Nursing and pre-hospital care: dead-ends and perspectives

The present paper is about a reflection related to the emerging of Pre-Hospital Care in Brazil ant its respective models of care during the last few decades. By drawing out a basic historical trajectory we were able to point out the successful and dead end paths of this modality of health assistance in our country. The most recent attempts of standardization at a national level of this kind of service were analyzed, especially the Health Ministry Decree no. 2048/02, which constitutes itself as a starting point, offering subsidies to institutions and to those involved in this specific field of health knowledge, in order to remake the path within another perspective.     

Nursing Home Design and COVID-19: Implications for Guidelines and Regulation

ObjectivesNursing homes (NHs) are important health care and residential environments for the growing number of frail older adults. The COVID-19 pandemic highlighted the vulnerability of NHs as they became COVID-19 hotspots. This study examines the associations of NH design with COVID-19 cases, deaths, and transmissibility and provides relevant design recommendations.DesignA cross-sectional, nationwide study was conducted after combining multiple national data sets about NHs.Setting and ParticipantsA total of 7785 NHs were included in the study, which represent 50.8% of all Medicare and/or Medicaid NH providers in the United States.MethodsZero-inflated negative binomial models were used to predict the total number of COVID-19 resident cases and deaths, separately. The basic reproduction number (R₀) was calculated for each NH to reflect the transmissibility of COVID-19 among residents within the facility, and a linear regression model was estimated to predict log(R₀ – 1). Predictors of these models included community factors and NHs’ resident characteristics, management and rating factors, and physical environmental features.ResultsIncreased percentage of private rooms, larger living area per bed, and presence of a ventilator-dependent unit are significantly associated with reductions in COVID-19 cases, deaths, and transmissibility among residents. After setting the number of actual residents as the exposure variable and controlling for staff cases and other variables, increased number of certified beds in the NH is associated with reduced resident cases and deaths. It also correlates with reduced transmissibility among residents when other risk factors, including staff cases, are controlled.Conclusions and ImplicationsArchitectural design attributes have significant impacts on COVID-19 transmissions in NHs. Considering the vulnerability of NH residents in congregated living environments, NHs will continue to be high-risk settings for infection outbreaks. To improve safety and resilience of NHs against future health disasters, facility guidelines and regulations should consider the need to increase private rooms and living areas.     

Definitions of allied health services in urban community contexts: consumer perspectives

This study, as part of a larger project designed to increase allied health services to underserved urban community agencies, focussed on understanding how consumers defined the services provided in community agencies. Consumers were asked to describe what they defined as service and what constituted good service provision. Qualitative methods were used to conduct key-informant interviews and focus groups with consumers and staff at six community agencies representing different underserved populations, including ethnic and racial minority groups, the homeless, and individuals with disabilities living in the community. Four major themes emerged across the data: 1) the struggle to maintain a stable life with a chronic illness or disability; 2) services need to help solve life challenges; 3) the challenge of accessing and maintaining services; and 4) the need for a peer community. Data analysis revealed that services are difficult to access within and outside community agencies, services need to address short-term as well as long-term issues, and services in the community are still driven by a professional or expert model despite the availability of peer models. Recommendations for health professionals working in community settings are provided.     

Competences and skills on teaching of administration in nursing by the National Curricular Guidelines

This arcticle presents a consideration about competences and skills on teaching of administration in nursing, by the guidelines of the National Curricular Guidelines, which constitute the guiding document of the nursing college education in Brazil. The construction of competences and skills for the area of administration in nursing is part of a set of actions that seek the improvement of the nurse's preparation to face the transformations of the jobs world. Teaching of competences must be directed to the integrality of the make health and, upon this, we present some competences that offer to our learners opporturnities to learn to make and learn to be.     

Israeli medical education: international perspectives,and reflections on challenges and changes

Medical education is a dynamic and continually evolving process, some of which is style, and some of which is linked to changing perspectives in medical practice. A paper by Reis et al., taken in conjunction with the recent paper from an ad hoc International Review Committee (Schoenbaum et al.), provides a reflective view of where Israeli medical education stood in 2014 and places it in an international perspective. Reis at al also take this further, showing that in Israel change is occurring as a result of this review and comment on a number of important issues where further reflection, discussion, and work is required.     

Guidelines for low back pain: changes in GP management.

BACKGROUND: Management guidelines are aimed at reducing inappropriate practice and improving efficiency; however, the effectiveness of many guidelines has yet to be confirmed. This study targets GPs' management of back pain and its relationship with the recent management guidelines. OBJECTIVES: We aimed to investigate changes in GP management of low back pain, low back pain episode duration and time before consultation, over a 5-year period. METHOD: A case series report of 574 patient notes was collected from a large practice in North Yorkshire (January 1992-March 1997). In addition, 713 referral notes from 26 practices across North Yorkshire were collected. The patients were potential subjects for a larger randomized controlled trial evaluating the effectiveness of an exercise programme. Both groups of data were analysed by identifying trends over time and using log linear regression. RESULTS: Recommendation of activity or exercise was found to be a trend increasing over time. In contrast, recommendation to rest was found to be a trend decreasing over time. Activity or exercise was more frequently recommended to younger patients. There was evidence that individuals are seeking a GP consultation more quickly. CONCLUSIONS: The gap between GP practice and the recent guidelines appears to be reducing. However, many variations in practice still exist. Evidence of decreasing time before consultations may indicate that the level of self-care by low back pain patients is decreasing. Although management guidelines may have some effect, there is some way to go before back pain management is optimized.     

