As práticas integrativas e complementares no campo da saúde: para uma descolonização dos saberes e práticas / Integrative and complementary practices in the health field: towards a decolonization of knowledge and practices

Resumo O manuscrito, em forma de ensaio, objetiva contribuir para o diálogo entre as abordagens das Epistemologias do Sul e o campo da saúde, com ênfase nas relações entre a biomedicina e os saberes e práticas tradicionais, complementares e integrativos. Essas relações são exploradas a partir da produção do conhecimento sobre as dimensões do saber, do poder e do ser na perspectiva da descolonização. Estudo de natureza teórico-conceitual. A descolonização do saber procura descolonizar a ciência e apropriar-se dela de forma contra-hegemônica, valorizar a interculturalidade, abrindo espaços para a inclusão dos diferentes tipos de saberes e práticas de cuidado. A descolonização do poder supõe a igualdade frente ao livre acesso e exercício dos diferentes tipos de recursos terapêuticos, deixando de tratá-los de forma marginal. A descolonização do ser incorpora práticas terapêuticas no campo da subjetividade, como a religiosidade/espiritualidade e as artes, sendo necessárias para a completude da pessoa. Dos encontros e articulações dessas dimensões emergem ecologias de saberes, abrindo o caminho à descolonização na saúde. O campo da saúde pública tem um papel central a desempenhar nesse processo, mas falta ampliar a sua concepção de saúde, incorporando a sua diversidade e pluralidade de saberes e práticas sociais.

Abstract This essay contributes to the dialogue between the approaches of Epistemologies of the South and the health field, focusing on the relationship between biomedicine and traditional, complementary and integrative knowledge and practices. Such relations are explored by using dimensions of knowledge, power and the self, based on the perspective of decolonization. This is a theorical-conceptual study. The decolonization of knowledge aims to decolonize science and appropriate it in an anti-hegemonic manner to value interculturality, enabling the inclusion of different types of knowledge and care practices. The decolonization of power presupposes equality in the face of free access while performing different types of therapeutic resources, not considered as marginal forms of treatment. The decolonization of the self incorporates therapeutic practices in subjective areas, such as religiosity/spirituality and the arts, which are necessary to a whole conception of the person. Ecologies of knowledges emerge from the encounters and articulations of these dimensions, as a pathway for decolonization in health. The public health field has a central role in this process, but its conception of health must be broadened by incorporating diversity and plurality of knowledges and social practices.

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.

EMIF Catalogue: A collaborative platform for sharing and reusing biomedical data.

OBJECTIVE: The collaboration and knowledge exchange between researchers are often hindered by the nonexistence of accurate information about which databases may support research studies. Even though a considerable amount of patient health information does exist, it is usually distributed and hidden in many institutions. The goal of this project is to provide, for any research community, a holistic view of biomedical datasets of interests, from which researchers can explore several distinct levels of granularity. METHODS: We developed a community-centered approach to facilitate data sharing while ensuring privacy. A dynamic schema allows exposing any metadata model about existing repositories. The framework was developed following a modular plugin-based architecture that facilitates the integration of internal and external tools. RESULTS: The EMIF Catalogue, a web platform for sharing and reusing biomedical data. Through this system, data custodians can publish and share different levels of information, while the researchers can search for databases that fulfill research requirements. CONCLUSIONS: The EMIF Catalogue currently fosters several distinct research communities, with different levels of data governance, combining, for instance, data available in pan-European EHR and Alzheimer cohorts. This portal is publicly available at https://emif-catalogue.eu.

[The paradigm shift for peptic ulcer disease]. / Magsårssjukdomens paradigmskiften ­ från högspecialiserad vårdorganisation till egenvård.

Knowledge development and paradigm shift for peptic ulcer disease is described over a fifty-year period using four levels of knowledge that place demands on the healthcare organization. When medical knowledge reached a healing level, continuity became subordinate. However, accessibility to treatment became more important. An important task for future healthcare will be to define and create broader knowledge structures. Efficiency losses can occur when control instruments apply to medical problems at low levels of knowledge which are not mature for this.

