Development of the Community-based complex Interventions to sustain Independence in Older People (CII-OP) typology: a qualitative synthesis of interventions in randomised controlled trials.

INTRODUCTION: Community-based services to sustain independence for older people have varying configurations. A typology of these interventions would improve service provision and research by providing conceptual clarity and enabling the identification of effective configurations. We aimed to produce such a typology. METHOD: We developed our typology by qualitatively synthesising community-based complex interventions to sustain independence in older people, evaluated in randomised controlled trials (RCTs), in four stages: (i) systematically identifying relevant RCTs; (ii) extracting descriptions of interventions (including control) using the Template for Intervention Description and Replication; (iii) generating categories of key intervention features and (iv) grouping the interventions based on these categories. PROSPERO registration: CRD42019162195. RESULTS: Our search identified 129 RCTs involving 266 intervention arms. The Community-based complex Interventions to sustain Independence in Older People (CII-OP) typology comprises 14 action components and 5 tailoring components. Action components include procedures for treating patients or otherwise intended to directly improve their outcomes; regular examples include formal homecare; physical exercise; health education; activities of daily living training; providing aids and adaptations and nutritional support. Tailoring components involve a process that may result in care planning, with multiple action components being planned, recommended or prescribed. Multifactorial action from care planning was the most common tailoring component. It involves individualised, multidomain assessment and management, as in comprehensive geriatric assessment. Sixty-three different intervention types (combinations) were identified. CONCLUSIONS: Our typology provides an empirical basis for service planning and evidence synthesis. We recommend better reporting about organisational aspects of interventions and usual care.

Exploring Organizational Culture Regarding Provision and Utilization of Palliative Care in a Nigerian Context: An Interpretive Descriptive Study.

BACKGROUND: Palliative care (PC) continues to be underutilized in Nigeria, but there is a lack of studies that explore organizational cultural dynamics regarding PC in Nigeria. The study aimed to understand the organizational culture in order to identify organizational enablers and inhibitors of the provision and utilization of PC in a Nigerian context. METHODS: Identification of the organizational culture was developed using a qualitative interpretive descriptive design. Cultural enablers and inhibitors were mapped out using semi-structured interviews with 38 participants, consisting of medical staff, patients, and their relatives. Thematic analysis was used to identify and analyze patterns within the collected data. RESULTS: Three themes were identified: cross-departmental collaborative practice, financial support practice, and continuity of care. The findings suggest that fundamental cultural changes, such as a policy for intradepartmental referral practices, telemedicine, and a welfare support system, are typically required as remedies for the failure to use PC in Nigeria and other similar contexts. CONCLUSIONS: This study offered a new understanding that not revealing deeper shared assumptions, and a shared way of thinking that underpins the PC practice within an organization, will have a negative bearing on organizational PC outcomes.

Family physicians' experience and understanding of evidence-based practice and guideline implementation in primary care practice, Cape Town, South Africa.

BACKGROUND: In primary care, patients present with multimorbidity and a wide spectrum of undifferentiated illnesses, which makes the application of evidence-based practice (EBP) principles more challenging than in other practice contexts. AIM: The goal of this study was to explore the experiences and understanding of family physicians (FP) in primary care with regard to EBP and the implementation of evidence-based guidelines. SETTING: The study was conducted in Cape Town primary care facilities and South African university departments of Family Medicine. METHODS: For this phenomenological, qualitative study, 27 purposefully selected FPs from three groups were interviewed: senior academic FPs; local FPs in public-sector practice; and local FPs in private-sector practice. Data were analysed using the framework method with the assistance of ATLAS.ti, version 6.1. RESULTS: Guideline development should be a more inclusive process that incorporates more evidence from primary care. Contextualisation should happen at an organisational level and may include adaptation as well as the development of practical or integrated tools. Organisations should ensure synergy between corporate and clinical governance activities. Dissemination should ensure that all practitioners are aware of and know how to access guidelines. Implementation should include training that is interactive and recognises individual practitioners' readiness to change, as well as local barriers. Quality improvement cycles may reinforce implementation and provide feedback on the process. CONCLUSION: Evidence-based practice is currently limited in its capacity to inform primary care. The conceptual framework provided illustrates the key steps in guideline development, contextualisation, dissemination, implementation and evaluation, as well as the interconnections between steps and barriers or enablers to progress. The framework may be useful for policymakers, health care managers and practitioners in similar settings.

