Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team: A Mixed Methods Study.

BACKGROUND: Integration into the health system is essential for safe care and efficient use of resources. OBJECTIVES: The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site. METHODS: The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out. RESULTS: The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care. CONCLUSION: The low score for the care plan factor indicates weakness in the care transition. IMPLICATIONS FOR PRACTICE: The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.

Transición del cuidado de pacientes con enfermedades crónicas y su relación con las características clínicas y sociodemográficas / Transition of care of patients with chronic diseases and its relation with clinical and sociodemographic characteristics / Transição do cuidado de pacientes com doenças crônicas e sua relação com as características clínicas e sociodemográficas

Objetivo: evaluar la transición del cuidado desde la perspectiva de las personas que viven con enfermedades crónicas e identificar su relación con las características clínicas y sociodemográficas. Método: estudio transversal, con 487 pacientes dados de alta de un hospital. Se utilizaron los instrumentos de caracterización clínica, sociodemográfica y Care Transitions Measure-15, que mide los factores Preparación para el automanejo, Preferencias aseguradas, Comprensión sobre medicamentos y Plan de cuidados. Análisis estadístico descriptivo e inferencial. Resultados: la transición del cuidado fue satisfactoria (76,8±10,4). Media de factores: Preparación para el automanejo (82,2±10,8), Preferencias aseguradas (84,7±14,3), Comprensión sobre medicamentos (75,7±13,7) y Plan de Cuidados (64,5±13,2). Pacientes del sexo femenino presentaron mayor promedio en el factor comprensión sobre medicamentos. Los blancos y los residentes en áreas urbanas calificaron mejor el Plan de cuidados. La media más alta se observó para el factor Preferencias aseguradas (84,7±14,3) y la más baja para el factor Plan de cuidados (64,5±13,2). En todos los factores se encontraron diferencias significativas en las variables (paciente quirúrgico, tener artefactos clínicos y no estar hospitalizado por COVID-19). Los pacientes internados hasta cinco días presentaron diferencia estadística en los factores Preparación para el automanejo y Comprensión sobre medicamentos. En los pacientes que no reingresaron dentro de los 30 días posteriores al alta, la preparación para el automanejo fue mejor. Cuanto mejor sea la preparación para el automanejo, menores serán las tasas de reingreso a los 30 días. Conclusión: en pacientes que viven con enfermedades crónicas, variables sociodemográficas y clínicas están asociadas a la transición del cuidado. Los pacientes que evaluaron mejor la preparación para el automanejo tuvieron menos reingresos dentro de los 30 días.

Objective: evaluate the transition of care from the perspective of people living with chronic diseases and identify its relation with clinical and sociodemographic characteristics. Method: cross-sectional study with 487 patients who were discharged from a hospital. Clinical and sociodemographic characterization instruments were used, as well as the Care Transitions Measure-15, which measures Preparation for self-management, Secured preferences, Understanding about medications and Care plan factors. Descriptive and inferential statistical analysis. Results: the transition of care was satisfactory (76.8±10.4). Average of the factors: Preparation for self-management (82.2±10.8), Secured preferences (84.7±14.3), Understanding about medications (75.7±13.7) and Care plan (64.5±13.2). Female patients had a higher average in the understanding about medications factor. Whites and residents in the urban area better evaluated the Care plan factor. The highest mean was observed for the Secured preferences factor (84.7±14.3) and the lowest for the Care plan factor (64.5±13.2). In all factors, significant differences were found in the variables (surgical patient, carrying clinical artifacts and not being hospitalized for COVID-19). Patients hospitalized for up to five days showed statistical difference in Preparation for self-management and Understanding about medications factors. In patients who were not readmitted within 30 days of discharge, Preparation for self-management was better. The better the Preparation for self-management, the lower the 30-day readmission rates. Conclusion: in patients living with chronic diseases, sociodemographic and clinical variables are associated with the transition of care. Patients who better evaluated preparation for self-management had fewer readmissions within 30 days.

Objetivo: avaliar a transição do cuidado na perspectiva de pessoas que vivem com doenças crônicas e identificar sua relação com as características clínicas e sociodemográficas. Método: estudo transversal, com 487 pacientes que receberam alta de um hospital. Foram utilizados instrumentos de caracterização clínica, sociodemográfica e Care Transitions Measure-15, que mensura os fatores Preparo para o autogerenciamento, Preferências asseguradas, Entendimento das medicações e Plano de cuidados. Análise estatística descritiva e inferencial. Resultados: a transição do cuidado foi satisfatória (76,8±10,4). Média dos fatores: preparo para o autogerenciamento (82,2±10,8), Preferências asseguradas (84,7±14,3), Entendimento das medicações (75,7±13,7) e Plano de Cuidados (64,5±13,2). Pacientes do sexo feminino apresentaram média superior no fator entendimento sobre medicações. Brancos e residentes na zona urbana avaliaram melhor o Plano de cuidados. Observou-se a maior média no fator Preferências asseguradas (84,7±14,3) e a menor no fator Plano de cuidados (64,5±13,2). Em todos os fatores, foram encontradas diferenças significativas nas variáveis (paciente cirúrgico, portar artefatos clínicos e não estar internado por COVID-19). Pacientes internados até cinco dias apresentaram diferença estatística nos fatores Preparação para o autogerenciamento e Entendimento das medicações. Em pacientes que não apresentaram reinternação em 30 dias após a alta, o Preparo para o autogerenciamento foi melhor. Quanto melhor o Preparo para o autogerenciamento, menores são os índices de reinternação em 30 dias. Conclusão: em pacientes que vivem com doenças crônicas, variáveis sociodemográficas e clínicas estão associadas à transição do cuidado. Pacientes que avaliaram melhor o preparo para autogerenciamento tiveram menos reinternações em 30 dias.

