Manual metodológico para la construcción de un protocolo de atención clínica / Methodological Manual for construction of a Clinical Care Protocol

El presente manual metodológico tiene como objetivo establecer una metodología para la elaboración de un protocolo de atención clínica basado en evidencia científica, con el propósito que sea utilizado a nivel nacional en las diferentes unidades de salud. Incluye la estructura del protocolo con una breve explicación de cada una de sus partes; se enfoca en el paso a paso de cómo elaborar las intervenciones en función del tema siendo estas la parte medular del documento, también incluye el proceso de selección del equipo elaborador, elaboración de borradores, pasando por la validación de expertos en el tema hasta llegar a la aprobación...(AU)

Efectividad de la hipnoterapia en pacientes deprimidos / Effectiveness of hypnotherapy in depressed patients

RESUMEN Introducción: la depresión es uno de los problemas de salud que más afecta a los seres humanos a nivel mundial. En Cuba, un elevado número de personas padece este flagelo, sin distinción de razas, sexos u otras categorías. Objetivo: evaluar la efectividad de la hipnosis como modalidad terapéutica en pacientes deprimidos. Materiales y métodos: se realizó un estudio explicativo de tipo experimental de comparación de grupo pre-post prueba en 30 pacientes con trastornos depresivos; 15 de ellos se atendieron con hipnoterapia (grupo estudio) y otros 15 mediante terapia racional emotiva conductual (grupo control). Por la importancia para enriquecer la investigación, se definió como variable independiente el tratamiento empleado según el grupo, y como variables dependientes la respuesta psicológica antidepresiva y ansiolítica. Los datos se procesaron cuantitativa y cualitativamente. Se empleó la prueba de las probabilidades exactas de Fisher y la t de Student para validar la significación del cambio. Resultados: en términos de evolución clínica, la hipnoterapia fue efectiva, ya que el 93,3 % de los pacientes mejoraron significativamente en comparación con los resultados obtenidos con la terapia conductual racional emotiva, dados en un 73,33 %. Conclusión: la hipnoterapia es tan efectiva como la terapia racional emotiva conductual, y si bien no hubo diferencias significativas por los resultados del estadígrafo matemático empleado, sí las hubo desde el punto de vista práctico y clínico, pues evolucionaron más rápido los pacientes del grupo estudio que los del grupo control (AU).

ABSTRACT Introduction: depression is one of the health problems more affecting the human being around the world. A high number of persons suffers this scourge, without distinction of race, sex or any other category. Objective: to assess hypnosis effectiveness as a therapeutic modality in depressed patients. Materials and methods: an experimental-kind explanatory study was carried out comparing a group of 30 patients with depressive disorders before and after test; 15 of them were treated with hypnotherapy (study group) and 15 with rational emotive behavioral therapy (control group). For the importance of enriching the research the treatment used according to each group was defined as independent variable and the anxiolytic and anti-depressive psychological answer. Data were quantitative and qualitatively processed. Fisher's exact test and T student test were used to validate the change significance. Results: in terms of clinical evolution, hypnotherapy was effective, since 93.3% of patients significantly improved in comparison to the results achieved with the rational emotive behavioral therapy, reaching 73.33%. Conclusions: hypnotherapy is as effective as rational emotive behavioral therapy, and although there were not significant differences due to the results of the used mathematical statistic, there they were from the practical and clinical point of view, because the patients from the study group improved faster than the ones in the control group AU).

Reflections on patient safety incident reporting systems.

OBJECTIVE: To reflect on the main characteristics and recommendations of Incident Reporting Systems, discuss the population's participation in reporting, and point out challenges in the Brazilian system. METHOD: Reflection study, based on Ordinance No. 529/13, which instituted the National Patient Safety Program, under Collegiate Board Resolution (CBR) No. 36/13; reflections by experts were added. RESULTS: Reporting systems are a source for learning and monitoring, allow early detection of incidents, investigations and, mainly, the generation of recommendations prior to recurrences, in addition to raising information for patients and relatives. There is little participation of the population in the reporting, regardless of the type of system and characteristics such as confidentiality, anonymity, and mandatory nature. FINAL CONSIDERATIONS: In Brazil, although reporting is mandatory, there is an urgency to advance the involvement and participation of the population, professionals, and institutions. To simplify data entry by improving the interface and importing data from the reporting system is an objective to be achieved.

Performance of family health teams for tackling chronic diseases in a state of the Amazon.

