A importância dos cuidados paliativos exercidos por médicos de família e comunidade na Atenção Primária à Saúde: uma revisão narrativa / The importance of palliative care performed by family practice doctors in primary health care: a narrative review / La importancia de los cuidados paliativos realizados por médicos de familia y comunitario en la Atención Primaria de Salud: una revisión narrativa

Introdução: A terminalidade é uma situação cada vez mais vivenciada nos serviços de saúde em razão da progressão da expectativa de vida da população e, consequentemente, do incremento de pacientes com doenças crônicas graves. No Brasil, os serviços de cuidados paliativos ainda se encontram centralizados nos serviços de atenção terciária. Entretanto, em diversos países, a Atenção Primária à Saúde tem sido a grande prestadora e coordenadora de cuidados paliativos dos usuários, em prol da descentralização dessa assistência e da promoção do cuidado integral. Objetivo: Realizar uma revisão narrativa da literatura, a fim de identificar a relação dos médicos de família e comunidade na atuação de cuidados paliativos na Atenção Primária à Saúde. Métodos: Revisão bibliográfica por meio do acesso às bases de dados: Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e PubMed. Foram selecionados 16 artigos, os quais foram submetidos a análise temática e posterior discussão das principais características que colaboram para a maior atuação dos médicos de família e comunidade em cuidados paliativos. Resultados: Observou-se a importância da atuação dos médicos de família e comunidade em cuidados paliativos no âmbito da Atenção Primária à Saúde, bem como a interligação entre as duas especialidades, os desafios existentes nesse caminho e os benefícios dessa prática. Conclusões: A oferta de cuidados paliativos pelos médicos de família e comunidade na atenção primária favorece o acesso e acompanhamento dos pacientes. Entretanto, a atuação dos profissionais das Equipes de Saúde da Família nessa linha de cuidado ainda é insuficiente em razão da escassa capacitação na área.

Introduction: Terminality is a situation increasingly experienced in healthcare services due to the progression of the population's life expectancy and, consequently, the increase in patients with serious chronic diseases. In Brazil, Palliative Care services are still centralized in tertiary care services. However, in many countries, Primary Health Care has been the major provider and coordinator of Palliative Care for users, in favor of decentralizing this assistance and promoting comprehensive care. Objective: To carry out a narrative literature review to identify the relationship of Family Practice Doctors in the performance of Palliative Care in Primary Health Care. Methods: Bibliographic review through access to databases: CAPES, LILACS, SciELO, and PUBMED. Sixteen articles were selected, which were submitted to thematic analysis and subsequent discussion of the main characteristics that contribute to the greater performance of Family Practice Doctors in Palliative Care. Results: The importance of Family Practice Doctors in Palliative Care within the scope of Primary Health Care was observed, as well as the interconnection between the two specialties, the challenges along this path, and the benefits of this practice. Conclusions: The offer of Palliative Care by Family Practice Physicians in Primary Care favors the access and monitoring of patients. However, the performance of the professionals in Family Health Teams in this line of care is still insufficient due to the lack of training in the area.

Introducción: La terminalidad es una situación cada vez más experimentada en los servicios de salud debido a la progresión de la esperanza de vida de la población y, en consecuencia, al aumento de pacientes con enfermedades crónicas graves. En Brasil, los servicios de Cuidados Paliativos todavía están centralizados en los servicios de atención terciaria. Sin embargo, en varios países, la Atención Primaria de Salud ha sido la principal proveedora y coordinadora de los Cuidados Paliativos para los usuarios, a favor de descentralizar esta asistencia y promover la atención integral. Objetivo: Realizar una revisión narrativa de la literatura, con el fin de identificar la relación de los Médicos de Familia y Comunitarios en la actuación de los Cuidados Paliativos en la Atención Primaria de Salud. Métodos: Revisión bibliográfica mediante acceso a bases de datos: Portal CAPES, LILACS, SciELO y PubMed. Fueron seleccionados dieciséis artículos, que fueron sometidos al análisis temático y posterior discusión de las principales características que contribuyen para una mayor actuación de los Médicos de Familia y Comunidad en Cuidados Paliativos. Resultados: Se constató la importancia del trabajo de los Médicos de Familia y Comunitarios en Cuidados Paliativos en el ámbito de la Atención Primaria de Salud, así como la interconexión entre las dos especialidades, los desafíos que existen en este camino y los beneficios de esta práctica. Conclusiones: La oferta de Cuidados Paliativos por Médicos de Familia y Comunitario en Atención Primaria favorece el acceso y seguimiento de los pacientes. Sin embargo, la actuación de los profesionales de los Equipos de Salud de la Familia en esta línea de atención aún es insuficiente debido a la falta de formación en el área.