Transition of care of patients with chronic diseases and its relation with clinical and sociodemographic characteristics. / Transición del cuidado de pacientes con enfermedades crónicas y su relación con las características clínicas y sociodemográficas.

OBJECTIVE: evaluate the transition of care from the perspective of people living with chronic diseases and identify its relation with clinical and sociodemographic characteristics. METHOD: cross-sectional study with 487 patients who were discharged from a hospital. Clinical and sociodemographic characterization instruments were used, as well as the Care Transitions Measure-15, which measures Preparation for self-management, Secured preferences, Understanding about medications and Care plan factors. Descriptive and inferential statistical analysis. RESULTS: the transition of care was satisfactory (76.8±10.4). Average of the factors: Preparation for self-management (82.2±10.8), Secured preferences (84.7±14.3), Understanding about medications (75.7±13.7) and Care plan (64.5±13.2). Female patients had a higher average in the understanding about medications factor. Whites and residents in the urban area better evaluated the Care plan factor. The highest mean was observed for the Secured preferences factor (84.7±14.3) and the lowest for the Care plan factor (64.5±13.2). In all factors, significant differences were found in the variables (surgical patient, carrying clinical artifacts and not being hospitalized for COVID-19). Patients hospitalized for up to five days showed statistical difference in Preparation for self-management and Understanding about medications factors. In patients who were not readmitted within 30 days of discharge, Preparation for self-management was better. The better the Preparation for self-management, the lower the 30-day readmission rates. CONCLUSION: in patients living with chronic diseases, sociodemographic and clinical variables are associated with the transition of care. Patients who better evaluated preparation for self-management had fewer readmissions within 30 days. (1) Brazilian study that evaluated the transition of care of patients with CNCDs. (2) Women had a higher average in the understanding about medications factor. (3) Whites and residents in the urban area better evaluated the care plan. (4) Better preparation for self-management reduces length of stay and readmissions. (5) Better preparation for understanding about medications reduces hospitalization time.

Quality of life in the voice of children who depend on health technologies: Mixed methods study.

OBJECTIVE: To examine the quality of life of children who depend on health technologies as expressed in their own words. METHODS: A parallel and convergent mixed methods design was employed with 30 aged five to 12 year old children who depend on health technologies. Data collection was done through a characterization form, Pediatric Quality of Life Inventory 4.0 questionnaire with the total sample in quantitative phase; semi-structured interviews with a subset of nine participants in qualitative phase. Quantitative and qualitative data were analyzed using descriptive statistics and deductive thematic content analyses, respectively. RESULTS: Findings from PedsQL 4.0 showed that quality of life for children who depend on health technologies is average. However, data integration through mixed methods showed that this average goes beyond quantitative data through hearing the children's own voices. The results from data integration pointed out that children recognize their limitations and adapt to them; what most affects their quality of life is the emotional domain; children reported suffering prejudice due to their physical limitations; and that the school positively impacts their quality of life. CONCLUSIONS: Data integration highlighted that children acknowledge their limitations and pain generated by these devices. Concerns about the future and the ability to do things that other children the same age can do was the most impactful aspect on their quality of life. IMPLICATIONS FOR PRACTICE: Nursing care plans should consider that what affects most children who depend on health technologies' quality of life is anxiety for the future of being incapacitated or dependent.

Validation of a Guideline for Nurses Taking Care of Patients With Liver Cirrhosis in the Context of COVID-19 in the Emergency Department.

The objective of this study was to prepare and validate the content of a guideline for nursing care of adult patients with liver cirrhosis and COVID-19 treated in the emergency department. The study was conducted in two stages: first, the guideline was developed based on an integrative literature review and existing guidelines on the topic. The guideline was prepared with six domains and 64 care items. In the second stage, 15 specialists in urgency and emergency services performed content validation of the guideline. The data were analyzed using the Content Validity Index, with reliability assessed through Cronbach's α. The judges validated the guide regarding language clarity, objectivity, theoretical relevance, and practical pertinence. The value of the guideline's Content Validity Index was 0.96. Cronbach's α reliability reached a value of 0.93. The judges validated all domains and items of the guideline for theoretical relevance and practical pertinence, to be used by researchers and clinical practice professionals in the nursing area.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study.

