Enhancing adaptive proton therapy through CBCT images: Synthetic head and neck CT generation based on 3D vision transformers.

BACKGROUND: Proton therapy is a form of radiotherapy commonly used to treat various cancers. Due to its high conformality, minor variations in patient anatomy can lead to significant alterations in dose distribution, making adaptation crucial. While cone-beam computed tomography (CBCT) is a well-established technique for adaptive radiation therapy (ART), it cannot be directly used for adaptive proton therapy (APT) treatments because the stopping power ratio (SPR) cannot be estimated from CBCT images. PURPOSE: To address this limitation, Deep Learning methods have been suggested for converting pseudo-CT (pCT) images from CBCT images. In spite of convolutional neural networks (CNNs) have shown consistent improvement in pCT literature, there is still a need for further enhancements to make them suitable for clinical applications. METHODS: The authors introduce the 3D vision transformer (ViT) block, studying its performance at various stages of the proposed architectures. Additionally, they conduct a retrospective analysis of a dataset that includes 259 image pairs from 59 patients who underwent treatment for head and neck cancer. The dataset is partitioned into 80% for training, 10% for validation, and 10% for testing purposes. RESULTS: The SPR maps obtained from the pCT using the proposed method present an absolute relative error of less than 5% from those computed from the planning CT, thus improving the results of CBCT. CONCLUSIONS: We introduce an enhanced ViT3D architecture for pCT image generation from CBCT images, reducing SPR error within clinical margins for APT workflows. The new method minimizes bias compared to CT-based SPR estimation and dose calculation, signaling a promising direction for future research in this field. However, further research is needed to assess the robustness and generalizability across different medical imaging applications.

Material decomposition maps based calibration of dual energy CT scanners for proton therapy planning: a phantom study.

We introduce a new calibration method for dual energy CT (DECT) based on material decomposition (MD) maps, specifically iodine and water MD maps. The aim of this method is to provide the first DECT calibration based on MD maps. The experiments were carried out using a general electric (GE) revolution CT scanner with ultra-fast kV switching and used a density phantom by GAMMEX for calibration and evaluation. The calibration process involves several steps. First, we tested the ability of MD values to reproduce Hounsfield unit (HU) values of single energy CT (SECT) acquisitions and it was found that the errors were below 1%, validating their use for HU reproduction. Next, the different definitions of computedZvalues were compared and the robustness of the approach based on the materials' composition was confirmed. Finally, the calibration method was compared with a previous method by Bourqueet al, providing a similar level of accuracy and superior performance in terms of precision. Overall, this novel DECT calibration method offers improved accuracy and reliability in determining tissue-specific physical properties. The resulting maps can be valuable for proton therapy treatments, where precise dose calculations and accurate tissue differentiation are crucial for optimal treatment planning and delivery.

Diseño y validación del cuestionario ACPAPS para valorar la atención centrada en la persona por el médico de familia / Design and validation of the ACPAPS questionnaire to assess person-centred care by the family doctor

Objetivos: Diseño, construcción y validación de un test autocumplimentable que permita al médico de familia (MF) valorar en qué medida integra en su práctica clínica la atención centrada en la persona (ACP).Diseño: Cualitativo. Diseño de cuestionarios. Emplazamiento: Atención primaria. Participantes: 214 MF y residentes de medicina familiar y comunitaria de 62 de los 80 centros de salud de la comunidad autónoma de Murcia. Métodos: Construcción de un cuestionario a partir de un banco de 873 ítems provenientes de una revisión sistemática y un estudio Delphi. Revisión por panel de 8 expertos ACP. Realización de pretest cognitivo con 10 MF. Se invita a participar a los médicos de 62 centros de salud. Con las respuestas medimos la fiabilidad, la validez y la factibilidad. Resultados: El cuestionario final contiene 37 ítems. Medimos la fiabilidad a través de la consistencia interna con un alfa de Cronbach de 0,915. Para la validez de constructo, el test de esfericidad de Bartlett adecuado y la medida de Kaiser-Mayer-Olkin de 0,889 nos permitió realizar un análisis factorial con la extracción de nueve factores (regla de Kaiser), siendo 5 los principales (Scree Test), cuyos ítems coinciden con las dimensiones propuestas por los expertos. Para valorar su factibilidad consideramos la tasa de respuesta del 31,15%, el tiempo de respuesta de 17 minutos 23 segundos, y solo el 0,9% de encuestados consideraban el cuestionario largo o complejo. Conclusiones: El cuestionario ACPAPS es una herramienta fiable, válida y factible para valorar la ACP en el MF, lo cual tiene múltiples y trascendentes aplicaciones.(AU)