Empatia (parte I): contribuições para a abordagem centrada na pessoa / Empathy (part I): contributions to a person-centered approach / Empatía (parte I): contribuciones a un enfoque centrado en la persona

Introdução: Este artigo explora o tema da empatia na relação médico-paciente. Objetivo: Contribuir para o aperfeiçoamento das habilidades de comunicação clínica ao revisar o entendimento e a aplicação da empatia na prática clínica. Métodos: Trata-se de uma revisão não sistemática dos principais livros utilizados na comunicação clínica sobre o tema da empatia. O recorte metodológico compreendeu as seguintes etapas: (1) amostra intencional da literatura; (2) coleta e leitura de dados ­ i.e., extração de fragmentos dos textos; (3) análise do conteúdo, com o foco na definição, importância e instrumentalização para a aplicação prática; (4) seleção e síntese, para facilitar a compreensão e a contextualização sobre o tema; e (5) comparação e ponderação do conteúdo selecionado. Resultados: A abrangência com que a empatia foi trabalhada na literatura selecionada resultou em três níveis de densidade empática: baixa, moderada e alta. Assim, a baixa densidade empática limitou-se mais à definição e importância do tema; a densidade moderada incorporou algum exemplo de como aplicar a empatia, porém de forma fragmentada; e a alta densidade empática abordou o tema de modo mais completo, facilitando a instrumentalização na prática clínica. Há concordância na literatura analisada de que a prática da empatia reflete-se na melhoria do cuidado médico, entretanto seu exercício permanece no campo racional. Ao exemplificar a aplicação prática da empatia, os autores sugerem que o médico adote uma postura isenta de julgamentos, ao mesmo tempo que propõem um exercício imaginativo, de adivinhação dos sentimentos/emoções do paciente. Apesar de os autores de alta densidade empática compreenderem a importância das emoções e nomeá-las no processo, percebe-se a necessidade de um desdobramento e aprofundamento a partir desse ponto. Conclusões: Por se tratar de um assunto complexo, com vários matizes, a empatia é abordada de diferentes formas na literatura selecionada. Isso evidencia sua riqueza e originalidade, ao mesmo tempo que apresenta lacunas para sua aplicação na prática clínica.

Introduction: This article explores the theme of empathy in the doctor-patient relationship. Objective: To contribute to the improvement of clinical communication skills by reviewing the understanding and application of empathy in clinical practice. Methods: A non-systematic review of the main books used in clinical communication on the topic of empathy. The methodological approach consisted in the following steps: (1) An intentional sample of the literature; (2) Data collection and reading, i.e., extracting fragments from texts; (3) Content analysis, focusing on definition, importance and instrumentalization for practical application; (4) Selection and synthesis to facilitate understanding and contextualization on the topic; and (5) Comparison and ponderance of the selected content. Results: The scope within which empathy was worked on in the selected literature resulted in three levels of empathic density: low, moderate, and high. Thus, low empathic density was limited to definition and importance; moderate density incorporated some examples of how to apply empathy in a fragmented way; high empathic density addressed the topic more fully, facilitating instrumentation in clinical practice. There is agreement in the literature analyzed that the practice of empathy reflects on the improvement of medical care. However, its exercise remains in the rational field. By exemplifying the practical application of empathy, the authors suggest that the physician adopt a non-judgmental posture, while proposing an imaginative exercise of guessing the patient's feelings/emotions. Although high-density empathy authors understand the importance of emotions and name them in the process, there is a need for an unfolding and deepening from this point on. Conclusions: Empathy is a complex subject with several nuances and is approached in different ways in the selected literature. This evidences its richness and originality, at the same time that it presents gaps for the application of empathy in clinical practice.

