Lineamientos técnicos para la supervisión de enfermería / Technical guidelines for nursing supervision

La supervisión de los servicios de enfermería es fundamental para constatar que se proporcione el cuidado con eficiencia, eficacia, calidad, calidez y equidad a la persona familia y comunidad, con conocimientos técnico científicos y tecnológicos, en las Redes Integrales e Integradas de Salud (RIIS) del Ministerio de Salud. En ese sentido los(as) profesionales de enfermería, aportan decididamente a la organización de la prestación de servicios de salud, ajustando su accionar al enfoque integral; por ello es importante fortalecer la función de supervisión en los diferentes niveles de atención para incidir positivamente, con procesos y procedimientos técnico-administrativos que faciliten la mejora continua de la calidad del cuidado de enfermería, que forma parte de un equipo multidisciplinario dentro de la organización

Supervision of nursing services is essential to ensure that care is provided efficiently, effectively, quality, warmth and equity to the family and community, with scientific and technological know-how, Integrated Health Networks (RIIS) of the Ministry of Health. In this sense, the nursing professionals(s) contribute decisively to the organization of the provision of health services, adjusting their actions to the comprehensive approach; therefore it is important to strengthen the supervisory function at the different levels of care in order to have a positive impact, with processes and administrative procedures that facilitate the continuous improvement of the quality of nursing care, part of a multidisciplinary team within the organization

Componente curricular projeto de vida: perspectivas de professoras da rede estadual de São Paulo / Curricular component life purpose: perspectives of teachers of the São Paulo state network / Componente curricular proyecto de vida: perspectivas de profesores de la red estadual de São Paulo

O objetivo deste estudo foi conhecer a experiência de alguns professores ao lecionar projeto de vida durante a implementação do componente curricular Projeto de Vida no estado de São Paulo. Realizou-se uma pesquisa qualitativa, de caráter exploratório. Participaram do estudo sete professoras que lecionavam o componente curricular Projeto de Vida em duas escolas públicas, de uma cidade do interior do estado de São Paulo, escolhidas por conveniência. Foram utilizados o Questionário de Dados Sociodemográficos e o Protocolo de Entrevista Semiestruturada para Projeto de Vida de Professores, elaborados para este estudo. As professoras foram entrevistadas individualmente, on-line, e as entrevistas foram gravadas em áudio e vídeo. Os dados foram analisados por meio de análise temática. Os resultados indicaram possibilidades e desafios em relação à implementação do componente curricular Projeto de Vida. Constatou- se que a maioria das docentes afirmou que escolheu esse componente curricular devido à necessidade de atingir a carga horária exigida na rede estadual. As professoras criticaram a proposta, os conteúdos e os materiais desse componente curricular. As críticas apresentadas pelas professoras estão em consonância com aquelas presentes na literatura em relação à reforma do Ensino Médio e ao Inova Educação. Esses resultados sugerem a necessidade de formação tanto nos cursos de licenciatura quanto em ações de formação continuada, para que os professores se sintam mais seguros e preparados para lecionar o componente curricular Projeto de Vida na Educação Básica. Propõe-se uma perspectiva de formação pautada na reflexão e na troca entre os pares para a construção de um projeto coletivo da escola para o componente Projeto de Vida.(AU)

This study aimed to know the experience of some teachers when teaching life purpose during the implementation of the curricular component "Life Purpose" (Projeto de Vida) in the state of São Paulo. A qualitative, exploratory research was carried out. Seven teachers who taught the curricular component "Life Purpose" (Projeto de Vida) in two public schools in a city in the inland state of São Paulo, chosen for convenience, participated in the study. The Sociodemographic Data Questionnaire and the Semi-structured Interview Protocol for Teachers' Life Purposes, developed for this study, were used. The teachers were interviewed individually, online, and the interviews were recorded in audio and video. Data were analyzed using thematic analysis. The results indicated possibilities and challenges regarding the implementation of the Life Purpose curricular component. It was found that most teachers chose this curricular component due to the need to reach the required workload in the state network. The teachers criticized the proposal, the contents and the materials of this curricular component. Teacher's critics are in line with the criticisms present in the literature regarding the reform of High School and Inova Educação. Therefore, training is essential, both in undergraduate courses and in continuing education actions, so that teachers can teach the curricular component Life Purpose in Basic Education. A training perspective based on reflection and exchange between peers is proposed for the construction of a collective school project for the Life Purpose component.(AU)

