Egressos de um programa de residência multiprofissional em cardiopneumologia e inserção no mercado de trabalho / Egresses from a multiprofessional residency program in cardiopneumology and insertion in the labor market / Egresos de un programa de residencia multiprofesional en cardiopneumología e inserción en el mercado de trabajo

A Residência Multiprofissional é uma importante estratégia de Educação Permanente (EPS) no Sistema Único de Saúde (SUS), sendo a primeira oportunidade para muitos recém-graduados de exercer sua profissão e adquirir experiência. O objetivo do presente estudo foi conhecer o perfil de profissionais egressos de um programa de Residência Multiprofissional em Cardiopneumologia no Ceará e sua inserção no mercado de trabalho. No estudo, transversal e quantitativo, coletaram-se dados socioeconômicos, sociodemográficos e sobre histórico no mercado de trabalho, entre junho e outubro de 2022, via formulário eletrônico enviado aos egressos. A grande maioria estava empregada, atuando no SUS como terceirizados, vinculados como celetistas ou cooperados, em áreas de atuação diversas, destacando o potencial de contribuição na saúde, na educação e na gestão pública. Estudos com profissionais egressos de outros programas hospitalares são necessários para melhor elucidar as potencialidades, contribuições e lacunas do processo formativo à inserção dos profissionais no mercado de trabalho.

Multiprofessional Residency is an important strategy for Continuing Education (PDE) in the Unified Health System (SUS), being the first opportunity for many recent graduates to exercise their profession and acquire experience. The aim of this study was to know the profile of professionals graduating from a Multiprofessional Residency in Cardiopneumology program in Ceará and their insertion in the labor market. In this cross-sectional and quantitative study, socioeconomic, sociodemographic and labor market history data were collected between June and October 2022, via an electronic form sent to the graduates. The vast majority were employed, working in the SUS as outsourced, contracted, or cooperative workers, in diverse areas, highlighting the potential to contribute to health, education, and public management. Studies with professionals graduating from other hospital programs are necessary to better elucidate the potentialities, contributions, and gaps of the formative process to the insertion of the professionals in the labor market.

La Residencia Multiprofesional es una importante estrategia de Educación Continuada (PDE) en el Sistema Único de Salud (SUS), siendo la primera oportunidad para muchos recién graduados de ejercer su profesión y adquirir experiencia. El objetivo de este estudio fue conocer el perfil de los profesionales egresados de un programa de Residencia Multiprofesional en Cardoneumología en Ceará y su inserción en el mercado de trabajo. En este estudio transversal y cuantitativo, se recogieron datos socioeconómicos, sociodemográficos y de historia laboral entre junio y octubre de 2022, a través de un formulario electrónico enviado a los graduados. La gran mayoría estaba empleada, trabajando en el SUS como tercerizados, contratados o cooperativistas, en diversas áreas, destacando el potencial de contribución a la salud, educación y gestión pública. Estudios con profesionales egresados de otros programas hospitalarios son necesarios para dilucidar mejor las potencialidades, contribuciones y lagunas del proceso formativo para la inserción de los profesionales en el mercado de trabajo.

Educação permanente em Saúde: Design Thinking para planejamento e construção de diretrizes / Educación permanente en salud: Design Thinking para planificar y construir lineamientos / Permanent education in health: Design Thinking for planning and constructing guidelines

Resumo Objetivo analisar o percurso do planejamento e construção de diretrizes de Educação Permanente em Saúde em uma regional de saúde. Método pesquisa participativa, desenvolvida pelo Design Thinking como estratégia colaborativa para o planejamento e construção de diretrizes de Educação Permanente em Saúde em uma Regional de Saúde do estado do Paraná-Brasil. Participaram gestores municipais, profissionais de saúde e representantes da Regional de Saúde, totalizando 32 participantes. Realizaram-se análise documental, grupos focais e formulários online para coleta de dados, que foram analisados segundo a Política Nacional de Educação Permanente em Saúde e a concepção dialógica problematizadora do percurso colaborativo. Resultados apontaram que o planejamento regional descreve ações de educação em saúde majoritariamente generalistas e quantificáveis, e que suscitaram inquietudes quando refletidas coletivamente. A atividade colaborativa oportunizou espaços de problematização do planejamento de Educação Permanente em Saúde, relações dialógicas, construção de conhecimento ancorado na ressignificação das práticas e elaboração coparticipativa de diretrizes qualitativas de educação permanente pautadas na reflexão da realidade vivenciada. Considerações finais implicações para prática o Design Thinking promoveu protagonismo e transformação de saberes e gestão por meio do diálogo emancipatório. O estudo corrobora de forma significativa a adoção do planejamento coparticipativo e regional de Educação Permanente em Saúde pela ressignificação das práticas.

