The effects of treatment as usual versus a computerized clinical decision aid on shared decision-making in the treatment of psychotic disorders

Background and objectives People with psychotic disorders can experience a lack of active involvement in their decisional process. Clinical decision aids are shared decision-making tools which are currently rarely used in mental healthcare. We examined the effects of Treatment E-Assist (TREAT), a computerized clinical decision aid in psychosis care, on shared decision-making and satisfaction with consultations as assessed by patients. Methods A total of 187 patients with a psychotic disorder participated. They received either treatment as usual in the first phase (TAU1), TREAT in the second phase or treatment as usual in the third phase of the trial (TAU2). The Decisional Conflict Scale was used as primary outcome measure for shared decision-making and patient satisfaction as secondary outcome. Results A linear mixed model analysis found no significant effects between TAU 1 (β = −0.54, SE = 2.01, p = 0.80) and TAU 2 (β = −1.66, SE = 2.63, p = 0.53) compared to TREAT on shared decision-making. High patient rated satisfaction with the consultations was found with no significant differences between TAU 1 (β = 1.48, SE = 1.14, p = 0.20) and TAU 2 (β = 2.26, SE = 1.33, p = 0.09) compared to TREAT. Conclusion We expected TREAT to enhance shared decision-making without decreasing satisfaction with consultations. However, no significant differences on shared decision-making or satisfaction with consultations were found. Our findings suggest that TREAT is safe to implement in psychosis care, but more research is needed to fully understand its effects on the decisional process. (AU)

Risky decision-making in major depressive disorder: A three-level meta-analysis / Toma de decisiones arriesgadas en el trastorno depresivo mayor: un metanálisis de tres niveles

Background: Individuals with major depressive disorder (MDD) are usually observed making inappropriate risky decisions. However, whether and to what extent MDD is associated with impairments in risky decision-making remains unclear. We performed a three-level meta-analysis to explore the relationship between risky decision-making and MDD. Method: We searched the Web of Science, PubMed, Scopus, and PsycINFO databases up to February 7, 2023, and calculated Hedges' g to demonstrate the difference in risky decision-making between MDD patients and healthy controls (HCs). The moderating effect of sample and task characteristics were also revealed. Results: Across 73 effect sizes in 39 cross-sectional studies, MDD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.187, p = .030). Furthermore, age (p = .068), region (p = .005), and task type (p < .001) were found to have moderating effects. Specifically, patients preferred risk-seeking over HCs as age increased. European patients showed significantly increased risk-seeking compared to American and Asian patients. Patients in the Iowa Gambling Task (IGT) exhibited a notable rise in risk-seeking compared to other tasks, along with an increased risk aversion in the Balloon Analogue Risk Task (BART). The multiple-moderator analysis showed that only task type had significant effects, which may be explained by a tentative framework of "operationalization-mechanism-measure" specificity. Conclusions: MDD patients generally exhibit higher risk-seeking than HCs. It implies that impaired risky decision-making might be a noteworthy symptom of depression, which should be placed more emphasis for clinical management and psycho-education.(AU)

Toma de decisiones de encomienda y evaluación de las actividades profesionales confiables en la educación médica basada en competencias: una revisión de alcance y análisis temático / Entrustment decision-making and evaluation of entrustable professional activities in the competency- based medical education: a scoping review and thematic analysis

