Anais da II Mostra Estadual de Educação Permanente em Saúde e I Mostra de Pesquisa Científica em Saúde: ciência e educação na saúde: transformando práticas / Proceedings of the 2nd State Exhibition of Permanent Education in Health and 1st Exhibition of Scientific Research in Health: science and education in health transforming practices

Anais da segunda Mostra Estadual de Educação Permanente em Saúde e da primeira Mostra de Pesquisa Científica em Saúde: Ciência e educação na saúde: transformando práticas realizadas em 7 e 8 de dezembro de 2022 em Palmas no Tocantins. Os temas abordados tratam de diferentes aspectos da área de saúde e suas práticas, com foco em melhorias nos processos de assistência, educação e gestão. São mencionados temas como primeiros socorros, humanização do atendimento hospitalar, segurança do paciente, planejamento estratégico, coleta de exames, regulamentação do trabalho na área da saúde, aleitamento materno, vigilância alimentar e nutricional, impactos da Covid-19, saúde mental, assistência odontológica, saúde do trabalhador, uso de tecnologia na capacitação em saúde, entre outros. As propostas e experiências relatadas buscam aprimorar a qualidade da assistência e dos serviços de saúde prestados à população, por meio da capacitação, atualização e aperfeiçoamento de profissionais, implementação de políticas públicas e melhoria dos processos de gestão e atendimento.

Proceedings of the Second State Exhibition on Permanent Education in Health and the First Scientific Research Exhibition in Health: Science and Education in Health: Transforming Practices held on December 7th and 8th, 2022, in Palmas, Tocantins. The topics covered deal with different aspects of the health field and its practices, focusing on improvements in the processes of assistance, education, and management. Topics such as first aid, humanization of hospital care, patient safety, strategic planning, examination collection, regulation of work in the health area, breastfeeding, food and nutritional surveillance, impacts of Covid-19, mental health, dental care, occupational health, use of technology in health training, among others, are mentioned. The proposals and experiences reported aim to improve the quality of assistance and health services provided to the population, through training, updating, and professional development, implementation of public policies, and improvement of management and care processes.

Actas de la Segunda Exhibición Estatal sobre Educación Permanente en Salud y la Primera Exhibición de Investigación Científica en Salud: Ciencia y Educación en Salud: Transformando Prácticas realizadas el 7 y 8 de diciembre de 2022 en Palmas, Tocantins. Los temas tratados abordan diferentes aspectos del campo de la salud y sus prácticas, enfocándose en mejoras en los procesos de asistencia, educación y gestión. Se mencionan temas como primeros auxilios, humanización de la atención hospitalaria, seguridad del paciente, planificación estratégica, recolección de exámenes, regulación del trabajo en el área de la salud, lactancia materna, vigilancia alimentaria y nutricional, impactos del Covid-19, salud mental, atención dental, salud ocupacional, uso de tecnología en la capacitación en salud, entre otros. Las propuestas y experiencias reportadas buscan mejorar la calidad de la asistencia y los servicios de salud proporcionados a la población, a través de la capacitación, actualización y desarrollo profesional, implementación de políticas públicas y mejora de los procesos de gestión y atención.

DNP or PhD as a Credential for Nurse Faculty: Choices and Consequences.

With the inception of the Doctor of Nursing Practice (DNP) as the designated practice doctorate in nursing and ultimate acceptance of the DNP as a terminal degree in nursing by professional nursing organizations, questions have arisen about the implications for faculty appointment in the teaching-learning in nursing. Following a brief discussion of the background of the DNP and recent trends in academic nursing programs, a challenge is presented to nurse faculty and administrators to consider carefully the illuminated critical issues and concerns in planning for the future of teaching-learning in nursing.

Knowledge of US Midwifery Credentials Among Members of the American College of Nurse-Midwives.