Resumen Objetivo analizar el curso de planificación y construcción de directrices para la Educación Permanente en Salud en una regional de salud. Método investigación participativa, desarrollada por Design Thinking como estrategia colaborativa para la planificación y construcción de directrices para la Educación Permanente en Salud en una Regional de Salud del estado de Paraná, Brasil. Participaron gestores municipales, profesionales de la salud y representantes de la Región Sanitaria, totalizando 32 participantes. Se realizaron análisis documentales, grupos focales y formularios en línea para la recolección de datos, los cuales fueron analizados de acuerdo con la Política Nacional de Educación Permanente en Salud y la concepción dialógica problematizadora del camino colaborativo. Resultados señalaron que la planificación regional describe mayoritariamente acciones de educación en salud generalistas y cuantificables, y que suscitó preocupación cuando se reflexiona colectivamente. La actividad colaborativa brindó espacios para cuestionar la planificación de la Educación Permanente en Salud, las relaciones dialógicas, la construcción de saberes anclados en la redefinición de prácticas y la elaboración coparticipativa de lineamientos cualitativos para la educación permanente a partir del reflejo de la realidad vivida. Consideraciones finales e implicaciones para la práctica el Design Thinking promovió el protagonismo y la transformación del conocimiento y la gestión a través del diálogo emancipador. El estudio corrobora significativamente la adopción de la planificación coparticipativa y regional para la Educación Permanente en Salud por medio de la redefinición de prácticas.

Abstract Objective to analyze the course of planning and construction of guidelines for Permanent Education in Health in a health regional. Method participatory research, developed by Design Thinking as a collaborative strategy for the planning and construction of guidelines for Permanent Education in Health in a Health Region in the state of Paraná, Brazil. Municipal managers, health professionals, and representatives of the Health Region participated, totaling 32 participants. Documentary analysis, focus groups and online forms for data collection were carried out, which were analyzed according to the Brazilian National Policy on Permanent Education in Health and the problematizing dialogic conception of collaborative path. Results they pointed out that regional planning describes mostly generalist and quantifiable health education actions, and that raised concerns when collectively reflected. The collaborative activity provided spaces for questioning the planning of Permanent Health Education, dialogical relationships, construction of knowledge anchored in the re-signification of practices and co-participatory elaboration of qualitative Permanent Health Education guidelines based on the reflection of experienced reality. Final considerations and implications for practice Design Thinking promoted leading role and transformation of knowledge and management through emancipatory dialogue. The study significantly corroborates the adoption of co-participatory and regional planning for Permanent Education in Health by redefining practices.

A importância dos registros de enfermagem no contexto avaliativo da auditoria / The importance of nursing records within the audit assessment context

Objetivo: Analisar a importância dos registros de enfermagem no contexto avaliativo da auditoria. Método: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados LILACS, MEDLINE e BDENF, por meio dos descritores Auditoria de Enfermagem; Auditoria Clínica; Registros de Enfermagem; Anotações de Enfermagem e Enfermagem. A busca foi realizada de 12 de janeiro a 26 de fevereiro de 2018 e selecionados 17 artigos que compõem o estudo. Resultados: a importância dos registros de enfermagem no contexto avaliativo da auditoria se dá pela investigação da qualidade do cuidado prestado por meio das evidências proporcionadas nos registro/anotações de enfermagem no portuário do paciente, evitar prejuízos na continuação do cuidado, intensificar sugestões de implantações de valores educacionais por meio da educação continuada e permanente, resgatar os valores econômicos perdidos por glosas em contas hospitalares e promover a melhoria da qualidade da assistência. Conclusão: foi possível verificar que, mesmo sendo uma prática que deva ser realizada com qualidade, o processo de auditora ainda encontra muita fragilidade nas informações encontradas nos diversos registros do profissional de enfermagem, o que acarreta grandes prejuízos.

Objective: To analyze the importance of nursing records in the evaluative context of the audit. Method: This is an integrative literature review performed in the LILACS, MEDLINE and BDENF databases using the descriptors Nursing Audit; Clinical audit; Nursing records; Nursing and Nursing Notes. The search was performed from January 12 to February 26, 2018, selecting a total of 17 articles. Results: the importance of nursing records in the evaluative context of the audit is due to the investigation of the quality of care provided through the evidence provided in the nursing records/annotations in the patient's chart, avoiding losses in the continuation of care, intensifying suggestions for implantation of nursing care, educational values through continuing and continuing education, recovering the economic values lost by disallowances in hospital bills and promoting the improvement of the quality of care. Conclusion: it was possible to verify that, even though it is a practice that should be performed with quality, the audit process still finds a lot of fragility in the information found in the various records of the nursing professional, which causes great losses.