El objetivo de este estudio fue conocer la experiencia de algunos profesores al enseñar proyecto de vida durante la implementación del componente curricular Proyecto de Vida en el estado de São Paulo. Se realizó una investigación cualitativa, exploratoria. Participaron en el estudio siete profesores que impartían el componente curricular Proyecto de Vida en dos escuelas públicas en un municipio del estado de São Paulo, elegidos por conveniencia. Los instrumentos utilizados fueron el cuestionario de datos sociodemográficos y el protocolo de entrevista semiestructurada para proyectos de vida de profesores, desarrollados para este estudio. Las entrevistas a los profesores fueron en línea, de manera individual, y fueron grabadas en audio y video. Los datos se sometieron a un análisis temático. Los resultados indicaron posibilidades y desafíos en relación a la implementación del componente curricular Proyecto de Vida. La mayoría de los profesores declararon elegir este componente curricular por la necesidad de alcanzar la carga horaria requerida en la red estatal. Los profesionales criticaron la propuesta, los contenidos y los materiales de este componente curricular. Las críticas presentadas están en línea con las críticas presentes en la literatura respecto a la reforma de la educación básica e Inova Educação. Por lo tanto, la formación es fundamental, tanto en los cursos de grado como en las acciones de educación permanente, para que los profesores puedan impartir el componente curricular Proyecto de Vida en la educación básica. Se propone una formación basada en la reflexión y el intercambio entre pares para la construcción de un proyecto escolar colectivo en el componente Proyecto de Vida.(AU)

General Pediatricians' Performance of Accreditation Agency's Recommended Procedures: A Complementary Analysis Using Administrative Data and the Knowledge Translation Model.

INTRODUCTION: The Accreditation Council for Graduate Medical Education provided guidelines, in 2013, regarding 13 clinical procedures pediatric residents should learn. Previous studies show that, when asked, general pediatricians (GPeds) self-report performing these procedures infrequently. When examined using the knowledge translation model, this low procedural performance frequency, especially by GPeds, may indicate a problem within the primary care landscape. METHODS: This was a descriptive study using the Partners For Kids, an accountable care organization, database to obtain how frequently each of the procedures was performed for a geographically representative sample of GPeds in central Ohio. RESULTS: A total of 296 physicians participated in Partners For Kids. Nearly one-third practiced for more than 15 years (n = 83, 28%) and one-third also lived in a rural region (n = 78, 26.4%). The most commonly billed procedure was administering immunizations (n = 79,292, 92.3%); the least was peripheral intravenous catheter placement (n = 2, 0.002%). Most procedures were completed in the office-based setting. DISCUSSION: General pediatricians in central Ohio do not frequently perform the 13 recommended procedures of Accreditation Council for Graduate Medical Education. Evaluation of this problem using the knowledge translation model shows that potential barriers could be inadequate training during or after residency or more likely that these procedures are not necessary in GPeds' current scope of practice. The next step should be to see, from the practitioner's perspective, what procedures are important to their daily practice. Adapting this knowledge to the local context will help target continuing medical education/continuing professional development interventions.

Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer.

BACKGROUND: The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES: This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS: NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS: Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.

