An assessment of legislative responses to cancer in Brazil's House of Representatives.

BACKGROUND: Cancer is a public health issue in Brazil. To mitigate exposure to risk factors, change habits and ensure access to cancer care, an increasing number of bills are presented every year. This article analyzes the changes proposed in these bills, portraying how the representatives perceive and respond to the challenges imposed by cancer on the healthcare system and society. METHODS: Through a systematic search on the Brazilian House of Representatives website, this exploratory study examines cancer-related bills presented up to 2022. RESULTS: Of 1311 bills identified, 310 met the inclusion criteria and were categorized based on their content. The increasing annual number of cancer bills reflects the interest of representatives on the topic. The cancer types addressed correspond to the most prevalent ones, except for the colorectal. The most common strategy is primary prevention (n: 129), proposing the reduction of risk factors exposure or the promotion of protective ones, followed by tertiary (n: 106) and secondary (n: 36) strategies, targeting, respectively, cancer treatment/management and its early diagnosis/detection. On the nature of proposed changes, most seek to implement increased healthcare access (n: 125), production/sale (dis)incentives for goods containing carcinogens (n: 60), and fiscal/financial (dis)incentives (n: 53). CONCLUSION: The identified gaps - such as the limited use of data and evidence to support what is proposed, overlapping but fragmented efforts with previous bills, scarce efforts directly addressing the determinants of health, and the low rate of conversion to law - entails opportunities to advance the Legislative propositions. POLICY SUMMARY: To effectively respond to cancer-related challenges, is essential that the Legislative branch takes into account what is already being proposed or being left out, inputs from society, real-world data, and the results produced by the multisectoral policies in place.

The Effect of Educational Initiatives on the Attitude and Knowledge of Health Care Professionals Regarding Organ Donation and Transplantation: An Integrative Literature Review.

BACKGROUND: This integrative literature review synthesizes evidence on the effect of educational initiatives (EI) on the attitude and knowledge of health care professionals regarding organ donation and transplantation (ODT), and the EI effect considering the risks of the ODT process related to the professionals' attitudes and knowledge. METHODS: This search included 8 databases, with search terms across 4 groups: ODT activities, health professionals, attitude/knowledge, and EI. We applied the PICO framework to select articles: Population - health care professionals; Intervention - any EI; Comparison - pre/post or intervention/control designs; and Outcomes - indicators of attitudes or knowledge toward ODT. After the appraisal of 2,221 citations, 21 studies were included in this review. RESULTS: The EI varied to a great extent in terms of format (seminars, workshops, video lectures; online or in-person training), duration (from 15 minutes to 3 months), and the number of participants (from 12 to 1011). The effects reported were positive, increasing professionals' knowledge and attitude regarding the ODT process for all EI formats. Most articles (14; 67%) presented positive results with statistical significance for all indicators analyzed, and the remaining studies (7; 35%) reported statistical significance for some of the indicators analyzed. All EIs focused on donation or post-transplantation activities, lacking studies on the transplantation stage. CONCLUSIONS: Results suggest that different types of EIs may positively affect the attitude and knowledge of health care professionals regarding the ODT process. This study provides an up-to-date overview of the main themes examined in this literature, highlighting critical knowledge gaps and methodological flaws.

Brazilian Health Care Professionals` Attitudes and Knowledge Regarding Organ Donation and Transplantation: A Systematic Review.

PURPOSE: This systematic literature review synthesizes evidence on Brazilian health care professionals' attitudes and knowledge regarding organ donation transplantation. METHOD: This search included 5 databases-EBSCO, PubMed, Web of Science, Scopus, and Virtual Health Library. Search terms were conceptualized into 4 groups-organ transplantation/donation, health care professionals, attitude/knowledge, and Brazil. The eligibility criteria included academic articles that applied quantitative methods to examine the attitudes and/or knowledge of health care professionals toward organ donation-transplantation (ODT). After a critical appraisal of the citations initially retrieved, 13 studies were included in this review. RESULTS: Although most studies pointed to an overall positive attitude of participants toward ODT, insufficient knowledge level among participants was also observed in most studies, especially knowledge gaps regarding aspects such as legal requirements and the functioning of the ODT processes in Brazil. In convergence with the broader ODT literature, education was highlighted as a central point in ODT processes. CONCLUSION: The results reveal the scarcity of studies on the subject in Brazil and indicate an opportunity for educational efforts to improve the knowledge of health care professionals regarding the ODT process. This study enriches the academic literature and encourages new investigations on the issue, especially in the North and Northeast of Brazil.

