Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Beneficios y limitaciones de la planificación centrada en la persona en el campo de la discapacidad intelectual y del desarrollo: una revisión sistemática según las directrices de PRISMA / Benefits and limitations of person-centered planning in the field of intellectual and developmental disabilities: a systematic review according to PRISMA guidelines

La metodología de Planificación Centrada en la Persona (PCP) cada vez tiene mayor impacto en España. Comenzando desde las distintas legislaciones que regulan la atención a este colectivo en las diferentes autonomías y terminando en los centros que proveen este servicio. No obstante, existe escasa literatura internacional de estudios empíricos a grandes escalas que sitúen este enfoque metodológico en una posición relevante que garantice la eficacia de la PCP. El objetivo principal de este estudio es conocer el estado del uso de la metodología de PCP a través de estudios avalados empíricamente que sostengan tanto beneficios como limitaciones durante los últimos 10 años (2012-2022). Para ello, se ha realizado una revisión sistemática desde las directrices de PRISMA (2020), que incluye un total de 31 artículos. Como conclusión, se han descubierto más beneficios que limitaciones entre las que destacan las ventajas en su uso para las personas con discapacidad intelectual y del desarrollo y las mejoras de aspectos relacionados con la autodeterminación. No obstante, las limitaciones prevalecen por la falta de apoyos y recursos adecuados de las organizaciones para responder a una planificación centrada en la persona y la necesidad de formación de las personas implicadas en la elaboración de la PCP, lo que genera la incógnita de si se están realizando buenas prácticas en el uso de dicha metodología. (AU)

The methodology of Person Centered Planning (PCP) is having an increasing impact in Spain. Starting from the different legislations that regulate the attention to this group in the different autonomous regions and ending in the centers that provide this service. However, there is little international literature on large-scale empirical studies that place this methodological approach in a relevant position to guarantee the efficacy of PCP. The main objective of this study is to know the status of the use of PCP methodology through empirically supported studies that sustain both benefits and limitations during the last 10 years (2012-2022). For this purpose, a systematic review has been conducted since the PRISMA guidelines (2020), including a total of 31 articles. As a conclusion, more benefits than limitations have been found, among which the advantages in its use for people with intellectual and developmental disabilities and improvements in aspects related to self-determination stand out. However, limitations prevail due to the lack of adequate support and resources from organizations to respond to person-centered planning and the need for training of the people involved in the development of the PCP, which raises the question of whether good practices are being carried out in the use of this methodology. (AU)

Beneficios y limitaciones de la planificación centrada en la persona en el campo de la discapacidad intelectual y del desarrollo: una revisión sistemática según las directrices de PRISMA / Benefits and limitations of person-centered planning in the field of intellectual and developmental disabilities: a systematic review according to PRISMA guidelines

La metodología de Planificación Centrada en la Persona (PCP) cada vez tiene mayor impacto en España. Comenzando desde las distintas legislaciones que regulan la atención a este colectivo en las diferentes autonomías y terminando en los centros que proveen este servicio. No obstante, existe escasa literatura internacional de estudios empíricos a grandes escalas que sitúen este enfoque metodológico en una posición relevante que garantice la eficacia de la PCP. El objetivo principal de este estudio es conocer el estado del uso de la metodología de PCP a través de estudios avalados empíricamente que sostengan tanto beneficios como limitaciones durante los últimos 10 años (2012-2022). Para ello, se ha realizado una revisión sistemática desde las directrices de PRISMA (2020), que incluye un total de 31 artículos. Como conclusión, se han descubierto más beneficios que limitaciones entre las que destacan las ventajas en su uso para las personas con discapacidad intelectual y del desarrollo y las mejoras de aspectos relacionados con la autodeterminación. No obstante, las limitaciones prevalecen por la falta de apoyos y recursos adecuados de las organizaciones para responder a una planificación centrada en la persona y la necesidad de formación de las personas implicadas en la elaboración de la PCP, lo que genera la incógnita de si se están realizando buenas prácticas en el uso de dicha metodología. (AU)