Norway's Healthcare Communities are set up to build bridges between hospitals and primary care

In 2012, the Coordination Reform was introduced inNorway to improve coordination between municipalities that organise primary care and the central government that organises specialised care. In 2020, a local governance reform is being implemented, and some municipalities and regions are being merged into larger entities. “Healthcare Communities”, a new partnership between hospitals and their surrounding municipalities, are being established to improve planning and development of services, as well as contribute to national planning. However, improving coordination between primary and specialist services may prove challenging, notably due to the way in which they are governed.

The Vasarhelyi Method of Child Art Psychotherapy in Child and Adolescent Mental Health Services: a stakeholder survey of clinical supervisors.

OBJECTIVES: The Vasarhelyi Method of Child Art Psychotherapy (CAP) is a largely understudied psychotherapeutic modality. This study aims to describe the Vasarhelyi Method of CAP and to describe a stakeholder survey of the views and attitudes of CAP placement supervisors towards CAP among various Child and Adolescent Mental Health Services (CAMHS) teams nationwide. METHODS: A phone- and letter-based survey of 17 CAP placement supervisors who oversee CAP masters students attached to CAMHS teams was performed. A questionnaire was designed enquiring about their experiences with CAP in their clinic and their thoughts on the validity of CAP in various conditions/patient demographics. Participants received written correspondence and were asked to return the survey by post; this was followed up by a telephone call to complete missing surveys. RESULTS: In all, 12 (70.6%) complete surveys were returned. Of the 12 respondents, all considered the CAP student to be a valuable member of the team. In total, 10 respondents (83.33%) stated they would make regular use of the service if it were made available to them. With regard to the therapy itself, nine respondents (75%) believed it was better for internalising symptoms than externalising symptoms. Depression, anxiety, attachment difficulties, trauma, deliberate self-harm and possible psychosomatic illnesses are the conditions viewed as receiving the most benefit from CAP. No gender difference was reported. CONCLUSION: CAP is considered an effective modality and valuable addition to a psychotherapeutic repertoire. Further, more extensive studies are needed in this field.

A Gestão do Conhecimento holística: análise de aderência do modelo de Mutuwa e Maiga / The holistic Knowledge Management: adherence analysis of the Mutuwa and Maita model / La Gestión del Conocimiento holística: análisis de adherencia del modelo de Mutuwa y Maiga

Há sinalizações acadêmicas para o desenvolvimento de modelos de gerenciamento do conhecimento pautados no paradigma holístico. Mutuwa e Maiga afirmam que não há um modelo unificador para o setor de saúde, o que permite inferir que o modelo desses autores se propõe ao atingimento desse feito. Assim, esta pesquisa se justifica pelo objetivo de analisar a aderência do modelo de Mutuwa e Maiga à Gestão do Conhecimento holística, de modo a identificar se esse modelo supre a lacuna de uma estrutura unificadora para este setor. Essa análise é realizada por meio de procedimentos metodológicos mistos, contemplando a abordagem qualitativa-quantitativa e a Análise de Conteúdo. Por resultado, há uma adesão de somente 15,4% do modelo de Mutuwa e Maiga à Gestão do Conhecimento holística, conforme caracterização apresentada nessa pesquisa, permitindo inferir que a Gestão do Conhecimento não tem demonstrado direcionamento para uma abordagem orientada ao paradigma holístico. Assim, esta pesquisa contribui por fomentar o desenvolvimento de novos modelos de gerenciamento do conhecimento alicerçados no paradigma holístico, considerando os delineamentos aqui expostos.

There are academic signals for the development of knowledge management models based on the holistic paradigm. Mutuwa and Maiga affirm that there is no unifying model for the health sector, which allows to infer that the model of these authors is proposed to reach this achievement. Thus, this research is justified by the objective of analyzing the adherence of the model of Mutuwa and Maiga to Holistic Knowledge Management, in order to identify if this model bridged the gap of a unifying structure for this sector. This analysis is performed by means of mixed methodological procedures, including qualitative-quantitative approach and Content Analysis. As a result, the model of Mutuwa and Maiga adheres in 15.4% to the Holistic Knowledge Management, according to the characterization presented in this research, allowing to infer that Knowledge Management has not presented a direction towards a holistic paradigm-oriented approach. Thus, this research contributes to foster the development of new models of knowledge management based on the holistic paradigm, considering the designs presented here.

