Bridging the gap: facilitating the use of rheumatology research results in clinical practice with hybrid implementation effectiveness studies.

The implementation of proven effective pharmacological and non-pharmacological interventions into routine rheumatology practice is a lengthy and complex process. Bridging this gap between research and practice is crucial. Hybrid implementation effectiveness studies, integrating effectiveness and implementation aspects, emerge as a proactive and innovative solution to shorten the process of translation of proven interventions into clinical practice. This viewpoint provides an overview of the various types of hybrid implementation effectiveness studies including examples from rheumatology research practice, explains their pivotal role in speeding up the implementation of rheumatology research results and concludes with practical recommendations for the conduct of hybrid implementation effectiveness studies.

Patient research partner involvement in rheumatology research: a systematic literature review informing the 2023 updated EULAR recommendations for the involvement of patient research partners.

BACKGROUND: Patient research partners (PRPs) are people with a disease who collaborate in a research team as partners. The aim of this systematic literature review (SLR) was to assess barriers and facilitators to PRP involvement in rheumatology research. METHODS: The SLR was conducted in PubMed/Medline for articles on PRP involvement in rheumatology research, published between 2017 and 2023; websites were also searched in rheumatology and other specialties. Data were extracted regarding the definition of PRPs, their role and added value, as well as barriers and facilitators to PRP involvement. The quality of the articles was assessed. Quantitative data were analysed descriptively, and principles of thematic content analysis was applied to qualitative data. RESULTS: Of 1016 publications, 53 articles were included; the majority of these studies were qualitative studies (26%), opinion articles (21%), meeting reports (17%) and mixed-methods studies (11%). Roles of PRPs ranged from research partners to patient advocates, advisors and patient reviewers. PRPs were reported/advised to be involved early in the project (32% of articles) and in all research phases (30%), from the conception stage to the implementation of research findings. The main barriers were challenges in communication and support for both PRPs and researchers. Facilitators of PRP involvement included more than one PRP per project, training of PRPs and researchers, a supportive environment for PRPs (including adequate communication, acknowledgement and compensation of PRPs) and the presence of a PRP coordinator. CONCLUSION: This SLR identified barriers and facilitators to PRP involvement, and was key to updating the European Alliance of Associations for Rheumatology recommendations for PRP-researcher collaboration based on scientific evidence.

Standardizing Fidelity to Evidence-Based Practice in the Early Psychosis Intervention Network.

OBJECTIVE: This study investigated variations in the measurement of fidelity to coordinated specialty care (CSC) within the Early Psychosis Intervention Network (EPINET), a learning health system that consists of 101 CSC programs within eight hubs. The study investigated the degree to which five fidelity scales could be mapped onto a standard scale. METHODS: The investigators identified six fidelity scales in use by EPINET participants; examined their item content, scoring, and data sources; and mapped five scales onto the First Episode Psychosis Services Fidelity Scale (FEPS-FS), which is the most widely used scale. RESULTS: Mapping five fidelity scales onto the FEPS-FS showed that the percentage of FEPS-FS components successfully mapped ranged from 42% to 81%. CONCLUSIONS: Mapping five scales onto one that uses dichotomous scoring identified the degree of variation in measures and reduced the amount and quality of usable fidelity data. Identifying variations in fidelity measurement is a core function of a learning health system.

Dynamic change in red cell distribution width as a predictor for short-time mortality in dermatomyositis-associated rapid progressive interstitial lung disease.

AIM: We aimed to explore a new and readily available practical marker for rapidly progressive interstitial lung disease (RP-ILD) and poor short-term outcomes in patients with idiopathic inflammatory myopathies (IIM). METHODS: A total of 1822 consecutive patients with IIM between 2009 and 2021 were evaluated retrospectively. All proven cases of naïve ILD with complete medical records were included. Red cell distribution width (RDW) values at the initial stage, 3 months and last follow-up were collected. The clinical characteristics and outcomes of the patients were recorded. RESULTS: We identified 532 patients with IIM with an average follow-up of 4 years. ILD prevalence was higher in patients of elevated RDW (p<0.001). The patients with ILD and elevated RDW had lower levels of PaO2/FiO2, FVC% and DLco% and a higher prevalence of RP-ILD than those with normal RDW (p<0.001). Prognostic analysis revealed that RDW was an independent risk factor for prognosis in patients with IIM-ILD (HR=2.9, p=0.03). Patients with dermatomyositis (DM) with RP-ILD with a change in RDW within 3 months (∆RDW-3) greater than 0 were more likely to die within 3 months. Moreover, the prevalence of ∆RDW-3>0 was higher in patients with RP-ILD and positive for anti-melanoma differentiation-associated gene 5 antibody who died within 3 months (87.5%) compared with those alive at 3 months (24.6%) (p<0.001). CONCLUSION: These findings suggest that repeated RDW assays could assist physicians in identifying patients with DM-ILD who were at a high risk of RP-ILD and death.