The methodology of Person Centered Planning (PCP) is having an increasing impact in Spain. Starting from the different legislations that regulate the attention to this group in the different autonomous regions and ending in the centers that provide this service. However, there is little international literature on large-scale empirical studies that place this methodological approach in a relevant position to guarantee the efficacy of PCP. The main objective of this study is to know the status of the use of PCP methodology through empirically supported studies that sustain both benefits and limitations during the last 10 years (2012-2022). For this purpose, a systematic review has been conducted since the PRISMA guidelines (2020), including a total of 31 articles. As a conclusion, more benefits than limitations have been found, among which the advantages in its use for people with intellectual and developmental disabilities and improvements in aspects related to self-determination stand out. However, limitations prevail due to the lack of adequate support and resources from organizations to respond to person-centered planning and the need for training of the people involved in the development of the PCP, which raises the question of whether good practices are being carried out in the use of this methodology. (AU)

Strategic use of resources to enhance colorectal cancer screening for patients with diabetes (SURE: CRC4D) in federally qualified health centers: a protocol for hybrid type ii effectiveness-implementation trial.

BACKGROUND: Persons with diabetes have 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from priority health disparities populations. Federally qualified health centers (FQHCs) struggle to implement CRC screening programs for average risk patients. Strategies to effectively prioritize and optimize CRC screening for patients with diabetes in the primary care safety-net are needed. METHODS: Guided by the Exploration, Preparation, Implementation and Sustainment Framework, we conducted a stakeholder-engaged process to identify multi-level change objectives for implementing optimized CRC screening for patients with diabetes in FQHCs. To identify change objectives, an implementation planning group of stakeholders from FQHCs, safety-net screening programs, and policy implementers were assembled and met over a 7-month period. Depth interviews (n = 18-20) with key implementation actors were conducted to identify and refine the materials, methods and strategies needed to support an implementation plan across different FQHC contexts. The planning group endorsed the following multi-component implementation strategies: identifying clinic champions, development/distribution of patient educational materials, developing and implementing quality monitoring systems, and convening clinical meetings. To support clinic champions during the initial implementation phase, two learning collaboratives and bi-weekly virtual facilitation will be provided. In single group, hybrid type 2 effectiveness-implementation trial, we will implement and evaluate these strategies in a in six safety net clinics (n = 30 patients with diabetes per site). The primary clinical outcomes are: (1) clinic-level colonoscopy uptake and (2) overall CRC screening rates for patients with diabetes assessed at baseline and 12-months post-implementation. Implementation outcomes include provider and staff fidelity to the implementation plan, patient acceptability, and feasibility will be assessed at baseline and 12-months post-implementation. DISCUSSION: Study findings are poised to inform development of evidence-based implementation strategies to be tested for scalability and sustainability in a future hybrid 2 effectiveness-implementation clinical trial. The research protocol can be adapted as a model to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT05785780) on March 27, 2023 (last updated October 21, 2023).

A hierarchical optimization approach to maximize hosting capacity for electric vehicles and renewable energy sources through demand response and transmission expansion planning.

Within the scope of sustainable development, integrating electric vehicles (EVs) and renewable energy sources (RESs) into power grids offers a number of benefits. These include reducing greenhouse gas emissions, diversifying energy sources, and promoting the use of green energy. Although the literature on hosting capacity (HC) models has grown, there is still a noticeable gap in the discussion of models that successfully handle transmission expansion planning (TEP), demand response (DR), and HC objectives simultaneously. Combining TEP, DR, and HC objectives in one model optimizes resource use, enhances grid stability, supports renewable and EV integration, and aligns with regulatory and market demands, resulting in a more efficient, reliable, and sustainable power system. This research presents an innovative two-layer HC model, including considerations for TEP and DR. The model determines the highest degree of load shifting appropriate for incorporation into power networks in the first layer. Meanwhile, the second layer focuses on augmenting the RES and EVs' hosting capability and modernizing the network infrastructure. System operators can choose the best scenario to increase the penetration level of EVs and RESs with the aid of the proposed model. The proposed model, which is formulated as a multi-objective mixed-integer nonlinear optimization problem, uses a hierarchical optimization technique to identify effective solutions by combining the particle swarm optimization algorithm and the crayfish optimizer. When compared to traditional methods, the results obtained from implementing the proposed hierarchical optimization algorithm on the Garver network and the IEEE 24-bus system indicated how effective it is at solving the presented HC model. The case studies demonstrated that integrating DR into the HC problem reduced peak load by 10.4-23.25%. The findings also highlighted that DR did not impact the total energy consumed by EVs throughout the day, but it did reshape the timing of EV charging, creating more opportunities for integration during periods of high demand. Implementing DR reduced the number of projects needed and, in some cases, led to cost savings of up to 12.3%.