Regimento interno [CIES. CIB-TO] / Internal regulations [CIES. CIB-TO]

Regimento para estabelecer normas, competências e procedimentos da Comissão Permanente de Integração Ensino-Serviço do Estado do Tocantins - CIES Estadual/CIB-TO, que é uma instância intersetorial e interinstitucional permanente que participa da formulação, condução, monitoramento e avaliação da Política de Educação Permanente em Saúde ­ EPS e atende o disposto no artigo 14 da Lei 8.080/1990, regulamentada pelo Decreto Presidencial N°. 7.508, de 28 de junho de 2011, e a Norma Operacional Básica de Recursos Humanos em Saúde (NOB/RH-SUS).

Rules to establish rules, competences and procedures of the Permanent Commission for Teaching-Service Integration of the State of Tocantins - State CIES / CIB-TO, which is a permanent intersectoral and interinstitutional body that participates in the formulation, conduction, monitoring and evaluation of the Education Policy Permanent in Health - EPS and meets the provisions of article 14 of Law 8.080 / 1990, regulated by Presidential Decree N °. 7,508, of June 28, 2011, and the Basic Operational Standard for Human Resources in Health (NOB / RH-SUS).

Normas para establecer normas, competencias y procedimientos de la Comisión Permanente de Integración Docente-Servicio del Estado de Tocantins - Estatal CIES / CIB-TO, que es un órgano permanente intersectorial e interinstitucional que participa en la formulación, conducción, seguimiento y evaluación de la Política Educativa. Permanente en Salud - EPS y cumple con lo dispuesto en el artículo 14 de la Ley 8.080 / 1990, reglamentado por Decreto Presidencial N °. 7,508, del 28 de junio de 2011, y la Norma Básica Operativa de Recursos Humanos en Salud (NOB / RH-SUS).

Components of an Effective Professional Development Strategy: The Professional Practice Model, Peer Feedback, Mentorship, Sponsorship, and Succession Planning.

OBJECTIVES: To review components of an effective professional development strategy in the oncology setting that includes mentorship, sponsorship, and succession planning. DATA SOURCES: OvidSP, practice standards, professional guidelines, and websites. CONCLUSIONS: There are compelling reasons why oncology nurses in all settings are required to remain current in their area of practice and use strategies that take advantage of available opportunities for professional development. Benefits include enhanced autonomy, strengthened individual competence, greater engagement, and enriched organizational cultures that can positively impact patient care. IMPLICATIONS FOR NURSING PRACTICE: Creating an environment that supports professional development is dependent on nurse leaders and the organizational commitment to the value of lifelong learning. Professional development can be enabled through many structures, including mentorship, sponsorship, and succession planning.

Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy.

PURPOSE: Palliative radiation therapy (PRT) has an essential role in cancer symptom control but is underutilized in Ontario. This initiative aimed to implement an educational outreach intervention to improve knowledge of and access to PRT among interprofessional palliative health care teams across an Ontario Local Health Integration Network. METHODS AND MATERIALS: A needs assessment was completed from June to September 2018 with interprofessional palliative health care teams. Participants completed a survey to identify perceived opportunities, barriers, and enablers to recommending or referring patients for PRT. Thematic analysis informed content of the educational outreach intervention and included how to access PRT, common indications, case studies, and side-effect management after completing PRT. The educational outreach intervention was completed from October 2018 to January 2019. Participants completed a survey, and results were analyzed using descriptive statistics. The number of patients who received PRT was determined by cross-referencing the regional database with the radiation oncology information system. RESULTS: Although 22.9% of participants had previously recommended or referred patients, 96.2% of participants agreed or strongly agreed that they are likely to recommend or refer patients for PRT after the educational outreach intervention (n = 131). An increase was observed in the number of patients receiving PRT from the community during the intervention period. CONCLUSIONS: The educational outreach intervention improved knowledge and the likelihood of interprofessional palliative health care teams providing access to PRT for patients in the community. More patients now receive PRT, conveying improved symptom control and quality of life.