Presupuesto por resultados y calidad del gasto del programa de cáncer en un hospital público / Budgeting for results and quality of cancer program spending in a public hospital / Orçamento para resultados e qualidade dos gastos com o programa de câncer em um hospital público

La implementación del Presupuesto por Resultados (PpR) requiere elementos como información oportuna, sistemas de monitoreo, incentivos y procedimientos normados. En el caso de Perú, su enfoque de PpR ha generado cambios significativos en resultados de salud, especialmente en programas como desnutrición y salud materna y neonatal, al priorizar actividades demostradas como más costo-eficaces a nivel mundial. Objetivo. Determinar la relación entre el presupuesto por resultados (PpR) y la Calidad del gasto del programa de cáncer en un hospital público del Ministerio de Salud, 2021. Materiales y Métodos. Se realizó un estudio de enfoque cuantitativo, tipo básico, diseño no experimental, descriptivo y nivel correlacional. La población fue de 131 trabajadores vinculados al ciclo del presupuesto, de los cuales se seleccionó una muestra de 32 trabajadores responsables directos del PpR. Se utilizó la técnica de encuesta y dos cuestionarios como instrumentos, sometidos a los coeficientes KR-20 y Alpha de Cronbach para evaluar la confiabilidad. Resultados. El coeficiente de Spearman fue de 0.387, indicando una relación positiva y media entre las variables. La significancia fue de 0.029 (< 0.05). Conclusiones. Se encontró una relación significativa entre el PpR y la Calidad del gasto del programa de Cáncer en el hospital del Ministerio de Salud, confirmando que un mejor manejo del PpR está asociado a una mejor calidad de gasto.

The implementation of results-based budgeting (RBB) requires elements such as timely information, monitoring systems, incentives and standardized procedures. In the case of Peru, its PfR approach has generated significant changes in health outcomes, especially in programs such as malnutrition and maternal and neonatal health, by prioritizing activities proven to be more cost-effective worldwide. Objective. To determine the relationship between the budget for results (BfR) and the Quality of cancer program spending in a public hospital of the Ministry of Health, 2021. Materials and Methods. A quantitative approach, basic type, non-experimental, descriptive and correlational study was carried out. The population was 131 workers linked to the budget cycle, from which a sample of 32 workers directly responsible for the PpR was selected. The survey technique and two questionnaires were used as instruments, subjected to Cronbach's KR-20 and Alpha coefficients to assess reliability. Results. Spearman's coefficient was 0.387, indicating a positive and average relationship between the variables. Significance was 0.029 (< 0.05). Conclusions. A significant relationship was found between PpR and Quality of expenditure of the Cancer program in the Ministry of Health hospital, confirming that better management of PpR is associated with better quality of expenditure.

A implementação do orçamento por desempenho (PfR) requer elementos como informações oportunas, sistemas de monitoramento, incentivos e procedimentos padronizados. No caso do Peru, sua abordagem de PfR gerou mudanças significativas nos resultados de saúde, especialmente em programas como desnutrição e saúde materna e neonatal, priorizando atividades comprovadamente mais econômicas em todo o mundo. Objetivo. Determinar a relação entre o orçamento por resultados (BfR) e a qualidade dos gastos com o programa de câncer em um hospital público do Ministério da Saúde, 2021. Materiais e métodos. Foi realizado um estudo de abordagem quantitativa, do tipo básico, não experimental, descritivo e correlacional. A população foi de 131 trabalhadores ligados ao ciclo orçamentário, dos quais foi selecionada uma amostra de 32 trabalhadores diretamente responsáveis pelo BfR. Como instrumentos, foram utilizados a técnica de survey e dois questionários, submetidos aos coeficientes KR-20 e Alfa de Cronbach para avaliar a confiabilidade. Resultados. O coeficiente de Spearman foi de 0,387, indicando uma relação positiva e média entre as variáveis. A significância foi de 0,029 (< 0,05). Conclusões. Foi encontrada uma relação significativa entre o PfR e a qualidade das despesas do programa de câncer no hospital do Ministério da Saúde, confirmando que uma melhor gestão do PfR está associada a uma melhor qualidade das despesas.

Effectiveness and Health Outcomes of Collaborative Nurse Prescribing for Patients Anticoagulated with Antivitamin K in Primary Care: A Study Protocol.

The development of collaborative nurse prescribing (NP) in Andalusia (Spain) in 2018 gives us the opportunity to measure the impact of this practice. Scientific evidence indicates that prescribing is not more costly when performed by nurses and, in fact, is more economical in some cases. The aim of this study is to determine the effects of NP on the effectiveness, health outcomes and adverse events related to prescribing including in the follow-up of patients treated with antivitamin K oral anticoagulants in primary care (PC) by nurses. The design is a randomized clinical trial. The population comprises 1208 anticoagulated patients in 2019. The sample size calculation considers an alpha error of 0.05, a power of 99% and an effect size of 0.5, resulting in 127 users per group. Therefore, a total sample of 254 participants is needed. However, as the project intends to treat patients it will include the universal sample that meets the criteria in the two health centers participating in the study, with 575 participants in total. Data collection was carried out in the PC District of the Alamillo-San Jerónimo Clinical Management Unit of Sevilla for one year from January 2020. Data analysis is performed using the SPSS Statistics 25 package. We intend to study if nurse collaborative prescription in the follow-up and management of patients taking antivitamin K oral anticoagulants in PC is as effective as the traditional approach to follow-ups carried out by a family physician.