Readiness for advance care planning and related factors in the general population: a cross sectional study in Iran.

CONTEXT: Advance Care Planning (ACP), as a process for expressing and recording patients' preferences about end-of-life care, has received increasing attention in recent years. However, implementing ACP has been challenging in Iran. OBJECTIVES: To assess the readiness for advance care planning and related factors in the general population of Iran. METHODS: This cross-sectional study was conducted on the general population of Iran in 2022. The data was collected using demographic information questionnaire and The RACP Scale. The purpose and methodology of the research was explained to all participants, and upon their agreement an informed consent was obtained. Participants were invited to fill out the questionnaires wherever is more convenient for them, either alone or if needed, with the help of the researcher to protect their privacy. Chi-square, fisher exact test and multiple logistic Regression model were used to assess the effective factors on the RACP. The data were analyzed by SPSS software version 26. RESULTS: A total of 641 people with an average age of 36.85 ± 12.05 years participated in this study. Of those, 377 (58.8%) had high RACP. The logistics model showed an association between the chance of readiness for receiving ACP with participants' education level, such that the chance of readiness in those with Master's or Ph.D. degrees was three times higher than those with a diploma (p = 0.00, OR:3.178(1.672, 6.043)). However, the chances of readiness in those with bachelor's degrees was not significantly different from those with a diploma (p = 0.936, OR: 0.984 (0.654, 1.479)). Moreover, the chance of readiness was 1.5 higher in participants over 40 years of age compared with participants under the age of 40 (P = 0.01, OR: 1.571(1.10, 2.23)). CONCLUSION: According to the findings of this study, it can be concluded that there is a relatively RACP among people in Iranian society. The readiness of individuals for ACP increases by their age and education level. Therefore, by holding appropriate training intervention, we can increase the readiness of the public for ACP to improve their end-of-life outcome.

Perceived barriers and opportunities of providing quality family planning services among Palestinian midwives, physicians and nurses in the West Bank: a qualitative study.

BACKGROUND: Despite advancements in family planning (FP) services, several barriers persist in the Occupied Palestinian territory (oPt), blocking women's access to suitable, high-quality and equitable FP services. The aim of this study was to understand how healthcare providers perceive their abilities, barriers and opportunities in providing good quality FP services. Furthermore, it seeks to explore knowledge and training regarding FP among healthcare providers engaged in providing FP services. METHODS: A qualitative study was undertaken from August to September 2022 in seven Primary Health Care (PHC) clinics distributed in three governorates and operating under the Palestinian Ministry of Health (MoH) in the West Bank. Semi-structured, in-depth face-to-face interviews were conducted with 13 health providers (Physicians, midwives and nurses), using an interview guide in Arabic language. Transcripts were subsequently analyzed using the six phases of reflexive thematic analysis. RESULTS: FP services face various challenges, including shortages in resources such as staff, supplies, infrastructures and FP methods. Midwives possess significant potentials to offer accessible, high-quality, efficient and equitable FP services, yet, their capacities remain underutilized, representing a missed opportunity for a country like Palestine. The study provided a current overview of FP services while illustrating the need for quality FP services and the need for an updated continuous education and training, updated standardized guidelines and protocols and supportive supervision are needed across all levels of healthcare providers. Finally, providers reported a wide range of structural barriers to FP services. CONCLUSIONS: It is crucial to meticulously address both community-related and health system factors to enhance the fulfillment of FP needs and reduce unintended and closely spaced pregnancies. Policymakers should invest in the development of laws and regulations regarding FP services, promoting a comprehensive and holistic approach to FP services. This includes formulating supportive policies, capacity building of human resources and maintaining security of FP commodities.