Introducción: La evaluación de las actividades profesionales confiables implica que el tutor tome decisiones de encomienda que posibiliten el desarrollo de competencias adecuadas de los futuros especialistas. Objetivo. El objetivo es conocer los componentes que sustentan la toma de decisiones de encomienda como herramienta de evaluación efectiva, segura y eficaz de las actividades profesionales confiables en la educación médica basada en competencias. Materiales y métodos: Se realizó una revisión sistemática en las bases de datos PubMed, BIREME-BVS y Web of Science. Se procedió al análisis y síntesis de los artículos, de acuerdo con la metodología JBI para las revisiones de alcance; el análisis se profundizó en otros artículos de revistas especializadas y citas bibliográficas relacionadas; y el manuscrito final se efectuó con base en las recomendaciones PRISMA-ScR. Resultados: La toma de decisiones de encomienda se centra en la relación tutor-estudiante, con base principalmente en la proactividad, la integridad, la capacidad y la humildad del estudiante, que confluyen en la confianza del tutor para sobrepasar la ‘zona de desarrollo próximo’ y alcanzar un siguiente nivel. Aunque eso signifique un determinado riesgo inicial sobre la seguridad de la atención médica, permite gradualmente generar la autonomía del estudiante. Conclusiones: No cabe duda de que la toma de decisiones de encomienda se basa en la confianza, la encomienda, la supervisión y la autonomía. Una escala retrospectiva-prospectiva que incluya la confianza-encomienda-supervisión-autonomía permite una adecuada evaluación de las actividades profesionales confiables y, por ende, la evaluación de las competencias.(AU)

Introduction: The evaluation of entrustable professional activities implies that the tutor makes assignment decisions that enable the development of appropriate competencies of future specialists. Aim. The aim of this work is to recognize the components that support entrustment decision making as an effective, safe and efficient evaluation tool of entrustable professional activities, in competency-based medical education. Materials and methods: A systematic review was carried out in the PubMed, BIREME-BVS and Web of Science databases. The analysis and synthesis of the articles was carried out in accordance with the JBI methodology for scoping reviews; and was further conducted including other articles from specialized journals and related bibliographic citations. The final manuscript was prepared based on the PRISMA-ScR recommendations.Results: Entrustment decision-making focuses on the tutor-student relationship, based mainly on the student’s proactivity, integrity, ability and humility, which converge in the tutor’s confidence to surpass the ‘zone of proximal development’ and reach the next level. Although this means a certain initial risk to the safety of medical care, it gradually generates the student’s autonomy. Conclusions: There is no doubt that entrustment decision-making is based on trust, entrustment, supervision and autonomy. A retrospective-prospective scale that includes trust-entrustment-supervision-autonomy allows for an adequate evaluation of entrustable professional activities and, therefore, the evaluation of competencies.(AU)

Diseño y validación mediante el método Delphi de un cuestionario para conocer los criterios del jugador de baloncesto cuando penetra hacia la canasta / Desenho e validação através do método Delphi de um questionário para conhecer os critérios do jogador de basquete quando ele penetra em direção ao cesto / Design and validation by Delphi method of a questionnaire to determine the criteria of a basketball player when he drives

Uno de los elementos que más determinan el rendimiento en el jugador de baloncesto es su capacidad de toma de decisiones. Por ello, es necesario ampliar los estudios que permitan entender esta capacidad. El objetivo de esta investigación fue construir y validar un cuestionario que permitiese conocer los Criterios del Jugador de Baloncesto cuando Penetra hacia la Canasta (CJB-PEC). Después de llevar a cabo una revisión de la literatura por parte de los investigadores y de sostener una mesa de discusión, se procedió a la creación de tres dimensiones y 24 ítems para el cuestionario. Posteriormente, se seleccionó a un grupo de 10 diez expertos en el objeto de estudio de esta investigación, los cuales colaboraron vía remota por correo electrónico en la evaluación cuantitativa y cualitativa del instrumento. Con el método Delphi en la primera versión tras obtener los valores medios de 10 expertos en univocidad, pertinencia e importancia a través del coeficiente de V de Aiken (0.75), con intervalos de confianza (IC) al 90% y nivel crítico al 0.70, se encontró que: la pregunta 20 no alcanzó el valor mínimo en la V de Aiken. Las preguntas 4,5,12,13,16, 20 en univocidad, la 12,18,19,20,21,24 en pertinencia, la 7,12,16, 18,19,20,21,24en importancia y la 12,18,19,20,24 en valor total no alcanzaron el nivel crítico. Con los resultados y observaciones de los expertos se modificó y construyó la segunda versión del cuestionario. Ésta tuvo 24 ítems, eliminándose las preguntas 4 y 20, reformulándose las preguntas por debajo del nivel crítico al 0.70 y agregándose 2 preguntas. Esta versión pasó a una segunda ronda con los expertos y consiguió valores superiores a 0.75 en la V de Aiken en todas las preguntas, con IC al 90%. Ninguna preguntaestuvo por debajo del nivel crítico al 0.70...(AU)