Introducción: Este artículo explora el tema de la empatía en la relación médico-paciente. Objetivo: contribuir a la mejora de las habilidades de comunicación clínica mediante la revisión de la comprensión y aplicación de la empatía en la práctica clínica. Método: se trata de una revisión no sistemática de los principales libros utilizados en comunicación clínica sobre el tema de la empatía. El enfoque metodológico comprendió los siguientes pasos: (1) Una muestra intencional de la literatura; (2) Recopilación y lectura de datos, es decir, extracción de fragmentos de textos; (3) Análisis de contenido, centrándose en definición, importancia e instrumentalización para la aplicación práctica; (4) Selección y síntesis para facilitar la comprensión y contextualización sobre el tema; y (5) Comparación y ponderación del contenido seleccionado. Resultados: el alcance con el que se trabajó la empatía en la literatura seleccionada tuvo como resultado tres niveles de densidad empática: baja, moderada y alta. Así, la baja densidad empática se limitaba más a la definición y la importancia; densidad moderada, incorporó algún ejemplo de cómo aplicar la empatía, pero de manera fragmentada; alta densidad empática se acercó del tema de manera más completa, facilitando la instrumentación en la práctica clínica. Existe acuerdo en la literatura analizada en que la práctica de la empatía se refleja en la mejora de la atención médica. Sin embargo, su ejercicio queda en el campo racional. Al ejemplificar la aplicación práctica de la empatía, los autores sugieren que el médico adopte una postura no crítica, al tiempo que propone un ejercicio imaginativo de adivinar los sentimientos/emociones del paciente. Si bien los autores de alta densidad empática entienden la importancia de las emociones y las nombran en el proceso, existe la necesidad de un desdoblamiento y profundización a partir de este punto. Conclusiones: Por tratarse de un tema complejo y con varios matices, la empatía es abordada de diferentes maneras en la literatura seleccionada. Esto evidencia su riqueza y originalidad, al mismo tiempo que presenta vacíos para la aplicación de la empatía en la práctica clínica.

Perfil epidemiológico dos acidentes por material biológico em médicos da atenção primária em Minas Gerais, de 2012 a 2021 / Epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, from 2012 to 2021 / Perfil epidemiológico de accidentes por material biológico en médicos de atención primaria en Minas Gerais, de 2012 a 2021

Introdução: Os acidentes ocupacionais com material biológico representam um problema de saúde pública. A exposição ocupacional dos profissionais da saúde configura-se como um risco de transmissão de diversos patógenos. Na literatura, há carência de estudos que analisem o perfil dos acidentes com material biológico nos médicos da atenção primária. Objetivo: Buscou-se compreender o perfil epidemiológico dos acidentes com material biológico em médicos da atenção primária em Minas Gerais. Métodos: Estudo epidemiológico descritivo com análise do perfil dos acidentes com material biológico em médicos da atenção primária em Minas Gerais, utilizando dados secundários. Resultados: No período analisado, foram registrados 111 acidentes com material biológico, dos quais 54% ocorreram somente em 2020 e 2021. A maioria dos casos deu-se em mulheres (59%), e os tipos mais frequentes de exposição foram mucosa (38%) e percutânea (33%). Dos médicos, 23% não possuíam esquema vacinal contra a hepatite B completo. Em média, em 36% dos acidentes os testes sorológicos foram negativos e em 61% não foram realizados ou o campo foi ignorado/deixado em branco. Em apenas 7,2% dos casos a quimioprofilaxia foi indicada, mas ressaltam-se os registros ignorados ou em branco. Mais da metade dos acidentados não emitiu a Comunicação de Acidente de Trabalho (CAT). Conclusões: Os acidentes com material biológico predominam em médicas e nas formas de exposição mucosa e percutânea. Investimentos em medidas de biossegurança e educação permanente são necessários para prevenir casos e estimular sua notificação.

Introduction: Occupational accidents with biological material represent a public health problem. The occupational exposure of health professionals represents a risk of transmission of various pathogens. In the literature, there is a lack of studies that analyze the profile of accidents with biological material among primary health care physicians. Objective: We aimed to understand the epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, Brazil. Methods: Descriptive epidemiological study that analyzed the profile of accidents with biological material among primary health care doctors in Minas Gerais, using secondary data. Results: In the period analyzed, 111 accidents with biological material were recorded, of which 54% occurred only in 2020 and 2021. Most cases occurred in women (59%) and the most frequent types of exposure were mucosal (38%) and percutaneous (33%). About a quarter (23%) of physicians did not have a complete immunization record for hepatitis B. On average, in 36% of accidents serological tests were negative and in 61% they were not performed or the field was ignored/left blank. In only 7.2% of cases, chemoprophylaxis was indicated, but ignored or blank records stood out. More than half of the victims did not fill out a work accident report. Conclusions: Accidents with biological material predominate in female doctors and in forms of mucosal and percutaneous exposure. Investments in biosafety measures and permanent education are necessary to prevent cases and encourage their notification.

