Abstract Purpose Biological agents used for the treatment of rheumatoid arthritis (RA) are associated with serious adverse events. Guidelines provide standards for the prescribing and monitoring of ...these drugs. In São Paulo, health litigation for access to medicines has fueled the demand for biological therapy. The extent to which biological agents are being appropriately prescribed and patients are being appropriately monitored is uncertain. Our goal was to determine whether RA clinical guidelines are being translated into clinical practice for patients receiving treatment as a result of lawsuits against the government. Methods We identified patients through records of the State Secretary of Health of São Paulo from 2003 to 2011. We consulted guidelines from 5 countries and chose those recommendations endorsed by all of the guidelines reviewed as standards. Pharmacy records provided data regarding biologic use. The guidelines recommended the use of biological agents only when patients had been receiving treatment with at least 1 disease-modifying antirheumatic drug (DMARD) and recommended annual monitoring of laboratory blood tests. Findings Of the 238 patients identified in the database, 216 patients were interviewed, and 124 (57.4%) patients were still using biological agents at the time of the survey. Of the patients interviewed, 167 patients (77.3%) started biological treatment when using ≥2 DMARDs before, 22 patients (10.2%) were using 1 DMARD before, and 27 patients (12.5%) had never taken a DMARD. Of the 124 patients still taking biological drugs, 117 patients (94.3%) had visited a doctor at least once per year, but 28 patients (22.6%) did not undergo the recommended laboratory blood testing. Only 43 of the 124 patients (34.7%) still taking biological agents met the guideline criteria for both the use of previous agents and the appropriate monitoring. Implications An important gap between clinical practice and the national guidelines exists among treatments prescribed for plaintiffs obtaining medicines for RA in São Paulo. The results suggest the need for intervention by health authorities.
This study aimed to reassess the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) adapted to Portuguese for use in the Brazilian context. An observational, ...cross-sectional study was performed in a large, private, non-profit, acute care hospital, reference in patient safety, in a major Brazilian metropolis. Participants were selected from a non-probability sample of all eligible personnel in the various hospital departments invited to participate in the study. Reliability of the HSOPSC was assessed by estimating Cronbach's alpha for each dimension. confirmatory factor analysis (CFA), a matrix of correlations between the dimensions, and exploratory structural equation modelling (ESEM) were used in exploratory and confirmatory analyses of the structural validity of the construct. The overall response rate was 18.7% (n = 1,439). Four dimensions ("overall perceptions of patient safety"; "staffing"; "teamwork across units"; and "non-punitive response to error") returned problems of internal consistency. CFA returned acceptable fit with the original 12-dimension model. Correlations between the dimensions of the original 12-dimension model indicated discriminant validity problems, while residual variance was greater than 0.70 in 13 items. The ESEM of the original 12-dimension model returned good fit, with the following indices: CFI = 0.985; TLI = 0.968, and RMSEA = 0.026 (90%CI: 0.024-0.029). Although better than those of the first evaluation, the results obtained in this validity and reliability reassessment of the Brazilian version of the HSOPSC require further research.
RESUMO A mudança no padrão de ocorrência da microcefalia associada à infecção pelo Zika Vírus em gestantes no Brasil resultou na decretação de emergência em saúde pública de importância nacional e ...internacional. Esforços coordenados e multisetoriais foram demandados, mas nem sempre houve respostas efetivas ou preparação das populações afetadas. A epidemia de Zika repercutiu nas políticas públicas, incluindo a de saúde, seja na investigação científica, seja na proposição de medidas de controle, diagnóstico, prevenção e tratamento. Objetivou-se apresentar proposta de análise integrada para abordagem de futuras emergências sanitárias com foco nas arboviroses. Partindo da experiência brasileira da epidemia e literatura relacionada, articularam-se quatro dimensões: vulnerabilidades e risco; condições e impactos socioeconômicos na população; desenvolvimento e emprego de tecnologias e pesquisas; e resposta e reprogramação do sistema de saúde. Pretende-se viabilizar loci específicos de investigação, para mensuração de possíveis desfechos e geração de novas evidências sobre os efeitos da epidemia nos sistemas de saúde. O conhecimento científico e suas lacunas são considerados os principais elementos integradores dessas dimensões analíticas, de forma a contribuir com resposta mais oportuna e efetiva em futuras emergências. Além do conhecimento adquirido, faz-se necessário agregar capacidade de enfrentar futuras emergências relacionadas com as epidemias de arboviroses.