One of the elements that most determines the performance of a basketball player is their decision-making ability. Therefore, it is necessary to expand the studies that allow us to understand this capacity. The objective of this research was to construct and validate a questionnaire that would allow us to understand the Criteria of the Basketball Player when Penetrating to the Basket (CJB-PEC). After conducting a literature review by the researchers and holding a discussion, we proceeded to create three dimensions and 24 items for the questionnaire. Subsequently, a group of 10 experts in the subject of this research was selected, and they collaborated remotely via email in the quantitative and qualitative evaluation of the instrument. Using the Delphi method in the first version, after obtaining the mean values from 10 experts in clarity, relevance, and importance through the Aiken's V coefficient (0.75), with confidence intervals (CI) at90% and a critical level at 0.70, itwas found that: question 20 did notreach the minimum value in Aiken's V. Questions 4, 5, 12, 13, 16, 20 in clarity, questions 12, 18, 19, 20, 21, 24 in relevance, questions 7, 12, 16, 18, 19, 20, 21, 24 in importance, and questions 12, 18, 19, 20, 24 in the total value did not reach the critical level. Based on the results and expert observations, the second version of the questionnaire was modified and constructed. This version had 24 items, with questions 4 and 20 removed, questions reformulated below the critical level of 0.70, and 2 newquestions added. This versionwent through a second round with the experts and achieved values above 0.75 in Aiken's V for all questions, with a 90% CI. No question was below the critical level of 0.70...(AU)

Um dos elementos que mais determina o desempenho de um jogador de basquetebol é a sua capacidade de tomar decisões. Assim, torna-se necessário expandir os estudos que nos permitam compreender essa capacidade. Desta forma, o objetivo deste estudo foi construir e validar um questionário para avaliar os Critérios do Jogador de Basquetebol ao Penetrar na Cesto (CJB-PEC). Após a realização de uma revisão da literatura pelos investigadores e uma discussão, procedemos à criação de três dimensões e 24 itens para o questionário. Posteriormente, foi selecionado um grupo de 10 especialistas no assunto desta pesquisa, que colaboraram remotamente por e-mail na avaliação quantitativa e qualitativa do instrumento. Usando o método Delphi na primeira versão, após obter os valores médios de 10 especialistas em clareza, relevância e importância por meio do coeficiente V de Aiken (0.75), com intervalos de confiança (IC) a 90% e um nível crítico de 0.70, constatou-se que: a pergunta 20 não atingiu o valor mínimo no V de Aiken. Asperguntas 4, 5, 12, 13, 16, 20 em clareza, as perguntas 12, 18, 19, 20, 21, 24 em relevância, as perguntas 7, 12, 16, 18, 19, 20, 21, 24 em importância e as perguntas 12, 18, 19, 20, 24 no valor total não atingiram o nível crítico. Com base nos resultados e observações dos especialistas, o questionário passou por uma modificação e construção da sua segunda versão. Essa versão continha 24 itens, com as perguntas 4 e 20 removidas, as perguntas reformuladas abaixo do nível crítico de 0.70 e 2 novas perguntas adicionadas. Esta versão passou por uma segunda rodada com os especialistas e alcançou valores acima de 0.75 no V de Aiken para todas as perguntas, com um IC de 90%. Nenhuma pergunta ficou abaixo do nível crítico de 0.70...(AU)

Evaluación crítica de la literatura sobre la toma de decisiones de las metástasis vertebrales / Critical evaluation of the literature on decision-making in spinal metastases