INTRODUCTION: Three midwifery credentials are granted in the United States: certified nurse-midwife (CNM), certified midwife (CM), and certified professional midwife (CPM). Confusion about US midwifery credentials may restrict growth of the midwifery profession. This survey assessed American College of Nurse-Midwives (ACNM) members' knowledge of US midwifery credentials. METHODS: ACNM members (N = 7551) were surveyed via email in 2017. The survey asked respondents to report demographic information and to identify correct statements about the education, certification, and scope of practice of CNMs, CMs, and CPMs. Responses to 17 items about all midwives certified in the United States, a 5-item subset specific to CNMs/CMs, and one item related to location of midwifery practice by credential were analyzed. RESULTS: Nearly a quarter of the membership (22.1%) responded to the survey. Higher scores on the survey indicated greater identification of correct statements about the education, certification, scope, and location of practice of CNMs, CMs, and CPMs. Significant differences in scores were found among ACNM members based on their level of education, degree of professional involvement in midwifery, and prior practice as a nurse. ACNM members with higher scores on the survey held a doctorate, worked in Region I, and had greater professional leadership involvement in midwifery organizations. Participants with less nursing experience prior to their midwifery education also scored significantly higher on the survey. DISCUSSION: Although two-thirds of respondents correctly answered items on the preparation, credentialing, and scope of practice of CNMs, CMs, and CPMs, a significant minority had gaps in knowledge. Results of this survey suggest the need for outreach about US midwifery credentials. Future research to replicate and expand upon this survey may benefit the profession of midwifery in the United States.

Comparison of specialties participating in the BEST-CLI trial to specialists treating peripheral arterial disease nationally.

BACKGROUND: The Best Endovascular vs Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI) trial compares open surgery and endovascular therapy for the treatment of critical limb ischemia (CLI). This report describes the types and proportion of investigators participating in BEST-CLI and determines how these compare with those specialists treating peripheral artery disease (PAD) outside of the trial. METHODS: To be credentialed to enroll in BEST-CLI, investigators must be approved by the Surgical and Interventional Management Committee to have sufficient experience and skill in the management of patients with CLI. Investigators must attest to having completed at least 12 below-knee interventions in the last 2 years on CLI patients for endovascular approval and 10 lower extremity below-knee bypass procedures in the last 2 years for open surgical treatment. Investigators who met these criteria but were within their first year of practice were conditionally approved to do procedures under the oversight of a fully approved investigator. The type and proportion of specialists credentialed in BEST-CLI were compared with those treating PAD on a national basis by auditing 10% of Medicare claims for PAD. RESULTS: As of September 2017, a total of 865 physicians were credentialed to enroll in the BEST-CLI trial. Of these, 596 (69%) are vascular surgeons, 128 (15%) are interventional cardiologists, 123 (14%) are interventional radiologists, 7 (1%) are vascular medicine specialists, and 11 (1%) are other. Of the 596 vascular surgeons enrolling in the trial, 113 (19%) are credentialed for open surgery only, 409 (69%) are credentialed for both open surgery and endovascular therapy, and 3 (1%) are credentialed for only endovascular therapy. The remaining 71 participating vascular surgeons were conditionally approved. Of the 136 centers enrolling patients, multispecialty involvement is present in 98 (72%). In 38 (28%), vascular surgery alone is the service enrolling CLI patients. Endovascular treatment by specialty in BEST-CLI vs national Medicare claims is as follows: vascular surgery, 55% vs 51%; interventional cardiology, 17% vs 13%; interventional radiology, 16% vs 25%; and other, 2% vs 10%. CONCLUSIONS: BEST-CLI contains a diverse group of specialists enrolling and treating patients with CLI. Whereas a majority of the participating practitioners are vascular surgeons who do both open and endovascular procedures, a broad variety of specialists are represented in BEST-CLI in a pattern that represents national treatment patterns outside of the BEST-CLI trial. These treatment patterns will help ensure that findings from BEST-CLI are applicable to the real-world practice of treatments for PAD.

Diploma Europeo en Anestesiología y Cuidados Intensivos en España: resultados de los exámenes de las partes 1 y 2 de los últimos cinco años. ¿Vamos por el buen camino? / European Diploma in Anaesthesiology and Intensive Care in Spain: Results for the part 1 and part 2 exams in the last five years. Are we going in the right direction?