ABSTRACT The change in the pattern of occurrence of microcephaly associated with Zika virus infection in pregnant women in Brazil resulted in the declaration of a Public Health Emergency of National and International Concern. Coordinated and inter-sector efforts were required, but there were not always effective responses or preparation of the affected populations. The Zika epidemic impacted public policies, including health policy, both in scientific research, proposals for control measures, diagnosis, prevention, and treatment. The study aimed to propose an integrated analysis for the approach to future health emergencies, with a focus on arboviral infections. Based on the Brazilian experience with the Zika epidemic and the related literature, the analysis links four dimensions: vulnerabilities and risk; the population’s socioeconomic conditions and impacts; development and use of technologies and research; and the health system’s response and reprogramming. The aim is to allow specific research focuses to measure the possible outcomes and generate new evidence on the epidemic’s effect on health systems. Scientific knowledge and its gaps are the main integrating elements in these analytic dimensions, aimed at contributing with a more timely and effective response in future emergencies. Besides the acquired knowledge, it is necessary to add capacity to confront future emergencies related to arbovirus epidemics.
To describe the academic profile, research experience, beliefs, and self-efficacy in research of clinical nurses in a Magnet Journey™ hospital.
Quantitative descriptive designed to assess research ...experience of clinical nurses. The survey was divided into demographics characteristics; scientific/academic profile (Nursing degree; membership in academic research groups, involvement in papers, teaching activities, scientific conferences, and posters presented); beliefs related to nursing research (about skills, benefits to career, reputation of institution, patient care; job satisfaction level); and Research Self-Efficacy (conducting literature review; evaluating quality of studies; using theory; understanding evidence; and scientific writing: putting ideas on paper easily; recognize and adapt the text to the reader; write to the standards required by science; write with objectivity, logical sequence, coherence, simplicity, clarity, and precision; insert the references in the text correctly; write the references appropriately; use correct spelling and grammar; write texts in English).
Most clinical nurses had low research experience, yet had positive beliefs in and perception of well-developed research skills.
Our findings should contribute to the preparation of research programs aimed at facilitating the engagement of clinical nurses in the development of scientific projects.
Abstract
Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider ...compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles’ adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool—Kamishibai board (K-board)—during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles’ compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles’ compliance was addressed in the K-board. Audit data were recorded in ‘SimpleQI’. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.
An ischemic stroke is usually a catastrophic event, mostly in the elderly. Cardiovascular involvement is the leading cause of ischemic stroke in this age population and hence the knowledge about its ...risk factors is important for the definition of specific policies of prevention.
To evaluate the prevalence of cardiovascular risk factors in patients with age equal to or above 80 in a hospital population with ischemic stroke.
Retrospective study of consecutive patients diagnosed with ischemic stroke admitted to a tertiary health facility.
From September 2004 to March 2006, 215 patients were studied. There was a female preponderance (p<0.01). Among patients over eighty, 72% had hypertension and atrial fibrillation was more common among the oldest old (p<0.01).
Hypertension and atrial fibrillation should be treated aggressively in the elderly. Anticoagulants should be considered more often in these patients.