La toma de decisiones en pacientes con metástasis vertebral es de gran complejidad. En ella intervienen distintos factores del paciente, de su enfermedad oncológica y de las opciones de tratamiento. Los esquemas y estrategias de tratamiento se han ido modificando con la propia evolución del conocimiento y tratamiento de la enfermedad oncológica diseminada. En este trabajo se analiza la bibliografía que se ha empleado para la toma de decisiones en las tres últimas décadas, así como la evolución a los esquemas que podríamos considerar contemporáneos.(AU)

Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.(AU)

[Translated article] Critical evaluation of the literature on decision-making in spinal metastases / Evaluación crítica de la literatura sobre la toma de decisiones de las metástasis vertebrales

La toma de decisiones en pacientes con metástasis vertebral es de gran complejidad. En ella intervienen distintos factores del paciente, de su enfermedad oncológica y de las opciones de tratamiento. Los esquemas y estrategias de tratamiento se han ido modificando con la propia evolución del conocimiento y tratamiento de la enfermedad oncológica diseminada. En este trabajo se analiza la bibliografía que se ha empleado para la toma de decisiones en las tres últimas décadas, así como la evolución a los esquemas que podríamos considerar contemporáneos.(AU)

Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.(AU)

Implanting rich autobiographical false memories: Meta–analysis for forensic practice and judicial judgment making

Objective: The implanting of rich autobiographical false memories is crucial for judicial decision–making, and the forensic evaluation of a testimony. In order to assess this issue, a meta–analytical review of the probability of implanting rich autobiographical false memories was performed. Method: A total of 30 primary studies analysing the probability of implanting rich autobiographical false memories were retrieved. Random–effects meta–analyses correcting the effect size for sampling error were performed. Results: The results revealed a significant, positive, generalizable (the lower limit for the 80% credibility value was d = 1.13), and more than large mean effect size (d = 1.43[1.33, 1.53]) for the implanting of false memory. The moderating effects of stimulus type showed that the effect of the probability of implanted false memory was significantly higher in experienced events (d = 2.03[1.63, 2.43]) than in false narratives (d = 1.35[1.23, 1.47]), and in doctored photographs (d = 1.29[1.06, 1.52]). A similar effect for memory implantation was observed in both the underage (d = 1.44[1.29, 1.59]), and in adults (d = 1.36[1.22, 1.50]). The moderator techniques for implanting false memories revealed a significantly lower probability of implanting false rich memory with non–directive instructions (d = 0.90[0.53, 1.27]) than with guided imagery (d = 1.45[1.32, 1.58]), or with pressure to answer (d = 1.56[1.17, 1.95]) instructions. The event emotional valence moderator exhibited the same effect for positive (d = 1.27[1.09, 1.45]) and negative valence events (d = 1.30[1.17, 1.43]). Conclusions: The implications of the results for forensic testimony evaluation, police interrogations, and judicial cross–examination are discussed. (AU)

Do consentimento informado à tomada de decisão compartilhada e a urgência de sua implementação no contexto brasileiro / Del consentimiento informado a la toma de decisiones compartida y la urgencia de su implementación en el contexto brasileño / Del consentiment informat a la presa de decisions compartides i la urgència de la seva implementació en el context brasiler / From informed consent to shared decision making and the urgency of its implementation in Braziliancontext

O presente artigo expõe um panorama geral da Tomada de Decisão Compartilhada (TDC), considerada cada vez mais como a melhor forma para envolver os pacientes no processo de decisão sobre seus cuidados em saúde. Contudo, a despeito do amplo reconhecimento internacional, a TDC ainda não se encontra amplamente implementada na prática clínica brasileira, sendo o consentimento informado o modelo de tomada de decisão mais comumente adotado pelos profissionais de saúde. Assim, este trabalho, após esclarecer as definições em torno da TDC, apresenta instrumentos para sua aplicação e as razões pelas quais essa nova forma de tomar decisões deve ser preferível ao consentimento informado.(AU)