Developing a set of emergency department performance measures to evaluate delirium care quality for older adults: a modified e-Delphi study.

BACKGROUND: Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized in routine clinical care. Lack of detection and treatment is associated with poor outcomes, such as mortality. Performance measures (PMs) are needed to identify variations in quality care to help guide improvement strategies. The purpose of this study is to gain consensus on a set of quality statements and PMs that can be used to evaluate delirium care quality for older ED patients. METHODS: A 3-round modified e-Delphi study was conducted with ED clinical experts. In each round, participants rated quality statements according to the concepts of importance and actionability, then their associated PMs according to the concept of necessity (1-9 Likert scales), with the ability to comment on each. Consensus and stability were evaluated using a priori criteria using descriptive statistics. Qualitative data was examined to identify themes within and across quality statements and PMs, which went through a participant validation exercise in the final round. RESULTS: Twenty-two experts participated, 95.5% were from west or central Canada. From 10 quality statements and 24 PMs, consensus was achieved for six quality statements and 22 PMs. Qualitative data supported justification for including three quality statements and one PM that achieved consensus slightly below a priori criteria. Three overarching themes emerged from the qualitative data related to quality statement actionability. Nine quality statements, nine structure PMs, and 14 process PMs are included in the final set, addressing four areas of delirium care: screening, diagnosis, risk reduction and management. CONCLUSION: Results provide a set of quality statements and PMs that are important, actionable, and necessary to a diverse group of clinical experts. To our knowledge, this is the first known study to develop a de novo set of guideline-based quality statements and PMs to evaluate the quality of delirium care older adults receive in the ED setting.

New blood biomarkers and imaging for disease stratification and monitoring of giant cell arteritis.

Relapses and late complications remain a concern in giant cell arteritis (GCA). Monitoring strategies are required to effectively tailor treatment and improve patients' outcomes. Current monitoring of GCA is based on clinical assessment and evaluation of traditional inflammatory markers such as C reactive protein and erythrocyte sedimentation rate; however, this approach has limited value in patients receiving interleukin (IL)-6 blocking agents. New blood biomarkers that are less dependent on the IL-6 axis such as IL-23, B cell activating factor, osteopontin and calprotectin have been explored, but none of them has yet accumulated sufficient evidence to qualify as a routine follow-up parameter. Imaging techniques, including ultrasound and 18F-fluorodeoxyglucose positron emission tomography/computed tomography, potentially offer additional insights; however, the choice of the imaging method as well as its interpretation must be investigated further. Future studies are required to investigate the outcome of patients with GCA whose treatment decisions are based on traditional plus novel (laboratory and imaging) biomarkers as compared with those undergoing conventional monitoring strategies.

Validation of SPARCC MRI-RETIC e-tools for increasing scoring proficiency of MRI sacroiliac joint lesions in axial spondyloarthritis

BACKGROUND: The Spondyloarthritis Research Consortium of Canada (SPARCC) developers have created web-based calibration modules for the SPARCC MRI sacroiliac joint (SIJ) scoring methods. We aimed to test the impact of applying these e-modules on the feasibility and reliability of these methods. METHODS: The SPARCC-SIJ RETIC e-modules contain cases with baseline and follow-up scans and an online scoring interface. Visual real-time feedback regarding concordance/discordance of scoring with expert readers is provided by a colour-coding scheme. Reliability is assessed in real time by intraclass correlation coefficient (ICC), cases being scored until ICC targets are attained. Participating readers (n=17) from the EuroSpA Imaging project were randomised to one of two reader calibration strategies that each comprised three stages. Baseline and follow-up scans from 25 cases were scored after each stage was completed. Reliability was compared with a SPARCC developer, and the System Usability Scale (SUS) assessed feasibility. RESULTS: The reliability of readers for scoring bone marrow oedema was high after the first stage of calibration, and only minor improvement was noted following the use of the inflammation module. Greater enhancement of reader reliability was evident after the use of the structural module and was most consistently evident for the scoring of erosion (ICC status/change: stage 1 (0.42/0.20) to stage 3 (0.50/0.38)) and backfill (ICC status/change: stage 1 (0.51/0.19) to stage 3 (0.69/0.41)). The feasibility of both e-modules was evident by high SUS scores. CONCLUSION: The SPARCC-SIJ RETIC e-modules are feasible, effective knowledge transfer tools, and their use is recommended before using the SPARCC methods for clinical research and tria.

Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort.

