Abordagem funcional na determinação da capacidade financeira e testamentária: linhas orientadoras e desenvolvimento de instrumentos de avaliação

Tese de doutoramento em Psicologia Forense, apresentada à Faculdade de Psicologia e Ciências da Educação da Universidade de CoimbraO envelhecimento da população, decorrente dos avanços médicos e do aumento da esperança média de vida, comportam incontornáveis exigências económicas, sociais, familiares e de saúde. Uma das consequências expetáveis do curso natural do envelhecimento e/ou das condições médicas que lhe surgem associadas, diz respeito à incapacidade funcional na realização de atividades de vida diária, incluindo as financeiras. A perda de capacidade implica considerações legais importantes, tendo sido uma área de debate e investigação nos últimos anos por várias disciplinas do saber (Direito, Psicologia, Medicina). A Constituição da República Portuguesa define o direito à capacidade civil, entendida no Direito Civil Português como poder de autodeterminação e condição básica da personalidade jurídica de todos os indivíduos. No entanto, em casos de comprovada incapacidade, a necessidade de proteção e segurança da pessoa incapaz ou com capacidade diminuída pode implicar processos de Interdição e Inabilitação. Nos processos legais com vista à determinação da capacidade, a necessidade de perícia implica/deve implicar vários profissionais, de entre os quais os psicólogos. Apesar da reconhecida importância atribuída ao processo de avaliação psicológica nestes âmbitos legais, em termos internacionais, em Portugal o cenário tem sido diferente. O ato pericial passa pelo envolvimento quase exclusivo do perito médico (psiquiatra) e apenas em raras exceções os psicólogos são chamados a intervir. No entanto, as alterações concetuais acerca da Incapacidade, bem como a mudança de uma abordagem médica/diagnóstica para uma abordagem funcional, colocam exigências adicionais. É neste âmbito que ressalvamos as vantagens de um processo de avaliação (neuro)psicológica, centrado em testes psicométricos e fortemente estandardizado, que inclua o recurso: (i) aos testes clássicos de funções cognitivas, emocionais, sócio afetivas e personalísticas; (ii) ao exame estandardizado das aptidões funcionais, desde as mais básicas às mais complexas e considerando múltiplas fontes de informação; (iii) aos instrumentos estandardizados, específicos da avaliação forense, que providenciam informação diretamente relevante para as questões colocadas pelo sistema legal. É neste enquadramento que surge o projeto apresentado nesta Dissertação de Doutoramento, desenvolvido em duas linhas principais de investigação. Em primeiro lugar, e considerando as guidelines já existentes internacionalmente, procurámos definir diretrizes para a atuação dos psicólogos nos processos judiciais que envolvem as questões de natureza financeira (Interdição/Inabilitação, Disposição do Património). Foram considerados todos os procedimentos e instrumentos de avaliação passíveis de utilização nos processos legais de determinação da capacidade, bem como as questões éticas que devem orientar os padrões de atuação dos psicólogos nestes contextos. O exposto nesta dissertação constitui uma primeira perspetiva acerca das futuras guidelines Portuguesas para o envolvimento dos psicólogos nos processos legais de determinação da capacidade. Este projeto de investigação focou-se, igualmente, no desenvolvimento de instrumentos de avaliação passíveis de providenciar informação útil e relevante ao sistema legal Português neste tipo de processos. Nos últimos anos foram observados avanços importantes no nosso país no âmbito da Avaliação Psicológica (incluindo a adaptação e validação de instrumentos de avaliação cognitivos, emocionais, sócio afetivos, de personalidade e qualidade de vida). No entanto, são igualmente essenciais instrumentos específicos de avaliação funcional e forense. Dada a ausência de investigação sistemática em Portugal nestes domínios, este projeto de investigação compreendeu o desenvolvimento de um instrumento para o exame funcional geral (o Inventário de Avaliação Funcional de Adultos e Idosos) e de um teste forense, específico para a avaliação das aptidões financeiras (o Instrumento de Avaliação da Capacidade Financeira). Os processos de revisão bibliográfica, o envolvimento de peritos, os estudos qualitativos e quantitativos permitiram o desenvolvimento destes instrumentos com preocupações especiais de validade ecológica e de conteúdo, passíveis de utilização pelos psicólogos envolvidos em processos legais relativos às Interdições/Inabilitações e/ou Disposição do Património (pelo Testamento ou Doação). O processo de avaliação psicológica, alicerçado em instrumentos de avaliação psicométricos tradicionais, conjugado com o recurso adicional a estes dois instrumentos, permitirá ao psicólogo obter informação abrangente dos perfis de funcionamento individuais e, além disso, proporcionará informação diretamente relevante para o sistema legal Português. The aging population, due to the medical advances and the increase in life expectancy, has been associated to significant economic, social, familiar, and health consequences. One of the consequences of the natural course of the aging process and/or the medical conditions that appear in the aging process is the functional incapacity in daily living activities, including those related to financial questions. The loss of functional capacity involves important legal consequences, and has been an area of debate and investigation in the last years by Law, Psychology, and Medicine. The Constitution of the Portuguese Republic defines the right to the civil capacity. This is defined by the Portuguese Civil Law as the power of self-determination, and it is a basic condition of the juridical personality of all individuals. Despite this, facing the incapacity conditions, the need to protect and ensure the security of these individuals through Interdiction and Inhabilitation appear. The legal processes for the capacity determinations implies an expertise process by several professionals, including psychologists. Despite the international well-known importance of the psychological assessment procedures in these legal arenas, in Portugal the expertise processes is done by a psyquiatrist, and the psychologists are not always called. Facing the conceptual models about incapacity, and the change from a diagnostic to a functional approach, some additional requirements occur. There are several advantages of the psychological assessment procedures