Análise dos serviços de Cirurgia Plástica da Sociedade Brasileira de Cirurgia Plástica sob o ponto de vista dos cirurgiões do último ano do curso de especialização em Cirurgia Plástica / Analysis of Training in Plastic Surgery by the Brazilian Society of Plastic Surgery as Reported by Final Year Trainees

Introdução: Muito se discute sobre a formação do cirurgião plástico na especialização médica nacional e internacionalmente. Há necessidade da busca por melhoras e padronização na formação visando o futuro da especialidade. Métodos: Foi avaliado protocolo preenchido no Congresso Brasileiro de Cirurgia Plástica (Belo Horizonte) por especializandos do terceiro ano. Resultados: Foram distribuídos 230 protocolos. 113 protocolos foram incluídos. A amostra incluiu 71 homens e 41 mulheres. 34 eram de serviços cadastrados pela Sociedade Brasileira de Cirurgia Plástica (SBCP) e 71 eram de serviços cadastrados pelo Ministério da Educação e SBCP. 96 afirmaram que em seus serviços são realizados procedimentos puramente estéticos, com média de 54,3% de procedimentos estéticos. O procedimento com menos confiança em realizar foi transplante capilar, e mais confiança foi abdominoplastia. Área de interesse mais requisitada foi rinoplastia e a menos foi abdominoplastia. Os especializandos estão regularmente satisfeitos com seus programas, com média de 3,89, em uma escala de 1 a 5. O procedimento que deve ser mais realizado foi rinoplastia, sendo necessário, do ponto de vista deles, realizar mais de 10 procedimentos. Os especializandos sentem-se bem preparados pela programa, com média de 3,8 em uma escala de 1 a 5. 65% deles acham necessário fazer fellow, sendo o mais requisitado de mastologia. O procedimento mais realizado foi mamoplastia redutora. A maioria dos especializandos quer trabalhar em clínica privada. Conclusão: Visando aprimorar a formação acadêmica, é necessário que os serviços credenciados se adequem aos requisitos necessários para a boa formação dos especializandos.

Introduction: Much has been discussed about the training of a plastic surgeon nationally and internationally. There is a need to improve and standardize training to ensure the future of this specialty. Methods: Questionnaires were filled by third year trainees at the Brazilian Congress of Plastic Surgery (Belo Horizonte). Results: A total of 230 questionnaires were distributed and 113 were included in the study. The respondents included 71 men and 41 women; 34 were from institutions recognized by the Brazilian Society of Plastic Surgery (SBCP) and 71 were from institutions recognized by the Ministry of Education and the SBCP. Ninety-six respondents revealed that purely aesthetic procedures were conducted in their institutions, with an average of 54.3% of aesthetic procedures. The respondents had the least confidence in performing hair transplants and the most confidence in performing an abdominoplasty. The topic most requested for training was rhinoplasty and the least requested was abdominoplasty. The trainees were fairly satisfied with their programs, with an average satisfaction level of 3.89, on a scale of 1 to 5. The procedure that needed to be performed more frequently was rhinoplasty (more than 10 procedures). Most trainees felt that the program prepared them to practice surgeries, with an average of 3.8 on a scale of 1 to 5. Further, 65% found it necessary to have a fellowship, with mastology being the most requested. The most common procedure was reduction mammoplasty. Most of the trainees wanted to work in a private clinic. Conclusion: In order to improve the level of education, the accredited institutions should meet the requirements necessary for good preparation of the trainees.

Educação permanente e gestão em saúde: a concepção de enfermeiros / Permanent education and health management: a conception of nurses / Educación permanente y gestión de la salud: una concepción de enfermeros

Objetivo: Analisar a compreensão de enfermeiros sobre a Educação Permanente em Saúde como ferramenta de gestão. Métodos: Investigação qualitativa realizada com o aporte teórico-metodológico da hermenêutica dialética. Os dados foram coletados por entrevistas com 14 enfermeiros. Resultados: Q maioria dos enfermeiros relata compreender a importância da Educação Permanente em Saúde como ferramenta de gestão, mas demonstra uma visão incipiente desta ao descrever práticas educativas como atividades de transmissão do conhecimento pontuais, geralmente direcionadas a um grupo profissional específico e com temáticas definidas à partir de necessidades gestoras. Conclusão: A Educação Permanente em Saúde, entendida como questionamento permanente e compartilhado do processo de trabalho, com vistas à transformação das práticas em saúde, é uma potente ferramenta para a mudança no cotidiano dos serviços, assim como na gestão do Sistema Único de Saúde