L'actual article exposa una visió general de la Presa de Decisions Compartides (PDC), cada vegada més considerada com la millor manera d'involucrar els pacients en el procés de decisió sobre la seva cura sanitària. No obstant això, malgrat el reconeixement internacional ampli, la PDC encara no està àmpliament implementada en la pràctica clínica brasilera, essent el consentiment informat el model de presa de decisions més comunament adoptatpels professionals de la salut. Així, aquest treball, després de clarificar les definicions al voltant de la PDC, presenta instruments per a la seva aplicació i les raons per les quals aquesta nova forma de prendre decisions ha de ser preferible al consentiment informat.(AU)

Este artículo presenta una visión general de la Toma de Decisiones Compartida (TDC), considerada cada vez más como la mejor manera de involucrar a los pacientes en el proceso de toma de decisiones sobre su atencion de salud. Sin embargo, a pesar del amplio reconocimiento internacional, la TDC aún no está ampliamente implementada en la práctica clínica brasileña, siendo el consentimiento informado el modelo de toma de decisiones más comúnmente adoptado por los profesionales de la salud. Así, este trabajo, tras aclarar las definiciones en torno a la TDC, presenta instrumentos para su aplicación y las razones por las que esta nueva forma de tomar decisiones debe ser preferible al consentimiento informado.(AU)

This article presents an overview of Shared Decision Making (SDM), increasingly considered the best way to involve patients in the decision-making process about their health care. However, despite wide international recognition, SDM is still not widely implemented in brazilian clinical practice, with informed consent being the decision-making model most commonly adopted by health professionals. Thus, this work, after clarifying the definitions around SDM, presents instruments for its application and the reasons why this new way of making decisions should be preferable to informed consent.(AU)

Impact of Actor’s Initial State of Engagement in a Course of Action on Judgements of Post-decisional Regret and Joy: Revisiting Kahneman and Tversky (1982)

According to the phenomenon commonly known as action effect and vastly replicated across the judgment and decision-making literature, more regret is associated with decisions resulting from action than inaction. Action vs. inaction, however, might either refer to change vs. no change or doing something vs. not doing something. The purpose of this study was to examine the effect of this variation in operationalization of action-inaction on the strength of action effect, for both positive and negative outcomes, across four different domains of employment, finance, education, and health. This was an experimental scenario-based study (N = 215) with four between-subjects conditions varying in outcome valence and the actor’s initial state as either engaged or non-engaged in a particular course of action. Action effect was found to be stronger with respect to the initially engaged than the initially non-engaged decision-maker (ηp2 = .04), indicating that action as change results in a stronger action effect than action as doing something. The effect of the initial state was also moderated by domain. In addition, we both replicated and went beyond prior empirical literature regarding the effect of outcome valence and domain on action effect, with our findings being mostly consistent across joy and regret. Findings are discussed in light of the norm theory and its key concept of normality and contribute to the literature on moderators of action effect. (AU)

Estilo de liderazgo en profesionales de enfermería dentro de un sistema público / Leadership style in nursing professionals within a public healthcare system

Introducción: El liderazgo implica influir, motivar y organizar a otros para alcanzar metas y objetivos de manera efectiva. En el ámbito de la salud, se requiere enfermeros líderes flexibles que fomenten la participación en la toma de decisiones y conduzcan discusiones. Objetivo: Identificar el estilo de liderazgo de los profesionales de enfermería del sector público de la región de Ñuble, 2022.Método: Estudio descriptivo de corte transversal. La muestra fueron 62 enfermeros el sector público de la región de Ñuble Se aplicó un cuestionario sociodemográfico y otro que describe la conducta del supervisor elaborado por investigadores de la Universidad de Ohio. Fue autorizado por el Comité Ético Científico de la Universidad Adventista de Chile. Se aplicaron frecuencias absolutas y tablas dinámicas en Microsoft Excel.Resultados: El estilo de liderazgo predominante es delegar, con un 33,9 %, y el menos utilizado es dirigir, con un 14,5 %. La muestra fue constituida mayoritariamente por mujeres de 23 a 33 años que realizan trabajo diurno y presentan una alta motivación laboral. Conclusiones: Se notó un predominio del liderazgo delegativo, posiblemente relacionado con el nivel de madurez de los profesionales de enfermería, destacando que este estilo está estrechamente ligado al nivel más bajo de ma-durez, como se evidencia en la muestra mayoritaria de individuos de 23 a 33 años. (AU)