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Care transitions among oncological patients: from hospital to community.

OBJECTIVE: To analyze the transition of care from the perspective of cancer patients, in a Southern Brazil hospital, correlating perspectives with sociodemographic and clinical characteristics. METHOD: Cross-sectional study using the Care Transitions Measure (CTM) with cancer patients undergoing clinical or surgical treatment following hospital discharge. Data collection was completed by telephone, between June and September 2019. Data analysis was performed using descriptive and inferential statistics. RESULTS: The average CTM score was 74.1, which was considered satisfactory. The CTM factors: understanding about medications (83.3) and preparation for self-management (77.7) were deemed satisfactory; while: secured preferences (69.4) and care plan (66.1) were unsatisfactory for an effective and safe care transition. No statistically significant difference was found between sociodemographic variables and the CTM. Among the clinical variables, primary cancer and the secured preferences factor showed a significant difference (p = 0.044). CONCLUSION: The transition from hospital care to the community was considered satisfactory in the overall assessment.

Predictors of deaths associated with covid-19 in patients admitted to two hospitals in the state of santa catarina, brazil / Predictores de muertes asociadas al covid-19 en pacientes ingresados en dos hospitales del estado de santa catarina, brasil / Preditores de óbitos associados à covid-19 em pacientes internados em dois hospitais do estado de santa catarina, brasil

ABSTRACT Objective: To investigate predictors of deaths associated with COVID-19 in patients admitted to two hospitals in the state of Santa Catarina, Brazil. Method: This is a retrospective cross-sectional study with 799 patients admitted to hospital for COVID-19 in 2020. The study took place in two reference hospitals for COVID-19 located in Greater Florianópolis, Santa Catarina, Brazil. Data collection took place from November 2020 to January 2021. Electronic medical records were used to collect data and were recorded in the Survey Monkey® application. The database was published in the Figshare Dataset Springer Nature© repository. Multivariate and bivariate analyzes were performed. Results: There was a predominance of male patients (57.9%), white patients (93.4%), senior patients (41.5%). The mean age was 61.5 years (±15.8). There was a higher occurrence of Diabetes Mellitus (54.2%) and hypertension (34.2%). Thus, 222 patients (27.8%) were admitted to the Intensive Care Unit. The outcome of death was observed in 157 patients (19.6%). There was a correlation between death and some sociodemographic and clinical variables. Conclusion: The study showed a higher prevalence of previous diseases such as hypertension, Diabetes Mellitus, obesity and chronic obstructive pulmonary disease. Age proved to be an independent risk factor for death. Occurrence of death in the age group over 80 years was 13 times higher compared to the younger population.

RESUMEN Objetivo: Investigar los predictores de muertes asociadas a COVID-19 en pacientes ingresados ​​en dos hospitales del estado de Santa Catarina, Brasil. Método: Estudio transversal retrospectivo con 799 pacientes hospitalizados por COVID-19 en 2020. El estudio se desarrolló en dos hospitales de referencia para COVID-19 ubicados en la Gran Florianópolis, Santa Catarina, Brasil. La recolección se realizó de noviembre de 2020 a enero de 2021. Para la recolección de datos se utilizaron historias clínicas electrónicas y se registraron en la aplicación Survey Monkey®. La base de datos se publicó en el repositorio Figshare Dataset Springer Nature©. Se realizaron análisis multivariados y bivariados. Resultados: Hubo predominio de pacientes masculinos (57,9%), pacientes blancos (93,4%), pacientes ancianos (41,5%). La edad media fue de 61,5 años (±15,8). Hubo mayor aparición de Diabetes Mellitus (54,2%) e hipertensión arterial sistémica (34,2%). Ingresaron en la Unidad de Cuidados Intensivos 222 pacientes (27,8%). El desenlace de muerte se observó en 157 pacientes (19,6%). Hubo correlación entre la muerte y algunas variables sociodemográficas y clínicas. Conclusión: El estudio mostró una mayor prevalencia de enfermedades previas como hipertensión, Diabetes Mellitus, obesidad y enfermedad pulmonar obstructiva crónica. La edad demostró ser un factor de riesgo independiente de muerte. La ocurrencia de muertes en el grupo de edad mayor de 80 años fue 13 veces mayor en comparación con la población más joven.

