Teoria da mudança para implementação de apoio matricial em saúde mental / Theory of change para implementación del apoyo matricial en salud mental / Theory of change for implementing matrix support in mental health

Resumo Objetivo Descrever o processo de elaboração da theory of change para implementação do Apoio Matricial em um município paulista de médio porte e refletir sobre contribuições dessa abordagem para o planejamento e avaliação dessa intervenção considerando as potencialidades e desafios a partir de sua execução no formato remoto. Métodos Estudo qualitativo realizado por meio de oficinas participativas e construção de narrativas com trabalhadores e gestores da Rede de Atenção Psicossocial seguindo as recomendações de um guia para o desenvolvimento de theory of change em intervenções complexas. Resultados A implementação do Apoio Matricial configura um dos três resultados distais que culminam na possibilidade de estabelecer a lógica do cuidado compartilhado relacionando-se à ativação da rede intersetorial e a implementação de um Comitê de Educação Permanente. Ainda foram reconhecidos componentes externos que deveriam ser garantidos pelo contexto organizacional para o efetivo alcance de alguns resultados intermediários e de longo prazo. Conclusão A elaboração da theory of change foi efetiva em delimitar objetivos e componentes da implementação a partir da perspectiva dos atores envolvidos, estabelecendo indicadores para seu monitoramento e avaliação a partir das condições do contexto e possibilitando o direcionamento de esforços dos trabalhadores para sua consolidação.

Resumen Objetivo Describir el proceso de elaboración de la theory of change para implementar el apoyo matricial en un municipio paulista de medio porte y reflexionar sobre las contribuciones de este enfoque para la planificación y evaluación de esta intervención, considerando las posibilidades y desafíos a partir de su ejecución en formato remoto. Métodos Estudio cualitativo realizado por medio de talleres participativos y construcción de narrativas con trabajadores y gerentes de la Red de Atención Psicosocial, siguiendo las recomendaciones de una guía para la elaboración de la theory of change en intervenciones complejas. Resultados La implementación del apoyo matricial configura uno de los tres resultados distales que culminan en la posibilidad de establecer la lógica del cuidado compartido y se relaciona con la activación de la red intersectorial y la implementación de un Comité de Educación Permanente. Además, se reconocieron componentes externos que deberían estar garantizados por el contexto organizacional para llegar a algunos resultados intermedios y de largo plazo. Conclusión La elaboración de la theory of change fue efectiva para definir objetivos y componentes de la implementación a partir de la perspectiva de los actores involucrados, lo que permitió establecer indicadores para su monitoreo y evaluación a partir de las condiciones del contexto y orientar los esfuerzos de los trabajadores para su consolidación.

Abstract Objective To describe the process of development of the theory of change for the implementation of Matrix Support in a medium-sized municipality in São Paulo and to reflect on the contributions of this approach to the planning and evaluation of this intervention, considering the potentialities and challenges from its execution remotely. Methods Qualitative study performed through participatory workshops and construction of narratives with workers and managers of the Psychosocial Care Network following the recommendations of a guide for the development of the theory of change in complex interventions. Results The implementation of Matrix Support configures one of the three distal results that culminate in the possibility of establishing the logic of shared care related to the activation of intersectoral network and the implementation of a Continuing Education Committee. External components that should be guaranteed by the organizational context for the effective achievement of some intermediate and long-term results were also recognized. Conclusion The development of the theory of change was effective in delimiting objectives and implementation components from the perspective of the actors involved, establishing indicators for its monitoring and evaluation based on context conditions, and enabling the direction of workers' efforts towards its consolidation.

Diferencia Mínima Clínicamente Importante: Centrando la Toma de Decisiones en el Paciente / Clinically Important Minimal Difference: Centering Decision Making on the Patient

Introducción. Las condiciones de salud evaluadas en la práctica clínica o la investigación requieren ser interpretadas más allá de la significancia estadística. Por ello, el objetivo de este artículo especial es presentar elementos que permitan entender la diferencia mínima clínicamente importante (DCMI). La DCMI se define como la diferencia más pequeña en la puntuación en cualquier dominio o desenlace de interés que los pacientes son capaces de percibir como beneficiosa. Estudios que incorporan la percepción de los pacientes en la valoración de los hallazgos, permiten valorar de mejor manera la evidencia y con ello una mejor toma de decisiones. Es necesario seguir investigando e incorporando la DCMI, ya que, si bien en el último tiempo ha habido un avance en esta línea, aun es insuficiente en todos los ámbitos de la salud, la rehabilitación y la kinesiología.

Background. Health conditions evaluated in clinical practice or research need to be interpreted beyond statistical significance. Therefore, the objective of this special article is to present elements that allow us to understand the minimal clinically important difference (MCID). The MCID is defined as the smallest difference in score in any domain or outcome of interest that patients are able to perceive as beneficial. Studies that incorporate the perception of the patients in the evaluation of the findings, allow a better evaluation of the evidence and with it a better decision making. It is necessary to continue investigating and incorporating MCID, since, although there has been progress in this line in recent times, it is still insufficient in all areas of health, rehabilitation and kinesiology.

