Technologies During the COVID-19 Pandemic: Teleconsultation in Care Management for Patients Undergoing Liver Transplant.

BACKGROUND: The aim of this study was to identify home care management strategies for patients undergoing liver transplant, through teleconsultation, during the COVID-19 pandemic for maintenance and improvements in treatment adherence. METHODS: This was a qualitative, exploratory, and descriptive research study. Participants included patients who underwent liver transplant between 2020 and 2021. Through a semistructured script, data were analyzed according to the recommendations of content analysis and then simple statistics were applied. RESULTS: Twenty-two people participated in the study. Two analysis categories were developed, which resulted in 7 strategies and 22 care actions. The care strategy with the highest adherence involved actions related to the prevention of COVID-19. CONCLUSIONS: Teleconsultation is an excellent tool to manage and supervise post-liver transplant care of patients. Considering that teleconsultation has presented strategies and care actions, which were developed by the patients, the patients have a direct effect on treatment adherence despite pandemic impositions.

Good Practices in Transitional Care: continuity of care for patients undergoing liver transplantation.

OBJECTIVES: to develop a guide of care recommendations for good practices in care transition for adult patients undergoing liver transplantation. METHODS: a methodological study, based on the Appraisal of Guidelines for Research & Evaluation in the updated version, II. Care recommendations were sustained by conducting an integrative literature review and qualitative research. RESULTS: from evidence, three topics emerged: Care Transition Planning; Health Education for Self-Care; Care Management. Each of the central topics has respective subtopics, totaling six, giving rise to 30 care recommendations. Concerning evaluators' scores, in all domains the scores were higher than 90%. FINAL CONSIDERATIONS: the proposed guide assists professionals in conducting care transition in liver transplantation, ensuring greater safety for patients in continuity of home care.

Complications Following Liver Transplant at a Teaching Hospital.

OBJECTIVE: The objective of this study is to analyze the liver transplant complications in a reference transplant hospital in southern Brazil. METHODS: The researchers used a cross-sectional, quantitative, exploratory, and descriptive study, conducted using 103 medical records of patients who underwent liver transplantation from 2011 to 2018. Data were analyzed through median, mean, and standard deviation, and the Kruskal-Wallis test was used. RESULTS: There was a higher proportion of men (70.9%), with a mean age of 53.3 years, who had hepatitis C (43.7%). The indication for the procedure was hepatocellular carcinoma (34%). The most frequent complications included pulmonary (26.7%), graft-related complications such as rejection (21.1%), and viral infections (14.4%). In addition, infectious complications, such as pneumonia (45%) and septicemia (29%), occurred. The main causes of death were septic shock (15.6%) and multiple organ failure (21.9%). There was statistical significance between the recipient's age and the Model for End-Stage Liver Disease value at the time of transplantation for the development of complications. CONCLUSIONS: The data from the present study provide important information about liver transplant. These data may enable the team to propose strategies for practice improvements, which will certainly offer better living conditions and transplant survival.

Health Needs of Patients Undergoing Liver Transplant From the Context of Hospital Discharge.

OBJECTIVE: To identify the health needs of the patient and family facing the perspectives of discharge, health care, and adaptation to the new reality at home. METHODS: This was a quantitative and qualitative, exploratory, descriptive study conducted at a reference hospital for liver transplantation. The participants were patients undergoing liver transplant in this hospital unit from 2011 to June 2019. A semistructured interview script was used for data collection, and data were analyzed according to guidelines proposed for content analysis. RESULTS: Twenty patients participated, with a mean age of 40.2 years; 76% were men. The interview data enabled the development of 3 categories: daily health care, warning signs, and adaptation to the new health care routine. The data obtained from the categories showed that the main health needs include difficulties in blood glucose management, insulin administration, the importance of awareness of the warning signs, and obtaining support from the health care team to deal with food restrictions and high doses of medication. CONCLUSION: The health needs are focused on identifying strategies to develop daily care, in addition to seeking better strategies to adapt to the new reality. The study showed the need for individualized discharge planning by the health care team, based on the health needs of each patient.

