The Communication and Bioethical Training (CoBiT) Program for assisting dialysis decision-making in Spanish ACKD units.

Healthcare professionals currently working in Advanced Chronic Kidney Disease (ACKD) units must cope with difficult situations regarding assisting patients with the dialysis decision-making process, and they are often untrained for these conversations. Although we have evidence from the literature that these skills can be learned, few professionals feel confident in this area. A Communication and Bioethical Training (CoBiT) Program for ACKD staff (physicians, nurses and allied health professionals) was developed to improve their ability and self-confidence in conducting these conversations. A four-stage study was conducted: (1) development of the CoBiT program, beginning with the creation of an interdisciplinary focus group (N = 10); (2) design of a questionnaire to assess self-confidence based on the areas identified by the focus group. The face validity of the instrument was tested using an inter-judge methodology (N = 6); (3) design of the format and contents of the program; (4) piloting the program. Thirty-six health professionals took an 8-h workshop based on role-playing methodology. Participants assessed their self-confidence in their communication skills before and after the program using self-report measures. The results show that after the program, participants reported significantly higher levels of self-confidence measured with a five-point Likert scale (p < 0.001). Participants felt that communication with colleagues of other professions significantly increased after the workshop (p = 0.004). The CoBiT program improves ACKD Unit healthcare professionals' self-confidence in their ability to perform a specific communication task.

Testing the consistency and feasibility of the standard Malmquist-Luenberger index: Environmental productivity in world air emissions.

Over the last twenty years an increasing number of studies have relied on the standard definition of the Malmquist-Luenberger index proposed by Chung et al. (1997) [J. Environ. Manage., 51, 229-240], to assess environmental sensitive productivity change. While recent contributions have shown that it suffers from relevant drawbacks related to inconsistencies and infeasibilities, no one has studied systematically the performance of the original model, and to what extent the existing results are unreliable. We introduce the optimization techniques that implement the model by Aparicio et al. (2013) [Eur. J. Oper. Res., 229(3), 738-742] solving these problems, and using a country level database on air pollutants systematically compare the results obtained with both approaches. Over the 1995-2007 period environmental productivity stagnation prevails across developed and developing countries, and while increasing technical progress takes place in the later years, it is offset by declining efficiency. Results show also that inconsistencies and infeasibilities in the original model are increasing in the number of undesirable outputs included, reaching remarkable values that seriously question the reliability of results, and compromise any environmental policy recommendation based on them.

Enhancing psychosocial and spiritual palliative care: Four-year results of the program of comprehensive care for people with advanced illnesses and their families in Spain.

OBJECTIVE: We aimed to describe the overall quantitative and qualitative results of a "La Caixa" Foundation and World Health Organization Collaborating Center Program entitled "Comprehensive Care for Patients with Advanced Illnesses and their Families" after four years of experience. METHOD: Qualitative and quantitative methods were employed to assess the program. Quasiexperimental, prospective, multicenter, single-group, and pretest/posttest methods were utilized to assess the quantitative data. The effectiveness of psychosocial interventions was assessed at baseline (visit 1) and after four follow-up visits. The following dimensions were assessed: mood state, discomfort, anxiety, degree of adjustment or adaptation to disease, and suffering. We also assessed the four dimensions of the spiritual pain scale: faith or spiritual beliefs, valuable faith or spiritual beliefs, meaning in life, and peace of mind/forgiveness. Qualitative analyses were performed via surveys to evaluate stakeholder satisfaction. RESULTS: We built 29 psychosocial support teams involving 133 professionals-mainly psychologists and social workers. During the study period, 8,964 patients and 11,810 family members attended. Significant improvements were observed in the psychosocial and spiritual dimensions assessed. Patients, family members, and stakeholders all showed high levels of satisfaction. SIGNIFICANCE OF RESULTS: This model of psychosocial care could serve as an example for other countries that wish to improve psychosocial and spiritual support. Our results confirm that specific psychosocial interventions delivered by well-trained experts can help to ease suffering and discomfort in end-of-life and palliative care patients, particularly those with high levels of pain or emotional distress.

Technological, institutional, and geographical peripheries: regional development and risk of poverty in the European regions.

In this paper, we analyze the interrelation between technological, institutional, and geographical peripheries. By distinguishing between the quality and quantity of access to information and communication technologies, together with institutional and geographical factors, and using a sample of 229 European regions during the period 2007-2018, we find that the diffusion and quality of information and communication technologies foster economic development and decrease the risk of social exclusion. A similar effect is found for institutional and geographical factors, suggesting that the interplay of these three determinants may be crucial to set up place-based policies. Supplementary Information: The online version contains supplementary material available at 10.1007/s00168-022-01127-9.

Effects of COVID-19 on trade flows: Measuring their impact through government policy responses.

This paper examines the impact of COVID-19 on bilateral trade flows using a state-of-the-art gravity model of trade. Using the monthly trade data of 68 countries exporting across 222 destinations between January 2019 and October 2020, our results are threefold. First, we find a greater negative impact of COVID-19 on bilateral trade for those countries that were members of regional trade agreements before the pandemic. Second, we find that the impact of COVID-19 is negative and significant when we consider indicators related to governmental actions. Finally, this negative effect is more intense when exporter and importer country share identical income levels. In the latter case, the highest negative impact is found for exports between high-income countries.