Introducción: Los accidentes de trabajo con material biológico representan un problema de salud pública. La exposición ocupacional de los profesionales de la salud representa un riesgo de transmisión de varios patógenos. En la literatura faltan estudios que analicen el perfil de accidentes con material biológico en médicos de atención primaria. Objetivo: Buscamos comprender el perfil epidemiológico de los accidentes con material biológico en médicos de atención primaria en Minas Gerais. Métodos: Estudio epidemiológico descriptivo con análisis del perfil de accidentes con material biológico en médicos de atención primaria en Minas Gerais, utilizando datos secundarios. Resultados: En el período analizado se registraron 111 accidentes con material biológico, de los cuales el 54% ocurrió solo en 2020 y 2021. La mayoría de los casos ocurrieron en mujeres (59%) y los tipos de exposición más frecuentes fueron mucosa (38%) y percutánea (33%). El 23% de los médicos no disponía de un calendario completo de vacunación frente a la hepatitis B. En promedio, en el 36% de los accidentes, las pruebas serológicas fueron negativas y en el 61% no se realizó o se ignoró/dejó el campo en blanco. Solo en el 7,2% de los casos se indicó quimioprofilaxis, pero destacan los registros ignorados o en blanco. Más de la mitad de las víctimas no emitieron el CAT. Conclusiones: Predominan los accidentes con material biológico en médicas y en formas de exposición mucosa y percutánea. Son necesarias inversiones en medidas de bioseguridad y educación permanente para prevenir casos e incentivar su notificación.

Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Practice of key essential nutrition action messages and associated factors among mothers of children aged six months to two years old in Karat town, Konso zone, South Ethiopia, 2024: a community-based cross-sectional study.

Background: Key essential nutrition actions (ENA) messages are a comprehensive and evidence-based nutritional package designed to improve the nutritional status during the critical first 1,000 days of life. The poor practice of ENA contributes significantly to mortality and morbidity related to malnutrition in young children. However, there is a dearth of studies focusing on the practice of key ENA messages among mothers and the factors associated with their practice. Therefore, this study aimed to assess the practice of key ENA messages among mothers of children aged 6 months to 2 years in Karat town, Konso zone, South Ethiopia in 2024. Methods: A community-based cross-sectional study involving 421 mothers of children aged 6 months to 2 years was conducted in Karat town, Konso zone, South Ethiopia from January 15 to February 29, 2024. Respondents were chosen using computer-generated random numbers. A structured, pretested, and interviewer-administered questionnaire was used to collect data. Following coding and entry into EpiData 3.1, the data were exported to SPSS version 25 for analysis. Logistic regression (bivariate and multivariable) was employed to identify factors influencing mothers' practice of key ENA messages, and statistical significance was set at p < 0.05 with a 95% confidence interval. Results: The study found that 47.6% (95% CI: 42.8, 52.42%) of mothers demonstrated good practices. Having secondary education or higher, institutional delivery, receiving nutritional counseling during antenatal care (ANC), receipt of postnatal care (PNC) services, having good knowledge, and having a good attitude towards ENA all increase the likelihood of good practice. Conclusion: This study emphasizes the need for multifaceted interventions to improve ENA practice among mothers residing in Karat town. To effectively address this issue, it is crucial to implement targeted education programs, strengthen postnatal care services, and nutritional counseling into routine antenatal care, promote institutional deliveries, and enhance awareness.

Predicting new cases of hypertension in Swedish primary care with a machine learning tool.

Background: Many individuals with hypertension remain undiagnosed. We aimed to develop a predictive model for hypertension using diagnostic codes from prevailing electronic medical records in Swedish primary care. Methods: This sex- and age-matched case-control (1:5) study included patients aged 30-65 years living in the Stockholm Region, Sweden, with a newly recorded diagnosis of hypertension during 2010-19 (cases) and individuals without a recorded hypertension diagnosis during 2010-19 (controls), in total 507,618 individuals. Patients with diagnoses of cardiovascular diseases or diabetes were excluded. A stochastic gradient boosting machine learning model was constructed using the 1,309 most registered ICD-10 codes from primary care for three years prior the hypertension diagnosis. Results: The model showed an area under the curve (95 % confidence interval) of 0.748 (0.742-0.753) for females and 0.745 (0.740-0.751) for males for predicting diagnosis of hypertension within three years. The sensitivity was 63 % and 68 %, and the specificity 76 % and 73 %, for females and males, respectively. The 25 diagnoses that contributed the most to the model for females and males all exhibited a normalized relative influence >1 %. The codes contributing most to the model, all with an odds ratio of marginal effects >1 for both sexes, were dyslipidaemia, obesity, and encountering health services in other circumstances. Conclusions: This machine learning model, using prevailing recorded diagnoses within primary health care, may contribute to the identification of patients at risk of unrecognized hypertension. The added value of this predictive model beyond information of blood pressure warrants further study.

