Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 97.521
Filtrar
1.
Rev. bioét. derecho ; (50): 37-61, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191345

RESUMEN

Este documento ofrece una propuesta desde la perspectiva de la bioética para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Dicha propuesta incluye recomendaciones sobre las normas procedimentales y normas sustantivas que deben regir la asignación y reasignación de recursos terapéuticos en condiciones de escasez extrema


This document offers a proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic. This proposal includes recommendations on the procedural norms and substantive norms that should govern the allocation and reallocation of therapeutic resources in conditions of extreme scarcity


Aquest document ofereix una proposta des de la perspectiva de la bioètica per a l'elaboració d'un protocol de triatge en el context de la pandèmia de COVID-19. L'esmentada proposta inclou recomanacions sobre les normes procedimentals I normes substantives que han de regir l'assignació I reassignació de recursos terapèutics en condicions d'escassetat extrema


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias/ética , Protocolos Clínicos , Triaje/ética , Toma de Decisiones/ética
2.
Rev. bioét. derecho ; (50): 1133-131, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191349

RESUMEN

Han sucedido tantas cosas, y en tan poco tiempo, que no resulta fácil seleccionar alguna temática sin dejarnos fuera otras igualmente relevantes. Probablemente nos pasaremos los próximos años debatiendo sobre lo acontecido, entre otros motivos, por la escasa información que aun hoy tenemos sobre la apisonadora que ha triturado nuestro estilo de vida. Pues bien, he seleccionado, de entre las innumerables que podríamos estudiar, cuatro narrativas. En concreto, la pandemia como refriega entre neokantianos y utilitaristas; como datificación de rebaño; como ajuste de cuentas epistemológico y como singularidad española. Con este análisis podremos interrelacionar, aunque sea de forma breve, las implicaciones éticas, jurídicas, políticas y científicas de una historia que recién ha comenzado


So many things have happened, and in such a short time, that it is not easy to select some topic without leaving out other equally relevant ones. We will probably spend the next few years debating what happened, among other things, due to the scant information that we still have today about the steamroller that has crushed our lifestyle. Well, I have selected, from the innumerable ones that remain to be studied, four narratives. Specifically, the pandemic as a fray between neo-Kantians and utilitarians; as herd dating; as an epistemological reckoning and as a Spanish singularity. With this analysis we will be able to interrelate, albeit briefly, the ethical, legal, political and scientific implications of a history that has just begun


Han passat tantes coses, I en tan poc temps, que no resulta fàcil seleccionar alguna temàtica sense deixar-nos fora d'altres igualment rellevants. Probablement ens passarem els propers anys debatent sobre els fets, entre altres motius, per l'escassa informació que encara avui tenim sobre la piconadora que ha triturat el nostre estil de vida. Doncs bé, he seleccionat, d'entre els innombrables que podríem estudiar, quatre narratives. En concret, la pandèmia com la batalla entre neokantians I utilitaristes; com datificació de ramat; com venjança epistemològica I com a singularitat espanyola. Amb aquest anàlisi podrem interrelacionar, encara que sigui de forma breu, les implicacions ètiques, jurídiques, polítiques I científiques d'una història que just acaba de començar


Asunto(s)
Humanos , Triaje , Biotecnología , Derechos del Paciente , Toma de Decisiones , Infecciones por Coronavirus , Neumonía Viral , Pandemias
3.
Rev. bioét. derecho ; (50): 189-203, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191353

RESUMEN

La actual pandemia por la COVID-19 está ocasionado serias amenazas para la salud pública a nivel mundial, especialmente para los grupos de población más vulnerables. Los casos más graves de la enfermedad han sido primeramente atendidos por los profesionales de urgencias y emergencias, los cuales han tenido que tomar decisiones en contextos altamente complejos donde la priorización en la asignación de los recursos sanitarios disponibles les ha generado situaciones éticamente conflictivas. El objetivo del presente artículo es analizar la importancia de implantar la PDA en los servicios de urgencias y emergencias como herramienta de consulta en la resolución de los problemas éticos surgidos durante la pandemia por COVID-19, concretamente, en la atención al paciente crónico complejo o con enfermedad crónica avanzada


The events of the present CoVID-19 pandemic are causing serious threats to Public Health worldwide, specifically at the most vulnerable population groups. Emergency professionals have served as the first responders for the most serious cases of this disease. At the same time, they have made decisions in highly complex contexts where the prioritization of allocated care resources has generated ethically conflictive situations. The aim of this article is to analyze the importance of implementing the ACP as a tool in the emergency services to solve ethical problems that have arisen during the COVID-19 pandemic, particularly in the care of complex chronic patients or those with advanced chronic disease