Objectives: Design, construction and validation of a self-completion test that allows the Family Physician (FP) to assess the extent to which he/she integrates person-centred care (PCC) in his/her clinical practice. Design: Qualitative. Questionnaire design. Location: Primary care. Participants: Two hundred and fourteen family and community medicine physicians and residents, from 62 of the 80 health centres in the autonomous community of Murcia (Spain). Methods: Construction of a questionnaire from a bank of 873 items from a systematic review and a Delphi study. Review by PCC panel of experts (8). Cognitive pretest with 10 FP. Doctors from 62 health centres were invited to participate. With the responses we measured reliability, validity and feasibility. Results: The final questionnaire contains 37 items. We measured reliability through internal consistency with a Cronbach's alpha of .915. For construct validity, the appropriate Bartlett's test of sphericity and the Kaiser-Mayer-Olkin measure of .889 allowed us to carry out a factor analysis with the extraction of nine factors (Kaiser's rule) with five main factors (Scree test) whose items coincide with the dimensions proposed by the experts. To assess its feasibility we considered the response rate of 31.15%, the response time of 17minutes 23seconds and only .9% of respondents considered the questionnaire long or complex. Conclusions: The ACPAPS questionnaire is a reliable, valid and feasible tool to assess PCC in FM, which has multiple and far-reaching applications.(AU)

[Design and validation of the ACPAPS questionnaire to assess person-centred care by the family doctor]. / Diseño y validación del cuestionario ACPAPS para valorar la atención centrada en la persona por el médico de familia.

OBJECTIVES: Design, construction and validation of a self-completion test that allows the Family Physician (FP) to assess the extent to which he/she integrates person-centred care (PCC) in his/her clinical practice. DESIGN: Qualitative. Questionnaire design. LOCATION: Primary care. PARTICIPANTS: Two hundred and fourteen family and community medicine physicians and residents, from 62 of the 80 health centres in the autonomous community of Murcia (Spain). METHODS: Construction of a questionnaire from a bank of 873 items from a systematic review and a Delphi study. Review by PCC panel of experts (8). Cognitive pretest with 10 FP. Doctors from 62 health centres were invited to participate. With the responses we measured reliability, validity and feasibility. RESULTS: The final questionnaire contains 37 items. We measured reliability through internal consistency with a Cronbach's alpha of .915. For construct validity, the appropriate Bartlett's test of sphericity and the Kaiser-Mayer-Olkin measure of .889 allowed us to carry out a factor analysis with the extraction of nine factors (Kaiser's rule) with five main factors (Scree test) whose items coincide with the dimensions proposed by the experts. To assess its feasibility we considered the response rate of 31.15%, the response time of 17minutes 23seconds and only .9% of respondents considered the questionnaire long or complex. CONCLUSIONS: The ACPAPS questionnaire is a reliable, valid and feasible tool to assess PCC in FM, which has multiple and far-reaching applications.

A Qualitative Study Exploring the Experiences and Perceptions of Patients with Hemophilia Regarding Their Health-Related Well-Being, in Salamanca.