Service-oriented HRP bundles and team performance: A team-level serial mediation model.

Drawing on two theoretical frameworks-positive psychology theory and conservation of resources theory-the relationship and underlying mechanism between team-level service-oriented human resource practice (SO-HRP) bundles and team performance were explored by constructing a team-level serial mediation model. Survey data were collected from 424 employees at 80 branches of five financial holding companies in Northern Taiwan. The team-level serial-mediated model and hypotheses were examined using SPSS version 24 and the PROCESS macro for SPSS. The results indicate that team psychological capital (PsyCap) and team work engagement serially mediated the relationship between SO-HRP bundles and team performance. These results imply that managers should plan and implement SO-HRP bundles in detail, reinforce team PsyCap, and increase engagement within their financial service teams to enhance team performance.

Uptake of evidence-based practice and its predictors among nurses in Ethiopia: a systematic review and meta-analysis.

Background: While evidence-based practice has demonstrated its capacity to enhance healthcare quality and bolster clinical outcomes, the translation of research into clinical practice encounters persistent challenges. In Ethiopia, there remains a dearth of comprehensive and nationally representative data concerning the extent of Evidence-based practice adoption among nurses. Thus, this systematic review and meta-analysis endeavors to assess the overall prevalence of Evidence-based practice implementation and delve into its determinants among Ethiopian nurses. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. In order to identify pertinent studies, a search was conducted across PubMed, Scopus, Google Scholar, and EMBASE databases. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence. Cochrane's Q-test and I2 statistics were calculated to assess heterogeneity among studies. Funnel plots and Egger's test were utilized to evaluate publication bias. Pooled implementation rates and meta-regression analysis were carried out using STATA 17. Results: Of the total 1,590 retrieved articles, twelve studies including 4,933 nurses were included in the final analysis. The pooled prevalence of Evidence-based practice uptake among nurses in Ethiopia is 53% (95% CI: 46%-60%). Having knowledge about Evidence-based practice (AOR = 2.29; 95% CI: 1.90, 2.69; I2 = 70.95%), holding a favorable attitude towards Evidence-based practice (AOR = 2.56; 95% CI: 1.63, 3.49; I2 = 88.39%), occupying a head nurse position (AOR = 3.15; 95% CI: 1.85, 4.46; I2 = 87.42%), possessing effective communication skills (AOR = 4.99; 95% CI: 1.47, 8.51; I2 = 99.86%), and having access to Evidence-based practice guidelines (AOR = 1.90; 95% CI: 1.55, 2.24; I2 = 57.24%) were identified as predictors of the uptake of Evidence-based practice. Conclusion: Only half of Ethiopia's nurses exhibit a strong embrace of Evidence-Based Practice within clinical settings, underscoring the urgent necessity for coordinated endeavors to cultivate this essential practice. Possessing knowledge, effective communication skills, access to updated guidelines, maintaining a positive attitude towards Evidence-Based Practice, and holding a position as head nurse emerged as predictors of successful implementation of Evidence-Based Practice. Hence, policymakers must prioritize capacity-building initiatives, disseminate the latest EBP guidelines widely, and strengthen mentorship roles for head nurses. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42023488943.

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth.