Introduction: Leadership involves influencing, motivating, and organizing others to achieve goals and objectives effectively. In the healthcare field, flexible nursing leaders are required to encourage participation in decision-mak-ing and lead discussions.Objective: To identify the leadership style of nursing professionals in the public sector of the Ñuble region in 2022.Method: A descriptive cross-sectional study was conducted with a sample of 62 nurses in the public sector of the Ñuble region. A sociodemographic questionnaire and another describing supervisor behavior, developed by re-searchers from the University of Ohio, were administered. The study was authorized by the Scientific Ethics Com-mittee of the Adventist University of Chile. Absolute frequencies and pivot tables were applied using Microsoft Excel.Results: The predominant leadership style is delegation, at 33.9%, and the least used is directing, at 14.5%. The sample consisted mainly of women aged 23 to 33 who work during the day and exhibit high work motivation.Conclusions: A predominance of delegative leadership was observed, possibly related to the maturity level of nurs-ing professionals. This style is closely linked to the lowest level of maturity, as evidenced by the majority of individ-uals in the sample aged 23 to 33. (AU)

Las competencias comunes en el sistema de formación sanitaria especializada. Aprendiendo comunicación clínica y bioética a partir de la reflexión sobre la actividad clínica cotidiana / Common competences in the specialised health training system. Learning clinical communication and bioethics from the reflection on daily clinical activity

Es necesaria la búsqueda de una metodología y de herramientas para facilitar el aprendizaje práctico de las competencias comunes o transversales por los especialistas en formación. Para ello son deseables propuestas que orienten a partir de la experiencia docente en la clínica, al lado del paciente, como punto de partida. Se plantea como ejemplo el aprendizaje de la toma de decisiones compartidas al final de la vida con los representantes de pacientes incapaces, con el pronóstico, la fragilidad y los valores como guías para la toma de decisiones. Saber cómo proceder ante un paciente incapaz es una de las competencias que se deben adquirir dentro de la formación transversal de las especialidades en ciencias de la salud. En este trabajo, la reflexión sobre la experiencia vivida con una residente en la atención a una paciente incapaz permite abordar con una mejor estructuración la conversación difícil con el familiar de un segundo paciente incapaz. Enunciar de forma explícita detalles aparentemente conocidos o intrascendentes ayuda a sistematizar los procesos de cara a la mejora de éstos, su aprendizaje en la cabecera del paciente y su evaluación formativa. Se plantea una propuesta práctica sobre la que seguir trabajando, utilizando como apoyo la narrativa clínica.(AU)

It is necessary to find a methodology and tools to help specialists undergoing training learn the practical aspects of common or cross-disciplinary competences. To this end, it would be preferable to start out with proposals that provide guidance based on the teaching experience in the clinic, alongside the patient. An example could be learning about end-of-life decision-making shared with representatives of incapacitated patients, taking prognosis, frailty and values as guides to decision-making. Knowing how to deal with an incapacitated patient is one of the competences to be acquired as part of the cross-disciplinary training in health sciences specialties. In this paper, reflecting on the experience of a resident in the care of an incapacitated patient allows for a better structured approach to the difficult conversation with the relative of a second incapacitated patient. Explicitly stating seemingly known or inconsequential details helps to systematise processes aimed at improving them, learning at the bedside and formative evaluation. A practical proposal for further work is put forward, using clinical narrative as a support.(AU)

La construcción del conocimiento en cirugía: un proceso artesanal / Knowledge-building in surgery: an evolving craft