OBJECTIVES: To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics of those developing definite (d-)axSpA over 2y. METHODS: We analysed the 2y data from SPondyloArthritis Caught Early, a European cohort of patients (<45 years) with CBP (≥3 months, ≤2y) of unknown origin. The diagnostic workup comprised evaluation of clinical SpA features, acute phase reactants, HLA-B27, radiographs and MRI (sacroiliac joints and spine), with repeated assessments. At each visit (baseline, 3 months, 1y and 2y), rheumatologists reported a diagnosis of axSpA or non-axSpA with level of confidence (LoC; 0-not confident at all to 10-very confident). MAIN OUTCOME: axSpA diagnosis with LoC≥7 (d-axSpA) at 2y. RESULTS: In 552 patients with CBP, d-axSpA was diagnosed in 175 (32%) at baseline and 165 (30%) at 2y. Baseline diagnosis remained rather stable: at 2y, baseline d-axSpA was revised in 5% of patients, while 8% 'gained' d-axSpA. Diagnostic uncertainty persisted in 30%. HLA-B27+ and baseline sacroiliitis imaging discriminated best 2y-d-axSpA versus 2y-d-non-axSpA patients. Good response to non-steroidal anti-inflammatory drugs and MRI-sacroiliitis most frequently developed over follow-up in patients with a new d-axSpA diagnosis. Of the patients who developed MRI-sacroiliitis, 7/8 were HLA-B27+ and 5/8 male. CONCLUSION: A diagnosis of d-axSpA can be reliably made in nearly one-third of patients with CBP referred to the rheumatologist, but diagnostic uncertainty may persist in 5%-30% after 2y. Repeated assessments yield is modest, but repeating MRI may be worthwhile in male HLA-B27+ patients.

Digital odyssey: lessons learnt from a reverse transition from a digital to a manual pathology workflow.

In the fully digital Caltagirone pathology laboratory, a reverse shift from a digital to a manual workflow occurred due to a server outage in September 2023. Here, insights gained from this unplanned transition are explored. Surveying the affected pathologists and technicians revealed unanimous preferences for the time-saving and error-reducing capabilities of the digital methodology. Conversely, the return to manual methods highlighted increased dissatisfaction and reduced efficiency, emphasising the superiority of digital workflows. This case study underscores that transition challenges are not inherent to digital workflows but to transitioning itself, advocating for the adoption of digital technologies in all pathology practices.

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica.

OBJECTIVES: To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR). METHODS: A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS: Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment. CONCLUSION: These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

Definition of rheumatoid arthritis flare based on SDAI and CDAI.

OBJECTIVE: To develop and validate definitions for disease flares in rheumatoid arthritis (RA) based on the quantitative Simplified and Clinical Disease Activity Indices (SDAI, CDAI). METHODS: We analysed RA treatment courses from the Norwegian disease-modifying antirheumatic drug registry (NOR-DMARD) and the Vienna RA cohort. In a receiver operating curve analysis, we determined flare definitions for absolute changes in SDAI and CDAI based on a semiquantitative patient anchor. NOR-DMARD was sampled into an 80%-training cohort for cut point derivation and a 20%-test cohort for internal validation. The definitions were then externally validated in the independent Vienna RA cohort and tested regarding their performance on longitudinal, content, face, and construct validity. RESULTS: We analysed 4256 treatment courses from NOR-DMARD and 2557 from the Vienna RA cohort. The preliminary definitions for absolute changes in SDAI and CDAI for flare are an increase of 4.7 and 4.5, respectively. The definitions performed well in the test and external validation cohorts, and showed clinical face and construct validity, as flares significantly impact both functional ( ∆ Health Assessment Questionnaire flare vs no-flare +0.43; p<0.001) and structural ( ∆ modified Sharp Score 43% higher after flare; p<0.001) disease outcomes, and reflect consistent worsening across all disease core sets, both patient reported and objective. CONCLUSION: We here provide novel definitions for flare in RA based on SDAI and CDAI, validated in two large independent real-world cohorts. In times of highly effective medications for RA, and consideration of their tapering, these definitions will be useful for guiding decision making in clinical practice and designing clinical trials.

4-domain sports prom translation and cultural adaptation into portuguese / 4-domain sports prom: traducción y adaptación cultural al portugués / 4-domain sports prom: tradução e adaptação cultural para a língua portuguesa

ABSTRACT Introduction: The literature presents several scientifically validated and cross-culturally adapted questionnaires in the area of orthopedics and Sports Medicine scientifically validated and cross-culturally adapted. However, they are anatomically specific, and do not consider the specific needs of athletes. The "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) is the first questionnaire, in the literature (International Journal of Sports Medicine - 2021), designed to assess athletes and highly active sports practitioners, and their specificities. physical and psychological. It comprises four domains: athlete without injury, after sports injury, expectation of treatment, athlete's assessment of the treatment received. Objectives: This work aims to carry out the translation and cross-cultural adaptation (TCA) to the Portuguese language. Methods: The questionnaire was self-administered by 50 participants, regular physical and sports activities practitioners. The translation and cultural adaptation process involved six steps: translation; synthesis; back translation; pre-test; review by the Expert Committee, clinical application and author approval of the original version. The Equivalence of translation and relevance of questionnaire items were evaluated. RESULTS: The Portuguese version of the 4-DOMAIN SPORTS PROM had a translation equivalence of 0.94, and item relevance was 0.98, while the percentage of agreement between patients for understanding was 0.98. Conclusion: The translation and cross-cultural adaptation of the 4 Domain Sports PROM into the Portuguese version proved to be understandable and reproducible in all questionnaire domains (agreement above 90% and content validity index of 100%) to assess the treatment of the population of athletes and regular sports practitioners. Level of Evidence II; A cross-sectional qualitative study.