Incontinência Pós-prostatectomia e Assistência de Enfermagem: uma Revisão Integrativa / Post-prostatectomy Incontinence and Nursing Care: an Integrative Review / Incontinencia Postprostatectomía y Cuidados de Enfermería: una Revisión Integradora

Objetivo:Identificar as ações de enfermagem correspondentes à assistência frente à incontinência urinária pós-prostatectomia (IUPP). Método: Trata-se de uma revisão integrativa realizada na PubMed Central, ScienceDirect, Scopus e Web of Science, mediante o uso dos termos em inglês "post-prostatectomy incontinence" e "nursing care", combinados com o operador booleano AND. Foram incluídos artigos publicados como texto completo ou em impressão, dentro do sistema acesso aberto, sem distinção de idiomas e ano de publicação. Resultados: A pesquisa inicial encontrou 477 trabalhos, mas apenas seis atenderam aos critérios de elegibilidade. Os cinco tipos de ações de enfermagem identificadas foram: treinamento muscular do assoalho pélvico; teste de interrupção do jato de urina com cronômetro unidade sob teste (UST); programa de intervenção de enfermagem psicológica; suporte telefônico de enfermagem; e cuidados contínuos de enfermagem pós-prostatectomia, unindo as intervenções anteriores. A maioria dos estudos demonstrou boa qualidade metodológica e baixo risco de viés. Conclusão: A presente revisão permitiu identificar diferentes tipos de manejo da IUPP pela enfermagem, mesmo considerando que o cenário de estudos sobre a área ainda é escasso. Espera-se que essa revisão possa ser útil para a elaboração de protocolos de assistência de enfermagem à IUPP de qualidade.

Objective:To identify nursing actions corresponding to assistance in post-prostatectomy urinary incontinence (PPUI). Method: This is an integrative review conducted in PubMed Central, ScienceDirect, Scopus and Web of Science, using the English terms "post-prostatectomy incontinence" and "nursing care," combined with the Boolean operator AND. Articles published as full text or articles in press, within the open access system, without distinction of languages or year of publication, were included. Results: The initial search found 477 papers, but only six met the eligibility criteria. The five types of nursing actions identified were pelvic floor muscle training; urine stream interruption test with Unit Under Test timer; psychological nursing intervention program; telephone nursing support; and continuous post-prostatectomy nursing care, together with the previous interventions. Most studies showed good methodological quality and low risk of bias. Conclusion: The present review allowed the identification of different types of management of PPUI by nursing, even considering that the scenario of studies on the area is still scarce. It is expected that this review may be useful for the development of quality nursing care protocols for PPUI

Objetivo:identificar las condiciones de enfermedad correspondientes a la asistencia frente a la incontinencia urinaria pós-prostatectomía (IUPP). Método: se trata de una revisión integradora realizada en PubMed Central, ScienceDirect, Scopus y Web of Science, mediante el uso de los términos en inglés "post-prostatectomy incontinence" y "nursing care", combinados con el operador booleano. Los artículos publicados como texto completo o artículos en prensa se incluyeron en el sistema de acceso abierto, sin distinción de idioma y año de publicación. Resultados: la búsqueda inicial incluyó 477 artículos, pero sólo seis cumplieron los criterios de elegibilidad. Los cinco tipos de tratamientos identificados fueron el tratamiento muscular del asno pélvico (PMFT); la prueba de interrupción de la micción con cronómetro Unidad en prueba; el programa de intervención de enfermería psicológica; el soporte telefónico de enfermería; y los cuidados continuos de enfermería posprostatectomía, sin contar con las intervenciones anteriores. La mayoría de los estudios mostraron una buena calidad metodológica y un bajo riesgo de sesgo. Conclusion: la presente revisión permitió identificar diferentes tipos de manejo de IUPP por parte de la enfermería, aún considerando que el escenario de estudios en esta área es aún escaso. Se espera que esta revisión pueda ser útil para el desarrollo de protocolos de cuidados de enfermería de calidad para la IUPP

Evidence-based interventions for promoting prosocial behavior in schools: integrative review / Intervenções baseadas em evidências para promover comportamentos pró-sociais em escolas: revisão integrativa / Intervenciones basadas en evidencias para promover las conductas prosociales en las escuelas: revisión integradora

Since the last decades, an increasing number of research in schools have looked towards prosocial behavior, which refers to voluntary actions aimed at benefiting other individuals. This study aimed to describe evidence-based interventions, available in the national and international literature, focused on promoting prosocial behavior in children and adolescents in the school context. An integrative literature review was carried out with searches in ERIC, LILACS, PePSIC, PsycINFO, SciELO, and Scopus databases, resulting in 21 articles. Nineteen studies reported positive effects in promoting prosocial behavior and other assessed outcomes, such as socioemotional skills, disruptive behavior, interpersonal relationships, and academic achievement. Future studies should investigate the sustainability of the interventions in schools, compare efficacy and effectiveness between their different modalities and invest in their development in countries in the southern hemisphere.

