Long-term Oral Suppressive Antimicrobial Therapy in Infective Endocarditis (SATIE Study): An Observational Study.

Background: The role of suppressive antimicrobial therapy (SAT) in infective endocarditis (IE) management has yet to be defined. The objective of this study was to describe the use of SAT in an IE referral center and the patients' outcomes. Methods: We conducted a retrospective observational study in a French IE referral center (Paris). All patients with IE who received SAT between 2016 and 2022 were included. Results: Forty-two patients were included (36 male [86%]; median age [interquartile range {IQR}], 73 [61-82] years). The median Charlson Comorbidity Index score (IQR) was 3 (1-4). Forty patients (95%) had an intracardiac device. The most frequent microorganisms were Enterococcus faecalis (15/42, 36%) and Staphylococcus aureus (12/42, 29%). SAT indications were absence of surgery despite clinical indication (28/42, 67%), incomplete removal of prosthetic material (6/42, 14%), uncontrolled infection source (4/42, 10%), persistent abnormal uptake on nuclear imaging (1/42, 2%), or a combination of the previous indications (3/42, 7%). Antimicrobials were mainly doxycycline (19/42, 45%) and amoxicillin (19/42, 45%). The median follow-up time (IQR) was 398 (194-663) days. Five patients (12%) experienced drug adverse events. Five patients (12%) presented with a second IE episode during follow-up, including 2 reinfections (different bacterial species) and 3 possible relapses (same bacterial species). Fourteen patients (33%) in our cohort died during follow-up. Overall, the 1-year survival rate was 84.3% (73.5%-96.7%), and the 1-year survival rate without recurrence was 74.1% (61.4%-89.4%). Conclusions: SAT was mainly prescribed to patients with cardiac devices because of the absence of surgery despite clinical indication. Five (12%) breakthrough second IE episodes were reported. Prospective comparative studies are required to guide this empirical practice.

Metastatic Cervical Cancer: A Case That Recalls the Importance of a Multidisciplinary Approach.

Cervical cancer is one of the most common neoplasms in women. Usually, this cancer is only symptomatic in advanced stages and is associated with a poor prognosis. We present the case of a 34-year-old woman with localized cervical cancer at diagnosis treated with surgery in 2011. Six years later, she presented recurrent disease with vaginal, pelvic, and lung metastases. Since then, the patient completed three lines of chemotherapy and a line of immunotherapy, and she was submitted to external radiotherapy and orthopedic surgery. Currently, the patient keeps regular follow-ups and maintains a good performance status. The treatment of recurrent cervical cancer remains a challenge, and the prognosis is poor. This case emphasized the importance of multidisciplinary discussion towards cases of locally advanced or metastatic cervical cancer, which may change this paradigm.

General Practitioner's Experience of Public-Private Partnerships to Develop Team-Based Care: A Qualitative Study.

Objectives: A tripartite public-private partnership was established between GPs' practices, public health authorities and a university department of family medicine, to develop multidisciplinary teams and integrate nurses into GPs' practices. The present paper describes the points of view of the GPs involved in this collaboration. Methods: We conducted a qualitative study, with data coming from eight interviews with GPs, one from each practice. We also used the facilitator's project diary to complete the discussion. Results: The principal issue discussed was the financial aspects of the collaboration. GPs are generally satisfied, but time spent coordinating with nurses and transferring activities made them fear financial losses. Secondly, the partnership with public health authorities was well appreciated, but not clear enough. Some aspects of the partnership, such as referring patient to the nurse should have been better defined et controlled. The last aspect was the academic support. It allowed reducing GPs' workload in training nurses and supporting the project implementation within the GPs' practice. Conclusion: GPs have a positive point of view of such public-private partnership and saw an opportunity to be involved in developing public health policies.

