Quality of dictated feedback associated with SIMPL operative assessments of pediatric surgical trainees.

BACKGROUND: SIMPL is a workplace-based operative performance assessment tool which allows for dictated feedback (DF). To better understand the value of DF, we sought to characterize the type and quality of DF generated during SIMPL evaluations. METHODS: Thematic analysis of DF from SIMPL assessments between June 2017 and December 2018 at a single pediatric surgery fellowship program was performed. Comments were categorized as specific, encouraging or corrective. Categories were combined to determine DF quality as effective, mediocre or ineffective. RESULTS: Of 781 SIMPL assessments (21 faculty, 5 trainees), 451 (57%) had DF. Most comments were encouraging (93%) and specific (65%). Only 21% were corrective, 17% had entrustment features, and 8% had an explicit learning plan. Feedback quality was deemed mediocre (45%), ineffective (33%) and effective (21%). CONCLUSION: SIMPL dictated feedback was mostly encouraging and specific. To improve quality, feedback should incorporate learning plans as well as corrective and entrustment features.

Impaired Quality of Working Life in Inflammatory Bowel Disease Patients.

BACKGROUND: Work-related aspects are important determinants of health for inflammatory bowel disease (IBD) patients. AIMS: We aimed to describe quality of working life (QWL) in IBD patients and to assess variables that are associated with QWL. METHODS: Employed IBD patients of two tertiary and two secondary referral hospitals were included. QWL (range 0-100) was measured using the Quality of Working Life Questionnaire (QWLQ). Work productivity (WP), fatigue, and health-related quality of life (HRQL) were assessed using the Work Productivity and Activity Impairment questionnaire, Multidimensional Fatigue Inventory, and Short Inflammatory Bowel Disease Questionnaire, respectively. Active disease was defined as a score > 4 for the patient-reported Harvey-Bradshaw index in Crohn's disease (CD) or Simple Clinical Colitis Activity Index in ulcerative colitis patients. RESULTS: In total, 510 IBD patients were included (59% female, 53% CD, mean age 43 (SD 12) years). The mean QWLQ score was 78 (SD 11). The lowest subscore (54 (SD 26)) was observed for "problems due to the health situation": 63% reported fatigue-related problems at work, 48% agreed being hampered at work, 46% had limited confidence in their body, and 48% felt insecure about the future due to their health situation. Intermediate/strong associations were found between QWL and fatigue (r = - 0.543, p < 0.001), HRQL (r = 0.527, p < 0.001), WP loss (r = - 0.453, p < 0.001) and disease activity (r = - 0.331, p < 0.001). Independent predictors of impaired QWL in hierarchical regression analyses were fatigue (B = - 0.204, p < 0.001), WP loss (B = - 0.070, p < 0.001), and impaired HRQL (B = 0.248, p = 0.001). CONCLUSIONS: IBD-related problems at work negatively influence QWL. Fatigue, reduced HRQL, and WP loss were independent predictors of impaired QWL in IBD.

Prevalence, Indirect Costs, and Risk Factors for Work Disability in Patients with Crohn's Disease at a Tertiary Care Center in Rio de Janeiro.

BACKGROUND AND AIMS: Crohn's disease (CD) can lead to work disability with social and economic impacts worldwide. In Brazil, where its prevalence is increasing, we assessed the indirect costs, prevalence, and risk factors for work disability in the state of Rio de Janeiro and in a tertiary care referral center of the state. METHODS: Data were retrieved from the database of the Single System of Social Security Benefits Information, with a cross-check for aid pension and disability retirement. A subanalysis was performed with CD patients followed up at the tertiary care referral center using a prospective CD database, including clinical variables assessed as possible risk factors for work disability. RESULTS: From 2010 to 2018, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs of US$ 8,562,195.86. Permanent disability occurred more frequently in those aged 40 to 49 years. In the referral center, the prevalence of work disability was 16.7%, with a mean interval of 3 years between diagnosis and the first benefit. Risk factors for absence from work were predominantly abdominal surgery, anovaginal fistulas, disease duration, and the A2 profile of the Montreal classification. CONCLUSIONS: In Rio de Janeiro, work disability affects one-sixth of CD patients, and risk factors are associated with disease duration and complications. In the context of increasing prevalence, as this disability compromises young patients after a relatively short period of disease, the socioeconomic burden of CD is expected to increase in the future.