RESUMO Objetivo: Investigar os fatores preditores de óbitos associados à Covid-19 em pacientes internados em dois hospitais do estado de Santa Catarina, Brasil. Método: Estudo transversal retrospectivo com 799 pacientes internados por Covid-19 em 2020. O estudo ocorreu em dois Hospitais referência para Covid-19 situados na Grande Florianópolis, Santa Catarina, Brasil. A coleta ocorreu de novembro de 2020 a janeiro de 2021. Para a coleta de dados, foram utilizados prontuários eletrônicos, sendo registrados no aplicativo Survey Monkey®. O banco de dados foi publicado no repositório Figshare Dataset Springer Nature©. Análises multivariadas e bivariadas foram realizadas. Resultados: Predominaram pacientes do sexo masculino (57,9%), brancos (93,4%), idosos (41,5%). A média de idade foi de 61,5 anos (±15,8). Houve maior ocorrência de Diabetes Mellitus (54,2%) e Hipertensão Arterial Sistêmica (34,2%). 222 pacientes (27,8%) foram internados na Unidade de Terapia Intensiva. O desfecho óbito foi observado em 157 pacientes (19,6%). Houve correlação do óbito entre algumas variáveis sociodemográficas e clínicas. Conclusão: O estudo evidenciou maior prevalência de doenças prévias como a hipertensão, diabetes mellitus, obesidade e doença pulmonar obstrutiva crônica. A idade mostrou-se um fator de risco independente para óbito. A ocorrência de óbito na faixa etária acima de 80 anos foi 13 vezes maior em relação à população mais jovem.

Translation and cross-cultural adaptation of the knowledge translation planning template for the brazilian context / Traducción y adaptación intercultural de la plantilla de planificación para la traducción de conocimiento al contexto brasileño / Tradução e adaptação transcultural da ferramenta knowledge translation planning template para o contexto brasileiro

ABSTRACT Objective: to translate, cross-culturally adapt, and validate the content of the Knowledge Translation Planning Template, a research dissemination planning tool, into Brazilian Portuguese. Method: this is a methodological study, sequentially divided into six stages: initial translation, translation synthesis, back-translation, judges' committee, pre-test, and approval of the adapted version by the instrument author. The judge's committee assessed content validity using the modified Kappa and Content Validity Index. The test was conducted with teachers and students from a Federal University of Santa Catarina graduate program. Results: the process of translating and back-translating the tool showed no discrepancies in terms of meaning. The committee was composed of seven judges who carried out semantic, cultural, and conceptual evaluations and made notes on the translation of the content. At this stage, the content validity showed excellent values for the Content Validity Index and modified Kappa, with 0.99 and 0.816, respectively. The tool was tested with 30 teachers and postgraduate students, where 90% of the respondents considered the tool to be sufficiently comprehensive and that all the items were relevant to the purpose of the instrument. In the last stage, the documents were analyzed together with the author of the original tool and the final version was approved. Conclusion: the Modelo de Planejamento de Tradução do Conhecimento results from a careful translation process, cross-cultural adaptation, and tool content validation. This has resulted in a tool that is applicable and understood by the target audience, which shows consistency in the equivalence of translation and cross-cultural adaptation for Brazil.

RESUMEN Objetivo: realizar la traducción, adaptación transcultural y validar el contenido de la Plantilla de Planificación para la Traducción del Conocimiento para el idioma portugués de Brasil. Método: estudio metodológico que siguió seis etapas: traducción inicial, síntesis de la traducción, retrotraducción, comité de expertos, pretest y aprobación de la versión adaptada por la autora de la herramienta. Em el comité de expertos, la validez del contenido se calculó mediante el índice de validez de contenido y el Kappa modificado. El pre-test se realizó con profesores y estudiantes de un programa de postgrado en la Universidad Federal de Santa Catarina. Resultados: el proceso de traducción y retrotraducción de la herramienta no mostró discrepancias en términos de significado. El comité estuvo formado por siete expertos que evaluaron los aspectos semánticos, culturales y conceptuales y realizaron observaciones sobre la traducción del contenido. En esta etapa, la validez de contenido mostró valores excelentes para el Índice de Validez de Contenido y el Kappa modificado, con 0,99 y 0,816 respectivamente. La herramienta se probó con 30 profesores y estudiantes de posgrado, donde el 90% de los encuestados consideraron que la herramienta era lo suficientemente completa y que todos los elementos eran pertinentes para el propósito de la herramienta. En la fase final, se analizaron los documentos junto con la autora de la herramienta original y se aprobó la versión final. Conclusión: el "Modelo de Planejamento de Tradução do Conhecimento" es el resultado de un proceso riguroso de traducción, adaptación transcultural y validación de contenido de la herramienta. El resultado fue una herramienta aplicable y comprensible para el público destinatario, y que muestra coherencia en la equivalencia de la traducción y la adaptación transcultural para Brasil.

RESUMO Objetivo: realizar a tradução, adaptação transcultural e validar o conteúdo da Knowledge Translation Planning Template para língua portuguesa do Brasil. Método: estudo metodológico, que seguiu seis etapas: tradução inicial, síntese da tradução, retrotradução, comitê de juízes, pré-teste e aprovação da versão adaptada pela autora da ferramenta. No comitê de juízes a validade do conteúdo foi calculada por meio do Índice de Validade de Conteúdo e Kappa modificado. O pré-teste foi realizado com docentes e discentes de um programa de pós-graduação da Universidade Federal de Santa Catarina. Resultados: o processo de tradução e retrotradução da ferramenta não apresentou discrepâncias em termos de significado. O comitê foi composto por sete juízes que realizaram avaliação semântica, cultural, conceitual e realizaram apontamentos quanto à tradução do conteúdo. Nesta etapa, a validade de conteúdo apresentou valores excelentes de Índice de Validade de Conteúdo e Kappa modificado, com 0,99 e 0,816 respectivamente. A ferramenta foi testada com 30 docentes e discentes de pós-graduação, onde 90% dos respondentes consideraram a ferramenta suficientemente abrangente, e que todos os itens são relevantes ao propósito da ferramenta. Na última etapa, os documentos foram analisados em conjunto com a autora da ferramenta original e a versão final foi aprovada. Conclusão: o Modelo de Planejamento de Tradução do Conhecimento é resultado de um processo criterioso de tradução, adaptação transcultural e validação de conteúdo da ferramenta. Isso gerou uma ferramenta aplicável e compreendida pelo público-alvo, a qual apresenta consistência na equivalência da tradução e adaptação transcultural para o Brasil.