Proper information during the surgical decision-making process lowers the anxiety of patients with high-grade gliomas.

PURPOSE: We aim to analyse the relationship between the quality of information during the decision-making process regarding surgery to treat high-grade gliomas and the level of anxiety of the patients. METHODS: This is a transversal, descriptive and correlational study on 26 patients with a clinical and radiological diagnosis of high-grade glioma. They scored the quality (in terms of comprehension and satisfaction) of information received about the treatment options and prognosis during the surgical decision-making process, and the Hospital Anxiety and Depression Scale questionnaire (HADS) was applied immediately afterward. RESULTS: Lower levels of anxiety were observed in patients who showed a desire to receive information regarding their illness, those with a higher degree of comprehension, and those with a higher level of satisfaction with the information provided. CONCLUSIONS: An improvement in the communication process contributes to a decrease in the levels of anxiety, and consequently to enhancement of the well-being of these patients.

Development and validation of a new tool for the assessment and spiritual care of palliative care patients.

CONTEXT: Spiritual assessment tools and interventions based on holistic approaches are needed to promote healing. Such tools must be adapted to the wide cultural backgrounds of contemporary Western society. OBJECTIVES: To develop and validate a new brief measure, simultaneously featuring clinical applicability and adequate psychometric properties. The tool uses six initial questions to establish a climate of trust with patients before they complete an eight-item, five-point Likert scale. The questionnaire is based on a model of spirituality generated by the Spanish Society of Palliative Care (SECPAL) Task Force on Spiritual Care (Grupo de Espiritualidad de la SECPAL), which aims to recognize, share, and assess the spiritual resources and needs of palliative care patients. METHODS: Multidisciplinary professionals from 15 palliative care teams across Spain interviewed 108 patients using the Grupo de Espiritualidad de la SECPAL questionnaire. Confirmatory factor analysis techniques were used to study the new tool factor structure and reliability. Additionally, concurrent criterion validity coefficients were estimated considering spiritual well-being, anxiety, depression, resilience, and symptoms. Descriptive statistics on questionnaire applicability were reported. RESULTS: Analyses supported a three-factor structure (intrapersonal, interpersonal, transpersonal) with an underlying second-order factor representing a spirituality construct. Adequate reliability results and evidence for construct validity were obtained. CONCLUSION: The new questionnaire, based on empirical research and bedside experience, showed good psychometric properties and clinical applicability.

Trajectory variance and autocorrelations within single-sperm tracks as population-level descriptors of sperm track complexity, predictability, and energy-generating ability.

The objectives of the present study were to develop an alternative theoretical approach to the analysis of sperm motility and to develop motility parameters that would complement those more commonly used in current computer-assisted semen analysis procedures. We have defined a set of parameters and have tested them using boar spermatozoa undergoing bicarbonate-induced motility activation. The new parameters were calculated for a series of (x,y) coordinates of sperm head positions recorded at each move along the trajectory. The parameters were: mean velocity (MV), immobility ratio, fractal dimension (FD), the variance of the steplengths (VAR), and 2 autocorrelation function coefficients of the step-length time series for lags 1 and 2 (C(1) and C(2)). MV measures the average speed along the trajectory, and VAR is a measure of displacement variability that can be related to the specific mean (per step) kinetic energy of the spermatozoon. All of the parameters except MV and FD were affected by the sampling frequency (25 vs 50 Hz); inappropriately high sampling frequency in relation to magnification resulted in step-lengths between successive frames that were below the resolution threshold of the imaging system. The autocorrelation functions were especially informative; discrimination between sperm subpopulations was obvious within simple histogram formats, and complex statistical analyses were not needed for their identification.

[Quality of life and adherence to nebulised antibiotic therapy using a new device in non-cystic fibrosis bronchiectasis]. / Calidad de vida y adherencia a la antibioterapia nebulizada mediante un nuevo dispositivo en bronquiectasias no debidas a fibrosis quística.

AIMS: Analysis of psychological variables, quality of life, depression and anxiety, subjective perception of compliance, level of satisfaction with the electronic device, and objective verification) in order to study the therapeutic adherence, in non-cystic fibrosis bronchiectasis (NCFB) colonized by Pseudomonas aeruginosa. METHODS: A cross-sectional descriptive study was conducted on 22 NCFB stable patients colonised by Pseudomonas aeruginosa (two groups of 11 subjects: GROUP 1, Pari-LC plus nebuliser device, and GROUP 2, with the I- neb device), both containing sodium colistemethate. Different variables, were obtained, such as, self-perceived health (St George questionnaire), state of mind (HADS scale), and subjective perception of therapeutic compliance and objective verification by using the device software. RESULTS: There were no significant differences in questionnaire results. The therapeutic support in GROUP 2, could be proved objectively (up to 60%) using specific software, and the excellent tolerability using a specific questionnaire created for the study. CONCLUSIONS: These types of aerosol devices demonstrate a high level of therapeutic support, that can be measured objectively and is different from what the patients subjectively indicates.