through psychometric and standardizes instruments, that must include: (i) classical tests of cognitive functions, emotional, socio-affective and personality; (ii) standardized exam of functional abilities (basic and more complex), considering several sources of information; (iii) standardized instruments specific for the forensic assessment, providing legally relevant information. This PhD project arise in these contexts and were developed in two main aspects. First, considering the international guidelines we also attempt to define some guidelines for the psychologists in those processes related to financial matters (Interdiction/Inhabilitation, Assets Disposition). The revision of the procedures and assessment instruments were done, considering also the important ethical questions that must be considered by the psychologists in these legal contexts. In this PhD thesis we intended to provide initial information for the development of the Portuguese guidelines concerning the involvement of the psychologists in legal determination of capacity. Additionally, this project also focus on the development of two instruments that will provide useful and relevant information to the Portuguese legal system. In the last years, important advances were made in Portugal about Psychological Assessment (adaptation and validation of several instruments regarding cognition, emotional aspects, personality, and quality of life). Despite this, the absence of functional and forensic instruments, as well as the absence of systematic investigation in Portugal about these questions led us to the development of two instruments – one for the general functional exam (Adults and Older Adults Functional Assessment Inventory, IAFAI), and one instrument for the assessment of specific financial abilities (Financial Capacity Assessment Instrument, IACFin). The development of these instruments were done through the bibliographic revisions, involvement of experts, qualitative and quantitative studies, ensuring their content and ecological validity. The IAFAI and the IACFin were useful instruments for the psychologists involved in legal processes (Interdiction/Inhabilitation, Assets Disposition by Will and Donation). In the psychological assessment process, the consideration of both traditional assessment tests, and these two specific instruments will provide comprehensive information about the individual profiles of functioning, and also legally relevant information for Portuguese legal system.The aging population, due to the medical advances and the increase in life expectancy, has been associated to significant economic, social, familiar, and health consequences. One of the consequences of the natural course of the aging process and/or the medical conditions that appear in the aging process is the functional incapacity in daily living activities, including those related to financial questions. The loss of functional capacity involves important legal consequences, and has been an area of debate and investigation in the last years by Law, Psychology, and Medicine. The Constitution of the Portuguese Republic defines the right to the civil capacity. This is defined by the Portuguese Civil Law as the power of self-determination, and it is a basic condition of the juridical personality of all individuals. Despite this, facing the incapacity conditions, the need to protect and ensure the security of these individuals through Interdiction and Inhabilitation appear. The legal processes for the capacity determinations implies an expertise process by several professionals, including psychologists. Despite the international well-known importance of the psychological assessment procedures in these legal arenas, in Portugal the expertise processes is done by a psyquiatrist, and the psychologists are not always called. Facing the conceptual models about incapacity, and the change from a diagnostic to a functional approach, some additional requirements occur. There are several advantages of the psychological assessment procedures through psychometric and standardizes instruments, that must include: (i) classical tests of cognitive functions, emotional, socio-affective and personality; (ii) standardized exam of functional abilities (basic and more complex), considering several sources of information; (iii) standardized instruments specific for the forensic assessment, providing legally relevant information. This PhD project arise in these contexts and were developed in two main aspects. First, considering the international guidelines we also attempt to define some guidelines for the psychologists in those processes related to financial matters (Interdiction/Inhabilitation, Assets Disposition). The revision of the procedures and assessment instruments were done, considering also the important ethical questions that must be considered by the psychologists in these legal contexts. In this PhD thesis we intended to provide initial information for the development of the Portuguese guidelines concerning the involvement of the psychologists in legal determination of capacity. Additionally, this project also focus on the development of two instruments that will provide useful and relevant information to the Portuguese legal system. In the last years, important advances were made in Portugal about Psychological Assessment (adaptation and validation of several instruments regarding cognition, emotional aspects, personality, and quality of life). Despite this, the absence of functional and forensic instruments, as well as the absence of systematic investigation in Portugal about these questions led us to the development of two instruments – one for the general functional exam (Adults and Older Adults Functional Assessment Inventory, IAFAI), and one instrument for the assessment of specific financial abilities (Financial Capacity Assessment Instrument, IACFin). The development of these instruments were done through the bibliographic revisions, involvement of experts, qualitative and quantitative studies, ensuring their content and ecological validity. The IAFAI and the IACFin were useful instruments for the psychologists involved in legal processes (Interdiction/Inhabilitation, Assets Disposition by Will and Donation). In the psychological assessment process, the consideration of both traditional assessment tests, and these two specific instruments will provide comprehensive information about the individual profiles of functioning, and also legally relevant information for Portuguese legal system.FCT - SFRH/BD/47677/200