Development of Care and Professional Identity in an Interprofessional Health Team: Graduation, Residency and Professional Practice as a Window of Opportunity / Desarrollo del Equipo Interprofesional de Atención e Identidad Profesional en Salud: Graduación y Posgrado como Ventana de Oportunidad / Desenvolvimento do Cuidado em Equipe Interprofissional e da Identidade Profissional em Saúde: Graduação e Pós-Graduação como Janela de Oportunidade

This integrative review analyzes aspects of professional identity (PI) and its relationship with teamwork, with patient care and safety, in multidisciplinary health teams; from graduation, residency and professional performance. Twenty-two papers were studied, over a period of five years, from the Embase, Scopus and Web of Science databases, classified into eleven professional categories, resulting in six papers with undergraduate students, five with undergraduates in professional internships, and eleven with health professionals, including residents. The construction process of the PI of residents and professionals who work in the hospital environment was analyzed, noting that, for the medical profession, it is necessary to change the paradigm regarding PI and teamwork, while for the other professionals it is that It is necessary to develop the PI process from graduation onwards, as an important factor in the work environment, for the management of conflicts between members of the health teams.

Esta revisión integradora analiza aspectos de la identidad profesional (IP) en equipos multiprofesionales de salud, desde la graduación. Se estudiaron veintidós artículos, en un período de cinco años, de las bases de datos Embase, Scopus y Web of Science, clasificados en once categorías profesionales, resultando seis artículos con estudiantes de pregrado, cinco con prácticas profesionales y once con profesionales de la salud. Se analizó el proceso de construcción de la IP de los residentes y profesionales que actúan en el ámbito hospitalario, observando que, para la profesión médica, es necesario un cambio de paradigma sobre la IP y el trabajo en equipo, mientras que para los demás profesionales es necesario desarrollar la Proceso de PI en el ambiente de trabajo, como factor importante para la gestión de conflictos entre los integrantes de los equipos de salud.

Esta revisão integrativa analisa aspectos da identidade profissional (IP) em equipes multiprofissionais da saúde, desde a graduação. Foram estudados vinte e dois artigos, no período de cinco anos, das bases de dados Embase, Scopus e Web of Science, classificados em onze categorias profissionais, resultando em seis artigos com alunos de graduação, cinco com estágios profissionalizantes e onze com profissionais da saúde. Analisou-se o processo de construção da IP de residentes e profissionais que atuam no ambiente hospitalar, observando-se que, para a profissão médica é necessária a mudança de paradigma sobre IP e trabalho em equipe, enquanto que para os demais profissionais faz-se necessário desenvolver o processo de IP no ambiente de trabalho, como fator importante para a gestão de conflitos entre os integrantes das equipes de saúde.

[Advanced nursing practice model for head and neck cancer: A practice development project]. / Advanced Nursing Practice für Patient_innen mit Kopf-Hals-Tumorerkrankungen und ihre Angehörigen.

Advanced nursing practice model for head and neck cancer: A practice development project Abstract. Background: Head and neck cancer confronts patients and their families with big challenges due to complex treatments as well as changes in vital functions and appearance. They require multifaceted support and benefit from coordinated, interprofessional collaboration and advanced nursing practice. Problem/aim: In a tertiary head and neck cancer center, a coordinating contact person was missing for patients, families and the care team. Therefore, a project was launched to develop an advanced nursing practice program. Methods: Methods included an advanced nursing practice concept, approaches for practice development, and action research. The project consisted of four phases: Stakeholder analysis and literature review were followed by the definition of the advanced nursing practice program, which was then tested during a pilot phase, and evaluated using structural/process data and stakeholder interviews. Results: Evidence-based, continuous, person-centered care was improved across the care continuum for patients/families. The nurses' expertise was supported and the collaboration with internal/external clinicians was facilitated. Patients/families valued the continuity offered by the advanced practice nurse. Discussion: The methodological approaches supported a goal-oriented approach; especially participatory practice development helped to address employees' concerns. Limitations/transfer: To date, a sustainable program cannot yet be warranted. For similar projects, an approach with stakeholder analysis, multidisciplinary focus, and early evaluation planning is recommended.

Examining Diurnal Differences in Multidisciplinary Care Teams at a Pediatric Trauma Center Using Electronic Health Record Data: Social Network Analysis.