Performance management in primary healthcare: Nurses' experiences.

BACKGROUND: The use of the performance management (PM) system is highly contested by public servants in South Africa, although its value as essential to the appraisal and management of staff is undeniable. OBJECTIVES: The aim of this study was to explore nurses' perceptions and experiences of the PM system at primary healthcare (PHC) facilities in relation to the current health system's reforms. METHOD: An exploratory, descriptive and qualitative design was utilised. Participants were selected through purposive sampling. A semi-structured interview tool was used to collect data from 18 nurses in four sub-districts of Dr. Kenneth Kaunda district in the North West province. Data were analysed through thematic analysis. RESULTS: The findings of this study confirmed that PM is implemented to some extent. However, various loopholes in its implementation threaten the accuracy and transparency of the system and leave it vulnerable to perceived organisational injustice and unfairness, with the objectivity of the system questioned. The limitations of the current PM system revealed by this study include (1) the lack of alignment with current health system reforms towards comprehensive and integrated care that demands person-centred care; (2) the system's usefulness for career progression, performance improvement and rewarding exceptional performance. CONCLUSION: Performance management is inadequately applied in PHC facilities at district level and needs to be realigned to include the appraisal of key attributes required for the current health system's reforms towards comprehensive and integrated care, including the provision of person-centred care, which is central for responding adequately to South Africa's changing disease profile towards multi-morbidity.

Gestão do desempenho por competências: relato de experiência em uma empresa brasileira de alimentos / Performance management by competences: report of experience in a brazilian food company

O presente artigo objetiva discutir as potencialidades e os desafios envolvidos na gestão do desempenho por competências no contexto organizacional, por meio de um relato de implantação e desenvolvimento de um programa de gestão do desempenho por competências em uma empresa brasileira de alimentos, localizada no estado do Ceará, demandada pela necessidade de atualização e adaptação do processo de avaliação de gestão do desempenho na referida organização. A metodologia empregada no estudo foi realizada por meio de observação participante e análise documental. As etapas do programa de gestão do desempenho foram as seguintes: mapeamento de competências, atualização das descrições de cargo, sensibilização acerca do processo de gestão do desempenho, aplicação da avaliação de desempenho, tabulação e análise dos dados relativos ao desempenho, feedback, relatórios finais e planos de ação. Todas as etapas utilizaram, como base, contribuições teórico-metodológicas da área de gestão por competências. Os resultados obtidos viabilizaram a elaboração de um amplo diagnóstico, alcançando aproximadamente 1600 trabalhadores, sendo 150 ocupantes de cargo de gestão em todas as áreas da organização: industrial; administrativa; comercial; e logística/transportes. Nomeado diagnóstico propiciou subsídios para a redefinição das descrições de cargo, dos perfis de seleção e construção do plano semestral de treinamentos da organização. Entre os desafios identificados, destaca-se, a falta de preparação dos gestores para o feedback

This article aims to discuss the potentialities and challenges involved in performance management by competencies in the organizational context, through an account of the implementation and development of a competency performance management program in a Brazilian food company in the state of Ceará , demanded by the need to update and adapt the process of evaluation of performance management in said organization. The methodology used was accomplished through participant observation and documentary analysis. The stages of the performance management program were: mapping competencies, updating job descriptions, raising awareness about the performance management process, applying performance evaluation, tabulating and analyzing performance data, feedback, final reports and action plans. All the steps used theoretical-methodological contributions of the area of management by competences. The results obtained enabled the elaboration of a comprehensive diagnosis, reaching approximately 1,600 workers, with 150 occupants of management position. Named diagnosis provided subsidies for the redefinition of job descriptions, selection profiles and construction of the organization's semi-annual training plan. Among the identified challenges, we highlight the lack of preparation of managers for feedback

Technical-tactical performance in basketball: evaluation of gaming actions according to specific positions