Hemophilia is a chronic, congenital/hereditary and X-linked disease, characterized by an insufficiency of factors VIII or IX, which are necessary for blood clotting. Those affected by hemophilia often suffer from particular psychosocial problems, both in the acceptance, coping, treatment and self-management of their disease and in their family and social relationships, which are often mediated by these circumstances. The aim of this study was to explore the experiences of people with hemophilia or their family members, of in a specific region of Spain, regarding the impact of having hemophilia. Structured interviews were conducted and developed, using the studies of the World Federation of Hemophilia and Osorio-Guzmán et al. as a guide, as well as a literature review of qualitative work on hemophilia. Data were analyzed using a six-step thematic analysis. A total of 34 interviews were thematically analyzed. The results showed that three key themes emerged from the data: (1) the daily impact of having hemophilia, (2) uncertainty about the disease, (3) the role of associations and (4) support from institutions. The results make it clear that the disease has a major impact on their lives (work, family, leisure and personal environment). The main conclusion is that hemophilia has a negative impact on the daily lives of patients, families and caregivers.

Attitudes about Mechanical Restraint Use in Mental Health Hospitalization Services: A Spanish Survey.

The aim of this study was to analyze the attitudes of professionals in Mental Health Services throughout Spain who are directly or indirectly involved in the use of mechanical restraint and the barriers perceived to reduce its use. The study involved an online anonymous survey using Google Forms completed by Spanish mental health professionals working with service users; the survey assessed their involvement in and general attitudes and beliefs towards mechanical restraint. The survey was completed by 225 participants. Only 13.30% of the participants considered that mechanical restraint use was never necessary to guarantee the safety of users/staff in dangerous situations. Poor staff training (38.0%) and a lack of resources/staff (34.7%) were the most frequent barriers identified for the reduction of mechanical restraint. In the multivariate analysis, participation in learning programs to prevent the use of mechanical restraint was associated with lower acceptance of the use of mechanical restraint, but the result was barely significant (p = 0.050). A high percentage of mental health staff still consider mechanical restraint use necessary for safety reasons. According to the results, the participants perceived that more staff and resources and better training could reduce the use of mechanical restraint in Mental Health Hospitalization Services.

Effects of Managed and Unmanaged Floral Margins on Pollination Services and Production in Melon Crops.

Melon is among the most consumed fruits in the world, being a crop that depends almost entirely on insects for its reproduction, which is why it is especially sensitive to declining pollination services. Restoration and maintenance of hedgerows and agricultural borders around crops are generally carried out by sowing flowering herbaceous plants or establishing shrubby species; however, a cost-effective and lower-maintenance alternative for farmers could be as simple as allowing vegetation to regenerate naturally without any management actions. This work aimed to test the effects of three different types of margins (managed herbaceous, managed shrubby, and unmanaged herbaceous) on the overall abundance and richness of wild pollinators in melon crops. The work was performed in three localities in southern Spain over two years. Pollinators were monitored visually using 1 × 1 m sampling squares and pan traps within melon fields. Moreover, crop yield was estimated by measuring fruit weight and the number of seeds. In general, higher abundances of pollinators were observed in melon fields during the second year. In addition, the abundances of Syrphidae, Andrenidae, Apidae (excl. Apis mellifera), and pollinators other than bees, belonging to the orders Diptera, Coleoptera, Hymenoptera, and Lepidoptera, showed higher values in melon fields with shrubby margins than in fields with herbaceous margins (managed or unmanaged). However, no effect of floral margins on the yield of melon crops was found.

Proanthocyanidins composition in new varieties descended from Monastrell.

BACKGROUND: The wine sector is constantly evolving, in order to adapt to consumer tastes. The organoleptic characteristics in wines are the main factors to obtain quality wines. Proanthocyanidins (PAs) are responsible in an important way for positive aspects in quality wines, such as body and color stability in red wines, but they are also responsible for sensory characteristics that can be negative for their quality when found in excessive concentrations. One strategy to improve grapevines and wines is to obtain new varieties, so our research institute has been selecting some of them from direct crosses between Monastrell and other considered premium varieties such as Cabernet Sauvignon and Syrah. RESULTS: A quantitative analysis in grapes, seeds and wines was carried out during three consecutive seasons (2018, 2019 and 2020) in order to characterize PAs composition and concentration in the following new varieties: MC80 (Monastrell × Cabernet Sauvignon), MC98, MC4, MC18 and MS10 (Monastrell × Syrah). Other aspect to study was the extraction capacity of the different new varieties of PAs during maceration process into must/wine. CONCLUSION: In general, the results showed higher concentrations in PAs in most crosses for the three seasons studied compared to Monastrell variety. It was remarkable that a higher concentration of epigallocatechin was found in most of the wines elaborated with the crosses, being a positive aspect from an organoleptic point of view, since this compound provides softness to the wines. © 2023 Society of Chemical Industry.