Desenvolvimento de um guia rápido para prática de atenção à saúde da população transgênero / Development of a quick guide for the practice of health care for the transgender population / Desarrollo de una guía rápida para práctica de atención a la salud de la población transgénero

Problema: Os direitos fundamentais das pessoas transgênero são negados cotidianamente. Neste cenário, o preconceito age como determinante social de saúde impactando na prevalência de problemas como saúde mental e infecções sexualmente transmissíveis (ISTs). O objetivo foi o desenvolvimento de um sumário de evidências para apoiar o atendimento clínico e embasar a capacitação dos profissionais da Atenção Primária de Saúde de Florianópolis - SC, a fim de melhorar os resultados de saúde dessa população. Métodos: Baseado na ferramenta PACK ­ interface acessível e intuitiva no modelo pergunte, solicite, aconselhe e trate ­ já implementada no município de Florianópolis. O método de revisão rápida foi utilizado para busca de evidência, priorizando sumários de prática clínica e protocolos internacionais. Fontes primárias foram utilizadas quando os dados anteriores eram insuficientes ou conflitantes. As perguntas de pesquisa seguiram o acrônimo PICO e a recomendação foi classificada de acordo com a adaptação GRADE do Center of Excellence for Transegender Health. Resultados: Foi criado o Guia Rápido para Prática de Atenção à Saúde da População Transgênero aos moldes do PACK Brasil. O mesmo aguarda aprovação do PACK Brasil e do Ambulatório de Atenção Integral à População Transexual de Florianópolis para futura incorporação do material. Conclusão: Apesar da falta de evidência de qualidade e estudos voltados para a população específica, a existência de diretrizes nesse campo legitima a necessidade de atenção à saúde transgênero, além de auxiliar profissionais de saúde e formuladores de políticas sobre como atender a essas necessidades. Na perspectiva de redução de danos, devemos transpor a barreira do estigma social e institucional para produção de diretrizes consensuais em busca de equidade para população transgênero.

Problem: The fundamental rights of transgender people are denied daily. In this scenario, prejudice acts as a social determinant of health impacting on the prevalence of conditions such as mental health and STIs. The objective was to develop a summary of evidence to support clinical care and support the training of Primary Health Care professionals in Florianópolis - SC, in order to improve the health outcomes of this population. Methods:Based on the PACK tool - accessible and intuitive interface in the ask, request, advise and treat model - already implemented in the municipality of Florianópolis. The rapid review method was used to search for evidence, prioritizing clinical practice summaries and international protocols. Primary sources were used when previous data were insufficient or conflicting. The research questions followed the acronym PICO and the recommendation was classified according to the GRADE adaptation of the Center of Excellence for Transgender Health. Results: The Quick Guide for the Health Care Practice of Transgender Population was created according to the mold of PACK Brazil. It is awaiting approval from PACK Brazil and the Ambulatory of Integral Attention to the Transsexual Population of Florianópolis for future incorporation of the material. Conclusion: Despite the lack of quality evidence and studies focused on the specific population, the existence of guidelines in this field legitimizes the need for transgender health care, in addition to assisting health professionals and policy makers on how to address these needs. In the perspective of harm reduction, we must overcome the barrier of social and institutional stigma to produce consensual guidelines in search of equity for the transgender population.

Problem: The fundamental rights of transgender people are denied daily. In this scenario, prejudice acts as a social determinant of health impacting on the prevalence of conditions such as mental health and STIs. The objective was to develop a summary of evidence to support clinical care and support the training of Primary Health Care professionals in Florianópolis - SC, in order to improve the health outcomes of this population. Methods:Based on the PACK tool - accessible and intuitive interface in the ask, request, advise and treat model - already implemented in the municipality of Florianópolis. The rapid review method was used to search for evidence, prioritizing clinical practice summaries and international protocols. Primary sources were used when previous data were insufficient or conflicting. The research questions followed the acronym PICO and the recommendation was classified according to the GRADE adaptation of the Center of Excellence for Transgender Health. Results: The Quick Guide for the Health Care Practice of Transgender Population was created according to the mold of PACK Brazil. It is awaiting approval from PACK Brazil and the Ambulatory of Integral Attention to the Transsexual Population of Florianópolis for future incorporation of the material. Conclusion: Despite the lack of quality evidence and studies focused on the specific population, the existence of guidelines in this field legitimizes the need for transgender health care, in addition to assisting health professionals and policy makers on how to address these needs. In the perspective of harm reduction, we must overcome the barrier of social and institutional stigma to produce consensual guidelines in search of equity for the transgender population.

A Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers (PROVALID) - Study Design and Baseline Characteristics.

BACKGROUND/AIMS: The prevalence of diabetes mellitus type 2 and kidney disease in these patients varies widely between European countries. METHODS: In addition to store bio-samples the "Prospective cohort study in patients with type 2 diabetes mellitus for validation of biomarkers" collects information on history, physical status, laboratory measurements and medication in 4000 patients with diabetes mellitus type 2, being taken care of at the primary level of healthcare in 5 European countries (Austria, Hungary, Netherlands, Poland and Scotland). Next to comparing the rate of loss of eGFR between the countries, a further objective of the PROVALID study is to determine the 5-year cumulative incidence of renal and cardiovascular outcomes. RESULTS: The mean age of the population recruited is 62.9±10 years, 54.6% are male and the mean BMI is 30.9±5.4 kg/m2. Metabolic control (median HBA1c 6.8 % (6.2; 7.5)) is achieved via administration of metformin in 67.4% of the patients and insulin in 30.3%. Median systolic and diastolic blood pressure at recruitment is 135 (125; 146) and 80 (72; 85) mmHg, 65.4% of subjects received RAAS blocking agents. Mean eGFR is 80.7±29.2 ml/min/1.73m2 and median baseline albumin/creatinine ratio 8.3 mg (IQR: 3.8 and 25.1). CONCLUSION: PROVALID will provide information on incidence and progression of renal and cardiovascular disease and therapy in patients with type 2 diabetes mellitus in different European countries. Thus, in contrast to many other cohort studies we will be able to associate national clinical practise pattern with outcome in this highly vulnerable patient population.

Innovation in nursing health care practice: expansion of access in primary health care / La innovación en la práctica asistencial del enfermero: mayor acceso a la atención primaria / Inovação na prática assistencial do enfermeiro: ampliação do acesso na atenção primária

ABSTRACT Objective: analyze the reorganization of the health care practice of nurses as an innovative strategy for expansion of access in primary care. Method: qualitative and quantitative study, which interviewed 32 management and care nurses and collected documentary data from public reports of production of nursing consultations from 2010 to 2014, in a municipality in southern Brazil. Data processing for textual analysis was performed by IRAMUTEQ software; for simple descriptive statistical analysis, the program Excel 2013 was used. Results: in the innovative care practice class, associated with awareness of change, related to implementation of the FHS, its challenges and advantages, the following subclasses were identified: reorganization of schedules, nursing consultation, physical restructuring of BHUs, and shared consultation. Final considerations: the need to expand access to and valorization of care practice encourages the development of innovative strategies. The protagonism of care needs to be discussed in the various spaces so that each professional carry out the respective role with competence and efficacy.

RESUMEN Objetivo: evaluar la reorganización de la práctica asistencial del enfermero como estrategia innovadora para proporcionar un mayor acceso a la atención primaria. Método: estudio cualitativo y cuantitativo, en el que contó con entrevistas de 32 enfermeros de gestión y de la asistencia, y con datos recolectados de informes públicos de consultas de enfermeros entre 2010 y 2014, en un municipio brasileño. Se emplearon el software IRAMUTEQ para el análisis textual de los datos y el Excel 2013 para el análisis estadístico descriptivo simple. Resultados: desde la categoría práctica asistencial innovadora asociada a la apertura al cambio relacionada a la implantación de la Estrategia Salud de la Familia, sus retos y fortalezas se identificaron las siguientes subcategorías: reorganización de las agendas, consulta del enfermero, reestructuración de las Unidades Básicas de Salud y consulta compartida. Consideraciones finales: la necesidad de proporcionar un mayor acceso y valorar la práctica asistencial permite el desarrollo de estrategias innovadoras. Se necesita discutir sobre el protagonismo del cuidado en varios espacios para que cada profesional cumpla su papel con competencia y decisión.