Feasibility and flexibility of a novel multi-dose level avoidance reirradiation technical methodology in recurrent head and neck cancer.

Reirradiation in recurrent head and neck cancer presents a considerable clinical challenge in radiation oncology. Though technically feasible due to advanced treatment delivery and planning techniques, confidence in delivering such treatments is not universal and patient selection is critical. Radiotherapy planning in reirradiation cases presents a complex technical challenge owing to the often-considerable overlap of dose from a patient's first treatment plan. This technical note describes three clinical case studies of recurrent head and neck cancer and the technical details of how their multidose level reirradiation was planned. Each patient had confirmed recurrence of squamous cell carcinoma and was referred for reirradiation to a previously irradiated area. The clinical details for each patient are provided before a detailed description of the treatment planning methodology is presented, which specifies how to approach such complex overlapping treatment volumes. The patient outcomes are described and a discussion is presented outlining the clinical challenges associated with these cases and the variables that must be accounted for when considering patients for potential reirradiation.

Practice recommendations regarding parental presence in NICUs during pandemics caused by respiratory pathogens like COVID-19.

Aim: To co-create parental presence practice recommendations across Canadian NICUs during pandemics caused by respiratory pathogens such as COVID-19. Methods: Recommendations were developed through evidence, context, Delphi and Values and Preferences methods. For Delphi 1 and 2, participants rated 50 items and 20 items respectively on a scale from 1 (very low importance) to 5 (very high). To determine consensus, evidence and context of benefits and harms were presented and discussed within the Values and Preference framework for the top-ranked items. An agreement of 80% or more was deemed consensus. Results: After two Delphi rounds (n = 59 participants), 13 recommendations with the highest rated importance were identified. Consensus recommendations included 6 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers' own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, and inclusion of parent partners in pandemic response planning) and 7 conditional recommendations (providing hands-on care tasks, providing touch, two parents present at the same time, food and drink access, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services). Conclusion: These recommendations can guide institutions in developing strategies for parental presence during pandemics caused by respiratory pathogens like COVID-19.

The emergence of enhanced intelligence in a brain-inspired cognitive architecture.

The Causal Cognitive Architecture is a brain-inspired cognitive architecture developed from the hypothesis that the navigation circuits in the ancestors of mammals duplicated to eventually form the neocortex. Thus, millions of neocortical minicolumns are functionally modeled in the architecture as millions of "navigation maps." An investigation of a cognitive architecture based on these navigation maps has previously shown that modest changes in the architecture allow the ready emergence of human cognitive abilities such as grounded, full causal decision-making, full analogical reasoning, and near-full compositional language abilities. In this study, additional biologically plausible modest changes to the architecture are considered and show the emergence of super-human planning abilities. The architecture should be considered as a viable alternative pathway toward the development of more advanced artificial intelligence, as well as to give insight into the emergence of natural human intelligence.

The relationship between health literacy and family planning attitude in women in Kirsehir province, Turkey.

To develop positive attitudes towards family planning, health literacy is important. This study aimed to investigate a relationship between health literacy and family planning attitudes among married women. 657 married women volunteered to participate in this cross-sectional, correlational and descriptive study. The Türkiye Health Literacy - 32 scale and the Family Planning Attitude Scale were used in the study. According to the results, the women's general health literacy score was 34.5±8.7 out of 50 points, which was adequate, and the family planning attitude score was 128.9±17.7 out of 170 points, which was above the average. It is found a weak positive relationship between health literacy and family planning attitudes. Educational status, occupation and income level affect health literacy and family planning attitude. It is noteworthy that 84.4% of women with inadequate health literacy were using modern family planning methods, while this rate was 77.1% among women with adequate health literacy. To improve women's attitudes towards family planning, it is recommended that health literacy is improved, effective media content is developed and women are encouraged to use primary health care services.