Methyl Jasmonate and Nanoparticles Doped with Methyl Jasmonate affect the Cell Wall Composition of Monastrell Grape Skins.

The structural composition of the cell wall of grape skins is related to the cell wall integrity and subsequent extraction of the different compounds that are contained inside vacuoles and also the cell wall breakdown products. Different reports have established that methyl jasmonate (MeJ) produces changes in the composition of the grape skin cell wall. The use of elicitors to promote the production of secondary metabolites in grapes has been studied in several reports; however, its study linked to nanotechnology is less developed. These facts led us to study the effect of methyl jasmonate (MeJ) and nanoparticles doped with MeJ (nano-MeJ) on the cell walls of Monastrell grapes during three seasons. Both treatments tended to increase cell wall material (CWM) and caused changes in different components of the skin cell walls. In 2019 and 2021, proteins were enlarged in both MeJ and nano-MeJ-treated grapes. A general decrease in total phenolic compounds was detected with both treatments, in addition to an increment in uronic acids when the grapes were well ripened. MeJ and nano-MeJ produced a diminution in the amount of cellulose in contrast to an increase in hemicellulose. It should be noted that the effects with nano-MeJ treatment occurred at a dose 10 times lower than with MeJ treatment.

Long-term complete remission of metastatic adrenocortical carcinoma.

OBJECTIVES: To report a rare case of a metastatic adrenocortical carcinoma (ACC) that achieve a complete and a long-term remission. CASE PRESENTATION: AAC is a rare and aggressive tumor, with a high risk of recurrence and that present metastases in 21% of cases at diagnosis. Treatment of advanced ACC is challenging, mitotane is the only available adrenolytic treatment, with modest and unpredictable responses. Response rates to systemic chemotherapy are not encouraging. We describe the case of a 39-year-old woman with a metastatic ACC, that achieve a complete and long-term remission after chemotherapy, mitotane treatment and surgery of primary tumor and liver metastases. CONCLUSIONS: A complete remission of a metastatic adrenocortical carcinoma is possible in some rare cases after a multimodal treatment.

Dietary Intake Contributed the Most to Chlorinated Paraffin Body Burden in a Norwegian Cohort.

Determining the major human exposure pathways is a prerequisite for the development of effective management strategies for environmental pollutants such as chlorinated paraffins (CPs). As a first step, the internal and external exposure to CPs were quantified for a well-defined human cohort. CPs in participants' plasma and diet samples were analyzed in the present study, and previous results on paired air, dust, and hand wipe samples were used for the total exposure assessment. Both one compartment pharmacokinetic modeling and forensic fingerprinting indicate that dietary intake contributed the most to body burden of CPs in this cohort, contributing a median of 60-88% of the total daily intakes. The contribution from dust ingestion and dermal exposure was greater for the intake of long-chain CPs (LCCPs) than short-chain CPs (SCCPs), while the contribution from inhalation was greater for the intake of SCCPs than medium-chain CPs (MCCPs) and LCCPs. Significantly higher concentrations of SCCPs and MCCPs were observed in diets containing butter and eggs, respectively (p < 0.05). Additionally, other exposure sources were correlated to plasma levels of CPs, including residence construction parameters such as the construction year (p < 0.05). This human exposure to CPs is not a local case. From a global perspective, there are major knowledge gaps in biomonitoring and exposure data for CPs from regions other than China and European countries.

Radical Production with Pulsed Beams: Understanding the Transition to FLASH.