A partir das últimas décadas, um número crescente de pesquisas em escolas tem voltado atenção a comportamentos pró-sociais, que se referem a ações voluntárias, direcionadas a beneficiar outros indivíduos. O objetivo do presente estudo consiste em descrever intervenções baseadas em evidência, disponíveis na literatura nacional e internacional, voltadas à promoção de comportamentos pró-sociais em crianças e adolescentes no contexto escolar. Foi realizada uma revisão integrativa da literatura com buscas nas bases de dados ERIC, LILACS, PePSIC, PsycINFO, SciELO e Scopus, resultando na inclusão de 21 artigos. Dezenove estudos relataram efeitos positivos das intervenções na promoção de comportamentos pró-sociais e em outros desfechos avaliados, como habilidades socioemocionais, comportamentos disruptivos, relacionamentos interpessoais e desempenho acadêmico. Sugere-se que estudos futuros investiguem a sustentabilidade das intervenções nas escolas, comparem eficácia e efetividade entre suas diferentes modalidades, bem como invistam em seu desenvolvimento em países do hemisfério sul.

Desde las últimas décadas, un número creciente de investigaciones en las escuelas se han orientado hacia la conducta prosocial, que se refiere a acciones voluntarias destinadas a beneficiar a otras personas. El objetivo de este estudio fue describir intervenciones basadas en evidencia, disponibles en la literatura nacional y internacional, direccionadas a promover conductas prosociales en niños y adolescentes en el contexto escolar. Se realizó una revisión integradora de la literatura con búsquedas en las bases de datos ERIC, LILACS, PePSIC, PsycINFO, SciELO e Scopus, resultando en la inclusión de 21 artículos. 19 estudios presentaron efectos positivos en la promoción de la conducta prosocial y en otros resultados evaluados, como habilidades socioemocionales, conducta disruptiva, relaciones interpersonales y rendimiento académico. Investigaciones futuras deben examinar la sostenibilidad de las intervenciones, comparar eficacia y efectividad entre sus diferentes modalidades e invertir en su desarrollo en el hemisferio sur.

Traditional versus simplified impression methods for complete dentures: critical appraisal of evidence / Método tradicional versus simplificado en impresiones para prótesis total removible: evaluación crítica de la evidencia Método tradicional versus simplificado

Abstract Introduction: Inspite of the great advances in dentistry, aging populations imply that there are still significant numbers of edentulous people worldwide. In most cases, implant-assisted prosthetic rehabilitation is the best solution. However, economic issues constrain access to this therapeutic approach, meaning that conventional removable prosthetics continue to be the most frequent treatment. In the removable denture making process, the so-called traditional method has been widely taught and used. It involves taking two impressions: a preliminary one followed by a definitive one (or functional). The simplified method constructs the prosthesis directly from the first impression obtained with a stock tray, without the need of a second impression. Purpose: To review the scientific evidence comparing both methods in terms of patient satisfaction, clinical quality, and masticatory performance and capacity. Results: No advantages have been found in favor of the traditional method regarding the four variables selected. Conclusions: According to the available information, the traditional method of taking impressions for complete removable dental prostheses does not provide significantly superior clinical results when compared to those obtained using the simplified method in terms of clinical quality, patient satisfaction, performance and masticatory capacity.

Resumen Introducción: Pese a los avances de la odontología, el fenómeno del envejecimiento de la población ha generado que la cantidad de personas desdentadas totales aún represente una cifra significativa. Los artificios protésicos implanto-asistidos constituyen, en la mayoría de los casos, la mejor alternativa rehabilitadora. Sin embargo, la variable económica surge como el principal impedimento para que los pacientes accedan a este recurso, y por este motivo, mantienen la prótesis total removible como una opción terapéutica. Para su confección, el método tradicional indica la necesidad de tomar dos impresiones: una preliminar y una definitiva o funcional. El método simplificado, confecciona la prótesis a partir de la primera impresión, obtenida con cubeta de stock. Objetivo: Revisar evidencia científica que compara ambos métodos en cuanto a las variables de: satisfacción del paciente, calidad clínica, rendimiento y capacidad masticatoria. Resultados: No se verifican ventajas a favor del método tradicional en relación a las variables estudiadas. Conclusiones: En concordancia con la información recabada, los resultados clínicos obtenidos mediante el método tradicional de toma de impresiones para prótesis totales no son significativamente superiores a los del método simplificado en relación a calidad clínica, satisfacción del paciente, rendimiento y capacidad masticatoria.

[Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain]. / Competencia en Práctica Basada en la Evidencia y factores asociados en las enfermeras de Atención Primaria en España.

OBJECTIVE: To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors. DESIGN: Cross-sectional, national survey design, carried out between January and March 2020. SETTING: PC in Spain. PARTICIPANTS: Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience. MAIN MEASUREMENTS: (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out. RESULTS: The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization. CONCLUSIONS: These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.

Evidencia basada en la práctica en psicoterapia: el reto en Latinoamérica / Practice-based evidence in psychotherapy: the challenge in Latin America

Resumen El artículo presenta una revisión teórica sobre el paradigma de la Práctica Basada en la Evidencia y sobre el de la Evidencia Basada en la Práctica en el ámbito de la psicoterapia; se profundiza especialmente en este último paradigma y su asociación con la investigación de la efectividad en psicoterapia. Posteriormente, se contextualiza el funcionamiento de este último paradigma en los sistemas de salud y en particular en la atención en salud mental, haciendo hincapié en su aplicabilidad en la evaluación rutinaria y su potencial para contribuir al campo de la investigación en psicoterapia. Finalmente, se presentan algunas conclusiones sobre cómo promover la investigación orientada a la Evidencia Basada en la Práctica en contextos psicoterapéuticos, a partir de Redes de Investigación en la Práctica en los países latinoamericanos.