Tecnologias de cuidado capazes de subsidiar segurança no contexto dos transplantes de órgãos / Care technologies capable of subsidizing safety in the context of organ transplants / Tecnologías asistenciales capaces de subsidiar la seguridad en el contexto de los

Objetivo: Mapear tecnologias de cuidado capazes de subsidiar segurança nas etapas do processo de transplante de órgãos. Métodos: Revisão de escopo desenvolvida em cinco etapas por meio de buscas em seis bases de dados, entre outubro e novembro de 2020. Resultados: Entre as publicações selecionadas, 2020 foi o ano com superior número de estudos (25,92%), a base de dados PubMed dispôs da maior seleção de artigos (37,03%) e o país com maior número de publicações foi o Estados Unidos (51,85%). Quanto às tecnologias de cuidado identificadas, 77,77% foram leves-duras e 22,22% duras. Referente ao tipo de tecnologia, 51,85% são digitais, 22,22% máquinas/equipamentos, 14,81% modelos preditivos e outras relacionadas com protocolo e tecnologia robótica (11,11%). Conclusão: Em relação às potencialidades das tecnologias, as mesmas oportunizam monitoramento, rastreamento de dados, educação em saúde, educação permanente, comunicação rápida e efetiva viabilidade dos órgãos, bem como qualidade nas etapas dos processos de transplante e segurança. O impacto desse estudo é a visualização do panorama do desenvolvimento tecnológico em saúde no cenário dos transplantes de órgãos, evidenciando as áreas que estão sendo estudadas e os problemas nesse contexto que estão sendo resolvidos através das tecnologias em saúde. (AU)

Objective: To map care technologies capable of subsidizing safety in the stages of the organ transplantation process. Methods: Scope review developed in five stages through searches in six databases, between October and November 2020. Results: Among the selected publications, 2020 was the year with the highest number of studies (25.92%), the PubMed database had the largest selection of articles (37.03%) and the country with the largest number of publications was the United States (51.85%). As for the care technologies identified, 77.77% were light-hard and 22.22% were hard. Regarding the type of technology, 51.85% are digital, 22.22% machines / equipment, 14.81% predictive models and others related to protocol and robotic technology (11.11%). Conclusion: In relation to the potential of the technologies, they provide monitoring, data tracking, health education, permanent education, rapid and effective communication of organs, as well as quality in the stages of the transplant and safety processes. The impact of this study is the visualization of the panorama of technological development in health in the context of organ transplants, highlighting the areas that are being studied and the problems in this context that are being solved through health technologies. (AU)

Objetivo: Mapear tecnologías asistenciales capaces de subsidiar la seguridad en las etapas del proceso de trasplante de órganos. Métodos: Revisión de alcance desarrollada en cinco etapas mediante búsquedas en seis bases de datos, entre octubre y noviembre de 2020. Resultados: Entre las publicaciones seleccionadas, 2020 fue el año con mayor número de estudios (25,92%), la base de datos PubMed tuvo la mayor selección de artículos (37,03%) y el país con mayor número de publicaciones fue Estados Unidos (51,85%). En cuanto a las tecnologías asistenciales identificadas, el 77,77% fueron ligeras y duras y el 22,22% fueron duras. En cuanto al tipo de tecnología, el 51,85% son digitales, el 22,22% máquinas / equipos, el 14,81% modelos predictivos y otros relacionados con la tecnología de protocolo y robótica (11,11%). Conclusión: En relación al potencial de las tecnologías, brindan monitoreo, rastreo de datos, educación en salud, educación permanente, comunicación rápida y efectiva de órganos, así como calidad en las etapas de los procesos de trasplante y seguridad. El impacto de este estudio es la visualización del panorama del desarrollo tecnológico en salud en el contexto de los trasplantes de órganos, destacando las áreas que se están estudiando y los problemas en este contexto que se están resolviendo a través de las tecnologías sanitarias. (AU)

