Aspectos neurobiológicos en la toma de decisiones afectivas y sociales e influencia del estrés: posibles implicancias en la toma de decisiones clínicas / Neurobiological aspects in affective and social decision-making: possible implications on clinical decision-making

RESUMEN: La toma de decisiones está influenciada por múltiples factores muchas veces no conscientes. En este artículo se sintetizan algunos correlatos neurobiológicos del componente afectivo y social sobre la toma de decisiones, incluyendo el impacto del estrés agudo y crónico y la perspectiva cognitiva de las heurísticas y los sesgos en la práctica clínica. A nivel afectivo, la hipótesis del marcador somático ha asociado la respuesta corporal periférica con estructuras nerviosas centrales en la configuración de las decisiones; intervienen estructuras como la corteza orbitofrontal y el hipocampo. En la toma de decisiones sociales se involucran las dimensiones recompensa y motivación. En este tipo de decisiones es crucial la capacidad de mentalizar a otro e integrar su perspectiva en la toma de decisiones. Esta función se ha relacionado con el surco temporal posterosuperior, la unión temporoparietal, la corteza cingulada anterior y la corteza prefrontal medial. No obstante, en la toma de decisiones sociales también se integra el cumplimiento de normas socialmente establecidas. El estrés agudo o crónico puede afectar la toma de decisiones, positiva o negativamente. En estos procesos se han involucrado al eje hipotálamo-hipófiso-adrenal junto con circuitos corticoestriados, prefrontales, amigdalinos e hipocampales. En la toma de decisiones clínicas se conjugan factores "prerreflexivos" emocionales, sociales y cognitivos que influyen directamente en las conductas adoptadas con los pacientes. Recomendamos enfatizar la investigación en esta área y fortalecer su enseñanza para reconocerlos adecuadamente.

ABSTRACT Decision-making is influenced by multiple unaware factors. We synthesize some neurobiological correlates of the affective and social components on decision-making, including the impact of acute and chronic stress. We also address the impact of heuristics and biases on clinical practice from the cognitive perspective. At an affective level, the hypothesis of the somatic marker has associated the peripheral body response with central nervous structures in the configuration of decisions; structures such as the orbitofrontal cortex and the hippocampus intervene. The reward and motivation dimensions are involved in social decision-making. In these types of decisions, the ability to mentally engage others and integrate their perspective into decision making is crucial. This function has been related to the posterior superior temporal sulcus, the temporoparietal junction, the anterior cingulate cortex, and the medial prefrontal cortex. However, compliance with socially established norms is also integrated into social decision-making. Acute or chronic stress may affect decision-making, positively or negatively. The hypothalamic-pituitary-adrenal axis has been involved in these processes together with corticostriatal, prefrontal, amygdala and hippocampal circuits. In clinical decision-making, "pre-reflective" emotional, social and cognitive factors are combined, influencing the decisions towards patients. We recommend emphasizing research in this field and strengthening education in this area to recognize these aspects adequately.

Evaluación de los contenidos de los gestores de información y conocimiento en el Instituto Superior de Tecnologías y Ciencias Aplicadas-Universidad de la Habana / Contents assessment of information and knowledge managers at the Higher Institute of Applied Sciences and Technologies-University of Havana

Resumen Evaluar el funcionamiento de los gestores de información y conocimiento implementados en el Instituto Superior de Tecnologías y Ciencias Aplicadas (InSTEC) es el objetivo de la investigación. Ello, no solo posibilita el mejoramiento futuro del desempeño de estos, sino también sirve como estudio preliminar para la inserción de otros gestores en el futuro. Los métodos de análisis documental y evaluación heurística sustentan las bases teóricas, mientras que las herramientas automáticas Nibbler, GooglePageRank, SEOptimer, Website Grader, la entrevista y las encuestas a usuarios evidencian el desempeño de los gestores. Los resultados revelaron que la calidad del sitio externo y de la intranet obtuvo 69,4% de competencia global. Varios de los indicadores de estos sitios se deben perfeccionar en aras de brindar un mejor servicio a los usuarios del Instituto en la gestión de la información y el conocimiento, tan necesaria en las universidades.