Estudios realizados en Portugal en el campo de cateterización venosa periférica: protocolo de scoping review

Background: Despite its ubiquitous nature, the practice of peripheral venous catheterization is not homogeneous among international clinical contexts. In Portugal, the information regarding the practice of peripheral venous catheterization is scattered in the literature, hindering efforts of a comprehensive analysis of its nature and implications. Objective: To map the studies developed in Portugal in the field of peripheral venous catheterization. Review method: Scoping review methodology proposed by the Joanna Briggs Institute. An adequate protocol was established for each base/repository to identify studies that meet the criteria outlined. The analysis of data relevance, extraction, and synthesis will be performed by independent reviewers. Presentation and interpretation of results: The mapping of the studies carried out in Portugal in this area will contribute to the identification of the main structure, process, and outcome indicators described in national studies. Conclusion: It is expected that this review will support the development of future interventions and systematic reviews that enhance the efficacy/safety of the care provided to patients with a peripheral catheter.Contexto: Apesar da sua natureza ubíqua, a prática de cateterização venosa periférica não é homogénea entre contextos clínicos internacionais. Em Portugal, a informação referente à prática de cateterismo venoso periférico encontra-se dispersa na literatura, impossibilitando uma análise suficientemente compreensiva e abrangente da sua natureza e implicações. Objetivos: Mapear os estudos realizados em Portugal no âmbito do cateterismo venoso periférico. Método de revisão: Metodologia de scoping review proposta pelo Joanna Briggs Institute. Foi definido um protocolo adequado a cada base/repositório, que visa a identificação de estudos que respondam aos critérios delineados. O processo de análise da relevância, extração e síntese dos dados será desenvolvido por revisores independentes. Apresentação e interpretação dos resultados: O mapeamento dos estudos realizados em Portugal neste âmbito contribuirá para a identificação dos principais indicadores de estrutura, processo e resultado descritos em estudos nacionais. Conclusão: Espera-se que esta revisão sustente o desenvolvimento de intervenções e revisões sistemáticas futuras que potenciem a eficácia/segurança dos cuidados prestados ao doente com cateter periférico.Contexto: Apesar de su naturaleza ubicua, la práctica del cateterismo venoso periférico no es homogénea en contextos clínicos internacionales. En Portugal, la información sobre la práctica del cateterismo venoso periférico está dispersa en la literatura, haciéndolo imposible un análisis lo suficientemente completo de su naturaleza e implicaciones. Objetivos: Mapear los estudios realizados en Portugal en el ámbito del cateterismo venoso periférico. Método de revisión: Metodología de scoping review propuesta por Joanna Briggs Institute. Se definió un protocolo adecuado a cada base/repositorio para identificar estudios que respondan a los criterios delineados. El proceso de análisis da relevancia, extracción y síntesis de los datos será desarrollado por revisores independientes. Presentación e interpretación de los resultados: El mapeo de los estudios realizados en Portugal en esta área contribuirá a la identificación de los principales indicadores de estructura, proceso y resultado descritos en estudios nacionales. Conclusión: Se espera que esta revisión contribuya al desarrollo de futuras intervenciones y revisiones sistemáticas que mejoren la eficacia/seguridad de la atención del paciente con catéter periférico.info:eu-repo/semantics/publishedVersio