Objective: To analyze the nurses understanding of Permanent Education in Health as a management tool. Methods: Qualitative research supported by the theoretical-methodological contribution of the dialectical hermeneutics. The data collection consisted of interviews with 14 nurses. Results: Most nurses report understanding the importance of Permanent Education in Health as a management tool, but show an incipient view of it when describing educational practices as punctual knowledge transmission activities, usually directed to a specific professional group and with pre-defined themes based exclusively on management needs. Conclusion: Permanent Education in Health, understood as a permanent and shared analysis of work process, aiming at the transformation of health practices, is a powerful tool to promote changes in the services, as well as in the management of the Unified Health System (SUS)

Objetivo: Analizar la comprensión de enfermero sobre la Educación Permanente en Salud como herramienta de gestión. Métodos: Investigación cualitativa realizada con el aporte teórico-metodológico de la hermenéutica-dialéctica. Los datos se recopilaron por medio de entrevistas con 14 enfermeros. Resultados:La mayoría de los enfermeros relata comprender la importancia de la Educación Permanente en Salud como herramienta de gestión, pero demuestra una visión incipiente de ella en describir las prácticas educativas como actividades puntuales de trasmisión de conocimiento, en general dirigidas a un grupo específico de profesionales y con temáticas definidas a partir de las necesidades gestoras. Conclusión: La Educación Permanente en Salud, comprendida como cuestionamiento permanente y compartido del proceso de trabajo, con el fin de la transformación de las prácticas en salud, es una fuerte herramienta para el cambio en la cotidianidad de los servicios, así como en la gestión del Sistema Único de Salud (SUS)

Federal management of the More Doctors Program: the role of the Ministry of Education / Gestão federal do Programa Mais Médicos: o papel do Ministério da Educação / Gestión federal del Programa Más Médicos: el papel del Ministerio de la Educación

Abstract The More Doctors Program (PMM) has three axes of action and is grounded on the pedagogical guidelines of Permanent Education. Considering the Program's scope, which ranges from the emergency supply of doctors to the expansion of the number of seats in undergraduate and medical residency courses, its management is interministerial, as the Ministry of Health and the Ministry of Education share responsibilities for its full operation. This article reports on the construction of the Ministry of Education's experience of managing PMM, which includes the structuring of a new Directorate and new ways of doing management in this Ministry. It also points out the main difficulties and facilities throughout the process, and reflects on the perspectives and challenges for the Program's continuity and sustainability.(AU)

Resumo O Programa Mais Médicos (PMM) possui três eixos de atuação e é fundamentado pelas diretrizes pedagógicas da Educação Permanente. Considerando a abrangência do programa, que vai do provimento emergencial de médicos até a ampliação do número de vagas em cursos de graduação e residência em Medicina, sua gestão é interministerial, na qual o Ministério da Saúde (MS) e o Ministério da Educação (MEC) compartilham responsabilidades para seu pleno funcionamento. O presente trabalho relata a construção da experiência de gestão do PMM por parte do MEC, que inclui a estruturação de uma nova diretoria e de novos modos de fazer gestão nesse ministério. Também aponta as principais dificuldades e facilidades durante todo o processo, além de sinalizar importantes reflexões sobre as perspectivas e desafios para a continuidade e sustentabilidade do programa.(AU)

Resumen El Programa Más Médicos (PMM) posee tres ejes de actuación y está fundamentado por las directrices pedagógicas de la Educación Permanente. En el marco del Programa, que va desde la provisión de emergencia de médicos hasta la ampliación del número de plazas en cursos de graduación y residencia en Medicina, su gestión es interministerial, en donde el Ministerio de Salud (MS) y el Ministerio de Educación (MEC) comparten responsabilidades para su pleno funcionamiento. El presente trabajo relata la construcción de la experiencia de gestión del PMM por parte del MEC, que incluye la estructuración de una nueva Dirección y de nuevos modos de realizar la gestión en este Ministerio. También señala las principales dificultades y facilidades durante todo el proceso, además de mostrar importantes reflexiones sobre las perspectivas y desafíos para la continuidad y sostenibilidad del Programa.(AU)

Mágica ou magia? Colegiados gestores no Sistema Único de Saúde e mudanças nos modos de cuidar / ¿Mágica o magia? Colegiados gestores en el Sistema Brasileño de Salud y cambios en los modos de cuidar / Magic or enchantment? Management committees in the Brazilian National Health System and changes in healthcare modes

Em uma pesquisa sobre a produção do cuidado nas redes de saúde, avaliou-se o papel dos colegiados de gestão em uma experiência de mudança no governo da saúde. Com metodologia qualitativa de abordagem cartográfica, observou-se que a ativação dos colegiados pela gestão visava uma dupla tarefa: por um lado, a democracia institucional, e por outro, a criação de governabilidade para a mudança proposta. No entanto, predominavam nesses colegiados pautas restritas aos agires técnicos ou profissionais, além de uma certa tensão junto com vários atores da rede. Por outro lado, também houve encontros nos quais se vivenciou novos pactos intra e entre-equipes, mediante relações simétricas e de coautoria: um analisador aqui denominado magia a-significante. Conclui-se como possível que os colegiados gestores configurem-se como cenários para uma mudança, e para tanto propõe-se o seu engravidamento com ferramentas de educação permanente em Saúde.