Abstract The papers goal is to assess the already implemented information and knowledge managers at InSTEC. This allows improving the managers future work, and serves as a preliminary study for including others in the future. Documentary analysis and heuristics evaluation methods are the theoretical basis; meanwhile, automatic tools Nibbler, GooglePageRank, SEOptimer, Website Grader, interviews and polls to users evidenced the actual development of both sites. The studys outcomes revealed the quality of InSTECs external website and its intranet achieved 69,4 % of general competency. These sites indicators must be enhanced to provide a better service to users in the information and knowledge management so needed in universities.

O processo de tomada de decisão médica em tempos de pandemia por coronavírus / The medical decision-making process in the time of the coronavirus pandemic

RESUMO A pandemia causada pelo novo coronavírus tem provocado mudanças significativas no processo de tomada de decisão médica diante do paciente grave. Repentinamente, aumentaram as admissões em unidades de tratamento intensivo, porém, muitos desses casos não apresentam quadros relacionados à infecção viral, mas à exacerbação de doenças preexistentes. Nesse contexto, precisamos evitar que o processo decisório intuitivo e a insegurança nos levem a exaurir a disponibilidade de leitos críticos, antes do momento em que eles sejam realmente necessários, mesmo reconhecendo a importância do método decisório rápido em situações emergências. Uma das melhores formas de atingir esse propósito talvez seja por meio da prática da metacognição e da estruturação de formas de feedback regulares aos profissionais envolvidos em processos decisórios inerentemente rápidos.

ABSTRACT The disease pandemic caused by the novel coronavirus has triggered significant changes in the medical decision-making process relating to critically ill patients. Admissions to intensive care units have suddenly increased, but many of these patients do not present with clinical manifestations related to the viral infection but rather exacerbation of preexisting diseases. In this context, we must prevent intuitive decision-making and insecurity from leading us to exhaust the available critical-care beds before they are truly necessary, while still recognizing the importance of rapid decision-making in emergency situations. One of the best ways to achieve this goal may be by practicing metacognition and establishing ways for regular feedback to be provided to professionals engaged in inherently rapid decision-making processes.

Análise do Sistema de Informação em Imunizações do Brasil sob a ótica das heurísticas de usabilidade / Análisis del sistema de información de inmunizaciones de Brasil desde la perspectiva de las heurísticas de usabilidad / Analysis of the Brazilian immunization information system from the perspective of usability heuristics

O estudo teve o objetivo de analisar o Sistema de Informação de Imunizações web do Brasil sob a ótica das heurísticas de usabilidade. Trata-se de um estudo descritivo, com abordagem qualitativa sobre a avaliação de usabilidade de um novo software sobre o Programa Nacional de Imunizações, com base nas dez Heurísticas de Nielsen. Participaram quatro especialistas da área de Tecnologia da Informação, com conhecimento sobre usabilidade e Programa de Imunizações. Os dados foram tratados pela análise de Conteúdo, na modalidade Temático-Categorial. O sistema proporciona, de um lado, facilidade de acesso aos usuários, podendo ser acessado de qualquer lugar e momento, desde que tenha conectividade com a internet; e de outro, apresenta problemas de usabilidade quanto à percepção de localização do usuário no percurso feito dentro do próprio sistema; apresenta entraves em relação a padronização tanto das telas, quanto dos recursos disponibilizados pelo sistema, além de falhas e duplicidade de comandos, que dificultam o registro e acesso às informações. Os problemas elucidados na avaliação de usabilidade do Sistema de Informação de Imunizações do Brasil poderão embasar melhorias nas novas versões de atualizações(AU)

