ABSTRACT
BACKGROUND: Organizations face diverse contexts and requirements when updating and maintaining their portfolio, or pool, of systematic reviews or clinical practice guidelines they need to manage. We aimed to develop a comprehensive, theoretical framework that might enable the design and tailoring of maintenance strategies for portfolios containing systematic reviews and guidelines. METHODS: We employed a conceptual approach combined with a literature review. Components of the diagnostic test-treatment pathway used in clinical healthcare were transferred to develop a framework specifically for systematic review and guideline portfolio maintenance strategies. RESULTS: We developed the Portfolio Maintenance by Test-Treatment (POMBYTT) framework comprising diagnosis, staging, management, and monitoring components. To illustrate the framework's components and their elements, we provided examples from both a clinical healthcare test-treatment pathway and a clinical practice guideline maintenance scenario. Additionally, our literature review provided possible examples for the elements in the framework, such as detection variables, detection tests, and detection thresholds. We furthermore provide three example strategies using the framework, of which one was based on living recommendations strategies. CONCLUSIONS: The developed framework might support the design of maintenance strategies that could contain multiple options besides updating to manage a portfolio (e.g. withdrawing and archiving), even in the absence of the target condition. By making different choices for variables, tests, test protocols, indications, management options, and monitoring, organizations might tailor their maintenance strategy to suit specific contexts and needs. The framework's elements could potentially aid in the design by being explicit about the operational aspects of maintenance strategies. This might also be helpful for end-users and other stakeholders of systematic reviews and clinical practice guidelines.
Subject(s)
Delivery of Health Care , Humans , Systematic Reviews as TopicABSTRACT
O objeto de estudo dessa pesquisa é definido como os cuidados básicos de enfermagem para promoção do conforto do cliente pós-angioplastia transluminal coronariana (ATC). Os objetivos são: 1 - Elaborar um protocolo de cuidados básicos de enfermagem para promoção do conforto do cliente pós-ATC; e 2 - Validar o protocolo através da avaliação de especialistas. Método: Estudo do tipo descritivo, de abordagem qualitativa e medidas quantitativas. O percurso metodológico foi dividido em três etapas: a primeira, uma revisão integrativa da literatura (RIL), que serviu como base teórico-científica para a segunda etapa: elaboração do protocolo. A terceira etapa é a validação do protocolo por enfermeiros especialistas. Foi feita a RIL, e após aplicar os critérios de inclusão e exclusão, foram selecionados 13 artigos. O protocolo foi elaborado a partir da identificação dos cuidados de enfermagem encontrados na literatura e do conhecimento teórico-prático das pesquisadoras. Constou de itens encontrados nos artigos e itens relacionados aos cuidados básicos de enfermagem de Virgínia Henderson, além de algumas recomendações da American Heart Association. Distribuiu-se os cuidados em três partes: Acolhimento do cliente na unidade pós-angioplastia transluminal coronariana, intervenções de enfermagem durante a recuperação/repouso e cuidados e orientações para a alta, totalizando 25 itens em sua primeira versão. Para validação do protocolo elaborado, foi utilizada a técnica Delphi e selecionados nove enfermeiros com experiência ou especialização na área de cardiologia e hemodinâmica como juízes. Resultados: Foi evidenciado na análise dos resultados da RIL e das respostas dos especialistas que os enfermeiros preferem discutir as complicações do procedimento ao invés dos cuidados básicos de enfermagem. Foram necessárias três rodadas de perguntas e respostas para que todos os itens do protocolo atingissem taxa de concordância e índice de validade de conteúdo de no mínimo 0,9. De acordo com as sugestões feitas pelos especialistas e análise das mesmas, o documento foi alterado, o qual em sua versão final totalizou 28 itens. Considerações Finais: Espera-se, com os resultados, nortear a prática do enfermeiro favorecendo a qualidade da assistência. Sugere-se a aplicação do protocolo elaborado na prática clínica, bem como a construção de novos protocolos abordando os períodos pré e trans-ATC
The object of study of this research is defined as basic care of nursing to promote client comfort after percutaneous transluminal coronary angioplasty (PTCA). The objectives are: 1 - To elaborate a protocol of basic care of nursing to promote the comfort of the client after PTCA; and 2 - Validate the protocol through expert assessment. Method: Descriptive study, qualitative approach and quantitative measures. The methodological course was divided into three stages: the first, an integrative literature review (RIL), which served as a theoretical-scientific basis for the second stage: protocol elaboration. The third step is protocol validation by specialist nurses. The RIL was done, and after applying the inclusion and exclusion criteria, 13 articles were selected. The protocol was elaborated from the identification of the nursing care found in the literature and from the theoreticalpractical knowledge of the researchers. It consisted of items found in the articles and items related to basic nursing care of Virginia Henderson, in addition to some recommendations from the American Heart Association. The care was distributed in three parts: Customer reception in the coronary transluminal post-angioplasty unit, nursing interventions during recovery / rest and care and guidelines for discharge, totaling 25 items in its first version. To validate the protocol, the Delphi technique was used and nine nurses with experience or specialization in the area of cardiology and hemodynamics as judges were selected. Results: It was evidenced in the analysis of the RIL results and the answers of the specialists that the nurses prefer to discuss the complications of the procedure instead of the basic nursing care. Three rounds of questions and answers were required for all items in the protocol to reach agreement rate and content validity index of at least 0.9. According to the suggestions made by the experts and their analysis, the document was changed, which in its final version totaled 28 items. Final Considerations: It is hoped, with the results, to guide the practice of the nurse favoring the quality of care. It is suggested the application of the protocol elaborated in clinical practice, as well as the construction of new protocols addressing the pre and trans-ATC periods
Subject(s)
Practice Guidelines as Topic , Angioplasty , Nursing CareABSTRACT
OBJECTIVE: To explore perceptions on access to medication supplied by the Specialized Component of Pharmaceutical Assistance (CEAF) within the Brazilian Unified Health System (which includes high-cost drugs) by the actors involved in the healthcare services of this component. METHOD: A descriptive, qualitative study was carried out by using a focal group with 7 users and 11 semi-structured interviews with health professionals (physicians and pharmacist) in the state of Santa Catarina. RESULTS: According to the participants, access to medicines had improved. Two main perceptions of the CEAF Clinical Guidelines were identified: the requirements constitute a bureaucracy that limits access, and the requisites increase the demand for tests and specialized healthcare services, exceeding the capacity of the healthcare services network. These assumptions generated the search for other means of access that revealed a lack of information and understanding of the right to health among the users. In addition, according to the participants, because of the difficulties of accessing services as a whole, full access to CEAF medicines is a goal that remains to be achieved. CONCLUSION: Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness.
Subject(s)
Patients , Pharmaceutical Preparations/economics , Pharmaceutical Preparations/supply & distribution , Pharmacists , Physicians , Prescription Fees , Brazil , Drug Costs , Focus Groups , Humans , Qualitative ResearchABSTRACT
Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema.