Introduction C-reactive protein (CRP) is a widely used laboratory test for assessing infections, inflammatory diseases, and malignancies, playing a critical role in clinical diagnosis and management. Despite its utility, CRP measurement practices vary among physicians, often influenced by training and clinical experience. This study explores general physicians' perceptions of CRP measurement in clinical practice, focusing on its diagnostic value, associated dilemmas, and impact on clinical growth and decision-making. Methods This qualitative study employed thematic analysis to examine the perceptions of general physicians at Unnan City Hospital, Unnan, Japan regarding CRP measurement. Sixteen general physicians were selected through purposive sampling and participated in one-on-one semi-structured interviews. The interviews were conducted in Japanese, recorded, transcribed verbatim, and analyzed inductively to identify themes. The analysis involved iterative coding and extensive discussion among the research team to ensure the reliability and validity of the findings. Results Three main themes emerged from the analysis: the usefulness of CRP for diagnosis and collaboration, dilemmas associated with CRP usage, and clinical growth through reconsideration of CRP's importance. Physicians highlighted CRP's value in distinguishing inflammatory from non-inflammatory diseases, predicting clinical courses, and facilitating communication with specialists. However, dilemmas arose from discrepancies between CRP levels and clinical symptoms, the influence of various non-specific factors, and habitual testing driven by training, leading to unnecessary tests and diminished clinical skills. Participants recognized the need to view CRP as one of many diagnostic tools, cultivate a habit of questioning its necessity, and reflect on its use to enhance clinical reasoning and professional growth. Conclusions CRP measurement is a valuable diagnostic tool, but effective use requires a balanced and critical approach. Discrepancies between CRP levels and clinical symptoms can lead to over-reliance on laboratory results and unnecessary testing. General physicians should integrate CRP within a broader diagnostic framework, combining it with patient history, physical examination, and other tests. Reflecting on the necessity and implications of CRP measurements can improve clinical reasoning and decision-making, ultimately enhancing patient care and resource management. Future research should explore similar perceptions in diverse healthcare settings and develop strategies to optimize CRP use in clinical practice.

Temporal changes in postural control strategy through single-leg stance practice with active restriction of knee movement.

[Purpose] This study aimed to examine and verify temporal changes in lower limb joint action after 2 weeks of single-leg stance training under active restriction of knee movement. [Participants and Methods] The participants included 28 healthy adult females (mean age, 19.6 ± 1.0 years). A stabile meter was used to measure the center of pressure sway as an index of ankle joint action. In addition, a triaxial accelerometer was used to measure pelvic and knee sways as indices of hip and knee joint actions, respectively. We established two experimental groups: an active-restriction group and an unrestricted group. Measurements of lower limb joint actions were recorded thrice during single-leg stance exercises during the first session of practice, the third session 1 week later, and the sixth session 2 weeks later. [Results] Both groups exhibited shorter total trajectory lengths in sessions three and six than in the first session. The active restriction group showed less knee sway in later sessions, whereas the unrestricted group showed reduced pelvic sway in the third session. [Conclusion] Single-leg stance exercises with active restriction of knee movement may alter the strategy of lower limb joint action.

Self-Correcting Method for Highly Effective Office-Based Helicobacter pylori Therapy Using Cumulative Test of Cure Data.

BACKGROUND AND AIM: Helicobacter pylori infections have become resistant to many previously highly effective antimicrobial regimens resulting in clarithromycin, metronidazole, or fluoroquinolone-containing therapies becoming unsuccessful. Pretreatment susceptibility testing is only widely available in the United States but is still rarely done. Here, we propose a framework to monitor H. pylori eradication in small clinical settings by routinely assessing the effectiveness of therapy. METHODS: Because of the small sample size in individual practice's, we assume an acceptable cure rate of ≥80% (preferred cure rate ≥85%) in adherent patients, with a dichotomous outcome (cured vs. failed) and consecutive patient enrollment. To obtain results (feedback) in a timely manner, for individual practices, cure rates can be estimated after 10 patients. Large practices which acquire patients more rapidly can delay analysis until a total of 104 H. pylori-infected patients, assuming a baseline cure rate of at least 85% with the preferred regimen. RESULTS: We show how data from individual practices can be utilized to improve the effectiveness of H. pylori treatment decisions. The method consists of recording and accumulating the confirmation of cure data for successive small groups of patients. These data are then analyzed as binary outcomes (pass-fail) and serve as the basis for studying and improving the effectiveness of H. pylori treatment decisions. CONCLUSION: A simple actuarial method can serve outpatient clinics to ensure a reliable test-to-cure method and avoid futile Hp regimens.

Effectiveness of nurse-led non-pharmacological interventions on outcomes of delirium in adults: A meta-analysis of randomized controlled trials.