Effectiveness of care transition strategies for colorectal cancer patients: a systematic review and meta-analysis.

INTRODUCTION: Implementing effective strategies to transition care for individuals with colorectal cancer is an important tool to qualify care for affected individuals, as well as contribute to the dispensation of continuous and quality care to patients. OBJECTIVE: To evaluate the effectiveness of strategies to transition from hospital care to the community compared to usual care for colorectal cancer patients to reduce hospital stay, readmissions at 30 days, and visit to the emergency department up to 30 days. METHOD: Systematic review and meta-analysis followed the recommendations of PRISMA statement, with protocol registered in PROSPERO (CRD 42,020,162,249). Searches were carried out in May 2020 in the following databases: PubMed/MEDLINE, LILACS, EMBASE, and Cochrane Central. Meta-analysis was performed using a random-effects model. The measure of effect used for dichotomous outcomes was relative risk, and for continuous outcomes, the difference of means was used, with their confidence intervals of 95%. Heterogeneity was evaluated using inconsistency statistics. RESULTS: Of 631 identified studies, seven studies were included. The meta-analysis of the studies showed a reduction in readmissions at 30 days of 32% and a significant reduction in hospital stay time of approximately one and a half days, both of which were analyzed in favor of the group of care transition interventions. CONCLUSION: The findings showed effective care transition strategies for the transition of colorectal cancer patients, such as post-discharge active surveillance program, standardized protocol of improved recovery, and telephone follow-up. TRIAL REGISTRATION: CRD42020162249.

Care transitions among oncological patients: from hospital to community / Transição do cuidado de pacientes oncológicos: do hospital para a comunidade / Transición de la atención al paciente oncológico: del hospital a la comunidad

ABSTRACT Objective: To analyze the transition of care from the perspective of cancer patients, in a Southern Brazil hospital, correlating perspectives with sociodemographic and clinical characteristics. Method: Cross-sectional study using the Care Transitions Measure (CTM) with cancer patients undergoing clinical or surgical treatment following hospital discharge. Data collection was completed by telephone, between June and September 2019. Data analysis was performed using descriptive and inferential statistics. Results: The average CTM score was 74.1, which was considered satisfactory. The CTM factors: understanding about medications (83.3) and preparation for self-management (77.7) were deemed satisfactory; while: secured preferences (69.4) and care plan (66.1) were unsatisfactory for an effective and safe care transition. No statistically significant difference was found between sociodemographic variables and the CTM. Among the clinical variables, primary cancer and the secured preferences factor showed a significant difference (p = 0.044). Conclusion: The transition from hospital care to the community was considered satisfactory in the overall assessment.

RESUMO Objetivo: Analisar a transição do cuidado na perspectiva de pacientes oncológicos, em um hospital do sul do Brasil, correlacionando perspectivas com características sociodemográficas e clínicas. Método: Estudo transversal utilizando o Care Transitions Measure (CTM) com pacientes oncológicos em tratamento clínico ou cirúrgico após a alta hospitalar. A coleta de dados foi realizada por telefone entre junho e setembro de 2019. A análise dos dados foi realizada por meio de estatística descritiva e inferencial. Resultados: A pontuação média do CTM de 74,1, foi considerada satisfatória. Os fatores CTM: compreensão sobre medicamentos (83,3) e preparo para autocuidado (77,7) foram satisfatórios, enquanto: preferências garantidas (69,4) e plano de cuidados (66,1) foram insatisfatórios para uma transição de cuidado efetiva e segura. Não foi encontrada diferença estatisticamente significativa entre as variáveis sociodemográficas e o CTM. Entre as variáveis clínicas, o câncer primário e o fator de preferências garantidas apresentaram diferenças significativas (p = 0,044). Conclusão A transição da assistência hospitalar para a comunidade foi considerada satisfatória na avaliação geral.