The relationship between knowledge management and creativity in bachelor degree compared to master degree nursing students.

OBJECTIVES: To investigate the relationship between knowledge management and creativity in undergraduate compared with master degree nursing students. METHODS: This cross-sectional study was conducted with nursing students of the faculty of nursing and midwifery in an urban area in the southeast of Iran from August 2017 to January 2018. In this study, 180 students were selected using a simple random sampling method (Bachelor degree=120 and Master degree=60). Data was collected using the Nonaka and Takeuchi̛s knowledge management and Randsip's Creativity questionnaires. RESULTS: There was a direct and significant relationship between knowledge management and creativity in the students (r=0.47 in Bachelor degree and r=0.36 in Master degree). The mean scores of knowledge management dimensions and creativity were higher in the master degree students. CONCLUSIONS: There was a relationship between knowledge management and creativity in the bachelor and master degree students. It is necessary to corroborate the Efforts for the implementation of strategies for the knowledge management in all its dimensions. Therefore, the education environment can help with the development of students' knowledge and skills.

From a Content Delivery Portal to a Knowledge Management System for Standardized Cancer Documentation.

Heterogeneous tumor documentation and its challenges of interpretation of medical terms lead to problems in analyses of data from clinical and epidemiological cancer registries. The objective of this project was to design, implement and improve a national content delivery portal for oncological terms. Data elements of existing handbooks and documentation sources were analyzed, combined and summarized by medical experts of different comprehensive cancer centers. Informatics experts created a generic data model based on an existing metadata repository. In order to establish a national knowledge management system for standardized cancer documentation, a prototypical tumor wiki was designed and implemented. Requirements engineering techniques were applied to optimize this platform. It is targeted to user groups such as documentation officers, physicians and patients. The linkage to other information sources like PubMed and MeSH was realized.

Role of Knowledge Management in Development and Lifecycle Management of Biopharmaceuticals.

Knowledge Management (KM) is a key enabler for achieving quality in a lifecycle approach for production of biopharmaceuticals. Due to the important role that it plays towards successful implementation of Quality by Design (QbD), an analysis of KM solutions is needed. This work provides a comprehensive review of the interface between KM and QbD-driven biopharmaceutical production systems as perceived by academic as well as industrial viewpoints. A comprehensive set of 356 publications addressing the applications of KM tools to QbD-related tasks were screened and a query to gather industrial inputs from 17 major biopharmaceutical organizations was performed. Three KM tool classes were identified as having high relevance for biopharmaceutical production systems and have been further explored: knowledge indicators, ontologies, and process modeling. A proposed categorization of 16 distinct KM tool classes allowed for the identification of holistic technologies supporting QbD. In addition, the classification allowed for addressing the disparity between industrial and academic expectations regarding the application of KM methodologies. This is a first of a kind attempt and thus we think that this paper would be of considerable interest to those in academia and industry that are engaged in accelerating development and commercialization of biopharmaceuticals.

Relación conceptual entre la gestión de la comunicación institucional y la gestión del conocimiento / Conceptual relationship between institutional communication management and knowledge management

El presente artículo ofrece una aproximación a la relación conceptual entre la gestión de la comunicación institucional y la gestión del conocimiento, áreas de prácticas profesionales, formación e investigación académicas que se objetivan en la actualidad en las organizaciones e instituciones, y marcan su identidad y desarrollo, pero con escasos diálogos entre ellas, en las que se desconoce su carácter complementario. Mediante una revisión bibliográfica en la literatura especializada y de múltiples triangulaciones entre sus diversos enfoques se pudo llegar a la identificación de elementos de relación entre ellas en sus definiciones (objetivos y funciones); tipologías; modelos y procesos principales en su concreción, así como la identificación y definición de áreas de desarrollo posibles en aras de ir dando pasos importantes que conduzcan a mayores interrelaciones prácticas y a razonamientos interdisciplinares(AU)