Aim: This study aimed to analyze the level of technical-tactical performance of female basketball base players, considering the association between the game actions and the specific positions performed by the players. Methods: Twenty-six players from a basketball club in the state of Santa Catarina (Brazil) participated. The performance was analyzed with the aid of the Individual Technical-Tactical Basketball Performance Assessment Instrument (IAD-BB). The statistical treatment involved the use of descriptive (simple and percentage frequency) and inferential (Pearson's Chi-square test, Cramer's V coefficients, adjusted residuals), adopting a 5% significance level for the interpretation of the results. Results: It was found a statistically significant association of the functions performed by the players with the actions of reception, dribble, throw, marking and rebound block. The guards performed better in the reception, dribble and clearing actions, the centers were better in rebound block, throw and clearing, while the forwards showed better performance in clearing and rebound block. Conclusion: It is concluded that the analysis of tactical-technical performance, considering the actions and specific positions of female players, is necessary for a better understanding of the factors that influence their performance in the game. Results are discussed with the literature and suggestions are made for future research in order to expand the quantity and quality of evidence in sports performance analysis.(AU)

Performance of nurses in the bed management service of a teaching hospital / Actuación de enfermeros en la gestión de camas de un hospital - escuela / Atuação de enfermeiros na gestão de leitos de um hospital de ensino

ABSTRACT Objectives: to analyze the performance of nurses in the Bed Management service of a public teaching hospital. Methods: descriptive, qualitative research inspired by Dubois theoretical model. 32 participants from the bed management unit and care units of a public hospital were interviewed from February to May 2018. Observations and data records from the Bed Management service complemented data collection. Theme/Category-Based Content Analysis was used. Results: the performance of nurses was described in three analysis matrices, represented by the categories: acquisition, implementation and maintenance of nursing resources; transformation of nursing resources into nursing service and results of the work of the nurse in Bed Management. Final Considerations: understanding the performance of nurses in bed management contributes to the scenario of new practices and different roles that favor visibility and strengthening of the nurse's identity.

RESUMEN Objetivos: analizar la actuación de los enfermeros en la gestión de camas de un hospital-escuela público. Métodos: se trata de una investigación descriptiva, cualitativa, inspirada en el modelo teórico de Dubois. Se entrevistaron 32 participantes de la unidad de Gestión de Camas y de las unidades asistenciales de un hospital público, durante el período comprendido entre febrero y mayo de 2018. La observación y el registro de los datos del servicio de gestión de camas complementaron la recolección y para su clasificación, se utilizó el Análisis de Contenido Temático Categorial. Resultados: el desempeño del enfermero se reveló en tres matrices de análisis, representadas por las categorías: adquisición, implementación y mantenimiento de los recursos de enfermería; transformación de los recursos de enfermería en servicios de enfermería; y resultados del trabajo del enfermero en la Gestión de Camas. Consideraciones Finales: es evidente que el desempeño de los enfermeros en la gestión de camas contribuye con el escenario de nuevas prácticas y diferentes roles a favor de la visibilidad y el fortalecimiento de la identidad del enfermero.

RESUMO Objetivos: analisar a atuação de enfermeiros na gestão de leitos de um hospital público de ensino. Métodos: trata-se de uma pesquisa descritiva, qualitativa, inspirada no modelo teórico de Dubois. Foram entrevistados 32 participantes da unidade de gestão de leitos e unidades assistenciais de um hospital público no período de fevereiro a maio de 2018. A observação e os registros de dados do serviço de Gestão de Leitos complementaram a coleta. Utilizou-se a Análise de Conteúdo Temático Categorial. Resultados: a atuação do enfermeiro foi desvelada em três matrizes de análise, representadas pelas categorias: aquisição, implementação e manutenção de recursos de enfermagem; transformação de recursos de enfermagem em serviços de enfermagem; e resultados do trabalho do enfermeiro da Gestão de Leitos. Considerações Finais: entender como a atuação de enfermeiros na Gestão de Leitos contribui no cenário de novas práticas e diferentes papéis em prol da visibilidade e fortalecimento da identidade do enfermeiro.

Evaluation of nurse's performance in telemedicine / Evaluación de la actuación del enfermero en telemedicina / Avaliação da atuação do enfermeiro em telemedicina

ABSTRACT Objective: Describe the nurse's role in the Telemedicine Program in Cardiology implanted in Pernambuco, Brazil. Methods: Qualitative study, with a target audience of nurses, performed between July and December 2016 at the Emergency Care Units. Data were collected through an online instrument, consisting of open and closed questions, performed with 19 professionals. The data were analyzed through the discourse of the collective subject by QuantiQualisoftware. Results: The sample consisted of 19 nurses, mostly female (80%), with a mean age of 30 years old. Two central ideas were constructed: nurses' knowledge about the Telemedicine Program in Cardiology; and actions developed by nurses. Also, a flow of the program's assistance was built. Final considerations: The nurse in Telecardiology performs functions of assistance and continuing education of monitoring and training for patients.