Nursing Professional Self-Concept: A Scoping Review Protocol

Nurses are considered one of the largest professional groups in healthcare, generating positive health outcomes for people at various stages of life. A significant impact on the construction of the professional self—or professional self-concept—is considered to exist through the educational process, influenced by factors such as the family and societal expectations often presented by teachers, tutors, and peers. Improving professional self-concept in nursing can offer specific gains in personal, relational, social, and interpersonal communication skills, favoring evolution in the academic and clinical path. This scoping review aims to map the literature related to the state of knowledge regarding professional self-concept in nursing. This scoping review will follow JBI recommendations with the PCC mnemonic and report its findings through PRISMA-ScR using a specific instrument made by the researchers. Providing healthcare complying with high scientific standards requires the professional to have enough self-confidence in his work and skills. The explicit acknowledgement of professional self-concept is essential for any educational tutor or experienced mentor to promote mental health and academic and professional performance.info:eu-repo/semantics/publishedVersio

Nursing Professional Self-Concept: A Scoping Review Protocol

Nurses are considered one of the largest professional groups in healthcare, generating positive health outcomes for people at various stages of life. A significant impact on the construction of the professional self—or professional self-concept—is considered to exist through the educational process, influenced by factors such as the family and societal expectations often presented by teachers, tutors, and peers. Improving professional self-concept in nursing can offer specific gains in personal, relational, social, and interpersonal communication skills, favoring evolution in the academic and clinical path. This scoping review aims to map the literature related to the state of knowledge regarding professional self-concept in nursing. This scoping review will follow JBI recommendations with the PCC mnemonic and report its findings through PRISMA-ScR using a specific instrument made by the researchers. Providing healthcare complying with high scientific standards requires the professional to have enough self-confidence in his work and skills. The explicit acknowledgement of professional self-concept is essential for any educational tutor or experienced mentor to promote mental health and academic and professional performance

The skin microbiome of infected pressure ulcers: a review and implications for health professionals

Background Pressure ulcers (PUs) are injuries resulting from ischemia caused by prolonged compression or shear forces on the skin, adjacent tissues, and bones. Advanced stages of PUs are associated with infectious complications and constitute a major clinical challenge, with high social and economic impacts in health care. Goals This study aims to identify and describe the relationship between PUs risk factors, stages, and anatomical locations, and the relevance of microbial cohabitation and biofilm growth. Methods The narrative review method to advocating a critical and objective analysis of the current knowledge on the topic was performed. Indexed databases and direct consultation to specialized and high-impact journals on the subject were used to extract relevant information, guided by co-authors. The Medical Subject Heading of pressure ulcer (or injury), biofilms, infection, and other analogues terms were used. Results Development of PUs and consequent infection depend on several direct and indirect risk factors, including cutaneous/PUs microbiome, microclimate, and behavioral factors. Infected PUs are polymicrobial and characterized by biofilm-associated infection, phenotypic hypervariability of species, and inherent resistance to antimicrobials. The different stages and anatomical locations also play an important role in their colonization. The prevention and monitoring of PUs remain crucial for avoiding the emergence of systemic infections and reducing healthcare-associated costs, improve the quality of life of patients, and reduce de mortality-associated infected PUs.The authors acknowledge the financial support of the project 4NoPressure, reference n. POCI-01- 0247-FEDER-039869, co-funded by the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).info:eu-repo/semantics/publishedVersio

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)