En una investigación sobre la producción del cuidado en las redes de salud se evaluó el papel de los colegiados de gestión en una experiencia de cambio en el gobierno de la salud. Con metodología de abordaje cartográfico, se observó que la activación de los colegiados por la gestión tenía como objetivo una tarea doble: por un lado, la democracia institucional y, por el otro, crear gobernabilidad para el cambio propuesto. Sin embargo, predominaban en ellos las mismas pautas restringidas a las actuaciones técnicas o profesionales, además de una cierta tensión en relación a varios de los actores de la red. Por otro lado, también hubo encuentros en los cuales se experimentaron nuevos pactos intra y entre equipos, mediante relaciones simétricas y de coautor: Un analizador aquí denominado magia a-significante. Se concluye como posible que los colegiados gestores se configuren como escenarios para un cambio y para ello se propone que ellos contengan herramientas de Educación permanente en salud.

In a qualitative research about healthcare production in the health networks, the role of management committees in an experience of change in the government of health was evaluated. Using a cartographic approach, we found that the activation of the committees by the government aimed at a double task: to promote institutional democracy and to create governability for the proposed change. Nevertheless, the committees' agendas were predominantly restricted to technical or professional matters, and there was some tension involving several of the network actors. On the other hand, there were encounters in which intra- and inter-team pacts were experienced, through symmetrical and co-authorial relationships: an analyzer that we called "a-significant enchantment". We conclude that the management committees can configure themselves as scenarios for a change, and to that end, we propose to make them pregnant with Permanent Health Education tools.

Enhancing Routine HIV Testing in Primary Care With a Continuing Education Intervention.

Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended routine HIV screening in primary care settings for people ages 13 to 64, regardless of individual risk factors. However, an extensive body of research has identified several barriers to primary care providers' (PCPs) adherence to the CDC recommendations. Employing a pre-postintervention design, this study provided an assessment of barriers among 11 PCPs and implemented an evidence-based continuing education program adapted to the specific individual barriers they identified. The study found that PCPs were initially providing HIV testing using risk-based criteria but that the continuing education program increased intentions to perform routine HIV testing (e.g., during annual wellness examinations and new patient visits). Results of the study inform individual quality improvement projects and legislative or policy actions to increase HIV screening in sites providing primary care. [J Contin Educ Nurs. 2018;49(12):563-574.].

Choosing Wisely in Georgia: A Quality Improvement Initiative in 25 Adult Ambulatory Medicine Offices.

BACKGROUND: Scant evidence exists of effective Choosing Wisely® initiatives, which are intended to reduce the use of unnecessary care. In 2013 substantial variations existed at Kaiser Permanente Georgia in the frequency of nonbeneficial services in ambulatory care. A Choosing Wisely campaign was implemented across 25 medical offices serving approximately 300,000 members. METHODS: The initiative was designed to reduce the use of complete blood counts (CBCs) and electrocardiograms (EKGs) as routine screening tests in physical examination visits, age-inappropriate dual-energy x-ray absorptiometry (DEXA) scans, and imaging for uncomplicated headache. The change management package consisted of (1) guideline selection by clinical leaders, (2) continuing medical education for clinicians and training and education for clinic staff and advice nurses, (3) an internal and external communication plan, and (4) monthly reports. RESULTS: Between January 2013 and December 2016, CBC use as a routine screening test decreased by 39.5 percentage points (95% confidence interval [CI] = 39.0-40.0)-from an average of 42.7% to 3.2%; EKG use as a routine screening test decreased by 15.5 percentage points (95% CI = 15.1-15.8)-from an average of 15.9% to 0.3%; inappropriate DEXA scan use decreased by 23.4 percentage points (95% CI = 22.5-24.5)-from an average of 25.4% to 2.0%; and imaging for uncomplicated headache decreased by 3.9 percentage points (95% CI = 3.3-4.6)-from an average of 10.8% to 6.9%. All decreases were statistically significant (p < 0.05) and were largely sustained after monthly reports ended. CONCLUSION: Sustained reductions in nonbeneficial services in ambulatory care followed implementation of a comprehensive change management package.

