RESUMEN
The environments in which neotropical primates live have been undergoing an intense fragmentation process, constituting a major threat to the species' survival and causing resource scarcity, social isolation, and difficulty in dispersal, leaving populations increasingly vulnerable. Moreover, the proximity of wild environments to anthropized landscapes can change the dynamics of pathogens and the parasite-host-environment relationship, creating conditions that favor exposure to different pathogens. To investigate the previous exposure of free-living primates in Rio Grande do Sul State (RS), southern Brazil, to the bacterial agents Leptospira spp. and Brucella abortus, we investigated agglutinating antibodies against 23 serovars of Leptospira spp. using the microscopic agglutination test and B. abortus acidified antigen test in primate serum samples; 101 samples from primates captured between 2002 and 2016 in different forest fragments were used: 63 Alouatta caraya, 36 Alouatta guariba clamitans, and 02 Sapajus nigritus cucullatus. In addition, the forest remnants where the primates were sampled were characterized in a multiscale approach in radii ranging from 200 to 1400 m to investigate the potential relationship of previous exposure to the agent with the elements that make up the landscape structure. The serological investigation indicated the presence of antibodies for at least one of the 23 serovars of Leptospira spp. in 36.6% (37/101) of the samples analyzed, with titers ranging from 100 to 1600. The most observed serovars were Panama (17.8%), Ballum (5.9%), Butembo (5.9%), Canicola (5.9%), Hardjo (4.9%), and Tarassovi (3.9%); no samples were seropositive for Brucella abortus. Decreased forest cover and edge density were the landscape factors that had a significant relationship with Leptospira spp. exposure, indicating that habitat fragmentation may influence contact with the pathogen. The data generated in this study demonstrate the importance of understanding how changes in landscape structure affect exposure to pathogenic microorganisms of zoonotic relevance. Hence, improving epidemiological research and understanding primates' ecological role in these settings can help improve environmental surveillance and conservation strategies for primate populations in different landscapes.
Asunto(s)
Alouatta caraya , Brucelosis , Cebinae , Leptospira , Leptospirosis , Animales , Brucella abortus , Leptospirosis/epidemiología , Leptospirosis/veterinaria , Brucelosis/epidemiología , Brucelosis/veterinaria , Brucelosis/microbiología , Brasil/epidemiología , Anticuerpos AntibacterianosRESUMEN
In canine visceral leishmaniasis, coinfections can aggravate the disease. Our aim was to investigate Brucella canis in dogs infected with Leishmania infantum. One hundred and six L. infantum-seropositive dogs were submitted to serology for B. canis, PCR for B. canis and L. infantum, and histopathological analysis of the genital tract. Anti-B. canis antibodies were detected in seven dogs whose clinical signs, L. infantum load and histological alterations were similar to those of seronegative animals. The circulation of anti-B. canis antibodies was low but demonstrates the exposure of dogs to this bacterium in a visceral leishmaniasis-endemic area.
Asunto(s)
Enfermedades de los Perros , Leishmania infantum , Leishmaniasis Visceral , Animales , Perros , Genitales , Leishmania infantum/genética , Leishmaniasis Visceral/veterinaria , Reacción en Cadena de la PolimerasaRESUMEN
Bovine tuberculosis (bTB) is a zoonotic disease caused by Mycobacterium tuberculosis var. bovis, for which the definitive diagnosis is accomplished by bacterial isolation, which has biosafety issues and requires long time. Thus, diagnostic methods with potential to be faster and more efficient can represent an advance in bTB epidemiological knowledge and decrease exposure to M. tuberculosis var. bovis. This study aimed to validate a molecular test for bTB post-mortem diagnosis, as a strategy to reduce waste in bovine production. A total of 185 tissues from animals of infected herds or with suspected lesions at abattoir were evaluated through bacterial isolation, PCR and histopathology. PCR and histopathology showed sensitivities of 45.1% and 71.2%, respectively, and specificities of 83.3% and 83.0%, respectively, when compared to bacterial isolation. The combination of both tests resulted in enhanced specificity and positive predictive values.Therefore, PCR in conjunction with histopathology may be used as screening, in which concordant results can be considered conclusive, and discordant results may be submitted to bacterial isolation.