Vivência do paciente submetido ao transplante hepático na transição do cuidado / The experience of patients undergoing liver transplantation in the transition of care

RESUMO Objetivo compreender a vivência do paciente submetido ao transplante hepático na transição do cuidado entre o hospital e o domicílio. Métodos estudo com abordagem qualitativa, com 20 pacientes submetidos ao transplante hepático e que foram entrevistados por meio de roteiro semiestruturado. A análise de conteúdo foi a técnica selecionada para identificar aspectos inerentes à transição do cuidado. Resultados com base nos dados obtidos, formaram-se quatro categorias temáticas: Percurso marcado por sentimentos e incertezas; Trajetória de idas e vindas à rede de saúde para adquirir insumos; Percurso de aprendizado para desenvolver cuidados domiciliares e: Itinerário entre idealização social e a realidade vivenciada após o transplante. Conclusão perceberam-se as dificuldades de receptores e família após o transplante hepático, em especial, no preparo para a transição do cuidado e no enfrentamento e adaptação às atividades cotidianas.

ABSTRACT Objective to understand the experience of patients undergoing liver transplantation in the transition of care between hospital and home. Methods study with a qualitative approach, with 20 patients undergoing liver transplantation who were interviewed using a semi-structured script. Content analysis was the selected technique to identify aspects inherent to the transition of care. Results based on the data obtained, four thematic categories were formed: Path marked by feelings and uncertainties; Path of comings and goings to the health network to acquire supplies; Learning path to develop home care and: Itinerary between social idealization and the reality experienced after transplantation. Conclusion difficulties of recipients and family after liver transplantation were perceived, especially in the preparation for the transition of care and in coping and adapting to daily activities.

Good Practices in Transitional Care: continuity of care for patients undergoing liver transplantation / Buenas Prácticas en la Atención Transicional: continuidad de la atención de los pacientes sometidos a trasplante de hígado / Boas Práticas no Cuidado Transicional: continuidade da assistência ao paciente submetido ao transplante de fígado

ABSTRACT Objectives: to develop a guide of care recommendations for good practices in care transition for adult patients undergoing liver transplantation. Methods: a methodological study, based on the Appraisal of Guidelines for Research & Evaluation in the updated version, II. Care recommendations were sustained by conducting an integrative literature review and qualitative research. Results: from evidence, three topics emerged: Care Transition Planning; Health Education for Self-Care; Care Management. Each of the central topics has respective subtopics, totaling six, giving rise to 30 care recommendations. Concerning evaluators' scores, in all domains the scores were higher than 90%. Final Considerations: the proposed guide assists professionals in conducting care transition in liver transplantation, ensuring greater safety for patients in continuity of home care.

RESUMEN Objetivos: desarrollar una guía de recomendaciones asistenciales de buenas prácticas en la transición asistencial para pacientes adultos sometidos a trasplante hepático. Métodos: estudio metodológico, utilizando el Appraisal of Guidelines for Research & Evaluation en la versión actualizada, II. Las recomendaciones de atención se sustentaron mediante la realización de una revisión integradora de la literatura y una investigación cualitativa. Resultados: con base en la evidencia, permitió la formación de tres temas: Planificación de la Transición del Cuidado; Educación Sanitaria para el Autocuidado; Administración de Cuidados. Cada uno de los temas centrales tiene subtemas respectivos, totalizando seis, dando lugar a 30 recomendaciones de cuidados. En cuanto a la puntuación de las puntuaciones de los evaluadores, en todos los dominios las puntuaciones fueron superiores al 90%. Consideraciones Finales: la guía propuesta ayuda a los profesionales a realizar la transición de la atención en el trasplante de hígado, garantizando una mayor seguridad para los pacientes en la continuidad de la atención domiciliaria.