L'actual pandèmia per la COVID-19 està ocasionat serioses amenaces a la salut pública a nivell mundial, especialment als grups de població més vulnerables. Els casos més greus de la malaltia han estat primerament atesos pels professionals d'urgències I emergències, els quals han hagut de prendre decisions en contextos altament complexos on la priorització en l'assignació dels recursos sanitaris disponibles els ha generat situacions èticament conflictives. L'objectiu d'aquest article va ser analitzar la importància d'implantar la PDA en els serveis d'urgències I emergències com a eina de consulta a la resolució dels problemes ètics sorgits durant la pandèmia per COVID-19, concretament, en l'atenció al pacient crònic complex o amb malaltia crònica avançada


Asunto(s)
Humanos , Prioridades en Salud/ética , Prioridades en Salud/organización & administración , Planificación de Atención al Paciente , Toma de Decisiones/ética , Conflicto de Intereses , Servicios Médicos de Urgencia/ética , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Enfermedad Crónica
4.
Rev. bioét. derecho ; (50): 315-331, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191360

RESUMEN

La inteligencia artificial y el Big Data se articulan para poder lidiar con diferentes problemas relacionados con el análisis de datos masivos, en particular información de la COVID-19. En el presente artículo se muestran algunos proyectos de investigación relacionados con el aprendizaje profundo, el aprendizaje automático, el Big Data y la ciencia de datos, tendientes a dar soluciones plausibles bien en el monitoreo, detección, diagnóstico y tratamiento de las enfermedades asociadas con el virus. Con esto en mente, se muestra la correspondencia entre las tecnologías disruptivas y la información crítica, creando sinergias que permiten elaborar sistemas más avanzados de estudio y análisis facilitando la obtención de datos relevantes para la toma de decisiones sanitarias


Artificial intelligence and Big Data are articulated to be able to deal with different problems related to the analysis of big data, in particular, information from the COVID-19. In this sense, this article shows some research projects related to deep learning, machine learning, Big Data and data science, aimed to provide plausible solutions in monitoring, detection, diagnosis and treatment of diseases associated with the virus. The correspondence between disruptive technologies and critical information is shown, creating synergies that allow the development of more advanced systems of study and analysis, facilitating the obtaining of relevant data for health decision-making


La Intel·ligència Artificial I el Big Data s'articulen per poder fer front a diferents problemes relacionats amb l'anàlisi de dades massiu, concretament, informació relativa a la COVID-19. En aquest sentit, en el present article es mostren alguns projectes d'investigació relacionats amb l'aprenentatge profund, l'aprenentatge automàtic, el Big Data I la ciència de dades, capaços de donar solucions plausibles en el monitoratge, detecció, diagnòstic I tractament de les malalties associades amb el virus. Amb això en ment, es mostra la correspondència entre les tecnologies disruptives I la informació crítica, creant sinergies que permeten elaborar sistemes més avançats d'estudi I anàlisi facilitant l'obtenció de dades rellevants per a la presa de decisions sanitàries


Asunto(s)
Humanos , Inteligencia Artificial , Macrodatos , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Toma de Decisiones , Betacoronavirus , Predicción
5.
BMC Psychol ; 8(1): 120, 2020 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-33168098

RESUMEN

BACKGROUND: Decisions made by individuals with disordered gambling are markedly inflexible. However, whether anomalies in learning from feedback are gambling-specific, or extend beyond gambling contexts, remains an open question. More generally, addictive disorders-including gambling disorder-have been proposed to be facilitated by individual differences in feedback-driven decision-making inflexibility, which has been studied in the lab with the Probabilistic Reversal Learning Task (PRLT). In this task, participants are first asked to learn which of two choice options is more advantageous, on the basis of trial-by-trial feedback, but, once preferences are established, reward contingencies are reversed, so that the advantageous option becomes disadvantageous and vice versa. Inflexibility is revealed by a less effective reacquisition of preferences after reversal, which can be distinguished from more generalized learning deficits. METHODS: In the present study, we compared PRLT performance across two groups of 25 treatment-seeking patients diagnosed with an addictive disorder and who reported gambling problems, and 25 matched controls [18 Males/7 Females in both groups, Mage(SDage) = 25.24 (8.42) and 24.96 (7.90), for patients and controls, respectively]. Beyond testing for differences in the shape of PRLT learning curves across groups, the specific effect of problematic gambling symptoms' severity was also assessed independently of group assignment. In order to surpass previous methodological problems, full acquisition and reacquisition curves were fitted using generalized mixed-effect models. RESULTS: Results showed that (1) controls did not significantly differ from patients in global PRLT performance nor showed specific signs of decision-making inflexibility; and (2) regardless of whether group affiliation was controlled for or not, gambling severity was specifically associated with more inefficient learning in phases with reversed contingencies. CONCLUSION: Decision-making inflexibility, as revealed by difficulty to reacquire decisional preferences based on feedback after contingency reversals, seems to be associated with gambling problems, but not necessarily with a substance-use disorder diagnosis. This result aligns with gambling disorder models in which domain-general compulsivity is linked to vulnerability to develop gambling-specific problems with exposure to gambling opportunities.