Risk Analysis of the Organ Donation-Transplantation Process in Brazil.

BACKGROUND: Organ transplantation has been for years one of the best treatment options for several medical conditions, and, all over the world, thousands of people need an organ transplant. However, the process through which an organ goes from a brain-dead patient to a new recipient is a complex and delicate one. RESEARCH QUESTIONS: This study aims at identifying and assessing the main risks, their impact, and their relevance on the organ donation-transplantation (ODT) process in Brazil. DESIGN: To identify and to assess the risks of the process, we interviewed coordinators at the 10 State Transplantation Centers in Brazil, which is responsible for over 90% of donations that occurred in Brazil in 2019. We applied the Failure Mode and Effect Analysis method to calculate the risks in terms of severity, occurrence, and detection. The scores obtained from each risk were used to elaborate a ranking comparing the impact of 1 risk in relation to the others. MAIN FINDINGS: The interviewees identified 30 risks throughout the ODT process in Brazil. Most of them are related to insufficient human and material resources, lack of staff training and commitment, and poor infrastructure or logistical aspects. CONCLUSIONS: This study complements findings from previous studies and add new risks, based on the Brazilian state coordinators' point of view. It highlights the most critical weaknesses of the process and serves as a basis for future studies to delve deeper into each of those risks.

Hospital accreditation impact on healthcare quality dimensions: a systematic review.

PURPOSE: To systematically review the impact of hospital accreditation on healthcare quality indicators, as classified into seven healthcare quality dimensions. DATA SOURCE: We searched eight databases in June 2020: EBSCO, PubMed, Web of Science, Emerald, ProQuest, Science Direct, Scopus and Virtual Health Library. Search terms were conceptualized into three groups: hospitals, accreditation and terms relating to healthcare quality. The eligibility criteria included academic articles that applied quantitative methods to examine the impact of hospital accreditation on healthcare quality indicators. STUDY SELECTION: We applied the PICO framework to select the articles according to the following criteria: Population-all types of hospitals; Intervention-hospital accreditation; Comparison-quantitative method applied to compare accredited vs. nonaccredited hospitals, or hospitals before vs. after accreditation; Outcomes-regarding the seven healthcare quality dimensions. After a critical appraisal of the 943 citations initially retrieved, 36 studies were included in this review. RESULTS OF DATA SYNTHESIS: Overall results suggest that accreditation may have a positive impact on efficiency, safety, effectiveness, timeliness and patient-centeredness. In turn, only one study analyzes the impact on access, and no study has investigated the impact on equity dimension yet. CONCLUSION: Mainly due to the methodological shortcomings, the positive impact of accreditation on healthcare dimensions should be interpreted with caution. This study provides an up-to-date overview of the main themes examined in the literature, highlighting critical knowledge-gaps and methodological flaws. The findings may provide value to healthcare stakeholders in terms of improving their ability to assess the relevance of accreditation processes.

[Efficiency indicators to assess the organ donation and transplantation process: systematic review of the literature]. / Indicadores de eficiência no processo de doação e transplante de órgãos: revisão sistemática da literatura.

OBJECTIVE: To search the literature and identify indicators used to monitor and control the organ donation and transplantation process and to group these indicators into categories. METHOD: In November 2014, a systematic review of the literature was carried out in the following databases: Biblioteca Virtual em Saúde (BVS), EBSCO, Emerald, Proquest, Science Direct, and Web of Science. The following search terms (and the corresponding terms in Brazilian Portuguese) were employed: "efficiency," "indicators," "organ donation," "tissue and organ procurement," and "organ transplantation." Of the 344 articles retrieved, 23 original articles published between 1992 and 2013 were selected and reviewed for analysis of efficiency indicators. RESULTS: The review revealed 117 efficiency indicators, which were grouped according to similarity of content and divided into three categories: 1) 71 indicators related to organ donation, covering mortality statistics, communication of brain death, clinical status of donors and exclusion of donors for medical reasons, attitude of families, confirmation of donations, and extraction of organs and tissues; 2) 22 indicators related to organ transplantation, covering the surgical procedure per se and post-transplantation follow-up; and 3) 24 indicators related to the demand for organs and the resources of hospitals involved in the process. CONCLUSIONS: Even if organ transplantation is a recent phenomenon, the high number of efficiency indicators described in the literature suggests that scholars interested in this field have been searching for ways to measure performance. However, there is little standardization of the indicators used. Also, most indicators focus on the donation step, suggesting gaps in the measurement of efficiency at others points in the process. Additional indicators are needed to monitor important stages, such as organ distribution (for example, organ loss indicators) and post-transplantation aspects (for example, survival and quality of life).