Hay señales académicas para el desarrollo de modelos de gestión del conocimiento pautados en el paradigma holístico. Mutuwa y Maiga afirman que no hay un modelo unificador para el sector de salud, lo que permite inferir que el modelo de esos autores se propone al logro de ese hecho. Así, esta investigación se justifica por el objetivo de analizar la adherencia del modelo de Mutuwa y Maiga a la Gestión del Conocimiento holístico, para identificar si ese modelo suplía la laguna de una estructura unificadora para este sector. Este análisis se realiza a través de procedimientos metodológicos mixtos, contemplando el abordaje cualitativocuantitativo y el Análisis de Contenido. Por lo tanto, el modelo de Mutuwa y Maiga se adhiere en un 15,4% puntos porcentuales a la Gestión del Conocimiento holístico, conforme caracterización presentada en esa investigación, permitiendo inferir que la Gestión del Conocimiento no ha presentado direccionamiento para un enfoque orientado al paradigma holística. Así, esta investigación contribuye por fomentar el desarrollo de nuevos modelos de gestión del conocimiento fundamentados en el paradigma holístico, considerando los delineamientos aquí expuestos.

O cuidado da pessoa idosa na atenção primária à saúde sob a ótica dos profissionais de saúde / Elderly care in primary health care from the perspective of health professionals

The aging of the Brazilian population requires elderly care policies to be evaluated. Objective: To identify health professionals' perceptions about elderly care in Primary Health Care. Method: Case study with triangulation of data based on Ayres' vulnerability framework, conducted in the north of Paraná, Brazil. Data collection took place from January to March 2016 and was divided into: visit to and interview with the regional coordination, elderly care observation, documental analysis, and focal groups with 18 health professionals. Results: The analyses led to three categories: "Social and emotional vulnerability resulting in PHC dependence", "Network-organized services for comprehensive care" and "Poor human and financial resources". Primary Health Care evidences the elderly's social and individual vulnerabilities. Poorhuman and financial resources and a practice centered on curative, biologistic and therapeutic actions reveal a programmatic vulnerability, forcing professionals to take on secondary-and tertiary-level roles. Conclusion: Changes in management planned according to local difficulties and characteristics could boost strategies that mitigate vulnerabilities by means of qualification actions and strengthening of the social network and existing services.

Em decorrência do crescente envelhecimento da população brasileira, são necessárias avaliações das políticas de atenção à saúde do idoso. Objetivo:identificar as percepções dos profissionais de saúde referentes ao cuidado voltado à pessoa idosa na Atenção Primária à Saúde. Método:Estudo de Caso com Triangulação de dados embasado no referencial teórico de Vulnerabilidade de Ayres. Realizado no norte do Paraná, Brasil. A coleta ocorreu de janeiro a março de 2016 e dividiu-se em: visita à coordenação regional e realização de entrevista, observação da assistência ao idoso, análise documental e grupos focais com dezoito profissionais da saúde. Resultados:Após análise, emergiram três categorias: "Vulnerabilidade social e afetiva voltada para dependência da APS", "Serviços organizados em rede e voltados para o cuidado integral" e "Dificuldade de recursos humanos e financeiros". A Atenção Primária aponta vulnerabilidades social e individual da pessoa idosa. Dificuldades de recursos humanos e financeiros, prática centrada em ações curativas, biologistas e terapêuticas denunciam a vulnerabilidade programática, impelindo os profissionais a funções de nível secundário e terciário. Conclusão: Mudanças na gestão planejadas sob a ótica das dificuldades e características locais poderiam potencializar estratégias que diminuíssemas vulnerabilidades por meio de ações de capacitação e fortalecimento da rede social e serviços existentes.