Abstract This article presents a theoretical review of the Evidence-Based Practice and the Practice-Based Evidence in psychotherapy, the latter is explained in depth considering its association with the research of the effectiveness in psychotherapy. Subsequently, the functioning of this last paradigm in health systems, particularly in mental health care is contextualized, emphasizing its applicability in routine evaluation and its potential to contribute to the field of research in psychotherapy. Finally, some conclusions are presented on how to promote research based on the paradigm of Practice-Based Evidence in psychotherapeutic contexts, based on Practice Research Networks in Latin American countries.

Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain. / Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España.

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.

Ciencias del deporte, basadas en la evidencia / Ciências do esporte baseadas em evidência / Evidence-based sports sciences

Resumen Las prácticas basadas en la evidencia son una herramienta útil y necesaria para las ciencias del deporte. La experiencia de las ciencias médicas, basadas en la evidencia podría ser útil para la implementación de este nuevo enfoque. Las prácticas basadas en datos empíricos, en las ciencias del deporte, también podrían afectar además de los campos de la práctica de la formación, como la gestión, la legislación y la educación. Esto permitirá que la toma de decisiones se base en las mejores pruebas científicas disponibles. En esta revisión, se resumen los enfoques y modelos de cómo aplicar la práctica basada en la evidencia, en las ciencias del deporte. También se comparte un enfoque de cinco pasos, con el objetivo de proporcionar una herramienta práctica. Ciertas condiciones requieren comenzar con la práctica de la evidencia. En primer lugar, la literatura científica debe responder a la pregunta. Acceso a bases de datos científicos, saber caminar por la selva del conocimiento, dominio del inglés (ya que la mayoría de los trabajos se publican en inglés) es obligatorio. Un compromiso de las partes interesadas en las ciencias del deporte, con la práctica basada en la evidencia y la eliminación de los obstáculos a la aplicación, sería un enfoque prometedor para las prácticas basadas en la evidencia, en las ciencias del deporte, en un corto período de tiempo.

Resumo A prática baseada em evidência é uma ferramenta útil e necessária para a ciência do esporte. A experiência da ciência médica baseada em evidência poderia ser útil para a implementação desta nova abordagem. As práticas baseadas em evidência em ciências do esporte também poderiam afetar, além das áreas de prática de treinamento, como gestão, legislação e educação. Isto permitiria que a tomada de decisões fosse baseada nas melhores evidências científicas disponíveis. Esta revisão resume abordagens e modelos de como aplicar a prática baseada em evidência na ciência do esporte. Também compartilha uma abordagem em cinco etapas com o objetivo de fornecer uma ferramenta prática. Certas condições exigem que se comece com a prática da prova. Em primeiro lugar, a literatura científica deve responder à pergunta. O acesso às bases de dados científicos, saber caminhar pela selva do conhecimento, o domínio do inglês (já que a maioria dos artigos são publicados em inglês) é obrigatório. Um compromisso das partes interessadas na ciência do esporte com a prática baseada em evidências e a remoção de barreiras à implementação seria uma abordagem promissora para a prática baseada em evidência na ciência do esporte em um curto período de tempo.

Abstract Evidence-based practice is a useful and necessary tool for sports science. The experience of evidence-based medical science could be useful for the implementation of this new approach. Evidence-based practices in sport sciences could also affect, in addition to the fields of training practice, such as management, legislation and education. This will allow decision making to be based on the best available scientific evidence. This review summarises approaches and models of how to apply evidence-based practice in sport science. It also shares a five-step approach with the aim of providing a practical tool. Certain conditions require starting with the practice of evidence. First, the scientific literature must answer the question. Access to scientific databases, knowing how to walk through the jungle of knowledge, mastery of English (since most papers are published in English) is mandatory. A commitment by sport science stakeholders to evidence-based practice and the removal of barriers to implementation would be a promising approach to evidence-based practice in sport science in a short period of time.

Evidencia científica de integración sensorial como abordaje de terapia ocupacional en autismo / Scientific evidence of sensory integration as an approach to occupational therapy in autism

Este artículo presenta brevemente los antecedentes teóricos y prácticos de Integración Sensorial de Ayres (ASI, Ayres Sensory Integration) y su aplicación en el trastorno del espectro autista (TEA). Se revisan críticas históricas sobre la evidencia de ASI como intervención terapéutica y se presenta evidencia contemporánea. Según estándares establecidos por el Consejo para Niños Excepcionales (CEC, Council for Exceptional Children), organismo internacional que desarrolla criterios para categorizar prácticas basadas en la evidencia, ASI es una práctica basada en la evidencia.

This article briefly presents the theoretical and practical background of Ayres Sensory Integration (ASI) and its application in autism spectrum disorder (ASD). Historical criticisms on the evidence of ASI as a therapeutic intervention are reviewed and contemporary evidence is presented. According to standards established by the Council for Exceptional Children (CEC), an international organization that develops criteria for categorizing evidence-based practices, ASI is an evidence-based practice.

The implementation of Best practice guidelines in Spain through the Programme of the Best Practice Spotlight Organizations®. / Implantación de Guías de buenas prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®.

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association. Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms. Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host. There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22. The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided.

Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey / Fatores do ambiente de trabalho no enfrentamento da morte de pacientes entre enfermeiros espanhóis: uma pesquisa transversal / Factores del entorno laboral de los profesionales de enfermería relacionados con el afrontamiento del cuidado al final de la vida: encuesta transversal

Objective: to explore self-perception competence among Spanish nurses dealing with patient death and its relationship with work environment, evidence-based practice, and occupational stress. Method: a cross-sectional web-based survey collected information from a convenience sample of 534 nurses from professional Spanish Colleges who answered four validated questionnaires: Coping with Death Scale, Practice Environment Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP) and Nursing Stress Scale. Results: a total of 79% of the participants were women, the average age was 40 years old, 38% had a postgraduate degree and 77% worked in public health settings. Many nurses evaluated their work environment as unfavorable (66%), reported high occupational stress (83.5±14.9), and had high scores on knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an optimal coping (>157 score). The multivariate logistic model indicated positive associations with work environment and EBP characteristics (OR: 1.30, p=0.054; OR: 1.04, p=0.007; OR: 1.13, p<0.001, respectively) but negative associations with occupational stress and short work experience (OR: 0.98, p=0.0043; OR: 0.74, p<0.002, respectively). These factors explained 23.1% of the coping variance (p<0.001). Conclusion: although most nurses perceived optimal coping, the situation could be enhanced by modifying several contextual factors. The identification of these factors would improve the quality of end-of-life care by facilitating nursing management.

Objetivo: explorar a capacidade de autopercepção entre enfermeiros espanhóis que lidam com a morte do paciente e sua relação com o ambiente de trabalho, a prática baseada em evidências e o estresse ocupacional. Método: pesquisa transversal pela internet coletou informações de uma amostra de conveniência de 534 enfermeiros das Faculdades Profissionais Espanholas que responderam a quatro questionários: Escala de Enfrentamento da Morte, Escala Ambiente de Trabalho da Prática de Enfermagem, Percepção da Prática Baseada em Evidências (EBP, acrônimo em inglês) e Escala de Estresse em Enfermagem. Resultados: 79% das participantes eram mulheres com média de 40 anos, 38% tinham pós-graduação e 77% trabalhavam em ambiente de saúde pública. Muitos enfermeiros avaliaram seu ambiente de trabalho como desfavorável (66%), relataram alto estresse ocupacional (83,5 ± 14,9) e altas pontuações em conhecimento/habilidades em EBP (47,9 ± 11,3). No entanto, 61,2% deles consideraram um enfrentamento ótimo (pontuação >157). O modelo logístico multivariado indicou associações positivas com o ambiente de trabalho e as características da EBP (OR: 1,30, p = 0,054; OR: 1,04, p = 0,007; OR: 1,13, p < 0,001, respectivamente), mas negativas com estresse ocupacional e curta experiência de trabalho (OR: 0,98, p = 0,0043; OR: 0,74, p < 0,002, respectivamente). Esses fatores explicaram 23,1% da variância de enfrentamento (p < 0,001). Conclusão: embora a maioria dos enfermeiros considerasse um enfrentamento ótimo, a situação poderia ser melhorada pela modificação de vários fatores contextuais. A identificação desses fatores melhoraria a qualidade da assistência no final da vida, facilitando a gestão da enfermagem.

Objetivo: explorar el afrontamiento autopercibido por los profesionales españoles de enfermería para trabajar con pacientes moribundos y su relación con el entorno laboral, la práctica clínica y el estrés ocupacional. Método: estudio observacional transversal vía internet de una muestra de conveniencia con 534 enfermeros reclutados a través de colegios profesionales españoles que respondieron a cuatro cuestionarios validados: Escala de Afrontamiento de la Muerte, Entorno de la Práctica Enfermera, Práctica Basada en la Evidencia en Enfermería (PBE) y Escala de Estrés para Enfermería. Resultados: la mayoría de los participantes fueron mujeres (79%), de 40 años de media, con estudios de posgrado (38%) y trabajando en el sistema público (77%). Gran parte evaluó su ambiente de trabajo como desfavorable (66%), mostrando estrés ocupacional (83,5 ± 14,9) y altas puntuaciones en conocimiento/habilidades-PBE (47,9 ± 11,3). Sin embargo, el 61,2% autopercibía un afrontamiento óptimo (> 157 puntos). El análisis de regresión logística multivariante mostró que el afrontamiento se asociaba positivamente con el entorno laboral y dos subescalas-PBE (OR: 1,30, p= 0,054; OR: 1,04, p= 0,007; OR: 1,13, p <0,001, respectivamente), pero negativamente con el estrés ocupacional y la poca experiencia laboral (OR: 0,98, p= 0,0043; OR: 0,74, p <0,002, respectivamente). Estos factores explicaban el 23,1% de la varianza (p <0.001). Conclusión: aunque la mayoría de los enfermeros percibían un afrontamiento óptimo, la situación podría mejorarse modificando algunos factores. La identificación de estos factores mejoraría la calidad de la atención de los pacientes al final de la vida, facilitando la gestión de enfermería.