RESUMEN Objetivo: Analizar la transición de la atención desde la perspectiva de los pacientes con cáncer en un hospital del sur de Brasil, correlacionando las perspectivas con las características sociodemográficas y clínicas. Método: Estudio transversal utilizando el Care Transitions Measure (CTM) con pacientes oncológicos en tratamiento clínico o quirúrgico tras el alta hospitalaria. La recogida de datos se realizó por teléfono entre junio y septiembre de 2019. Los datos se analizaron mediante estadísticas descriptivas e inferenciales. Resultados: La puntuación media de la CTM, 74,1, se consideró satisfactoria. Los factores de la CTM: comprensión sobre la medicación (83,3) y preparación para el autocuidado (77,7) fueron satisfactorios, mientras que: preferencias garantizadas (69,4) y plan de cuidados (66,1) fueron insatisfactorios para una transición de cuidados eficaz y segura. No se encontraron diferencias estadísticamente significativas entre las variables sociodemográficas y las medidas de CTM. Entre las variables clínicas, el cáncer primario y el factor de preferencias garantizadas mostraron diferencias significativas (p = 0,044). Conclusión: La transición de la atención hospitalaria a la comunitaria se consideró satisfactoria en la evaluación global. (175 palavras)

Family arrangement, social support and frailty among community-dwelling older adults: a mixed methods longitudinal study / Conformación familiar, apoyo social y fragilidad en ancianos que viven en la comunidad: estudio longitudinal con métodos mixtos / Arranjo familiar, apoio social e fragilidade em idosos da comunidade: estudo longitudinal com métodos mistos

ABSTRACT Objective to analyze, over time, the constitution of the older adults' family arrangements and their relationship with social support, frailty, quality of life and cognition; in addition to verifying existing tensions in the family context from the perspective of these subjects. Method a longitudinal study, using mixed methods and concomitant triangulation. A sociodemographic interview, the Edmonton Frailty Scale, WHOQOL-BREF and OLD, The Montreal Cognitive Assessment, Genogram and Ecomap were applied. The quantitative data used the Wilcoxon and Mann Whitney comparison test; and those with a qualitative approach were treated according to Bardin's content analysis, with dialectical materialism as a theoretical framework. Results most of the 84 aged people in the study period (2012/2016-2019) were over 70 years old and female (83.3%). Frailty and cognition did not present a statistically significant relationship with the type of family arrangement. Aged people who lived alone had a worse quality of life in the physical (p=0.044) and psychological (p=0.031) domains. Older adults who lived with grandchildren showed worsening in the social relationship domain (p=0.047) and improvement in the death and dying domain (p<0.001). Three categories and nine subcategories were found, which highlighted the importance of interdependent and supportive relationships in the family. Data integration showed that the family size arrangement and the types of its members do not determine the existence of support, but the bonds formed with family and community. Conclusion frailty and cognition presented no statistical difference with the type of family arrangement, although this relationship was found in some quality of life domains.

RESUMEN Objetivo analizar a lo largo del tempo la constitución de las conformaciones familiares de los ancianos y su relación con el apoyo social, la fragilidad, la calidad de vida y la cognición; al igual que verificar, desde la perspectiva de estos sujetos, diversas tensiones existentes en el contexto familiar. Método estudio longitudinal que recurrió al uso de métodos mixtos, con triangulación concomitante. Se aplicó una entrevista sociodemográfica, la Escala de Fragilidad de Edmonton, los instrumentos WHOQOL-BREF y OLD, The Montreal Cognitive Assessment, y las técnicas de Genograma y Ecomapa. Los datos cuantitativos se sometieron a la prueba de comparación de Wilcoxon y Mann Whitney y los de enfoque cualitativo, al análisis de contenido de Bardin, con el materialismo dialéctico como referencial teórico. Resultados la mayoría de los 84 ancianos incluidos en el período del estudio (2012/2016-2019) tenía más de 70 años de edad y pertenecía al sexo femenino (83,3%). La fragilidad y la cognición no presentaron ninguna relación estadística significativa con el tipo de conformación familiar. Los ancianos que vivían solos presentaron peores niveles de calidad de vida en los dominios físico (p=0,044) y psicológico (p=0,031), mientras que los que vivían con nietos presentaron peores valores en el dominio de relaciones sociales (p=0,047) y una mejoría en el dominio relacionado con la muerte y morir (p<0,001). Surgieron tres categorías y nueve subcategorías, que hicieron evidente la importancia de las relaciones de interdependencia y apoyo en la familia. La integración de los datos demostró que el tamaño de la familia y los tipos de familiares no determinan la existencia de apoyo, pero sí los vínculos que se establecen con la familia y la comunidad. Conclusión la fragilidad y la cognición no presentaron ninguna diferencia estadística con el tipo de conformación familiar, pese a que esta relación sí se encontró en algunos dominios de la calidad de vida.