BACKGROUND: The care of pediatric trauma patients is delivered by multidisciplinary care teams with high fluidity that may vary in composition and organization depending on the time of day. OBJECTIVE: This study aims to identify and describe diurnal variations in multidisciplinary care teams taking care of pediatric trauma patients using social network analysis on electronic health record (EHR) data. METHODS: Metadata of clinical activities were extracted from the EHR and processed into an event log, which was divided into 6 different event logs based on shift (day or night) and location (emergency department, pediatric intensive care unit, and floor). Social networks were constructed from each event log by creating an edge among the functional roles captured within a similar time interval during a shift. Overlapping communities were identified from the social networks. Day and night network structures for each care location were compared and validated via comparison with secondary analysis of qualitatively derived care team data, obtained through semistructured interviews; and member-checking interviews with clinicians. RESULTS: There were 413 encounters in the 1-year study period, with 65.9% (272/413) and 34.1% (141/413) beginning during day and night shifts, respectively. A single community was identified at all locations during the day and in the pediatric intensive care unit at night, whereas multiple communities corresponding to individual specialty services were identified in the emergency department and on the floor at night. Members of the trauma service belonged to all communities, suggesting that they were responsible for care coordination. Health care professionals found the networks to be largely accurate representations of the composition of the care teams and the interactions among them. CONCLUSIONS: Social network analysis was successfully used on EHR data to identify and describe diurnal differences in the composition and organization of multidisciplinary care teams at a pediatric trauma center.

From village health volunteers to paid care givers: the optimal mix for a multidisciplinary home health care workforce in rural Thailand.

BACKGROUND: Thailand is a rapidly aging society, which places high demand on home health care services for the elderly. The shortage of health care workforce in rural areas is a crucial obstacle to the delivery of adequate home health care services. The appropriate skill-mix between multidisciplinary health team and care givers (CGs) is an attractive solution for improving home health care services in rural Thailand. This study assessed the potential of trained CGs to provide home health care services and projected what the optimal mix for a multidisciplinary home health care team in rural Thailand would be in 2030. METHODS: Eleven pilot districts in Thailand were recruited for the study. Secondary data were collected along with surveys of home health care providers. A total of 130 care managers (nurses) and 351 care givers (CG) were recruited for the survey. Workload, skill-mix potential, and acceptance of care givers were assessed in the surveys. The results from secondary data and the survey were used to project the health workforce requirements in 2030. RESULTS: It is projected that in 2030 the number of elderly living in rural areas will be 7,156,700 (27% of the projected rural population). Of this, 20.3% will be home-bound, 1.1% will be bed-ridden and 1.6% will need rehabilitation. The main members of the multidisciplinary health workforce involved in home health care were nurses, doctors, and physiotherapists. The home health care services that were provided by the multidisciplinary health workforce included patient assessment, development of a care plan and case conference, home visits, and teaching and supervision of CGs. The CGs were village health volunteers trained to carry out regular home visits to patients. The CGs provided assistance with the activities of daily living, basic health services, moral support to patients and relatives, and surveillance of the home environment during home visits. CGs were well accepted by both the health professionals and the patients. Projections showed that 16,094 nurses, 1,542 doctors, 1,022 physiotherapists and 50,148 CGs will be required in 2030 to meet the needs of the dependent elderly for home health care in rural Thailand. CONCLUSION: With the increased need for home health care services in the future, appropriate team work between the members of the multidisciplinary health team and the CGs in the community is the appropriate solution for likely shortages of health professional workforce.

Atenção à saúde bucal na atenção primária à saúde em Portugal: perceção dos médicos dentistas portugueses / Oral health care in primary health care in Portugal: perception of Portuguese dentists

Objetivos: o presente estudo objetivou analisar as perceções dos médicos dentistas relativamente à implementação da atenção à saúde bucal na atenção primária à saúde em Portugal. Métodos: estudo exploratório-descritivo, de abordagem qualitativa, realizado com recurso a entrevista semiestruturada gravada aplicada a 75 médicos dentistas. A coleta de dados ocorreu entre julho e dezembro de 2017, sendo utilizada para a análise a técnica da análise de conteúdo. Resultados: as falas revelam a importância da realização de tratamentos e educação em saúde bucal integrada na equipe de saúde da atenção primária à saúde. Conclusões: Em conformidade com a literatura, os dentistas destacam a importância do reforço da atenção à saúde bucal de acesso universal integrada no Serviço Nacional de Saúde, reforçam a necessidade de criar mais equipes de saúde bucal (médico dentista, higienista e assistentes) em toda a atenção primária e destacam a necessidade da implementação de uma carreira médica de medicina dentária para promover a colocação de mais médicos dentistas em zonas mais carenciadas. (AU)

