Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review.

BACKGROUND: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.

Ethical, legal, organizational and social issues related to the use of scalp cooling for the prevention of chemotherapy-induced alopecia: A systematic review.

INTRODUCTION: Scalp cooling (SC) aims to prevent chemotherapy-induced alopecia. The goal of this systematic review is to tackle ethical, legal, organizational and social issues related to SC. METHODS: A critical appraisal of the literature was carried out using a systematic review design. MEDLINE, Embase and Web of Science databases were searched up until 2 June 2021. Studies addressing these aspects in English or Spanish were considered. Representatives of both patient associations and professional scientific societies related to the topic participated in the design of the protocol and the review of the findings. RESULTS: A total of 17 studies were included. Articles were critically appraised using the MMAT and SANRA. Findings were organized into four categories: (1) ethical aspects focused on equal access, gender equity and doctor-patient communication supported by Patient Decision Aids (PtDAs); (2) patient perspective and acceptability; (3) professional perspective and acceptability; (4) organizational aspects focused on accessibility and feasibility. CONCLUSION: Cancer patients' expectations when using SC need to be adjusted to reduce the potential distress associated with hair loss. PtDAs could help patients clarify their values and preferences regarding SC. Equal access to technology should be guaranteed. PATIENT OR PUBLIC CONTRIBUTION: In this systematic review, the representatives of the patient associations (Ms. María Luz Amador Muñoz of the Spanish Association Against Cancer [AECC] and Ms. Catiana Martinez Cánovas of the Spanish Breast Cancer Federation [FECMA]) participated in the review of the study protocol, as well as in the results, discussion and conclusions, making their contributions. In the type of design of these studies (systematic reviews), it is not usual to have the direct participation of patients, but in this one, we have done so, as it is a systematic review that is part of a report of the Spanish Network of Health Technology Assessment Agencies (ETS).

Universal programs to prevent eating disorders in children and adolescents: A scoping review of ethical, legal, organizational and social impacts.

BACKGROUND: Appropriate and timely consideration of ethical, legal, organizational, and social issues in universal preventive programs for eating disorders (UPPED) are relevant for the approval, funding and implementation of health-policy decision making. OBJECTIVE: To identify and analyse the ethical, legal, organizational, and social aspects involved in interventions aimed at the universal prevention of eating disorders (ED) in children, pre-adolescents and adolescents in the school settings. METHOD: A scoping review of the literature was carried out. MEDLINE, EMBASE, CENTRAL, PsycINFO, and Social Science Citation Index were searched for studies published in English or Spanish. The quality of the studies was assessed using specific scales for each study design. RESULTS: Fourteen studies were included: one scoping review; four narrative reviews, six observational studies, two qualitative studies, and one mixed methods study. Results were narratively synthesised according to: (1) equity; (2) gender perspective; (3) potential harm; (4) participants and facilitators profile; (5) feasibility; and (6) acceptability. CONCLUSIONS: Interactive programs with relevant contents for participants have greater acceptability. Programs focussed on developing competencies can reduce the risk of potential harm. Incorporating a gender perspective contributes to improving equity. Teachers with prior training in ED are well suited as facilitators of these programs.

De las instrucciones previas a la planificación anticipada de la asistencia sanitaria / From the advanced directives to the advance care planning

En la última década hemos asistido a una importante modificación legislativa en lo relacionado con la muerte digna y el respeto a la toma de decisiones de las personas en este marco. Así, diferentes legislaciones a nivel autonómico en nuestro país se han articulado para garantizar el derecho de los pacientes a elaborar documentos de instrucciones previas o manifestación anticipada de voluntades. Esto, a su vez, ha puesto de manifiesto la necesidad no solo de regulación jurídica, sino de un cambio profundo en el modelo de relación entre el profesional sanitario y el paciente. La planificación anticipada de la asistencia sanitaria (PAAS) representa un paso importante en el respeto por la autonomía de los pacientes, así como en el deseo de involucrar a la persona en la toma de decisiones, en los aspectos relacionados con su propia muerte. Dicho proceso se desarrolla con la finalidad de buscar soluciones para garantizar la autonomía y la libertad de quienes, a partir de un momento dado, han perdido la capacidad para tomar decisiones. En este modelo de atención, el papel de enfermería será no solo necesario, sino indispensable (AU)

In the last decade we have witnessed a significant legislative transformation with regard the death with dignity process, and respect the decision of the people in this framework. In that way, different legislation at regional level in our country have been articulated to ensure the right of patients to produce documents of advanced directives or living will. This fact has highlighted the need not only to legal regulation, but a deep change in the pattern of relationship between health professional and patient. Advance planning of healthcare (PAAS) represents an important step in respect for patient autonomy and the desire to involve the person in decision making process, in matters relating to his own death. This process is developed in order to find solutions to ensure the autonomy and freedom of those who, from a given moment, have lost the ability to make decisions. In this model of care, the role of nursing is not only necessary but essential (AU)

[From the Advance Directives to the Advance Care Planning]. / De las instrucciones previas a la planifi cación anticipada de la asistencia sanitaria.