Pour développer des attitudes positives à l'égard de la planification familiale, il est important d'avoir des connaissances en matière de santé. Cette étude visait à examiner la relation entre les connaissances en matière de santé et les attitudes à l'égard de la planification familiale chez les femmes mariées. 657 femmes mariées se sont portées volontaires pour participer à cette étude transversale, corrélationnelle et descriptive. L'échelle Türkiye Health Literacy - 32 et l'échelle Family Planning Attitude Scale ont été utilisées dans l'étude. Selon les résultats, le score général des femmes en matière de santé était de 34,5±8,7 sur 50 points, ce qui est adéquat, et le score de l'attitude de planification familiale était de 128,9±17,7 sur 170 points, ce qui est supérieur à la moyenne. Il existe une faible relation positive entre les connaissances en matière de santé et les attitudes à l'égard de la planification familiale. Le niveau d'éducation, la profession et le niveau de revenu influencent les connaissances en matière de santé et l'attitude à l'égard de la planification familiale. Il convient de noter que 84,4 % des femmes dont les connaissances en matière de santé sont insuffisantes utilisent des méthodes modernes de planification familiale, alors que ce taux est de 77,1 % chez les femmes dont les connaissances en matière de santé sont suffisantes. Pour améliorer l'attitude des femmes à l'égard de la planification familiale, il est recommandé d'améliorer les connaissances en matière de santé, de développer un contenu médiatique efficace et d'encourager les femmes à utiliser les services de soins de santé primaires.

Air quality in a revitalized special economic zone at the center of an urban monocentric agglomeration.

In this study, we have examined the air quality within a revitalized, post-industrial urban area in Lódz, Poland. The use of Dron technology with mobile measurement equipment allowed for accurate assessment of air quality (particulate matter and gaseous pollutants) and factors influencing air quality (wind speed and direction) on a local scale in an area of 0.18 km2 and altitudes from 2 to 50 m. The results show that the revitalization carried out in the Lodz special economic zone area contributed to eliminate internal air pollution emitters through the use of ecological and effective heat sources. The exceedances permissible concentration values were local, and concerned mainly the higher measurement zones of the troposphere (more than 30 m above ground level). In the case of gaseous pollutants, higher wind speeds were associated with a decrease in the concentration of SO2 and an increase in H2S concentration. In both cases, the wind contributed to the occurrence of local areas of accumulation of these gaseous pollutants in the spaces between buildings or wooded areas.

Normality and compassionate care: experiences from advanced cancer patients in their last time at home.

BACKGROUND: Many cancer patients prefer to receive palliative treatment at home, as it allows them to be in a familiar and comfortable environment. Integrating Advance Care Planning (ACP) into routine practice in primary healthcare helps patients and their relatives prepare for end-of-life (EoL) care in accordance with patients' preferences. This includes the option to spend their final days at home if desired. The aim of this study was to gain insights from experiences of advanced seriously ill cancer patients at home while receiving palliative treatment and being engaged in ACP within primary healthcare settings. METHOD: This study employed a qualitative design, utilizing individual, semi-structured interviews that were analysed through reflexive thematic analysis, employing an abductive approach with a latent-level focus. The study included interviews with 12 participants with cancer who were receiving palliative care, had an estimated lifetime under 3 months, and had undergone an organized ACP approach in primary healthcare, documented with a palliative plan. RESULTS: Participants emphasized the importance of (1) Preserving normality at home, maintaining a sense of routine, comfort, and familiarity in the face of present and future challenges. The top obstacles for success identified by participants included (1a) The challenge of deterioration and the dual aspects of (1b) The value and burden of family caregivers. Cancer treatment placed a significant demand on patients due to side effects. Family caregivers played a crucial role for participants, providing support in daily life and serving as a key factor in the overall decision to which extend they are able to involve in support and care at home in the future. (2) Compassionate health care personnel (HCP) made a difference by fostering a culture of understanding participants' concerns, fears, and preferences, which was a key element that built and maintained trust for the participants. (3) Preparing for the future, especially EoL discussions initiated by healthcare personnel, was deemed important but, at times, uncomfortable for participants as it confronted them with reality. Guidance from ACP provided them with a sense of certainty and control. CONCLUSION: Preserving normality at home, along with the desire to stay at home for as long as possible, is a crucial goal for advanced cancer patients. Consistent professional communication and care in primary healthcare play a key role in building and maintaining trust, as well as fostering a sense of certainty and control for the participants.