Asunto(s)
ADN Bacteriano/genética , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa , Tuberculosis Bovina/diagnóstico , Animales , Bovinos , Tuberculosis Bovina/genética , Tuberculosis Bovina/microbiologíaRESUMEN
Quartz Crystal Microbalance (QCM) biosensor technology was used to study the interaction of the DNA-binding domain (DBD) of the transcription factor RXRα with immobilized specific (DR1) and unspecific (DR1neg) DNA oligoduplexes. We identify the QCM sensor frequency at the susceptance minimum (fBmin) as a better measuring parameter, and we show that fBmin is proportional to the mass adsorbed at the sensor surface and is not influenced by interferences coming from viscoelastic variations of the adsorbed layers or buffers. This parameter was used to study the binding of RXRα to DNA and to calculate the association and dissociation kinetic constants of RXRαDBD-DR1 interaction. We show that RXRαDBD binds to DNA both as a monomer and as a homodimer, and that the mechanism of binding is salt dependent and occurs in two steps. The QCM biosensor data reveal that a high ionic strength buffer prevents the unspecific interactions and at a lower ionic strength the dissociation of RXRαDBD-DR1 occurs in two phases.
Asunto(s)
ADN/metabolismo , Receptor alfa X Retinoide/metabolismo , Secuencia de Bases , ADN/química , Humanos , Cinética , Unión Proteica , Dominios y Motivos de Interacción de Proteínas , Tecnicas de Microbalanza del Cristal de Cuarzo , Receptor alfa X Retinoide/químicaRESUMEN
A novel quartz crystal microbalance (QCM) analytical method is developed based on the transmission line model (TLM) algorithm to analyze the binding of transcription factors (TFs) to immobilized DNA oligoduplexes. The method is used to characterize the mechanical properties of biological films through the estimation of the film dynamic shear moduli, G and G, and the film thickness. Using the Saccharomyces cerevisiae transcription factor Haa1 (Haa1DBD) as a biological model two sensors were prepared by immobilizing DNA oligoduplexes, one containing the Haa1 recognition element (HRE(wt)) and another with a random sequence (HRE(neg)) used as a negative control. The immobilization of DNA oligoduplexes was followed in real time and we show that DNA strands initially adsorb with low or non-tilting, laying flat close to the surface, which then lift-off the surface leading to final film tilting angles of 62.9° and 46.7° for HRE(wt) and HRE(neg), respectively. Furthermore we show that the binding of Haa1DBD to HRE(wt) leads to a more ordered and compact film, and forces a 31.7° bending of the immobilized HRE(wt) oligoduplex. This work demonstrates the suitability of the QCM to monitor the specific binding of TFs to immobilized DNA sequences and provides an analytical methodology to study protein-DNA biophysics and kinetics.
Asunto(s)
ADN/química , Modelos Teóricos , Conformación de Ácido Nucleico , Proteínas de Saccharomyces cerevisiae/metabolismo , Factores de Transcripción/metabolismo , Secuencia de Bases , ADN/metabolismo , Unión Proteica , Cuarzo , Saccharomyces cerevisiae/químicaRESUMEN
A hydrogenated amorphous silicon (a-Si:H) photosensor was explored for the quantitative detection of a HIV-1 virion infectivity factor (Vif) at a detection limit in the single nanomolar range. The a-Si:H photosensor was coupled with a microfluidic channel that was functionalized with a recombinant single chain variable fragment antibody. The biosensor selectively recognizes HIV-1 Vif from human cell extracts.
Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , Técnicas Analíticas Microfluídicas/instrumentación , Silicio/química , Productos del Gen vif del Virus de la Inmunodeficiencia Humana/aislamiento & purificación , Células HEK293 , Humanos , Óptica y Fotónica/instrumentaciónRESUMEN
Advanced impedance spectroscopy analysis based on the transmission line model (TLM) is explored as a novel QCM acoustic biosensing platform for the detection of the single point mutation effect on the binding of the transcription factors (TFs) to immobilized DNA oligoduplexes and the characterization of the protein-DNA mechanical properties.