Objectives: This study aimed to analyze the perceptions of dentists regarding the implementation of oral health care in primary health care in Portugal. Methods: an exploratory-descriptive study, with a qualitative approach, performed using a semi-structured interview applied to 75 dentists. Data collection took place between July and December 2017, and the content analysis technique was used for the analysis. Results: the speeches reveal the importance of performing treatments and oral health education integrated in the health team of primary health care. Conclusions: According to the literature, physicians emphasize the importance of strengthening oral health care for universal access integrated into the National Health Service, reinforcing the need to place oral health teams (dentist, hygienist and assistants) throughout the country. primary care and highlight the need to implement a medical career in dentistry to promote the placement of more dentists in more needy areas. (AU)

'SI-SRH' - a new model to manage sexual health following a spinal cord injury: our experience.

AIMS AND OBJECTIVES: To maximise involvement of the multidisciplinary team using a model of sexual health management for spinal cord-injured persons. BACKGROUND: Regaining sexual function is a priority following spinal cord injury, with the majority of people remaining sexually active with a satisfying sex life. Nevertheless, rehabilitation programmes often focus on activities related to mobility and elimination, with sexual health relegated to a secondary under-resourced position. DESIGN: Model creation and audit of current and desired status to identify required education. METHODS: A four-tier model for sexual health management identified phases of management, increasing in complexity, from tier 1 to tier 4. The model was used to audit the current and desired status of the multidisciplinary team on a spinal injuries unit, identifying knowledge levels, barriers to involvement and education requirements. RESULTS: Fifty-nine questionnaires were completed (85%) by nurses and allied health professionals. Knowledge deficits and discomfort with the topic were the primary reasons prohibiting involvement with sexual health rehabilitation. Two thirds were willing to be involved with sexual health activities, mainly at an introductory level rather than providing education or problem-solving. However, following relevant education, the level of involvement changed: 90% (n = 53) desired involvement at more complex levels, and 10% (n = 6) were unwilling to be involved. CONCLUSIONS: Developing the necessary skills and knowledge creates potential to increase the resources available to participate in sexual health rehabilitation following a spinal cord injury and ensure that it is a core rehabilitation activity. RELEVANCE TO CLINICAL PRACTICE: The progressive model portrayed discrete phases of sexual health management, which collectively portray the whole. Team members identified a level of involvement to compliment their skills and knowledge. The audit demonstrated that the primary barriers to involvement were not culture, language or attitude as hypothesised, but inadequate knowledge, addressable through education.

O processo de trabalho na estratégia saúde da família: uma abordagem multiprofissional no município de Barra Mansa-RJ / The work process in the family health strategy: a multiprofessional approach in the municipality of Barra Mansa-RJ

Dissertação de mestrado que se propôs a refletir sobre o processo de trabalho em equipe na Estratégia Saúde da Família (SF) do município de Barra Mansa-RJ, identificar as estratégias utilizadas pelas equipes de SF em seu processo de trabalho e analisar as tecnologias empregadas pelas equipes no processo de trabalho. Trata-se de um estudo de caso qualitativo e descritivo, que foi realizado com duas equipes de saúde da família do município de Barra Mansa- RJ. Os aspectos éticos foram respeitados conforme a resolução 196/96. A coleta de dados se deu através de entrevistas abertas individuais, entrevistas em grupo, diário de campo e observação descritiva. O estudo tem base na metodologia caso traçador. Para análise de dados foi utilizada a análise de conteúdo temática com categorização dos dados. As categorias encontradas foram: "O processo de trabalho das equipes: foco nas tecnologias do cuidado", "O trabalho em equipe: entre aproximação e distanciamento", e "A verticalização da assistência e a autonomia dos sujeitos cassada". Após a análise das entrevistas verificou-se que os profissionais têm dificuldade em modificar as práticas em saúde, assim baseiam suas atividades em tecnologias duras e leve-duras, valorizando o uso de equipamentos, porém existe abertura para incorporação de outras práticas e do uso de tecnologias leves. Os profissionais entrevistados tendem a orientar os pacientes de forma verticalizada, a interação entre os membros da equipe ocorre de forma hierarquizada e o trabalho em equipe está majoritariamente organizado como equipe agrupamento. Existem várias conformações das equipes, mas o centro do trabalho se mantém no centro do núcleo profissional, e não no do usuário. Investir em educação permanente para os profissionais que foram formados sob outra lógica, a hospitalocêntrica, médico centrada e biologista, pode ser uma forma de facilitar a efetivação de outros modos de cuidar e produzir saúde em curto prazo