Nursing home resident assessment and case-mix classification: cross-national perspectives

Two broadly applied systems in the United States, the National Resident Assessment Instrument/Minimum Data Set and the Resource Utilization Groups, have provided new insight into the quality, delivery, and financing of nursing home care. In this article, the authors describe research efforts in eight other nations to translate, validate, and use one or both systems to understand their own long-term care systems. This consortium of studies, using common instruments, provides potential cross-national analyses that capitalize on differences in practice patterns and system designs to address critical policy issues.     

制定肠外肠内营养指南和规范的"指南":方法学、推荐意见分级与通过程序

中华医学会肠外肠内营养学分会自2004年12月成立，即开始了合理规范应用肠外肠内营养学的有关工作。在中华医学会正副会长的指导下，2005年4月启动了肠外肠内营养“指南”和“规范”的制定工作。参与“指南”和“规范”编写的52位专家来自多个学科，也包括部分基层医院医护人员；共组成8个编写组，分别完成“指南”（草案）相应部分和部分“规范”的内容。 2006年5—8月，有7个编写组先后召开了8次总论和各论的“共识”和“规范”会议，就本版的编撰结构、证据分级和推荐意见分级体系、文献检索策略等方法学问题展开讨论，确定了工作方案，各自召开“共识会议”进行讨论，完成相应的文件。 通过确定检索策略、入选标准和特定关键词，采用系统化的文献检索，收集指南推荐意见相关支持证据。按照证据级别，参照国际标准并结合本领域的国内情况，制定推荐意见分级体系。 分会的“指南”（草案）和“规范”（草案）由各个“共识工作组”相互配合完成。达成“共识”后和最终定稿前，按“议事规则”对“指南”（草案）和“规范”（草案）进行投票表决。“肠外肠内营养临床指南和操作规范”力图反映目前国内外肠外肠内营养支持的最新证据，为临床医师、护理工作者、营养师和患者在特定临床条件下制定和实行肠外肠内营养支持方案提供帮助，并为卫生政策的制定者提供决策依据。由于内容宽广，部分内容欠缺甚多，有待今后补充。     

Pedagogical Project for the Graduate Nursing Program at UFAL: adaptations to curricular guidelines

This is an analysis of the adaptation of the Pedagogical Political Project of the Nursing Graduate Program at Alagoas Federal University (PPP/Enf/UFAL) to new Brazilian curriculum guidelines, evidencing convergence points and some points that need to be approached, taking into account that the present project was established prior to the existence of the current curricular guidelines. Our analysis shows that the main difficulties presented by the newly implemented curriculum lie in the ones inherent to the process of changing conceptions on the educational process in Nursing and in the work conditions imposed by the current situation of the Brazilian Public University System. It calls for a review on strategies and contents related to the basis of research and expansion in Nursing Sciences, as well as the search for alternatives to integration with domain areas from Humanistic and Health Sciences.     

Graduate and mature entrants to medicine: changes in career intentions

Fifty-nine students who had previously taken degrees or commenced careers in subjects other than medicine entered the Cambridge Clinical Course in its first 5 years of operation, commencing in 1976. A questionnaire was used to ascertain their original career plans when entering medical education, their career plans in 1981, and the reasons for any changes. Graduates originally planning careers in general practice and teaching or research maintained their intentions, but some of those who had favoured hospital clinical work changed their minds in favour of general practice. General practice was also the most common choice amongst those students who were earlier unsure as to what branch of medicine they would enter. Of students changing their career intentions, half indicated that disenchantment with hospital medicine was a prime reason for the change.     

新型冠状病毒肺炎疫情期间养老机构卫生防护指南

老年人身体免疫力弱,且往往患有糖尿病、高血压、心脏病等基础性疾病,合并病毒感染预后较差,死亡风险大,是新型冠状病毒肺炎(COVID-19)的高危人群。养老机构中老年人数量多且集中,环境卫生设施相对落后,易发生聚集性感染,是COVID-19疫情防控重点场所。为此,中国疾病预防控制中心环境与健康相关产品安全所组织专家编制了《养老机构新型冠状病毒肺炎卫生防护指南》。该指南从机构卫生和个人防护两个方面,对如何进行环境清洁消毒、室内通风换气、垃圾处理和手卫生等提出相应措施,旨在为养老机构有效开展疫情防控提供技术指导。     

Professional formation: changes happened in Nursing Courses, CE, Brazil

The investigation has as objectives to understand the new scenarios of the nurse's formation in the teaching institutions. The courses of two universities of the State of Ceará were analyzed. The data were picked up of reports in normative and curricular documents, and you interview with the coordinators of the courses. The results demonstrate that in the teaching programs in certain decades of the history, it was identifying more punctual changes related with the reformations happened in the Law of Guidelines and Base of the Education (LDB), in the politicians of health and in the work market.