RESUMEN Objetivo: Describir la actuación del enfermero en el Programa de Telemedicina en Cardiología implantado en Pernambuco, Brasil. Métodos: Estudio cualitativo, con público objetivo de enfermeros, realizado entre julio y diciembre de 2016 en las Unidades de Atención de Emergencia. Los datos fueron recolectados por medio de un instrumento on-line, constando de cuestiones abiertas y cerradas, realizado con 19 profesionales. Los datos fueron analizados a través del discurso del sujeto colectivo por el QuantiQualisoftware. Resultados: La muestra fue compuesta de 19 enfermeros, la mayoría del género femenino (80%), con una media de edad de 30 años. Se construyeron dos ideas centrales: conocimiento de los enfermeros sobre el Programa de Telemedicina en Cardiología; y acciones desarrolladas por los enfermeros. También se construyó un flujo de la atención del Programa. Consideraciones finales: El enfermero en la Telecardiología desempeña funciones de asistencia y educación continuada de monitoreo y de cuño formativo a los pacientes.

RESUMO Objetivo: Descrever a atuação do enfermeiro no Programa de Telemedicina em Cardiologia implantado em Pernambuco, Brasil. Métodos: Estudo qualitativo, com público-alvo de enfermeiros, realizado entre julho e dezembro de 2016 nas Unidades de Pronto Atendimento. Os dados foram coletados por meio de um instrumento on-line, constando de questões abertas e fechadas, realizado com 19 profissionais. Os dados foram analisados através do discurso do sujeito coletivo pelo QuantiQualisoftware. Resultados: A amostra foi composta de 19 enfermeiros, em sua maioria do sexo feminino (80%), com média de idade de 30 anos. Foram construídas duas ideias centrais: conhecimento dos enfermeiros sobre o Programa de Telemedicina em Cardiologia; e ações desenvolvidas pelos enfermeiros. Ainda, foi construído um fluxo do atendimento do Programa. Considerações finais: O enfermeiro na Telecardiologia desempenha funções de assistência e educação continuada de monitoramento e de cunho formativo aos pacientes.

How are medical groups identified as high-performing? The effect of different approaches to classification of performance.

BACKGROUND: Payers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as "high-performing", but no consistently-applied approach exists to identifying high performers. This paper uses publicly available data to examine how different classification approaches influence which providers are designated as "high-performers". METHODS: We conducted a quantitative analysis of cross-sectional publicly-available performance data in the U.S. We used 2014 Minnesota Community Measurement data from 58 medical groups to classify performance across 4 domains: quality (two process measures of cancer screening and 2 composite measures of chronic disease management), total cost of care, access (a composite CAHPS measure), and patient experience (3 CAHPS measures). We classified medical groups based on performance using either relative thresholds or absolute values of performance on all included measures. RESULTS: Using relative thresholds, none of the 58 medical groups achieved performance in the top 25% or 35% in all 4 performance domains. A relative threshold of 40% was needed before one group was classified as high-performing in all 4 domains. Using absolute threshold values, two medical groups were classified as high-performing across all 4 domains. In both approaches, designating "high performance" using fewer domains led to more groups designated as high-performers, though there was little to moderate concordance across identified "high-performing" groups. CONCLUSIONS: Classification of medical groups as high performing is sensitive to the domains of performance included, the classification approach, and choice of threshold. With increasing focus on achieving high performance in healthcare delivery, the absence of a consistently-applied approach to identify high performers impedes efforts to reliably compare, select and reward high-performing providers.

Avaliação de profissionalismo como competência na formação do enfermeiro: uma revisão integrativa / Evaluation of professionalism as a competence in in nursing education: an integrative review / Evaluación de competencias de profesionalismo como en la formación en enfermería: una revisión integrativa

Trata-se de revisão da literatura com o objetivo de identificar pelas evidências na literatura como é realizada a avaliação do profissionalismo nos cursos de enfermagem no período de 2014- 2018. Foi realizada a busca dos artigos na base de dados PubMed, utilizando os descritores Profissionalism, Evaluation, Nursing.Selecionaram-se 8 artigos conforme os critérios de inclusão e a análise destes permitiu a identificação de 5 categorias que subsidiaram a discussão sobre as formas de avaliar profissionalismo nos cursos de enfermagem. Os resultados apresentaram distintas formas de avaliação, como o impacto dos modelos de avaliação, os métodos de aprendizagem que estimulam atitudes dos estudantes, a avaliação dos comportamentos e atitudes dos docentes em sala de aula ou em campo de prática e a avaliação das instituições formadoras, incluindo a forma como instituem o profissionalismo em seus currículos e planejamentos de aprendizagem.