Asunto(s)
Espectroscopía Dieléctrica/métodos , Ácidos Nucleicos Inmovilizados/metabolismo , Mutación Puntual , Tecnicas de Microbalanza del Cristal de Cuarzo/métodos , Proteínas de Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/metabolismo , Saccharomyces cerevisiae/metabolismo , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Ácidos Nucleicos Inmovilizados/química , Modelos Moleculares , Unión Proteica , Saccharomyces cerevisiae/química , Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/química , Factores de Transcripción/químicaRESUMEN
BACKGROUND: The diaphragm, the main muscle involved in respiration and one of those responsible for maintaining life, is still little explored in terms of its morphology in wild animals. There are few studies on the anatomy of Eira barbara, a carnivorous mustelid that is a victim of the urbanization process. In order to contribute to the conservation of the species, we described the topography and morphology of the diaphragm, which may be involved in injuries caused by the impacts of human activities. RESULTS: We studied five specimens of Eira barbara, whose diaphragmatic muscle had a dorsal insertion on the 14th thoracic vertebra, laterally between the 8th and 13th intercostal space (EIC) and ventrally on the 8th EIC, with attachment to the xiphoid process. Consisting of three muscle regions (lumbar, costal and sternal), the diaphragm in Eira barbara showed radially arranged bundles, with the right costal muscle being slimmer than the left; the left pillar wider than the right and between them were the aortic and esophageal hiatuses. The Y-shaped tendinous center housed the foramen of the vena cava bordering the right costal region. In the most dorsal portion of the diaphragm, between the costal regions and the diaphragmatic pillar, we found two triangular-shaped regions devoid of muscle. CONCLUSIONS: Our findings, when compared with the current literature, indicate that the location and positioning of the diaphragm are independent of the physical conformation of the species, and that the right costal region, as well as the triangular areas devoid of musculature, may be fragile points for herniation in cases of Eira barbara being run over.
RESUMEN
Leptospirosis and toxoplasmosis are re-emerging zoonosis caused by infection with pathogenic spirochaetes of Leptospira and the protozoa Toxoplasma gondii, respectively. Wild boars (Sus scrofa), an exotic invasive species in Brazil, could play a role in the diseases' epidemiological cycles, but this issue is still unexplored. This study aimed to evaluate the Leptospira spp. and T. gondii seropositivity in wild boars in Rio Grande do Sul state, south Brazil. Of evaluated animals, 16% (13/80) and 85% (52/61) had antibodies to T. gondii and Leptospira spp., respectively. Sex, weight, age, hunt location and season of hunt were evaluated by their association with seropositivity for both pathogens, but none of them had statistical significance. This study revealed that wild boars should be considered as a potential source of Leptospira spp. and T. gondii dissemination for humans and animal species in shared environments in Rio Grande do Sul state.
Asunto(s)
Anticuerpos Antiprotozoarios , Leptospira , Leptospirosis , Sus scrofa , Enfermedades de los Porcinos , Toxoplasma , Toxoplasmosis Animal , Animales , Leptospirosis/epidemiología , Leptospirosis/veterinaria , Brasil/epidemiología , Toxoplasmosis Animal/epidemiología , Toxoplasmosis Animal/inmunología , Toxoplasma/inmunología , Leptospira/inmunología , Sus scrofa/parasitología , Porcinos , Enfermedades de los Porcinos/epidemiología , Enfermedades de los Porcinos/parasitología , Enfermedades de los Porcinos/microbiología , Anticuerpos Antiprotozoarios/sangre , Masculino , Femenino , Estudios Seroepidemiológicos , Anticuerpos Antibacterianos/sangre , Zoonosis/epidemiología , Zoonosis/parasitología , Humanos , Salud PúblicaRESUMEN
Leptospirosis is a bacterial zoonosis that affects both humans and animals worldwide. Currently, it is known that cats may be susceptible to infection. This study aims to investigate the presence of anti-Leptospira spp. antibodies and leptospiruria in cats, using Microscopic Agglutination Test (MAT) and Real-time Polymerase Chain Reaction (PCR) techniques, respectively. A total of 76 cats, undergoing comprehensive anamnesis, general physical examination, and complementary exams were included in the investigation. Among the 76 cats tested, 9.2% (7/76) exhibited the presence of anti-Leptospira spp. antibodies, while Leptospira spp. DNA was detected in at 1.3% (1/76) of the evaluated urine samples. No significant associations were observed between the serological and molecular diagnostic results and the assessed variables, including clinical data and laboratory results of cats testing positive. This study provides insight into the occurrence of Leptospira spp. infection and leptospiruria in cats treated at a veterinary teaching hospital in southern Brazil.