Antecedentes: El Diploma Europeo en Anestesiología y Cuidados Intensivos (EDAIC) se ha convertido en un estándar de calidad entre los anestesiólogos españoles. El objetivo de este estudio retrospectivo observacional fue valorar los resultados de los participantes españoles en los dos exámenes -parte1 y parte2- en un periodo reciente de 5años, entre 2012 y 2016 y entre 2013 y 2017, respectivamente. Material y métodos: Después de obtener la autorización de la European Society of Anaesthesiology, los resultados de los dos exámenes del EDAIC fueron analizados de manera anónima en un periodo de 5años. Analizamos el número de inscripciones, la tasa de aprobados, la causa de suspensos y la nota media en ciencias básicas (cuadernilloA de la parte1 del examen y las dos primeras mesas de la parte2 del examen) y en anestesiología clínica y cuidados intensivos (cuadernilloB de la parte1 del examen y las dos últimas mesas de la parte2 del examen). Las variables cuantitativas fueron analizadas con análisis de varianza y las variables cualitativas con test de chi-cuadrado para tendencias. El nivel de significación estadística fue establecido en p<0,05. Resultados: Para la parte 1 del examen escrito, 1.189 de un total de 10.954 candidatos (10,85%) fueron inscritos en centros españoles, reflejando el crecimiento global del examen (p=0,29). La tasa de aprobados fue del 62,1%, sin diferencias significativas con los demás países (p=0,38). Las ciencias básicas supusieron el 84,1% de los suspensos. La nota media fue de 71,74+/-5,98% para las ciencias básicas (cuadernilloA) y de 74,48+/-4,29% para la anestesiología clínica (cuadernilloB). En relación con la parte2 del examen, el 72,4% de los candidatos aprobados en la parte1 del examen se inscribieron en la parte2, con una tasa de aprobados del 62,7%, versus el 62,2% en el resto del mundo (p=0,91). Los suspensos en las mesas de ciencias básicas de la parte2 del examen supusieron el 93,8% de los candidatos suspensos en la parte2 del examen. Los suspensos eliminatorios en una mesa fueron registrados en 56 (31,5%) de los candidatos suspensos, de los que el 71,3% se produjeron en las mesas de ciencias básicas. Los suspensos eliminatorios aislados se produjeron solo en 7 (3,9%) de los candidatos. Conclusiones: La evolución del EDAIC en España ha sido muy similar a la del resto del mundo. En el futuro, los esfuerzos persistentes de los anestesiólogos españoles para mejorar sus conocimientos en ciencias básicas y preparar mejor la técnica del examen oral podrían mejorar la tasa de aprobados en el EDAIC en una cohorte de candidatos en constante aumento

Background: The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. Material and methods: After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P<.05. Results: For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74+/-5.98% for basic science (paperA) and 74.48+/-4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. Conclusions: The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates

Gender Differences in Authorship in the Journal of Cardiothoracic and Vascular Anesthesia: A 28-Year Analysis of Publications Originating From the United States, 1990-2017.

OBJECTIVE: Gender-based differences in scholarship among cardiothoracic anesthesiologists have not been studied. The authors examined the gender distribution of authorship of original research articles, case reports, review articles, and editorials in the Journal of Cardiothoracic and Vascular Anesthesia (JCVA) originating from the United States during four 3-year intervals to determine temporal changes in productivity of women in cardiothoracic anesthesiology. The authors tested the hypothesis that scholarly output of women has increased progressively in JCVA over time concomitant with greater participation in first, last, and corresponding author roles. DESIGN: Observational study. SETTING: Internet analysis. PARTICIPANTS: Authors of research articles, case reports, review articles, and editorials published in JCVA in 1990-92, 1999-2001, 2008-10, and 2015-17. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The gender of each author was determined by inspection of the first name. If gender could not be established easily, the author's institutional website was examined or an internet search using the Google search engine was conducted. First, last, and corresponding authors as well as coauthors were noted for each article. A total of 1,195 publications with 4,982 authors (1,032 women; 20.7%) were examined. Gender was identified positively in 98.5% of authors. Women were first, last, and corresponding authors on 22.4%, 10.3%, and 14.6% of publications, respectively. The percentage of women who were authors increased from 12.1% in 1990-92 to 20.9% in 1999-2001 (p < 0.05), but plateaued in 2008 to 2010 (22.3%) and 2015 to 2017 (22.9%). Greater percentages of women were first authors (26.2%), senior authors (11.8%), and corresponding authors (16.6%) in 2015 to 2017 compared with 1990 to 1992 (9.6%, 7.0%, and 8.7%, respectively; p < 0.05 for each). The contributions of women to research articles and case reports were primarily responsible for these observed increases, although women also made a substantial impact with review articles in 2015 to 2017. The percentage of publications that included at least 1 female author in any capacity increased in a time-dependent manner (p < 0.05) from 31.0% (1990-1992) to 74.4% (2015-2017). The proportion of female first or last authors (35.0%) appearing in JCVA during 2015 to 2017 was modestly higher than the current percentage of female cardiothoracic anesthesiologists practicing in departments with accredited fellowship programs (29.1%). CONCLUSION: The results indicate that scholarly output of women rose in JCVA over time, but gains in productivity have plateaued more recently. These findings are encouraging, but women continue to be underrepresented in corresponding and last author roles.