This is a literature review to identify, through the evidence in the literature, how the assessment of professionalism in nursing courses in the 2014-2018 period is performed. The search of articles was performed in PubMed database, using the descriptors Professionalism, Evaluation, Nursing. Eight articles were selected according to the inclusion criteria, and their analysis allowed the identification of 5 categories that subsidized the discussion on ways of assessing professionalism in nursing courses. The results showed different forms of assessment, such as the impact of assessment models, learning methods that stimulate students' attitudes, the assessment of teachers' behaviurs and attitudes in the classroom or in the field of practice and the evaluation of the institutions, including how they establish professionalism in their curricula and learning plans

Revisión de la literatura para identificar la evidencia en la literatura como es realizada la evaluación de la profesionalidad en cursos de enfermería en el período 2014-2018. Se realizó una búsqueda en la base de datos de artículos en PubMed, utilizando los descriptores de profesionalismo, evaluación, enfermería. Fueron seleccionados 8 artículos según sus criterios de inclusión y análisis, eso permitió la identificación de las 5 categorías que subsidiaron la discusión sobre las formas de evaluar la profesionalidad en los cursos de enfermería. Los resultados mostraron diferentes formas de evaluación, como el impacto de los modelos de evaluación, métodos de aprendizaje que estimulan actitudes de los estudiantes, la evaluación del comportamiento y actitudes de los docentes en el aula o en el campo de esa práctica y la evaluación de las instituciones de formación, incluyendo cómo establecer profesionalismo en sus currículos y planes de aprendizaje

Adaptação transcultural do Competency Evaluation Questionnaire - versão brasileira / Adaptación transcultural del Competency Evaluation Questionnaire - versión brasileña / Transcultural adaptation of the Competency Evaluation Questionnaire - Brazilian version

Resumo OBJETIVO Descrever o processo de tradução e adaptação para cultura brasileira do Competency Evaluation Questionnaire para enfermeiros hospitalares. MÉTODOS Estudo metodológico de tradução e adaptação transcultural, compreendendo as etapas tradução do instrumento original para o português do Brasil, avaliação consensual das versões traduzidas, retrotradução, validação por juízes e piloto com 29 enfermeiros hospitalares do interior paulista, ocorrido em 2016. RESULTADOS Apresentaram as etapas do processo de adaptação transcultural do instrumento, com ajustes propostos por um Comitê de juízes, composto por 27 itens distribuídos em cinco domínios de competências para enfermeiros hospitalares. O instrumento adaptado para o português apresentou equivalência semântica, idiomática, experimental e conceitual com o original, e o valor total do Alpha de Cronbach 0,932, além da validação parente. CONCLUSÕES O Competency Evaluation Questionnaire demonstrou ser um instrumento confiável, possível de ser utilizado, mas não exclui a necessidade de futuros testes estatísticos visando à validade psicométrica.

Resumen OBJETIVO Describir el proceso de traducción y adaptación a la cultura brasileña de la encuesta evaluativa de competencias para enfermeros en hospitales. MÉTODOS Estudio metodológico sobre la traducción y adaptación cultural, que comprende la traducción del instrumento al portugués, la evaluación consensuada de las versiones traducidas, la retro-traducción, la traducción de validación por los jueces y un piloto con 29 enfermeras del hospital, que se produjo en 2016. RESULTADOS Se presentaron las etapas del proceso de adaptación transcultural, con ajustes propuestos por un comité de jueces, compuesto por 27 ítems distribuidos en cinco dominios de competencias para enfermeros de hospitales. El instrumento adaptado demostró equivalencia semántica, idiomática, experimental y conceptual al original, y cantidad total de alpha de Cronbach de 0,932, además de una validación relativa. CONCLUSIONES La Competency Evaluation Questionnaire demostró ser un instrumento confiable, posible de ser utilizado, pero no excluye la necesidad de futuras pruebas estadística con el objetivo de lograr una validez psicométrica.