Asunto(s)
Leptospira , Leptospirosis , Humanos , Gatos , Animales , Leptospira/genética , Hospitales Veterinarios , Brasil/epidemiología , Hospitales de Enseñanza , Leptospirosis/diagnóstico , Leptospirosis/epidemiología , Leptospirosis/veterinaria , Pruebas de Aglutinación/veterinaria , Anticuerpos AntibacterianosRESUMEN
Surveillance of bovine tuberculosis (bTB) lesions in animals at slaughterhouses is useful for controlling and eradicating the disease, besides providing epidemiological information. This study aimed to identify risk factors for bovine tuberculosis (bTB) condemnation in cattle at slaughterhouses in Rio Grande do Sul, Brazil. A logistic regression analysis was conducted using data on bTB-related condemnations. Variables examined included animal origin, number of slaughtered animals, season, inspection level (state or municipality), animal sex, and slaughterhouse location. A total of 297,817 Animal Transport Guides were evaluated, representing the transportation of 3497,521 animals. Among these, 6097 (2.05%) had at least one animal condemned due to bTB lesions. Risk factors for condemnation included larger batch sizes, female animals, slaughterhouses, and animal origin. The higher condemnation frequency in females and regions with dairy farms suggests links to milk production. Variation in condemnation rates by inspection level and slaughterhouse highlights the need for standardized procedures in identifying bTB lesions. Identifying these risk factors enables targeted interventions to enhance disease control and eradication efforts.
Asunto(s)
Enfermedades de los Bovinos , Tuberculosis Bovina , Tuberculosis , Bovinos , Femenino , Animales , Tuberculosis Bovina/epidemiología , Brasil/epidemiología , Tuberculosis/veterinaria , Factores de Riesgo , Mataderos , Enfermedades de los Bovinos/epidemiologíaRESUMEN
INTRODUCTION: Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness. METHODS: A systematic review of qualitative studies was conducted using the JBI methodology. RESULTS: A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators. CONCLUSION: To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior. REVIEW REGISTRATION NUMBER: PROSPERO CRD42023402496.
Asunto(s)
Actitud , Personal de Salud , Humanos , Personal de Salud/educación , Aprendizaje , Investigación Cualitativa , MentoresRESUMEN
OBJECTIVE: This systematic review will assess the effectiveness of school-based sleep promotion programs on sleep knowledge, hygiene, quality, behavior, and efficiency in adolescents. INTRODUCTION: Adolescents need to sleep between 8 and 10 hours per night; however, most sleep fewer hours due to peer and school pressure, stress, and excessive use of electronic devices at night. Sleep deprivation can lead to cardiovascular problems, issues with stress management, and suicidal ideation. Schools are an ideal space to implement intervention programs, providing the opportunity to reach a large number of adolescents. Considering the negative impacts of poor sleep, it is essential to assess the effectiveness of school-based sleep promotion programs on sleep knowledge, hygiene, quality, behavior, and efficiency. INCLUSION CRITERIA: Studies with adolescents (10-19 years old) exposed to school-based sleep promotion programs will be included. Studies in English, Spanish, and Portuguese will be considered, with no time limits. METHODS: Nine databases, CINAHL, Cochrane Central Register of Controlled Trials, ERIC (all via EBSCOhost), MEDLINE (PubMed), LILACS, SciELO, Psychology and Behavioral Sciences Collection, Web of Science Core Collection, and Scopus, will be searched from inception to identify relevant studies. Two independent reviewers will perform the study selection, critical appraisal using JBI tools, and data extraction. Studies will, where possible, be pooled in meta-analysis. Heterogeneity will be assessed using the standard χ 2 and I2 tests. Statistical analyses will be performed using the random effects model. If fewer than 5 studies are included, the fixed effects model will be used. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of evidence and a Summary of Findings will be created. REVIEW REGISTRATION: PROSPERO CRD42023374838.