OBJETIVO: Descrever o perfil acadêmico, a experiência em pesquisa, as crenças e a autoeficácia em pesquisa dos enfermeiros clínicos de um hospital em Jornada Magnet®. MÉTODOS: Estudo descritivo, tipo ...survey, para avaliar perfil acadêmico, experiência em pesquisa, crenças e habilidades de pesquisa dos enfermeiros clínicos. A análise foi dividida em características demográficas; perfil acadêmico/científico (titulação acadêmica, participação em grupos de pesquisa, envolvimento em publicações, atividades de ensino, conferências científicas e apresentação de posteres); crenças relacionadas à Pesquisa em Enfermagem (habilidades, benefícios para a carreira, reputação da instituição, para o cuidado do paciente, satisfação no trabalho); e autoeficácia em pesquisa (conduzir revisão de literatura, avaliar a qualidade dos estudos, usar teoria; compreender as evidências e escrita científica: facilidade para colocar as ideias no papel, reconhecer e adaptar o texto para o leitor, escrever obedecendo os padrões requeridos pela ciência, escrever com objetividade, clareza e precisão; inserir as referências apropriadamente, usar corretamente a ortografia e gramática; escrever textos em inglês). RESULTADOS: A maioria dos enfermeiros clínicos tinha pouca experiência em pesquisa, todavia, demonstraram crenças positivas e percepção de habilidades de pesquisa bem desenvolvidas. CONCLUSÃO: Nossos achados devem contribuir para a elaboração de programas de pesquisa que objetivem facilitar o engajamento dos enfermeiros clínicos no desenvolvimento de projetos científicos.
BackgroundThe Breakthrough Series model uses learning sessions (LS) to promote education, professional development and quality improvement (QI) in healthcare. Staff divergences regarding prior ...knowledge, previous experience, preferences and motivations make selecting which pedagogic strategies to use in LS a challenge.AimWe aimed to assess new active-learning strategies: two educational games, a card game and an escape room-type game, for training in healthcare-associated infection prevention.MethodsThis descriptive case study evaluated the performance of educational strategies during a Collaborative to reduce healthcare-associated infections in Brazilian intensive care units (ICUs). A post-intervention survey was voluntarily offered to all participants in LS activities.ResultsSeven regional 2-day LS were held between October and December 2022 (six for adult ICUs and one for paediatric/neonatal ICUs). Of 194 institutions participating in a nationwide QI initiative, 193 (99.4%) participated in these activities, totalling 850 healthcare professionals. From these, 641 participants responded to the survey (75.4%). The post-intervention survey showed that the participants responded positively to the educational activities.ConclusionThe participants perceived the various pedagogical strategies positively, which shows the value of a broad and diverse educational approach, customised to local settings and including game-based activities, to enhance learning among healthcare professionals.
RESUMO A mudança no padrão de ocorrência da microcefalia associada à infecção pelo Zika Vírus em gestantes no Brasil resultou na decretação de emergência em saúde pública de importância nacional e ...internacional. Esforços coordenados e multisetoriais foram demandados, mas nem sempre houve respostas efetivas ou preparação das populações afetadas. A epidemia de Zika repercutiu nas políticas públicas, incluindo a de saúde, seja na investigação científica, seja na proposição de medidas de controle, diagnóstico, prevenção e tratamento. Objetivou-se apresentar proposta de análise integrada para abordagem de futuras emergências sanitárias com foco nas arboviroses. Partindo da experiência brasileira da epidemia e literatura relacionada, articularam-se quatro dimensões: vulnerabilidades e risco; condições e impactos socioeconômicos na população; desenvolvimento e emprego de tecnologias e pesquisas; e resposta e reprogramação do sistema de saúde. Pretende-se viabilizar loci específicos de investigação, para mensuração de possíveis desfechos e geração de novas evidências sobre os efeitos da epidemia nos sistemas de saúde. O conhecimento científico e suas lacunas são considerados os principais elementos integradores dessas dimensões analíticas, de forma a contribuir com resposta mais oportuna e efetiva em futuras emergências. Além do conhecimento adquirido, faz-se necessário agregar capacidade de enfrentar futuras emergências relacionadas com as epidemias de arboviroses.