Ultra-high dose rate (UHDR) irradiation regimes have the potential to spare normal tissue while keeping equivalent tumoricidal capacity than conventional dose rate radiotherapy (CONV-RT). This has been called the FLASH effect. In this work, we present a new simulation framework aiming to study the production of radical species in water and biological media under different irradiation patterns. The chemical stage (heterogeneous phase) is based on a nonlinear reaction-diffusion model, implemented in GPU. After the first 1 µs, no further radical diffusion is assumed, and radical evolution may be simulated over long periods of hundreds of seconds. Our approach was first validated against previous results in the literature and then employed to assess the influence of different temporal microstructures of dose deposition in the expected biological damage. The variation of the Normal Tissue Complication Probability (NTCP), assuming the model of Labarbe et al., where the integral of the peroxyl radical concentration over time (AUC-ROO) is taken as surrogate for biological damage, is presented for different intra-pulse dose rate and pulse frequency configurations, relevant in the clinical scenario. These simulations yield that overall, mean dose rate and the dose per pulse are the best predictors of biological effects at UHDR.

Analysis of psychic imbalance, caused by screening of a video of surgical extraction of a lower third molar in a sample of mental patients as compared to the general population.

Background: The goal of this study is to validate the psychometric properties of the Hamilton Rating Scales for anxiety and depression. These two scales will be used to analyze anxiety and depression, seven days before, after and seven days after screening of a video showing ex-traction of a lower third molar in four different strata of the sample: mixed disorder, anxiety dis-order, adaptive disorder, and no mental disorder. Material and Methods: A prospective study was performed of 240 Caucasian subjects ages 18-70 in a psychiatry outpatient clinic in Malaga. The study was ap-proved by the Research Ethics Committee of the University of Seville. Following interviews with a psychiatrist and completion of the Hamilton scales, the participants were divided into four levels, with 60 participants per group. The influence of sex and place of residence were analysed. Results: The scales showed good psychometric properties. At the three video screenings, the means were higher for women, persons from rural environments and persons with mixed disorder in the first instance and then anxiety disorder. Conclusions: Patients with mixed disorder experience a higher level of anxiety and depression than do patients free of mental pathologies. Key words:Anxiety disorder, adaptive disorder, dental anxiety, mixed anxiety-depressive disorder, surgical extraction.

Effects of Methyl Jasmonate and Nano-Methyl Jasmonate Treatments on Monastrell Wine Volatile Composition.

The application of methyl jasmonate (MeJ) as an elicitor to enhance secondary metabolites in grapes and wines has been studied, but there is little information about its use in conjunction with nanotechnology and no information about its effects on wine volatile compounds. This led us to study the impact of nanoparticles doped with MeJ (Nano-MeJ, 1mM MeJ) on the volatile composition of Monastrell wines over three seasons, compared with the application of MeJ in a conventional way (10 mM MeJ). The results showed how both treatments enhanced fruity esters in wines regardless of the vintage year, although the increase was more evident when grapes were less ripe. These treatments also achieved these results in 2019 in the cases of 1-propanol, ß-phenyl-ethanol, and methionol, in 2020 in the cases of hexanol and methionol, and in 2021, but only in the case of hexanol. On the other hand, MeJ treatment also increased the terpene fraction, whereas Nano-MeJ, at the applied concentration, did not increase it in any of the seasons. In summary, although not all families of volatile compounds were increased by Nano-MeJ, the Nano-MeJ treatment generally increased the volatile composition to an extent similar to that obtained with MeJ used in a conventional way, but at a 10 times lower dose. Therefore, the use of nanotechnology could be a good option for improving the quality of wines from an aromatic point of view, while reducing the necessary dosage of agrochemicals, in line with more sustainable agricultural practices.

Productiveness and Berry Quality of New Wine Grape Genotypes Grown under Drought Conditions in a Semi-Arid Wine-Producing Mediterranean Region.