The paper provides an overview of the conceptual relationship between institutional communication management and knowledge management; areas of professional practice; academic training and research currently materializing in organizations and institutions, marking their identity and development, but with scarce communication between them and little awareness of their complementary nature. A review of specialized bibliography on the topic and multiple triangulations between their various approaches led to identification of points of contact between them in their definitions (aims and functions), typologies, main models and processes for their materialization, as well as to identification and definition of areas of potential development in order to take important steps leading to greater practical interrelationship and interdisciplinary reasoning(AU)

La utilidad práctica de la Epistemología en la clarificación de la pertinencia teórica y metodológica en la disciplina enfermera / The practical utility of Epistemology in the clarification of the theoretical and methodological relevance in the nursing discipline

Para el desarrollo de este estudio se ha partido del objetivo de identificar la utilidad de la Epistemología en la práctica y en desarrollo disciplinar de la Enfermería. Metodológicamente se ha empleado la reflexión crítica de las formas de construcción del conocimiento enfermero y se han analizado las diferentes clasificaciones del mismo realizadas por diversos autores en: patrones, niveles y dimensiones. Asimismo se ha valorado la incidencia de los planteamientos holísticos, el conocimiento práctico y la reflexión en la acción en las dificultades para la sistematización y planificación del conocimiento y su repercusión en el tradicional puente teórico-práctico. La ausencia de reflexión epistemológica tiene efectos adversos tales como: crecimiento invertebrado de la ciencia que redunda en su marginación o invisibilidad en las taxonomías científicas (ausente o subsumida por otras disciplinas) y, ausencia de pertinencia teórica, metodológica y técnica incidiendo en el aumento del dilema teórico-práctico

For the development of this study to identify party utility epistemology in practice and developing discipline of nursing has. It has used methodologically critical reflection of the forms of construction of nursing knowledge and analyzed the different classifications of the same made by various authors: patterns, levels and dimensions. It has also estimated the impact of holistic approaches, practical knowledge and reflection in action on the difficulties in planning and systematization of knowledge and its impact on the traditional theoretical and practical bridge. The absence of epistemological reflection has adverse effects such as growth of science invertebrate resulting in their marginalization or invisibility in scientific taxonomies (absent or subsumed by other disciplines) and absence of theoretical, methodological and technical relevance focusing on increasing theoretical and practical dilema

The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data.

BACKGROUND: The National Comprehensive Cancer Network and the American Society of Clinical Oncology have established guidelines for the treatment and surveillance of colorectal cancer (CRC), respectively. Considering these guidelines, an accurate and efficient method is needed to measure receipt of care. METHODS: The accuracy and completeness of Veterans Health Administration (VA) administrative data were assessed by comparing them with data manually abstracted during the Colorectal Cancer Care Collaborative (C4) quality improvement initiative for 618 patients with stage I-III CRC. RESULTS: The VA administrative data contained gender, marital, and birth information for all patients but race information was missing for 62.1% of patients. The percent agreement for demographic variables ranged from 98.1-100%. The kappa statistic for receipt of treatments ranged from 0.21 to 0.60 and there was a 96.9% agreement for the date of surgical resection. The percentage of post-diagnosis surveillance events in C4 also in VA administrative data were 76.0% for colonoscopy, 84.6% for physician visit, and 26.3% for carcinoembryonic antigen (CEA) test. CONCLUSIONS: VA administrative data are accurate and complete for non-race demographic variables, receipt of CRC treatment, colonoscopy, and physician visits; but alternative data sources may be necessary to capture patient race and receipt of CEA tests.

Modelo de sistema de organización del conocimiento basado en ontologías / Model of a knowledge organization system based on ontologies

El presente trabajo tiene como objetivo proponer un modelo para el diseño y construcción de un sistema de organización del conocimiento basado en ontologías. Se propone, a través del uso de métodos descriptivos y criterios de otros autores, un modelo a partir del cual se puede obtener un sistema de información basado en ontologías. Se muestra y se explica la relación entre cada una de las partes del modelo, y se demuestran sus propiedades holísticas. Se plantean los resultados obtenidos de la evaluación del modelo para su validación a través del criterio de expertos. Todos los pasos establecidos a través del modelo resultaron importantes. La mayoría de los encuestados estuvieron a favor y en ningún caso se consideró que los pasos eran poco importantes o no importantes. Con la aplicación del modelo se espera estructurar las bases de un dominio del conocimiento en específico, tras una progresiva sustitución de los modelos convencionales del proceso de recuperación de la información por un modelo cognitivo(AU)