Asunto(s)
Conducta Adictiva/psicología , Conducta Compulsiva , Juego de Azar , Aprendizaje Inverso , Trastornos Relacionados con Sustancias/psicología , Adulto , Toma de Decisiones , Femenino , Humanos , Conducta Impulsiva , Masculino , Recompensa , Índice de Severidad de la Enfermedad
6.
Rev Med Suisse ; 16(713): 2092-2098, 2020 Nov 04.
Artículo en Francés | MEDLINE | ID: mdl-33146957

RESUMEN

Consistent with the principles of evidence-based medicine, communicating clinical risks to patients and their families is an essential part of informed consent and decision-making. Communication of clinical risks can take place during and after consultations, orally or in writing, based on the latest available scientific data, when available. Numerous studies show that there are different degrees of innumeracy in the general population, meaning more or less significant difficulties mastering numbers in everyday situations. It is therefore imperative to communicate risks in a way that is adapted to the patients' variable numeracy and health literacy levels. This article presents a synthesis of international research on risk communication, as well as recommendations for clinical practice.


Asunto(s)
Comunicación , Alfabetización en Salud , Toma de Decisiones , Medicina Basada en la Evidencia , Humanos , Consentimiento Informado , Riesgo
7.
JAMA Netw Open ; 3(11): e2023547, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33136133

RESUMEN

Importance: Hospitals ceased most elective procedures during the height of coronavirus disease 2019 (COVID-19) infections. As hospitals begin to recommence elective procedures, it is necessary to have a means to assess how resource intensive a given case may be. Objective: To evaluate the development and performance of a clinical decision support tool to inform resource utilization for elective procedures. Design, Setting, and Participants: In this prognostic study, predictive modeling was used on retrospective electronic health records data from a large academic health system comprising 1 tertiary care hospital and 2 community hospitals of patients undergoing scheduled elective procedures from January 1, 2017, to March 1, 2020. Electronic health records data on case type, patient demographic characteristics, service utilization history, comorbidities, and medications were and abstracted and analyzed. Data were analyzed from April to June 2020. Main Outcomes and Measures: Predicitons of hospital length of stay, intensive care unit length of stay, need for mechanical ventilation, and need to be discharged to a skilled nursing facility. These predictions were generated using the random forests algorithm. Predicted probabilities were turned into risk classifications designed to give assessments of resource utilization risk. Results: Data from the electronic health records of 42 199 patients from 3 hospitals were abstracted for analysis. The median length of stay was 2.3 days (range, 1.3-4.2 days), 6416 patients (15.2%) were admitted to the intensive care unit, 1624 (3.8%) received mechanical ventilation, and 2843 (6.7%) were discharged to a skilled nursing facility. Predictive performance was strong with an area under the receiver operator characteristic ranging from 0.76 to 0.93. Sensitivity of the high-risk and medium-risk groupings was set at 95%. The negative predictive value of the low-risk grouping was 99%. We integrated the models into a daily refreshing Tableau dashboard to guide decision-making. Conclusions and Relevance: The clinical decision support tool is currently being used by surgical leadership to inform case scheduling. This work shows the importance of a learning health care environment in surgical care, using quantitative modeling to guide decision-making.


Asunto(s)
Infecciones por Coronavirus , Toma de Decisiones , Sistemas de Apoyo a Decisiones Clínicas , Procedimientos Quirúrgicos Electivos , Asignación de Recursos para la Atención de Salud , Hospitalización , Hospitales , Pandemias , Neumonía Viral , Anciano , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Registros Electrónicos de Salud , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Respiración Artificial , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Instituciones de Cuidados Especializados de Enfermería
11.
Rev Bras Epidemiol ; 23: e200091, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027433

RESUMEN

OBJECTIVE: To analyze the association between the transmission potential of SARS-CoV-2 and the decisions made by the municipal government of Florianópolis (Brazil) regarding social distancing. METHODS: We analyzed new cases of COVID-19 identified in Florianópolis residents between February 1 and July 14, 2020, using a nowcasting approach. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, whether they loosened social distancing measures, or increased or maintained existing restrictions, was analyzed, thus creating a Social Distancing Index. Time-dependent reproduction numbers (Rt) for a period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees. RESULTS: A total of 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased social distancing measures, nine maintained them, and eight loosened them. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonance was observed in all of the decrees that maintained the distance measures or loosened them. The fastest expansion in the number of new cases and the greatest amount of dissonant decrees was found in the last two months analyzed. CONCLUSION: There was an important divergence between municipal measures of social distancing with epidemiological indicators at the time of each political decision.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Toma de Decisiones , Gobierno Local , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Brasil/epidemiología , Humanos , Estudios Retrospectivos , Distancia Social
13.
Nat Commun ; 11(1): 4961, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32999287