RESUMO Objetivo: analisar a reorganização da prática assistencial do enfermeiro como estratégia inovadora para ampliação do acesso na atenção primária. Método: estudo qualiquantitativo, tendo sido entrevistados 32 enfermeiros gerenciais e assistenciais e coletados dados documentais de relatórios públicos de produção de consultas dos enfermeiros de 2010 a 2014, num município sul-brasileiro. O processamento dos dados para análise textual foi realizado pelo software IRAMUTEQ; para análise estatística descritiva simples, o programa Excel 2013. Resultados: na classe prática assistencial inovadora, associada à sensibilização para a mudança, relacionada à implantação da ESF, seus desafios e fortalezas, foram identificadas as subclasses: reorganização das agendas, consulta do enfermeiro, reestruturação física das UBS e consulta compartilhada. Considerações finais: a necessidade de ampliar o acesso e valorização da prática assistencial incentiva o desenvolvimento de estratégias inovadoras. O protagonismo do cuidado precisa ser discutido nos diversos espaços a fim de que cada profissional desempenhe seu papel com competência e resolutividade.

Utilization of the Arkansas Prescription Monitoring Program to Combat Prescription Drug Abuse.

OBJECTIVE: The Arkansas Prescription Monitoring Program (AR PMP) was implemented in 2013 to combat prescription drug abuse. All enrollees were invited to participate in a user survey available in February 2014, to identify makeup of users, utilization of the program, and changes made to health care practices after implementation of the program. METHODS: Of the 3,694 individual enrollees invited to participate, 1,541(41.7%) completed the survey. Data collected were analyzed to identify changes in health care practices by program frequency of use and user profession. RESULTS: Medical doctors, advanced practice nurses, and pharmacists are the professions who use the program most frequently. Daily AR PMP users are considerably more likely than infrequent users to be prompted to access the program by the involvement of a controlled substance (CS) prescription or by office/facility policy requirements. Increased frequency of use of the AR PMP results in positive impacts on CS prescribing and dispensing practices. CONCLUSION: Compelling more users of the AR PMP to be prompted to access the program by the involvement of a CS prescription or by requirements per office/facility policy may increase frequency of use of the program and thereby changes in health care practices to combat prescription drug abuse.

Past, present and perspectives of Manipur traditional medicine: A major health care system available for rural population in the North-East India.

BACKGROUND: Traditional health care practices are still being followed extensively in Manipur, North-East India. This is the major or the only medical facility available in some rural areas of Manipur. Cross cultural ethno-pharmacological survey was conducted to document traditional health care practices by Maiba-Maibi (male-female traditional health care practitioners of Manipur). MATERIALS AND METHODS: All together 59 traditional practitioners belonging to 12 ethnic communities in nine districts of the Manipur state were interviewed. A predesigned questionnaire was used for interviews, which included queries for type of ailments treating, symptoms, bioresources used, method of preparation, dosage forms, formulation, unit doses. The entire interviews were done in the residence of respective Maiba-Maibi, their patient handing and preparation of medicinal formulations were documented in written and audio-visual format. RESULTS: The survey recorded traditional knowledge on 949 formulations used for 66 human ailments. Five hundred forty six plant products, 42 animal products and 22 organic/inorganic materials were found to be used in these 949 formulations. Five plant species - Zingiber officinale (Zingiberaceae), Cocos nucifera (Arecaceae), Oroxylum indicum (Bignonaceae), Curcuma longa (Zingiberaceae) and Allium sativum (Liliaceae) used by maximum number of Maiba and Maibi in maximum number of formulations. RECOMMENDATION: This particular method of documentation keeps traditional knowledge alive. The WHO estimated perspective of traditional medicine across the world. These observations support therapeutic worth of Manipur Traditional medicines (MTM). Having generated a large database in course of this survey, next focus targeted for the scientific justification of MTM with an aim to develop commercially viable products.

Uma etnografia sobre as práticas de saúde dos imigrantes bolivianos na cidade de São Paulo / An ethnography about the Bolivian immigrants health practice in São Paulo