Technology for improving accessibility of end-of-life care: Extension for Community Healthcare Outcomes Project.

PURPOSE OF REVIEW: To describe how Project ECHO works and to analyze what has been published on Project ECHO Palliative Care (Project ECHO PC) over the last 18 months. RECENT FINDINGS: Only two articles on Project ECHO PC have been published over the last 18 months: a descriptive study of experiences in seven health centers of the United States, the United Kingdom, Uruguay and India; and a quantitative and qualitative study of the impact of the teleECHO clinic on physicians and nurses in Northern Ireland, which reports a significant boost in knowledge acquisition and self-efficacy. SUMMARY: Project ECHO is an innovative telemedicine strategy, which creates learning communities, which use a standardized methodology and benefits healthcare professionals, particularly primary care providers or practitioners based on remote or rural areas.Since 2011, Project ECHO PC has been implemented in 12 health centers in 4 different countries, with greater growth in 2017. It has facilitated a wider access to professional education, improvements in clinical practice and knowledge acquisition, the development of professional curricula and more confidence and self-efficacy among healthcare professionals. Project ECHO PC is engaged in several international initiatives to aid countries with different degrees of palliative care development.

Improving Rural Nurse Practitioner Knowledge About Polycystic Ovary Syndrome Through Continuing Education.

BACKGROUND: Polycystic ovary syndrome (PCOS), a common androgen-excess disorder in reproductive-aged women, is often a missed diagnosis. Rural nurse practitioners (NPs) need to be able to diagnose and provide basic management for PCOS. This study's objective was to determine whether a continuing education program about PCOS would improve NPs' knowledge about PCOS. METHOD: A pretest-posttest design was used. Forty-eight participants attending a regional NP conference completed a pretest before a continuing education presentation about PCOS. Afterward, 43 participants completed an identical posttest. A two-step multivariate analysis of variance compared the results. RESULTS: Pretest results indicated NPs had low levels of knowledge for assessing, diagnosing, and managing PCOS. The posttest results demonstrated significant (p = .000) improvements in these areas. CONCLUSION: Continuing education presentations have the potential to increase rural NPs' knowledge about PCOS so they can provide evidence-based care to rural women with PCOS. J Contin Educ Nurs. 2018;49(4):164-170.

Intersectionality and the LGBT Cancer Patient.

OBJECTIVES: To present the ways in which race, ethnicity, class, gender, and sexual orientation interact in the context of cancer risk, access to care, and treatment by health care providers. Cancer risk factors, access to care, and treatment for lesbian, gay, bisexual, and transgender (LGBT) patients are discussed within the context of intersectionality and cultural humility. DATA SOURCES: Peer reviewed articles, cancer organizations, and clinical practice. CONCLUSION: LGBT patients have multiple identities that intersect to create unique experiences. These experiences shape their interactions with the health care system with the potential for positive or negative consequences. More data is needed to describe the outcomes of those experiences and inform clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have an obligation to acknowledge patients' multiple identities and use the practice of cultural humility to provide individualized, patient-centered care.

The Future of LGBT Cancer Care: Practice and Research Implications.

OBJECTIVES: To synthesize state of the knowledge collected in this volume and propose future directions for lesbian, gay, bisexual and transgender (LGBT) cancer practice, education, research, and advocacy. DATA SOURCES: Current and extant literature. CONCLUSION: Health care disparities that are known but not yet fully elucidated in the LGBT population carry into the cancer arena. Substantially more effort is required in the domains of patient care, nursing practice, nursing and patient-facing services provider education, patient education, nursing and interprofessional research, governmental commitment, professional organization action, and patient advocacy. IMPLICATIONS FOR NURSING PRACTICE: Professional nurses are committed to the uniqueness of each individual and respect and value the health and well-being of each individual. To that commitment, oncology nurses are positioned to advance the research in the field, which will help to clarify the issues and concerns related to LGBT cancer, address the health care inequities in this important population, and lead to improved outcomes for all.

Plano estadual de educação permanente em saúde do Tocantins: 2020-2023 / State plan of permanent education in health of Tocantins: 2020-2023

Trata do instrumento de gestão que deve nortear as ações de educação permanente em saúde nos 139 municípios do estado do Tocantins, balizado nas ações da Política Nacional de Educação Permanente em Saúde e os princípios do SUS. Tem o propósito de transformar as práticas para qualificar o cuidado em saúde.