Dependence of Europe's most threatened mammals on movement to adapt to climate change.

Current rates of climate change and gloomy climate projections confront managers and conservation planners with the need to integrate climate change into already complex decision-making processes. Predicting and prioritizing climatically stable areas and the areas likely to facilitate adaptive species' range adjustments are important stages in maximizing conservation outcomes and rationalizing future land management. I determined, for the most threatened European terrestrial mammal species, the spatial adaptive trajectories (SATs) of highest expected persistence up to 2080. I devised simple spatial network indices for evaluation of species in those SATs: total persistence; proportion of SATs that offer in situ adaptation (i.e., stable refugia); number of SATs converging in a site; and relationship between SAT convergence and persistence and protected areas, the Natura 2000 and Emerald networks, and areas of low human disturbance. I compared the performance of high-persistence SATs with a scenario in which each species remained in the areas with the best climatic conditions in the baseline period. The 1000 most persistence SATs for each of the 39 species covered one fifth of Europe. The areas with the largest adaptive potential (i.e., high persistence, stability, and SAT convergence) did not always overlap for all the species. Predominantly, these regions were located in southwestern Europe, Central Europe, and Scandinavia, with some occurrences in Eastern Europe. For most species, persistence in the most climatically suitable areas during the baseline period was lower than within SATs, underscoring their reliance on adaptive movements. Importantly, conservation areas (particularly protected areas) covered only minor fractions of species persistence among SATs, and hubs of spatial climate adaptation (i.e., areas of high SAT convergence) were seriously underrepresented in most conservation areas. These results highlight the need to perform analyses on spatial species' dynamics under climate change.

Los mamíferos más amenazados de Europa y su dependencia del movimiento para adaptarse al cambio climático Resumen La tasa actual del cambio climático y las proyecciones climáticas pesimistas confrontan a los gestores y a los planeadores de la conservación con la necesidad de integrar este cambio a la ya de por sí compleja toma de decisiones. La predicción y priorización de áreas con estabilidad climática y áreas con probabilidad de facilitarles ajustes adaptativos de distribución a las especies son etapas importantes para maximizar los resultados de conservación y racionalizar la gestión futura de las tierras. Determiné las trayectorias espaciales adaptativas (TEA) para la mayoría de los mamíferos terrestres más amenazados de Europa con la persistencia esperada más alta hasta el 2080. Diseñé los siguientes índices de redes espaciales simples para la evaluación de especies en aquellas TEA: persistencia total, proporción de TEA que brindan adaptación in situ (refugios estables), número de TEA que convergen en un sitio y relación entre la convergencia de TEA y la persistencia con las áreas protegidas, las redes Natura 2000 y Emerald y las áreas de poca perturbación humana. Comparé el desempeño de las TEA de gran persistencia con un escenario en el que las especies permanecían dentro de las áreas con las mejores condiciones climáticas en el periodo de línea base. Las mil TEA más persistentes para cada una de las 39 especies cubrieron la quinta parte de Europa. Las áreas con el mayor potencial adaptativo (es decir, gran persistencia, estabilidad y convergencia de TEA) no siempre se traslaparon para todas las especies. Estas regiones predominaron en el suroeste de Europa, Europa Central y Escandinavia, con algunas ocurrencias en el este de Europa. Para la mayoría de las especies, la persistencia de las áreas con el mejor clima posible durante el periodo de línea base fue menor que dentro de las TEA, lo que resalta su dependencia por los movimientos adaptativos. Destaca que las áreas de conservación (en particular las áreas protegidas) cubrieron sólo pequeñas fracciones de la persistencia de las especies entre las TEA y los núcleos de adaptación climática (es decir, las áreas de gran convergencia de TEA) contaban con muy poca representación dentro de la mayoría de las áreas de conservación. Estos resultados enfatizan la necesidad de realizar análisis de las dinámicas espaciales de las especies bajo el cambio climático.