In the last decade we have witnessed a significant legislative transformation with regard to the death and dignity process, and respect the decision of the people in this framework. In that way, different legislation at regional level in our country have been articulated to ensure the right of patients to produce documents of advanced directives or living will. This fact has highlighted the need not only to legal regulation, but a deep change in the pattern of relationship between health professional and patient. Advance planning of healthcare (PAAS) represents an important step in respect for patient autonomy and the desire to involve the person in the decision making process, in matters relating to his own death. This process is developed in order to find solutions to ensure the autonomy and freedom of those who, from a given moment, have lost the ability to make decisions. In this model of care, the role of nursing is not only necessary but essential.

Cuidados interculturales, un reto para la Enfermería / Intercultural care, a nursing challenge

La práctica de la Enfermería se puede enmarcar en esa intersección entre lo que deben ser los cuidados universales y los cuidados individualizados, adaptables a las características concretas y específicas de cada uno. Para compatibilizar la autonomía del paciente y la justicia, la práctica enfermera de nuestro tiempo debe esforzarse por atender a las diferencias, a los contextos concretos en los que viven las personas con sus múltiples formas de entender la vida, la salud, la enfermedad, etc. El objetivo de este trabajo consiste en destacar la importancia que tiene para los profesionales de la Enfermería la adopción de un modelo de cuidados desde la perspectiva intercultural y la necesidad de adquirir competencia cultural, puesto que será a través de ella como se puedan prestar cuidados enfermeros de calidad. Se describen y analizan los significados de cuidar desde una perspectiva intercultural y de competencia cultural, señalando los objetivos y elementos esenciales para el desarrollo de cada uno de estos conceptos y se enfatiza el importante papel de los mediadores culturales en el ámbito sanitario (AU)

The practice of nursing can be framed in that intersection between what universalizable care as opposed to individualized care, adaptable to the concrete and specific characteristics of each. To reconcile the patient's autonomy and justice, the nursing practice of today must strive to address the differences, in the particular contexts in which people live with multiple ways of understanding life, health, disease, etc. The aim of this paper is to stress the importance for professionals of adapting a nursing care model from an intercultural perspective and the need to acquire cultural competence, since it will be through it that nursing care quality will be provided. We describe and analyze the meaning of caring from an intercultural and cultural competence, identifying the essential objectives and elements for the development of each of these concepts, emphasizing the important role of cultural mediators in the health setting (AU)

[Responsibility versus informed consent nurse]. / Responsabilidad enfermera frente al consentimiento informado.

In recent years we have witnessed a quick development in concern and research about informed consent in the biomedical field. This development has taken place mainly due to the increased importance given within the medical field to the patient's autonomy as well as law ratified legally recognized and regulated in our country in law 41/2002 of patient autonomy However, in the field of nursing is not even clear what the role of professional nursing with regard to informed consent, or what its responsibilities in this regard. Therefore, the objective of this study is to clarify what is the responsibility of nursing in relation to the CI. In addition, we discuss the relevance or otherwise of the implementation of informed consent documents for nursing care, addressing both its advantages and disadvantages.

Responsabilidad enfermera frente al consentimiento informado / Responsibility versus informed consent nurse

En los últimos años hemos asistido a un desarrollo vertiginoso de la preocupación y la investigación acerca del consentimiento informado dentro del ámbito biomédico. Éste ha tenido lugar, fundamentalmente, como consecuencia de la mayor importancia dentro del mundo sanitario de la autonomía del paciente, ratificado -además- como derecho legalmente reconocido y regulado en nuestro país en la Ley 41/2002 de autonomía del paciente. Sin embargo, en el ámbito de enfermería no queda aún claro cuál es el rol que desempeña dicho profesional con respecto al consentimiento informado, ni cuáles son sus responsabilidades al respecto. Por ello, el objetivo de este trabajo es clarificar cuál es la responsabilidad de enfermería en relación al consentimiento informado. Además, se pretende discutir sobre la pertinencia o no de la implementación de documentos de consentimiento informado de cuidados para enfermería, abordando tanto sus ventajas como sus inconvenientes (AU)

In recent years we have witnessed a quick development in concern and research about informed consent in the biomedical field. This development has taken place mainly due to the increased importance given within the medical field to the patient's autonomy, as well as law ratified legally recognized and regulated in our country in law 41/2002 of patient autonomy. However, in the field of nursing is not even clear what the role of professional nursing with regard to informed consent, or what its responsibilities in this regard. Therefore, the objective of this study is to clarify what is the responsibility of nursing in relation to the CI. In addition, we discuss the relevance or otherwise of the implementation of informed consent documents for nursing care, addressing both its advantages and disadvantages(AU)