Asunto(s)
Sueño , Humanos , Adolescente , Niño , Adulto Joven , Adulto , Revisiones Sistemáticas como Asunto , Metaanálisis como AsuntoRESUMEN
INTRODUCTION AND OBJECTIVES: Sexually transmitted infections are a public health problem affecting 45% of adolescents and young adults worldwide. The evidence suggests that primary care settings are uniquely positioned to provide an opportunity for these preventive interventions. The aim of this project is to improve nurses' interventions for preventing risky sexual behaviors in adolescents attending nursing consultations in a primary healthcare unit. METHODS: An audit and feedback were conducted by the JBI Model and Implementation Framework. Five audit criteria representing best practice recommendations for preventing risky sexual behaviors in adolescents were used. Barriers to compliance with the best practices were identified, and strategies were adopted to overcome them. A follow-up audit was conducted using the same approach as the baseline audit. RESULTS: Compliance rates improved in four criteria from baseline audit to follow-up audit. CONCLUSION: Through auditing and feedback, evidence-based interventions were implemented to prevent sexual risk behavior in adolescents in primary care settings. Further best practice implementation projects should be conducted to improve adolescent health outcomes.
RESUMEN
Background: A large number of workers attend work despite being ill. Attending work during sickness can have a number of consequences for the worker (e.g., worsening of physical and mental condition), for co-workers, and for the company, and for service users. Objectives: The aim of this study was to assess the factors influencing presenteeism and mental health of workers during the COVID-19 pandemic. Methods: A systematic review following the PRISMA format was conducted in the PubMed, Scopus, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and ScienceDirect electronic databases in January 2023, using the following key words: Presenteeism, Mental Health, and COVID-19. The eligibility criteria applied were original articles published in English, Spanish, French, German, and Portuguese, workers during the COVID-19 pandemic (data collection date: January 01, 2020 - January 01, 2023), and articles assessing at least one measure of presenteeism and mental health status. Methodological quality was assessed using the critical appraisal tools of the Joanna Briggs Institute. The followed protocol is listed in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42023391409. Results: A total of 25 studies were included in this review recruiting a total of 164,274 participants. A number of factors influencing mental health and sickness presenteeism were identified: (1) mental health-related factors (burnout [in 4 studies], stress [in 9 studies], depression [in 1 study], fear of COVID-19 [in 1 study], no well-being [in 2 studies], etc.); (2) individual factors (health status [in 1 study], being young [in 1 study], workers who experienced interrupted medical care [in 2 studies], having a chronic disease [in 1 study], etc.); (3) factors related to the situation caused by COVID-19 (confinement, symptoms, loss of contract, risk of bankruptcy, etc. [in 1 study each one]); and (4) factors derived from working conditions (organisational support [in 1 study], patient care [in 1 study], work functioning or task performance impairment [in 4 studies], work fatigue [in 2 studies], safety climate [in 1 study], workload [in 1 study], etc.). Conclusion: Identifying the key determinants of presenteeism and understanding the phenomena and origins of sickness presenteeism will help to create a safe working environment and optimal organisational systems to protect vulnerable workers in a pandemic context. Systematic review registration: The unique identifier is CRD42023391409.