Doctors' opinions on clinical coordination between primary and secondary care in the Catalan healthcare system.

OBJECTIVE: To analyse doctors' opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. METHODS: A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted. RESULTS: In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination. CONCLUSIONS: Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination.

Suppressive Effects of the Standardized Extract of Phyllanthus amarus on Type II Collagen-induced Rheumatoid Arthritis in Sprague Dawley Rats.

BACKGROUND: Standardized extract of Phyllanthus amarus has been shown to possess inhibitory effects on cellular and humoral immune responses in Wistar-Kyoto rats and Balb/c mice. OBJECTIVE: In the present study, the standardized extract of P. amarus was investigated for its suppressive effects on type II collagen-induced rheumatoid arthritis (TCIA) in Sprague Dawley rats. METHOD: The major components of the extracts, lignans and phenolic compounds were analysed by using a validated reversed phase HPLC and LC-MS/MS. A rheumatoid arthritis rat model was induced by administering a bovine type II collagen emulsion subcutaneously at the base of tail, on day 0 and 7 of the experiment. Effects of the extract on severity assessment, changes in the hind paw volume, bone mineral density, body weight and body temperature were measured. Concentrations of cytokines (TNF-α, IL-1ß, IL-1α, IL-6) released, matrix metalloproteinases (MMP-1, MMP-3 MMP-9) and their inhibitor (TIMP-1), haematological and biochemical changes were also measured. ELISA was used to measure the cytokines and proteinases in the rat serum and synovial fluid according to manufacturer's instructions. RESULTS: The extract dose-dependently modulated the progression in physical parameters (i.e. decrease in body weight, increase in body temperature, reduced hind paw volume, reduced the severity of arthritis), bone mineral density, haematological and biochemical perturbations, serum cytokines production and levels of matrix metalloproteinases and their inhibitor in the synovial fluid. Histopathological examination of the knee joint also revealed that the extract effectively reduced synovitis, pannus formation, bone resorption and cartilage destruction. CONCLUSION: The results suggest that the oral administration of a standardized extract of P. amarus was able to suppress the humoral and cellular immune responses to type II collagen, resulting in the reduction of the development of TCIA in the rats.

Competências dos profissionais técnicos de Enfermagem: o que esperam os enfermeiros gestores? / Competence of technical Nursing professionals: what to expect from nursing managers?

Objetivo: avaliar as competências esperadas por enfermeiros gestores para os técnicos de enfermagem. Metodologia: estudo quantitativo, descritivo e exploratório, desenvolvido em um hospital-escola de um município do sul de Minas Gerais. Participaram 12 enfermeiros dos setores de Clínica Médica, Clínica Cirúrgica, Pronto Socorro e Unidade de Terapia Intensiva. Para a coleta de dados, foi utilizado um instrumento elaborado pelas autoras que avalia as competências, por meio de uma escala de seis pontos, que varia entre “irrelevante” e “extremamente relevante”. Resultados: Observou-se maior valorização dos conhecimentos e habilidades técnicas em detrimento dos componentes atitudinais. Conclusão: As atitudes devem ser articuladas aos conhecimentos e habilidades, favorecendo a prestação de uma assistência holística e humana.

Objective: to evaluate the competencies expected by nursing managers for nursing technicians. Method: quantitative, descriptive and exploratory study, developed in a school hospital, from a municipality in the south of Minas Gerais. Twelve nurses of the sectors of Clinical Medicine, Surgical Clinic, Emergency Room and Intensive Care Unit participated. For the data collection, an instrument elaborated by the authors was used that evaluates the competences, through a scale of six points, that varies between “irrelevant” and “extremely relevant”. Results: Greater appreciation of technical knowledge and skills was observed to the detriment of the attitudinal components. Conclusions: Attitudes should be articulated to knowledge and skills, favoring the provision of holistic and human assistance.