Este estudio tuvo como objetivo analizar el sistema de información de inmunizaciones en Brasil desde la perspectiva de las heurísticas de usabilidad. Se realizó un estudio descriptivo, con un enfoque cualitativo, sobre la evaluación de la usabilidad de un nuevo software en el programa nacional de inmunización, basado en las diez heurísticas de Nielsen. Participaron cuatro especialistas del área de Tecnología de la Información, con conocimiento sobre usabilidad y el programa de inmunizaciones. Los datos fueron tratados mediante análisis de contenido, en la modalidad temático-categorial. El sistema proporciona facilidad de acceso a los usuarios, al que se puede acceder desde cualquier lugar y en cualquier momento, siempre que tenga conectividad a internet, y presenta problemas de usabilidad con respecto a la percepción del usuario de la ubicación en la ruta tomada dentro del propio sistema. Presenta obstáculos en relación con la estandarización de ambas pantallas y los recursos puestos a disposición por el sistema, además de fallas y duplicación de comandos, que dificultan el registro y el acceso a la información. Los problemas aclarados en la evaluación de usabilidad del sistema de información de inmunizaciones en Brasil pueden respaldar mejoras en nuevas versiones de actualizaciones(AU)

The purpose of the study was to analyze the Brazilian immunization information system from the perspective of usability heuristics. A descriptive qualitative study was conducted evaluating the usability of a new software for the national immunization program based on the ten Nielsen's heuristics. Four specialists from the Information Technology area participated who were knowledgeable about usability and the immunization program. The data were processed by thematic-categorial content analysis. The system provides users with easy access from any place at any time, as long as they can connect to the Internet, and presents usability problems related to perception by users of their place along the route taken within the system itself. It also poses hurdles concerning standardization of the two screens and the resources made available by the system, besides failures and duplication of commands, which hampers the recording of and access to information. The problems clarified in the evaluation of the usability of the Brazilian immunization information system may serve to improve new updated versions(AU)

How heuristics and cognitive biases affect vaccination decisions / Cómo los sesgos heurísticos y cognitivos afectan a las decisiones de vacunación / Como as heurísticas e os vieses cognitivos afetam as decisões sobre vacinação

Abstract: Immunization, the most successful public health intervention to date, can only be effective if eligible individuals or their legal representatives have access to vaccines and subsequently comply with their use. Under-vaccination stems from multiple causes: access, affordability, awareness, acceptance and activation. In this paper, we focus on acceptance and, specifically, on factors pertaining to individual or parental compliance, specifically the psychology of judgment and decision making. We describe how heuristics and cognitive biases - a facet of thoughts and feelings - affect vaccination decision making. Additionally, we address when and how social processes play a role and how attitudes towards vaccines might reflect a more general underlying attitude or ideology. The understanding of how decision making, with regards to vaccines occurs, and the role played by heuristics and cognitive biases can help inform more appropriate public health interventions.

Resumen: La inmunización es la intervención en salud pública más exitosa hasta la fecha. No obstante, sólo puede ser efectiva si las personas elegibles, o sus representantes legales, tienen acceso a las vacunas y, consecuentemente, cumplen con su uso. Existen múltiples causas de infravacunación: acceso, asequibilidad, concienciación, aceptación y activación. En este trabajo, nos enfocamos en la aceptación y esceficamente, centrándonos en factores respecto a la conformidad individual o parental, específicamente en cuanto a la psicología de juicio y toma de decisiones. Describimos como sesgos heurísticos y cognitivos -una faceta de pensamientos y sentimientos- que afectan a la toma de decisiones sobre la vacunación. Asimismo, nos centramos en cuándo y cómo los procesos sociales desempeñan un papel y cómo las actitudes hacia las vacunas quizás reflejen una actitud subyacente más general o ideológica. La compresión sobre cómo se toman las decisiones, en relación a cuándo se tienen que tomar las vacunas y el papel desempeñado por sesgos heurísticos y cognitivos puede informarnos más apropiadamente sobre las intervenciones en salud pública.

Resumo: A imunização, a intervenção da saúde pública mais bem sucedida até hoje, só pode ser eficaz se as pessoas elegíveis ou seus representantes legais tiverem acesso às vacinas e aderirem ao seu uso. A subvacinação pode resultar de várias causas: acesso, viabilidade, conscientização, aceitação e ativação. Neste trabalho, focamos na aceitação e, especificamente, nos concentramos nos fatores relativos à cooperação do indivíduo ou de seus pais, especificamente a psicologia do julgamento e da tomada de decisões. Descrevemos como as heurísticas e os vieses cognitivos - um aspecto dos pensamentos e sentimentos - afetam a tomada de decisão quanto à vacinação. Além disso, abordamos quando e como os processos sociais desempenham um papel e como as atitudes em relação às vacinas podem refletir uma atitude ou ideologia subjacente mais geral. A compreensão de como a tomada de decisões em relação às vacinas ocorre e o papel desempenhado pelas heurísticas e pelos vieses cognitivos pode ajudar a informar as intervenções de saúde pública de forma mais adequada.