The study is aimed at proposing a model for the design and construction of a knowledge organization system based on ontologies. Descriptive methods and criteria provided by other authors were used to devise and propose a model to obtain an information system based on ontologies. It is expected that the bases of a specific knowledge domain may be structured with the application of this method, following gradual replacement of conventional information retrieval models by a cognitive model. A discussion is also provided about the relationship between the various parts of the model, showing its holistic properties. The results obtained from evaluation of the model are presented for consideration by experts. All the steps established by the model were important. Most respondents were in favor and none considered that the steps were not very important or not important at all(AU)

Modelo de sistema de organización del conocimiento basado en ontologías / Model of a knowledge organization system based on ontologies

El presente trabajo tiene como objetivo proponer un modelo para el diseño y construcción de un sistema de organización del conocimiento basado en ontologías. Se propone, a través del uso de métodos descriptivos y criterios de otros autores, un modelo a partir del cual se puede obtener un sistema de información basado en ontologías. Se muestra y se explica la relación entre cada una de las partes del modelo, y se demuestran sus propiedades holísticas. Se plantean los resultados obtenidos de la evaluación del modelo para su validación a través del criterio de expertos. Todos los pasos establecidos a través del modelo resultaron importantes. La mayoría de los encuestados estuvieron a favor y en ningún caso se consideró que los pasos eran poco importantes o no importantes. Con la aplicación del modelo se espera estructurar las bases de un dominio del conocimiento en específico, tras una progresiva sustitución de los modelos convencionales del proceso de recuperación de la información por un modelo cognitivo...

The study is aimed at proposing a model for the design and construction of a knowledge organization system based on ontologies. Descriptive methods and criteria provided by other authors were used to devise and propose a model to obtain an information system based on ontologies. It is expected that the bases of a specific knowledge domain may be structured with the application of this method, following gradual replacement of conventional information retrieval models by a cognitive model. A discussion is also provided about the relationship between the various parts of the model, showing its holistic properties. The results obtained from evaluation of the model are presented for consideration by experts. All the steps established by the model were important. Most respondents were in favor and none considered that the steps were not very important or not important at all...

Agri-environmental collaboratives as bridging organisations in landscape management.

In recent years, landscape and its management has become a focus of policies and academic conceptualisation. Landscape is understood as a concept of interconnected natural and human systems. Its management must take into account the dynamic interdependencies and diverging interests of various stakeholders at different levels. Bridging organisations can provide an arena for trust-building, conflict resolution, learning and collaboration between relevant stakeholders. This paper draws on two strands of literature - landscape governance and co-management of social-ecological systems - to investigate the contributions of agri-environmental collaboratives (AEC) to sustainable landscape management. Based on data from 41 interviews with key informants and AEC members in Germany and the Netherlands, six fields of contributions were identified: policy implementation and service provision; coordination and mediation; awareness raising and behaviour change; care for 'everyday' landscapes; maintenance and protection of landscapes (including species and habitats); and income generation and economic benefits. Some of the contributions evolve around the specific role of AEC as bridging organisations, but other contributions such as economic benefits emerge beyond this analytical lens. The paper therefore emphasises holistic, bottom up assessment of AEC contributions and argues that governments should support such organisations through i) funding for facilitators and ii) funding for impact monitoring and data management.