The Diagnostic Impact of Contrast-Enhanced Computed Tomography (CECT) in Evaluating Lymph Node Involvement in Colorectal Cancer: A Comprehensive Review.

Colorectal cancer (CRC) remains a significant global health burden, necessitating accurate staging and treatment planning for optimal patient outcomes. Lymph node involvement is a critical determinant of prognosis in CRC, emphasizing the importance of reliable imaging techniques for its evaluation. Contrast-enhanced computed tomography (CECT) has emerged as a cornerstone in CRC imaging, offering high-resolution anatomical detail and vascular assessment. This comprehensive review synthesizes the existing literature to evaluate the diagnostic impact of CECT in assessing lymph node involvement in CRC. Key findings highlight CECT's high sensitivity and specificity in detecting lymph node metastases, facilitating accurate staging and treatment selection. However, challenges such as limited resolution for small lymph nodes and potential false-positives call for a cautious interpretation. Recommendations for clinical practice suggest the integration of CECT into multidisciplinary treatment algorithms, optimizing imaging protocols and enhancing collaboration between radiologists and clinicians. Future research directions include refining imaging protocols, comparative effectiveness studies with emerging modalities, and prospective validation of CECT's prognostic value. Overall, this review stresses the pivotal role of CECT in CRC management and identifies avenues for further advancements in imaging-guided oncology care.

Experiences with implementing advance care planning (ACP-GP) in Belgian general practice in the context of a cluster RCT: a process evaluation using the RE-AIM framework.

BACKGROUND: General practice is often recommended as an ideal setting to initiate advance care planning (ACP), but uptake of ACP in this setting is low. ACP-GP is a complex intervention to facilitate ACP for patients with chronic, life-limiting illness in Belgian general practice. It aims to increase patient ACP engagement and general practitioner (GP) ACP self-efficacy. In a cluster-randomized controlled trial, the intervention was not superior to control in increasing these outcomes. A parallel process evaluation aimed to enhance understanding of how the intervention was implemented, and which factors might have influenced trial results. METHODS: We conducted a mixed-methods process evaluation following the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources include recruitment and implementation monitoring, questionnaires for patients and GPs, and semi-structured (focus group) interviews with patients and GPs. Questionnaire data were analyzed descriptively. Qualitative data were first analyzed inductively; themes were then assigned deductively to RE-AIM dimensions. RESULTS: Thirty-five GPs and 95 patients were recruited to the trial; GP reach was low. Sixteen GPs and 46 patients provided questionnaire data at 3 months post-baseline; qualitative data were transcribed for 14 GPs and 11 patients. Adoption of intervention components was moderate to good, with the exception of the documentation template for GPs. Interviews revealed varying patient attitudes towards ACP, but patients nonetheless emphasized that conversations made them feel reassured. GPs especially valued a positive framing of ACP. When adopted, the intervention was well-implemented and participant satisfaction was high. However, intention for maintenance was moderate, with GPs raising questions of how to sustainably implement ACP conversations in the future. CONCLUSIONS: Implementing the complex ACP-GP intervention in general practice is feasible, and can be successful. However, the implementation process is challenging and the sustainability is suboptimal. Our findings will guide future research and recommendations for facilitating and implementing ACP in general practice. TRIAL REGISTRATION: ISRCTN12995230; prospectively registered on 19/06/2020.