A lógica da falta ou a falta da lógica: como responder ao desafio de compreender o suicídio? / The logics of absence or the absence of logics: how to answer the challenge of understanding suicide? / La lógica de la falta o la falta de lógica: ¿cómo responder al desafío de entender el suicidio? / La logique du manque ou le manque de logique: comment répondre au défi de comprendre le suicide?

Neste artigo, discuto como a proposta de uma compreensão filosófica sobre o suicídio é um desafio e como um viés teórico multidisciplinar, aqui proposto por meio de um breve contraponto entre antropologia e psicanálise, apresenta potenciais heurísticos e epistemológicos no desvelamento do fenômeno. Apresento também a narrativa de um caso de pesquisa etnográfica para incorporar alguns elementos na discussão sobre o suicídio.

In this paper, I discuss how challenging it is to propose a philosophical understanding on suicide and how a theoretical and multidisciplinary bias, here as a concise counterpoint between the Anthropology and the Psychoanalysis, has heuristic and epistemological potential to unveil the phenomenon. I also introduce the narrative of a case from an ethnographic research to incorporate elements in the discussion about suicide.

En este artículo, discuto cómo la propuesta de una comprensión filosófica sobre el suicidio es un desafío y cómo un enfoque teórico multidisciplinario, propuesto aquí a través de un breve contrapunto entre Antropología y Psicoanálisis, presenta potenciales heurísticos y epistemológicos para desvelar el fenómeno. También presento la narración de un caso de investigación etnográfica para incorporar algunos elementos en la discusión sobre el suicidio

Dans cet article, je discute comment la proposition d'une compréhension philosophique sur le suicide est un défi et comme un biais théorique multidisciplinaire, ici proposé par un bref contrepoint entre l'anthropologie et la psychanalyse, présente des potentiels heuristiques et épistémologiques dans le dévoilement du phénomène. J'expose aussi la narrative d'un cas d'une recherche ethnographique pour incorporer certains éléments dans la discussion concernant le suicide.

Deficiência: uma heurística para a condição humana / Disability: a heuristic for the human condition / Discapacidad: una heurística para la condición humana

Resumen Estudio de naturaleza teórica donde se evidencia la discapacidad como dispositivo heurístico para indagar la condición humana. La relación entre discapacidad y condición humana ha sido poco explorada. En la primera sección se analiza cómo vulnerabilidad y dependencia pertenecen a la condición humana e inciden en la discapacidad condicionando la pérdida de cualidades. Posteriormente se analiza la modalidad peculiar de posesión de las mismas. En la tercera parte se argumenta cómo a pesar de que con la discapacidad intelectual puede no manifestarse la racionalidad esto no supone una exclusión de la condición personal. Por último, se explica cómo no obstante con la discapacidad se puedan perder cualidades, no es posible perder la corporeidad y la pertenencia a la familia humana. Se empleó el enfoque heurístico con la formulación de preguntas apoyándose en tres casos hipotéticos. La discapacidad es un modo de manifestarse de la condición humana con valor heurístico porque ayuda a examinar aspectos constitutivos de nuestra existencia.

Abstract A theoretical study in which disability is evidenced as a heuristic device to investigate the human condition. The relationship between disability and human condition has been little explored. The first section analyzes how vulnerability and dependence belong to the human condition and affect disability by conditioning the loss of qualities. Subsequently, the peculiar modality of possession of our qualities is analyzed. The third part argues that even though a human being with intellectual disability may not manifest rationality this does not suppose an exclusion of the status of person. Finally, it is explained how, although qualities can be lost with the disability, it is not possible to lose the embodiment and belonging to the human family. The heuristic approach was used with the formulation of questions based on three hypothetical cases. Disability is a manifestation of the human condition. It has heuristic value because it helps to examine constitutive aspects of our existence.