Objetivo: evaluar las competencias esperadas por gestores de enfermería para los técnicos de enfermería. Método: estudio cuantitativo, descriptivo y exploratorio, desarrollado en un hospital-escuela, de un municipio del sur de Minas Gerais. Participaron 12 enfermeros que actúan en los sectores de Clínica Médica, Clínica Quirúrgica, Pronto Socorro y Unidad de Terapia Intensiva. Para la recolección de datos, se utilizó un instrumento elaborado por los autores que evalúa las competencias, por medio de una escala de seis puntos, que varía entre “irrelevante” y “extremadamente relevante”. Resultados: Se observó mayor valorización de los conocimientos y habilidades técnicas en detrimento de los componentes actitudinales. Conclusiones: Las actitudes deben ser articuladas a los conocimientos y habilidades, favoreciendo la prestación de una asistencia holística y humana.

Predictores selectivos en el sector público: validez predictiva y reacciones de los candidatos / Selection predictors in the public sector: predictive validity and candidate reactions

Esta investigación ha tenido como objetivo profundizar en el conocimiento sobre el funcionamiento de los procedimientos selectivos en el sector público. Para ello, a partir de los datos del concurso-oposición de 2010 para la selección de auxiliares administrativos en el Gobierno Vasco se estudiaron dos cuestiones: a) la validez predictiva de los predictores empleados y b) la justicia percibida por parte de los auxiliares con respecto al proceso selectivo y a las pruebas empleadas y su relación con el resultado en las mismas y el desempeño laboral. Los resultados muestran que la prueba de conocimientos es el mejor predictor del desempeño y que las reacciones de los candidatos presentan una correlación positiva con el desempeño laboral y con el resultado en el test de juicio situacional. Se comentan las limitaciones de la investigación así como las implicaciones prácticas de los resultados

The purpose of this research has been to deepen the knowledge about how selection procedures work in the public sector. To this aim two aspects were considered: a) the predictive validity of the predictors employed and b) the perceived justice of the hired workers regarding the selection process and the tests used and their relation with test performance and job performance. The results show that the job knowledge test is the best predictor of performance and that the reactions of the candidates present a positive correlation with job performance and with the situational judgment test results. The limitations of the research as well as the practical implications of the results are discussed

Update of aristolochic acid nephropathy in Korea

BACKGROUND/AIMS: The true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to contain aristolochic acid (AA) are used in traditional medicine in Korea. METHODS: We collected data on cases of AAN since 1996 via a database in Korea. We evaluated the year of AAN development, route to obtaining AA-containing herbal medicine, gender, reason for taking AA-containing herbal medicine, clinical manifestations, histological findings, phytochemical analysis, and prognosis of patients with AAN. RESULTS: Data on 16 cases of AAN were collected. Thirteen cases developed AAN before and three cases after the prohibition of AA-containing herbal medicine by the Korea Food and Drug Administration. Patients were prescribed AA-containing herbal medicine from oriental clinics or had purchased it from traditional markets. AAN was distributed in all age groups. Young females were most commonly exposed to AA-containing herbal medicine for slimming purposes and postpartum health promotion, while older adults took AA-containing compounds for the treatment of chronic diseases. The most common symptoms presented at hospitalization were nausea and vomiting, and acute kidney injury was accompanied by Fanconi syndrome in almost half of the patients. Phytochemical analysis of AA in herbal medicine was available in six cases. Progression to end stage renal disease (ESRD) was observed in seven patients (43.8%), and five patients (31.3%) had progressed to ESRD within 6 months of diagnosis. CONCLUSIONS: Our report shows that patients were still exposed to AA-containing herbal medicine and that there is a possibility of underdiagnosis of AAN in Korea. A stronger national supervision system of herbal ingredients and remedies in oriental medicine is needed to prevent AAN.

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions.

Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.