En cirugía la construcción de conocimiento está moldeada en 2escenarios: la medicina basada en la evidencia y el aprendizaje experiencial. La primera se ha constituido como un pilar esencial en este proceso. A partir de ella se han desarrollado las guías de práctica clínica. Sin embargo, su temporalidad, su constante renovación y la falta de individualización las distancian del actuar diario. Por otro lado está la construcción de conocimiento mediante el aprendizaje vicario y experiencial. Su existencia va ligada al inicio de la medicina y su importancia es irrefutable. No obstante, va cargada del «efecto verdad», del dogma quirúrgico y del singularismo. El desarrollo de un sentido crítico frente a la integración de la constricción del conocimiento en estos escenarios es primordial y necesario para guiar al cirujano en la toma de decisiones en el dinamismo quirúrgico. El presente artículo explora esta situación y su impacto. (AU)

In surgery, the construction of knowledge is shaped in 2scenarios, evidence-based medicine, and experiential learning. The first has become an essential pillar in this process. Based on this, clinical practice guidelines have been developed. However, their temporality, their constant renewal and lack of individualization distance them from daily action. On the other hand, there is the construction of knowledge through vicarious and experiential learning. Its existence is linked to the beginning of medicine, and its importance is irrefutable. However, it is loaded with the «truth effect», surgical dogma and singularism. The development of a critical sense against the integration of the construction of knowledge in these scenarios is paramount and necessary to guide the surgeon in decision-making in surgical dynamism. This article explores this situation and its impact. (AU)

Perspectiva bioética de la adecuación del esfuerzo terapéutico en pacientes adultos terminales. Revisión sistemática / Bioethical perspective of the limitation of therapeutic effort in adult terminal patients. Systematic review

Introducción: Ante la capacidad de mantenimiento de las funciones vitales de forma artificial, surgen nuevas preocupaciones éticas en los profesionales sanitarios en relación con la muerte. Se cuestiona desde la ética si el equipo asistencial debe hacer siempre todo lo necesario y posible para impedir la muerte de un paciente. Objetivo: Analizar los aspectos bioéticos de la limitación del esfuerzo terapéutico en pacientes en el final de la vida, fomentar la reflexión y contribuir a mejorar los cuidados en el final de la vida. Método: Se realizó una revisión narrativa e integradora de la literatura científica mediante la búsqueda de publicaciones en metabuscadores y bases de datos de PubMed, SciELO y la revista de Nursing Ethics. Se identificaron 6.325 estudios publicados a partir de 2018 y se incluyeron un total de 9 artículos. Resultados/Discusión: Se describen las dificultades que presentan los profesionales en relación a la toma de decisiones en el final de la vida, la necesidad de mejorar la formación en ética y en aspectos relacionados con pacientes que se encuentran en sus últimos días, los cuidados paliativos y la limitación del esfuerzo terapéutico. Solo una minoría de los estudios están enfocados en enfermería. Conclusiones: Las decisiones del profesional están influenciadas por valores, emociones, creencias y experiencias, que unidas a la dificultad que existe en ocasiones para establecer un diagnóstico clínico certero, dificulta las decisiones de limitación de esfuerzo terapéutico. Se hace necesario mejorar la formación en ética y conocimiento de los procesos de final de la vida por parte de los profesionales. (AU)

Introduction: Faced with the ability to maintenance vital functions artificially, new ethical concerns arise among health professionals regarding death. It is been questioned from ethics if the care team should always do everything necessary and possible to prevent the death of a patient. Objective: to analyze the bioethical aspects of limiting therapeutic effort in end-of-life patients, encourage reflection and contribute to improving end-of-life care. Method: a narrative and integrative review of the scientific literature was performed by searching for publications in meta-search engines and databases of PubMed, SciELO and the journal of Nursing Ethics. A total of 6,325 studies published since 2018 were identified and a total of 9 articles were included. Results/Discussion: Issues presented by professionals regarding making-decisions at the end of life, the need to improve training in ethics and aspects related to patients in their last days, palliative care and the limitation of therapeutic effort are described. Only a minority of studies are focused on nursing. Conclusions: professional's decisions are influenced by values, emotions, beliefs and experiences, which, together with the difficulty that sometimes exists to establish an accurate clinical diagnosis, makes it difficult to limit therapeutic effort. It is therefore necessary to improve training in ethics and knowledge about end-of-life processes from professionals. (AU)