RESUMEN

The ongoing coronavirus disease 2019 (COVID-19) pandemic has heightened discussion of the use of mobile phone data in outbreak response. Mobile phone data have been proposed to monitor effectiveness of non-pharmaceutical interventions, to assess potential drivers of spatiotemporal spread, and to support contact tracing efforts. While these data may be an important part of COVID-19 response, their use must be considered alongside a careful understanding of the behaviors and populations they capture. Here, we review the different applications for mobile phone data in guiding and evaluating COVID-19 response, the relevance of these applications for infectious disease transmission and control, and potential sources and implications of selection bias in mobile phone data. We also discuss best practices and potential pitfalls for directly integrating the collection, analysis, and interpretation of these data into public health decision making.


Asunto(s)
Teléfono Celular , Infecciones por Coronavirus/epidemiología , Aplicaciones Móviles , Pandemias , Neumonía Viral/epidemiología , Conducta , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Bases de Datos Factuales , Toma de Decisiones , Humanos , Control de Infecciones/métodos , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Salud Pública , Factores de Riesgo
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1035-1038, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018162

RESUMEN

During gambling, humans often begin by making decisions based on expected rewards and expected risks. However, expectations may not match actual outcomes. As gamblers keep track of their performance, they may feel more or less lucky, which then influences future betting decisions. Studies have identified the orbitofrontal cortex (OFC) as a brain region that plays a significant role during risky decision making in humans. However, most human studies infer neural activation from functional magnetic resonance imaging (fMRI), which has a poor temporal resolution. In particular, fMRI cannot detect activity from neuronal populations in the OFC, which may encode specific information about how a subject reacts to mismatched outcomes. In this preliminary study, four human subjects participated in a gambling task while local field potentials (LFPs), captured at a millisecond resolution, were recorded from the OFC. We analyzed high-frequency activity (HFA: >70 Hz) in the LFPs, as HFA has been shown to correlate to activation of neuronal populations. In 3 out of 4 subjects, HFA in OFC modulated between matched and mismatched trials as soon as the outcome of each bet was revealed, with modulations occurring at different times and directions depending on the anatomical location within the OFC.


Asunto(s)
Juego de Azar , Toma de Decisiones , Lóbulo Frontal/diagnóstico por imagen , Humanos , Motivación , Corteza Prefrontal
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3469-3472, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018750

RESUMEN

Choices and decisions involve a series of complex cognitive processes, and the time-frequency analysis of electroencephalogram (EEG) signals can help understand the brain activities in different cognitive tasks. In this study, a decision-making cognitive task of rock-paper-scissors was designed, and the complex decision-making task was divided into three stages (decision planning, confirmation, and feedback). 64 channels of EEG signals were simultaneously recorded using the Neuroscan QuikCap system during the whole task. The average spectral power and phase synchronization values of each frequency band (delta, theta, alpha and beta band) were extracted and compared within and across different stages. The results showed the desire to win or not to lose within the first stage might be accompanied by the increase of alpha and theta components. In the second stage, the spectral power inhibition of alpha wave and phase synchronization increase of delta wave indicated that subjects would improve their attentions when they confirmed their choice. In the third stage, the theta increased effect and alpha decreased effect were related to different feedback. This pilot study suggests that the time-frequency analysis of EEG signals could be a great tool to visualize the brain activities in response to different cognitive tasks.


Asunto(s)
Cognición , Electroencefalografía , Toma de Decisiones , Humanos , Proyectos Piloto
19.
Stud Health Technol Inform ; 273: 258-261, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-33087623

RESUMEN

As with any diagnosis, the underlying purpose of a 'multimorbidity' one is to identify and establish the impact of a person's health conditions on their lives and to facilitate personalized decisions regarding proposed interventions. Clinicians routinely make decisions about the use of interventions for people with multiple long-term conditions. This is challenging because evidence to support this process currently relies on guidance on single health conditions for people without multimorbidity, typically taking fewer medications. Establishing the person's preferences over relevant criteria is central to a person-centered decision-making process, and it is particularly challenging, given the complexities of the person's multiple conditions. The final challenge is in combining the clinician's best estimates of the benefits and harms of possible interventions with the person's preferences. A review of these challenges, drawing on the NICE guidelines, leads to a proposal for using a Multi-Criteria Decision Analysis-based support tool for personalized shared decision making for multiple long-term conditions.


Asunto(s)
Toma de Decisiones , Multimorbilidad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA