[The euthanasia law and professional experiences: tensions in clinical practice]. / La ley de eutanasia y experiencias profesionales: tensiones en la práctica clínica.

OBJECTIVE: To analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. METHOD: A qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. RESULTS: The assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. CONCLUSIONS: Throughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.

Short-term postoperative outcomes of gastric adenocarcinoma patients treated with curative intent in low-volume centers.

BACKGROUND: Quality standards in postoperative outcomes have not yet been defined for gastric cancer surgery. Also, the effect of centralization of gastric cancer surgery on the improvement of postoperative outcomes continues to be debated. Short-term postoperative outcomes in gastric carcinoma patients in centers with low-volume of annual gastrectomies were assessed. The effect of age on major postoperative morbidity and mortality was also analyzed. METHODS: Patients with gastric or gastroesophageal junction Siewert III type carcinomas who underwent surgical treatment with curative intent between January 2013 and December 2016 were included. Data were obtained from the population-based surgical registry Esophagogastric Carcinoma Registry of the Comunitat Valenciana (RECEG-CV). The RECEG-CV gathers information on demographic characteristics and comorbidity, preoperative study and neoadjuvant treatment, surgical procedure, pathological study, postoperative outcomes, and follow-up. Seventeen hospitals belonging to the public network participated in this registry. RESULTS: Data from 591 patients were analyzed. Postoperative major morbidity occurred in 154 (26.1%) patients. Overall 30-day or in-hospital mortality, and 90-day postoperative mortality rates were 8.6% and 10.1% respectively. Failure-to-rescue was 39% and it was significantly higher in patients aged 75 years or older in comparison with younger patients (55.3% vs 23.1% p < 0.001). In the multivariable analysis, age ≥ 75 years (p = 0.029), laparoscopic approach (p = 0.005), and total gastrectomy (p = 0.005) were associated with major postoperative morbidity. Age ≥ 75 years (p = 0.027), pulmonary complications (p = 0.001), cardiac complications (p = 0.001), leakage (p = 0.003), and hemorrhage (p = 0.013) were associated with postoperative mortality. CONCLUSIONS: Centralization of gastric adenocarcinoma treatment in centers with higher annual caseload should be considered to improve the short-term postoperative outcomes in low-volume centers. Patients aged 75 or older had a significantly increased risk of major postoperative morbidity and mortality, and higher failure-to-rescue.

Robots in Healthcare? What Patients Say.

In this paper, we analyse patients' perspectives on the introduction of artificial intelligence (AI) and robotic systems in healthcare. Based on citizens' experiences when hospitalised for COVID-19, we explore how the opinions and concerns regarding healthcare automation could not be disassociated from a context of high pressure on the health system and lack of resources, and a political discourse on AI and robotics; a situation intensified by the pandemic. Thus, through the analysis of a set of interviews, a series of issues are identified that revolve around the following: the empirical effects of imagined robots, the vivid experience of citizens with the care crisis, the discomfort of the ineffective, the virtualised care assemblages, the human-based face-to-face relationships, and the automatisation of healthcare tasks. In light of these results, we show the variability in patients' perspectives on AI and robotic systems and explain it by distinguishing two interpretive repertoires that account for different views and opinions: a well-being repertoire and a responsibility repertoire. Both interpretative repertoires are relevant in order to grasp the complexity of citizens' approaches to automatisation of healthcare. Attending to both allows us to move beyond the dominant (political) discourse of technology markets as the only way to respond to healthcare challenges. Thus, we can analyse and integrate patients' perspectives to develop AI and robotic systems in healthcare to serve citizens' needs and collective well-being.

[Robots for care. The ethics of measured action in the face of uncertainty]. / Robots para los cuidados. La ética de la acción mesurada frente a la incertidumbre.

Beyond the utopian or dystopian scenarios that accompany the progressive introduction of robots for care in daily environments, their use in the medical field entails controversies that require alternative forms of ethical responsibility. From this general objective, in this article we propose a series of reflections to articulate an ethical framework capable of orienting the introduction and use of robots in the field of health. The presented proposal is developed from a series of considerations about robots and care, as a starting point to develop an ethical framework based on the principle of precaution and measured action. It proposes a non-essentialist conceptualization of robots, that emphasizes their relational and contextual nature, understanding robots as heterogeneous artifacts that are constituted in a network of therapeutic relationships and that mediate our care relationships. This approach has a set of implications, which we articulate around measured action as an ethical proposal. The measured action, in our interpretation, responds to the principle of precaution and is configured through four dimensions: (1) the institutional commitment, (2) which integrates the fears and hopes of all those concerned actors, (3) which is realized carrying out progressive and revocable actions, under continuous monitoring and evaluation, and (4) which incorporates into the design process those actors practicing ″good care″.