RESUMEN Introducción: La literatura presenta varios cuestionarios científicamente validados y transculturalmente adaptados en el área de la ortopedia y Medicina del Deporte. Sin embargo, son anatómicamente específicos y no consideran las necesidades específicas de los atletas. El "4-Domain PROM for Orthopaedic and Sports Medicine" (4-Domain Sports PROM) es el primer cuestionario, en la literatura (International Journal of Sports Medicine - 2021), diseñado para evaluar atletas y practicantes de deportes altamente activos, y sus especificidades físicas y psicológicas. Comprende cuatro dominios: atleta sin lesión, después de una lesión deportiva, expectativa de tratamiento, evaluación del atleta sobre el tratamiento recibido. Objetivos: El objetivo de este trabajo es realizar la traducción y adaptación transcultural (TCA) a la lengua portuguesa. Métodos: El cuestionario fue autoadministrado por 50 participantes, practicantes habituales de actividades físicas y deportivas. El proceso de traducción y adaptación cultural involucró seis pasos: traducción; síntesis; traducción inversa; prueba previa; revisión por el comité de expertos; aplicación clínica y aprobación del autor de la versión original. Se evaluaron la equivalencia de traducción y la relevancia de los ítems del cuestionario. Resultados: La versión portuguesa del 4-DOMAIN SPORTS PROM tuvo una equivalencia de traducción de 0,94 y la relevancia de los ítems fue de 0,98, mientras que el porcentaje de acuerdo entre los pacientes para la comprensión fue de 0,98. Conclusión: La traducción y adaptación transcultural del 4-DOMAIN SPORTS PROM al portugués amplía las posibilidades de evaluar los diferentes momentos que involucran el tratamiento de lesiones deportivas, ya que este cuestionario fue diseñado para capturar datos sobre la percepción de los pacientes antes de la lesión, después de la lesión, expectativa y evaluación del trato recibido en deportistas y practicantes habituales de actividad física. Nivel de Evidencia II; Estudio Cualitativo Transversal.

RESUMO Introdução: A literatura apresenta diversos questionários cientificamente validados e adaptados transculturalmente na área de na Ortopedia e Medicina Esportiva validados cientificamente e adaptados transculturalmente. Entretanto, eles são anatomicamente específicos, e não consideram as necessidades especificas dos atletas. O "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) é o primeiro questionário, na literatura (International Journal of Sports Medicine - 2021), concebido para avaliar atletas e praticantes de esportes altamente ativos, e suas especificidades físicas e psicológicas. Ele compreende quatro domínios: atleta sem lesão, após lesão esportiva, expectativa do tratamento, avaliação do atleta sobre o tratamento recebido. Objetivos: O objetivo deste trabalho é realizar a tradução e a adaptação transcultural (TCA) à língua portuguesa. Métodos: O questionário foi autoadministrado por 50 participantes, praticantes regulares de atividades físicas e esportivas. O processo de tradução e adaptação cultural envolveu seis etapas: tradução; síntese; retrotradução; pré-teste; revisão pelo comitê de experts; aplicação clínica e aprovação do autor da versão original. Foi avaliado a Equivalência da tradução e relevância de itens do questionário. Resultados: A versão em português do 4-DOMAIN SPORTS PROM apresentou equivalência da tradução de 0,94 e relevância dos itens foi de 0,98, enquanto a porcentagem de concordância entre os pacientes para compreensão foi de 0,98. Conclusão: A tradução e adequação cultural do 4-DOMAIN SPORTS PROM para língua portuguesa mostrou-se compreensível e reprodutibilidade adequada em todos os domínios do questionário (concordância acima de 90% e Índice de Validade de Conteúdo de 100%) para avaliar o tratamento de população de indivíduos atletas e praticantes regulares de esportes. Nível de Evidência II; Estudo Qualitativo Transversal.

Avaliação normativa do atendimento obstétrico emergencial na prevenção da COVID-19 / Evaluación normativa de la asistencia obstétrica de emergencia en la prevención de COVID-19 / Normative evaluation of emergency obstetric care in the prevention of COVID-19

Resumo Objetivo Avaliar a estrutura e o fluxo assistencial do acolhimento - classificação de risco e emergência obstétrica em uma maternidade pública no contexto da COVID-19. Métodos Estudo do tipo avaliação normativa e observacional nos setores de Acolhimento (Classificação de Risco e Emergência Obstétrica) de uma maternidade pública no Rio de Janeiro. A coleta de dados foi realizada de junho a agosto de 2020 por 480 horas de observação direta não participante, com registros sistematizados em checklist contendo variáveis relacionadas à disponibilidade e conformidade dos recursos estruturais, e à conformidade do fluxo assistencial. Os dados foram organizados em planilhas (Microsoft Excel® 2010) e analisados usando a estatística descritiva. Resultados A avaliação da estrutura obteve 80,3% de disponibilidade, resultando em classificação de alta disponibilidade e 91,1% de conformidade, obtendo conformidade adequada. O fluxo assistencial mostrou 72,7% de conformidade total; 9,1% de conformidade parcial e 18,2% de não cumprimento, configurando-se como alta conformidade. Conclusão A avaliação normativa indicou altas disponibilidade e conformidade em estrutura e fluxo assistencial nos cenários estudados.