Research that aimed to reflect about the process of teamwork of the Family Health Strategy (SF) in the city of Barra Mansa-RJ, identify the strategies used by SF teams in their working process and analyze the technologies employed by teams in their working process. This is a qualitative and descriptive case study, which was conducted with two teams of family health in the city of Barra Mansa-RJ. The ethical aspects were respected, according to resolution 196/96. Data collection was through individual open interviews, group interviews, and descriptive observation. The study is based on tracer methodology. For data analysis was used thematic analysis with data categorization. The categories found were: "The working process of teams: focus on technologies of care", "Teamwork: between approximation and distance," and "The vertical integration of care and personal autonomy revoked." After reviewing the interviews it was found that the professionals have difficulty in modifying health practices, and base their activities on hard and soft-hard technologies, valuing the use of equipment, but there is openness to incorporate other practices and use soft technologies. The interviewed professionals tend to guide patients in a vertical structure, the interaction between team members occurs in a hierarchical way and teamwork is largely organized as a team grouping. There are different conformations of the teams, but the work's center is on the professional, not on the user. In short-term investing in continuing education for professionals who were trained under other logic, focus on the hospital care and biologist, can be a way to facilitate the execution of other ways to produce health care

Gingivitis artefacta o autoinducida como conducta autolesiva: presentación de un caso clínico / Artefacta gingivitis or autoinduced by autoinfringed behaviour: case clinic

La gingivitis “artefacta” o autoinducida constituye una serie de recesiones gingivales caprichosas que, por lo general, son inducidas por el propio paciente. El objetivo de este artículo fue identificar la presencia de autolesiones gingivales en pacientes pediátricos para dar a conocer las causas que la propician, establecer el diagnóstico oportuno y el tratamiento adecuado que permita prevenir lesiones mayores. Se describe un paciente masculino de 10 años de edad en quien a la exploración clínica se observó la presencia de una hendidura vertical en la encía correspondiente al primer molar temporal inferior derecho. De acuerdo a los antecedentes se diagnosticó gingivitis artefacta o autoinducida. En razón al normal proceso de recambio de dentición como elemento básico para uin pronóstico favorable, como tratamiento específico para el caso se decidió hacer la extracción del órgano dental que presentaba una corona metálica y dejar en observación al paciente. Después de tres meses, la erupción del diente permanente concluyó sin alteración periodontal. Se considera de mucha importancia tener conocimientos sobre la prevalencia y la etiología de este tipo de lesiones, para poder prevenirlas con un enfoque multidisciplinario que permita darles el mejor tratamiento posible. Por esta razón se realiza el presente aporte a la literatura odontológica, mas exactamente a la literatura de la Odontopediatría.

Gingivitis artefacta is a series of capricious gingival recessions. Generally they are nominated “self– nducted lesions” or “artificial lesions.” This paper presents the periodontal findings in a 10 years old boy who presents a vertical fissure on the right first lower temporal molar near to the gingival margin. This tooth presented a steel chromium crown and on the soft tissue had an unusual redness resilient to plaque control. Due to the gingival recession, the root surfaces were exposed. Treatment adopted was performing the tooth extraction. Three months after extraction, the eruption of permanent tooth concluded and there was not further periodontal alteration. Pedodontics should be aware of self –induced gingival lesions to perform a better diagnosis and treatment. Preventive advice should include the study and control of children´ habits that could lead to hard and soft tissue dental lesions. Pedodontics should also work in conjunction with other dental specialists as a part of a multi-disciplinary team to offer the best professional decision to the patients´ needs.