RESUMO Objetivo analisar, ao longo do tempo, a constituição dos arranjos familiares de idosos e a relação destes com o apoio social, a fragilidade, qualidade de vida e cognição. Também, verificar, na perspectiva destes sujeitos, tensões existentes no contexto familiar. Método estudo longitudinal, com métodos mistos e triangulação concomitante. Aplicaram-se entrevista sociodemográfica, Escala de Fragilidade de Edmonton, WHOQOL-BREF e OLD, The Montreal Cognitive Assessment, Genograma e Ecomapa. Os dados quantitativos utilizaram teste de comparação de Wilcoxon e Mann Whitney; e os de abordagem qualitativa, a análise de conteúdo de Bardin, com o materialismo dialético como referencial teórico. Resultados dos 84 idosos no período do estudo (2012/2016-2019), a maioria tinha mais de 70 anos e era do sexo feminino (83,3%). A fragilidade e cognição não apresentaram relação estatística significativa com o tipo de arranjo familiar. Idosos que moravam sozinhos apresentaram pior qualidade de vida nos domínios físico (p=0,044) e psicológico (p=0,031). Idosos que moravam com netos apresentaram piora no domínio relação social (p=0,047) e melhora no domínio morte e morrer (p<0,001). Encontraram-se três categorias e nove subcategorias, as quais evidenciaram a importância das relações de interdependência e apoio na família. A integração dos dados demonstrou que o tamanho do arranjo familiar e os tipos de membros não determinam a existência de apoio, mas os vínculos formados com a família e comunidade. Conclusão a fragilidade e cognição não apresentaram diferença estatística com o tipo de arranjo familiar, porém essa relação foi encontrada em alguns domínios da qualidade de vida.

Care Transitions of Colorectal Cancer Patients from Hospital to Community: Systematic Review and Meta-analysis Protocol

Objective: To evaluate the effectiveness of care transition strategies from hospital-to-community compared to usual care for patients with colorectal cancer to reduce hospital stay, 30-day readmissions, and emergency room visits up to 30 days. Methods: Systematic review and meta­analysis protocol that followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The protocol was registered on PROSPERO (CRD42020162249). We will include studies available in the electronic databases PubMed/Medline, Embase, Cochrane CENTRAL and LILACS with care transition strategies/actions from hospital to community as the primary outcome. Eligible studies will be selected, and data will be combined and synthesized using Review Manager (RevMan 5.4) software. We will combine risk ratios or odds ratios for dichotomous data and mean differences for continuous data using a random effects model. Discussion: This review will contribute to the practice and development of effective and safe care transition strategies from hospital to community for colorectal cancer patients. There is an expectation that this review will provide much needed evidence that effective care transitions could reduce short term hospital readmission, and may thus provide added value in the care of colorectal cancer patients. Conclusion: The results of the review will be used to provide clear recommendations for hospital and primary care management to improve care transitions and, as a result, also improve integration in the healthcare system.

Objetivo: Evaluar la efectividad de estrategias de transición de cuidados del hospital a la comunidad en comparación con el cuidado usual en pacientes con cáncer colorrectal para reducir el tiempo de estancia hospitalaria, readmisiones a los 30 días y visitas al departamento de emergencias dentro de los 30 días. Métodos: Protocolo de revisión sistemática y metaanálisis que siguió las recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). El protocolo se registró en PROSPERO (CRD42020162249). Se incluirán estudios disponibles en las bases de datos electrónicas PubMed/Medline, Embase, Cochrane CENTRAL y LILACS con estrategias/acciones de transición del cuidado del hospital a la comunidad como desenlace principal. Se seleccionarán los estudios elegibles y los datos se combinarán y sintetizarán mediante el software Review Manager (RevMan 5.4). Serán combinados los riesgos relativos u odds ratios para los datos dicotómicos y las diferencias de medias para los datos continuos mediante un modelo de efectos aleatorios. Discusión: Esta revisión contribuirá a la práctica y el desarrollo de estrategias de transición de cuidado efectivas y seguras del hospital a la comunidad para los pacientes con cáncer colorrectal. Se espera que esta revisión proporcione evidencias muy necesarias de que las transiciones de cuidado efectivas podrían reducir la readmisión hospitalaria a corto plazo y, por lo tanto, pueden proporcionar un valor agregado en el cuidado de los pacientes con cáncer colorrectal. Conclusión: Los resultados de la revisión se utilizarán para proporcionar recomendaciones claras para la gestión hospitalaria y de cuidado primario para mejorar las transiciones de cuidado y, como resultado, también mejorar la integración en el sistema de salud.

Objetivo: Avaliar a efetividade de estratégias de transição do cuidado do hospital para a comunidade comparada aos cuidados habituais para pacientes com câncer colorretal para diminuir tempo de permanência hospitalar, readmissões aos 30 dias e visita ao setor de emergência até 30 dias. Métodos: Protocolo de revisão sistemática e meta-análise que seguiu as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). O protocolo foi registrado no PROSPERO (CRD42020162249). Incluiremos estudos disponíveis nas bases de dados eletrônicas PubMed/Medline, Embase, Cochrane CENTRAL e LILACS tendo como desfecho primário as estratégias/ações de transição do cuidado do hospital para a comunidade. Os estudos elegíveis serão selecionados e os dados serão combinados e sintetizados usando o software Review Manager (RevMan 5.4). Serão combinados os riscos relativos ou odds ratios para dados dicotômicos e diferenças de médias para dados contínuos usando um modelo de efeitos aleatórios. Discussão: Esta revisão contribuirá para a prática e desenvolvimento de estratégias de transição de cuidados efetivas e seguras do hospital para a comunidade para pacientes com câncer colorretal. Espera-se que esta revisão forneça evidências muito necessárias de que as transições de cuidados efetivas podem reduzir a readmissão hospitalar de curto prazo e podem, assim, fornecer valor agregado no cuidado de pacientes com câncer colorretal. Conclusão: Os resultados da revisão serão usados ​​para fornecer recomendações claras para a gestão hospitalar e de cuidados primários para melhorar as transições de cuidados e, como resultado, também melhorar a integração no sistema de saúde.