The most common cause of death worldwide is noncommunicable diseases. A cross-sectional study was conducted to evaluate the adequacy of the work process among family health teams and compare differences in regional adequacy in the state of Tocantins, in the Amazonian Region, Brazil. Categorical principal components analysis was used, and scores of each principal component extracted in the analysis were compared among health regions in Tocantins. A post hoc analysis was performed to compare the heath region pairs. The adequacy of family health teams' work process was evaluated with respect to the Strategic Action Plan to Tackle NCDs. The results showed that the family health teams performed actions according to the Strategic Action Plan to Tackle NCDs. However, overall, the adequacy percentages of these actions according to the axes of the Plan are very uneven in Tocantins, with large variations among health regions. The family health teams in the Bico do Papagaio (Region 1), Médio Norte Araguaia (Region 2), Cantão (Region 4) and Capim Dourado (Region 5) regions have adequacy percentages ≥ 50% with the Strategic Action Plan to Tackle NCDs, whereas all other regions have percentages <50%. Health teams perform surveillance actions, health promotion, and comprehensive care for NCDs in accordance with the guidelines of the Strategic Action Plan to Tackle NCDs. The challenge of NCDs in primary care requires a care model that is tailored to users' needs and has the power to reduce premature mortality and its determinants.

The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil.

INTRODUCTION: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. CONCLUSIONS: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients-A Scoping Review.

Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on the impact of organizational conditions on TBC and diabetic patient outcomes.

The relationship between management practices and the efficiency and quality of voluntary medical male circumcision services in four African countries.

INTRODUCTION: Given constrained funding for Human Immunodeficiency Virus (HIV) programs across Sub-Saharan Africa, delivering services efficiently is paramount. Voluntary medical male circumcision (VMMC) is a key intervention that can substantially reduce heterosexual transmission-the primary mode of transmission across the continent. There is limited research, however, on what factors may contribute to the efficient and high-quality execution of such programs. METHODS: We analyzed a multi-country, multi-stage random sample of 108 health facilities providing VMMC services in sub-Saharan Africa in 2012 and 2013. The survey collected information on inputs, outputs, process quality and management practices from facilities providing VMMC services. We analyzed the relationship between management practices, quality (measured through provider vignettes) and efficiency (estimated through data envelopment analysis) using Generalized Linear Models and Mixed-effects Models. Applying multivariate regression models, we assessed the relationship between management indices and efficiency and quality of VMMC services. RESULTS: Across countries, both efficiency and quality varied widely. After adjusting for type of facility, country and scale, performance-base funding was negatively correlated with efficiency -0.156 (p < 0.05). In our analysis, we did not find any significant relationships between quality and management practices. CONCLUSIONS: No significant relationship was found between process quality and management practices across 108 VMMC facilities. This study is the first to analyze the potential relationships between management and service quality and efficiency among a sample of VMMC health facilities in sub-Saharan Africa and can potentially inform policy-relevant hypotheses to later test through prospective experimental studies.

Cancer care in Brazil: structure and geographical distribution.

BACKGROUND: The organisation and systematisation of health actions and services are essential to ensure patient safety and the effectiveness and efficiency of cancer care. The objective of this study was to analyse the structure of cancer care envisaged in Brazilian norms, describe the types of accreditations of cancer services and their geographic distribution, and determine the planning and evaluation parameters used to qualify the health units that provide cancer care in Brazil. METHODS: This observational study identified the current organisation of cancer care and other health services that are accredited by Brazil's national health system (SUS) for cancer treatment as of February 2017. The following information was collected from the current norms and the National Registry of Health Establishments: geographic location, type of accreditation, type of care, and hospital classification according to annual data of the number of cancer surgeries. The adequacy of the number of licensed units relative to population size was assessed. The analysis considered the facilitative or restrictive nature of policies based on the available rules and resources. RESULTS: The analysis of the norms indicated that these documents serve as structuring rules and resources for developing and implementing cancer care policies in Brazil. A total of 299 high-complexity oncology services were identified in facilities located in 173 (3.1%) municipalities. In some states, there were no authorised services in radiotherapy, paediatric oncology and/or haematology-oncology. There was a significant deficit in accredited oncology services. CONCLUSIONS: The parameters that have been used to assess the need for accredited cancer services in Brazil are widely questioned because the best basis of calculation is the incidence of cancer or disease burden rather than population size. The results indicate that the availability of cancer services is insufficient and the organisation of the cancer care network needs to be improved in Brazil.

Conflicting Views in Narratives on HIV Transmission via Medical Care.

Molecular studies suggest that HIV arose in Africa between 1880 and 1940. During this period, there were campaigns by European colonial governments that involved unsterile injections of large numbers of Africans. That, along with other unsafe therapeutic interventions, may have propelled the evolution of HIV from SIV. Since subtype B in Africa may have been concentrated in white African homosexuals, it is possible that Westerners rather than Haitians introduced the virus to the New World. Amplification of HIV subtype B took place in Haiti, where transmission was facilitated by hazardous medical procedures including plasmapheresis. Representations in the media, however, largely ignore Western contributions to the spread of AIDS. This article focuses on the value of alternative narratives in fostering a balanced view that is less stigmatizing on developing nations.