Abstract OBJECTIVE Describe the process of translation and adaptation to Brazilian culture of the Competency Evaluation Questionnaire for hospital nurses. METHOD Methodological study of translation and cross-cultural adaptation, including the steps translation of the original instrument into Portuguese, consensual evaluation of translated versions, back - translation, validation by judges and pilot with 29 hospital nurses. RESULTS They presented the stages of process of cross-cultural adaptation of the instrument, with adjustments proposed by a Judges Committee, composed of 27 items distributed in five domains of competencies for hospital nurses. The instrument adapted to Portuguese presented semantic, idiomatic, experimental and conceptual equivalence with the original, and the total value of the Cronbach Alpha 0.932, in addition to the relative validation. CONCLUSIONS The Competency Evaluation Questionnaire has been shown to be a reliable instrument that can be used but does not exclude the need for future statistical tests aiming at psychometric validity.

An Academic Relative Value Unit System for Incentivizing the Academic Productivity of Surgery Faculty Members.

OBJECTIVE: The objective of this study was to evaluate a new academic relative-value unit (aRVU) scoring system linked to faculty compensation and analyze its association with overall departmental academic productivity. SUMMARY BACKGROUND DATA: Faculty are often not incentivized or financially compensated for educational and research activities crucial to the academic mission. METHODS: We launched an online, self-reporting aRVU system in 2015 to document and incentivize the academic productivity of our faculty. The system captured 65 specific weighted scores in 5 major categories of research, education, innovation, academic service, and peer review activities. The aRVU scores were rank-aggregated annually, and bonuses were distributed to faculty members in 3 tiers: top 10%, top third, and top half. We compared pre-aRVU (academic year 2015) to post-aRVU (academic year 2017) departmental achievement metrics. RESULTS: Since 2015, annual aRVU bonuses totaling $493,900 were awarded to 59 faculty members (58% of eligible department faculty). Implementing aRVUs was associated with significant increases in several key departmental academic achievement metrics: presentations (579 to 862; P = 0.02; 49% increase), publications (390 to 446; P = 0.02; 14%), total research funding ($4.6 M to $8.4 M; P < 0.001; 83%), NIH funding ($0.6 M to $3.4 M; P < 0.001; 467%), industry-sponsored clinical trials (8 to 23; P = 0.002; 188%), academic society committee positions (226 to 298; P < 0.001; 32%), and editorial leadership positions (50 to 74; P = 0.01; 48%). CONCLUSIONS: Implementing an aRVU system was associated with increases in departmental academic productivity. Although other factors undoubtedly contributed to these increases, an aRVU program may represent an important mechanism for tracking and rewarding academic productivity in surgery departments.

Tecobé no Marajó: tendência de indicadores de monitoramento da atenção primária antes e durante o Programa Mais Médicos para o Brasil / Tecobé in Marajó: trend of indicators for the monitoring of primary care before and during the More Physicians for Brazil Program

O estudo objetivou avaliar o desempenho da Estratégia Saúde da Família após implementação do Programa Mais Médicos (PMMB) no território do Marajó-PA-Brasil, através da série histórica de quatro indicadores de cuidados primários no período de 2011-2015: cobertura populacional, proporção de nascidos vivos de mães por consultas de pré-natal, taxas de internação por condição sensível a atenção primária (ICSAP) e taxa de mortalidade infantil. A tendência de melhora foi evidente após implantação do PMMB em 2013, alcançando cobertura de 42,8% em 12/2015 na região. Em 04/2014 todos os 16 municípios tinham equipes implantadas com médicos. A proporção de nascidos vivos de mães por consultas de pré-natal apresentou tendência crescente na maioria dos municípios, aumentando em média 97%, predominando 7 ou mais consultas e reduzindo a proporção de nascidos vivos de mães sem consulta pré-natal. A taxa de mortalidade infantil obteve tendência de queda a partir de 2014. Os resultados sinalizam melhoria da atenção primária, a partir dos indicadores selecionados, impulsionando a ESF na região estudada.(AU)