Safety culture in healthcare: mixed method study.

PURPOSE: Healthcare providers' perceptions of management's effectiveness in achieving safety culture improvements are low, and there is little information in the literature on the subject. Objective: The overall aim of this study was to examine the patient safety culture within an interprofessional team - physicians, nurses, nurse technicians, speech therapist, psychologist, social worker, administrative support - practicing in an advanced neurology and neurosurgery center in Southern Brazil. DESIGN/METHODOLOGY/APPROACH: The authors applied the safety attitudes questionnaire (SAQ) in a mixed methods study, with a quan→QUAL sequential explanatory approach. FINDINGS: In the quantitative phase, the authors found a negative safety climate through the SAQ. In the qualitative phase, the approach enabled participants to identify specific safety problems. For that, participants proposed improvements that were directly and quickly implemented in the workplace during the study. The joint analysis of the quantitative and qualitative data inferred that the information and reflections of the focus group participants supported and validated the SAQ statistical analysis results. This integrated approach illustrated the importance of various safety culture aspects as a multifaceted phenomenon related to healthcare quality. ORIGINALITY/VALUE: This study provides explanations for why management is associated negatively with safety climate in healthcare institutions. In addition, the study provides a novel contribution adding value to mixed methods research methodology.

Cultura de segurança do paciente na perspectiva da equipe multiprofissional: uma revisão integrativa / Patient safety culture from the perspective of the multiprofessional team: an integrative review / Cultura de seguridad del paciente en la perspectiva del equipo multiprofesional: uma revision integrativa

Objective:To identify the scientific production on patient safety culture in a hospital setting from the perspective of the multiprofessional team. Method: review of the literature, in the LILACS, PubMed, WoS and Scopus databases, in Portuguese, English and Spanish. Results: twelve publications were found, which were concentrated between the years 2004 and 2016. The analysis of the studies allowed to identify that the security climate is still fragile in most of the evaluated institutions. Among the strategies to generate improvements in safety culture, training programs, open communication in the work environment, notification of adverse events and non-punitive response to the error were highlighted. The organizational learning dimensions for continuous improvement and teamwork within the units were evidenced as potentialities. Conclusion: incipient scientific production was observed. Few studies have included all professionals to perform the analysis of patient safety culture in the hospital setting, despite their relevance to the promotion of safe care

Objetivo: Identificar a produção científica sobre cultura de segurança do paciente em âmbito hospitalar na perspectiva da equipe multiprofissional. Método: revisão integrativa, realizada nas bases de dados LILACS, PubMed, WoS e Scopus, em português, inglês e espanhol. Resultados: foram localizadas 12 publicações, que concentraram-se entre os anos de 2004 e 2016. A análise dos estudos permitiu identificar que o clima de segurança ainda é frágil na maioria das instituições avaliadas. Dentre as estratégias para gerar melhorias na cultura de segurança, destacaram-se os programas de treinamento, comunicação aberta no ambiente de trabalho, notificação de eventos adversos e resposta não punitiva ao erro. Evidenciaram-se como potencialidades as dimensões aprendizado organizacional para a melhoria contínua e trabalho em equipe dentro das unidades. Conclusão: poucos estudos incluíram todos os profissionais para realizar a análise da cultura de segurança do paciente em âmbito hospitalar, apesar da sua relevância para a promoção do cuidado seguro

Objetivo: Identificar la producción científica sobre cultura de seguridad del paciente en ámbito hospitalario en la perspectiva del equipo multiprofesional. Método: revisión integradora, llevado a cabo en las bases de datos LILACS, PubMed, Scopus y WoS en portugués, Inglés y Español. Resultados: se localizaron 12 publicaciones, que se concentraron entre los años 2004 y 2016. El análisis de los estudios permitió identificar que el clima de seguridad aún es fragil en la mayoría de las instituciones evaluadas. Entre las estrategias para generar mejoras en la cultura de seguridad, se destacaron los programas de entrenamiento, comunicación abierta en el ambiente de trabajo, notificación de eventos adversos y respuesta no punitiva al error. Se evidenció como potencialidades las dimensiones aprendizaje organizacional para la mejora continua y trabajo en equipo dentro de las unidades. Conclusión: pocos estudios incluyeron a todos los profesionales para realizar el análisis de la cultura de seguridad del paciente en el ámbito hospitalario, a pesar de su relevancia para la promoción del cuidado seguro