Fundamentos y métodos de las revisiones sistemáticas / Fundamentals and method of systematic reviews

Las revisiones sistemáticas (RS) son síntesis cualitativas y, a veces, cuantitativas sobre la evidencia disponible respecto de un tema puntual. Este trabajo contextualiza su origen en el movimiento de la medicina basada en la evidencia y las define como un tipo de investigación orientada a identificar, valorar críticamente y sintetizar conocimiento científico previo. El método de RS se presenta aquí en una serie de fases o pasos: planteo del objetivo, búsqueda y selección de estudios, evaluación de calidad, extracción y análisis de datos, metaanálisis e interpretación de resultados. Los criterios de evaluación de la evidencia científica, un pilar fundamental de este tipo de investigación, son la validez interna, la precisión y la validez externa de los resultados. La calidad de la evidencia científica, junto con la cantidad y la consistencia, son la base sobre las cuales se pueden establecer recomendaciones. El método de RS es útil en la práctica profesional, donde se requiere el manejo de evidencia científica actualizada sobre los asuntos en los que a diario se deciden diagnósticos o intervenciones, así como un tipo de investigación que puede implementarse en grado o posgrado, ya que podría llegar a resultados originales mediante la síntesis de sus antecedentes

Systematic reviews (SR) are qualitative and, sometimes, quantitative syntheses on the available evidence regarding a specific topic. This work contextualizes its origin in the evidence-based medicine movement and defines it as a type of health research aimed to identify, critically appraise and synthesize previous scientific knowledge. The SR method is presented here in a series of steps: objective, search and selection of studies, quality assessment, data extraction and analysis, meta-analysis and interpretation of results. The internal validity, precision and external validity of the results are explained as criteria to assess the quality of the evidence. The quality of the evidence, together with the quantity and consistency, are the basis on which recommendations can be made. The SR method is useful in professional practice, where the management of up-to-date scientific evidence is required to make decisions on diagnoses or interventions daily, as well as a type of research that can be implemented in undergraduate or graduate studies, since it could arrive at original results by synthesizing the previous knowledge.

Transformando la enfermería a través el conocimiento: resultados del programa de guías de buenas prácticas de la Registered Nurses' Association of Ontario (RNAO) / Transforming nursing through knowledge: results of the Registered Nurses' Association of Ontario (RNAO) good practice guidelines program / Transformando a enfermagem através do conhecimento: resultados do programa de guia de boas práticas da Registered Nurses' Association of Ontario (RNAO)

El programa de Guías de Buenas Prácticas (BPG Program) fue lanzado en 1999 por la RNAO y fue financiado por el Ministerio de Salud de Ontario. El propósito de este programa, desde su inicio, ha sido apoyar a las enfermeras proporcionándoles guías basadas en la evidencia para el cuidado del paciente en diversos contextos y sectores de la salud. Con ya cincuenta y cuatro guías en inglés, y otros idiomas inclusive, en su mayoría traducidas al español, se facilita su aseso libre de costo a millones de enfermeras y demás profesionales sanitarios en todo el mundo (www.rnao.ca).

The RNAO Good Practice Guidelines Program was started in 1991 and was funded by the Ontario Ministry of Health. The purpose of this program, since its beginnings, has been the support of nursing by providing evidence-based guidelines for patient care in different contexts. Currently, fifty-four guides in English, most of them translated into Spanish, are provided free of charge to millions of nurses and other health professionals around the world (www.rnao.ca).

O Programa de Guías de Boas Práticas da RNAO foi iniciado em 1991 e financiado pelo Ministério da Saúde de Ontário. O objetivo deste programa, desde o início, tem sido o apoio da enfermagem, fornecendo diretrizes baseadas em evidências para o atendimento ao paciente em diferentes contextos. Atualmente, cinquenta e quatro guias em inglês, a maioria deles traduzidos para o espanhol, são fornecidos gratuitamente a milhões de enfermeiros e outros profissionais de saúde em todo o mundo (www.rnao.ca).

Community and family nurse: Present keys, future challenges. / Enfermería Familiar y Comunitaria: claves de presente, retos de futuro.

It is the mission of the Community and Family Nurse through an integral and holistic approach to accompany people from cradle to death in developing their health potential, and promote different family, work and social environments to facilitate this development. Throughout history, various international, European and national organizations have regulated the figure of the Community and Family Nurse, and now their functions, powers and professional performance are fully regulated. The Community and Family Nurse can respond to the needs of a changing population and take on new responsibilities in management and research. Their extensive basic and advanced skills gathered under a rigorous training programme, benefit the health system, the nursing profession, citizenry and its communities. Many challenges remain for the Health Departments of each Autonomous Region to make it possible for this specialty to develop its full potential for improving care.

Caracterización del uso de fuentes de información para el acceso a criterios diagnósticos por parte de fonoaudiólogas y fonoaudiólogos en Chile / Characterizing the use of information sources for accessing diagnostic criteria by speech and language therapists in Chile

En el modelo de la Práctica Basada en la Evidencia el fonoaudiólogo debe conocer los criterios diagnósticos y el nivel de evidencia de los procedimientos de intervención para ofrecer un tratamiento adecuado. En la literatura se describe un bajo grado de formación académica y un escaso uso de la Práctica Basada en la Evidencia como fuente de acceso a diagnósticos y tratamientos. Este estudio investigó las dificultades de los fonoaudiólogos para acceder a los criterios para el diagnóstico fonoaudiológico. Se realizó una encuesta masiva online a 384 fonoaudiólogos, usando un método cuantitativo, descriptivo y transeccional. Los resultados indican que, independiente de los años de ejercicio laboral, un 79,7% de los encuestados utiliza fuentes secundarias para el acceso a criterios para el diagnóstico fonoaudiológico, un 46% no conoce fuentes de información fiables para acceder a diagnósticos y un 73,4% afirma haber tenido dificultades para acceder a criterios diagnósticos. Los sujetos encuestados no utilizan fuentes primarias que les permitan acceder a criterios que apoyen los diagnósticos fonoaudiológicos. Por lo anterior, se considera relevante educar sobre Práctica Basada en la Evidencia en el contexto universitario.