Resumen Objetivo Evaluar la estructura y el flujo de asistencia de recepción, clasificación de riesgo y emergencia obstétrica, en una maternidad pública en el contexto del COVID-19. Métodos Estudio tipo evaluación normativa y observacional en los sectores de Recepción (clasificación de riesgo y emergencia obstétrica) de una maternidad pública en Rio de Janeiro. La recopilación de datos se realizó de junio a agosto de 2020 durante 480 de observación directa no participante, con registros sistematizados en una checklist con variables relacionadas con la disponibilidad y conformidad de los recursos estructurales y con la conformidad del flujo de asistencia. Los datos se organizaron en planillas (Microsoft Excel® 2010) y se analizaron usando la estadística descriptiva. Resultados La evaluación de la estructura obtuvo un 80,3 % de disponibilidad, que tuvo como resultado una clasificación de alta disponibilidad, y un 91,1 % de conformidad, con una conformidad adecuada. El flujo de asistencia mostró un 72,7 % de conformidad total, un 9,1 % de conformidad parcial y un 18,2 % de no cumplimiento, lo que se configura como alta conformidad. Conclusión La evaluación normativa indicó alta disponibilidad y alta conformidad en estructura y flujo de asistencia en los escenarios estudiados.

Abstract Objective Evaluate the structure and care flow - risk classification and obstetric emergency in a public maternity hospital in the context of COVID-19. Methods Normative and observational evaluation study in the Care sectors (Risk Classification and Obstetric Emergency) of a public maternity hospital in Rio de Janeiro. Data collection was carried out from June to August 2020 for 480 hours of non-participant direct observation, with records systematized in a checklist containing variables related to the availability and compliance of structural resources, and the compliance of the care flow. Data were organized into spreadsheets (Microsoft Excel® 2010) and analyzed using descriptive statistics. Results The framework assessment scored 80.3% availability, resulting in a high availability rating, and 91.1% compliance, achieving adequate compliance. The care flow showed 72.7% of total compliance; 9.1% of partial compliance and 18.2% of non-compliance, configuring high compliance. Conclusion Normative evaluation indicated high availability and compliance in structure and care flow in the studied scenarios.

Big Data-Planetary Health approach for evaluating the Brazilian Dengue Control Program / Abordagem Big Data-Saúde Planetária para avaliação do Programa de Combate à Dengue

ABSTRACT OBJECTIVE This study aims to integrate the concepts of planetary health and big data into the Donabedian model to evaluate the Brazilian dengue control program in the state of São Paulo. METHODS Data science methods were used to integrate and analyze dengue-related data, adding context to the structure and outcome components of the Donabedian model. This data, considering the period from 2010 to 2019, was collected from sources such as Department of Informatics of the Unified Health System (DATASUS), the Brazilian Institute of Geography and Statistics (IBGE), WorldClim, and MapBiomas. These data were integrated into a Data Warehouse. K-means algorithm was used to identify groups with similar contexts. Then, statistical analyses and spatial visualizations of the groups were performed, considering socioeconomic and demographic variables, soil, health structure, and dengue cases. OUTCOMES Using climate variables, the K-means algorithm identified four groups of municipalities with similar characteristics. The comparison of their indicators revealed certain patterns in the municipalities with the worst performance in terms of dengue case outcomes. Although presenting better economic conditions, these municipalities held a lower average number of community healthcare agents and basic health units per inhabitant. Thus, economic conditions did not reflect better health structure among the three studied indicators. Another characteristic of these municipalities is urbanization. The worst performing municipalities presented a higher rate of urban population and human activity related to urbanization. CONCLUSIONS This methodology identified important deficiencies in the implementation of the dengue control program in the state of São Paulo. The integration of several databases and the use of Data Science methods allowed the evaluation of the program on a large scale, considering the context in which activities are conducted. These data can be used by the public administration to plan actions and invest according to the deficiencies of each location.