This study aimed to evaluate the performance of the Family Health Strategy after implementation of the More Physicians Program (MPBP) in the territory of Marajó-Pa-Brazil through an historical series of four primary care indicators during 2011-2015: population coverage, proportion of live births to mothers with/without prenatal consultations, hospitalization rates due to primary care sensitive condition (taxas de internações por condições sensíveis à atenção primária - ICSAP) and infant mortality rate. A trend of improvement was evident after implementation of the MPBP in 2013, achieving 42.8% of coverage in December 2015. In April 2014, all 16 municipalities had established teams with physicians. The proportion of live births to mothers with/without prenatal consultations showed increasing trends in most municipalities, increasing by 97% on average, predominantly with seven consultations or more and reducing the proportion of live births to mothers without prenatal visits. The infant mortality rate achieved a downward trend starting in 2014. The results indicate improvements in primary care based on the selected indicators, boosting the Family Health Strategy (FHS) in the studied region.(AU)

Cross-cultural adaptation of the Four Habits Coding Scheme (4HCS) for teaching and assessing patient-centered communication skills in Brazil / Adaptação transcultural do Four Habits Coding Scheme (4HCS) para o ensino e avaliação de habilidades de comunicação centradas no paciente no Brasil / Adaptación transcultural del Four Habits Coding Scheme (4HCS) para la enseñanza y evaluación de habilidades de comunicación centradas en el paciente en Brasil

Abstract: Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians' communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as "Engage in small talk", "Expansion of concerns", "Elicit full agenda", "Use patient's frame of reference", and "Explore plan acceptability". They also had difficulty in reaching consensus on the translation of the word "clinician", which was first translated as "physician". Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.

Resumo: As diretrizes brasileiras para a educação enfatizam as habilidades de comunicação centradas no paciente enquanto importante competência para os estudantes de medicina. O Four Habits Coding Scheme (4HCS) é um instrumento utilizado no ensino e avaliação das habilidades de comunicação do clínico em uma abordagem de cuidado centrado na pessoa. O nosso objetivo foi traduzir e realizar a adaptação transcultural do 4HCS para o português do Brasil. O processo de tradução foi realizado em sete estágios: tradução independente, reconciliação, retro-tradução, revisão pelo autor, revisão independente - consenso através da técnica Delphi -, revisão por um coordenador linguístico e pré-teste. Durante o pré-teste, três observadores independentes avaliaram quatro consultas médicas realizadas por estudantes e residentes de medicina que foram gravadas em um cenário de atendimento real. Os revisores tiveram dificuldade em chegar a um consenso sobre expressões referentes à compreensão da pessoa como um todo, tais como "engage in small talk", "expansion of concerns", "elicit full agenda", "use patient's frame of reference" e "explore plan acceptability". Também tiveram dificuldade em chegar a um consenso sobre a tradução da palavra "clinician", que fora traduzida primeiro como "médico". Questões históricas e culturais na relação médico-paciente podem ter influenciado o resultado. A versão brasileira do 4HCS é um instrumento válido no sentido cultural, conceitual, semântico e operacional. Pode representar um avanço importante no fortalecimento do modelo de cuidado centrado no paciente no Brasil.

Resumen: Las directrices brasileñas para la educación enfatizan las habilidades de comunicación centradas al paciente, por considerarla una importante competencia para los estudiantes de medicina. El Four Habits Coding Scheme (4HCS) es un instrumento utilizado en la enseñanza y evaluación de las habilidades de comunicación dentro del ámbito clínico, desde una perspectiva de cuidado centrado en la persona. El objetivo fue traducir y realizar la adaptación transcultural del 4HCS al portugués de Brasil. El proceso de traducción se realizó en siete fases: traducción independiente, conciliación, retro-traducción, revisión por parte del autor, revisión independiente -consenso a través de la técnica Delphi-, revisión por parte de un coordinador lingüístico y prueba previa. Durante la prueba previa, tres observadores independientes evaluaron cuatro consultas médicas, que fueron realizadas por estudiantes y residentes de medicina que se grabaron en un escenario de atención real. Los revisores tuvieron dificultades para llegar a un consenso sobre expresiones referidas a la comprensión de la persona como un todo, tales como "engage in small talk", "expansion of concerns", "elicit full agenda", "use patient's frame of reference" y "explore plan acceptability". También tuvieron dificultades para llegar a un consenso sobre la traducción de la palabra "clinician", que se tradujo en primera instancia como "médico". Las cuestiones históricas y culturales en la relación médico-paciente pueden haber influenciado el resultado. La versión brasileña del 4HCS es un instrumento válido, en el sentido cultural, conceptual, semántico y operacional. Puede representar un avance importante en el fortalecimiento del modelo de cuidado centrado en el paciente en Brasil.