BACKGROUND: Delirium is a common complication among adults. It is essential to improve the outcomes of delirium. AIM: To systematically synthesize the evidence on the effectiveness of the nurse-led non-pharmacological interventions on outcomes of delirium in adults. METHODS: Electronic databases including CINAHL, Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, and Clinical Trial Registration were searched comprehensively by the authors. The authors reviewed the full text and assessed the risk of bias using the Cochrane Risk of Bias Tool 2.0. The meta-analysis was performed using RevMan and Stata software. The forest plots showed the overall effect of the included study and the I2 test was used to assess the degree of heterogeneity between studies. Random effects models were used to analyze studies with significant heterogeneity. RESULTS: A total of 32 studies (10,122 participants) were included in the meta-analysis. Nurse-led non-pharmacological interventions resulted in a significantly lower incidence of delirium compared with the usual care/control group (risk ratio = 0.74, p < .001) and reduced mortality in the hospital compared with usual care (risk ratio = 0.81, p = .04). However, the implementation of nurse-led, non-pharmacological interventions had no significant effect on the duration, severity of delirium, or length of hospital stay. LINKING EVIDENCE TO ACTION: Our findings suggest that the nurse-led, non-pharmacological strategy was effective in reducing the incidence of delirium and mortality in the hospital. Multicomponent interventions were the most effective strategy for reducing the incidence of delirium in adults.

Advancing evidence-based practice through the Knowledge Translation Challenge: Nurses' important roles in research, implementation science and practice change.

AIM: To describe a knowledge translation capacity-building initiative and illustrate the roles of nurses in practice change using an exemplar case study. DESIGN: The report uses observational methods and reflection. METHODS: The Knowledge Translation Challenge program involves a multi-component intervention across several sites. The advisory committee invited eligible teams to attend capacity-building workshops. Implementation plans were developed, and successful teams receive funding for a 2 year period. Evaluation involved collecting data on program uptake and impact on practice change. Data has been collected from five cohorts. The exemplar case study employed an action-research framework. RESULTS: Four nurse-led teams have demonstrated successful implementation of their practice change. The case study on implementing a clinical toolkit for clozapine management further illustrates a thoughtful planning process, and implementation journey and learnings by a team of nurses. CONCLUSION: The Knowledge Translation Challenge program empowers nurses to use implementation science practices to enhance the quality and effectiveness of healthcare services. Success of this initiative serves as a model for addressing the persistent gap between knowledge and practice in clinical settings and the value of activating nurses to help close this gap. IMPLICATIONS: As the most trusted and numerous profession, it is vital that nurses contribute to efforts to translate research evidence into clinical practice. The Knowledge Translation Challenge program supports nurses to lead practice change. IMPACT: The Knowledge Translation Challenge program successfully equips nurses and other health care providers with the knowledge, skills and resources to implement practice improvements which enhance the quality and effectiveness of healthcare services and nursing practice. PATIENT OR PUBLIC CONTRIBUTION: The Knowledge Translation Challenge advisory committee has three patient-public partners that support teams to develop a patient-oriented approach for their projects by providing feedback on the implementation plans. Each team was also supported to include patient-public partners on their project.

The Landscape of Pain Medicine for Women Physicians: A Perspective.

BACKGROUND: The gender bias in academic anesthesiology is well known. Women are not only a minority in the field but also underrepresented in leadership positions. Reported reasons for this underrepresentation include barriers to career advancement, lack of mentorship, and differences in compensation, among others. Interventional pain, a competitive procedural subspecialty of anesthesiology, sees the trickle-down effects of this disparity. According to a report from the ACGME that sorted medical subspecialties by number of female trainees, pain medicine ranked in the bottom quartile across all disciplines from 2008-2016. OBJECTIVES: To better understand the landscape for women physicians in the field of pain medicine, we undertook this investigation to review the knowledge about the topic and what questions remain unanswered. STUDY DESIGN: This study is a review of the current literature and aims to summarize and describe the landscape of pain medicine for women physicians. SETTING: All literature review and manuscript preparation took place at the Yale University School of Medicine. METHODS: We performed a comprehensive search using the PubMed, Scopus, and Cochrane databases for the combined terms "gender disparity," "pain medicine," and "anesthesiology," limiting our search to the year 2000 onward for the most recent literature on the topic. Our initial search retrieved 38 articles. All relevant articles pertaining to this perspective piece were collated. The available literature is discussed below. RESULTS: Women are underrepresented in interventional pain. The grim scarcity of female pain physicians is unlikely to improve soon, since while the number of Accreditation Council for Graduate Medical Education pain fellowship programs continues to grow, women trainees comprise only between 22-25% of all pain medicine fellows. Additionally, although studies have compared the numbers of male interventional pain faculty to their female counterparts in academic hospitals and shown the ratio to range from 71.84-82% to 18-28.52%, respectively, no studies have truly explored the landscape for women physicians in private practice. Patients prefer and have better experiences with physicians who are racially and ethnically like themselves. In fact, the preference for and the lack of female clinicians have been associated with delayed pursuit of care and adverse health outcomes. The consequences of the burnout and attrition caused by the gender disparity, especially in a field like pain medicine, cannot be understate. LIMITATIONS: The review might not have been comprehensive, and relevant studies might not have been included. CONCLUSION: While the gender disparity in academia is well documented for both anesthesiology and pain medicine, the reasons for this disparity have not been fully explored. Moreover, it is also unknown whether the minority of female physicians who select pain medicine as a subspecialty gravitate toward an academic or a private-practice path. To address the existing gender disparity, it is necessary to explore the landscape of interventional pain medicine in both academic and private practices and understand pain physicians' beliefs and sentiments regarding their subspecialty.