One alternative for adapting viticulture to high temperatures and the scarcity of water is the development of new varieties adapted to such conditions. This work describes six new genotypes, derived from "Monastrell" × "Cabernet Sauvignon" (MC16, MC19, MC72, MC80) and "Monastrell" × "Syrah" (MS104, MS49) crosses, grown under deficit irrigation and rainfed conditions in a semi-arid wine-producing area (Murcia, southeastern Spain). The effect of genotype, year, and irrigation treatment on the phenological, productiveness, morphological, and grape quality data was evaluated. The study material was obtained and selected as part of a breeding program run by the Instituto Murciano de Investigación y Desarollo Agrario y Medioambiental (IMIDA). The results obtained show that under rainfed conditions, the values for productive variables decreased, while those referring to the phenolic content increased. Notable variation in the parameters evaluated was also seen for the different genotypes studied. The behavior of the genotypes MC80 and MS104 under rainfed conditions was noteworthy. In addition to maintaining very adequate yields, phenolic contents, must pH, and total acidity values, MC80 fell into the best 'phenolic quality group' and MS104 returned a low º°Baumé value, ideal for the production of low-alcohol-content wines. These genotypes could favor the development of sustainable quality viticulture in dry and hot areas.

Natural Repellents as a Method of Preventing Ant Damage to Microirrigation Systems.

Ants are important because they damage agricultural equipment, including microirrigation systems. The aim of this research was to assess the efficiency of the incorporation of repellents in drip irrigation tubing as a method of protection against ant damage. Unlike previous studies, we tested a series of nontoxic compounds that are repellent to ants. First, we assessed their repellent effects on a local ant species via olfactometer trials. Then, the candidates showing the best results (cinnamon essential oil, p-anisaldehyde and ethyl anthranilate) were incorporated via compounding, injection and extrusion to polyethylene tubing to test their efficiency in the field. Field tests showed high damage levels in the control tubing containing no repellents, presumably caused by up to six different ant species (Cardiocondyla batesii, Plagiolepis pygmaea, P. schmitzii, Solenopsis sp., Tapinoma nigerrimum and Tetramorium semilaeve). In contrast, the pipes containing the three selected compounds remained almost intact, with the treatment including ethyl anthranilate showing no damage at all. These results suggest the strong repellent potential of the selected compounds, even when integrated into plastic, as well as the apparent success of the proposed methodology against the damage caused by ants. The diversity of damage-causing agents that exist in or above the soil strongly encourages further studies to determine the overall efficiency of repellents in protecting irrigation pipes.

Factors associated with prolonged episodes of mechanical restraint in mental health hospitalization units in Andalusia.

WHAT IS KNOWN ON THE SUBJECT?: Risk factors associated with prolonged episodes of mechanical restraint and other coercive measures are understudied. There have been no studies of this phenomenon in the context of the Andalusian public health system. Knowledge about factors associated with prolonged episodes is essential to increase the understanding of this phenomenon and develop strategies to reduce its occurrence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at the level of the units could be necessary to prevent prolonged episodes of mechanical restraint. The results suggest the need for stricter control during the shifts on which restraint starts, especially in the first days after the patient's admission. Preventive risk assessment considering clinical and sociodemographic risk factors could help to reduce prolonged restraint. ABSTRACT: Introduction Factors associated with prolonged episodes of mechanical restraint and other coercive interventions are not clearly established and have been not studied in Andalusia (Spain). Aim To study factors associated with prolonged episodes of mechanical restraint. Method We analysed retrospectively episodes of mechanical restraint (N = 6267, prolonged episode >9.5 hours) in all public mental health hospitalization units (N = 20, 535 beds) that offer health coverage for the autonomous community of Andalusia. The data came from clinical records. A multivariable mixed logistic regression was used. Results In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. Discussion The results provide evidence that prolonged episodes largely depend on the unit where they occur and that stricter control and regulation are necessary to prevent prolonged episodes. Implications for practice Interventions at the level of the unit are necessary. Stricter control in the shifts during which there is more risk of prolonged restraint may be necessary, especially in the first days following admission.

Effect of clay and guishe-ash as substrate on Lycopersicon esculentum germination and production.