Advancing Health Professions Education Research by Creating a Network of Networks.

Producing the best evidence to show educational outcomes, such as competency achievement and credentialing effectiveness, across the health professions education continuum will require large multisite research projects and longitudinal studies. Current limitations that must be overcome to reach this goal include the prevalence of single-institution study designs, assessments of a single curricular component, and cross-sectional study designs that provide only a snapshot in time of a program or initiative rather than a longitudinal perspective.One solution to overcoming these limitations is to develop a network of networks that collaborates, using longitudinal approaches, across health professions and regions of the United States. Currently, individual networks are advancing educational innovation toward understanding the effectiveness of educational and credentialing programs. Examples of such networks include (1) the American Medical Association's Accelerating Change in Medical Education initiative, (2) the National Center for Interprofessional Practice and Education, and (3) the Accreditation Council for Graduate Medical Education's Accreditation System. In this Invited Commentary, the authors briefly profile these existing networks, identify their progress and the challenges they have encountered, and propose a vigorous way forward toward creating a national network of networks designed to determine the effectiveness of health professions education and credentialing.

Establishing Clinical Pharmacy Services With Prescribing Privileges in a Federally Qualified Health Center Primary Care Clinic.

OBJECTIVES: To describe the process and cost of establishing clinical pharmacy services with prescribing privileges in a federally qualified health center (FQHC) primary care clinic. SETTING: The primary care clinic was located in a low-income area of Southern California and served patients with Medicaid and Medicare. The primary care clinic had preventive medicine and family medicine physicians, a family medicine residency program, behavioral health services, and a registered dietician. PRACTICE INNOVATION: New clinical pharmacy services were established at this FQHC primary care clinic. The medication assistance program was a stepping stone to establish rapport with the physicians. Credentialing and privileging was implemented for clinical pharmacists. An open protocol collaborative practice agreement was developed to allow clinical pharmacists to manage ambulatory patients. RESULTS: From August 2014 to June 2015, the clinical pharmacist interacted with 392 patients and spent 336 hours educating patients and providing disease state management. The pharmacist also provided consults to residents and providers. Diabetic patients made up 76% of all clinical pharmacy encounters. There were 86 face-to-face clinical pharmacy appointments with the pharmacist. The average time for clinical pharmacy appointments was 77 minutes. CONCLUSION: By describing ways to develop rapport with providers, how to credential and privilege pharmacists, and explain resources and costs of setting up a service, the hope is that more clinical pharmacists will be able to incorporate into independent or FQHC primary care clinics for improved management of ambulatory patients.

Instrumentos geniales: diplomas de acreditación y diplomas de acreditación avanzada / Brilliant instruments: diplomas of accreditation and advanced diplomas of accreditation

No disponible

Prescribing pharmacists in the ambulatory care setting: Experience at the University of North Carolina Medical Center.

PURPOSE: The prescribing authorities, clinical activities, and productivity documentation strategies of ambulatory care clinic-based pharmacists practicing within a large academic health system are described. SUMMARY: North Carolina law encourages progressive pharmacy practice through acquisition of the clinical pharmacist practitioner (CPP) designation. Qualified CPPs are authorized to provide collaborative drug therapy management services, including medication prescribing and ordering of laboratory tests, according to defined protocols and under physician supervision. The University of North Carolina Medical Center has approximately 30 CPPs deployed across a wide range of ambulatory care clinical practice sites. This article describes (1) the pharmacy department's implementation of an ambulatory care practice model, (2) the credentialing and privileging process leading to granting of prescribing privileges, (3) metrics used to demonstrate the impact of CPP activities, (4) recommended general criteria for ambulatory care practice site identification, and (5) strategies for overcoming barriers to successful implementation of ambulatory care-focused clinical pharmacist services. Aggregated intervention-tracking data compiled by seven of the medical center's CPP ambulatory care practice sites indicate extensive CPP involvement in direct patient care encounters and patient or provider consultations, with large numbers of medication-related interventions to support institutional cost-avoidance and revenue goals. CONCLUSION: CPPs deployed at the medical center's ambulatory care clinics have had a positive impact on clinical and cost outcomes, improving patient care through interventions, contributing to readmission reduction efforts, generating indirect revenue through cost avoidance, and generating new revenue through billing for patient visits.