Resumo Estudo teórico em que a deficiência é evidenciada como dispositivo heurístico para sondar a condição humana. A relação entre deficiência e condição humana tem sido pouco explorada. A primeira seção analisa como vulnerabilidade e dependência pertencem à condição humana e afetam a deficiência, condicionando a perda de qualidades. Posteriormente, a ideia de posse de nossas qualidades é analisada. Na terceira parte se argumenta que, embora um ser humano com deficiência intelectual não possa manifestar racionalidade, isso não supõe a exclusão do status pessoal. Por último, se explica como, apesar de ser possível perderem-se qualidades na deficiência, não é possível perder a corporeidade e o pertencimento à família humana. A abordagem heurística foi utilizada com a formulação de questões com base em três casos hipotéticos. A deficiência é uma manifestação da condição humana e tem valor heurístico porque ajuda a examinar aspectos constitutivos de nossa existência.

Diagramática: a arte do bem pensar para pensar o bem / Diagrammatic reasoning: the art of good thinking to think about the greater good / Diagramática: el arte del buen pensar para pensar el bien

Resumo Modelos são construções conceituais com certo grau de simplificação que mantêm correspondência parcial com o fenômeno que se pretende abordar. Na bioética destaca-se o modelo principialista, baseado em matriz formada por quatro princípios: beneficência, não maleficência, autonomia e justiça. Diante de conflito entre diretrizes éticas, esse modelo possibilita avaliar aquelas mais adequadas à situação concreta. A partir do diagrama lógico, procurou-se aprofundar o projeto de fundamentação teórico-conceitual da bioética, considerando o modelo padrão principialista importante ferramenta heurística. Relações lógicas são subjacentes a todo pensamento, e os diagramas dispõem essas relações em estruturas espaciais, representando a topologia dos conceitos. As relações lógicas, presentes na estrutura dos modelos, permitem compreender o campo conceitual de princípios que operam no raciocínio bioético. A elaboração diagramática permite, portanto, observar que diante de situações-problema não há incompatibilidade entre as concepções principialista e personalista - pelo contrário, há complementaridade e sinergia.

Abstract Models are conceptual constructions, with some degree of simplification, that keep a partial match with the phenomena they aim to address. The Principialist model, which is based on a matrix formed by four principles: Beneficence, Non-Maleficence, Autonomy and Justice, stands out in the Bioethical field. When addressing a conflict between ethical guidelines, this model makes it possible to evaluate those guidelines that are more appropriate to the specific concrete situation. Based on the logical diagram, we sought to deepen the theoretical-conceptual foundation of bioethics, considering the standard Principialist model, which is an important heuristic tool. Logical relationships underlie all thoughts, and diagrams show such relationships in integrated spatial structures, representing the topology of concepts. The logical relationships, present in the structure of the models, allow one to understand the conceptual field of principles that operate within bioethical reasoning. The diagrammatic reasoning thus allows us to observe that, in the face of problem situations, there is no incompatibility between the Principialist and Personalist concepts - on the contrary, they complement one another and have synergy.

Resumen Los modelos son construcciones conceptuales con cierto grado de simplificación que mantienen una correspondencia parcial con el fenómeno que se pretende abordar. En la bioética se destaca el modelo principialista, basado en una matriz formada por cuatro principios: beneficencia, no maleficencia, autonomía y justicia. Ante el conflicto entre directrices éticas, este modelo posibilita evaluar aquellas más adecuadas para la situación concreta. A partir del diagrama lógico se procuró profundizar el proyecto de fundamentación teórico-conceptual de la bioética, considerando al modelo estándar principialista como una importante herramienta heurística. Las relaciones lógicas subyacen a todo pensamiento, y los diagramas disponen dichas relaciones en estructuras espaciales, representando la topología de los conceptos. Las relaciones lógicas, presentes en la estructura de los modelos, permiten comprender el campo conceptual de los principios que operan en el razonamiento bioético. La elaboración diagramática permite, por lo tanto, observar que frente a las situaciones-problema no hay incompatibilidad entre las concepciones principialista y personalista - por el contrario, existe complementariedad y sinergia.

Understanding uncertainty in medicine: concepts and implications in medical education / 한국의학교육

In an era of high technology and low trust, acknowledging and coping with uncertainty is more crucial than ever. Medical uncertainty has been considered an innate feature of medicine and medical practice. An intolerance to uncertainty increases physicians' stress and the effects of burnout and may be a potential threat to patient safety. Understanding medical uncertainty and acquiring proper coping strategies has been regarded to be a core clinical competency for medical graduates and trainees. Integrating intuition and logic and creating a culture that acknowledges medical uncertainty could be suggested ways to teach medical uncertainty. In this article, the authors describe the concepts of medical uncertainty, its influences on physicians and on medical students toward medical decision making, the role of tolerance/intolerance to uncertainty, and proposed strategies to improve coping with medical uncertainty.

Safety and Usability Guidelines of Clinical Information Systems Integrating Clinical Workflow: A Systematic Review / 대한의료정보학회지

OBJECTIVES: The usability of clinical information systems (CISs) is known to be an essential consideration in ensuring patient safety as well as integrating clinical flow. This study aimed to determine how usability and safety guidelines of CIS consider clinical workflow through a systematic review in terms of the target systems, methodology, and guideline components of relevant articles. METHODS: A literature search was conducted for articles published from 2000 to 2015 in PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement method was employed. Articles containing recommendations, principles, and evaluation items for CIS usability and safety were included. The selected articles were classified according to article type, methodology, and target systems. Taking clinical workflow into consideration, the components of guidelines were extracted and classified. RESULTS: A total of 7,401 articles were identified by keyword search. From the 76 articles remaining after abstract screening, 15 were selected through full-text review. Literature review (n = 7) was the most common methodology, followed by expert opinions (n = 6). Computerized physician order entry (n = 6) was the most frequent system. Four articles considered the entire process of clinical tasks, and two articles considered the principles of the entire process of user interface affecting clinical workflow. Only two articles performed heuristic evaluations of CISs. CONCLUSIONS: The usability and safety guidelines of CISs need improvement in guideline development methodology and with consideration of clinical workflow.

Development of the IMB Model and an Evidence-Based Diabetes Self-management Mobile Application / 대한의료정보학회지

OBJECTIVES: This study developed a diabetes self-management mobile application based on the information-motivation-behavioral skills (IMB) model, evidence extracted from clinical practice guidelines, and requirements identified through focus group interviews (FGIs) with diabetes patients. METHODS: We developed a diabetes self-management (DSM) app in accordance with the following four stages of the system development life cycle. The functional and knowledge requirements of the users were extracted through FGIs with 19 diabetes patients. A system diagram, data models, a database, an algorithm, screens, and menus were designed. An Android app and server with an SSL protocol were developed. The DSM app algorithm and heuristics, as well as the usability of the DSM app were evaluated, and then the DSM app was modified based on heuristics and usability evaluation. RESULTS: A total of 11 requirement themes were identified through the FGIs. Sixteen functions and 49 knowledge rules were extracted. The system diagram consisted of a client part and server part, 78 data models, a database with 10 tables, an algorithm, and a menu structure with 6 main menus, and 40 user screens were developed. The DSM app was Android version 4.4 or higher for Bluetooth connectivity. The proficiency and efficiency scores of the algorithm were 90.96% and 92.39%, respectively. Fifteen issues were revealed through the heuristic evaluation, and the app was modified to address three of these issues. It was also modified to address five comments received by the researchers through the usability evaluation. CONCLUSIONS: The DSM app was developed based on behavioral change theory through IMB models. It was designed to be evidence-based, user-centered, and effective. It remains necessary to fully evaluate the effect of the DSM app on the DSM behavior changes of diabetes patients.