Implementation process of the Surgical Safety Checklist: integrative review / Processo de implementação da Lista de Verificação de Segurança Cirúrgica: revisão integrativa / Proceso de implementación del Listado de Verificación de Seguridad Quirúrgica: revisión integrativa

ABSTRACT Objective: to analyze the evidence available in the literature on the process of implementing the Surgical Safety Checklist, proposed by the World Health Organization, in the practice of health services. Method: integrative review, the search for primary studies was performed in three relevant databases in the health area, and the sample consisted of 27 studies, which were grouped into three categories. Results: the synthesis of the evidence indicated the different strategies that can be adopted in the implementation process (introduction and optimization) of the Surgical Safety Checklist, and the facilitators and barriers that determine the success in using this tool. Conclusion: in health services, implementing the checklist is a complex and challenging process that requires effective leadership, clear delegation of responsibilities from each professional, collaboration between team members, and institutional support. The synthesis of the generated knowledge can assist nurses in decision making, especially in identifying strategies for the effective implementation of the Surgical Safety Checklist, since nursing has the potential to be a protagonist in the planning and implementation of best practices for patient safety.

RESUMO Objetivo: analisar as evidências disponíveis na literatura sobre o processo de implementação da Lista de Verificação de Segurança Cirúrgica, proposta pela World Health Organization, na prática dos serviços de saúde. Método: revisão integrativa. A busca dos estudos primários foi executada em três bases de dados relevantes na área da saúde, sendo a amostra composta por 27 pesquisas, as quais foram agrupadas em três categorias. Resultados: A síntese das evidências indicou as diferentes estratégias que podem ser adotadas no processo de implementação (introdução e otimização) da Lista de Verificação de Segurança Cirúrgica, e os facilitadores e barreiras determinantes para o sucesso no uso dessa ferramenta. Conclusão: nos serviços de saúde, a implementação do checklist é um processo complexo e desafiador que exige liderança efetiva, delegação clara das responsabilidades de cada profissional, colaboração entre os membros da equipe e suporte institucional. A síntese do conhecimento gerado pode auxiliar os enfermeiros na tomada de decisão, principalmente na identificação de estratégias para a implementação efetiva da Lista de Verificação de Segurança Cirúrgica, uma vez que a enfermagem tem potencial para ser protagonista no planejamento e na implementação das melhores práticas em prol da segurança do paciente.

RESUMEN Objetivo: analizar las evidencias disponibles en la literatura sobre el proceso de implementación del Listado de Verificación de Seguridad Quirúrgica, propuesto por la Organización Mundial de la Salud, en la práctica de los servicios de salud. Método: revisión integrativa, la búsqueda de los estudios primarios fue ejecutada en tres bases de datos relevantes en el área de salud, siendo la amuestra compuesta por 27 investigaciones, las cuales fueron agrupadas en tres categorías. Resultados: la síntesis de las evidencias indicó las diferentes estrategias que pueden ser adoptadas en el proceso de implementación (introducción y optimización) del Listado de Verificación de Seguridad Quirúrgica, los facilitadores y barreras determinantes para el éxito en el uso de esa herramienta. Conclusión: en los servicios de salud, la implementación del listado de verificación es un proceso complejo y desafiador que exige liderazgo efectivo, delegación clara de las responsabilidades de cada profesional, colaboración entre los miembros del equipo y soporte institucional. La síntesis del conocimiento generado puede auxiliar a los enfermeros en la toma de decisión, sobre todo en la identificación de estrategias para la implementación efectiva del Listado de Verificación de Seguridad Quirúrgica, una vez que la enfermería tiene un potencial para ser protagonista en la planificación e implementación de las mejores prácticas en beneficio de la seguridad del paciente.

Plan de salud para la juventud afrodescendiente de américa Latina y el caribe / Health Plan for Afro-Descendant Youth in Latin America and the Caribbean

El Plan de Salud para Jóvenes Afrodescendientes surgió de los esfuerzos de la Organización Panamericana de la Salud (OPS) crear oportunidades de diálogo que promuevan y faciliten la participación social en acciones relacionadas con la salud y el bienestar de los diferentes grupos étnicos que comparten la Región de las Américas, a lo largo de las diferentes etapas del curso de vida

The Health Plan for Afro-descendant Youth emerged from the efforts of the Pan American Health Organization (PAHO) to create opportunities for dialogue that promote and facilitate social participation in actions related to the health and wellbeing of the different ethnic groups that share the Region of the Americas, throughout the different stages of the life course

The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen

The objective of the study was to evaluate the use of human albumin in a Brazilian university hospital, in compliance with the institutional protocol and other clinical guidelines, taking into account the therapeutic indications and the dosage regimens. Data was obtained from the pharmacy dispensing records of human albumin, the requests for use it and, when available, the patient's records between January and October 2017. After evaluation the therapeutic indications and the dosage regimens were classified as "appropriate" and "inappropriate". The analysis of 98 requests showed that, when compared to the institutional protocol, 54 (55.1%) requests had an inappropriate therapeutic indication. However, when a comparison was made between 25 medical records (54 requests) and other clinical guidelines, it was observed that the therapeutic indication had none classified as inappropriate. In addition, 16 (29.7%) requests were considered inappropriate in relation to dosage regimens. From these results, it was possible to conclude that although the use of human albumin in the hospital was associated to a clinical protocol, it was outdated. Thus, it is possible to affirm that not only the adoption of a clinical protocol, but its periodical updating is an important strategy to promote the rational use of drugs.