Application of a Taxonomy to Characterize the Public Health Workforce.

OBJECTIVE: A public health workforce taxonomy was published in 2014 to provide a standardized mechanism for describing public health worker characteristics. The Public Health Workforce Interests and Needs Survey (PH WINS) used 7 of the taxonomy's 12 axes as a basis for its survey response choices, 3 of which are the focus of this analysis. The purpose of this study was to determine the relative utility, reliability, and accuracy of the public health workforce taxonomy in categorizing local and state public health workers using a survey tool. This specifically included the goal of reducing the number of responses classified as "other" occupation, certification, or program area by recoding responses into taxonomy categories and determining potential missing categories for recommendation to the advisory committee that developed the taxonomy. DESIGN: Survey questions associated with the occupation, certification, and program area taxonomy axes yielded qualitative data from respondents who selected "other." The "other" responses were coded by 2 separate research teams at the University of Michigan Center of Excellence in Public Health Workforce Studies and NORC at the University of Chicago. MAIN OUTCOME MEASURES: Researchers assigned taxonomy categories to all analyzable qualitative responses and assessed the percentage of PH WINS responses that could be successfully mapped to taxonomy categories. RESULTS: Between respondent self-selection and research team recoding, the public health workforce taxonomy successfully categorized 95% of occupation responses, 75% of credential responses, and 83% of program area responses. Occupational categories that may be considered for inclusion in the taxonomy in the future include disease intervention specialists and occupations associated with regulation, certification, and licensing. CONCLUSIONS: The public health workforce taxonomy performed remarkably well in categorizing worker characteristics in its first use in a national survey. The analysis provides some recommendations for future taxonomy refinement.

Optimizing All Licensed Staff: Magnet Standards Require an All-BSN/RN Staff in Hospital Settings by 2020: Truth or Myth?

This column, presented by the executive vice president and chief officer of the American Nurses Credentialing Center, Linda Lewis, MSA, RN, NEA-BC, FACHE, discusses a topic of interest to nurse executives as they develop plans for the nursing workforce. Ms Lewis addresses the direction of the Magnet Recognition Program® with regard to requirements for staffing mix.

Recorrido legislativo de la profesión de matrona / The regulatory journey of the midwife profession

A lo largo de la historia, las mujeres han sido las responsables de los cuidados de la embarazada y el parto. Los conocimientos eran transmitidos de madres a hijas, hasta que se inició el reconocimiento de la profesión en el siglo XIII. En este trabajo se describe la evolución de la legislación contemporánea que regula las competencias de las matronas españolas. Se ha llevado a cabo una revisión documental. Se han localizado documentos primarios, consulta del Boletín Oficial del Estado y revisión de las bases de datos CUIDEN y MEDLINE. No se han utilizado límites de tiempo. Formando parte de los resultados, se describen las diferentes disposiciones y leyes que han regulado la profesión desde 1973 hasta la actualidad. Hay una evolución favorable a lo largo de la historia de la profesión de matrona, en la que el reconocimiento de sus funciones ha aumentado, tanto en las ordenaciones jurídicas europeas como españolas. Actualmente, en nuestro entorno, la matrona es una figura reconocida y con unas competencias bien delimitadas

Throughout history, women have been responsible for pregnancy care and labour. Knowledge was transmitted from mothers to daughters, until the acknowledgement of the profession started in the XIII century. This article describes the evolution of contemporary legislation which regulates the responsibilities of Spanish midwives. A document review was conducted. Primary documents were located, the Official Gazette of the State (BOE) was consulted, and there was a review of the CUIDEN and MEDLINE databases. No time limitations were used. As part of the results, there is a description of the different regulations and laws which have ruled the profession from 1973 to our current day. There has been a favourable evolution along the history of the midwife profession, with an increase in the acknowledgement of its functions, both by European and Spanish legal systems. Currently, in our setting, the midwife is an acknowledged figure, with well-specified responsibilities

State of the state: NNP program update 2013.

Findings from a spring 2013 survey of neonatal nurse practitioner (NNP) program directors are presented and concerning trends identified. Implications of these findings, in combination with other external factors influencing the supply/demand ratio on the stability of the NNP workforce nationwide, are explored. Present and future NNP workforce demands in relation to the educational programs available to prepare nurses for NNP practice are examined. Finally, discussion focuses on the politics and pragmatics of sustaining the NNP role for posterity.