Robots para los cuidados. La ética de la acción mesurada frente a la incertidumbre / Robots for care. The ethics of measured action in the face of uncertainty

Más allá de los escenarios utópicos o distópicos que acompañan la progresiva introducción de robots de cuidado en entornos cotidianos, su utilización en el ámbito médico plantea controversias que requieren formas alternativas de responsabilidad ética. Desde este objetivo general, en este artículo proponemos una serie de reflexiones para articular un marco ético capaz de guiar la introducción y el uso de robots en el ámbito de la salud. La propuesta presentada se desarrolla a partir de una serie de consideraciones acerca de los robots y los cuidados, como punto de partida para desarrollar un marco ético basado en el principio de precaución y la acción mesurada. Proponemos una conceptualización de los robots no-esencialista, enfatizando su naturaleza relacional y contextual, entendiendo los robots como artefactos heterogéneos que se constituyen en una red de relaciones terapéuticas y que median nuestras relaciones de cuidados. Este planteamiento tiene una serie de implicaciones, que articulamos alrededor de la acción mesurada como propuesta ética. La acción mesurada, tal y como la entendemos, responde al principio de precaución y se configura a través de cuatro dimensiones: (1) el compromiso institucional, (2) que integra los miedos y esperanzas de todos aquellos actores concernidos, (3) que se realiza llevando a cabo acciones progresivas y revocables, bajo continuo seguimiento y evaluación y, (4) que incorpora en el proceso de diseño a los actores que practican el "buen cuidar"

Beyond the utopian or dystopian scenarios that accompany the progressive introduction of robots for care in daily environments, their use in the medical field entails controversies that require alternative forms of ethical responsibility. From this general objective, in this article we propose a series of reflections to articulate an ethical framework capable of orienting the introduction and use of robots in the field of health. The presented proposal is developed from a series of considerations about robots and care, as a starting point to develop an ethical framework based on the principle of precaution and measured action. It proposes a non-essentialist conceptualization of robots, that emphasizes their relational and contextual nature, understanding robots as heterogeneous artifacts that are constituted in a network of therapeutic relationships and that mediate our care relationships. This approach has a set of implications, which we articulate around measured action as an ethical proposal. The measured action, in our interpretation, responds to the principle of precaution and is configured through four dimensions: (1) the institutional commitment, (2) which integrates the fears and hopes of all those concerned actors, (3) which is realized carrying out progressive and revocable actions, under continuous monitoring and evaluation, and (4) which incorporates into the design process those actors practicing "good care"

Children's Imaginaries of Human-Robot Interaction in Healthcare.

This paper analyzes children’s imaginaries of Human-Robots Interaction (HRI) in the context of social robots in healthcare, and it explores ethical and social issues when designing a social robot for a children’s hospital. Based on approaches that emphasize the reciprocal relationship between society and technology, the analytical force of imaginaries lies in their capacity to be embedded in practices and interactions as well as to affect the construction and applications of surrounding technologies. The study is based on a participatory process carried out with six-year-old children for the design of a robot. Imaginaries of HRI are analyzed from a care-centered approach focusing on children’s values and practices as related to their representation of care. The conceptualization of HRI as an assemblage of interactions, the prospective bidirectional care relationships with robots, and the engagement with the robot as an entity of multiple potential robots are the major findings of this study. The study shows the potential of studying imaginaries of HRI, and it concludes that their integration in the final design of robots is a way of including ethical values in it.

Mujer joven con masa quística intraabdominal gigante / Young woman with a giant intraabdominal cystic mass

Introducción. Las masas quísticas intraabdominales gigantes son, en nuestro medio, una entidad poco frecuente. Los orígenes más frecuentes de las mismas son el ovario, el mesenterio y el omento. Caso clínico. Mujer de 29 años, con clínica de aumento del perímetro abdominal y dolor en hipogastrio-pelvis de meses de evolución. Mediante pruebas de imagen se evidencia una tumoración quística intraabdominal gigante de 35 × 31 × 14 cm que desplaza estructuras viscerales y ocupa prácticamente toda la cavidad abdominal, sin aparente origen ovárico. Tras laparotomía y ooforosalpingectomía derecha se confirma un cistadenoma seroso de 14 kg. Conclusiones. La presencia de una lesión quística intraabdominal debe plantear un diagnóstico diferencial entre diversos orígenes (ovario, mesenterio, genitourinario, etc.). Incluso hoy en día con los avances en imagen se llega al diagnóstico definitivo en quirófano. En los cistadenomas serosos, la exéresis del quiste junto con el anexo afectado es el tratamiento de elección (AU)

Introduction. Giant intra-abdominal cystic masses are a rare entity in our environment. The most common locations are the ovary, mesentery, and omentum. Case report. A 29-year-old woman gave a history of abdominal distension and pain in the lower abdomen-pelvis for several months. Radiological studies showed a giant cystic tumor measuring 35 × 31 × 14 cm, displacing visceral structures and occupying almost the entire abdominal cavity, with no apparent ovarian origin. After laparotomy and right oophorosalpingectomy, the existence of a 14-kg serous cystadenoma was confirmed. Conclusions. The presence of an intraabdominal cystic lesion requires a differential diagnosis among various origins (ovary, mesentery, urinary bladder, etc.). Even today, with advances in radiology, the definitive diagnosis is reached during surgery. In serous cystadenomas, the treatment of choice is excision of the cyst and affected annex(AU)