It deals with the management instrument that should guide the actions of permanent education in health in the 139 municipalities of the state of Tocantins, guided by the actions of the National Policy of Permanent Education in Health and the principles of SUS. Has the purpose of transforming practices to qualify health care.

Se trata del instrumento de gestión que debe orientar las acciones de educación permanente en salud en los 139 municipios del estado de Tocantins, guiados por las acciones de la Política Nacional de Educación Permanente en Salud y los principios del SUS. Tiene el propósito de transformar las prácticas para calificar la atención médica.

Saúde mental e atenção básica no cuidado aos usuários de álcool e outras drogas / Mental health and primary care in alcohol and drug users care / Salud mental y atención primaria en atención a los usuarios de alcohol y otras drogas

Este artigo aborda a integração entre o cuidado em saúde mental e a atenção básica no Sistema Único de Saúde (SUS). Discute a participação dos tutores do Projeto Caminhos do Cuidado - Formação em crack, álcool e outras drogas para Agentes Comunitários de Saúde e Auxiliares e Técnicos de Enfermagem, e a contribuição da formação em Saúde Mental para sua vida profissional. A participação dos tutores foi analisada por banco de dados secundários, organizado a partir de formulários eletrônicos. Dos 890 questionários preenchidos, foram analisadas três questões abertas, utilizando-se a Análise de Conteúdo como método. A formação mostrou-se capaz de transformar a imagem de preconceito em relação aos usuários de álcool e outras drogas; essa mudança despertou novas possibilidades para o cuidado na Atenção Básica, além de desenvolver capacidades pedagógicas para a educação permanente em saúde.

The present paper approaches the integration between care in mental health and basic attention in Brazilian National Health System (SUS). The focus of the discussion is tutors' participation in Caminhos do Cuidado (Care Paths) Project- Training in Crack, Alcohol and other drugs given to Community Health Agents and Nursing Technicians and the contribution of Mental Health training for their professional lives. The tutors' participation was analyzed using a secondary data base organized from electronic forms. From a total of 890 questionnaires, we analyzed three open questions using content analysis as a method. The training revealed itself capable of transforming prejudiced images in relation to other drug users and this change has awakened new possibilities for care in primary health care, as well as it developed pedagogical capacities to be used in continuing education in health.

Este artículo aborda la integración entre el cuidado en salud mental y la atención básica en el Sistema Brasileño de Salud (SUS). Discute la participación de los tutores del Proyecto Caminos del Cuidado - Formación en crack, alcohol y otras drogas para Agentes Comunitarios de Salud y Auxiliares Técnicos de Enfermería y la contribución de la formación en Salud Mental para su vida profesional. La participación de los tutores fue analizada por banco de datos secundarios, organizado a partir de formularios electrónicos. De los 890 cuestionarios llenados, se analizaron tres preguntas abiertas, utilizándose como método el Análisis de Contenido. La formación se mostró capaz de transformar la imagen de prejuicio en relación a los usuarios de alcohol y de otras drogas; ese cambio despertó nuevas posibilidades para el cuidado en la Atención Básica, además de desarrollar capacidades pedagógicas para la educación permanente en salud.

Public Health Detailing to Increase Routine HIV Screening in Baltimore, Maryland: Satisfaction, Feasibility, and Effectiveness.

The objective of this study was to evaluate the satisfaction with, and the feasibility and effectiveness of, a public health detailing project focused on increasing routine human immunodeficiency virus (HIV) screening of people aged 13-64 by primary care providers working in areas of Baltimore City, Maryland, with high rates of HIV transmission (defined as a mean geometric viral load of ≥1500 copies/mL per census tract). In public health detailing, trained public health professionals (ie, detailers) visit medical practice sites to meet with providers and site staff members, with the intention of influencing changes in clinical practice policy and/or behavior. During 2014, detailers made personal visits and gave HIV Testing Action Kits containing maps, educational and guideline documents, and resource lists to 166 providers and office managers at 85 primary care sites. At follow-up, 88 of 91 (96.7%) providers and 37 of 38 (97.4%) clinic managers were very satisfied or satisfied with the project. Of the 79 sites eligible at follow-up (ie, those that had not closed or merged with another practice), 76 (96.2%) had accepted at least 1 HIV Testing Action Kit, and 67 of 90 (74.4%) providers had increased their HIV screening. Public health detailing projects can be used to educate and support providers, establish relationships between providers and local health departments, and disseminate public health messages.