RESUMO OBJETIVO Integrar os conceitos de Saúde Planetária e Big Data ao modelo de Donabedian, para avaliar o Programa de Combate à Dengue no estado de São Paulo. MÉTODOS Foram adotados métodos de Ciência de Dados para integração e análise de dados relacionados à dengue, agregando o contexto aos componentes de estrutura e de resultado do modelo de Donabedian. Esses dados, considerando o período de 2010 a 2019, foram coletados de fontes como Datasus, Instituto Brasileiro de Geografia e Estatística (IBGE), WorldClim e MapBiomas, e integrados em um Data Warehouse. Para a identificação de grupos com contextos similares, foi utilizado o algoritmo K-means. Em seguida, foram realizadas análises estatísticas e visualizações espaciais dos grupos, considerando variáveis socioeconômicas, demográficas, solo, estrutura de saúde e casos de dengue. RESULTADOS Com o uso das variáveis climáticas, o algoritmo K-means identificou quatro grupos de municípios com características similares. A comparação dos seus indicadores revelou certos padrões nos municípios com pior desempenho quanto aos resultados de casos de dengue. Embora tivessem melhores condições econômicas, eles tinham menor número médio de agentes comunitários e de unidades básicas de saúde por habitante. Dessa forma, as condições econômicas não refletiram em melhor estrutura de saúde nos três indicadores avaliados. Outra característica desses municípios é a urbanização. Os municípios de pior desempenho tinham maior taxa de população urbana e de modificações antrópicas relacionadas à urbanização. CONCLUSÕES Por meio desta metodologia, foi possível identificar importantes deficiências nas condições para a execução do programa de combate à dengue no estado de São Paulo. A integração de diversas bases de dados e a utilização de métodos de Ciência de Dados permitiram a avaliação do programa em larga escala, considerando o contexto em que as ações são executadas. Dessa forma, a gestão pública pode utilizar as informações coletadas para planejar ações e investir de acordo com as deficiências de cada local.

Relación entre las competencias profesionales de los enfermeros en emergencias y el producto del cuidado de enfermería / Relationship between emergency nurses' professional competencies and the Nursing care product / Relação das competências profissionais do enfermeiro em emergência com o produto do cuidar em enfermagem

Objetivo: relacionar las competencias profesionales de los enfermeros de urgencia y emergencia con el producto del cuidado de enfermería. Método: estudio transversal, realizado en las unidades de urgencia y emergencia de dos hospitales públicos. Participaron 91 enfermeros, 3 residentes de enfermería, 4 coordinadores y 1 gestor. Se utilizaron dos instrumentos validados: 1) Escala de Competencia de las Acciones de los Enfermeros en Emergencias y 2) Evaluación del Producto del Cuidado de Enfermería. Se utilizaron factores y dominios, respectivamente. Se aplicaron estadística descriptiva, alfa de Cronbach, pruebas de Wilcoxon y correlación de Spearman (p<0,05). Resultados: para las competencias profesionales se registraron valores más altos en la autoevaluación (p<0,001). En las 1.410 evaluaciones del producto del cuidado de enfermería, prevaleció el puntaje "bueno" (n=1034 - 73,33%). El dominio "dimensionamiento del personal de enfermería" se relacionó con los factores "práctica profesional" r=0,52719, "relaciones en el trabajo" r=0,54319, "desafío positivo" r=0,51199, "acción dirigida" r=0,43229, "conducta constructiva" r=0,25601 y "adaptación al cambio" r=0,22095; el dominio "seguimiento y transferencia del cuidado", con "práctica profesional" r=0,47244, "relaciones en el trabajo" r=0,46993, "desafío positivo" r=0,41660 y "adaptación al cambio" r=0,31905 y el dominio "satisfacción de las necesidades asistenciales", con "práctica profesional" r=0,32933, "relaciones en el trabajo" r=0,31168, "desafío positivo" r=0,29845 y "adaptación al cambio" r=0,28817. Conclusión: hay relación entre las competencias profesionales y los dominios del producto del cuidado de enfermería.

Objective: to relate urgency and emergency nurses' professional competencies with the Nursing care product. Method: a cross-sectional study conducted in the urgency and emergency units of two public hospitals. The participants were 91 nurses, 3 Nursing residents, 4 coordinators and 1 manager. Two validated instruments were used: 1) Competence Scale of Actions of Nurses in Emergencies and 2) Nursing Care Product Evaluation. Factors and domains were used, respectively. Descriptive statistics were applied, as well as Cronbach's alpha, Wilcoxon and Spearman's correlation tests (p<0.05). Results: in the professional competencies, higher values were verified for self-evaluation (p<0.001). In all 1,410 Nursing care product assessments, there was predominance of the "Good" score (n=1,034 - 73.33%). The "Nursing staffing" domain was related to the "Professional practice" (r=0.52719), "Relationships at work" (r=0.54319), "Positive challenge" (r=0.51199), "Targeted action" (r=0.43229), "Constructive behavior" (r=0.25601) and "Adaptation to change" (r=0.22095) factors; the "Care monitoring and transfer" domain, with "Professional practice" (r=0.47244), "Relationships at work" (r=0.46993), "Positive challenge" (r=0.41660) and "Adaptation to change" (r=0.31905) and the "Meeting care needs" domain, with "Professional practice" (r=0.32933), "Relationships at work" (r=0.31168), "Positive challenge" (r=0.29845) and "Adaptation to change" (r=0.28817). Conclusion: there is a relationship between professional competencies and the Nursing care product domains.