Anchoring bias in face-to-face Time-Trade-Off valuations of health states / Sesgo de anclaje en valoraciones de estados de salud por Time Trade-Off

ABSTRACT Objective To test whether anchoring (a cognitive bias) occurs during face-to-face interviews to value health states by Time-Trade-Off. Methods 147 Colombian subjects (111 males, 36 females) valued five EQ-5D health states better than death during a face-to-face interview. Subjects were randomly assigned to two different starting points. Results Shapiro-Wilk test discarded normality, while non-parametric tests, including Kolmogorov-Smirnov and Wilcoxon-Mann-Whitney, showed that anchoring was significant in four out of five health states. A higher starting point increased the elicited value by 15 %-188 %. The size of the anchoring effect was not uniform among health states. Conclusion Anchoring effects may bias face-to-face Time Trade-Off valuations. The size of the anchoring effect is relevant enough for health policy.(AU)

RESUMEN Objetivos Comprobar si se presenta anclaje (un sesgo cognitivo) en las valoraciones de estados de salud por Time-Trade-Off realizadas en entrevistas en persona. Métodos 147 sujetos colombianos (111 hombres, 36 mujeres) valoraron five estados de salud EQ-5D mejores que la muerte en una entrevista personal. Los sujetos se asignaron aleatoriamente a dos puntos de partida distintos. Resultados El test de Shapiro-Wilk descartó normalidad de las distribuciones. Las pruebas no paramétricas de Kolmogorov-Smirnov y Wilconson-Mann-Whitney mostraron que el anclaje era significativo en cuatro de los cinco estados de salud. Un punto de partida más alto aumentaba el valor obtenido en un 15 %-188 %. El tamaño del anclaje no era uniforme en los distintos estados de salud. Conclusiones El anclaje puede sesgar las valoraciones por Time Trade-Off realizadas en entrevistas. El efecto es lo suficientemente alto como para hacerlo relevante en términos de política.(AU)

"Era óbvio que isso iria acontecer": considerações sobre o viés retrospectivo / "It was obvious that this would happen": consideration about the hindsight bias

O viés retrospectivo é o fenômeno de perceber e avaliar eventos diferentemente, uma vez que eles tenham ocorrido. Dada uma falha cognitiva, pessoas tendem a ter distorções da memória e a produzir falsas sensações de inevitabilidade e previsibilidade. Os objetivos deste trabalho foram fazer uma revisão de literatura do viés retrospectivo e discutir as implicações teóricas e práticas do tema. Uma pesquisa, realizada nas principais bases de dados do país, não encontrou nenhum artigo relacionado com o tema. A partir de uma seleção das principais pesquisas internacionais sobre o assunto, foi feita uma análise que mostrou os níveis cognitivos do viés retrospectivo, suas implicações e as estratégias usadas para atenuar o viés. Nas considerações finais, são discutidos o impacto e a importância do conhecimento desse fenômeno no dia a dia de tomadores de decisão e cidadãos, assim como a necessidade de se explorar o tema em pesquisas nacionais.

Hindsight bias is the phenomenon of perceiving and evaluating events differently once they are occurred. Given a cognitive flaw, people tend to have distortions of memory and produce false sensations of inevitability and predictability. The objective of this work is to make a literature review of the hindsight bias and to discuss both theoretical and practical implications of the theme. A search conducted in the Brazilian's main databases did not find any articles related to the topic. From a selection of the main international studies on the subject, an analysis was made showing the cognitive levels of the hindsight bias, its implications and the strategies used to attenuate the bias. In the final considerations, the impact and importance of day-to-day knowledge of the phenomenon and the need to explore the subject in national research are discussed.

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions / 가정의학회지

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

Development and Cross-cultural Validation of the Korean Version of SMArtphone’s uSability Heuristics (SMASH) / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to develop and cross-culturally validate the Korean version of SMArtphone's uSability Heuristics (K-SMASH). METHODS: In the study, it was used the adaptation process consisted of five stages, namely, translation, synthesis, back translation, expert committee review, and pretesting. In the pretesting stage, a mobile application, using the prefinal K-SMASH, was evaluated for the severity of usability problems by three experts in computer science and informatics. Each participant completed the evaluation and was interviewed about their understanding, interpretation, and opinion of the cultural relevance of the prefinal K-SMASH. Next, we reviewed the differences in the experts’ opinions and the questionnaire results. RESULTS: Twelve SMASH items, words and sentences, were translated, back translated, and revised, considering the conceptual meaning in the context of the Korean culture, by experts in various fields, including a Korean linguist and a bilingual translator, through the first stage to the fourth stage. In the pretesting stage, the results showed no major differences among the severity ratings of participants. Furthermore, all participants answered that there were no critical discrepancies or inconsistencies with the cultural relevance of the prefinal K-SMASH. CONCLUSIONS: The results of the study provide preliminary evidence that the modified K-SMASH can be used for heuristic evaluation, one of the usability tests, when developing applications in Korea.