Knowledge Management and Safety Compliance in a High-Risk Distributed Organizational System

BACKGROUND: In a safety perspective, efficient knowledge management is important for learning purposes and thus to prevent errors from occurring repeatedly. The relationship between knowledge exchange among employees and safety behavior may be of particular importance in distributed organizational systems where similar high-risk activities take place at several locations. This study develops and tests hypotheses concerning the relationship between knowledge exchange systems usage, knowledge exchange in the organizational system, and safety compliance. METHODS: The operational context of the study is petroleum drilling and well operations involving distributed high-risk activities. The hypotheses are tested by use of survey data collected from a large petroleum operator company and eight of its main contractors. RESULTS: The results show that safety compliance is influenced by use of knowledge exchange systems and degree of knowledge exchange in the organizational system, both within and between units. System usage is the most important predictor, and safety compliance seems to be more strongly related to knowledge exchange within units than knowledge exchange between units. CONCLUSION: Overall, the study shows that knowledge management is central for safety behavior.

[Knowledge management and healthcare organizations]. / Knowledge management e organizzazioni sanitarie.

The present scenario is characterized by a high "environmental turbulence". Healthcare professionals and organizations must increase their knowledge, skills and attitudes for choosing wisely. Healthcare organizations are complex adaptive systems which should use integrated governance systems: knowledge management should be a strategic goal. These organizations should become learning organizations: they should build and renovate their knowledge in a systematic, explicit and definite way.

Expert knowledge maps for knowledge management: a case study in Traditional Chinese Medicine research.

OBJECTIVE: To design a model to capture information on the state and trends of knowledge creation, at both an individual and an organizational level, in order to enhance knowledge management. METHODS: We designed a graph-theoretic knowledge model, the expert knowledge map (EKM), based on literature-based annotation. A case study in the domain of Traditional Chinese Medicine research was used to illustrate the usefulness of the model. RESULTS: The EKM successfully captured various aspects of knowledge and enhanced knowledge management within the case-study organization through the provision of knowledge graphs, expert graphs, and expert-knowledge biography. CONCLUSION: Our model could help to reveal the hot topics, trends, and products of the research done by an organization. It can potentially be used to facilitate knowledge learning, sharing and decision-making among researchers, academicians, students, and administrators of organizations.

Achieving Holistic Health for the Individual through Person-Centered Collaborative Care Supported by Informatics / 대한의료정보학회지

OBJECTIVES: This article seeks to describe the current state of informatics supported collaborative care and to point out areas of future research in this highly interdisciplinary field. METHODS: In this article, person-centered collaborative care is seen as a concept addressing both the provision of care over organizational borders between health and social care, and within care teams as well as the changed patient/client-care provider relationship characterized by increased patient/client involvement. RESULTS: From a health systems perspective, there are several attempts to describe the conceptual and theoretical basis for collaborative care indicating that agreement on core concepts and terminology is difficult. From an informatics perspective, focus is on standardization of clinical content models and terminology to achieve interoperability of information technology systems and to support standardized care pathways. Few examples look into how ad-hoc collaborative care processes can be supported using information technology and informatics standards. Nevertheless, promising examples do exist showing that integrational Information Communication Technology services can be supportive for collaborative care developments. However, the current landscape consists of many fragmented, often technology-driven eHealth solutions targeting specific diagnostic groups in geographically and/or organizationally restricted settings. CONCLUSIONS: A systematic approach incorporating organizational, clinical, informatics and social science knowledge is needed to perform further research in areas such as virtual team partnerships, new paradigms of care delivery, data and knowledge management as well as its secure sharing. Also organizational and legal aspects need to be further researched in order to facilitate the coordinated provision of health and social care to citizens including self-management, utilizing informatics support in a societal context.

[Paradigms in the analysis of public health policies: limitations and challenges]. / Paradigmas en el análisis de políticas públicas de salud: limitaciones y desafíos.

Research on health policies is considered essential to ensure the effectiveness and efficiency of public policies. Analyses of public health policies have various objectives, including helping to solve the problems for which the policy was originated. That objective faces two large obstacles: (1) the ambiguity and heterogeneity of the models applied for the analysis of public policies, conditions that hinder the selection of analytical methods and the assessment of the scope of the objective; and (2) the traditional methodological approaches that limit the capacity of analyses to help solve the problems detected. This paper reviews the epistemology of the predominant models of public health policy analysis in order to assess their scope and limitations. It concludes that the development of new conceptual approaches could improve the quality of research on public policies and their ability to favorably impact decisions.