Objetivo: relacionar as competências profissionais do enfermeiro em urgência e emergência com o produto do cuidar em enfermagem. Método: estudo transversal, realizado nas unidades de urgência e emergência de dois hospitais públicos. Participaram 91 enfermeiros, 3 residentes em enfermagem, 4 coordenadores e 1 gerente. Utilizaram-se dois instrumentos validados: 1) Escala de Competências das Ações dos Enfermeiros em Emergências e 2) Avaliação do Produto do Cuidar em Enfermagem. Utilizaram-se fatores e domínios, respectivamente. Aplicaram-se estatística descritiva, alfa de Cronbach, testes Wilcoxon e correlação de Spearman (p<0,05). Resultados: em competências profissionais, verificaram-se maiores valores para autoavaliação (p<0,001). Nas 1.410 avaliações do produto do cuidar em enfermagem, predominou o escore "bom" (n=1034 - 73,33%). O domínio "dimensionamento de pessoal de enfermagem" relacionou-se com os fatores "prática profissional" r=0,52719, "relações no trabalho" r=0,54319, "desafio positivo" r=0,51199, "ação direcionada" r=0,43229, "conduta construtiva" r=0,25601 e "adaptação à mudança" r=0,22095; o domínio "acompanhamento e transferência do cuidado", com "prática profissional" r=0,47244, "relações no trabalho" r=0,46993, "desafio positivo" r=0,41660 e "adaptação à mudança" r=0,31905 e o domínio "atendimento das necessidades assistenciais", com "prática profissional" r=0,32933, "relações no trabalho" r=0,31168, "desafio positivo" r=0,29845 e "adaptação à mudança" r=0,28817. Conclusão: existe relação entre as competências profissionais e os domínios do produto do cuidar em enfermagem.

Distinction and prognosis of early arthritis phenotypes: an analysis in three European cohorts.

OBJECTIVES: The objective of this study is to evaluate whether there are differences in the long-term prognosis across various phenotypes of early arthritis (EA). METHODS: Three EA cohorts (Reade, Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) and Early Arthritis Clinic (EAC)) were analysed. Clinical data were collected up to 24 years. Hands and feet radiographs were scored according to the Sharp van der Heijde (SvdH) method. Latent class analysis was applied to determine the EA phenotypes at baseline. Each class received a label reflecting its most prominent features. Prognostic outcomes included Health Assessment Questionnaire (HAQ), Short Form 36 (SF36) and SvdH score. The association between class membership and outcomes over time was tested in multivariable models. RESULTS: In total, 390 (Reade), 798 (ESPOIR) and 3991 (EAC) patients were analysed separately. Two classes with symmetrical polyarthritis emerged; one of these labelled as autoimmune inflammatory polyarthritis (AIPA), had high likelihood of acute phase reactants (APR) elevation and autoantibody positivity, while the other (mild-inflammatory polyarthritis; MIPA) had not. A third class had oligoarthritis of upper limbs (OAUL) and could be subdivided into autoimmune OAUL and mild-inflammatory OAUL. A fifth class had oligoarthritis of lower limbs. The SvdH scores were worse in patients with APR/autoantibodies (AIPA) than in those without (MIPA). No clinically meaningful differences across classes in HAQ or SF36 over time were found. CONCLUSION: Radiographic progression over time primarily occurs in EA patients with APR/autoantibodies. The absence of these markers, however, does not necessarily translate into better long-term function and quality of life. Clinicians should not only aim at preventing joint damage, but look beyond structural progression in order to further improve the lives of people with EA.

Involving patients as research partners in research in rheumatology: a literature review in 2023.

OBJECTIVE: The inclusion of patient research partners (PRPs) in research projects is increasingly recognised and recommended in rheumatology. The level of involvement of PRPs in translational research in rheumatology remains unknown, while in randomised clinical trials (RCTs), it has been reported to be 2% in 2020. Therefore, we aimed to assess the involvement of PRPs in recent translational studies and RCTs in rheumatology. METHODS: We conducted a scoping literature review of the 80 most recent articles (40 translational studies and 40 RCTs) from four target diseases: rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus and lower extremity osteoarthritis. We selected 20 papers from each disease, published up until 1 March 2023, in rheumatology and general scientific journals. In each paper, the extent of PRP involvement was assessed. Analyses were descriptive. RESULTS: Of 40 translational studies, none reported PRP involvement. Of 40 RCTs, eight studies (20%) reported PRP involvement. These trials were mainly from Europe (75%) and North America (25%). Most of them (75%) were non-industry funded. The type of PRP involvement was reported in six of eight studies: six studies reported PRP participation in the study design or design of the intervention and two of them in the interpretation of the results. All the trials reporting the number of PRPs (75%), involved at least two PRPs. CONCLUSION: Despite a worldwide movement advocating for increased patient involvement in research, PRPs in translational research and RCTs in rheumatology are significantly under-represented. This limited involvement of PRPs in research highlights a persistent gap between the existing recommendations and actual practice.