Estudio y manejo de casos y contactos en población general / Study and management of cases and contacts in general population

El 30 de enero de 2020 la enfermedad COVID-19 fue declarada emergencia de salud públicainternacional. El 31 de enero se confirmó el primer caso en España y casi un mes después, el28 de febrero, se detectó el primer caso positivo en la Comunidad Foral de Navarra.Desde el inicio de los primeros casos de COVID-19 se visualizó el rastreo de casos y contactoscomo herramienta esencial de Salud Pública para trazar el rastro de contagios y romper lacadena de transmisión de la COVID-19.En el contexto de responder a las necesidades de todo tipo que generó la pandemia, el Institutode Salud Pública y Laboral de Navarra (ISPLN) como responsable técnico y la Subdirecciónde Urgencias Extrahospitalarias a nivel operativo, emprendieron activamente la detección yrastreo de posibles casos y contactos por COVID-19 en mayo de 2020, dando inicio al rastreopoblacional.La evolución en olas de alta incidencia seguidas de periodos valle y la dificultad de disponerde profesionales de Enfermería complicaron el dimensionamiento y la composición del equi-po de rastreo.Los diferentes procedimientos específicos según colectivos y sus continuas actualizacionesfueron una dificultad añadida que se palió en gran medida con la formación continua en lasactualizaciones de la estrategia nacional de manejo de casos y contactos actualizada de ras-treo, la realización de reuniones informativas diarias y la especialización del equipo.La creación de nuevas herramientas informáticas con acceso desde la historia clínica deAtención Primaria, la automatización de procesos, la coordinación interdepartamental y contodos los intervinientes en el proceso, fueron clave para el adecuado desarrollo del equiporastreo.(AU)

Cómo dar una respuesta de Salud Pública con un enfoque multidisciplinar, basándose en la experiencia del período de la COVID-19 / How to provide a Public Health response with a multidisciplinary approach based on the COVID-19 period

En el seno de la Dirección General de Salud Pública, Consumo y Cuidados (DGSPCC) del Gobierno de La Rioja se articuló un procedi-miento de actuación, siendo su finalidad dar respuesta a la ciudadanía ante la gran incertidumbre surgida como consecuencia delas medidas y restricciones para el control de la pandemia de la COVID-19. Se desarrolló un trabajo coordinado de colaboración mul-tidisciplinar para responder consultas y dudas, evaluar el riesgo en la celebración de eventos multitudinarios y elaborar guías parala difusión de medidas preventivas. Tras la evaluación de cada caso, se establecía una gradación del riesgo y, de acuerdo con ello, serecomendaba la realización del evento, la adopción de medidas adicionales o la suspensión del mismo. En todo momento se apelabaal deber de cautela y protección de la ciudadanía para adoptar las medidas necesarias con el fin de evitar la generación de riesgosde propagación del virus SARS-CoV-2. El objetivo de este trabajo fue comunicar la experiencia de la colaboración multiprofesional enel ámbito de la Salud Pública.(AU)

The establishment of regulatory measures and restrictions to take control of the COVID-19 pandemic generated uncertainty and arequest for information among the population. To address this demand, the Public Health Department (DGSPCC) of the Governmentof La Rioja (Spain) created a multidisciplinary work group. This group worked in a coordinated multidisciplinary manner to respond togeneral inquiries and doubts, generate risk assessments of multitudinous events, and create guides and summaries of preventive me-asures. Every event was assessed individually and, based on the corresponding risk assignment, a recommendation for its executionor the need for additional measures was issued. In any case, citizens were encouraged to behave cautiously to avoid potential risksof spreading the SARS-CoV-2 virus. Our goal was to report a multidisciplinary collaborative experience in the area of public health.(AU)

Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review

Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions. (AU)