A imigração boliviana para São Paulo remonta ao início do ano 1950, quando Brasil e Bolívia estabeleceram um programa de intercâmbio cultural. Os bolivianos migram para o Brasil em busca de melhores condições de vida e, quando chegam, geralmente, vão trabalhar em indústrias de confecções têxteis, em condições de trabalho muito precárias, quase sob o regime de escravidão. Não se sabe ao certo a quantidade de bolivianos imigrantes, contudo as pesquisas chegam a um consenso que, atualmente, São Paulo é o destino mais procurado e que a maioria dos imigrantes que tem chegado ao Brasil são bolivianos. Os imigrantes bolivianos muitas vezes são marginalizados e excluídos do campo social, no sentido de não ter garantia dos direitos universais, e o seu acesso aos serviços de saúde muitas vezes ser dificultado pelas questões culturais. Nota-se que a estrutura social é extremamente importante na relação com o sofrimento social, entendido como a humilhação, vergonha e falta de reconhecimento, este não tem visibilidade visto que é inscrito no interior das subjetividades e não há um compartilhamento coletivo. Esta forma de sofrimento é mais comum na contemporaneidade, já que há uma veneração excessiva ao individualismo, um crescimento de um ideal pseudo meritocrático, onde há a ilusão de que todos têm oportunidades para ter êxito social - exceder sua classe social, ter uma liberdade econômica para suprir seu consumo - quando o sistema social não suporta que todos tenham essa ascensão...

The Bolivian immigration to São Paulo started in the beginning of 1950s, when Brazil and Bolivia placed a cultural interchange program. Bolivians migrate to Brazil looking for better conditions of life and, when arriving, they usually end up working in textile manufacturing companies under considerably precarious work conditions, almost under slavery regime. It is not known the exact amount of Bolivian immigrants, however researches agree that, currently, São Paulo is the most common destiny and that the majority of the immigrants that has been arriving in Brazil are Bolivians. Bolivian immigrants are, many times, made apart of the society and excluded of social life, in terms of having no guarantee of universal rights, and their access to health services are frequently more difficult due to cultural issues. It is remarkable that the social structure is extremely important on the relation with the social suffering - understood as humiliation, shame and lack of recognition -, which has no visibility once it is inscribed inside the subjectivity and there is no collective sharing. Such kind of suffering is more frequent on the contemporaneity, once there is an excessive veneration to the individualism, an increase of a pseudo meritocratic ideal, where there is the illusion that everyone has opportunities to succeed in the society to overcome their social level, to have an economical freedom to fulfill their consumption - while the social system do not stand that everyone ascend like this...

Participación en la toma de desiciones sanitarias por parte de los menores de edad según desarrollo moral, y marco normativo venezolano / Participation in health decisions by minors under development moral and legal framework for Venezuela

El presente artículo tiene como propósito establecer la participación que pueden tener los menores de edad en la toma de decisiones en la práctica sanitaria, según su desarrollo moral y el marco normativo venezolano. En los procedimientos se realizó la revisión bibliográfica, desde los clásicos hasta lo más reciente sobre el tema y se aplicó un método analítico. Se concluyó: que es fundamental una deliberación participativa con el menor, incluyéndolo en un proceso serio, honesto y sincero que exige escuchar al niño antes de los 12 años y solicitar su asentimiento de 12 a 17 años; los niños y adolescentes, pueden llegar a tomar decisiones con la adecuada ayuda por parte de familiares, equipo de salud, y otros expertos, que los apoyen en el desarrollo de una comprensión de los problemas y en la demostración de su capacidad de decisión, promoviendo el desarrollo de su independencia y responsabilidad; los profesionales de la salud requieren de formación ética y psicológica, para lograr una verdadera relación de ayuda en función del bienestar superior para con sus pacientes menores de edad y sus familiares

This paper aims to establish the participation that may have minors in decision-making in health care practice, according to their moral and legal framework in Venezuela. The procedures conducted the literature review, from the classics to the latest on the subject and applied an analytical nematode. It concluded that participatory deliberation is essential to the child, including it in a serious process, honest and sincere that requires listening to the child before age 12 and apply for consent from 12 to 17 years, children and adolescents, may reach appropriate decisions with help from family, health team and other experts to support them in developing an understanding of the problems and to demonstrate the ability of decision, promoting the development of independence and responsibility, health professionals require ethical and psychological training to achieve a real relationship based aid to higher welfare with their minor patients and their families

Medical technology and research: an engineer's view.

Medical Technology and Research are discussed here from the particular viewpoint of a university engineering department active in a specific area of biomedical engineering research (biomechanics and rehabilitation engineering) and in charge of a postgraduate programme in Biomedical and Clinical Engineering. Hence the focus of this paper is on medical technology. Medical technology is discussed within two distinct - but interrelated - contexts: health care practice on the one hand (1) and medical research on the other hand (2). European cooperation in Biomedical Engineering research is reviewed, together with the relevant EC programmes (3). Finally, our own conclusions are added to those of the EC-IRDAC report (4).