The effect of biomass ash and clay on tomato plants (Lycopersicon esculentum) in greenhouse conditions from germination to production was studied. Biomass ash is a waste obtained from thermal treatment of guishe (a by-product of natural fiber), and clay is collected from local soils. Several trials were performed to assess the influence of the addition of clay and guishe-ash on seeds germination, seedling growth, and production yield. The decrease in the values of these variables was considered an indicator of toxicity. The obtained results showed that based clay/ash materials positively affect germination (average ∼90% and six materials allow obtaining 90%) and seedlings growth (an increase of ∼20% in height and more than 50% in fresh air corpuscular weight). However, applying these materials on the production stage induces minor positive effects on fruit diameter, locule number, pericarp thickness, and the number of seeds per fruit. Also, adverse effects (first harvest yield, number of fruits, fresh mass of ripe fruits, lycopene content) were observed. To valorize biomass ash, its combination with other materials such as clay could be an alternative to improve tomato production.

The concern to attend the growing demand for food has promoted the use of different kinds of materials as enhancers of plant growth and crop productivity. Among the materials that have been applied in crops are the wastes of biomass thermochemical processes, such as biochar and ashes. This work highlights the importance of evaluating the effect of applying a residue (guishe-ash) to a crop before promoting its use.

¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi / How to assess Person-Centered Care according to professionals? A Delphi study

Objetivos: Conocer la perspectiva de profesionales sobre aspectos y dimensiones que deberían formar parte indispensable de la Atención Centrada en la Persona (ACP).DiseñoTécnica Delphi.EmplazamientoAtención Primaria.ParticipantesSetenta y cuatro expertos médicos especialistas en medicina familiar y comunitaria (MF), tutores docentes, psicólogos y sociólogos distribuidos por todo el territorio nacional (enero-junio 2015).MétodosRespondieron a tres cuestionarios: primero sobre aspectos que debería tener en cuenta un MF para realizar ACP en todas sus dimensiones. En el segundo se preguntó sobre el grado de acuerdo con cada ítem y dimensión en que lo clasificaba. Las respuestas se priorizaron en un tercer cuestionario (escala Likert, rango de puntuación 1-10).ResultadosLa tasa de respuesta (TR) al primer cuestionario fue de 54,05%, obteniéndose 84 ítems, los más frecuentes Respeto y Atención Integral. El 2.° cuestionario con TR=48,6%, obtuvo 52 ítems con acuerdo superior al 75%. La TR del tercer cuestionario fue de 52,7%, obteniendo 21 ítems con puntuación >9. Los valores más altos correspondieron a aspectos esenciales de la ACP: respeto, atención integral, enfoque biopsicosocial, autonomía del paciente y participación en la toma de decisiones.ConclusionesSe identificaron nuevas dimensiones: Prevención y promoción de la salud, Gestión de Recursos y Competencia Clínica; añadidas a las previamente descritas: Perspectiva biopsicosocial, Médico como persona, Paciente como persona, Relación médico-paciente y Poder y Responsabilidad compartidas.El respeto, la atención integral, el enfoque biopsicosocial, la autonomía del paciente y su participación en la toma de decisiones, son los aspectos más valorados entre los seleccionados por los profesionales participantes.

Objectives: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA).DesignDelphi Technique.LocationPrimary Care.Participants74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015).MethodsThey responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10).ResultsThe response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making.

[How to assess Person-Centered Care according to professionals? A Delphi study]. / ¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi.

OBJECTIVES: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA). DESIGN: Delphi Technique. LOCATION: Primary Care. PARTICIPANTS: 74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015). METHODS: They responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10). RESULTS: The response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making. CONCLUSIONS: New dimensions were identified: Prevention and health promotion, Resource Management and Clinical Competence, added to those previously described: Biopsychosocial perspective, Doctor as a person, Patient as a person, Doctor-patient relationship and Shared Power and Responsibility. Respect, comprehensive care, the biopsychosocial approach, the patient's autonomy and their participation in decision-making, are the most valued aspects among those selected by the participating professionals.