A Cost-Affordable Methodology of 3D Printing of Bone Fractures Using DICOM Files in Traumatology.

Three-dimensional (3D) printing has gained popularity across various domains but remains less integrated into medical surgery due to its complexity. Existing literature primarily discusses specific applications, with limited detailed guidance on the entire process. The methodological details of converting Computed Tomography (CT) images into 3D models are often found in amateur 3D printing forums rather than scientific literature. To address this gap, we present a comprehensive methodology for converting CT images of bone fractures into 3D-printed models. This involves transferring files in Digital Imaging and Communications in Medicine (DICOM) format to stereolithography format, processing the 3D model, and preparing it for printing. Our methodology outlines step-by-step guidelines, time estimates, and software recommendations, prioritizing free open-source tools. We also share our practical experience and outcomes, including the successful creation of 72 models for surgical planning, patient education, and teaching. Although there are challenges associated with utilizing 3D printing in surgery, such as the requirement for specialized expertise and equipment, the advantages in surgical planning, patient education, and improved outcomes are evident. Further studies are warranted to refine and standardize these methodologies for broader adoption in medical practice.

Development and validation of an automated Tomotherapy planning method for cervical cancer.

PURPOSE: This study aimed to develop an automated Tomotherapy (TOMO) planning method for cervical cancer treatment, and to validate its feasibility and effectiveness. MATERIALS AND METHODS: The study enrolled 30 cervical cancer patients treated with TOMO at our center. Utilizing scripting and Python environment within the RayStation (RaySearch Labs, Sweden) treatment planning system (TPS), we developed automated planning methods for TOMO and volumetric modulated arc therapy (VMAT) techniques. The clinical manual TOMO (M-TOMO) plans for the 30 patients were re-optimized using automated planning scripts for both TOMO and VMAT, creating automated TOMO (A-TOMO) and automated VMAT (A-VMAT) plans. We compared A-TOMO with M-TOMO and A-VMAT plans. The primary evaluated relevant dosimetric parameters and treatment plan efficiency were assessed using the two-sided Wilcoxon signed-rank test for statistical analysis, with a P-value < 0.05 indicating statistical significance. RESULTS: A-TOMO plans maintained similar target dose uniformity compared to M-TOMO plans, with improvements in target conformity and faster dose drop-off outside the target, and demonstrated significant statistical differences (P+ < 0.01). A-TOMO plans also significantly outperformed M-TOMO plans in reducing V50Gy, V40Gy and Dmean for the bladder and rectum, as well as Dmean for the bowel bag, femoral heads, and kidneys (all P+ < 0.05). Additionally, A-TOMO plans demonstrated better consistency in plan quality. Furthermore, the quality of A-TOMO plans was comparable to or superior than A-VMAT plans. In terms of efficiency, A-TOMO significantly reduced the time required for treatment planning to approximately 20 min. CONCLUSION: We have successfully developed an A-TOMO planning method for cervical cancer. Compared to M-TOMO plans, A-TOMO plans improved target conformity and reduced radiation dose to OARs. Additionally, the quality of A-TOMO plans was on par with or surpasses that of A-VMAT plans. The A-TOMO planning method significantly improved the efficiency of treatment planning.

A marginal structural model for normal tissue complication probability.

The goal of radiation therapy for cancer is to deliver prescribed radiation dose to the tumor while minimizing dose to the surrounding healthy tissues. To evaluate treatment plans, the dose distribution to healthy organs is commonly summarized as dose-volume histograms (DVHs). Normal tissue complication probability (NTCP) modeling has centered around making patient-level risk predictions with features extracted from the DVHs, but few have considered adapting a causal framework to evaluate the safety of alternative treatment plans. We propose causal estimands for NTCP based on deterministic and stochastic interventions, as well as propose estimators based on marginal structural models that impose bivariable monotonicity between dose, volume, and toxicity risk. The properties of these estimators are studied through simulations, and their use is illustrated in the context of radiotherapy treatment of anal canal cancer patients.