A Phenomenological Study on the Lived Experience of Train Operators Exposed to Person under Train (PUT)

PURPOSE: To understand the meaning of the lived experience with Person under train (PUT) for train or subway operators. METHODS: The study was built on hermeneutic phenomenological themes from individual interviews of present-day train or subway operators in South Korea. Eight participants were selected to participate in the study. All qualitative data were analyzed using the heuristic guides of Van Manen. RESULTS: Four fundamental lifeworld themes and eight sub themes emerged in the findings. The first theme of spatiality had‘the place pressed by the darkness’ and ‘the train drags me there’. The second theme, corporeality had ‘a foreboding fear’, and ‘debris of death that gets stuck in the whole body’. The temporality theme had‘distorted time in chaos’, and ‘memory trapped in time’. Finally the last existential theme of relationality had ‘intrapersonal encounter’ and ‘resentment and guilt’. CONCLUSION: The four existential lifeworld themes provided a framework for in-depth investigation of the operator's “lived experience.” This leads to clear understanding of effects of PUT experience on related individuals. The findings imply that specific active nursing intervention strategies are necessary in order to treat affected train operators, and to prevent further issues in their work and private life.

The Lived Experience of Suffering of Family with Cancer Patients: Parse's Human Becoming Research Method / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study was to discover the structure of the lived experience of suffering of families with cancer patients to develop a theoretical foundation that can be used to reinforce nursing practice for cancer patients and their families. METHODS: A qualitative study was performed using Parse's research method. Participants were four families with cancer patients. From February 2009 through April 2010, data were collected via dialogicalengagement between participants and the researcher and analyzed through the extraction-synthesis and heuristic interpretation processes. RESULTS: The structure was identified as follows. The families' lived experience of suffering was a process through which they experienced a psychological shock of cancer diagnosis and difficulties associated with reshuffled roles among family members, and made efforts to care for the patients. CONCLUSION: Amidst sadness, pain, anxiety, guilt, fear and agony, the families focused on the human-health-universe aspect and found meanings of their experiences as love, triumphant, responsibility and hope. As such, the study results suggest that the suffering of families with cancer patients is a human becoming process of positive transformation.

Apontamentos para uma história comparada do esporte: um modelo heurístico / Notes to a comparative history of sport: a heuristic model

Ao analisar o recente crescimento do número de investigações históricas que têm como objeto as práticas corporais institucionalizadas, Melo (2007a), mesmo reconhecendo a importância desses esforços, demonstra preocupação com a fragmentação e o não estabelecimento de iniciativas de maior alcance. Para esse autor, uma possível saída estaria na utilização do método da História Comparada, uma contribuição para a busca de sínteses históricas mais aprofundadas. Partindo dessas compreensões, esse artigo tem por objetivo apresentar um modelo heurístico cujo intuito é constituir-se em ferramenta para analisar/interpretar a trajetória conceitual moderna do fenômeno esportivo. Construído basicamente a partir do próprio percurso histórico do esporte, cremos que pode se constituir em um bom instrumento não só para o desenvolvimento de estudos locais, como também, talvez ainda mais, de investigações comparadas.

Considering the recent growth of historical research that has as object the institutionalized body practices, Melo (2007a), even though recognizes the importance of these efforts, demonstrates concern about the fragmentation of these initiatives. To this author, a possible solution would be the use of the method of Comparative History, a contribution to search for deep historical analyzes. Since these understandings, this article aims to present a heuristic model whose aim is to establish itself as a tool to analyze/interpret the sport modern conceptual trajectory. Built primarily from the history of the sport, we believe that it can be a useful tool not only for the development of local studies, but also to comparative investigations.