RESUMO Objetivos: elaborar um guia de recomendações de cuidados para boas práticas na transição do cuidado de pacientes adultos submetidos ao transplante hepático. Métodos: estudo metodológico, tendo como referencial o Appraisal of Guidelines for Research & Evaluation na versão atualizada, II. Sustentaram-se as recomendações de cuidados por meio da realização de uma revisão integrativa da literatura e uma pesquisa qualitativa. Resultados: a partir das evidências, oportunizou a formação de três tópicos: Planejamento da Transição do Cuidado; Educação em Saúde para o Autocuidado; Gestão dos Cuidados. Cada um dos tópicos centrais apresenta respectivos subtópicos, totalizando seis, originando 30 recomendações de cuidados. No que se refere à pontuação dos escores pelos avaliadores, em todos os domínios os escores foram superiores a 90%. Considerações Finais: o guia proposto auxilia os profissionais na condução da transição do cuidado no transplante hepático, garantindo maior segurança aos pacientes na continuidade do cuidado em domicílio.

Care transition for liver transplanted patients during the Covid-19 pandemic / Transición del cuidado de pacientes sometidos a transplante hepático durante la pandemia del Covid-19 / Transição do cuidado de pacientes submetidos ao transplante hepático durante a pandemia da Covid-19

ABSTRACT Objective: to submit the experience lived in the care transition for hospital discharge of patients undergoing liver transplantation due to the COVID-19 pandemic. Method: an experience report on hospital discharge planning and care transition for patients undergoing liver transplantation at a teaching hospital. Results: after COVID-19 pandemic has been declared, several technological means were used to support self-care strategies at the time of the hospital-home transition, as well as remote care for patients focusing on doubts about the routine of care and treatments. In addition, new counterreferral strategies were structured, prioritizing safety and social isolation. Conclusion: the adjustments in care transition with the support of the technologies provided transplanted patients access to all the information that guides self-care. Likewise, they regulated the flow of the support network and the health network, decreasing the possibility for COVID-19 spread, infection and development.

RESUMEN Objetivo: presentar la experiencia en la transición del cuidado para el alta hospitalaria de pacientes sometidos a trasplante hepático en vistas de la pandemia del COVID-19. Método: informe de experiencia sobre la planificación del alta hospitalaria y la transición del cuidado de pacientes sometidos a trasplante hepático en un hospital escuela. Resultados: después de declarada la pandemia del COVID-19 se utilizaron diversos medios tecnológicos para respaldar las estrategias de autocuidado al momento de la transición entre el hospital y el domicilio, al igual que la asistencia remota a los pacientes enfocada en dudas acerca de la rutina de cuidados y tratamientos. También se estructuraron nuevas estrategias de contra-derivación, priorizando la seguridad y el aislamiento social. Conclusión: los ajustes en la transición del cuidado con el respaldo de las tecnologías viabilizaron el acceso de los pacientes trasplantados a todas las informaciones que guían el autocuidado. De igual manera, regularon el flujo de la red de apoyo y de la red de salud, reduciendo así la posibilidad de propagación, infección y desarrollo del COVID-19.

RESUMO Objetivo: apresentar a experiência vivenciada na transição do cuidado para alta hospitalar de pacientes submetidos ao transplante hepático em razão da pandemia da COVID-19. Método: relato de experiência sobre planejamento da alta hospitalar e transição do cuidado de pacientes submetidos ao transplante hepático em um hospital-escola. Resultados: após a declaração da pandemia da COVID-19 foram utilizados diversos meios tecnológicos para apoiar as estratégias de autocuidado no momento da transição entre hospital e domicílio. Assim como, atendimento remoto aos pacientes com foco em dúvidas acerca da rotina de cuidados e tratamentos. Além disso, novas estratégias de contrarreferência foram estruturadas, priorizando a segurança e o isolamento social. Conclusão: os ajustes na transição de cuidado com apoio das tecnologias oportunizaram acesso aos pacientes transplantados a todas as informações que orientam o autocuidado. Igualmente, regularam o fluxo da rede de apoio e rede de saúde, diminuindo a possibilidade de propagação, infecção e desenvolvimento da COVID-19.