Continence App® Impact on Puerperal Women's Knowledge, Attitude and Practice: Randomized Clinical Trial.

INTRODUCTION AND HYPOTHESIS: Enhancing women's knowledge, attitude, and practice (KAP) concerning urinary incontinence (UI) through diverse educational strategies has been a focal point for professionals in recent years. This study was aimed at assessing the impact of the educational application Continence App® on the KAP of postpartum women experiencing UI. We hypothesized that access to the app would lead to improved KAP among these women. METHODS: Postpartum women who had undergone vaginal birth, aged 18 years or above, literate, admitted in a maternity ward, delivered a full-term or large-for-gestational-age infant, and possessed a smartphone or compatible device for app usage were included. Changes in KAP were evaluated using a survey specifically designed for this purpose. The Mann-Whitney U test was employed to compare KAP scores between control and intervention groups, as well as between baseline and post-intervention assessments. RESULTS: Among the 542 women screened for eligibility, 349 were enrolled in the study, with 138 completing post-intervention assessments. The mean (standard deviation [SD]) age of participants was 25.9 (5.8) years. Post-intervention scores for knowledge and practice demonstrated a decline among non-app users, whereas a significant increase was observed among those in the intervention group. Attitudinal changes remained insignificant. CONCLUSIONS: The findings highlight the effectiveness of an app-based educational intervention in enhancing the knowledge and practice related to UI among postpartum women.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths.

OBJECTIVE: Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. METHODS: Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). RESULTS: Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). CONCLUSIONS: These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.

Task shifting for musculoskeletal disorders in Norwegian primary care: a qualitative interview study of general practitioners and specialist musculoskeletal physiotherapists.

OBJECTIVE: To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development. DESIGN, SETTING, AND SUBJECTS: We analysed interviews with five GPs and 11 physiotherapists and used Lipsky's theories about street-level bureaucracy and Foucault's theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions. RESULTS AND INTERPRETATION: The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.

The demand on primary care is placing increasing pressure on general practitioners.Multidisciplinary teamwork has potential to improve primary care, for both healthcare professionals and for patients.In this study, it appeared that both competition and cooperation exist between general practitioners and physiotherapists around the management of patients with musculoskeletal disorders in primary care.There is a case for change in service delivery for patients with musculoskeletal disorders in Norwegian primary care.

Discordances in patients' and physicians' perspectives on which contextual factors should be accounted for during smoking cessation.

BACKGROUND: Smoking cessation interventions requires attending to the circumstances and needs of individual patients. We aimed at highlighting the discordances between patients' and physicians' perspectives on contextual factors that should be considered during smoking cessation. METHODS: We identified 36 contextual factors identified that should be considered during smoking cessation using PubMed and interviewing general practitioners. Physicians recruited through social networks campaigns and smoker or former smoker patients from the ComPaRe cohort selected the factors they considered most relevant in two online paired comparison experiment. Bradley Terry Luce models estimated the ability of each factor (i.e. the probability to be preferred). We calculated the Pearson's correlation and the intraclass correlation coefficients for the contextual factor from each perspective and compared the ranking of the 10 contextual factors with the highest abilities. RESULTS: Seven hundred and ninety-three patients' and 795 physicians' perspectives estimated the ability (i.e., importance) of the contextual factors in 11 963 paired comparisons. We found a high correlation between physicians' and patients' perspectives of the contextual factors to be considered for smoking cessation (r = 0.76, P < 0.0001). However, the agreement between the abilities of contextual factors was poor (ICC = 0.42 [-0.10; 0.75]; P = 0.09). Fine-grain analysis of participants' answers revealed many discrepancies. For example, 40% factors ranked in the top 10 most important for physicians were not in patients' top 10 ranking. CONCLUSION: Our results highlight the importance of patient-centered care, the need to engage discussions about patients' values, beyond what is thought to be important, to avoid overlooking their real context.