In the Evidence-Based Practice model, the speech and language therapist must know the diagnostic criteria and be aware of the evidence supporting the intervention procedures, to provide an effective treatment. However, the literature describes both low levels of academic training and scarce use of evidence-based practices as a base of speech and language diagnosis and treatments. This study probes into the difficulties speech and language therapists face to access the diagnostic criteria and their bibliographic references. A massive online survey was conducted with 384 speech therapists, using a quantitative, descriptive and transectional method. Results show that 79.7% of respondents use secondary sources to access criteria on which subsequently base their speech and language diagnoses, 46% do not know reliable sources of information to access criteria for diagnoses and 73.4% maintain that they had difficulties in accessing diagnostic criteria. These difficulties do not recede with years of practice. Based on these results it is possible to conclude that surveyed therapists presented difficulty to find information on which to establish their diagnostic criteria and they do not use primary sources for access information. All of this supports training students on Evidence Based Practice when in their University programs.

Ciencias de la implementación: de la evidencia a la práctica / Implementation science: from evidence to practice

Resumen La amplia gama de evidencias científicas que respaldan diversas intervenciones clínicas no son suficientes para que dichas intervenciones se utilicen en la práctica. De tal modo que la Medicina Basada en la Evidencia debe dar el paso hacia la Practica Basada en la Evidencia, a través de procesos de implementación que permitan desplegar y contextualizar intervenciones en salud respaldadas por la evidencia. Para tal fin se ha desarrollado la Ciencia de la implementación, la cual investiga los factores que influencian el uso efectivo y completo de las innovaciones científicas en la práctica, intentando maximizar los beneficios de las intervenciones en salud. Esta ciencia se define como el estudio de los métodos que promueven la incorporación sistemática de hallazgos de investigación en la rutina clínica, con el objetivo de mejorar la calidad y efectividad de los servicios e intervenciones en salud. El propósito de este artículo es introducir el concepto de Ciencia de la Implementación en relación con la epidemiología clínica y establecer las razones por las cuales existe una imperiosa necesidad de su desarrollo. Además, tiene el propósito de explicar el porqué de la necesidad de acelerar la aplicación efectiva de la Medicina Basada en Evidencia y definir los principales modelos que precisan el ámbito de trabajo de esta ciencia, incluyendo: las particularidades de los estudios de implementación, sus diferencias con los estudios clásicos de la epidemiología clínica, los modelos de implementación y evaluación, así como la definición de los desenlaces esperados en un estudio de implementación. (Acta Med Colomb 2018; 43: 207-216).

Abstract The wide range of scientific evidence supporting various clinical interventions is not sufficient for these interventions to be used in practice. For this reason, Evidence-Based Medicine must take the step towards Evidence-Based Practice, through implementation processes that allow deploying and contextualizing the health interventions supported by evidence. For this purpose, the Science of implementation has been developed, which investigates the factors that influence the effective and complete use of scientific innovations in practice, trying to maximize the benefits of health interventions. This science is defined as the study of methods that promote the systematic incorporation of research findings in the clinical routine, with the aim of improving the quality and effectiveness of health services and interventions. The purpose of this article is to introduce the concept of Implementation Science in relation to clinical epidemiology and establish the reasons by which there is an urgent need for its development. In addition, it has the purpose of explaining why the need to accelerate the effective application of Evidence-Based Medicine and define the main models that define the scope of work of this science, including: the particularities of implementation studies, their differences with the classic studies of clinical epidemiology, the implementation and evaluation models, as well as the definition of expected outcomes in an implementation study. (Acta Med Colomb 2018; 43: 207-216).

Adherencia a las recomendaciones de la OMS en la atención del parto y nacimiento humanizado. Medellín, Colombia / Adherence to the WHO recommendations in the care of humanized delivery and birth. Medellín, Colombia

Resumen Objetivo: Describir el grado de adherencia del personal sanitario a las recomendaciones de la Organización Mundial de la Salud en la atención del parto y nacimiento humanizado en Medellín, Colombia. Métodos: Estudio descriptivo de corte transversal, se estudiaron 256 partos atendidos en tres instituciones de tercer nivel en Medellín y Rionegro Antioquia (abril - diciembre 2016), se incluyeron las gestantes que ingresaron en etapa del trabajo de parto, los datos se obtuvieron a partir de observación directa y aplicación de lista de chequeo de las recomendaciones de la OMS. Para el análisis de la información se aplicó estadística descriptiva, y para el análisis bivariado la prueba Chi cuadrado. Resultados: La proporción de cesárea fue elevada 34.8 %; no hubo diligenciamiento del partograma en 29,3 %; se viola la privacidad de las mujeres 26.2 %; no hubo facilidades para la deambulación 92.2 %; sigue presentándose el uso de fórceps, aunque en baja proporción 7.4 %; se realizó episiotomía en el 16.8 % de los partos. Conclusiones: El grado de adherencia por parte de las instituciones y el personal de salud que participa durante el proceso de atención del trabajo de parto, parto y del recién nacido están alejadas a las recomendaciones propuestas por la OMS.