ABSTRACT The change in the pattern of occurrence of microcephaly associated with Zika virus infection in pregnant women in Brazil resulted in the declaration of a Public Health Emergency of National and International Concern. Coordinated and inter-sector efforts were required, but there were not always effective responses or preparation of the affected populations. The Zika epidemic impacted public policies, including health policy, both in scientific research, proposals for control measures, diagnosis, prevention, and treatment. The study aimed to propose an integrated analysis for the approach to future health emergencies, with a focus on arboviral infections. Based on the Brazilian experience with the Zika epidemic and the related literature, the analysis links four dimensions: vulnerabilities and risk; the population’s socioeconomic conditions and impacts; development and use of technologies and research; and the health system’s response and reprogramming. The aim is to allow specific research focuses to measure the possible outcomes and generate new evidence on the epidemic’s effect on health systems. Scientific knowledge and its gaps are the main integrating elements in these analytic dimensions, aimed at contributing with a more timely and effective response in future emergencies. Besides the acquired knowledge, it is necessary to add capacity to confront future emergencies related to arbovirus epidemics.
OBJETIVO: Descrever o perfil acadêmico, a experiência em pesquisa, as crenças e a autoeficácia em pesquisa dos enfermeiros clínicos de um hospital em Jornada Magnet®. MÉTODOS: Estudo descritivo, tipo ...survey, para avaliar perfil acadêmico, experiência em pesquisa, crenças e habilidades de pesquisa dos enfermeiros clínicos. A análise foi dividida em características demográficas; perfil acadêmico/científico (titulação acadêmica, participação em grupos de pesquisa, envolvimento em publicações, atividades de ensino, conferências científicas e apresentação de posteres); crenças relacionadas à Pesquisa em Enfermagem (habilidades, benefícios para a carreira, reputação da instituição, para o cuidado do paciente, satisfação no trabalho); e autoeficácia em pesquisa (conduzir revisão de literatura, avaliar a qualidade dos estudos, usar teoria; compreender as evidências e escrita científica: facilidade para colocar as ideias no papel, reconhecer e adaptar o texto para o leitor, escrever obedecendo os padrões requeridos pela ciência, escrever com objetividade, clareza e precisão; inserir as referências apropriadamente, usar corretamente a ortografia e gramática; escrever textos em inglês). RESULTADOS: A maioria dos enfermeiros clínicos tinha pouca experiência em pesquisa, todavia, demonstraram crenças positivas e percepção de habilidades de pesquisa bem desenvolvidas. CONCLUSÃO: Nossos achados devem contribuir para a elaboração de programas de pesquisa que objetivem facilitar o engajamento dos enfermeiros clínicos no desenvolvimento de projetos científicos.
OBJECTIVE: To describe the academic profile, research experience, beliefs, and self-efficacy in research of clinical nurses in a Magnet Journey™ hospital. METHODS: Quantitative descriptive designed to assess research experience of clinical nurses. The survey was divided into demographics characteristics; scientific/academic profile (Nursing degree; membership in academic research groups, involvement in papers, teaching activities, scientific conferences, and posters presented); beliefs related to nursing research (about skills, benefits to career, reputation of institution, patient care; job satisfaction level); and Research Self-Efficacy (conducting literature review; evaluating quality of studies; using theory; understanding evidence; and scientific writing: putting ideas on paper easily; recognize and adapt the text to the reader; write to the standards required by science; write with objectivity, logical sequence, coherence, simplicity, clarity, and precision; insert the references in the text correctly; write the references appropriately; use correct spelling and grammar; write texts in English). RESULTS: Most clinical nurses had low research experience, yet had positive beliefs in and perception of well-developed research skills. CONCLUSION: Our findings should contribute to the preparation of research programs aimed at facilitating the engagement of clinical nurses in the development of scientific projects.
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