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1.
Rev. bioét. derecho ; (50): 37-61, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191345

RESUMO

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


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias/ética , Protocolos Clínicos , Triagem/ética , Tomada de Decisões/ética
2.
Rev. bioét. derecho ; (50): 1133-131, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191349

RESUMO

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


Assuntos
Humanos , Triagem , Biotecnologia , Direitos do Paciente , Tomada de Decisões , Infecções por Coronavirus , Pneumonia Viral , Pandemias
3.
Rev. bioét. derecho ; (50): 189-203, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191353

RESUMO

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


Assuntos
Humanos , Prioridades em Saúde/ética , Prioridades em Saúde/organização & administração , Planejamento de Assistência ao Paciente , Tomada de Decisões/ética , Conflito de Interesses , Serviços Médicos de Emergência/ética , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Doença Crônica
4.
Rev. bioét. derecho ; (50): 315-331, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191360

RESUMO

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


Assuntos
Humanos , Inteligência Artificial , Big Data , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Tomada de Decisões , Betacoronavirus , Previsões
8.
Rev Bras Epidemiol ; 23: e200091, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33027433

RESUMO

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.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Governo Local , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Brasil/epidemiologia , Humanos , Estudos Retrospectivos , Distância Social
10.
Nat Commun ; 11(1): 4961, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32999287

RESUMO

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.


Assuntos
Telefone Celular , Infecções por Coronavirus/epidemiologia , Aplicativos Móveis , Pandemias , Pneumonia Viral/epidemiologia , Comportamento , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Tomada de Decisões , Humanos , Controle de Infecções/métodos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Saúde Pública , Fatores de Risco
11.
Lancet HIV ; 7(10): e711-e720, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33010243

RESUMO

Despite a large and growing body of literature on sexual and reproductive health (SRH) and HIV integration, the drivers of integration of SRH and HIV services, from a health systems perspective, are not well understood. These drivers include complex so-called hardware (structural and resource) and software (values and norms, and human relations and interactions) factors. Two groups of software factors emerge as essential enablers of effective integration of SRH and HIV services that often interact with systems hardware: (1) leadership, management, and governance processes and (2) provider motivation, agency, and relationships. Evidence suggests the potential for software elements that are essential enablers to overcome some of the obstacles posed by the non-integration of health system hardware elements (eg, financing, guidelines, and commodity supplies). These enabling factors include flexible decision making, inclusive management, and support in motivating frontline staff who can work with agency as a team. Improved software, even within constrained hardware (especially in low-income and middle-income countries), can directly contribute to improved SRH and HIV service delivery.


Assuntos
Prestação Integrada de Cuidados de Saúde , Infecções por HIV/epidemiologia , Serviços de Saúde Reprodutiva , Saúde Sexual , África ao Sul do Saara/epidemiologia , Tomada de Decisões , Análise Fatorial , Pessoal de Saúde , Humanos , Vigilância em Saúde Pública , Responsabilidade Social
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1035-1038, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018162

RESUMO

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.


Assuntos
Jogo de Azar , Tomada de Decisões , Lobo Frontal/diagnóstico por imagem , Humanos , Motivação , Córtex Pré-Frontal
15.
Stud Health Technol Inform ; 273: 258-261, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087623

RESUMO

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.


Assuntos
Tomada de Decisões , Multimorbidade
17.
Rev. esp. med. legal ; 46(3): 119-126, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192313

RESUMO

La pandemia por COVID-19 ha suscitado problemas éticos y médico-legales, entre los que destaca la asignación equitativa de recursos sanitarios, sobre todo en relación a la priorización de pacientes y el racionamiento de recursos. El establecimiento de prioridades está siempre presente en los sistemas sanitarios y depende de la teoría de justicia aplicable en cada sociedad. El racionamiento de recursos ha sido necesario en la pandemia por COVID-19, por lo que se han publicado documentos de consenso para la toma de decisiones sustentadas en cuatro valores éticos fundamentales: maximización de los beneficios, tratar a las personas igualmente, contribuir en la creación de valor social y dar prioridad a la situación más grave. De ellos derivan recomendaciones específicas: maximizar beneficios; priorizar a los trabajadores de la salud; no priorizar la asistencia por orden de llegada; ser sensible a la evidencia científica; reconocer la participación en la investigación y aplicar los mismos principios a los pacientes COVID-19 que a los no-COVID-19


The COVID-19 pandemic has raised ethical and medico-legal problems, which include the equitable allocation of health resources, especially in relation to the prioritization of patients and the rationing of resources. Priority setting is always present in healthcare systems and depends on the theory of justice applicable in each society. Resource rationing has been necessary in the COVID-19 pandemic, and therefore consensus documents have been published for decision-making based on four fundamental ethical values: maximization of benefits, treating people equally, contributing to creating social value and giving priority to the worst off, from which specific recommendations derive: maximize benefits; prioritize health workers; do not prioritize attendance on a first-come, first-served basis; be sensitive to scientific evidence; recognize participation in research and apply the same principles to COVID-19 patients as to non-COVID-19 patients


Assuntos
Humanos , Valor da Vida , Administração dos Cuidados ao Paciente/legislação & jurisprudência , Seleção de Pacientes/ética , Infecções por Coronavirus , Cuidados Paliativos na Terminalidade da Vida/ética , Cuidados para Prolongar a Vida/ética , Pandemias/legislação & jurisprudência , Tomada de Decisões/ética , Temas Bioéticos , Revisão da Utilização de Recursos de Saúde/legislação & jurisprudência , Alocação de Recursos/legislação & jurisprudência , Recusa do Médico a Tratar/ética , Recusa do Médico a Tratar/legislação & jurisprudência
20.
Value Health ; 23(9): 1157-1162, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940233

RESUMO

OBJECTIVES: Despite wide support for patient involvement in health technology assessments (HTA), determining meaningful engagement is complex. This article explores experiences and perceptions among patient groups participating in the Canadian Agency for Drugs and Technologies in Health (CADTH)'s pan-Canadian Oncology Drug Review (pCODR) process. METHODS: We created a qualitative interview study comprising 22 semi-structured telephone interviews with individuals representing 21 different patient groups registered with the pCODR process. The analysis used a qualitative descriptive approach employing techniques from grounded theory. RESULTS: Patient groups view the ability to make submissions to the pCODR process as a meaningful activity closely aligned with organizational priorities. Concurrently, they face substantial resource challenges to prepare submissions, including high opportunity costs and difficulty accessing needed literature and finding relevant patients. Although patient groups felt that CADTH is committed to transparency, they expressed considerable uncertainty around the direct impact of their submissions and desired additional avenues for engagement. CONCLUSIONS: This study suggests a strong commitment by patient groups to participate in the pCODR process despite uncertainty about how their submissions are used to inform HTA recommendations. Identifying opportunities to provide both financial and nonfinancial resources to patient groups is crucial to encouraging and supporting their meaningful participation in HTA processes.


Assuntos
Antineoplásicos/economia , Oncologia/economia , Participação do Paciente , Avaliação da Tecnologia Biomédica/organização & administração , Canadá , Análise Custo-Benefício , Tomada de Decisões , Humanos , Pesquisa Qualitativa
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