Asunto(s)
COVID-19 , Humanos , COVID-19/epidemiología , Salud Mental , Pandemias , Presentismo , Carga de TrabajoRESUMEN
Oral hygiene has been shown to reduce adverse events and promote the quality of life of patients with stroke. However, a stroke can result in the impairment of physical, sensory, and cognitive abilities, and comprise self-care. Although nurses recognize its benefits, there are areas for improvement in the implementation of the best evidence-based recommendations. The aim is to promote compliance with the best evidence-based recommendations on oral hygiene in patients with stroke. This project will follow the JBI Evidence Implementation approach. The JBI Practical Application of Clinical Evidence System (JBI PACES) and the Getting Research into Practice (GRiP) audit and feedback tool will be used. The implementation process will be divided into three phases: (i) establishing a project team and undertaking the baseline audit; (ii) providing feedback to the healthcare team, identifying barriers to the implementation of best practices, and co-designing and implementing strategies using GRIP, and (iii) undertaking a follow-up audit to assess the outcomes and plan for sustainability. So, the successful adoption of the best evidence-based recommendations on oral hygiene in patients with stroke will reduce the adverse events related to poor oral care and may improve patients' quality of care. This implementation project has great transferability potential to other contexts.
RESUMEN
An acoustic quartz crystal microbalance (QCM) was used to signal and follow the celladhesion process of epithelial cells [human embryonic kidney(HEK) 293T and cervical cancer (HeLa) and fibroblasts [African Green Monkey kidney cells (COS-7)] onto gold surfaces. Cells were applied on the sensor and grown under serum-free and serum-supplemented culture media. The sensor resonance frequency (Δf) and motional resistance (ΔR) variations were measured during cell growth to monitor cell adhesion processes. Fingerprints of the adhesion processes, generated using the QCM signal, were found to be specific for each cell type while enabling the identification of the phases of the adhesion process. Under serum-free conditions, the deposition of HEK 293T and HeLa cells was characterized by a decrease of Δf with constant ΔR, whereas for COS7 cells, this initial deposition was signaled by variations of ΔR at constant Δf. Toward the end of the adhesion process, fingerprints were characterized by a continuous increase of ΔR consistent with the increase in viscoelasticity. The morphology of adherent cells was visualized by fluorescent microscopy, enabling the association of the cell morphology with QCM signals.
Asunto(s)
Acústica , Tecnicas de Microbalanza del Cristal de Cuarzo/métodos , Animales , Células COS , Adhesión Celular , Supervivencia Celular , Chlorocebus aethiops , Medio de Cultivo Libre de Suero , Células HEK293 , Humanos , Microscopía Fluorescente , ViscosidadRESUMEN
The article analyzes the Army's political and social proposal for the Brazilian nation in the 1910s. It considers the Army's climate of modernization in conjunction with the prevailing context of critical evaluation of the republican regime and greater recognition of the role of the armed forces in power games. The analytical method was to cross-reference photographs from the Contestado campaign with militarist discourses found in books authored by Army officers, in articles published in the Rio de Janeiro press, and in Olavo Bilac's speeches in favor of a draft lottery. It was found that the Army wanted to link the hinterlands to the coast and to adopt the barracks as a prime space for forming citizens.
RESUMEN
BACKGROUND: In palliative care, symptoms are multiple and combined, evolving and changing, with a multidimensional character and multifactorial causes, and a high prevalence, negatively influencing the patient's and family's quality of life. Nurses who provide palliative care need to recognize and respond effectively to their patients' symptoms. METHODS: A project will be applied to implement the best practice in monitoring and managing palliative care patients' symptoms. The Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool will be used. The JBI PACES and GRiP framework for promoting evidence-based healthcare involves three phases of activity. First, a baseline audit. In a second phase, feedback will be given to the project team after the conclusion of the baseline audit report. Then, a third phase will be conducted as a follow-up audit. CONCLUSIONS: This project will improve the practice of the nursing team in monitoring and managing the symptoms of palliative care patients, positively influencing the quality of life of the patient and his family. The implementation and dissemination of this project could boost its replication in other centres.
RESUMEN
BACKGROUND: Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM: This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS: To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS: The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION: The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.