ABSTRACT Objective: To describe the degree of adherence of the health personnel to the recommendations of the World Health Organization in the care of humanized delivery and birth in Medellín, Colombia. Methods: Descriptive cross-sectional study, 256 deliveries attended in three institutions of third level in Medellín and Rionegro Antioquia (April - December 2016), were studied. Pregnant women who entered the stage of labor were included, data were obtained from direct observation and application of a checklist of WHO recommendations. For the analysis of the information, descriptive statistics and for the bivariate analysis Chi square test were applied. Results: The proportion of caesarean section was high 34.8 %; there was no completion of the partogram in 29.3 %; the privacy of women is violated 26.2 %; there were no facilities for ambulation 92.2 %; the use of forceps continues to present, although in a low proportion 7.4 %; Episiotomy remains an unjustified procedure with 16.8 %. Prophylactic antibiotics were used in 41 %. Conclusions: The degree of adherence on the part of the institutions and health personnel participating during the process of the care labor, delivery and the newborn are far from the recommendations by the WHO.

[Evidence of community engagement in health in Spain: thoughts and proposals. SESPAS Report 2018]. / Evidencia sobre la participación comunitaria en salud en el contexto español: reflexiones y propuestas. Informe SESPAS 2018.

Community engagement has recently become key in the development of health promotion programmes at a local level. However, evidence-based tools are necessary to implement strategies and interventions with a participatory approach. The objective of this article is to reflect on the existing evidence in Spain about community engagement in health, drawing on the results of the AdaptA GPS Project (Adapt and Apply Health Promotion Guidelines), intended to adapt NICE guideline NG44 on community engagement to improve health and wellbeing, and to reduce inequalities. After describing the methodology for the adaptation process, we discuss some of the findings from the review of the evidence on community engagement in the Spanish context. We ask whether the limited evidence identified is due to the difficulties involved in evaluating these interventions, or to the lack of interest in these programmes and the limited resources and funding dedicated to them. Two recommendations are proposed: to promote more and better research, fostering training, research and evaluation towards the development of community engagement interventions in health, and to promote more and better interventions using evidence-based tools, supporting their long-term sustainability by taking into account the time needed for community engagement programmes to be properly developed. Generating more evidence on community engagement in health in Spain will allow us to learn from successful processes and encourage the transfer of good practice to different contexts.

Implementation science: from evidence to practice.

The wide range of scientific evidence supporting various clinical interventions is not sufficient for these interventions to be used in practice. For this reason, Evidence-Based Medicine must take the step towards Evidence-Based Practice, through implementation processes that allow deploying and contextualizing the health interventions supported by evidence. For this purpose, the Science of implementation has been developed, which investigates the factors that influence the effective and complete use of scientific innovations in practice, trying to maximize the benefits of health interventions. This science is defined as the study of methods that promote the systematic incorporation of research findings in the clinical routine, with the aim of improving the quality and effectiveness of health services and interventions. The purpose of this article is to introduce the concept of Implementation Science in relation to clinical epidemiology and establish the reasons by which there is an urgent need for its development. In addition, it has the purpose of explaining why the need to accelerate the effective application of Evidence-Based Medicine and define the main models that define the scope of work of this science, including: the particularities of implementation studies, their differences with the classic studies of clinical epidemiology, the implementation and evaluation models, as well as the definition of expected outcomes in an implementation study.

La amplia gama de evidencias científicas que respaldan diversas intervenciones clínicas no son suficientes para que dichas intervenciones se utilicen en la práctica. De tal modo que la Medicina Basada en la Evidencia debe dar el paso hacia la Practica Basada en la Evidencia, a través de procesos de implementación que permitan desplegar y contextualizar intervenciones en salud respaldadas por la evidencia. Para tal fin se ha desarrollado la Ciencia de la implementación, la cual investiga los factores que influencian el uso efectivo y completo de las innovaciones científicas en la práctica, intentando maximizar los beneficios de las intervenciones en salud.Esta ciencia se define como el estudio de los métodos que promueven la incorporación sistemática de hallazgos de investigación en la rutina clínica, con el objetivo de mejorar la calidad y efectividad de los servicios e intervenciones en salud.El propósito de este artículo es introducir el concepto de Ciencia de la Implementación en relación con la epidemiología clínica y establecer las razones por las cuales existe una imperiosa necesidad de su desarrollo.Además, tiene el propósito de explicar el porqué de la necesidad de acelerar la aplicación efectiva de la Medicina Basada en Evidencia y definir los principales modelos que precisan el ámbito de trabajo de esta ciencia, incluyendo: las particularidades de los estudios de implementación, sus diferencias con los estudios clásicos de la epidemiología clínica, los modelos de implementación y evaluación, así como la definición de los desenlaces esperados en un estudio de implementación.