Indicadores de eficiência no processo de doação e transplante de órgãos: revisão sistemática da literatura / Efficiency indicators to assess the organ donation and transplantation process: systematic review of the literature

RESUMO Objetivo Verificar, por meio de revisão sistemática da literatura, os indicadores utilizados para acompanhar e controlar o processo de doação e transplante de órgãos e elaborar um painel para tipificação dos indicadores descritos na literatura. Método Em novembro de 2014, foi realizada uma busca sistemática da literatura nas bases de dados da Biblioteca Virtual em Saúde (BVS), EBSCO, Emerald, Proquest, Science Direct e Web of Science. Foram utilizados os descritores “eficiência”, “indicadores”, “doação de órgãos”, “captação de órgãos”, “transplante de órgãos” e seus correspondentes na língua inglesa. Dos 344 artigos retornados pela busca, foram selecionados e revisados para análise dos indicadores de eficiência 23 artigos originais publicados de 1992 a 2013. Resultados Foram identificados 117 indicadores de eficiência, os quais foram agrupados por similaridade de conteúdo e divididos em três categorias: 1) 71 indicadores relacionados à doação de órgãos, envolvendo estatísticas de mortalidade, notificação de morte encefálica, situação clínica dos doadores e exclusão por razões médicas, atitude da família, confirmação da doação e extração dos órgãos; 2) 22 indicadores relacionados ao transplante de órgãos, envolvendo a cirurgia propriamente dita e o acompanhamento pós-transplante; e 3) 24 indicadores relacionados à demanda por órgãos e aos recursos dos hospitais envolvidos no processo. Conclusões O alto número de indicadores encontrados mostra que, mesmo sendo o transplante de órgãos um fenômeno recente, os estudiosos do processo têm buscado formas de mensurar o seu desempenho. Contudo, há pouca padronização dos indicadores e o foco é predominantemente na etapa da doação, sugerindo lacunas na mensuração da eficiência em outros pontos do processo. Além disso, ainda há carência de indicadores em importantes etapas, como na distribuição de órgãos (por exemplo, indicadores de perda de órgãos) e no pós-transplante (por exemplo, indicadores de sobrevida e qualidade de vida após a cirurgia de transplante).

ABSTRACT Objective To search the literature and identify indicators used to monitor and control the organ donation and transplantation process and to group these indicators into categories. Method In November 2014, a systematic review of the literature was carried out in the following databases: Biblioteca Virtual em Saúde (BVS), EBSCO, Emerald, Proquest, Science Direct, and Web of Science. The following search terms (and the corresponding terms in Brazilian Portuguese) were employed: “efficiency,” “indicators,” “organ donation,” “tissue and organ procurement,” and “organ transplantation.” Of the 344 articles retrieved, 23 original articles published between 1992 and 2013 were selected and reviewed for analysis of efficiency indicators. Results The review revealed 117 efficiency indicators, which were grouped according to similarity of content and divided into three categories: 1) 71 indicators related to organ donation, covering mortality statistics, communication of brain death, clinical status of donors and exclusion of donors for medical reasons, attitude of families, confirmation of donations, and extraction of organs and tissues; 2) 22 indicators related to organ transplantation, covering the surgical procedure per se and post-transplantation follow-up; and 3) 24 indicators related to the demand for organs and the resources of hospitals involved in the process. Conclusions Even if organ transplantation is a recent phenomenon, the high number of efficiency indicators described in the literature suggests that scholars interested in this field have been searching for ways to measure performance. However, there is little standardization of the indicators used. Also, most indicators focus on the donation step, suggesting gaps in the measurement of efficiency at others points in the process. Additional indicators are needed to monitor important stages, such as organ distribution (for example, organ loss indicators) and post-transplantation aspects (for example, survival and quality of life).