in the course of the history of medicine and to political concepts harkening back as far as Plato. This work reviews these historical developments and demonstrates their relevance to current bioethics.

Beneficence↗